目的 为确保消化内镜消毒时邻苯二甲醛的消毒效果,探索该消毒剂合理的更换频率.方法 分别监测邻苯二甲醛使用中的浓度、染菌量和消毒后消化内镜微生物学指标,通过初步及确证试验,确定邻苯二甲醛有效使用频数.结果 邻苯二甲醛用于胃镜消毒时有效频数为102次,用于肠镜消毒时有效频数为85次.结论 将使用时间与使用频率作为更换邻苯二甲醛的依据更具科学性,且临床实践操作性较强.

目的 了解儿科重症监护病房(PICU)医院感染的发生特点,为制定预防措施提供依据.方法 对某儿童医院PICU 2015-2016年住院患儿进行目标性监测和分析.结果 共监测患儿2921例,医院感染率及例次感染率分别为1.78％和1.95％;2016年医院感染发生率和例次感染率分别为1.35％和1.47％,均明显低于2015年的感染率(2.33％)和例次感染率(2.56％).2015年及2016年医院感染均以下呼吸道感染最常见,其次为口腔及胃肠道感染;呼吸机、中央导管及导尿管使用率分别为14.26％、20.92％和9.16％;呼吸机相关肺炎、中央导管相关血流感染及导尿管相关尿路感染发生率分别为6.20‰、0.50‰和0.57‰.2015年共检出病原菌18株,肺炎克雷伯菌最常见(50.0％),其次为铜绿假单胞菌(33.3％),2016年检出病原菌13株,仍以肺炎克雷伯菌最常见(46.1％),其次为白假丝酵母菌(30.8％).结论 PICU医院感染以下呼吸道感染最常见,器械相关感染以呼吸机相关肺炎为主,真菌感染增多,需加强重点部位的感染管理及抗菌药物的合理使用.

Objective To investigate the current status of nosocomial infection in a children's hospital,so as to provide scientific basis for prevention of nosocomial infection.Methods The prevalence rate of nosocomial infection among children who hospitalized in a children's hospital was investigated by cross-sectional method on September 1,2016.Results A total of 1 020 hospitalized children were investigated,15 patients developed 16 times of nosocomial infection,the prevalence rate and prevalence case rate of nosocomial infection were 1.47％ and 1.57％ respectively.The department with the highest prevalence rate was the department of hematology and oncology (9.09％),followed by the department of integrated traditional chinese and western medicine (4.17％) and ICU (3.70％).The main infection sites were respiratory tract (43.75％) and intestines (25.00％).The rate of antimicrobial agents usage was 60.10％.The submission rate of pathogens before using antimicrobial agents was 69.49％.Conclusion The department with the highest prevalence rate was the department of hematology and oncology.The rate of antimicrobial agents usage was a little high,It is necessary to strengthen the management of nosocomial infection of key departments.

Objective To explore application of the ATP bioluminescence detection in management of hospital infections. Methods ATP biological fluorescence detection method was used to do routine detection and special detection when emer-gency public health events happens of the equipment,material surface and hand hygiene,and the results from January 2014 to December were collected. Evaluate the effect of ATP bioluminescence detection on the base of passing rate in different months and different position. Results After using ATP bioluminescence detection method in management process,the av-erage passing rate raised from 33. 33% in January to 80. 76% in December,and there was an obvious trend of improvement in cleaning effect with the Pearson correlation coefficient was 0. 864(P<0. 01). Conclusion ATP bioluminescence detec-tion can significantly improve the efficiency of hospital infection management.

目的:全面掌握某儿童医院住院患者感染多重耐药菌的分布情况及变化趋势.方法:通过目标性监测,收集2011年至2014年多重耐药菌感染病例资料,并对结果进行统计分析.结果:该儿童医院4年来共检出多重耐药菌4 777株,检出率18.11％,主要为ESBLs(+)大肠埃希菌、ESBLs(+)肺炎克雷伯菌、鲍曼不动杆菌,送检的标本主要为痰液、分泌物、尿液,检出的病例多为社区感染,主要集中在内科区域,肺炎克雷伯菌、大肠埃希菌、鲍曼不动杆菌的耐药率均超过30％.结论:针对上述分布特点,该儿童医院应该采取有针对性的控制措施.

目的：比较三种清洗方法对医疗器械的清洗效果。方法采样ATP生物荧光法，对三种清洗方法清洗剖宫产术后医疗器械的效果进行评价。结果手工清洗法合格率为74.21%，手工＋机械清洗法合格率为96.05%，机械清洗法合格率为70.00%。结论使用后剖宫产手术器械需要在手工清洗的基础上，再用机械清洗法效果最好。

目的 研究不同预处理方式及不同放置时间对器械清洗效果的影响,以明确最佳预处理方法.方法 运用ATP生物荧光法,对剖宫产术后的器械预处理及其放置时间的影响进行了对比观察和评价.结果 设计直接放置、预冲洗、喷水保湿、喷酶保湿、多酶溶液浸泡等5个预处理组,每组处理使用后器械456件,共计2 280件.以预冲洗组和多酶溶液浸泡组的清洗合格率最高,放置时间以不超过2h为宜.结论 使用后污染器械最佳预处理方法是用后立即冲洗,用多酶洗液浸泡保湿在2h内进行清洗效果最佳.

目的 了解儿童医院住院患儿多重耐药菌的感染现状及临床分布,为有效预防与控制多重耐药菌感染提供依据.方法 采取细菌分离鉴定技术和药敏试验方法,对某儿童医院2013年度住院患儿送检标本进行检测与分析.结果 在2013年度,该儿童医院共送检病原学标本55 450份,检出多重耐药菌1 063株,检出率1.92％.多重耐药菌中,以产超广谱β-内酰胺酶大肠埃希菌比例最高,占42.43％;其次是肺炎克雷伯菌,占17.31％.多重耐药菌感染病例主要分布在儿童重症监护病房和新生儿内外科等.结论 该医院住院患儿发生多重耐药菌感染率较高,且以产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌为主,提示应加强耐药菌株监测和抗菌药物监管.

目的 利用ATP生物荧光检测法评价器械放置方式、时间和清洗方法对口腔科器械清洗效果的影响. 方法 选取口腔科门诊回收的污染器械,选取7件常用的器械为一套,总共选取80套,根据器械放置时间(0 h、1 h、2 h、4 h、8 h)随机分为5组,每组16套,每组再根据放置方式(干燥放置)和清洗方式(手洗和机洗)分为4个亚组,每个亚组4套,清洗后采用ATP生物荧光检测法进行清洗效果的评价. 结果 干燥放置组和清水浸泡组分别检测清洗后器械280件,合格率分别为82. 86%和90. 71%,差异有统计学意义(χ2=7. 54,P=0. 006);干燥组随着放置时间变长,清洗效果变差;清水组清洗效果与放置时间无关联;手洗组和机洗组总合格率分别为85. 71%和86. 43%,差异无统计学意义(χ2=0. 06,P=0. 91). 结论 口腔科器械干燥放置时间越长,清洗效果越差,清洗前置于清水中可以有效提高清洗效果.

Objective This study was to determine the incidence and risk factors of ventilator-associated pneumonia(VAP) in a pediatric intensive care unit(PICU). Methods 180 patients with mechanical ventilation for more than 48 hours in the PICU were studied by targeted surveillance. Patients were divided into VAP group and non-VAP group. Potential risk factors for VAP were analyzed with univariate analysis and multivariate logistic regression analysis. Results The incidence of VAP was 13.3%(24/180). Univariate analysis showed that basic diseases, malnutrition and long intubation time(≥7days) were risk factors for VAP. Multivariate logistic regression analysis showed that malnutrition(OR=3.048, P=0.034) and long intubation time(OR=9.281, P=0.004) were independent risk factors for VAP, but basic diseases was not. Conclusion Patients receiving mechanical ventilation in PICU have a high incidence of VAP. There were some risk factors for VAP, and comprehensive prevention measures should be taken to prevent the occurrence of VAP.

目的 研究PDCA循环圈在口腔科综合治疗台水系统管理中的应用价值.方法 通过现场采样和细菌学检验方法,评价PDCA管理措施对口腔科综合治疗台水系统水质卫生管理效果.结果 实施第一、第三循环圈管理前后,采样监测结果均有显著性差异(P＜0.05).结论 PDCA循环圈是口腔科综合治疗台水系统管理的有效方法,并能广泛应用于医院感染管理的各个方面.

目的 了解医院消毒与灭菌效果状况,分析存在问题,为加强医院感染与消毒管理提供参考.方法 通过回顾性调查方法,对某医院消毒管理和消毒灭菌质量状况进行监测与分析.结果 常规监测成本明显高于特殊情况监测,并逐年增加;常规监测阳性率明显低于特殊情况监测.常规监测中医务人员手、紫外线等和使用中消毒剂阳性率较高;特殊情况监测中物体表面、医务人员手、消毒器械阳性率较高.结论 常规卫生消毒监测费用较高,其监测标本阳性率与医院感染率之间相关性不明确.

目的 通过对一起新生儿伦敦沙门菌感染事件进行调查与分析,总结预防控制经验,为防止该类事件的发生提供依据.方法 于2011年12月29日-2012年1月13日调查新生儿内科108例患儿临床资料,采取现况调查与回顾性调查相结合的方法,对该次事件中的感染病例进行流行病学调查和环境卫生学监测,并分析存在的危险因素.结果 该次事件共持续16 d,调查病例108例,发现感染病例33例,罹患率为30.56％,时间分布呈现细菌性食源性疾病的流行特点,空间分布有聚集性,环境卫生学监测结果显示污染的环境和手是造成沙门菌属感染传播的重要途径,暴露于ICU、食用早产儿奶、接触护理人员是危险因素.结论 此次腹泻事件是一起由细菌性食源性疾病引起的疑似感染暴发事件,通过采取综合防控措施该事件得到有效控制.

目的 探讨利用六西格玛管理控制多药耐药菌医院感染的效果.方法 应用六西格玛管理的DMAIC流程,即定义阶段、测量阶段、分析阶段、改进阶段和控制阶段,找出引起医院感染的主要原因,针对原因采取控制和改进措施.结果 改进前发生多药耐药菌医院感染率为5.39％,Z值1.908,对影响因子进行回归分析,得出患儿病情、住院天数、侵入性操作、洗手次数、接受培训次数等均是影响感染率的显著因子;严格落实各项措施后,得出改进后多药耐药菌医院感染率为3.31％,Z值由1.908提高至2.547;对改进前后感染率进行x2分析,得出x2=6.667,P≤0.01,说明改进措施落实有效.结论 通过六西格玛管理能有效缩短患儿住院天数,提高病床周转率,带来了巨大的经济效益,同时提高了患儿满意度,产生了较好的社会效益;在引进六西格玛管理的过程中,必须结合本单位自身的特点,不断摸索、探寻最适合的个性化六西格玛管理模式,使之为医院质量管理奉献出巨大能量.

目的 探讨ATP生物荧光检测法应用于医院感染突发事件中的可行性,为医院感染专业人员快速处理突发事件提供理论依据.方法 以1起医院感染突发事件为例,运用ATP生物荧光检测法与微生物检测法平行采 样,并对检测的RLU值的对数值与CFU的对数值进行相关性分析及线性回归分析.结果 通过统计分析,手持式ATP生物荧光检测法检测的RLU值对数值与微生物检测法检测的CFU值对数值(P＜0.05);台式ATP生物荧光检测法检测的RLU值对数值与微生物检测法检测的CFU值对数值(P＜0.05)均呈现线性关系,运用ATP生物荧光检测法及微生物检测法各检测29件,合格率分别为68.97％、75.86％,合格率差异无统计学意义,结合两种检测法发现携带病菌的复苏气囊及工作人员的手为此次事件的传播媒介,及时采取措施切断传播途径,迅速控制事态发展.结论 ATP生物荧光检测法与微生物检测法检测结果之间具有显著相关性,是主动监控医院感染突发事件发生发展的有效方法,与微生物检测法结合使用能加快控制速度及效率.

目的 分析医院耐甲氧西林金黄色葡萄球菌(MRSA)的感染分布及危险因素,为有效预防与控制MRSA医院感染提供依据.方法 对2011年1月1日-12月31日住院患儿送检标本中分离的1007株金黄色葡萄球菌进行了MRSA感染监测,并对临床感染资料进行统计分析.结果 住院患儿送检标本中共分离出MRSA 115株,分离率为11.42％; MRSA标本来源于下呼吸道68株、外科伤口41株,分别占59.13％、35.65％;MRSA感染患儿主要分布在新生儿外科、新生儿内科、重症医学科,分别占13.04％、11.30％、11.30％.结论 免疫功能低下、皮肤受损、接受手术、使用侵入性操作、住院时间长以及抗菌药物不合理应用是发生MRSA感染的主要危险因素;加强高危科室、高危人群、重点部位的监测,减少危险因素的发生,可预防和减少MRSA的产生,控制医院感染.

OBJECTIVE High-risk factors for occupational exposures in medical staffs and the correct protective measures were investigated.METHODS Occupational exposures occurred between January of 2005 and June of 2012 in 54 medical staffs of our Center were retrospectively analyzed.RESULTS Among the 54 cases of occupational exposure,medical staffs between the age of 20 and 30 accounted for 64.8%(35/54),and the remaining age groups accounted for 35.2%(19/54).66.7%(36/54) of the cases were nurses,and 33.3%(18/54) were staffs of other professions.In terms of the medical departments,surgical staffs accounted for 48.1%(26/54) of the cases,and the remaining 51.9%(28/54) were staffs from other departments.The three most common sources of occupational exposure were improper disposal of medical sharps(29.6%,16/54),surgical procedures(27.8%,15/54),and arterial and venous puncture(24.1%,13/54).CONCLUSION Medical staffs between the age of 20 and 30,nurses,and surgical staffs are among the high-risk populations of occupational exposure.Medical staffs shall always implement the standard protective measures and develop good operation practices,so to reduce the occurrence of occupational exposures.

Objective To evaluate the effectiveness of Kirkpatrick four-level training evaluation model on evaluating healthcare-associated infection(HAI) training program,so as to improve the training quality of HAI knowledge gradually.Methods Through combination of questionnaires,field survey and expert interviews,the effectiveness of HAI knowledge training among new employees was evaluated by Kirkpatrick four-level training evaluation model.Results A total of 192 new employees participated in the training program,including 132(68.75%) doctors and technicians(D&T),60(31.25%) nurses,the response rate was 100%,the overall satisfaction rate was 89.41%.The post-training score was significantly increased compared with pre-training score([83.43±5.56] vs [54.22±5.13],t=54.15,P<0.001);The year-end assessment score was significantly different compared with post-training score([82.38±4.28] vs [83.43±5.56],t=2.16,P=0.03),the year-end assessment score decreased by 1.05 points compared with post-training score.Multiple comparison of pre-and post-training score on HAI knowledge among D&T and nurses were conducted,except the scores on "hospital cleaning,disinfection and sterilization and isolation" as well as "aseptic technique",the scores on the other aspects were significantly different(P<0.05).Multiple comparison of post-training and year-end assessment score on HAI knowledge among D&T and nurses showed that the scores on most knowledge points have declined(P<0.05).Doctors and technicians' knowledge on "hand hygiene" and "occupational safety" decreased,and the nurses' knowledge on "bacterial resistance mechanisms" and "rational use of antimicrobial agents" decreased.Conclusion Kirkpatrick four-level training evaluation model can objectively reflect the internal and external effectiveness of training,the training has achieved a significant short-term effect,but long-term effect is not obvious.The quality of training can be improved by perfecting training mode and establishing a systematic evaluation system.

Objective:To use X cephalometric analysis methods to explore the changes in the structure of craniopharyngeal when the children patients with obstructive sleep apnea syndrome(OSAS) advance mandibulas as treated by the author-designed adjustable oral appliances.Methods:Datas were analyzed by X-cephalometry before and after the treatment of adjustable oral appliances in 45 cases of children patients who were diagnosed with obstructive sleep apnea syndrome(OSAS) before treatment by polysomnography(PSG).Those children were aged from 5 to 12 years old with an average age of 7.71 ± 2.01 years old.Results:In the 45 children patients with OSAS,the angle of SNB increased by 2.21%;the angle of ANB reduced by 21.29%;the angle of SN-FH increased by 13.39%;the distance of AH-MP decreased by 37.27%;the distance of AH-Ge decreased by 8.55%;the distance of AH-CVP increased by 5.31%;the distance of AH-FH decreased by 5.84%;the distance of V-T reduced by 1.64%;the distance of SPP-SPPW decreased by 26.92%;the distance of U-MPW increased by 15.07%;the distance of TB-TPPW increased by 24.79%;the distance of V-LPW decreased by 14.39%;the distance of LPW-CVP decreased by 19.35%;the distance of V-Ge increased by 18.38%:all of them have statistical significance.Conclusion:After wearing adjustable oral appliances,OSAS children patients' upper airway and the surrounding structures have changed significantly with their upper airway space increased significantly.

[Objective] In order to know the information of the incidence of hospital infection in our hospital in time,to improve the prevention and control of infection in hospitals,and to provide clinical basis in to reduce hospital infection. [Methods] Conducted a retrospective survey on 70 225 cases of hospitalized children from January 2007 to June 2008. [Results] There were 1 736 cases of hospital infection,the incidence of the i1nfection was 2.47%,and the number of infected(including repeating infection) was 1 774,occupying 2.53%,The cases underreported were 128,occupying 7.37%. The more time patients stay in hospital,the more chances they get infected. The infection sites were mostly respiratory and gastrointestinal tracts. [Conclusion] The incidence of hospital infection is closely related to the environmental quality,disinfection and isolation as well as the individual resistance. Good isinfection and isolation is the key point to reduce the hospital infection.