Preventing surgical site infection using operating room bundle of care in patients undergoing elective exploratory laparotomy cholecystectomy surgery

Objective:Surgical procedures manifest immense risks to patients.One of the adverse events that healthcare professionals see as a threat to the patient’s health is the development of complications known as surgical site infection(SSI).Although several effor ts are being under taken to determine the proper means to reduce such complications,there is still a high incidence of SSI worldwide.Surgery requires knowledge in infection control and high precision in maintaining a clean surgical site.This study tested the effectiveness of an operating room(OR)bundle of care in preventing SSI in patients undergoing elective exploratory laparotomy cholecystectomy surgery.Methods:A quasi-experimental pretest and posttest design was utilized to determine its effectiveness.The study was composed of 60 par ticipants divided into two groups:30 subjects were selected to receive the OR bundle of care,while the other 30 subjects received the usual care.The groupings were determined through a systematic random sampling technique.The OR bundle of care had three interventions,namely:(1)maintaining perioperative normothermia,(2)no pre-operative surgical site hair removal,and(3)changing gloves before abdominal wall closure.These patients were evaluated using the standard instrument,Bates–Jensen Wound Assessment Tool(BWAT)in the post-intervention phases of the wound healing process,which are as follows:hemostasis,inflammatory,and proliferative phases.To describe the difference in the patients’wound status after implementation of the OR bundle of care in each post-intervention phase,Friedman’s test was used.To describe the difference in the patients’wound status in both groups after implementation of the OR bundle of care,the Mann–Whitney U test was used.Results:The patient’s wound status was lower,indicating a more healing process.Differences between the wound status of the control and the experimental group were observed on the third postoperative day.This indicates that the experimental group’s wound status healed much faster and more effectively than the control group based on the BWAT scoring severity scoring.A significant difference in the patient’s wound status from the hemostasis phase compared with the proliferative phase was observed.Conclusions:The OR bundle of care has been shown to be effective in preventing SSI in patients who had undergone exploratory laparotomy cholecystectomy surgery in the selected hospital,if there is uniform and consistent implementation of the said intervention.

An impacts of logging operations on understory plants for the broadleaved／Korean pine mixed forest on Changbai Mountain, China

Natural regeneration of tree species is important to the sustainability of native forest ecosystems in the temperate zone of north- east China. This study compared the densities and heights of seedlings and the diversities of shrubs and herbs on three sites of logging op- erations: log-skidding trails (LST), logging gaps (LG) and log landing sites (LLS). Sites undisturbed by logging gaps operations were sam- pled as control. The species, counts and height of tree seedlings and the species, counts, height and percentage coverage of shrubs and herbs were recorded in the field. The highest density and greatest height of regeneration trees were observed at LG and LST. The effects of LST on the densities of broadleaved trees were greater than those of coniferous trees. The difference in seedling density between LLS and control was significant (p=0.05). There was no significant difference in average seedling height for all the tree species between the disturbed sites and control. There were more shrub and herb species at the disturbed sites than at control. The diversity of understory plants at LG was the highest among all the sites. LST and LLS were different in shrub diversity, so were LLS and control. Both LG and LLS were different from control in herb diversity. Active measures need to be taken on the operation sites to protect the coniferous trees and the diversities of under- story plants for sustaining the structure and composition of the broadleaved-Korean pine mixed forest on Changbai Mountain of China. Since different operation sites have different effects on different tree species, site-dependent actions must be taken to assure the regeneration of ecologically important tree species.

Operating Site Infections at General Surgery Department of Gabriel Toure Training Hospital

The operating site infections constitute the major postoperative issue in surgery. Our objectives were to determine the hospital frequency, the risk factors, the involved germs as well as the cost generated by the operating site infections. Method: Our three months prospective survey run from September the 1st to November the 30th 2013 has included all department patients being operated on and hospitalized. The criteria have been set by CDC d’Atlanta. Results: 374 files were involved, among them 229 (61.2%) were emergencies and 145 (38.8%) were scheduled. The average age was 41 (extremes 7 and 95 standard deviation 17.46), the sex ratio 1.67. The infective risk according to Altmeier has found 17.5% type 1, 25.1% type 2, 11.2% type 3 and 46.3% type 4;according to NNISS, 96 (25.7) were NNISS 0;94 (51.9%) NNISS 1;80 (21.4%) NNISS 2;and 4 (1.1%) NNISS. In the Altmeier class I have not got antibiotic before infection signs appearances. Our overall rate of operating site infections was 7.9% (29 cases), with 24 (82.8%) emergency cases. According to Altmeier’s class of infective risk, the rate of operating site infections was 1.54% making 1 out of 65 type I patients;4.3% making 4 out of 93 type II patients;11.9% making 5 out of 42 type III patients;10.9% making 19 out of 174 type IV patients. According to NNISS, the infective risk has been assessed and was 2.08% for score 0, we have got 8.25% score 1, and 12.5% for score 2, and 25% for score 3. The bacteriology has been dominated by Escherichia colii(51.7), Proteus mirabilisi(13.8), and Klebsiella pneumoniaei(10.34). The germs have been resistant to the combination Amoxicillin-clavulanic Acid between 50% and 87% of cases. The most active antibiotics on the germs have been Cephalosporin, Polypeptides, and aminoglycosides. The hospital stay has been delayed to 12 days on average by operating site infections, making 2.5 times greater than those uninfected. The infection has increased the cost of management around 600 Euro.

What Is the Evidence Supporting the Use of Surgical Face Masks in the Operating Room in Preventing Surgical Site Infection after Clean Surgery? A Systematic Review

Background: Facemask is an essential component of the surgical outfit adorned by operating room staff to filter microorganisms by droplets from the oral and nasopharynx of the personnel, thereby reducing contamination, protecting the patient’s wound and minimising the risk of Surgical Site Infections (SSI). Objective: The objective of this review was to explore the available evidence and provide a better understanding of the effect of a surgical facemask in preventing SSI in clean surgery performed in the operating room. Data sources: Key electronic databases related to nursing, allied health, life science, biomedicine and research were searched for published literature on the use of facemask in the operating room. Methodology: A systematic review of quantitative research studies of randomised controlled trials was conducted with a meta-analysis of the results. Results: No variation in the rate of infection between the two (masked and unmasked) groups. Conclusion: The effect of facemask in minimising SSI after clean surgery remains questionable due to the limited results. More comprehensive research is needed.

Risk Factor of Postoperative Lumbar Surgical Site Infection: A Literature Review

Nowadays there have been various advanced techniques to overcome disparate types of lumbar degenerative diseases. However, post-operation complications such as Surgical Site Infection (SSI) still give the surgeon with a big challenge. This article is going to study the risk factor that causes the lumbar SSI by reviewing all the articles that can be assessed through PubMed, websites of science and other internet data base. Numerous articles have stated different reported prevalence rates of 0.7% to 16% for surgical site infection. This article will document the most common and significant risk factors for SSI. At last, we suggest that there should be preoperative patient screening and postoperative internal environment maintenance, this will be the best way to reduce postoperative SSI rate or prevent SSI from happening.

新线引入既有客运专线车站软土地基加固技术

以新线引入既有客运专线车站软土地基加固工程为依托,开展布袋注浆桩试桩研究,分析不同浆液配比布袋注浆桩复合地基加固效果,对布袋注浆桩施工工艺、质量检验进行了研究。结果表明:布袋注浆桩机械设备高度低,对既有线影响小,对于空间受限的邻近营业线地基加固工程适用性强;提高单位面积布袋质量、采用桶式钻头引孔等可解决碎石成分类填土地基应用布袋注浆桩技术时遇到的布袋破裂、塌孔等问题。浆液质量配比水泥∶水∶粉煤灰=0.70∶0.55∶0.45时桩身无侧限抗压强度平均值9.6 MPa,加固效果优于高压旋喷桩;采用低应变反射波法检测桩体完整性效果较差,工程应用中应加强桩身取芯检测。

基于改进YOLOv5的井场作业风险智能识别与分类

为精确识别井场安全生产过程中存在的不规范行为,降低井场事故发生率,提出了一种改进YOLOv5井场作业风险智能分类识别方法。首先,使用labelimg工具标注出这些不规范的行为;其次,以YOLOv5为基础网络,通过在基础网络结构中替换损失函数和增加注意力机制模块来改善目标检测问题。用SIoU Loss损失函数替换CIoU Loss损失函数,对距离损失进行重新定义,有效减少了回归自由度,加速了网络收敛速度,提高了回归精度。通过增加注意力机制模块,网络能够对输入图像进行自主学习并关注其中的重要信息,以提升模型的鲁棒性和泛化能力。实验证明,改进的YOLOv5算法可以对井场作业中的不规范进行有效的分类和识别。与原有YOLOv5方法相比精度提高了3%,改进方法在保证正确率的前提下,具有较高的预测精度和较好的实时性,获得了较满意的效果。

基于改进区间法的含多裂纹铝合金蒙皮扩展寿命区间研究

飞机机身蒙皮的多部位损伤(Multiple-Site Damage, MSD)一直以来都是飞机损伤容限设计与后期维修分析重点考虑的问题之一。为了研究MSD的寿命区间,结合区间理论和区间运算公式、泛灰数理论和泛灰数运算公式及两个运算公式之间的关系,得到可以消除区间运算扩张问题和泛灰数运算失误问题的区间数-泛灰数之间新的转换模型。综合考虑新的转换模型、Paris公式、材料属性、材料尺寸和载荷性质等影响因素,最终得到了2024-T3铝合金板材的MSD裂纹扩展寿命区间:厚度为1.6 mm、不限制长宽时的寿命区间为[90 531, 143 689],厚度1.6 mm、长度240 mm、宽度60 mm时的寿命区间为[11 427, 114 071]。通过验算经典数学算例证明了所研究模型可以消除运算扩张问题和运算失误问题,使运算结果更精确;并进行了三种不同裂纹角度下的MSD裂纹扩展寿命试验,试验结果与理论预测的MSD裂纹扩展寿命区间值相吻合,证明了所研究模型的正确性和有效性。所研究模型可以为MSD裂纹扩展寿命预测和分析提供指导。

基于逆向学习的水电厂现场作业风险预警模型研究

以保障水电厂现场作业安全为目的,研究基于逆向学习的水电厂现场作业风险预警模型。从公共风险、机组器械系统设备风险、电气系统设备风险与水工建筑风险四类风险出发选取指标构建水电厂现场作业风险预警指标体系。采用基于逆向学习传感系统,基于传感器输入样本点与期望输出值组成的线性表反演测量点位置,获取准确的风险预警指标数据。利用LSTM神经网络构建风险预警模型,将预警指标数据作为模型输入,将风险预警等级作为模型输出,通过传播路径实施反向输出比对,优化不同权重矩阵与偏差,由此获取水电厂现场作业风险预警结果。同时利用基于逆向学习行为粒子子群算法优化预警模型参数,提升模型预警精度。实验结果显示该模型能够准确预警水电厂现场作业风险,保障现场作业的安全性。

仪表着陆系统下滑信标运行保护区仿真研究

仪表着陆系统下滑信标运行保护区的科学防护,对于确保民用航空导航空间信号质量、保障航空器进近阶段运行安全、提升机场运行效率均具有重要意义。结合下滑信标运行保护区概念的演进,对民用航空国家标准、行业标准,以及国际民用航空公约附件十第I卷要求的下滑信标运行保护区的划设情况进行了对比分析。以特大型航空器A380-800为例,对特定运行类别的下滑信标运行保护区进行了研究,以期作为国际民用航空公约附件十第I卷关于下滑信标保护区相关数据的补充和实际工程论证的示例。给出了针对特定机场实际运行进行下滑信标场地保护的典型研究方法以及下滑信标运行保护区的保护建议,为机场的建设和运行提供参考。

世界遗产地管理者在《保护世界文化和自然遗产公约》实施体系中的参与度及发展趋势

文章探讨了世界遗产地管理者在《保护世界文化和自然遗产公约》(以下简称《公约》)实施中的关键作用及其在世界遗产大会中的低参与度问题。基于对相关数据的分析,文章指出:尽管遗产地管理者在保护全球遗产资源方面发挥着举足轻重的作用,但因其在《公约》执行机制的决策过程中缺乏被认可的参与身份,且代表性不足,故声音常被忽视。《实施〈世界遗产公约〉操作指南》(以下简称《操作指南》)对遗产地管理者的角色缺乏系统性考量,导致其在《公约》执行体系中的地位尴尬。世界遗产地管理者论坛在推动这一群体走向前台、构建集体意识和行动力方面起到了积极的推动作用。世界遗产地管理者群体自下而上、去中心化的行动已经开始,或将对《公约》实施机制形成具有积极意义的影响。为切实提升世界遗产地管理者的参与度,积极响应新的发展趋势,笔者建议对《操作指南》和世界遗产大会的《议事规则》进行修订完善,明确遗产地管理者的角色和职责,建立更有效的沟通渠道。文章最后提出,中国作为缔约国中的遗产大国,应积极参与和推动这一变化进程,并加紧提升中国遗产地管理者的国际参与度和领导力,更好地传播中国的遗产地管理经验和智慧,为世界遗产事业作出更突出的贡献。

在产石化企业污染场地风险管控技术

针对在产石化企业石油烃污染场地风险防控需要,基于企业安全生产要求,选择污染源区多相抽提-污染羽水平拦截组合技术,对罐区地下水进行了源削减和污染羽扩散阻截,并充分利用企业污水收集和处理系统,有效控制了场地污染场地下水污染扩散风险。探索了在产石化企业边生产边管控的土壤地下风险防控技术模式。

基于人因工程的水电厂现场作业安全性分级量化分析模型研究

为提升水电厂现场作业安全,研究基于人因工程的水电厂现场作业安全性分级量化分析模型,降低水电厂现场作业的风险等级。以人因工程中的人、机和环境为切入,分析水电厂现场作业影响因素,并选取人、作业环境及作业现场三部分重要因素,建立水电厂现场作业安全性分级量化分析指标体系,经人因工程指标量化处理后,以此为基础,构建基于BP神经网络的水电厂现场作业安全性分级量化分析模型,以量化处理后水电厂现场作业安全性分级量化分析指标为模型输入,经模型训练、测试后,输出水电厂现场作业安全性分级量化分析等级。实验表明:该模型所得水电厂现场作业安全性分级量化分析结果与实际情况吻合度高,具备风险预警可行性;BP神经网络模型隐含层节点数为15时,模型的风险预警效果最佳;人员劳动负荷和强度越大,水电厂现场作业风险越高,合理设置人员工作强度与负荷,可提升水电厂现场作业安全性。

初期雨水就地调蓄处理工程方案及运行策略

雨水排口出流污染是南方某市“两湖”水质恶化的重要因素之一,通过排水管网改造解决雨污混接污染问题,采用调蓄处理的工程方案解决初期雨水污染及溢流污染问题,初期雨水处理工艺采用“高效沉淀池+曝气生物滤池(BAF)+高效澄清池+转盘滤池”的组合工艺。通过中试试验验证BAF间歇运行的适用性,连续运行工况下,COD_(Cr)、氨氮均能稳定达到Ⅳ类水水质;当间歇运行时,随着间歇期增大,氨氮的去除效果大幅度降低,当间歇期超过4 d后,出水氨氮浓度无法达到地表Ⅳ类水水质。文章提出了初期雨水处理工艺运行维护模式,为类似工程提供借鉴。

汽提脱氨在垃圾填埋场渗滤液处理中的应用

利用汽提脱氨系统去除并回收垃圾填埋场渗滤液中的高浓度氨氮,在不加碱的工况下取得了良好且稳定的运行效果,出水可直接进入MBR生化系统进行进一步处理。工程系统15 d的运行数据显示:进水量为188 m^(3)/d~252 m^(3)/d,出水量为215 m^(3)/d~285 m^(3)/d;进水氨氮浓度为2250 mg/L~2520 mg/L,出水氨氮浓度为335 mg/L~486 mg/L;氨水产量为6.1 m^(3)/d~8.4 m^(3)/d,氨水浓度为5.68%~6.12%;氨氮去除率为76.90%~83.97%,氨氮回收率为72.96%~83.09%。汽提脱氨塔中产生的氨气可被高效回收,且产生氨水的浓度在一定范围内可自由调整。系统吨水直接运行成本为9.92元,远低于渗滤液补加复合碳源调整碳氮比的费用。

基于Android的智能电能表现场运维系统设计与实现

针对当前智能电能表现场运维方式效率低的问题,设计了一款基于Android终端的运维系统。利用Android手机和红外接发模块,实现了现场运维数据自动采集和电能表异常状态智能诊断,提升现场运维工作效率和质量。

基于移动作业的电力现场异常智能化稽查方法研究

针对电力现场人工稽查危险性高、准确率低的问题,提出基于移动作业的电力现场异常智能化稽查方法。采集电力电场周围的电流变化数据,根据安倍定律得出电缆内外部形成的环形闭合电流。建立空间三点坐标系,计算电缆在三个方向上闭合电流值,若电流值超出既定阈值,判定周围存在磁场影响。模拟矩形的稽查空间体,在该空间体中计算待稽查点间位置关系,将位置阈值代入到异常判定矩阵中,输出异常信号位置。实验结果表明,所提方法可充分利用电力现场的暂态数据,稽查结果符合现场实际情况,具有适用性强、稽查覆盖范围广、准确率高的优势。

文旅融合背景下的公共空间设计及提升研究

对新时代工程项目发展趋势及其原因进行探讨,结合当下文旅融合的热点并对国内外各具特色的公共空间设计与提升案例进行分析,提出文旅融合背景下的公共空间设计及提升思路及策略。研究表明:存量市场下,工程项目多偏向于城市更新、公共空间提升、现状改造及城乡融合等类型,更注重彰显场地的文化和游憩价值,城市公共空间品质的塑造成为城市品牌塑造中的重要一环。因此,设计师进行场地设计时需要深入挖掘场所精神,打造在地化、场景化、非标化的设计;需要适度考虑项目的商业价值和文旅影响力,需要融入适合场地的IP形象与适量的休闲配套设施。

多业态生产经营性场所火灾原因及防控对策分析

对多业态生产经营性场所的火灾案例进行概述,并从中总结出多业态生产经营性场所的特点,深入分析了多业态生产经营性场所火灾的主要原因,包括消防设施不完善、消防安全管理混乱、消防意识淡薄等,同时提出了针对性的防控对策,如规范场所设置,配备消防设施器材,强化消防教育宣传和制订切实可行的灭火和紧急疏散预案等。

面向典型作业场景的现场安全监管数据库风险识别方法

针对现场安全监管数据库风险识别错误率较高、识别效率较低的问题,提出面向典型作业场景的现场安全监管数据库风险识别方法。针对典型作业场景现场安全监管数据库中存在的异常数据,根据异常数据类型,分别采用移动平均线法和AR模型法对数据进行预处理;通过灰色关联聚类算法提取数据风险特征;引入树突状细胞算法,将MAP作为抗原综合评价指标实现现场安全监管数据库风险识别。实验结果表明,所提方法风险识别错误率更低、识别效率更高,具有较好的应用价值。