医院感染管理流程在口腔科门诊的应用体会

我院口腔科以卫生部颁发《医院感染管理规范》、《消毒技术规范》、《医疗机构口腔诊疗器械消毒技术操作规范》为依据,制定科学化、制度化、标准化的医院感染管理流程,在口腔科感染控制工作上取得较好效果。     

医院感染控制及管理在口腔科护理中的应用

目的探讨医院感染控制及管理在口腔科护理工作中的作用。方法将2011年收治的1500例口腔科患者作为对照组,采用常规护理,2012年收治的1600例口腔科患者作为观察组,进行护理管理,对两组患者的感染情况、科室卫生指标合格率进行检测和比较。结果观察组感染率为0．2％,明显低于对照组的10．0％,差异有统计学意义（x2=8．85,P〈0．05）;观察组的使用器械、手部卫生、空气质量、消毒液标准合格率分别为96．9％,97．5％,97．4％,98．6％,明显高于对照组的81．3％,83．3％,80．0％,85．3％,差异有统计学意义（〈分别为196．60,183．23,238．12,190．04;P〈0．05）。结论在口腔科实施有效的医院感染控制及管理,能够预防院内感染,降低患者感染率,值得临床推广。     

口腔科门诊针对院内感染的防控措施

目的 降低门诊口腔科医院感染的发生,规范医院感染的有效控制措施.方法 针对门诊口腔科发生医院感染的因素,制定相对应的管理制度与防控措施.结果 严格的消毒隔离制度得以执行,规范了口腔科医院感染管理工作.结论 加强门诊口腔科的医院感染规范管理,有效降低医院感染的发生.     

口腔科门诊医院感染的控制

目的探讨口腔科门诊医院感染控制的管理方法。方法制订并实施口腔科门诊医院感染控制管理程序及职业安全防护等管理制度。结果每月进行的物品、空气、物体表面及医务人员手的卫生学监测，其结果均符合要求，未发生1例医院感染。结论规范化、标准化、系统化口腔科门诊医院感染控制的管理方法，可控制医院感染的发生率。     

浅谈门诊口腔科感染控制及措施

门诊口腔是医院最易造成交叉感染的场所。因其特殊性，造成交叉感染的因素和环境十分复杂。因此，口腔科的医院感染控制管理工作关系到医务人员与病人的健康。医院感染控制的成效在一定程度上反映了一个医院的医疗质量。     

口腔科的感染管理

我院亦将加强口腔科医院感染管理作为我院感染管理工作重点之一。经过努力,使得口腔科在感染管理方面初见成效,规范了口腔诊疗器械的消毒工作,保障了医疗安全和医护人员的健康,在实践中我们体会到口腔感染管理必须做好以下几方面工作。     

加强口腔科医源性感染的监测控制与管理

口腔诊疗过程中发生医院感染的问题越来越受到医务人员及社会各界人士的关注,尤其是经血液、唾液传播的疾病如乙型肝炎、丙型肝炎及艾滋病等。众所周知,口腔疾病的诊疗均在口腔内进行,口腔医疗器械随时可被带有大量病原微生物的唾液、血液污染,如果处理不当,     

门诊口腔科诊室空气消毒前后的监测效果分析与对策

目的进一步探讨引起门诊口腔科医院感染的因素,采取有效控制措施.方法2004年11月～2005年10月对门诊口腔科诊疗环境（空气）消毒前后进行监测.将口腔诊室空气消毒前的监测作为对照组;将口腔诊室空气消毒后的监测作为观察组,比较2组空气监测的合格率.结果采取有效管理前门诊诊室空气合格率为23.8%,采取有效管理措施后,门诊诊室空气合格率为100%.结论进行有效的空气消毒,可减少环境污染,加强医院感染管理工作能有效控制门诊口腔科的医院感染.     

ICU机械通气患者翻身前行口咽部吸引的效果评价

目的 探讨ICU机械通气患者每2h翻身前行口咽部吸引对降低呼吸机相关性肺炎(VAP)的影响.方法 ICU机械通气患者随机分为试验组和对照组,试验组每2h翻身前行口咽部吸引,对照组在有可视分泌物时才吸引.比较两组机械通气时间、住ICU时间、口咽部分泌物吸引量、VAP发生情况和住院期间的病死率等指标.结果 试验组1周内发生VAP的例数、发生的时间、机械通气时间、住ICU天数等均低于对照组,两组差异有统计学意义(P＜0.05);两组口咽部分泌物吸引量、住院期间的病死率比较,差异无统计学意义(P＞0.05).结论 ICU机械通气患者每2h翻身前行口咽部吸引,可以提高吸引效果,减少VAP的发生率.     

门诊口腔科再生医疗器械全程质控管理流程的探讨

目的 探讨门诊口腔科再生医疗器械的全程质量控制管理。 方法 认真执行门诊口腔科再生医疗器械操作规程,严格回收、清洗、分类包装、灭菌、发放、监测各环节的质量控制管理。 结果 使门诊口腔科再生医疗器械的全程质控管理走向规范化、制度化、程序化。 结论 实施管理措施,完善管理方法,提高管理质量,保证再生医疗器械安全、有效地使用,达到控制医院感染管理标准,提高医疗护理水平。     

橡皮障在牙体治疗过程中降低诊室微生物污染效果的观察

目的 探讨橡皮障在牙体治疗过程中降低诊室微生物污染的效果.方法 选取口腔科门诊需要树脂或银汞充填的患者20例,在知情同意的基础上,将治疗中同一患者使用橡皮障的患牙(n=20)作为试验组,将未使用橡皮障的患牙(n=20)作为对照组,对两组治疗时所在诊室进行空气菌落采样.并对菌落计数进行统计学分析.结果 试验组空气菌落计数大大低于对照组,差异有统计学意义(P<0.01).结论 橡皮障能有效减少口腔微生物对环境的污染,对口腔感染控制起到非常重要的作用.     

密闭式吸痰器在呼吸机治疗中的应用与护理

目的探讨密闭式吸痰器在呼吸机治疗中对呼吸道感染发生率、气管内出血发生率、吸痰前后经皮血氧饱和度(SpO2)变化及吸痰耗材费用的影响,以及护理人员使用密闭式吸痰器的注意事项.方法选取183例预期呼吸机治疗时间超过7d的病人,按照疾病危重度评分(APACHE Ⅱ),应用分层随机化法分为2组.第1组采用密闭式吸痰器,其中实际呼吸机治疗时间超过7d的病人58例组成试验组;第2组采用一次性吸痰管,实际呼吸机治疗时间超过7d的病人58例组成对照组.观察两组病人呼吸机治疗开始即刻、治疗后1d、3d、7d痰培养结果、气管内出血发生率、吸痰前后血氧饱和度(SpO2)变化及吸痰耗材费用.结果试验组呼吸道感染发生率、SpO2下降及吸痰耗材费用显著低于对照组(均P<0.05),而气管内出血的发生率则明显高于对照组(P<0.05).结论使用密闭式吸痰器能降低呼吸道感染发生率、减少吸痰过程中SpO2下降、降低治疗费用,但会增加气管内出血的发生率.     

Contamination of a multiple-use suction catheter in a closed-circuit system compared to contamination of a disposable, single-use suction catheter.

Multiple-use (M-U) closed-system endotracheal suction catheters are effective in preventing arterial oxygen desaturation in patients on positive end-expiratory pressure (PEEP) and may lessen the frequency of bradycardia and hypotension in unstable patients who are prone to these complications of suctioning. However, because M-U catheters remain attached to the ventilator circuit and are reintroduced repeatedly into the patient's airway over 24 hours or longer, they could become heavily contaminated with pathogens. We hypothesized a risk of autocontamination to the patient by re-inoculation of the respiratory tract with organisms that flourished on the M-U catheter while it was isolated from the patient's immune defenses or antibiotic therapy. Methods: We tested this hypothesis in 30 mechanically ventilated adult patients with positive sputum cultures. We measured and compared the amount of bacteria present on an M-U catheter at the end of a 24-hour use period, the amount of bacteria present in the patient's sputum at that time, and the amount of bacteria present on a single-use (S-U) catheter at that time, after it had made one pass into the patient's airway. Organisms recovered and colony counts were also compared to results of a sputum culture obtained before the study began. Results: Fourteen different pathogens or potential pathogens were recovered, in numbers of 2 x 10(1) to 2 x 10(7)colony-forming units. The greatest number of colonies was most often recovered from the sputum specimen, and statistical analysis showed no differences in rate or magnitude of contamination between M-U and S-U catheters.(ABSTRACT TRUNCATED AT 250 WORDS)     

Using research-based interventions to decrease patient falls.

The purpose of this study was to decrease patient falls by applying relevant interventions found in the nursing research literature. Clinical nurse specialists assisted staff with the application of selected research-based patient fall program interventions on two adult medical-surgical specialty units in a tertiary care facility. The fall rate on these two units decreased during the study year, while the all-hospital patient fall rate increased. To encourage comparison of fall data among institutions, a standard method for calculating fall rate is presented.     

Cardiology clinic follow-up did not decrease return visits to the ED for chest pain patients

Background

We initiated a program to rapidly rule out myocardial infarction and make an appointment (with no co-payment) with a cardiologist within 72 hours for patients with low-risk chest pain.

Objective

The objectives of this study were to determine if the rate of return emergency department (ED) visits for chest pain decreased among patients who kept their appointments and to evaluate factors that impacted clinic no-show rates.

Methods

The study was conducted at a safety net facility with 65 000 adult patient visits per year. This study was a retrospective review of patients with chest pain discharged from the ED with a scheduled cardiology clinic appointment between October 2008 and December 2009. We compared those who kept their clinic appointment with those who did not for repeat ED visits for 6 months after the study period. Multivariate analysis evaluated factors associated with keeping appointments.

Results

Of 381 patients, 265 (70%) kept their appointments. Show rates did not differ based on age, sex, race, or language. Patients with commercial insurance were more likely to keep appointments than Medicare, Medicaid, and uninsured (OR, 51.3; 95% confidence interval [CI], 2.53-1041.64; P = .010). The 116 no-show patients averaged 0.39 return ED visits (95% CI, 0.15-0.63), and the 265 patients who kept their appointments averaged 0.28 (95% CI, 0.17-0.39). Two hundred twenty-nine patients who kept their appointment had no return ED visits, but 36 patients had 74 return ED visits. There was no difference in return ED visits between the 18 who had diagnostic cardiac testing (mean, 1.78; 95% CI, 1.60-3.06) and the 18 who did not (mean, 2.33; 95% CI, 1.20-2.36; P = .251).

Conclusions

This program did not reduce repeat ED visits. Patients with insurance were more likely to keep follow-up appointments.     

输氧湿化瓶微生物污染及污染途径调查

目的调查输氧湿化瓶的污染途径,了解其微生物污染情况及所检出致病菌的抗生素敏感度。方法对正在使用的输氧设施345套次的不同部位及痰和病房空气等处分别取样做细菌培养;针对致病菌铜绿假单胞菌进行药敏试验。结果湿化液严重污染占37.1%;湿化瓶和湿化液连续使用时间越长细菌检出率越高,且严重污染者亦随之升高,使用时间〉3d与〈1d对比差异显著（P〈0.05）;湿化瓶盖、鼻导管、咽拭子、痰及病房空气培养检出的细菌种类与湿化液检出的细菌种类相似。结论湿化液的常见污染菌多为条件致病菌。本研究提示湿化液的污染途径为经鼻导管的逆行污染。     

输氧湿化瓶微生物污染及污染途径调查

目的调查输氧湿化瓶的污染途径,了解其微生物污染情况及所检出致病菌的抗生素敏感度。方法对正在使用的输氧设施345套次的不同部位及痰和病房空气等处分别取样做细菌培养;针对致病菌铜绿假单胞菌进行药敏试验。结果湿化液严重污染占37.1%;湿化瓶和湿化液连续使用时间越长细菌检出率越高,且严重污染者亦随之升高,使用时间〉3d与〈1d对比差异显著（P〈0.05）;湿化瓶盖、鼻导管、咽拭子、痰及病房空气培养检出的细菌种类与湿化液检出的细菌种类相似。结论湿化液的常见污染菌多为条件致病菌。本研究提示湿化液的污染途径为经鼻导管的逆行污染。