1998～2008年四川省直属医疗机构消毒质量监测结果分析

[目的]通过对医疗机构消毒质量监测结果分析,探索存在的问题,有利于加强医院感染管理,提高消毒灭菌工作质量,有效预防和控制医院感染发生。[方法]按卫生部《消毒技术规范》的技术要求,依据GB15982—1995《医院消毒卫生标准》等,于1998～2008年对19所省直医疗机构的室内空气、物体表面、医护人员手等进行连续11年监测。[结果]11年监测结果的总合格率为93.33%,各年合格率呈上升趋势。各监测项目中除压力蒸汽灭菌、干热灭菌、环氧乙烷灭菌效果的合格率达100%外,其余各监测项目各年度均未完全达到国家标准要求,表明医疗机构消毒质量还需进一步提高。[结论]影响消毒质量的因素很多,但管理是最重要的因素之一。应加强医院感染管理工作,认真落实各项消毒制度,开展消毒技术知识培训,提高医务工作人员的消毒灭菌意识,提高医疗机构消毒质量,加强对医疗机构医院感染和消毒工作的监督监测和技术指导,才能有效预防和控制医院感染的发生。     

我国艾滋病防治定点医疗制度的变迁

目的:梳理我国艾滋病定点医疗制度的发展过程,综合分析主要问题及原因,探讨解决思路。方法:对30个省的184个省市县三级医疗卫生机构中从事艾滋病防治工作五年及以上的领导或专家进行问卷调查,对7省2 432名HIV感染者和病人进行问卷调查。结果:防治人员认为定点医疗制度导致的艾滋病病人手术难和住院难问题突出,严重程度为6.49分,在艾滋病防治十大问题中位列第3;2 367名(97.3%)HIV感染者和病人知道定点医疗制度,1 376人在定点医院就诊过,其中,1 177人认为病情得到了有效治疗,124人认为定点医院的医疗技术有限;55名的手术或住院病人认为非定点医院存在推诿问题。政策分析显示,我国艾滋病定点医疗制度是逐渐发展的,表现出历史阶段性和目标短期性。结论:我国艾滋病定点医疗制度的作用明显,但问题突出。改进现有制度的思路包括:提高定点医院的综合服务能力,健全会诊和转诊机制,协调非定点医院提供技术支援,降低医务人员对艾滋病的歧视和恐惧,减少职业暴露风险,加强医院、疾控和病人的沟通。     

对基层医院医护人员实施医院感染管理培训的效果

目的探讨对基层医院医护人员实施医院感染管理培训的效果。方法大连市第七人民医院于2018年1月开始在全院内实施全员医院感染管理培训,该研究选取60名医护人员作为观察对象进行考核,统计培训前、培训6个月后医护人员的医院感染防控专业能力。结果培训6个月后,医护人员的手卫生合格率、医院感染知识掌握评分及医院感染专业技能操作能力评分均高于培训前,差异有统计学意义(P<0.05)。结论对基层医院医护人员开展医院感染管理培训有利于提高医护人员的医院感染防控专业能力,促进医院感染防控工作更好地开展。     

从SARS医院感染分析医院感染管理缺陷

目的 从SARS医院感染角度探讨医院感染管理方面存在的缺陷与改善的措施。方法 以现有的信息资料和实践经验从医院感染管理角度分析对突发疫情控制存在的缺陷，探讨改善的措施。结果 医院感染管理方面存在的缺陷主要是医院感染信息监控网没有充分发挥应有的作用；医院感染管理机构对医院感染重视不够，指导措施不力；医护人员有法不依、有章不循；某些现代化的医院基础设施不利于医院感染的控制。结论 尽快完善和加强医院感染信息监控网的职能；医院感染管理机构高度重视和正确指导医院感染管理工作；加大医院感染规范执行力度及加强医院感染基础设施投资和改造是提高医院感染管理水平的当务之急和关键措施。     

Infection control and meticillin-resistant Staphylococcus aureus in nursing homes in Oslo

Healthcare workers (HCWs) might be important in reducing healthcare-associated infections but infected or colonised HCWs may still spread pathogenic microbes to others. Norwegian policies for infection control in healthcare environments emphasise infection control programmes for both patients and HCWs. In this study, HCWs from 42 of 55 nursing homes in Oslo participated in an investigation concerning the implementation of infection control programmes during 2006-2007. Three separate questionnaires were used: the first aimed at nursing staff (enrolled nurses and assisting staff); the second for ward sisters; and the third for institution managers. Nearly 70% of the nursing homes had policies for controlling infection and transmission of meticillin-resistant Staphylococcus aureus (MRSA). About 60% of the institutions had policies for tracing MRSA infections. Four of five ward sisters tested patients for MRSA when wounds were not healing, when admitted from hospitals overseas, when patients shared a room with an MRSA-infected patient, or if patients had ever been MRSA positive. Two of five sisters would test patients with chronic urinary tract infection or patients admitted from another hospital. Among nursing staff, one out of five had cared for MRSA-positive patients. Only 4% of the staff had worked in healthcare institutions abroad, and only a few of them had been tested for MRSA. Almost 20% of the responding nursing staff worked at several institutions at the same time.     

基层医院医院感染管理现状

目的 了解赣州市基层医院医院感染管理的基本情况，为今后工作的开展提供依据。方法 采用随机抽样问卷调查法，对赣州市8个县市的15所医院进行医院感染管理基本情况的调查。结果 共调查15所县、市级医院，其中〈300张病床的医院14所，〉500张病床的医院1所，有7所医院的医院感染专职人员是从2003年才开始配备的，15所医院中，每专职人员床位数为143．9；专职人员的构成中护士73．7％，医生21．9％，技师5．2％，63．2％为中级职称，36．8％为初级职称；19名专职人员外出学习56次，消毒剂和防护用品的使用均逐年增加。结论 基层医院的医院感染管理工作已逐步走向正规，但在某些方面仍需进一步完善，加大领导对医院感染管理的重视，加大人力、物力的投入是搞好基层医院医院感染工作的前提。     

Wearing masks in a pediatric hospital: developing practical guidelines

During the outbreak of Severe Acute Respiratory Syndrome (SARS) in the spring of 2003, strict infection control measures were implemented in Toronto and surrounding hospitals. These measures included extreme restrictions on those who would normally accompany patients to the hospital, screening for SARS, and protective attire for hospital staff, including masks, face shields, goggles, gloves and gowns. At Toronto's Hospital for Sick Children (HSC), patients could only be accompanied or visited by one person, often only in patients' rooms. For the first four weeks, patients and their designated parent had to wear masks in almost all areas of the hospital. Staff wore masks (and other appropriate protective clothing) whenever in contact with patients and in many patient care areas. Although these barriers were an important part of containing SARS, their use created significant challenges for patients and staff. This article focusses on the use of infection control masks in routine pediatric healthcare and the tools developed by HSC staff to reduce the negative psychosocial impact on children and families.     

Role changes of hospital social workers in South Korea

The roles of social workers in hospitals have changed in accordance with the environmental changes in the healthcare system. Since 1958, hospital social workers have performed important roles in providing care services in South Korea. Providing psychosocial services was considered to be the most important for more than 30 years from the 1970s to the 1990s. The healthcare system has since undergone major environmental changes, yet there has been little study on the role of hospital social workers in South Korea. In order to address this research gap, this study aims to explore how the roles of hospital social workers have changed since the 2000s. We recruited 198 hospital social workers who were active members of the Korean Association of Medical Social Workers as study participants. The average age of participants was 35.36 years old (SD = 8.27), and they had an average of 8.24 years in hospital social work experience (SD = 6.35). The results indicated that the roles of financial support and community resource linkage, which were regarded to be relatively less important until the 1990s, were recognized as the most important. Given the role changes of hospital social workers in South Korea, implications are discussed.     

对医院员工培训问题的思考

随着医疗卫生体制改革的不断深入,医院对员工的培训越来越重视。文章从介绍医院员工培训的必要性入手,对医院员工培训的原则、内容、方法和评估进行阐述,为有效开展医院员工培训工作奠定了基础。     

眼科病房医院感染的危险因素与控制措施

目的分析与探讨眼科病房中发生医院感染的危险因素。方法针对发生医院感染的危险因素高度重视,对引起医院感染的危险因素进行探讨分析。结果对医务人员就医院感染加强管理,提高保健意识是控制医院感染和预防其再次发生的重要措施。结论只要按照规范的操作工程进行操作,控制好医院的交叉污染,就可以有效地控制眼科病房在医院的感染。     

Community-associated meticillin-resistant Staphylococcus aureus strains as a cause of healthcare-associated infection

Community-associated meticillin-resistant Staphylococcus aureus (CA-MRSA) was first noticed as a cause of infection in community-based individuals without healthcare contact. As the global epidemic of CA-MRSA has continued, CA-MRSA strain types have begun to emerge as a cause of healthcare-associated infections (HAIs) and hospital outbreaks have occurred worldwide. In areas where CA-MRSA clones have become established with high prevalence, for example USA300 (ST8-IV) in the USA, CA-MRSA are beginning to supplant or overtake traditional healthcare-associated MRSA strains as causes of HAI. The emergence of CA-MRSA as a cause of HAI puts a wider group of hospitalised patients, healthcare workers and their community contacts potentially at risk of MRSA infection. It also exposes CA-MRSA strains to the selective pressure of antibiotic use in hospitals, potentially resulting in increased antibiotic resistance, challenges traditional definitions of CA-MRSA and hampers control efforts due to the constant re-introduction of MRSA from an emerging community reservoir. There is thus an urgent need to clarify the definitions, prevalence and epidemiology of CA-MRSA and to develop systems for the identification and control of these organisms in the community, in hospitals and other healthcare facilities, and at the community–hospital interface.     

Data bank has operational impact. Proper peer review can protect hospitals from antitrust and defamation suits

The Health Care Quality Improvement Act of 1986 can help protect medical professionals and healthcare facilities from antitrust and defamation claims and other forms of litigation arising from the peer review process. Some hospitals may need to make major changes in their peer review activity as a result of the act. The healthcare entity, not the physicians involved in peer review, has the burden of complying with the provisions of the act. Failure to comply with the act can lead to loss of immunity from damages, fines, and potential exclusion from the Medicare program. The potential for liability has sparked a need for hospitals to reexamine and possibly reorganize medical staff and update procedures and related governing documents. Healthcare entities may consider changes such as implementing a director of medical affairs function, choosing medical staff for multiple-year terms, and centralizing physician review files. In the 1980s many hospitals created quality assurance and risk management programs. Risk managers need to share data with quality assurance personnel, who must in turn share the information with medical staff involved with credentialing, peer review, and medical affairs management. Legal counsel will need to be familiar with the legalities of the act, as well as the hospital's peer review procedures and operations. General legal counsel should oversee coordination of hospital proceedings and assist in educating staff on the legalities of peer review.     

加强医院感染管理的实践与体会

随着医院诊疗水平的发展,医院收治的重病患者越来越多.医院感染已成为影响医疗安全和患者生命健康的重要因素。本文总结在医院感染管理的实践中的经验和体会,认为落实医院感染管理的各项法律法规的要求,提供医务人员对医院感染相关知识的认识是保障医疗安全的基础,落实各相关人员的责任制是控制医院感染的必要条件,掌握有效的监测方法才能及时发现医院感染的苗头,控制医院感染事件的发生。     

Information systems for the materials management department: stand-alone and enterprise resource planning systems

Materials management information systems (MMISs) incorporate information tools that hospitals can use to automate certain business processes, increase staff compliance with these processes, and identify opportunities for cost savings. Recently, there has been a push by hospital administration to purchase enterprise resource planning (ERP) systems, information systems that promise to integrate many more facets of healthcare business. We offer this article to help materials managers, administrators, and others involved with information system selection understand the changes that have taken place in materials management information systems, decide whether they need a new system and, if so, whether a stand-alone MMIS or an ERP system will be the best choice.     

湖北省医院感染管理现状及多重耐药菌防控调查研究

目的了解湖北省医疗机构医院感染管理基本情况和多重耐药菌感染防控现状。方法采用问卷调查方式对湖北省47所三级和二级医院进行医院感染管理基本情况和多重耐药菌感染现状的调查。结果 47所医院中,医院感染管理专职人员配备中位数为0.90人/250床;2015年耐甲氧西林金黄色葡萄球菌、耐碳青霉烯类肠杆菌、耐碳青霉烯类铜绿假单胞菌、耐碳青霉烯类鲍曼不动杆菌、耐万古霉素肠球菌检出率分别为39.13%、4.13%、19.44%、63.60%、2.77%。47所医院均开展了多重耐药菌监测,共有28所(59.57%)医院安装了医院感染监测系统软件,同时与检验系统对接可直接获得数据。多重耐药菌感染诊断方式中以医院感染专职人员和临床医生共同诊断为主(26所,占55.32%)。44所(93.62%)医院均定期召开多重耐药菌防控协调会,2015年全院自查手卫生依从率为10.0%~89.2%;42所(89.36%)医院对多重耐药菌感染患者常规开具隔离医嘱,33所(70.21%)医院环境清洁消毒频次2次/d,24所(51.06%)医院采用全套的防护物品进行个人防护。结论此次调查有助于了解医疗机构医院感染管理工作的总体情况,掌握该地区多重耐药菌检出和防控情况。针对调查项目发现的问题和薄弱环节进行持续改进,有助于推动该地区医院感染管理工作的良性发展。     

COVID-19 Guidelines to Protect Healthcare Workers at Hospitals and Dental Professionals at Dental Office

BackgroundCoronavirus disease 2019 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2. This study aimed to address the preventive procedures to protect healthcare workers at hospital to avoid COVID-19, and infection control procedures to protect dental professionals in dental office.MethodsWe conducted a search of published articles from PubMed, google scholar databases using key words such as COVID-19, healthcare worker, infection control, and dental practice. Relevant articles were identified and reviewed. Most published papers were clinical reports and case studies. We have selected some of the current published papers written in English in 2020.ResultsInfection control procedures to protect health workers at hospitals, and dental professionals at dental office were summurised and presented. Infection control procedures for healthcare workers at hospitals include Personal protective equipment, Korea filter (KF)94 respirator, goggles, face protector, disposable waterproof long-arm gown, and gloves, and others. Extra-protection procedures should be taken with old and vulnerable healthcare workers. Dental professionals should evaluate patients in advance before starting dental treatment. Aerosols generating procedures should be avoided and personal protective equipment should be used. Dental treatment should be restricted to emergency cases only.ConclusionOld medical staff should be in safer distance to avoid infection, but young physicians and nurses should work at frontline as their immunity is better than their colleagues at old age. Screening patients and measurement of the body temperature are essential measures before dental treatment.     

对我国医院感染管理现状及发展趋势分析

目的掌握我国医院感染管理现状,探讨其发展趋势.方法采用问卷形式对北京、上海、广州三城市不同级别的16家医院进行医院感染管理基本情况的调查,并与1994及1999年两次全国调查中的相关结果进行比较,同时对手部卫生执行情况进行现场观察评估.结果我国大中型医院的感染管理体系已日趋完善,在专业科室职能建设、专职人员队伍层次及水平等方面已达到较高水平,但仍存在许多问题;医护人员在接触病人后洗手率达60%,明显高于接触病人前及接触物品后35%的手卫生执行率.结论我国医院感染管理专业正处在飞速发展的关键时期,已有相当的积累和较为扎实的基础,但在发展方向上应全面引进质量管理的技术指标,尝试由结果评价为主的管理向过程管理转变,并突出循证医学在管理上的指导作用,用系统的观点推动医院感染管理与医疗过程的良性互动.     

Burden of meticillin-resistant Staphylococcus aureus colonization and infection in London acute hospitals: retrospective on a voluntary surveillance programme

Although meticillin-resistant Staphylococcus aureus (MRSA) is recognized as an important cause of hospital and community healthcare-associated morbidity, and colonization as a precursor to infection, few studies have attempted to assess the burden of both colonization and infection across acute healthcare providers within a defined health economy. This study describes the prevalence and incidence of MRSA colonization and infection in acute London hospital Trusts participating in a voluntary surveillance programme in 2000-2001. Hospital infection control staff completed a weekly return including details on incident and prevalent colonizations, bacteraemias and other significant infections due to MRSA. Incidence and prevalence rates were calculated for hospitals with sufficient participation across both years. Colonizations accounted for 79% of incident MRSA cases reported; 4% were bacteraemias, and 17% other significant infections. There was no change in incidence of colonization of hospital patients between 2000 and 2001. By contrast, there was an unexplained 49% increase in prevalence of colonizations over this period. For any given month, prevalent colonizations outnumbered incident colonizations at least twofold. This MRSA surveillance programme was unusual for prospective ascertainment of incident and prevalent cases of both colonization and infection within an English regional health economy. Consistent with other studies, the incidence and prevalence of colonization substantially exceeded infection. Given the small contribution of bacteraemias to the overall MRSA burden, and the surveillance, screening and control interventions of recent years, it may be appropriate to review the present reliance on bacteraemia surveillance.     

Perception in relation to a potential influenza pandemic among healthcare workers in Japan: implications for preparedness

Due to the potential for an influenza pandemic, preparedness for infection control in healthcare settings is essential from the standpoint of occupational health for healthcare workers. We conducted questionnaire surveys among Japanese hospitals to assess preparedness at the individual and institutional levels and their inter-relationship. Questionnaires were administered at 7 tertiary hospitals in Japan during the spring of 2006. We analyzed 7,378 individual responses of the 10,746 questionnaires administered and all seven institutional responses by hospital infection control committees. Healthcare workers assigned low importance to personal protective equipment and showed mixed attitudes (anxious but accepting) to the potential risk. Institutional gaps existed in preparedness across hospitals and most hospitals lacked the specificity to cope with a pandemic. A higher level of institutional preparedness, as determined by expertise as well as general and specific countermeasures, was an important predictor of individual recognition of preventive measures, perception of institutional measures, and attitude toward coping with risk. A higher level of institutional preparedness stood out to be an important predictor of individual preparedness. Considering the risk of a future influenza pandemic, hospitals should improve preparedness at all levels.     

陕西省医院感染管理体系现状调查及分析

目的调查陕西省二级及以上医疗机构医院感染管理现状,分析发展趋势,提出改进建议。方法采用分层随机抽样方法抽取陕西省10个地市的170所二级及以上医院进行调查,调查时间为2016年5—6月。调查内容包括：医院的基本情况,医院感染管理情况以及医院感染相关监测情况等。结果共获取165所二级及以上医院的有效问卷资料,其中三级医院43所,二级医院122所。165所医院中90%以上医院感染管理组织机构及制度职责基本健全,但医院风险管理方面亟待加强,目前仅63.03%的医院完善了风险管理制度,66.06%的医院进行了风险评估。医院感染相关培训及效果反馈较好,分别为99.09%和88.41%。人员配置方面：88.48%的医院医院感染管理专职人员配备符合规范要求,但仅有34.55%的医院有人才培养计划。仅33.94%的医院有医院感染专项经费。医院感染监测方面：仅21.21%的医院已安装使用医院感染监测软件;监测项目开展情况：开展医院感染病例监测和环境卫生学监测的医院占90%左右;但开展重症监护病房和新生儿目标性监测的仅占34.55%和23.64%。结论陕西省医院感染管理组织结构健全,相关规章制度基本建立,基础监测项目普及;但风险管理意识有待加强,并存在专职人员配备及专业素质发展不均衡,信息化监测力度不够等问题。