Prévention de l'hépatite C en milieu de soins

Hepatitis C virus (HCV) is mainly a blood-borne pathogen. Its transmission in health care facilities has remained partly unexplained until now. Two modes of transmission have been suggested, either through medical devices reused in invasive procedures and incorrectly cleaned or disinfected, or through accidental blood contacts generating a risk of contamination between health care workers and patients. Prevention of HCV transmission is based on the respect of standard precautions for all patients and all cares. These precautions need to be reinforced in facilities where patients are frequently exposed to invasive procedures, such as haemodialysis units, interventional radiology, surgery, intensive cares or transplant units. Specific disinfecting measures should be implemented according to material, including endoscope or dialysis generator. Health care workers protection against accidental blood exposure includes to avoid high risk tasks and to use protective material during cares or discarding cares waste (protective gowns and clothes, containers for sharp objects, etc).     

Operating theatre ventilation standards and the risk of postoperative infection

Some form of specialized ventilation has been a feature of operating theatres for over 60 years, and ultraclean ventilation has been shown to reduce postoperative infection after prosthetic joint surgery. However, controversy remains over the contribution of plenum (conventional) ventilation to the prevention of infection after surgery in which there is no prosthetic implant. A previous survey in Great Britain and Ireland indicated the continued use of non-ventilated theatres for minor surgery. Laparoscopic and other forms of minimally invasive surgery (MIS) have become more common in the last decade, and offer the advantages of reduced morbidity and shorter hospital stay. However, it is not clear whether such surgery requires the same standard of ventilation facilities as open surgery and, in particular, whether all MIS procedures should be performed in a plenum-ventilated theatre. Furthermore, there are many diagnostic and therapeutic procedures currently performed in cardiac and radiology departments where only natural ventilation is available. The Hospital Infection Society (HIS) Working Party on Infection Control and Operating Theatres is attempting to assess the ventilation facilities currently utilized for a wide variety of MIS procedures. This review should form the basis of future HIS guidance on minimum standards in this area.     

颅脑外科介入性操作感染原因分析

目的查找某院颅脑外科介入性操作引起医院感染的原因。方法对2009年全年颅脑外科接受介入性操作的477例患者进行回顾性调查。结果在477例介入性操作的患者中,发生医院感染83例次,感染率17．4％,其中留置尿管和气管插管并用呼吸机感染发生率较高。结论介入性操作是引起医院感染的高危因素,在工作中要采取各种措施,有效控制由此引发的医院感染。     

介入放射学程序中患者的辐射防护

目的 通过分析介入放射学术前和术中对患者剂量影响的关键环节,探讨术前和术中对患者的辐射防护。方法 通过对介入放射学实施流程的分析和查阅相关的文献,研究介入放射术中患者剂量的控制方法。结果 患者辐射防护应注意多方面的影响,并关注术中可利用的多种剂量数据。结论 合理的术前规划和完善的术中患者剂量管理与控制是减少患者吸收剂量的有效方法。     

2009-2017年南通市某三甲综合医院介入放射工作人员个人剂量和工作场所监测结果分析

目的 分析南通市某三甲医院介入放射工作人员2009-2017年个人剂量以及现场辐射状况,为保障医院介入放射工作人员健康提供数据支撑。方法 介入放射工作现场辐射剂量率检测采用辐射检测仪（AT1123）,个人剂量检测系统采用热释光剂量仪（RGD-3D、FJ-427A）。结果 该三甲医院2台介入设备透视防护区测试平面空气比释动能率为39.74~492.48 μGy/h、17.28~198.72 μGy/h,2009-2017年介入放射工作人员年个人剂量值均高于普放科室工作人员（2015年除外）,差异具有统计学意义。结论 介入放射科机房内的辐射剂量率要明显高于机房外,介入手术的工作人员个人剂量要明显高于其他放射工作人员。因此,介入放射工作人员应当正确佩戴个人防护用品科学操作介入放射设备。     

抽拉式介入手术性腺防护装置的研制与应用

目的：根据医院介入手术临床应用需求,研制一种抽拉式介入手术性腺防护装置。方法：通过对环绕式双层结构的可弯曲式放射防护材料收纳器和三段式放射防护材料等进行技术设计,实现患者盆部性腺的环绕式防护。结果：该装置设计简单、结构合理,可在不透X射线的防护状态和透X射线的可视状态之间方便地进行切换,并符合介入手术的无菌要求。结论：抽拉式介入手术性腺防护装置在保证临床介入手术效果的同时,解决了患者性腺防护的难题,具有良好的临床应用价值。     

From operating theatre to operating studio--visualizing surgery in the age of telemedicine.

We have conducted a telemedicine project between two of Norway's largest hospitals (Rikshospitalet and Ullev?l Hospital) with a focus on image-guided surgical and radiological procedures. Video was broadcast using a 34 Mbit/s ATM network. This resulted in changes in the local work practice to accommodate and facilitate the communication. It also required changes to the surgeon's tasks to improve communication with remote viewers. These changes were not trivial and can be viewed as signs of a shift towards a more public kind of surgery and interventional radiology, brought about by new technology.     

Survey of operating theatre ventilation facilities for minimally invasive surgery in Great Britain and Northern Ireland: current practice and considerations for the future

Increasing use of minimally invasive surgery (MIS) and other invasive procedures has raised the question of what ventilation facilities are appropriate for such procedures to prevent infection. The Hospital Infection Society (HIS) Working Party on Infection Control in Operating Theatres undertook a survey of practice in Great Britain and Northern Ireland on the ventilation facilities provided for a variety of MIS and other procedures. Five hundred and fifty questionnaires were forwarded to HIS members, and 186 (39%) replies were received. Fifty-eight percent were from district general hospitals (DGHs). Designated theatres for orthopaedic surgery (although not necessarily ultraclean ventilated theatres) were available in more than 80% of hospitals, with approximately 50% of hospitals having designated theatres for a variety of other surgical subspecialities. Approximately two-thirds of urological procedures were performed in conventionally ventilated operating theatres. Most radiological procedures were performed in non-ventilated theatres or treatment rooms. In around half of the DGHs and university/referral hospitals, orthopaedic MIS procedures such as arthroscopy were performed in ultraclean ventilated theatres. This survey revealed considerable variation in the use of conventionally ventilated theatres and ultraclean ventilated theatres. In particular, many radiological and anaesthetic procedures are performed in treatment rooms or ventilated rooms with less than 20 air changes per hour. Whilst it is not clear whether this is acceptable practice given current knowledge, large-scale clinical trials to determine what standards of ventilation are appropriate to minimize infection for these types of procedures would be difficult to conduct. Research is needed on the relative risk of airborne infection for a variety of procedures, including whether all prosthetic implant procedures should be carried out in ultraclean ventilated theatres, as infection associated with implants is often of airborne origin and of considerable clinical significance.     

眼晶状体新剂量限值对介入放射工作人员辐射防护的影响

目的 对完善我国介入放射工作人员辐射防护给出适当建议。方法 结合现行相关标准内容和国内外研究结果,分析探讨眼晶状体剂量限值改变对介入放射工作人员防护的影响。结果 对于介入工作人员,眼晶状体剂量监测应作为常规监测内容,应配给相应的防护设备,并对辐射防护相关知识技能进行培训。结论 我国介入放射工作人员职业照射的防护需进一步完善。     

Trends and future needs in clinical radiology: insights from an academic medical center

OBJECTIVE: Advances in technology, expanding indications and defensive medical practice, in combination with population aging, have all contributed to a substantial increase in utilization of imaging and therapeutic radiology procedures in recent years. Moreover, the integration of education, innovation and research into high-volume workflow, although challenging, is a key requirement in teaching hospitals. Therefore, identifying forthcoming demand in the use of radiology services at a referral center might be of special interest and facilitate health policy planning in this context. METHODS: Data regarding conventional radiographic, ultrasonographic and computed tomography (CT) investigations, radiotherapy sessions, and interventional procedures were collected for a 5-year period (2000-2004). Based on these observations, we deployed appropriate models to forecast utilization rates in 2005-2009. RESULTS: Between 2000 and 2004, ultrasound examinations increased by 31.8%, mammography by 31.6%, CT scans by 17.4%, interventions by 14.5% and radiotherapy sessions by 13.9%, while conventional investigations decreased by 42.5%. We identified significant increasing trends for ultrasound, mammography, CT and interventions (all p<0.001 for linear component). Compared to current levels, the workload for these modalities is expected to rise in the next 5 years by 43%, 31%, 20% and 14%, respectively. Radiotherapy sessions demonstrate an unstable, non-significant increasing trend (p=0.189), while utilization of conventional radiography declines rapidly (p<0.001 for linear trend, 5-year prediction -51%). CONCLUSIONS: In forthcoming years, the demand for radiology services at referral centers will increase substantially. Advances in digital technology alone will not suffice to completely alleviate the need for additional resources and well-trained personnel.     

Practice variation in the Dutch long‐term care and the role of supply‐sensitive care: Is access to the Dutch long‐term care equitable?

Universal access and generous coverage are important goals of the Dutch long‐term care (LTC) system. It is a legal requirement that everyone eligible for LTC should be able to receive it. Institutional care (IC) made up for 90% of Dutch LTC spending. To investigate whether access to IC is as equitable as the Dutch government aspires, we explored practice variation in entitlements to IC across Dutch regions. We used a unique dataset that included all individual applications for Dutch LTC in January 2010–December 2013 (N = 3,373,358). This dataset enabled an accurate identification of the need for care. We examined the local variation in the probability of being granted long‐term IC and in the intensity of the care granted given that individuals have applied for LTC. We also investigated whether the variation observed was related to differences in the local availability of care facilities. Although our analyses indicated the presence of some practice variation, its magnitude was very small by national and international standards (up to 3%). Only a minor part of the practice variation could be accounted for by local supply differences in care facilities. Overall, we conclude that, unlike many other developed countries, the Dutch system ensured equitable access to long‐term IC.     

某市不同级别医院介入的放射卫生现状调查

目的 调查珠三角某市不同级别医疗机构介入放射学的放射卫生现状。方法 通过采用全面普查的方法,选择该市截至2019年12月31日已开展介入治疗业务的所有医疗机构作为研究对象。采用现场流行病学调查的方法调查研究对象的基本情况、防护设施现状、环境辐射剂量、个体防护用品现状、职业健康监护现状。结果 截至2019年12月31日,该市7家医疗机构共有12台介入治疗设备,现有180名介入治疗从业人员。不同级别医院的介入治疗从业人员构成差异无统计学意义（P > 0.05）。不同级别医院的介入治疗的防护设施构成差异无统计学意义（P > 0.05）。三甲医院介入治疗设备机房的周围辐射剂量高于二甲医院,差异有统计学意义（P < 0.05）。不同级别医院的介入治疗个体防护用品构成差异无统计学意义（P > 0.05）。二甲医院上岗前职业健康检查和在岗期间的职业健康检查比例高于三甲医院（P < 0.01）。结论 该市不同级别医疗机构介入治疗业务发展良好,加强对介入治疗申请辐射防护管理、积极开展建设项目的职业病危害放射防护评价,督促从业人员按要求进行职业健康监护检查,可能有助于提高该市介入治疗的放射卫生防护水平。     

2010—2011年北京市密云县放射工作人员个人剂量监测

【摘要】目的了解北京市密云县放射工作人员个人剂量监测状况，为加强和改善放射防护提供科学依据。方法用Excel和SPSS软件对个人剂量数据进行统计分析。结果2010～2011年该县个人剂量监测结果都在允许的范围之内，不同工种放射工作人员的年有效计量均〈20mSv，从事介入放射诊断的工作人员平均剂量高于该地区年平均剂量水平。结论密云县放射防护工作应重点加强介入放射诊疗操作人员的防护。     

介入手术医生受照剂量研究进展

近些年来介入放射技术得到了迅猛的发展，随着介入放射诊疗技术的不断提高，并且介入手术医生因近距离操作会受到较高的辐射剂量，对健康造成损害，因此对介入手术医生受照剂量的研究越来越重视。对有关文献进行汇总可知，目前有多种方法来评估介入手术医生的受照剂量，例如单剂量计法、双剂量计法、模体法以及蒙特卡罗模拟法等，已经得到大量的实验数据。说明一方面在逐步降低估算全身受照剂量时的误差，另一方面从某一种疾病受照剂量的估算，逐渐发展全面到多种疾病，各种手术类型及手术部位的研究。本文通过对介入手术医生的受照剂量相关文献进行分析总结，为介入手术医生的防护提供重要依据。     

介入放射工作人员血细胞指标的分析

目的 探讨电离辐射对介入放射工作人员血细胞的影响,为介入放射工作人员的健康防控提供依据。方法 以医院34名介入放射工作人员为接触组,35名不接触电离辐射的行政人员为对照组,比较分析其血细胞的变化。结果 接触组淋巴细胞均值明显低于对照组,介入放射工作人员中女性白细胞异常值检出率明显高于男性,年龄和工龄对介入放射工作人员的血细胞影响不明显。结论 电离辐射对介入放射工作人员血细胞会产生一定的影响,应加强介入放射工作人员健康管理,提高个人防护意识。     

介入医学的现状和发展趋势

自1967年提出介入放射学的概念以来,此项技术发展迅速,已形成一系列诊断方法与治疗方法,成为与内科学、外科学并驾齐驱的第三治疗学科。且具有微创性,可重复性,定位准确,疗效高、见效快,并发症少,多种技术联合应用简便易行等优点。扼要介绍其主要分支腹部介入放射学、心脏介入放射学、神经介入放射学、妇产介入放射学等系列边沿学科的现状及发展趋势。     

河北省部分放射工作人员个人剂量监测与分析

目的调查河北省部分县级以上(含县级)医院放射防护工作情况。方法对2010年不同工种放射工作人员(248人)年人均剂量当量监测数值进行比较,个人剂量监测采用热释光剂量测量方法。结果放射工作人员年人均剂量当量范围为0.13～1.41 m〕mSv/a,平均值最低的工种为诊断放射学(0.13 mSv/a),最高工种为介入放射学(1.41 mSv/a)。介入放射学及医用加速器年人均有效剂量与诊断放射学相比较,差异有统计学意义(P0.01)。与牙科放射学比较,差异有统计学意义(P0.05)。结论河北省县级以上医院放射防护工作开展较好。但仍应进一步加强防护工作。对牙科X线机的防护也应加以重视。     

介入放射线诊疗设备应用及不良事件检测

目的：介绍介入放射学的设备、材料及其在临床中的应用,更好地掌握介入放射治疗的方法,减少介入放射治疗在临床应用中不良事件的发生。方法：介绍各种影像设备DSA、CT、MRI等的性能及使用方法以及介入放射线设备防护知识,分析产生介入治疗不良事件的原因,给出避免介入治疗不良事件的方案。结果：介入放射医生在介入放射线诊疗中增强了放射线设备防护意识,减少了不良事件的发生。结论：介入放射治疗应用中存在不良事件发生的潜在因素,会损害医生与患者的身体健康以及导致临床诊断事故,为此应做好防犯工作,使介入放射治疗工作得以顺利开展。     

Novel laparoscopic techniques in gynecologic surgery

The practice of gynecologic surgery has been revolutionized by laparoscopic techniques in the past decades. Nowadays minimal invasive procedures are feasible and safe standard options in the management of most benign and malignant gynecologic diseases. Natural orifices transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) have been developed in an attempt to further reduce the morbidity and scarring with minimal invasive procedures. These techniques share a common conception that a reduction in the number of transcutaneous points of access may benefit patients in terms of port-related complications, risk of hernia formation, recovery time, pain and cosmetics by potentially performing scarless surgery. The development of LESS has been facilitated by the concept of scarless surgical procedures. Increasing experience revealed by recent publications have allowed for the expansion of NOTES and LESS techniques in the gynecologic surgery. Almost all laparoscopic procedures can be performed by acquiring these concepts. Although these surgical methods are feasible and safe, certain technical problems (e.g. loss of triangulation, problems of visualization, ergonomic considerations) has yet to be solved and several questions must be answered before LESS and NOTES could gain widespread acceptance as single procedures. Despite successful technical developments these methods remain investigational approaches and refinement of indications as well as further development of instrumentation are expected to define its area of future application.     

Application of ALARP to extremity doses for hospital workers.

The implementation of ALARP for hospital workers is considered in relation to extremity doses. Criteria are proposed which could provide guidance in determining strategies for both implementing radiation protection measures and dose monitoring for the extremities. Two groups of hospital workers have been studied, namely interventional radiologists/cardiologists, and radionuclide staff preparing and administering radiopharmaceuticals. The radiology procedures can give high doses to both the hands and legs. Those to the legs can be reduced by the use of lead rubber shields. Study of the distribution of dose across radiologists' hands has identified the ring position on the little finger as the appropriate position for dose monitoring. The variations in dose across the hands of radionuclide workers are greater, with the tip likely to receive the highest dose. The protection strategy will need to be determined for each department, because of the wide range in techniques used in handling radiopharmaceuticals. It is hoped that the criteria could aid balanced decision-making about the appropriate protection strategy and ensure that protection measures are in place where they are required, but avoid their introduction where they are unnecessary.