Sister-chromatid exchanges in operating room personnel.

Sister-chromatid exchange (SCE) analysis was carried out in 67 operating room personnel (anaesthetists M.D.; anaesthesia nurses and anaesthesia unit technicians) exposed to waste anaesthetic gases such as halothane, nitrous oxide and isoflurane and in 50 healthy unexposed controls. The SCE frequencies were increased significantly in operating room personnel as compared to controls. A significant increase in SCEs was found in non-smoking operating room personnel as compared to non-smoking controls. This study supports the existence of an association between occupational exposure to mutagens and an increase in SCEs in lymphocytes.     

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。     

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。     

规范化培训与量化绩效考核对手术室感染率的影响

目的 探讨规范化培训与量化绩效考核对手术室感染率的影响。方法 2012年1—12月对我院手术室护理人员进行规范化培训并实施量化绩效考核,与2011年1—12月感染率情况进行比较。结果 对手术室护理人员规范化培训,采取量化绩效考核之后,手术室感染率由1.46%下降到0.70%（P=0.001）。结论 在护理管理中对护理人员进行规范化培训,并绩效考核量化其工作内容,能够调动其工作积极性,降低手术室感染率并提高护理服务质量。     

Contribution of wood stoves and fire places to mutagenic activity of airborne particulate matter inside homes

Wood combustion produces compounds that are mutagenic in the Salmonella/microsome assay. As combustion products can be emitted in the home and the use of wood as a residential energy source is growing, an impact on human health might be of concern. In this study experiments were carried out to determine the contribution of wood combustion in stoves and fire places to indoor mutagenic activity under normal living conditions. Airborne particles from living rooms which were heated by stoves, or by fire places, and from outdoors were collected simultaneously. In each room two samples were collected during two consecutive weeks: one week the room was heated by central heating, the other week by wood combustion. Sampling took place in a total of 24 homes. Methanol extracts of the samples were tested in the Salmonella/mammalian microsome assay. Results show that mutagenic activity of outdoor air exceeds indoor mutagenicity. At the same time a correlation is found between in- and out-door mutagenicity, both with and without S9. However, a large difference is found between the ratio -S9/+S9 of in- and out-door mutagenic activity. Systematic differences in the ratio -S9/+S9 between control and experimental conditions are not observed. The use of wood stoves caused an increase of indoor mutagenicity in 8 out of 12 homes. It could be concluded that the use of an open fire consistently leads to an increase of mutagenic activity. This increase was caused by wood combustion products.     

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。     

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。     

某军队大型综合医院全麻择期手术流程的干预研究

手术室是为病人提供手术及抢救的场所,是医院的重要核心技术部门。手术室的正常、高效、科学运行关系到了所有外科科室及与手术相关科室的整体效率。因此,针对目前手术科室术前等待时间过长,手术台次安排低效的情况,通过对某军队大型三级甲等医院24 间手术室的全麻手术运行情况进行跟踪调查,运用专家咨询、调查问卷、头脑风暴等方法对手术运转流程进行分析并采取干预措施,破除制约手术科室的瓶颈,提高手术科室的效率。     

OPERATING ROOM DEATHS—An Analysis of Mortality in a Veterans Administration Hospital Over a Ten-Year Period

A study of operating room and recovery room deaths which occurred during a ten-year period from 1948 through 1957 at one hospital revealed that there were 59 deaths associated with 57,132 surgical procedures.Factors which directly influenced the rate of operating room and recovery room death were the age of the patient and the length of operating time. Seventy-five per cent of the deaths occurred in cases in which the operation took longer than one hour. Combined anesthesia techniques may have indirectly contributed to death in some cases.Complications of operation requiring another surgical procedure sometimes occur. In this series, reoperation proved to be more hazardous in terms of mortality rate than did single operations. This is not surprising for most complications occur in the poorer risk patients.The operating room death rate steadily increased during the ten-year period studied. This increasing death rate can largely be attributed to the more intricate operations which are being done on poorer risk patients. The use of the curariform drugs had no influence on the increasing death rate.     

Operating room deaths; an analysis of mortality in a Veterans Administration hospital over a ten-year period

A study of operating room and recovery room deaths which occurred during a ten-year period from 1948 through 1957 at one hospital revealed that there were 59 deaths associated with 57,132 surgical procedures. Factors which directly influenced the rate of operating room and recovery room death were the age of the patient and the length of operating time. Seventy-five per cent of the deaths occurred in cases in which the operation took longer than one hour. Combined anesthesia techniques may have indirectly contributed to death in some cases. Complications of operation requiring another surgical procedure sometimes occur. In this series, reoperation proved to be more hazardous in terms of mortality rate than did single operations. This is not surprising for most complications occur in the poorer risk patients. The operating room death rate steadily increased during the ten-year period studied. This increasing death rate can largely be attributed to the more intricate operations which are being done on poorer risk patients. The use of the curariform drugs had no influence on the increasing death rate.     

Modeling forest fire risk based on GIS-based analytical hierarchy process and statistical analysis in Mediterranean region

This study proposed an integrated approach to generating a forest fire risk map. It used geographic information system–based multiple criteria decision analysis (GIS-MCDA) with the analytic hierarchy process (AHP) and a statistical index (SI). The research was carried out at the Mersin Regional Directorate of Forestry (RDF) in the eastern Mediterranean region of Turkey. Four main criteria, the forest structure, topography, environment, and climate, and 16 subcriteria were used to create the fire risk map. The weight of each criterion was determined using the AHP. The AHP model revealed that environmental factors are the most influential in igniting forest fires, followed by the forest structure. In order to evaluate the results, 990 historical forest fire ignition points were obtained from the Mersin RDF. According to the forest fire risk map, more than 85% of the ignition points were in areas classified as having an extreme or high risk for forest fires. The findings show that the study area is highly prone to forest fires. The relative operating characteristic curve and area under the curve were used to validate the accuracy of the fire risk map. This validation revealed a very high accuracy of 0.775 for the AHP model, indicating a high accuracy in forest fire risk mapping, and the map produced was consistent and reliable. The AHP model and its results will assist decision makers in taking necessary precautions to prevent forest fires and to minimize fire damage, particularly in the eastern Mediterranean region.     

Air Quality Monitoring of the Post-Operative Recovery Room and Locations Surrounding Operating Theaters in a Medical Center in Taiwan

To prevent surgical site infection (SSI), the airborne microbial concentration in operating theaters must be reduced. The air quality in operating theaters and nearby areas is also important to healthcare workers. Therefore, this study assessed air quality in the post-operative recovery room, locations surrounding the operating theater area, and operating theaters in a medical center. Temperature, relative humidity (RH), and carbon dioxide (CO₂), suspended particulate matter (PM), and bacterial concentrations were monitored weekly over one year. Measurement results reveal clear differences in air quality in different operating theater areas. The post-operative recovery room had significantly higher CO₂ and bacterial concentrations than other locations. Bacillus spp., Micrococcus spp., and Staphylococcus spp. bacteria often existed in the operating theater area. Furthermore, Acinetobacter spp. was the main pathogen in the post-operative recovery room (18%) and traumatic surgery room (8%). The mixed effect models reveal a strong correlation between number of people in a space and high CO₂ concentration after adjusting for sampling locations. In conclusion, air quality in the post-operative recovery room and operating theaters warrants attention, and merits long-term surveillance to protect both surgical patients and healthcare workers.     

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。     

Bronchiolitis obliterans in a man who used his wood-burning stove to burn synthetic construction materials

Many people heat their homes with wood-burning stoves. However, toxic fire effluent can escape from old or improperly operated stoves. The authors describe a case in which bronchiolitis obliterans developed in a man within hours after he burned synthetic construction materials in his wood-burning stove. Certain factors, such as careless or improper use of the stove, the size of the room, the lack of open-air ventilation and the composition of the materials burned, strongly point to inhalation of the fire effluent as the cause.     

Inhalation anesthetics.

The inhalation anesthetics affect operating room personnel as well as the patient. This occupational exposure is similar in all respects to industrial solvent exposures. Although the extent of the hazard is not yet established, it is clear that only quite low levels of these active chemical should be allowed in the operating room air.     

The mutagenicity of electrocautery smoke.

Careful analysis of electrocautery smoke produced during breast surgery has found organic compounds that are unidentifiable with current analytical techniques. The purpose of this study was to determine the potential mutagenicity of the smoke produced by the electrocautery knife during reduction mammaplasty. Multiple air samples were collected in the operating room during two reduction mammaplasty procedures. Airborne smoke particles were tested for mutagenic potential in both tester strains of Salmonella typhimurium (TA98 and TA100) using the standard Salmonella microsomal test (Ames test). All testing was performed by the Hazard Evaluations and Technical Assistance Branch of the National Institute of Occupational Safety and Health. The smoke produced with the electrocautery knife during reduction mammaplasty was found to be mutagenic to the TA98 strain. The Ames test, an established technique for evaluating the mutagenicity of a substance, was convincingly positive for the smoke collected during the breast surgery. Whether the smoke represents a serious health risk to operating room personnel is not known. Development of techniques to limit electrocautery smoke exposure in the operating room appears to be needed, and surgeons should attempt to minimize their exposure.     

Fire regimes of China: inference from statistical comparison with the United States

Aim Substantial overlap in the climate characteristics of the United States and China results in similar land‐cover types and weather conditions, especially in the eastern half of the two countries. These parallels suggest similarities in fire regimes as well, yet relatively little is known about the historical role of fire in Chinese ecosystems. Consequently, we aimed to infer fire regime characteristics for China based on our understanding of climate–fire relationships in the United States. Location The conterminous United States and the People's Republic of China. Methods We used generalized additive models to quantify the relationship between reference fire regime classes adopted by the LANDFIRE initiative in the United States, and a global climate data set. With the models, we determined which climate variables best described the distribution of fire regimes in the United States then used these models to predict the spatial distribution of fire regimes in China. The fitted models were validated quantitatively using receiver operating characteristic area under the curve (AUC). We validated the predicted fire regimes in China by comparison with palaeoecological fire data and satellite‐derived estimates of current fire activity. Results Quantitative validation using the AUC indicated good discrimination of the distribution of fire regimes by models for the United States. Overall, fire regimes with more frequent return intervals were more likely in the east than in the west. The resolution of available historical and prehistorical fire data for China, including sediment cores, allowed only coarse, qualitative validation, but provided supporting evidence that fire has long been a part of ecosystem function in eastern China. MODIS satellite data illustrated that fire frequency within the last decade supported the classification of much of western China as relatively fire‐free; however, much of south‐eastern China experiences more fire activity than predicted with our models, probably as a function of the extensive use of fire by people. Conclusions While acknowledging there are many cultural, environmental and historical differences between the United States and China, our fire regime models based on climate data demonstrate potential historical fire regimes for China, and propose that large areas of China share historical fire–vegetation–climate complexes with the United States.     

浅谈眼科手术室患者感染危险因素及防控措施

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。