近年来,随着我国预防医学与卫生学领域科研水平的提高和发展,投寄我刊发表的具有科研基金资助项目的论文正在逐年增多.根据国家出版管理部门统计需求和国内外重要数据库著录数据规范采编要求,本刊力求准确完整地报道刊登文章的科研基金资助项目内容,并对基金资助项目的稿件予以优先发表.为此,敬请来稿中凡标有科研基金资助项目内容的作者,在投稿时务必将相应的科研基金项目批准证书复印件与单位介绍信及版权转让协议一并上传,以示该资助项目报道的真实性和严肃性. 谢谢合作!
目的 探讨手术器械预处理流程增加多酶清洗液浸泡对提高手术复用器械清洗质量的影响.方法 抽取1000件手术后复用器械,按随机分组法平均分为2组.对照组采用手术室冲洗加消毒供应科冲洗的常规预处理,试验组采用手术室冲洗加消毒供应科多酶酶液浸泡;采用目测法和ATP荧光检测法检测清洗质量,并记录2组预处理时间和器械返洗件数.结果 与对照组相比,试验组预处理时间短、清洗合格率高、返洗率低,表明其清洗质量优于对照组.结论 改进后的预处理流程有利于提高手术器械清洗质量,可有效预防医院感染.
Objective To assess the health risks of volatile halogenated disinfection byproducts in urban drinking water in Shaanxi Province,and to provide scientific basis for ensuring urban drinking water safety.Methods From 2020 to 2022,the municipal water supply projects in Shaanxi Province which used chlorine disinfection and composite chlorine dioxide disinfection were monitored.The concentrations of four volatile halogenated disinfection byproducts,including trichloromethane(TCM),bromodichloromethane(BDCM),chlorodibromomethane(DBCM),and tribromomethane(TBM),were evaluated for compliance with the GB5749-2022 Sanitary Standards for Drinking Water.The health risks of adult exposure to the four disinfection byproducts through drinking water were evaluated using the health risk assessment method recommended by the US Environmental Protection Agency(USEPA).Results A total of 3662 water samples were monitored from 2020 to 2022,with TCM having a qualified rate of 99.37%,and the remaining indicators BDCM,DBCM,and TBM all meeting the standards.The non-carcinogenic health risk levels for the four disinfection byproducts were in the order of TBM>TCM>BDCM>DBCM.The carcinogenic risk levels for the three disinfection byproducts were in the order of BDCM>TBM>DBCM.There were statistically significant differences in the different disinfection methods,water periods,water samples,and water source types for different indicator concentration levels,non-carcinogenic and carcinogenic health risk levels(P<0.05).Conclusion The non-carcinogenic health risks of volatile halogenated disinfection byproducts in urban drinking water in Shaanxi Province are still at an acceptable level,but attention should be paid to the carcinogenic health risks of BDCM,DBCM,and TBM exposure to ensure urban drinking water safety.
克雅病是一种快速进展的可致死性中枢神经系统变性疾病,属于朊病毒病中最常见的类型.根据不同病因被分为散发型、医源型、遗传型和变异型 [1].虽然在人群中的发病率仅为(0.4～0.8)/100 万,但近年来呈现持续上升的趋势,引起临床广泛的关注 [2-4].由于该病具有传染性且潜伏期长,致死率达 100％[5],因此处理诊疗过程中被污染的医疗物品是防控该病传播的关键.某医院 2022 年 6 月接诊 1 例克雅病患者,本文总结了对其使用的器械进行特殊处理的流程,为制订此类疾病医院感染防控措施提供参考.
Objective To study disinfectant resistance and select related genes of Staphylococcus aureus(S.aureus)from different sources.Methods The gene detection and the quantitative germicidal test were used to detect the resistance of S.aureus to common disinfectants and related genes.Results The killing logarithm values of 75%ethanol,2000 mg/L quaternary ammonium salt,5000 mg/L polyhexamethylene biguanide to S.aureus with 1 min contact time were all>5.00.The average killing logarithm values of 1000 mg/L effective chlorine to 4 clinical strains(No.Y7,Y19,Y24,Y13)with 1 min were all>5.00.The average killing logarithm values of 3000 mg/L trichloro hydroxydiphenyl ether against 4 clinical strains(No.Y7,Y19,Y24,Y13)with 3 min were all<5.00.Drug resistance gene ermA,TetM,mecA,acc-aph and disinfectant resistance gene qacA were detected in 3 clinical strains(No.Y7,Y19,Y24).Conclusion There are different in the resistance of S.aureus to disinfectants between foodborne and hospital sources.Drug resistance genes and disinfectant resistance genes are detected in some clinical strains.
目的 比较不同类型的消毒物品采用纸塑袋包装后在规范环境中的储存时效,为复用医疗消毒物品质量的科学管理提供参考.方法 将7类共560件复用消毒物品用纸塑袋包装后按类别随机分为8组,于临床科室消毒物品储存柜内放置14、30、60、90、120、150、180和210 d,用ATP荧光检测并比较各物品的RLU值.结果 7类物品RLU值均随着储存时间的增加而递增(r值为0.782～0.869),不同消毒物品在同一储存时间下 RLU值存在明显差异(P＜0.001),呼吸机管路和加湿器RLU值相对较高.结论 纸塑袋包装的可复用消毒物品在规范的储存环境存放时间宜在150 d内,应适当缩短纸塑袋包装的呼吸机管路和加湿器的存储时间.
目的 探索内源性内参在判断新型冠状病毒核酸标本检测实验室污染中的应用效果.方法 采取现场采样和检测方法,对某医院新型冠状病毒核酸检测实验室内源性内参检出情况进行调查和分析,并对不同消毒方法清除内源性内参效果进行评价.结果 实验室内各区域均可检出内源性内参,主要分布在移液器、门把手、试验台面、生物安全柜和核酸提取仪等高频接触物体表面.采用含氯消毒剂和75%乙醇消毒湿巾擦拭消毒,均可明显降低重点区域内源性内参检出率.结论 新型冠状病毒核酸检测实验室应定期监测内源性内参污染,对重点区域加强清洁消毒工作,以有效避免标本污染.
支气管镜在重症医学中的应用越来越广泛,已成为重症监护病房(ICU)的核心技术之一,是ICU医师手中的"利器".随着临床应用日益频繁和相关产品种类增多,清洗消毒和临床操作的不规范性亦日渐增加,加之危重患者局部及全身抵抗力减弱,近些年来ICU内支气管镜相关感染(bronchoscopy-related infections, BRI),尤其是耐药菌感染的发生和报道增多.然而,无论是 2005 年的共识还是 2015年美国食品药品管理局(FDA)发布的指导文件, BRI的发病率报道几乎完全基于文献,不包括未披露或未发现的感染,也不包括仅记录在FDA数据库中的感染.因此,确切的BRI发生率是不清楚的.作为一项微创性诊疗技术,科学的清洗消毒流程、合理的养护管理以及规范的临床操作使用是ICU内避免BRI的重要环节.本文就这一相关问题作综述,以为临床参考.
目的 了解某医院呼吸内科下呼吸道感染住院患者呼吸道标本中病原菌分布特点及耐药性.方法 采用回顾性调查,对2017-2021年下呼吸道感染住院患者痰液或支气管分泌物送检标本细菌培养及药物敏感试验结果进行分析.结果 18045例送检标本中检测出病原菌3294株,革兰阴性菌、革兰阳性菌和真菌分别占68.18%、6.86%和24.95%.革兰阴性菌以铜绿假单胞菌、肺炎克雷伯菌、鲍曼复合醋酸钙不动杆菌和嗜麦芽窄食单胞菌为主;革兰阳性病原菌以金黄色葡萄球菌为主.药敏试验结果显示,铜绿假单胞菌对阿米卡星耐药率最低,肺炎克雷伯菌对妥布霉素耐药率最低,未发现对万古霉素、利奈唑胺和替加环素耐药的金黄色葡萄球菌.结论 该院呼吸内科下呼吸道感染病原菌主要以革兰阴性病原菌为主,各病原菌具有不同的耐药特点,临床应加强和重视病原菌的耐药性监测,合理选择抗菌药物.
目的 探讨使用传统紫外线消毒车与医用等离子体空气消毒净化器对医院发热门诊和发热监测哨点病原采样室的消毒效果,为制订防控医院高风险场所感染疾病措施提供参考.方法 在紫外线消毒车或医用等离子体空气消毒净化器对发热门诊和监测哨点采样室消毒前后,采用平板暴露法检测空气中的细菌总数,评价2种消毒设备的消毒效果.结果 紫外消毒灯直接照射60 min和医用等离子体空气消毒净化器开机60 min后,室内空气细菌菌落总数均<4.0 cfu/(皿·5min),达到Ⅲ类环境卫生标准;2种方式消毒后空气细菌菌落数减少量差异无统计学意义(t=0.88,P>0.05).结论 医用等离子体空气消毒净化器消毒效果与紫外线消毒车相同,但可在门诊患者接受诊疗全程使用,且具有杀菌广谱、高效,操作简单等优点,适合在基层医疗机构发热门诊中推广应用.
Objective To investigate the quality of disinfection and sterilization of oral diagnosis and treatment institutions,and analyze the possible risk points of infection prevention and control measures,so as to provide reference for hospital infection prevention and control.Methods 13 secondary and above oral diagnosis and treatment institutions in a district of Beijing had been investigated and monitored by questionnaire survey and disinfection effect testing.Results The investigation showed that 69.2%of the 13 oral diagnosis and treatment institutions had the issue of inadequate layout in the area because of space limitation.All the institutions had relatively completely established the disinfection system,the daily disinfection of the clinic,and the disinfection and sterilization of instruments were basically good,some institutions had the issue of inadequate disinfection.The disinfection effect monitoring showed that the air and material surface had high qualification rate,up to 100%.The hand hygiene of medical staff had relatively low qualification rate,about 87.5%.Conclusion The disinfection and sterilization of dental diagnosis and treatment agencies in a district of Beijing is generally good,but the layout of a small number of institutions is unreasonable.We should strengthen the management of regulatory and improve the weakness of disinfection and sterilization.
Objective To study the preservative and antibacterial effects of nano platinum disinfectant on fruits,so as to providing reference for the application of fruit preservation.Methods The growth rate method,soaking method,and fruit punching test were used to detecting the antibacterial activity and fruit preservation effect of nano platinum disinfectant.Results The in vitro antibacterial rate of 5.0 μg/mL nano platinum disinfectant against Penicillium italicum and Botryosphaeria dothidea were 100%.Perforating with a concentration of 2.5 μg/mL nano platinum disinfectant liquid could extend the preservation time of citrus by 2 d and kiwifruit by 3 d.Soaking citrus and kiwifruit in 5.0 μg/mL nano platinum disinfectant solution could maintain 10 days without spoilage.Conclusion The nano platinum disinfectant has good antibacterial effects in the fruit body and surface,and has good preventive effects on some fruit spoilage fungi.
目的 调查大型体育赛事大学生志愿者手卫生知识和行为现状,为采取针对性措施防控呼吸道传染病疫情提供科学依据.方法 自行设计问卷并采用探索性因子分析检验信效度,对292名参加北京冬奥会志愿服务的大学生进行手卫生问卷调查.结果 大学生志愿者手卫生知识得分为7.01±1.41,掌握情况较好的占38.01%.医学专业得分高于非医学专业(t =-4.291,P<0.05).进行过手卫生相关培训者得分高于未进行过培训者(t= 3.624,P<0.05);分布在不同服务领域的大学生志愿者手卫生知识掌握情况存在差异(F= 4.148,P<0.05).手卫生行为中,大小便后和手明显脏时洗手的人数占比最高(93.84%),接触公共物品后洗手的人数占比最低(48.29%).结论 大学生志愿者手卫生知识掌握情况不佳,手卫生执行情况尚可但容易忽视关键环节,在大型赛事期间应重视对此类群体卫生培训,并督促其手卫生规范执行.
Objective To visually analyze the literature of nosocomial infection control under the background of COVID-19 epidemic,to summarize the research progress and hotpots,and to predicted the future research direction.Methods The relevant literature from 2020 in the database of CNKI were searched.The CiteSpace 6.1 software was used to draw the visual knowledge map,and to conduct clustering analysis of keywords,publishing agencies,publishing authors,etc.Results A total of 610 articles were included,and the number of related papers increased.The major medical institutions had formed close regional cooperation mode,but the cooperation among authors was scattered.The research focus was prevention and hospital management.Conclusion In order to deal with the problems of nosocomial infection in the COVID-19 epidemic,new management models are needed.The primary stage is nucleic acid testing with other supporting preventive measure to complete the prevention and control work.
目的 了解某医院医务人员血源性职业暴露现状及相关危险因素,探讨有效防护措施.方法 采用回顾性调查方法,分析2014-2021年该医院医务人员发生的130例次血源性职业暴露资料.结果 发生血源性职业暴露的主要群体是护士,占67.69%;科室分布构成比排名前4位为骨科、普通外科、麻醉科和血液净化科,分别占16.15%、13.08%、11.54%和11.54%;最主要的暴露方式为锐器伤,占87.69%;手指是最常见的受伤部位,占76.15%;医生的主要暴露环节为手术操作,护士为拔出针头、处理废弃物、穿刺和注射;医生的高频暴露地点为手术室,护士为病房;职业暴露最常见的血源性病原体为HBV,其次为梅毒及HCV;发生锐器伤暴露中,能及时采取处理措施的占85.38%.结论 针对血源性职业暴露的高危因素,应加强重点部门重点人群的培训教育,规范操作流程,制订和落实科学严密的防控措施,以降低职业暴露风险,保障医务人员安全.
目的 调查北京市医院门诊区环境表面洁净度情况,为有效防控医院感染提供参考.方法 采用ATP生物荧光检测法对22家三级医院门诊区自助设备和诊室内高频接触物体表面采样.比较不同类型医院的不同物体表面洁净度合格率差异,分析门诊量与物体表面洁净度的相关性.结果 医院门诊区高频接触物体表面总合格率为84.60%,其中诊室洁净度合格率最高(88.65%),自助售卖机和自助挂号机的合格率较低,分别为76.47%和82.23%.综合医院洁净度合格率高于专科医院(92.07%vs 79.20%).物体表面洁净度合格的医院门诊量较大,综合医院门诊自助挂号机和专科医院门诊检验结果打印机洁净度与门诊量的关联性最强(Eta2=0.592和0.524).结论 医院应提高门诊区卫生消毒管理水平,根据门诊量调整高频接触物体表面消毒频次,并加大环境卫生监测力度.
Objective To observe the effect of different dosage of disinfectant on terminal disinfection of COVID-19 contamination,and to guide terminal disinfection scientifically.Methods The terminal disinfection effect of aerosol spray disinfectant and constant spray disinfectant at different dosage on SARS-CoV-2 contaminated sites was tested and evaluated by on-site sampling and quantitative bacterial detection.Results 30 g/L hydrogen peroxide was used to apply ultra-low volume spray at 10,20 and 30 mL/m3 respectively,the effective killing rate of natural bacteria in indoor air and the qualification rate of disinfection were both 100.0%in 30 min.The same method had a killing rate of 66.7%-73.3%for natural bacteria on the surface of objects,and a disinfection qualification rate of 33.3%-66.7%.The qualified disinfection rate of indicator bacteria on the surface of objects was 0.0%,and the killing rate was only 20.0%-55.0%.The chlorine containing disinfectant containing 1000 mg/L of effective chlorine was used for constant spray disinfection with different dosage.After 30 min of application,the dosage was 100-300 mL/m2,and the qualification rate of disinfection of indicator bacteria for surface pollution of objects was 100.0%.Conclusion When 30 g/L hydrogen peroxide aerosol spray is used for air disinfection,the application amount of 10-30 mL/m3 is basically effective,but the disinfection effect on object surface is not qualified.The surface of objects can be effectively disinfected with constant chlorine containing disinfectant spray containing 1000 mg/L effective chlorine at a dose of 100 mL/m2.
Objective To understand the current situation of hospital management of disinfectants in Zhejiang province,and to evaluate the effectiveness of improving the management of disinfectants in a hospital's central sterile supple department(CSSD),in order to provide reference for improving the quality of hospital disinfection management.Methods A questionnaire survey was conducted on the knowledge background,nature of organization,management attribution,education and training,and personnel turnover of disinfection personnel in 87 hospitals in the province.Based on the survey results,we improved the CSSD disinfection management of a certain hospital,compared the changes in disinfection monitoring indicators before and after the improvement of management quality,and strengthened the theoretical and operational levels of disinfectants before and after training.Results Only 21.83%of the 371 disinfection workers surveyed had bachelor degree or above,46.90%had informal establishment,and 1.89%had lost their staff within one year.Disinfectors in 55 hospitals were managed by non-nursing departments,and the training and assessment of disinfectors in 76 hospitals were handled by nursing departments.After the improvement of management quality,the indicators of CSSD equipment bar code posting error rate,equipment bar code missing brush rate,wet package rate of sterilized goods,equipment backwashing rate and sterile goods distribution error rate in a hospital all reached the qualified target value,and the theoretical and operational assessment scores of disinfectors after intensive training were higher than those before training.Conclusion Targeted and planned management and training of disinfectors in hospitals will help to improve the ability of disinfectors,stabilize the team of disinfectors and meet the development needs of CSSD in hospitals.
目的 探讨医共体模式下一级医院一体化管理中消毒供应质量管理的应用效果.方法 在医共体医院建立一体化管理"线上教育培训+线下指导帮扶"的联动模式,比较该模式实施前后器械清洗灭菌及包装质量、人员专业培训和综合服务能力评分,对质量管理效果进行评价.结果 采用一体化管理应用后,专科工作质量、专科理论知识掌握、实践操作和综合服务能力评价均优于实施一体化管理前.结论 医共体模式下一级医院一体化管理模式可提高消毒供应工作质量,提升人员专业水平及服务能力.
Objective To understand the disinfection quality of medical institutions in Guangzhou,so as to strengthen the disinfection management of hospitals.Methods The disinfection quality of key departments of medical institutions at all levels was monitored and analyzed by field sampling and detection methods.Results A total of 92947 samples from different medical institutions were monitored for 10 years,and the total qualified rate of disinfection quality was 93.22%.Among the 10 monitoring items,the qualification rate of medical staff hands,ultraviolet lamps,sewage and medical water was low.The total qualified rate of disinfection in different years was significantly different(χ2 = 361.88,P<0.001),with the highest in 2019(96.53%)and the lowest in 2014(91.12%).The total qualified rate of different monitoring items was significantly different(χ2 = 4385.29,P<0.001),and the qualified rate of sewage was the lowest(76.04%).The total qualified rate of disinfection quality in different medical institutions was statistically significant(χ2 = 436.82,P<0.001).The qualified rate of disinfection quality monitoring in municipal,district and county medical institutions was 94.59%,95.29%and 93.35%,respectively.The qualified rate of clinics and health centers was 90.90%.Conclusion The overall pass rate of disinfection quality in medical institutions in Guangzhou is over 90%,but there are weak links.Comprehensive management of medical institutions should be strengthened to improve the overall disinfection management level.
