电信个人述职报告.ppt

5 min PI vs.1min PI/Alc,28 OR volunteersMean CFU,1 hr post:1.5 and.83(p=.59)Mean CFU,2 hr post:4.0 and 1.5(p=.33)Conclusion:no significant difference Mil Med 1998;163:145,Comparison of Five ProtocolsPereira,JHI,1997;36:49,23 OR nurses,all protocols random orderProtocols Tested:CHG 5/3.5 minCHG 3/2.5 minPI-Tri 3/2.5 minCHG-IPA 2/0.5 minCHG-EA 2/0.5 min,Results.,CHG-5 and ALC had lowest post-scrub countsNo difference between CHG-5 and ALC at day 1,but ALC significantly lower post-scrub counts at day 5(p=0.003)No significant difference in skin condition,Effect of Brush on Skin Acta Derm Ven 1999;79:230,Compared brush scrub with wash for 11 days in different seasonsTEWL,conductance,pH measuredSignificantly higher TEWL for brush in autumn,Antiseptic Scrub With or Without Brush AJIC 1997;25:11,15 volunteers did 5 min scrub using CHG/ALC with and without brush(crossover design)No significant differences in CFUBut,up to twice the number of subjects without a brush had greater CFU reductions,ALC(no brush),CHG,PI(brush)Surg Serv Mgmt 1998;4:36,0,0.5,1,1.5,2,2.5,3,3.5,4,4.5,5,Mean Log Reduction(n=12),Day 1,Day 2,Day 5,Alc,CHG,PI,Alcohol Vs.Traditional Scrub:30-Day SSI Rates,Clean and clean-contaminated surgeryProtocols:75%propanol,4%PI,4%CHGInfection rates:2.44%(55/2252)in alc group;2.48%(53/2135)in other groupsCompliance significantly better with alc(p=0.008),and hands were less dry with less skin irritation Parienti,JAMA 2002;288:722-7,What About the Time?AORN J 1997;66:574,25 OR staff,randomized crossover2 vs.3 min scrubDifference 0.5 logConclusion:clinically equivalent,Time Tests Aust New Zeal J Surg 1998;68:65,Single wash with 10%PI failed to provide lasting CFU reductions30 sec wash as effective as longer washesConclusion:“prolonged vigorous pre-operative scrubbing is unnecessary”,MRSE Dispersal from Skin of OR Personnel Tammelin,et al,JHI,2/00,Dispersal(1%total CFU shed into air)occurred in 43%of men,25%of women;Most frequent carriage on cheek(50%),axilla(24%),but dispersal most frequently associated with perineal carriage(5%prevalence)Significantly less shedding of total CFU with tightly woven clothes,but no reduction of MRSE shedding,Effect of Fingernails on Counts Nurs Res 1998;47:54,0,50,100,150,200,Natural,Artificial,Polished,Geometric Mean CFUs(in 1000s),Prescrub,Postscrub,Effect of Fingernails on GNBs Nurs Res 1998;47:54,0,5,10,15,20,25,30,35,40,%Recovery of GNBs,p0.05,Natural(n=31),Artificial(n=27),Polished(n=31),Cleaning with artificial and natural nails McNeil,CID,2001;32:367,21 nurses with,20 without artificial nailsBefore cleaning,85%with and 35%without had gnb,yeast or S.aureus(p=.003)For those with artificial nails,14%cleared these organisms after cleaning with soap,80%after alcohol,Prolonged outbreak traced to staff fingernails.,Over 15 months,10.5%of 439 neonates acquired P.aeruginosa,35%died;Significant association with two nurses:one with long natural nails and one with artificial nails;“Requiring short natural fingernails.is a reasonable policy”Moolenaar,et al.ICHE,2/00,Candida osteomyelitis and diskitis,Three post-laminectomy patients got deep wound infection with identical strain of C.albicansCase-control study found significant relationship with one OR tech who wore artificial nails and carried C.albicans in noseCID 2001;32:352.,S.marcesens wound infections,7 cardiovascular infectionsRisk factor:exposure to a nurse with artificial nailsExfoliant cream removed from nurses home Passaro,JID 1997;175:992,Percentage free of S.aureus,gnbs,yeast CID,2001;32:367,0,10,20,30,40,50,60,70,80,Before HW,After Soap,After Alc,Art.Nails(n=21),Nat.Nails(n=20),Pilot Study,NICU,Purpose:Compare traditional antiseptic wash(CHG)and mild soap wash+alcohol rinseOutcomes:Microbial flora,skin conditionRandom assignment(n=8 in each group),Hand Hygiene Practices,Traditional WashMean Washes:21.2Mean Glovings:12.4,Soap/alcohol23.812.4,Microbiology,NS differences in mean CFU counts at baseline,2,4 wksNS differences in types of organisms isolatedAll p 0.44,Skin Condition,By week 4,significant improvement in skin condition of alcohol groupby observer assessment(p=0.001)by subject assessment(p=0.007)Larson,Heart and Lung,2000,Sequential Trial of ALC and CHG,Two products:Detergent w/4%CHG(TSS)61%ethyl ALC,1%CHG,and emollients(HP)20 OR staff used each product for 3 weeks sequentially,Background,Our study designProspective single center clinical trial3 Operating Suites of the HospitalSample Sizerequired 20 recruited 27,22 Randomly Assigned to Treatment5 Randomly Assigned to ReferenceDrop-outs 225 Completed Entire Study,Background cont.,Hand Prep(HP),Traditional Surgical Hand Scrub,