Convenient Sampling of Air Bacteria in Operating Rooms

A convenient arrangement for sampling air bacteria in operating rooms with a slit sampler (the Fort Detrick sampler) is described. Its purpose is to contribute as far as possible to the convenience of the surgical staff and thereby to the safety of the patient. It has the advantages of recording minute-to-minute changes in bacterial air count; it is unobtrusive and yet can be continually observed by a technician; it is not noisy and avoids the dangers of explosion and static electricity; it is inexpensive, and parts are easily replaced; and finally it provides a means of keeping permanent photographic records of bacterial counts. Results of a preliminary trial of this method appeared to be satisfactory.     

Allocation of Surgeries to Operating Rooms by Goal Programing

High usage rate in a surgical suite is extremely important in meeting the increasing demand for health care services and reducing costs to improve quality of care. In this paper a goal programming model which can produce schedules that best serve the needs of the hospital, i.e., by minimizing idle time and overtime, and increasing satisfaction of surgeons, patients, and staff, is described. The approach involves sorting the requests for a particular day on the basis of block restrictions, room utilization, surgeon preferences and intensive care capabilities. The model is tested using the data obtained during field studies at Dokuz Eylul University Hospital. The model is also tested for alternative achievement functions to examine the model's ability to satisfy abstract goals.     

Bacteriology of Air-Conditioning Ducts with Special Reference to Operating Rooms

The number of bacteria in air, before filtration with five different easily available filters in the low positive-pressure type of airconditioning system of the Winnipeg General Hospital, was between 3 and 4/cu. ft., and after filtration between 1 and 2/cu. ft. with all types of filters. Cl. welchii contributed about 1% and Staph. pyogenes about 0.1% of this total. Sampling the exhaust air from an operating room during an operation showed that the bacterial count fluctuated with the degree of activity in the room and was from two to 10 times as high as in the air delivered to the room.

Atlhough every reasonable attempt should be made to diminish the bacterial count of air in hospitals, if much energy and money is to be spent it would probably be wiser to investigate sources of hospital infection other than the type of air-conditioning system described in this report.

     

Economic and Quality Scheduling for Effective Utilization of Operating Rooms

Under the constraints of limited medical resources and severe competition among hospitals, administrators have begun to pay attention to the opportunities of cost reduction and quality improvement in hospital management, in order to find methods to increase hospital revenue and improve service quality. The operating room should be one of the most important sources of hospital income, yet it is both costly to run and constrictive to inpatient flow. Successful hospital management necessitates the construction of cost-effective and quality operating room scheduling. This paper attempts to model the scheduling problem in the form of mathematical programming with the objective being to minimize the deviation between the total operation time and the total available time in operating rooms. Urgent revisions to the model in consideration of such factors as doctor’s availability, outpatient consulting hours and unfavorable surgery hours can be achieved in a timely manner. With the present approach, surgical procedures can start punctually, inpatient waiting time for surgery and length of stay can be reduced, and staff morale can be enhanced. These improvements will result in cost reduction, and increased hospital revenue without sacrificing the quality of medical care.     

基于数字化手术室的临床信息共享平台建设

介绍基于数字化手术室的临床信息共享平台的构建,包括院内信息共享平台和区域信息共享平台,阐述信息共享平台建设的关键技术,最后对信息共享平台的建设意义和未来发展趋势进行展望。     

手术室增效

对于管理的精益化追求,医院从来没有像现在这样迫切,作为各种医疗资源最为集中的手术室则首当其冲地成为变革的对象借助于一套专业的信息化系统,医院不但可计算出每台手术的平均时间,而且还可以计算出每个医生手术的平均时间,从而为手术室的科学化管理服务。     

自体血液回输在手术中的应用及护理

自体血液回输技术最大的优点是可以防止血源疾病的传播，无输血反应，无须验血，缓解血库压力，解决特殊血型病人输血的要求，尊重部分宗教人士的信仰。术中自体血液的采集、分离、清洗和回收；解冻血细胞的分离、清洗和回收，可以在短时间内应用到紧急病人的急救治疗中，特别在库存血短缺时对病人的急救。     

Electronic Screening Improves Efficiency in Clinical Trial Recruitment

This study evaluated the performance of an electronic screening (E-screening) method and used it to recruit patients for the NIH sponsored ACCORD trial. Out of the 193 E-screened patients, 125 met the age criterion (“age ≥ 40”). For all of these 125 patients, the performance of E-screening was compared with investigator review. E-screening achieved a negative predictive accuracy of 100% (95% CI: 98-100%), a positive predictive accuracy of 13% (95% CI: 6-13%), a sensitivity of 100% (95% CI: 45-100%), and a specificity of 84% (95% CI: 82-84%). The method maximized the use of a patient database query (i.e., excluded ineligible patients with a 100% accuracy and automatically assembled patient information to facilitate manual review of only patients who were classified as “potentially eligible” by E-screening) and significantly reduced the screening burden associated with the ACCORD trial.     

Computerized Control of the Procedure for Detecting and Removing Airborne Particles in Operating Rooms

Surgical-site infections are still a major problem in modern medicine. Normal skin flora of patients or healthcare workers causes more than half of all infections following clean surgery, but the importance of airborne particles in this setting remains controversial. The use of ultraclean air in operating rooms has been shown to reduce infection rates significantly. High efficiency particulate air (HEPA) filters are used in some modern operating rooms. Although the uses of HEPA filters, the air quality should be controlled by another device to make safe the air in operating rooms and intensive care units. In this study, a computerized system was established to control the cleanliness of the air by measuring the presence of airborne particles of varying sizes and numbers in operating rooms. When the maximum values are exceeded, the system warns the authorized people by phone, sound, or displays.     

基于物联网技术的智慧手术室研究与实现

分析手术室信息化的现状与问题以及物联网技术在手术室的应用前景,介绍基于物联网技术和信息技术的智慧手术室系统架构、功能模块,有效整合手术室的设备、器械和药品资源以及手术参与各类人员的信息。     

腹腔镜手术室CO2浓度对医护人员健康的影响

目的探讨腹腔镜手术室内CO2浓度对医护人员健康的影响.方法本研究将60名手术室护士随机分为开腹手术组和腔镜手术组,分别于术前及术后对2组人员测量生命体征、检测动脉血气、评价疲倦程度,并采用便携式红外线CO2分析仪检测手术室内不同时刻CO2浓度.结果腔镜手术室内CO2浓度于手术30 min时升高,术中维持较高水平,于手术结束时达最高值;与本组术前和开腹手术组相比,腔镜手术组人员手术后心率和呼吸频率明显增快,p H降低,PCO2升高,且疲倦严重度评分显著增加(P<0.05).结论腔镜手术造成手术室内CO2污染,危害医护人员身心健康,应予以重视.     

手术室外科急诊患者护理探析

目的探讨手术室急诊手术的规范化护理，提高外科手术的安全和成功率。方法对1907例急诊手术病例进行分析，其中急病患者754例，外伤1153例，均先了解病情和致伤原因，再行伤情或病情检查后进行分类护理的规范程序。结果通过护理程序全部伤病员均自愿地接受并顺利地完成手术，术后1wk到病房探访754例急病患者，无切口感染和术腔内出血。探访1153例外伤患者，术后感染34例，术后术腔出血10例，经1-7d的相应治疗均都得以控制；1例喉及气管伤患者出现吸入性肺炎，于术后21d死亡；1例耳廓组织部分缺血性坏死，最后畸形愈合。结论手术室的各项护理完善是非常重要的，是促使伤病员配合完成手术，控制感染，促进创面愈合和功能恢复，提高生活质量的重要保障。     

流程再造对提高供应室工作效率的探讨

目的：创建科学有效的供应室管理流程,以提高供应室工作效率。方法：再造供应室的工作流程,从制定标准、完善制度、优化流程、明确职责几方面,进行全方位的静态与动态相结合的流程管理。结果：流程再造后,既节约了人力、物力,又快捷、准确地为临床科室提供了消毒供应服务,各相关科室人员对供应室工作的满意度较流程再造前明显提高。结论：流程再造有利于提高供应室的工作效率,增强消毒供应各环节的时效性,是实现资源成本最低化的重要管理方法。     

EHR in Emergency Rooms: Exploring the Effect of Key Information Components on Main Complaints

This study characterizes the information components associated with improved medical decision-making in the emergency room (ER). We looked at doctors’ decisions to use or not to use information available to them on an electronic health record (EHR) and a Health Information Exchange (HIE) network, and tested for associations between their decision and parameters related to healthcare outcomes and processes. Using information components from the EHR and HIE was significantly related to improved quality of healthcare processes. Specifically, it was associated with both a reduction in potentially avoidable admissions as well as a reduction in rapid readmissions. Overall, the three information components; namely, previous encounters, imaging, and lab results emerged as having the strongest relationship with physicians’ decisions to admit or discharge. Certain information components, however, presented an association between the diagnosis and the admission decisions (blood pressure was the most strongly associated parameter in cases of chest pain complaints and a previous surgical record for abdominal pain). These findings show that the ability to access patients’ medical history and their long term health conditions (via the EHR), including information about medications, diagnoses, recent procedures and laboratory tests is critical to forming an appropriate plan of care and eventually making more accurate admission decisions.     

A Norm Utilisation for Scarce Hospital Resources: Evidence from Operating Rooms in a Dutch University Hospital

Background  

Utilisation of operating rooms is high on the agenda of hospital managers and researchers. Many efforts in the area of maximising the utilisation have been focussed on finding the holy grail of 100% utilisation. The utilisation that can be realised, however, depends on the patient mix and the willingness to accept the risk of working in overtime.     

输出小管-睾丸网注射提高小鼠精原干细胞移植效率

目的:探讨小鼠精原干细胞移植的关键技术,寻求有效可行的精原干细胞移植方法。方法:选用4-5周龄雄性BALB/c小鼠45只腹腔内注射40 mg/kg的白消安建立受体模型,消化分离新生绿色荧光小鼠睾丸精原细胞作供体细胞。在三维显微注射系统下分别采用睾丸网注射法(n=15),输出小管注射法(n=30),经输出小管注射失败后的补救方式为经输出小管-睾丸网注射,将供体细胞注射到受体小鼠左侧睾丸精曲小管内,右侧睾丸作为对照。观察注射后精曲小管的充盈度和外漏的情况;移植后2个月观察受体小鼠的生精功能恢复情况。结果:经睾丸网注射成功率仅为35.7%(5/14),其中9只因睾丸网穿破、细胞悬液外漏到间质而失败。经输出小管注射成功率为72.4%(21/29),失败的主要原因为穿刺过程中穿破输出小管,进一步采用经输出小管-睾丸网注射补救,总成功率提高为93.1%(27/29),注射成功后可见70%-80%的精曲小管被蓝染的细胞悬液充盈,均无外漏现象。移植后2个月,体视荧光显微镜下可见移植侧睾丸包含多段绿色阳性克隆;组织学染色示移植侧睾丸大部分精曲小管恢复正常生精。结论:经输出小管和经输出小管-睾丸网显微注射技术是小鼠精原干细胞移植的有效方法。     

创伤性休克病人在手术室的临床急救护理措施

目的：探究对创伤性休克病人在手术室的临床急救护理的有效措施。方法该实验随机选取2011年8月—2013年8月该院手术室收治的创伤性休克病患60例为研究对象,根据计算机随机法则将其平均分成2组,对照组30例患者采取常规护理;观察组30例患者采取急救护理。结果观察组患者的总有效率约为93.33%（28/30）显著高于对照组的76.67%（23/30）,差异有统计学意义（P＜0.05）。结论良好的护理方式,是保证创伤性休克病患得意救治的前提条件,病患在入院之后,医生护士对其实施有效救治,能够令病患得到满意的治疗效果。     

三氧消毒机与甲醛薰蒸对不同手术间空气消毒效果的对比分析

我们应用三氧消毒机对污染和无菌手术间的空气消毒效果进行了实验观察 ,并与甲醛薰蒸进行比较。1　方法及结果分别应用三氧消毒机与甲醛薰蒸对污染和无菌手术间进行空气消毒 ,消毒后按《医院消毒技术规范》要求进行空气采样培养以菌落计数 (ｃｆｕ/ｍ3 ) ,每次空气采样间隔 30ｄ。所有的数据均进行统计学处理。甲醛薰蒸消毒后污染和无菌手术间的菌落计数无显著差异。三氧消毒机消毒持污染和无菌手术间的菌落计数也无显著差异。甲醛薰蒸消毒后污染、无菌及所有手术间空气培养菌落计数均明显高于三氧消毒机组。2　讨论我们通过较大样本的研究…     

护理干预对手术室非全身麻醉患者的负性情绪及舒适度的影响

目的：探讨护理干预对手术室非全身麻醉患者的负性情绪及舒适度的影响,提高手术质量,降低手术风险。方法：选择符合标准的患者85例,随机分为观察组43例和对照组42例,对照组实施常规护理,观察组实施护理干预,比较二者护理效果。结果：入院时,两组患者抑郁自评量表（ SDS ）及焦虑自评量表（ SAS）评分相似,差异均无显著性（ P＞0．05）;术后1d,两组患者SAS及SDS评分与入院时比较均下降（P＜0．05）,但是观察组患者下降幅度更大,差异有显著性（P＜0．05）。围手术期观察组患者简化舒适状况量表（ GCQ）的生理、心理精神、社会文化及环境各单项评分均高于对照组患者,差异具有统计学意义（ P＜0．05）。结论：护理干预可以有效缓解手术室非全身麻醉患者的负性情绪,提高生理及心理舒适度,有利于患者术后康复。