AF-A低噪音阻菌式输氧器和传统氧气湿化瓶使用分析

目的 探讨传统的氧气湿化瓶导致医院感染的途径,选择安全、有效控制医源性感染的吸氧设施. 方法 分别对51例呼吸道感染患者痰液、37例使用传统氧气湿化瓶吸氧的湿化瓶、98例使用一次性AF-A低噪音阻菌式输氧器,使用1～6 d后进行细菌培养. 结果 51例医院感染患者中使用传统氧气湿化瓶的细菌培养与患者痰液培养的病原菌结果有明显的一致性,痰培养检测到铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌、鲍氏不动杆菌,分别占21.43%、21.43%、10.71%、3.57%;湿化瓶检测到铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌、鲍氏不动杆菌,分别占34.78%、21.74%、8.69%、13.05%,而AF-A低噪音阻菌式输氧器使用4 d内无细菌生长,安全使用期为5 d. 结论 传统氧气湿化瓶易被细菌污染,是导致医源性呼吸系统感染的危险因素,而使用一次性AF-A低噪音阻菌式输氧器可防止因氧气湿化瓶污染引起的医院感染.     

综合ICU氧气湿化瓶污染细菌与医院感染关系分析

目的调查综合ICU氧气湿化瓶污染细菌,分析氧气湿化瓶与医院感染的关系,为防范医院感染提供依据。方法采集感染、非感染患者使用后和安装未使用共3组氧气湿化瓶标本和呼吸道感染患者痰液标本,对其细菌进行分离鉴定,分析常见细菌的耐药率。结果感染组和非感染组氧气湿化瓶的污染率分别为86.79%和79.25%,两者比较,差异无统计学意义,与安装未使用组(30.18%)比较,差异有统计学意义;氧气湿化瓶和患者下呼吸道痰液分离的细菌以革兰阴性菌为主,分别占64.81%和75.38%,两者的细菌分布差异有统计学意义(P<0.05);而湿化瓶之间的细菌谱差异无统计学意义;感染患者下呼吸道痰液培养的细菌耐药率远高于氧气湿化瓶培养的细菌耐药率,差异有统计学意义(P<0.01)。结论氧气湿化瓶污染是重症监护病房患者医院感染的一个不可忽视的因素,定期更换氧气湿化瓶对于防治因其导致的医院感染至关重要。     

氧气湿化瓶污染与肺部感染病原菌的研究

目的 研究氧气湿化瓶污染与肺部感染的关系。方法 取肺部感染患者的痰液及湿化液进行普通细菌培养。结果 84％湿化液细菌培养阳性，共分离到20种69株细菌，以G^-杆菌为主（57.96%）；58％的痰培养有致病菌生长，其细菌分布以G^-杆菌为主；31.8%痰培养与湿化液所分离的细菌一致。结论 湿化液细菌污染是造成院内肺部感染的重要病源之一，对湿化液的定期更换和消毒是预防医院感染的重要措施。     

ICU氧气湿化瓶细菌污染与医院感染关系及预防

目的研究重症监护(ICU)氧气湿化瓶细菌污染与医院感染的关系及预防措施。方法选取2016年5月至2017年3月该院ICU患者98例,将其中发生感染的50例患者作为感染组,采集患者痰液标本50份及氧气湿化瓶50只;将未发生感染的48例患者作为未感染组,采集患者氧气湿化瓶48只;另取安装未使用的氧气湿化瓶47只作为对照组。检测各组细菌污染率,分离鉴定细菌标本,检测常见细菌耐药率并探讨预防感染措施。结果感染组氧气湿化瓶细菌感染率为86.00%,未感染组为81.25%,两组细菌感染率比较差异无统计学意义(P0.05);对照组细菌感染率为42.55%,感染组及未感染组细菌感染率高于对照组,差异均有统计学意义(均P0.05);50例感染者痰液标本分离菌株中革兰阴性菌占75.97%,革兰阳性菌占24.03%;单因素方差分析可知,各组氧气湿化瓶细菌分布对比差异无统计学意义(P0.05);感染者痰液标本对临床常用抗菌药的耐药率较高,对阿米卡星耐药性较低,痰液标本耐药率高于氧气湿化瓶,差异有统计学意义(P0.05)。结论氧气湿化瓶细菌污染是医院ICU患者感染的重要原因,及时更换、消毒氧气湿化瓶是主要预防措施。     

重症监护病房氧气湿化瓶污染细菌与呼吸道感染关系探讨

目的探讨重症监护病房(ICU)氧气湿化瓶污染细菌与住院患者呼吸道感染的关系,为防治其引起的医院感染提供依据.方法采集4个ICU氧气湿化瓶标本和ICU患者下呼吸道痰,对其细菌进行分离、鉴定,重点分析铜绿假单胞菌的耐药率.结果从氧气湿化瓶分离的细菌158株,以G-杆菌共116株(73.4%),其中铜绿假单胞菌75株(47.5%);痰培养的细菌340株,G-杆菌278株(81.8%),铜绿假单胞菌85株(25.0%),患者下呼吸道痰培养的铜绿假单胞菌,对16种抗生素(除亚胺培南)的耐药率为37.5%～84.2%;氧气湿化瓶分离的铜绿假单胞菌除羧苄西林耐药率为57.1%外,其余为3.5%～28.6%.结论氧气湿化瓶污染细菌与呼吸道感染有密切的关系.     

氧气湿化瓶倒挂晾干架的使用

氧气湿化瓶的污染可导致患者呼吸系统感染.医院感染规范要求氧气湿化瓶应每日清洁消毒,晾干后备用.我院以前将消毒后的湿化瓶倒置在干净的桌面上进行控水晾干,但这种方法水流不畅,易导致二次污染,所以,我们采用了康家宝杯架,结果符合医院感染管理要求,经济实用,值得推广使用.     

医院氧气湿化液与湿化瓶消毒效果目标性监测与分析

目的 对医院氧气湿化液与湿化瓶消毒效果进行目标性监测,预防医院感染,确保医疗安全.方法 采用目标性监测方式,每季度到临床科室采样,随机抽取使用中氧气湿化液、备用氧气湿化液以及消毒后的湿化瓶进行细菌学检查.结果 2008年共监测备用湿化液66份,合格率45.45%,使用中湿化液110份,合格率34.55%,已消毒湿化瓶62份,合格率80.65%,各季度合格率比较,备用湿化液差异无统计学意义;使用中湿化液,一季度与二季度、三季度与四季度差异有统计学意义,合格率提高,已消毒湿化瓶,四季度有明显变化,合格率达100.00%;120份不合格标本细菌谱分析示,非发酵革兰阴性杆菌构成比为83.33%,其中产碱杆菌属为67.00%、黄杆菌属为21.00%.结论 医院对氧气湿化液及湿化瓶进行目标性监测,每季度针对监测结果提出意见,不断整改,收到一定效果,建立健全规章制度和加大监控管理力度是预防湿化液污染的有效措施.     

氧气湿化瓶与管道的消毒方法

随着医学及相关科学的不断发展，中心管道给氧等装置广泛应用于医院临床，因此，对于如何杜绝氧气湿化瓶引发院内感染问题，已逐渐引起广大医护人员重视。我院自2003年6月上旬-7月下旬，对全院氧气湿化瓶液及管道进行反复检测。发现所有湿化瓶液都有大量的细菌生长，每ml湿化瓶液的细菌在4000个以上，有6份标本培养出绿脓杆菌与致病菌，这是一种重要的院内感染因素。     

呼吸科湿化瓶应用与管理

我院呼吸科有40张床位,其中>75%的患者需要氧疗。呼吸科为普通病房,湿化瓶用量大,加之多为老年慢性病患者,住院时间偏长以及抗菌药物的应用,医院感染部位以呼吸道为最高。因此,在呼吸科湿化瓶的管理应避免每一个引起医院感染的环节:(1)提高护理人员预防感染的意识:加强人员素质培养,有效预防感染,降低了医疗费用,减少了患者的负担,缩短了住院天数,提高了满意度。(2)彻底消毒:患者使用后40%的氧气湿化瓶的内芯、内壁及管道各部位不同程度被污染,因此对其各部位进行严格彻底消毒。消毒前打开所有接头彻底清洗干净,防止水垢产生,浸泡于1%环境型…     

氧气瓶湿化液污染情况调查

为防止病原微生物通过吸氧途径进入下呼吸道引起疾病 ,造成医院感染 ,绵竹市防疫站对医院住院患者使用的氧气瓶湿化液进行了调查 ,现将湿化液的细菌污染情况报告如下。1　对象与方法1 1　调查对象　均为随机抽取的各医院住院患者使用的氧气瓶湿化液 ,共 62份 ,其中消毒前采取样本 3 2份 ,消毒后采取样本 3 0份。1 2　湿化瓶的消毒方法　调查单位医护人员用有效氯含量为5 0 0ｍｇ/Ｌ的消毒液将湿化瓶浸泡 10ｍｉｎ后用蒸镏水冲洗。1 3　湿化液的采样方法　将被抽检的氧气瓶的湿化瓶卸下 ,摇匀瓶内液体 ,在酒精灯下无菌吸取湿化液 0 4ｍｌ,注…     

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.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

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.     

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.     

Fatigue and health in a seafaring population

Background Occupational fatigue is relatively common withinthe general population and has been linked to reduced performance,injury and longer term ill-health. Despite growing acknowledgementof this problem in the maritime sector, little research hasbeen conducted into the risk factors, prevalence and consequencesof seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identifypotential risk factors and assess possible links with poor performanceand ill-health. Methods Cross-sectional questionnaire survey of seafarers workingin the offshore oil support, short-sea and deep-sea shippingindustries. A number of tools were used including the fatiguesubscale of the profile of fatigue-related symptoms, the CognitiveFailures Questionnaire, the General Health Questionnaire andthe SF36 General Health scale. Results In all, 1855 questionnaires were completed giving anoverall response rate of 20%. Fatigue symptoms were associatedwith a range of occupational and environmental factors, manyunique to seafaring. Reporting a greater number of risk factorswas associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35)for those with three or four risk factors and OR = 9.54 (6.95–13.09)for those with five or more risk factors]. There was also astrong link between fatigue and poorer cognitive and healthoutcomes, with fatigue the most important of a number of riskfactors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety withinthe industry and may be linked to longer term individual ill-health.It can only be addressed by considering how multiple factorscombine to contribute to fatigue.     

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.