急诊重症监护病房中心静脉导管相关感染的病原学及危险因素分析

目的了解急诊重症监护病房（ICU）中心静脉导管相关感染（CVC-RI）的病原菌特点和危险因素。方法对急诊ICU 2006年1月至2008年12月放置中心静脉导管并符合CVC—RI诊断标准,细菌学检查均阳性的103例患者进行回顾性调查分析。结果CVC—RI病原菌中革兰阳性菌（37．9％,39／103）和革兰阴性菌（42．7％,44／103）发生感染的比例差异无统计学意义。CVC—RI与使用导管腔数、置管时间、置管部位有关。锁骨下静脉置管发生感染的比例最低。结论应尽量选择在锁骨下静脉置管,控制置管时间和导管腔数,注意监测病原菌菌谱的变化。预防重点是避免导管腔内外的污染。     

老年胃肠肿瘤患者外周穿刺中心静脉导管置管感染的临床分析

目的研究老年胃肠肿瘤患者外周穿刺中心静脉导管(PICC)置管后发生导管相关性感染临床资料,并对病原菌分布和耐药性进行分析,为预防和治疗老年胃肠肿瘤患者PICC置管后感染提供参考。方法选取2011年3月-2014年3月就诊的老年胃肠肿瘤并行PICC置管患者共238例作为研究对象,对患者感染部位送检标本进行细菌培养及药敏试验,研究菌群分布和耐药性。结果 80岁以上患者、高APACHEⅡ评分、股静脉置管、置管时间长、置管次数多、静脉营养患者发生感染的比例较高(P<0.05);共分离病原菌92株,其中革兰阳性菌51株占55.4%,革兰阴性菌36株占39.1%,真菌5株占5.5%;金黄色葡萄球菌对万古霉素敏感,敏感率为100.0%,鲍氏不动杆菌对亚胺培南较敏感。结论针对高龄、高APACHEII评分、股静脉置管、置管时间长次数多、静脉营养的老年胃肠肿瘤患者给予加强监护,根据药敏试验结果进行针对性治疗。     

创伤行静脉留置导管患者血流感染病原菌分布及相关因素与预后研究

目的探讨创伤行静脉留置导管抢救的危重患者血流感染的相关因素,为临床治疗提供参考。方法对医院2015年6月-2016年12月收治的104例创伤危重患者静脉置管抢救情况进行分析,患者均符合中心静脉导管感染诊断标准,采集创伤患者创口分泌物进行菌种鉴定,分析患者导管相关性血流感染发生的相关因素。结果 104例创伤危重患者中,颈内静脉置管32例,锁骨下静脉置管45例,股静脉置管27例。锁骨下静脉感染率低于股静脉和颈内静脉,差异有统计学意义(P0.05),使用硅胶导管的患者感染率低于聚乙烯材质导管和聚氨基甲酸乙酯导管,置管7d患者感染率低于置管7d,单腔导管感染率低于多腔导管,差异有统计学意义(P0.05),将单因素指标纳入Logistic回归分析可知置管部位、导管种类、置管时间及导管腔数为血流感染的独立影响因素;送检标本共分离病原菌128株,其中革兰阴性菌101株,占78.90%;革兰阳性菌16株,占12.50%;真菌11株,占8.59%。其中,革兰阴性菌以大肠埃希菌、肺炎克雷伯菌、产气肠杆菌为主;革兰阳性菌以粪肠球菌、屎肠球菌为主;真菌以白假丝酵母为主。结论重视创伤危重患者静脉留置导管的无菌操作、护理和监控,可以降低导管相关性血流感染的发生,降低创伤危重患者的病死率和致残率。     

血液透析患者股静脉留置导管感染病原菌分析

目的观察血液透析患者股静脉留置导管感染的病原菌分布及其临床治疗效果,为临床合理选用抗菌药物提供参考。方法回顾性分析2010年1月-2012年12月行血液透析的68例股静脉留置导管患者临床资料,并观察其感染病原菌分布与临床治疗效果。结果血液透析治疗的68例股静脉留置导管患者中发生股静脉置管感染9例,感染率为13.2%;共检出10株病原菌,主要为革兰阳性菌和革兰阴性菌,分别占90.0%和10.0%;革兰阳性菌对米诺环素、万古霉素以及替考拉宁均具有较高的敏感性,敏感率分别为100.0%、100.0%、95.0%;革兰阴性菌对哌拉西林的敏感率100.0%;临床中均依据药敏性选取敏感抗菌药物治疗,并在治疗1周后,所有患者复查均阴性。结论临床中对于血液透析治疗过程中留置股静脉置管导管的患者,易发生股静脉导管感染,临床中应加强细菌的监测,并依据药敏性合理选用抗菌药物,提高临床治疗效果。     

经外周静脉穿刺中心静脉置管新生儿导管相关血流感染病原菌及其影响因素

目的 探究经外周静脉穿刺中心静脉置管的新生儿导管相关血流感染的病原菌分布及其影响因素。方法 回顾性分析杭州市临安区第一人民医院和杭州市儿童医院2018年1月-2023年1月收治的689例经外周静脉穿刺中心静脉置管的新生儿临床资料,根据是否发生导管相关血流感染分为感染组34例和非感染组655例,分析经外周静脉穿刺中心静脉置管新生儿发生导管相关血流感染病原菌分布特征,单因素及多因素Logistic回归分析发生感染的影响因素。结果 689例经外周静脉穿刺中心静脉置管新生儿,34例发生导管相关血流感染,感染发生率为4.93%;共检出病原菌34株,其中革兰阴性菌11株占32.35%,革兰阳性菌20株占58.82%,真菌3株占8.82%;多因素Logistic分析结果显示,出生体质量≤1 500 g、置管天数>14 d、5 min阿普加(Apgar)评分≤7分是经外周静脉穿刺中心静脉置管新生儿导管相关血流感染发生的影响因素(P<0.05)。结论 经外周静脉穿刺中心静脉置管新生儿导管相关血流感染的发生率较高,感染病原菌以革兰阳性菌为主,出生体质量、置管天数、5 min Apgar评分与经...     

心脏外科患者中心静脉导管感染的相关因素及预防对策研究

目的分析心脏术后中心静脉导管感染的原因,并探讨干预措施。方法选择2015年2月-2016年2月医院收治的心脏手术患者90例,术后均行中心静脉导管置管,分析全部患者临床资料,统计中心静脉导管感染率,讨论感染原因及干预措施。结果 90例中心静脉置管患者,中心静脉导管感染20例,感染率22.22%,共检出病原菌20株,革兰阴性菌6株占30.00%,革兰阳性菌13株占65.00%,真菌1株占5.00%;多因素Logistic回归分析结果显示,使用三腔导管、颈内静脉穿刺、置管时间>10d、有合并症是中心静脉导管感染的独立危险因素(P<0.05)。结论导致心脏术后中心静脉导管感染的原因较多,应针对危险因素术前应积极处理合并症,选择合理的导管种类、穿刺和封管方式,根据药敏试验科学使用抗菌药物,缩短置管时间,从而减少中心静脉导管感染风险,保障手术效果。     

心脏外科患者中心静脉导管感染的相关因素及预防对策研究北大核心CSCD

目的分析心脏术后中心静脉导管感染的原因,并探讨干预措施。方法选择2015年2月-2016年2月医院收治的心脏手术患者90例,术后均行中心静脉导管置管,分析全部患者临床资料,统计中心静脉导管感染率,讨论感染原因及干预措施。结果 90例中心静脉置管患者,中心静脉导管感染20例,感染率22.22%,共检出病原菌20株,革兰阴性菌6株占30.00%,革兰阳性菌13株占65.00%,真菌1株占5.00%;多因素Logistic回归分析结果显示,使用三腔导管、颈内静脉穿刺、置管时间>10d、有合并症是中心静脉导管感染的独立危险因素(P<0.05)。结论导致心脏术后中心静脉导管感染的原因较多,应针对危险因素术前应积极处理合并症,选择合理的导管种类、穿刺和封管方式,根据药敏试验科学使用抗菌药物,缩短置管时间,从而减少中心静脉导管感染风险,保障手术效果。     

老年恶性肿瘤患者深静脉导管相关性血流感染影响因素与预防

目的分析老年恶性肿瘤患者深静脉导管相关性血流感染的影响因素,及预防深静脉导管相关性感染的对策。方法选择2015年1月-2016年12月医院收治的老年恶性肿瘤深静脉置管患者489例为研究对象,统计深静脉导管相关性血流感染的病原菌与药敏情况,分析患者性别、年龄、合并疾病、肿瘤部位、治疗方式等资料,归纳老年恶性肿瘤患者深静脉导管相关性血流感染的影响因素。结果老年恶性肿瘤静脉置管患者导管相关性血流感染率为13.70%(67/489);共培养分离病原菌83株,其中革兰阳性菌34株占40.96%,以凝固酶阴性葡萄球菌、金黄色葡萄球菌为主;革兰阴性菌45株占54.22%,以大肠埃希菌、肺炎克雷伯菌为主;真菌4株占4.82%。主要革兰阳性菌对奈替米星和阿米卡星较敏感;主要革兰阴性菌对美罗培南、亚胺培南和头孢哌酮/舒巴坦较敏感。股静脉置管、置管时间、三腔导管、院外维护、恶性肿瘤晚期是老年恶性肿瘤患者导管相关性血流感染的影响因素(P<0.05)。结论老年恶性肿瘤置管患者并发深静脉导管相关性血流感染率较高,病原菌对临床常用抗菌药物具有一定的耐药性,应针对患者个体情况结合影响因素制定个性化医护措施,降低深静脉导管相关性血流感染率。     

521例ICU患者中心静脉导管感染分析

目的分析ICU患者留置中心静脉导管感染的病原学及感染危险因素,探讨中心静脉导管感染的防治策略。方法回顾性分析2000年1月-2009年11月ICU送检中心静脉导管尖端培养521份标本的培养结果,数据行线性趋势2χ检验。结果 521例中培养阳性209例,分离出真菌73株占34.93%,革兰阳性菌62株占29.66%;革兰阴性菌74株占35.41%;颈内静脉和股静脉导管培养阳性率大于锁骨下静脉;置管时间8～14 d的阳性率最高;普通管感染高于血液透析管和抗感染管。结论中心静脉导管感染与静脉置管类型、部位、留置时间具有相关性,革兰阴性杆菌和真菌感染为主要的病原菌;ICU应加强对导管感染的预防措施。     

危重患者中心静脉导管相关性感染16例临床分析

目的了解危重患者中心静脉导管相关性感染（CVC—RI）的原因及影响因素。方法以回顾性调查方法对ICU中16例发生CVC—RI患者的年龄、导管留置时间、置管部位及细菌学检查结果进行统计分析。结果CVC—RI与年龄无明显相关,但与导管留置时间、置管部位有关。CVC—RI病原菌中以革兰阳性菌、革兰阴性菌和真菌有关。结论应尽量选择锁骨下静脉置管,减少置管留置时间,注意各种操作的无菌技术,对于CVC—RI的预防有积极作用。     

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.