山东省12所综合性医院ICU目标性监测分析

目的 了解ICU患者的医院感染发生率、危险因素、预防措施,防止医院感染发生.方法 采取目标性监测方法,对12所综合性医院ICU的住院患者发生医院感染的情况进行调查,用ASA法调整医院感染发病率,并对侵入性操作相关感染进行分析.结果 2087例ICU住院患者中,发生医院感染236例,医院感染发生率为11.31%,患者日感染率为2.38%,根据病情的平均严重程度经ASA法调整后的医院感染发生率为3.57%,患者日感染率为0.67%.结论 ICU患者是医院感染易感人群,目标性监测可以有效地降低ICU患者医院感染的发生.     

急诊重症监护病房医院感染危险因素与干预措施

目的 调查急诊重症监护病房(EICU)医院感染的现状和危险因素,以制定干预对策.方法 采用前瞻性监测和回顾性调查相结合的方法.对72例医院感染病例进行统计分析.结果 EICU患者医院感染率为29.50%,显著高于同期医院平均感染率5.25%;发生医院感染的病例中≥60岁老年患者感染率高达61.11%;平均住院日为28 d;医院感染部位的分布以下呼吸道感染为主,医院感染的病原菌以革兰阴性杆菌为主.结论 EICU是医院感染的高发科室,其收治的患者基础疾病严重、侵入性诊疗操作多、大量使用抗菌药物、老年患者免疫功能低下等均是造成医院内感染的危险因素,应采取综合性干预对策,以切实降低感染率,提高抢救成功率.     

重症监护室患者医院感染病原菌及其影响因素

目的分析医院重症监护室(ICU)患者医院感染病原菌及其影响因素,并总结其防治对策。方法采用回顾性调查法调查2014-2018年安徽医科大学第一附属医院ICU患者的病历资料,统计医院感染及其病原菌情况,收集所有医院感染患者临床资料,归纳ICU患者医院感染的影响因素,总结防治措施。结果共调查2 980例ICU患者,发生医院感染147例,感染率为4.93%;2014-2016年医院感染率分别为5.69%、4.97%、4.84%,呈降低趋势,2017年(5.60%)有上升,2018年有所降低(4.01%);感染部位以下呼吸道(61.22%)、泌尿系统(12.24%)、血管(8.84%)为主;医院感染病原菌以革兰阴性菌(69.87%)为主,位列前三致病菌分别为铜绿假单胞菌、鲍氏不动杆菌、肺炎克雷伯菌;其次为革兰阳性菌(18.91%),以金黄色葡萄球菌检出率(11.54%)最高;真菌(11.22%)中以白假丝酵母检出率(4.49%)最高;年龄、基础疾病、住院时间、泌尿系统插管、使用呼吸机、气管插管、气管切开是ICU患者医院感染的影响因素(P<0.05)。结论 2014-2018年ICU医院感染率整体呈降低趋势,医院感染病原菌以革兰阴性菌感染为主,高龄、合并多种基础疾病、住院时间延长及介入诊疗均为ICU患者发生医院感染的影响因素。为降低ICU医院感染率,应尽可能减少非必要介入性诊疗操作,避免滥用抗菌药物,严格参照药敏试验结果选择敏感性抗菌药物,对高危人群重点监测,对介入性诊疗病例强化感染监测。     

目标性监测在ICU医院感染控制中的应用

目的 通过目标性监测,了解ICU医院感染率,探讨医院感染的预防控制措施.方法 采用目标性监测方法对2011年1-8月ICU住院患者发生医院感染进行监测.结果 目标性监测1064例患者发生医院感染141例,感染率为13.25％,日感染率为23.51‰,调正日感染率为5.54‰;ICU医院感染仍以下呼吸道感染最多见,占80.85％;其中检出最多的病原菌为金黄色葡萄球菌,占16.36％.结论 ICU目标性监测可提高医护人员医院感染监控意识,同时可以发现医院感染的高危因素并进行干预,从而降低ICU的医院感染率.     

重症监护病房患者医院感染目标性监测分析

目的 了解重症监护病房(ICU)患者的医院感染发生率、危险因素、预防措施,防止医院感染发生.方法 采取目标性监测方法,对医院2005年11月-2009年6月ICU住院患者发牛医院感染的情况进行调查,用ASA法调整医院感染发病率,并对侵入性操作相关感染进行分析.结果 833例ICU住院>48 h的患者中,发生医院感染92例,医院感染发生率为11.04%,患者日感染率为5.73%,根据病情的平均严重程度经ASA法调整后的医院感染患者日感染率为4.43%.检出病原菌145株,主要为革兰阴性杆菌(56.55%),鲍氏不动杆菌占VAP致病菌的百分率逐年上升.结论 ICU患者是医院感染易感人群,医院感染菌以鲍氏不动杆菌为主且有多药耐药性,目标性监测町以有效地降低ICU患者医院感染的发生.     

重症监护病房患者院内感染的调查与分析

目的 了解重症监护病房(ICU)患者的医院感染特点,探讨其病原菌和耐药性,为控制院感提供依据.方法 对本院自ICU成立以来25个月所发生的医院感染的患者的临床资料采取前瞻性调查和回顾性调查相结合进行整理分析.结果 ICU患者医院感染率为21.76%;医院感染发生的部位以呼吸道最多(55.14%);医院感染的病原菌以革兰氏阴性菌为主(52.8%);医院感染的发生与侵入性操作相关;病原菌对抗菌药物耐药率均较高.结论 ICU是医院感染的多发科室,应重点监测;严格执行无菌技术,合理使用抗生素;针对高危因素和薄弱环节,采取积极有效的综合管理措施,以降低ICU患者医院感染的发生.     

重症监护病房医院感染目标性监测及危险因素分析

目的对医院重症监护病房(ICU)发生医院感染的情况开展目标性监测,探讨降低医院感染率的措施。方法对2009年6月1日-2010年5月30日,入住ICU患者进行前瞻性监测,重点监测呼吸机相关性肺炎、血管导管相关性血流感染、导尿管相关泌尿道感染,医院感染病例均按要求填写医院感染病例登记表,对监测数据进行统计学处理。结果 ICU医院感染发生率14.3%,感染例次率为18.8%,日感染率为19.8‰;最常见部位为下呼吸道感染,其次为泌尿道、血液感染,ICU医院感染最常见病原菌为铜绿假单胞菌和不动杆菌属,其次为金黄色葡萄球菌。结论 ICU是医院感染的高发病区,只有加强监测和控制,积极进行干预,才是降低ICU医院感染发生的有效办法。     

ICU患者导管相关性感染与留置时间的关系分析

目的了解综合性ICU患者导管相关性医院感染情况,分析相关影响因素,为制定干预措施提供科学依据。方法采用目标性监测的方法,对某三级甲等医院综合性ICU,2004年1月-2010年12月,住院患者的导管相关性医院感染进行调查。结果 2060例住院患者中,发生医院感染662例,感染发生率为32.14%,患者日感染发生率为22.20‰,经病情平均严重程度调整法(ASIS)调整后,患者医院感染发病率为7.30%,日感染率为5.05‰;与使用呼吸机、动静脉插管、留置尿管相关的日医院感染率分别为42.36‰、5.98‰、3.93‰;侵入性操作是医院感染的危险因素(P<0.01),且均与管道的留置时间有关。结论各类导管的应用是综合性ICU患者发生医院感染的危险因素,应加强对ICU患者侵入性操作的管理,尽可能减少导管的使用并缩短留置时间,以降低医院感染率。     

基层医院重症监护病房的医院感染特点及其对策

目的分析基层医院重症监护病房(ICU)的医院感染特点,提出相应的防范措施,以有效降低医院感染发生率. 方法以主动监测与系统回顾相结合的方法,对2003年全年入住ICU 383例患者的相关临床资料进行分析评判,并与全院住院患者进行对比. 结果 ICU的医院感染率是28.8%,显著高出同期的医院平均感染率23.6个百分点;因医院感染而导致死亡的占ICU总死亡的36%;ICU医院感染的病原菌以G-菌为主,占50%,而双重感染达78.7%;下呼吸道感染为医院感染的主要部位占61.7%,但多部位多器官感染占29.6%. 结论 ICU医院感染的特点是高发病率、高死亡率、高耐药性;其相关因素有病情重、年龄大、基础疾病多、侵入性诊疗操作多与交叉感染等.     

综合ICU医院感染相关危险因素的对照研究

目的 调查综合ICU医院感染的发生情况,探讨其危险因素,为更好地预防控制综合ICU医院感染提供依据.方法 对2011年1月-2012年2月入住综合ICU＞48 h的患者进行目标性监测,填写统一调查表并录入计算机进行统计.结果 505例患者中发生医院感染74例、93例次,感染率为14.65％、例次感染率为18.42％,平均病情严重程度3.74,调整患者日感染率3.49％;发生呼吸机相关性肺炎20例次,导管相关性血流感染26例次,导尿管相关性尿路感染22例次,其他部位感染25例次;使用免疫抑制剂、使用激素、放化疗患者、昏迷、长期卧床患者与医院感染的发生有显著关系(P＜0.05).结论 目标性监测能及时准确获得ICU医院感染相关危险因素,制定有效干预措施,降低医院感染发生率.     

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.     

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.     

Stress in the Norwegian police service

BACKGROUND: High levels of stress have been attributed to the conditions of police work, but there is little empirical evidence for this. AIMS: To develop a new instrument to measure job stress in the police; to assess the most severe and frequent police stressors; to compare levels of stress according to the demographic and organizational factors; and to study stress in relation to personality traits, work locus of control and coping strategies. METHODS: A comprehensive nationwide questionnaire survey of 3272 Norwegian police at all hierarchical levels, including the Norwegian Police Stress Survey (NPSS), the Job Stress Survey, the Basic Character Inventory, the Work Locus of Control Scale, and the Coping Strategies Scale. RESULTS: Work injuries were appraised as the most stressful but least frequent stressor and job pressure was reported the least severe but most frequent stressor. Females experienced job stressors less frequently, but appraised them as more severe than men did. Older police officers reported more job pressure severity and fewer work injuries. The police in districts where peer support was planned but not implemented, and who worked in districts with more than 50,000 inhabitants, perceived the lack of support more severely than others. The correlations between stress and personality traits, work locus of control, and coping were moderate. CONCLUSIONS: The NPSS captures police-specific stressors that are not adequately measured by global stress instruments. The study of stress in police work should preferably involve a nationwide use of police-specific stress instruments.