北京市口腔医疗机构清洗消毒灭菌能力评价

摘要 目的 了解北京市口腔医疗机构的清洗消毒灭菌现况,提出改进措施,为规范管理提供基础数据。方法 采用现场调查与生物监测的方法,对北京市口腔医疗机构的消毒与灭菌管理现状进行调查。结果 共调查不同级别口腔医疗机构257家,有71.21%的医疗机构在口腔科进行医疗器械清洗消毒与灭菌,有88.72%的口腔医疗机构制定了消毒相关制度,有91.87%的消毒室人员进行了岗前培训。现场监测显示,超声清洗效果总体合格率为69.00%,小型压力蒸汽灭菌器灭菌温度总体合格率为84.90%,灭菌时间总体合格率为64.08%,生物监测总体合格率为99.18%。结论 北京市口腔医疗机构在口腔科进行器械清洗消毒与灭菌的比例较高,仍存在安全风险,应加强监督管理。     

成都市某区64家口腔诊所小型压力蒸汽灭菌器使用现状调查与分析

摘要 目的 了解某区口腔诊所小型压力蒸汽灭菌器使用现状,进一步规范灭菌器管理,保障口腔器械消毒灭菌质量。方法 通过现场查看、问卷调查、灭菌效果检测等方式,对某区64家口腔诊所小型压力蒸汽灭菌器的使用现状及灭菌效果进行调查分析。结果 64家口腔诊所中,小型压力蒸汽灭菌器配备有打印装置的机构占8.96%,每锅次进行化学监测的机构占18.75%,定期进行生物监测的机构占1.56%,有灭菌运作记录的机构占43.75%,灭菌监测资料保存规范的机构占31.25%,常用灭菌程序选择正确率为79.69%,灭菌操作人员经过规范培训的机构占9.37%,生物监测合格率97.01%,化学监测合格率为88.06%。结论 口腔诊所在灭菌设备使用管理、灭菌质量监测等方面存在较多问题,应加强小型压力蒸汽灭菌器规范化使用的监管与培训。     

医院压力蒸汽灭菌器物理监测与生物监测的结果比较

摘要 目的 比较压力蒸汽灭菌器在灭菌过程中物理监测及生物监测的结果,以便加强压力蒸汽灭菌质量管理。方法 采用温度压力检测仪法和生物指示剂监测法,对河南省部分医院使用中的压力蒸汽灭菌器灭菌程序的物理参数和灭菌效果进行对比监测。结果 对6所医院(二级和三级各3所)的28台压力蒸汽灭菌器进行了物理监测与生物监测。共监测压力蒸汽灭菌器107台次,生物监测结果全部合格;灭菌温度监测合格率为88.24%,灭菌时间监测合格率为43.93%。预真空式压力蒸汽灭菌器与下排气式等其他类型压力蒸汽灭菌器的物理监测合格率一致。大型压力蒸汽灭菌器与小型压力蒸汽灭菌器物理监测参数监测结果一致。结论 加强压力蒸汽灭菌器物理参数定期监测,确保灭菌参数的科学性和规范性,达到灭菌效果和正确使用的良好结合。     

医疗机构医疗器械消毒灭菌监测结果分析

摘要 目的 了解医疗机构的清洗消毒灭菌工作质量和医院消毒与感染控制措施的效果,控制院内感染和传染病发生。方法 采用现场采样和灭菌参数实时监测方法,对哨点医院消毒供应中心可复用医疗器械清洗、消毒和灭菌效果进行监测。结果 哨点医院各种类型医疗器械清洗效果肉眼裸视法与放大镜法合格率均为88.28%,ATP含量中位数值为1 937 amol/件;医院压力蒸汽灭菌器生物监测指标均合格,物理参数监测问题突出,灭菌器中温度均匀度≤2 ℃的仅占33.33%,灭菌温度实测值高于设定值＋3 ℃的占80%以上,灭菌时间实测值符合要求的仅占38.09%;过氧化氢等离子灭菌器生物监测指标均合格。结论 医院清洗灭菌控制措施存在薄弱环节与感染风险,应加强清洗消毒过程的质量控制和医护人员相关培训。     

基层医疗机构压力蒸汽灭菌器灭菌效果现况调查

摘要 目的 了解基层医疗机构压力蒸汽灭菌器使用及其灭菌效果,为感染防控提供依据。方法 采用生物监测的方法对134所基层医疗机构的压力蒸汽灭菌器进行调查。结果 共调查138台灭菌器,82.61%容量≤60 L;口腔诊所多用抽真空台式灭菌器并有干燥程序;社区中心/卫生院多用下排或立式无干燥灭菌器,湿包多见。灭菌效果合格率为81.88%,灭菌器合格率为86.96%,灭菌器合格率有差异,手提式＜立式＜台式＜卧式;89.13%的灭菌器从未做过生物监测。结论 基层医疗机构压力蒸汽灭菌生物监测及灭菌质量监管未落实,应引起有关部门重视,加强灭菌器操作培训和灭菌质量监管。     

成都地区医院消毒供应中心灭菌设备调查研究

摘要 目的 了解成都市部分医院消毒供应中心灭菌设备运行情况和灭菌效果，为医院消毒中心灭菌设备管理和医院感染控制的相关政策法规、标准规范修订提供科学依据。方法 问卷调查并结合使用无线温度压力验证仪、生物及化学指示物，对灭菌设备进行物理、化学和生物监测与分析。结果 脉动真空压力蒸汽灭菌器、过氧化氢低温等离子体灭菌器、环氧乙烷灭菌器消毒供应中心配有率分别为100.00％、76.92％、23.08％；脉动真空压力蒸汽灭菌器生物监测与化学监测灭菌效果合格率均为100.00％，脉动真空压力蒸汽灭菌器物理监测灭菌合格率为85.36％，过氧化氢低温等离子体灭菌器与环氧乙烷灭菌器生物监测灭菌合格率均为100.00％。结论 成都地区医院消毒供应中心总体灭菌设备运行良好，但灭菌设备的稳定性与安全性应引起关注。     

玉溪市中心血站消毒效果评价与分析

摘要 目的 了解玉溪市中心血站消毒灭菌质量状况,进一步规范消毒质量管理。方法 通过现场采样和细菌定量检测,连续5年对玉溪市中心血站消毒灭菌效果进行监测和分析。结果 2011-2015年共采样监测样品2 936份,消毒监测效果平均合格率为99.05%。各年度合格率分别为98.42%、98.60%、98.58%、99.66%和99.83%,呈递增趋势。不同监测对象中,物体表面、献血者手臂、室内空气、工作人员手指和压力蒸汽灭菌器的消毒质量合格率超过99%;紫外线灯和使用中的消毒液合格率分别为97.02%和94.49%。结论 玉溪市中心血站消毒质量总体良好,消耗性的消毒工具和药品仍需持续做好质量监督管理。     

太原市晋源区医疗机构压力蒸汽灭菌效果调查分析

摘要 目的 <\b>了解太原市晋源区各类医疗机构压力蒸汽灭菌器的使用情况和灭菌效果。方法 <\b>采用物理监测、化学监测和生物监测方法对区级医院、社区卫生服务机构、乡镇卫生院和民营医院的压力蒸汽灭菌器的灭菌效果进行监测。结果 <\b>共调查172台灭菌器中,预真空及脉动真空压力蒸汽灭菌器和下排气式压力蒸汽灭菌器分别占29.1%和70.9%,合格率分别为94.0%和80.3%,两种灭菌器合格率差异具有统计学意义（P<0.05）,且三类医疗机构中所使用的灭菌器类型所占比例和监测合格率差异具有统计学意义（P<0.05）。结论 <\b>不同类型压力蒸汽灭菌器中,预真空及脉动真空压力蒸汽灭菌器合格率要高于下排气式。民营医院配置的预真空及脉动真空式压力蒸汽灭菌器中所占比例较高,这也是其检测合格率高于其余两类医疗机构的主要原因之一,医疗机构应进一步健全规章制度,加强灭菌技术培训,确保操作规范化,有效提高医疗机构器械灭菌质量。     

压力蒸汽灭菌器蒸汽冷凝水再利用研究

摘要 目的 研究压力蒸汽灭菌器灭菌后产生的蒸汽冷凝水经回收、消毒、灭菌后用于诊疗器械、器具和物品终末漂洗的可行性。方法 收集压力蒸汽灭菌器蒸汽冷凝水,检测铁、铅、镉、氯化物、浑浊度、肉眼可见物、色度和电导率等水质指标,将使用回收蒸汽冷凝水进行漂洗及终末漂洗的器械做为试验组,使用反渗透制水机制备的纯化水进行漂洗及终末漂洗的器械做为对照组,每组3 500件器械,2组器械均采用全自动清洗机清洗,使用目测法及ATP生物荧光法检测2组器械清洗质量。结果 回收压力蒸汽灭菌器蒸汽冷凝水水质符合压力蒸汽灭菌器供给水的相关质量指标要求,电导率≤5 μS/cm(25℃),符合器械终末漂洗用水水质标准要求。2组器械清洗合格率差异无统计学意义(P>0.05)。结论 压力蒸汽灭菌器蒸汽冷凝水用于医疗器械终末漂洗,可以达到节能降耗的目的。     

手供一体化管理在缩短胸腔镜器械周转时间上的应用

摘要 目的 了解新乡市各级医疗机构消毒现状,为提高医疗机构的消毒质量提供科学依据。方法 通过现场采样检测的方法,对新乡市医疗机构消毒质量现状进行监测与分析。结果 新乡市医疗机构的消毒质量监测总体合格率为88.52%。压力蒸汽灭菌器和无菌用品合格率均为100%,使用中消毒液合格率为98.70%,物体表面和医务人员手合格率分别为97.42%和91.28%,医院污水合格率仅为43.80%。结论 新乡市各级医疗机构消毒与灭菌合格率总体较好,医院污水处理质量亟待提高。     

Measurement of L-carnitine and acylcarnitines in body fluids and tissues in children and in adults

We have developed a reliable and validated radio-enzymatic method for the assay of L-carnitine and acylcarnitines, using a modification of existing methods. The sensitivity of the assay is 10 mumol/l using 10 microliters of plasma or urine. It is also suitable for measurements of carnitine in a 10 mg sample of liver or muscle obtained by percutaneous biopsy. The use of N-ethylmaleimide in the reaction mixture together with an excess of [1-14C]acetyl CoA ensures that the reaction proceeds to completion and a linear response is obtained. Using this method control ranges have been established for plasma and urine carnitine concentrations in healthy children and adults, and for the carnitine content of liver and muscle in adults. No significant difference was found between fasting and post-prandial plasma carnitine levels. An age-related increase was found in urinary total carnitine and acylcarnitine concentration throughout childhood. These data provide a reliable basis for studies of patients with abnormal carnitine and acylcarnitine metabolism, distribution and excretion.     

Rosamicin in Urethral and Vaginal Secretions and Tissues in Dogs and Rats

In animal studies we investigated the distribution of rosamicin in plasma and urethral and vaginal tissues in rats as well as in urethral and vaginal secretions in dogs. We found concentration ratios between urethral secretion and plasma of 1.9 and between vaginal secretion and plasma of 2.4. The rosamicin concentrations in urethral and vaginal tissue significantly exceeded the levels of all other tissues investigated. Because rosamicin could be valuable for the treatment of bacterial urethritis and the colonization of the vaginal introitus with fecal bacteria in women, it should be investigated clinically in this respect.     

Similarities and differences in clients treated and in medications prescribed by APRNs and psychiatrists in a CMHC

This study is part of a larger study comparing prescribing practices of psychiatrists and advanced practice psychiatric nurses (APRNs) using the following three groups of patients: patients treated by psychiatrists, those treated by APRNs, and those treated by both APRNs and psychiatrists at different times in 1 year. Demographics for 5507 patients were examined. A subsample of APRNs and psychiatrists prescribed similar total numbers of medications. Psychiatrists prescribed more types of antidepressant medications other than the SSRI antidepressants, and they prescribed more than twice the number of benzodiazepines. APRNs prescribed more SSRIs and spent more time with clients during medication visits.     

Postural strategies and falls in elderly and in parkinsonism]

OBJECTIVE: To use a posture analysis to show the evolution of postural pattern connected with falls.MATERIAL AND METHOD: It is a prospective study on two groups of 16 persons of more than 60 years. A group concerns 16 small disability off drug parkinsonian patients, a group concerns 16 healthy witnesses. All the persons benefited from a posture recording by means of a force platform and were followed during 1 year. RESULTS: Data analysis underlines three groups of persons corresponding to three postural patterns, independently of the presence of Parkinson disease. A group (n = 18) did not contain fallers, the second (n = 10 ) contained 20% of fallers, the third (n = 4) contained 100% of fallers. Differences between the groups were identified on 16 posturographic parameters. DISCUSSION: A group has a good functional value and one does not record any fall. Its characteristics, which correspond to a category of persons who compensate well for the phenomena of ageing, are found in the literature. A group has an intermediate functional value and regrets 20% of fallers. Kinetic profile reveals a tendency to the stiffness of the posture. This group is going to operate rather ankle strategies. A group has an inferior functional value and regrets 100% of fallers. Kinetic profile seems disrupted and not to be able to adapt itself in a satisfactory way to the situation otherwise than by stereotypical reactions. This group is going to operate systematically much less stabilizing hip strategies. CONCLUSION: A close determinism between physiological neuromotor ageing and Parkinson disease does exist. We showed with a prospective follow-up, the arisen of fall and showed the evolution of postural patterns related to fall. It appears as well that evolution mainly follows three stages leading from a small risk of fall gait pattern to a major risk of fall gait pattern.     

Racial differences in oxidative stress and inflammation: in vitro and in vivo

African American race is an independent risk factor for enhanced oxidative stress and inflammation. We sought to examine whether oxidative-stress and inflammatory markers that are typically measured in humans also differ by race in cell culture. We compared levels between African American and Caucasian young adults and then separately in human umbilical vein endothelial cells (HUVECs) from both races. We found heightened oxidative stress and inflammation in the African Americans both in vitro and in vivo. African American HUVECs showed higher nitric oxide (NO) levels (10.8 ± 0.4 vs. 8.8 ± 0.7 μmol/L/mg, p = 0.03), Interleukin-6 (IL-6) levels (61.7 ± 4.2 vs. 23.9 ± 9.0 pg/mg, p = 0.02), and lower superoxide dismutase activity (15.6 ± 3.3 vs. 25.4 ± 2.8 U/mg, p = 0.04), and also higher protein expression (p < 0.05) of NADPH oxidase subunit p47phox, isoforms NOX2 and NOX4, endothelial nitric oxide synthase (NOS), inducible NOS, as well as IL-6. African American adults had higher plasma protein carbonyls (1.1 ± 0.1 vs. 0.8 ± 0.1 nmol/mg, p = 0.01) and antioxidant capacity (2.3 ± 0.2 vs. 1.1 ± 0.3 mM, p = 0.01). These preliminary translational data demonstrate a racial difference in HUVECs much like that in humans, but should be interpreted with caution given its preliminary nature. It is known that racial differences exist in how humans respond to development and progression of disease, therefore these data suggest that ethnicity of cell model may be important to consider with in vitro clinical research.