脉动真空压力蒸汽灭菌湿包原因分析与对策

目的分析脉动真空压力蒸汽灭菌湿包原因,提出控制对策,减少湿包的发生. 方法采用<消毒技术规范>和美国消毒锅公司建议的湿包评判标准,对4 076锅次,134 840个灭菌包进行观察分析. 结果有269个湿包产生,湿包率为0.199%;其中错误装载占59.1%,设备故障、蒸汽质量差、拟灭菌物品准备不当占40.9%. 结论加强消毒员操作规范管理,提高业务素质是控制湿包关键;灭菌器保持正常运转状态;提供高质量蒸汽;灭菌前物品正确准备,才能减少湿包发生率.     

脉动真空压力蒸汽灭菌致湿包原因分析 FREE

目的方法结果结论对某院消毒供应中心脉动真空压力蒸汽灭菌中出现湿包的原因进行分析。2006年10月,共灭菌64锅次,2 245个灭菌包,其中出现湿包56个,湿包率达2.49%。53个湿包发生在第1锅次,占湿包总数的94.64%。蒸汽质量差是造成湿包的主要原因（占64.29%）,且主要发生在第1锅次;其次为灭菌器相关问题（16.07%）,拟灭菌物品准备不当（12.50%）,物品装载不合理（7.14%）。针对各相关因素采取措施后,每个月湿包数下降为3个左右,湿包率降至0.13%,湿包现象得到明显改善。     

压力灭菌器消毒产生湿包的分析与控制

目的分析消毒供应中心消毒发生湿包的原因,提出控制湿包的对策,减少湿包的发生。方法采用《消毒技术规范》湿包评判标准,消毒灭菌包裹含水量≤3%,>6%视为湿包,对2012年1-12月脉动真空压力灭菌器2 192锅次、72 160个灭菌包进行观察分析。结果物品潮湿占8.3%、包装不规范占12.5%、蒸汽质量占22.0%、装载不合理占28.6%、冷却不当占13.1%、灭菌器故障占15.5%,针对原因总结出压力灭菌器产生湿包,包括物品保持干燥、选择合适的包装材料正确包装、蒸汽质量必须为饱和蒸汽、加强人员操作的规范管理、正确装载、正确操作设备、良性运行灭菌器等,采取控制措施后湿包由控制前的2.33‰降至0.66‰,差异有统计学意义(χ2=83.94,P<0.01)。结论湿包破坏了包装材料阻挡微生物的屏障作用,使微生物侵入已灭菌的无菌物品内造成污染,属于灭菌失败,需花费大量人力物力重新消毒灭菌处理包裹,因此,控制湿包的产生是消毒供应中心工作人员的重要责任。     

压力蒸汽灭菌器湿包形成原因

压力蒸汽灭菌是医院首选的灭菌方法,具有控制方便、效果可靠、费用经济等优点.但压力蒸汽灭菌属湿热灭菌,灭菌过程中有一定量的冷凝水产生,偶尔灭菌后会发现有湿包现象,不能保证灭菌质量,就要重新处理.为了保证压力蒸汽灭菌物品的质量,经排查原因,采取相应措施,取得一定的效果.原因与措施:(1)蒸汽含水量高,进气管道内残留有冷凝水,灭菌程序运行时,被压入锅内,导致进气口处多个灭菌包潮湿.经过干燥程序,有的灭菌包外包布潮湿,被消毒员及时检出;有的灭菌包外包布干燥,发往临床使用,打开后发现内部潮湿不能使用,使我们的工作非常被动.请工程师进行检查处理,在进气口处加入滤网,延缓进气速度;与蒸汽房沟通,取得他们的合作,降低蒸汽内水分.经过处理,潮包现象消失.(2)排气管道不通畅,滤网清洁不及时,蒸汽不能及时排出,导致湿包现象发生.经清洁滤网,湿包现象改善.(3)错误的装载,是导致湿包的又一主要原因.消毒员不重视正确装载,灭菌器内灭菌包摆放过于拥挤,影响蒸汽流通;敷料包、器械包混放,甚至金属灭菌盒、储槽放在敷料包的上面及物品包碰到消毒锅内壁,蒸汽遇到器械、消毒锅内壁形成冷凝水,滴落在敷料包上,导致湿包发生,使灭菌失败.     

154个灭菌湿包的原因分析

目的 客观分析医院在预真空压力蒸汽灭菌时产生湿包的原因,寻求相应的控制对策,以减少湿包的发生.方法 根据近5年产生湿包的现象描述,将154个湿包在灭菌器中产生的部位作为关注点进行整理和分类,共分为内室排汽口上方浸湿型、内室进蒸汽口周围浸湿型、内室四壁浸湿型、载物架与器械包的接触面浸湿型和载物架几何体积中部潮湿型等5类,并且归纳统计每类湿包产生的可能原因.结果 154个灭菌湿包有18.2%是因为灭菌器故障所致,36.4%是因为灭菌包装器具的缺陷或器械的结构特点所致,46.4%是因为灭菌装载上存在的缺陷所致.结论 加强对灭菌器的监测和维护、提高工作人员工作能力和责任心、改进器材灭菌包装方式,可有效降低湿包发生率.     

脉动真空灭菌器湿包的原因分析及排除

压力蒸汽灭菌器湿包现象是灭菌失败的重要因素之一,多发生于纯棉布巾包装的器材包。为保证灭菌物品的质量合格,杜绝灭菌后出现的湿包现象,分析灭菌器湿包原因,避免引起湿包各种因素,提供高蒸汽质量,排除机械故障,正确摆放灭菌物品,才有效的降低灭菌物品湿包发生率。     

压力蒸汽灭菌中湿包的成因和预防

目的探讨压力蒸汽灭菌湿包形成的原因及预防方法。方法采用回顾性方式,对2005年5月~2006年4月灭菌2298锅次共计167690个灭菌包进行观察。结果有317个湿包产生,湿包率0.189%。结论严格要求灭菌前物品的包装和入炉装载,加强消毒员的技术操作管理,才能减少湿包的发生。     

压力蒸汽灭菌不同装载方式对灭菌参数的影响

目的研究不同装载方式对压力蒸汽灭菌参数的影响。方法采用无线温度和压力记录器测量灭菌器柜室内温度分布;不同装载条件下,测试包中心和上层的温度时间关系、柜室内压力时间关系。分析同一台灭菌器,相同的灭菌循环参数,灭菌装载不同对温度、包裹内空气排除程度的影响。结果装载方式不同对灭菌包包裹内的温度、空气排除程度有直接的作用,超满载装载方式可能会导致灭菌包包裹内的温度达不到灭菌温度,影响灭菌质量。结论灭菌器的装载对于灭菌过程的成功与否有很大影响,从操作上规范好灭菌器的装载很有必要。     

脉动真空压力蒸汽灭菌器灭菌效果的监测

目的高压蒸汽灭菌是医院医疗器械和物品的主要灭菌方式,探讨使用脉动真空压力蒸汽灭菌器的灭菌效果,为消毒灭菌提供参考依据。方法回顾性调查2006-2009年共监测用脉动真空压力蒸汽灭菌器的灭菌的医疗器械及物品共18 978份,依据原卫生部《清洗消毒及灭菌技术操作规范》对灭菌物品进行正确包装、装载及卸载,同时加强灭菌设备的管理,注重灭菌员的专业知识技能培训;对所有灭菌物品分别进行生物监测、B-D测试及化学监测,找出影响灭菌效果的相关因素。结果 18 978份灭菌医疗器械及物品进行生物监测201次,合格率为88.56%;B-D测试3 250次,合格率为89.78%;化学监测共进行15 527次,平均合格率为91.50%,经干预后合格率达99.27%。结论脉动真空压力蒸汽灭菌器具有灭菌时间短、灭菌彻底的优点,有效降低医院感染的发生,保障了灭菌物品的质量安全。     

不同装载方法降低蒸汽灭菌湿包率的探讨

目的探讨不同装载方法降低蒸汽灭菌湿包率的效果。方法采用观察法对2009年10月～2010年3月灭菌1 762锅次共计129 985个灭菌包进行观察。结果湿包有264个,湿包率0.203%。而采用篮筐单独放置,避开排水口等不同装载方式。2010年4月～2010年9月共有灭菌1 812锅次,共计139 650个灭菌包,湿包有156个,湿包率0.111%。结论采取有效改进措施,在规范待灭菌物品包装的前提下,使用正确的装载方法灭菌可降低湿包发生率。     

纸塑包装物品在压力蒸汽灭菌时质量保存期限的探讨

目的探讨纸塑包装物品压力蒸汽灭菌时在不同时段和不同环境的无菌保存期限。方法于2005年1-12月,1次/月在同一时段抽取存放于供应室、急诊室、产后区的无菌包随机采样做细菌培养,每次抽取各存放区的无菌包10个;无菌包均采用纸塑包装,然后进行压力蒸汽灭菌。结果存放在临床科室的无菌包第9个月开始长菌,在供应室保存的无菌包在第12个月仍无菌生长。结论选择优质的包装材料,确保清洗质量,提供良好的存放环境,减少人为污染,才能保证纸塑包装压力蒸汽灭菌物品保存的质量。     

压力蒸汽灭菌湿包相关知识培训效果评价

目的 评价压力蒸汽灭菌湿包相关知识培训后的效果.方法 对工作人员进行湿包相关知识的理论培训和工作现场操作培训,比较培训前后人员相关知识、实际操作掌握情况及湿包率的变化.结果 培训后人员湿包相关知识掌握正确率由36.7％升至91.4％,操作中不合格率由0.29％降至0.17％,湿包率由0.23％降至0.10％,差异有统计学意义.结论 培训后人员更好地掌握了理论知识,操作更加规范,明显降低了湿包率.     

Do calorie-controlled portion sizes of snacks reduce energy intake?

In a cross-over study, participants (n = 59) were randomly assigned to receive either 100 kcal packs or standard size packages of snacks for 1 week. After a minimum of a 1-week washout period, participants received the other form of the snack for 1 week. Snack consumption was recorded by participants in a diary. Participants consumed an average of 186.9 fewer grams of snacks per week when receiving 100 kcal snack packs compared to standard size packages of snacks. Post hoc comparisons revealed the effect of package size depended on both randomization order and study week. Total grams of snacks consumed in week 1 differed significantly between the two randomized groups. In week 2, however, grams of snacks did not differ significantly between the two groups. This interaction was primarily due to a significantly lower consumption of snacks from standard size packages in the week following the portion-controlled packages. The results suggest that portion-controlled packaging reduce total intake from the provided snacks. Further, initial exposure to portion-controlled packages might have increased awareness of portion size such that less was consumed when larger packages were available.     

Evaluation of rapid readout biological indicators for 132 degrees C gravity and 132 degrees C vacuum-assisted steam sterilization cycles using a new automated fluorescent reader.

OBJECTIVE: The primary objective of this study was to evaluate fluorescent readout results of Attest 1291 Biological Indicators (BIs) (3M Health Care, St. Paul, MN) and Attest 1296 BI test packs (containing Attest 1292 BIs) using full and fractional cycles compared with the growth data when prolonged incubation (7 days) was included. Gravity displacement and vacuum-assisted steam sterilization cycles were evaluated. A secondary objective of this study was to evaluate the new automated rapid fluorescent reader (Attest 290 Auto Reader). DESIGN: The rapid readout BIs for gravity displacement and vacuum-assisted steam autoclave cycles at 132 degrees C were processed using full (4 minutes) and four fractional cycles that provided 30% to 80% positive results for growth after 24 hours of incubation (48 hours of incubation for Attest 1292 BIs from the Attest 1296 test packs). Sixty of each type of BI were tested for each cycle (300 of each BI type in total). RESULTS: For all full steam sterilization cycles, results of the rapid fluorescent readout and the 24-hour, 48-hour, and 7-day growth tests were negative for all Attest 1291 and 1292 BIs tested. For all fractional cycles, the 24- and 48-hour growth results for the Attest 1291 and 1292 BIs, respectively, were the same as the 7-day growth results. The fractional cycle data indicated that fluorescent rapid readout was a more sensitive indicator than growth. There were rare (0.9%) false-negative results for BIs under fractional cycle conditions and these all correlated with short fractional cycle exposure times. CONCLUSIONS: The fluorescent rapid readout results of the 1291 BIs and 1296 BI test packs reliably predict both 24- and 48-hour and 7-day growth. These data support the value of rapid readout BIs for sterilizer monitoring for both the vacuum-assisted and the gravity displacement steam sterilization cycles. The new automated reader requires less manipulation of the BI and makes monitoring user friendly and less prone to user errors.     

不同包装材料对骨科外来医疗器械分筐包装灭菌湿包的影响

目的探讨不同包装材料对骨科外来医疗器械分筐包装灭菌湿包的影响,为规范器械包装提供依据。方法选取2018年9月至2019年12月医院消毒供应中心处理的1500包骨科外来医疗器械,随机分成A、B、C 3组,每组500包。所有器械均装载于标准器械筐内,分别用3种不同的包装材料包装,灭菌前称重,采用相同灭菌程序,灭菌完成后2 min取出灭菌包称重,待灭菌包冷却后检查其内外干燥情况,比较3组灭菌包的湿包率。结果A、B、C组湿包率分别为1.8%、4.0%、19.8%,差异有统计学意义(P<0.01)。结论灭菌包湿包受多种因素影响,在相同条件下,采用最终灭菌医疗器械纺织品包装材料分筐包装骨科外来医疗器械能有效地降低灭菌湿包率。     

Do cigarette health warning labels comply with requirements: A 14-country study

The Framework Convention on Tobacco Control, a global health treaty ratified by over 175 countries, calls on countries to ensure that tobacco packages carry health warning labels (HWLs) describing the harmful effects of tobacco use. We assessed the extent of compliance with 14 countries' HWL requirements. Unique cigarette packs were purchased in 2013 using a systematic protocol in 12 distinct neighborhoods within three of the ten most populous cities in the 14 low- and middle-income countries with the greatest number (count) of smokers. HWL compliance codebooks were developed for each country based on the details of country-specific HWL requirements, with up to four common compliance indicators assessed for each country (location, size, label elements, text size). Packs (n = 1859) were double coded for compliance. Compliance was examined by country and pack characteristics, including parent company and brand family. Overall, 72% of coded cigarette packs were compliant with all relevant compliance indicators, ranging from 17% in the Philippines to 94% in Mexico. Compliance was highest for location of the warning (ranging from 75%–100%) and lowest for warning size (ranging from 46%–99%). Compliance was higher for packs bought in high SES neighborhoods, and varied by parent company and brand family. This multi-country study found at least one pack in every country – and many packs in some countries – that were not compliant with key requirements for health warning labels in the country of purchase. Non-compliance may be exacerbating health disparities. Tobacco companies should be held accountable for complying with country HWL requirements.     

A Brief Review of Worker Disability with a Call for a Consumer Perspective

A study of the steam penetration comparing muslin and non-woven wrappers was conducted using thermocouples. The results showed that although the location of the thermocouples in the packs showed heat differences, the two types of wrappers showed no significant difference in steam penetration.     

真空包装技术在保存无菌包中的应用研究

目的探讨应用真空包装技术保存无菌包,以延长无菌包保存的有效期。方法无菌包420个,210个为试验组,按无菌技术操作原则的要求,应用真空包装技术对无菌包进行包装后保存;余下210个为对照组,按常规包装后保存;两组包装同时存放无菌柜内,定期各抽30个包进行细菌培养。结果无菌包在保存后试验组第8个月开始长菌、对照组第1个月开始长菌,对照组无菌包经保存后细菌培养阳性率明显高于试验组,两者比较差异有显著的统计学意义(P<0.01)。结论应用真空包装技术对无菌包进行包装保存,延长了无菌包保存的有效期,保存时间可至6个月。