葡萄糖酸氯己定醇皮肤消毒液对多药耐药菌的杀菌效果评价

目的 评价葡萄糖酸氯己定醇皮肤消毒液对多药耐药菌的杀灭作用,为临床合理选用消毒剂提供依据.方法 采用悬液定量杀菌方法,设试验组:耐甲氧西林金黄色葡萄球菌、产ESBLs大肠埃希菌和泛耐药铜绿假单胞菌3种多药耐药菌;对照组:与试验组相对应的金黄色葡萄球菌、大肠埃希菌和铜绿假单胞菌3种非耐药菌;比较葡萄糖酸氯己定醇皮肤消毒液对耐药菌和非耐药菌的杀灭作用.结果 2％葡萄糖酸氯己定醇皮肤消毒液原液作用30 s、1、3 min对试验组和对照组的杀灭对数值均＞5.0.结论 2％葡萄糖酸氯己定醇皮肤消毒液对多药耐药菌的杀灭作用与非耐药菌同样快速和有效.     

三种葡萄糖酸氯己定复方手消毒剂杀菌效果和临床实验研究

目的测试三种葡萄糖酸氯己定复方手消毒剂临床消毒效果,为临床科室提供安全有效的手消毒剂。方法根据《消毒技术规范》对三种葡萄糖酸氯己定复方手消毒剂进行检测。结果三种葡萄糖酸氯己定复方手消毒剂pH值,泡沫抗菌洗手液为6.50、泡沫外科消毒剂为6.38,外科手消毒凝胶为6.70,有效成分葡萄糖酸氯己定含量分别为0.185%、1.23%、1.19%,泡沫和凝胶手消毒液乙醇含量分别为:38.2%、54.7%,泡沫抗菌洗手液细菌总数、大肠杆菌、金黄色葡萄球菌、真菌菌落符合国家标准要求;泡沫抗菌洗手液对大肠杆菌杀灭对数值均>5.00,对金黄色葡萄球菌杀菌不合格;泡沫外科消毒剂对大肠杆菌、金黄色葡萄球菌作用1.5min,对白念珠菌、铜绿假单胞菌作用3.0min,可达到消毒合格;外科手消毒凝胶大肠杆菌、金黄色葡萄球菌、白念珠菌、铜绿假单胞菌作用1.0min,可达到消毒合格;使用葡萄糖酸氯己定泡沫抗菌洗手液后用葡萄糖酸泡沫外科消毒剂或葡萄糖酸氯己定外科手消毒凝胶5ml,消毒作用3min,对临床科室医务人员手上自然菌杀灭对数>1.0,手上残留菌数<1cfu/cm2。结论三种葡萄糖酸氯己定复方手消毒剂消毒配合使用消毒效果达到临床消毒要求,可以在临床科室使用。     

铜绿假单胞菌对5种消毒剂抗性的研究

目的 了解临床分离的铜绿假单胞菌对碘伏、戊二醛、氯己定、氯氧三嗪(三氯异氰尿酸)和苯扎溴铵5种消毒剂的抗性.方法 采用PhoenixTM-100系统鉴定铜绿假单胞菌和药敏试验,用液体稀释法检测碘伏、戊二醛、氯己定、氯氧三嗪和苯扎溴铵对铜绿假单胞菌的最低抑菌浓度(MIC).结果 190株铜绿假单胞菌对氨苄西林/舒巴坦、氯霉素、四环素、复方新诺明耐药率最高均＞98.0%,几乎已失去对该菌的杀菌能力;而对亚胺培南、美罗培南耐药率较低,仅为15.3%和6.8%,5种消毒剂中,铜绿假单胞菌对戊二醛和氯氧三嗪的抗性最强,MIC50分别为32 μg/ml和64μg/ml;而对氯己定、苯扎溴铵的抗性最弱,MIcso分别为1μg/ml和2.4 μg/ml;氯己定在1 MIC作用10 min,仍能产生快速而强烈的杀菌作用.结论 铜绿假单胞菌对碘伏、戊二醛、氯己定、氯氧三嗪和苯扎溴铵5种消毒剂的抗性差异有统计学意义,应合理使用消毒剂,以降低耐药菌扩散及医院感染发生.     

内镜中铜绿假单胞菌生物膜对消毒剂抗性研究

目的:研究内镜中铜绿假单胞菌生物膜对常用消毒剂的抵抗性.方法:用高分子滤膜模拟制备生物膜,利用肉汤稀释法分别进行临床内镜中分离出的铜绿假单胞菌对常用消毒剂的抗性变化的探讨,并与标准菌株进行平行比较.结果:其中培养物对一种含氯消毒剂的最小抑菌浓度和最小杀菌浓度均为有效氯450 mg/L;其余铜绿假单胞菌株均小于400 mg/L.对含苯扎溴铵消毒剂最小抑菌浓度为80 mg/L,最小杀菌浓度为156 mg/L;对碘消毒剂的最小抑(杀)菌浓度相同.均为1000 mg/L.结论:内镜中产生的铜绿假单胞菌对常用消毒剂抗力有相关性影响.     

爱尔碘皮肤消毒剂对生物膜阳性致病菌的体外杀菌试验

目的 了解爱尔碘皮肤消毒剂对生物膜阳性致病菌的最小杀菌浓度.方法 将所有受试菌进行生物膜形成检测,再用对倍稀释法,以爱尔碘皮肤消毒剂不同浓度对生物膜阳性致病菌作用不同时间,观察杀菌效果.结果 金黄色葡萄球菌、大肠埃希菌和铜绿假单胞菌生物膜形成阳性率分别为54.3％、47.3％和57.0％;爱尔碘皮肤消毒剂在有效碘含量为9.203×10-4 mg/L时,作用1 min后,可将所有受试菌株全部杀灭.结论 爱尔碘皮肤消毒剂对生物膜阳性致病菌具有高效的杀菌性.     

不同皮肤消毒剂对中心静脉导管相关血流感染发病率的影响

目的研究不同皮肤消毒剂对预防导管相关性血流感染（CRBSI）的影响。方法采用临床对照研究,比较2011年12月—2014年5月某三级甲等医院综合重症监护病房(ICU)患者中心静脉置管前使用复合型皮肤消毒剂、2%葡萄糖酸氯己定醇皮肤消毒剂患者CRBSI发病率差异。结果使用2%葡萄糖酸氯己定醇皮肤消毒剂的患者发生CRBSI 2例,其中革兰阴性菌（铜绿假单胞菌）和革兰阳性菌感染（金黄色葡萄球菌）各1例, CRBSI发病率为0.44‰（2/4 546）;使用复合型皮肤消毒剂的患者发生CRBSI 22例,其中13例革兰阴性菌感染, 7例革兰阳性菌感染,2例真菌感染,CRBSI发病率4.11‰（22/5 349）,两组CRBSI发病率比较,差异有统计学意义（χ2=15.640,P<0.01）。结论中心静脉置管前使用2%葡萄糖酸氯己定醇的皮肤消毒效果更好,可以有效地降低ICU患者CRBSI发病率,值得临床优先应用。     

季铵盐消毒剂中检出一株洋葱假单胞菌

目的　观察从复合季铵盐消毒剂中分离得到的洋葱假单胞菌对常用消毒剂的抗力。方法　以常用的氯和戊二醛消毒剂对其进行杀菌试验,并与对大肠杆菌和金黄色葡萄球菌相应的杀菌效果进行比较,以除菌后污染样液对大肠杆菌、金黄色葡萄球菌进行了杀菌试验和ＨＢｓＡｇ 抗原性破坏试验,对芽胞和白色念珠菌进行抑菌试验。结果　该洋葱假单胞菌对氯和戊二醛的抗力与大肠杆菌和金黄色葡萄球菌接近,污染样液除菌后１ ０００ 倍稀释对大肠杆菌和金黄色葡萄球菌仍有较好的杀菌效果,２０ 倍稀释可完全破坏ＨＢｓＡｇ 抗原性,和抑制枯草杆菌黑色变种芽胞的生长,１ ６００ 倍稀释可抑制白色念珠菌生长,而原液则不能抑制分离菌株的生长。结论　洋葱假单胞菌可在高浓度（１ ．６％ ）季铵盐消毒剂中大量生长,其对该类消毒剂抗力明显高于大肠杆菌、金黄色葡萄球菌、白色念珠菌、枯草杆菌黑色变种芽胞和ＨＢｓＡｇ,其对氯和戊二醛的抗力与大肠杆菌和金黄色葡萄球菌接近     

醇类免洗手消毒液和无醇类免洗手消毒液对多药耐药菌的杀菌效果比较

目的比较醇类免洗手皮肤消毒液和无醇免洗手消毒液两种产品对多药耐药菌的杀菌情况。方法采用悬液定量法,以耐甲氧西林金黄色葡萄球菌17株、泛耐药铜绿假单细胞菌15株、产ESBLs大肠杆菌12株等多药耐药菌为实验组;以金黄色葡萄球菌20株、铜绿假单胞菌19株、大肠杆菌15株为对照组,对比两种产品对各种菌种的杀灭情况。结果醇类免洗手消毒液对于耐甲氧西林金黄色葡萄球菌、泛耐药性铜绿假单胞菌、产ESBLs大肠杆菌等多药耐药菌的杀灭对数均大于5,对于金黄色葡萄球菌、铜绿假单胞菌、大肠杆菌的杀灭对数也都大于5;无醇免洗手消毒液对于耐甲氧西林金黄色葡萄球菌、泛耐药性铜绿假单胞菌、产ESBLs大肠杆菌等多药耐药菌的杀灭对数均大于5,对于金黄色葡萄球菌、铜绿假单胞菌、大肠杆菌的杀灭对数也都大于5。结论醇类免洗手皮肤消毒液和无醇免洗手消毒液这两种免洗手皮肤消毒液对多药耐药菌以及其对应非耐药菌的杀灭效果均十分优秀,值得信赖。     

两种泡腾消毒剂的消毒效果及对化脓性伤口作用的临床观察

目的 考察聚维酮碘泡腾滴丸和醋酸氯己定泡腾滴丸体内外消毒效果,为临床消毒剂的选择应用提供依据.方法 制备金黄色葡萄球菌、大肠埃希菌、铜绿假单胞菌、白色假丝酵母菌菌悬液,蛋白胨生理盐水为中和剂,用中和剂载体定量试验考察观察中和剂及其使用浓度适宜性,用悬液定量杀菌试验考察泡腾滴丸溶液对这些细菌的体外杀灭作用;选取93例外伤化脓病例,随机分组,常规治疗为对照,观察泡腾滴丸溶液促进伤口愈合的作用.结果 含0.1％有效碘或0.1％氯己定的泡腾滴丸溶液能在1 min内有效杀灭金黄色葡萄球菌和大肠埃希菌,在2 min内有效杀灭铜绿假单胞菌和白色假丝酵母菌,对化脓性外伤的治疗作用也与对照组相当.结论 聚维酮碘泡腾滴丸和醋酸氯己定泡腾滴丸是方便实用的消毒制剂.     

一种复方醋酸氯己定-乙醇消毒剂性能的研究

目的研究一种以醋酸氯己定和乙醇复配的消毒剂的消毒性能。方法用理化测定方法、消毒性能检测方法,对该复方消毒剂的性能进行检测。结果含醋酸氯己定600 mg/L、乙醇11.23%的复方消毒液作用2 min;含醋酸氯己定450 mg/L、乙醇8.43%的复方消毒液作用2 min;含醋酸氯己定780 mg/L、乙醇14.60%的复方消毒液作用2 min,分别对悬液内金黄色葡萄球菌、大肠杆菌、铜绿假单胞菌的杀灭对数值5.00;含醋酸氯己定780 mg/L、乙醇14.60%的复方消毒液作用1 min,对悬液内白色念珠菌的杀灭对数值4.00。消毒剂原液作用1 min对手和皮肤的自然菌杀灭对数值1.00。结论该复方消毒剂储存性能稳定,原液和一定浓度的稀释液均对指标菌的细菌繁殖体和真菌有较好的杀菌作用,对皮肤和手上自然菌的杀菌效果均可以达到标准的要求。     

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.     

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.     

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.     

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.