手术器械清洁方法国内研究进展

医疗器械使用后,应进行彻底地清洁处理,去除附着在上面的血液、黏液和体液等有机物,这是预防和控制医院感染,保证医疗安全的重要环节。器械清洁方法正确与否,清洗质量合格与否,清洗后的维护和保养及如何通过物理和化学方法将器械上的有机物、无机物和微生物清除到安全的水平,对保证灭菌效果和控制交叉感染具有重要的作用［1］。在所有环节中,器械清洗是基础和前提,如果清洁不彻底,医疗器械上残留的有机物会在微生物的表面形成一层保护层,妨碍消毒灭菌因子与微生物接触或延迟其作用,影响消毒灭菌效果。因此,器械清洗质量是否合格尤为重要。     

固体清洗剂和多酶清洗剂清洗手术器械的效果比较

目的比较固体清洗剂和液体多酶清洗剂清洗手术器械的效果,并进行成本分析,为消毒供应中心提供新的清洗技术选择。方法将消毒供应中心4台清洗消毒机随机平分为实验组和对照组,实验组使用固体清洗剂,对照组使用液体多酶清洗剂对手术器械进行清洗。对两组手术器械的清洗效果,采用目测(裸眼和10倍光源放大镜）、ATP生物荧光检测和蛋白残留检测方法进行效果评价,并对两组的清洗成本以及产生的医疗废弃物进行统计分析。结果肉眼裸视评价清洗效果,实验组合格率为97.70%（4 678/4 788）,对照组为92.01%（5 075/5 516）;10倍光源放大镜评价清洗效果,实验组合格率为94.30%（2 546/2 700）,对照组为88.72%（2 453/2 765）;实验组合格率均高于对照组,差异具有统计学意义（P=0.000）。ATP荧光检测法评价清洗效果,实验组合格率为84.41%（996/1 180）,对照组为86.83%（1 042/1 200）,两组差异无统计学意义（P=0.092）。实验组蛋白残留检测阳性率为3.71%（26/700）,对照组为16.31%（106/650）,实验组蛋白残留检测阳性率比对照组低,差异有统计学意义（P=0.000）。实验组清洗成本为对照组的2/3;实验组产生医疗废弃物（塑料薄膜）0.40 kg,对照组（空桶）为12.30 kg。结论固体清洗技术可以高效去除手术器械的蛋白污染,并降低清洗成本,减少医疗废物的产生,是值得推广的新型清洗技术。     

Associations Between Social Media Engagement and Vaccine Hesitancy

There has been a surge in vaccine hesitancy following the Coronavirus pandemic. This study measured the prevalence of and identified factors associated with vaccine hesitancy and social media use. An online survey was administered (n?=?1050) between May and July 2021. Chi-square tests were used to examine bivariate associations with vaccine hesitancy (partially vaccinated and unvaccinated participants). Logistic regression was used to identify associations between social media use and vaccine hesitancy. Chi-square tests showed women (69.7% vs 28.2% men, p_adjusted?=?.002), African American participants (52.3% vs 17.8% white, p_adjusted?<?.001), high school diploma (54.4% vs 38.6% college degree, p_adjusted?<?.001), political unaffiliated (15.8% vs 14.5% republican, p_adjusted?<?.001), Muslim (10.0% vs 0% Jewish, p_adjusted?<?.001), and never married/single (53.9% vs 17.0% married, p_adjusted?<?.001) were more likely to be vaccine hesitant. Controlling for all demographic variables (age, race, gender, and education), more frequent use of social media for reading news was associated with lower vaccine hesitancy (OR 0.35, 99% CI 0.20, 0.63, p?<?0.001). However, using social media as a source of vaccine information without any other trusted source (health department, doctor, CDC,) was associated with higher odds of being vaccine hesitant (OR 2.00, 99% CI 1.15, 3.46, p?=?0.001). People who use social media without referencing trusted sources may be particularly vulnerable to disinformation or vaccine hesitant persons are more likely exposed to non-trusted social media sites as their only information source.

     

Épidémiologie des patients porteurs d’entérobactéries sécrétrices de bêtalactamase à spectre élargi (EBLSE), à l’admission

Objective

The incidence of extended-spectrum beta-lactamase-producing enterobacteria (ESBLE) has regularly increased over the last few years. However, little is known about epidemiology of ESBLE carriers in France. The objective of this study was to determine the ESBLE carriers or infected patients profile, identified within 48 hours following hospital admission.

Design

This retrospective study included all patients admitted in 2006 and 2007 at the Necker–Enfants-Malades (NEM) teaching hospital, carrying or infected with ESBLE isolated within 48 hours following admission. The pediatric and adult populations were compared.

Results

There was no significant difference between pediatric and adult populations. Escherichia coli and Klebsiella pneumoniae were the two main species isolated, accounting respectively for 59.6 and 21.1 % of the 114 isolated strains. Among the 114 analyzed files, 24 patients (21 %) were known to be EBLSE carriers, 37 (32 %) were transferred from another hospital, including 16 from another country. Concerning the 54 (47 %) other patients, five (4 %) came from a country with high prevalence, and 44 (39 %) were treated for a chronic illness. Only five patients (4 %) carrying ESBLE did not have any usual risk factor for multidrug resistance (MDR) bacterial carriage.

Conclusions

In our study, 4 % of patients carrying ESBLE admitted had no usual risk factor for MDR bacteria. Targeted screening of previous carriers, patients with chronic illness, transferred patients, or patients coming from country with high prevalence, would help to limit the spread of ESBLE.     

医院感染阴沟肠杆菌多重耐药基因分析 FREE

目的了解医院感染阴沟肠杆菌的耐药性及其耐药基因,为防控感染提供依据。方法对40株临床分离的阴沟肠杆菌,以纸片扩散法和琼脂稀释法进行药敏试验,聚合酶链反应(PCR)及序列分析法分析12种耐药相关基因。结果40株阴沟肠杆菌仅对亚胺培南和美罗培南高度敏感,敏感率均为100.00%;对头孢吡肟耐药率较低,为15.00%;对其他15种抗菌药物耐药率较高,为42.00%～92.50%。共检出8种耐药基因,分别为TEM 1、SHV 2a、CTX M 3、CTX M 9、AmpC、aac(3′) Ⅰ、IntⅠ1、sul1,大多数菌株携带sul1+IntⅠ1型基因;耐药谱共分为A～I 9型,以C和D型为主。抗菌药物耐药谱分型和基因分型有一定相关性。结论阴沟肠杆菌呈现多重和高度耐药性,耐药机制复杂且呈多种耐药机制共同作用。     

Érythème noueux unilatéral associé à une leishmaniose cutanée homolatérale

Objective

The authors wanted to report an uncommon etiology of erythema nodosum.

Case report

A 45-year-old woman presented with numerous encrusted nodular lesions on the left leg and arm. Leishmania was identified after a parasitological examination. Subcutaneous erythematous nodules developed later on the same leg. Erythema nodosum was diagnosed with a biopsy of the nodules. The patient was treated with systemic meglumine 60 mg/kg per day for 13 days. All lesions improved under treatment.

Discussion

This was the first reported case of unilateral erythema nodosum with cutaneous leishmaniasis. Clinical and laboratory exams were in the range of normal and led the authors to exclude common causes of erythema nodosum. Subcutaneous nodules occurred before the beginning of treatment with meglumine. Thus, drug allergy (previously reported) was excluded as an etiology of EN.