医务人员对医用电离辐射相关知识的知晓情况调查

目的 探讨医务人员对医用电离辐射相关知识的知晓情况。方法 选取2016年6月-2017年6月在我院工作的150名医务人员进行医用电离辐射相关知识及认知水平的问卷调查,并选取同期的非医务人员100例,对比分析所有医务人员对医用电离辐射的知晓度、从业感想及医务人员与非医务人员对医用电离辐射知识的获取途径。结果 医务放射人员对电离辐射基础知识的知晓率为48.0%,对辐射危害知识的知晓率为67.9%,对防护知识的知晓率为23.8%（P<0.05）;放射人员对于医用电离辐射的获取途径主要为专业书籍,其次为临床实践、媒体报道、网络,非放射人员对于医用电离辐射的获取途径主要为媒体报道和网络（P<0.05）;所有医务人员中,与男医务人员相比,女医务人员不愿暴露于电离辐射下工作所占比例较高,且对比不同科室的医务人员,其中医学影像学科室的医务人员不愿暴露于电离辐射下工作所占比例较高（P<0.05）。结论 医务人员对于医用电离辐射相关知识的知晓程度并不是很高,对相关知识的了解较为缺乏,因此要采取相应措施,加强医学辐射安全文化教育的宣传和普及,促使医务人员树立对待医用电离辐射的正确态度。     

Use of safety devices and the prevention of percutaneous injuries among healthcare workers.

OBJECTIVE: To study the effectiveness of safety devices intended to prevent percutaneous injuries.Design. Quasi-experimental trial with before-and-after intervention evaluation. SETTING: A 350-bed general hospital that has had an ongoing educational program for the prevention of percutaneous injuries since January 2002. METHODS: In October 2005, we implemented a program for the use of engineered devices to prevent percutaneous injury in the emergency department and half of the hospital wards during the following procedures: intravascular catheterization, vacuum phlebotomy, blood-gas sampling, finger-stick blood sampling, and intramuscular and subcutaneous injections. The nurses in the wards that participated in the intervention received a 3-hour course on occupationally acquired bloodborne infections, and they had a 2-hour "hands-on" training session with the devices. We studied the percutaneous injury rate and the direct cost during the preintervention period (October 2004 through March 2005) and the intervention period (October 2005 through March 2006). RESULTS: We observed a 93% reduction in the relative risk of percutaneous injuries in areas where safety devices were used (14 vs 1 percutaneous injury). Specifically, rates decreased from 18.3 injuries (95% confidence interval [CI], 5.9-43.2 injuries) to 0 injuries per 100,000 patients in the emergency department (P=.002) and from 44.0 injuries (95% CI, 20.1-83.6 injuries) to 5.2 injuries (95% CI, 0.1-28.8 injuries) per 100,000 patient-days in hospital wards (P=.007). In the control wards of the hospital (ie, those where the intervention was not implemented), rates remained stable. The direct cost increase was 0.558 euros (US$0.753) per patient in the emergency department and 0.636 euros (US$0.858) per patient-day in the hospital wards. CONCLUSION: Proper use of engineered devices to prevent percutaneous injury is a highly effective measure to prevent these injuries among healthcare workers. However, education and training are the keys to achieving the greatest preventative effect.     

“三科一室”联合业务查房的做法与体会

"三科一室"联合业务查房是将业务查房与医疗质量管理相结合的查房形式。由主管业务院长带队,医务科、质控科、护理部、临床药学室主要负责人参与,到临床科室现场查房,全面把握医疗质量管理情况,进一步规范了医疗行为,提高了医疗质量,保障了医疗安全。     

Gloves as medical devices or individual protection devices: current regulations and correct use in hospital environments

BACKGROUND: Hospital work consists of the care and assistance of patients, who therefore constitute another group of individuals besides the workers, which is a completely different situation compared to other workplaces in manufacturing industries. OBJECTIVES: Health professionals must know how to use the right devices to protect both the patients and themselves. In the case of protection of the hands, health professionals must also know when to use gloves as "individual protection gloves" and when to use gloves as "medical devices", and comply with both Italian and European Community regulations. METHODS AND RESULTS: The Hospital of Vimercate (Milan) has drawn up technicalprocedures regarding the various types of gloves used in hospitals, which provide health care workers with accurate information on regulations and protocols, prevention guidelines, safety management recommendations, purchasing specifications, quality controls, correct uses of gloves and devices.     

Safety and complexity: inter-departmental relationships as a threat to patient safety in the operating department

PURPOSE: Current thinking about "patient safety" emphasises the causal relationship between the work environment and the delivery of clinical care. This research draws on the theory of normal accidents to extend this analysis and better understand the "organisational factors" that threaten safety. DESIGN/METHODOLOGY/APPROACH: Ethnographic research methods were used, with observations of the operating department setting for 18 month and interviews with 80 members of hospital staff. The setting for the study was the Operating Department of a large teaching hospital in the North-West of England. FINDINGS: The work of the operating department is determined by inter-dependant, "tightly coupled" organisational relationships between hospital departments based upon the timely exchange of information, services and resources required for the delivery of care. Failures within these processes, manifest as "breakdowns" within inter-departmental relationships lead to situations of constraint, rapid change and uncertainty in the work of the operating department that require staff to break with established routines and work with increased time and emotional pressures. This means that staff focus on working quickly, as opposed to working safely. ORIGINALITY VALUE: Analysis of safety needs to move beyond a focus on the immediate work environment and individual practice, to consider the more complex and deeply structured organisational systems of hospital activity. For departmental managers the scope for service planning to control for safety may be limited as the structured "real world" situation of service delivery is shaped by inter-department and organisational factors that are perhaps beyond the scope of departmental management.     

An educative practice of sensitization to ionizing radiation exposition with health professionals

This study present a nursing care practice whose objective is to sensitize health professionals of neonatal intensive care unit about the risk of exposition to ionizing radiation, aiming to optimize the radiological protection. The Operative Italian Model (OIM) was the main theoretical and methodological reference which guided this practice, carried out with twelve participants in a public hospital in Floriandpolis-SC, Brazil. The results demonstrated that health professionals are exposed to ionizing radiation, especially for not being aware of the recommendations already included in the legislation.     

临床医护人员电离辐射安全和防护知识知晓率调查

目的 了解临床医护人员对电离辐射安全和防护知识的知晓率。方法 采用横断面调查方法,以270例护理人员为调查对象发放自行设计的问卷进行调查。问卷内容包括调查对象社会人口学特征,以及放射物理学和生物学、放射使用原则、辐射防护、电离辐射安全使用指南等三大类放射性知识。采用描述性流行病学方法对问卷调查结果进行分析。结果 共发放调查问卷270份,回收有效问卷252份,有效应答率为93.33%。252例调查对象以女性为主（占99.21%）,年龄以25～<55岁为主（占80.16%）,工作年限以≥20年为主（占31.35%）,受教育程度以本科为主（占66.67%）,75.00%曾接受过医学辐射知识培训和教育。调查对象对“知晓怀孕的放射工作者相关要求”、“在日常工作中尽力普及有关放射性剂量和应用的相关安全知识”、“能意识到在日常工作中做到辐射安全防护”、“知晓辐射安全文化的重要性”、“在辐射控制区工作时能注意到警示标志”、“知晓有关辐射安全警示标志的含义”、“知晓如何报告放射性使用中的异常事件”、“知晓如何合理使用个人辐射防护用品”、“知晓辐射防护的剂量限值原则”、“知晓电离辐射如何产生”、“知...     

Environmental exposure scenarios: development, challenges and possible solutions

Under the new REACH system, companies importing, producing and marketing chemical substances will be obliged to register the single substances and to carry out a safety assessment for all identified uses during the life cycle of the substance. This duty will apply to about 10,000 existing substances in the EU market exceeding an annual production or import volume of 10 t per company. If the substance is already known to be dangerous or turns out to be dangerous(1) during the hazard assessment, the registrant is obliged to carry out an exposure assessment and a risk characterisation for all identified uses. The goal of the safety assessment is to define the conditions of use that allow for adequate control of risk with regard to health and safety at the work place, consumer safety and protection of the environment. Once the registrant has established and documented these conditions in the Chemicals Safety Report (CSR), that information is to be communicated down the supply chain by means of the Extended Safety Data Sheet (eSDS). The ultimate aim of the new legislation is to establish duties and mechanisms that systematically prevent or limit exposure to dangerous industrial chemicals. The current paper explains this concept with regard to environmental exposure and highlights the challenges and possible solutions.     

Brazilian legislation and the international recommendations related to the occupational exposure to biologic agents

Bibliographic review with the objective to identify the Brazilian legislation related to occupational exposure of health workers to biological material and compare it with the main recommendations of the International Labor Organization (ILO) and the Centers for Disease Control and Prevention (CDC). The information was searched by access to the websites of the Ministry of Health, Ministry of Labor and Employment, ILO and CDC. The data collected were categorized into five themes for better understanding and analysis. We find that the Brazilian legislation covers most of the international recommendations, but the obligation of providing safety devices was later included in the legislation. It is concluded that workers need information about their rights and duties before the exposure to biological hazards.     

Genetic counseling in Catholic hospitals. Facilities must provide guidance to keep pace with new knowledge and techniques

As advances in the knowledge of human genetics change the practice of medicine, Catholic healthcare facilities will, according to ethicists, be increasingly obliged to provide genetic counseling services to their patients. Facilities should ensure that counselors make genetic information available in a context in which no pressure, overt or subtle, is exerted to use that information in a way that may violate an individual's value system. Some hospitals may, for example, set up a separate genetic counseling department, which does not diagnose or treat genetic disorders but does facilitate access to these treatments when patients need them. Effective counseling requires accurate, current knowledge about tests and treatments, as well as about theological discussions and Church decisions on the subject. Counselors also need to be aware of some typical misconceptions people have about genetic disease. Catholic hospitals should also work with other Catholic organizations to influence legislation addressing human genetic issues, especially when such legislation addresses reproductive rights.     

Safety training and legal liability

Safety at work depends on knowledge of the hazards of the working environment and their effects. Training is needed to avoid, reduce, or manage the effects of these hazards. Health and safety legislation requires employers to provide staff with the knowledge needed for safety management and the confidence to deal with hazards at work. This article considers the general health and safety training requirements for different members of staff in terms of management and competence.     

National survey on the use of chemicals in the working environment: estimated exposure events.

OBJECTIVES--To obtain knowledge about the use and distribution of hazardous chemicals in Danish industry. This knowledge is used to regulate the occupational environment and prevent hazardous exposure. METHODS--A national survey on the use of chemicals was carried out in 1989 in a stratified sample of 1448 Danish businesses. 13,000 different chemical products were reported. Information on components in the chemical products was obtained from the Danish product register data base (PROBAS) and by inquiries to suppliers and manufacturers. At the end of the study the composition of about 9400 of the products was known. A model was developed to estimate national numbers of chemical exposure events as a supplement to data on weights of chemicals used. RESULTS--Data are presented for 36 chemical substances with chronic toxic effects and high estimated national numbers of exposure events for the industry groups included in the survey. Seven of the 36 substances are carcinogens, 17 are reproductive toxicants, 12 are allergens, and 18 are neurotoxicants according to listings of chronic toxicants used by the Danish authorities. The largest national number of exposure events was estimated for the industry groups manufacture of fabricated metal products, and personal services, cleaning, and hair dressing. These should have special attention in further preventive work. CONCLUSIONS--This survey on the use of chemicals is the first nationwide investigation in Denmark to delineate the use of all chemicals. The data have been used in a project to review occupational hazards in general in Danish industry. In the future, the data may be used as a basis for measuring chemical substitution, developing chemical safety, and as reference for more specific investigations and for follow up studies. Also job exposure matrices based on actual use of chemical products can be constructed.     

Current epidemiological evidence regarding the health effects of low-dose ionizing radiation. Implications for radiation protection, public health and forensic medicine

The health effects of low-dose ionizing radiation have been widely studied, but remain uncertain. Up-to-date knowledge about epidemiologic evidence for potential human health effects of low dose ionizing radiation is important for revising national radiation protection legislation. This review, conducted by a multidisciplinary research team of the Italian Institute of Social Medicine, evaluates epidemiologic studies published since July 2003. After careful selection, a total of 302 studies were reviewed. Greater emphasis was given to papers that analyzed data using standardized incidence and mortality ratios and to studies regarding occupational exposures in all workers, healthcare workers and aircrew members. Nevertheless, studies regarding A-bomb survivors of Hiroshima/Nagasaki, Chernobyl cleanup workers, patients exposed for medical reasons, and workers in nuclear plants were also included. Given the limitations of epidemiological studies and excluding the cosmic rays context, which requires further research, the authors conclude that harmful effects from exposures to ionizing radiation at doses lower than 100 mSv cannot be ruled out. Nevertheless, if any harmful health effects do exist, they are certainly very small. The implications for radiation protection, public health and forensic medicine are discussed.     

SOCIAL WORK IN HEATLH CARE IN THE NEXT TEN YEARS

The social worker in health settings in the future will have medical knowledge that affects his practice, be a more active psychosocial counselor, and be prepared to work in group practice that includes a number of disciplines. The social work department of the future will be organized in a more decentralized fashion, and will develop stronger links to other clinical and administrative departments within the medical center, to departments of social work of other medical centers, and particularly with community groups outside of the hospital. The department will need to assign manpower expertise in such areas as knowledge of changing social and welfare systems, legislation affecting programs, as well as in research, computerization, data gathering and retrieval.     

浅谈医院资产管理信息化的实现

目的：资产信息化系统的建立,有助于实现医院的资源整合、流程优化,使运行成本降低,提高服务质量、工作效率和管理水平。有助于实现数字化医院,是现代医疗发展的新趋势。方法：信息系统采用C/S和B/S模式相结合,全模块功能,导航清晰、灵活、易学易用;预留专用接口数据平台,易于扩展。结果：通过信息化系统的实施,解决了资产管理手段单一、请领复杂、信息孤立、会计核算信息滞后等问题,提高了医院资产设备的保障效率和患者满意度,实现了医院资产的透明化、一体化、动态化、精确化管理。结论：该系统实现了对资产全过程、专业化、信息化的质量安全控制。系统适应医院资产管理的真实业务,满足了医院资产信息化管理的要求。     

Mise sur le marché européen des dispositifs médicaux innovants à haut risque : l’efficacité clinique et la sécurité sont-elles garanties ?

BackgroundInnovative high-risk medical devices, such as new types of heart valves or hip prostheses, become available on the European market more rapidly than in USA. This is due to the European legislation allowing early marketing of innovative high-risk medical devices before high-quality clinical evidence is obtained from randomized controlled trials.MethodsWe studied the premarket clinical evaluation of innovative high-risk medical devices in Europe compared with the USA. We also discussed patient safety and the transparency of information. The literature and regulatory documents were checked. Representatives from industry, competent authorities, notified bodies, ethics committees, and health technology assessment agencies were consulted.ResultsIn contrast to the US, there is no requirement in Europe to demonstrate the clinical efficacy of high-risk devices in the premarket phase. For the patient, this implies earlier access to innovative technology, but at the risk of potential safety issues. At this moment, European requirements for clinical studies are lower for medical devices than for drugs, and data from premarket clinical trials are scarce or remain unpublished. The European Medical Device Directives are currently being reworked.ConclusionsFor innovative high-risk devices, and while awaiting a reworked Medical Device Directive, patient risk should be minimized by limiting the market introduction of novel high-risk devices with minimal clinical data to physicians with the necessary training and expertise. The new European legislation should require the premarket demonstration of clinical efficacy and safety, using a randomized controlled trial if possible, and a transparent clinical review, preferably centralized.     

高压氧舱火灾事故预防控制策略的研究

目的:研究制定高压氧舱火灾事故预防控制策略,提高高压氧舱隐患预防能力和安全管理效率。方法:分析高压氧舱火灾事故发生原因,根据燃烧三要素(火三角)的性质,从严格禁止可燃物、严格控制助燃剂和严格消除火源3个方面,制定高压氧舱火灾事故预防控制策略,结合安全管理实践,制定"高压氧舱安全使用与管理制度"。结果:医院高压氧舱火灾预防控制制度实施后,高压氧舱正常开机率、违规操作率、违禁物品入舱率、未签知情同意书发生率和治疗不良反应发生率等相关指标明显改善,违规操作率、违禁物品入舱率和未签知情同意书发生率均降为0;高压氧舱的安全使用率由71%提升到100%,综合管理评价分值由72.25%提升到95.75%,达到了高压氧舱火灾事故的预防控制管理要求。结论:高压氧舱火灾事故预防控制策略可提升高压氧舱医疗安全,规范高压氧舱的业务流程管理和风险防控管理,提高设备安全管理效率。     

综合医院医务科室经济效益奖分配方法研究

本文在分析医院运营过程的基础上，应用数学、统计学、经济学、会计学原理，分析了表征医院经济效益的各个变量的含义，建立了医院对各医务科室以其经济效益为依据的奖金分配模型。经用综合医院三个月的数据资料模拟实验证明，该模型可使各科室奖金额与其劳动量成正比，且具有激励科室负责人改善管理方法，激励医护人员努力提高技术、改善医德医风的作用。     

Developments in reproductive risk management.

Internationally, the debate on aims for occupational health policy is expanding its horizons. Included among the issues are not only concerns about safety for workers, but also for their progeny. Equality among the sexes is also assuming a prominent position. In several countries, existing and proposed legislation already considers these matters. In the course of this article it is argued that this legislation and its implementation are inadequate. There are several reasons for this. Firstly, what constitutes health risks for workers exposed to chemical substances is subject to different interpretations. This is further complicated when one includes risks to reproductive function and to the progeny: the reproductive risks of toxicity. The different interpretations of the concepts of safety and equality are also discussed. There are differences in regulations and in standards about whether or not safety factors should be used when knowledge is uncertain. The operation of reasonable measures with a generic or sex specific policy also differs. Secondly, the current occupational exposure limits are set too high. These aspects are considered and it is probable that the policy aims should be made more specific. An elaborated approach that includes the "precautionary principle" in safety standards is proposed. To advise employers in their role as managers of reproductive risks of toxicity, a recently developed system for occupational health and safety services is described. This system is based on two criteria: effectiveness and reasonableness of proposed measures. The effectiveness criterion includes the precautionary principle; the reasonableness criterion includes equal rights and opportunities for men and women. Finally, a supportive governmental policy that is consistent with the most recent international development is recommended.     

Electrical safety Q&A. A reference guide for the clinical engineer

This guide, which ECRI developed to answer the electrical safety questions most frequently asked by member hospitals, features practical advice for addressing electrical safety concerns in the healthcare environment. Questions addressed include: STANDARDS AND APPROVALS: What electrical safety standards apply? How do NFPA 99 and IEC 60601-1 differ? What organizations approve medical devices? LEAKAGE CURRENT LIMITS AND TESTING: How are leakage current limits established? What limits apply to equipment used in the hospital? And how should the limits be applied in special cases, such as the use of PCs in the patient care area or equipment used in the clinical laboratory? ISOLATED POWER: What are its advantages and disadvantages, and is isolated power needed in the operating room? Other topics addressed include double insulation, ground-fault circuit interrupters (GFCIs), and requirements for medical devices used in the home. Supplementary articles discuss acceptable alternatives to UL listing, the use of Hospital Grade plugs, the limitations of leakage current testing of devices connected to isolated power systems, and the debate about whether to designate ORs as wet locations. Experienced clinical engineers should find this guide to be a handy reference, while those new to the field should find it to be a helpful educational resource.