格林模式健康教育在预防手术室血源性职业暴露中的应用

目的评价格林模式健康教育对手术室护士预防血源性职业暴露的知识水平、态度和标准防护措施行为依从性的影响。方法 2018年7—12月采用整群抽样法在西安交通大学第二附属医院(西北医院)选取92名手术室护士作为调查对象,基于格林模式设计调查问卷和健康教育干预方式。采用自行设计的手术室医务人员血源性暴露调查问卷,评估干预前发生血源性职业暴露防护现状相关防护知识、态度和标准防护措施行为依存性,及过去1年中发生的暴露史。根据得分较低的条目制定针对性倾向因素、促成因素和强化因素的健康教育干预方案。采用t检验比较干预前后血源性暴露防护知识、态度和标准防护措施行为依存性得分。结果干预前手术室护士血源性职业暴露防护知识、态度和行为依从性得分分别为7.13±1.69、31.46±5.37和30.09±4.65。格林模式健康教育干预后6个月,防护知识、态度、行为依从性得分分别为11.73±1.02、37.20±4.15和43.51±1.00,差异均有统计学意义(t=23.92、31.88、26.84,均P0.05),结论格林模式健康教育可增强手术室护士预防血源性职业暴露的知识水平,改善防护态度和标准防护措施行为依从性。     

手术室护士血源性病原体职业危害相关因素调查分析

目的了解手术室护士职业危害现状,为采取针对性的职业教育和防护措施,降低手术室护士血源性病原体职业危害提供科学依据。方法采用问卷方法调查2008-2009年医院手术室38名护士血源性病原体职业危害因素及相关知识掌握情况测评。结果 38名护士中接触血性传播性疾病达68.42%;受伤率78.9%,缝合针居首位;护龄<5年的低年资护士锐器伤占76.67%;大多数损伤发生在整理或清洗器械占36.67%;职业危害相关知识测评中,主要问题是对职业暴露的危害认识不清,不了解、不遵从标准的行为仍普遍存在。结论手术室护士接触血源性病原体概率高,锐器损伤概率大,血源性疾病传播危害性大,手术室护士预防血源性病原体感染迫在眉睫,应采取积极有效的措施加以防护。     

护士血源性病原体职业暴露的防护

目前，各国都在用不同的方式预防护士血源性职业暴露的问题，在国内护士的职业安全问题开始受到关注，也做了一些相关的调查研究。笔者现就国内外护士血源性病原体职业暴露的防护研究进展进行论述如下。     

医务人员血源性职业暴露危险因素的预防

目的 调查医务人员发生血源性职业暴露的高危人群、科室及操作环节,并探讨发生血源性职业暴露高危险因素的防护策略。方法 建立血源性职业暴露监测报告系统,医务人员发生职业暴露后填写“职业暴露个案登记表”,调查分析2012年6月-2013年5月所上报61名医务人员发生血源性职业暴露情况,采用SPSS 17.0软件进行统计处理。结果 在上报的61名职业暴露人员中,以护士和护生人数最多,占80.33%;发生职业暴露较多的科室为普通病房、手术室和急诊室,分别占54.1%、19.67%和9.84%;发生较多的操作环节为输液完毕拔针及各种注射、穿刺、抽血拔针,手术缝合和集中分离针头,分别占39.34%及13.11%,11.48%和9.48%;暴露者未戴手套操作占86.89%,以接触不明源患者或病原体的后续预防最为棘手,暴露源中以携带乙型肝炎病毒最多,占54.10%。结论 血源性职业暴露多发生于护士和护生,病房、手术室和急诊室是主要场所,某些不规范的临床操作为高发因素,对标准预防知识的掌握和应用态度、使用安全锐器或针具进行安全操作、及时接种乙型肝炎病毒疫苗以及发生职业暴露后主动上报,是医务人员血源性职业暴露的最佳防护策略。     

低年资护士血源性职业暴露防护依从性现状及影响因素

目的 探讨低年资护士血源性职业暴露防护依从性现状及影响因素。方法 对2019年6月至2021年5月在长沙市某医院入职时间为3年内的且已获得护士从业资格证书的护士人员进行血源性职业暴露防护依从性及相关因素问卷调查,采用描述性分析方法对低年资护士血源性职业暴露防护依从性进行分析并探讨其影响因素。结果 共纳入低年资护士112人,均为女性,平均（22.12±2.12）岁。血源性职业暴露防护依从性总评分为（18.51±2.98）分,得分>20分的低年资护士有46人,依从性良好率为41.1%。多元线性回归分析结果显示,每年参与职业暴露培训次数（β’=0.248）、职业暴露风险认知水平（β’=0.379）、自我效能水平（β’=0.106）、防护态度水平（β’=0.241）、健康信念水平（β’=0.119）是影响低年资护士血源性职业暴露防护依从性的因素。结论 低年资护士职业暴露防护依从性较低,通过加强低年资护士职业暴露培训、提高护士血源性职业暴露防护知识、态度及自我效能水平将有助于提高护士职业暴露防护依从性,从而降低血源性职业暴露发生率。     

手术室护士血源性暴露危险因素的预防措施

目的 探讨手术室护士对血源性暴露危险因素的预防措施,为其临床防治提供依据.方法 共纳入47名手术室护理人员,详细记录其相关信息,对发生血源性暴露的患者进行分析,根据具体情况分析可能的原因并提出相应的预防措施.结果 47名护理人员中23人有血源性暴露史,6人发生≥2次,共31人次;其中11人次被锐器损伤,损伤率为35.5％,18人次污血等溅落到眼睛或皮肤上,发生率为58.1％,2次为直接接触血液,占6.4％;23人有暴露史的人员均未发生血源性感染;31人次暴露史中主要以乙型肝炎病毒为主,有14人次,其次为丙型肝炎病毒,有11人次,其他包括人类免疫缺陷病毒、梅毒、疟疾等共6人次,分别占45.2％、35.5％及19.4％.结论 由于职业因素影响,手术室护士发生血源性感染的风险比较大,个人及医院均需要采取积极的预防措施,避免血源性感染的发生,保护护理人员的生命安全及健康.     

兰州大学第一医院医护人员血源性病原体职业暴露调查分析

目的探讨医护人员血源性病原体职业暴露的危险因素和预防措施。方法对2011—2013年兰州大学第一医院发生血源性病原体职业暴露的310名医护人员报告登记的"血源性病原体职业接触登记表"进行统计分析。结果 310名发生职业暴露的医护人员中,感染血源性疾病0人;护士的职业暴露发生率最高,占49.68%;被空心针头扎伤的比例最高,占62.26%;引起职业暴露最常见的原因是由于诊疗过程中的操作或处理不慎,占58.06%。结论加强职业安全教育,严格执行标准预防,是控制医护人员职业暴露的关键。     

医务人员血源性职业暴露监测分析与防护对策

目的 了解血源性职业暴露状况,建立医务人员血源性职业暴露报告流程和监测管理系统,为制定职业暴露防护对策提供科学依据.方法 监测了2005年11月-2008年11月,95名血源性职业暴露的医务人员,对其职业、高危因素、致锐器伤操作环节、暴露后的风险评估以及预防用药等进行了分析.结果 血源性职业暴露护士发生率最高(75.79%),其次是医师(16.84%);职业暴露类型主要是锐器伤造成,锐器类型以输液器针头占首位;致锐器伤操作环节以输液结束拔针与回套或徒手拔针帽时发生率最高;经风险评估,3名HIV职业暴露者,给予预防用药,无1名因职业暴露而发生血源性病原体感染.结论 加强医务人员培训教育,规范操作流程,实施标准预防,建立监测系统、完善报告流程及暴露后正确有效处理和干预,是降低职业暴露风险的关键.     

河南省部分医疗机构手术室医护人员血源性职业暴露风险研究

目的 分析手术室医护人员血源性职业暴露风险及其影响。方法 于2019年9月采用方便抽样方法对河南省3家三甲医院的手术室医护人员作为调查对象进行过去1年血源性职业暴露情况调查,采用描述性分析方法对医护人员血源性职业暴露发生情况进行分析,并采用单、多因素分析方法对血源性职业暴露发生影响因素进行分析。结果 本研究共收集304名手术室医护人员调查问卷,其中医生128名,护士156名,麻醉医师20名。304名医护人员中过去1年发生过血源性暴露者37例,发生率为12.17%。血源性暴露病原体以HBV为主,22例,占59.46%。非条件Logistic回归分析结果显示年龄（OR=1.363）、工龄（OR=1.784）、学历（OR=0.516）、专业知识认知程度（OR=0.400）均是血源性职业暴露的影响因素。结论 手术室医务人员存在血源性职业暴露风险,发生率主要受年龄、工龄、学历、专业知识认知程度影响,应对该类医护人员专业知识培训并实施针对性保护措施;乙肝病毒为最主要的暴露源,医护人员应提前接种乙肝疫苗,加强工作时的自我保护意识。     

手术室医务人员血源性职业暴露调查分析

目的分析手术室医务人员血源性职业暴露情况。方法以2018年1月至2019年10月在本院手术室工作的医务人员625例为调查对象,记录血源性职业暴露发生情况。使用自制的调查问卷收集血源性职业暴露者的性别、年龄、受教育程度、工作年限、血源性职业暴露相关认知、暴露病原体、暴露环节。结果 625例手术室医务人员中,发生血源性职业暴露51例(8.16%)。不同性别、年龄、受教育程度、工作年限、血源性职业暴露相关认知情况的医务人员血源性职业暴露发生率比较差异均有统计学意义(均P0.05)。多因素Logistic回归分析显示,年龄、受教育程度、工作年限、血源性职业暴露相关认知情况是手术室医务人员血源性职业暴露的独立影响因素(均P0.05)。主要病原体为乙型肝炎病毒、丙型肝炎病毒及苍白密螺旋体;主要暴露环节为手术缝合时刺伤、输液拔管时刺伤、手术操作器械割伤。结论手术室医务人员血源性职业暴露发生率较高;应针对影响因素、职业暴露病原体构成、职业暴露环节构成情况进行重点防控。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.