医院感染管理的探讨与防治措施

目的探讨医院感染管理存在的问题及对策,制定出防治措施. 方法对疑诊医院感染的病例及时上报医院感染科,组织调查、分析原因,寻找预防和控制医院感染发生措施. 结果医院感染既有患者自身内在因素及抗生素的不合理使用引起的内源性感染,又有因医疗护理不当或无菌操作不严引起的外源性感染. 结论医院感染的防治措施是消除传染源、切断传播途径、保护易感人群,达到有效控制医院感染的目的.     

Cure rate is not a valid indicator for assessing drug efficacy and impact of preventive chemotherapy interventions against schistosomiasis and soil-transmitted helminthiasis

Every year in endemic countries, several million individuals are given anthelminthic drugs in the context of preventive chemotherapy programmes for morbidity control of schistosomiasis and soil-transmitted helminthiasis. The capacity to evaluate accurately the efficacy of the drugs used as well as the health impact produced by treatment is of utmost importance for appropriate planning and implementation of these interventions. Cure rate is an indicator of drug efficacy that was originally developed for assessing the clinical efficacy of antibiotics on selected bacterial diseases. Over time, this indicator has also been widely applied to anthelminthic drugs and consequently used to monitor and evaluate preventive chemotherapy interventions. In the author's opinion, however, measurement of cure rate provides information of limited usefulness in the context of helminth control programmes. The present article analyses the peculiarities of helminth infections and those of the drugs used in preventive chemotherapy, explaining the reasons why the cure rate is not an adequate indicator in this specific public health context.     

重症监护病房导管相关性血液感染的危险因素与预防控制措施

目的 分析重症监护病房(ICU)导管相关性血液感染(CRBSI)的危险因素,探讨有效预防与控制感染的方法.方法 对2008年1-12月人住ICU的患者进行前瞻性目标性监测,分析导管相关性血液感染的危险因素.结果 共调查257例次,发生医院感染147例次,例次感染率为57.20%,其中导管相关血液感染36例次,例次感染率为14.00%,占感染的24.49%,导管相关性血液感染的日感染率为16.57%,明显高于普通病房;检出的病原菌以G~-菌为主,占54.05%,G~+菌次之,占37.84%,真菌占8.11%;特殊耐药菌检出11株,其中ESBLs阳性菌6株,MRS 5株.结论 导管相关性血液感染与导管放置时间、置管部位、医护人员的操作、患者机体免疫功能及静脉高营养药物的应用有关;严格无菌技术操作,合理选择置管部位,缩短导管留置时间,保持导管通畅,是有效预防CRBSI发生的关键.     

预防医学专业实习生疾控中心现场教学实践与问题探讨

通过预防医学专业实习生在疾控中心实习基地的现场教学实践活动,发现问题,探索规范化的实习基地的建设,提高实习基地的现场教学实践活动的教学质量,培养实用型公共卫生人才。     

胸腔术后引流液病原菌检测及预防措施

目的 了解胸腔术后留置引流病原菌感染现状,探讨预防感染的措施.方法 在拔管前以无菌操作从负吸瓶上段引流管内抽取引流液送检,检出的病原菌用ATB细菌仪鉴定到种.结果 2006-2007年行胸腔手术并术后留置引流的患者共174例.174份引流液标本中有51份培养阳性,总阳件率29.3%;3类手术患者的阳性检出率差异无统计学意义(χ~2=0.38,P>0.05);共检出病原菌57株,以革兰阴性杆菌和革兰阳性球菌为主,分别占50.9%和40.3%,真菌占8.8%;患者免疫防御屏障削弱,无菌操作不严格,皮肤消毒不严密,引流小通畅等均是导致引流液染菌的主要原因.结论 有指征地使用抗菌药物,严格无菌操作,加强引流全过程的护理巡视,确保引流通畅,以及加强患者的营养支持,是预防胸腔术后引流感染的主要对策.     

医院工作人员SARS感染的原因及预防对策

目的 探讨医院工作人员在收治严重急性呼吸综合征(SARS)过程中受到感染的原因及预防对策，以减少医院感染的发生。方法 对我院从2003年2～4月约3个月收治SARS过程中受到感染的医院工作人员的临床特征及感染的原因及在此过程中所不断完善的预防对策做一回顾性分析。结果 我院感染SARS19名工作人员中11名护士、8名医生，通过近距离接触患者或接触患者的呼吸道分泌物等途径传播，在收治过程中，通过不断完善消毒隔离及个人防护措施、加强宣传教育，医院感染得到有效控制。结论完善医院感染管理监督机制、强调个人防护是减少SARS医院感染的关键。     

预防性护理对ICU内肺部感染发生情况的影响分析

目的研究分析预防性护理干预对ICU内肺部感染发生情况的影响。方法选择2011年12月—2013年12月在我院确诊收治的130例ICU患者作为研究对象,将所有患者随机分为对照组和观察组各65例,对照组患者给予传统的常规护理,观察组患者在对照组基础上给予预防性护理干预。观察两组患者的临床疗效、肺部感染发生情况、各项临床指标等,并作对比分析。结果观察组患者的临床疗效明显优于对照组,两组对比差异显著（P〈0.05）;观察组患者的肺部感染发生率明显低于对照组,两组对比差异显著（P〈0.05）;观察组患者经预防性护理干预后住院时间以及感染时间明显少于对照组,两组对比差异显著（P〈0.05）。结论对ICU患者给予预防性护理干预具有较高的临床应用价值,能够有效降低患者的肺部感染发生率,减少住院时间,提高治疗有效率,改善患者生活质量,值得在临床护理干预中大力推广。     

Control of human fascioliasis by selective chemotherapy: design, cost and effect of the first public health, school-based intervention implemented in endemic areas of the Nile Delta, Egypt

Human fascioliasis is becoming a serious public health problem with a number of endemic areas identified in different countries. The viability of humans as definitive hosts has been experimentally demonstrated, and there is now a need to control the human infection along with the veterinary infection. In 1998, following reports on high prevalence among children in the Nile Delta, the Egyptian Ministry of Health and Population launched the first public health, school-based intervention to control human fascioliasis. An innovative selective treatment approach, with chemotherapy targeted to specific high risk age groups and villages, was adopted. First, high prevalence districts were identified by a regional baseline survey, then screening and selective treatment of all schoolchildren took place in high prevalence villages within those districts. From 1998 to 2002 the programme screened almost 36000 schoolchildren, in six districts, treating 1280 cases of human fascioliasis. Prevalence in the endemic area was reduced from 5.6 to 1.2%. The control intervention is described in detail, including data on cost. The targeted, selective chemotherapy approach was appropriate in addressing low prevalence infection, effective in reducing prevalence rates and transmission of the disease, and in the present situation, more cost-effective than mass distribution.     

肺癌化疗患者医院感染临床分析

目的了解肺癌化学治疗（化疗）患者并发医院感染情况及其感染部位分布与临床特点。方法对某省肿瘤医院肺癌化疗专科2003年1月-2007年12月期间收治的2 067例肺癌化疗患者临床资料进行回顾性分析。结果5年间肺癌化疗患者的医院感染发生率为7.93%，上呼吸道感染与下呼吸道感染分别占所有医院感染的51.11%和33.89%。发生与未发生医院感染的病例在平均住院天数、平均化疗周期、白细胞降低程度和粒细胞集落刺激因子使用情况等方面差异均无显著性（均P＞0.05）；Ⅲ度或Ⅳ度白细胞降低患者感染率显著升高（P＝0.000），但其中的预防性使用与未预防性使用抗菌药物者医院感染发生率差异无显著性（均P＞0.05）。结论肺癌化疗患者医院感染以上呼吸道和下呼吸道感染为主；白细胞降低较为常见，抗菌药物的预防性使用与否对Ⅲ度或Ⅳ度白细胞降低患者的医院感染率无明显影响。     

Adolescent Preventive Services: Rates and Disparities in Preventive Health Topics Covered during Routine Medical Care in a California Sample

PurposeThe objective was to examine rates and disparities in preventive health topics covered during routine medical care for adolescents, using a California sample.MethodsUtilizing 2003 California Health Interview Survey data, the sample included 2192 adolescents attending a physical exam within the past 6 months. Adolescents reported whether nine health topics: tobacco, alcohol, drugs, seatbelts, helmets, violence, exercise, nutrition, and sexually transmitted diseases (STDs) were discussed during their most recent physical exam. Outcomes were rates of health topics discussed and disparities in rates based on age, gender, race/ethnicity, income level, and insurance status.ResultsRates ranged from 15% (violence) to 76% (nutrition, exercise). Compared to older teens, younger teens reported discussing safety more, but substances, nutrition, and STDs less. Compared to males, females reported discussing tobacco and helmets less, but exercise and STDs more. Compared to white youths, Hispanic youths reported more discussion of most topics, black youths reported more discussion of nutrition and less of violence, and Asian youths reported more discussion of seatbelts and helmets. Lower income and uninsured groups reported more discussion of health topics compared to higher income and insured groups.ConclusionsRates of coverage of health topics are below recommended levels. Contrary to expectations, minority, uninsured, and lower income groups reported higher rates of discussing health topics. Strategies to increase the coverage of preventive health topics during routine medical care should address these findings.     

江苏省医疗纠纷情况的调查和思考

1997年,对江苏省全省医疗纠纷情况进行了调查,得出的结论如下:发生医疗纠纷的主要原因,一是责任心不强,二是技术原因,三是服务态度差,四是医疗意外,五是无理索赔。提出的对策:(1)建议采取措施加大医德医风建设的力度。(2)建议修订《医疗事故处理办法》。(3)建议建立病人医疗安全保险制度。(4)建议进一步做好新闻、公安部门的协调工作。     

Young Adult Preventive Healthcare: Changes in Receipt of Care Pre- to Post-Affordable Care Act

PurposeYoung adults have unique health and health care needs. Although morbidity and mortality stem largely from preventable factors, they lack a structured set of preventive care guidelines. The Affordable Care Act (ACA), enacted in 2010, increased young adult insurance coverage, prohibited copayments for preventive visits among privately insured and for many preventive services. The objectives were to evaluate pre- to post-ACA changes in young adults' past-year well visits and, among those using a past-year health care visit, the receipt of preventive services.MethodsWe used pooled Medical Expenditure Panel Survey data, comparing pre-ACA (2007–2009, N = 10,294) to post-ACA (2014–2016, N = 10,567) young adults aged 18–25 years. Bivariable and multivariable stratified logistic regression, adjusting for sociodemographic covariates, were conducted to determine differences in well visits and in preventive services among past-year health care utilizers: blood pressure and cholesterol checks, influenza immunization, and all three received.ResultsPast-year well visits increased from pre-ACA (28%) to post-ACA (32%), p < .001. Increases were noted for most demographic subgroups with greatest increases among males, Asian, and highest income subgroups. Larger pre- to post-ACA increases were found for most of the preventive services, p < .05, including the receipt of all three services (7% vs. 16%), p < .001, among past-year health care utilizers.ConclusionFollowing ACA implementation, young adults experienced modest increases in well visit rates and larger increases in most preventive services received. Overall rates of both remain low. Building on these improvements requires concerted efforts that account for young adults' unique combination of health care issues and challenges in navigating an adult health care system.     

肿瘤化疗后粒缺状态患者医院感染及对策

目的：了解肿瘤化疗后粒细胞缺乏状态患者并发医院感染发生率、易感因素及处理对策。方法及结果：分析了5年来177例肿瘤（其中主要为血液系肿瘤）患者。共发生粒缺359例次,并发医院感染221次（61.56%）,其中败血症61次,肺部及上呼吸道感染74次,口腔、咽部感染38次。共分离出细菌87株,G^-杆菌52株（占59.77%）,其中大肠杆菌24株;G^ 球菌24株（占28.74%）,其中金葡菌15株;真菌10例次。死亡35例（19.77%）。结论：长期住院、患者处于非无菌环境下、粒细胞缺乏持续时间长是并发感染的主要因素。认为无菌病房的建立、缩短粒缺持续时间,是预防感染的主要手段。     

湖南省1996-2006年狂犬病流行病学分析及防制对策

目的分析湖南省1996-2006年2719例狂犬病病例情况,探讨湖南狂犬病急剧上升的原因,了解其流行规律,为科学防制提供依据。方法收集1996-2006年湖南省疫情资料及2004-2006年的狂犬病人的个案调查资料进行统计、分析。结果1996-2006年狂犬病发病率由1996年的0.03/10万上升到2006年的0.70/10万,发病率呈逐年上升趋势,疫情以湘南、湘中农村地区尤为严重;养犬数增加、犬免疫接种率低、疫苗质量及管理把关不严、伤后处理不及时、不规范,相关部门之间缺乏协作等是狂犬病发病率持续上升的主要原因。结论湖南省狂犬病疫情严重,应组织有关部门共同协作,采取综合防制措施,有效降低发病率。     

加强军队医院疾病预防控制工作

目的 重视医院疾病预防控制工作,提高医院感染管理水平.方法 依据国家、军队有关疾病预防控制的法律、法规、政策,制定符合医院工作实际的疾病预防控制工作规程,并进行全方位的监控与管理.结果 有效地杜绝了医院内交叉感染的发生和医院感染的暴发、流行,较好地完成了各级赋予医院的疾病预防控制工作目标.结论 医院的疾病预防控制工作是做好医院感染管理工作的前提和条件,是医院感染控制工作的重要内容.     

华支睾吸虫病预防性化疗SIS模型构建和应用

目的  通过构建华支睾吸虫病动力学模型,评价预防性化疗措施对疾病控制的长期效果。 方法  构建符合华支睾吸虫病传播特征的SIS（susceptible-infected-susceptible）仓室模型。以典型流行地区为例,采用数据驱动（data-driven）的贝叶斯融合方法进行模型参数估计。利用模型模拟不同给药方式（脉冲/连续）、覆盖率、频次和时长的预防性化疗,以观察其长期动态变化和效果。 结果  模型具有较好的拟合和预测效果。脉冲式与连续式给药方式长期效果相似。预防性化疗对华支睾吸虫病控制的效果显著,化疗覆盖率越高、频次越多以及干预时间越长,防治效果越显著。但其效果并不持续,化疗停止后感染率出现反弹,一般强度的单纯化疗并不能达到疾病消除效果。 结论  应用华支睾吸虫病的传播动力学模型,可以有效模拟预防性化疗对疾病控制的长期效果。预防性化疗单独应用时效果不持续,需结合健康教育或环境改善等措施共同防治,以增强疾病控制的持续性。     

不忘初心,砥砺奋进,努力服务全省预防医学事业

预防医学会是党和政府联系预防医学、公共卫生科技工作者重要纽带,是推动我省预防医学和公共卫生科技事业发展的中坚力量。本文回顾了30年来,江苏省预防医学会在服务省预防医学事业上的发展历程与取得的成就,并从意识强化、资源整合、机遇抢抓、队伍建设等方面,展望谋求预防医学事业发展的新蓝图。     

肺癌化疗患者症状群因子分析及管理对策研究

目的 探索肺癌化疗患者存在的症状群及其症状发生频率和严重程度,为肺癌化疗患者的临床医护工作提供有针对性的管理对策。方法 采用中文版记忆症状评估量表对150名肺癌化疗患者进行问卷调查,采用主成分分析法进行探索性因子分析。结果 150名肺癌化疗患者平均年龄为（61.8±9.7）岁,男性占66.7%,文化程度主要为初中/中专及以下（85.4%）。症状中"担忧"发生率最高,"疼痛"严重程度较高。中文版记忆症状评估量表共提取5个公因子,分别为胃肠道不适症状群因子、疲乏相关症状群因子、心理不适症状群因子、病态行为症状群因子、不良反应症状群因子,公因子累计解释总变异60.47%。结论 临床医护人员需重点关注患者一般特征,寻找症状根源;利用群内症状协同作用,做好症状群识别工作;发现重点症状群,提出针对性管理措施,以改善肺癌患者的生活质量。     

肺癌患者术前辅助化疗与肺部感染的相关性研究

目的探讨肺癌术前辅助化疗与肺部感染的关系,为提高肺癌的治愈率和患者生存率提供研究依据。方法选取2008年1月-2010年12月进行肺癌手术的126例患者为研究对象,所有患者随机分为两组,各63例,肺癌术前辅助化疗患者设为试验组,单纯肺癌手术患者设为对照组,采用不同方式化疗后,分别对两组肺癌患者手术后的肺部感染及临床治疗效果进行分析,数据采用SPSS15.0软件进行统计处理。结果单纯肺癌手术对照组的63例患者,术后肺部感染为58.7%,试验组63例患者,术后肺部感染为38.1%,术前辅助化疗后,试验组的肺部感染明显低于手术对照组,差异有统计学意义(P<0.05);对照组术后完全缓解占19.0%、部分缓解36.5%、总有效率55.6%,试验组63术后完全缓解占30.2%、部分缓解49.2%、总有效率79.4%,试验组的治疗效果明显高于对照组,差异有统计学意义(P<0.05);术后1年存活率对照组为81.0%、试验组为88.9%,不同方式治疗后,两组患者1年生存率基本相同,差异无统计学意义。结论肺癌术前辅助化疗可显著降低肺部感染率,提高手术后疗效以及患者的3年生存率。