加强供应室消毒隔离以防止院内感染

随着现代医学的不断进步和发展,国内医院消毒供应室的建设与管理虽然有了很大的提高,但控制院内感染一直是重要的课题。加强供应室消毒隔离,是护理工作中防止院内感染的重要环节。供应室回收的物品来自我院各科室,交叉感染的机会很多。因此,供应室工作是医院防止交叉感染的关键。为有效防止院内感染,分析院内感染在供应室工作中存在的隐患,切断感染途径,从管理和思想上提高认识,制定出严密而又行之有效的预防院内感染的措施,从而防止院内感染的发生。     

呼吸机的清洗与消毒

目的：通过对呼吸机的有效清洗及消毒防止交叉感染,控制院内感染。方法：根据呼吸机的不同部件采取相应的消毒方法。结果：有效控制感染,在抢救过程中发挥必不可少的作用。结论：经过对呼吸机的清洗与消毒,明显地控制院内交叉感染,并且有效地提高了临床抢救成功率。     

保障供应室灭菌质量控制院内感染

在院内感染问题日益突出的今天，如何控制院内感染是每一个医务人员都关注的问题。供应室是医院不可缺少的重要组成部分。它既是医疗、护理、教学、科研所需各种灭菌器材、敷料及用品的供应中心，又是消毒灭菌防止交叉感染的重要基地。因此，保证供应室灭菌质量，是预防和控制院内感染的重要措施。     

试谈加强培养护生的无菌观念

医院是病人集中的场所，各种病原微生物多而汇集。如若管理不善，消毒隔离制度不健全，有可能成为疾病传播的发源地，而将病菌传给易感者，使疾病蔓延或发生交叉感染，甚至流行传染病。因此必须防止医源性感染或交叉感染。而院内杜绝感染及交叉感染的重要手段——消毒隔离等工作的主要具体执行者是护理人员，其消毒隔离的优劣，不仅直接影响防止院内感染及交叉感染的效果，以及护理管理工作的质量；还影响护生素质的培养，因此，我们必须加强防止医源性感染及交叉感染，以提高培养护生的无菌观念。     

ICU床旁血液净化42例的护理管理

目的：对床旁血液净化进行管理,保证机器的正常运行,防止院内感染及交叉感染。方法：将血液透析机搬至患者床旁进行治疗。结果：42例患者床旁血液净化治疗,机器运行良好,无1例发生院内感染及交叉感染。结论：加强床旁血液净化治疗过程中的环节控制和管理,能够及时发现病情变化,提高抢救、治疗成功率,有效避免医疗纠纷和差错事故的发生。     

控制因检验而造成的院内感染

控制因检验而造成的院内感染，是控制医院感染的一个重要环节。检验每天接触病人的血，尿，便，痰等各种标本，以及通过给患者采血等环节容易交叉感染。因此，保护检验人员自身有受感染，控制病人因检验而发生交叉感染，是搞好控制医院感染的重要任务。     

医院门诊口腔科感染的预防与控制

门诊口腔科是医院最易造成交叉感染的场所,我科现采用有效措施,按标准预防进行个人防护,控制内源性及外源性感染,防止发生院内交叉感染.     

加强护理管理预防院内感染

院内感染严重威胁着病人的身体健康,使病人住院天数延长,费用增加,控制院内感染已引起国内外医学界的普遍重视.在卫生部颁布的医院分级管理(试行草案)中,将院内感染发病率作为评价医院医护质量、实行医院分级管理的重要质量标准.防止院内交叉感染又是目前医院管理中的重要问题,与护理管理密切相关,而病区又是院内交叉感染的重要地方.因此,做好院内和病区的管理,预防院内感染是护理工作的一项重要内容.……     

院内感染的预防与护理措施

院内感染是指病人在医院内获得的感染。医院是各种病原微生物聚集的场所。医护人员在为病人治疗过程中，直接或间接的成为各种病原微生物的携带者和传播者．随着医学科学的发展和医疗技术的进步，院内感染的因素不断增多，多数住院病人身体抵抗力低下，易于再次感染。所以医院内感染已成为直接影响医疗效果的重要因素。因此我们认识和分析获得性感染的有关问题，对控制医院内的感染，提高医护质量是很有必要的。1空气污染的预防与控制空气是呼吸道疾病交叉感染的主要媒介。做好医院内空气消毒是防止院内呼吸道交叉感染的有力措施。1．l加强…     

血清感染性指标检测的临床应用及意义

在临床患者需要手术、输血及孕妇产前，以往实验室检查仅做血、尿、便常规检验，随着医院现代化管理和院内感染控制的开展，为了防止院内疾病交叉感染和母婴传播疾病的发生，我院检验科对手术、输血病人或产前妇女进行了乙肝表面抗原(HBsAg)，抗丙型肝炎病毒抗体(HCV)，抗人类免疫缺陷病毒(HIV)及梅毒螺旋体(TP)的检测，并作为患者血清感染指标的常规项目。现总结如下：     

广州市1例境外误诊登革热的新型冠状病毒肺炎病例调查

对1例境外误诊为登革热的新型冠状病毒肺炎（coronavirus disease 2019,COVID-19）进行流行病学调查,探讨被误诊的可能关键环节,为制定登革热流行期的新型冠状病毒肺炎防控策略提供依据。运用描述性流行病学方法对COVID-19病例及其密切接触者和可疑感染来源进行调查和分析,采用RT-PCR方法进行新型冠状病毒核酸检测、免疫层析法进行登革热病毒抗原、抗体检测。结果该COVID-19病例于病前14 d有武汉和柬埔寨居住史,2020年1月23日发病,在柬埔寨“某集团医院”门诊就诊1月30日检测登革热抗原NS1结果为可疑阳性,登革热抗体IgM、IgG结果均为阴性,该医院诊断为“可疑登革热”。1月31日凌晨,病例入境广州在某酒店隔离观察。经酒店驻点医务人员为病例采血送海珠区疾病预防控制中心以免疫层析法（胶体金）排查登革热,结果登革病毒NS1抗原阴性,IgM、IgG抗体均为阴性,排除“登革热”。1月31日医院采集咽拭子标本检测,结果新型冠状病毒核酸阳性,以“新型冠状病毒肺炎疑似病例”网络直报,2月1日广州市疾病预防控制中心复核新型冠状病毒核酸阳性,以“新型冠状病毒肺炎确诊病例”进行订正。COVID-19早期症状与登革热相似。在登革热流行期,做好登革热与COVID-19早期鉴别诊断非常重要,早诊早治,是预防疫情扩散的关键。     

PAIgG and PAIgM levels in secondary dengue virus infections lead to thrombocytopenia in patients from KP,Pakistan

Objective: To understand the impact of platelet associated immunoglobulin G(PAIg G)/platelet associated immunoglobulin M(PAIg M) on severity of dengue virus infection leading to thrombocytopenia.Methods: In this study we examined a total of 52 patients who were having secondary infection of dengue in acute phase by using competitive ELISA.Results: A decrease in the platelet count was observed at the acute phase of infection while all along the recovery stage the count of platelet was significantly increased. A significant decrease was observed in PAIg G and PAIg M in these subjects. Inverse correlation was found between platelets count and PAIg G/PAIg M among the subjects studied. In the platelets elution from ten subjects, anti-dengue virus immunoglobulin G and immunoglobulin M were observed. PAIg G and PAIg M with inclined levels were higher in dengue hemorrhagic fever than the classical dengue fever. In the development of dengue hemorrhagic fever PAIg M inclined level was independently associated with high specificity, showing a possible indication of dengue hemorrhagic fever.Conclusions: This study suggests that in secondary dengue virus infection, the PAIg G and PAIg M levels, and the activity of anti-dengue virus play key roles, both in the development and severity of the disease.     

Risk factors associated with development of dengue haemorrhagic fever or dengue shock syndrome in adults in Hospital Tengku Ampuan Afzan Kuantan

A retrospective study was conducted to investigate 183 serologically-confirmed cases of dengue fever (DF) admitted from October 2004 to March 2005 in a large hospital in Pahang. Clinical and laboratory features, progress and outcome of these patients were analysed in order to identify risk factors associated with development of dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS). Individually, we found that older patients, secondary dengue infection, high baseline haematocrit levels, low platelet levels and prolonged activated partial thromboplastin time (APTT) ratio were significant associations with bleeding tendencies. Of these risk factors, haematocrit and APTT ratio were two independent significant risk factors on multivariate analysis. Older patients with primary infection and younger patients with secondary infection had significant bleeding tendencies. We also verified the validity of the haematocrit levels suggested as cut-off levels for plasma leakage for the Malaysian population by Malaysian Clinical Practice Guidelines for Dengue Infection in Adults (2003).     

Repeated tourniquet testing as a diagnostic tool in dengue infection

Prospective evaluation of repeated standard tourniquet testing as a diagnostic indicator of dengue infection was done. Included were patients admitted to a children's hospital in Kuala Lumpur on a clinical suspicion of dengue infection based on the World Health Organization (WHO) criteria. A standard method of tourniquet was performed on 79 patients on a daily basis following admission. subjects and negative in the remaining 14 subjects. Fifty-eight subjects were serologically confirmed cases, 4 indeterminate and the remaining 17 subjects had negative serology. For diagnostic classification, 13 had dengue fever, 49 with dengue haemmorhagic fever (DHF) while 17 had non-dengue infection. The sensitivity and specificity of the tourniquet test was 82.8% and 23.5% respectively. The positive predictive value (PPV) was 78.7% while the negative predictive value (NPV) was 28.6%. In addition, the tourniquet test aided in the diagnosis of one-fifth of patients with DHF, who presented with a positive tourniquet test as the only bleeding manifestation. It seems that in a hospital setting, the tourniquet test adds little to the diagnosis of dengue infection/DHF. A positive tourniquet test, repeatedly performed, was found clinically useful as a preliminary screening test in dengue infection as recommended by WHO. However, it was not very specific and had a high false positive rate.     

Clinical and laboratory profile of dengue infection in children

The present work is a prospective, observational, hospital based study on 100 sero positive cases of dengue infection, admitted to Dhaka Children Hospital, Dhaka, Bangladesh during the period 2000 -2001. The patients were in the age group 8 months to 14 years with a mean age of 8.3 years. The serological tests were performed by rapid strip test. Primary dengue infection (only Ig M positive) was observed in 15% cases while rest 85% were secondary dengue infection (either Ig G or both Ig M and Ig G positive). Classical dengue fever (DF) was noted in 11% patients and 89% children presented with dengue hemorrhagic fever / dengue shock syndrome (DHF / DSS). Common clinical presentations were fever, headache, retro- orbital pain, arthralgia / bone pain, vomiting, abdominal pain and bleeding manifestations. Other presentations were tachycardia, bradycardia, hypotension, hepatomegaly, splenomegaly, pleural effusion, ascites, thrombocytopenia and high hematocrit values. The incidences of tachycardia, hypotension, hepatomegaly, high hematocrit and thrombocytopenia were significantly higher in DHF / DSS cases. The tourniquet test was positive in significantly higher percentage of DF cases. The tourniquet test and thrombocytopenia did not correlate well with other bleeding manifestations suggesting alternate pathogenesis for bleeding. In an epidemic setting, if a child presents with fever, vomiting, musculoskeletal pain and bleeding along with hepatomegaly, low platelet count and high hematocrit, a strong possibility of DHF/ DSS should be kept.     

Serum transaminase level changes in dengue fever and its correlation with disease severity

It was observed that liver enzymes are elevated in dengue fever. In this study our aims were to determine the changes in serum transaminases in dengue fever, dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) and to find out the relation of transaminase level changes with the disease severity. This cross sectional, prospective hospital based observational study was carried out in the department of Gastrointestinal Hepatobiliary and Pancreatic diseases and Internal Medicine department of BIRDEM Hospital, Dhaka. Patients are classified into 3 groups depending on clinical & laboratory findings: Group 1 dengue fever (DF), Group 2 dengue hemorrhagic fever & Group 3 dengue shock syndrome. A total of 240 cases were taken in this study who fulfilled the selection criteria. Out of whom 125 male and 115 female patients. DF was 157(65.4%) & DHF was 83(34.6%). Aminotransferases [aspartate aminotransferase (AST) and alanine aminotransferase (ALT)] were significantly raised in DHF cases compared to those of classical dengue fever (AST 84.5±42.4 in DF vs. 507±106.8 IU/L in DHF and ALT 59.9±31.3 in DF vs. 234±30.6 IU/L in DHF). The rise of AST is far greater than ALT in both DF and DHF. Dengue fever is usually associated with mild to moderate elevations of aminotransferase levels. The increase in aminotransferases, mainly AST has been associated with disease severity and serves as an early indicator of dengue infection.     

广州市越秀区一起家庭登革Ⅲ型病毒感染疫点调查

目的通过对一起本地感染登革Ⅲ型病毒疫点调查与处理,为登革热疫情的现场调查和蚊媒控制提供参考。方法对2009年8月广州市越秀区发生的一起感染登革Ⅲ型病毒疫情进行调查,采用酶联免疫吸附试验（ELISA）对病家成员和疫点周围人群进行登革热抗体检测,采用布雷图指数对蚊媒密度进行监测和评估,按照登革热疫点处理规范开展疫情控制。结果现场调查和实验室检测确证矿泉街内发生一起1家3口同时感染登革Ⅲ型病毒的登革热疫情,病例均在1个潜伏期内发病,未出现二代病例,监测点蚊媒密度布雷图指数高达35.19,采取措施后,降低到5以下。结论该疫点可能是由输入病例引起的一起本地感染登革Ⅲ型病毒的家庭聚集性疫情,采取以整治环境卫生、迅速杀灭成蚊、清理积水和隔离治疗病人等综合措施后,疫情在较短时间内得到有效控制。     

The first patient with locally acquired dengue fever in Hong Kong

This report is of the first locally acquired case of dengue fever. The diagnosis was made even in the absence of a history of travel outside Hong Kong. The patient was a 21-year-old man, who presented with high fever, leukopenia, thrombocytopenia, and elevated liver enzymes. His haematocrit revealed mild haemoconcentration but the albumin was normal throughout the course of the illness. His blood pressure remained low with no tachycardia or overt shock syndrome. The pyrexia subsided 4 days after admission to hospital and all haematological and biochemical abnormalities eventually normalised. The pathogenesis, diagnostic criteria of dengue haemorrhagic fever and dengue shock syndrome, and control of dengue infection are discussed.     

深圳市福田区2005~2013年登革热疫情及流行风险分析

目的了解深圳市福田区登革热流行现状、分布特征,为防治登革热提供科学依据。方法收集2005~2013年福田区登革热报告病例资料,建立数据库并进行流行病学分析。结果 2005~2013年福田区共报告登革热病例24例,输入性病例13例,占54.17%,本地病例11例,占45.83%,每年输入性病例在7~10月最多,主要源于东南亚。24例病例发病至报告时间中位数为6d,波动范围3~13d。初诊至诊断的时间中位数为2 d,波动范围为0~11d,属于最不稳定的时间段。结论福田区登革热发病率较低,以输入性病例为主,建议加强从东南亚等重点国家入境旅客的检疫查验;影响登革热病例发病至报告的间隔主要为发病至初诊的时间,建议加强社区健康教育宣传,加强临床医生知识培训以及加快推广登革热快速检测技术。     

汕头市2006年登革热的流行情况及防制对策

目的分析2006年汕头市登革热流行特征和防治措施,探索适宜的防制对策。方法对2006年汕头市登革热监测、实验室结果及疫情调查处理进行综合分析。结果汕头市2006年报告登革热177例,发病率为18.72/10万。疫情波及1区个8个镇（街道）,病例集中在9-10月份,流行期为53d。临床表现以轻型登革热为主。在7份急性期病人的血标本中分离出3株登革Ⅰ型病毒。病例以多点散发流行为主。疫点媒介密度高,传染源未及时发现是造成传播扩散的主要因素;设立定点医院,开展地毯式病例搜索和清理伊蚊孳生地是疫情得到较快控制的主要措施。结论2006年汕头市登革热疫情是由登革Ⅰ型病毒引起的,病例临床症状轻。以疫情多发区为中心,以周边区为重点,采取加强传染源控制管理和清除蚊媒孳生地及疫点紧急灭蚊等综合措施,是较快扑灭疫情的有效防制对策。