医疗废弃物收纳车的制作与临床应用

<正>医疗废物是指从医院、诊所和卫生防疫保健等医疗单位的医疗废弃物,含有多种病原微生物、有毒的化学物质和锐器等,对临床医务人员的健康构成极大的威胁[1]。为了减少医疗废弃物所带来的危害,做好医护人员的职业防护,降低医院感染的发生,医院相关部门在医疗废物分类处置和流程上进行了很大力度的改造。在这一背景之下,我们设计了病区治疗室医疗废弃物收纳车。病区治疗室是完成患者治疗准备工作的     

医务人员锐器伤发生时间与工作规律关系的研究

目的研究医务人员锐器伤发生时间与工作规律关系,预防和控制职业感染。方法采用《医疗锐器伤登记表》填写、调查和收集医务人员锐器伤情况,进行统计分析。结果锐器伤发生在上午11~12点时段占整个发生人数的30.88%;发生在下午14~15点时段占整个发生人数的11.76%。发生在医疗操作中的损伤人数占27.94%,发生在操作后整理用物阶段的人数占55.88%,发生在处理废弃物阶段的人数占16.18%。发生锐器损伤的临床医生、护士和其他工作人员等3组人员间差别均无统计学意义。结论锐器伤高峰时段均在工作量下降阶段,常见于操作后整理用物和处理废弃物阶段。     

护士锐器伤的根本原因分析

[目的] 寻找护士锐器伤的根本原因并进行整改,减少护士锐器伤的发生,保障护士职业安全.[方法] 对某医疗机构发生并上报的114例护士锐器伤事件进行回顾性分析,对发生经过进行分类整理,采用根本原因分析法进行分析.[结果] 114例护士锐器伤发生几率由高到低依次为治疗操作59.2%,处理锐器32.6%,病人因素造成为8.2%;对护士操作过程进一步分析显示,护士违反操作规程、治疗时间不足分别占50.7%和46.3%;治疗车锐器盒摆放位置不合理,使用非一次性锐盒再次处理锐器分别为44.7%和34.2%.[结论] 应加强护士职业安全教育,严格遵守操作规程;配备足够的护士,并根据各时段工作量实行弹性排班,保证护士治疗操作时间充足;医疗单位应启用"针头自动回缩自毁式安全注射器".对治疗车进行改造,锐器盒摆放位置应便于护士操作;锐器盒一次性使用.     

护士锐器伤的根本原因分析

[目的]寻找护士锐器伤的根本原因并进行整改,减少护士锐器伤的发生,保障护士职业安全。[方法]对某医疗机构发生并上报的114例护士锐器伤事件进行回顾性分析,对发生经过进行分类整理,采用根本原因分析法进行分析。[结果]114例护士锐器伤发生几率由高到低依次为治疗操作59.2%,处理锐器32.6%,病人因素造成为8.2%;对护士操作过程进一步分析显示,护士违反操作规程、治疗时间不足分别占50.7%和46.3%;治疗车锐器盒摆放位置不合理,使用非一次性锐盒再次处理锐器分别为44.7%和34.2%。[结论]应加强护士职业安全教育,严格遵守操作规程;配备足够的护士,并根据各时段工作量实行弹性排班,保证护士治疗操作时间充足;医疗单位应启用＂针头自动回缩自毁式安全注射器＂。对治疗车进行改造,锐器盒摆放位置应便于护士操作;锐器盒一次性使用。     

医院社区健康服务中心护士发生锐器伤的调查和对策

目的探讨护士预防锐器伤的对策,旨在提高社康护士的预防医院感染和职业防护的水平。方法采用对本院9处社康共77位护士的问卷调查,对其发生锐器伤的有关情况通过统计学进行处理和分析。结果被调查的72名护士有55人发生锐器伤,发生率76.4%,共发生223例次损伤,平均每人发生锐器伤3.1次,发生锐器伤的锐器主要是针头和玻璃。其中在注射、拔针、开安瓿、处理废弃物等环节容易发生。其中71.3%为针头所刺伤;22.9%为玻璃类所伤。操作后整理用物特别在处理使用过的锐器时刺伤率19.7%。结论应加强社康护士的职业安全教育,科室有正确的锐器伤处理原则和操作指引,使护士在面临锐器伤职业危险时,能积极正确采用防护工具,做到锐器伤后能正确处理,从而既有效预防也能正确处理锐器伤害,大大地提高社康护士的预防医院感染和职业防护水平。     

护理人员使用锐器盒的依从性调查与对策

目的了解护理人员临床工作中使用锐器盒的依从性,为职业防护管理提供依据。方法采用自行设计的"护理人员使用锐器盒依从性调查表",随机抽取我院护理人员229人进行问卷调查。结果治疗车上备锐器盒为4.37±1.41分,用后针头由操作者本人放入锐器盒为4.49±0.85分,治疗盘内备锐器盒及动静脉采血、注射、拔针等操作时使用备有锐器盒治疗车或治疗盘均在3.0分以下;锐器使用后立即放入锐器盒仅占39.74%,有22.27%带回治疗室处理,36.68%有时立即处理有时带回治疗室处理。结论护理人员使用锐器盒依从性较差,职业防护管理有待加强,提高使用锐器盒的依从性可减少锐器伤的发生。     

护理人员医疗锐器伤原因分析及防护

目的探讨护理人员在临床工作中医疗锐器伤发生时段、发生率、损伤原因及护防方法。方法采用问卷方式对180名护理人员进行回顾性调查,并对调查结果进行分析。结果发生医疗锐器伤127名,占总调查人数70．56％。锐器伤发生时间：10：00～12：00为64人次,占50．39％;8：00～10：00为20人次,占1575％;14：30～16：30为16人次,占1260％。护龄≤5年组护理人员与〉10年组人员比较,差异具有统计学意义（P〈0．05）。护士与主管护师比较,差异具有统计学意义（P〈0．05）。结论锐器伤多发生在护理工作相对集中的上、下午高峰时段,且常见于操作中、后时段。护理管理者要重视对锐器伤高发时段的管理,以降低护理人员锐器伤的发生。     

2012年某三甲医院实习护士锐器伤调查

目的 了解实习护士在实习期间发生医疗锐器伤的情况,探讨实习护士锐器伤的危险相关因素和防范对策.方法 对2012年实习的护士进行回顾性问卷调查,问卷为自制,内容包括调查对象基本情况、职业暴露防护知识教育或培训情况、锐器伤伤害的情况、防锐器伤的防护意识、锐器伤发生后的处理等.结果79.9％ （188/238）的实习护士在l～10个月的实习期间至少发生过1次锐器伤,平均每个实习护士发生锐器伤的次数为1.78次;实习头1个月发生的次数最多,实习护士中93.7％不同程度接受过职业防护知识培训,锐器伤主要发生在：儿科、急诊科、神经外科等比较忙的科室;导致锐器伤发生的主要操作为：徒手掰安瓿、处置医疗废物、双手回套针帽、拔针、静脉注射;76.1％的锐器伤案例能正确处理伤口,仅有9.9％锐器伤能正确报告.不同学历者、不同培训途径及是否接受过职业防护相关知识培训护士锐器伤发生率差异均有统计学意义（P＜0.05）.结论 实习护士锐器伤发生率目前处于较高水平,要加强实习护士的“三基”及职业防护相关知识培训,使她们尽快规范、熟练护理操作,提高锐器伤防范意识;医院要减少患者静脉输注治疗;尽可能用高分子材料的安瓿（如塑料）代替玻璃安瓿;建立健全职业防护制度,强化职业暴露报告意识,以降低实习护士锐器伤发生率.     

某院锐器伤的危险因素及对医护人员焦虑水平的影响

目的：探讨传染病医院医护人员锐器伤的危险因素及对心理焦虑水平的影响。方法收集某传染病专科医院2008-2012年临床医生、护士发生医疗锐器伤资料,分析锐器伤危险因素和对医护人员心理焦虑状态的影响。结果护士5年累积锐器伤暴露率为35．8％（43/120）,高于医生组的12．7％（7/55）,差异有统计学意义（χ2＝9．87,P＜0．01）;医生组SAS得分为（49．7±11．3）分,高于护士组的（45．2±9．3）分,差异有统计学意义（t＝12．39,P＜0．05）;导致锐器伤的利器主要为污染头皮针;操作中和操作后为高危操作环节。结论锐器伤导致医护人员心理焦虑,及时对暴露者实施针对性心理辅导,对医护人员职业防护意义重大。     

江干区临床护理人员医疗锐器伤情况调查

目的了解杭州市江干区医疗机构临床护理人员医疗锐器伤情况,为制定预防锐器伤措施提供参考。方法采用问卷调查方式,对江干区所属部分医疗机构护理人员锐器伤情况进行了调查。结果此次共调查临床护士363名,其中有280名护士自参加工作以来至少发生过一次锐器伤,锐器伤的发生率为77.13%。锐器伤发生率最高的科室是治疗室和输液室。护士在实习期锐器伤年发生率61.5%。结论临床护理人员是医疗锐器伤主要群体,应加强对护理人员特别是年轻护士预防锐器伤知识教育,采取有效的防护措施。     

Intérêt du Télos dans l'évaluation de la laxité chronique antérieure du genou en pré- et en postopératoire

The objective of our work is to clarify the contribution of knee arthrometer in the diagnosis of the anterior laxity of the knee, to look for the factors of escalation of this pathology, to estimate the objective results and outcomes following of the anterior cruciate ligament surgery. It is about a retrospective study which concerned 78 patients presenting the anterior chronic laxity of the knee, investigated, treated and followed in the M.-T.-Kassab Institute of Orthopaedics over a period of 10 years. The average age of our patients was of 27.6 years with a male ascendancy. The anterior cruciate ligament surgery was realized according to the technique of Kenneth-Jones under arthroscopy. The arthrometer has been used to determine the outcome 6 months after the surgery. Before the surgery, the average anterior translation of the tibia was 15.3 mm, 95% of the patients had 8 mm previous absolute laxity, while the differential was about 4 mm in 87% of the cases in which comparative study could be made. There was a statistically significant correlation between the Lachman's test, the internal meniscus injuries and the delay accident — surgery with the anterior knee laxity in the arthrometer. The postoperative average laxity was bout 8.2 mm and earning was proportional to the importance of the initial tibial translation. The present study demonstrates that arthrometer tests may be an objective complement for the clinical exam, with a diagnostic, previous and therapeutic purpose.     

Instabilité antérieure récidivante de l'épaule chez le rugbyman. Résultats d'une série de 85 épaules opérées par la technique de Latarjet avec un recul moyen de sept ans

The stabilization of an unstable chronic shoulder is a difficult challenge in the contact sportsman especially the rugby player. We report our experience of the modified Latarjet procedure with a retrospective series of 85 shoulders (79 rugbymen at 75 months follow-up). It acted all young men with a prevalence of dominant shoulder, occupying all the stations (over-representation of the third lines). Eighty percent presented osseous lesions; the first luxation was traumatic during a tackle. We describe our technique and our postoperative protocol. Seven percent experienced recurrence of their instability after a new traumatism and 67% returned to rugby within 8 months by keeping for some of them a sport practice functional embarrassment (16 patients). Only two mechanical complications were observed, 93% of the patients were satisfied with their intervention.     

宫颈高度鳞状上皮内瘤变的“即诊即治”策略

目的探讨宫颈高度鳞状上皮内瘤变应用＂即诊即治＂策略的价值。方法选取宫颈细胞学检查为高度鳞状上皮内瘤变（HSIL）,并经阴道镜检查、镜下活检及宫颈电圈切除术（LEEP）治疗的患者76例,按阴道镜RCI评分分成高评分组、低评分组,对组织病理结果及过度治疗率进行回顾性分析。结果 RCI高评分组CINⅡ、Ⅲ及以上病变比例为97.4%,低评分组59.5%,高评分组过度治疗率2.6%,低评分组40.5%（P〈0.001）,不同RCI评分组的过度治疗率差异有统计学意义,高评分组过度治疗率显著低于低评分组。结论对于细胞学为HSIL,经阴道镜检查RCI高评分,提示高度病变的患者,采取＂即诊即治＂策略快速而有效地进行诊治,是较为适宜的;而细胞学检查HISL、RCI低评分者,仍以传统三阶梯方案进行筛查诊治为宜。     

Place du traitement médicamenteux et des infiltrations dans la prise en charge médicale des lésions de la coiffe des rotateurs

One of the main objectives of medical treatment of rotator cuff lesions is to attenuate or totally relieve pain and allow the patient to access the next phase of functional rehabilitation. Relative rest is desirable. Harmful sports movement should be avoided. Strict immobilization is never indicated. The question is raised as to whether wider use of analgesics would be warranted. The inflammatory nature of rotator cuff tendiopathies remains to be clearly demonstrated and the efficacy of analgesics in this indication would be related more to their intrinsic pain killer action. Analgesics should thus be prescribed prudently and limited to a few days, particularly because of the potential adverse effects. Theoretically, steroidal anti-inflammatory drugs should not be used for tendonitis. Myorelaxing agents could be used in the event of associated muscle contracture. If the patient requires further relief, corticosteroid injections could be considered, taking care to avoid contraindications for intra-articular injections and avoiding any risk of contamination while keeping in mind the possible adverse effects.     

Épicondylites : « les nouveautés en 2007 »

What news for 2007 concerning sportsmen lateral epicondylitis? Concerning biomechanics, we will evaluate the role of the supinatus at the same time we will talk about the complex characteristics of the functionnel unit. An anatomic work has showed in some cases, the involvment of ligment structure that could explain the atypical side of the pain and sometime the failure of the treatment. As for rehabilitation, we will insist on the importance of excentric work. The braces conserve a certain importance. We insist on new therapeutics and mostly on the interest of trinitrine patches. Botulinium toxic is still discussed and the recent study of Hayton does not show any significant difference with placebo injection. An original autologue blood injection in the epicondylitis tendon demonstrates good results and specially in the cases that resist to the corticoid therapeutics. We will talk about our experience. Considering corticoide injections a Crowther publication reveals a significant result compared to choc waves therapy. At last, we will criticize the Smidt study because we believe that the use of fluorite corticoid induce iatrogenic effects. We will conclude this article by our 2007 propositions about the local corticoid indication.     

Analysis of older adults visiting the emergency department with fever as a suspected Covid-19 vaccine-related adverse reaction: A retrospective multicenter study

IntroductionAfter COVID-19 vaccination was initiated, the number of patients visiting the emergency department (ED) with vaccine-related adverse reactions increased. We investigated the clinical features of older adults (aged 65 years and older) visiting the ED with self-reported COVID-19 postvaccination fever.MethodsWe conducted a retrospective observational study at three EDs between March 2021 and September 2021. Patients who reported adverse reactions, fever (≥37.5 °C) and/or febrile sensation or rigors following COVID-19 vaccination were included. The demographic and clinical data of these patients were collected by reviewing their medical records.ResultsA total of 562 patients were selected, and 396 (70.5%) were female. The older adult group included 155 (27.6%) patients, and the median age was 75 (69–79 years). The older adults less frequently had a fever (≥37.5 °C) upon ED presentation (75.5% vs. 85.7%, respectively), used more emergency medical services (43.9% vs. 18.7%, respectively), and visited an ED more frequently during early hours (00:00–06:00) (31% vs. 20.1%, respectively) compared to the younger adults (p = 0.004, p < 0.001 and p = 0.036). Fewer older adults visited an ED within 2 days of fever onset (73.5% vs. 84%) (p = 0.012), and more older adults were admitted for medical conditions other than vaccine-related adverse reactions (32.9% vs. 4.2%) (p < 0.001). Older adults received more thorough testing (laboratory and imaging tests). Among the older adults, the admission rate was associated with age (p = 0.003).ConclusionOlder adults presenting with fever as an adverse reaction following COVID-19 vaccination less frequently had a fever upon visiting the ED, required more ED testing, and had higher admission rates for non-vaccination-related medical conditions.     

Spécificités de la pratique du rugby chez l'enfant

The knowledge of the specificity of the child compared to the adult and his reactions regarding the exercise will make it possible to answer parents questions as well as possible and to accompany the child and the teenager in their sporting practice. Five essential concepts govern the practice of Rugby in the child: 1) the child is not an adult in miniature. It is an organization in constant evolution towards its physical and psychic statute of adult. He has a free will depending on the others; 2) Rugby must remain for him a ludic space, where the motivation must be the first condition; 3) the child is a mosaic of growth cartilages. Traumatic pathology is preferentially a pathology of this structure in the acute traumatisms (epiphysium separation rather than distorsion, muscular apophyse avulsion rather than tear) and under the effect of chronic microtraumatisms (osteochondrosis rather than tendinitis); 4) overtraining will result in a disturbance of one of the factors of the general balance of the organization which it acts of a pain, of against performance, an abnormal tiredness, of a demotivation, a relational disorder (mood, affectivity), of lower school output of which it will be necessary to establish a relationship to the sporting practice; 5) the execution of a sporting gesture must always be modulated as of the appearance of a pain, true alarm.