内镜室医务人员的自身防护

内镜室医务人员的自我防护问题，已引起国内外同行的高度重视，内镜室病人多，医务人员经常接触分泌物，排泄物和各种消毒剂，这些均易造成内镜室医务人员的职业危害。为了提高内镜室医务人员的自我防护意识，先后制定了各种规章制度，健全各项安全防范措施，以确保内镜室医务人员的自身安全。[第一段]     

内镜室医务人员职业暴露风险及干预措施

随着内镜技术的普及,其临床应用日趋广泛,内镜已经成为常规诊疗工具.由于内镜经常接触病人的分泌物、排泄物和血液,沾染大量致病微生物,常因洗消和处理过程给医务人员带来暴露机会,可引发医院感染[1].内镜室医务人员面临的职业暴露危害越来越受到人们的关注.医院内镜诊疗患者多、流动性大,医护人员与患者近距离接触,使他们成为易受感染的高危人群.     

内镜室的消毒管理

近年来,随着胃肠镜检查在临床的广泛应用和内镜治疗技术的不断开展,经内镜传播的疾病时有发生.在临床使用过程中,胃肠镜作为一种侵入人体腔内的仪器,其构造复杂,不能耐高温、高压,只能采用某些化学消毒剂浸泡,又由于其使用频率高、往往因冲洗不够彻底、消毒时间不足等原因而导致消毒灭菌不彻底引起医院感染的发生,因此做好内镜室的消毒管理是预防医院感染的重要环节之一.     

ICU病房护理人员职业相关性腰背痛原因调查及其危险因素

目的:探讨ICU病房护理人员职业相关腰背痛的发生情况及相关的危险因素。方法:以综合性医院ICU病房护士为观察组,普通病房护士为对照组进行横断面调查,发放问卷调查,了解护理操作危险姿势发生状况。结果:ICU病房护士腰背痛现患率(83%)、发作频率(每月1次以上者占45%)与对照组现患率(45%)、发作频率(每月1次以上者占28%)比较均明显升高,差异有统计学意义(P<0.01,P<0.05)。ICU病房护士典型护理操作危险姿势发生频率依次为高频率弯腰、在床上搬台病人、晨晚间护理、翻身叩背、记录引流液、胸外心脏按压、穿刺注射等。结论:ICU病房护士腰背痛患病率较普通病房护士高,其危险因素较多,应引起重视。     

内镜室护理相关危险因素分析

[目的]分析内镜室护理相关危险因素。[方法]结合内镜室护理工作中的实际问题,分析并总结出内镜室护理人员长期处于损伤性、吸入性、感染性三大危险因素中。[结果]通过对危险因素的分析,提高内镜室护理人员自我防护意识,从而降低危险。[结论]加强对内镜室护理职业危险因素教育,可提高护理人员防护意识,使职业危险降低。     

内镜室医务人员的职业防护体会

医务人员的职业危害及自我防护巳受到普遍关注，尤其是内镜室医务人员的自我防护。其工作性质决定她们可能面临各种危害，为避免这些危害的发生，我们2004年8月至今做到加强专业知识的学习，熟练掌握消毒灭菌知识和内镜清洗、消毒、灭菌方法。严格执行卫生部《内镜清洗消毒技术规范》（2004年版），按此内容的要味进行整改。加强设备装置，保证设施，改善防护、隔离等条件，减少噪音的危害。在工作中自觉遵守《规范》的各项操作规程，清洗消毒流程合理，提高工作效率，使内镜富的空气污染得到治理；加强宣传教育，强化感染控制意识，加强自身素质修养，把意外发生率降低到最低限度。     

耳鼻喉门诊内镜室医院感染危险因素剖析及干预措施探究

选取耳鼻喉门诊内镜室接受诊疗150例患者作为研究对象,采取回顾性研究分析的方法,根据是否发生医院感染将患者分为感染组和未感染组,对两组的临床资料进行回顾性的总结分析,对可能引起医院感染的危险因素进行单因素分析和多因素Logistics回归分析。经单因素分析得出,年龄、ASA分级、诊疗季节、合并其他疾病、内镜消毒不规范可能与耳鼻喉门诊内镜室发生医院感染有关;经多因素Logistics回归分析确认,年龄、ASA分级、诊疗季节、合并其他疾病、内镜消毒不规范是耳鼻喉门诊内镜室发生医院感染的危险因素。耳鼻喉门诊内镜室的诊疗过程中可能会发生医院感染,年龄、ASA分级、诊疗季节、合并其他疾病、内镜消毒不规范是导致耳鼻喉门诊内镜室发生医院感染的危险因素,临床上应针对相关危险因素实施有针对性的预防干预措施,以减少医院感染的发生。     

内镜室医护人员潜在的职业危险因素及防护对策

内镜室包含有胃镜、肠镜、支气管镜、膀胱镜等相关工作,由于其性质和环境的特殊性,医护人员在日常工作中不但要接触大量沾有病人血液、体液的物品,污物及锐利器械,极易引起损伤,而且要服务于较多门诊病人,易产生医疗纠纷.所以对内镜室潜在职业危险因素进行分析,并提出防护措施,对保障自身安全和健康具有重要意义.     

内镜室医源性感染的管理措施

探讨如何预防内镜造成的医源性感染,其方法是阻断内镜检查治疗中易造成医源性感染的各个环节,主要包括（1）内镜室环境的管理;（2）内镜及附件清洗消毒的管理;（3）内镜工作人员的管理;并对目前存在的问题进行讨论.通过严格的管理措施,杜绝由内镜引发的医源性感染,确保安全的内镜诊疗.     

谈内镜室护理人员的心理素质

临床护理人员是人类健康的守护神，作为一位护理人员，尤其是一位内镜室护理人员，除应具有扎实的理论基础、丰富的临床经验、熟练的操作技术，与医生紧密配合，当好助手之外，还应具有高尚的思想境界、医德修养和良好心理素质。这是保证护理工作顺利进行的必要条件之一。因此内镜室的护理人员应具备以下几点心理素质。     

办公室人员腰痛患病率抽样调查及康复相关因素分析

目的：明确办公室人员腰痛的患病率和分布情况及康复相关因素，为康复治疗干预和健康宣教等工作提供依据。方法：采用多阶段整群抽样方法，选取300名广州市办公室工作人员作为调查对象，使用统一的结构式问卷进行访问调查，对结果进行统计学分析。结果：共完成291份调查，应答率为97％。受访者年龄18—69（34．04±10．31）岁，腰痛患病率为41．9％。腰痛与工作体位有关（P=0．023）；每日同一体位工作时间〉2h是腰痛的危险因素（P=0．005，OR=3．342，CI：1．445—7．733），年龄对于办公室工作人员患腰痛是影响因素之一（P〈0．001）。康复相关因素分析中发现：被访者中对治疗腰痛最认同的方法是中医推拿按摩54．6％，其次为理疗18．2％；有68．7％的人知道运动也能够治疗腰痛；85．9％的人知道预防对于腰痛的重要性，其中只有10％的人知道如何预防：受访者治疗腰痛时首先选择保健按摩医院（中心）的占26．8％，康复科则列第4位13．1％。结论：广州市办公室人员腰痛的患病率较高，与年龄、体位和工作时间有关；他们对康复相关因素及现代康复治疗手段的认识度不高，值得业界关注。     

妊娠晚期下腰及骨盆痛影响因素分析

目的了解妊娠晚期孕妇下腰及骨盆痛发生率及其影响因素。方法采用问卷调查对1 254例妊娠晚期孕妇进行下腰、骨盆痛及其相关因素调查、分析。1 254例妇女在孕36周常规产前检查时接受问卷调查,包括:年龄,身高,肥胖指数,受教育程度,是否失业,城市或农村人口,有无保姆,孕前有否腰痛,前次妊娠有否腰痛,疼痛部位、程度、性质、加重及缓解方法,孕妇活动能力(日常活动,家务劳动,户外活动)等。结果妊娠晚期孕妇下腰及骨盆痛发生率为48.96%。身高,受教育程度,是否失业及有无保姆与疼痛无明显关系。低龄、高龄孕妇较适龄孕妇更易腰痛。超重孕妇更易腰痛。孕前有腰痛及前次妊娠有腰痛者在本次妊娠中发生腰痛比例增大。城乡孕妇腰痛发生率有较大差异。久站最易加重腰痛,卧位可以明显减轻疼痛。下腰及骨盆痛对妊娠晚期孕妇的活动影响较大。结论妊娠晚期孕妇下腰及骨盆痛发生率高,对于某些影响因素有必要采取相应的有效干预措施以提高孕妇的生活质量。     

心理因素与下腰痛

尽管临床上下腰痛很常见,但目前仍有很多不明确的问题,文章从下腰痛发生的影响因素及生理、心理学机制等方面,对心理因素与下腰痛的相关性进行了综述。指出一些下腰痛患者表现出“抑郁-疑病-癔病”之神经三联征的个性特征;并建议在下腰痛的处理上对患者的心理和躯体成分予以同样重视。     

Acute low back pain: clinical course and prognostic factors

Purpose.?The aim of this study was to assess the clinical course of patients with acute low back pain (LBP) throughout 12 weeks and to identify the prognostic factors for non-recovery in the short term.

Method.?A total of 91 patients with acute LBP (<3 weeks) were included in this study. Baseline assessments including demographic variables, clinical characteristics of pain, lost work time and results of clinical examination were noted. Pain intensity, disability, general health perception and depression were assessed according to visual analogue scale, Roland Morris Disability Questionnaire (RMDQ), Nottingham Health Profile (NHP) and Beck Depression Inventory, respectively. Patients were assessed for pain intensity and disability at baseline, and at 1, 2, 4, 8 and 12 weeks of follow-up. Recovery was considered if patients scored <4 on the RMDQ and pain had resolved. At the 2nd week of follow-up, patients were divided into two groups according to recovery (Group 1) or non-recovery (Group 2) to identify the prognostic factors, which were analysed by multiple logistic regression.

Results.?At 2 weeks, 52 (57.1%) of the patients had recovered and only eight (8.7%) developed chronic LBP. Mean pain intensity and mean disability scores dropped 96.7 and 96.4%, respectively, of initial levels during the 12 weeks. Sixty per cent of 63 employed patients reported lost time from work. A comparison between groups revealed that finger-floor distance, RMDQ and NHP (pain, physical mobility, emotional reactions, sleep, energy level, and distress subgroups) were statistically significantly lower in Group 1, and NHP-pain was strongly associated with non-recovery in the short term.

Conclusions.?Acute LBP patients with disability generally recover in the first weeks. General health perception (NHP) – pain subgroup score was identified in particular as the best prognostic factor for non-recovery in the short term. Hence, pain should be given particular consideration in baseline assessments of acute LBP patients.     

手术室医护人员健康状况及其影响因素调查分析

目的:了解手术室医护人员的健康状况,分析影响医护人员健康状况的主要职业因素。方法:选择我市3家医院手术室108名医护人员为研究对象,采用自设问卷调查手术室医护人员的一般资料及影响手术室医护人员健康的职业因素,采用欧洲五维度健康量表(EQ-5D量表)测量自评健康得分。结果:≤35岁、低职称及大专学历的手术室医护人员健康自评分高于其他组,均P0.05。对可能影响手术室医护人员健康的职业因素进行分析,筛选出前3位影响因素为:物理因素占90.77%,化学因素占72.31%,生物因素占58.46%。结论:≤35年龄、低职称及大专学历的手术室医护人员其健康状况更加良好,物理、化学及生物因素是影响手术室医护人员健康的主要职业因素。为了提高手术室医护人员的健康状况,需要对上述因素予以有针对地防护。     

The effects of a back rehabilitation programme for patients with chronic low back pain

AIM: The aim of this paper was to perform a pragmatic before-after analysis of a back rehabilitation programme (BRP) for patients with chronic low back pain (LBP). A total of 877 patients were recruited onto the BRP, which were carried out at four centres within the Wrightington, Wigan and Leigh NHS Trust. The BRP consisted of nine 2-hour group sessions of therapy run over 5 weeks and included 1 hour of exercise and 1 hour of education, advice problem solving and goal setting. METHOD: Using the Wilcoxen signed rank tests and paired t-tests levels of pain, disability, anxiety and depression were significantly reduced pre-post programme (P < 0.001). In addition, the levels of fitness and perceived control improved significantly (P < 0.001) suggesting that participants were better able to manage their LBP. CONCLUSION: Overall, the BRP proved to be effective in reducing pain, disability, anxiety and depression levels for people with chronic LBP. However, despite significant improvements in outcome measures only 50% of the patients completed the BRP and questionnaires post BRP. The implications of the findings are discussed with respect to modified programmes and alternative management for patients within different subgroups of LBP.     

Prognostic factors in first-time care seekers due to acute low back pain.

There is limited knowledge on prognostic factors for developing chronic low back pain (LBP) at an early stage of LBP. The objectives of this study were to investigate the clinical course of pain and disability, and prognostic factors for non-recovery after 1-year, in patients seeking help for the first time due to acute LBP. An inception cohort study included 123 patients with acute LBP lasting less than 3 weeks and consulting primary care for the first time. Main outcome measures were pain intensity, Roland-Morris disability questionnaire (RMQ), and sickness absence. Eleven patients (9%) did not return for the 12-month follow-up. There were large and significant reductions in pain intensity (P<0.001) and RMQ scores (P<0.001) during follow-up. Patients with neurological signs showed significantly less improvement in pain (P=0.001) and RMQ (P=0.004) compared with those without neurological signs. The proportions with sickness absence due to LBP at 6, 9, and 12 months were 7%, 8%, and 9%, respectively. At 12 months, 17% of patients had not fully recovered. Multivariate logistic regression analyses showed that high scores on a psychosocial screening (acute low back pain screening questionnaire) and emotional distress (Hopkin's symptom check list) were significantly associated with non-recovery at 12 months, with odds ratios of 4.4 (95% confidence interval 1.1-17.4) and 3.3 (1.1-10.2), respectively.     

Low back pain: prevalence and associated risk factors among hospital staff

Title. Low back pain: prevalence and associated risk factors among hospital staff. Aim. This paper is a report of a study conducted to describe the prevalence and risk factors for lower back pain amongst a variety of Turkish hospital workers including nurses, physicians, physical therapists, technicians, secretaries and hospital aides. Background. Hospital workers experience more low back pain than many other groups, the incidence varies among countries. Work activities involving bending, twisting, frequent heavy lifting, awkward static posture and psychological stress are regarded as causal factors for many back injuries. Method. A 44‐item questionnaire was completed by 1600 employees in six hospitals associated with one Turkish university using a cross‐sectional survey design. Data were collected over nine months from December 2005 to August 2006 and analysed using Chi square and multivariate logistic regression techniques. Findings. Most respondents (65·8%) had experienced low back pain, with 61·3% reporting an occurrence within the last 12 months. The highest prevalence was reported by nurses (77·1%) and the lowest amongst secretaries (54·1%) and hospital aides (53·5%). In the majority of cases (78·3%), low back pain began after respondents started working in the hospital, 33·3% of respondents seeking medical care for ‘moderate’ low back pain while 53·8% (n = 143) had been diagnosed with a herniated lumbar disc. Age, female gender, smoking, occupation, perceived work stress and heavy lifting were statistically significant risk‐factors when multivariate logistic regression techniques were conducted (P < 0·05). Conclusion. Preventive measures should be taken to reduce the risk of lower back pain, such as arranging proper rest periods, educational programmes to teach the proper use of body mechanics and smoking cessation programmes.