住院患者医院感染现患率调查分析

目的了解住院患者医院感染情况,为住院患者感染预防和控制工作提供科学依据。方法采用横断面调查方法 ,床旁与病历调查相结合,对2013年7月18日0∶00-24∶00所有住院患者进行医院感染现患率调查,采用SPSS17.0软件进行统计分析。结果当日全院住院患者601例,实查601例,实查率为100.0%;医院感染20例、24例次,现患率3.33%、例次感染率3.99%;感染部位以下呼吸道感染为主,占58.33%;ICU是医院例次感染率最高的科室,为33.33%;病原学检查送检率为66.67%,共检出病原菌18株,其中革兰阴性菌11株占61.11%;抗菌药物使用率为39.27%,治疗用药使用率为63.98%,预防用药使用率为36.02%,一联用药占72.88%,二联用药占25.85%,三联及以上用药占1.27%;医院感染与患者年龄、气管切开、泌尿道插管等因素有关(P<0.05)。结论通过现患率调查结果 ,有针对性地开展相关监测,及时采取控制、预防措施,规范抗菌药物的合理使用,提高病原学送检率,可有效降低医院现患率。     

某县级医院感染现患率调查分析

目的了解安溪县医院医院感染现患率和抗菌药物的使用现况,提高医院感染监测的准确性。方法采用横断面调查,床旁与病历调查相结合,于2015年8月24日0:00-24:00,调查所有住院病人的医院感染现患率和抗菌药物使用等情况,对调查结果进行统计分析。结果当日住院患者659例,实查率100.0%,院感现患率1.7%。感染部位泌尿系感染占45.5%,呼吸道感染占27.3%。抗菌药物使用率45.2%,其中治疗用药占50.7%、预防用药占42.6%、治疗+预防用药占6.7%;一联用药占71.1%,二联占27.9%,三联占1.0%;抗菌药物使用率最高的科室为ICU 100.0%、儿科非新生儿组87.2%、儿科新生儿组77.8%和普外科71.4%。病原菌送检率15.2%。结论医院需加强重点科室医院感染管理,降低泌尿系感染,提高病原学送检率,规范抗菌药物使用,以有效预防和控制医院感染。     

408例住院患者医院感染现患率调查

目的 了解和掌握医院感染现状及抗菌药物使用,更好地预防与控制医院感染.方法 采用横断面调查方法,床旁调查和病历调查相结合,将调查日处于医院感染状态的病例进行统计分析.结果 应调查住院患者408例,实际调查405例,实查率为99.26％,医院感染22例,医院感染现患率为5.43％;神经内科感染率最高为16.00％,其次为肾病科感染率12.5％;医院感染部位居前3位的依次为下呼吸道、泌尿道、上呼吸道感染,分别占36.36％、27.27％、18.18％;共检出病原菌18株,分别为肺炎克雷伯菌9株,铜绿假单胞菌及大肠埃希菌各3株,白色假丝酵母菌2株,粪肠球菌1株;抗菌药物使用率为60.74％,其中治疗用药78.86％,预防用药17.89％,治疗十预防为3.25％;一联使用占74.79％,二联使用占23.98％,三联使用占1.22％.结论 加强重点科室医院感染管理,降低呼吸道感染,提高病原学送检率,规范化使用抗菌药物,降低医院感染现患率.     

东莞市13所三级医院医院感染现患率调查

目的通过首次开展东莞市13所三级医院医院感染现患率调查,了解东莞市三级医院医院感染情况,为指导医院感染的预防与控制提供依据。方法采用床旁调查和查阅病历相结合的方法,调查东莞市13所三级医院2014年9月24日0:00-24:00期间的住院患者医院感染情况。结果共调查患者11 344例,发生医院感染379例,404例次,医院感染现患率为3.34%,例次现患率为3.56%。重症监护病房(ICU)医院感染例次现患率最高(12.82%)。医院感染部位主要为呼吸道(173例次,占42.82%)。抗菌药物使用率为30.50%,以治疗用药(包括治疗+预防用药)为主(2 545例,占73.55%),一联用药为主(2 689例,占77.72%),治疗用药患者病原微生物标本送检率为53.79%。医院感染病例共检出299株病原菌,主要为大肠埃希菌(56株,占18.73%)、铜绿假单胞菌(54株,占18.06%)、肺炎克雷伯菌(35株,11.71%),检出多重耐药菌(MDR)92株,占所有病原菌的30.77%。结论通过调查初步了解了全市三级医院医院感染的基本特点,应加强高风险科室、高危人群、高风险环节的识别,落实医院感染预防与控制措施。     

2012年医院感染现患率调查分析

目的了解住院患者的感染率及抗菌药物使用情况,为提高医院感染管理水平提供科学依据。方法采用横断面调查方法,床旁调查和病历调查相结合,对医院2012年8月7日0∶00-24∶00的住院患者进行医院感染现患率调查。结果调查住院患者共1 278例,发生医院感染50例,医院感染现患率为3.91%,其中下呼吸道感染占52.00%,泌尿道及表浅切口感染各占14.00%;社区感染率9.70%,其中下呼吸道感染占54.03%,泌尿道感染占17.74%,皮肤软组织感染占11.29%;医院感染共检出病原菌22株,其中革兰阳性菌6株占27.27%,革兰阴性菌16株占72.73%;社区感染共检出病原菌34株,其中革兰阳性菌13株占38.24%,革兰阴性菌21株占61.76%;日抗菌药物使用率为21.60%,一联用药占88.77%,二联用药占11.23%,无三联及以上用药病例,细菌送检率为58.10%。结论医院感染现患率调查对医院感染控制具有指导意义,社区感染高于医院感染,医院感染管理科应与多部门沟通合作,共同规范临床抗菌药物的合理应用。     

658例住院患者医院感染现患率调查分析

目的了解医院感染的横断面情况。方法采用床旁和病历相结合调查方式,填写个案调查表,对全院所有住院患者进行了1d的医院感染情况调查。结果应查例数663例,实查658例,实查率99.25%,发生医院感染12例,15例次,现患率为1.82%,例次感染率为2.28%,消化内科感染率最高,为3.80%,例次感染率为6.33%,其次为呼吸内科,其感染率及例次感染率均为3.16%;医院感染部位构成中呼吸道感染居首位,其中下呼吸道感染率8例次,占53.33%,上呼吸道感染2例次,占13.33%,泌尿道感染2例次,占13.33%,胃肠道、皮肤软组织和表浅切口感染各1例次,各占6.67%;病原菌送检15例次,送检率为100.00%,检出病原菌8株,阳性率为53.33%;住院患者抗菌药物使用385例,使用率为58.51%,其中治疗用药260例,预防用药99例,治疗+预防26例;一联使用350例,二联使用34例,三联使用1例;抗菌药物使用种类以头孢菌素类为最多,占68.57%。结论通过医院感染现患率调查,及时发现医院感染管理中存在的问题,有利于控制和预防医院感染。     

2013年医院感染横断面调查分析

目的通过医院感染横断面调查,了解医院感染发生的相关因素和医院感染现患率,为医院感染管理提供参考依据。方法采用横断面调查方法,对2013年11月11日全天所有住院1 192例患者,采用个案调查和床旁调查,调查医院感染现患率、抗菌药物使用及病原菌检出结果,数据采用SPSS 18.0软件进行统计分析。结果应查住院患者1 192例,实查1 180例,实查率98.99%;发生医院感染24例,医院感染现患率为2.03%;调查1 180例患者中,使用抗菌药物568例,抗菌药物使用率为48.14%,治疗性使用抗菌药物381例,占67.08%;医院感染24例患者中,共检出10株病原菌,以革兰阴性菌为主,共8株占80.00%。结论重症医学科、皮肤感染、下呼吸道感染、三管、抗菌药物合理使用及使用前的标本送检是感染预防控制的主要工作重点。     

2013年肿瘤专科医院医院感染现患率调查分析

目的了解肿瘤专科医院感染现患率,分析影响感染的因素,为预防与控制肿瘤患者医院感染及规范抗菌药物使用提供科学依据。方法感染管理专职人员分组跟踪进行现场业务指导,各临床科室感染管理兼控医师、兼控护士具体实施,调查2013年10月17日0∶00-24∶00所有住院患者,采取床旁调查和查阅病历相结合,填写统一的床旁调查表和个案登记调查表,将所有调查结果进行统计、分析。结果调查住院肿瘤患者890例,医院感染7例,现患率0.79%;医院感染部位以下呼吸道为主,占28.55%;感染病例标本送检率为100.00%,主要分离菌为真菌,占75.00%;抗菌药物使用率19.10%,其中治疗用药、预防用药、治疗+预防用药分别占37.06%、48.24%、14.70%;一联、二联、三联用药分别占72.35%、26.47%、1.18%;170例接受抗菌药物治疗患者病原菌标本送检率为20.59%;使用化疗药物、抗菌药物、动静脉插管、泌尿道插管等是医院感染的主要危险因素。结论现患率调查可在短期内全面了解肿瘤住院患者医院感染现状,根据结果提示有针对性地开展目标性监测,预防与控制医院感染易感因素,加强临床标本送检,规范抗菌药物使用,从而有效降低医院感染率。     

2010年中医院医院感染现患率调查与分析

目的了解中医院医院感染的基本情况,为改进监控措施提供依据。方法 2010年8月10日0:00-24:00采用横断面调查方法,床旁调查和查阅住院病历相结合,填写统一的个案调查表,对调查日处于医院感染状态的病例进行统计分析。结果应查689例,实查678例,实查率为98.96%,发生医院感染22例,现患率为3.24%;医院感染最高的科室是综合ICU,其次为心脑病科;感染部位以下呼吸道感染居首位,占所有感染部位的31.82%,其次为泌尿道感染,占22.73%;全院治疗性细菌培养送检率为40.91%,检出医院感染病原菌5株,分别为铜绿假单胞菌、鲍氏不动杆菌、大肠埃希菌等,抗菌药物的日使用率为28.17%。结论通过对医院现患率的调查,将加强对综合ICU、心脑病科及脑病外科等重点科室、重点环节的监控,降低医院感染率,提高病原菌送检率,合理使用抗菌药物。     

某三甲医院医院感染现患率与抗菌药物应用横断面调查

目的动态评估医院感染管理成效,了解三甲医院医院感染的高危科室、高危人群、感染高危因素以及抗感染药物应用现状,为制定和落实目标监测方案和持续质量改进方案提供依据。方法于2014年10月16日0∶00-24∶00采用横断面调查方式对某三甲医院住院患者医院感染现患率和抗菌药物使用进行调查和记录,采用SPSS19.0统计软件对各科医院感染现患率、感染部位分布、病原菌检出分布、抗菌药物的使用与病原学送检等进行描述和分析。结果实际调查住院患者2 203例,发生医院感染68例、71例次,医院感染现患率3.09%、例次感染率3.22%;不同标本中检出的病原菌均以革兰阴性菌为主,均60.00%,呼吸道感染病原菌主要为肺炎克雷伯菌、副流感嗜血菌,尿道和腹腔感染病原菌主要为大肠埃希菌;抗菌药物使用率为40.04%,以治疗性和一联用药为主,分别占61.90%和73.58%,感染病原菌标本送检率为32.20%。结论病原学标本送检和围手术期预防性抗菌药使用为医院感染管理的薄弱环节,均应纳入医院目标监测范围开展实时监控和采取前瞻性干预措施,以保障患者安全和遏制多药耐药菌产生。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.