广州市40所医院内镜清洗消毒管理现况调查

目的了解广州市不同等级医院内镜清洗消毒管理现况,发现存在问题,以便改进内镜消毒质量。方法采用问卷调查与现场调查相结合的方法,对广州市不同等级开展胃肠镜诊疗工作的40家综合医院内镜清洗消毒管理现状进行调查。结果清洗人员主要为护理人员和聘用工人;有72.5%的医院由护理人员负责内镜的清洗消毒工作,27.5%的医院由聘用工人负责内镜清洗消毒;其中有24.2%属兼职清洗人员。有70%的医院能将内镜诊疗与清洗消毒分室进行,只有35%的三级医院内镜清洗消毒室面积≥20 m2。内镜室基本清洗消毒设施齐全的医院只占37.5%,三级医院占60%配置齐全,所有二级医院消毒设施配置均不齐全。40所医院中,仅有5所医院能对消毒剂浓度进行择机检测。结论广州市医院内镜清洗消毒管理现状不理想,内镜超负荷使用,消毒设施配置不齐全,需要加强管理。     

静电式空气消毒洁净器动态净化除尘效果的试验观察

为了解静电式空气消毒洁净器动态空气洁净效果,采用尘埃粒子计数器采样监测,观察其对手术室实际除尘的效果。结果,在启动空气净化器0.5~2.5 h内手术室空气中平均中值直径大于0.5μm尘粒数为3811484.1个/m3,接近世界卫生组织(WHO)的十万级洁净度标准。在手术进程不同时段手术室空气中尘埃颗粒数逐步下降,从净化后0.5~2.5 h内平均除尘率达到77.85%。实验组不同粒径范围的颗粒数和总尘粒数低于对照组。两组手术室内空气中各种粒径范围的颗粒构成情况无差别,以小于5μm尘粒为主,占室内空气中总尘粒数的96.57%。结论,静电式空气消毒洁净器对手术室内空气中不同粒径粒子具有一定净化效果;净化质量可达到十万级洁净度标准。     

酸性氧化电位水杀菌效果及其对内镜清洗消毒效果观察

采用载体定量杀菌试验和模拟现场消毒试验方法,对酸性氧化电位水杀菌作用和内镜清洗消毒效果进行了试验研究。结果,新生产的酸性氧化电位水原液平均含有效氯118.7 mg/L、氧化还原电位1200 mV、pH2.29。用该酸性氧化电位水原液浸泡作用20 m in,对载体上枯草杆菌黑色变种芽孢杀灭对数值>3.0。用该酸性氧化电位水原液经内镜清洗消毒机循环冲洗20 m in,对模拟塑料管道内枯草杆菌黑色变种芽孢清除对数值>4.0。医疗器械模拟消毒现场试验对止血钳齿部枯草杆菌黑色变种芽孢浸泡作用30 m in,杀灭对数值>3.0。结论,该酸性氧化电位水对清洁条件下载体上枯草杆菌黑色变种芽孢杀灭效果较好,模拟现场消毒试验结果达到规范要求。     

Cleaning effectiveness of root canal irrigation with electrochemically activated anolyte and catholyte solutions: a pilot study

AIM: The aim of this study was to evaluate the potential of electrochemically activated (ECA) anolyte and catholyte solutions to clean root canals during conventional root canal preparation. METHODOLOGY: Twenty extracted single-rooted human mature permanent teeth were allocated randomly into four groups of five teeth. The pulp chambers were accessed and the canals prepared by hand with conventional stainless steel endodontic instruments using a double-flared technique. One or other of the following irrigants was used during preparation: distilled water, 3% NaOCl, anolyte neutral cathodic (ANC) (300 mg L-1 of active chlorine), and a combination of anolyte neutral cathodic (ANC) (300 mg L-1 of active chlorine) and catholyte. The teeth were split longitudinally and the canal walls examined for debris and smear layer by scanning electron microscopy. SEM photomicrographs were taken separately in the coronal, middle and apical parts of canal at magnification of x800 to evaluate the debridement of extracellular matrix and at a magnification of x2500 to evaluate the presence of smear layer. RESULTS: Irrigation with distilled water did not remove debris in the apical part of canals and left a continuous and firm smear layer overlying compressed low-mineralized predentine. All chemically active irrigants demonstrated improved cleaning potential compared to distilled water. The quality of loose debris elimination was similar for NaOCl and the anolyte ANC solution. The combination of anolyte ANC and catholyte resulted in improved cleaning, particularly in the apical third of canals. The evaluation of smear layer demonstrated that none of the irrigants were effective in its total removal; however, chemically active irrigants affected its surface and thickness. Compared to NaOCl, the ECA solutions left a thinner smear layer with a smoother and more even surface. NaOCl enhanced the opening of tubules predominantly in the coronal and middle thirds of canals, whereas combination of ANC and catholyte resulted in more numerous open dentine tubules throughout the whole length of canals. CONCLUSIONS: Irrigation with electrochemically activated solutions cleaned root canal walls and may be an alternative to NaOCl in conventional root canal treatment. Further investigation of ECA solutions for root canal irrigation is warranted.     

Respiratory Symptoms and Respiratory-Related Absence from Work among Health Care Workers in Sweden

Objective. To investigate respiratory symptoms and respiratory-related absence from work among Swedish health care workers (HCWs). Methods. From a postal questionnaire study among a general Swedish working population (n = 12,186), we identified 2156 HCW (555 assistant nurses, 377 nurses, 109 physicians, and 1115 others), including 429 with mainly cleaning tasks (HCW-cleaning). The remaining respondents were classified as non-HCW. Multiple logistic regressions with 95% confidence intervals (CIs) were used to compare respiratory symptoms and respiratory-related absence from work between HCW and non-HCW, adjusting for potential confounders. Results. The prevalence of adult onset asthma was 4.3% in HCW and 3.0% in non-HCW (p = .003). Asthmatic symptoms during the past year were reported mainly by HCW-cleaning, 14.7%, in comparison to 8.3% among non-HCW (p < .0001). HCW had an increased odds ratio (OR) for asthmatic symptoms during the past year (OR 1.3, 95% CI (1.1–1.5)) and more prominent among assistant nurses (OR 1.5, 95% CI (1.1–2.0)) and HCW-cleaning (OR 1.9, 95% CI (1.4–2.5)). Respiratory-related absence from work in the past year was reported by 1.4% of non-HCW, 3.0% of HCW-cleaning, 2.9% of nurses, and 1.6% of assistant nurses. Taking smoking and age into account, there was still significantly increased respiratory-related absence from work in nurses (OR 2.0, 95% CI (1.1–3.8)) and in HCW-cleaning (OR 2.1, 95% CI (1.2–3.7)). Conclusions. HCW in Sweden, especially those with cleaning tasks, reported more respiratory symptoms and respiratory-related absence from work than the general working population. There is a need for longitudinal studies with detailed information on both occupational exposures and socioeconomic factors to explore what influences respiratory-related absence from work among HCW.     

Nebulizer and Spacer Device Maintenance in Children with Asthma

Objective. To evaluate inhalation device cleaning practices of children with asthma and its effect on their asthma morbidity. Methods. A survey of patients aged 4 to 18 years admitted to an urban pediatric emergency department (ED) with an acute asthma exacerbation. Questions included demographics, asthma history, preference of delivery devices, and frequency of device cleaning. Patients were followed until their disposition from the ED, or until the end of their hospitalization, if admitted. Results. 220 subjects completed the survey. Mean age was 9.2 (± 3.9) years-old. One hundred and four (47.3%) patients used both nebulizers and spacer devices, while 18 (8.1%) used spacers only and 98 (44.5%) used nebulizers alone. Seventy-seven (38.1%; 95%CI: 31.7%–45.0%) patients cleaned their nebulizers and 57 (46.7%; 95%CI: 38.1%–55.4%) cleaned their spacer devices after each use as recommended by the Centers for Disease Control. There were no detectable differences in visit admission rate, total number of previous admissions, number of asthma exacerbations per year, and number of ED visits in one year between users who cleaned their devices after every, or every other use, compared to those who cleaned their devices less frequently. Conclusion. Although the majority of patients did not follow accepted guidelines for inhalation device cleaning, further studies are necessary to correlate cleaning practices to patients' clinical outcome.     

Patient environment microbial burden reduction: a pilot study comparison of 2 terminal cleaning methods

Effective cleaning of the patient environment has been advocated to reduce the risk for nosocomial infection. This pilot study compared 2 terminal cleaning methods, a traditional method in which a disinfectant was applied with a wetted cloth and an alternative method in which the disinfectant was applied using the PureMist system (PureCart Systems, Green Bay, WI). There was no difference in effectiveness, with a mean relative reduction of microbial burden of 84% for the traditional method versus 88% for the PureMist method.     

Healthcare‐acquired infections: prevention strategies

Healthcare‐acquired infections (HAI) impact on patient care and have cost implications for the Australian healthcare system. The management of HAI is exacerbated by rising rates of antimicrobial resistance (AMR). Health‐care workers and a contaminated hospital environment are increasingly implicated in the transmission and persistence of multi‐resistant organisms (MRO), as well as other pathogens, such as Clostridium difficile. This has resulted in a timely focus on a range of HAI prevention actions. Core components include antimicrobial stewardship, to reduce overuse and ensure evidence‐based antimicrobial use; infection prevention strategies, to control MRO – particularly methicillin‐resistant Staphylococcus aureus (MRSA), vancomycin‐resistant Enterococcus spp. (VRE) and, more recently, multi‐resistant Gram‐negative bacteria; enhanced institutional investment in hand hygiene; hospital cleaning and disinfection; and the development of prescribing guidelines and standards of care. AMR surveillance and comparisons of prescribing are useful feedback activities once effectively communicated to end users. Successful implementation of these strategies requires cultural shifts at local hospital level and, to tackle the serious threat posed by AMR, greater co‐ordination at a national level. HAI prevention needs to be multi‐modal, requires broad healthcare collaboration, and the strong support and accountability of all medical staff.     

The Role of Chemical Composition of High-Manganese Cast Steels on Wear of Excavating Chain in Railway Shoulder Bed Ballast Cleaning Machine

The main task for a ballast bed is to transmit the sleeper pressure in a form of stress cone to the subsoil, provide proper drainage and resist the sleeper displacement. Poorly maintained ballast could severely limit the maximum speed capacity and create further problems with the structural integrity, possibly leading to a complete failure of a given rail line. To prevent the unwanted corollaries, the ballast bed has to be periodically cleaned with an appropriate machinery. In this paper the authors investigated the effect of the chemical composition on the physical properties of the ballast excavating chains made of high-manganese steels. The authors focused on the wear mechanism, work hardening ability and hardness in the cross-sections areas. A microstructure analysis was performed as well, and observations revealed divergent morphology of precipitations at the grain boundaries, which influenced the size of austenite grains. The deformation twins formed as a result of operation were noticed in the samples. Research has shown that less carbon and chromium reduces the hardness of cast steel, and it specifically affects the ability to strain hardening. The authors explained the role of adjustments in chemical composition in the operational properties of high-manganese cast steels. It has been shown in the paper that different chemical compositions affect the properties of the alloys, and this causes different types of wear. The high content of chromium increases the hardness of materials before and after plastic deformation hardening, which in the conditions of selector chains results in greater dimensional stability during wear of holes in pin joints and will be more susceptible to abrasive wear in the presence of dusts from the ballast than creep.