Differences in social isolation between young and old elderly in urban areas of Beijing,China: A cross-sectional study

ObjectivesTo understand the differences in social isolation among older adults and to identify risks associated with social isolation.MethodsTotally 485 participants aged 60 and older were recruited for this study. The Lubben Social Network Scale-6 and the Chinese version of the Medical Outcomes Study Social Support Survey were used to measure social isolation and the different types of social support that the participants experienced.ResultsThe proportions of young elderly (60–74 years of age) and old elderly (greater than 74 years of age) that experienced social isolation in this study were 24.4% and 33.1%, respectively. For the young elderly, three types of social support were observed to be protective factors to help avoid social isolation, and the positive effect of social support obtained from friends and neighbors was slightly stronger than that of family members. Old elderly with only a senior high school education background were at high risk of being socially isolated. Only support from friends was observed to be a protective factor for the old elderly.ConclusionsThe study indicated that different ages of older adults experienced different aspects of social relationships. We propose that nursing interventions for the elderly should focus on individualized social support as a protective factor to help older adults avoid being socially isolated.     

Is there still an indication for nursing patients with prolonged neutropenia in protective isolation?. An evidence-based nursing and medical study of 4 years experience for nursing patients with neutropenia without isolation.

Patients with severe neutropenia due to high-dose chemotherapy and/or total-body irradiation are at risk of serious infections and are frequently nursed in strict protective isolation. This is a costly procedure and results in a psychological burden for the patient and its significance has been debated for a long time. The introduction of very potent systemic antibiotics, antibiotic prophylaxis, haematopoietic growth factors and peripheral stem cell transplantation might have decreased the need for it. We performed a systematic literature review and conducted a medical/nursing guideline study. In the literature we searched especially for prospective randomised studies. Only six were found, these were prospective randomised studies and contradicted each other on the usefulness of protective isolation.In an initiative aimed at promoting evidence-based care, we conducted a combined medical and nursing guideline study consisting of three parts: (1) inventory of (inter) national guidelines; (2) analysis of potential sources of infection; and (3) follow-up study post-implementation of new guidelines.RESULTS: (1) The practices in different centres in Europe appeared to vary widely. (2) Micro-organisms spread easily, especially if hands are not adequately dried. Isolation does not prevent this. Based on these findings we decided to stop protective isolation. This change of policy was combined with a campaign for optimal hygiene and introduction of hand alcohol. (3) We monitored the incidence of febrile neutropenia, infections and use of systemic antibiotics and antifungals in a 3-year period without protective isolation and compared this with the findings in the preceding 3 years with isolation. No significant differences in infections and mortality were found. We concluded that abandoning protective isolation combined with increased hygienic measures in nursing of patients with severe neutropenia does not increase the risk of infections, but improves the quality of care and patient satisfaction and reduces costs.     

造血干细胞移植患者保护性隔离期间孤独感的研究进展

造血干细胞移植（hematopoietic stem cell transplantation,HSCT）患者保护性隔离期间多具有孤独感,对其健康结局会造成不良影响。该文对HSCT患者保护性隔离期间孤独感的研究进行综述,包括孤独感的概念、相关理论、评估工具、影响因素及干预措施等。目前,国内相关研究较少,建议未来开展HSCT患者孤独感现状、影响因素及其与患者健康结局间关系的研究,为构建系统化干预方案提供依据。     

新型冠状病毒肺炎疫情期间消毒供应中心隔离要求和工作人员防护建议

新型冠状病毒传染性强,医院消毒供应中心需处理新型冠状病毒感染患者的复用诊疗物品和医务人员的防护用具,同样具有高风险。医院消毒供应中心应根据区域工作性质做好隔离区域的划分,根据岗位性质落实各岗位工作人员防护用具的穿戴,严格执行消毒隔离和人员防护,确保工作正常开展。     

白血病病人化疗后实施保护性隔离预防感染的效果评价

目的评价白血病病人在化疗后即开始保护性隔离预防感染护理的效果。方法对照组在骨髓抑制期开始实施常规预防感染措施,实验组在化疗后实施严格的保护性隔离,观察2组病人感染的发生率。结果对照组无感染率35.48%,实验组无感染率63.44%。结论在化疗后实施严格的保护性隔离有助于降低感染发生率,使病人顺利度过骨髓抑制期。     

A nurse's experience of isolation

A nurse specialist in infection control, describes how it felt to be on the receiving end of protective isolation.     

新护士标准预防与保护性隔离措施培训的研究

目的研究新护士在一年轮转期内对标准预防知识与技能的掌握及保护性隔离措施的落实情况。方法采用自行设计的问卷,对新护士在专项培训前后予以测试,以了解新护士对标准预防知识的掌握、轮转不同时期职业防护技能考核、每月护理质控组检查及对住院易感患者保护性隔离措施的落实情况进行统计分析。结果实施专项培训前后新护士整体知晓率χ2检验差异有统计学意义（P〈0.01）;3个月后再培训的知晓率差异无统计学意义;新护士掌握标准预防措施中,手有伤口时操作带双层手套、注射后护针套不回套和进离隔离病房母婴同室洗手3项技能正确率半年后χ2检验差异无统计学意义（P〉0.05）;保护性隔离措施的落实率每年比较差异有统计学意义（P〈0.01）。结论对新护士在职专项培训3个月内2次培训方法是可行有效的;在临床护理中对标准预防与保护性隔离措施技能考核与检查培养了新护士双向防护能力并能自觉地将其整合到护理流程中,有助于新护士在临床护理中不断强化防护意识和形成良好的行为习惯。     

方舱医院工作人员穿脱个人防护用品的自我认知状况调查

目的： 调查新型冠状病毒流行期间方舱医院不同工作人员穿脱个人防护用品的认知状况,以便针对问题展开重点培训,为医院感染防控培训工作提供依据。方法：选取2022年4月14日至2022年5月20日上海某方舱医院工作人员共499名,通过问卷星收集不同人群的基本情况及其对穿脱个人防护用品的认知状况,对不同分组工作人员之间存在的差异之处进行分析讨论。结果：医生组、护理组平均分数均高于非医护人员组；其中穿防护服、脱隔离衣这2个条目评分,医生组、护理组、非医护人员组三组之间存在显著差异,有统计学意义(P<0.05)；穿防护服、脱防护服、穿隔离衣、脱隔离衣、戴帽子、手卫生消毒行事后分析两两比较后,护理组高于非医护人员组,差异具有统计学意义(P<0.05)；穿防护服,医生组平均分数高于护理组高于非医护人员组,组间比较差异均有统计学意义(P<0.05)。结论：非医护人员穿脱个人防护用品整体认知评分低于医生组、护理组,需要在日常工作中继续督导,强化培训及考核,进一步提高其对穿脱个人防护用品的认知,最大可能的降低院内感染发生的风险。     

大型综合医院防控甲型H1N1流感的干预措施

目的研究大型综合医院甲型H1N1流感院内感染控制措施。方法根据流行病学调查资料,有针对性地采取重点管理和消毒隔离综合措施。结果通过对病人和医护人员分别隔离保护措施以及严格执行消毒隔离措施,本院2009年度共接诊甲型H1N1流感确诊病例386例(含住院确诊29例),未发生病人间横向传播,亦没有医院内工作人员感染。结论通过实施感染综合管理措施,实现了大量接诊甲型H1N1流感病人的医院内零感染目标。     

The role of gown and glove isolation and strict handwashing in the reduction of nosocomial infection in children with solid organ transplantation

OBJECTIVE: Nosocomial infection is an important contributor to morbidity and mortality in pediatric solid organ transplantation. The relative effect of protective gown and glove isolation was compared with strict handwashing in pediatric intensive care unit (PICU) patients with solid organ transplantation. DESIGN/SETTING: A prospective, randomized design was used; children in a 23-bed PICU with solid organ transplantation were enrolled into a gown and glove protective isolation protocol or a strict handwashing protocol. PATIENTS: All children admitted to the PICU immediately after solid organ transplantation, excluding renal transplantation, and at subsequent readmissions to the PICU were eligible for the study. Children with current infection or known exposure to varicella were excluded from the study initially or at readmission. INTERVENTIONS: By using a block randomization design based on organ transplanted, age, and initial admission vs. readmission, each patient was randomized to either strict handwashing or protective gown and glove isolation intervention groups. MEASUREMENTS: We analyzed demographics, infection outcomes (defined according to Centers for Disease Control criteria), and monitoring of patient contacts in compliance with protocols. RESULTS: The infection rate in the overall PICU population did not change significantly from the year before the study compared with during the study (2.1 per 100 vs. 1.95 per 100 patient days; p =.4) The infection rate in the gown and glove group (2.3 per 100 patient days) was reduced significantly compared with the prestudy infection rate in the transplant population (4.9 per 100 patient days; p =.0008). Strict handwashing also significantly reduced the infection rate in the transplant population (3.0 per 100 patient days; p =.008). Compliance with gowning and gloving was 82% and compliance with handwashing was 76% (compared with 22% before study [p <.0001] and 52% after the study [p <.0001]). Despite an increased mean length of stay in the PICU in the gown and glove group (p =.014), there was a trend toward reduction in the incidence of infection (Fisher's exact test, p =.07; odds ratio,.76) in the gown and glove group. CONCLUSIONS: Increased compliance with handwashing was associated with a reduction in nosocomial infections, and gown and glove isolation appeared to have an additional protective effect. Some nosocomial infections may be preventable in the pediatric solid organ transplantation population.     

Respiratory syncytial virus (RSV): a common health problem.

RSV infections pose a variety of considerations for emergency personnel. Nurses should be suspicious of this cause of illness during the winter months because of its prevalence, should be able to recognize and treat those who are experiencing or are at risk for acquiring lower respiratory tract complications, and should be aware of the need to reduce the spread of the virus by using isolation techniques, vigorous hand-washing protocol, and other protective measures to reduce contact with the organism. Patients who are at high risk for respiratory distress should be admitted for observation and supportive therapy.     

Feelings of oncology patients about being nursed in protective isolation as a consequence of cancer chemotherapy treatment

This qualitative research explores the feelings of oncology patients nursed in protective isolation following high-dose chemotherapy. Five patients described their feelings about the isolation experience during audio-taped interviews lasting between a half and one hour. Tapes were transcribed and analysed, with emergent themes considered in relation to the other interviews and to the literature. The research findings indicate that cancer patients have specific concerns with regard to their experience in the isolation environment, which fall into four distinct categories of: 'being shut in'; 'coping with the experience'; 'being alone'; and 'maintaining contact with the outside world'. In addition, patients have concerns with regard to the experience of having cancer, that impinge upon the isolation experience. These are: 'having cancer'; 'suffering chemotherapy'; 'knowing what to expect'; and 'developing relationships with the health professionals'. The core variable is 'something that I have to go through'. The nature of the relationship between the categories led to the development of an integrative model for exploring the feelings of cancer patients nursed in isolation. Most of the informants coped well with the isolation experience and described feeling supported by the nursing staff. Their overriding concern in fact, reflected a desire to receive information about their disease and reassurance regarding their treatment. Being in isolation appears to inhibit communication about these issues.     

Social support and the chronically ill individual

Nurses caring for the chronically ill need to be alert for the problems of social isolation and social impairment. Families often respond initially to serious illness by becoming over-protective and fostering dependence and a sense of impaired competence in the ill person. As the illness continues, families often experience exhaustion because of the demands of new roles, depleted finances, and other aspects of a changed lifestyle. Feelings of anger, guilt, and helplessness occur in the network, often leading to withdrawal of support--especially as the ill person's ability to reciprocate support is impaired. Nursing interventions in situations of social isolation focus on reducing isolation by promoting social interaction as appropriate, and by directly or indirectly mobilizing or expanding the social network. The problem of impaired social interaction may occur secondary to the personality changes that often accompany chronic illnesses, or as a function of the chronic illness or disability itself, as in the case of mental illnesses. Social impairment is an appropriate nursing diagnosis in abusive families. Nursing interventions range from educational programs for social skill development to reduction of the amount of contact within the network to involvement of protective and psychotherapy services. Chronic illness has profound effects on social support and the social network of both the ill person and his or her family. As both long-term illnesses and family involvement in care giving increase, nursing care in situations of chronic illness must include attention to issues of social support. Nursing diagnosis provides a framework for nurses to include social support in their care of the chronically ill patient. Social isolation and social impairment can be reduced by nursing interventions.     

Nurses' experiences of the phenomenon ‘isolation communication’

Background

Communication with patients and relatives can be a challenge in the intensive care unit (ICU) setting because of the acute and critical situation. However, when caring for patients with infectious diseases like COVID-19, nurses' communication is challenged further due to the required use of personal protective equipment (PPE) and mandatory isolation regimes.

Aim

To explore nurses' experiences of communicating while wearing PPE during COVID-19 isolation precautions in the ICU.

Study Design

A qualitative study within the phenomenological-hermeneutic tradition. Data were collected via 12 interviews with nurses working in a Danish ICU from September to November 2020. Data were analysed using a Ricoeur-inspired text interpretation method.

Findings

Three themes emerged during the analysis: (1) communication was limited and distanced and nurses had to compromise; (2) the nurses' senses were reduced, and verbal and nonverbal communication practises changed; and (3) patients' and relatives' communicative vulnerability were exposed in an extraordinary situation.

Conclusion

The analysis revealed a phenomenon that can be described as ‘isolation communication’. The isolation precautions and use of PPE had a profound impact on the nurses' caring and communicative practices, which were limited in this situation. The nurses found themselves physically, emotionally and socially distanced from the patients, relatives and their colleagues. However, to prevent the spread of the virus, isolation communication is something that the nurses have to endure.

Relevance to Clinical Practice

As our findings show that the nurses' communicative practises had to change during isolation communication, it is important for clinical practise and education to focus on implementing communication methods that optimise message transmission between ICU clinicians, patients and relatives in conditions requiring PPE and isolation. We should also focus on how to optimise interdisciplinary health communication in this situation.     

灾害救援物资的配置与管理

探讨灾害发生时救援物资的配置与管理.(1)外伤用物品:地震发生初期大量的外伤病员,需要的外伤用物品相对较多,如纱布、棉垫、绷带和各种规格夹板用于包扎止血以及清创缝合.(2)隔离防护物资:随着时间的延长,被救出来的灾区伤员伤口创面发生感染,消毒隔离所需要的防护物资相应增加,例如一次性隔离衣、床单、一次性治疗巾,避免交叉感染.(3)转运出诊箱:①为到机场接灾区来的伤员准备的物资;②为去灾区医院转运危重病员所准备的物资;③为将病员转至外省、空中转运所准备的物资.3种不同转运的出诊箱包含的药品都包括肾上腺素、阿托品、多巴胺、间腔胺等,在第2、3种出诊箱里还增加了吸痰器、心电监护仪、气管插管等.通过这次震灾救援,笔者建议今后在平时器材应该分为A、B、C类储备:A类为固定器材,包括各种小型设备、仪器等;B类为药材,包括急救药材、消毒药品、各系统疾病用药,根据保质期进行随时更换、清理;C类为消耗性器材,包括手术衣帽、注射器、纱布、绷带、针线等.B类与C类器材与A类固定装备进行随时组合,保证各项医疗操作技术顺利进行.     

空气和空调器样本中SARS冠状病毒的检测

为研究SARS的传播途径,给医务人员防护提供依据。采用8级安德森空气微生物采样器对SARS病房中空气进行采样、收集空调器冷凝水和空调器滤网尘土标本,应用常规反转录套式PCR检测样本中SARS冠状病毒。结果,共检测40份样,检出阳性标本18份,阳性率为45%;其中空气标本36份,阳性15份,2份空调滤网尘土标本均为阳性,2份空调冷凝水标本检出1份阳性。随机挑选PCR阳性标本2份进行病毒分离试验,2份均为阳性。结果显示,检测SARS病房空气标本以及空调器冷凝水和空调器滤网尘土标本,均获得较高的SARS冠状病毒阳性率并分离到存活病毒。表明环境空气中存在活的SARS冠状病毒,推测SARS确有可能通过空气飞沫传播,本结果可供SARS病房的医护人员采取防护措施参考。     

电刺激迷走神经对大鼠急性内脏炎症痛的保护作用

目的:应用大鼠急性内脏炎症疼痛模型,研究胆碱能抗炎通路对急性内脏炎症疼痛的保护作用.方法:SD大鼠32只,随机分为4组.(1)假手术组(Sham);(2)疼痛模型组(EIP);(3)迷走神经切断疼痛模型组(VGX);(4)迷走神经电刺激疼痛模型组(STM),术毕即刻持续电刺激20min.各组模型制备完毕,电刺激后0,1,2h检测TNF-α,并每15min进行疼痛学评分,连续记录2h.结果:Sham组与EIP,VGX,STM组比较,在1h,2h时TNF-α有显著性差异,疼痛评分在120min内有显著性差异,EIP与VGX组比较TNF-α在1,2h时无差异,疼痛评分无差异.STM与VGX组及EIP组比较,TNF-α在1,2h时有显著性差异,疼痛评分在90min内有显著性差异.结论:电刺激迷走神经可以减轻急性内脏炎性疼痛,减轻TNF-α的释放,对急性内脏炎性疼痛具有保护作用.     

葛西手市治疗胆道闭锁患儿的护理

目的探讨葛西手术治疗胆道闭锁的围手术期护理措施及其临床意义。方法对112例胆道闭锁行葛西手术患儿于术前密切观察临床表现，协助明确诊断及时手术；围手术期护理措施包括术前肠道准备，术后全程严密的病情观察，细致全面的基础护理，及时发现胆管炎先兆表现，配合胆管炎的医疗处理，实施保护性隔离措施。结果9例手术后至出院前无胆管炎发生，恢复好，3例放弃治疗，其余患者顺利出院。结论对胆道闭锁行葛西手术治疗的患儿护理的目的在于术前尽早明确诊断，尽早手术。减少各种术后并发症发生的重点在于积极预防，及早发现胆管炎的发生，及时对症处理。     

Protective isolation precautions for the prevention of nosocomial colonisation and infection in burn patients: A systematic review and meta-analysis

ObjectivesTo assess the impact of protective isolation precautions on nosocomial colonisation and infection rates in burn patients.Research methodologyA systematic review and meta-analysis were performed of studies identified through Pubmed and Web of Science. Only articles in English were considered. The Downs and Black tool was used to evaluate their methodological quality. Random-effects meta-analysis obtained pooled risk ratios (RRs) and 95% confidence intervals (CIs) of nosocomial colonisation and infection rates.ResultsFive eligible before-after studies were identified, encompassing a total of 3033 patients (1192 in the experimental group; 1841 in the control group). Varying protective isolation precautions were investigated, resulting in high clinical heterogeneity. Quality assessment revealed overall poor methodological quality. Protective isolation significantly reduces combined colonisation and infection rates compared to baseline care (RR 0.52, 95% CI 0.40–0.69; P < 0.0001). Subgroup analyses indicated significant reductions in both nosocomial colonisation (RR 0.65, 95% CI 0.51–0.83; P = 0.02) and infection rates (RR 0.53, 95% CI 0.49–0.58; P < 0.0001).ConclusionsProtective isolation precautions appear to decrease the risk of colonization and infection in burn patients. Because of the absence of higher quality study designs, clinical heterogeneity and the small number of studies involved, these results must be interpreted cautiously.     

肝移植患者围手术期呼吸道感染的预防性护理

对70年代末80年代初期4例肝移植患者的资料分析,发现除1例因肿瘤复发死亡外,其余3例均因肺部感染等原因死亡,认为对肝移植手术患者严密的消毒隔离工作应贯穿于整个围手术期的每一个环节,尤其要注意呼吸道感染的预防性护理.在总结以往经验和教训的基础上,对1999年后行肝移植的患者实施严格的呼吸道感染预防性护理,主要有注重围手术期环节管理,采用综合性的防治感染措施,严格做好保护性隔离工作.医疗方面注意预防性应用抗生素,在术前半小时静脉推注.术后继续应用抗生素,无1例发生肺部感染.