1999年萧县医疗机构消毒灭菌质量监测分析

为分析评价萧县三级医疗机构消毒灭菌质量 ,为预防和控制医源性感染提供科学依据。对 1 999年萧县县、乡、村医疗机构 4类标本微生物污染监测结果分析。共监测医疗单位 42 4个 ,采集标本 2 950份 ,合格率 77.4 %。县、乡、村监测合格率分别为 86 .1 %、77.3 %和75 .7% (P <0 .0 1 ) :4类标本监测合格率依次是 :一次性使用医疗用品 1 0 0 % ;使用中消毒用品92 .6 % :消毒后医疗用品 67.8% ;灭菌后医疗用品 60 .7% (P <0 .0 1 )。结果表明医疗机构消毒灭菌质量均不高 ,但级别高的医疗相对医疗相对较好 ,一次性使用医疗用品消毒灭菌合格率高 ,而医院灭菌后医疗用品合格率偏低 ,应强化消毒管理措施 ,全面提高医疗单位消毒灭菌质量     

2005～2006年辰溪县不同级别医疗单位消毒质量检测分析

[目的]了解我县医疗单位消毒工作现状,为促进指导全县医疗消毒工作提供科学依据.[方法]收集县疾病预防控制中心卫生监测科2005～2006年的医疗单位消毒质量监测资料,进行统计分析.[结果]2005～2006年共检测2 068份,合格1 630份,合格率为78.82%.2005年合格率为74.85%,2006年合格率为82.76%,差异有统计学意义(P<0.01).县、乡、村三级医疗单位消毒监测合格率以县级最高(83.5%),村级最低(76.2%),不同级别医疗单位的消毒质量差异有统计学意义(P<0.01).[结论]县、乡、村三级医疗单位消毒合格率较低,各级要各自针对消毒灭菌的薄弱环节加以改进,全面提高消毒质量.     

清流县医疗单位室内空气消毒质量监测分析

为了解我县医疗单位空气消毒质量,我站于2004年6～8月,对县、乡(镇)、村三级医疗单位的室内空气消毒效果进行监测,现将情况报告如下。     

县,乡,村三级医疗单位院内感染现状及防治对策的研究

为全面了解县、乡、村三级医疗单位院内感染工作现状,我们对其消毒质量进行了监测,现将结果报告如下。1对象与方法1．1对象我市人民医院、中医院、妇保所、皮防所、计划生育技术指导站等5个县级医疗单位、25个乡镇卫生院,及随机抽查的43个村卫生室。1．2方法严格按照卫生部制定的《消毒技术规斯以及各项检验技术操作规程要求,对县、乡、村三级医疗单位的手术室、产房、治疗室、供应室、注射室、采血室、门诊以及病房等有关科室的室内空气、台面、医疗人员的手部、各种无菌器械和物品的消毒质量、各种消毒液的细菌指标、浓度等进行了全面…     

内乡县医疗机构消毒监测报告与分析

目的：了解和掌握我县医疗机构消毒工作状况，分析原因，提出改进对策。方法：按《全国卫生防疫规范》中消毒监测规范和卫生部1991年《消毒技术规范》规定的方法对我县县、乡、村三级医疗单位进行消毒监测。结果：1999年-2002年共检测品6785份，合格5989份，合格率88．3％，1999年-2002年合格率依次为69．6％、88．5％、96．4％、96．5％。消毒液、物体表面、医务人员手表面、空气、紫外线杀菌强度依次为89．9％、89．2％、87．7％、81．3％。县、乡、村各级医疗单位消毒的合格率分别为91．6％、88．5％及87．5％。结论：县、乡、村三级医疗构消毒效果不容乐观，村级存在问题较多。     

2002年太湖县医疗机构消毒灭菌质量监测分析

目的：分析评价太湖县三级医疗机构消毒灭菌质量，为预防和控制医源性感染提供科学依据。方法：按照卫生部《消毒技术规范》等规定的方法，对2002年太湖县县、乡、村医疗机构消毒灭菌质量监测结果分析。结果：共监测医疗单位264个，采集样本1223份，合格率为65．2％。县、乡、村监测合格率分别为93．2％、71．1％和60．3％(P＜0．01)。6类样本监测合格率分别是：紫外线灯辐照值为100％，物体表面和医护人员手为75％，压力蒸汽灭菌为75％，灭菌后医疗用品为73．4％，消毒后医疗用品为68．5％，空气为26．6％。结论：消毒灭菌工作是医疗机构医院感染管理中的一个薄弱环节，存在不少问题，需采取切实可行的措施强化管理，全面提高医疗机构消毒灭菌质量。     

巨野县医院消毒情况调查报告

为贯彻执行《传染病防治法》和《消毒管理办法》,控制医院感染 ,我站于 2 0 0 0年 8～ 11月对县、乡、村三级医疗单位的消毒情况进行了调查 ,现将调查情况报告如下。1　材料与方法1.1　调查对象　县级医疗单位 6处 ,乡镇卫生院 2 7处 ,村卫生所 313处。1.2　调查方法　按照《消毒技术规范》之微生物污染监测技术 ,对医院物体表面、医务人员手、空气、使用中的消毒液进行采样及检测。1.3　判断标准　按照《消毒与灭菌效果的评价方法与标准》(GB15 981- 1995 )和《医院消毒卫生标准》 (GB15 982 -1995 )判定。2　结果在检测的 4类物品中 ,合…     

1997～2000年濮阳县三级医疗机构消毒监测结果

目的 加强全县县、乡村三级医疗机构消毒管理工作。方法 依据《传染病防治法》、《消毒管理办法》,于1997～2000年对全县三级医疗机构采取随机抽样方式进行了消毒监测。结果 县、乡、村三级医疗机构消毒监测总合格率之间差异有非常显著性(X~2=460.0,P<0.01);,1997～2000年各年消毒总合格率之间差异有显著性(X~2=653.8,P<0.01)。结论 进一步加强监督管理,巩固县级,抓好乡级,促进村级的改进意见,目的是进一步提高消毒质量,保障医疗安全,预防医疗纠纷的发生,提高该县的全面医疗服务水平。     

鼎城区三级医疗单位消毒现状的调查

为了解我区医疗单位的消毒现状，遂于1996年进行了调查。现将结果报告如下。1内容与方法在全区范围随机抽取区级医院3所、乡卫生院10所、村卫生室25所为调查单位，按湖南省卫生厅湘卫函（1993）39号颁布的《湖南省医院消毒监测方案》，对各受查单位进行样品采集、检测和结果评价。2结果抽检38所区、乡、村三级医疗单位的7类17种物品样553份，附表可见，总合格率为75．59％，三级医疗单位合格率以区级院为最高，乡卫生院次之，村卫生室最低，三者间有高度显著性差异（X2=12．30，P＜0．01），不同物品的合格率，以高压蒸气灭菌锅和医疗卫生…     

淮北市医疗机构消毒工作质量监测结果分析

目的　了解近几年淮北市医疗机构消毒工作质量状况 ,为预防和控制医源性感染提供依据。方法　依据《医院消毒卫生标准》(GB15 982 - 1995 )、《消毒技术规范》 ,于 1997～ 2 0 0 3年间对辖区医疗机构消毒工作质量进行调查。结果　监测总样本合格率由 1997年的 5 1.71%上升到 2 0 0 3年的 76 .99% (P <0 .0 1) ,其中市、厂矿、个体 (村 )诊所三级医疗机构合格率分别为 6 1.0 7%～ 87.78% (P <0 .0 1)、5 0 .30 %～ 76 .72 %(P <0 .0 1)、32 .5 3%～ 5 4 .19% (P <0 .0 1)。不同监测内容中以一次性使用医疗用品、使用中消毒液、灭菌医疗用品、压力蒸汽灭菌器消毒灭菌效果合格率较高 ,分别为 89.4 7%～ 10 0 .0 0 %、6 8.16 %～ 86 .6 7%、71.71%～ 86 .2 5 %、71.4 3%～ 82 .19% ;空气合格率最低 ,为 12 .6 9%～ 6 0 .4 7%。结论　市级医院有较完善的组织制度和自我监测系统 ,消毒方法合理、规范 ;而基层医疗机构 ,尤其是个体诊所、村卫生室消毒意识淡薄 ,消毒技术、方法更新较慢 ,消毒资金投入少 ,又缺乏有效的监督管理 ,是目前医院消毒管理工作的薄弱环节。     

安阳县2005—2007年医院及诊所消毒效果检测分析

目的 了解安阳县医院及诊所消毒工作状况,找出消毒中存在的问题,降低和控制医院及诊所的感染发生率。方法 于2005-2007年抽样监测,全县3家县直属医院、15家乡级卫生院和30家村级诊所的消毒效果,对结果进行回顾性分析。结果 县直属医院共检测样品625份,合格率为91．84％;乡级卫生院共检测样品856份,合格率为86．92％;村级诊所共检测样品1531份,合格率为62．31％。各级医院医护人员手的消毒合格率均最低,分别与空气、物体表面消毒合格率比较,P〈0．01;村级诊所消毒效果合格率低,与其直属医院和乡级卫生院比较,差别均有统计学意义（x^2：29．36,V=2,P〈0．01）。结论该县村级诊所消毒合格率偏低,存在发生院内感染的危险,应提高医护人员手的消毒合格率。     

Injection practices among nurses--Vâlcea, Romania, 1998

In the early 1990s, human immunodeficiency virus (HIV) infection associated with possible reuse of syringes and needles was reported among children in Romanian orphanages. These findings led health-care workers to use new disposable syringes and needles for administering injections. Bythe late 1990s, reports suggested that new disposable syringes and needles had become standard for all injections. However, surveillance data collected by the Romanian Ministry of Health (MoH) during 1997-1998 indicated that acute hepatitis B virus (HBV) infection was associated with receiving injections among children aged <5 years. In Romania, injection frequently is used to administer medication, and nurses administer most injections. To identify the practices that might have resulted in injection-associated HBV transmission, selected clinic and hospital nurses were surveyed. This report summarizes the findings of the survey, which indicated that although nurses used new disposable syringes and needles, other inadequate infection-control practices might explain injection-associated HBV transmission. Results of the survey were used by the Romanian Coalition to Prevent Nosocomial Infections to prepare standards for injection safety to protect patients and health-care workers from HBV infection.     

Survey of knowledge,attitude and behavior regarding safe injection among health practitioners in Shandong,China

PURPOSE: To assess the knowledge, attitude and behavior of health practitioners (HPs) about safe injection in Shandong, China and to clarify risk factors related to unsafe injection and improper handling of used disposable syringes. METHODS: A cross-sectional study of 497 HPs in three-levels of health units (village clinic, township health center, and county hospital) in two areas of Shandong, China was carried out using a questionnaire. RESULTS: 468 HPs returned completed questionnaires. The proportion that did not receive formal medical education in the village (21.5%) was higher than in the township (9.9%) and in the county (2.5%). Proportions of HPs who only used disposable syringes were 97.0% in the county, 81.1% in the township and 69.0% in the village. Scores for safe injection knowledge among village HPs were significantly lower than those with township and county HPs (P < 0.001). Rate of unsafe injection practice was 6.2%, rate of improper handling of used disposable syringes was 7.6%, and both of which were significantly greater at the village level. Four factors were found to be significantly related to unsafe injection practice (P < 0.05): lower than middle level professional grade; knowledge scores of < 15 (full score 18); thinking that AIDS is not a terrible disease; and thinking that patients would accept the practice of sharing the same syringe for different persons. Four factors were found to be significantly related to improper handling of used disposable syringes (P < 0.05): working in the village; knowledge scores of < 15; thinking that patients would accept the practice of sharing the same syringe for different persons; and unwillingness to properly handle used disposable syringes. CONCLUSIONS: HPs working in village clinics had comparatively high rates of unsafe injection practice and improper handling of used disposable syringes, and a lower level of knowledge about safe injection. Lack of knowledge about safe injection was a risk factor for both unsafe injection and improper handling of used disposable syringe. Therefore, interventions should focus on this insufficient level of safe injection knowledge.     

新疆乡镇卫生院患者满意度调查研究

目的通过深入了解新疆乡镇卫生院患者的满意度情况,为制定满足患者需求的可行性制度和办法提供科学依据。方法采用随机分层抽样方法,从新疆地区最早试点的13个县中随机抽取6个试点县,按财政收入分为3个层次,每个层次中随机抽取1个乡镇卫生院,对患者采用问卷调查获取资料。结果患者对乡级医疗机构与村卫生室总体满意度高于县级医疗机构;乡镇卫生院患者对新型农牧区合作医疗的总体满意的占77.09%,其中愿意继续参加新型农牧区合作医疗的占89.90%。对乡政府的补助满意者占65.31%。结论服务态度及医疗技术水平对各个医疗机构就诊患者满意度影响较大;且农村合作医疗需要进一步完善;目前各级乡镇卫生院患者对其服务态度、收费及就诊程序已经能广泛接受,但是设备环境、技术水平等方面仍需进一步提高。     

Hepatitis B control in China: knowledge and practices among village doctors.

OBJECTIVES. To guide development of a hepatitis B control program in China, we investigated village doctors' sterilization practices, injection use, vaccination levels, and knowledge and counseling skills. METHODS. The head doctor from each village health station in a rural county (n = 260) completed a self-administered questionnaire. RESULTS. Of the respondents, 94.2% reported adequate sterilization of needles; however, inadequate sterilization of syringes and acupuncture needles was common. Injections were found to be frequent and profitable. Of head doctors, 16.2% reported that most infants in their villages are vaccinated against hepatitis B. There was very high knowledge of modes of hepatitis B transmission, but it was not used to formulate advice for a hypothetical carrier. Knowledge of the consequences, prevalence, and use of condoms to prevent sexual transmission was lower. CONCLUSIONS. The sterilization of acupuncture needles, reuse of syringes, and frequent injections are practices that may transmit the hepatitis B virus. Research into issues of vaccine acceptance is needed to expand immunization. A review of treatment practices and better training in counseling for village doctors is suggested.     

欠发达地区门诊患者就诊机构选择及影响因素——基于我国西部地区县级医院及乡镇卫生院的实证研究

目的:调查西部农村地区医疗机构门诊患者治疗常见病的就诊机构选择,并分析其影响因素。方法:研究收集我国西部11省的县级医院和乡镇卫生院门诊患者常见病就诊机构选择情况,采用非条件无序多分类logistic回归和卡方检验分析就诊选择的影响因素。结果:共纳入4 233名样本,其中45.5%选择乡镇卫生院。样本来源机构、省份和受访者性别、教育程度、职业、月收入、医保类型等自身因素对患者的选择意愿有显著影响。就诊机构的"距离"、"收费的合理性"、"医务人员服务态度"及"医务人员技术水平"是就诊选择的主要外部原因。结论:男性、务农务工群体、教育程度较低、收入较低的患者,倾向于在级别较低的医疗机构就诊;农村居民对村卫生室的医疗需求多为方便、及时,对较高级别的医疗机构(如县级及以上医院)的需求则定位于更好的服务态度和技术水平,因此村卫生室、乡镇卫生院应更注重提高基本医疗服务的可及性,而县级及以上医疗机构应着眼于提升医疗服务水平、改善患者的可负担性及满足患者较高层次的卫生服务需求。     

2008年夏津县村级医疗机构医疗废弃物管理知识水平调查

[目的]了解夏津县村级医疗机构医务人员对医疗废物管理知识的知晓情况,探讨开展健康教育的方法。[方法]2008年4月,采用随机抽样方法对夏津县村级医疗机构的医务人员进行问卷调查。[结果]村级医疗机构的医务人员对医疗废弃物管理知识的知晓率在19．21％～90．39％之间。不同文化程度、不同技术职称、不同专业人员对相关知识的知晓率除个别知识外多无明显不同,差异无统计学意义（P〉0．05）。55．37％的村级医疗机构医务人员是以继续教育和业务培训来获取相关知识。[结论]村级医疗机构医务人员对医疗废弃物管理知识的掌握不够系统、全面,应加强对村级医疗机构医务人员医疗废弃物管理相关知识的培训。     

Risk of transmission of hepatitis B virus through childhood immunization in northwestern China

Transmission of bloodborne pathogens by means of unsafe injection practices is a significant public health problem in developing countries. Although the overall proportion for immunization is low among injections, unsafe immunization practices affect mostly infants, a population with an increased likelihood of becoming hepatitis B virus carriers. This study estimated the prevalence of unsafe injection among vaccinators working at the peripheral level in northwestern China and the risk of HBV infections among infant vaccinees, and analyzed factors contributing to the most prevalent unsafe practice: the reuse of a non-sterilized reusable syringe among infants. A knowledge-attitude-practice survey was conducted in which 180 peripheral vaccinators selected by multi-stage cluster sampling in each of four provinces and one autonomous region completed a self-administered questionnaire. The lack of observational data for assessing the validity of the self-reported practices made the study prone to systematic respondent bias that may have skewed the results towards underestimation of unsafe practices. The minimum estimate of the percentage of peripheral vaccinators reusing a syringe and/or needle without sterilization between infants was 7.2-55.0%, whereas the percentage of those disposing of used disposable syringes and needles inappropriately was 8.9-23.3% by province. According to a model-based estimate, the annual number of HBV infections among 100,000 fully immunized children due to unsafe immunization injection was at least 135-3120. An insufficient supply of syringes and the attitude to justify reuse were significantly associated with the unsafe reuse of a reusable syringe in most part of the area studied. Introduction of auto-disable syringes may contribute to curb the unsafe practices, but the development of safe collection and disposal procedures for used syringes and needles is prerequisite. Sufficient supply of equipment as well as training, supervision, and monitoring targeting specifically on the risk behaviors and concerned attitudes are essential for behavior changes among the vaccinators.     

Model-based estimates of risks of disease transmission and economic costs of seven injection devices in sub-Saharan Africa

OBJECTIVE: To investigate and compare seven types of injection devices for their risks of iatrogenic transmission of bloodborne pathogens and their economic costs in sub-Saharan Africa. METHODS: Risk assumptions for each device and cost models were constructed to estimate the number of new hepatitis B virus (HBV) and human immunodeficiency virus (HIV) infections resulting from patient-to-patient, patient-to-health care worker, and patient-to-community transmission. Costs of device purchase and usage were derived from the literature, while costs of direct medical care and lost productivity from HBV and HIV disease were based on data collected in 1999 in Côte d''Ivoire, Ghana, and Uganda. Multivariate sensitivity analyses using Monte Carlo simulation characterized uncertainties in model parameters. Costs were summed from both the societal and health care system payer''s perspectives. FINDINGS: Resterilizable and disposable needles and syringes had the highest overall costs for device purchase, usage, and iatrogenic disease: median US dollars 26.77 and US dollars 25.29, respectively, per injection from the societal perspective. Disposable-cartridge jet injectors and automatic needle-shielding syringes had the lowest costs, US dollars 0.36 and US dollars 0.80, respectively. Reusable-nozzle jet injectors and auto-disable needle and syringes were intermediate, at US dollars 0.80 and US dollars 0.91, respectively, per injection. CONCLUSION: Despite their nominal purchase and usage costs, conventional needles and syringes carry a hidden but huge burden of iatrogenic disease. Alternative injection devices for the millions of injections administered annually in sub-Saharan Africa would be of value and should be considered by policy-makers in procurement decisions.     

587名医务人员乙型肝炎标志物检测结果与分析

目的 了解临床医务人员乙型肝炎标志状况,为医院进一步制定高危医务人员干预策略和措施提供依据.方法 医院有可能接触患者血液、体液,存在利器损伤风险的医师、护士、检验人员进行乙型肝炎标志物检测,采用酶联免疫吸附试验法(ELISA).结果 在被检测的587名医务人员中,对乙型肝炎病毒缺乏有效主动免疫能力者311人,占52.98%;乙型肝炎病毒感染者196人,占33.39%.结论 医务人员是乙型肝炎感染的高风险人群,各级医疗单位在注重对他们的自身防护工作的同时,还应积极推广对高危医务人员接种乙型肝炎疫苗,预防医源性乙型肝炎感染.