供应室管理与控制医院感染

消毒供应室承担着全院医疗器械回收、清洗、包装、消毒灭菌和发放工作,其工作质量与医院感染的发生密切相关,只有全面提高供应室的质量管理,严把消毒供应关,才能有效地控制医院感染。1环境管理供应室周围环境应整洁、无污染源,室内环境整洁。小扫除1次/d,大扫除2次/周;每室工作前后均用消毒液擦拭物体表面,抹布、拖把分区固定放置,并有标志;严格区分无菌区、清洁区、污染区,路线采用强行通行的方式,不准逆行;严格区分无菌物品、清洁物品、污染物品,流水线操作不逆行;空气消毒2次/d,定期做空气细菌培养。2人员管理2.1做好自身防护供应室所有…     

加强供应室消毒灭菌监测预防医院感染

目的加强供应室消毒灭菌质量监测,强化消毒灭菌效果,控制医院感染。方法按《消毒技术规范》要求,采用化学、物理的监测方法对物品灭菌进行监测,定期对供应室无菌区、清洁区空气消毒效果监测。结果自2007年以来未发生因供应室原因所造成的医院感染。结论加强消毒灭菌质量监测,确保消毒灭菌效果,能有效控制医院感染发生。     

消毒供应室的质量控制与医院感染控制的研究

目的 探讨提高消毒供应室质量控制水平以及降低医院感染概率的方法,有效控制医院感染率.方法 在遵守《消毒技术规范》的要求和原则的基础上,通过采用化学、物理和生物等多种方法对供应室物品进行消毒灭菌处理及空气消毒,同时定时监测供应室的无菌区及清洁区的无菌效果.结果 2001年消毒供应室达标至2012年,无一起因供应室工作失误引发的医院感染事件发生,所有无菌物品均能够保证优质供应.结论 制定并且不断健全消毒供应室管理制度,明确岗位责任,严格执行消毒灭菌的质量监控以及保持供应室的无菌环境,是供应室为医院高效提供无菌物品,监测预防医院感染的有效措施.     

加强供应室消毒灭菌监测预防医院感染

目的加强供应室消毒灭菌质量监测,强化消毒灭菌效果,控制医院感染。方法按《消毒技术规范》要求,采用化学．物理的监测方法对物品灭菌进行监测,定期对供应室无菌区、清洁区空气消毒效果监测。结果自2007年以来未发生因供应室原因所适成的医院意染。结论加强消毒灭菌质量监测,确保消毒灭菌效果,能有效控制医院感染发生。     

消毒供应室无菌物品污染原因分析及对策

医院消毒供应室是医院内对各种医疗器械集中消毒灭菌的地方,为医院各个科室提供无菌物品,其医疗器械灭菌质量的高低直接关系着各种医源性感染的发生,直接影响医疗诊断、治疗、护理和患者的安危。笔者对所在医院的消毒供应室进行调查,检测清洁区的空气、物体表面、医疗器械和工作人员的手卫生情况,采用调查问卷分析相关原因,现报告如下。1资料和方法1.1一般资料调查对象为本院消毒供应室,在2011年1月1日—2011年12月31日每月随机两次检测清洁区的空气、物体表面和工作人员手卫生的无菌情况,共计24次;每周一次检测清洗消毒器消毒的医疗器械,共计52次。     

无菌区不同阶段空气含菌量监测

目的 保护供应室无菌区空气不洁净度。方法 对3个不同时期无菌区进行空气动态监测。结果 无菌区空气含菌量：旧供应室100－500CFU/m^3，新供应室100－200CFU／m^3，加强管理后0－50CFU／m^3。结论 改善条件，严格管理，加强人员在职教育对控制医院感染有重要的作用。     

做好供应室消毒灭菌监测预防医院感染

目的 通过加强供应室消毒灭菌质量监测，预防医院感染发生。方法 按《消毒技术规范》要求，采用化学的、物理的、生物的监测方法对物品灭菌进行有效监测；定时对供应室无菌区、清洁区进行空气消毒并进行效果监测。结果 自1989年以来未发生因供应室原因所造成的医院感染。结论 健全管理制度，严格岗位责任制，加强消毒灭菌质量监测，确保供应室环境清洁，无菌物品绝对无菌、无热原，是有效控制医院感染发生的保证。     

供应室易被忽视的医院感染因素及预防措施

供应室是控制医院感染的重点科室。物流在进入污染区、清洁区、无菌区的处理过程中,应严格按照各自的工作程序和操作规程进行。但在实际工作中某些被忽视因素是引起院内交叉感染的隐患,也可能危害供应室人员身体健康,值得引起重视。 1 环境因素 1.1 回收室、洗涤室是污染物品集中、分类予处理和清洗的场所。由于热水、常水的大量使用,室内温度、湿度长期偏高,地面潮湿,极易导致微生物生长繁殖,污染区空气中含菌量增高。据报道室内相对湿度为59％时,空气中真菌为相对温度<50％者     

无菌物品间空气分时段消毒方法

为了提高和保证供应室无菌物品存放间室内空气质量,我院供应室采取昼夜用消毒液、紫外线和臭氧机等对无菌物品间进行分时段空气消毒,效果满意。1方法使用含氯消毒液在7∶00~8∶00进行室内桌面、贮存柜表面、地面擦拭;在中午11∶30~13∶00用紫外线照射消毒30~60 min;在启动消毒机前(即下午约18∶00),用消毒液进行室内湿式擦拭和喷洒;用臭氧消毒机在夜间0∶00~3∶00进行消毒2 h。然后采用平板自然沉降法分别在紫外线消毒前和次日,无人进入前对无菌物品间进行空气采样。2结果试验结果,消毒前空气中含菌量为(152~498)CFU/m3,消毒后空气中含菌…     

21所医院手术室和产房空气含菌量调查

本文报导了河南省21所省、市、县、乡四级医院手术室和产房空气中细菌总数的监测结果、结果显示：各级医院手术室无菌区、清洁区、产房和待产室空气含菌量的总体合格率分别为42.86％（9/2114.28％（3／21）、25.00（4／16）和31.25％（5／16）其中县.乡两级医院手术室和产房的空气含菌量几乎全部超标。省、市两级医院空气含菌量合格率高于县、乡医院．但仍与国家要求相距甚远这说明各级医院手术室和产房的空气污染情况不容乐观。因此．加强手术室和产房的细菌监测及消毒管理．对降低医院内手术创伤的感染率是至关重要的。1996年4月.河南省卫…     

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。