基层医院门诊医院感染存在的问题及对策

基层医院门诊患者多,病种复杂,设施简陋,存在医院感染控制薄弱环节. 1 存在问题 1.1 医院感染预防控制体系不健全 门诊部大多数未建立自上而下的医院感染管理委员会、医院感染管理科、科室感染控制小组三级预防控制组织.仅由护士长1人兼职不能完全发挥三级预防控制组织的管理职能,致使各诊室医院感染工作未落到实处. 1.2 医院感染控制布局不合理 门诊手术室无菌区、清洁区、污染区划分不明确,标志不明显;门诊口腔科器械消毒间布局不合理,清洗、消毒未分开,无菌物品消毒后仍放在清洗消毒间;各诊室医护人员在诊室内更衣;未备快速手消毒液等手卫生设备.     

四手操作预防口腔诊疗中的医院感染

目的 探讨四手操作在预防口腔诊疗机构医院感染中的作用.方法 在口腔诊疗过程中,实行1名医师和1名护士共同服务于1例患者的四手操作方法,严格执行消毒隔离制度,减少医院感染.结果 通过加大医院对四手操作的重视度,严格的规范四手操作,有效降低了口腔诊疗机构感染发生,确保了口腔医疗安全.结论 四手操作技术能有效阻断医源性传播途径,在预防医院感染中起到了重要作用.     

加强供应室管理力度从源头控制医院感染

医院感染风险控制,是评价医疗安全质量和管理水平的重要指标。消毒供应中心是医院无菌医疗器材与物品的处理中心,为医院临床各科室供应消毒、灭菌器械、敷料和一次性无菌物品,消毒供应中心的规范化管理有利于提高医院感染控制水平。我院从布局与流程、质量监测、人员因素以及无菌物品等方面着手加强管理,以保障医院无菌物品供应的质量,有效预防并控制医院感染。     

加强无菌物品的质量管理

无菌物品广泛应用于临床,它的质量关系到医疗技术质量和控制医院感染乃至患者生命健康.为此,我院供应室着力抓好无菌物品质量管理,保证无菌物品优质供应,预防和控制医院感染,促进医院整体医技水平的提高.无菌物品的质量总体上可以分为物理性能质量、消毒灭菌质量和贮藏发放质量.     

初探消毒供应中心质量管理控制医院感染

目的:加强消毒供应中心质量控制,预防医院感染,确保医疗、护理质量安全。方法:消毒供应中心对医院所有的再生医疗器械及物品统一实施回收、清洗、消毒、包装、灭菌、储存发放、监测等流程质量控制。结果:科学规范的流程管理,可避免污染扩散,确保人员、物品、环境、过程的安全,同时确保无菌物品质量,预防控制医院感染。结论:强化流程质量控制,明显提高消毒供应中心无菌物品的质量,是预防控制医院感染重要措施。     

医院消毒供应中心职能与管理

医院清毒供应中心(CSSD)是医院内承担各科室所有重复使用诊疗器械、器具和物品清洗、消毒、灭菌以及无菌物品供应的部门,是控制医院感染的关键科室.因此医院消毒供应中心应做到:1科学配置人员医院应根据CSSD的工作量与各岗位的需求,科学、合理配置具有执业资格的护士、消毒员和其他工作人员.CSSD的工作人员应当接受与其岗位职责相应的岗位培训,正确掌握各类诊疗器械、物品的清洗、灭菌知识与技能,掌握相关设备操作过程及医院感染预防与控制的相关知识.     

医院消毒供应中心无菌物品发放环节质量管理

目的:探讨医院消毒供应中心无菌物品发放环节质量管理,提高无菌物品发放合格率,控制医院感染发生。方法:严格执行无菌物品发放标准操作规程,以保障无菌物品发生二次污染,影响无菌物品消毒质量。结果:有效确保无菌物品高质量到达临床科室及手术室,有效预防了医院感染的发生。结论:加强消毒供应中心无菌物品发放环节质量管理,可避免无菌物品二次污染,是建立消毒供应中心工作科学化、规范化、标准化的基础。     

口腔门诊医院感染的管理

目的为了降低口腔门诊医院感染的发生,探讨预防医院感染的管理措施. 方法针对口腔门诊发生医院感染的原因,制定口腔门诊预防医院感染的措施. 结果严格执行消毒隔离制度,正确选择口腔器械消毒灭菌方法,就能降低口腔门诊医院感染的发生. 结论严格制定和落实消毒隔离及防护措施对预防口腔门诊的医院感染非常必要.     

消毒供应室对再生医疗器械的感染控制对策

目的 了解消毒供应室感染关键点与程序,探讨预防控制对策.方法 采用回收、清洗消毒、包装、灭菌、无菌物品储存及下送等控制点管理,制定控制感染程序,并落实执行.结果 供给临床质量可靠的无菌物品,封闭回收保证污染物品在运输过程中不传播有害病菌,清洗彻底是保证灭菌成功的关键;正确包装,保证无菌物品建立无菌屏障完整有效性;灭菌合格,有效控制医院感染;正确的无菌物品储存和下送,确保无菌物品使用前不被污染.结论 做好消毒供应室感染控制要点,可提高供应室工作质量,确保无菌物品不被污染.     

加强医院消毒供应室的监测及管理工作

目的 加强医院消毒供应室的环节质量管理,确保无菌物品的质量,预防医院感染的发生. 方法 由院感染控制科、护理部、科室护士长检查和考评各环节工作质量是否符合消毒供应中心质量标准的要求. 结果 完善了各项规章制度、操作规程,加强了供应室护士的培训及消毒灭菌监测,有效的控制医院感染的发生.绪论健全各项工作制度及管理制度,严格按标准要求实施操作,提高消毒供应室工作质量.     

长春新碱过量引起严重毒副反应1例的护理体会

报道1例霍奇金淋巴瘤患者因误用长春新碱（VCR）10mg一次性静脉推注后治疗护理情况。其出现间断性神志恍惚、眼睑闭合不全、言语不清、口腔黏膜糜烂、全身疼痛、麻痹性肠梗阻、尿潴留、手足麻木等症状,经积极解救,禁食,持续胃肠减压、胃管内注入麻油、开塞露、生理盐水灌肠,合理应用肠外营养,注重疼痛、心理护理,做好口腔、肛周护理,预防感染加重,患者病情得到控制好转出院。     

Correlates of stages of change of smoking among inhabitants of deprived neighbourhoods

BACKGROUND: This study examines the prevalence and correlates of stages of change of smoking, in terms of psychosocial, structural and sociodemographic factors, among inhabitants of deprived neighbourhoods. METHODS: Cross-sectional data were obtained from a survey on health related behaviour. Subjects were 2009 current and former smokers, aged 20-46, living in deprived neighbourhoods in Rotterdam, the second largest city in the Netherlands. Three groups of smokers were formed according to the stages of change-definitions of the Transtheoretical Model: smokers not planning to quit (precontemplators), smokers planning to quit (contemplators/preparators) and former smokers (actors/maintainers). Smokers planning to quit and smokers not planning to quit were compared regarding psychosocial factors (attitude, social norm, self-efficacy), structural factors (neighbourhood problems, material deprivation, financial problems, employment status) and sociodemographic factors (age, gender, marital status, cultural background, educational level). Former smokers were compared with smokers planning to quit regarding structural and sociodemographic factors. Logistic regression was used to assess correlates of stages of change. RESULTS: Smokers planning to quit (prevalence = 19%) reported a more positive attitude, stronger social norms and higher self-efficacy expectations in quitting smoking than smokers not planning to quit (prevalence = 57%). Smokers planning to quit less often were Dutch-born, more often had attended higher vocational schooling or university and more often reported experiencing two or more neighbourhood problems compared to smokers not planning to quit. Former smokers (prevalence = 24%) were older, more often Dutch-born, married, employed and higher educated, compared to smokers planning to quit. Furthermore, former smokers less often reported material deprivation and financial problems than smokers planning to quit. CONCLUSION: Among people living in deprived neighbourhoods, different factors correlate with different stages of change of smoking. Implications for health promotion are discussed.     

Choice of measures of vaccination and estimates of risk of pediatric pertussis

BackgroundVaccination uptake at the individual level can be assessed in a variety of ways, including traditional measures of being up-to-date (UTD), measures of UTD that consider dose timing, like age-appropriate vaccination, and risk reduction from individual doses. This analysis compared methods of operationalizing vaccination uptake and corresponding risk of pertussis infection.MethodsCity-wide case-control study of children in Philadelphia aged 3 months through 6 years, between 2001 and 2013. Multiple logistic regression was used to isolate the independent effects of each measure of vaccination uptake and the corresponding relative odds of pertussis.ResultsBeing UTD on vaccinations was associated with a 52% reduction in risk of pertussis (OR 0.48, 95% CI: 0.34, 0.69). Evaluation of delayed receipt of vaccine versus on-time UTD yielded similar results. There was a decrease in risk of pertussis for each additional dose received with the greatest reduction in pertussis infection observed from the first (OR 0.48, 95% CI: 0.28, 0.83) and second dose (OR 0.17, 95% CI: 0.08, 0.34). Additional doses conferred minimal additional protection in this age group.ConclusionExamining vaccination status by individual doses may offer improved predictive capacity for identifying children at risk for pertussis infection compared to the traditional UTD measure.     

两种不同肌瘤剔除术治疗子宫肌瘤的临床疗效比较

目的:比较腹腔镜子宫肌瘤剔除术与腹式子宫肌瘤剔除术的临床疗效。方法:回顾分析63例腹腔镜子宫肌瘤剔除术与61例腹式子宫肌瘤剔除术的临床资料,比较2种手术方式的手术时间、术中出血量、肛门排气时间、使用抗生素时间、术后感染率、体温恢复正常时间、住院时间等情况。结果:两组患者接受子宫肌瘤剔除术顺利完成,腹腔镜组手术时间长于开腹组(P0.05),腹腔镜组术中出血量及剔除肌瘤个数均少于开腹组(P0.05),术后腹腔镜组体温恢复正常时间、肛门排气时间、抗生素使用及住院时间均短于开腹组,两组患者最多随访6个月,腹腔镜组平均康复时间较开腹组短(P0.05),两组随访B超均未发现明显肌瘤结节。结论:腹腔镜子宫肌瘤剔除术损伤小,恢复快,住院时间短,是值得推广的微创手术。     

上海市某医院骨科平均住院日影响因素分析

对上海市某医院2003年-2007年骨科出院病人的住院日描述性分析．2003年-2007年骨科的床位利用指数与平均住院日相关性分析．2003年-2007年骨科床位与医护比例分析．2007年骨科前10大病种平均住院目影响因素分别进行单因素相关性分析和多因素逐步回归分析（STATA软件）。通过对骨科10大病种住院日影响因素分析,术前等待天数、手术类型、是否输血分别对10个、9个和8个病种的住院目有影响。输血因素和手术类型是医院不可控、由病人的病情决定的,术前等待天数是管理因素,是最值得医院重视的影响因素。     

性发育异常发病机制的研究进展

正常的性腺分化可分为3个过程：原始性腺形成、性别决定和卵巢/睾丸发育。在任一环节中,基因表达或调控发生异常均有可能导致性发育异常疾病的发生。性发育异常是指染色体、性腺和解剖性别不典型。随着分子生物学技术的发展,不断地发现新的基因或信号通路参与性腺分化和发育,如SRY、SF1、WT1、Sox9等基因与睾丸发育密切相关,Wnt/Rspo1/B连环蛋白通路、Dax1、Foxl2等基因在卵巢分化中发挥着重要作用,一些非编码RNA和转化生长因子也有重要的调节功能,且睾丸和卵巢发育均为主动过程,即使在出生后因某些基因的改变两者间也可出现横向分化。这些为揭示性分化异常的发病机制提供了可能。     

尘肺病患者145例死因调查

目的分析汉中市尘肺病的发生、发展和死亡原因，以提高尘肺病患者的生存质量。方法对145例尘肺病患者的死因进行回顾性分析，计算其平均发病年龄、死亡年龄及患尘肺病后的存活年限。结果矽肺的平均发病年龄和死亡年龄均早于煤工尘肺和石棉肺，尘肺病的主要死因为患肺部疾患，患尘肺病后的平均存活年限为12a。结论加强职业健康体检工作，对尘肺病人做到早发现早治疗和预防并发症的发生。     

One-year stability of the Measure of Processes of Care

BACKGROUND: The Measure of Processes of Care (MPOC) is a 56-item self-administered measure designed to examine what parents of a child with a chronic health problem think of the services they and their child receive, and to measure the extent to which these services are family-centred. Reliability and validity of the MPOC were established in prior studies. The aim of the present study was to assess the 1-year stability of the MPOC to justify its use as an evaluative tool. METHODS: Nine paediatric rehabilitation centres in the Netherlands participated in this short longitudinal survey study. Subjects were 205 parents (response rate 74.8%) of children aged 1-18 years who received care in one of the participating paediatric rehabilitation centres. All subjects filled out two MPOCs with a 1-year interval. RESULTS: All correlations between the scale scores of the MPOC at the first and second administration were relatively high and significant (range: 0.443-0.609, all P < 0.001), demonstrating high inter-individual stability. However, all mean scale scores, except for Providing General Information, significantly reduced after 1 year. CONCLUSIONS: The MPOC has a moderate 1-year stability. However, because of its tendency to score lower when repeated after 1 year, its use as an evaluative follow-up instrument to assess the effectiveness of a programme intervention is restricted.     

儿童皮质发育畸形的MRI诊断

目的探讨儿童皮质发育畸形(MCD)的MRI表现特点,为MCD的早期诊断提供依据。 方法选择2010年1月至2012年12月在四川省医学科学院·四川省人民医院放射科经MRI检查确诊为MCD的44例患儿为研究对象。回顾性分析及总结其MRI影像学特征。本研究遵循的程序符合四川省医学科学院·四川省人民医院人体试验委员会制定的伦理学标准,得到该委员会批准,征得受试对象及其监护人知情同意,并与监护人签署临床研究知情同意书。 结果本组44例经MRI确诊为MCD患儿中,巨脑回-无脑回为17例,多小脑回为14例,灰质异位为9例,脑裂畸形为4例。MCD的MRI特点中,巨脑回表现为脑回增宽、皮质增厚及白质变薄;无脑回表现为正常脑沟、脑回消失,皮质增厚及白质变薄;多小脑回表现为脑回增多、细小;灰质异位表现为皮质下及侧脑室周围深部白质区结节状、团块状或带状病灶,信号与灰质信号相同;脑裂畸形表现为从侧脑室到脑表面贯穿大脑半球的裂隙,表面覆盖灰质。 结论MRI是诊断儿童MCD的可靠影像学方法。     

244株真菌鉴定结果分析

目的 了解某院2000～2001年各类真菌的检出率。方法 用酵母样真菌同化试验编码鉴定板TH-15进行编码鉴定。结果 真菌分离率为8．85％；244株真菌分为10种，其中以白色念珠菌和热带念珠菌较高，分别占真菌总数的75．41％和11．47％；检出真菌的主要标本是痰和阴道分泌物。结论 及时进行真菌培养，有利于合理使用抗菌药物和控制真菌感染。