品管圈在降低医务人员针刺伤的质量改善

目的通过品管圈(OCC)活动,进一步降低医护人员针刺伤的发生率。方法开展以降低医护人员针刺伤的发生率为主题的品管圈活动,对医护人员针刺伤进行现状调查,分析医护人员针刺伤的原因,制定对策进行质量改善。结果通过品管圈活动,医护人员针刺伤发生率由活动前的4.52%下降到活动后的0.84%,差异具有统计学意义(P0.001);圈员综合能力和团队凝聚力均有较大程度提高,差异具有统计学意义(P0.001)。结论品管圈活动能充分调动医务人员的积极性,培养团队协作精神和防范意识,降低针刺伤的发生。     

失效模式与效应分析在急诊科工作人员锐器伤防范中的应用

目的探讨失效模式与效应分析在急诊科工作人员锐器伤防护中的应用与效果。方法对2009年1月至12月发生的锐器伤事件中可能出现的失效模式进行评估、分析,从加强操作培训、加强环境和制度管理、提高工作人员的安全防护意识方面制订整改措施,并监控实施情况和效果。结果急诊科工作人员锐器伤发生率降低(P<0.05)。结论应用失效模式与效应分析能有效减少急诊科工作人员的职业风险。     

240例实习护生锐器伤及低上报率原因分析

目的了解实习护生对锐器伤知识的掌握及影响上报率的因素,为护生防护措施提供依据。方法对240例在我院实习的护生进行有关标准预防知识及行为等方面的问卷调查。结果240例实习生中发生锐器伤167人（69．5％）,未上报人数为127人（76％）,被污染针头刺伤为90人（53．8％）。结论实习护生防护措施不容乐观,尤其是受伤后的处理及上报制度不完善,医院和有关部门应采取切实可行的措施改善实习护生目前现状及条件,提高上报率,防止职业暴露的危害。     

我院医务人员针刺伤现状与防护意识的调查分析

目的了解医务人员针刺伤的现状及防护意识,促进其树立职业防护观念。方法采用问卷调查法对我院577名临床医务人员进行有关针刺伤情况和防护知识调查。结果50.26%的医生、89.33%的护理人员有被针刺伤的经历;其中,66.67%的外科、妇产科医生发生过针刺伤,30.00%的感染病科医生发生过针刺伤。护理人员发生针刺伤最多的科室是急诊科和手术室,发生率分别为96.15%和93.33%。医护人员对于针刺伤相关知识了解程度存在较大差异,45.54%的医生、34.84%的护士不知道自身乙型肝炎和丙型肝炎的免疫状态;20.94%和42.70%的医生和护士不知道预防血源性感染疾病的措施。结论医务人员对于针刺伤的危害及相关预防知识不足,应加强对医务人员针刺伤相关知识的宣传与教育。     

Long work hours and chronic insomnia are associated with needlestick and sharps injuries among hospital nurses in Taiwan: A national survey

BackgroundNeedlestick and sharps injuries are prevalent work-related injuries among nurses. Safety devices prevent only one-quarter of related injuries. More studies of modifiable risk factors are needed.ObjectivesTo examine whether long work hours and chronic insomnia are associated with needlestick and sharps injuries among hospital nurses in Taiwan.DesignCross-sectional survey.Settings/participantsThis analysis included 19,386 full-time bedside nurses working in 104 hospitals across Taiwan.MethodsParticipants filled out an anonymous questionnaire from July to September 2014. Chronic insomnia, needlestick injuries, and sharps injuries during the past year were each measured by a yes/no question. Multivariate logistic regression models were applied to examine the effects of long work hours and chronic insomnia on needlestick and sharps injuries, given with control for sex, marital status, educational level, age, years of practice, work unit, and hospital level in the model.ResultsMore than 70% of study nurses worked long hours during the previous week (>50 h: 27.5%; 41–50 h: 43.2%), and 15.5% of nurses reported chronic insomnia. The percentage of sharps injuries (38.8%) was higher than that for needlestick injuries (22.4%) during the previous year among nurses. After adjusting for potential confounders, logistic regression yielded significant results showing that those who worked 41 to 50 h per week, >50 h per week, and had chronic insomnia were 1.17 times (95% C.I. = 1.04–1.32), 1.51 times (95% C.I. = 1.32–1.72), and 1.45 times (95% C.I. = 1.25–1.68) more likely to experience needlestick injuries, and 1.29 times (95% C.I. = 1.17–1.42), 1.37 times (95% C.I. = 1.23–1.53), and 1.56 times (95% C.I. = 1.37–1.77) more likely to experience sharps injuries, respectively, than those who worked fewer hours and did not have insomnia.ConclusionsThis nationwide nurse survey showed that high rates of needlestick and sharps injuries persist in hospital nurses in Taiwan. The common problems of long work hours and chronic insomnia increase the risk of these injuries. We suggest that hospital managers follow regulations on work hours and optimize shift schedules for nurses to decrease related injuries.     

A training programme for prevention of occupational exposure to bloodborne pathogens: impact on knowledge,behaviour and incidence of needle stick injuries among student nurses in Changsha,People's Republic of China

BACKGROUND: Although the human immunodeficiency virus (HIV) epidemic in China is expanding rapidly, the principles of universal precautions (UP) are not widely disseminated in Chinese hospitals. Lack of training about occupational prevention of bloodborne pathogens (BBP) may place student nurses at risk when they are in clinical practice. AIM: To examine the impact of structured training on prevention of occupational exposure to BBP on knowledge, behaviour, and incidence of medical sharp injuries among student nurses in Changsha, China. METHODS: A quasi-experimental study evaluated changes in knowledge, self-reported UP behaviours, observed adherence to UP, and needle stick/sharp injuries during a 4-month follow-up period. The study population consisted of 106 student nurses in two classes. One class served as the experimental group, while the other served as a control group. Students in the experimental group participated in a structured training intervention consisting of lectures and demonstrations. RESULTS: At 4 months, the group that received the BBP training scored significantly higher than the standard education group on both knowledge (P < 0.001) and behaviour (P = 0.002). Although students in the experimental group were not observed to practise UP significantly more frequently than those in the control group, they were less likely to experience needle stick/sharp injuries (OR = 0.29; 95% CI 0.11, 0.74; P = 0.004). CONCLUSION: Structured training in prevention of occupational exposure to BBP improved knowledge and behaviour and reduced the number of needle stick/sharp injuries among Chinese student nurses, compared with students who did not receive the training. Training in the techniques of UP could play a role in reducing the risk for occupational exposure to BBP among Chinese future nurses. In view of the accelerating HIV epidemic, implementation and evaluation of such training programmes are urgently needed.     

武警部队医院医护人员复合性损伤知识现状调查

[目的 ]了解武警部队医院医护人员对复合性损伤知识掌握程度。 [方法 ]根据战伤救治标准、《护理操作常规》、《军事医学》教材 ,自行设计复合伤相关知识问卷 ,对武警部队医院 2 0 5名医护人员进行调查。[结果 ]部队医院医护人员掌握复合伤知识总均分偏低 ,在复合伤知识掌握上医生好于护士 ;军队护士好于地方合同制护士 ;机动师医院好于总队医院。 [结论 ]部队医院的医护人员复合伤知识欠缺。应建立有效的培训机制 ,加强护理人员复合伤知识的学习。     

Health-enhancing behaviours of nurses in Poland and their association with shift work and age

Background

Deficiencies in terms of healthy lifestyle may exacerbate the negative characteristics of nursing work, especially those arising from shift work.

严重医疗不良事件中第二受害者认知与心理体验的质性研究

目的了解医务人员在严重医疗不良事件中作为第二受害者的认知与心理体验,为医疗不良事件管理体系相关研究提供依据。方法采用质性研究中的现象学研究法,于2019年1—2月,选取3所三级医院9名经历过严重医疗不良事件医务人员进行访谈,根据Colaizzi 7步分析法对访谈资料进行整理分析。结果提炼出4个主题:各种负性体验的经历、对职业认知的改变、认同完善预防不良事件系统的重要性、渴求设立第二受害者支持体系。结论主管部门应关注到医疗不良事件中涉事医务人员的困境,积极构建第二受害者的支持体系,以此来降低他们在医疗不良事件中受到的伤害,从而确保医疗安全。     

按摩及穴位埋针预防CT增强扫描时恶心呕吐的疗效观察

目的 探讨按摩及穴位埋针对预防CT增强扫描时恶心、呕吐的影响.方法 将300例CT增强扫描检查的患者按检查顺序分成观察组和对照组各150例.对照组在CT增强扫描前4～6 h禁食,观察组在常规禁食的基础上于检查前30 min再行按摩及穴位埋针.比较两组CT增强扫描时恶心、呕吐的情况及CT片的图像质量.结果 观察组恶心、呕吐发生率及CT片图像伪影发生率明显低于对照组(P＜0.01).结论 按摩及穴位埋针可预防CT增强扫描时恶心、呕吐症状,提高CT片图像质量,减轻患者痛苦.     

肠道病毒71型感染手足口病患儿的肠道排毒时间及传播机制的初步探讨

目的 探讨肠道病毒71型(EV71)感染手足口病患儿的肠道排毒时间及传播机制,为科学防控手足口病提供参考. 方法 采集咽拭子或粪便标本用实时荧光定量反转录聚合酶链反应法进行病毒核酸检测,对实验室确诊的65例EV71感染手足口病患儿进行追踪和随访,直至患儿大便病毒转阴为止.同时调查与58名EV71核酸阳性患儿有密切接触史家庭成员(每位患儿2名)116人,其中36人采集咽拭子,80人采集粪便标本.采集手足口病病区医务人员粪便标本31人,其中医生10人,护士21人. 结果 25例普通型EV71感染患儿第1~6周大便病毒核酸阳性率分别为100%、88.4%、59.4%、22.3%、22.3%、0,持续最长时间为6周.40例EV71重症组患儿第1～10周大便病毒核酸阳性率分别为100%、97.0%、79.5%、60.6%、35.3%、25.2%、16.8%、16.8%、8.4%、0,持续最长时间为10周.31名医务人员粪便未检出EV71及柯萨奇病毒A组16型(Cox A16)核酸.80名有患儿密切接触史人员中,22份粪便标本EV71核酸阳性,占27.5%;36份咽拭子标本除1例EV71核酸阳性其余均阴性,阳性者均无自觉症状. 结论 EV71感染手足口病患儿恢复期肠道排毒时间长,成为隐性感染者,易造成手足口病流行和传播.建议延长手足口病患者,特别是重症手足口病患者管理时限.EV71感染手足口病患儿家庭成员易成为隐性感染者,可造成手足口病传播.     

医护一体化健康教育在房颤射频消融术后患者随访管理中的应用

目的:探讨医护一体化健康教育在房颤射频消融术后患者随访管理中的应用效果。方法:采用便利抽样法,于2019年9月—2020年8月选取在南京医科大学附属脑科医院住院的房颤射频消融术后患者112例为研究对象。按照随机数字表法将患者分为试验组和对照组,各56例。对照组采用专科护士负责的健康教育进行随访管理,试验组在对照组基础上...     

知信行健康教育模式护理在老年静脉留置针输液患者中的应用效果及对不良事件发生情况的影响

目的 探讨知信行健康教育模式护理在老年静脉留置针输液患者中的应用效果及对不良事件发生情况的影响。方法 将于本院接受静脉留置针输液治疗的46例老年患者根据护理方式的不同分为对照组与观察组,各23例。对照组给予常规护理,观察组给予知信行健康教育模式护理。比较两组的干预效果。结果 观察组的健康教育知识掌握率高于对照组（P<0.05）。观察组的不良事件总发生率低于对照组（P<0.05）;干预后,观察组的积极应对与消极应对评分均优于对照组（P<0.05）。观察组的总依从率、护理满意度均高于对照组（P<0.05）。结论 知信行健康教育模式护理应用于老年静脉留置针输液患者中,可提升患者健康教育知识掌握度与依从性,并可获得较高的护理满意度。     

Characterization of plasma daptomycin in patients with serum highly glycated albumin and obesity

PurposePlasma daptomycin has not been fully characterized in diabetic and obese patients. This study aimed to evaluate the associations of plasma daptomycin with glycation of serum albumin and obesity.MethodsInfectious patients (n = 70) receiving intravenous daptomycin were enrolled. The plasma concentration of total and free daptomycin were determined using liquid chromatograph-tandem mass spectrometer. The associations of the plasma concentrations of daptomycin with clinical factors including serum albumin fractionations and physical status (obese including overweight, body mass index ≥ 25.0) were investigated. Daptomycin doses were adjusted using total body-weight.ResultsThe serum albumin level was positively and negatively correlated with the plasma concentration of total daptomycin and its free fraction proportion, respectively. The serum non-glycated albumin was negatively correlated with the free fraction proportion. The dose-normalized plasma concentration of total daptomycin was higher in the obese patients than in non-obese patients when the body-weight was corrected with total and adjusted values. For the dose adjustment with lean body-weight, no difference was observed in the dose-normalized plasma concentration of total daptomycin between the physical statuses. For each body-weight correction method, physical status did not affect the dose-normalized plasma concentration of free daptomycin.ConclusionThe glycation of serum albumin and obesity did not associate with dose-normalized plasma free daptomycin. In obese patients, daptomycin dosage adjustment with total body-weight and adjusted body-weight may lead to an apparent excessive exposure resulting in overdosage compared to lean body-weight.     

Association of visceral and subcutaneous fat with glucose intolerance, insulin resistance, adipocytokines and inflammatory markers in Asian Indians (CURES-113)

Objectives:

The aim of the study was to assess the association between visceral and subcutaneous fat with glucose intolerance, adipocytokines, inflammatory markers and carotid IMT in Asian Indians.

Design and methods:

Subjects with NGT (n = 85), IGT (n = 49) and T2DM (n = 93) were randomly selected from CURES. Total abdominal, visceral and subcutaneous fat were measured using Helical CT scan. Adiponectin, hs-CRP, TNF-alpha, oxidized LDL, visfatin and leptin and IMT and insulin resistance were assessed.

Results:

Total abdominal fat (p = 0.041) and the visceral fat (p = 0.039) but not subcutaneous fat progressively increased from NGT, IGT and T2DM subjects. With increasing quartiles of visceral fat, there was a significant increase in insulin resistance (p = 0.040); significant decrease in adiponectin (p = 0.043) and increase in TNF-alpha (p = 0.028), hs-CRP (p = 0.043), OX-LDL (p = 0.034) and visfatin (p = 0.040), and carotid IMT (p = 0.047) was observed.

Conclusion:

Visceral fat levels increased with increasing glucose intolerance and are associated with decreased levels of adiponectin and increased levels of hs-CRP, TNF-alpha, oxidized LDL, visfatin, HOMA-IR and IMT.