血液透析透析液的细菌学监测方法探讨

目的对血液透析透析液细菌超标的原因和有效的监测方法进行探讨。方法在血透机开机运转正常5,15,30,60min分别对透析进液采用3种采样方法进行采样,采集样本20,60,37份,透析出液采样97份,透析废弃液采样10份。对透析进液、出液和置换液进行细菌培养。结果按无菌注射法斜刺入透析进液管内抽取透析进液进行采样,细菌菌落数含量最低为(19.5±18.0)CFU/ml,无菌注射器针头平行穿过接头器口抽取接头器内部透析液采样,其细菌菌落数增高至(122.5±87.5)CFU/ml,进液接头器自然流出法采样的细菌菌落数为(1280.0±120.0)CFU/ml。各组采样数据以经t检验,P<0.01,为差异有统计学意义。不同时间段采集透析液的细菌含量,透析装置经过反渗水的冲洗,冲洗了机器内部的细菌,随着时间的延长细菌数减少。结论透析液进液细菌含量高于出液的原因在于采样时开放进液接头器装置时污染。所以,建议在血透机的透析进液接头器前10cm处安装一进液采样口,使透析进液、出液采样标准化。     

第二汽车制造厂医院消毒质量调查

<正> 为了解我厂医院消毒现状,对厂属6所医疗卫生机构进行了调查。调查中,对使用中的消毒液,如75％乙醇、2％碘酊、0.1％新洁尔灭、3～5％来苏儿、0.1～0.2％过氧乙酸与0.1～0.2％氯胺T等共采样78份进行污染菌量的检测。结果仅有1份(2％碘酊)超过允许菌量的下限(250个/ml),     

手术间3种不同采样高度细菌计数结果分析

手术间空气中细菌的采样培养 ,是经常进行的一项消毒效果的监测方法。根据规定[1] 其采样高度要求在 80～ 15 0ｃｍ范围内 ,如严格的按测试标准去做 ,事先要准备培养皿放置的高度 ,操作较为繁琐。为此 ,我们进行了 3种不同高度的采样测试。1　方　法选择一个手术间设置 5 0ｃｍ、15 0ｃｍ、2 0 0ｃｍ 3种不同的采样高度 ,每个高度按要求在房间的中央及四角各放一个皿采样 ,观察结果按公式细菌数 /ｍ3 =5 0 0 0 0Ｎ/ＡＴ计算出空气中细菌数 /ｍ3 ,每个高度每项次采样 10份 ,连取 10次共 30 0份 ,每次间隔 1个月。为了减少误差 ,确保测试的真…     

对献血者采血量不足的原因分析

《中华人民共和国献血法》规定，献血者献血量一般为200ml或400ml为一个标准单位，不足标准为采血量不足。采血量不足可引起抗凝剂与血液比例失调，这样的血液不能应用于临床。在实际的采血操作中，受性别、年龄、血型、季节、受教育程度、采血操作等多种因素的影响，采血量不足的现象时有发生。笔者对北京市血液中心2003年2月至2005年1月2年中采血量不足的血液进行分析，采用x^2检验进行统计学处理，旨在探讨采血量不足发生的原因。     

护理部主任工作压力源的调查分析

目的对血液透析透析液细菌超标的原因和有效的监测方法进行探讨。方法在血透机开机运转正常5，15，30，60min分别对透析进液采用3种采样方法进行采样，采集样本20，60，37份，透析出液采样97份，透析废弃液采样10份。对透析进液、出液和置换液进行细菌培养。结果按无菌注射法斜刺入透析进液管内抽取透析进液进行采样，细菌菌落数含量最低为（19．5±18．0）CFU／ml，无菌注射器针头平行穿过接头器口抽取接头器内部透析液采样，其细菌菌落数增高至（122．5±87．5）CFU／ml，进液接头器自然流出法采样的细菌菌落数为（1280．0±120．0）CFU／ml。各组采样数据以经t检验，P〈0．01，为差异有统计学意义。不同时间段采集透析液的细菌含量，透析装置经过反渗水的冲洗，冲洗了机器内部的细菌，随着时间的延长细菌数减少。结论透析液进液细菌含量高于出液的原因在于采样时开放进液接头器装置时污染。所以，建议在血透机的透析进液接头器前10cm处安装一进液采样口，使透析进液、出液采样标准化。     

三种不同采样高度细菌计数结果对比及分析

空气中细菌的采样培养,是临床上经常进行的一项消毒效果的监测方法。根据规定[1]其采样高度要求在80～150ｃｍ范围内,如严格的按测试标准去做,事先要准备培养皿放置的高度,操作较为繁琐。为此,我们进行了三个不同高度的采样测试。1　方法选择一个手术间,设置50ｃｍ、150ｃｍ、200ｃｍ三种不同的采样高度,每个高度按要求在房间的中央及四角各放一个培养皿采样,观察结果按公式:细菌数/ｍ3=50000Ｎ/ＡＴ计算出空气中细菌数/ｍ3,每个高度每次采样10份,连取10次共300份。每次间隔一个月。为了减少误差,确保测试的真实可靠性,三个不同高度的采样均…     

医用计算机染菌情况分析及职业防护

目的 探讨医用计算机的染菌量,染菌菌种及其分布,研究计算机的物表消毒及清洁,解释职业防护的必要性.方法 按照<消毒技术规范>物表采样方法进行随机采样检测计算,应用医用微生物技术进行接种,应用HX-21A细菌分析仪进行细菌培养和鉴定.结果 40份采样监测标本有35份存在细菌生长,按消毒技术规范医院感染管理方法规定超标3份(10 cfu/cm2)超标率为7.5%.超标科室为普外重症监护病区,神经内科B超室.检出致病菌铜绿假单胞菌,金黄色葡萄球菌各1株.结论 计算机染菌情况严重,必须加强手的卫生消毒,加强计算机的清洁和消毒,认真落实职业防护.     

消毒剂有效含量及微生物监测

2003年,我们对新泰市部分医疗卫生机构使用中消毒剂有效成分含量及细菌污染情况,进行了随机抽样监测。抽测到的产品涉及到6个厂家生产的157份84消毒液和两种次氯酸钠发生器生成的消毒液。现将结果报告如下。1方法采样方法,对使用中消毒剂取30～50ml置干燥无菌瓶中,4h内送入实验室,检测其有效含量和细菌总数、霉菌总数及致病菌。检测方法均按现行版消毒技术规范规定的方法进行。判定结果,以细菌总数≤100cfu/ml,并不得检出致病菌为合格;有效成分含量以包装标签标示浓度为准。2结果2.1有效含量检测结果共检测使用中消毒剂78份,合格47份,合格率…     

2007年青山湖区医疗机构消毒监测报告

目的对南昌市青山湖区2007年医疗机构的消毒质量进行监测、评价。方法按GB15982—1995规定方法对医疗机构各类检测点进行采样、检验。结果检测各种标本共610份，合格数为462份，合格率为75．7％。结论个体卫生所、民营医院、少数社区卫生服务中心消毒意识较为淡薄，必须加强管理，才能有效控制院内感染事件发生。同时对医疗机构消毒工作提出建议。     

GICA法检测HBsAg的探讨

目的　对3种胶体金免疫层析测定(GICA)试条检测 HBsAg的性能、结果等技术参数进行初步探讨,为各实验室的选用提供参考。方法　采用 GICA法和酶联免疫吸附法(ELISA)对定值的HBsAg质控品和1 322份血清标本同时测定,并结合有关实验,对3种 GICA试条的敏感性、特异性、渗透性、固相膜均匀性等结果进行初步评价。结果　3 种 GICA试条对 HBsAg的最小检出量为1~5ng/ml;与ELISA法比较,检出率为97.37%~99.57%,一般不出现假阳性,未发现前带反应。结论　GICA适用于急诊检验,其敏感性低于 ELISA法,成本高;特殊情况下,还必须与 ELISA法并用,实行双检。     

紫外分光光度法快速测定消毒剂中三氯生含量

为建立紫外分光光度法测定消毒剂和抗菌剂中三氯生的方法,采用紫外分光光度计,在280 nm波长下,对用无水乙醇稀释后的三氯生样品直接测定,进行了工作曲线、精密度、回收率等实验。结果,当标准溶液在0.0～50.0 μg/ml浓度范围内,回收率90％～105％,相对标准偏差1.5％,与高效液相色谱法对比,结果无显著性差异,并与配方值相符。经过对54℃ 14 d和37℃ 90 d保存样检测,标准和样品含量均没有降低。结果显示,三氯生具有良好稳定性,紫外分光光度法测定三氯生含量,方法简便、快速、准确、灵敏度高,适宜大批样品测定。     

Improved procedure for determination of flucytosine in human blood plasma by high-pressure liquid chromatography.

Several high-pressure liquid chromatography procedures for the determination of flucytosine in serum or plasma have appeared. Some of these suffer from significant disadvantages, and none was applicable in our routine clinical therapeutic-drug-monitoring laboratory. A new high-pressure liquid chromatography assay for flucytosine was therefore developed. A 100-microliter sample of plasma was treated with an aqueous 5-iodocytosine internal-standard solution, and the mixture was deproteinized with trichloroacetic acid. A portion of the protein-free supernatant was diluted with 0.1 M ammonium phosphate, and an aliquot of the resulting solution was injected into the high-pressure liquid chromatography system. Chromatography was performed on a strong-cation-exchange column with a mobile phase containing aqueous ammonium phosphate, phosphoric acid, methanol, and acetonitrile. Detection was at 254 nm. The assay was shown to be linear in the 10 to 200-micrograms/ml drug-concentration range. Forty other drugs were tested for potential interference with the assay, and none was found. For routine use, a single-point working standard containing 75 micrograms of flucytosine per ml was used, giving intraassay coefficients of variation at 50 and 150 micrograms/ml of 1.8 and 2.3% respectively, whereas the day-to-day coefficient of variation at 50 micrograms/ml was 10.0%. Advantages of the procedure include the small sample size, the use of a convenient and reliable internal standard, speed, and simplicity. The assay is highly suitable for routine clinical drug-analysis laboratories.     

五步碘量法测定消毒剂中二氧化氯的方法改进

目的改进五步碘量法对二氧化氯测定方法,以便更准确地检测消毒剂中二氧化氯含量。方法采用调整测定试液pH值和延长吹氮气时间的措施进行了实际样品检测。结果改进五步碘量法测定中,样品溶液中氧化性物质的总浓度在1000~3000mg/L,取样量为2~5ml为佳。测定不同样品需要将磷酸盐缓冲溶液pH值调节到7.0,pH值随缓冲液加入量的变化而变化,达到一定量后pH值趋于稳定。同一种二氧化氯样品的不同次取样,吹氮时将样品溶液吹至无色,测得二氧化氯含量存在差别;吹至无色后再继续吹不同时间,测得二氧化氯量基本一致,在吹至无色后,再继续吹30min即可。结论在改进五步碘量法操作中,采用控制样品液氧化物总浓度,适当调整试液酸碱度和延长吹氮气时间,可保证二氧化氯测定浓度准确性。     

胃肠道磁共振水成像方法研究

目的探讨胃肠道磁共振水成像方法.方法 36名健康自愿者,随机分为胃组16名、小肠组20名.依检查部位和目的不同,扫描前口服水或2%～4%安其格纳芬水溶液.选用单次激发厚层投射2D FASE 序列和3D FASE序列进行胃肠道磁共振水成像.结果 36例均获得较为满意的2D胃肠道磁共振水成像图像.图像无运动伪影,胃肠道内液体信号与周围组织信号对比良好,结构清晰.10例3D MIP图像有运动伪影,胃肠道轮廓模糊,黏膜皱襞显示不清,2D与3D图像质量有明显差异(P<0.01).水能很好充盈胃,胃磁共振水成像能勾勒出胃大体轮廓,区分胃底、胃体和胃窦.水在小肠内易被吸收而不易到达远段小肠,2%～4%安其格纳芬水溶液使小肠各段充盈扩张良好.结论单次激发厚层投射2D FASE序列是胃肠道磁共振水成像简便有效的序列,2%～4%安其格纳芬水溶液是较理想的小肠磁共振水成像口服造影剂.     

Small intestine contrast ultrasonography.

The entire small bowel can be visualized on ultrasonography after ingestion of nonabsorbable, isosmotic polyethylene glycol electrolyte balanced oral solution, termed small intestine contrast ultrasonography. The aims of this study were to assess whether the ingestion of different volumes of sonographic contrast solution may differently affect (1) small bowel distention and thus its sonographic appearance and (2) the time to visualize the entire small intestine. An additional aim was to identify the minimal amount of contrast solution necessary to visualize the entire small bowel. An ultrasonographic examination of the abdomen was performed twice in six healthy subjects after the ingestion of the isosmotic polyethylene glycol solution. During the first investigation each subject was asked to drink increasing amounts of sonographic contrast solution until the jejunum was visualized at ultrasonography. During the second investigation each subject was asked to drink increasing amounts of sonographic contrast solution, not to exceed a total volume of 260 ml. At the first examination the entire small bowel was visualized 39.3 +/- 17 min after ingestion of 647 +/- 105 ml of contrast solution. At the second examination the entire small bowel was visualized 43.5 +/- 13.5 min (not significant with respect to the first study) after the ingestion of 239 +/- 32 ml of contrast solution (P < 0.01 versus the first study). The mean luminal diameter and wall thickness at three intestinal levels did not differ in the two studies and were not statistically related to the amount of ingested sonographic contrast solution. Loose stools were the only side effect and were reported after the ingestion of more than 600 ml. Ultrasonography offers reproducible information on the morphology of the contrast agent-filled small bowel after ingestion of a wide range of volumes (175 to 820 ml) of isosmotic polyethylene glycol electrolyte balanced solution. On average, the entire small intestine could be visualized on ultrasonography by about 45 min after the ingestion of 600 ml or less of contrast solution without any side effects.     

快速筛选菌尿症-尿涂片镜检法探讨

目的　探讨一种快速筛选菌尿的方法。　方法　用10μl尿液直接涂片,经革兰染色后镜检,同时取10μl尿液做细菌培养及菌落计数。　结果　总计检测1155份尿标本,其中显微镜检查阳性(每个油镜视野平均菌数≥2)且尿培养阳性(菌落计数≥10     

戊二醛对金属腐蚀性的实验观察

试验表明，戊二醛对碳钢与铜有腐蚀性，其浸泡时所用液量及消毒液更换与否对不锈钢、铝、铜与碳钢等同一金属的腐蚀速率均属同一级别     

碱性“彗星”法检测肺癌放射敏感性初步研究

目的采用碱性彗星法检测肺癌标本的初始DNA单链断裂,探讨碱性彗星法用于预测临床肺癌的放射敏感性的可行性。方法对2002年4月~2003年8月在本院经纤维支气管镜取样并为病理证实的150例肺癌标本采用碱性彗星法检测初始DNA单链断裂,以经本底较正的平均尾力矩(RTM)和平均中位尾力矩(mRTM)为评价指标;采用SPSS 10.0统计软件包以单因素方差分析法比较不同病理类型平均较正尾力矩差异,并分析影响结果的相关因素。结果纤维支气管镜取样,多数样品细胞数较少;样品质量对结果影响较大,35%样品中位RTM≤1.0,无显著性差异,全组平均较正尾力矩在不同病理类型中的分布均未显示出与临床一致的趋势,在细胞数小于100的样品中可见小细胞大于非小细胞的趋势;全组平均中位较正尾力矩尤其在中位RTM>1.0的样本中,显示与临床放射反应一致分布趋势,但样本小,结果无统计学差异。结论碱性彗星法可初步显示不同病理类型肺癌细胞间的放射敏感性差异,样品质量对结果影响较大,分析方法有待改进完善。     

Sample taking through central venous catheter for the control of partial thromboplastin time in patients with heparin sodium perfusion

The need to systematically monitor activated partial thromboplastin time (APTT) in patients undergoing continuous perfusion of heparin sodium (non-fractionated) in order to maintain therapeutic levels of anticoagulation leads to two questions: 1. can blood be withdrawn from the catheter through which the heparin solution is being perfused without altering APTT values? and 2. how much blood should be discarded so that APTT values remain unchanged? To obtain APTT values in these patients, two samples were extracted simultaneously: one through the central venous catheter through which the heparin was being perfused, after previously discarding 10 or 20 ml of blood according to the group to which the patient was assigned and the other through direct venous puncture or through the peripheral catheter inserted in the arm not being used for heparin perfusion. The values obtained by both methods were analyzed for statistical significance. Comparison of the results of APPT in the samples, having previously extracted 10 or 20 ml of blood, with those obtained through venous puncture or through peripheral venous catheter revealed statistically significant differences. These differences were lower when 20 ml were discarded than when 10 ml were discarded. In conclusion, APPT monitoring should be performed whether the sample is obtained through direct venous puncture or through a peripheral catheter inserted in the arm not being used for heparin perfusion.     

False-positive DAT caused by variables in sample procurement

A positive DAT may occur when blood samples are drawn from an intravenous line and are a function of 1) drawing the sample from a line containing 5% or 10% dextrose rather than dextrose with lactated Ringer's; 2) using a large bore rather than a small bore needle; 3) using a clot rather than anticoagulated sample for the DAT; and 4) drawing a smaller volume of blood (reactions strongest at a sample size of 0.5 ml).