多学科协作管理模式在多重耐药菌感染控制中的应用与成效评价

目的:探究多学科协作管理模式在多重耐药菌(MDRO)感染控制中的应用与成效,为制定医院感染防控措施提供参考.方法:选取医院2018年1月—2020年2月收治的住院患者300例资料,其中2018年1月—2019年1月实施常规管理模式的150例住院患者为管理前组,2019年2月—2020年2月实施多学科协作管理模式的150例住院患者为管理组;比较2组住院患者住院期间MDRO医院感染率、医院感染率以及医护人员MDRO感染防控执行力(个人防护、消毒隔离、手卫生执行率、医疗废品处理)评分值的差异.结果:管理组患者MDRO医院感染率、医院感染率均低于管理前组(P＜0.05),医护人员的个人防护、消毒隔离、手卫生执行率、医疗废品处理的评分值均高于管理前组(P＜0.05).结论:多学科协作管理模式有效控制了MDRO感染的发生,降低了医院感染率,有效提高了医护人员对MDRO感染防控执行力.     

强化ICU医务人员手卫生管理措施对防控医院感染的影响及其管理对策

目的:评价强化重症加强护理病房(ICU)医务人员手卫生管理措施对防控医院感染的影响及其管理对策。方法:选取2015年10月—2017年2月期间医院ICU医护人员50例手卫生记录资料,采用随机信封法将其分为常规组和强化组(每组25例),常规组医护人员给予常规管理干预,强化组医护人员给予强化手卫生管理措施干预,比较两组医护人员对手卫生的认知度、执行率和患者感染的发生率及手微生物菌数的合格率。结果:强化组医护人员对手卫生的认知度、执行率及手微生物菌数的合格率高于常规组(P<0.05),医护人员感染的发生率低于常规组(P<0.05)。结论:强化ICU医务人员手卫生管理对医院感染防控意义重大,提高了医护人员对手卫生的认知度、执行率及手微生物菌数的合格率,降低了感染的发生率。     

护理管理在口腔科门诊医院感染控制中的作用

目的探讨护理管理在口腔科门诊医院感染控制中的作用。方法研究对象为我院在2013年~2015年期间护理管理前后的口腔科门诊医院感染情况以及相关卫生标准达标情况。结果管理前感染率为8.32%,管理后感染率为1.92%,P<0.05;在手部卫生合格率上,管理前为80%,管理后为95%,P<0.05;空气质量合格率上,观察组为75%,对照组为90%,P<0.05;在使用器械合格率上,观察组为75%,对照组为95%,P<0.05。结论口腔科门诊中运用护理管理可以减少医院感染率,提升相关操作质量。     

护理管理预防妇产科患者院内感染的作用效果观察

目的：观察护理管理预防妇产科患者院内感染的效果。方法2000年1月-2005年1月采用常规方式对妇产科患者进行基础性护理，并同时对常见的院内感染进行常规性预防。2011年1月-2013年1月我院采用全面护理管理方式加强对院内感染的预防以及控制。比较2个时间段的院内感染率、环境卫生合格率及消毒效果合格率。结果2000年1月-2005年1月院内感染发生率为4．0％高于2011年1月-2013年1月，差异有统计学意义（ P＜0．05）。2011年1月-2013年1月的环境卫生检测合格率和消毒效果合格率均高于2000年1月-2005年1月，差异均有统计学意义（ P＜0．05）。结论加强妇产科的护理管理，对预防患者院内感染作用明显，值得推广应用。     

多学科协作管理在多重耐药菌医院感染防控中的效果

目的探讨多重耐药菌(MDRO)医院感染防控应用多学科协作管理的效果。方法选取2020年1—6月泰安市妇幼保健院收治的患者为观察组(345例),实施多学科协作管理;选取2019年6—12月本院收治的患者为对照组(345例),采用常规防控措施,回顾性分析防控数据。两组患者均进行MDRO检测,比较两组的MDRO检出率、医院感染率及防控依从性。结果干预后,观察组的MDRO防控措施依从性明显高于对照组(P 0.05);经过干预后,观察组(ICU)患者MDRO(非重复株)医院感染率明显低于对照组(ICU)患者的感染率(P 0.05);经过干预后,观察组的MDRO(非重复株)检出率明显低于对照组(P 0.05)。结论 MDRO医院感染防控过程中应用多学科协作管理应用价值显著,可降低MDRO的检出率及感染率,提高医护人员的防控依从性,值得临床推广。     

护理管理在口腔科门诊医院感染控制中的作用

目的观察护理管理在口腔科门诊医院感染控制中的效果。方法将我院口腔科门诊2015年1月至6月作为观察时间段,设为观察组,2014年7月至12月作为对照时间段,设为对照组;对照组实施门诊常规管理,观察实施护理管理;比较两组门诊患者院内感染、卫生合格情况及患者满意度。结果观察组患者的医院感染率7.50%明显低于对照组22.50%,卫生检测合格率97.50%明显高于对照组的88.75%,满意率96.25%明显高于对照组87.50%,差异有统计学意义(P<0.05)。结论护理管理的实施能提升医院感染控制质量,减少医院感染率,提高患者满意度。     

碘伏消毒对预防手术室导管相关性血流感染的临床观察

目的探讨碘伏消毒对预防手术室导管相关性血流感染的效果。方法选取我院手术室(2015年1月至2017年1月)收治的90例患者,随机分为两组,对照组(n=45)常规消毒,观察组(n=45)给予碘伏消毒,对比两组患者导管留置时间和导管相关性血流感染发生率。结果观察组患者导管留置时间明显长于对照组,差异具有统计学意义(P<0.05)。观察组患者导管相关性血流感染发生率4.44%明显低于对照组13.33%,差异具有统计学意义(P<0.05)。结论碘伏消毒可有效延长患者导管留置时间,降低术后导管相关性血流感染率,值得临床推广。     

重症监护病房多重耐药菌感染的防控措施与对策

目的:分析重症监护病房(ICU)多重耐药菌感染的防控措施。方法:选取2013年1—12月间ICU收治的多重耐药菌感染患者120例作为对照组;2014年1月医院实施对多重耐药菌感染的防控措施,选取2014年1—12月间收治的患者120例为观察组,以其病原培养标本为依据;对照组患者均给予常规院感防控措施防治,观察组患者均给予强化院感防控措施防治,分析多重耐药菌种类、数量、来源,以及评价两组患者多重耐药菌感染防控前后的感染率和患者对防控的满意度。结果:观察组患者多重耐药菌感染率为3.33%明显低于对照组为12.50%(P<0.05);患者对防控的满意度评分值为(95.6±3.1)分,高于对照组为(85.4±3.3)分(P<0.05)。结论:多重耐药菌感染为院感的主要病原菌,针对感染患者给予院感控制措施可有效降低感染率,提高医护人员手卫生消毒意识,提高了患者对防控的满意度。     

ICU医院感染原因分析及护理干预疗效分析

目的 探讨ICU医院感染原因及护理干预的疗效.方法 2010年1～12月住院患者378 例作为观察组,2009年1～12月住院患者312例作为对照组,对照组给予常规护理,观察组在常规护理基础上给予护理干预.观察2组医院感染情况和消毒效果.结果 观察组医院感染发生率为7.41%高于对照组的15.06%,差异有统计学意义(P<0.05).观察组呼吸道感染9例占本组感染例数的32.14%,对照组21例占44.68%,均高于泌尿道、胃肠道和其他部位的感染率,差异有统计学意义(P<0.05).观察组消毒后空气菌落数、物体表面细菌菌落数、医务人员洗手后手菌落数均少于对照组,差异具有统计学意义(P<0.05).结论 加强ICU护理,有针对性地进行护理干预,能有效预防和控制医院感染.     

强化ICU环境卫生对医院感染的影响研究

目的探讨强化ICU环境卫生对医院感染控制的效果。方法通过多种措施改进ICU环境卫生状况并结合调查方法,将环境卫生改善前后3次与医院感染发生率进行比较分析。结果 ICU内微生物检测结果显示,医护人员手和物体表面均是混合污染条件致病菌的载体,从ICU环境、物体表面、医护人员手检出细菌多为芽孢、革兰阳性等非致病菌,但不动杆菌、肺炎克雷伯菌、沙雷氏菌和肠球菌等条件致病菌亦广泛存在。医院感染与环境监测结果表明,3次的环境卫生学监测合格率逐次增加(P<0.05),病房感染率也是逐次降低(P<0.05),说明强化干预措施取得了较好效果。结论 ICU感染率与环境监测合格率不存在相关关系,但这只说明环境卫生效果监测不是评价医院感染管理的主要关注指标,二者不是无关的,单纯通过环境消毒效果监测进行医院感染管理并不能完全控制住医院感染的发生。     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

Comparison of in vitro cell models in predicting in vivo brain entry of drugs

Although several in vitro models have been reported to predict the ability of drug candidates to cross the blood-brain barrier, their real in vivo relevance has rarely been evaluated. The present study demonstrates the in vivo relevance of simple unidirectional permeability coefficient (P(app)) determined in three in vitro cell models (BBMEC, Caco-2 and MDCKII-MDR1) for nine model drugs (alprenolol, atenolol, metoprolol, pindolol, entacapone, tolcapone, baclofen, midazolam and ondansetron) by using dual probe microdialysis in the rat brain and blood as an in vivo measure. There was a clear correlation between the P(app) and the unbound brain/blood ratios determined by in vivo microdialysis (BBMEC r=0.99, Caco-2 r=0.91 and MDCKII-MDR1 r=0.85). Despite of the substantial differences in the absolute in vitro P(app) values and regardless of the method used (side-by-side vs. filter insert system), the capability of the in vitro models to rank order drugs was similar. By this approach, thus, the additional value offered by the true endothelial cell model (BBMEC) remains obscure. The present results also highlight the need of both in vitro as well as in vivo methods in characterization of blood-brain barrier passage of new drug candidates.