血液透析患者中心静脉导管相关性感染的危险因素分析

目的分析血液透析患者发生中心静脉导管相关性感染的危险因素,为采取必要措施降低感染率提供理论依据。方法回顾性分析2007年2月-2012年9月387例血液透析患者的临床资料,记录中心静脉导管相关性感染率,同时分析年龄、性别、基础疾病、穿刺次数、导管留置时间、穿刺部位与发生中心静脉导管相关性感染的关系;采用SPSS17.0软件分析。结果 57例患者发生中心静脉导管相关性感染,感染率为14.7%,年龄≥55岁患者感染率为19.7%,高于<55岁的7.5%;患有糖尿病患者的感染率为21.2%,高于非糖尿病患者的10.4%;穿刺次数≥3次患者的感染率为22.2%,高于<3次的12.5%;导管留置时间≥2周患者的感染率为19.3%,高于<2周的10.4%,差异均有统计学意义(P<0.05);股静脉、颈内静脉、锁骨下静脉穿刺患者的感染率分别为24.5%、11.1%、5.6%,3组比较差异均有统计学意义(P<0.05)。结论高龄、基础疾病为糖尿病、穿刺次数多、导管留置时间长、穿刺部位为股静脉是引起中心静脉导管相关性感染发生的危险因素。     

中心静脉导管感染因素及预防对策

目的探讨导致中心静脉导管感染因素,根据感染因素制定预防对策,为中心静脉导管感染的预防提供指导依据。方法选择2012年1月-2013年4月85例中心静脉留置导管患者,均采用超声引导下静脉穿刺中心静脉置管,怀疑导管感染或治疗结束后送导管尖端细菌培养,分析患者的相关资料,探讨中心静脉留置导管感染的相关因素,采用SPSS 17.0进行统计分析。结果 85例中心静脉留置导管患者中12例细菌学检测阳性,感染率为14.12%;一次穿刺置管成功69例,发生感染6例,感染率为8.70%;多次穿刺置管成功16例,发生感染6例,感染率为37.50%,一次穿刺置管成功患者感染率明显低于多次穿刺置管成功的患者;不同置管部位、置管时间、置管类别的患者感染率差异有统计学意义(P<0.05)。结论中心静脉导管感染的发生与患者穿刺次数、置管部位、置管时间、置管类别紧密相关,在行超声引导下中心静脉导管穿刺置管技术时,应注意熟练操作,并选择合适的探头、导管类别、穿刺部位,同时注意无菌操作,以避免感染的发生。     

肝移植术后静脉导管相关感染原因分析及预防对策

目的探讨肝移植术后颈内静脉导管相关感染原因以及预防对策,分析导管相关感染和颈内静脉置管时间、血管相关性感染及颈内静脉导管相关性感染原因,为临床诊断提供依据。方法选择2006年7月-2012月年1月医院28例DCD供体肝移植术后颈内静脉插管患者作为研究对象,所有患者均于DCD供体肝移植术后行颈内静脉插管,对其导管相关感染与颈内静脉置管时间相关性、颈内静脉导管相关性感染原因进行分析,并针对具体原因制定预防措施。结果 28例肝移植术后患者的平均置管时间为22d,其中2例患者发生感染,局部和血流感染各1例,感染率为7.14%;置管1²d的患者感染率为0、122d的患者感染率为0、12²4d的感染率为5.88%、>24d的感染率为16.67%;血液以及导管尖端共培养病原菌3株;颈内静脉导管相关性感染的原因主要有导管的材料选择,导管的留置时间以及医护人员的无菌操作意识相关。结论颈内静脉导管相关感染率较高,应加强医护人员的无菌操作意识,选择合适的导管,并要重视导管的护理,可有效地预防导管相关性感染。     

血透用深静脉导管相关感染因素的分析及预防

目的分析血液透析患者中心静脉留置导管感染的相关因素,探讨预防措施。方法回顾314例通过中心静脉置管进行血透的患者,分析不同置管方式、导管抗凝方法及留置时间与感染的关系。结果股静脉感染率32.1%,留置时间小于2周的感染率11.3%,大于2周时为58.0%;非股静脉置管的感染率为15.8%,留置时间小于2周的感染率为6.9%,大于2周的感染率为20.8%。右锁骨下静脉置管期间每天肝素盐水抗凝组(A组)的感染率为19.0%,导管内血栓形成率为4.76%,每次透析结束时肝素盐水抗凝组(B组)的感染率为9.2%,导管内血栓形成率为5.75%。结论选取非股静脉置管方式、缩短留置时间、减少打开导管的次数可有效降低与中心静脉留置导管相关的感染率。     

血液透析中心静脉导管相关性感染危险因素分析

目的 分析血液透析患者中心静脉导管相关性感染的危险因素,为采取相应措施降低感染率提供理论依据.方法 回顾性分析2005年1月-2012年6月医院收治的400例血液透析患者的临床资料,判断术后发生中心静脉导管相关性感染的例数,分析患者的性别、年龄、基础疾病、插管部位、插管次数、留置时间与发生中心静脉导管相关性感染的关系.结果 400例患者中发生中心静脉导管相关性感染60例,感染率为15.0％;其中年龄≥50岁患者的感染率为20.0％,高于＜50岁者的8.9％,(P＜0.05);原发病为糖尿病患者感染率为22.3％,高于非糖尿病患者的11.5％(P＜0.05);穿刺部位位于颈内静脉、股静脉、锁骨下静脉患者感染率分别为11.5％、25.4％、6.7％,三者比较差异有统计学意义(P＜0.05);穿刺次数≥3次患者感染率为22.5％,高于＜3次者的14.0％ (P＜0.05);导管留置时间≥2周患者感染率为20.7％,高于＜2周者的11.6％(P＜0.05).结论 血液透析患者中心静脉导管相关性感染的危险因素包括高龄、糖尿病、穿刺部位、穿刺次数多、置管时间长.     

皮下潜行法颈内静脉穿刺置管的可行性研究

目的：皮下潜行法颈内静脉穿刺置管与中路颈内静脉穿刺置管进行比较,评价其可行性。方法选择脊柱手术病人80例,随机分为2组,每组40例,A组皮下潜行法颈内静脉穿刺置管,B组中路颈内静脉穿刺置管。观察记录总穿刺成功率、一次试穿成功率、置管成功率及并发症,并均于术后摄胸部平片观察中心静脉导管的位置,记录导管留置时间及导管相关性感染发生率。结果 A组穿刺总成功率97.50%,一次试穿成功率90.00%,无误穿动脉、气胸、血胸及导管异位等并发症发生,与B组比较无显著差异（P〉0.05）。 A组导管平均留置时间（15.2±2.3）d,无导管相关性感染,B组导管平均留置时间（9.5±1.5）d,导管相关性感染4例（10.00%）。 A组导管相关感染率明显低于（P=0.04）,而导管留置时间明显高于B组（P=0.00）存在明显区别。结论皮下潜行法颈内静脉穿刺置管具有操作容易、安全性大、导管留置时间长、导管相关性感染率低等特点,具有实用价值。     

587例中心静脉导管相关感染的调查分析

目的分析患者发生中心静脉导管相关性感染(CVC-RI)的危险因素,为临床预防控制CVC-RI提供参考依据。方法对医院2004年1月-2009年12月587例中心静脉穿刺并置管患者取导管尖端进行细菌培养,并对结果进行分析。结果 587例患者平均相关性感染率为14.1%,其中革兰阳性菌占分离菌的47.0%,革兰阴性菌占分离菌的38.5%,真菌占分离菌的14.5%。锁骨下静脉、贵要静脉、颈内静脉、股静脉置管后导管相关性感染率分别为7.8%、8.5%、18.4%、28.9%,置管时间≤7、8～14、≥15d的导管相关感染率分别为6.9%、7.5%、38.9%。结论尽量选择锁骨下静脉和贵要静脉行中心静脉置管,规范穿刺技术、严格置管护理、减少留置时间,可降低导管相关性感染。     

超声引导锁骨下静脉置管术对中心静脉导管相关性血流感染的影响分析

目的探讨超声引导锁骨下静脉精确置管对危重患者导管相关性血流感染的影响,以降低血流感染率。方法随机选取ICU2013年1月-2014年1月收治的危重患者260例,分为对照组和试验组,每组各130例,对照组采用经外周静脉穿刺中心静脉置管(PICC)进行深静脉置管,试验组采用超声引导锁骨下静脉置管法进行深静脉置管,比较两组患者置管平均穿刺所需时间、一次穿刺成功率、平均导管留置时间及患者置管后发生导管相关性血流感染率。结果对照组患者的穿刺所需时间为(8.76±3.68)min,一次穿刺成功为112例,成功率为86.15%,导管留置时间为(58.34±6.78)d,患者置管后发生血流感染8例,感染率为6.15%;试验组患者穿刺所需时间为(9.34±3.17)min,一次穿刺成功124例,成功率为95.38%,导管留置时间为(59.07±5.97)d,置管后发生血流感染1例,感染率为0.77%,两组患者置管穿刺所需时间和导管留置时间差异无统计学意义,试验组的一次穿刺成功率要高于对照组,导管相关性血流感染发生率低于对照组,差异有统计学意义(P<0.05)。结论超声引导锁骨下静脉精确置管能有效提高穿刺成功率,减少危重患者导管相关性血流感染的发生。     

超声引导下的颈内静脉穿刺与置管后感染率的探讨

目的 分析超声显像定位引导下颈内静脉穿刺置管的应用和置管后感染率.方法 360例拟实施颈内静脉穿刺置管的患者随机分为超声组和对照组,超声组采用超声定位引导术,在超声显像实时引导下进行穿刺置管,对照组采用常规直视穿刺置管.结果 超声组颈内静脉穿刺一次成功率高,穿刺时间明显短于对照组,颈内静脉穿刺后置管感染率明显低于对照组,长期留置颈内静脉置管出口处分泌物培养阳性者,超声组感染7例,感染率为3.9％,对照组感染20例,感染率为11.1％,两者差异均有统计学意义(P＜0.01).结论 超声显像定位引导下颈内静脉穿刺置管简便、安全、一次穿刺成功率高,并发感染少,可延长颈内静脉置管的使用,减少抗菌药物的使用,缩短静脉穿刺时间,对于静脉穿刺困难的患者有重要的临床实用价值.     

中心静脉置管相关感染前瞻性调查分析

目的 了解中心静脉置管相关感染(CVC-RD发生情况,分析CVC-RI危险因素、病原菌种类,探讨预防控制感染措施.方法 对2006-2008年行中心静脉置管的患者进行CVC-RI的前瞻性调查.结果 305例患者中,总置管日为7954 d,感染40例,其中28例血流感染,中心静脉置管感染率为5.03‰置管日,中心静脉置管相关血流感染率为3.52‰置管日;留置时间≤2周的感染率为6.87%,留置时间＞2周的感染率为17.81%,差异有统计学意义(P＜0.05);＜80岁年龄组感染率为11.07%,≥80岁年龄组感染率为50.00%,差异有统计学意义(P＜0.01);病原学培养前5位为金黄色葡萄球菌、表皮葡萄球菌、铜绿假单胞菌、白色假丝酵母菌和肠杆菌科.结论 中心静脉导管相关感染与患者的年龄及留置时间相关,年龄越大、留置时间越长,感染率越高;避免中心静脉相关感染的有效措施是尽可能缩短中心静脉导管留置时间,严格无菌操作,老年患者应作为感染监控的重点.     

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.     

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.