临床感染管理小组干预对医护人员手卫生的认知和依从性的影响

目的临床感染管理小组对手卫生工作进行干预督查,了解医护人员对手卫生知识的掌握和执行情况。方法在实施干预前调查医护人员手卫生的认知情况、手卫生依从情况、洗手方法正确情况和采样监测的合格情况,于实施干预3个月后对这4个方面再进行调查进行统计比较分析。结果干预3个月后医护人员对手卫生知识认知水平、洗手依从率、洗手方法正确率和采样监测合格率大幅提高,与督查干预前比较差异有统计学意义(P<0.05)。结论临床感染管理小组开展手卫生督查,能提升医护人员对手卫生的认知水平,掌握洗手方法,提高手卫生的依从性。

微生物检验在临床感染控制管理中的应用价值分析

探究临床感染控制管理中微生物检验的应用效果,进而评价其应用价值。方法 本次研究对象收集时间为2019年6月-2020年6月,入组对象共计200例。依据收集阶段临床感染控制管理是否实施微生物检验作为分组依据,对比不同阶段临床感染控制管理工作质量及应用效果。结果 观察组院内感染率低于对照组且轻度及中度感染例数均少于对照组(P<0.05);观察组医疗纠纷发生率低于对照组(P<0.05);观察组患者对临床感染控制管理工作满意度评分高于对照组(P<0.05)。结论 临床感染控制管理中微生物检验应用价值显著,一方面能够有效控制临床感染发生,并可降低感染严重程度,有助于降低医疗纠纷发生率,提升大众对临床工作满意程度,社会价值高。

表格式记录在规范科室感染管理小组中的作用

目的探讨表格式记录在规范科室感染管理小组的重要作用。方法建立科室感染管理小组,确定小组成员及职责,院感科针对加强科室成员业务培训、医院感染病例及感染环节的监测等方面制订了《临床科室医院感染管理小组活动记录本》,进一步规范了临床科室医院感染管理小组服务内涵。结果表格式记录明确规范了临床院感小组工作内容,灵活、方便,减少了传统记录的繁琐,为临床工作人员节省了宝贵的时间,同时提高了感染管理小组成员的工作积极性和责任感,提高了管理水平和工作效率,使临床各项院感相关制度落实到位,有记录可查。结论充分发挥了表格式记录在增强临床科室感染管理小组管理医院感染中的作用,使小组成员可以掌握各科院感相关制度落实情况,及时发现医院感染暴发、流行的趋势,达到有效控制医院感染发生的目的。

Management of hepatitis C virus infection in HIV/HCV co-infected patients: Clinical review

Nearly one fourth of individuals with human immunodeficiency virus (HIV) infection have hepatitis C virus (HCV) infection in the US and Western Europe. With the availability of highly active antiretroviral therapy and the consequent reduction in opportunistic infections, resulting in the prolongation of the life span of HIV-infected patients, HCV co-infection has emerged as a signif icant factor influencing the survival of HIV patients. Patients with HIV/HCV co-infection have a faster rate of fibrosis progression resulting in more frequent occurrences of cirrhosis, end-stage liver disease, and hepatocellular carcinoma. However, the mechanism of interaction between the two viruses is not completely understood. The treatment for HCV in co-infected patients is similar to that of HCV monoinfection; i.e., a combination of pegylated interferon and ribavirin. The presence of any barriers to antiHCV therapy should be identified and eliminated in order to recruit all eligible patients. The response to treatment in co-infected patients is inferior compared to the response in patients with HCV mono-infection. The sustained virologic response rate is only 38% for genotype-1 and 75% for genotype-2 and -3 infections. Liver transplantation is no longer considered a contraindication for end-stage liver disease in coinfected patients. However, the 5 year survival rate is lower in co-infected patients compared to patients with HCV mono-infection (33% vs 72%, P = 0.07). A better understanding of liver disease in co-infected patients is needed to derive new strategies for improving outcome and survival.

Hepatitis B virus infection:A favorable prognostic factor for intrahepatic cholangiocarcinoma after resection

AIM： To study the prognostic factors for intrahepatic cholangiocarcinoma （ICC） and evaluate the impact of chronic hepatitis B virus （HBV） infection on survival rate of ICC patients. METHODS： A total of 155 ICC patients who underwent macroscopic curative resections （R0 and R1） were enrolled in this retrospective study and divided into group A with HBV infection and group B without HBV infection according to their chronic HBV infection, represented by positive hepatitis B surface antigen （HBsAg） in serum or in liver tissue. Clinicopathological characteristics and survival rate of the patients were evaluated. RESULTS： All patients underwent anatomical resection. Their 1- and 3-year survival rates were 60.6% and 32.1%, respectively. Multivariate analyses revealed that HBV infection, hepatolithiasis, microscopic satellite lesion, and lymphatic metastasis were the independent prognostic factors for the survival rate of ICC patients. The median disease-free survival time of the patients was 5.0 too. The number of tumors, microscopic satellite lesion, and vascular invasion were the independent prognostic factors for the disease-free survival rate of the patients. The prognostic factors affecting the survival rate of ICC patients with HBV infection and those without HBV infection were not completely consistent. Alkaline phosphatase 〉 119 U/L, microscopic satellite lesion, vascular invasion, and lymphatic metastasis were the independent factors for the patients with HBV infection, while r-glutamyltransferase 〉 64 U/L, microscopic satellite lesion, and poor tumor differentiation were the independent factors for the patients without HBV infection. CONCLUSION： HBV infection is a valuable clinical factor for predicting tumor invasiveness and clinical outcome of ICC patients. ICC patients with HBV infection should be distinguished from those without HBV infection because they have different dinicopathological characteristics, prognostic factors and outcomes after surgical resection.

Antimicrobial management of intra-abdominal infections:Literature's guidelines

Antimicrobial management of severe intra-abdominal infections (IAIs) involves a delicate balance of optimizing empirical therapy,which has been shown to improve clinical outcomes,while simultaneously reducing unnecessary antimicrobial use.Two sets of guidelines for the management of intra-abdominal infections were recently published.In 2010,the Surgical Infection Society and the Infectious Diseases Society of America (SIS-IDSA) created guidelines for the diagnosis and management of complicated IAIs.The new SIS-IDSA guidelines replace those previously published in 2002 and 2003.The World Society of Emergency Surgery (WSES) guidelines represent additional contributions,made by specialists worldwide,to the debate regarding proper antimicrobial drug methodology.These guidelines represent the conclusions of the consensus conference held in Bologna,Italy,in July 2010 during the first congress of the WSES.

细节干预措施对改善消毒供应中心护理质量的作用探讨

探析消毒供应中心护理工作中引入细节干预模式后对其护理质量改善的影响。方法 对2021年7月至2022年7月这一时间段内,消毒供应中心工作的护理人员30名予以抽取,将其作为研究对象,通过规范性分组处理后,有15名进入对照组,选择常规护理干预完成护理工作,另有15名进入观察组,采用细节干预模式展开护理工作,就两组护理质量评价值、眼科感染统计结果、器械合格统计值、临床科室感染管理满意度评价、不良事件发生统计结果展开对比分析。结果 应用自制的工具表统计两组护理质量,干预前两组在回收、包装、发放、服务质量、风险防范意识等方面的质量评分值均无明显差异,组间对比后P>0.05,护理干预后,观察组在回收、包装、发放质量、服务质量、风险防范意识等方面的质量评分值与对照组相比后有更高水平的表现,P<0.05。对比两组眼科感染发生率后,观察组眼科感染发生率相较对照组表现更优,P<0.05。观察组有关1000例器械在灭菌、清洗、包装等环节中的合格率均比对照组更高,P<0.05。护理后,观察组对于护理服务满意度的评分值以及对于器械回收、器械包装、器械发放方面的满意度评分值均优于对照组各项指标数值,P<0.05。观察组分类错误、功能损伤、延迟供应、器械遗失、无菌物品暴露、包装材料选择有误、包装日期错误、其他错误等不良事件发生率统计值与对照组相比占据更低水平,P<0.05。结论 细节干预对于改善消毒供应中心护理工作流程,提高工作有序化,促进护理质量提升有显著效果,有利于保证器械消毒灭菌合格,能够有效减少院内感染的发生,规避不良事件的发生。