戊二醛熏蒸消毒柜消毒效果的实验研究

目的观察肯格王牌戊二醛熏蒸消毒柜与传统甲醛熏箱的消毒效果，选择消毒迅速、效果可靠、无毒无刺激的消毒方法，用于不耐高温高压的手术物品消毒。方法用戊二醛熏蒸消毒柜和甲醛熏箱消毒不同时间采集标本进行细菌培养，分析戊二醛熏蒸消毒柜与甲醛熏箱消毒效果的差异及戊二醛熏蒸消毒柜上室以及不同柜层的消毒效果。结果消毒前样本细菌培养阳性率为100％；戊二醛熏蒸消毒柜消毒2h杀菌效果明显优于甲醛熏箱（P〈0．01）；消毒4h两者杀菌效果相同；戊二醛熏蒸消毒柜上室对小件物品消毒1h灭菌效果可靠；戊二醛熏蒸消毒柜各层的灭菌效果无区别，甲醛熏箱消毒2h不同箱层的杀灭效果不同，上下两层相比差异有统计学意义（P〈0．01）。结论肯格王牌戊二醛熏蒸消毒柜是一种高效、快速、安全的消毒设备，可替代甲醛熏箱。     

医院内窥镜消毒现况调查

目的：了解上海市医院对内窥镜消毒的现况，进一步规范消毒操作方法。方法：对上海市41家医疗机构进行各类内窥镜检查人次构成比、污染情况、消毒方法与效果以及消毒剂副反应等进行调查，结果：平均约每70名就诊病人有1人接受各种内窥镜检查，其中胃镜、肠镜检查人次占60．23％与21．15％，喉镜与支气管镜占8．22％、2．34％，膀脱镜占6．51％，腹腔与关节镜占1．55％。各类内窥镜的污染程度也以胃镜与脑镜最严重，细菌菌落总数分别为2824cfu／100cm2与408cfu／100cm2，其次为喉镜148cfu／100cm2，经常规消毒后，胃镜的合格率71％～77％。内窥镜消毒主要存在以下问题：（1）消毒剂选用不当：采用低水平消毒剂占10．75％；（2）消毒时间未达规定时间：膀胱镜全部未达到灭菌时间，其他消毒类内窥镜与灭菌类内窥镜作用时间符合率也仅24．39％与35．29％；（3）部分医院用自来水配制灭菌剂及作灭菌后冲洗。19．44％（7／36）的医院反映戊二醛对工作人员有头痛、皮肤粘膜刺激等副反应，2778％（10／36）的医院反应戊二醛对内窥镜镜面与通道有损害作用。结论：内窥镜的消毒灭菌剂还有待改进，内窥镜的消毒操作应进一步规范。     

腔镜器械两种灭菌方法的效果比较

目的：探讨腔镜器械两种灭菌方法的应用效果。方法选取本院2011年10月～2013年10月使用的腔镜器械384件,随机分为试验组和对照组,192件腔镜器械使用2%碱性戊二醛浸泡消毒灭菌（对照组）,192件腔镜器械使用过氧化氢等离子低温灭菌（试验组）,比较两组的细菌培养合格情况、消毒灭菌有效性、器械损伤情况、操作人员不良反应情况。结果试验组腔镜器械的细菌培养合格率明显高于对照组,消毒时间明显小于对照组,灭菌后有效时间明显长于对照组,器械损伤率、操作人员的不良反应发生率均明显低于对照组,差异均有统计学意义（P＜0.05）。结论2%碱性戊二醛浸泡消毒灭菌、过氧化氢等离子低温灭菌均是腔镜器械的有效灭菌方法。过氧化氢等离子低温灭菌的效果更好,值得临床推广。     

2005年山东省部分医院牙科手机、车针消毒灭菌方式及效果调查

[目的]了解山东省医疗机构口腔器械消毒灭菌方式及灭菌效果。[方法]依据卫生部2002年版《消毒技术规范》对医疗机构消毒后手机及车针进行无菌检验。[结果]大部分医疗机构的手机及车针的灭菌方式为压力蒸汽灭菌（分别为91．7％和66．7％），灭菌效果可靠；以戊二醛和乙醇浸泡消毒的手机及车针的消毒效果全部达不到无菌要求。[结论]压力蒸汽灭菌是手机灭菌的首选方法，灭菌剂浸泡无法使手机内腔达到无菌要求；压力蒸汽灭菌及灭菌剂浸泡可使用于车针的灭菌，乙醇等低效消毒剂无法使车针达到无菌要求。     

影响戊二醛灭菌效果的因素

戊二醛是一种新型、广谱、高效、低毒消毒灭菌剂，它可以杀灭包括细菌芽胞、真菌孢子、分枝杆菌、病毒（包括甲肝、乙肝、艾滋病毒），被誉为是继甲醛和环氧乙烷之后，化学灭菌剂发展史上的第三个里程碑，现在被临床广泛应用于医疗器械的冷灭菌和内窥镜的消毒。为了保证消毒效果的可靠性应注意有效的浓度和浸泡时间，一般临床上应用２％戊二醛溶液在室温２５℃下浸泡３０分～６０分钟即达到消毒，４～１０小时达到灭菌。关于使用期限，２％戊二醛消毒液使用说明书上介绍，２％戊二醛加入缓冲剂后，可以连续使用４个星期。临床上也是４个星期…     

医疗机构戊二醛消毒剂使用安全性研究

[目的]通过现况调查了解戊二醛消毒剂使用以及职业暴露与个人防护情况，并为制定相应卫生标准与技术规范提供依据。[方法]采用问卷方法调查医疗机构口腔科、内镜室、手术室和外科换药室戊二醛的使用、暴露与防护。[结果]被调查的15所医疗机构中除2所使用戊二醛消毒口腔手机（应采用压力蒸汽灭菌）外，在戊二醛消毒与灭菌对象、作用浓度与时间基本符合要求，但戊二醛使用液的监测频率有待进一步提高；不同科室戊二醛消毒与诊疗分室率57．14％。83．33％，通风良好率71.42％-90．91％，但91.67％-100．00％的科室不经处理直接将使用后的戊二醛消毒液倒入下水道；在配制与使用戊二醛消毒剂时的防护，以戴手套与口罩最常见，其次为穿防护服，戴防护镜较少，均未设洗眼设施，现用防护用品材料不能有效防护戊二醛蒸气渗透；在129名接触戊二醛的医务人员中，出现皮炎、眼或鼻和呼吸道刺激症状的百分率分别为20．93％、48、84％和35、66％。[结论]建议尽快建立空气中戊二醛浓度的检测方法并制定戊二醛消毒剂职业暴露标准与安全使用规范，以减少医务人员职业暴露的危险。     

康健牌戊二醛灭菌效果的试验观察

戊二醛被誉为继甲醛和环氧乙烷之后化学消毒灭菌剂发展史上的第三个里程碑。是一种广谱，高效、低毒、腐蚀性小、性质稳定的消毒剂，广泛应用于各种医疗器械的消毒与灭菌，尤其是对麻醉设备、导液管、内窥镜、止血器等的消毒灭菌提供了安全可靠、简便易行的方法。戊二醛消毒液是临床内镜及其他医疗器械常用消毒剂和灭菌剂。康健牌戊二醛浓度为21600mg／L，无色。     

戊二醛浓度不合格原因分析

目的分析使用中戊二醛浓度不合格原因,提出相应对策,以保证医疗器械消毒灭菌质量。方法按照《消毒技术规范》（2002年版）要求,采用戊二醛浓度测试卡对全院用于小手术器械、内镜、口腔科器械消毒灭菌的使用中戊二醛浓度进行检测。结果共抽查1 219份戊二醛溶液进行浓度测定,结果合格1 099份（90.16%）,不合格120份（9.84%）。不合格原因为：未按时更换、浸泡器械过多、测试卡浸入消毒剂测试的时间过短、误将乙醇用作戊二醛、戊二醛浓度测试卡过期。经干预整改, 2011-2012年（干预后）戊二醛浓度监测不合格样本数显著减少,不合格样本率（5.41%,17/314）显著低于2007-2010年（干预前,11.38%,103/905）,差异有统计学意义（χ2=9.35,P＜0.05）。结论医疗机构应加强对使用中戊二醛浓度的监测。     

2011—2013年西安市各级医疗机构消毒灭菌质量监测

目的了解西安市属各级医疗机构消毒灭菌质量现状,加强医院消毒工作的监督管理,以改进医疗机构消毒灭菌水平与感染控制措施。 方法依据2002年版《消毒技术规范》和GB 15982－1995《医院消毒卫生标准》相关规定,对全市69所医疗机构的消毒灭菌效果进行监测与评价。结果2011-2013年共检测样品2 224份,消毒灭菌质量合格1 766份,总合格率为79.41％。消毒灭菌质量监测中,三级医疗机构合格率（83.67％）高于二级及以下医疗机构（77.50％）,差异有统计学意义（P=0.001）;公立医疗机构（79.64％）合格率与民营医疗机构合格率（78.20％）差异无统计学意义（P=0.532）;综合医疗机构合格率（80.18％）高于专科医疗机构（74.92％）,差异有统计学意义（P=0.030)。不同监测对象（样品）中,使用中消毒剂和压力蒸汽灭菌效果（测试包和PCD）合格率（分别为98.46%、100.00%、98.06%）较高,医护人员手卫生和戊二醛合格率（分别为58.48%和43.28%）较低。结论西安市各级医疗机构消毒灭菌质量水平参差不齐,不同监测对象消毒灭菌质量差异较大,应重点加强医务人员手卫生和戊二醛浓度的监管工作。     

压力蒸汽灭菌器的物品灭菌质量控制

提出了健全灭菌操作规章制度，选择有责任心、经过特种设备培训且取得上岗证的消毒人员．规范灭菌前物品的清洗、包装、装载等操作，监测灭菌效果（物理监测、化学监测、生物监测、B-D测试），遵守灭菌器的操作、注意事项及加强维护保养、计量检测等方面的要求。系统地介绍了压力蒸汽灭菌器的物品灭菌质量控制和质量保证的内容与方法．对提高院内消毒灭菌物品的灭菌质量、控制院内感染具有一定的指导意义。     

Cultural change versus behavioral change

Health care culture is a powerful force in hospitals that must be taken into consideration in attempting to effect changes in employees' behaviors. A survey can be taken to assess the cultural climate of a health care institution.     

Improving subjective decision making in health care administration

Managing a health care institution typically requires the consideration of many nonquantifiable factors, such as community relations, quality of service, and employee morale. As a result, subjective judgments are an inevitable, and often major, part of decision making in health care financial management. A large body of scientific research has shown that people's subjective, or intuitive, judgments tend to be biased and inaccurate. This article reviews the major types of errors typically found in four phases of decision making: defining the problem, estimating the effects of different alternatives, choosing an alternative, and evaluating the outcomes as the basis for subsequent action. In addition to alerting health care administrators to these potential judgment errors, several methods to improve subjective decision making are explained.     

Endoscopic decontamination: an audit and practical review

A comprehensive audit of endoscopic decontamination practices throughout a 1200-bedded teaching hospital trust was undertaken, prior to a review of the current policy and consideration of alternative disinfectants. Pharmacy records of glutaraldehyde usage, occupational health staff survey data of glutaraldehyde exposure, discussions with all departments where endoscopy might be conducted and information from all companies supplying endoscopes and allied equipment were reviewed. In total, 56 endoscopes were found to be in use in 16 areas of the Trust. In the main designated endoscopy units, compliance with the established policy was generally good, but in other areas, equipment which could tolerate autoclaving was being disinfected with chemical sterilants; some units were still using endoscopes which were not fully immersible and there was widespread use of disinfectant troughs, rather than automated washer-disinfectors. In most cases, this was because staff were concerned about endoscopy equipment passing to a central processing department with potential delays and losses. An updated Trust-wide endoscopy policy, using glutaraldehyde and incorporating the current British Thoracic Society, British Gastroenterological Society and British Urological Society guidelines, has now been implemented. The issues around this and alternative disinfectants are discussed.     

A look at the hospital administrator

The key individual in health care management in the new multidimensional health care system will be the hospital administrator, the person responsible for the overall management and direction of a single health care institution in a community. This person will have to deal with a vertically integrated institution and changing delivery and financing mechanisms.     

El consumo sanitario inapropiado y la trivialización de la medicina

One of the main problems of our health care system is its excessive use. The most evident results of this misuse are the waste of resources and the iatrogenic consequences that are not justified by any expectations in health improvement. Among the possible causes of this inappropriate use, the trivialization of medical practice should be emphasized. This entails not only a loss of respect and consideration, but facilitates and even stimulates reckless use. Although patients and health care workers are both responsible for this recklessness, politicians and health care managers should be held responsible more so. Without a real emancipation allowing health care users and the population to control the factors that determine their health, it is unlikely that the inappropriate use of health resources and its associated iatrogenic consequences will be reduced.     

From the production to the use of research results in care practice: a consolidating experience

Although it is desirable that professionals use research results, often they are not prepared for that. This article aims to present the process of development and establishment of innovations, based on Rogers' model, through strategies to train nurses to use the best evidences for a quality clinical practice. It is a partnership between a educational institution and a hospital care institution. Following identification of problems from nurses' own practice in a health institution research proposals were developed to search for evidences and to test interventions. Results of this experience evidenced the viability of use of a model presented as a methodological framework what contributed to reach the institutions' goal.     

Making better use of health care information

Effective use of health care information holds the promise of improved care and reduced health costs. A number of challenges must, however, be met. Incentives for using information must be introduced. A code of practice for using patient data to allay confidentiality concerns is needed. An institution is needed to accelerate the development of health information standards. Awareness must be raised about the opportunities provided by more effective use of information. Champions are needed to create the required information-intensive infrastructures.     

Transformational leadership, transnational culture and political competence in globalizing health care services: a case study of Jordan's King Hussein Cancer Center

Background

Following the demise of Jordan's King Hussein bin Talal to cancer in 1999, the country's Al-Amal Center was transformed from a poorly perceived and ineffectual cancer care institution into a Western-style comprehensive cancer center. Renamed King Hussein Cancer Center (KHCC), it achieved improved levels of quality, expanded cancer care services and achieved Joint Commission International accreditation under new leadership over a three-year period (2002–2005).

Methods

An exploratory case research method was used to explain the rapid change to international standards. Sources including personal interviews, document review and on-site observations were combined to conduct a robust examination of KHCC's rapid changes.

Results

The changes which occurred at the KHCC during its formation and leading up to its Joint Commission International (JCI) accreditation can be understood within the conceptual frame of the transformational leadership model. Interviewees and other sources for the case study suggest the use of inspirational motivation, idealized influence, individualized consideration and intellectual stimulation, four factors in the transformational leadership model, had significant impact upon the attitudes and motivation of staff within KHCC. Changes in the institution were achieved through increased motivation and positive attitudes toward the use of JCI continuous improvement processes as well as increased professional training. The case study suggests the role of culture and political sensitivity needs re-definition and expansion within the transformational leadership model to adequately explain leadership in the context of globalizing health care services, specifically when governments are involved in the change initiative.

Conclusion

The KHCC case underscores the utility of the transformational leadership model in an international health care context. To understand leadership in globalizing health care services, KHCC suggests culture is broader than organizational or societal culture to include an informal global network of medical professionals and Western technologies which facilitate global interaction. Additionally, political competencies among leaders may be particularly relevant in globalizing health care services where the goal is achieving international standards of care. Western communication technologies facilitate cross-border interaction, but social and political capital possessed by the leaders may be necessary for transactions across national borders to occur thus gaining access to specialized information and global thought leaders in a medical sub-specialty such as oncology.     

我国妇幼保健机构人员现状及需求分析

目的了解我国妇幼保健机构人员现状,并进行人力需求分析,为制定妇幼保健机构人员配置情况提供参考。方法通过查阅相关文献及专家咨询,了解妇幼保健机构提供妇幼保健服务的市场份额、妇幼保健机构人力变化及构成情况。结果妇幼保健机构提供了大量的妇幼保健服务,妇幼保健机构工作人员的增长速度跟不上服务需求增长速度,人员编制不足的现象日益严重,人员素质有待进一步提高。结论随着妇幼保健服务需求的增加,且妇幼保健服务内涵进一步扩展以及落实医改任务,妇幼保健机构亟需数量充足、结构合理、素质精良的人才队伍。