超广谱β-内酰胺酶细菌医院感染调查

目的 研究产超广谱β-内酰胺酶（ESBLs)的革兰阴性菌引起的医院感染发生率，为临床防治对策提供依据。方法 分析了1999年5月-2000年7月间由产ESBLs革兰阴性菌引起医院感染。结果 产ESBLs革兰阴性菌的医院感染细菌多见于肺炎克雷伯菌，占57.15%。其次为大肠埃希菌，阴沟肠杆菌等。约各占14.25%。研究发现，此感染多见于那些健康等级差，住ICU病房。烧伤及机体抵抗力差的患者中，并与长期住院和应用广谱抗生素有明显关系。结论 产ESBLs革兰阴性菌在医院中的感染正日益增多，尤其多见于长期住院应用广谱抗生素，住ICU病房的患者中；亚胺培南是目前少数对ESBLs高度稳定的品种之一。     

某三级综合医院多重耐药菌临床分布

目的了解某院多重耐药菌的临床分布特点,以采取针对性的预防控制措施。方法回顾性分析该院2012年1月1日-12月31日检出的891株多重耐药菌监测资料。结果 891株多重耐药菌中,以产超广谱β 内酰胺酶（ESBLs）的大肠埃希菌居首位（342株,38.39%）,其次为产ESBLs肺炎克雷伯菌（195株,21.89%）、多重耐药鲍曼不动杆菌（185株,20.76%）、耐甲氧西林金黄色葡萄球菌（138株,15.49%）、多重耐药铜绿假单胞菌（27株,3.03%）、产ESBLs奇异变形杆菌（2株,0.22%）、产ESBLs产酸克雷伯菌（2株,0.22%）;主要集中在综合重症监护室（ICU;163株,18.29%）、神经内科（136株,15.26%）、普通外科（103株,11.56%）、神经外科（85株,9.54%）和呼吸内科（71株,7.97%）。痰标本分离多重耐药菌最多的是多重耐药鲍曼不动杆菌(242株,50.63%),主要集中在综合ICU;尿标本分离最多的是产ESBLs大肠埃希菌(141株,80.57%),主要集中在神经内科和泌尿外科。结论该院多重耐药菌感染部位主要为下呼吸道和泌尿系统;应加强对高危科室和易感人群的监控,制定有针对性的预防控制措施,遏制多重耐药菌的感染和传播。     

Incidence of infections dues to Escherichia coli strains producing extended spectrum betalactamase, in the Zou/Collines Hospital Centre (CHDZ/C) in Benin

OBJECTIVES: Over a 6-month period, extended-spectrum betalactamase (ESBL)-producing isolates of Escherichia coli (EC) were collected from in-patients and their environment at the Zou-Collines Hospital Centre (CHDZ/C) in Benin. The aim of this study was to determine the incidence of ESBL and to describe their phenotypic susceptibility to antibiotics in a secondary hospital (500 beds) in Benin. METHODS: From 15 May to 15 November 2005, clinical informations and samples were collected from patients suspected to have nosocomial infections. The isolates were identified, tested for antimicrobial susceptibility and analysed for the presence of ESBL genes blaTEM and blaSHV by PCR. RESULTS: One hundred ninety-seven enterobacteria were isolated from the clinical samples of 342 patients, these isolates included 143 EC and 32/143 (22%) of these isolates produced ESBL. Forty-six EC were isolated from the environment and 7 (15%) of them produced ESBL. Except for Imipenem for which the difference was not significant, the isolates producing ESBL were more resistant to the other antibiotics (especially to third generation cephalosporins: Ceftriaxone, Cefotaxime, Ceftazidime (P<0.00001)) than non-ESBL producing isolates. Both ESBL genes blaSHV and blaTEM were identified in the EC ESBL strains from patient and from the environment. CONCLUSION: This study shows the presence of ESBL genes among EC in various wards of the CHDZ/C hospital proving that there is a need to implement a strict hospital infection control program and a regular surveillance of resistance to antimicrobial agents.     

One-day point prevalence of emerging bacterial pathogens in four secondary and five tertiary care German hospitals - results from a pilot study of the German Society for Hospital Hygiene (Deutsche Gesellschaft für Krankenhaushygiene, DGKH)

Objective: Data on the prevalence of emerging bacterial pathogens like extended-spectrum-lactamase-building (ESBL) Gram negative organisms, multiresistant Pseudomonas and Acinetobacter species or toxin-building Clostridium difficile in German hospitals are sparse. To provide data for different regions in Germany, a one-day point prevalence study with five tertiary care hospitals and four secondary care hospitals was conducted on the 10(th) of February 2010.Method: For participating hospitals, the level of care (primary/secondary/tertiary), staffing with infection prevention personnel, availability of a MRSA-screening, microbiological support and the prevalence of five emerging bacterial pathogens in intensive care, surgical and medical wards was assessed by questionnaire.Results: Overall, 3411 patients were included. In tertiary hospitals, the following prevalences were given: MRSA 1.8%, ESBL E. coli 0.45%, ESBL Klebsiella spp. 0.41%, multiresistant Pseudomonas 0.53%, multiresistant Acinetobacter species 0.15%, VRE 0.49% und Clostridium difficile 1.01%. In secondary hospitals, as prevalences resulted for MRSA 3.48%, ESBL E. coli 0.4%, ESBL Klebsiella spp. 0.4%, multiresistant Pseudomonas 0%, multiresistant Acinetobacter species 0%, VRE 0.13% und Clostridium difficile 1.34%.Discussion: The prevalence of MRSA found is comparable to other prevalence studies published in the last years, but remarkably higher than reported by the German National Surveillance System (KISS). As no prevalence data for other pathogens as MRSA could be found, only data from the ITS-KISS are available for comparison. Again, the prevalences found in the present study are much higher than reported by the KISS. Whether this is by chance or indicates a systematic underreporting in the KISS remains unclear.Conclusion: The results from this one day point prevalence study show that prevalences of emerging bacterial pathogens differ markedly between regions, departments and hospitals. This can be explained by regional, methodical and other difference associated with the level of care provided by these hospitals. Still, the prevalences found fit well to other prevalence studies from the last years but are remarkably higher than to be expected by the KISS. As questionnaire-based one-day prevalence studies have been shown to be inexpensive and feasible, such studies, using a fixed day and protocol, should be extendedly used in the future to collect representative data for Germany. By such initiatives, scientific societies as the DGKH can take part in collecting valuable epidemiological data of emerging bacterial pathogens.     

Phenotypic confirmation of extended-spectrum B-lactamases (ESBL) in clinical isolates of Escherichia coli and Klebsiella pneumoniae at the San Juan Veterans Affairs Medical Center

Extended-spectrum Beta (beta)-lactamases (ESBLs) have emerged as an important mechanism of resistance to B-lactam antibiotics in gram-negative bacteria (GNB). They are enzymes that hydrolyze older B-lactam antibiotics as well as broad-spectrum cephalosporins and monobactams. ESBL producers have been reported in many bacteria but special attention has been paid to the ones in E.coli and Klebsiella spp. Detection of the ESBLs by the clinical laboratory is a special challenge. Surveillance to monitor resistance is important to decide when detection of ESBLs must be started. This study determined the prevalence of ESBL producers in the strains E.coli and K.pneumoniae at the San Juan VA Medical Center, and characterized their phenotypes to evaluate the importance to identify these bacteria as a standard routine procedure in the institution. All E.coli and K.pneumoniae isolated from Jan 1 to Mar 31, 2003 were evaluated according to National Committee for Clinical Laboratory Standards (NCCLS) screening criteria for suspected ESBL producers. Phenotypic confirmation of the ESBL production was performed using the Etest method. A total of 112/253 (44%) E.coli and 72/137 (53%) K.pneumoniae were identified as suspected ESBL producers. Etest was performed in 60% of the E.coli and 57% of the K.pneumoniae suspected to be ESBL producers. The overall ESBL prevalence for E.coli was 25% and in K.pneumoniae was 26%. Most E.coli ESBL-producers were from urine while the K.pneumoniae were from sputum. ESBL-producers were isolated from different sources including pleural and synovial fluids, blood, and skin besides urine and sputum. According to susceptibility results, the most reliable antibiotic in predicting a negative ESBL was cefpodoxime (CPD), and in the strains studied, the ESBL producers were consistently resistant to aztreonam (ATM). A large proportion (95%) of ESBL producing K.pneumoniae were susceptible to cefepime (CEP). Of the ESBL producing E.coli, 24% were susceptible. In the case of E.coli ESBLproducers, Cefepime can be considered as a therapeutic option if susceptibilities are available. Automated identification and sensitivity systems are valid alternatives for routine evaluation of B-lactam resistance but when increased resistance is documented in GNB and/or ESBL prevalence is high, ESBL detection should be performed. All confirmed ESBL producers should be reported resistant to all penicillins, cephalosporins, and aztreonam in spite of having susceptible ranges with routine susceptibility tests. Inappropriate antibiotic selection in infections caused by these organisms is associated with treatment failures, poor clinical outcomes, increased mortality and longer hospital stays.     

中国临床微生物室参与医院感染及抗菌药物使用管理的现状

目的了解中国医院临床微生物室参与医院感染及抗菌药物使用管理的现状。方法抽取中国7大地区14个省(市)、自治区及部队所属的医院,对2000年以前、及以后每5年为一时间段至2015年的临床微生物室参与医院感染性疾病的会诊,标本质量控制,抗菌药物使用及多重耐药菌管理等方面开展调查,并对调查结果进行统计分析。结果共抽取调查医院187所,2015年其临床微生物室参与感染性疾病会诊以及多重耐药菌多部门协作管理工作的医院分别有96、172所(占51.34%、、91.98%),但仍有23.53%(44所)医院临床微生物室使用手工统计分析药敏结果,具备病原菌同源性鉴定能力者仅26所(13.90%)。2010年与2015年相比,MDRO监测数据反馈临床的比率由66.84%(125所)上升至95.72%(179所),反馈频率以每月和每季度为主;开展向临床反馈药敏结果的比率从62.03%(116所)上升至94.12%(176所),82.35%(154所)临床微生物室实现按季度反馈;开展痰培养前痰涂片镜检质量控制的比率由63.10%(118所)上升至87.17%(163所);血培养推行双侧双份的比率由35.83%(67所)提升至72.73%(136所);其他无菌体液(除血、尿以外)标本的比率由4.86%上升至5.74%;2010年与2015年各组比较,差异均有统计学意义(均P0.05)。结论中国医院临床微生物室在医院感染防控方面取得了较大进展,特别是2011—2015年间,但在医院感染病原菌同源性分析、结果反馈信息化推进和无菌体液标本的送检方面有待进一步加强。     

Current approaches to screening for Multi-resistant Organisms (MRO) in acute care Australian and selected New Zealand hospitals and recommendations for a minimum standard

This article provides information regarding current screening practices. Draft recommendations have been compiled to foster debate regarding a national approach to multi-resistant organisms (MRO) screening in acute care Australian and New Zealand hospitals. There is no consensus internationally as to the best manner in which to conduct screening for MROs. The AICA National Advisory Board decided that to facilitate a consensus approach towards MRO screening, it was useful to describe current screening practices in detail.Hospital infection control practitioners and microbiologists were invited to respond to a survey questionnaire distributed bye-mail to infection control, infectious diseases and microbiology specialists with involvement in infection control. In order to improve response rates, where necessary, individuals in each state were approached directly.Surveys were completed by representatives from a majority of large public hospitals and a significant number of private and district hospitals. There was wide variation in practice in Australian hospitals with regard to screening of patients for MROs. The approaches (clinical and microbiological) taken in different hospital settings, different clinical services and to each of the different MROs - MRSA, VRE and multi-resistant Gram negatives (MRGN) - are described. Approaches to ‘clearing’ previously colonised patients are also described.     

肺炎克雷伯菌的耐药情况分析

目的了解医院感染肺炎克雷伯菌的药敏耐药性与变化情况,为临床抗感染合理用药提供依据。方法对2009～2010年从医院感染患者临床标本中分离的肺炎克雷伯菌采用琼脂扩散法（K-B）进行药敏试验。结果 186株肺炎克雷伯菌中产ESBLs占28.5%,其产酶率呈上升趋势。结论应重视细菌培养,合理使用抗菌药物,根据药敏结果选择敏感抗菌药,对产EXBLs肺炎克雷伯菌应首选阿米卡星,亚胺培南,并应加强对产ESBLs菌株的监测。     

重症监护室和普通病房产ESBL肺炎克雷伯菌的耐药性对比

目的通过分析重症监护室和普通病房产超广谱β-内酰胺酶(ESBL)肺炎克雷伯菌的耐药性的不同,探讨其临床意义。方法利用VITEK-2Compact全自动微生物鉴定仪对我院2010年3月至2011年9月重症监护室和普通病房送检标本中分离的细菌进行鉴定及药敏试验,并用大肠埃希菌ATCC25922作为质控菌。结果除了头孢哌酮/舒巴坦、亚胺培南、头孢西丁和阿米卡星外,从重症监护室分离出的ESBL肺炎克雷伯菌对12种抗生素的耐药性明显高于从普通病房分离出的ESBL肺炎克雷伯菌(P<0.05)。结论重症监护室分离的ESBL肺炎克雷伯菌株耐药性明显高于普通病房,应对其加强临床监测和病房管理。     

Controversies about extended-spectrum and AmpC beta-lactamases

Many clinical laboratories have problems detecting extended-spectrum beta-lactamases (ESBLs) and plasmid-mediated AmpC beta-lactamases. Confusion exists about the importance of these resistance mechanisms, optimal test methods, and appropriate reporting conventions. Failure to detect these enzymes has contributed to their uncontrolled spread and sometimes to therapeutic failures. Although National Committee for Clinical Laboratory Standards recommendations exist for detecting ESBL- producing isolates of Escherichia coli and Klebsiella spp., no recommendations exist for detecting ESBLs in other organisms or for detecting plasmid-mediated AmpC beta-lactamases in any organisms. Clinical laboratories need to have adequate funding, equipment, and expertise to provide a rapid and clinically relevant antibiotic testing service in centers where these resistance mechanisms are encountered.     

Surveillance of multi-resistant bacteria in Lorraine: a three-year multicentre incidence study

OBJECTIVE: Controlling outbreaks of nosocomial infections is a priority for public healthcare in France. This study concerned the incidence of multidrug-resistant bacteria (MDRB) in Lorraine and the impact of the national guidelines for the prevention of MDRB. METHODS: A multicenter incidence study was conducted for 5 months, in volunteer hospitals. Samples collected for the clinical diagnostic were included. The bacteria studied were: methicillin-resistant Staphylococcus aureus (MRSA), Klebsiella sp., Enterobacter sp., and other Enterobacteriaceae producing extended-spectrum beta-lactamase (ESBL), and vancomycin resistant Enterococci sp. RESULTS: A total of 30 hospitals were included in the surveillance of MDRB. During the study period (2001-2003), 17874 strains were identified. MRSA reached 29.3% of the 4038 strains of S. aureus, 20.9%, 1.23% and 1.21% of ESBL, respectively, for Enterobacter sp., Klebsiella sp., and other Enterobacteriaceae (for 895, 1061 and 9419 strains). Overall, the incidence of MRSA reached 0.55 per 1000 hospital-days and 0.087 for Enterobacter sp. The incidence increased during the 3 years, from 3.36 to 4.84 per 1000 new patients for MRSA, and from 0.43 to 0.90 for Enterobacter sp. CONCLUSION: Despite guidelines on isolation, MRSA remains poorly controlled and requires more efficient measures. Surveillance of ESBL should be improved.     

Impact and cost of infection control measures to reduce nosocomial transmission of extended-spectrum beta-lactamase-producing organisms in a non-outbreak setting

We evaluated the impact of infection control interventions to reduce nosocomial extended-spectrum beta-lactamase (ESBL) transmission in a non-outbreak setting. This study was conducted at a tertiary 1200-bed hospital in Canada. The incidence of ESBLs was based on recovery of clinical isolates and assessed prospectively from 1999 to 2005. The incidence increased significantly from 0.28 to 0.67 per 1000 admissions during this period (P<0.001), reflecting an increase in the regional ESBL incidence from 1.32 to 9.28 per 100 000 population (P<0.001). Despite this increase, nosocomial ESBL rates increased only marginally, suggesting that infection control measures had an impact on nosocomial transmission. Infection control measures consisted of isolating all ESBL patients, as well as implementing the use of contact precautions for those with a high risk for transmission. The cost of these measures was CN$138 046.00 per year and CN$3191.83 per case admitted. A combination of control measures including active surveillance cultures, contact precautions for all colonized or infected patients and antimicrobial stewardship is required to significantly reduce the incidence of ESBLs.     

National survey of hospital infection control organization in Italian public hospitals

A questionnaire was mailed to 1073 Italian public hospitals in an attempt to find out if infection control programmes existed, the type of programme used and available resources. After two attempts a total of 54.9 per cent of the hospitals responded to the request and of these 16.1 per cent claimed to have an infection control programme. Sixty-six per cent of the hospitals who have a control programme also have a system of continuous surveillance whilst the remainder investigated epidemics only. Infection control programmes were encountered most frequently in paediatrics, obstetrics and surgical departments. The organisms most often surveyed were the salmonellas, other types of enterobacteria, staphylococci and streptococci.     

One-day point prevalence of emerging bacterial pathogens in a nationwide sample of 62 German hospitals in 2012 and comparison with the results of the one-day point prevalence of 2010

Background: Antibiotic resistance of bacterial pathogens is an emerging problem worldwide. To combat multidrug resistant organisms (MRDOs) networks of care providers have been established in all states in Germany. The HICARE-network, a project to combat MRDOs, founded by the Federal Ministry of Education and Research, has published data from 2010 of a voluntary, German-wide, multicenter point-prevalence survey in 2011 conducted in collaboration with the German Society of Hospital Hygiene. The aim of the present survey was the re-evaluation of the situation in 2012.Method: The survey was conducted as a voluntary, anonymous, point-prevalence in May 2012 using routine data of microbiological diagnostics of the hospitals. As in the former survey of 2010 it was differentiated between primary, secondary and tertiary care hospitals and only data from intensive care units, surgical and medical wards were collected. Based on the survey form used in 2010, an updated version was used including more pathogens and corrected issues observed in the former survey. Methicillin-resistant Staphylococcus aureus (MRSA) (total as well as separated in hospital-acquired (HA), community-acquired (CA) and lifestock-associated (LA) MRSA), vancomycin resistant Staphylococcus aureus (VRSA/GRSA), vancomycin resistant Enterococcus faecalis resp. Enterococcus faecium (VR-E. faecalis resp. VR-E. faecium), extended-spectrum-beta-lactamase-building (ESBL) E. coli (ESBL-EC) and Klebsiella pneumoniae (ESBL-KP), multiresistant Acinetobacter spp. (MAB), multiresistant Pseudomonas spp. (MRP), carbapenemase-producing Enterobacteriaceae (CRE) as well as Clostridium difficile (CD) infections and severe infections requiring ICU-treatment were included in the survey along with additional data on screening strategy, the equipment with infection control staff and possible confounders.Results: Out of 1,550 hospitals asked to participate, 62 returned data (4%). Data from 56 hospitals including primary (26), secondary (20) and tertiary (10) care hospitals were analyzable (3.6%). The most frequently reported organisms were MRSA 1.53% [CI95: 1.32–1.75], followed by CDAD 1.30% [CI95: 1.11–1.50], ESBL-EC 0.97% [CI95: 0.80–1.14], and ESBL-KP 0.27% [CI95: 0.18–0.36], regardless of the level of care. Prevalence of MRDOs depended on the level of care and on the type of ward, as expected. Overall prevalence was highest on intensive care wards, and prevalences were remarkably high on medical wards compared to surgical wards. All tertiary care providers employed their own infection control nurse, while only ~70% of the secondary and primary care hospitals did. Surprisingly, in two of the ten participating tertiary care providers neither an internal nor an external infection control doctor was available.Discussion: With more than 13,000 patients in 56 hospitals distributed all over Germany, the survey included more than three times as many patients as the first survey and therefore not only adds valuable information about the epidemiology of emerging nosocomial pathogens, but also helps to raise awareness of the problem of antibacterial resistance in Germany. The prevalences reported seem to be comparable to the results of the former survey and of other surveys published. Some hospitals reported to have no infection control personnel available at all. This statement is in line with another survey published in this issue.     

A bacteriological assessment of ampicillin with sulbactam as antibiotic prophylaxis in patients undergoing biliary tract operations. The West of Scotland Surgical Infection Study Group

A prospective audit of 644 patients undergoing biliary tract operations has been conducted in ten district general hospitals. All patients received a single dose of ampicillin 2 g and sulbactam 1 g as antibiotic prophylaxis. Bacteria were cultured from the bile of 121 patients. In patients with sterile bile the incidence of postoperative infection was 2.5%, while in those with colonized bile it was 22% (P less than 0.0001). The 35 patients from whose bile bacteria of two or more species were isolated, had a higher incidence of wound infection (34%) than those whose bile yielded only one species of bacterium (17%; P less than 0.05). Seventeen of the 27 patients with colonized bile who developed postoperative infection were shown to be infected by the same organisms that had been isolated from their bile. The patients whose bile yielded organisms resistant to the prophylactic antibiotic combination did not have a significantly higher rate of infection than those from whose bile only sensitive organisms were obtained. A marked difference in sensitivity patterns between the participating hospitals was observed.     

2型糖尿病合并感染患者的肺炎克雷伯菌分布及耐药特征分析

目的分析2型糖尿病(T2DM)合并感染患者的肺炎克雷伯菌分布及耐药特征。方法从126例T2DM合并感染患者的痰液、尿液等标本分离肺炎克雷伯菌,全自动微生物分析仪鉴定细菌及药敏试验,测定菌株产超广谱β-内酰胺酶(ESBL)情况。结果126株来自T2DM合并感染患者的肺炎克雷伯菌,在痰液、尿液、血液、脓液及其他标本的构成比分别为45.2%、19.1%、12.7%、9.5%和13.5%;痰液的肺炎克雷伯菌对头孢哌酮/舒巴坦耐药率(31.7%)高于非痰液标本(22.2%)(P<0.01),痰液的肺炎克雷伯菌对庆大霉素耐药率(23.0%)高于非痰液标本(15.9%)(P<0.05);双重耐药、3种及以上药物耐药菌株检出率均高于单一耐药菌株检出率(P<0.01);痰液的产ESBL酶肺炎克雷伯菌检出率(17.5%)高于非痰液标本(6.3%)(P<0.01)。结论T2DM合并感染患者的肺炎克雷伯菌主要分布在痰液和尿液中,菌株交叉耐药现象较严重,产ESBL肺炎克雷伯菌趋于增多。     

Pulsed-field gel electrophoresis (PFGE): A review of the “gold standard” for bacteria typing and current alternatives

Pulsed-field gel electrophoresis (PFGE) is considered the “gold standard” for bacteria typing. The method involves enzyme restriction of bacteria DNA, separation of the restricted DNA bands using a pulsed-field electrophoresis chamber, followed by clonal assignment of bacteria based on PFGE banding patterns. Various PFGE protocols have been developed for typing different bacteria, leading it to be one of the most widely used methods for phylogenetic studies, food safety surveillance, infection control and outbreak investigations. On the other hand, as PFGE is lengthy and labourious, several PCR-based typing methods can be used as alternatives for research purposes. Recently, matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS) and whole genome sequencing (WGS) have also been proposed for bacteria typing. In fact, as WGS provides more information, such as antimicrobial resistance and virulence of the tested bacteria in comparison to PFGE, more and more laboratories are currently transitioning from PFGE to WGS for bacteria typing. Nevertheless, PFGE will remain an affordable and relevant technique for small laboratories and hospitals in years to come.     

Extended-Spectrum ��-Lactamase Genes of Escherichia coli in Chicken Meat and Humans, the Netherlands

We determined the prevalence and characteristics of extended-spectrum β-lactamase (ESBL) genes of Enterobacteriaceae in retail chicken meat and humans in the Netherlands. Raw meat samples were obtained, and simultaneous cross-sectional surveys of fecal carriage were performed in 4 hospitals in the same area. Human blood cultures from these hospitals that contained ESBL genes were included. A high prevalence of ESBL genes was found in chicken meat (79.8%). Genetic analysis showed that the predominant ESBL genes in chicken meat and human rectal swab specimens were identical. These genes were also frequently found in human blood culture isolates. Typing results of Escherichia coli strains showed a high degree of similarity with strains from meat and humans. These findings suggest that the abundant presence of ESBL genes in the food chain may have a profound effect on future treatment options for a wide range of infections caused by gram-negative bacteria.     

医用放射性核素实验室辐射防护效果的调查和评价

本文报道了三个医院放射性核素实验室的辐射水平。调查表明,这些实验室的某些工作区在使用后出现了不同程度的异常污染。测得的材料对于临床核医学部分的辐射防护可能是有益的,本文对改进这些实验室的工作状态也提出了一些建议。