失效模式与效应分析应用于内镜消毒管理的效果评价

目的 寻找并发现纤维内镜管道内腔细菌监测不合格的原因,提高内镜清洗消毒合格率.方法 应用失效模式与效应分析法对纤维内镜管道内腔细菌监测不合格结果进行分析,进行流程改造.同时用细菌学监测的方法对整改前后纤维内镜管道内腔进行抽样监测.结果 管道内腔手工清洗时刷洗次数对监测结果有影响,修订管道内腔清洗消毒流程并进行员工培训,纤维内镜管道内腔监测结果较整改前有提高,合格率由84.15%提高到98.65%,差异显著.对内镜清洗消毒失效风险指数进行计算,风险较高的前2项是:操作员管腔内刷洗次数的RPN=640,管腔内刷洗方法的RPN=480,是影响监测质量的关键因素.结论 对管道内腔刷洗次数进行调整,采用细菌学监测的方法对效果进行检验,管道内腔刷洗应不少于5次,可提高管道内腔细菌监测的合格率.

Abstract：

Objective To identify and investigate the cause of the unacceptable bacteria level inside the lumen of fiberendoscope during monitoring so as to increase the pass rate of its cleaning and disinfection. Methods A failure mode effect analysis of the cause was done and the workflow was thereafter improved. Meanwhile, pre and post bacteriological monitor was applied to the fiberendoscope lumen samples. Results The number of scrubbing times while manual cleaning affected the monitoring results. The scrubbing times was amended and the pass rate increased from 84.15% to 98.65%. The results were significantly different The failure mode risk index of endoscope cleaning and disinfection was calculated, and the highest two items were: The number of scrubbing times the operators execute RPN=640, the method of lumen cleaning RPN=480. These were the key factors of qualification of monitoring. Conclusions After the amendment, no less than 5 times' scrubbing was required and the bacteriological monitoring method was used to analyze the effects,thereafter the pass rate of lumen bacteria monitoring can be increased significantly.     

抗生素在海上环境下海战伤中的应用

目的 探讨抗生素在海上环境下海战伤中的有效应用.方法 选取40只成年杂种犬,制作海上环境下海水浸泡复合火器伤动物模型.随机将动物分成对照组和治疗组,每组20只犬.对照组采用头孢地嗪治疗,治疗组头孢地嗪加左氧氟沙星治疗.海战伤的其他处理方法相同.在伤后第2和第4天进行细菌培养与药敏试验,观察6天伤口感染率、死亡率.结果 ...     

Enteric Pathogens in HIV/AIDS from a Tertiary Care Hospital

Background:

Patterns of enteric infections in HIV in developing countries may differ in several important ways from developed countries, the knowledge of which can often guide therapy when resource limitations hamper the exact diagnosis of the etiological agent in HIV-associated diarrhea.

Objectives:

The primary objective of this study was to define and compare the microbial etiologies of diarrhea in HIV-1 infected and non infected patients and in HIV infected non diarrheal patients.

Materials and Methods:

This study was conducted between April 2007 and July 2007 at the Department of Microbiology, Maulana Azad Medical College, New Delhi. Stool samples from 50 HIV seropositive cases with diarrhea (study group), 50 HIV seropositive cases without diarrhea (control group I), and 50 HIV seronegative cases with diarrhea (control group II) were examined. After the diagnosis of HIV infection was made, routine parasitological and bacteriological detection was done. An ELISA was used for the detection of Clostridium difficile toxin and Cryptosporidium antigen in stool samples.

Results:

The overall prevalence of enteric parasitosis in the study group was 20% and the bacteria identified were Escherischia coli in 24% of the case, Clostridium difficile in 10% of the cases, Salmonella species and Vibrio cholerae in 4% of the cases, and Shigella species in 2% of the cases. Candida species was identified in 36% of the cases.

Conclusions:

Identification of the etiological agent of diarrhea in a patient with AIDS is very important as it can help in the institution of appropriate therapy and the reduction of morbidity and mortality in these patients.