妊娠晚期合并性传播疾病对新生儿的影响及预防对策

目的：探索与研究妊娠晚期合并性传播疾病对于新生儿的影响并探讨预防的对策。方法：选取我院自2013年6月至2015年6产科收治住院分娩的孕产妇作为研究对象,选取55例诊断为妊娠合并性传播疾病的孕产妇作为观察组,随机选取55例同时期的正常孕产妇作为对照组,对比分析两组产妇分娩情况、新生儿情况。结果：观察组孕妇早产率明显高于对照组,差异有统计学意义（χ^2=4.82,P〈0.05）;两组孕妇生产方式相比较,无明显差异（χ^2=0.98,P〉0.05）;观察组孕妇产后出血、产后子宫内膜炎的发生率明显高于对照组,且差异有统计学意义（χ^2=4.16,P〈0.05;χ^2=4.32,P〈0.05）;观察组新生儿出现胎膜早破、新生儿窒息、新生儿感染差异的概率明显高于对照组,差异有统计学意义（χ^2=5.13,P〈0.05;χ^2=4.97,P〈0.05;χ^2=5.28,P〈0.05）;观察组新生儿死亡率明显高于对照组,差异有统计学意义（χ^2=4.16,P〈0.05）。结论：妊娠期间合并性传播疾病不仅对孕妇本身存在危害还可以危害新生儿的健康,及时诊断并治疗对于这种现象的预防与治疗都存在明显的效果,进一步保障了母婴的健康。     

基于授权赋能的医院感染目标性监测在综合ICU中的应用

目的：探讨授权赋能在医院感染目标性监测中的应用方法与效果。方法采用基于授权赋能的目标性监测方法,对某院2013年间（实验组）综合ICU患者发生医院感染的情况进行监测和及时公示,同时对呼吸机相关肺炎千日感染率及医护人员洗手依从性进行分析,并与传统目标性监测中2012年（对照组）的结果进行比较。结果实验组呼吸机相关肺炎千日感染率为13.57‰,较对照组降低;实验组医生、护士、实习生、医护工洗手依从性分别由原先的70.19%、79.36%、70.29%、60.40%提升至78.57%、88.41%、77.70%、74.27%,差异均有统计学意义（P＜0.05）。结论综合ICU是医院感染的高发病区,通过授权赋能的目标性监测方法可提高医护人员的警示作用,及时根据高危人群实施早期干预,采取有效的综合控制措施,降低呼吸机相关肺炎感染率,提高洗手依从性。     

2005年美国心脏学会（AHA）心肺复苏与心血管急救指南解读（二十一）濒死性哮喘

在美国，每年有200余万人因哮喘而光顾急诊室，其中5000～6000人死亡，许多患者死亡发生在到达医院之前。有2％～20％的患者因严重哮喘而需入住重症监护病房，其中1／3患者需要气管插管和机械通气。本章重点讨论如何评估和治疗濒死性哮喘患者。     

妊娠期梅毒患者胎儿宫内感染的超声诊断研究

目的:探讨超声对诊断梅毒感染孕妇宫内感染的意义。方法:选取2012年4月至2014年3月来院就诊并确诊为妊娠合并梅毒的孕产妇46例,本研究根据所选妊娠合并梅毒孕妇是否发生宫内感染,分为发生宫内感染组(观察组)和未发生宫内感染组(对照组),对比两组患者的产前宫内超声诊断结果,分析可以用于判断早期胎儿宫内感染的指标。结果:将观察组和对照组患者的产前早中期超声检测结果进行统计学分析发现,两组检测指标在胎囊不规则(0 vs.23.1%),胎心异常(5.0%vs.19.2%)、胎动异常(10.0%vs.15.4%)和胎盘水肿(0 vs.23.1%)等方面均具有差异性(χ2=9.000,4.410,3.889,1.440,9.000,P<0.01),具有统计学意义。孕后期超声检查结果显示两组之间在宫内窘迫(15.0%vs.69.2%)、全身水肿(0 vs.46.2%)、腹水(0 vs.61.5)、肝肿大(0 vs.88.5%)和脾肿大(0 vs.88.5%)等方面差异显著,具有统计学意义(χ2=10.10,12.49,61.54,88.46,88.46,P<0.01)。结论:产前超声监测可以为临床医生提供全面且直观的临床数据,有利于诊断和评估患者的病情,减少新生梅毒儿的数量。     

OPCABG在高危冠心病应用中的疗效及可行性分析

目的探讨非体外循环冠状动脉旁路移植术(OPCABG)在高危冠心病应用中的疗效及可行性。方法以高州市人民医院2016年1月-2018年1月收治的108例高危冠心病(CHD)患者为研究对象,根据患者住院单双号分为观察组(54例)和对照组(54例),观察组给予OPCABG,对照组给予体外循环冠状动脉旁路移植术(CABG);对比两组手术相关指标、并发症及预后。结果观察组手术时间(3.56±0.83)h、桥血管个数(2.97±0.24)个、动脉桥使用率100%、静脉桥血管远端吻合口数(3.36±0.47)个、二次开胸率1.85%、气管切开率5.56%、左室射血分数(LVEF)(53.64±7.89)%,N末端B型脑钠肽前体(NT-proBNP)(425.43±68.21)μg/L,与对照组[手术时间(3.82±0.91)h,桥血管个数(2.95±0.26)个,动脉桥使用率100%,静脉桥血管远端吻合口数(3.54±0.56)个,二次开胸率9.26%,气管切开率9.26%,LVEF(52.76±8.14)%,NT-proBNP(432.16±74.45)μg/L]比较无明显差异(P>0.05);观察组输血量(693.24±87.36)mL、住院天数(2.23±0.54)d及ICU住院天数(14.67±4.85)d明显低于对照组[输血量(952.18±106.74)mL,住院天数(3.56±0.72)d,ICU住院天数(18.86±6.52)d](P<0.05)。观察组脑肝肾损伤并发症发生率(0.00%)明显低于对照组(7.41%)(P<0.05);随访16个月,观察组预后与对照组无明显差异(P>0.05)。结论OPCABG在高危冠心病应用中手术效果较好,能够明显减少患者输血量、住院时间及ICU住院天数,降低患者并发症发生率。     

综合困难气道训练考核系统在急诊规培住院医师气管插管培训中的应用

目的 探讨综合困难气道训练考核系统在急诊规范化培训（规培）住院医师气管插管培训中的应用效果。方法 选择2021年6月—2022年10月在首都医科大学宣武医院急诊科轮转的规范化培训住院医师57人,随机分为观察组29人和对照组28人。观察组气管插管技能培训应用综合困难气道训练考核系统进行,对照组应用简单气管插管模型进行,培训结束后对两组住院医师进行气管插管技能考核,分别比较两组住院医师在正常气道和困难气道气管插管成功率、气管插管时间、喉镜对门齿的压力、气管插管位置正确率的区别。分别对两组住院医师进行问卷调查,调查住院医师对2种教学方法满意度、培养自信心等方面的区别。结果 观察组住院医师在普通气道气管插管的成功率、气管插管时间和气管插管位置正确率与对照组比较差异无统计学意义（P>0.05）;在困难气道气管插管中,观察组插管成功率高于对照组（P=0.038）,气管插管时间、喉镜对门齿的压力明显小于对照组(P<0.05),气管插管位置正确率两组比较差异无统计学意义（P=0.501）。调查问卷自评结果显示,观察组对培训方法的满意程度、气管插管自信心和学习兴趣高于对照组(P<0.0...     

经鼻高流量氧疗与无创通气治疗急性左心衰竭的效果比较

目的比较经鼻高流量氧疗(high-flow nasal cannula oxygen therapy,HFNC)和无创通气(non-invasive ventilation,NIV)在急性左心衰竭中的治疗效果。方法选择2016年8月-2018年6月我院重症医学科收治的急性左心衰竭患者68例,按随机数字表法分为HFNC组和NIV组,HFNC组35例,NIV组33例。观察两组患者治疗后2h、12h、24h、48h生命体征、动脉血气及心功能指标。比较两组患者的临床疗效;比较两组患者治疗后各时间点心率(HR)、呼吸频率(RR)、平均动脉压(MAP)、PaO2、PaCO2;比较两组患者治疗后各时间点Tei指数、左心室射血分数(LVEF)及脑利钠肽前体(NT-proBNP);比较两组患者气管插管率、28d病死率、ICU住院时间结果两组患者的临床疗效无统计学差异(P>0.05);两组治疗后各时间点PaO2、PaCO2、SaO2、HR、RR无统计学差异(P>0.05);两组治疗后各时间点Tei指数、LVEF、NT-proBNP无统计学差异(P>0.05);HFNC组气管插管率5.7%,NIV组15.2%,HFNC组气管插管率明显低于NIV组,差异有统计学意义(P<0.05);两组28d病死率、ICU住院时间无统计学差异(P>0.05)。结论HFNC可改善急性左心衰竭患者氧合和心功能,气管插管率低于NIV,病死率、ICU住院时间与NIV无明显差异,疗效不劣于NIV。     

气管插管机械通气患者的镇静管理

目的探讨气管插管机械通气患者插管期间的镇静管理，为临床实践提供依据。方法采集重症监护病房98例气管插管患者插管期间的镇静管理相关资料，进行分析、总结。结果98例患者使用镇静药物后0．5h和1h的呼吸、心率、血压、氧饱和度发生明显变化。5例患者出现延迟拔管，11例出现一过性血压下降，3例出现神经系统抑制过深，1例出现甘油三酯过高。结论对镇静治疗的患者做好镇静评估、循环功能的管理、呼吸功能的管理、神经系统的管理、药物代谢的管理、环境的管理和减少应激因素及预防并发症的管理是镇静治疗能否顺利进行的关键。     

危机管理模式对急性重症病毒性心肌炎合并急性肾衰竭患者急诊救治情况及心肾功能的影响

目的分析危机管理模式对急性重症病毒性心肌炎合并急性肾衰竭患者急诊救治情况及心肾功能的影响。方法回顾性收集2016年7月—2020年11月青海省交通医院肾内科收治的急性重症病毒性心肌炎合并急性肾衰竭患者108例临床资料,根据护理管理方式的不同,将2016年7月—2018年5月收治的患者纳为对照组,2018年6月—2020年11月收治的患者纳为危机管理模式组,各54例。对照组采用常规护理管理进行干预,危机管理模式组采用危机管理模式进行干预。比较两组急诊救治情况、心肾功能、并发症及复发、满意度。结果危机管理模式组住院和救护时间短于对照组,救治成功率高于对照组(P<0.05)。干预后,危机管理模式组血清心肌肌钙蛋白I(CTnI)、肌酸激酶同工酶MB(CK-MB)、尿素氮(BUN)、血肌酐(Scr)水平,心律均降低,收缩压、尿量均升高,危机管理模式组高于对照组(P<0.05)。危机管理模式组并发症发生率、复发率低于对照组(11.11%vs 29.63%,1.85%vs 14.81%,P<0.05)。危机管理模式组护理满意度为97.33%,对照组为86.67%,危机管理模式组高于对照组(P<0.05)。结论与常规护理管理模式相比,危机管理模式应用在急性重症病毒性心肌炎合并急性肾衰竭的急诊护理,能提高急诊救治效果,改善患者心肾功能,降低并发症及疾病复发风险,提高患者预后,获得患者及家属认可。     

急诊重症监护病房院内感染管理与对策

急诊重症监护病房（emergency intensive care unit，EICU）是医院内感染高危病区之一。危重患者因自身免疫力低下、各种侵袭性操作、不合理使用抗生素以及患者间的交叉感染等导致院内感染几率高于普通病房。院内感染的发生不仅增加了患者不必要的痛苦和经济负担，更严重威胁了患者的生命安全。     

PDCA循环护理管理在降低内镜室院内感染中的价值

目的探讨PDCA循环护理管理在改善内镜院内感染的价值。方法采用自身对照队列研究方法,将近一年中山大学附属第七医院内镜室检查的患者600例作为研究对象,将其中2018年5月-2018年10月300例作为对照组,将2018年11月-2019年3月300例作为研究组,对比实施PDCA循环护理管理前后,内镜室空气合格率、医护人员感染知识知晓率、职业暴露发生率、内镜消毒清洗合格率。结果研究组内镜室空气合格率较为99.0%,明显高于对照组,组间对比统计学意义存在(P<0.05);研究组医护人员无茵操作率和手卫生合格率均达100%,,而感染知识知晓率为93.33%,均明显高于对照组(P<0.05),两组洗手率比较未见统计学差异(P>0.05);内镜感染监测方面,研究组的内镜腔消毒合格率和内镜外表消毒合格率均较高,但两组比较差异未见统计学差异(P>0.05);而研究组职业暴露发生率0.33%,低于对照组(P<0.05)。结论PDCA循环护理管理可以最大限度降低内镜室感染的概率,有效减少感染风险事件,同时有利于内镜室护理人员有效增强感染控制意识以降低职业暴露风险。     

Händedesinfektion im Krankenhaus – Nutzen und Risiken

The WHO regards hand hygiene as an essential tool for the prevention of noso‐comial infections. The hygienic hand disinfection has a superior antimicrobial efficacy compared to hand washing and should be performed as the treatment of choice before and after a variety of activities at the point of patient care. Washing hands should be preferred when the hands are visibly soiled. Skin irritation is quite common among healthcare workers and is mainly caused by water, soap and long lasting occlusion. Compliance with hand disinfection in clinical practice is often low. Measures to improve compliance include training, provision of hand rubs where they are needed, and the responsibility of doctors to set a good example. Improved compliance in hand hygiene and targeted use of alcohol‐based hand rubs can reduce the nosocomial infection rate by up to 40 %. The benefit of hand disinfection is therefore much larger than possible risks.     

Skin tolerance and effectiveness of two hand decontamination procedures in everyday hospital use

BACKGROUND: Hand decontamination is crucial to control nosocomial infections. The utility of hand decontamination is related not only to its antimicrobial effectiveness, but also to its acceptability by hospital staff. OBJECTIVES: We aimed to assess skin tolerance and antimicrobial effects of two widely accepted hand hygiene measures under in-use conditions. METHODS: Fifty-two nurses were randomly assigned for an 8-day period to either an alcohol-based disinfectant or a hand wash with a non-antiseptic soap. At baseline and at the end of the test period, microbiological hand samples were obtained both before and after a hand hygiene procedure, and skin tolerance was assessed using clinical scores and measurement of transepidermal water loss. RESULTS: Self-assessment of skin condition and grade of skin damage worsened significantly more in the group using soap than in the group using alcoholic disinfectant (P = 0.004 and P = 0.01, respectively). The alcohol-based rinse was significantly more effective than liquid soap in removing transient contaminant micro-organisms (P = 0.016). Twenty of 50 hand washes with non-antiseptic soap apparently resulted in bacterial contamination of the hands. At the end of the study, the total bacterial count increased with the increasing number of hand washes in the soap group (P = 0.003), and with the degree of skin damage (P = 0.005) in the antiseptic group. CONCLUSIONS: In everyday hospital practice, alcohol-based disinfectant is more effective and better tolerated than non-antiseptic soap; soap is at risk of spreading contamination; and skin comfort strongly influences the number and the quality of hand hygiene procedures.     

Handwashing patterns in two dermatology clinics

BACKGROUND: The hands of health care workers are a major source of nosocomial infection. Studies conducted mainly in intensive-care units and emergency departments have shown low compliance with hand hygiene recommendation. OBJECTIVE: To study hand hygiene practices in outpatient dermatology clinics in Israel. METHODS: The fingers of 13 dermatologist physicians were sampled for bacterial cultures and their hand hygiene practices were monitored by two observers. In addition, 51 dermatologists attending a professional conference completed a questionnaire on hand hygiene practice. RESULTS: All the physicians' hands were found to be contaminated. Staphylococcus aureus was isolated in 9 cases (69.2%), a methicillin-resistant S. aureus in 1 (7.7%). Monitoring revealed 555 opportunities for handwashing; the average compliance was 31.4%. In the questionnaire, the main reasons given for poor hand hygiene were excessive work schedule (58%), lack of awareness (35.3%), reaction to disinfectants (17.7%) and lack of readily available facilities (15.7%). CONCLUSION: The hands of dermatologists are frequently colonized with microbial pathogens, but compliance with hand hygiene practice recommendations is low, despite a fairly high awareness of the importance. An active educational infection control program should be introduced in dermatology clinics.     

综合医院急诊科新型冠状病毒感染肺炎的预防和控制

目的探讨综合医院急诊科新型冠状病毒感染肺炎预防和控制的方法和对策。方法通过成立新型冠状病毒肺炎工作小组、制定新型冠状病毒肺炎防控应急工作预案、开展接诊疑似患者流程演练、不断学习和更新诊疗知识、实施防控知识和方法培训与考核、加强预检分诊、实时医患心理干预、医疗安全沟通管理、专家组会诊、相关科室防控一体联动、工作人员健康管理、感染控制相互监督机制、优化工作流程等方法,防止出现院内患者交叉感染、医护人员感染以及已感染患者因漏诊入住普通病房,确保疫情得到有效控制。结果2020年1月22日—2月22日,医院急诊和发热门诊就诊患者总量2654人,疑似病例34人,确诊病例4人,交叉感染0例,医务人员感染0例,医务人员严重心理应激反应0例,医疗投诉和纠纷及安全事故0例。结论急诊科实施的各项预防和控制措施,促进了医院感染控制措施的落实,实现了“感染患者零漏诊、医务人员零感染、院内感染无交叉”的目标,保证了医务人员良好的心理状态,确保了医疗安全,为综合医院急诊科有效预防和控制新型冠状病毒感染肺炎提供了参考。     

院内深部真菌感染的调查

目的了解昆明医学院第二附属医院2007年6月至12月期间院内深部真菌感染的状况。方法对目标时间内住院病人送检标本,进行真菌检查、鉴定和药敏实验;对检出真菌的病例进行临床资料的调查分析。结果调查期间共收到标本l313例,真菌培养阳性213例,其中白假丝酵母菌124例,68．55％,白假丝酵母菌对氟康唑敏感。临床资料显示：主要感染部位是呼吸系统;主要相关因素是使用广谱抗生素和激素;白假丝酵母菌是主要病原菌。结论2007年6月至12月期间昆明医学院第二附属医院院内真菌感染阳性检出率为16．22％;68．55％,白假丝酵母菌是主要的病原菌对氟康唑敏感。主要感染部位是呼吸系统;主要相关因素是使用广谱抗生素和激素;白假丝酵母菌是主要病因原菌。     

Disinfection, sterilization and operation theater guidelines for dermatosurgical practitioners in India

Modern day dermatologists conduct different esthetic and surgical procedures, with risk of infective complications. Hence, infection control practices need to be established in dermatological practice to minimize the risk of exogenous infections. These practices include hand washing, cleaning, sterilization, disinfection, operation theater sterilization and specifications. Proper hand washing after examination of each patient and prior to any surgery with a formulation containing alcohol alone or as a combination with other agents reduces the chances of transferring infections to and from patients. Sterilization and disinfection constitute the most important aspect of infection control. Disinfectants and disinfecting procedures vary according to the environment and equipment. Proper knowledge of different processes/agents for sterilization and disinfection is essential. Disinfectants for use in hospitals should always be freshly prepared and should be of adequate strength. Sterilization is carried out most commonly using steam sterilizers or ethylene dioxide sterilizers. The waste generated during practice is a potential source of nosocomial infections and should be treated as per the proper protocol and guidelines. Trained staff to carry out these practices is essential.     

Preventing hand eczema in nurses working in the NHS

The SCIN trial was designed to prevent nurses from developing hand dermatitis (eczema). We recruited student and intensive care (ICU) nurses who were at high risk of hand dermatitis. Overall, 35 study sites took part. Each site was randomised (selected at random) to either be in the ‘intervention’ or ‘control’ arm of the trial. Participants in the intervention sites received access to a web-based intervention to change participants’ behaviour to improve hand care, and a written leaflet with advice on how to prevent dermatitis. The student nurse participants in the intervention arm were provided with personal supplies of hand moisturisers to use during their clinical placements (i.e. when working with patients), and we ensured that the ICU nurses in the intervention arm had access to moisturising creams on the wards. Participants in the control arm only received the written leaflet with advice on how to prevent dermatitis. All participants were reminded to contact their occupational health service early on if they developed hand dermatitis during the study. The main aim of the trial was to see if there was a difference between the proportion of participants in the intervention and control arms who had hand dermatitis at the beginning of the study and at the end. We collected hand photographs at the time of recruitment and after 12 months. Participants completed questionnaires about their skin. Our results showed that there was no evidence that the risk of developing hand dermatitis in the intervention arm was less than the control arm. Linked Article:   Madan et al. Br J Dermatol 2020; 183 :462–470 .     

住院患者真菌感染的现况调查及病原学分析

目的　了解住院患者真菌感染的临床特点、发病率和疾病谱，为减少真菌感染提供依据。方法2006年1 - 12月间住院患者真菌培养阳性的病例，从患者年龄、疾病种类、标本、菌种分布、科室等方面进行分析。结果　住院患者真菌感染的发病率为5.07%，年龄分布在7 ～ 96岁之间，多为60岁以上患有基础疾病的老年人；感染部位以下呼吸道为最多；感染真菌主要为念珠菌属（93.68%），且以白念珠菌居多；所有患者均使用过2种或2种以上抗细菌药物。住院患者真菌感染的发生与多种广谱抗生素的使用、糖皮质激素或免疫抑制剂治疗、气管切开或插管、年龄≥60岁、留置导尿、恶性肿瘤性疾病等有关。结论　白念珠菌仍是住院患者真菌感染的主要病原菌。合理使用药物、减少侵入性治疗、提高机体免疫力是预防侵袭性真菌感染及改善预后的重要手段。     

Primary prevention in health care employees: a prospective intervention study with a 3-year training period

Irritant contact dermatitis is a mayor problem in health care employees. Because educational programs have shown convincing success in certain occupations (e.g. in hairdressers), this study investigates the effect of a special training program in health care trainees. 521 trainees from 14 nursing schools in Central Germany were randomly divided in 2 groups, (i) an intervention group with a regular teaching protocol regarding all aspects of primary prevention and (ii) a control group without any further teaching. Morphological changes of the hands, use of hand care creams and knowledge regarding skin care were evaluated regularly during their 3 years lasting training period (1999-2002). In the intervention group, we found at the end of the 3-year training period a significant better skin condition of the hands than in the control group: a 3-year prevalence of morphological skin changes of 66.7% versus 89.3%. The unteached trainees (control group) had an odds ratio (OR) of 4.8 [95% confidential interval (CI): 2.9-7.8] for developing any skin changes on the hands after 3 years. Besides the effect of the teaching, the history of hand dermatitis before the study start was an independent risk factor for development of further hand dermatitis [OR 1.9, 95% CI: 1.0-3.6). Age and sex showed no influence on the skin condition. Atopic constitution had an influence on the development of skin changes only at the evaluation after 18 month. The observed effect in the intervention group may best be explained by different behaviour of the trainees, e.g. the amount of hand washing was reduced, while procedure of hand disinfection remained unchanged compared with the control group. However, the amount of used skin care cream did not differ between the both groups. This study shows that primary prevention of skin disease by regularly teaching during the training period of medical employees can effectively reduce the risk of development of irritant skin changes of the hands. Therefore, teaching and continuous motivation regarding preventive individual and collective measures during the training of medical staff should be an obliged part of the curriculum.