手术室内备皮对预防手术部位感染的影响

目的 探讨患者在进人手术室内备皮与在病房手术前ld备皮对预防手术部位感染的影响.方法 调查2010年10月在普外科和妇产科手术患者200例,将其随机分为两组,各100例;试验组在手术室的半限制区内建立备皮间,由科室人员对手术室的备皮人员进行备皮的管理制度、工作流程、人员职责、操作规范等进行专项培训,然后将同期于术前ld在病房备皮的100例患者作为对照组;将对照组和试验组的患者备皮后消毒前进行采样,并对琼脂平板细菌的培养结果进行比较,同时比较两组患者一般资料及切口愈合情况.结果 试验组与对照组患者的年龄、性别比、体重指数、美国麻醉医师协会体能分级、手术时间比较,差异无统计学意义;试验组和对照组患者皮肤消毒前,细菌培养阳性率试验组为56.0％、对照组为70.0％;菌落数1～10 CFU/cm2试验组25例、对照组30例,菌落数20～30 CFU/cm2试验组31例、对照组40例,两组菌落计数比较差异有统计学意义(P＜0.05);手术切口感染率试验组为2.0％、对照组为4.0％,两组差异无统计意义.结论 在手术室备皮距离手术时间＜2 h,在预防手术部位感染方面优于术前ld在病房常规备皮,值得推广应用.     

术前不同备皮方法与手术切口感染的差异

目的 观察两种不同术前备皮方法的手术切口感染情况.方法 将530例普外科择期手术患者随机分为两组:试验组采用术前2 h清洁局部皮肤,不剃毛备皮法;对照组采用术前1 d清洁局部皮肤加术野剃毛备皮法,分别于手术消毒皮肤前采样手术部位皮肤作细菌培养,并统计术后手术切口感染率.结果 试验组术前手术部位皮肤细菌菌落数、术后手术切口感染率均低于对照组,两者差异有统计学意义.结论 术前2 h内清洁皮肤不剃毛备皮法在预防手术切口感染方面明显优于常规备皮方法.     

2％葡萄糖氯己定在骨科术前皮肤清洁消毒中的应用研究

目的 探讨2％葡萄糖氯己定(2％CHG)皮肤消毒液沐浴在骨科无菌手术前运用的可行性,有效预防与降低术后切口感染率.方法 以160例骨科择期手术患者按术前两晚+术日晨、术前一晚+术日晨、术日晨2％CHG沐浴和改良骨科备皮法随机均分为试验组A、试验组B、试验组C和对照组,分别于各组患者首次备皮前、手术消毒前及术后24 h对手术野皮肤采样,进行细菌检测并比较各组间差异.结果 手术消毒前细菌培养与基线(首次备皮前)比较,试验组A、试验组B与对照组的细菌清除率分别为99.0％、98.9％ 97.9％,差异无统计学意义,试验组C细菌的清除率为95.8％,低于对照组,差异有统计学意义(P＜0.05);术后24 h手术野皮肤细菌培养,细菌菌落数试验组A为(3.90±1.80) CFU/cm2,对照组为(6.57±1.04) CFU/cm2,两组差异有统计学意义(P＜0.05),其余各组与对照组相比菌落数均值差异无统计学意义,各组患者术后均无切口感染发生.结论 术前两晚+术日晨2％CHG消毒液沐浴法在提高患者满意度、降低耗材和术后24 h手术野菌落数培养等均优于改良骨科备皮法;术前备皮效果同于改良骨科备皮法,具有较大的临床价值.     

缩短术前备皮时间对降低表浅手术切口感染发生的临床观察

目的 探讨缩短术前备皮时间对降低阑尾炎患者手术切口感染发生率的影响。方法 对2010年9月~2011年8月326例阑尾炎需手术患者,按术前不同备皮时间随机分成2组,实验组163例术前30分钟备皮;对照组163例术前一天备皮,比较两组切口感染率,探讨科学合理的备皮时间。结果 实验组表浅切口感染发生率为0.61%;对照组表浅切口感染发生率为3.07%,明显高于对照组,差异有统计学意义(P0.05)。结论 术前30分钟备皮较术前一天备皮能显著降低阑尾炎患者表浅切口感染发生。     

骨科术前不同备皮方法与手术切口感染的关系研究

目的探讨不同备皮方法在骨科手术术前应用对患者切口感染的影响。方法选取100例符合纳入标准的拟行骨科手术的患者随机分为两组各50例,研究组采用脱毛剂备皮法、对照组采用传统剃刀备皮法。结果研究组和对照组的手术时间、术中出血量、切口长度、术后抗菌药物应用时间差异均无统计学意义(P>0.05);研究组的备皮时间长于对照组,细菌培养结果、手术切口甲级愈合指标均优于对照组(P<0.05)。结论脱毛剂备皮法较传统剃刀备皮法的备皮时间略长,但备皮后患者术野皮肤菌落少,术后切口恢复效果好,备皮过程中患者不良感受发生率低。     

不同皮肤准备方法对骨科手术部位感染的影响

目的比较不同皮肤准备方法对骨科清洁手术部位感染的影响以及预防控制感染的可行性。方法选择2014年4月-2015年3月骨科230例四肢闭合性骨折且需要去除毛发的清洁手术患者,将其随机分为试验组119例和对照组111例,其中试验组采用改良皮肤准备方法,术前1d晚和手术当日分别用2%葡萄糖氯己定消毒液消毒皮肤,手术当日术前2h内或术前即刻用电动备皮器去除毛发,对照组采用传统皮肤准备方法,术前1d采用肥皂清洁皮肤并使用刀片剃除毛发,比较两组患者在性别、年龄、手术持续时间、麻醉方式、术后是否留置引流管、手术间级别和术后感染率的差异。结果两组患者性别、年龄、手术间净化级别、手术持续时间、麻醉方式、术后是否留置引流管之间的差异均无统计学意义;患者发生手术部位感染试验组1例、对照组8例,感染率分别为0.84%和7.20%,差异有统计学意义(χ2=6.192,P0.05),传统备皮方法手术部位感染率明显高于用2%葡萄糖氯己定清洁手术野、备皮器去除毛发的改良备皮方法。结论 2%葡萄糖氯己定及备皮器去除毛发的改良备皮方法,有利于降低骨科清洁手术部位感染率。     

膝关节镜手术备皮与不备皮的细菌学比较

目的探讨不备皮对膝关节镜手术的可行性。方法选择拟行膝关节镜手术的患者,观察组不备皮,对照组常规术前1天备皮,观察组患者于手术当日,对照组患者于术前1天肥皂水清洗,然后用清水冲洗洁净,更换清洁衣服,分别于消毒前、消毒后在手术部位取样做细菌培养,观察术后切口感染情况。结果两组患者消毒前皮肤细菌培养结果差异有统计学意义,两组患者消毒后皮肤细菌培养结果差异无统计学意义,切口愈合良好无感染。结论不备皮能减少患者不必要的不适和痛苦,可有效降低皮肤菌落数,于传统备皮比较具有操作简便、患者容易接受、安全可行的优点。     

层流净化手术室医院感染预防效果分析

目的 探讨层流净化手术室用于手术感染的预防效果,为医院感染预防工作提供借鉴.方法 选取医院2011年7月-2012年3月行骨科手术患者300例,其中120例于普通手术室进行手术治疗,设为对照组,180例于层流净化手术室行手术治疗,设为观察组;比较两组患者手术切口感染率、不同类型手术切口感染率及手术室平均菌落数等.结果 对照组与观察组患者手术切口感染率分别为3.33％、0.56％,观察组患者手术切口感染率明显低于对照组,组间比较差异有统计学意义(P＜0.05);观察组患者术后Ⅰ、Ⅱ类手术切口感染率均明显低于对照组,组间比较差异有统计学意义(P＜0.05),但两组患者Ⅲ类手术切口感染率组间比较差异无统计学意义;对照组与观察组手术室空气平均菌落数分别为(123.6±11.8)CFU/m3、(47.2±5.0) CFU/m3,观察组手术室平均菌落数明显少于对照组,组间比较差异有统计学意义(P＜0.05).结论 层流净化手术室用于手术感染预防效果确切,能够显著降低手术切口感染风险及手术室菌落数,具有临床使用价值.     

骨科手术术前不同皮肤清洁方法的效果观察

目的:通过观察骨科无菌手术术前不同皮肤清洁方法的效果,寻找骨科无菌手术术前皮肤清洁的理想方法.方法:将205例骨科择期无菌手术患者术前晚均沐浴或擦浴,不常规剃毛,必要时加剪毛备皮,随机分为2组并接受两种不同术前皮肤清洁方法,实验组术前1/2h用洁芙柔免洗手消毒凝胶擦拭术野皮肤;对照组术前2h用肥皂水擦洗术野皮肤,采集患者术前、术毕备皮区表面皮肤标本做细菌培养,并观察术后切口愈合情况及统计切口感染率.结果:实验组在手术消毒前和术后缝皮时的术野皮肤细菌培养数均明显低于对照组,具有统计学意义;实验组的切口甲级愈合率明显高于对照组,差异比较有统计学意义.两组手术切口感染率有差异,但无统计学意义.结论:骨科手术术前1/2h采用洁芙柔免洗手消毒凝胶擦拭术野皮肤,不仅皮肤清洁效果显著,而且操作简单方便,省时省力,病人依从性高,值得临床推广应用.     

抗菌药物使用时机与术后感染率的调查研究

目的正确掌握术前、术中、术后抗菌药物使用时间,从而降低术后手术部位的感染率。方法选取医院2012年3-6月580例住院手术患者的临床资料,调查分析术前预防性抗菌药物应用的时间及术后手术部位的感染情况。结果 580例患者中有15例术前1d使用抗菌药物,占2.6%;术后发生切口感染2例,占13.3%;485例患者在术前30min¹h使用抗菌药物,占83.6%;术后发生切口感染7例,占1.4%;50例患者在术中使用抗菌药物,占8.6%;术后发生切口感染2例,占4.0%;30例患者在术后使用抗菌药物,占5.2%;术后发生切口感染2例,占6.6%。结论预防性使用抗菌药物的给药时间应选择在术前1h,其术后切口感染率最低,故而合理把握使用抗菌药物的时机,能显著减少手术部位的感染率。     

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.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

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.     

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.     

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.     

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.