全院消毒灭菌物品一体化管理的探讨

目的探讨将全院消毒灭菌物品集中处理的管理措施,以降低管理成本,使全院设备物资资源达到共享。方法我院中心供应室自2002年12月起,应用先进的网络技术,对全院所有消毒灭菌物品进行集中处理,同时进行细致准确的成本核算,并与各科分散的处理进行比较。结果供应室经一体化管理后,消毒灭菌物品的质量及成本效益均取得明显成效。结论实施一体化的管理不仅加强了各环节的工作质量,更充分发挥了中心供应室的职能,有利于提高医院的管理效益。     

深圳市药品集团采购改革的做法和成效分析

深圳市为解决药品集中采购中招采分离、量价脱钩等问题，借鉴国内外经验，探索政府引导、市场主导的药品集团采购改革，由政府负责招标确定专业化的药品集团化采购机构，由其受全市公立医院的委托，负责组织开展药品集团化采购，建立起"政府定规则、医院提需求、专家评质量、市场谈价格"的药品供应保障新机制。改革后，深圳市公立医院的保障用药采购成功率稳定在95%以上，重点降价药品的价格综合降幅达到21.99%，一年节省药品采购费用15.16亿元，为医疗服务价格调整提供了改革空间。药品供应保障体系改革应转变政府职能，加强药品采购宏观管理；促进权力归位，落实医院采购自主权；坚持市场主导，发挥企业的市场主体地位；坚持公开透明，实现全流程实时动态监管。     

A centralised, automated dental hospital water quality and biofilm management system using neutral Ecasol™ maintains dental unit waterline output at better than potable quality: A 2-year longitudinal study

Most studies addressing biofilm formation in dental chair unit waterlines (DUWLs) have focused on a range of individual dental chair units (DCUs) and no studies on a centralised approach in a large number of DCUs have been reported to date.

Objectives

To develop a centralised, automated water quality and biofilm management system serving the distribution network providing water to Dublin Dental Hospital's 103 DCUs, capable of maintaining DUWL supply and output water at better than potable quality standards in the long-term and requiring a minimum of human intervention. The potable water standard for the European Union does not specify an upper limit of aerobic heterotrophic bacteria, whereas a maximum of 100 cfu/mL is permitted in bottled water.

Methods

Mains water of varying quality was treated by specifically selected automated filtration units to provide DCUs with water of consistent chemical composition. This water was then automatically disinfected using an electrochemically activated solution Ecasol™ (Trustwater Group, Clonmel, Ireland) (2.5 ppm) prior to distribution to DCUs. Microbiological quality of both DUWL supply and output water was monitored weekly by culture on R2A agar for 10 sentinel DCUs for a 100-week period. DUWLs were tested for the presence of biofilm by electron microscopy.

Results

Chemical composition of processed mains water consistently bettered potable water standards. DUWL supply water and output water aerobic heterotrophic bacterial counts averaged <1 and 18.1 cfu/mL, respectively, from the 10 DCUs, compared to 88 cfu/mL for unprocessed mains water. This correlated with the absence of biofilm in DUWLs. No adverse effects due to Ecasol™ treatment of supply water were observed for DUWLs or DCU instruments.

Conclusions

This centralised and automated water treatment and biofilm management system consistently maintains DUWL output water at better than potable quality simultaneously in a large number of DCUs over the long-term.     

消毒供应中心岗位技能培训基地的实践

总结了消毒供应中心岗位技能能手的培养和效果.通过建立消毒供应中心岗位技能培训基地,应用"实践-讲座-研讨"每日循环的培训方法对学员实施培训,提高了学员的专业理论知识水平和分析、解决实际问题的技能,有助于学员正确理解和落实卫生部<消毒供应中心管理规范>.     

指导教师在器械整理教学管理中的策略及作用

目的 充分发挥护士在供应部教学管理中的骨干作用,完善供应部教学的培训模式.方法 对我院2009年6月至2010年5月期间参与基本器械整理培训的43名人员所形成的资料进行分析.结果 培训期人员临床质量考核均达标,其中新人员工临床质量考评达到（9.91±0.12）分.结论 指导教师在器械整理教学管理中具有中心轴控的作用,并有效促进其专业的发展.     

从柯达DR7500的几例故障维修看预防性维护的重要性

本文主要通过实例介绍我院在用柯达DR7500在使用过程中出现的几种故障及其检修方法,并由此归纳出进行预防性维护（preventive maintenance,PM）的重要性。     

确认程序在采供血工作中的应用

分析了采供血工作中确认程序存在的问题,从策划和建立确认程序,过程、方法、设备、计算机软件、检验试剂、质控品和一次性关键物料的确认过程,以及不同项目确认的相互关联和整合3个方面,就如何进行采供血工作确认过程进行了探讨,旨在为同行提供借鉴。     

欧洲重建初级卫生保健服务体系的理念与措施

越来越多的欧洲国家政府开始呼吁重建初级卫生保健服务体系,很多国家已经采取了一系列的改革措施来强化初级卫生保健服务体系。由于在社会经济背景、改革理论依据和价值取向等方面的差异,各国逐步形成了各具特色的初级卫生保健服务模式。这些模式的特点包括集治疗、康复和预防,以及健康促进等工作为一体,基于初级卫生保健服务来改善卫生服务的供给,突出以人为本的卫生保健服务特色,强调卫生服务的协调性与整体性,提供综合、连续、可获得的卫生保健服务等。这也为我国完善初级卫生保健服务体系提供了许多经验。     

Seasonal influenza vaccine supply and target vaccinated population in China, 2004–2009

To better understand the gap between limited influenza vaccine supply and the target population for vaccination in China, we conducted a retrospective survey to quantify the production capacity, supply and sale of seasonal trivalent inactive vaccine (TIV) from the 2004–2005 through the 2008–2009 season, and estimated the target population who should receive annual influenza vaccine. The maximum domestic capacity to produce TIV was 126 million doses in 2009. A total of 32.5 million doses of TIV were supplied in 2008–2009, with an average annual increase rate of 18% from 16.9 million in 2004–2005. This represents an amount sufficient to vaccinate 1.9% of Chinese population. The average number of doses of TIV for sale by province ranged from <5 to 108 per 1000 people. The differences are explained in part by level of economic development but also influenced by local reimbursement policies in some provinces. Based on national recommendations, we estimated a target population of 570.6 million or 43% of the total population. Supply and domestic production capacity for influenza vaccine is currently insufficient to vaccinate the estimated target population in China. The Government of China should consider measures to improve domestic production capacity of influenza vaccine, expand successful promotional campaigns, and add cost subsidies in high risk groups to further encourage influenza vaccine usage.     

Demand and supply factors affecting the rising overmedicalization of birth in India

Objective

To understand the interaction between health systems and individual factors in determining the probability of a cesarean delivery in India.

Methods

In a retrospective study, data from the 2007–2008 District Level Household and Facility Survey was used to determine the risk of cesarean delivery in six states (Punjab, Delhi, Maharashtra, Andhra Pradesh, Kerala, and Tamil Nadu). Multilevel modeling was used to account for district and community effects.

Results

After controlling for key risk factors, the analysis showed that cesareans were more likely at private than public institutions (P < 0.001). In terms of demand, higher education levels rather than wealth seemed to increase the likelihood of a cesarean delivery. District-level effects were significant in almost all states (P < 0.001), demonstrating the need to control for health system factors.

Conclusion

Supply factors might contribute more to the rise in cesarean delivery than does demand. Further research is needed to understand whether the quest for increased institutional deliveries in a country with high maternal mortality might be compromised by pressures for overmedicalization.