成都地区医院消毒供应中心灭菌设备调查研究

摘要 目的 了解成都市部分医院消毒供应中心灭菌设备运行情况和灭菌效果，为医院消毒中心灭菌设备管理和医院感染控制的相关政策法规、标准规范修订提供科学依据。方法 问卷调查并结合使用无线温度压力验证仪、生物及化学指示物，对灭菌设备进行物理、化学和生物监测与分析。结果 脉动真空压力蒸汽灭菌器、过氧化氢低温等离子体灭菌器、环氧乙烷灭菌器消毒供应中心配有率分别为100.00％、76.92％、23.08％；脉动真空压力蒸汽灭菌器生物监测与化学监测灭菌效果合格率均为100.00％，脉动真空压力蒸汽灭菌器物理监测灭菌合格率为85.36％，过氧化氢低温等离子体灭菌器与环氧乙烷灭菌器生物监测灭菌合格率均为100.00％。结论 成都地区医院消毒供应中心总体灭菌设备运行良好，但灭菌设备的稳定性与安全性应引起关注。     

太原市晋源区医疗机构压力蒸汽灭菌效果调查分析

摘要 目的 <\b>了解太原市晋源区各类医疗机构压力蒸汽灭菌器的使用情况和灭菌效果。方法 <\b>采用物理监测、化学监测和生物监测方法对区级医院、社区卫生服务机构、乡镇卫生院和民营医院的压力蒸汽灭菌器的灭菌效果进行监测。结果 <\b>共调查172台灭菌器中,预真空及脉动真空压力蒸汽灭菌器和下排气式压力蒸汽灭菌器分别占29.1%和70.9%,合格率分别为94.0%和80.3%,两种灭菌器合格率差异具有统计学意义（P<0.05）,且三类医疗机构中所使用的灭菌器类型所占比例和监测合格率差异具有统计学意义（P<0.05）。结论 <\b>不同类型压力蒸汽灭菌器中,预真空及脉动真空压力蒸汽灭菌器合格率要高于下排气式。民营医院配置的预真空及脉动真空式压力蒸汽灭菌器中所占比例较高,这也是其检测合格率高于其余两类医疗机构的主要原因之一,医疗机构应进一步健全规章制度,加强灭菌技术培训,确保操作规范化,有效提高医疗机构器械灭菌质量。     

医院压力蒸汽灭菌器物理监测与生物监测的结果比较

摘要 目的 比较压力蒸汽灭菌器在灭菌过程中物理监测及生物监测的结果,以便加强压力蒸汽灭菌质量管理。方法 采用温度压力检测仪法和生物指示剂监测法,对河南省部分医院使用中的压力蒸汽灭菌器灭菌程序的物理参数和灭菌效果进行对比监测。结果 对6所医院(二级和三级各3所)的28台压力蒸汽灭菌器进行了物理监测与生物监测。共监测压力蒸汽灭菌器107台次,生物监测结果全部合格;灭菌温度监测合格率为88.24%,灭菌时间监测合格率为43.93%。预真空式压力蒸汽灭菌器与下排气式等其他类型压力蒸汽灭菌器的物理监测合格率一致。大型压力蒸汽灭菌器与小型压力蒸汽灭菌器物理监测参数监测结果一致。结论 加强压力蒸汽灭菌器物理参数定期监测,确保灭菌参数的科学性和规范性,达到灭菌效果和正确使用的良好结合。     

全国42家医院过氧化氢低温等离子体灭菌器现状调查及生物监测抽检比较

摘要 目的 了解过氧化氢低温等离子体灭菌器在使用过程中存在的问题,以便加强灭菌质量管理。 方法 采用生物监测方法,抽取国内部分省市42家医院使用中的过氧化氢低温等离子体灭菌器进行现场抽样监测,并以问卷形式进行灭菌效果影响因素调查。 结果 从42家医院抽检用于内镜灭菌的过氧化氢低温等离子体灭菌器217台次,出现14次生物监测失败(管腔PCD监测失败12次和普通生物监测失败2次)。生物监测失败的过氧化氢低温等离子体灭菌器主要分布在二级医院,且灭菌器使用时间较久。调查发现过氧化氢低温等离子体灭菌器使用中的问题主要有部分灭菌器陈旧(使用约10年),多数灭菌器内物品摆放不正确,还存在装载过量的问题。 结论 对于管腔器械的灭菌监测,管腔生物PCD相对于普通生物指示物更容易发现灭菌失败。目前国内医院使用中的低温等离子体灭菌器生物监测失败率仍较高,使用中仍存在较多的问题,应加强督查和培训。     

过氧化氢低温等离子体灭菌器及其生物指示物应用现状调查

目的了解医疗机构中过氧化氢低温等离子体灭菌器及其生物指示物的应用状况。方法采用问卷调查和现场查看形式,对江苏省部分医疗机构使用中的过氧化氢低温等离子体灭菌器及其生物指示剂生物负载进行调查与测试。结果共调查江苏省市级医疗机构97家,其中67家拥有过氧化氢低温等离子体灭菌器,拥有率为88.16%。过氧化氢低温等离子体灭菌器的灭菌效果均采用生物指示剂进行定期监测,所使用的生物指示剂的回收菌量合格率为35.48%。结论江苏省医疗机构过氧化氢低温等离子体灭菌器拥有率较高,其灭菌效果监测专用生物指示剂多数不符合标准,亟待规范。     

微生物实验室小型压力蒸汽灭菌器现状调查

目的了解微生物实验室用小型压力蒸汽灭菌器的使用现状,提高微生物实验室灭菌质量,确保实验室生物安全。方法采用资料调查和现场检测的方法对某医学科研机构微生物实验室使用中的小型压力蒸汽灭菌器进行了调查。结果共调查71台小型压力蒸汽灭菌器,其中预真空式压力蒸汽灭菌器占15.49%,下排气式压力蒸汽灭菌器占71.83%,尚有12.68%的压力蒸汽灭菌器采用直火加热方式产生蒸汽。这些压力蒸汽灭菌器内室温度检测合格率为60.56%;时间控制检测合格率为71.83%。灭菌包化学指示物检测合格率为100%;生物检测合格率亦为100%。结论某医学科研机构微生物实验室内小型压力蒸汽灭菌器的灭菌过程监测全部合格,部分灭菌器质控监测不合格,灭菌设备管理和灭菌操作人员的知识存在问题,存在灭菌质量隐患。     

民营医疗美容机构压力蒸汽灭菌器使用现状调查

目的了解民营医疗美容机构压力蒸汽灭菌器的使用现状,为规范民营医疗美容机构的消毒灭菌工作提供依据。方法采用资料调查和现场检测的方法,对某市98家民营医疗美容机构压力蒸汽灭菌器使用状况进行监测。结果共调查101台压力蒸汽灭菌器,其中有67.33%为下排气式压力蒸汽灭菌器,其余为预真空式压力蒸汽灭菌器。这些灭菌器均属微小型,灭菌腔体容积小于60 L的占71.29%。该城市医疗美容机构使用中的压力蒸汽灭菌器灭菌温度检测合格率为34.65%,生物指示物检测合格率为96.04%。结论该城市民营医疗美容机构压力蒸汽灭菌器温度不合格的问题突出,实际灭菌效果距离灭菌保证水平要求相差甚远。     

压力蒸汽灭菌器性能验证情况调查

目的了解压力蒸汽灭菌器相关性能验证状况,为改进验证准确性提供参考。方法采用调查表方法,对广州地区40家医院消毒供应中心(室)压力蒸汽灭菌器验证情况进行调查。结果验证发现脉动真空式压力蒸汽灭菌器真空度的改变对灭菌平衡时间、维持时间的影响明显,继而影响灭菌效果。结论压力蒸汽灭菌器在使用前和使用过程中,通过性能验证对确保其灭菌效果具有重要意义。     

脉动真空压力蒸汽灭菌器灭菌效果监测

目的了解影响脉动真空压力蒸汽灭菌器灭菌效果的因素,提高灭菌质量。方法采用物理监测、化学指示剂和生物指示剂监测方法以及无菌检验技术进行了观察。结果经连续4年进行的监测,B-D试验平均合格率为98.8%,化学监测平均合格率为96.43%,生物监测平均合格率为98.6%,灭菌物品无菌检验合格率为99.1%。结论该医院脉动真空压力蒸汽灭菌器所采用的4种监测方法,监测结果均未达到全部合格,其中人为操作因素不可忽视。     

过氧化氢低温等离子体灭菌器灭菌效果监测

目的了解过氧化氢低温等离子体灭菌器灭菌效果。方法对过氧化氢低温等离子体灭菌器进行工艺监测、化学监测和生物监测,检验其灭菌效果。结果过氧化氢低温等离子体灭菌器的灭菌效果和监测方法方便有效,经过近1年时间,临床未发生因灭菌不合格而造成手术感染的现象。结论过氧化氢低温等离子灭菌器操作简单、安全,是一种高效、快速的临床灭菌方法,能显著提高手术器械的使用率,增加单位时间内的手术例数。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.