医疗器械清洗质量监测方法与影响因素研究

目的比较两种器械清洗质量监测方法,探索影响清洗质量的因素。方法选择16所医院共228件清洗消毒灭菌后待用的医疗器械(结构对称),每件器械左侧采用隐血试纸法、右侧采用蛋白质残留法进行清洗质量监测。结果 228件器械中残留血阳性7件,蛋白质残留阳性58件,阳性率分别为3.1%和25.4%(χ2=46.668,P=0.000);手工清洗和机器清洗残留血阳性率分别为3.7%和2.2%(χ2=0.446,P=0.504),蛋白质残留阳性率分别为30.4%和18.3%(χ2=4.244,P=0.039);采用消毒剂浸泡的70件器械,残留血无阳性,蛋白质残留阳性率为24.3%(Fisher精确测验,P=0.000);消毒剂使用与否,对清除蛋白质残留差异无统计学意义;采用国产酶与进口酶清洗,其蛋白质残留阳性率分别为25.0%和28.1%(2χ=0.210,P=0.647)。结论残留血试纸法和蛋白质残留法可用于医疗器械清洗质量监测,但前者敏感度和检出率低于后者;机器清洗效果明显优于手工清洗。     

轴节类医疗器械清洗方法的探讨

目的 探讨和改进轴节器械清洗方法,提高医疗器械灭菌质量,有效控制医院感染.方法 按照随机原则,将回收的1298件污染轴节器械随机分为试验组(使用自制的关节撑开架)和对照组(常规清洗法),对两种清洗效果进行试验观察.结果 试验组清洗合格率为98.9％;对照组清洗合格率为77.8％,两组间差异有统计学意义(x2=141.14,P＜0.01).结论 使用关节撑开架清洗轴节器械,提高了医疗器械的清洗质量,值得推广使用.     

杭州市医疗器械清洗质量情况分析

目的了解杭州市医疗机构医疗器械清洗质量,为提高医院医疗器械清洗质量提供依据。方法采用残留血试纸法,对杭州市辖区内各级医疗机构重复使用的医疗器械进行抽检,以器械上血红蛋白存在与否作为指标,考核器械的清洗质量。结果2004-2007年间,每年监测30余单位,每单位采样医疗器械10件左右。结果显示,医疗器械的合格率在86.43%-95.03%之间,平均合格率为90.50%,其中省市级医院的平均合格率为94.85%,县（市）区医院的平均合格率为76.32%（χ^2=93.005,P=0.000）。结论医疗单位应进一步增强医疗器械清洗意识,严格把好器械清洗关,以防止医院相关性感染的发生。     

医疗器械不同清洗方法效果比较

目的 探讨医疗器械有效的清洗方法,提高清洗质量,保证灭菌效果,有效控制医院感染的发生.方法 选择手术后中度污染的器械600件,随机分为试验组和对照组,每组300件;传统清洗法(对照组)采用流动水人工清洗;多酶清洗法(试验组)采用多酶清洗剂浸泡后人工清洗;比较两组器械清洗后的洁净度和隐血试验阳性率.结果 试验组清洗后器械的洁净度和隐血试验阳性率分别为99.33%和0;对照组清洗后器械的洁净度和隐血试验阳性率分别为80.67%和32.67%,试验组明显优于对照组(P＜0.01).结论 加多酶清洗医疗器械,清洗效果好,质量保证,是理想的清洗方法,值得推广使用.     

2种不同清洗方法对复杂器械的清洗效果比较

目的探讨复杂医疗器械的有效清洗方法,提高清洗质量,保证灭菌效果,控制医院感染。方法选择供应室回收的中度污染器械500件,分为观察组和对照组,每组齿类器械150件,管腔器械100件。观察组采用手工配合多酶超声机清洗,对照组采用流动水手工清洗,比较2组清洗后的洁净度合格率和隐血试验阳性率。结果观察组清洗后齿类器械和管腔类器械的洁净度合格率分别为98.67%和98.00%,隐血试验阳性率分别为0.67%和1.00%;对照组清洗后齿类器械和管腔类器械的洁净度合格率分别为78.67%和70.00%,隐血试验阳性率分别为28.67%和34.00%;上述指标,观察组与对照组比较,差异均有统计学意义（均P＜0.01）,即观察组均明显优于对照组。结论复杂的医疗器械,采用手工与多酶超声机清洗效果理想,提高了清洗质量。     

全自动清洗消毒器多舱式与单舱式的应用比较

目的 比较全自动清洗消毒器多舱式与单舱式清洗不同类医疗器械的质量.方法 将各临床科室使用后的医疗器械及手术器械同收后放置于全自动清洗消毒器多舱式与单舱式中,按各自程序处置.结果 全自动多舱式清洗消毒器具有高效、省时、省力,操作简单,清洗齿类器械剩余残留物为3.55‰,非齿类器械为1.10‰,两种器械清洗效果差异有统计学意义(x2=0.451,P＜0.01);单舱式清洗消毒器清洗齿类器械剩余残留物为11.81‰,非齿类器械剩余残留物为5.24‰,两种器械清洗效果差异有统计学意义(x2=1.58,P＜0.01),清洗齿类器械效果差;而两种清洗机清洗齿类器械效果观察差异有统计学意义(x2=2.532,P＜0.01).结论 运用DC-4型全自动多舱式清洗消毒器处理医疗器械,无论非齿类或齿类,均有效提高了清洗质量,确保灭菌效果及控制医院感染的发生.     

上海市9所医院骨科外来器械清洗效果监测

目的了解上海市骨科外来器械灭菌前清洗效果。方法 2011年12月随机选取上海市骨科手术较多的9所医院外来骨科器械和医院自行清洗器械,采用残留血、残留蛋白、ATP和细菌培养计数等4种方法进行监测。结果共监测1 405件手术器械,其中1 115件外来器械,290件医院自行清洗器械;残留血阳性率外来器械35.7%、医院自行清洗器械4.3%(OR=12.39);残留蛋白阳性率外来器械59.1%、医院自行清洗器械32.5%(OR=3.00);ATP对数值外来器械(3.19±0.89)、医院自行清洗器械(1.71±0.47)(P<0.001);细菌菌落数均值外来器械为165.69CFU/cm2、医院自行清洗器械为12.36CFU/cm2,秩和检验P<0.001。结论外来器械灭菌前清洗不到位,残留血、残留蛋白、ATP和细菌菌落数合格率均低于医院自行清洗器械。     

风险管理在消毒供应中心外来医疗器械管理中的应用效果

目的探讨风险管理在消毒供应中心外来医疗器械管理中的应用效果。方法将2018年3—12月医院消毒供应中心的2 148件外来医疗器械设为对照组,对其实施常规管理;将2019年1—10月医院消毒供应中心的2 346件外来医疗器械设为观察组,对其实施风险管理;比较两组器械管理质量及使用满意度。结果观察组器械清洗、消毒、包装、灭菌合格率(98.93%、98.81%、99.32%、99.66%)均高于对照组(97.86%、98.00%、98.74%、99.12%),差异有统计学意义(P<0.05);观察组器械使用满意度(93.33%)高于对照组(80.00%),差异有统计学意义(P<0.05)。结论风险管理在消毒供应中心外来医疗器械管理中的应用效果显著,可提升器械管理质量,改善器械使用满意度。     

两种内镜手术器械清洗效果的比较

目的 探讨可拆洗与不可拆洗的两种内镜手术器械清洗的效果,提高手术器械的清洗质量.方法 选择手术室中度污染的内镜器械300件,按可拆洗、不可拆洗分为两组,每组150件,均按卫生部内镜清洗规范要求清洗.结果 清洗后可拆洗组内镜器械的洁净度和隐血试验阳性率分别为94.7%和5.3%;清洗后不可拆洗内镜器械的洁净度和隐血试验阳性率分别为49.3%和69.3%;可拆洗组明显优于不可拆洗组(P＜0.05).结论 可拆洗内镜器械清洗质量有保证,是医院内镜手术的首选器械.     

两种多酶清洗剂对外来再生医疗器械清洗效果分析

目的比较两种多酶清洗剂清洗外来再生医疗器械的质量。方法取外来再生医疗器械800件,随机分为试验A组和对照B组,每组400件;A组使用鲁沃夫传统型酶洗剂+超声机洗,B组使用万福金安多酶清洗剂+超声机洗;比较2组器械清洗后的目测洁净合格率和2%联苯胺冰醋酸隐血显色合格率。结果试验组清洗后器械目测洁净合格率和隐血显色合格率分别为98%和97%,对照组清洗后器械目测洁净合格率和隐血显色合格率分别为95%和91%,以2χ检验进行统计学处理,试验组优于对照组差异有统计学意义(P<0.01)。结论鲁沃夫传统型酶洗剂清洗外来再生医疗器械提高了清洗质量,确保了灭菌效果,是外来再生医疗器械清洗的理想清洗剂。     

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.     

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.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

Planning research

The starting point for any research project should be a question.Once this has been defined and the relevant scientific literaturereviewed, a protocol should be drawn up. This will be used notonly as a guide to the conduct of the study and in the preparationof the final report, but also in seeking any financial supportand approvals that are required for the investigation. A protocolis normally arranged in sections covering the background tothe study, the question(s) that it will address, the methodsthat will be used for the collection and analysis of data, thestatistical power of the investigation (where relevant), anyethical considerations, and the financial input that will beneeded. A pilot study is often helpful where aspects of thestudy method are untried or of uncertainvalidity.