门诊换药室严格控制医院感染的护理体会

目的:控制门诊换药室发生医院感染.方法:加强门诊换药室医院感染的管理,同时钟对不同的患者进行健康宣教.结果:门诊换药室未发生医院感染.结论:做好门诊换药室医院感染的预防控制具有重要的意义.     

浅谈门诊换药室的感染控制

目的:探讨门诊换药室院内感染的控制措施。方法:通过我院门诊换药人次8632人/年,综合分析其院内感染的有效控制措施。结果:无1例发生院内感染。结论:门诊换药室作为医院感染预防和控制的重点,必须做到:①加强室内空气消毒;②器械、敷料等用物实行一人一包一灭菌;③加强隔离管理,严格无菌操作技术;④加强血原性感染的预防。     

换药室器械物品消毒方法的改进与应用

换药室是外科治疗工作中的重要组成部分,我院骨科自1999年2月至2003年5月对换药室器械物品消毒方法进行改进,取得满意效果,现介绍如下。     

烧伤科换药室的管理

烧伤患者由于皮肤的屏障功能破坏,易引起创面感染,目前感染仍是烧伤患者创面延迟愈合和并发败血症甚或引起死亡的主要原因,因此如何治疗与预防感染是促进创面愈合、提高治愈率的重要措施。除系统的应用抗生素治疗外,加强创面的换药无疑是创面治疗的重点。     

骨科换药室空气消毒效果的观察

目的:观察骨科换药室内工作环境中两种空气消毒方法的消毒效果.方法:以2008年换药室内空气消毒效果监测样本为对照组,采用“84”消毒液和紫外线进行消毒.2009年的换药室内空气消毒效果监测样本为观察组,采用75％乙醇消毒液和三氧消毒灭菌机进行消毒,对两组的消毒效果进行比较分析.结果:观察组的室内环境空气消毒效果优于对照组,用百分构成法统计分析,经x2检验,P＜0.01,差异具有统计学意义.结论:75％乙醇消毒液和臭氧对空气消毒效果优于“84”消毒液和紫外残对空气的消毒效果,降低了医院感染的危险因素,提高了骨科患者换药的安全系数.     

舒适护理在门诊换药室的应用

<正>舒适护理是指人在心里、生理、社会、灵性上达到最愉悦状态,或缩短降低其不愉快的程度而达到的愉悦感受,促进健康及疾病的康复。2009-03~2009-08,我院换药室对1 625例患者进行了舒适护理,取得满意效果。     

专职物价成本核算员在临床科室的试行与效果评价

目的探讨专职物价成本核算员在临床科室设置的可行性和有效性。方法由护理部和经管科室共同考核,选定6个科室作为试点,对选拔的6名专职物价成本核算员进行理论、临床培训及考核,培训合格后按照工作职责从事医嘱核对、物资请领、核对账本等工作。结果通过在试点科室试行专职物价成本核算员半年来,试点科室的各项护理指标合格率均在96%以上,护士工作满意度从实施前的88%上升至93%,住院患者满意率由93%上升到98%,出院患者意见征询满意率由90%提升到99%。结论在临床科室设立专职物价成本核算员是一种新的科室经济管理模式,使病区的物价收费更规范,物资管理有序,欠费管理有跟踪,利于加强病区物价收费管理、经济核算管理、护理管理和人事管理。     

我院创口治疗中心与换药中心的工作开展及成效

我院烧伤与皮肤外科有着55年的处理各种伤口的经验,随着患者的不断增加以及业务的扩展,我科门诊换药室的空间和工作人员已远远满足不了患者的需求。于2008年6月在医院门诊部及护理部的支持下,医院把门诊部换药室与本科的门诊换药室合并,扩建成创口治疗中心、换药中心,隶属烧伤与皮肤外科,是国内目前最人的、综合的创口治疗中心、换药中心之一。中心成立后在布局、人员及业务等儿方面进行了改进和扩展,取得了良好效果,现将中心的工作开展情况及其成效报道如下。     

区级医院消毒供应室在落实行业新规范过程中的细节质控

目的探讨区级医院消毒供应室在落实新规范中的细节质控方法。方法构建细节质控运行构架,如完善消毒供应室质量体系文件并编辑成册、设置质控管理岗位和人员合理分工、设计不同的表格记录本、每周定期汇总讨论讲评、制作流程图梳理程序完善细节。结果实施细节质控后,消毒供应室工作质量效率指标、出现偏差情况与实施细节质控前比较,差异有统计学意义(P<0.05,P<0.01);护理部检查评分高于实施细节质控前。结论区级医院消毒供应室在落实行业新规范中,按照细节质控路径运行,能促使工作流程细节中的不规范问题迅速解决,达到工作质量和效率提高、物耗降低的目的。     

病房住院总护师岗位的设置与成效

目的探讨设置住院总护师岗位的方法及效果,以降低护士长及夜班护士工作压力,提高护理质量。方法参照《住院总医师实施管理办法》,在内科、外科、妇科、产科、儿科等15个病区设置住院总护师岗位,由经过系统规范化培训,并经考试考核合格的高年资护师担任。于设岗后半年,分别发放护士长、夜班护士工作压力程度调查表,同时进行护理质量检查评价与患者满意度调查。结果设岗后,护士长及夜班护士的工作压力较设岗前显著降低（均P〈0.01）;病房管理、特一级护理、护理技术水平、病历书写、患者满意度、护理投诉与纠纷显著优于设岗前（均P〈0.01）。结论住院总护师岗位的设置,能缓解护士长及夜班护士的工作压力,提高护理质量及患者满意度,且使一大批护理人员得到培养和锻炼,有利于护理人才的发掘和储备。     

手术室开展优质护理服务的实践与效果

目的 探讨手术室开展优质护理服务的具体措施及效果.方法 通过采取优化手术室护理工作程序,创新服务内容、注重护理细节等方法,有效落实并进一步深化手术室优质护理.结果 实施1年后,患者及手术医生对手术室满意度均分与上年度比较,差异有统计学意义(均P＜0.01).结论 手术室开展优质护理服务示范工程活动能改善护理服务质量,有利于提高患者及医生满意度.     

The sitting position in neurosurgery: a critical appraisal

The potential for serious complications after venous air embolism and successful malpractice liability claims are the principle reasons for the dramatic decline in the use of the sitting position in neurosurgical practice. Although there have been several studies substantiating the relative safety compared with the prone or park bench positions, its use will continue to decline as neurosurgeons abandon its application and trainees in neurosurgery are not exposed to its relative merits. How can individual surgeons continue to use this position? Will individual, difficult surgical access cases be denied the obvious technical advantages of the sitting position? Limited use of the sitting position should remain in the neurosurgeon's armamentarium. However, several caveats must be emphasized. Assessment of the relative risk-benefit, based on the individual patient's physical status and surgical implications for the particular intracranial pathology, is of paramount importance. The patient should be informed of the specific risks of venous air embolism, quadriparesis and peripheral nerve palsies. Appropriate charting of patient information provided and special consent issues are essential. An anaesthetic input into the decision to use the sitting position is a sine qua non. The presence of a patient foramen ovale is an absolute contraindication. Preoperative contrast echocardiography should be used as a screening technique to detect the population at risk of paradoxical air embolism caused by the presence of a patent foramen ovale. The technique involves i.v. injection of saline agitated with air and a Valsalva manoeuvre is applied and released. Use of this position necessitates supplementary monitoring to promptly detect and treat venous air embolism. Doppler ultrasonography is the most sensitive of the generally available monitors to detect intracardiac air. The use of a central venous catheter is recommended, with the tip positioned close to the superior vena cava junction with the right atrium, to aspirate intravascular gas. Measures to minimize hypotension associated with the sitting position include a slow, staged positioning over 5-10 min and use of the 'G suit' inflated with compressed air applied to the lower extremities and pelvis. Use of the sitting or upright position for patients undergoing posterior fossa and cervical spine surgery presents unique challenges for the anaesthetist. With appropriate patient selection and preparation, and using prudent intraoperative monitoring and anaesthetic techniques, selected patients should still benefit from the optimum access to mid-line lesions, improved cerebral venous decompression, lower intracranial pressure and enhanced gravity drainage of blood and CSF associated with the sitting position.      

聘用制护士联络员的设立及实践

目的 探讨设立聘用制护士联络员的成效。方法自2007年起采取个人申请、护士长筛选、聘用制护士投票的方式选取聘用制护士联络员,明确工作职责,定期培训及考核。结果聘用制护士主动离职率由2007年的21.9％降至2010年的2.4％。结论推行科室聘用制护士联络员制,规范了聘用制护士管理,有利于护理人员基数的动态管理,避免了人...     

Man-machine interface: The position of the anaesthetic machine in the operating room

The question posed for this study was: “While holding a watching brief during an uneventful intra-abdominal surgical procedure do anaesthetists adopt the same position in the operating room with reference to the patient’s head and ’anaesthetic machine’ and, if they do, what is it?” A study of the relative positions of the patient, the anaesthetist, and the “anaesthetic machine” during routine laparotomy showed great variation. The implication was that there was also great variation in the amount of movement necessary by the anaesthetist if the same amount of information was to be obtained with the same frequency. The significance of this with reference to the quality of patient care is discussed. The role of changes in apparatus and the declared need for this by anaesthetists is mentioned and recommendations regarding the visual acquisition of data during anaesthesia are made.     

西部地区三年制护理专业人才培养质量评价体系的初步构建

目的探讨西部地区三年制护理专业人才培养质量评价的内容与方法。方法运用动态评价理论,从教学质量评价和社会评价两个方面对三年制护理专业学生进行评价,根据评价结果进一步改革人才培养方案,并对效果进行动态观测。结果护理专业学生的基本理论与技能扎实,护理职业能力强,就业率明显高于其他专业,用人单位对学生的满意度高。结论该评价体系可以为制定护理专业人才培养方案提供参考,在西部地区三年制护理专业教育中切实可行。     

The quality assessment of clinical practice guidelines for intracranial aneurysms: a systematic appraisal

Neurosurgical Review - Intracranial aneurysms are common in adults. The relevant guidelines for patients with intracranial aneurysms aim to standardize the clinical practice and decision making for...     

Setting for single position surgery: survey from expert spinal surgeons

Purpose

To describe a comprehensive setting of the different alternatives for performing a single position fusion surgery based on the opinion of leading surgeons in the field.

Methods

Between April and May of 2021, a specifically designed two round survey was distributed by mail to a group of leaders in the field of Single Position Surgery (SPS). The questionnaire included a variety of domains which were focused on highlighting tips and recommendations regarding improving the efficiency of the performance of SPS. This includes operation room setting, positioning, use of technology, approach, retractors specific details, intraoperative neuromonitoring and tips for inserting percutaneous pedicle screws in the lateral position. It asked questions focused on Lateral Single Position Surgery (LSPS), Lateral ALIF (LA) and Prone Lateral Surgery (PLS). Strong agreement was defined as an agreement of more than 80% of surgeons for each specific question. The number of surgeries performed in SPS by each surgeon was used as an indirect element to aid in exhibiting the expertise of the surgeons being surveyed.

Results

Twenty-four surgeons completed both rounds of the questionnaire. Moderate or strong agreement was found for more than 50% of the items. A definition for Single Position Surgery and a step-by-step recommendation workflow was built to create a better understanding of surgeons who are starting the learning curve in this technique.

Conclusion

A recommendation of the setting for performing single position fusion surgery procedure (LSPS, LA and PLS) was developed based on a survey of leaders in the field.

     

Parental presence in the operating room: effect on the quality of anesthetic induction and postoperative agitation in children

Background and objectiveVarious nonpharmacologic strategies for reducing anxiety in children and improving cooperation during induction of anesthesia have been investigated. Parental presence during anesthetic induction has been the alternative studied most often, especially in English-speaking populations. Mixed results have been reported, however. The aim of this study was to evaluate the quality of anesthetic induction and the development of postoperative agitation in Spanish children undergoing ear, nose, or throat surgery with or without parental presence in the operating room.Patients and methodsChildren in American Society of Anesthesiologists class 1 or 2 who were scheduled for ear, nose or throat surgery under inhalation anesthesia were randomized to 2 groups for presence or absence of a parent in the operating room. The induction experience was classified as easy, carried out with moderate resistance, or traumatic. The postoperative period was assessed as easy or traumatic.ResultsForty children were randomized. Time to onset of anesthesia was similar in the 2 groups. Induction was easy for 65% of the children with parental presence and for 25% of the children without a parent present (P < .05). Induction was traumatic for 25% in the parental presence group and for 35% in the parental absence group (P < .05). The incidence of moderate resistance during induction was similar in the 2 groups; the quality of the postoperative experience was also similar.ConclusionsParental presence during induction of inhalation anesthesia improves the induction experience of nonpremeditated Spanish children, increasing the incidence of easy induction and decreasing the presence of traumatic induction. The quality of the postoperative experience is similar.