儿科门诊留观室医院感染隐患及干预措施

目的 调查、了解儿科门诊留观室医院感染的隐患,进一步探讨预防医院感染的干预措施.方法 调查医院儿科门诊留观室存在的医院感染隐患,制定相应的预防医院感染措施.结果 门诊及留观室的医师缺乏较详细的病史询问和仔细的体格检查、儿科门诊留观室空气质量差、医护人员预防感染的意识薄弱、手卫生重视不够、抗菌药物的不规则使用等方面存在着医院感染隐患.结论 积极采取相应的干预措施,加强健康卫生宣传教育工作,注重消毒、隔离与监测,合理使用抗菌药物等,以达到预防及控制医院感染的目的.     

儿科病房医院感染的危险因素及预防控制对策

目的 探讨儿科病房医院感染的危险因素,制定医院感染的预防控制措施.方法 调查分析儿科病房医院感染的隐患,制定针对性预防医院感染的干预措施.结果 儿科病房医院感染管理工作尚不够规范,在职工医院感染的理念意识、医院感染管理制度的执行、医护人员和保沽人员的培训和考核监督机制、无菌操作、洗手依从性、医疗废弃物处理等方面存在医院感染的诸多危险因素.结论 必须采取综合性干预措施,医院感染管理规范化、医护人员培训上岗、严格执行消毒隔离制度,加强医护人员洗手依从性等,才能达到预防与控制儿科病房医院感染的目的.     

混合科室的医院感染管理

目的 针对胸心外科与生物治疗科混合科室患者的疾病特点,总结胸心外科与生物治疗科的医院感染管理,预防与控制医院感染.方法 分析胸心外科与生物治疗科医院感染各个环节存在的问题,包括病房环境、重症监护病房消毒、患者和陪护人员、手卫生、中心静脉置管、呼吸机管路消毒管理以及白细胞下降患者的护理,采取针对性的规范管理,包括建筑布局合理、环境管理、重视医护人员手卫生消毒、加强中心静脉导管的护理知识培训和呼吸机管道消毒的管理以及对白细胞减少患者病房合理安置等针对性的护理工作.结果 实施医院感染控制后,降低了患者医院感染率,环境卫生学等各项监测指标合格率提高.结论 通过实施医院感染控制及医院感染的知识培训,加强胸心外科与生物治疗科混合科室的感染管理,使科室工作人员均能自觉执行手卫生,严格执行无菌操作规范及消毒隔离制度,切实有效控制和切断医院感染的各个环节,是医院感染管理工作的关键.     

儿科门诊医院感染隐患及干预措施

目的查找儿科门诊存在的医院感染隐患,制订干预措施,有效控制儿科门诊医院感染的发生。方法以儿科门诊的工作流程为基点,加强对布局流程、预检分诊、环境物表消毒、手卫生、雾化吸入装置、抗菌素合理使用等各环节管理。结果通过对儿科门诊布局流程、环境消毒、培训监督、手卫生、抗菌素合理使用等环节加强管理,增强了儿科门诊的医院感染防控意识。手卫生依从性、正确性明显提高,环境卫生明显改善。有效降低儿科门诊医院感染风险,提高了患儿及家长的满意度。结论应定期查找隐患,制订干预措施,加强环节管理。     

2005年胶州市医护人员手卫生情况调查

[目的]了解本市医护人员手卫生情况,调查影响手卫生的因素,制定相应的工作制度或采取有效的措施,提高医护人员手清洗、消毒的依从性,从而降低手造成医院感染的发生率.[方法]从各级医疗机构（市直医院、市直以下医院）Ⅲ类环境医护人员中随机抽取180名对其进行手卫生问卷调查和手卫生情况检测.采样方法、活菌计数均按国家卫生部颁布的《消毒技术规范》要求进行.[结果]医护人员消毒洗手合格率为81.7%、每次进行诊疗操作前主动洗手率仅占28.0%、手卫生意识薄弱、规范洗手的依从性差、医疗机构洗手设施、设备不完善、医院管理对医护人员手卫生缺乏明确要求.[结论]本市医护人员手卫生状况不容乐观,有待采取相应对策提高医护人员手卫生情况.     

消毒供应中心工作人员手卫生状况调查

目的 了解手卫生情况执行对医院感染控制的影响,探讨消毒供应中心有效的手卫生执行措施. 方法 调查六个医院消毒供应中心的工作人员290人,其中护士200人,工人90人.采取问卷和现场观察模式调查其手卫生知识的掌握情况和实际执行情况. 结果 护士对手卫生知识掌握和实际操作合格率均高于工人,差异有统计学意义（P＜0.05）,且手卫生指征各项执行率护士均高于工人（P＜0.05）,但执行情况均不理想,仅处理污染物品后和下班前执行率达100％. 结论 手卫生是控制医院感染的重要措施之一,应从制定规划、加强监督使用相应配套设施去保障消毒供应中心人员执行手卫生的依从性.     

消毒供应室人员手卫生状况调查与干预效果

目的针对医院消毒供应室工作人员手卫生状况进行调查,并采取干预措施,以提高供应室工作人员手卫生依从性,降低医院内部感染的发生。方法自制调查表,查找消毒供应室工作人员手卫生依从性差的原因,进而制定相应的干预措施。并对干预前后手卫生依从性情况进行对比分析。结果通过调查发现消毒供应室工作人员手卫生依从性差的原因,主要包括认识不足、知识缺乏、设备不足、工作繁忙、从众心理、缺乏监管等方面。采取干预措施前后,消毒供应室工作人员手卫生执行水平分别为38.21%和90.66%。结论针对影响消毒供应室工作人员手卫生依从性差的原因,制定切实可行的干预措施,可显著提高消毒供应室工作人员手卫生的依从性,有效预防医院内部感染的发生。     

耐碳青酶烯类抗菌药物鲍氏不动杆菌医院感染暴发与控制

目的调查重症监护病房(ICU)耐碳青酶烯类抗菌药物鲍氏不动杆菌感染暴发,并采取有效控制感染措施。方法采用前瞻性和回顾性调查相结合的方法对2009年11月ICU住院的32例患者资料进行流行病学调查和病区内环境卫生学检测分析;采取环境消毒、隔离防护、加强手卫生等一系列感染控制措施控制感染暴发。结果耐碳青酶烯类鲍氏不动杆菌感染或定植10例,患者罹患率达31.25%,例次感染率为50.00%,日感染率28.74‰;患者基础疾病严重、过度使用抗菌药物、呼吸机辅助呼吸、住院时间长等是鲍氏不动杆菌感染的易感因素;病房空气、地面、部分公用医疗器械鲍氏不动杆菌检出率50.00%,医务人员手和工作服鲍氏不动杆菌检出率30.00%。结论病房环境鲍氏不动杆菌污染严重、医务人员接触传播可能是造成此次鲍氏不动杆菌流行的重要原因;彻底病房环境消毒、手卫生依从性提高等消毒隔离防护措施的长期执行,在控制和预防医院感染暴发中发挥重要作用。     

临床医护人员手卫生现状及对策

目的通过对临床医护人员手卫生状况分析,寻找存在的问题并提出改进措施,从而减少医院感染的发生。方法调查医护人员手卫生现状,针对该现状制定相应对策。结果医护人员对遵循手部卫生条例的重要性、必要性仍认识不足,手带菌率高,洗手的依从性较低。结论要求医护人员从思想上重视手卫生,认识到手卫生与控制医院感染的密切关系,自觉地提高洗手的依从性,降低因手部接触而引起医院感染的发生率。     

持续质量改进在提高ICU医护人员手卫生依从性策略与效果研究

目的：讨论研究持续质量改进在提高重症监护病房医护人员手卫生依从性的重要作用,以降低院内感染发生概率。方法：收集资料评估目前质量现状并进行原因分析,制定预期目标并采取相应改进方案。对我院重症监护病房医护人员加强手卫生知识宣传教育、培训指导及考核检查,及时发现实施过程中存在的不足与问题并及时执行改正措施已达到持续质量改进的目的。将持续质量改进后医护人员与未参与改进医护人员手卫生习惯依从性等指标进行比较。结果：经过持续质量改进循环模式组医护人员对手卫生知识掌握程度及手卫生依从性均显著高于未进行任何干预对照纽人员（P〈0．05）。实验组经持续质量改进模式后手卫生执行率及人数均显著高于未进行干预组（P〈O．05）。结论：持续质量改进是一个不断、渐进的长期过程,对每一位重症监护病医护人员来说是长期、持续的工作内容。通过持续质量改进进行重症监护病房医护人费手卫生管理有勘亍加强冀对手卫生重耍性的认识并自觉提高手卫生依从性,对降低院内感染发生率具有重要意义。     

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.