急诊手术感染的护理预防

手术感染的发生受多种危险因索的影响，急诊手术是感染发生的相关危险因素之一。在急诊条件下施行手术，由于术前皮肤清洁不充分、开放性创口的存在，病情急而导致操作不规范等问题，而容易引起手术感染的发生。     

妇产科急诊手术风险因素及护理对策

正妇产科急诊手术病情多变,尤以病理产科和宫外孕为多,近年来我院急、危、重手术病人比例增多,手术室护理质量高低直接影响手术治疗效果。本文回顾性分析我院以往妇产科急诊手术发生的护理不良事件,对存在的风险因素进行风险评估,深刻反思,提出整改措施,认识到制定护理风险防范措施的重要性,对近3年来我院妇产科急诊手术护理工作提出了战略性的指导方针,通过护理实践,效果满意。现将体会报告如下。1妇产科急诊手术存在风险因素     

如何预防护理急诊手术的感染

手术感染的发生受多种危险因素的影响，急诊手术是感染发生的相关危险因素之一。在急诊条件下施行手术，可因术前皮肤清洁不充分、存在开放性创口、术者为及时抢救伤患而不规范洗手等多方面原因削弱灭菌效果，从而引起手术感染的发生。     

急诊手术病人心理状态分析及护理对策

[目的]分析急诊手术病人的心理状态,探讨其护理对策.[方法]200例急诊病人随机分为观察组和对照组,每组100例,观察组采取心理护理,对照组采取常规护理措施.观察两组病人术中的生命体征变化情况,调查并比较其术前心态和术中身心反应.[结果]观察组病人术前心态、术中身心反应和生命体征变化情况均优于对照组.[结论]术前针对性的心理护理可减轻手术病人术前的应激反应,有利于手术麻醉的顺利进行及术后的身心健康.     

褥疮预防在危重大手术中的困难与对策

探讨褥疮预防在危重大手术中的困难与对策．时临床典型病例进行了原因分析，总结了预防中的困难并提出了：（1）保护爱压部的骨隆突处和身体空隙处；（2）保持术中皮肤清洁干燥；（3）提高手术室护理人员的前馈意识；（4）制定皮肤交接班制度等相应对策，取得良好效果。     

标准预防在急诊手术中的防护应用

我院手术室2005年至今将标准预防应用到急诊手术的预防中，取得了较好的效果，报告如下。     

急诊护理中的暴力风险因素分析及预防对策

目的 从护理的角度发现急诊护理中存在的暴力风险,分析这些因素产生的原因,以及探讨预防对策.方法 对急诊科62名护士进行观察,以发现存在于急诊护理工作中的暴力风险因素,进一步对这些护士进行调查考核以发现产生这些暴力危险的原因,提出干预措施,进行暴力危险的预防干预.结果 62名急诊护士积极配合暴力干预措施,干预前后62名护士的专业知识考核通过率、急救技能考核通过率、护理记录合格率分别较干预前有明显的提高,患者投诉率、暴力的发生率较干预前也有显著下降.结论 护士在急诊患者的治疗以及抢救过程中发挥了重要的作用,但是护理工作中存在较多的安全隐患,发现这些导致暴力的高危因素,并进行积极的干预处理,可以显著提高急诊护士的自我保护意识,减少护理工作中暴力的发生,也减少护患纠纷的发生,在临床上有积极的意义.     

急诊手术占主导的手术室护理特点及管理对策

为提高工作效率和质量,增加手术医生和病人的满意度,我们在手术室管理中采取了相应的对策,现将护理管理体会介绍如下。1　临床资料我院2 0 0 3年1～12月共完成手术9978例。其中急诊手术7343例,占手术总数的73 6 %。平均每天手术2 7 34例,其中急诊2 0 12例。四肢创伤占总急诊手术的90 6 % ,其他占急诊手术的9 4 %。我院共有手术室8间,其中3间为洁净层流手术间,5间为普通手术间,层流手术间原则上不安排创伤性急诊手术。1 1　急诊手术的病种分类,见表1。表1　急诊手术病种分类序号疾病名称急诊手术病人数量构成比( % )1手外伤(腕部以下) 3 40…     

急诊患者压力性损伤现状及预防的研究进展

正急诊是急危重症患者通往医院的第一道关口,也是整个医疗护理服务链的重要一环,但急诊护理流程复杂,对患者安全存在重大挑战。压力性损伤(pressure injury,PI)作为患者护理质量的重要评价指标,在急诊环境中优先级并不高,往往容易被忽视;此外,急诊中存在的沟通、交接与转运、医疗器械使用等因素,都可能导致压力性损伤的预防措施无法得到有效执行,使急诊患者PI风险增加,但目前对这一问题仍然缺乏足够的关注。本文旨在对急诊室中的PI流行病学、危险因素、风险评估和预防措施等作一综述,为临床医护人员提供急诊PI预防和管理思路。     

急诊手术血源性职业暴露的预防

职业暴露是指医务人员从事诊疗、护理等工作过程中意外被感染病人的血液、体液污染了皮肤或者黏膜，或者是被污染的针头及其他锐器刺破皮肤，有可能被病毒感染的情况。随着乙肝、梅毒、艾滋病发病率的上升，手术室护士发生职业暴露的机率大大增加。手术室是血源性病原体职业暴露高发场所，急诊手术由于对病人感染状况的不确定也会加重护理人员的心理压力，     

临床护理人员标准防护措施实施状况分析

目的：对临床护理人员标准防护措施实施状况进行描述。方法：采用问卷调查方法抽样调查了北京市某三级甲等医院142名临床护理人员标准防护措施的实施状况。结果：临床护理人员标准防护措施实施状况不好。标准防护措施各个层面、各单项要求执行的偏差较大。结论；对临床护理人员进行标准防护措施的有效培训、提高遵从率十分必要。     

标准操作规范在急诊接诊与分流中的应用

目的 探讨急诊接诊与分流中应用标准操作规范的方法与效果.方法 制订急诊接诊与分流标准操作规范,合理配置人力资源并进行培训.结果 加快了急诊接诊与分流速度(P<0.05),分诊失误率下降(P<0.01),患者满意度提高(P<0.05).结论 规范化、科学的急诊接诊与分流标准实现了快速救治,提高了患者满意度.     

331名妇产科医护人员标准预防依从性调查分析

目的：了解妇产科医护人员标准预防依从性情况,探讨改进对策。方法：采用自行设计调查问卷,对10家二级以上综合性医院331名妇产科医护人员标准预防相关知识的知晓度、防护措施执行情况和影响因素、职业暴露情况等进行调查分析。结果：30.2%医护人员掌握标准预防相关知识,依从性较强;55.3%基本掌握标准预防相关知识,依从性不足;14.5%标准预防相关知识缺乏,依从性差。二级医院与三级医院、医师与助产士在标准预防依从性方面存在差别有统计学意义（P〈0.05）。影响因素主要为防护设备不足、医院重视不够、自身防护意识薄弱。职业暴露主要为锐器损伤和皮肤黏膜接触孕产妇血液、羊水、阴道分泌物。结论：妇产科医护人员标准预防依从性亟待加强,医院应强化标准预防相关知识培训,改善医院感染管理监督机制,提高医护人员标准预防依从性。     

我院急诊手术的时间分布规律及管理对策

目的：分析我院常见急诊手术的时间分布规律,以及形成这种规律的原因,并制定处理常见急诊手术的对策和措施。方法：将本院中心手术室2004～2006年急诊手术的时间分布进行统计。结果：手术量依次为创伤科、产科、妇科、普外科、泌尿科,其余科室无明显规律性;总急诊手术高峰出现于秋冬季和冬春季交界时。结论：研究结果可以指导手术室进行更科学的人员及物资管理。     

乌鲁木齐市二级及以上医院标准预防相关物品的配备现状调查及分析

目的了解医院标准预防相关物品配备现状。方法采用分层随机抽样的方法,参照美国疾病控制中心提出的标准预防,自行设计调查表,对22所医院的300个科室调查标准预防相关物品的配备情况。结果手部卫生设施配备严重不足,仅55.00%的医生办公室配备洗手池,44.67%的护士站配备洗手池;防护用具配备不到位,仅22.33%的科室配备护目镜、防水围裙;职业暴露登记制度不健全,仅27.67%的科室有针刺伤上报制度。结论应进一步完善标准预防相关物品配备以保证医务人员执行标准预防。     

Taiwanese nursing students' knowledge, application and confidence with standard and additional precautions in infection control

Aim. This study reports on nursing students’ current capacity to handle standard and additional infection‐control precautions in terms of their knowledge, application skills and confidence. Background. These precautions are recommended as the guidelines for preventing infections and ensuring occupational safety. As nursing students undertake patient care during clinical practice, their knowledge of and ability to apply these precautions with confidence should be examined before they enter the clinical field. Method. A specific tool, the Infection Control Evaluation, was developed and distributed. Design. A cross‐sectional survey involving a sample of preservice nursing students was conducted in southern Taiwan. Results. The results were based on an 88% response rate and indicated that the level of knowledge concerning standard and additional precautions was low among Taiwanese nursing students. Their ability in applying these precautions in clinical practice also appeared to be inadequate. Conclusions. Such findings indicate that Taiwanese preservice nursing students require a comprehensive foundation course in infection‐control precautions before they enter the clinical environment. This will help to ensure their protection and that of their patients. Relevance to clinical practice. As the findings highlight the importance of providing such education for students before they undertake any clinical work, the information provided here can help nursing educators and academics to develop a specific program.     

A review of the evidence for suboptimal compliance of healthcare practitioners to standard/universal infection control precautions

Aims. The review examines from international research: the extent to which practitioners comply with infection control precautions; the pertinent issues that are considered influential in compliance; what strategies have been evaluated to instigate positive behaviour changes amongst practitioners and the effect of these interventions. Background. Internationally, standard/universal precautions (UP) are regarded as fundamental in the prevention and control of infection, and effective in protecting practitioners and patients. However, adherence has been problematic and the practice of standard/UPs is globally suboptimal. Design and methods. Literature review where relevant evidence was identified using several electronic databases, from 1994 to 2006, with number of key terms utilized. Data were extracted by using key headings, which facilitated analysis. Results. Thirty‐seven studies were appraised. Twenty‐four related to measuring practitioner compliance and 13 studies that evaluated the effect of a research intervention on compliance. In addition, other studies were included which examined the specific reasons for suboptimal compliance, or discussed infection control precautions generally. Conclusions. Compliance to infection control precautions is internationally suboptimal. The evidence confirms that compliance to specific aspects of standard/UPs varies, and practitioners are selective in their application of recommended practice. Compliance does improve following a structured intervention; however, research fails to indicate for how long the intervention affects practitioner compliance, or whether compliance after a period of time returns to the norm. Several reasons for non‐compliance are discussed, and recommendations for future research are suggested. Relevance to clinical practice. Suboptimal compliance has significant implications for staff safety, patient protection and the care environment. Infection control teams and researchers need to consider the reasons for non‐compliance and provide a supportive environment that is conducive to the routine, long‐term application of standard precautions.     

Emergency operation indications in emergency medicine clinic (model of emergency medicine in Turkey)

Although patients who present for emergency medical care have a broad spectrum of symptoms, such events can generally be categorized as internal medicine, surgical, and pediatric emergency cases. Indications for emergency surgery are estimated to be infrequent compared with the overall number of patients admitted for emergency care. This study investigated the indications for emergency surgery in patients (612 of 8422 patients who sought emergency care) admitted to the surgical division of the emergency department at Konya City Hospital between January and July of 2002. This retrospective study, which investigated reasons for surgical procedures and relevant branch distribution, comprised 405 men (65%) and 207 women (35%). Ages of enrolled patients ranged from 6 months to 70 years. Most of the patients (n=280, 46%) who underwent surgery at the emergency clinic were treated for acute abdomen. Emergency indications for neurosurgery (n=71, 12%) were the second most common reason for emergency procedures. Epidural hematoma and depressed fracture were the most apparent indications for neurosurgery. Surgery of the thorax was the third most common emergency surgery performed (n=44, 7%). Patients who had emergency surgery indications and who underwent surgery account for approximately 7% of the total number of patients who presented for emergency care. Acute abdomen and trauma were the most frequently reported precipitating events. This study was presented orally at the 4th International Trauma and Emergency Surgery Congress, held in 2002 in Istanbul, Turkey.     

急诊护士工作过程质量标准条目的归类研究

目的探讨适用于急诊护士工作过程的质量标准条目,明确急诊护士工作思路及急诊护理质量控制方向。方法将急诊科护士全部工作内容系统地归类出基础一级标准条目10项,再以追踪方法学为理论指导拟定出基础二级标准条目56项,应用Delphi法对32名专家进行两轮函询。结果归类形成急诊护士工作过程质量检查标准,其中一级条目6项,二级条目33项。结论新归类的急诊护士工作过程质量检查标准条目涵盖了急诊护士工作过程中涉及到的全部内容,具有专家积极性、权威性及较高的专家意见一致性,结果可信。     

减少急诊手术切口感染的体会

切口感染在外科手术的术后并发症中屡见不鲜,直接影响手术的成败。急诊手术因为手术准备时间不充分更容易发生切口感染,因此预防急诊手术切口感染至关重要。 1资料与方法 1.1一般资料 我院2010～2013年共收治了1 780例急诊手术患者,男1 269例,女511例;年龄18～80岁;住院时间5～43d,平均住院21d。其中前2年2010～2011年收治了急诊手术患者968例,后2年2012～2013年收治了812例急诊手术患者。患者多是外伤（408例）、急腹症（737例）、大出血（273例）和急性感染（362例）等病患。