化学消毒剂对牙科手机灭菌效果研究

目的为制定我国牙科手机化学灭菌标准及其操作规范提供参考数据. 方法选择国内目前应用比较普遍的几种用于牙科手机灭菌处理的化学消毒剂,对标准微生物、对牙科手机上人工污染的标准微生物及临床分离微生物、对临床使用后自然污染牙科手机进行灭菌试验观察. 结果含氯氧三嗪(三氯异氰尿酸)的含氯消毒剂,有效氯含量2 000 mg/L、浸泡30 min,可完全杀灭布片上污染的细菌及细菌芽胞、破坏HBsAg抗原性,将有效氯含量提高到3 000 mg/L、浸泡处理作用时间延长到50 min,仍然不能完全杀灭污染在牙科手机上的同类微生物;含二氧化氯的消毒剂,二氧化氯含量30 mg/L、浸泡处理作用40 min,可完全杀灭布片上污染的细菌及细菌芽胞、破坏HBsAg抗原性,将二氧化氯含量提高到100 mg/L、浸泡处理作用时间延长到50 min,仍不能完全杀灭牙科手机上污染的同类微生物;2%碱性戊二醛浸泡处理作用4 h可完全杀灭污染在布片上的细菌芽胞、破坏HBsAg抗原性,将浸泡作用时间延长到10 h,仍不能完全杀灭牙科手机上污染的细菌芽胞;环氧乙烷熏蒸可完全杀灭牙科手机上污染的细菌芽胞. 结论采用化学消毒剂浸泡方式处理牙科手机达不到灭菌合格标准,灭菌可靠性有限,环氧乙烷灭菌效果可靠,但必须使用环氧乙烷灭菌专用设备,并注意安全操作、人员防护.     

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。     

压力蒸汽灭菌对牙科手机使用性能的影响

目的 探讨压力蒸汽灭菌对牙科手机使用性能影响。方法 压力蒸汽灭菌效果试验方法,设1种温度、1个时间段为一试验组,每一试验组取化学指示卡10个、生物指示菌片10片进行试验,灭菌温度范围是100—134℃,灭菌时间范围是1—45min,根据压力蒸汽灭菌对嗜热脂肪杆菌芽胞的杀灭效果、化学指示卡检测结果论证压力蒸汽灭菌的可靠性;采用国产、进口2种品牌新牙科手机各10把进行试验,根据不同压力蒸汽灭菌器灭菌处理牙科手机后出现的性能变化,探讨压力蒸汽灭菌对牙科手机使用性能的影响。结果 经对221支经压力蒸汽灭菌处理后牙科手机无菌检测均达到合格标准的结果证明,压力蒸汽灭菌牙科手机的灭菌效果可靠;根据化学指示卡灭菌效果指示,在121℃条件下包内达到灭菌要求需要20min、包外达到灭菌要求仅需要15min,在134℃条件下包内达到灭菌要求需要4min、包外达到灭菌要求仅需要2min,证明物品包装后灭菌较裸露灭菌所需时间长;压力蒸汽灭菌对牙科手机使用性能有影响,快速压力蒸汽灭菌器灭菌牙科手机,对牙科手机的使用性能影响较小,在一定的灭菌循环次数范围内,灭菌全过程为6min的快速压力蒸汽灭菌器对牙科手机的使用性能影响是可复的。结论 压力蒸汽灭菌效果可靠;为了减少压力蒸汽灭菌对牙科手机使用性能的影响,对牙科手机可不进行包装灭菌,应使用快速压力蒸汽灭菌器灭菌牙科手机。     

氧化电位水对口腔器械消毒效果的探讨

目的 评价氧化电位水（EOW）对口腔器械污染菌的消毒效果。方法 以临床使用后的扩大针和高速手机为对象，扩大针分别用EOW和2％戊二醛消毒，手机分别用EOW消毒和高温高压灭菌，于消毒前、后采样，细菌培养，菌落计数。结果 对扩大针消毒10min，两种消毒剂的消毒合格率均达100％，对手机采用两种消毒方法均可全部杀灭其表面和冷却水管内污染菌，但EOW组不采用内部冲洗时，手机内部冷却水管内仍有大量细菌生长。结论 EOW消毒可达与2％戊二醛浸泡消毒、高温高压蒸汽灭菌同样可靠的消毒效果。     

牙科手机消毒与灭菌现状调查

目的了解目前口腔专科医院、综合医院口腔门诊中使用的牙科手机种类、消毒与灭菌处理方法及消毒与灭菌效果。方法2000～2001年随机抽取同一城市中口腔专科医院、具有口腔门诊的三级医院、二级医院、一级医院各10所,调查医院口腔门诊中正在使用的所有牙科手机的类型及消毒与灭菌处理方式。随机抽取医院口腔门诊中1个诊室内使用后污染的牙科手机,按照卫生部《消毒技术规范》规定的方法进行细菌菌落总数检测,通过活菌培养计数,观察细菌污染情况;通过检测乙型肝炎表面抗原(HBsAg),间接判断乙型肝炎病毒(HBV)污染存在的可能性;通过对消毒与灭菌处理后牙科手机的无菌检测,判断灭菌效果。结果使用无防回吸牙科手机占临床使用牙科手机比例的941%(959/1019),有防回吸功能的牙科手机占59%(60/1019)。采用消毒剂擦拭消毒法处理临床使用后牙科手机的比例为629%(214/340),其中2617%无菌检测阴性;采用消毒剂浸泡法的比例为100%(34/340),其中5588%无菌检测阴性;采用压力蒸汽灭菌法的比例为271%(92/340),其中8043%无菌检测阴性。使用后牙科手机均存在细菌污染,HBsAg抗原性检测阳性率为167%。结论应取代无防回吸功能的牙科手机或使用有防回吸功能的综合治疗台;必须灭菌处理临床使用后污染的牙科手机;应提高口腔医务工作者     

牙科手机污染HBV灭活方法及效果的研究

目的评价消毒剂和消毒方法对牙科手机污染HBV的灭活效果. 方法牙科手机浸泡在污染HBsAg测定值≥300 S/N值和HBV(105 拷贝/ml)血清经清洗后,采用4种化学消毒剂和压力蒸汽灭菌方法消毒处理,并用高灵敏度HBsAg AXSYM自动酶标检测仪检测方法,检测牙科手机消毒后的HBsAg灭活情况. 结果 3种含氯消毒液在有效氯含量1 000 mg/L浓度下,作用5～20 min后,＞50%的牙科手机HBsAg检测仍为阳性;牙科手机污染后没有及时清洗会增高手机消毒阳性率;2%戊二醛消毒20 min阳性率为100%;压力蒸汽灭菌134 ℃ 4 min条件下对污染的HBV可以灭活. 结论化学消毒剂不能对牙科手机进行有效的HBV灭活,而有效的灭活方法为134℃ 4 min条件下的热力学处理.     

纸塑单包装灭菌口腔科器械的临床应用

近年来，我院口腔科器械一直采用化学消毒剂浸泡灭菌和棉布包装高压灭菌。自2007年8月以来，我院将纸塑包装灭菌应用于口腔科，取得了满意效果，现报告如下：     

牙科手机传播乙型肝炎病毒的可能性探讨

目的探讨牙科手机(简称手机)传播乙型肝炎病毒(HBV)的可能性。方法2001至2004年在同一城市中随机抽取具有口腔门诊的三级医院、二级医院、一级医院各10所,调查使用后手机消毒与灭菌处理方式、消毒与灭菌处理前后HBsAg污染情况。利用血清斑点杂交方法观察鸭乙型肝炎病毒(DHBV)污染手机后,在洗脱液中DHBV检测阴性的情况下,能否排除其对动物的感染性。结果2001至2004年,抽检的医院中压力蒸汽灭菌处理手机的比例显著上升,从2001年的27.06％上升至2004年的84.51％;化学消毒剂浸泡、擦拭及其他方法处理手机的比例显著下降,从2001年的60％以上,下降到2004年的10％左右。使用后手机HBsAg抗原性检测阳性率为1．65％。用血清斑点杂交方法检测,在手机洗脱液中DHBV检测阴性的情况下,转染动物后仍可引起动物DHBV感染,证明未灭菌手机HBsAg抗原性检测阴性并不能排除手机仍存在传播HBV的可能性。结论手机传播HBV的可能性存在。压力蒸汽灭菌可杀灭手机上污染的HBV。     

加强口腔科医院感染的监测控制与管理

目的 为了了解口腔科器械乙型肝炎病毒的污染状况，达到有效预防和控制口腔科医医院感染问题。方法 抽查口腔手机，应用PCR技术检测HBV-DNA。结果 发现应用1%PVP碘消毒后的口腔科器械中HBV-DNA的阳性率为7.7%，而应用STATIM卡式压力蒸汽灭菌器9min，无包装灭菌。可达到消毒灭菌效果。结论 常规消毒的效果不可靠，而STATIM卡式压力蒸汽灭菌器消毒的效果可靠。     

戊二醛杀灭菌作用及毒副反应研究进展

自从 196 2年 Peppe等人发现了戊二醛 (Glutaralde-hyde,GAT)的强大杀菌作用 ,国外 196 3年就开始生产 2 %碱性戊二醛消毒剂。近 4 0年的广泛应用已表明戊二醛具有使用浓度低、高效、广谱、快速杀灭微生物等优点 ,被誉为化学低温灭菌剂发展史上的里程碑之一。现已把戊二醛作为怕高温、怕腐蚀医疗器械的首选消毒剂 ,尤其作为内镜的消毒灭菌剂。1　戊二醛对微生物的杀灭作用戊二醛消毒剂具有杀菌谱广、快速、高效等优点 ,可有效杀灭细菌繁殖体、某些细菌芽胞、真菌和病毒等微生物。意大利的 Angelillo IF等评估了戊二醛对牙科器械的杀菌效…     

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.