口腔正畸医疗器械消毒效果及医务人员手卫生调查分析

目的分析口腔正畸器械消毒效果,调查医务人员手卫生情况,并探讨针对性预防措施,为临床提供借鉴。方法将医院口腔科正畸器械于消毒前后分别进行细菌培养,医护人员消毒后采用一次性擦手纸巾擦手为对照组,采用消毒干毛巾擦手为观察组,比较正畸器械消毒前后以及两组医护人员消毒前后手部细菌菌落数,数据采用SPSS14.0软件进行统计分析。结果包括细丝钳、弓丝架、冠剪、钢丝筒、持针器、橡皮链合、工具架、医疗车及抽屉在内的正畸器械消毒后细菌菌落数较消毒前明显下降,组间比较差异有统计学意义(P<0.05);对照组和观察组消毒前手部细菌菌落数分别为20.4、20.4CFU/cm2;对照组和观察组消毒后手部细菌菌落数分别为207.5、2.5CFU/cm2;对照组和观察组医护人员消毒前手部细菌菌落数组间比较差异无统计学意义;消毒后手部细菌菌落数对照组明显多于消毒前,观察组明显少于消毒前,组间比较差异有统计学意义(P<0.05)。结论正畸器械消毒不严格及医护人员洗手方式不正确,是诱发正畸治疗期间医院感染的重要因素;故口腔正畸治疗医院感染预防应当注重器械消毒及提高医护人员感染控制意识。     

不同类别护手霜对洗必泰类外科手消毒剂消毒效果的影响

目的探讨不同护手霜对洗必泰类外科手消毒剂消毒效果的影响。方法将60名手术室医护人员随机分成A、B、C三组。受试者均按六步洗手法洗手1 min,用无菌擦手纸擦干双手。 A组不使用护手霜,B、C组分别使用3M爱护佳9260护手霜（水包油乳化液）及某品牌凡士林护手霜（油包水乳化液）。分别采集各组洗手后、使用护手霜后30 min及外科手消毒后的手部样本,进行细菌培养及菌落计数。结果洗手后各组间菌落计数比较,差异无统计学意义（P＞0.05）。擦护手霜后30 min,各组间［A组：（3.33±0.64）CFU/cm2;B组：（3.32±0.97）CFU/cm2;C组：（4.05±1.78）CFU/cm2］比较, 菌落计数差异有统计学意义,C组菌落计数显著高于A、B组(P<0.05);A、B两组差异无统计学意义（P＞0.05）。外科手消毒后,A、B两组受试者均达到外科手消毒要求,差异无统计学意义（P＞0.05）;C组有2人未达到外科手消毒要求,且菌落计数［（1.28±1.45）CFU/cm2］显著高于A组［（0.07±0.10）CFU/cm2］及B组［（0.06±0.12）CFU/cm2］ (P<0.05)。结论使用与乳胶及洗必泰兼容的护手霜（水包油乳化液）可有效保护手部皮肤,同时对外科手消毒无显著影响。     

手卫生在外科感染管理中存在的问题与对策

目的 了解外科医院感染发生的主要因素,为有效控制手卫生、改善医院感染提供举措,以降低外科医院感染率.方法 现场进行随机采样,检测内容包括医护人员手卫生及科室内部空间诊疗环境、无菌物品的表面等设备,对各项检测指标进行对比分析.结果 经各项指标检测,外科医师与护士手阳性率分别为55.0％、75.0％;外科医师与护士手阳性率,差异有统计学意义;外科医师手部菌落数浓度(0.28±0.46)CFU/cm2与护士手部菌落数浓度(0.10±0.24)CFU/cm2,差异有统计学意义(z=4.259,P＜0.01).结论 对医护人员手卫生进行培训及规范化管理,可有效降低医院接触性感染.     

爱护佳洗手液与传统皂液刷手消毒效果的对照研究

部菌落数(4.10±4.03)CFU/cm2,洗手后即刻菌落数(0.08±0.26)CFU/cm2,洗手后2 h菌落数(0.49±1.31)CFU/cm2;两组间各项评价指标的差异均有统计学意义(均P＜0.01).结论 爱护佳皮肤清洁剂+免洗外科手消毒液,有助于洗手后长时间抑菌,并且在皮肤舒适度、挥发速度、整体接受程度方面均优于传统外科手消毒方法.     

安多福喷雾法与擦拭法皮肤消毒效果的临床观察

目的探讨安多福消毒液喷雾法与擦拭法皮肤消毒效果。方法对35例试验对象双侧手背部皮肤分为两组,一组采用喷雾法消毒,另一组采用擦拭法消毒,对消毒前、后两组细菌培养结果进行比较,观察两种方法的消毒效果。结果擦拭法与喷雾法两组消毒前细菌培养菌落数分别为(21.94±11.93)CFU/cm2、(20.60±10.22)CFU/cm2,消毒后分别为(0.20±0.47)CFU/cm2、(0.11±0.32)CFU/cm2,无致病菌生长,两种方法消毒细菌培养菌落数前后组间比较差异无统计学意义,消毒前后组内比较差异有统计学意义;喷雾法操作时间为(2.34±0.48)s明显少于擦拭法(11.17±1.20)s,但待干时间喷雾法为(55.17±1.85)s却高于擦拭法(30.31±1.60)s,两者差异均有统计学意义;喷雾法平均每例使用消毒液0.5ml,而擦拭法平均每例使用消毒液0.77ml,消耗2根棉签。结论安多福消毒液喷雾法与擦拭法具有相同的消毒效果,喷雾法具有操作时间短,使用消毒液量少,消毒部位有效消毒液量多,不需要使用棉签等优点,可以取代擦拭法在临床广泛推广应用,对减少医疗废物,降低医疗成本具有重要意义。     

杀菌型医用超声耦合剂消毒杀菌效果的观察

目的观察杀菌型医用超声耦合剂的消毒杀菌效果。方法搜集2010年10-11月行完整皮肤检测的超声检查的60例患者,分成对照组(非杀菌型耦合剂)和试验组(杀菌型耦合剂),各组均为30例;对检查前、后超声探头和受检皮肤进行细菌培养。结果检查前超声探头对照组(263±50)CFU/cm2与试验组(279±42)CFU/cm2间菌落数差异无统计学意义,受检皮肤的对照组(247±75)CFU/cm2与试验组(252±85)CFU/cm2间菌落数差异无统计学意义;对照组的超声探头与受检皮肤在检查前后间菌落数差异无统计学意义;试验组超声探头检查前的菌落数(279±42)CFU/cm2与检查后的菌落数(4±3)CFU/cm2之间及受检皮肤检查前菌落数(252±85)CFU/cm2与检查后菌落数(3±2)CFU/cm2间差异有统计学意义(P<0.01)。结论杀菌型医用超声耦合剂对超声探头和受检皮肤具有明显的消毒杀菌作用。     

优质服务干预在预防手术室患者感染的效果研究

目的探讨优质服务干预在预防手术室患者感染的效果,以提高患者的满意度与获得良好的社会与经济效益。方法选取2012年6月-2013年6月医院收治的行手术患者180例,随机分为试验组和对照组各90例,两组患者在手术室均按照正常程序进行常规治疗,而试验组患者在常规治疗基础上给予优质干预措施,包括心理疏导、健康教育、手术相关干预与手术室环境管理等,观察和记录两组患者手术前后手术室空气菌落、刷手后护士手菌落数、术后患者感染率及对手术治疗的满意程度,数据均采用统计软件SPSS 19.0进行统计处理。结果试验组患者术后手术室空气菌落数(85.26±29.57)CFU/m3、护士手部菌落数(1.96±0.32)CFU/cm2均明显低于对照组的(388.10±92.25)CFU/m3、(8.36±2.08)CFU/cm2,差异有统计学意义(P<0.05);手术后试验组与对照组患者的感染率分别为5.56%、25.56%。结论手术室为医院感染高危科室,医疗工作各环节均相互地关联且互相影响,任何一个环节发生问题均可能引发手术室患者医院感染,医护人员应该增加职业道德教育与学习有关感染预防的知识,积极地采用现代化洁净手术室的护理干预新理念为患者提供服务,争取获得良好的社会与经济效益。     

手术室护工手卫生的调查与分析

目的 调查手术室护工手卫生现状,提高护工手卫生意识,以降低手术室医院感染率.方法 将仙居县4所县级医院的23名护工作为研究对像,按照卫生部《医疗机构医务人员手卫生规范》中的标准,对其手进行采样,并采用发放调查问卷方式对手术室护工的手卫生执行情况进行调查.结果 手术室护工手菌落数洗手前为(11.25±6.58)CFU/cm2;洗手后为(10.35±6.67)CFU/cm2,洗手前手术室护工手上的菌落数多于洗手后,差异无统计学意义;手术室护工手卫生的合格率洗手前为43.5％,洗手后为47.8％,手术室护工手卫生接触患者后及接触无菌物品后执行率分别为47.8％及52.2％.结论 手术室护工手卫生状况不容乐观,手卫生执行率低,洗手依从性差.     

洁夫柔消毒凝胶临床使用效果观察

目的观察洁芙柔消毒凝胶临床使用消毒效果。方法按照2002年版《消毒技术规范》手消毒、采样,随机对100名医护人员使用洁芙柔消毒凝胶前、后进行检测,采用计量资料自身配对t检验方法进行分析。结果消毒后手平均菌落总数(2.22±1.69)CFU/cm2,明显少于消毒前细菌平均菌落总数(40.24±19.53)CFU/cm2,对自然菌的杀灭率为94.48%,经t检验差异有统计学意义(P0.01)。结论洁芙柔消毒凝胶除菌效果佳、作用迅速、手感舒适,临床使用效果好。     

应用六西格玛质量管理方案改善医护人员手卫生依从性的研究

目的应用六西格玛质量管理方案改善手术室医护人员手卫生依从性,从而达到降低手术室感染的目的。方法选取2013年10月-2014年11月进入医院手术室的326名医务人员为研究对象,将六西格玛质量管理应用于手术室医护人员的手卫生依从性改善,针对前期对医护人员手卫生依从性的调查,分析目前医护人员手卫生依从性低的原因,采取针对性措施,并进行质量监控;观察改善前后手术室医护人员手卫生依从率及正确洗手情况,比较改善前后手术室患者感染率。结果应用六西格玛质量管理改进前手术室医护人员洗手率为52.01%,正确使用六步洗手法的医护人员为47.60%;改进后医护人员洗手率为93.89%,93.47%的医护人员可以正确使用六步洗手法,差异均有统计学意义(P<0.05);改进后医护人员手部菌落数为(2.3±0.5)CFU/cm2,显著低于改进前的(7.1±2.8)CFU/cm2;改进后手术室感染发生率为4.40%,显著低于改进前的7.91%,差异均有统计学意义(P<0.05)。结论六西格玛质量管理可以明显改善手术室医护人员手卫生依从性,提高医护人员对手卫生的重视度,减少手术室感染的发生。     

Acceptability of willingness to pay techniques to consumers

Objective The purpose of this study was to assess and compare the proportion of usable responses and protest votes obtained with two willingness to pay (WTP) techniques, contingent valuation (CV) and discrete choice experiment (DCE) and to assess the acceptability of the techniques to respondents. Setting and participants Pregnant women attending the public antenatal clinics of a Sydney teaching hospital were surveyed. Main variables studied Preference for either Treatment A (artificial rupture of the membranes followed by intravenous oxytocin) or Treatment B (prostaglandin E₂ gel followed by oxytocin if necessary) was assessed. Then WTP for the preferred treatments was assessed using CV and WTP for specific attributes of the treatments in the DCE. In addition, the acceptability of the two techniques was compared in terms of responses deemed to be valid according to defined criteria, protest votes and comments recorded by consumers. Results With the CV, 74% of respondents chose gel and their maximum WTP was Aus$178 compared with $133 for the alternative. A total of 68% of responses were deemed to be valid including 5% who may have been expressing a protest vote. With the DCE, respondents were WTP $55 for every 1 h reduction in the length of time from induction to delivery. A total of 72% of responses were deemed valid and only two of these 258 women were considered to have expressed a protest vote. Conclusions Only a small number of women expressed objections to the use of WTP questions in health‐care and the majority of women completed both questions successfully.     

重视主要诊断的选择适应医保制度改革

目的了解在主要诊断选择中存在的问题及其对单病种费用的影响.方法首先依据病案内容判断主要诊断的正确性,然后进行医疗质量及单病种费用的统计和分析.结果在主要诊断的选择中存在着概念不清、人为拔高、错选它科疾病、诊断依据不充分及诊断名称不规范等问题.结论主要诊断选择不当可致医疗质量统计和病种费用统计失真,这将影响医院管理者或卫生管理部门的决策,也影响着病案资源的利用和共享.     

Factors influencing the conversion of carotenoids to retinol: bioavailability to bioconversion to bioefficacy

Vitamin A (retinol) is a necessary nutrient for vision, reproduction, growth, and immune function. Pro-vitamin A carotenoids are an important source, especially in developing countries. While preformed vitamin A is readily available from foods, carotenoids are much more difficult to assimilate. A number of factors have been identified that either enhance or hinder the bioavailability of carotenoids. These have been presented in the literature and given the mnemonic SLAMENGHI by some researchers. The following factors are summarized: Species of carotenoid, molecular Linkage, Amount in the meal, Matrix Properties, Effectors, Nutrient status, Genetics, Host specificity, and Interactions between factors. Identifying which of these are key issues for the general public, and promoting the increased consumption of fruits and vegetables with moderate and high levels of pro-vitamin A carotenoids, are important to vitamin A status and overall good health.     

Characteristics of men most likely to respond to an invitation to be screened.

Some of the characteristics of men, with known risk factors, who were most likely to respond to an invitation to be screened in a national randomized clinical trial to prevent heart disease were determined in 18,872 men, 35-57 years of age, members of the Kaiser Foundation Health Plan of Oregon. Demographic characteristics and risk factor variables (blood pressure, blood cholesterol, and cigarette smoking levels) were abstracted from medical records. The men were ranked high priority or low priority according to level of risk. All age-eligible men in the health plan received at least one invitation to be screened, with high-priority men receiving more invitations. Despite concentrated efforts to bring them in, less than one-half the high-priority men were screened. Participants were older and wealthier than non-participants, and more likely to have more dependents and to routinely use medical services. Whether or not a man received a medical care service within the preceding two years was a powerful discriminating variable in both the univariate and multivariate analyses reported. The findings suggest that health care programs serving a stable population group should give more consideration to screening in routine medical care.