骨科术中外来器械与手术室器械污染监测对比分析

目的监测骨科术中外来器械和手术室器械污染情况,为外来器械管理提供参考.方法在骨科手术进行至2.5 h、3.5 h时由手术护士配合采集未使用的术中器械样本,其中外来器械98个,手术室器械75个.样本均置于37℃恒温箱中培养72 h后观察记录,肉汤混浊、变色、有生物膜生成视为阳性,肉汤透明清亮视为阴性.结果外来器械总体样本阳性率、3.5 h样本阳性率高于手术室器械,差异有统计学意义(P<0.05);外来器械组内比较,2.5 h和3.5 h间差异有统计学意义(P<0.05);手术室器械组内比较,2.5 h和3.5 h间差异无统计学意义(P>0.05).骨科手术中所用全部器械污染率2.5 h和3.5 h时比较差异有统计学意义(P<0.05).结论骨科术中外来器械污染率高于手术室器械,手术开始3.5 h时污染率明显高于手术室器械,外来器械的污染率随手术时间延长而升高;骨科手术器械整体采样阳性率偏高,且随手术时间延长呈升高趋势.     

骨科术中外来器械与手术室器械污染监测对比分析

目的:探讨骨科手术室外来器械与手术室器械污染监测方法。方法:对2011年1月~2012年1月我院骨科手术器械进行样本采集并监测,分别于手术开始后2 h和4 h进行抽样采集并经恒温培养后,比较外来器械与手术器械的污染情况。结果:手术室器械2 h与4 h阳性率无统计学差异(P0.05),外来器械2 h与4 h的阳性率存在统计学差异(P0.05)。结论:骨科手术中外来器械的污染率远远高于手术室器械,且随着手术时间的延长,其污染几率显著增加。加强手术器械的人员及消毒管理,注重手术器械的污染监测,严格控制手术室的无菌环境,是降低手术室器械阳性率的关键措施,值得推广应用。     

骨科术中外来器械与手术室器械污染监测对比

目的:探讨骨科术中外来器械与手术室器械污染情况。方法:选择2012年1月~2015年1月我院骨科层流手术室内外来器械80件作为观察组,选择同期本院骨科层流手术室内手术器械80件为对照组,分别于手术开始后2.5,3.5,5 h时实施手术器械污染采样,同时进行两组冷凝水污染采样。将所得样本进行培养,比较两组采样的阳性率情况。结果:两组手术器械手术开始后2.5 h阳性率差异无统计学意义(P0.05),观察组3.5,5 h阳性率高于对照组(P0.05)。完成压力蒸汽灭菌后,外来器械以及手术室器械采集包内残存微量冷凝水样本均为10个,其培养结果阳性率均为0,差异无统计学意义(P0.05)。结论:严格控制手术器械使用时间,对外来器械进行严格消毒和灭菌,可以有效降低手术器械导致的污染。     

手术室骨科外来器械的管理

目的对骨科外来器械进行规范化管理,防止因为植入物污染导致患者发生术后感染,保证患者手术安全。方法本院从2016年1月起实行器械准入制度:器械实行预约、接收、核对、清洗、检查、包装、灭菌登记等规范化流程;对配合手术的器械商进行上岗培训,培训合格后发放合格证,凭证进入手术室配合手术。统计该制度实行后外来器械准备错误率及因外来器械发生手术感染率。结果 2016年1月～2017年9月1420例次骨科外来器械,未出现外来器械准备错误而影响手术,也未出现因为外来器械原因而发生手术感染。结论手术室对骨科外来器械实行规范化流程,重视器械在清洗检查灭菌方面的质量控制,保证手术安全和手术及时进行,防止发生术后感染。     

品管圈在手术室外来器械管理中的应用

[目的]探索品管圈在手术室外来器械管理中的应用。[方法]由9人组成品管圈,分析手术室外来器械管理问题产生的原因并采取整改措施。[结果]品管圈应用到手术室外来器械管理中后手术室外来器械不合格率从12.41%降到2.70%,差异有统计学意义(P0.05);手术医生对外来器械的满意度从85.93%提高到96.43%,差异有统计学意义(P0.05)。[结论]品管圈应用到手术室外来器械管理取得了较好的效果,提高了手术室外来器械的合格率,增加了手术医生的满意度。     

外来骨科器械在手术室无菌质量的管理

目的 探讨有效的外来骨科器械在手术室无菌质量管理方法.方法 2010年1月至2011年12月为研究组,共处理外来骨科器械2 300例,2008年1月至2009年12月为对照组,共处理外来骨科器械2812例.分别统计和记录两组外来器械应用过程中器械包破损、丢失损坏、术前准备污染、手术过程中污染的发生率.结果 研究组不良事件发生率明显多于对照组,数据经统计学比较具有显著差异(P＜0.05).结论 新标准化手术室外来骨科器械无菌质量管理流程有利于减少不良事件的发生,提高无菌管理效率,应从台账管理、相关人员培训管理、术前器械准备、术中使用规范和术后处理要求等方面入手管理.     

探讨手术室外来器械的管理

手术室外来器械多见于外来骨科器械和外请教授自备器械。外来骨科器械主要指由外单位（厂家）带来在医院临时使用的手术器械,如各种骨科植入物、手术内固定用工具等。我院2009年4月-2010年4月涉及外来器械的手术820例。手术中心接收的外来器械包括腰椎、     

风险管理在手术室外来骨科器械管理中的应用

风险管理是通过识别风险,衡量风险,分析风险,从而有效控制风险。用最经济的方法来综合处理风险,以实现最佳安全生产保障的科学管理方法[1]。近年来随着科学技术的发展,现代骨外科医学也在迅速发展,新技术、新手术、新业务的广泛开展和应用,导致越来越多的器械广泛应用于临床,如人工关节、内固定器械、内固定植入物、电钻。由于某些医疗器械更新快、价格昂贵,医院一般不常规配备,多采用临时借用的形式,由经销商提供给医院手术室临时使用,这种器械一般称外来手术器械,是在普通手术器械的基础上增加的专项操作器械,它是市场经济的产物[2]。手术室外来骨科器械主要是指由器械商提供给医院手术室临时使用的手术器械,如各种骨科植入物,手术内固定的工具等,需要严格执行国家技术监督局,国家卫生部《医院消毒卫生标准》及外来手术器械消毒灭菌程序。因为外来器械由厂家业务员负责,而业务员的自身素质以及掌握的医学知识参差不齐,由此引起的器械清洗、保养及器械的安全不容乐观。而且外来植入器械价格变化大、差异大、收费容易出错,同时器械进货、出货混乱容易丢失,护士对器械验收标准把关难。骨科器械管理混乱会给医院,科室和个人带来严重损失和压力。因此,医院必须加强外来器械的管理。我院手术室运用风险管理的方法管理外来骨科器械取得良好效果,现介绍如下。     

流程管理在外来骨科器械接收中的应用

[目的]加强外来骨科手术器械管理,避免因流程不畅通导致的外来骨科手术器械灭菌时间的延误。[方法]通过制订外来骨科器械的流程管理,落实急需特殊外来骨科器械消毒交接班记录表登记,灭菌效果监测。[结果]实施后各环节交接到位,职责清晰,特殊情况时能及时沟通、处理,记录齐全,无因流程不畅通导致的问题。[结论]通过流程管理,加强及规范外来骨科器械管理,各级人员职责清晰,信息反馈及时、沟通渠道通畅。     

骨科外来器械手术清点的临床优化与成效

目的优化骨科外来器械的手术清点,提高手术室护理人员的清点效率和准确性。方法对外来器械清点进行优化,如器械包系统分类、数量基数核定、摆放功能化分区、设计电子化清点单等,选取2018年9-12月行人工髋关节置换术和骨盆骨折内固定术各50例患者为观察组,与2018年3-6月行此两种手术的各50例患者(对照组)进行比较,比较在同类手术方式、相同巡回和器械护士的情况下器械包使用个数、外来器械清点消耗时长、清点错误复点率、骨科手术医生满意率等方面的差异。结果优化后外来器械包使用的数量、外来器械清点消耗时长、清点错误复点患者例数、骨科手术医生满意率等方面差异均有统计学意义(P0.05)。结论对外来器械手术清点的优化,能有效提高清点效率,降低手术室护理人员的工作量,保障骨科手术患者的安全,具有一定护理指导意义。     

Assessment instruments used in rehabilitation

Nowadays the word assessment is commonly used in the field of health, but what aspects does it cover in rehabilitation medicine? This paper presents conceptual and operational approaches to the assessment of patients suffering from functional limitation. These systems of assessment either represent a global approach--considering patients' activities of daily living--or have been specifically elaborated for a category of patients such as those with quadriplegia. However, such instruments pose problems of validity, construct validity, sensitivity and easy use. While advanced approaches exist for improving assessment of clinical follow-up in rehabilitation, we have also to consider the difficulty of combining objective assessment of functional abilities with measurement of perceived or felt handicap from the treated patient's point of view.     

Development of laparoscopic instruments

Laparoscopy has important consequences for the functioning of the surgeon, affecting both his/her perception and manipulation capabilities. To be able to judge the perception and manipulation aspects of laparoscopic instruments, a thorough insight into the functioning of the laparoscopic surgeon is needed, and a realistic model of the operation process should be a starting point for every new design. In addition, it is efficient to use observational methods to gain insight into the most important limitations encountered in clinical practice and into the effect of an alternative design. To achieve simplification of the laparoscopic procedure, innovative and unconventional solutions are needed. Thus, the design strategy for laparoscopic instruments is important. Passive and active design strategies, and force- and motion-directed design concepts are reviewed, and their characteristics are compared in view of minimally invasive application. Three design examples are presented and the related design strategy is discussed in each case. These examples are: a laparoscopic grasper with force perception, a passive instrument positioner and a force-controlled robotic system with active constraints. Future trends in the development of laparoscopic instruments are also discussed.     

Surgical instruments (I). An introduction to surgical instruments

In surgical wards, the variety and increasing complexity of techniques used, together with the high number of materials and instruments employed, demands that professionals who join these wards have a specific professional development related to instruments and techniques. In this short series of articles, the author shall present distinct manners to gain knowledge about instruments in such a way that at the end of this series, professionals who are interested will have a guide to help them acquire a deep understanding of surgical instruments, their common usage and their specialized characteristics. A bibliography will be included with the last article.     

改进器械装载方式对手术器械清洗质量的影响

目的探讨改进器械装载方式对手术器械清洗质量的影响。方法将4000件污染的手术复用器械根据随机数字表法分为对照组(n=2000,传统装载方式)与研究组(n=2000,基于器械的结构特点及清洗机清洗原理的改进器械装载方式)。比较两组手术器械的清洗质量。结果研究组的管腔类器械、轴节齿纹类器械、实体类器械的清洗合格率及灭菌合格率均高于对照组(P<0.05)。研究组的外观清洁度、轴节齿纹部清洁度、管腔清洁度、清洗质量及消毒质量评分均高于对照组(P<0.05)。结论基于器械的结构特点及清洗机清洗原理改进器械装载方式,有利于提高手术器械的清洗质量,提高灭菌效果。     

Problems in the development of new instruments

Despite the complexity of much modern apparatus the responsibility for inventing new equipment still rests with the scientist. A high level of practical skill is not necessary, but working models play a valuable part. The instrument industry has an equally essential part to play in converting an innovation into a viable commercial product and must take great financial risks in doing so.     

Decontamination of reusable instruments in primary care

Staff who undertake effective decontamination in non-centralized settings such as general practices must be provided with training and easy-to-follow guidance. In this article we present a distillation of the current guidance in an industrial quality control format of fishbone charts. A fishbone chart (or cause-and-effect chart) depicts all the causes of an outcome in a logical way to facilitate the identification of a specific problem. We developed our fishbone chart to include instructions that, if followed, would achieve safe and effective cleaning and sterilization. A survey of those given the charts showed high user acceptability: 76% found the fishbone better than existing guidelines - although the response rate was low at 46%. The charts will enable those involved in decontamination of instruments, including managers and infection control staff, to audit the facilities, equipment and practices. The use of industrial quality tools may assist other specialties that require complicated and comprehensive guidelines to be presented in a more user-friendly design.     

巧饮蜜香饮预防排便困难

蜜香饮配方为蜂蜜、香油、热开水，分别将蜂蜜15mL、香油5mL加热开水150mL搅匀，于每日早饭和晚饭后20min-30min饮入。适合老年、下肢骨折、心肌梗死、肛肠手术等需卧床易引起排便困难者。单纯性便秘者只需早餐前30min饮用蜂蜜茶即可达到通便作用。观察30例，有效率达96．67％。蜜香饮香甜可口，无副反应，且有养颜美容作用。