骨科无菌手术切口感染相关因素研究及手术室护理对策

目的探讨骨科无菌手术切口感染的相关因素及手术室护理对策,降低骨科手术感染率。方法对本院2009)2010年收治的3634例骨科无菌手术患者资料进行调查,分析导致骨科无菌手术切口感染的相关因素。结果 2009)2010年共发生骨科无菌手术切口感染20例,切口感染发生率为0.55%。其中,2009年为0.61%,2010年为0.50%;在20例切口感染中手术时间>2 h的为13例,1~2 h的为5例,<1h的2例,其构成比依次为65.0%、25.0%、10.0%。结论骨科无菌手术切口感染与手术类型、手术地点、手术部位、手术时间、是否接台手术等手术室因素密切相关,因此在手术室护理工作中采取一系列有效措施,实施手术室护理干预,严格无菌操作,以减少骨科无菌手术切口的感染。     

普通外科手术切口感染的影响因素与防治

目的 探讨普通外科手术后切口感染的影响因素及防治措施.方法 回顾性分析2009年1月-2012年12月医院普通外科手术患者切口感染的影响因素及治疗与预防措施.结果 2915例普通手术患者术后发生切口感染203例,感染率6.96％,其中高龄、急症手术、Ⅱ、Ⅲ类手术切口、合并基础疾病患者更易发生切口感染.结论 年龄、手术种类、切口类型、合并基础疾病是普通外科手术切口感染的影响因素,临床工作中需针对性采取防范措施减少切口感染发生.     

手术室致骨科无菌切口手术感染影响因素和护理分析

目的 对手术室所致骨科无菌切口手术感染的影响因素和护理干预策略分析.方法 针对我院骨科2013年1月-2014年1月出现无菌切口手术感染的20例患者为对照组,对其临床感染影响因素分析,并针对因素对2014年2月-2015年2月的80例骨科无菌切口手术患者实施护理,为观察组,对比分析两组患者的感染发生率.结果 :其中观察组患者的临床感染发生率显著低于对照组,差异显著(P<0.05).结论 :对手术室骨科无菌切口手术患者实施有效护理干预,有助于降低患者的临床感染发生率,值得推广.     

骨科手术Ⅰ类切口感染目标性监测与控制的应用分析

目的 探讨骨科手术Ⅰ类切口感染相关因素,采取有效干预措施,降低感染率.方法 以2009年1月-2010年12月骨科Ⅰ类手术患者1416例为研究对象,根据2009年切口感染危险因素制定干预措施,2010年实施干预措施,比较两年感染率和危险因素的变化.结果 2009年影响手术切口感染的危险因素有麻醉方式、住院时间、手术时间、切口长度、手术医师组(P＜0.05),2010年以上危险因素差异均无统计学意义;2009年骨科手术Ⅰ类切口感染率为2.17％,2010年降至0.24％,两年切口感染率比较差异有统计学意义(P＜0.01).结论 监测并采取相应干预措施能有效降低骨科Ⅰ类切口手术感染的发生.     

外科手术患者发生切口感染的手术室相关因素分析及防治策略

目的探讨外科术后患者发生切口感染的手术室相关影响因素及采取干预措施后的效果评价,为预防患者术后感染提供有效方法。方法选取2014年1月-2016年12月期间于医院接受外科手术患者2210例作为研究对象,其中2014年1月-2015年6月期间1026患者未实施干预作为对照组,2015年7月-2016年12月1184例患者实施干预为研究组,对患者发生术后切口感染情况及与手术室相关影响因素进行单因素和多因素Logistic回归分析,并对两组患者干预前后的切口感染率、平均住院时间及住院费用进行比较分析。结果外科术后患者发生切口感染的主要手术室因素为手术时间、手术切口、非流层手术、手术参观人数和手术室空气细菌含量;对照组感染率为7.60%(78/1026),实施干预后研究组感染率为2.20%(26/1184),两组比较差异有统计学意义(P0.05);研究组患者的住院时间(7.87±3.060)周、住院费用(10.62±2.39)万元少于对照组的(12.94±5.63)周、(15.32±3.57)万元,(均P0.05)。结论外科手术后患者发生切口感染的感染率较高,其中与手术室相关影响因素有手术时间、手术切口、非流层手术、手术参观人数和手术室空气细菌含量,根据影响因素实施针对性的防治策略能够有效降低切口感染率,同时缩短患者的住院时间和减少住院费用。     

手术室护理干预对骨科无菌手术患者切口感染的影响分析

目的探讨手术室护理干预对骨科无菌手术患者切口感染的影响。方法抽取我院在2011年1月~2014年7月治疗的80例骨科无菌手术患者,其中16例患者切口感染,分析影响因素,并实施手术室护理干预。结果切口感染受到多种因素影响。在手术室护理干预后,切口感染患者痊愈出院。结论手术室护理有效降低了骨科无菌手术患者切口感染的发生率。     

手术室护理在骨科无菌手术的应用分析及对切口感染的影响

目的:研究分析手术室护理应用于骨科无菌手术的效果及对切口感染的影响。方法:选择2013年1月-2014年1月期间在我院实施骨科无菌手术治疗的112例患者,切口感染者23例,并针对手术室护理措施及影响因素进行分析。结果:本组108例骨科无菌手术患者中,23例出现切口感染,约为21.30%。其有关因素包括:手术时间、手术部位、手术地点、手术类型以及接台手术。23例患者通过对症治疗及手术室护理干预以后,均痊愈出院,没有感染加重的病例。结论:手术室护理应用于骨科无菌手术患者,能有效避免切口感染的发生,提高手术治疗的成功率,促进术后的康复,临床意义重大。     

切口感染的手术室影响因素与病原菌分布特点

目的探讨和分析手术患者发生切口感染的手术室影响因素与感染病原菌分布特点。方法选取2012年1月-2016年12月期间在医院手术室施行手术的3596例患者作为临床研究对象,回顾性分析手术患者的性别、年龄、手术性质、手术地点、手术时间、放置引流管、接台手术及参观人员等临床资料,分析引起切口感染的手术室影响因素以及病原菌分布特点。结果医院手术室施行手术的3596例患者中发生切口感染35例,感染率为0.97%;患者切口感染类型为表浅手术切口感染占71.43%,深部手术切口感染占28.57%;年龄60岁、手术性质为急诊手术、手术地点为非层流室、手术时间3h、接台手术、有参观人员均为切口感染的手术室影响因素;35例切口感染患者共检出病原菌40株,其中革兰阴性菌26株占65.00%,革兰阳性菌11株占27.50%,真菌3株占7.50%。结论患者年龄、手术性质、手术地点、手术时间、接台手术、参观人员均为切口感染的手术室影响因素,感染的病原菌主要以革兰阴性菌为主,临床上应根据其影响因素和病原菌分布特点给予针对性的应对措施。     

层流洁净手术室对手术切口感染的影响研究

目的 探讨层流洁净手术室对手术切口感染的影响,为不同类型手术的手术室安排及手术切口感染控制提供参考依据.方法 采用回顾性方法对医院2010年1月-2011年6月普通手术室1652台手术以及2011年7月-2012年6月层流洁净手术室842台手术资料分析,比较各类切口在普通手术室和层流洁净手术室施行的手术切口感染率.结果 洁净手术室手术切口总感染率为1.31％,普通手术室切口总感染率为2.66％,洁净手术室切口总感染率低于普通手术室(P＜0.05);洁净层流手术室Ⅰ、Ⅱ、Ⅲ类手术切口感染率分别为0、0.40％、5.10％,普通手术室Ⅰ、Ⅱ、Ⅲ类手术切口感染率分别为1.14％、2.48％、5.77％,洁净层流手术室Ⅰ、Ⅱ类切口感染率低于普通手术室(P＜0.05);Ⅲ类手术切口感染率同普通手术室差异无统计学意义.结论 层流洁净手术室能够降低Ⅰ、Ⅱ类手术切口感染率,有利于医院感染控制.     

手术室手术部位感染的相关因素分析及防治策略

目的 探讨手术室可诱发手术部位感染的相关因素,并讨论防治措施.方法 选取医院2009年5月-2012年5月接受手术治疗的患者共8000例,回顾性分析患者病例,将术后发生手术部位感染者病例选出,着重记录患者年龄、性别、现病史、术前ASA分级、手术室消毒情况、手术切口清洁程度、手术时机、手术切口愈合、手术操作时间、手术过程出血量、手术切口类型等,将所有数据输入计算机,运用logistic回归模型对所有相关因素进行分析并用Backward-LR法进行回归分析,获得相关性较大的因素.结果 8000例患者中感染375例,感染率为4.69％；年龄≥50岁较＜50岁、普通手术室较洁净手术室、参观人数≥2人较＜2人、手术时间＞2h较≤2h、Ⅱ、Ⅲ类切口较Ⅰ类切口、切口长度＞10 cm较≤10 cm者感染率均高,糖尿病患者感染率较其他并发症感染率更高,且差异有统计学意义(P＜0.05)；logistic统计分析,年龄、手术室类型、参观人数、手术时间、切口类型与并发症6类因素为高危因素.结论 严格手术室内空气、环境及物品消毒,提高护理人员素质、施术者业务能力、强化无菌操作理念可有效控制手术部位切口感染,并降低医院感染.     

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.     

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.