我县手术器械清洗质量现状调查分析

目的:了解我县手术后医疗器械清洗质量,分析主要影响因素,探讨提高清洗质量的有效措施。方法:按照卫生部《WS310.3-2009医院消毒供应中心第3部分:清洗消毒及灭菌效果监测标准》规定的清洗质量的检测方法,即采用目测和(或)借助带光源的放大镜检查的方法,对该县4家二级医院和10家中心卫生院清洗后待灭菌的手术器械清洗质量进行现场抽样检查。结果:4家二级医院共检测已清洗器械2089件,目测合格1567件(合格率75.01%),放大镜下目测合格1358件(合格率65.01%);10家中心卫生院共检测已清洗器械584件,目测合格235件(合格率40.24%),放大镜下目测合格205件(合格率35.10%)。结论:所查医疗机构未对医疗器械的清洗质量引起足够的重视,其清洗质量存在严重问题,各级医院管理人员应加强对医疗器械清洗质量的监督管理。     

跨理论模型提升保洁人员对高频接触物体表面清洁度

目的提升保洁人员对临近患者区域高频接触物体表面清洁消毒工作的重视程度和物品表面清洁度。方法应用跨理论模型对张家港市某三级中医医院88名保洁人员进行工作行为干预,干预小组团队成员采用行为阶段性改变评估问卷对保洁人员进行测评,针对保洁人员所处的不同阶段分为5个小组,给予各期相对应的培训指导。比较干预前和干预后6个月保洁人员的行为阶段分布情况、临近患者区域高频接触物体表面荧光标记清除率和物体表面三磷酸腺苷(ATP)生物荧光检测合格率。结果干预后6个月,保洁人员行为阶段分布情况、临近患者区域高频接触物体表面荧光标记清除率和物体表面ATP生物荧光检测合格率均较干预前有明显改善,差异有统计学意义(均P0.01)。结论基于跨理论模型的培训和干预可提高保洁人员对临近患者区域高频接触物体表面清洁工作的重视程度,从而改变工作态度和行为,更规范地做好清洁消毒工作,提高清洁有效度,减少物体表面菌落数。     

Intrauterine cleaning after placental delivery at cesarean section: a randomized controlled trial

Objective: The objective of this study is to evaluate whether omission of intrauterine cleaning increases intraoperative and postoperative complications among women who deliver via cesarean section.

Methods: We randomized 206 women undergoing primary elective cesarean deliveries to intrauterine cleaning or omission of cleaning. Postpartum endomyometritis rates across groups were the primary outcome. We also examined secondary outcomes. To detect a 20% difference in infection rate between the cleaned and the non-cleaned groups (two-tailed [alpha]?=?0.05, [beta]?=?0.2), 103 women were required per group. Analysis was by intention-to-treat.

Results: Two hundred and six were randomized as follows: 103 to intrauterine cleaning and 103 to omission of cleaning after placental delivery. There were no statistically significant differences in the rate of endomyometritis between the two groups (2.0% versus 2.9%, RR =0.60; 95% CI 0.40–1.32). There were no statistically significant differences in postpartum hemorrhage rates (5.8% versus 7.7%, RR 0.75; 95% CI 0.6–1.2), hospital readmission rates (2.9 versus 3.8%, RR 0.75; 95% CI 0.5–1.6), time to return of gastrointestinal function, need for repeat surgery, or quantitated blood loss between the two groups.

Conclusions: Our randomized controlled trial provides evidence suggesting that omission of intrauterine cleaning during cesarean deliveries in women at low risk of infection does not increase intraoperative or postoperative complications.     

Comparison of Four Methods of Cleaning Hollow-Fiber Dialyzers for Reuse

Four methods of cleaning hollow-fiber artificial kidneys (HFAKs) for reuse were compared in a prospective study. Each cleaning method was randomly assigned and HFAKs were reused until volume loss was greater than or equal to 15 ml, unless discarded for other reasons. HFAKs cleaned with 0.3 M sodium hydroxide averaged 14.5 uses, significantly better (p less than 0.01) than reverse ultrafiltration (6.4 uses), 3% hydrogen peroxide (5.7 uses), or water flush (4.7 uses). Only 1 of 10 HFAKs cleaned with NaOH was discarded owing to volume loss, whereas 25 of 30 HFAKs cleaned by the other methods were rejected for this reason. To relate changes in solute clearance to volume loss, urea and creatinine clearances were determined on HFAKs cleaned by water flush. By the fifth use the average volume had declined to 86.3% of original, but creatinine and urea clearances were reduced, respectively, to 97 and 95% of the original values.     

Root cleaning or root smoothing An in vivo study

Abstract The goal of the present study was to determine whether the clinical treatment results in terms of pocket probing depth reduction and attachment gain would be different following conventional periodontal flap surgery if, on the one hand, root surfaces were smoothed after plaque and calculus removal or, on the other hand, root surfaces were first thoroughly cleaned but then intentionally roughened. 13 adult patients with moderate periodontitis participated: the same patients acted as a unit of control. Evaluations were performed on a total of 224 sites on 81 anterior and premolar teeth. On the 41 test teeth (111 sites). a coarse diamond stone was used following traditional root planing to roughen the root surfaces. The 40 control teeth (113 sites) were cleaned and planed using Gracey curettes. Measurements performed 3 and 6 months post-surgery revealed significant reductions in probing depths at both “rough” and “smooth” sites. However, no differences between the 2 methods were detected. This was true also with regard to attachment gain. We conclude that striving for root surface smoothness during periodontal surgery appears unnecessary.     

The effect of high-frequency electrical pulses on organic tissue in root canals

AIMS: To evaluate debris and smear layer scores after application of high-frequency electrical pulses produced by the Endox Endodontic System (Lysis Srl, Nova Milanese, Italy) on intact pulp tissue and organic and inorganic residues after endodontic instrumentation. METHODOLOGY: The study comprised 75 teeth planned for extraction. The teeth were randomly divided into two groups (60 teeth) and a control group (15 teeth): group 1 (30 teeth) was not subjected to instrumentation; group 2 (30 teeth) was instrumented by Hero Shaper instruments and apical stops were prepared to size 40. Each group was subdivided into subgroups A and B (15 teeth); two electrical pulses were applied to subgroups 1A and 2A (one in the apical third and one in the middle third, respectively, at 3 and 6 mm from the root apices); four electrical pulses were applied to subgroups 1B and 2B (two in the apical third, two in the middle third). The control group (15 teeth) was prepared with Hero Shapers and irrigated with 5 mL of EDTA (10%) and 5 mL of 5% NaOCl at 50 degrees C but not subjected to the electrical pulse treatment. Roots were split longitudinally and canal walls were examined at 80x, 200x, 750x, 1500x and 15,000x magnifications, using a scanning electron microscope. Smear layer and debris scores were recorded at the 3 and 6 mm levels using a five-step scoring scale and a 200-microm grid. Means were tested for significance using the one-way anova model and the Bonferroni post-hoc test. The differences between groups were considered to be statistically significant when P < 0.05. RESULTS: The mean value for debris scores for the three groups varied from 1.80 (+/-0.77) to 4.50 (+/-0.68). The smear layer scores for group 2 and the control specimens varied from 2.00 (+/-0.91) to 2.33 (+/-0.99). A significant difference was found in mean debris scores at the 3 and 6 mm levels between the three groups (P < 0.001). The Bonferroni post-hoc test confirmed that the difference was due to group 1. In the two subgroups treated with four high-frequency pulses (1B and 2B) a substantial reduction in mean debris scores was found at the 3 and 6 mm level; subgroup 2B was practically free of organic residue. No significant differences for mean smear layer and debris scores were recorded between group 2 and the control group at the two levels; a significant difference was found only for mean smear layer scores at the 3 mm level between subgroup 2B and the control group (P < 0.05). CONCLUSIONS: The Endox device used with four electrical pulses had optimal efficacy when used after mechanical instrumentation. Traditional canal shaping and cleaning was essential to ensure an effective use of high-frequency electrical pulses in eliminating residues of pulp tissue and inorganic debris.     

Microbiological evaluation of endodontic files after cleaning and steam sterilization procedures

BACKGROUND: Infection control procedures are essential for modern dental practice and they are continually evolving to meet the dental profession's high standards. The present study evaluated the efficacy of two cleaning procedures to reduce bacterial numbers on endodontic files, and evaluated the effect of biological debris on the subsequent sterilization of files. METHODS: Stainless steel and nickel-titanium (NiTi) files were examined upon removal from the manufacturer's packaging, after instrumentation in root canals of human teeth inoculated with a broth containing two anaerobic species and one facultative anaerobic species of bacteria, and after instrumentation and cleaning with either an ultrasonic bath or a thermal disinfector. For each file, the bacterial numbers were quantified using routine microbiological techniques in an anaerobic chamber. RESULTS: No bacteria were detected from files direct from their packets. The size, taper and type of file did not affect the ability of either of the cleaning procedures to reduce bacterial numbers. However, an absence of bacteria was more likely when files were cleaned in the thermal disinfector. No bacteria were detected from files that were-subjected to steam sterilization irrespective of the type of prior cleaning procedure. CONCLUSIONS: Steam sterilization eliminated all bacteria from the endodontic files irrespective of the presence of biological debris. The majority of bacteria were eliminated from endodontic files after either ultrasonic cleaning or using a thermal disinfector.     

Characteristics of wet work in the cleaning industry

Wet work is the main cause of occupational contact dermatitis in the cleaning industry. Dermatologists and occupational physicians need to base their primary and secondary prevention for workers in the cleaning industry on the characteristics of wet work exposures. We quantified the burden of wet work in professional office cleaning activities with a continuous standardized observation by trained observers of 41 office cleaners. Duration and frequency of wet work exposure and of different cleaning activities were assessed. Wet work made up 50% of such cleaning work. Within a typical 3-hr shift, a mean frequency of 68 episodes of wet work was observed, which classifies office cleaning as wet work. Skin exposure to irritants was markedly different among cleaners who did the same cleaning activities. Reduction in skin irritation can be achieved by training the workers. Because this group of workers, who have a low level of education, has a high risk of developing irritant hand dermatitis, a special effort on training and instruction should be made. A reduction of exposure can be achieved by: using gloves more often; using gloves for a shorter period of time; using gloves while doing activities that otherwise cause the skin to be in contact with water and cleaning substances and washing hands with water only, reserving soap for when the hands are visibly dirty.     

Work-related asthma among health care workers: surveillance data from California, Massachusetts, Michigan, and New Jersey, 1993-1997

BACKGROUND: Asthma morbidity has increased, posing a public health burden. Work-related asthma (WRA) accounts for a significant proportion of adult asthma that causes serious personal and economic consequences. METHODS: Cases were identified using physician reports and hospital discharge data, as part of four state-based surveillance systems. We used structured interviews to confirm cases and identify occupations and exposures associated with WRA. RESULTS: Health care workers (HCWs) accounted for 16% (n = 305) of the 1,879 confirmed WRA cases, but only 8% of the states' workforce. Cases primarily were employed in hospitals and were nurses. The most commonly reported exposures were cleaning products, latex, and poor air quality. CONCLUSIONS: Health care workers are at risk for work-related asthma. Health care providers need to recognize this risk of WRA, as early diagnosis will decrease the morbidity associated with WRA. Careful product purchasing and facility maintenance by health care institutions will decrease the risk.     

Contact dermatitis in Nigeria

In our Department, the incidence of sensitization to cobalt has more than doubled in the last 5 years. 28% of cobalt-sensitive patients showed no other sensitivity. Of isolated cobalt sensitive patients, 68% were housewives. We determined by atomic absorption spectrophotometry with a graphite camera, the cobalt and nickel content of the 30 most popular Spanish domestic detergents and cleaners sold in 1985. 78.6% of them contain considerable amounts of cobalt.