门诊手术室消毒灭菌质量监测与管理

目的 加强门诊手术室管理，预防与控制医院感染的发生。方法 2003～2007年每月定期对门诊手术室的空气、物体表面、工作人员手、使用中的消毒液及无菌包进行抽样检测，采用检测-反馈-教育-整改-检测的管理方法对消毒灭菌工作进行系统管理。结果 物体表面、使用中的消毒液和灭菌物品5年监测均达100％，空气与工作人员手2005～2007年合格率均达100％。结论 门诊手术室消毒灭菌质量整体情况较好，且有逐年改善趋势。科学合理的监控操作和管理手段，是保证消毒灭菌质量的关键，是预防和控制医院感染的重要措施。     

门诊手术室消毒灭菌质量监测与管理

目的 加强门诊手术室管理,预防与控制医院感染的发生.方法 2003～2007 年每月定期对门诊手术室的空气、物体表面、工作人员手、使用中的消毒液及无菌包进行抽样检测,采用检测-反馈-教育-整改-检测的管理方法对消毒灭菌工作进行系统管理.结果 物体表面、使用中的消毒液和灭菌物品5年监测均达100%,空气与工作人员手2005～2007年合格率均达100%.结论 门诊手术室消毒灭茵质量整体情况较好,且有逐年改善趋势.科学合理的监控操作和管理手段,是保证消毒灭菌质量的关键,是预防和控制医院感染的重要措施.     

消毒供应室无菌物品的监测

目的:探讨如何确保医院消毒供应室无菌物品的灭菌效果及性能良好.方法:通过医院感染管理科对消毒供应室工作的指导,加强相关知识的培训,规范物品清洗,灭菌流程,进行灭菌效果监测和质控.结果:对消毒供应室无菌物品采用102件进行监测,合格率达100％.结论:医院感染管理科对消毒供应室无菌物品监测结果满意.     

医院感染管理院科两级监测结果比较

目的探讨医院感染管理办公室与临床科室医院感染管理小组两级组织监测医院消毒灭菌效果与环境卫生学监测结果的差异,分析导致差异的原因,以寻求解决的方案。方法回顾性统计分析2009年1月至2010年4月医院感染管理办公室对10个医院感染管理重点部门使用中消毒灭菌剂、消毒灭菌物品、医护人员手、空气、环境表面等项目的监测结果及相对应科室同期自我监测的结果。结果除灭菌物品和使用中消毒剂2项外,环境空气、物体表面、医护人员手、其他项目及总体合格率,两级组织监测结果比较,差异有统计学意义（P〈0.05,P〈0.01）。结论医院感染管理办公室监测合格率低于科室自我监测合格率。建议根据医院规模配备足够的专职人员,制定合理的管理制度保证科室自我监测的真实性和准确性。     

医院感染管理院科两级监测结果比较

目的探讨医院感染管理办公室与临床科室医院感染管理小组两级组织监测医院消毒灭菌效果与环境卫生学监测结果的差异,分析导致差异的原因,以寻求解决的方案。方法回顾性统计分析2009年1月至2010年4月医院感染管理办公室对10个医院感染管理重点部门使用中消毒灭菌剂、消毒灭菌物品、医护人员手、空气、环境表面等项目的监测结果及相对应科室同期自我监测的结果。结果除灭菌物品和使用中消毒剂2项外,环境空气、物体表面、医护人员手、其他项目及总体合格率,两级组织监测结果比较,差异有统计学意义(P0.05,P0.01)。结论医院感染管理办公室监测合格率低于科室自我监测合格率。建议根据医院规模配备足够的专职人员,制定合理的管理制度保证科室自我监测的真实性和准确性。     

过程管理在重症监护病房医院感染控制中的应用

目的:将过程管理应用于重症监护病房医院感染管理中,规范医疗护理工作,提高医院感染的管理水平,以有效地降低医院感染发病率.方法:通过对2009 ～ 2011年医院感染监测项目,ICU综合目标质量管理合格率进行比较,评价重症监护病房实施过程管理的效果.结果:实施过程管理后,重症监护病房感染率感染率显著降低,ICU综合目标质量管理合格率和消毒灭菌质量监测合格率有不同程度的提高.结论:以医院感染管理相关法规为依据,以医院感染重点环节为质控点的过程管理,是降低重症监护病房医院感染率的有效措施.     

加强口腔医院感染管理 不断提高医疗服务质量

目的加强口腔专科医院感染管理，提高医疗服务质量，确保医疗安全。方法采取全员教育，全体参与，制定专科医院预防交叉感染的措施，规范医疗行为。结果控制医院感染措施提升了全体医务人员对参与医院感染管理工作重要性的认识和自觉性，诊疗器械消毒、灭菌合格率达1.0％。结论规范医疗行为和重点管理是控制医院感染的有效措施，能保证患者的就诊安全。     

加强口腔医院感染管理不断提高医疗服务质量

目的 加强口腔专科医院感染管理,提高医疗服务质量,确保医疗安全.方法 采取全员教育,全体参与,制定专科医院预防交叉感染的措施,规范医疗行为.结果 控制医院感染措施提升了全体医务人员对参与医院感染管理工作重要性的认识和自觉性,诊疗器械消毒、灭菌合格率达100%.结论 规范医疗行为和重点管理是控制医院感染的有效措施,能保证患者的就诊安全.     

加强医疗器械清洗有效预防与控制医院感染

目的:加强医疗器械清洗质量管理,提高清洗质量,保证灭菌效果,有效地预防与控制医院感染.方法:分析清洗对于医疗器械消毒灭菌的重要性及消毒效果的影响因素结果:有效的清洗可去除器械上大量污染的有机物、细菌和热原质,提高消毒灭菌效果结论:加强医疗器械清洗质量管理,是保证清洗质量,有效预防与控制医院感染的重要手段.     

医院消毒供应室的管理

目的总结医院消毒供应室的管理方法。方法医院供应室从规范布局、科学化管理、设备更新及灭菌监测方法的改进进行管理。结果消毒灭菌合格率为100%。结论供应室管理是一项全过程、全员性、全方位的管理工作;加强布局,完善制度,强化管理是保证消毒质量的前提。     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.