手术室环境卫生学监测分析

我院是一所综合性医院 ,手术室有手术床 1 2张 ,能同时开展多种手术 ,但手术室修建时间已久 ,布局不能完全达到卫生部的要求。如何在此基础上保证手术正常进行并有效控制医院感染 ,是感染管理科与手术室工作的重点。1　资料与方法　　 2 0 0 1年 1～ 1 2月 ,我院感染管理专职人员对手术室空气、无菌器械、物体表面、医护人员手、外科洗手刷、洗手肥皂、消毒剂等采样 ,并根据卫生部《消毒技术规范》标准要求[1] ,进行细菌学监测的效果评价 ,达卫生部标准的为合格 ,不达标的为不合格。2　结果　　共采样 5 80件 (其中包括手术室工作人员采样的…     

手术室环境卫生学监测结果分析及管理对策

目的 了解手术室环境卫生现状,探讨管理对策.方法 调查2007-2010年手术室环境卫生学检测结果.结果 手术室无菌物品及环境卫生学监测样品共539份,对7类项目进行检测,合格525份,合格率为97.4％,均未检出致病菌,除呼吸气囊外,监测结果符合质控标准.结论 加强各项管理措施,严格手术室消毒制度,专人负责,职责明确,重视可能导致污染的每一个环节,是保证手术室环境质量的重要对策.     

现代净化手术室系统及其质量控制

本文介绍了现代净化手术室的发展，原理、构成、物流、布局及工艺，并从工程招标、设计、施工、验收及维修保养培训方面提出了医院净化手术室系统质量保证和质量控制的具体内容。     

Tactical and operational decisions for operating room planning: Efficiency and welfare implications

In this paper, we evaluate the impact on welfare implications of a 0-1 linear programming model to solve the Operating Room (OR) planning problem, taking a patient perspective. In particular, given a General Surgery Department made up of different surgical sub-specialties sharing a given number of OR block times, the model determines, during a given planning period, the allocation of those blocks to surgical sub-specialties, i.e. the so called Master Surgical Schedule Problem (MSSP), together with the subsets of elective patients to be operated on in each block time, i.e. the so called Surgical Case Assignment Problem (SCAP). The innovation of the model is two-fold. The first is that OR allocation is “optimal” if the available OR blocks are scheduled simultaneously to the proper sub-specialty, at the proper time to the proper patient. The second is defining what “proper” means and include that in the objective function. In our approach what is important is not number of patients who can be treated in a given period but how much welfare loss, due to clinical deterioration or other negative consequences related to excessive waiting, can be prevented. In other words we assume a societal perspective in that we focus on “outcome” (health improving or preventing from worsening) rather than on “output” (delivered procedures). The model can be used both to develop weekly OR planning with given resources (operational decision), and to perform “what if” scenario analysis regarding how to increase the amount of OR time available for the entire department (tactical decision). The model performance is verified by applying it to a real scenario, the elective admissions of the General Surgery Department of the San Martino University Hospital in Genova (Italy). Despite the complexity of this NP-hard combinatorial optimization problem, computational results indicate that the model can solve all test problems within 600 s and an average optimality tolerance of less than 0,01%.     

The adaptation problems of patients undergoing hemodialysis: socio-economic and clinical aspects

OBJECTIVES:

to identify adaptation problems under Roy''s Model in patients undergoing hemodialysis and to correlate them with the socioeconomic and clinical aspects.

METHOD:

a transversal study, undertaken using a questionnaire. The sample was made up of 178 individuals. The Chi-squared and Mann-Whitney U tests were undertaken.

RESULTS:

the adaptation problems and the socioeconomic and clinical aspects which presented statistical associations were: Hyperkalemia and age; Edema and income; Impairment of a primary sense: touch and income; Role failure and age; Sexual dysfunction and marital status and sex; Impairment of a primary sense: vision and years of education; Intolerance to activity and years of education; Chronic pain and sex and years of education; Impaired skin integrity and age: Hypocalcemia and access; Potential for injury and age and years of education; Nutrition below the organism''s requirements and age; Impairment of a primary sense: hearing and sex and kinetic evaluation of urea; Mobility in gait and/or coordination restricted, and months of hemodialysis; and, Loss of ability for self-care, and months of hemodialysis and months of illness.

CONCLUSION:

adaptation problems in the clientele undergoing hemodialysis can be influenced by socioeconomic/clinical data. These findings contribute to the development of the profession, fostering the nurse''s reflection regarding the care.     

Peer Reviewed: Arthritis in the Canadian Aboriginal Population: North-South Differences in Prevalence and Correlates

Background

Information on arthritis and other musculoskeletal disorders among Aboriginal people is sparse. Survey data show that arthritis and rheumatism are among the most commonly reported chronic conditions and their prevalence is higher than among non-Aboriginal people.

Objective

To describe the burden of arthritis among Aboriginal people in northern Canada and demonstrate the public health significance and social impact of the disease.

Methods

Using cross-sectional data from more than 29 000 Aboriginal people aged 15 years and over who participated in the Aboriginal Peoples Survey 2006, we assessed regional differences in the prevalence of arthritis and its association with other risk factors, co-morbidity and health care use.

Results

The prevalence of arthritis in the three northern territories ("North") is 12.7% compared to 20.1% in the provinces ("South") and is higher among females than males in both the North and South. The prevalence among Inuit is lower than among other Aboriginal groups. Individuals with arthritis are more likely to smoke, be obese, have concurrent chronic diseases, and are less likely to be employed. Aboriginal people with arthritis utilized the health care system more often than those without the disease.

Conclusion:

Aboriginal-specific findings on arthritis and other chronic diseases as well as recognition of regional differences between North and South will enhance program planning and help identify new priorities in health promotion.

Keywords

arthritis, Aboriginal people, Northern Canada, Inuit, First Nations, Métis, North American Indians, Aboriginal Peoples Survey     

Peer Reviewed: Obesity and Obesity-Related Comorbidities in a Canadian First Nation Population

Introduction

Rates of obesity are higher among Canada''s Aboriginal First Nations populations than among non-First Nations populations. We studied obesity and obesity-related illness in a Manitoba First Nation community.

Methods

We conducted a screening study of diabetes and diabetes complications in 2003, from which we drew a representative sample of Manitoba First Nations adults (N = 483). We assessed chronic disease and chronic disease risk factors.

Results

Prevalence of obesity and associated comorbidities was higher among women than men. By using multivariate analysis, we found that factors significantly associated with obesity among women were diastolic blood pressure, insulin resistance, and employment status. Among men, factors were age, apolipoprotein A1 level, apolipoprotein B level, and insulin resistance. Seventy-five percent of study participants had at least 1 of the following conditions: obesity, dyslipidemia, hypertension, or diabetes. Comorbidity was high even among the youngest age groups; 22% of men and 43% of women aged 18 to 29 had 2 or more chronic conditions. Twenty-two percent of participants had undiagnosed hypertension. Participants with undiagnosed hypertension had significantly more chronic conditions and were more likely to have microalbuminuria than were those without hypertension. The number of chronic conditions was not significantly different for participants with newly diagnosed hypertension than for those with previously diagnosed hypertension.

Conclusions

The prevalence of obesity and other chronic conditions in the study community is high, especially considering the number of young people. Community-based interventions are being undertaken to reduce the excessive rate of illness.     

Peer Reviewed: Cardiovascular Risk According to Plasma Apolipoprotein and Lipid Profiles in a Canadian First Nation

Introduction

Despite high diabetes rates among Canadian First Nations people, little is known about their cardiovascular disease risk. Our aim was to describe the apolipoprotein profile with respect to cardiovascular risk in a Canadian First Nation community.

Methods

In 2003, a representative sample of adult members of a Manitoba First Nation (N = 483) participated in a screening study for diabetes and diabetes complications. We assessed their cardiovascular risk factors.

Results

Sixty percent of women were at increased cardiovascular risk because of low apolipoprotein A1 (apoA1) levels, compared with 35% of men. The proportion of women with low apoA1 levels decreased with age, but the proportion with low high-density lipoprotein levels remained stable across age groups. Both apoB and apoA1 were significantly associated with obesity when age, sex, diastolic blood pressure, homocysteine, diabetes, and insulin resistance were controlled for.

Conclusion

Apolipoprotein and lipid profiles in this First Nation population suggest high cardiovascular risk. Future research should characterize the lipoprotein particle size in this population.     

影响洁净手术室环境质量的原因及改进措施

目的对影响洁净手术室环境质量的若干因素进行分析,并探讨改进的措施。方法采用回顾性调查方法,对医院洁净手术室近几年环境细菌检测结果和手术切口感染发生率进行统计,对存在的问题及其原因进行分析。结果洁净手术室环境质量尚存在缺陷,主要表现在空气、物体表面、医护人员手的消毒质量不稳定,手术切口感染发生率较高等;其原因是手术室人员对医院感染认识程度参差不一,各项管理制度未能完全落实;术中人流、物流管理欠严格,导致空气污染严重;层流设施的日常维护工作未按规定落实,有重启用、轻效果的情况。结论加强手术室人员医院感染相关知识的培训,完善和落实各项管理制度,严格层流装置的维护管理,做好人流、物流优化管理是提高洁净手术室环境质量的有效措施。     

Chlorhexidine and gauze and tape dressings for central venous catheters: a randomized clinical trial

OBJECTIVE:

to assess the effectiveness of the chlorhexidine antimicrobial dressing in comparison to the gauze and tape dressing in the use of central venous catheters.

METHOD:

a randomized clinical trial was conducted in the intensive care and adult semi intensive care units of a university hospital in the south of Brazil. The subjects were patients using short-term central venous catheters, randomly assigned to the intervention (chlorhexidine antimicrobial dressing) or control (gauze and micro porous tape) groups.

RESULTS:

a total of 85 patients were included: 43 in the intervention group and 42 in the control group. No statistically significant differences were found between dressings in regard to the occurrence of: primary bloodstream infections (p-value = 0.5170); local reactions to the dressing (p-value = 0.3774); and dressing fixation (p-value = 0.2739).

CONCLUSION:

both technologies are effective in covering central venous catheters in regard to the investigated variables and can be used for this purpose. Registry ECR: RBR-7b5ycz.     

Critical appraisal in clinical practice: sometimes irrelevant, occasionally invalid

A core activity of evidence-based practice is the search for and appraisal of evidence on specific clinical issues. Clinicians vary in their competence in this process; we therefore developed a 16-item checklist for quality of content (relevance and validity) and presentation (useability, attribution, currency and contact details). This was applied to a set of 55 consecutive appraisals conducted by clinicians and posted at a web-based medical journal club site. Questions were well formulated in 51/55 (92%) of the appraisals. However, 22% of appraisals missed the most relevant articles to answer the clinical question. Validity of articles was well appraised, with methodological information and data accurately extracted in 84% and accurate conversion to clinically meaningful summary statistics in 87%. The appraisals were presented in a useable way with appropriate and clear bottom-lines stated in 95%. The weakest link in production of good-quality critical appraisals was identification of relevant articles. This should be a focus for evidence-based medicine and critical appraisal skills.