医务人员手卫生执行现状调查分析

目的 了解临床医务人员手卫生执行现状,探讨提高医务人员手卫生依从性的措施,从而减少医院感染的发生.方法 采用自行设计的调查问卷并结合现场观察手卫生过程的方法 ,对医院30个临床科室的120名医务人员进行手卫生知识和执行率的调查.结果 81.7%的医务人员接受过手卫生知识的培训;89.2%的医务人员认为洗手可减少医院感染,2.5%的医务人员认为手卫生对临床治疗结果 无影响;接触患者前手卫生执行率为30.8%,接触患者后手卫生执行率为49.2%,两者比较,差异有统计学意义(P<0.01).结论 医务人员手卫生意识薄弱,手卫生相关知识缺乏,执行率低;应加强宣传教育,提高医务人员手卫生知识,推广使用快速手消毒剂,提高医务人员手卫生依从性,降低医院感染.     

中国医务人员执行手卫生的现状调查

目的了解我国医院医务人员手卫生清洁执行及手卫生设施情况。方法采用现场观察的方法对北京、上海、广州3城市不同级别医院进行了手清洁卫生行为的调查。结果医务人员在接触患者后洗手率为56.5%,明显高于接触患者前及接触物品后手卫生执行率(35%);接触患者前的手卫生执行率以护士最高(39.3%);接触患者后的手卫生执行率以医生为最高(61.0%);从科室类别看,妇产科的手卫生执行情况最好,洗手设施中肥皂的提供率约83.3%,ABHR的提供率达56%,但ABHR的使用率只有14.2%。结论我国医务人员手卫生执行状况亟待改善,提高手卫生执行率是一项涉及行为学的系统工程,应加强培训,提高医务人员,重点是医生的手卫生执行率。     

重症监护病房医务人员手卫生执行情况调查

目的 了解重症监护病房医务人员操作前、后及出病房前手卫生的执行情况.方法 采用过程监测的方法 .结果 操作前、后手卫生执行率分别为54.55%、47.00%;两组比较差异无统计学意义;侵人性操作前、后的手卫生执行率分别为68.75%和66.67%;侵入性操作前后医师手卫生情况与护士比较差异无统计学意义;手卫生时采用流动水洗手60.52%,使用快速手消毒剂39.47%;护士使用快速手消毒剂情况好于医师,两组比较差异有统计学意义(P<0.01).结论 重症监护病房医务人员手卫生执行率亟待提高,除加强相关知识培训、提高医务人员手卫生意识、加强督导外,医院应当加强专项资金的投入,加强手卫生的硬件建设,从而提高医务人员手卫生的依从性,降低医院感染的发生.     

2011年宜昌市37所医院执行手卫生现状调查

目的了解宜昌市城区各级医院医务人员手卫生执行情况,探讨提高手卫生执行率的途径。方法现场调查该市城区37所医院医务人员手卫生执行情况,发放问卷调查影响手卫生执行的因素。结果37所医院共调查医务人员238名,总体手卫生执行率为32.38%（125/386）,其中三级医院为46.81%,二级医院为53.19%,民营医院为23.53%,乡镇卫生院为7.69%,其他一级医院为17.95%,各医院间医务人员手卫生执行率差异有统计学意义（P＜0.05）。接触患者前、进行无菌操作前、体液暴露后、接触患者后、接触患者周围环境后和脱手套后6项手卫生指征执行率中,进行无菌操作前(89.58%,43/48)和脱手套后(80.49%,33/41)手卫生执行率最高。护士的手卫生执行率为54.82%（74/135）,显著高于其他组（P＜0.01）;妇产科医务人员手卫生执行率为83.78%（31/37）,显著高于其他科室（P＜0.01）。37所医院中,18.92%配备有非手触式水龙头,43.24%配备有干手设施。洗手后, 39.76%(33/83)的医务人员用一次性纸巾擦手或风干机吹干手,13.25%(11/83)自然晾干双手,46.99%(39/83)用工作服擦手。影响医务人员手卫生执行的前3位因素是：工作太忙（42.86%）、未引起足够重视（38.24%）、手卫生设施不足（36.56%）。结论宜昌市城区医院总体手卫生执行率低,手卫生执行状况亟待改进。     

基层医院医务人员手卫生现状调查

目的 了解基层医务人员手卫生状况.方法 采用调查问卷并结合现场观察手卫生过程的方法,对312名医务人员进行问卷调查.结果 基层医院医务人员手卫生依从率为40.18%,接触患者前的手卫生执行率为31.01%,接触患者后的手卫生执行率为52.84%;护士手卫生执行率为47.78%,医生手卫生执行率为42.09%;妇产科执行率最高为63.89%,检验科最低为18.10%.鲍氏不动杆菌及金黄色葡萄球菌为检出最多的致病菌.医务人员手卫生知识掌握较好.六步洗手法较为繁琐、洗手指征掌握不全及工作忙没洗手时间是主要影响因素.结论 宁海县基层医务人员手卫生知识掌握较好,但洗手执行率不高,需采取有效措施提高医务人员手卫生执行率.     

医院工勤人员执行手卫生与干预措施

目的了解工勤人员手卫生执行情况,建立切实可行的手卫生干预措施,提高其手卫生执行率。方法通过对全院各类工勤人员采取手卫生干预措施,调查比较干预前后工勤人员手卫生执行率及洗手方法正确率的变化。结果全院各类工勤人员接触患者及进出特殊病房前后、接触污染物品后洗手执行率从干预前分别为19.8%、26.7%、30.2%提高到干预后的48.8%、60.0%、61.6%;脱手套后洗手执行率从干预前30.2%提高至干预后的51.2%,洗手方法正确率从干预前的24.4%提高至干预后的60.0%。结论重视对医院工勤人员手卫生执行情况的监督并采取相应的干预措施,有助于提高手卫生执行率,降低医院感染率,减轻患者痛苦和经济损失。     

揭阳市二级以上综合医院医护人员手卫生执行情况及依从性调查

目的了解揭阳市二级以上综合医院医护人员的手部卫生认知水平、手卫生执行情况及影响因素。方法现场观察医护人员手卫生执行情况,问卷调查医护人员的手部卫生认知水平和影响手卫生执行因素及改进措施。结果医护人员接触病人黏膜、破损皮肤或伤口前和直接接触病人前洗手执行率为36.76%和29.51%;直接接触病人前、后(x2=15.32,P=0.001),接触病人黏膜、破损皮肤或伤口前、后(x2=8.95,P=0.002)以及医疗护理前、后(x2=9.63,P=0.001)的洗手执行率差异均有统计学意义;洗手方式以使用洗手液为主,占65.63%;干手方式以一次性纸巾擦干为主,占62.54%;医生使用白大褂擦手明显多于护士(x2=4.46,P=0.03);医护人员一次洗手超过30 s仅占14.98%;工作忙、经常洗手损伤皮肤是影响手部卫生依从性的主要因素。结论医护人员手部卫生知识掌握较好,但洗手执行率偏低。加强培训和完善洗手设施,提供快速手消毒剂等措施,使手卫生制度执行规范化。     

乡镇卫生院医务人员手卫生现状调查

目的了解卫生部《医务人员手卫生规范》颁布后中心乡镇卫生院医务人员手卫生执行状况及影响因素。方法采用问卷法调查医务人员手卫生知识和手卫生设施;现场观察医务人员手卫生执行情况。结果医务人员手卫生执行率为21.5%;接触患者前与接触患者后医务人员执行手卫生相比较,两者差异有极显著统计学意义(P<0.01)。护士手卫生依从率为28.7%,医生手卫生依从率为12.8%,护士手卫生依从率比医生要好,两者比较差异有极显著统计学意义(P<0.01)。乡镇医院医务人员手卫生知识水平比较低,医院手卫生设施差。结论乡镇医院医务人员手卫生知识水平相对比较低;意识不强,手卫生执行率低,医院手卫生设施不完善。应重视手卫生规范的实施,通过加强培训,宣传教育,改善手卫生设施,以进一步提高手卫生执行率。     

医务人员手卫生执行率与干预方法的调查

目的了解临床一线医务人员手卫生执行率的现状,探讨一系列科学、合理、切实可行的手卫生干预方法,以提高医护人员手卫生的执行率。方法采用自行设计的调查问卷并结合现场观察手卫生过程的方法,调查不同等级医院ICU、急诊、儿科、内科、外科、口腔科医务人员手部卫生知晓情况,评估洗手指征的执行率。结果调查发现76.00%的医护人员接受过手部卫生知识的培训,在规定手卫生指征下,手卫生执行率为50.00%～70.00%,接触患者前的手卫生执行率59.82%,接触患者后的手卫生执行率77.97%;按科室分类,接触患者前儿科执行率最高为82.78%,急诊最低为11.11%,接触患者后传染科执行率最高达100.00%,内科最低为39.93%。结论医务人员手卫生的意识尚薄弱,手卫生相关知识缺乏,有必要总结一套合理有效的干预方案提高医务人员在医院执业过程中手卫生的执行率,降低医院感染率,减轻患者痛苦和经济损失。     

医务人员接触患者后手卫生执行情况的调查分析

目的了解医务人员接触患者后的手卫生执行情况及不同条件对医务人员手卫生执行率的影响。方法对北京、上海、广州3城市8所三级医院不同职务、不同科室的医务人员进行现场观察。结果医务人员接触患者后的手卫生执行率为56．5％，医生为61．0％、护士为53．8％。在提供手套时医务人员手卫生执行率为52．8％，不提供手套为82．0％，差异有统计学意义；在提供醇类快速手消毒剂、肥皂和洗手液时医务人员手卫生执行率（58．7％、61．3％）比不提供的手卫生执行率（51．2％、48．4％）高（P〈0．05、P〈0．01）。医务人员接触患者后使用肥皂（洗手液）和流动水洗手时间≥15s的占74．6％。结论我国大城市、大医院医务人员接触患者后的手卫生执行情况相对较好，洗手时间和流程较为规范，但仍存在手卫生意识薄弱、硬件设施不足等缺陷，尚需加强手卫生教育，采取干预措施，提高医院感染控制水平。     

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.     

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.     

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.     

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.