实验室生物安全

实验室生物安全的目的是减少实验室员工暴露于感染性物质、避免感染事件的发生和防止实验室感染性废弃物对公众产生危害。1979年，Pike总结出了“知识、方法和必要的实验设备对防止大多数实验室感染是有效的”。当然实验室安全措施不是一成不变的，随着对致病性微生物知识和宿主易感性的了解、实验设备的更新，特别是对其传播途径认识的不断深入，人们采取更好的操作和处理致病性微生物的方法来减少人员的暴露和感染。目前实验室生物安全内容主要涉及微生物危害分类、危险度评估、实验室生物安全级别、标准操作规范、人员安全等。     

甲型肝炎疫苗预防二次HIV感染效果的随机研究

动物实验表明,应用甲型肝炎减毒活疫苗(简称甲肝疫苗)能成功地阻止甲型肝炎病毒(HAV)暴露后的感染。在人类,这种暴露后疫苗接种的效果如何尚未被证实。作者的研究通过在暴露后的家庭接触者中进行甲肝疫苗接种,观察接触者发生二次HAV感染     

基于人为因素实验室获得性感染风险与生物安全应对策略

病原微生物实验室生物安全通常强调使用保护设备、程序和操作规范来保护人员和环境免受潜在危险生物材料的影响。实验室获得性感染是实验室人员安全的主要威胁,会导致疾病、残疾甚至死亡;病原微生物还可能被携带到周围环境,造成社区感染,应当受到重视。研究分析实验室获得性感染案例有助于了解暴露发生的原因,明确暴露后预防和应对措施的潜在风险,进而维护生物安全。随着设备和基础设施的优化,人为因素所导致的实验室获得性感染趋于增加。与气溶胶化和液滴飞溅、锐器材料有关的实验室活动、执行工作人员的生物安全素质能力、实验室设施和管理4种主要因素密切相关。本研究从导致实验室获得性感染的人为因素出发,探讨病原微生物实验室的生物安全风险,回顾实验室生物安全的发展演变,以及目前对实验人员的保护措施,并据此提出应对策略和建议。     

加强生物安全柜正确使用规避感染风险

[目的]确保生物安全柜正确使用,规避感染风险。[方法]严格按照生物安全柜的性能、结构、防护级别及注意事项等进行实验室选择和安装生物安全柜,严格按照操作规程使用生物安全柜,并加强生物安全柜管理,加强人员培训,严格规章制度,对使用过的器材、物品等进行严格消毒。[结果]正确使用生物安全柜,减少或避免实验室感染事件发生。[结论]只有掌握生物安全柜的性能、结构、原理及防护级别等,严格按照操作规程,正确使用生物安全柜,才能保护实验环境不受污染,有效地减少由于气溶胶暴露或有害气体扩散所造成的实验室感染事件的发生,规避感染风险。     

肾综合征出血热病毒气溶胶动物实验感染研究

为了研究HFRSV的吸入感染性和动物与动物间空气传播感染,用TK_2型气溶胶发生器发生H8205株病毒气溶胶,引入动态气溶胶暴露装置并对实验动物进行暴露.以AGI微生物气溶胶采样器进行采样,以Vero-E_6细胞空斑法分析病毒含量,对病毒耐气溶胶化和吸入病毒剂量进行了测定.对染毒动物产生气溶胶引起交叉感染能力进行了观察.结果表明:HFRS病毒雾化30min回流液病毒存活50%,AGI冲击5分钟其效价下降不明显.数种动物对该病毒气溶胶比较敏感.在本实验装备和条件下其气溶胶乳小鼠吸入0.065pfu全部感染;离乳小鼠吸入0.72pfu几乎全部感染;乳小鼠半数吸入致死量(ILD50)为0.57pfu.从乳小鼠脏器组织分离出了HFRS病毒.结果认为,气溶胶传播是HFRS流行的重要危险因素.     

以降低导管暴露风险为主导的导尿管相关尿路感染监测新进展

导尿管相关尿路感染(CAUTI)因其巨大的暴露人群、严重的继发性血流感染等并发症而引发严重健康损害。以降低导管暴露风险为主导的CAUTI监测是系统推进感染防控措施落实、降低CAUTI发生的有效手段。依据CAUTI防控资源情况,规范制定CAUTI监测方案,明确各监测要素标准及关键环节标准工作流程,围绕减少导尿管暴露机会、降低感染风险、缩短暴露期限以及膀胱容量扫描设备辅助的导尿管暴露管理等主体任务目标开展监测,依托信息化数据提取及成效分析,提升CAUTI监测效率与效果。     

HFMEA法在医疗职业暴露管理中的应用研究

目的 探讨医疗失效模式与效应分析法(HFMEA)在职业暴露管理中的应用效果及应用推广价值。 方法 通过组建专业的HFMEA团队,对职业暴露管理中的风险进行综合分析评估,查找潜在失效模式并针对高风险因素采取干预措施,降低职业暴露感染风险。 结果 职业暴露管理中发生的主要失效流程和环节有设备、人员、管理等方面的因素,其中人员因素优先风险数值(RPN)最高。进行HFMEA后RPN值下降,下降率52.50%。医务人员的正确防护率由实施HFMEA管理前的58.62%上升到72.45%,职业暴露正确处置率由74.03%上升到92.86%,差异均有统计学意义(χ2=5.233、10.521,P<0.05)。 结论 应用HFMEA对医疗职业暴露管理进行评估、分析并采取相关措施,有助于提高管理效率,降低职业暴露感染风险。     

豚鼠胃肠道实验感染流行性出血热的探讨

本文用一种既能防止EHF病毒从口腔进入消化道、又能防止实验中形成气溶胶感染的实验攻毒方法进行了豚鼠胃肠道实验感染流行性出血热的研究。共用动物29只,经抗 EHFV-McAb 检测,79%在肺组织中可检出 EHF 病毒抗原。实验结果表明:豚鼠胃肠道暴露于 EHF 病毒亦可引起感染,从而为证明食入被 EHF 病毒污染的食物而引起 EHF 的传播途径提供了实验依据。     

界标模型介绍及在动态预测中的应用

传统的生存预测属于“静态预测”,即其只能利用基线暴露信息预测结局的发生情况。而目前出于临床研究实际需求,越来越多的研究者开始关注“动态预测”,该方法能利用截至预测起点（界标时点）的暴露信息对预测模型进行更新,从而实现对患者结局的动态预测。界标模型即一种动态预测模型,其结构简单、容易实现、计算效率高,且其性能与相较之下更...     

门诊抽血室血液性职业暴露的防护措施

血源性职业暴露是指工作人员在从事疾病的诊疗、护理等工作过程中,暴露于被病毒感染的血液、体液,污染了皮肤、黏膜等非肠道黏膜,或被污染的针头及其他锐器刺破皮肤或工作中被实验动物或患者抓伤等,导致血源性病原菌感染的危险。门诊抽血室护士经常暴露于被感染的血液中,因     

To what extent do community characteristics drive health facility delivery? Findings among Women who had recent live births in Nigeria

Existing studies have established several individual drivers of health facility delivery in many developing countries. However, the community characteristics that drive health facility delivery have been less studied across developing countries. This study thus examines the extent to which community characteristics drives health facility delivery among women who had recent live births in Nigeria based on data from the 2018 Nigeria Demographic and Health Survey (NDHS). A weighted sample size of 7,342 women was analysed. The outcome variable was health facility delivery. The explanatory variables were selected individual and community characteristics. Results show 39.7% prevalence of health facility delivery among the women. Findings further reveals that the community characteristics have significant effects on the variations in health facility delivery across the communities. Community characteristics significantly drive health facility delivery in Nigeria. More community-based priority actions are required to improve demand for health facility delivery in the country.     

Imbalances in the health labour force: an assessment using data from three national health facility surveys

Accurate knowledge of the characteristics of the health labour force that can affect health care production is of critical importance to health planners and policymakers. This study uses health facility survey data to examine characteristics of the primary health care labour force in Nicaragua, Tanzania and Bangladesh. The characteristics examined are those that are likely to affect service provision, including urban/rural distribution, demographic characteristics, and experience and in-service training, for three types of providers (physicians, nurses and auxiliary nurses). The profiles suggest a pattern of urban/rural imbalances in Nicaragua and Tanzania. The Bangladesh facility survey did not include hospitals, thereby making concrete conclusions on the supply and distribution of providers difficult to make. Multivariate logistic regressions are used to assess the relationship between the urban/rural placement of providers by health need, population demand and facility characteristics. Health need, as measured by child mortality rates, does not have a significant association with the placement of providers in either country, unlike population size and annual growth rates. The mean number of years providers have worked at a facility is significantly associated with a decreased likelihood of rural placement for the three types of providers in Nicaragua. The mean age and percentage of female providers at each facility has a negative association with the placement of rural providers in Tanzania. The use of health facility data to profile the health care labour force is also discussed.     

Health-care facility choice and the phenomenon of bypassing.

Health policy-makers in developing countries are often disturbed and to a degree surprised by the phenomenon of the ill travelling past a free or subsidized local public clinic (or other public facility) to get to an alternative source of care at which they often pay a considerable amount for health care. That a person bypasses a facility is almost certainly indicative either of significant problems with the quality of care at the bypassed facility or of significantly better care at the alternative source of care chosen. When it is a poor person choosing to bypass a free public facility and pay for care further away, such action is especially bothersome to public policy-makers. This paper uses a unique data set, with a health facility survey in which all health facilities are identified, surveyed, and located geographically; and a household survey in which a sample of households from the same health district is also both surveyed and located geographically. The data are analyzed to examine patterns of health care choice related to the characteristics and locations of both the facilities and actual and potential clients. Rather than using the distance travelled or some other general choice of type of care variable as the dependent variable, we are able actually to analyze which specific facilities are bypassed and which chosen. The findings are instructive. That bypassing behaviour is not very different across income groups is certainly noteworthy, as is the fact that the more severely ill tend to bypass and to travel further for care than do the less severely ill. In multivariate analysis almost all characteristics of both providers and facilities are found to have the a priori expected relationships to facility choice. Prices tend to deter use, and improved quality of services to increase the likelihood of a facility being chosen. The answer to the bypassing dilemma seems to be for providers to provide as good quality care relative to the money charged (if any), as other, often further away, providers.     

Determinants of Quality of Family Planning Counseling among Private Health Facilities in Lagos

We use a unique dataset that includes an objective measure of the quality of family planning counseling from 927 private health facilities in Lagos State, Nigeria, to determine which variables at the facility and provider levels are most closely correlated with the quality of family planning counseling. Our data on quality come from mystery client surveys in which the clients posed as women seeking family planning counseling. We find that quality is strongly associated with the cadre of provider, with doctors delivering substantially higher‐quality counselling than nurses. Doctors not only outperform nurses overall, but also perform better on each category of quality and spend nearly three minutes longer on average counseling the mystery client. Location, fees charged for the service, and facility type are also strongly correlated with quality. The degree to which a facility specializes in family planning and facility size are only weakly predictive of quality.     

Is there a relationship between physician and facility volumes of ambulatory procedures and patient outcomes?

This study explores associations between patient outcomes (7- and 30-day hospitalization and mortality) and healthcare provider (physician and facility) volumes of outpatient colonoscopy, cataract removal, and upper gastrointestinal endoscopy performed in outpatient surgical settings in Florida. Findings indicate that patients treated by high-volume physicians or facilities had lower adjusted odds ratios for hospitalizations and mortality. When physician and facility volume were assessed simultaneously, physician volume accounted for larger effects than facility volume in hospitalization models. When assessing both physician and facility volume together for mortality, facility volume was a stronger predictor of mortality outcomes at 30 days. Further examinations of associations of outpatient physician and facility volumes and patient outcomes are suggested.     

Interior design. Mastering the master plan

Reflecting on the results of the survey, this proposed interior design master planning process addresses the concerns and issues of both CEOs and facility managers in ways that focus on problem-solving strategies and methods. Use of the interior design master plan process further promotes the goals and outcomes expressed in the survey by both groups. These include enhanced facility image, the efficient selection of finishes and furnishings, continuity despite staff changes, and overall savings in both costs and time. The interior design master plan allows administrators and facility managers to anticipate changes resulting from the restructuring of health care delivery. The administrators and facility managers are then able to respond in ways that manage those changes in the flexible and cost-effective manner they are striving for. This framework permits staff members to concentrate their time and energy on the care of their patients--which is, after all, what it's all about.     

Analysis of capacity decisions for progressive patient care hospital facilities.

In this study we provide a methodology for investigating the relationships between capacity decisions and selected performance measures for a progressive patient care facility. The methodology is illustrated with published data from a coronary care facility. The facility is modeled using a simulation approach. The utilization rate of each unit, the fraction of transfers blocked in each unit, and the proportion of each unit's patient-days resulting from inappropriate use are determined for a range of capacity levels. Finally, the results of this experimentation are transformed by regression analysis into prediction equations that give insight into the sensitivity of these performance measures to capacity levels and provide a useful tool for guiding resource allocation decisions.     

Detecting systematic discrepancies in nursing home assessments of residents

Medicare and Medicaid reimbursement received by nursing homes are linked to the care needs of residents in a facility. Thus, a facility may have an incentive to overestimate the care needs of residents. To evaluate this, a sample of nursing homes in Ohio was selected, and independent assessors were sent to sampled facilities, and the rating of residents by the independent assessor was compared to a similar rating by the staff at nursing homes. We first evaluated whether the independent assessors were homogeneous with respect to agreement with nursing facility assessors using a permutation test procedure. Since there was evidence of heterogeneity among the independent assessors, we evaluated agreement between the independent nurse and facility assessors separately for each independent nurse. Responses were collapsed into three categories: independent assessor was lower, equal or greater than the facility assessor. Under a null hypothesis that lower and greater categories were equally probable, the maximum likelihood estimate of the vector of probabilities corresponding to these categories was constructed for each independent assessor. The P-value for detecting a difference between independent and facility assessors was calculated for each facility by summing the multinomial probabilities of obtaining a result at least as extreme as observed in the direction of the “lower” category being more probable. Five of the 39 facilities had P-value < 0.10 with three of the low P-value facilities occurring in reviews by one of the independent assessors. We believe that there is not evidence of systematic differences between the facility assessors and independent assessors although a caveat associated with this statement is the power of this assessment procedure is strongly linked to number of cases reviewed per facility along with the size of the effect expected. We believe this provides a screening mechanism to identify facilities where additional samples are warranted.     

Use and cost of skilled nursing facility services under Medicare, 1987.

The data in this article are focused on the use, covered charges, and Medicare program payments for skilled nursing services during calendar year 1987. Data for the period 1971-87 are included to show trends in the use and cost of skilled nursing facility services under the Medicare program. The impact of the Medicare prospective payment system on skilled nursing facility use is also discussed.