小儿ICU医院感染目标性监测分析

目的了解小儿ICU医院感染发病特点及规律。方法采用目标性监测的方法,前瞻性地研究2009年4月-2010年3月ICU患儿医院感染发病情况,用患者平均病情严重程度(ASIS)调整医院感染发生率,并对侵入性操作相关感染进行分析。结果 883例住院患儿中,发生医院感染103例次,例次感染率为11.66%,患者日例次感染率为15.30‰,经ASIS调整后患者日医院感染率为4.15‰;3种侵入性操作相关性感染日感染率分别为:呼吸机相关性肺炎49.44‰、留置导尿管相关性泌尿道感染2.41‰、动静脉插管相关性血液感染0.99‰。结论小儿ICU医院感染发生率较高,与应用各种导管相关,以呼吸机相关性肺炎为主;应重视目标性监测,加强对侵入性操作的管理与干预。     

某新建医院综合ICU医院感染目标性监测分析

目的了解某新建医院综合ICU医院感染、导管相关性感染特点,探讨相关医院感染预防控制措施。方法通过目标性监测,对2014年10月-2015年9月入住ICU患者进行医院感染率、导管相关性感染率和导管使用率等指标的调查分析。结果监测的1 408例患者中,发生医院感染116例、137例次,感染率为8.24%,例次感染率9.73%,患者日例次感染率15.40‰,根据平均病情严重程度调整后日例次感染率为3.69‰;其中呼吸机相关性肺炎感染28例次,感染率6.32‰,中心静脉导管相关性血流感染2例次,感染率1.74‰,导尿管相关泌尿道感染32例次,感染率3.77‰;感染部位以下呼吸道为主,占38.68%,其次为泌尿道(35.77%)、中枢神经系统(8.03%);在侵入性操作相关感染中以呼吸机相关性肺炎为主;检出的病原菌以肺炎克雷伯菌和大肠埃希菌为主,分别占36.45%和21.50%。结论 ICU是医院感染的高危科室,结合目标监测数据分析可及早分析和制定相关干预措施并执行。     

综合性ICU医院感染目标性监测分析

目的分析综合性重症监护病房(ICU)医院感染目标性监测结果,了解ICU医院感染特点。方法监测2009年2月-2010年1月ICU患者医院感染发病率,用患者平均病情严重程度(ASIS)调整法调整发病率,监测3种侵入性操作相关感染及常见病原菌特点。结果 498例患者中发生医院感染87例、感染率为17.47%,日感染率为18.39‰,经ASIS调整后日感染率为5.24‰;呼吸机相关性肺部感染32.90‰、留置尿管相关性泌尿道感染7.32‰、中心静脉插管相关性血流感染7.32‰;共检出802株病原菌,以革兰阴性菌为主(71.45%)。结论 ICU医院感染率高,主要为3种侵入性操作相关感染;目标性监测能及时准确获得ICU医院感染动态变化信息,制定有效干预措施,降低医院感染发生率。     

ICU患者留置导管相关感染监测分析

目的通过对ICU留置导管相关感染的监测资料进行分析,探讨降低ICU医院感染的针对性护理干预措施。方法采用目标监测法收集2012年10月-2013年6月苏北人民医院ICU住院患者709例感染监测的数据,对使用呼吸机、深静脉置管、留置尿管侵入性操作的相关感染率进行分析。结果 709例患者医院感染86例、95例次,感染率12.13%、例次感染率13.40%;其中留置导管感染60例,占69.77%;呼吸机相关性肺炎感染率为8.32‰,血管导管相关性血流感染率为4.50‰,尿管相关性尿路感染率为3.47‰;留置导管相关感染与侵入性操作、导管留置时间及导管维护等有关。结论建立留置导管患者监护档案、规范留置导管的应用、加强导管护理过程的监控等干预措施,可以有效降低ICU的医院感染率,提高患者的救治率。     

肿瘤医院重症医学病房医院感染目标性监测分析

目的了解重症医学病房(ICU)医院感染特点、病原菌分布及侵入性操作的感染情况,为控制感染和持续质量改进提供依据。方法采用目标性监测方法,收集2012年1月-2013年12月ICU710例患者发生医院感染、侵入性操作相关感染及常见病原菌分布情况资料,以患者平均病情严重程度(ASIS)评分调整发病率,采用Excel电子表格录入数据资料,对数据进行描述性统计分析。结果 710例患者中发生医院感染94例、感染例次97例、感染率为13.24%、感染例次率为13.66%;日感染率为15.06‰、日例次感染率为15.54‰,平均病情严重程度为3.09分,经调整后分别为4.87‰、5.03‰;2012年呼吸机相关性肺部感染率为21.28‰、中心静脉插管相关性血流感染率7.31‰、留置尿管相关性泌尿道感染率0.42‰,2013年感染率分别为7.73‰、2.29‰、0.29‰;两年共检出141株病原菌,其中革兰阴性杆菌94株,占66.67%。结论 ICU医院感染率高,主要为3种侵入性操作相关感染,其中以呼吸机相关肺部感染最高,应加强引起感染相关因素控制。     

ICU患者导管相关性感染与留置时间的关系分析

目的了解综合性ICU患者导管相关性医院感染情况,分析相关影响因素,为制定干预措施提供科学依据。方法采用目标性监测的方法,对某三级甲等医院综合性ICU,2004年1月-2010年12月,住院患者的导管相关性医院感染进行调查。结果 2060例住院患者中,发生医院感染662例,感染发生率为32.14%,患者日感染发生率为22.20‰,经病情平均严重程度调整法(ASIS)调整后,患者医院感染发病率为7.30%,日感染率为5.05‰;与使用呼吸机、动静脉插管、留置尿管相关的日医院感染率分别为42.36‰、5.98‰、3.93‰;侵入性操作是医院感染的危险因素(P<0.01),且均与管道的留置时间有关。结论各类导管的应用是综合性ICU患者发生医院感染的危险因素,应加强对ICU患者侵入性操作的管理,尽可能减少导管的使用并缩短留置时间,以降低医院感染率。     

ICU导管相关性感染目标性监测分析

目的了解某院重症监护病房(ICU)医院感染发生情况,尤其是导管相关性感染基线数据,为干预措施的制定提供参考。方法采用前瞻性调查方法对2010年6月-2011年12月入住ICU患者的医院感染发生情况进行目标性监测,并对侵入性操作使用率与相关医院感染发生率进行分析。结果调查期间共监测2741例ICU患者,发生感染198例、307例次,感染率为7.22%、例次感染率为11.20%;同期ICU住院总日数9666d,日感染率为20.48‰,例次日感染率为31.76‰;经ASIS调整后的日感染率为6.86‰,日感染例次率为10.64‰;导尿管、中心静脉插管及呼吸机的使用率分别为96.39%、58.66%和50.77%,使用导管所致相关泌尿道、血流感染和呼吸机相关性肺炎分别为3.11‰、5.47‰和20.58‰。结论 ICU医院感染发病率和导管相关性感染率较高,必须制定相应感染控制预防措施,使其相应的感染得到有效控制。     

肿瘤专科医院ICU医院感染目标性监测分析

目的分析肿瘤专科医院重症监护病房(ICU)医院感染目标性监测结果,为制定医院感染预防控制措施提供科学依据。方法对2011年1-12月入住ICU的患者进行目标性监测,采用患者平均病情严重程度(ASIS)调整法调整医院感染发病率,监测3种侵入性操作相关感染及常见病原菌特点。结果共监测住院患者357例,发生医院感染4例,感染率为1.12%,日感染率为6.08‰,经ASIS调整后日感染率为2.17‰;无呼吸机相关性肺炎、留置尿管相关性泌尿道感染及中心静脉插管相关性血流感染的发生;共检出病原菌33株,以革兰阴性菌为主,占54.55%。结论 ICU医院感染率与3种侵入性操作无密切相关性;针对病原学监测,合理使用抗菌药物、加强医务人员手卫生等工作将是一项持续工程。     

综合医院ICU目标性监测分析与干预

目的了解医院ICU导管相关医院感染以及呼吸机相关性肺炎感染现状,采取相应措施进行预防控制,以降低其感染率。方法采用前瞻性监测方法对医院2012年1-12月入住ICU并有留置导管及呼吸机的患者进行监测,对监测数据进行统计处理。结果 2012年1-12月ICU 1 500例患者发生医院感染155例、209例次,感染率为10.33%、例次感染率为13.93%;其中目标性监测患者中感染80例、109例次,感染率为5.33%、例次感染率为7.27%;感染部位为下呼吸道为主,占41.63%,其次为血液和泌尿系感染,分别占30.14%、24.88%;ICU导管相关感染以中心静脉导管相关性血流感染(CRBSI)为主,占39.45%,其次是导尿管相关尿路感染(UTI)和呼吸机相关性肺炎(VAP),分别占33.94%和26.61%;呼吸机相关性肺炎千导管日感染率最高,为4.23‰,其次为中心静脉导管和导尿管,分别为4.12‰和3.71‰;共检出病原菌106株,其中革兰阴性菌58株占54.72%,革兰阳性菌31株占29.24%,真菌17株占16.04%。结论 ICU患者病情危重,住院时间长,抗菌药物使用级别高、时间长,侵入性操作多,容易发生医院感染;加强ICU的探视管理、积极评估导管的必要性,及时拔管、严格执行手卫生、合理使用抗菌药物、严格执行无菌技术操作等措施以降低ICU医院感染的发生率。     

ICU医院感染相关因素分析

目的 调查ICU患者侵入性操作发生相关性医院感染情况和危险因素,为有效地制定预防控制对策提供科学依据。方法 对2011-2012年入住ICU 843例患者进行相关性医院感染监测,采取以感染管理科环节和终末质量控制监测相结合的方法进行目标性监测,并采用SPSS17.0进行统计分析。结果 发生相关性医院感染48例、64例次,感染率5.7%、例次感染率7.6%、日感染率为10.2‰、调整感染率2.3%;呼吸机、静脉置管和留置导尿管使用率分别为36.8%、33.8%和84.9%,感染率分别为20.2‰、9.9‰和3.2‰;感染病原菌以革兰阴性菌为主,占71.0%,其中鲍氏不动杆菌、铜绿假单胞菌是呼吸机相关性肺炎的主要致病菌。结论 通过调查分析,长期机械通气、留置导尿管和静脉置管是发生相关医院感染的主要危险因素,针对以上相关因素,积极采取预防控制对策,可有效地预防相关医院感染的发生。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.