2011年~2013年青州市医疗单位消毒效果监测调查与分析

目的：了解青州市各级医疗卫生单位消毒效果，为科学指导医院消毒工作、预防和控制医院感染提供科学依据。方法按卫生部《消毒技术规范》、《医院消毒卫生标准》（GB15982-1995）和《消毒与灭菌效果的评价方法与标准》（GB15981-1995）的方法和要求，2011年~2013年对本市、乡、村三级医疗卫生单位消毒效果情况进行了监测。结果共监测使用中消毒剂、医务人员手、物体表面、空气中细菌、灭菌物品等各种样品共7601份，合格6688份，合格率为87.99%，合格率呈逐年增高趋势。本市、镇和村级医疗卫生单位的合格率依次为96.89%、91.48%和84.34%；5类监测样品中合格率最高的是使用中消毒剂（99.42%），最低的是空气中细菌含量（82.26%）。结论青州市各级医疗卫生单位消毒效果不平衡，村卫生室是今后监测重点，应加强空气消毒工作的落实。     

医院消毒灭菌效果的监测与分析

目的掌握各科室消毒灭菌现状,为控制医院感染提供依据。方法对本院20个临床科室的空气、使用中的消毒液、脉动真空灭菌效果、医务人员手和物体表面的消毒灭菌质量进行监测。结果2008年全年空气消毒合格率70．74％;消毒液和脉动真空灭菌合格率100％;医护人员手和物体表面消毒合格率为88．03％和93．71％。结论加强医院消毒灭菌效果的监测,科学正确的分析和应用检测监测资料,以便及时发现医院感染的各种隐患,采取有效措施,降低医院感染发生率。     

医院消毒灭菌效果的监测与评价

目的正确评价医院各科室消毒灭菌工作,预防和控制医院感染。方法对2009年25个临床科室的空气、物体表面和医护人员的手、使用中的消毒液、透析液、灭菌物品、高压蒸汽灭菌效果进行了监测。结果全年空气消毒合格率为87.88%,物体表面和医护人员的手分别为95.78%和89.69%,高压蒸汽灭菌和灭菌物品的合格率为100%,消毒液合格率为99.56%,透析液合格率为99.11%。结论应加强消毒灭菌工作的管理,使消毒工作规范化、制度化,降低医院感染率。     

2005年太原地区医院消毒质量监测分析

为了加强医院消毒管理工作，降低和控制医院感染的发生率，对太原地区各级各类医院的各类环境中的空气、物体表面、医护人员手、医疗用品等进行了消毒质量监测，本次共检测样品465份，合格率为91．18％。各类检测项目中，空气和医护人员的手合格率较低，分别为66．67％和67．31％。因此，医院消毒工作仍须继续加强，空气和医护人员手的消毒应引起高度重视。     

1999～2004年医院科室消毒状况调查

1999—2004年对我院手术室和急诊科的各类物品的消毒隔离质量效果进行监测。共监测样品2021份，合格1819份，总合格率90.0％。监测结果表明：所有消毒物品的合格率明显高于空气的合格率。手术室与急诊科的消毒质量的差别非常显著（X^2=17．726，P〈0.01）。     

2014年重庆市30个区县医疗机构消毒质量监测分析

目的：了解重庆市30个区县各级医疗机构消毒灭菌工作现状,指导医疗机构规范消毒管理工作和提高消毒灭菌工作质量,督促区县疾病预防控制中心加强医疗机构消毒质量监测工作。方法采用现场调查及现场采样检测方法,对重庆市30个区县各级医疗机构的消毒质量进行监测与汇总分析。结果从30个区县各级医疗机构共采样28510件,总体平均合格率93．3％。各级医疗卫生机构合格率由高到低为村卫生室（96．7％）、城镇社区医疗机构（96．6％）、区县级医疗机构（96．1％）、个体诊所（93．7％）、民营医院（90．9％）、乡镇（街道）医疗机构（86．5％）。不同类别的医疗机构监测结果合格率比较,差异有统计学意义（χ2＝666．84,P＜0．01）;监测项目中合格率最低的是紫外线灯辐照强度（52．8％）,其次是室内空气（80．4％）,不同项目监测合格率差异有统计学意义（χ2＝1706．8069,P＜0．01）。结论各级医疗卫生机构消毒质量总体较好,但对村卫生室的监测覆盖面不足,紫外线灯强度等个别监测项目有待加强监测。     

宁波江东医疗机构消毒质量监测

为了加强江东辖区内各类医疗机构的消毒工作质量,于1995~2003年对其进行了全面的监测。1方法各监测对象的采样和检验方法均按照《消毒技术规范规定的方法进行。结果判定依照《医院消毒卫生标准(GB15982-1995)规定的标准。2结果连续 9年检测结果显示,室内空气细菌总数合格率很低,平均为 31. 58%,最低只有 11. 54%。其次是压力蒸汽灭菌效果合格率均在 80%以下。物体表面与医护人员手的细菌总数和紫外线灯辐照度的合格率平均为 69. 55%、72. 88%和 84. 23% (表 1)。检测结果显示,压力蒸汽灭菌效果合格率最高只有78%,最低者仅有 23%,这是极…     

2005-2007年广东省医疗机构消毒质量监测分析

目的了解广东省各级医疗机构消毒监测质量,探讨消毒监测中存在的问题, 加强医院感染监控力度。方法收集2005-2007年广东省疾病预防控制机构按照统一的技术方案对医疗机构进行消毒质量监测的数据, 并用SPSS 统计软件进行分析。通过对不同监测项目的监测结果进行分析, 发现医疗机构消毒质量存在的问题。结果 2005-2007年全省医疗机构消毒监测样品总数依次为142 969、140 014、161 991份,合格率依次为91.10％、90.71％、91.22％,总合格率为91.02％。3年的合格率比较差异无统计学意义(I/Isup2/sup=1.644, IP/I＞0.05)。3年间市、县、镇三级医疗机构的消毒质量监测合格率依次为93.59％、93.94％、 89.34％,有统计学意义,呈市、县级别的合格率均比镇级高的趋势。监测项目中,以使用中消毒液的合格率97.62％为最高,其次为压力蒸汽灭菌效果95.98％和灭菌医疗用品95.63％。医务人员手合格率为90.67％,空气中细菌含量的合格率最低,仅为73.25％。经比较各类监测项目的合格率差异有统计学意义（I/Isup2/sup=36768.34,IP/I＜0.05)。结论在不同级别的医疗机构消毒监测侧重点应有所不同, 镇以下医疗机构是今后消毒监测工作的重点。     

医院消毒灭菌效果监测报告

目的了解医院消毒与灭菌效果，进一步落实医院消毒管理措施和提高消毒质量。方法用现场抽样检测方法进行采样和检测。结果该医院2006年度消毒效果监测合格率分别为空气合格率为98．7％，物体表面消毒合格率为97％，医务人员手消毒合格率为76％，消毒浸泡液合格率为98％，透析液合格率为86．3％。无菌医疗物品和压力蒸汽灭菌器生物指示剂监测合格率均为100％。结论该医院消毒质量整体水平较好，存在部分监测项目不合格现象，应加强改进提高。     

济南市医疗机构消毒效果监测

目的了解某医院环境卫生学及消毒效果现状,为提高医院控制院内感染提供科学依据。方法采用现场采样和微生物检测方法,对医院各科室环境卫生及消毒灭菌效果进行监测。结果空气洁净手术室和普通手术室合格率分别为84.62%和60.00%;物体表面消毒前后合格率分别为83.52%和97.81%;手术室医护人员手合格率为100.00%;消毒内镜合格率为66.67%;灭菌器灭菌效果和使用中消毒剂合格率都达到100.00%。所有样品均未检出致病菌。结论该医院洁净手术室空气卫生质量合格率普遍好于普通手术室,应重视普通手术室的消毒工作,加强一般医护人员的手卫生工作。对使用的各种内镜采取有效措施加大消毒力度,减少和控制院内交叉感染。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.