医务人员接触患者前手卫生执行情况及其相关影响因素分析

目的探讨分析我国医务人员在接触患者前手卫生执行情况及相关影响因素。方法采用现场观察的方法对北京、上海、广州10多所不同级别医院进行了手卫生行为的调查。结果医务人员在接触患者前的手卫生执行率为35%,远低于接触患者后的手卫生执行率56.5%;接触患者前手卫生执行率以护士为最高,占39.3%;从科室类别看,妇产科最好而外科最差;接触患者前进行手卫生清洁的医务人员,在接触患者后手卫生执行率也较高,且较多使用快速手消毒剂(ABHR),并且在医疗过程中正确使用手套的比率也较高,差异有统计学意义(P<0.01);另外,接触患者前手卫生执行率与病房内是否提供肥皂等洗手剂密切相关(P<0.01),而与病房外其他洗手设施无关。结论我国医务人员在接触患者前的手卫生意识相对薄弱,这与人偏重自我防护忽视他人的意识有关,除有针对性改善病房内洗手设施外,加强培训、改变观念对促进手卫生执行水平的提高十分重要。     

基层医院医务人员手卫生现状调查

目的 了解基层医务人员手卫生状况.方法 采用调查问卷并结合现场观察手卫生过程的方法,对312名医务人员进行问卷调查.结果 基层医院医务人员手卫生依从率为40.18%,接触患者前的手卫生执行率为31.01%,接触患者后的手卫生执行率为52.84%;护士手卫生执行率为47.78%,医生手卫生执行率为42.09%;妇产科执行率最高为63.89%,检验科最低为18.10%.鲍氏不动杆菌及金黄色葡萄球菌为检出最多的致病菌.医务人员手卫生知识掌握较好.六步洗手法较为繁琐、洗手指征掌握不全及工作忙没洗手时间是主要影响因素.结论 宁海县基层医务人员手卫生知识掌握较好,但洗手执行率不高,需采取有效措施提高医务人员手卫生执行率.     

2011年宜昌市37所医院执行手卫生现状调查

目的了解宜昌市城区各级医院医务人员手卫生执行情况,探讨提高手卫生执行率的途径。方法现场调查该市城区37所医院医务人员手卫生执行情况,发放问卷调查影响手卫生执行的因素。结果37所医院共调查医务人员238名,总体手卫生执行率为32.38%（125/386）,其中三级医院为46.81%,二级医院为53.19%,民营医院为23.53%,乡镇卫生院为7.69%,其他一级医院为17.95%,各医院间医务人员手卫生执行率差异有统计学意义（P＜0.05）。接触患者前、进行无菌操作前、体液暴露后、接触患者后、接触患者周围环境后和脱手套后6项手卫生指征执行率中,进行无菌操作前(89.58%,43/48)和脱手套后(80.49%,33/41)手卫生执行率最高。护士的手卫生执行率为54.82%（74/135）,显著高于其他组（P＜0.01）;妇产科医务人员手卫生执行率为83.78%（31/37）,显著高于其他科室（P＜0.01）。37所医院中,18.92%配备有非手触式水龙头,43.24%配备有干手设施。洗手后, 39.76%(33/83)的医务人员用一次性纸巾擦手或风干机吹干手,13.25%(11/83)自然晾干双手,46.99%(39/83)用工作服擦手。影响医务人员手卫生执行的前3位因素是：工作太忙（42.86%）、未引起足够重视（38.24%）、手卫生设施不足（36.56%）。结论宜昌市城区医院总体手卫生执行率低,手卫生执行状况亟待改进。     

乡镇卫生院医务人员手卫生现状调查

目的了解卫生部《医务人员手卫生规范》颁布后中心乡镇卫生院医务人员手卫生执行状况及影响因素。方法采用问卷法调查医务人员手卫生知识和手卫生设施;现场观察医务人员手卫生执行情况。结果医务人员手卫生执行率为21.5%;接触患者前与接触患者后医务人员执行手卫生相比较,两者差异有极显著统计学意义(P<0.01)。护士手卫生依从率为28.7%,医生手卫生依从率为12.8%,护士手卫生依从率比医生要好,两者比较差异有极显著统计学意义(P<0.01)。乡镇医院医务人员手卫生知识水平比较低,医院手卫生设施差。结论乡镇医院医务人员手卫生知识水平相对比较低;意识不强,手卫生执行率低,医院手卫生设施不完善。应重视手卫生规范的实施,通过加强培训,宣传教育,改善手卫生设施,以进一步提高手卫生执行率。     

医务人员手卫生执行率与干预方法的调查

目的了解临床一线医务人员手卫生执行率的现状,探讨一系列科学、合理、切实可行的手卫生干预方法,以提高医护人员手卫生的执行率。方法采用自行设计的调查问卷并结合现场观察手卫生过程的方法,调查不同等级医院ICU、急诊、儿科、内科、外科、口腔科医务人员手部卫生知晓情况,评估洗手指征的执行率。结果调查发现76.00%的医护人员接受过手部卫生知识的培训,在规定手卫生指征下,手卫生执行率为50.00%～70.00%,接触患者前的手卫生执行率59.82%,接触患者后的手卫生执行率77.97%;按科室分类,接触患者前儿科执行率最高为82.78%,急诊最低为11.11%,接触患者后传染科执行率最高达100.00%,内科最低为39.93%。结论医务人员手卫生的意识尚薄弱,手卫生相关知识缺乏,有必要总结一套合理有效的干预方案提高医务人员在医院执业过程中手卫生的执行率,降低医院感染率,减轻患者痛苦和经济损失。     

医务人员接触患者后手卫生执行情况的调查分析

目的了解医务人员接触患者后的手卫生执行情况及不同条件对医务人员手卫生执行率的影响。方法对北京、上海、广州3城市8所三级医院不同职务、不同科室的医务人员进行现场观察。结果医务人员接触患者后的手卫生执行率为56．5％，医生为61．0％、护士为53．8％。在提供手套时医务人员手卫生执行率为52．8％，不提供手套为82．0％，差异有统计学意义；在提供醇类快速手消毒剂、肥皂和洗手液时医务人员手卫生执行率（58．7％、61．3％）比不提供的手卫生执行率（51．2％、48．4％）高（P〈0．05、P〈0．01）。医务人员接触患者后使用肥皂（洗手液）和流动水洗手时间≥15s的占74．6％。结论我国大城市、大医院医务人员接触患者后的手卫生执行情况相对较好，洗手时间和流程较为规范，但仍存在手卫生意识薄弱、硬件设施不足等缺陷，尚需加强手卫生教育，采取干预措施，提高医院感染控制水平。     

探讨手卫生工作推进

目的加强医疗机构医务人员手卫生工作,探索医务人员手卫生改善措施。方法由医院感染管理专职人员在医务活动的五个时刻,即接触患者前,无菌操作前,接触患者体液后,接触患者后,接触患者环境后,观察记录医务人员手卫生依从性。结果某院各个科室的依从性普遍介于20%~40%;医务人员接触患者后的洗手率依从性最高(接触患者后vs.接触患者前vs.接触患者的物品物面后:53.81%vs.38.14%vs.15.88%);护士应用洗手液洗手时间达标情况远较医生高(护士vs.医生:84.09%vs.42.86%);一次性手套使用情况仅占约一半(操作前戴手套vs.操作后更换手套:55.57%vs.49.76%);医生接触患者前后洗手情况普遍不佳(接触患者前vs.接触患者后:19.23%vs.37.29%)。结论影响手卫生行为的因素是多方面、多层次的,加强手卫生知识培训和考核、加强监督力度、进一步完善手卫生设施,可使手卫生工作进一步提高。     

医院工勤人员执行手卫生与干预措施

目的了解工勤人员手卫生执行情况,建立切实可行的手卫生干预措施,提高其手卫生执行率。方法通过对全院各类工勤人员采取手卫生干预措施,调查比较干预前后工勤人员手卫生执行率及洗手方法正确率的变化。结果全院各类工勤人员接触患者及进出特殊病房前后、接触污染物品后洗手执行率从干预前分别为19.8%、26.7%、30.2%提高到干预后的48.8%、60.0%、61.6%;脱手套后洗手执行率从干预前30.2%提高至干预后的51.2%,洗手方法正确率从干预前的24.4%提高至干预后的60.0%。结论重视对医院工勤人员手卫生执行情况的监督并采取相应的干预措施,有助于提高手卫生执行率,降低医院感染率,减轻患者痛苦和经济损失。     

医务人员手卫生执行现状调查分析

目的 了解临床医务人员手卫生执行现状,探讨提高医务人员手卫生依从性的措施,从而减少医院感染的发生.方法 采用自行设计的调查问卷并结合现场观察手卫生过程的方法 ,对医院30个临床科室的120名医务人员进行手卫生知识和执行率的调查.结果 81.7%的医务人员接受过手卫生知识的培训;89.2%的医务人员认为洗手可减少医院感染,2.5%的医务人员认为手卫生对临床治疗结果 无影响;接触患者前手卫生执行率为30.8%,接触患者后手卫生执行率为49.2%,两者比较,差异有统计学意义(P<0.01).结论 医务人员手卫生意识薄弱,手卫生相关知识缺乏,执行率低;应加强宣传教育,提高医务人员手卫生知识,推广使用快速手消毒剂,提高医务人员手卫生依从性,降低医院感染.     

揭阳市二级以上综合医院医护人员手卫生执行情况及依从性调查

目的了解揭阳市二级以上综合医院医护人员的手部卫生认知水平、手卫生执行情况及影响因素。方法现场观察医护人员手卫生执行情况,问卷调查医护人员的手部卫生认知水平和影响手卫生执行因素及改进措施。结果医护人员接触病人黏膜、破损皮肤或伤口前和直接接触病人前洗手执行率为36.76%和29.51%;直接接触病人前、后(x2=15.32,P=0.001),接触病人黏膜、破损皮肤或伤口前、后(x2=8.95,P=0.002)以及医疗护理前、后(x2=9.63,P=0.001)的洗手执行率差异均有统计学意义;洗手方式以使用洗手液为主,占65.63%;干手方式以一次性纸巾擦干为主,占62.54%;医生使用白大褂擦手明显多于护士(x2=4.46,P=0.03);医护人员一次洗手超过30 s仅占14.98%;工作忙、经常洗手损伤皮肤是影响手部卫生依从性的主要因素。结论医护人员手部卫生知识掌握较好,但洗手执行率偏低。加强培训和完善洗手设施,提供快速手消毒剂等措施,使手卫生制度执行规范化。     

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.