微酸性电解水用于手消毒的效果观察

目的观察微酸性电解水用于手消毒的效果。方法将某综合医院94名医务人员及陪护家属分为三组,分别以15℃、5℃微酸性电解水以及百能抗菌洗手液按标准六步洗手法洗手1min,采用微生物培养计数法评价洗手后的消毒效果。结果15℃水温的微酸性电解水洗手后对手部细菌平均清除率达99．65％,优于百能抗茵洗手液和5℃的微酸性电解水（均P〈0．05）。结论15℃水温的流动微酸性电解水洗手消毒效果肯定。     

医护人员洗手技术与手再污染的调查研究

目的为探讨医护人员的最佳洗手技术,更有效控制医院感染。方法对该院新生儿科、妇科、手术室、普外科四个护理单元的124名护士采用不同洗手和干手方法及不同消毒剂擦手后带菌状态进行微生物监测研究和带菌分析。结果肥皂搓洗加自来水清洗法,六种不同方式擦手后,以消毒毛巾擦手方式效果最好,自然干燥和热风干手器次之,一次性纸巾,白大衣腋下擦干,后背臀部擦干对手有污染;五种消毒剂擦手后,用0.25%碘伏、1%84消毒液、洗必泰甘油酒精等3种消毒剂擦手后效果好,全部为无菌,75%甘油酒精次之,新洁尔灭甘油酒精擦手后消毒效果差。结论肥皂搓洗加自来水清洗法明显优于自来水清洗法;中高效消毒剂擦手效果优于低效消毒剂擦手及肥皂搓洗加自来水清洗法和自来水清洗法;消毒毛巾干手方式最好。因此医护人员在进行操作前后应严格按照洗手标准进行洗手和擦手。     

护理人员手清洁方法的实验观察

目的：寻求简单有效的手清洁方法，方法：将60例护理人员随机分为三组（各20名），即肥皂流水洗手（1组），消毒灵液擦手（Ⅱ组）、消毒纸贴擦手（Ⅲ组），分别将三组人员手清洁前后采样，比较三种方法的效果。结果：清洁各组间菌落数比较，差异无显著性意义（P＞0．05），手清洁后合格率(≤10cfu/cm^2）三组比较，差异无显著性意义；Ⅰ组与Ⅱ组菌落数比较，差异有极显著性意义（P＞0．01），消毒灵擦手效果明显优于肥皂液洗手；手清洁耗时Ⅰ组与Ⅱ、Ⅲ组比较，差异有显著性意义（P＜0．05），消毒纸贴擦手组耗时最短，洗手组最长。结论：99消毒纸贴擦手法对手清洁效果较好，具有操作简单，耗时短等优点，适用于紧急情况和连续操作时的手清洁处理。     

微酸性电解水用于手消毒的效果观察

目的观察微酸性电解水用于手消毒的效果。方法将某综合医院94名医务人员及陪护家属分为三组,分别以15℃、5℃微酸性电解水以及百能抗菌洗手液按标准六步洗手法洗手1min,采用微生物培养计数法评价洗手后的消毒效果。结果 15℃水温的微酸性电解水洗手后对手部细菌平均清除率达99.65%,优于百能抗菌洗手液和5℃的微酸性电解水(均P0.05)。结论15℃水温的流动微酸性电解水洗手消毒效果肯定。     

爱护佳洗手液手部皮肤消毒效果观察

目的 了解爱护佳外科快速无水洗手液（爱护佳液）用于手术人员手部皮肤的消毒效果。方法 采用爱护佳液和洛本清消毒液分别对50名手术人员的手部皮肤进行消毒，监测消毒后即刻、2h、6h手部皮肤的细菌茼落数，比较两组操作时间和消毒后手部皮肤不良反应。结果两组消毒效果均达到国家标准，爱护佳组操作时间显著短于洛本清组（P〈0.01），且无干燥现象发生。结论爱护佳液用于手部皮肤消毒所需时间少，有效,舒适。     

爱护佳洗手液手部皮肤消毒效果观察

目的了解爱护佳外科快速无水洗手液(爱护佳液)用于手术人员手部皮肤的消毒效果.方法采用爱护佳液和洛本清消毒液分别对50名手术人员的手部皮肤进行消毒,监测消毒后即刻、2 h、6 h手部皮肤的细菌菌落数.比较两组操作时间和消毒后手部皮肤不良反应.结果两组消毒效果均达到国家标准,爱护佳组操作时间显著短于洛本清组(P＜0.01),且无干燥现象发生.结论爱护佳液用于手部皮肤消毒所需时间少,有效,舒适.     

两种七步洗手法的效果比较

目的 比较两种"七步洗手法"的洗手效果,为进一步完善医务人员的洗手方法提供有力的依据.方法 选择Ⅲ类环境的医护人员200人,随机分成实验组和对照组各100人.对照组采用标准的"七步洗手法"洗手,实验组采用改进的"七步洗手法"洗手.结果 实验组和对照组洗手后标准采样合格率比较,差异无统计学意义(P>0.05);局部采样合格率实验组显著高于对照组(P<0.01).结论 改进的"七步洗手法"洗手更科学,效果更好.     

电视滚动播放法规范术前洗手探讨

目的提高外科术前洗手合格率。方法随机将200名参加手术人员分为观察组与对照组,各100名,观察组洗手时洗手间滚动播放规范化洗手操作录像;对照组采用传统教学法进行术前洗手,两组洗手后接受细菌学监测。结果对照组洗手后细菌学监测阳性率18.0%,观察组为0,两组比较,差异有显著性意义(χ2=19.8,P<0.01)。结论电视滚动播放法用于规范术者术前洗手,可提高洗手质量,节省人力,促进手术室的现代化教学。     

低强度微波辐射对大鼠神经细胞死亡率影响的实验研究

目的 探讨低强度微波辐射对大鼠神经细胞死亡率的影响。方法 在对体外新生大鼠(0～1天)皮层神经细胞进行原代培养的基础上,以频率900MHz,功率密度分别为0．025mW／cm^2、0．05mW／cm^2、0．1mW／cm^2的低强度微波辐射4、8、12、16、20、24小时。检测细胞死亡率。结果 和对照组相比,0．05mW／cm^2功率密度组辐射12小时、0．1mW／cm^2功率密度组辐射8小时后均可引起神经细胞细胞死亡率增高,且随着辐射时间的延长,细胞死亡率也逐渐上升,0．025mW／cm^2功率密度组未见明显改变。结论 长期连续的低强度微波辐射对培养大鼠神经细胞存在损伤作用。     

不同清洁用品临床应用的比较

目的:检验自制液态皂的临床效果。方法:以使用固态肥皂(A组)、自制液态皂(B组)和速干消毒剂(C组)分为三组,于清洁护理操作、污染物清理操作及无菌操作前和洗手后进行手部采样送检,记录细菌菌落数。结果:B组与A组相比,二者手部细菌菌落数在三类操作之前无统计学差异,洗手后均有统计学差异。与C组相比,二者在清洁操作前、污染物清理操作前和污染物清理洗手后无统计学差异,在无菌操作前、清洁操作和无菌操作后有统计学差异。结论:自制液态皂清洁能力优于固态肥皂,不低于速干消毒剂,能够改善手卫生的依从性。     

Clean and green: saving water in the operating theatre

INTRODUCTION

There is a growing trend to use alcohol-based hand disinfectants in clinical practice. In addition to their antibacterial efficacy, these disinfectants offer an alternative to traditional surgical hand disinfection agents that can save water in the operating theatre.

MATERIALS AND METHODS

The amounts of water and soap used during traditional surgical hand disinfection with antiseptic soap preparations were measured and water usage over a 1-year period was estimated. Costs of traditional disinfection agents were compared with alcohol-based agents.

RESULTS

One surgical hand disinfection episode with traditional agents used 18.5 l of water. During 15,500 procedures performed at our institution over a 1-year period, 931,938 l of water were used which could have been saved had alcohol-based agents been used. Cost per episode of hand disinfection depends on the amounts used and is not higher compared to traditional agents.

CONCLUSIONS

The benefits of using an alcohol-based surgical hand disinfectant may include significant water savings, in addition to previously published advantages of improved efficacy. When deciding on the method of surgical hand disinfection, careful thought should be given to the use of water as a resource. Surgeons should be aware of the environmental impact of their profession.     

关节置换术相关感染监测和分析

目的：对我院关节置换术的相关感染情况进行监测和分析,为预防关节置换术后感染提供依据。方法：2008年7—8月对我院进行的9台关节置换手术进行了相关感染监测。采用5点采样法对面积约30m^2的手术室空气进行了4次采样和细菌培养。通过棉拭子采样法对手术医师手部和手术器械（止血钳、手术剪、拉钩）分别进行14人次、76次采样并细菌培养。结果：手术间空气中浮游菌总数平均值为88．2cfu／m^3。对参与关节置换手术的医师手部检测中有8人次的细菌培养为阳性。暴露于空气中不同时间的未使用手术器械和使用不同时间后的手术器械细菌培养结果中有11次样本为阳性。结论：在关节置换手术中,手术人员要尽力维护手术间的空气洁净度,遵守外科洗手规则,减少无菌台在空气中的暴露。     

不同手卫生方式对术后肺部感染的影响研究

目的 探讨全身麻醉过程中使用手消毒液及佩戴一次性薄膜手套对患者术后肺部感染发生率的影响.方法 选择气管插管全身麻醉手术(预计手术时间＞2 h)患者180例,按随机数字表法分为3组(每组60例):常规组(A组)、手消毒液组(B组)及薄膜手套组(C组).分别于麻醉前、麻醉2h及麻醉结束时对麻醉机吸气端、呼气端、储气囊口进行细菌采样,随后进行培养及鉴定.术后对患者进行5d随访,统计肺部感染发生率.结果 ①麻醉全程麻醉机通气系统中,A组污染标本共94份(52.22％),B组31份(17.22％),C组34份(18.89％).B组、C组麻醉全程麻醉机通气系统污染率低于A组(P＜0.05),B组、C组比较,差异无统计学意义(P＞0.05).②术后随访,A组患者中12例出现肺部感染,发生率为20.0％,B组、C组患者各出现2例肺部感染,发生率均为3.33％,B组、C组患者术后肺部感染发病率低于A组,差异有统计学意义(P＜0.05).结论 麻醉过程中使用手消毒液及佩戴一次性薄膜手套均可降低术中麻醉机通气系统污染率及患者术后肺部感染发生率.     

Residual protein contamination of ProSeal laryngeal mask airways after two washing protocols

The risk of prion protein cross-infection has focussed attention on the potential hazards of protein contamination of re-usable medical devices. This study determined the frequency of protein contamination of ProSeal laryngeal mask airways (PLMA) after two cleaning procedures and tested the hypothesis that the combination of hand- and machine-washing removes protein contamination more effectively than hand-washing alone. After clinical use fifty-four PLMAs were randomly allocated to be washed by hand or by hand then machine. All PLMAs were then autoclaved at 134 degrees C for 4 minutes. After processing, each PLMA was immersed in a 1.2% solution of erythrosin B and examined for uptake of stain. The site (outer surface, bowl and edges of the cuff airway and drain tube, finger strap) and severity (nil/mild/moderate/severe) of staining was scored by a blinded observer. There were no differences in the site or severity of staining between the two cleaning procedures. Staining was detected on 89% of PLMAs that were hand-washed and 78% of PLMAs that were hand-, then machine-washed (P=0.27). When staining occurred, it was mild in 98%, moderate in 2% and was never severe. Staining was more frequent on the edge than at any other location (all comparisons: P < or = 0.01). The strap never had any staining. We conclude that residual contamination of PLMAs with protein deposits is common even when machine-washing is used to augment hand-washing before autoclaving. The infection risk associated with these deposits remains to be determined.     

The effectiveness of ozonated water for hand washing before surgery]

Using an ozonated water-dispensing machine for sterilization of hands (Mediaqua MA-III; Core Medical Co., Ltd, Tokyo, Japan), we investigated the effectiveness of ozonated water as a disinfectant for hand washing before surgery. The effectiveness of this new hand-washing method, using 4 ppm of ozonated water, which is expected to have a short-term bactericidal effect, and 0.2% benzalkonium chloride/83% ethanol solution (Welpas), which is expected to have a long-term bactericidal effect, was compared with that of the conventional hand-washing method (Fürbringer's method using a scrubbing agent containing povidone-iodine). The results showed no significant differences in the numbers of live bacteria and exponential reduction rates in live bacteria. Thus, this new method for hand washing using ozonated water is an effective method for sterilization of the hands before surgery.     

UVA1照射对人工皮肤分泌MMP-1影响的初步研究

目的：探讨不同UVA1剂量照射对人工皮肤分泌MMP-1的影响,明确光致人工皮肤损伤的UVA1剂量。方法：通过ELISA法检测不同剂量的UVA1（0～90J/cm^2）对人工皮肤表达MMP-1分泌的变化。结果：与0J/cm^2相比,UVA1剂量为10J/cm^2时MMP-1的分泌量无明显变化（P〉0.05）,当UVA1剂量大于20J/cm^2时人工皮肤分泌MMP-1的量逐渐增高（P〈0.05,P〈0.0001）,UVA1剂量在小于50J/cm^2以前呈剂量依赖性增高,至70J/cm^2以后分泌量较前有所降低。结论：引起人工皮肤光损伤的初始UVA1照射剂量为20J/cm^2。     

Creating a Manual for Proper Hand Hygiene and Its Clinical Effects

Purpose To prevent cross-infections, we created a manual for the treatment of infectious wounds that clarifies when to wash one's hands and when to wear gloves. Methods Six patients with widespread infectious wounds caused by methicillin-resistant Staphylococcus aureus (MRSA) were treated. The bacterial count on the hands of the staff was calculated. We then compared the number of patients with MRSA isolated, and typed the MRSA isolates using pulsed-field gel electrophoresis (PFGE). Results The pathogenic bacterial count among hospital staff before treatment/before hand hygiene was 8.2 × 10 colony-forming units (cfu)/hand, which were not detected before treatment/after hand hygiene. The pathogenic bacterial count on the hands before hand hygiene/after treatment climbed to 9.1 × 10⁵ cfu/hand, and after treatment/after hand hygiene decreased to 0.38 cfu/hand. The number of patients with MRSA isolates before this protocol was 15/402 (3.7%), but that level significantly decreased to 5/411 (1.2%) after implementation of the manual. There were 13 strains of type F by PFGE before the manual was adopted, but five strains of MRSA isolated after the present manual was enforced were all observed to have different migration patterns. Conclusion A hand hygiene manual is effective for decreasing the rate of cross-infection.     

不同剂量rhGM-CSF凝胶促进大鼠深Ⅱ度烧伤创面愈合的实验研究

目的：观察不同剂量重组人粒细胞-巨噬细胞集落刺激因子（rhGM-CSF）凝胶（商品名为金扶宁）对SD大鼠深Ⅱ度烫伤创面愈合的促进作用并筛选最佳剂量.方法：42只SD大鼠,雌雄各半,随机分为7组：模型组,凝胶基质对照组,金扶宁100、250、500、750和1 000 mg/cm^2治疗组.每只大鼠背部制备两个深Ⅱ度烫伤创面,凝胶基质对照组创面于伤后1～10 d每日涂抹凝胶基质100 mg/cm^2,然后于伤后12、14、17和19 d间断创面涂抹凝胶基质100 mg/cm^2;不同剂量金扶宁治疗组创面涂沫相应剂量金扶宁,给药方法及时间同凝胶基质对照组;模型组不予处理.伤后3、7、10、14、17、21 d分别测量痂皮形成及脱落创面数,计算创面上皮化率、创面愈合率,伤后21 d行组织学检查.结果：与模型组和凝胶基质对照组相比,金扶宁各组对烫伤后7～10 d前后创面的融痂脱痂效果非常明显,以250～500 mg/cm^2治疗组疗效最佳（P〈0.05）.治疗后7～10 d,金扶宁各组新生上皮较模型组和凝胶基质对照组均显著增多（P〈0.05）;治疗后14 d,金扶宁500 mg/cm^2治疗组上皮化率[（55.46±6.13）%]较模型组[（48.81±4.99）%]和凝胶基质对照组[（43.17±5.65）%]仍然显著增多,并优于其他剂量治疗组（P〈0.05）.治疗后10～14 d,金扶宁250～500 mg/cm2治疗组创面愈合率较模型组、凝胶基质对照组和其他剂量治疗组显著增高（P〈0.05）;治疗后21 d,金扶宁250～1 000 mg/cm^2治疗组毛囊再生数量较模型组[（1.531±0.374）/mm2]和凝胶基质对照组[（1.423±0.346）/mm^2]显著增高,以500～750 mg/cm^2治疗组[分别为（7.145±1.153）/mm2和（6.250±0.768）/mm2]明显（P〈0.05）.结论：rhGM-CSF凝胶可以促进痂皮形成和脱落、加快上皮生长、促进毛囊再生,增加烧伤创面修复速度并改善修复质量,以500 mg/cm^2剂量治疗效果最佳.     

红宝石点阵激光联合胶原修复贴治疗黄褐斑的临床观察

目的:对红宝石点阵激光联合胶原修复贴治疗黄褐斑进行临床疗效观察。方法:使用Q开关红宝石固体激光治疗,点阵模式,能量密度3~4.5mJ/cm2,每2周1次,10次为1个疗程;术后1周每天外敷胶原修复贴治疗1次,观察临床疗效及副作用。结果:60例患者经治疗后,基本治愈28例,显效24例,好转8例,无效0例,总有效率86.7%,患者耐受性好,未出现严重不良反应。结论:采用红宝石点阵激光联合胶原修复贴治疗黄褐斑患者疗效显著、安全,副作用少。     

大光斑低能量Q开关激光治疗褐青色痣疗效观察

目的:探讨大光斑低能量Q开关Nd:YAG激光治疗褐青色痣的临床疗效。方法:采用Q开关Nd:YAG激光治疗20例褐青色痣患者,波长1 064nm,光斑直径6mm,脉冲频率5~10Hz,能量密度2.2~3.0J/cm2,每3周1次,10次1个疗程。结果:20例患者经过1个疗程治疗后,4例皮损消失,恢复正常肤色;16例效果明显,皮损明显减退,总有效率达100%,所有患者未见明显色素沉着。结论:大光斑、低能量模式治疗颧部褐青色痣效果好,术后炎症性色素沉着概率低,患者依从性好,该方法值得推广。