不同海拔高度对压力蒸汽灭菌效果的影响

目的为了解高原部队消毒灭菌工作质量,促进高原部队消毒灭菌工作不断发展,为官兵提供符合国家标准的消毒灭菌物品. 方法采用化学监测(包外指示胶带、包内指示卡)、生物监测(指示剂和细菌培养)、工艺监测的方法,设定不同海拔高度、不同温度时间灭菌效果观察. 结果海拔高度不同,灭菌温度、时间不同,消毒灭菌的结果也有所不同;化学指示胶带和指示卡显示,在海拔高度>3 200 m、灭菌温度<127℃、时间20 min时,化学反应变色无一例达到标准黑色;生物监测有细菌生长. 结论高原地区压力蒸汽灭菌时,其温度、时间以及操作程序都可能是影响高原地区消毒灭菌质量的因素.     

我院脉动真空灭菌器灭菌质量的监测

目的：为了解脉动真空灭菌器的灭菌质量,确保灭菌效果.方法：采用物理、化学、生物方法,对其灭菌质量进行监测.结果：经监测4 576锅次,温度监测合格率为99.6%,包内化学指示卡监测合格率达到99.8%,B-D试验监测合格率99.9%,生物指示剂监测合格率100%.结论：该院脉动真空灭菌器运行状况良好,物理、化学、生物监测合格率达到99%以上.     

三种生物指示物监测过氧化氢低温等离子灭菌的效果比较

目的探讨三种生物指示物对福迪威牌(ASP)三种型号过氧化氢低温等离子灭菌器共五种灭菌循环的生物监测效果。方法中山大学孙逸仙纪念医院分别选用三种生物指示物(型号:ASP STERRAD CycleSure、STERRAD VELOCITY和3M Attest~(TM) 1295)对ASP STERRAD~? 100S灭菌器的长循环和短循环、STERRAD~? NX灭菌器的标准循环和高级循环以及STERRAD~? 100NX灭菌器的标准循环开展生物监测。每种灭菌循环分别开展20次的日常装载,根据三种指示剂说明书的要求,在灭菌循环启动前,将三种指示剂分别置于灭菌器内腔的不同位置,灭菌循环结束后,选用指示剂匹配的培养箱或阅读器进行生物监测。结果三种生物指示物在ASP三种型号过氧化氢低温等离子灭菌器的五种灭菌循环共100炉次的灭菌监测中,300支对照管均为阳性,300支测试管均为阴性。使用ASP STERRAD CycleSure生物指示物在其配套的恒温箱内需要培养24 h,通过颜色变化人为判断监测结果;使用ASP STERRAD VELOCITY~?生物指示物及3M Attest~(TM )1295生物指示物开展生物监测,分别在30 min及24 min内由其配套的阅读器自动显示监测结果。结论使用ASP STERRAD CycleSure指示剂进行生物监测,需要人为判读且监测时间长。选用ASP STERRAD VELOCITY~?指示剂及3M~(TM)1295指示剂进行生物监测,由阅读器自动判读且监测时间短,能为过氧化氢等离子灭菌的快速与安全供应提供保障。     

影响手术敷料包内化学指示卡因素分析

对手术敷料包内化学指示卡时有出现黑灰白色的现象进行了研究,找出产生的原因,并进行相应改进,达到了预期的目的。现将试验介绍如下并进行探讨。1 材料与方法 试验物品:留点温度计（北京生产）、化学指示卡（北京军医科院）生产、生物指示剂嗜热脂肪杆菌芽胞（3M生产）、包内包外化学指示胶带（3M生产）。灭菌设备:脉动与真空压力灭菌器1M（日本樱花生产）。将新棉布制品与煮沸洗涤后棉布制品按常规监测包的要求包成 30cm×30 cm×50 cm、重量 5 kg。在包内同一部位均放有化学指示卡、留点温度计、生物指示菌片。用脉动式压力灭菌器进行灭菌。灭菌完成后生物指示剂放于 56℃恒温箱内进行细菌培养 48 h后观察化学指示卡、留点温度计测试结果。     

压力蒸汽灭菌化学指示卡有效性的监测

目的 监测压力蒸汽灭菌化学指示卡的有效性。方法 对脉动真空灭菌器的灭菌效果在设定不同灭菌温度、不同灭菌时间的情况下进行压力蒸汽灭菌指标卡监测及生物监测，并对监测结果进行比较分析。结果 压力蒸汽灭菌化学指标卡监测结果与生物监测结果存在较大的差异性。结论 压力蒸汽灭菌指示卡的变化并不能代表压力蒸汽灭菌效果，不能有效地反映物品的灭菌状况，要求消毒人员严格遵守操作规程，生物监测应每周1次，在更换指示卡批号时，应对其有效性与生物监测相比较，确认产品合格方可使用。     

微生物实验室培养基高压蒸汽灭菌效果的监测

目的为了保证使用于微生物检测的试剂达到灭菌效果,监测和分析高压蒸汽灭菌器的灭菌效果及其影响因素,保证灭菌质量。方法用3种不同的监测方法,每月对实验室4个高压蒸汽灭菌器灭菌效果进行监测。结果一年共监测了48次,化学指示法监测合格48次,合格率为100.00%;生物指示法监测合格39次,合格率为81.25%;Prospore2生物指示法监测合格37次,合格率为77.08%;监测结果与实验室培养基灭菌效果要求温度和时间有关。结论正确使用监测方法是确保高压蒸汽灭菌器灭菌效果的关键。     

化学指示卡在消毒检测中存在的问题分析及对策

目的探讨化学指示卡在消毒检测中存在的问题和原因,并找出解决问题的措施,提高压力蒸汽灭菌器灭菌效果监测的质量。方法采用下排气式压力蒸汽灭菌器,3M压力蒸汽灭菌包内化学指示卡,对150炉次中的各类手术包和敷料、贮槽等采用相同的压力、时间、温度进行灭菌,并在灭菌完毕后,对所有的试验包进行现场打开检查,并记录实际情况。结果采取措施前有16个试验包内化学指示卡变色不标准。采取措施后无发现有试验包内化学指示卡变色不标准的现象。结论用来检测压力蒸汽灭菌器灭菌效果方法之一的3M压力蒸汽灭菌包内化学指示卡变色不标准因素,受蒸汽灭菌过程中蒸汽的冷凝水的影响;要使化学指示卡变为标准黑色,必须要正确使用化学指示卡和规范物品包装及正确使用消毒器。     

脉动真空蒸汽灭菌器模拟升温阶段泄漏的灭菌风险研究

目的通过模拟脉动真空蒸汽灭菌器升温阶段泄漏,研究手术器械的灭菌失败风险,为提高灭菌保障和加强手术器械感染控制提供参考。方法在脉动真空蒸汽灭菌器的空气过滤器进气管上安装球阀,在灭菌程序升温阶段分别人为打开球阀0、5、15和25 s。采用温度压力检测仪测试手术器械包内的灭菌参数,并结合标准测试包测试灭菌器性能参数,手术器械包和标准测试包内分别放置生物指示物和化学指示卡,灭菌器腔体放置不同类型的PCD,同时记录日常物理监测结果。各时间组分别重复实验三次。结果灭菌器升温阶段进入空气0 s时,器械包内部分探头升温延迟,但均可以达到灭菌温度,而其他各项测试均合格;5 s三组测试,器械包内2号探头均达不到灭菌温度,而化学监测和生物监测均合格;15 s三组测试中,2号探头均达不到灭菌温度,六类PCD、标准测试包内的无铅四类卡与无铅五类卡均不合格,标准测试包内生物监测不合格一次;25 s三组测试中,1号和2号探头均达不到灭菌温度,六类PCD、标准测试包内的无铅四类卡与无铅五类卡均不合格,管腔PCD和标准测试包内爬行卡各一次监测不合格。除了进入空气0 s组,灭菌器性能参数测试均不合格。但是各组测试中,物理监测、器械包中心的探头和指示物均合格。结论进入空气的占位效应会造成灭菌失败,但是温度探头和指示物放置在器械包中心无法有效揭示灭菌风险。温度压力检测仪灵敏度较高,可及时发现灭菌失败风险,其次为六类PCD、无铅五类卡与无铅四类卡,值得推广应用于压力蒸汽灭菌监测。     

3种方法验证小型预真空灭菌器的灭菌效果

目的 通过化学过程验证装置(PCD)监测、模拟生物PCD监测和人工染菌牙科手机验证小型预真空灭菌器不同程序的灭菌效果,进而选择简便、易行、安全的灭菌监测方法.方法 将染菌牙科手机、化学PCD、模拟生物PCD放置于小型预真空灭菌器内的排气口上方,分别选择灭菌器的通用程序和快速程序,经过一个灭菌周期后,取出化学PCD、模拟生物PCD和牙科手机,观察试验结果并记录.结果 小型预真空灭菌器的两个不同程序均能使牙科手机达到无菌水平,两个程序生物PCD测试均合格,快速程序中化学PCD监测均不合格,在通用程序合格率93.3％.结论 小型预真空灭菌器的两个不同程序均可用于牙科手机的灭菌,化学PCD通过率低,安全系数最高,无生物监测条件的医疗机构可选用化学PCD对小型预真空灭菌器的通用程序进行灭菌效果监测.     

野战条件下高原部队压力蒸汽灭菌方法的改进

目的为了战时更好地救治伤后官兵,满足官兵伤后对无菌医疗用品的需求,保证一线救治医疗活动的无菌医疗器具供应. 方法采取实验调查的方法,掌握高原影响灭菌工作的因素,根据灭菌原理,结合地域特点,提出选用136℃作为高原地区灭菌温度的方法进行实验. 结果选用仪表温度示值136℃20 min灭菌方法后,灭菌效果监测达到灭菌效果评价标准,可以满足海拔高度≤5 380 m灭菌条件需求. 结论仪表温度示值136℃ 20 min灭菌,提高了高原地区部队的灭菌工作质量,有利于战时灭菌物品供应,促进了战时卫勤保障能力的提高.     

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.