重点护理病房环境物体表面消毒效果分析

目的了解医院重症医学科(ICU)环境卫生状况及物体表面的消毒质量,探讨控制措施,为加强医院感染的预防与控制提供科学依据。方法 2014年5月—2015年1月对ICU医务人员手高频接触的环境物体表面的消毒效果进行目标性监测,监测对象主要为床单元和医护公共区域两部分,比较两部分的环境物体表面消毒效果监测的合格率及目标性病原菌的阳性率,数据分析应用SPSS 19.0软件处理。结果采集各类标本317份,合格率69.08%,其中床单元环境物体表面合格率为66.48%,医护公共区域环境物体表面合格率为72.46%,两者χ~2检验比较差异无统计学意义;目标性病原菌监测采集各类标本467份,检测到鲍氏不动杆菌66株,阳性率为14.13%,且全部为泛耐药鲍氏不动杆菌。结论 ICU环境物体表面总体合格率较低,其日常清洁消毒质量有待提高,手高频接触的物体表面应增加消毒频次;医务人员应加强手卫生管理,并加强落实与监督。     

ICU泛耐药鲍氏不动杆菌肺部感染暴发原因及控制

目的 分析ICU鲍氏不动杆菌感染暴发的原因与经过,为预防与控制感染提供依据.方法 对ICU2011年1月29日-2月15日陆续发生4例鲍氏不动杆菌肺部感染开展流行病学调查,查找感染源与传播途径,并采取干预措施控制感染.结果 从34份环境卫生学标本中分离出6株鲍氏不动杆菌,检出率为17.65％;对4例患者分离的4株泛耐药鲍氏不动杆菌进行随机扩增多态性DNA(RAPD)基因分型,结果显示,4株具有高度的同源性;采取综合性干预措施,泛耐药鲍氏不动杆菌感染患者集中隔离、加强医务人员手卫生、加强环境物体表面与医疗设备的清洁消毒等,有效控制了感染.结论 医院间传播、医护人员手卫生较差、环境与医疗设备物体表面污染严重是造成鲍氏不动杆菌感染暴发的原因.     

医院环境中物体表面碳青霉烯耐药鲍曼不动杆菌污染及同源性分析

目的调查某院重点部门物体表面碳青霉烯耐药鲍曼不动杆菌污染情况及其同源性。方法对该院重症监护室(ICU)、急诊重症监护室(EICU)、血液透析室、手术室进行环境卫生学监测,采用肠杆菌科基因间重复序列聚合酶链反应(ERIC-PCR),对ICU、EICU环境中污染的条件致病菌鲍曼不动杆菌进行扩增分型。结果除EICU医务人员手卫生结果达标外,ICU及EICU各检测项目细菌计数均不达标;血液透析室及手术室采样标本均合格。ICU、EICU物体表面共采集标本53份,检出鲍曼不动杆菌7株,检出率为13.21%;此7株菌均为碳青霉烯耐药鲍曼不动杆菌,其中6株基因型相同,与患者痰中分离的鲍曼不动杆菌基因型相同。结论该院重点部门环境中物体表面分离的碳青霉烯耐药鲍曼不动杆菌具有同源性,应加强其环境物体表面清洁与消毒,降低医院感染的发生。     

ICU感染多药耐药鲍氏不动杆菌暴发与控制

目的调查重症监护病房(ICU)多药耐药鲍氏不动杆菌(MDRAB)暴发的原因,提出感染控制措施,以减少该类医院感染的发生。方法对2013年2月4-14日ICU 8例下呼吸道多药耐药鲍氏不动杆菌感染患者进行流行病学调查和病区环境卫生学监测分析;并对患者采取严格隔离、加强手卫生和环境消毒等一系列措施控制感染暴发。结果 2013年2月4-14日ICU 23例住院患者中8例检出多药耐药鲍氏不动杆菌,罹患率为34.8%,共19株鲍氏不动杆菌,其对抗菌药物的耐药谱一致;患者高龄、伴严重基础疾病、大量使用抗菌药物、侵入性操作等是鲍氏不动杆菌感染的易感因素;医务人员手及病区物体表面均检出鲍氏不动杆菌。结论手卫生和环境消毒落实不到位是该次多药耐药鲍氏不动杆菌感染暴发的重要原因;采取多部门协作,促进手卫生和环境清洁消毒落实到位,能预防和控制多药耐药菌的暴发流行。     

哈尔滨市医院重症监护室环境病原菌分布特征及多重耐药性研究

目的了解哈尔滨市医院重症监护室(ICU)环境物体表面、医务人员手病原菌群种类和分布情况及病原菌对抗菌药物的耐药性,为探明医院感染传播途径及传播媒介提供主要依据。方法对哈尔滨市10家医院ICU环境物体表面及医务人员手采样后进行细菌分离鉴定及药敏试验,并按不同采集区域分别进行统计分析。结果共采集ICU动态环境标本724份,检出病原菌479份,其中革兰氏阳性菌344株,占71.8%,革兰氏阴性菌135株,占28.2%;分离的病原菌株数位于前3位的分别是表皮葡萄球菌81株、松鼠葡萄球菌73株、鲍氏不动杆菌66株。主要的革兰氏阴性菌对氨苄西林、头孢哌酮、头孢孟多、头孢噻肟的耐药率较高,主要的革兰氏阳性菌对磺胺复合物、甲氧苄氨嘧啶、四环素、氨苄西林的耐药率较高。结论 ICU环境物体表面和医务人员手均分离出多种引起医院感染的常见病原菌,主要以革兰氏阳性菌为主,且对抗菌药物均有不同程度的耐药性。     

重症监护病房环境二氧化氯消毒的效果评价

目的 评价二氧化氯溶液对重症医学监护病房(ICU)环境的清洁消毒效果。方法 采用实验研究方法,以2019年3-4月ICU的多药耐药隔离区域环境为基线期,使用500 mg/L含氯消毒剂对物表擦拭清洁消毒;2019年5-6月为干预过渡期,2019年7-12月为干预期,均使用二氧化氯消毒液制取设备制备的80 mg/L～100 mg/L二氧化氯溶液对物表擦拭清洁消毒。对三个阶段该区域高频接触的环境物体表面采样,分析消毒合格率及病原菌检出情况。结果 研究期间,ICU多药耐药菌隔离区域高频接触物表监测合格率均高于92%,过渡期和干预期均高于基线期,呈上升趋势,但比较无统计学差异;基线期、干预过渡期、干预期分别采样266份、364份、450份标本,细菌检出率分别为5.26%、1.92%、1.56%,呈下降趋势(P<0.05);研究期间ICU病房隔离区周围环境中共检出病原菌29株,其中耐碳青霉烯鲍氏不动杆菌17株占58.62%。结论 二氧化氯消毒液制取设备操作简便,制备的80 mg/L～100 mg/L二氧化氯溶液对环境表面具有良好的消毒效果。     

高频接触物体表面消毒质量管理在多药耐药菌控制中的作用研究

目的探讨ICU高频接触物体表面消毒质量管理在多药耐药菌控制中的作用,以提高医疗质量。方法选择2013年5月-2014年12月ICU 1 297例住院患者的多药耐药菌检出结果为研究对象,将2013年5月-2014年2月住院患者594例设为干预前组,2014年3-12月住院患者703例设为干预后组,由责任护士负责组内高频接触物体表面的消毒,并规范消毒方法和消毒质量的督查,比较两组的消毒质量和多药耐药菌检出结果。结果高频接触物体表面消毒质量在干预前后合格率分别为80.3%和94.3%,差异有统计学意义(P0.05);干预前后目标性病原菌监测多药耐药菌检出率分别为77.9%和37.5%,差异有统计学意义(P0.05);ICU患者目标性病原菌监测多药耐药菌检出率在干预前后分别为45.2%和26.3%,其中耐甲氧西林金黄色葡萄球菌、耐碳青霉烯类肺炎克雷伯菌和泛耐药鲍氏不动杆菌检出率显著下降,差异有统计学意义(P0.05)。结论重视并规范高频接触物体表面消毒质量管理,能有效控制多药耐药菌在医院内的传播。     

重症监护病房鲍氏不动杆菌感染病例的调查分析

目的了解医院重症监护病房(ICU)鲍氏不动杆菌感染的流行病学资料,为预防与控制医院感染暴发流行提供参考依据。方法对重症监护病房鲍氏不动杆菌感染病例进行回顾性分析;环境卫生学监测采样方法参照卫生部《消毒技术规范标准》。结果 6例患者平均年龄为70岁,入住ICU时间均>10 d,原发基础疾病重;在74份物体表面标本中共分离出大肠埃希菌、铜绿假单胞菌、枯草芽胞杆菌黑色变种芽胞、凝固酶阴性葡萄球菌4种细菌,合格率为94.59%;23份医护人员手卫生标本中分离出肺炎克雷伯菌、凝固酶阴性葡萄球菌和日沟维肠杆菌,菌落计数未超标,均未检出致病菌。结论鲍氏不动杆菌感染在ICU有上升的趋势,应引起医护人员的高度警惕,及时采取防控措施以避免医院感染的暴发流行。     

重症监护病房4例泛耐药鲍氏不动杆菌肺部感染暴发

目的 分析重症监护病房鲍氏不动杆菌感染暴发的原因与经过,为预防与控制感染提供依据.方法 对重症监护病房于2009年2月11-16日,陆续发生的4例鲍氏不动杆菌肺部感染开展流行病学调查,查找感染源与传播途径,并采取干预措施控制感染.结果 采取综合性干预措施,泛耐药鲍氏不动杆菌感染患者集中隔离、停用自动清洗消毒机、加强医务人员手卫生、加强环境物体表面与医疗设备的清洁消毒等,有效地控制了感染.结论 自动清洗消毒机消毒不彻底、医护人员手卫生较差、环境物体表面与医疗设备物体表面污染严重,是造成该次鲍氏不动杆菌感染暴发发生的原因.     

手术室环境消毒质量现状及其监管措施

目的回顾医院近3年手术室环境消毒的现状,并讨论监管措施。方法对手术室空气、物体表面和医务人员手进行病原菌检测,对分离的病原菌和条件致病菌作出鉴定。结果3年间共检测空气478间次手术室;物体表面652份次;医务人员手284人份次;总合格率分别为98.1%、90.2%和96.5%,呈逐年上升趋势;从空气和物体表面均检出葡萄球菌属、大肠埃希菌、真菌、鲍氏不动杆菌和铜绿假单胞菌等病原菌或条件致病菌。结论加强环境消毒的质量管理,制定和落实各项管理制度,提高手术室医护人员的防患意识,以及严格人流、物流管理是保证手术室环境消毒质量,降低手术期间医院感染的有效措施。     

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.