手术器械集中管理模式的探讨

消毒供应中心是医院供应无菌器械的重要部门,也是预防和控制院内感染的重点科室。随着卫生部于2009年12月1日出台《医院消毒供应中心管理规范》三项强制性标准实施后,我院消毒供应室于2010年4月至今对手术器械实行集中管理,改变了过去不规范的管理方式和工作流程,经过1年多的运作,取得良好的效果,现总结如下。     

2003年-2006年鸡西市区医院消毒效果监测分析

目的:了解鸡西市医疗机构消毒效果状况,加强对辖区内医疗机构消毒质量管理,预防和控制医院感染的发生。方法:依据《消毒技术规范》(卫生部2002年版)对我市17家医院消毒物品采样,进行消毒效果检测。结果:17家医院消毒总合格率为97．44% (991/1017),其中室内空气一项市直医院合格率92．05%(81/88)低于区级医院100%(11/11)(x~2=77,P＜0．005);室内空气、物体表面、医务人员手、使用中消毒剂、无菌器械、污水合格率分别为93．43%(128/137)、98．79%(244/247)、97．97%(290/296)、100%(73/73)、97．62%(246,252)、83．33%(10/12),污水合格率明显低于医务人员手(x~2=9．77,P＜0．0031)、物体表面(x~2=14．43,P＜0．0031)和使用中消毒剂(x~2=12．46,P＜0．0031)。结论:本市医院消毒情况以污水合格率偏低,室内空气、物体表面和医务人员手不同程度地存在细菌超标现象,存在院内感染的威胁。     

加强手术室管理,控制医院感染

目的加强手术室医院感染的控制与管理,降低医院感染的发生率。方法针对手术室的工作特点,制定并落实各项有效的消毒隔离措施和感染监测制度,严格执行无菌操作规程,创造合格的手术环境。结果制定有效的手术室消毒隔离制度和感染监测制度,并通过医护人员的积极配合,创造合格的手术室环境,使无菌手术切口感染率下降至0.25%,特殊手术无医院感染发生。结论加强手术室医院感染的管理,可有效地防止医院感染的发生,降低无菌手术切口感染率。     

信息追溯系统在消毒供应中心的应用体会

目的研究信息追溯系统在消毒供应中心的应用效果,为实现无菌物品实施可追溯性管理提供依据。方法应用美美软件医院消毒供应中心(CSSD)追溯系统,对消毒物品执行回收、清洗、包装、灭菌、储存、发放等环节进行管理。结果通过信息追溯系统的建立使用,完善质量控制过程的相关记录,更好保证供应物品的安全。结论美美软件信息追溯系统在消毒供应中心使用过程中各环节的质量管理和追溯运行效果良好,值得推广使用。     

PDCA循环方法在医院感染控制管理工作中的应用

目的:探讨PDCA循环方法在医院感染控制管理工作中的应用效果。方法:我院于2014年1月-2014年12月期间在医院感染控制管理工作中采用PDCA循环方法;分别对比PDCA循环方法实行期间及实行前一年(2013年1月~2013年12月)我院院内感染发生情况及消毒灭菌物品的抽检合格率。最后,分析PDCA循环方法在医院感染控制管理工作中的应用效果。结果:干预后我院感染发生率、抗生素使用率、患者平均住院时间均显著小于干预前;而干预后我院医务人员手部、医疗器械物品表面、空气抽检合格率明显大于干预前;且前后以上比较差异具有统计学意义(P0.05)。结论:在医院感染控制管理工作中采用PDCA循环方法可有效降低医院感染的发生率,提高消毒灭菌物品抽检合格率,避免住院患者发生某些感染性病发疾病,维护患者生命健康。因此,该方法值得临床推广应用。     

消毒供应室质量控制及医务人员的职业防护与医院感染控制的相关性分析

目的:研究通过加强消毒供应室的质量控制和供应室医务人员的安全防护及操作规范,减少医院感染的措施及其效果。方法:严格遵守《消毒技术规范》的要求和原则,联合采用化学、物理和生物的方法对供应室物品进行消毒灭菌处理及空气消毒,定时对供应室的无菌区及清洁区的无菌效果进行检测。采用调查表形式对供应室医务人员的职业防护行为进行调查和分析。结果:无菌物品能够保证优质供应,我院50名供应室医务人员中正确掌握消毒剂用途及效能的占96%,被利器刺伤后能够正确处理伤口的占98%,但仍有7%的人较少应用防护措施,4.25%的人从不应用防护措施。原因是思想上不够重视,认为遇到的传染病人少。我院自2000年起无因供应室工作失误引发的医院感染事件发生。结论:完善消毒供应室管理制度,健全岗位责任制,严格执行消毒灭菌的质量监控,确保供应室的无菌环境,加强供应室医务人员职业安全防护知识的宣教,是供应室为医院高效提供无菌物品,监测预防医院感染的有效措施。     

持续质量改进在重症医学科中心静脉导管相关性感染的控制效果

目的观察重症医学科中心静脉导管相关性感染的预防控制效果,以进一步降低中心静脉导管相关性血流感染（CRBSI）的发生率。方法对2010年7月～2011年12月重症医学科（ICU）留置中心静脉导管的患者进行目标性监测,观察中心静脉导管相关性血流感染的预防与控制,并进行持续质量改进,评价控制效果。结果通过持续质量改进,中心静脉导管相关性血流感染（CRBSI）率呈持续下降趋势,由9.8%逐渐降低至无相关感染病例发生。结论持续质量改进能切实提高各级人员对医院感染的预防控制意识,有效地控制重症医学科CRBSI的发生率。     

应用闭环管理提高骨科手术外来医疗器械使用后归还清洗合格率

目的分析闭环管理对骨科手术外来医疗器械使用后归还清洗合格率的影响。方法选取我院2018年7月～2019年9月应用闭环管理后的150个外来医疗器械包作为观察组,回顾性分析2017年1月～2018年5月采用常规管理模式下的150个外来医疗器械包作为对照组,对比两组使用后归还器械的清洗合格率、蛋白质残留检测合格率,并比较两组的护理质量评分及科室满意度情况。结果观察组的器械清洗合格率明显高于对照组(P0.05),蛋白质残留合格率高于对照组(P0.05);而两组的护理质量各项评分及科室满意度比较,观察组均高于对照组,差异均有统计学意义(P0.05)。结论在消毒供应中心应用闭环管理对使用后的外来医疗器械再回收清洗流程进行监控管理,能有效提升外来医疗器械使用后归还清洗合格率,避免外来医疗器械在流转过程中对社会环境造成污染,落实WS310-2016中外来医疗器械应经CSSD清洗消毒后方可交还规范要求。     

临床微生物在感染控制中作用

目的:研究和探讨临床微生物检验在医院感染控制中的作用。方法:通过统计自2012年加强医院检验科室微生物检测管理以来院感发生率来分析临床微生物在感染控制中的作用。结果:通过微生物检测对医院感染的各个环节进行有效管理,医院获得性感染的发生率比前期有着明显下降。结论:微生物检验技术在临床中的运用可以有效控制感染源有利于降低医院感染的发生及发展。     

消毒供应中心下收下送工作中存在的问题和对策

目的解决消毒供应中心管理工作中存在的问题,加强质控管理,减少交叉感染率,杜绝院内感染的发生。方法总结分析我院消毒供应中心下收下送工作中存在的问题,并制定相应的防范对策。结果通过科学规范的管理和相应的防范对策,可确保物品消毒灭菌的质量。结论加强消毒供应中心工作的管理,是确保医疗质量和护理安全,减少院内感染的重要环节。     

Serology and systematics of the Ebenales and the Theales

The systematic position ofthe Ebenaceae, Sapotaceae, Styracaceae, Ochnaceae, Stachyuraceae, Dipterocarpaceae, Clusiaceae and Hypericaceae has been investigated using serological comparisons of sets of antigenic determinants. The results show that the Sytracaceae and Sapotaceae are undoubtedly more closely associated with the Actinidiaeceae and Theaceae, respectively, than with each other. We found no corresponding determinants betnween antigen systems from the Ebenaceae and systems from any other family whose relations to this family have been proposed. As discovered previously, investigations of antigen systems from the Ochnaceae, Dipterocarpaceae, Stachyuraceae, Clusiaceae and Hypericaceae are against the idea of a natural order “Theales” in which these families, or at least some of them, are combined with the Theaceae and Actinidiaceae. This paper completes our previous investigations which largely support a superorder Ericanae sensu Ehrendorfer and Takhtajan. We propose to include the Actinidiaceae and Theaceae in this superorder, assigning them a central position laong with the Sapotaceae and Sytracaeae on one side and the Primulales and Ericales on the other. Another most interesting finding is that there are corresponding determinants between antigen systems from the members of the Ericanae and representatives of the Polemoniaceae and Loasaceae.     

The Choroid Plexuses and the Barriers Between the Blood and the Cerebrospinal Fluid

1. The fluid homeostasis of the brain depends both on the endothelial blood–brain barrier and on the epithelial blood–cerebrospinal fluid (CSF) barrier located at the choroid plexuses and the outer arachnoid membrane.2. The brain has two fluid environments: the brain interstitial fluid, which surrounds the neurons and glia, and the CSF, which fills the ventricles and external surfaces of the central nervous system.3. CSF acts as a fluid cushion for the brain and as a drainage route for the waste products of cerebral metabolism.4. Recent findings suggest that CSF may also act as a third circulation conveying substances secreted into the CSF rapidly to many brain regions.     

Epigenetics and aging: the targets and the marks

'Aging epigenetics' is an emerging field that promises exciting revelations in the near future. Here we focus on the functional and biological significance of the epigenetic alterations that accumulate during aging and are important in tumorigenesis. Paradigmatic examples are provided by the global loss of DNA methylation in aging and cancer and by the promoter hypermethylation of genes with a dual role in tumor suppression and progeria, such as the Werner syndrome (WRN) and lamin A/C genes. Another twist is provided by sirtuins, a family of NAD-dependent deacetylases that act on Lys16 of histone H4, which are emerging as a link between cellular transformation and lifespan.     

Biophysics and Structure of the Patch and the Gigaseal

Interpreting channel behavior in patches requires an understanding of patch structure and dynamics, especially in studies of mechanosensitive channels. High resolution optical studies show that patch formation occurs via blebbing that disrupts normal membrane structure and redistributes in situ components including ion channels. There is a 1-2 μm region of the seal below the patch where proteins are excluded and this may consist of extracted lipids that form the gigaseal. Patch domes often have complex geometries with inhomogeneous stresses due to the membrane-glass adhesion energy (E_a), cytoskeletal forces, and possible lipid subdomains. The resting tension in the patch dome ranges from 1-4 mN/m, a significant fraction of the lytic tension of a bilayer (∼10 mN/m). Thus, all patch experiments are conducted under substantial, and uneven, resting tension that may alter the kinetics of many channels. E_a seems dominated by van der Waals attraction overlaid with a normally repulsive Coulombic force. High ionic strength pipette saline increased E_a and, surprisingly, increased cytoskeletal rigidity in cell-attached patches. Low pH pipette saline also increased E_a and reduced the seal selectivity for cations, presumably by neutralizing the membrane surface charge. The seal is a negatively charged, cation selective, space with a resistance of ∼7 gigohm/μm in 100 mM KCl, and the high resistivity of the space may result from the presence of high viscosity glycoproteins. Patches creep up the pipette over time with voltage independent and voltage dependent components. Voltage-independent creep is expected from the capillary attraction of E_a and the flow of fresh lipids from the cell. Voltage-dependent creep seems to arise from electroosmosis in the seal. Neutralization of negative charges on the seal membrane with low pH decreased the creep rate and reversed the direction of creep at positive pipette potentials.     

The efficacy of ropivacaine and bupivacaine in the caesarean section and the effect on the vital signs and the hemodynamics of the lying-in women

ObjectiveTo investigate the efficacy of ropivacaine and bupivacaine in caesarean section and vital signs and the hemodynamics of the lying-in women.MethodsA total of 480 lying-in women who were admitted to this hospital for treatment between December 2017 and June 2018 were enrolled into this study as the subjects, which were divided into the experiment group and the control group, with 240 subjects in each group. In the experiment group, subjects received the local anesthesia by infusion of 1.5 mL ropivacaine (0.75%), while those in the control group also took the local anesthesia by infusion of 1.5 mL bupivacaine (0.75%). Thereafter, we observed the differences in the anesthetic efficiency, vital signs and hemodynamics of the lying-in women between two groups.ResultsThe excellent and good rates of the anesthesia in two groups were 92.1% and 87.9%, showing no obvious difference; in the experiment group, the average arterial pressures and systolic pressures at 5 min and 10 min after combined spinal and epidural analgesia (CSEA) were all elevated when comparing to the control group (all P < 0.05); in the experiment group, the onset time was obviously extended, while duration of sensory and motor block and the duration of motor block were all shorter than those in the control group (all P < 0.05). During anesthesia, the incidence rate of the adverse reactions in the control group was 2.50%, significantly higher than 0.83% in the experiment group (P < 0.05).ConclusionDespite that ropivacaine and bupivacaine are efficient in anesthesia in the CSEA in the caesarean section, ropivacaine is more recommended for little influence on the hemodynamics, shorter duration of sensory block and motor block and low incidence rate of adverse reactions, which are conducive to the recovery and also safe to the patients.     

On the structure and dynamics of the complex of the nucleosome and the linker histone

Several different models of the linker histone (LH)–nucleosome complex have been proposed, but none of them has unambiguously revealed the position and binding sites of the LH on the nucleosome. Using Brownian dynamics-based docking together with normal mode analysis of the nucleosome to account for the flexibility of two flanking 10 bp long linker DNAs (L-DNA), we identified binding modes of the H5-LH globular domain (GH5) to the nucleosome. For a wide range of nucleosomal conformations with the L-DNA ends less than 65 Å apart, one dominant binding mode was identified for GH5 and found to be consistent with fluorescence recovery after photobleaching (FRAP) experiments. GH5 binds asymmetrically with respect to the nucleosomal dyad axis, fitting between the nucleosomal DNA and one of the L-DNAs. For greater distances between L-DNA ends, docking of GH5 to the L-DNA that is more restrained and less open becomes favored. These results suggest a selection mechanism by which GH5 preferentially binds one of the L-DNAs and thereby affects DNA dynamics and accessibility and contributes to formation of a particular chromatin fiber structure. The two binding modes identified would, respectively, favor a tight zigzag chromatin structure or a loose solenoid chromatin fiber.     

Initiating and promoting the aquatic ecosystem health concept: the Society and the Journal

Since the 1970's the management of aquatic habitats has changed from piecemeal monitoring to the ecosystem approach; this was initiated in the North American Great Lakes, comprising social, economic, and environmental aspects. The information included in this paper is based on the presentation made at the Seminar On Ecosystem Approach To Water Management held in Oslo, Norway during 1991. Recently, the multidisciplinary, holistic, and integrated concept of ecosystem health has emerged, and is being advanced for the implementation of an ecosystem approach to environmental management, which has resulted in the formation of an international society (Aquatic Ecosystem Health & Management Society) and the publication of a primary journal (Journal of Aquatic Ecosystem Health). The information has been updated to incorporate new developments and recent progress about the Society and the journal since the Oslo Seminar.