洁净手术部控制医院感染流程优化管理

目的 探讨洁净手术部控制医院感染流程优化管理的方法.方法 从医院洁净手术部的建筑布局入手,按照洁净手术部的设计标准,从洁净手术部的日常环境管理,控制人流、物流等综合措施.结果 优化了医院洁净手术部的感染控制体系,促进手术室工作次序最佳化达到流程次序最佳化,有效控制医院感染.结论 坚持按照洁净手术部的设计标准,使预防感染的措施具有可操作性、可控制性,达到医院洁净手术部控制医院感染流程的优化管理.     

洁净手术部的医院感染管理

目的 探讨提高洁净手术部医院感染管理工作水平的方法.方法 从洁净手术部的建设标准入手,运用空气和物体表面微生物的理论,论述了洁净手术部医院感染管理的艰巨性、复杂性、专业性和法规性.结果 严格规范洁净手术部的建设标准,是做好医院感染管理工作的坚实基础;坚持介入洁净手术部的工程质量验收,是做好医院感染管理工作不可缺少的重要环节;全面开展洁净手术部的日常监控,是做好医院感染管理工作的有效手段;努力创新洁净手术部现代管理模式是做好医院感染管理工作的精髓.结论 洁净手术部的医院感染管理,必须要强调全方位控制细菌的综合措施,要规范净化空调保障体系,实施全过程监控.     

口腔专科洁净手术部的感染控制及管理

作者通过临床实践,探讨了符合口腔专科手术部安全、有效、实用要求的感染管理方法。分析了洁净手术部的使用情况,对手术部感染监控工作提出了相应的管理措施,即口腔专科洁净手术部为专科手术提供安全的无菌环境,通过合理有效的管理,预防专科手术院内感染。而先进的洁净设备是创造无菌环境的条件,合理有效的感染管理是实现无菌环境的保证。     

洁净手术部的建设与管理(四)--洁净手术部平面布局设计

手术部布局是医院整体设计的重要组成部分。手术部平面布局设计包括手术部整体布局、手术室平面布局、手术室设备布局。布局设计是手术部关键设计,它直接影响手术部的使用效果,可变性差,一旦建成,就难以修改变动。由于各医院手术部规模不一样,各医院管理模式、工作习惯存在差异,造成手术部布局差异很大,难以从学术的角度总结成几类标准的模式。平面布局最基本原则是保证人流、物流、气流的合理性,使人、物分流,污、洁分流,提高手术室洁净度,减少感染的发生,并使医护人员操作管理舒适、高效、安全、节能。1手术部整体布局洁净手术部主要有洁…     

医院洁净手术部的运行管理与日常监测(续)

合理的设计,优质的施工是洁净手术部实现无菌环境的前提。科学的运行管理,规范的日常监测的运行状态则是实现全方位、全过程控制污染的保证。本文阐述洁净手术部动态管理的理念,旨在提高洁净手术部运行管理水平,实施更有效的控制“二次污染”,全方位地实现“无菌保障体系”之最终目的。(本文分二部分阐述:第一部分运行管理;第二部分日常监测)     

医院层流洁净手术部原理及功能特点

1层流洁净手术部原理 随着医院的现代化发展,对医疗质量和医疗环境都产生更高的要求,洁净手术部是近年来快速发展的医疗项目,它的出现有效地降低了术后的患者感染率,改善手术环境,提高了手术的整体质量。为医护人员创造出有利于工作的舒服环境,满足手术过程对空气的温度、湿度、风速、清新洁净度、噪声及空气中的菌落数等各项指标的严格要求。洁净手术部的核心部分是净化空调系统,该系统运行的质量直接影响着整个洁净手术部的使用效果。因此,提高净化空调系统的可操作性及可维护性,会在很大程度上提高整个净化手术部的性能。     

洁净手术部全环境监测与制度化管理

严格洁净手术室管理、规范制度、措施到位、全员参与，是达到预期实施效果的重要保证。北京武警总医院自启用洁净手术部后，采取本底调查，坚持日常全环境监测与制度化管理。完善了硬件、软件建设的实践研究，使洁净手术部整体管理水平飞跃发展，充分发挥了其洁净质量的效能。达到了制度约束医疗行为，措施提升质量的有利效果。     

北京大学所属医院洁净手术部质量管理监测结果分析

目的通过对医院洁净手术部综合性能和管理现状监测结果的分析,发现质量管理中存在的问题,促进医院加强管理．保障洁净手术部有效运行。方珐回顾性分析洁净手术部检查资料,了解质量管理中存在的问题及薄弱环节,提出有效的改进措施。结果洁净手术部的管理还存在着一定的缺陷,应进一步加强管理力度,定期监测。结论洁净手术部的管理涉及多专业,多学科,多部门,是对医院感染管理工作的挑战。需要制定与此相适硬的、科学合理的运行和管理的措施．以保障洁净手术部的安全运行。     

医院洁净手术部的运行管理与日常监测

合理的设计,优质的施工是洁净手术部实现无菌环境的前提。科学的运行管理,规范的日常监测的运行状态则是实现全方位、全过程控制污染的保证。本文阐述洁净手术部动态管理的理念,旨在提高洁净手术部运行管理水平,实施更有效的控制“二次污染”,全方位地实现“无菌保障体系”之最终目的。     

医院洁净手术部的感染控制与管理

目的 探讨洁净手术室的科学管理方法 ,为手术患者提供高度洁净、安全的手术环境,预防感染.方法 根据洁净手术室的特点,实行了人、物净化及严格的分区管理,采取无菌,净化运行、清洁管理措施,加强洁净手术部的流程管理的方法 .结果使洁净手术室控制工作做到"人尽其责,物尽其用",有效地控制了污染源,避免了交叉感染,保证手术和患者的医疗护理安全.结论 洁净手术室的启用和完善的管理措施,对于提高手术室洁净度确实、有效,降低了手术感染率,提高手术质量.     

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.     

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.     

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.     

Empathic processes: perception by medical students of patients'' anxiety and depression

Perceptions by medical students of patients' affective states were investigated, and the effect of the students' own emotions on such perceptions. One hundred and one fourth-year medical students rated the levels of anxiety and depression of three women patients presented on videotape, rated their own levels of anxiety and depression and completed a questionnaire on aspects of the rating process. Students had widely different and often inappropriate perceptions of patients' levels of anxiety and depression. Students who consistently overrated anxiety or depression in patients, compared to those who consistently underrated, were themselves significantly more anxious or depressed. These data suggest a need in medical education for systematic teaching of empathic skills and for recognition of potential bias in clinical decision-making arising from the clinician's own emotional state.     

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.