医院医疗设备管理存在的问题及对策初探

现代医院的生存与发展离不开优秀的医务工作者,更需要高精尖的医疗设备进行辅助。医院医疗设备主要包括诊断设备、 治疗设备及辅助设备。先进的医疗设备不仅为医疗水平的提高提供了有力保证,同时也是医院实力的体现。近年来医疗机构改革 不断深入,大部分医院均加大了在先进医疗设备上的投资,但在医院的现代化建设中,医疗设备管理存在诸多问题,包括设备管 理人员稀缺、配置不均衡、重用轻管、制度监管不严等,这些问题如不能及时解决,可能会导致设备仪器诊疗结果不准确,进一步 影响患者的病情恢复,损害医院的经济效益及社会效益。2011 年我国卫生部公布的《医疗卫生机构医学装备管理办法》中,规定医 疗卫生机构的医学装备管理实行机构领导、医学装备管理部门和使用部门三级管理制度,为医院医疗设备管理进行了规范。本文 对医院医疗设备管理常见的问题进行分析总结,并提出一系列改善措施,以期为医院医疗设备实现科学化管理,及长期、安全、有 效使用提供参考,提升医院服务质量,增加医院经济效益及社会效益。     

影像设备电路板测试与故障诊断之系统实现

大型医学影像设备是医院中的贵重设备,其中不少进口设备的维护修理的技术难度较高,医院每年花费在医学影像设备上的维护修理费是非常之大。本文从建立国内的维修力量着眼,研讨医学影像设备维修方法。     

试析医院制剂室设备和器具改造的思路

本文主要对医院制剂室制药设备及器具的选择、制药设备材质的选择、制药设备的技术性能、制药设备的生产能力、利旧设备的改造处理等方面进行分析,为医院制剂室设备和器具改造提供良好的建议。     

现代医院设备采购管理的探索

医院的采购管理是医院设备管理的重要组成部,该文分析了当今医院设备采购的原则、相关流程及评标方法进行了技术探讨和解析。     

基于Android系统的医院设备共享服务管理系统

为了提高设备利用率,大多医院将部分设备集中放置于病区服务中心,供全院科室共享使用,但是设备的借用、归还登记依然采用手工模式,这种模式工作效率低下且数据统计难度大。为了解决该问题,本文设计开发了一套基于Android系统的医院设备共享服务管理系统。该系统利用二维码作为设备唯一识别标识,利用Android移动终端软件扫描设备二维码获取该设备基础信息,并通过Web Service接口从数据服务器中获取设备详细信息后进行共享服务管理操作。该软件系统采用Java+MVC框架开发,利用SQL Server 2008实现设备信息存储、共享。通过对徐州医科大学附属医院病区服务中心200余台设备的日常共享服务管理的实际应用与测试,该系统能很好的优化医院设备共享服务管理流程,提高了设备管理人员工作效率。     

新医改背景下医疗设备信息化管理存在的问题及解决对策探究

医疗设备是医院的重要资产,可在一定程度上反映医院的诊断能力以及现代化程度。新医改政策出台后,各地均大力推进医药卫生信息化建设,随着医疗设备种类的增加,给医院设备管理带来一定的困难,医疗设备信息化管理已成为医院不可或缺的一部分。我国的医疗设备信息化管理起步较晚,尚处于初级研究阶段,从而导致现阶段医疗设备信息化管理问题较多。本文简短叙述了医疗设备信息化管理现状,以及当前医疗设备信息化管理所存在的问题,并对所描述问题提出针对性的解决方案。     

医院设备利用率管理的探究

分析了医院医疗设备利用率管理的现状,提出了医疗设备利用率管理的前期工作与实施方法。建立设备的性能价值评定标准以及加强设备的维护保养工作都是提高设备利用率的有效途径。     

医院设备的接地方式探讨

本文根据某些医院设备接地方式上存在的问题提出了十条改进意见，并建议制订了《医院设备接地方式指南》强制性规范，改善防电击安全性。     

医院计算机化医疗设备的维护管理

现代医疗设备大都采用了计算机化设计,分析了目前医院拥有的计算机现状、医疗设备的分类和管理。最后,提出了维护管理措施。     

浅谈设备维修人员的应急能力

先进的医疗仪器是现代化医院的重要组成部分,及时做好医疗仪器的维修工作是充分发挥医疗仪器作用的保证。医疗仪器维修质量的高低,直接影响到仪器完好率和使用率,也是医院医疗工作正常运转的保证。随着中国现代化建设不断发展,一些县级医院医疗设备不断增添和更新,各种高、精、尖技术进口设备应用到临床,伴随而来的维修人员队伍也越来越大。这些年来实践证明,维修人员在对支持临床医疗工作中起着重要的作用,但由于维修技术队伍素质差,技术水平低,难以适应换代产品的技术进展。目前医疗设备进入以电脑芯片控制为重要模式的大规模集成电路时代,而我们的维修人员多数仍停留在晶体管时代,个别的处于电工水平,从技术发展阶段来看,已落后一个时代,不能发挥应有的作用。从全局来看,在新技术日新月异的今天,我们设备维修人员面临如何提高技术素质的迫切任务。因此现在完全有必要提出加强“应急能力”的训练。     

Sterilization of various diameter dead-ended tubes

Effect of tube diameter on steam-in-place sterilization of dead-ended tubes was studied by examining temperature profiles and rates of kill of Bacillus stearothermophilus spores. Time required for sterilization was determined for 9.4-cm-long tubes with various inside diameters from 0.4 to 1.7 cm. Sterilization time increased with decreasing tube diameter. Experimentally measured kill kinetics in 1.7-cm tubes were in agreement with those predicted if measured temperatures represented saturated steam. A 12-log spore reduction was achieved in 1.7-cm diameter vertical and horizontal tubes in less than 63 minutes. For smaller diameter tubes, entrapped air remained after 2 hours and rates of kill were very dependent on position within the tube, tube diameter, and tube orientation with respect to the gravitational vector. Times to achieve a 1-log drop in spore population in the smaller tubes were as much as 10 times greater than those expected if measured temperatures represented saturated steam. Sterilization was not achieved throughout the 0.4-cm tubes. Recommendations are made for including steam bleeders or using prevaccum cycles for these smaller diameter tubes. (c) 1993 John Wiley & Sons, Inc.     

Temperature dependence of F-, D- and z-values used in steam sterilization processes

Aims:  To develop a model, based on microbiological principles, to safely optimize steam sterilization processes.
Methods and Results:  The minimum exposure time F for a decontamination process at a certain temperature is usually calculated from an empirical model with the decimal reduction time D and the temperature resistance coefficient z as parameters. These are implicitly assumed to be independent of temperature. Using a microbiological approach, it is shown that also D and z depend on temperature, indicating that the usual models provide only reliable results in a limited temperature region. The temperature dependence of F resulting from this approach describes the available experimental data very well. Safety margins to assure sterility can be included in a straightforward way.
Conclusions:  The results from the present approach can be used to safely optimize decontamination processes. The corresponding mathematical model can be implemented rather directly in process control systems.
Significance and Impact of the Study:  Our results show that for steam sterilization and disinfection processes the values of F predicted by the usual models largely underestimate the required minimum exposure times at temperatures below 120°C. This has important consequences for the optimization of such processes.     

Modeling transport processes in sterilization-in-place.

SIP (sterilization-in-place) of equipment using saturated steam is limited by transport processes that restrict the distribution of sterilizing steam. The following are two crucial operations: the removal of air prior to sterilization, and the removal of condensate during the sterilization. Using simple model systems of pipes and tanks, characteristic operating parameters were examined and steady-state models were analyzed. The results were used to evaluate design aspects of SIP, including heat insulation, spacing of steam traps, sloping of lines, steam velocities and consumption, placement of temperature sensors, and scale factors in piping. A more reliable SIP design is achievable by insulating equipment, spacing steam traps to limit condensate buildup, providing an effective air removal operation, and providing reliable, high-quality steam.     

Application of a dense gas technique for sterilizing soft biomaterials

Sterilization of soft biomaterials such as hydrogels is challenging because existing methods such as gamma irradiation, steam sterilization, or ethylene oxide sterilization, while effective at achieving high sterility assurance levels (SAL), may compromise their physicochemical properties and biocompatibility. New methods that effectively sterilize soft biomaterials without compromising their properties are therefore required. In this report, a dense-carbon dioxide (CO(2) )-based technique was used to sterilize soft polyethylene glycol (PEG)-based hydrogels while retaining their structure and physicochemical properties. Conventional sterilization methods such as gamma irradiation and steam sterilization severely compromised the structure of the hydrogels. PEG hydrogels with high water content and low elastic shear modulus (a measure of stiffness) were deliberately inoculated with bacteria and spores and then subjected to dense CO(2) . The dense CO(2) -based methods effectively sterilized the hydrogels achieving a SAL of 10(-7) without compromising the viscoelastic properties, pH, water-content, and structure of the gels. Furthermore, dense CO(2) -treated gels were biocompatible and non-toxic when implanted subcutaneously in ferrets. The application of novel dense CO(2) -based methods to sterilize soft biomaterials has implications in developing safe sterilization methods for soft biomedical implants such as dermal fillers and viscosupplements.     

高压蒸汽灭菌对钛合金内植入物的疲劳的影响

分析了制约骨折手术成功的因素,一是钛合金内植人物经受长期反复高压蒸汽灭菌造成材料疲劳引起断裂;二是AO手术的引起应力集中和疲劳断裂。提出了发展骨内固定植入物的建议。     

RFID技术在手术灭菌器械质量追溯管理中的应用

根据原卫生部提出的手术灭菌器械的可追溯管理要求,采用RFID信息化追溯管理技术,通过与医院HIS对接,结合无线网络、中间件等技术,实现了手术器械从回收、清洗、检查、包装、灭菌、发放和使用各个关键环节信息数据的全程跟踪监控,有效保证了各类手术器械的质量管理,使消毒供应中心工作更加科学、规范、高效、便捷,提升了医院手术器械的管理水平。     

灭菌对杀菌剂药效的影响

灭菌会对杀菌剂的药效生产影响,实验表明,高压灭菌和常压灭菌对多菌灵,甲基托布津等杀菌的药效均会产生影响。     

VACUUM DRYING OF STEAM STERILIZED DRESSINGS

SUMMARY: The degree of vacuum and time of application needed to dry steam sterilized dressings has been investigated. If the steam supply is dry, and the pressure in the drying stage is reduced to an absolute pressure of 50 mm Hg, dressings will be cool and dry without holding the vacuum, provided they are not damp before sterilization.     

不同消毒方法对生物化PET 人工韧带的生物力学影响

目的:探讨环氧乙烷、高压蒸汽、60Co照射三种消毒方法,对生物化PET人工韧带的生物力学影响,为选取合适的消毒灭菌方法提供实验依据。方法:以表面改性的聚对苯二甲酸乙二醇酯纤维为材料,制备生物化PET人工韧带,分别给予环氧乙烷熏蒸、高压蒸汽、60Co照射消毒处理,并设未作消毒处理的空白对照组,分别进行生物力学测试,对测量结果行统计学比较分析。结果:高压蒸汽消毒后,韧带所能承受的最大拉力及第一次破裂力降低,且与对照组间的差异均有统计学意义(P<0.05);60Co照射消毒后,韧带所能承受的最大拉力降低,与对照组间的差异有统计学意义(P<0.05),但第一次破裂力的差异不明显(P>0.05);环氧乙烷消毒处理后,最大拉力、第一次破裂力与对照组之间无明显差异(P>0.05);各组间断裂伸长率无明显差异(P>0.05)。结论:高压蒸汽消毒后韧带样品的生物力学性能降低比较明显;采用60Co射线消毒方法对产品的力学性能影响较小,但进一步的消毒方法改进可能更为理想;环氧乙烷消毒法可作为生物化PET人工韧带的有效消毒方法。     

In vitro biocompatibility evaluation of a heat‐resistant 3D printing material for use in customized cell culture devices

Additive manufacturing (3D printing) enables the fabrication of highly customized and complex devices and is therefore increasingly used in the field of life sciences and biotechnology. However, the application of 3D‐printed parts in these fields requires not only their biocompatibility but also their sterility. The most common method for sterilizing 3D‐printed parts is heat steam sterilization—but most commercially available 3D printing materials cannot withstand high temperatures. In this study, a novel heat‐resistant polyacrylate material for high‐resolution 3D Multijet printing was evaluated for the first time for its resistance to heat steam sterilization and in vitro biocompatibility with mouse fibroblasts (L929), human embryonic kidney cells (HEK 293E), and yeast (Saccharomyces cerevisiae (S. cerevisiae)). Analysis of the growth and viability of L929 cells and the growth of S. cerevisiae confirmed that the extraction media obtained from 3D‐printed parts had no negative effect on the aforementioned cell types, while, in contrast, viability and growth of HEK 293E cells were affected. No different effects of the material on the cells were found when comparing heat steam sterilization and disinfection with ethanol (70%, v/v). In principle, the investigated material shows great potential for high‐resolution 3D printing of novel cell culture systems that are highly complex in design, customized and easily sterilizable—however, the biocompatibility of the material for other cell types needs to be re‐evaluated.