浅谈一体化功能手术室

分析了传统手术室的现状与存在问题,提出将手术室设备与医院信息整合,组建一体化功能手术室是医院发展方向。建议对手术室一体化设制制定专门标准。     

哈尔滨市综合医院手术室病人安全管理现状与对策研究

采用随机抽样的方法,在哈尔滨市随机抽取5家三级、5家二级综合医院的手术室进行病人安全管理现状调查。从手术室护理人员构成、人员培训、规制、布局流程、设备配置、病人辨识、消毒灭菌、医护配合8个方面全面分析了目标医院在手术室病人安全管理方面存在的问题,并提出改进对策,旨在改善手术室管理现状,保障手术室病人安全。     

手术室工作流程现状分析

目的 通过具体的手术室流程分析，探索医院手术室流程科学合理的管理方法。方法 运用现场调研法对手术室的流程进行考察分析，并应用流程图的方法显化现有手术室的流程，对现有流程采用德尔菲法和FTA的方法进行分析。结果 得到手术室工作流程的问题报告。结论 手术室的流程问题主要有：等待浪费，沟通失效，操作行为不当，管理技术不当，设施布局不合理。     

关于外科手术室感染控制的问题与护理管理分析

目的:总结外科手术室感染控制存在的问题,并分析相应的护理管理对策。方法:对我院2012年1月-2012年12月手术室感染高危因素进行总结分析,并提出相应的护理管理措施,比较外科手术室实施护理管理前后的感染情况。结果 外科手术室感染高危因素主要包括术前洗手不彻底、器械物品消毒不认真、医护人员流动管理不严格、以及患者自身的因素等;实施护理管理措施后感染率为2.39%(9例/376例),明显低于实施护理管理前的感染率9.52%(35例/368例),差异有统计学意义(P<0.05)。结论:在外科手术室加强护理管理可以明显的降低感染率,为患者在外科手术室的安全提供了保障。     

医院手术室运行效率分析及改进策略探讨

通过对某院为期一年的手术记录和为期两月的停台手术记录进行挖掘与分析,了解手术室及相关手术科室的工作量和工作效率,分析手术停台原因,提出改进策略。结果显示,手术室运行效率存在改进空间。应改善手术室工作流程,缩短术前时间;加强患者术前监测,降低手术暂停比例;改进手术麻醉信息系统,持续改进手术质量,提高手术效率。     

医院中央空调系统与手术室净化层流空调系统并网应用的实践与体会

通过将中央空调系统与手术室净化层流空调系统、静脉药物配置中心并网运行的实例,引出如下思考：在医院建设过程中,将空调系统的应用要求分类归纳,并进行整体规划、设计和施工,对节能、满足不断产生的服务需求和设备运行安全等方面大有裨益。     

PBL教学法在手术室专科护士培训中的运用

目的研究以问题为基础的教学法(PBL)在手术室专科护士培训中的应用效果。方法对我科2010~2016年进行的6期手术室专科护士培训实施PBL教学,在教学过程中,老师或学员提出相关问题,由学员自己找出答案,再由小组讨论,老师修正答案,实现理论与实践的结合。结果 PBL教学方法的实施,提高了学员的学习积极性和临床操作能力,培养了学员自学能力,提高了学员综合素质。结论PBL教学法能激发学员的学习兴趣,提高学习主动性,从而提高了教学质量。     

住院择期手术取消的国内外研究进展

手术室资源是医院关键医疗资源之一,具有多维、不确定性。手术室资源的调度、优化与使用是一个非常重要的研究问题。基于国内大型三甲医院住院择期手术需求巨大与有限的手术室资源之间的矛盾,分析国内外住院择期手术取消的研究现状,包括定义、取消率、取消原因及分类、影响因素、对策及建议,为我国手术室管理提供参考,这对减少资源浪费、提高资源利用率具有重要的指导意义。     

手术室人员配合外伤性颅脑手术的体会

手术室人员配合外伤性颅脑手术的体会李凤（贵港市人民医院５３７１００）颅脑外伤多发生于车祸，其次为生产意外，打架斗欧等。其发病急，病情变化快，病死率高。有时多个病人同时入院，甚至由现场直接送入手术室。如果抢救不及时或抢救措施不得力，极易导致死亡。因此，...     

浅谈手术室护理工作中应注意的问题

手术室是外科病人治疗疾病的重要场所。手术是通过侵入性操作为病人解除病痛。为伤员医治创伤的手段。随着医疗体制的改革,法律知识的普及,病人在就诊过程中的自我保护意识不断增强。对医疗保健水平的要求也随之增高．投诉和付诸法律的医疗纠纷呈上升趋势。这就对医务工作者提出了更高的要求。特别是手术室的工作涉及面广,工作节奏快,患者病情复杂．意外情况发生多,产生医疗纠纷甚至医疗事故的可能性大。一刀一剪,一针一线都是确保生命安全取得手术成功不可忽视的细节。作者根据多年的工作经验,对手术室护理工作中应注意的问题作一简述。     

基于数学优化的手术室调度研究

手术室是医院的重要医疗资源,通过有效流程优化及使用麻醉恢复室,其运转效率不断提高,但是仍然不能满足患者和临床科室日益增长的医疗服务需求,仍然存在手术室过度利用和利用不足的情况。人工手术资源调度一定程度提高手术资源利用效率,而借助计算机系统的数学协同优化的手术资源调度,能弥补人工调度的不足,实现系统资源匹配与动态实时优化,有效减少手术患者住院等待时间、提高手术资源利用效率。     

浅谈眼科手术室患者感染危险因素 及防控措施

摘要：目的 分析眼科手术室患者感染危险因素,讨论感染风险管理对策。方法 回顾2017年7月至2018年8月我院眼科手术室患者的感染情况,分析感染危险因素并制定应对策略。结果 2017年7月至2018年8月我院共实施眼科手术1 987只眼,均未发生感染。空气污染,医疗器械污染,防控意识薄弱可能是患者发生感染的危险因素。结论 规范流程可以有效规避眼科手术感染,注重细节管理是预防眼科手术感染的关键。     

手术室护士对外科手消毒相关知识的认知状况调查分析

目的:了解手术室护士对外科手消毒相关知识的认知状况,为手术室管理者提供护士掌握外科手消毒知识的整体水平,以全面提高外科手消毒的效果。方法:自行设计的问卷对哈尔滨市8家三级甲等综合性医院手术室护士进外科手消毒相关知识的认知调查。结果:目前手术室护士掌握外科手消毒相关知识的状况不容乐观,共20个被调查问题,回答正确率平均为49.85%;工作年限、第一学历、职称、学习过《医务人员手卫生规范》、消毒重要性的认识对答题结果的影响具有统计学意义(P0.05),表现为工作年限时间越长、第一学历越低、职称越高、学习过《医务人员手卫生规范》的、认为外科手术消毒重要的护士理论知识掌握情况越好。结论:被调查者自主学习较差,手术室管理者应当注重和加强手术室护士的外科手消毒专题学习培训与考核,理论与实践相结合,不断探索长期、可持续的培训教育模式,管理者制定与临床工作相结合并且适合不同学历背景和年资护士的培训方式和学习计划。充分调动护士的自我管理意识,建立外科手消毒"品管圈",分析和解决问题,使手术室的护理质量在持续的改进中得到不断提高。     

手术室非惩罚性护理不良事件报告制度的建立

手术室护理不良事件发生率影响因素较多,建立非惩罚性护理不良事件报告制度是非常有效的控制不良事件的方法。通过在本院手术室建立非惩罚性护理不良事件报告制度,对上报的护理不良事件分析发生的根本原因并提出修正方案及预防措施,提升护理质量,完善护理流程及管理制度。     

Patient doses and occupational exposure in a hybrid operating room

PurposeThis study aimed to characterize the radiation exposure to patients and workers in a new vascular hybrid operating room during X-ray-guided procedures.MethodsDuring one year, data from 260 interventions performed in a hybrid operating room equipped with a Siemens Artis Zeego angiography system were monitored. The patient doses were analysed using the following parameters: radiation time, kerma-area product, patient entrance reference point dose and peak skin dose. Staff radiation exposure and ambient dose equivalent were also measured using direct reading dosimeters and thermoluminescent dosimeters.ResultsThe radiation time, kerma-area product, patient entrance reference point dose and peak skin dose were, on average, 19:15 min, 67 Gy·cm², 0.41 Gy and 0.23 Gy, respectively. Although the contribution of the acquisition mode was smaller than 5% in terms of the radiation time, this mode accounted for more than 60% of the effective dose per patient. All of the worker dose measurements remained below the limits established by law.ConclusionsThe working conditions in the hybrid operating room HOR are safe in terms of patient and staff radiation protection. Nevertheless, doses are highly dependent on the workload; thus, further research is necessary to evaluate any possible radiological deviation of the daily working conditions in the HOR.     

Decontamination with vaporized hydrogen peroxide is effective against Mycobacterium tuberculosis

AIMS: To determine the efficacy of room fumigation with vaporized hydrogen peroxide (VHP) in decontamination of viable Mycobacterium tuberculosis. METHODS AND RESULTS: About 8 x 10(4)-2.3 x 10(6) CFU of M. tuberculosis H37Rv and M. tuberculosis Beijing were dried in 10-microl drops in tissue culture plates, placed in steam-permeable Tyvek pouches and distributed on laboratory surfaces. The room was exposed to VHP delivered by air conditioning. Different exposure conditions were tested. Exposure to VHP resulted in sterilization of the bacterial samples in three different test runs. CONCLUSIONS: VHP treatment is an effective means of reducing and eliminating room contaminations of M. tuberculosis. SIGNIFICANCE AND IMPACT OF THE STUDY: Fumigation with VHP represents an alternative to formaldehyde fumigation, particularly for decontamination of animal rooms in tuberculosis research laboratories.     

Improving cancer patient emergency room utilization: A New Jersey state assessment

IntroductionDue to its increasing incidence and its major contribution to healthcare costs, cancer is a major public health problem in the United States. The impact across different services is not well documented and utilization of emergency departments (ED) by cancer patients is not well characterized. The aim of our study was to identify factors that can be addressed to improve the appropriate delivery of quality cancer care thereby reducing ED utilization, decreasing hospitalizations and reducing the related healthcare costs.MethodsThe New Jersey State Inpatient and Emergency Department Databases were used to identify the primary outcome variables; patient disposition and readmission rates. The independent variables were demographics, payer and clinical characteristics. Multivariable unconditional logistic regression models using clinical and demographic data were used to predict hospital admission or emergency department return.ResultsA total of 37,080 emergency department visits were cancer related with the most common diagnosis attributed to lung cancer (30.0%) and the most common presentation was pain. The disposition of patients who visit the ED due to cancer related issues is significantly affected by the factors of race (African American OR = 0.6, p value = 0.02 and Hispanic OR = 0.5, p value = 0.02, respectively), age aged 65 to 75 years (SNF/ICF OR 2.35, p value = 0.00 and Home Healthcare Service OR 5.15, p value = 0.01, respectively), number of diagnoses (OR 1.26, p value = 0.00), insurance payer (SNF/ICF OR 2.2, p value = 0.02 and Home Healthcare Services OR 2.85, p value = 0.07, respectively) and type of cancer (breast OR 0.54, p value = 0.01, prostate OR 0.56, p value = 0.01, uterine OR 0.37, p value = 0.02, and other OR 0.62, p value = 0.05, respectively). In addition, comorbidities increased the likelihood of death, being transferred to SNF/ICF, or utilization of home healthcare services (OR 1.6, p value = 0.00, OR 1.18, p value = 0.00, and OR 1.16, p value = 0.04, respectively). Readmission is significantly affected by race (American Americans OR 0.41, standard error 0.08, p value = 0.001 and Hispanics OR 0.29, standard error 0.11, p value = 0.01, respectively), income (Quartile 2 OR 0.98, standard error 0.14, p value 0.01, Quartile 3 OR 1.07, standard error 0.13, p value 0.01, and Quartile 4 OR 0.88, standard error 0.12, p value 0.01, respectively), and type of cancer (prostate OR 0.25, standard error 0.09, p value = 0.001).ConclusionWeb based symptom questionnaires, patient navigators, end of life nursing and clinical cancer pathways can identify, guide and prompt early initiation of treat before progression of symptoms in cancer patients most likely to visit the ED. Thus, improving cancer patient satisfaction, outcomes and reduce health care costs.