医院感染基础知识

　 医务人员标准预防与职业暴露医院感染的相关知识一、标准预防在20世纪90年代中期，美国疾病控制中心提出了“标准预防”目的在于尽最大可能来降低医务人员与病人之间，病人与病人之间微生物传播的危险性，起到了双向防护的作用标准预防应用于：所有病人的诊疗活动，不论病人的诊断是什么，处理污染的医疗器械标准预防的主要措施：1、手卫生2、使用个人防护用品（手套，口罩，防护鞋），避免接触病人的体液和非完整的皮肤3、呼吸道卫生和咳嗽礼节4、预防锐器伤5、正确处理医疗废物6、清洁消毒环境和呼吸道设备WHO关于手卫生的六个指征包括：*接触病人前后*摘除手套后*进行侵入性操作前*接触病人体液，排泄物，粘膜，破损的皮肤或者伤口敷料后*从病人脏的身体部位到干净的身体部位*直接接触接近病人的无生物物体（包括医疗器械）后戴手套的优点：*减少病原体迁移到手上或从手上迁移出来的最好方法*如果规范性戴手套及更换，成本效果好*手套的类型，用途和材料比较多样*降低病原体双向传播的危险*明显减少被针头刺破皮肤的几率，保护不受血液性传染病的感染佩戴口罩的注意事项：*佩戴口罩前后都必须清洁双手*要让口罩紧贴面部*口罩有颜色的一面向外*系紧固定口罩的绳子，或把口罩的橡筋绕在耳朵上，使口罩紧贴面部针刺安全与防护法案*强调在医疗场所使用安全医疗设备以降低医务工作者出现锐器伤和血液接触的国家级法规*医院应选用安全器械以防止或减少医务人员发生锐器伤害*让第一线的医务人员参与安全器具的评价和应用情况*医院坚持记录锐器伤发生情况，记录引起伤害的设备类型以及对每一起事件的情况进行解释。上海市调查情况*69所医院*医务人员48351名，69所医院合计医务人员61501名，调查率高达78.6%。*2243名人员发生锐器伤，合计3083次，人均每月发生锐器伤0.06次（每百床年114.4例，远高于美国的2007年30例）*上报率仅为6%锐器伤管理的国内现状*发生率高，危害大*不安全的锐器使用量大*锐器盒使用不规范*标准预防制度不完善，落实不到位*缺乏职业暴露上报制度*医务人员宣传教育不够*暴露后的处理制度缺失*政府及医院无保障制度空气消毒1自然通风是最简便，经济，有效的保持室内空气新鲜，减少细菌浓度的方法2在出现呼吸道传染病人后，较合理的方法应物体表面消毒和空气消毒同时进行，可选用过氧乙酸或过氧化氢等消毒剂进行熏蒸3人在时的空气消毒方法，可选用循环风消毒机或静电等空气消毒器进行连续动态消毒处理紫外线消毒：1适用于无人状态下室内空气的消毒2没有持续作用3需要一定的时间及强度二、职业暴露预防：*去除伤害，减少不必要的注射*使用无针系统或安全器具*防止重复盖帽，正确使用锐器收集盒*个人防护设备，口罩，手套等职业暴露处理原则：*及时处理原则*及时报告原则*保密原则*知情同意原则职业暴露后的处理步骤：1、在伤口旁轻轻挤压，尽可能挤出损伤的血液再用肥皂液和大量流动水冲洗污染的伤口，冲洗后用75%酒精，0.5%碘伏消毒伤口2、皮肤和粘膜污染时，立即用肥皂液和流动水清洗污染的皮肤3、贱入口腔，眼睛等部位，用清水，自来水或生理盐水反复冲洗粘膜处理步骤2*及时报告主管部门，填写针刺伤报告表下一步工作*消除危害，尽量避免使用锐器*大力推广安全器具*加强医务人员职业暴露检测*加强医务人员宣教*规范使用合格的锐器盒*规范医务人员锐器操作，禁止回套针帽*规范使用个人防护用品*规范职业暴露后的追踪和处置*加强高危医务人员的疫苗接种三、医院感染的定义：指住院病人在医院内获得的感染，包括在住院期间发生的感染和在医院内获得出院后发生的感染，但不包括入院前已开始或者入院时已处于潜伏期的感染。医院感染微生物的来源*在水中或潮湿的地方，偶尔出现在无菌物品或消毒剂中（假单胞菌属，不动杆菌属，分枝杆菌属）*物品如被服，护理过程中使用的器械和物品*在食物中*细小的尘埃和咳嗽或说话产生的飞沫医院感染的主要危险因素：1、侵入性操作2、使用未经完全灭菌的各种医疗器械3、环境污染（医疗用具，空气，医务人员手等）4、输入已被污染的药品，血液，血制品等5、医务人员的职业暴露等等※ 牢记院感“一二三四五六”1、1双手——（重视手卫生）2、2天——院感就是入院48小时后发生的院内感染3、3例——短时间内发生3例同种同源的感染为医院感染暴发4、4种——常见的耐药菌 耐甲氧西林金黄色葡萄球菌，耐万古霉素肠球菌，多重耐药的鲍曼不动杆菌，泛耐药铜绿假单胞菌。5、5类——小心使用5类抗菌药（头孢，加酶抑制剂，碳青霉烯，糖肽，喹诺桐类6、6——步洗手法结束语 医院感染防控像一道防线，保护患者的安危，保护医院的正常运行，保护医疗行业的声誉。医院感染控制工作有自身的特殊性，实际上是防范于未来，重视医院感染控制任重道远，预防为主，杜绝感染，医院方可取得经济效益，社会效益双丰收。and work. Many classes established the duty monitor system, let every students have class member services and for the class the opportunity to work, this is not a fixed position of the monitor system of rotation, which not only can let the monitor on duty in a day's work for class service work, also can let students know more of the solution in the class, every student can learn. And the class cadre conference held regularly. Pay attention to class and major incidents in the recent, Concerned about the class need to help students and make the class committee work plan and the new division.A good class of 4..Each class in the formulation of the goal, the class of the Convention at the same time, pay more attention to the class a good class construction work class. The class construction is the pillar industry of class education work, to perform the correct public opinion guide guide, schools, teachers' education intent can be more smoothly issued, strict execution. Discipline, clean environment, learning atmosphere, most students with emotional attachment and collective identity, and consciously safeguard the collective honor and so on. We must first establish a collective concept, the formation of "we are the best", and "I win glory for the class" collective concept, then do the selection of class cadres Appointment work. Finally, we must adhere to the positive guidance, set up the correct example in the class.5 class warm atmosphere to create a warm atmosphereRegularly engage in various small activities in the class, such as class members birthday, so these usually small activities can become the lubrication class work, the formation of heavy important part of team cohesion.B, material carrier1, classroom environmentOne of the material carrier class culture in the classroom environment, custody arrangement and class a variety of hardware facilities and perfect, the following is the class certificate, notice.Concise typeThe classroom inside decoration small, quiet harmony learning environment. The usual props: students of their own creation painting and excellent articles and class certificates, inform the knowledge.Warm typeIn the classroom can make the class more decorative ornaments, a warm warm feeling of home. Every member of all will participate in the layout and landscaping of the process to use props: collective action. Photos, photos of various kinds of students, small decorations, potted plants and so on.Festival typeA simple method and warm, usually a simple layout of the classroom clean, but in every festival or major activities will be arranged and re decoration cloth on the classroom. The usual props: Jie Qingqing theme decorations, blackboard, ribbon, Christmas tree, window and so on.2, class slogan, logo, class, class songEach class for their struggle direction and goal force and put forward the corresponding slogan, emblem, subject to production class and class song creation is one students of various class loading to highlight the personality mode.3, class logIn the class log records every class of what happened, the true sense of the expression of feelings and thoughts, the exchange of thoughts and feelings. The class log has authenticity, communication flow and rich and colorful, so this to create a healthy, positive class culture and public opinion atmosphere is very important.4, class team, class small band and so on.The students practice according to their own strengths, not only in class, to show a variety of school activities in the skill, but also enhanced the mutual affection and friendship, but also cultivate interest interest and ability, and excellent to enrich students' campus life, this is the students' independent development, very good way to self management.5, class teachingThe formation of teachers, students, teachers in teacher-student interaction scenarios. Understanding the teacher teaching or spare time, and teachers can become friends. When students listen carefully, assiduously, extracurricular foreign teachers and students as a friends sincere exchange flow. Whether it is learning, work is life, have the interaction between teachers and students, enhance the students, friendship, understanding and cooperation.6, class pageThe enthusiasm of the class web fully class students, their photos, photo, articles, etc. according to the information of interest, hobbies, aesthetic beauty and other factors constitute the class of "out with style, encourage each class in the school web game, in the game communicate with each other by the exchange of learning, to explore for expertise in web design students, and excellent web page links to the school homepage, showing the flow characteristics and style of each class, for all to enjoy.7, publicity column, black blackboard newspaperEach class in the classroom layout, beautification process will be in the publicity column, some innovation and breakthrough in the process of the blackboard. Some classes will be used in the social practice, military training, basketball, sports in the photos posted on the bulletin board or blackboard, some students will learn calligraphy class the works, for exchange and appreciation to the students in the publicity column and blackboard. In addition, the class blackboard design also create new styles. There are some things some classes, the class in recent writing on the blackboard, there will be some class class slogan, the objectives of painting in the struggle on the blackboard.C, specific activity1 regular class activitiesMany classes will often organize class class in the holiday party, to be in nervous at ordinary times more than learning can easily more, better communication and communication between each other, in order to increase the understanding and feelings, enhance the class cohesion setting.2 class volunteersMany organizations volunteer to class activities, every holiday, the class of alternate students will go to some communities, the elderly, some school or kindergarten, primary school to carry out volunteer service. Or to help the community, street cleaning cleaning, filing, board newspaper publicity and other things. Some of the class is arrange the students to go to kindergarten or small school compulsory counselling, usually with classes, extracurricular knowledge to help more students in lower grades have difficulties or learning difficulties of the students, and the students actively participate in the city, District, the volunteer activities organized by our school.3 loving actionPart of the class and the poor old man, or that some poor students in poor areas became trapped on the poor peers, as well as students are free on the streets to raise money or sponsored charity in the campus and other activities to help the people who need help.4 warm classEvery holiday or with the classmate's birthday, the class held a simple ceremony to celebrate the birthday of the students, give blessing and birthday gifts, not only enhance the students understanding between the solution and feelings, is a good method of class cohesion cohesion and class culture.5 autonomous learningSome classes than pay more attention to the common progress of students academic performance in the class, to help each other in school or holiday period, autonomous learning. Take "one to one" structure for learning methods, to achieve common progress with the purpose and effect. And the establishment of students' autonomous learning class adviser asked group, a real school self learning and learning mode.6 art activitiesClass art, sports and other activities are also very rich and colorful, the students will arrange spare time to rehearse chorus, recitation, aerobics, gymnastics, the activities in the school to get good grades but also to show their talents and efforts, such as the positive class team in the basketball game. Not only can eliminate the fatigue and tension of learning, can enhance students, between teachers and students together.The 7 main theme class meetingEach class regularly held open meaningful theme class meeting, through the distinctive theme, rich and colorful activities, the interaction between teachers and students in the ideological education to students ideological purpose, and the theme class meeting of written materials, pictures, data file.8 group activitiesRegularly organize students to watch the same movie, visit the museum and so on, so that the students in the rich extracurricular life, an increase of knowledge. There are often organized class activities, including condolences to solitary elderly, participate in various activities such as neighborhood living, have played a very good self education effect.Parent committee1, organizationThe parent committee is composed of representatives from each class of students' parents, and is the supreme authority of the Council. It is set up by the Standing Committee and the grade group.The Standing Committee shall be elected by the members of the parent committee of the year grades, and the director shall be elected one, 22 deputy directors and 10 members.Parent Committee Liaison Office: XX City No. 1 middle school moral education office, Tel:: 369266872, ,The members of the parents Committee have the right to participate in the activities of the school's parent committee.The members of the Committee of the parents have their views and suggestions on the work of the school, and the right to supervise and improve.Under the arrangement of the Senate, the members of the parents Committee have the right to observe the school education and to carry out the work of teaching and learning.A member of the Standing Committee members attended the meeting at the parents long school staff congress right3,The members of the board of parents have the obligation to cooperate with the school to carry out education and teaching activities.The members of the board of parents have the obligation to help other parents raise their children's level of education.The parents' committee members have the obligation to collect other parents' opinions and suggestions, and to feed back to the school.The members of the Committee of the parents have the responsibility to coordinate the relationship between parents and school.Arrangement of major activities in schools1, make the activity with specific programs. Implement the activity of specific content, time, responsible person, clear all the offices of the division of labor, make the responsibilities clear, play their respective roles.2, do the activities of the mobilization work. For the school teachers and students of the week Monday activities of the "speech" under the flag, and a specific solution to each class under various activities, to attract attention to teachers and students, encourage students to actively participate in excitation. At the same time held a class meeting, specifically to do requirements and arrangements for the class activities. Use classes will be described for the students, and in the moving process, to guide the students.3, arrange the details of the activities of the activities of the day. The day of the event such as the rules say leadership class admission order, class teacher evaluation, administrative leadership column in attendance, specific activities and activities in a project person in charge of the arrangements.4, with the school general office to do logistics service work, and to defend, the Communist Youth League Committee for safety management.5, do a good job in the activities of the propaganda work.. organization campus reporter, youth volunteers, such as the use of campus radio, publicity, publicity banners, campus network, to conduct a comprehensive campaign to create a good atmosphere.6, do a good summary of the activities report. All teachers and students to complete a summary of this event by Monday "under the flag of the speech", pointed out the advantages and disadvantages, in order to show the model. And at the same time for School Leadership Award, let the students experience to show the pride and joy of success. A happy ending.Campus cultural construction1, keep the school clean and beautiful appearance of the whole campus environment, beautiful landscaping, greening, cleaning, to form a thick green atmosphere for education;2, starting from the establishment of the motto, the actual school school school school spirit, teaching style, study style, making its flag, emblem, flag and class ";;3, the establishment of a fixed position of education, such as the school honor room, the team activities, the office of mental health counseling room;;4, the establishment of a fixed position, such as the national flag under the flag speech, publicity column, the radio room, by the special management, planning to use these fixed positions to carry out the development of educational activities;5, according to the school education arrangements, combined events, major festivals, anniversaries, combined with the routine education of students, to determine the main content of the theme class meeting;6, the positive pole of XX local culture and school Liuliushiduo years of school history, finishing, mining, the formation of the school in the history of rescue in the spirit of culture;7, in a series of compilation <xx >, established the Alumni Association, editor <xx reported. safety education A, student's birthday is often safe1, out of the school gate to consciously get off, to enter the school gate to the required parking.2, out of the classroom, not urgent, not crowded.No, teach in laboratory teaching, chasing and running off the corridor, to avoid slipping and falling., it is forbidden to climb the walls of any one of the schools, doors and windows, fences, trees, and the ball.Are not allowed to carry flammable, explosive, toxic substances and flammable, weapon into school.If the electric fan, lighting and electrical failure, shall not exclude private private hands, teachers should report or the general office, the electrical troubleshooting by the school, do not open the distribution box, touch switch. Fire fighting equipment without permission, not free to move., pay attention to the safety of cleaning, the glass window on the high, do not scrape wipe., are not allowed to go out for a swim., students are not allowed to be outside the public places for entertainment, sports and any form of fun activities. Any private party, you must obtain the consent of the parents.10, doing a civilized student, do not have any intention to harm others, steal the behavior of other people's property, not allowed to participate in any place in the fight.11, to detect any unsafe factors and should always report for teachers. In order to ensure the preservation of their calm, safe, not quite reckless impulse.12, on the experimental class to strictly comply with the safety requirements of the laboratory to complete the experiment.113, extracurricular activities and physical exercise, according to the relevant safety rules.14, in the school on the way back home, we should pay attention to traffic safety, road to strictly abide by the traffic rules.15, participate in the school organization's outdoor collective activities, activities must strictly abide by the discipline, are not allowed to leave the individual actions.16, the accommodation must be strictly abide by the rules and regulations of the safety management of accommodation.17, give full play to the student's self management ability, students are responsible for the preservation of students' characters, should be careful to do a good job security..B, classroom safety1, the doors and windows of the classroom must be kept in good condition all the year round, no one can not be deliberately damaged.2 doors and windows, the window was found damaged, the teacher has the responsibility to take measures to prevent and repair timely, and its prevention measures.Key to the door of the classroom, the key class should appoint a special person to keep the door every day, on duty at any time to close the doors and windows to implement Suosuo., in addition to the students' desks, books and textbooks, school supplies, not allowed to store any other valuablesStudents are not allowed to play, slapstick chase in the classroom, just move the desk, chair.On the desk, students are not allowed to write to write graffiti, but not scratches traces with the tool.In the classroom, mustn't Lara to connect the power supply device, socket, arbitrary charge.Students are not allowed to, without security protection measures in the case without climbing outdoor window glass wash scrub, to prevent accidents and accidents.C, teachers and students out of the activities of security1, the organization division of teachers and students go out to develop a detailed activity plan and safety measures, the programme of activities must be approved by the leaders of the school case review sign meaning before implementation. The organization to the field or far activities required by the Education Bureau deputy director in charge of the pipe safety approval.22, each event should have a specific responsibility, pay attention to the age of the staff, the body state of the match., the activities of the line, location, prior to the field survey should be carried out.Hand tools and traffic activities, shall submit to the Department of specialized transportation rent rent, required to comply with the safety requirements for operation, before the Department of inspection and repair of the car., each event has to have security, security, accident emergency plan.Have a picnic, hiking, picnic, and pay attention to fire prevention, prevent food poisoning, prevent fall accident, there is a river near the event, the reservoir, there is no organizational measures or do not have the safety conditions, can not let school students into the water., who go out to participate in various activities, school leaders and safety team members must be on the activities of the whole process of monitoring., in the activities of the implementation of accountability system, such as the case of security incidents, the responsibility of everyone to be held accountable.D, fire safety1, strengthen fire safety education for teachers and students. According to the "Fire Law > requirements, so everyone has to maintain the fire protection An Anquan, fire facilities, fire prevention, fire alarm reporting obligations. To do so that everyone knows that the fire alarm call 119, everyone is familiar with the fire from anti self knowledge and safe escape skills.2, the protection of the various kinds of fire fighting facilities in the school is good. To ensure regular inspection, maintenance, and ensure the equipment to complete the rate of 100%, and do a good inspection records.The classroom, office, dormitory, safety exit, evacuation channels unblocked, safety evacuation signs, emergency lighting condition., students gathered in the field may not be used for low grade refractory material decoration.Flammable, dangerous goods, the explosive, do special deposit deposit, by the chemical laboratory technician two people at the same time when the lock open and shut in the room must be responsible for the custody of a basin, fire extinguishers etc... in the use of flammable, explosive chemical drugs when doing the experiment, the teacher must do the experiment before talking to students clear note, and guide the students to correctly use and prevention to prevent fire accidents., library, chemical laboratory, physical science laboratory, room and other places are prohibited smoking and the use of open flame, after work, the staff should be in time to close the doors and windows, to ensure security.Fire hydrant, fire protection equipment, fire protection facilities, to people all love. No one shall be arbitrarily moved and damaged, the offenders shall be dealt with severely., strengthen the use of electrical safety inspection, the electrician must often on campus with the use of electrical wiring, equipment, etc. to check, such as the discovery of security risks, to promptly carry out rectification, maintenance, to ensure safety.The student dormitory, prohibited the use of open flame, prohibition of burning furnace, hot fast, light candles, incense, no smoke, no private pull random access wires. Are not allowed to use any unauthorized access of home appliances.10, the canteen must be used for pressure vessel, qualified boiler, every year to detect, check, boiler workers certificates, in strict accordance with the operating procedures, safety distance and liquefied gas range head should prevent meters, prevent accidents.11, due to ignoring the fire safety requirements and adverse consequences, should be punished severely punished, until legal liability.E, traffic safety11, security: walking pedestrians to walk in line within the Tao, there is no sidewalk right across the street to walk on the right side; walk the crosswalk; control system through effective communication on the sidewalk, shall comply with the regulations of the signal; watch through no traffic signal control system, attention to sidewalks, vehicles are not allowed chase, Ben runs; pedestrian crossing not, must be straight straight through, not in the vehicle near always suddenly across; do not climb the road edge and the road guardrail, fence, not allowed to pull cars on the road, car chase, strong line or hailed parabolic blow car.2, bike safety: under 116 years of age can not ride electric cars, motorcycles on the road; not to open an umbrella ride; ride; do not get rid of; do not wear a cycle;; don't ride the sick car; not riding fast;; not with the vehicle cut; not parallel to ride bikes.Safety: to get off the bus, parked on the bus on the bus, in the car to grasp the handrail, head, hand and body parts can not be out of the window, tube good things around, to prevent theft; fasten the safety belt ride on a high-speed car; do not ride on the overloading of vehicles.F, food safetyDo not buy do not eat fresh and rotten change bad food not to eat by health department; prohibit market seafood; do not buy food without undocumented vendors; do not buy no trademark or no date, no production unit, no warranty tags do not complete food; do not eat poisonous food; don't drink without disinfection, drink boiled water, not kept for a long time, out of pure water.Rules and regulations model essay:: middle school moral education practicemeasurement management system 29 engineering claims management system 9 engineering progress target award assessment management program 30 pre settlement management system 10 production will, and schedulingand work. Many classes established the duty monitor system, let every students have class member services and for the class the opportunity to work, this is not a fixed position of the monitor system of rotation, which not only can let the monitor on duty in a day's work for class service work, also can let students know more of the solution in the class, every student can learn. And the class cadre conference held regularly. Pay attention to class and major incidents in the recent, Concerned about the class need to help students and make the class committee work plan and the new division.A good class of 4..Each class in the formulation of the goal, the class of the Convention at the same time, pay more attention to the class a good class construction work class. The class construction is the pillar industry of class education work, to perform the correct public opinion guide guide, schools, teachers' education intent can be more smoothly issued, strict execution. Discipline, clean environment, learning atmosphere, most students with emotional attachment and collective identity, and consciously safeguard the collective honor and so on. We must first establish a collective concept, the formation of "we are the best", and "I win glory for the class" collective concept, then do the selection of class cadres Appointment work. Finally, we must adhere to the positive guidance, set up the correct example in the class.5 class warm atmosphere to create a warm atmosphereRegularly engage in various small activities in the class, such as class members birthday, so these usually small activities can become the lubrication class work, the formation of heavy important part of team cohesion.B, material carrier1, classroom environmentOne of the material carrier class culture in the classroom environment, custody arrangement and class a variety of hardware facilities and perfect, the following is the class certificate, notice.Concise typeThe classroom inside decoration small, quiet harmony learning environment. The usual props: students of their own creation painting and excellent articles and class certificates, inform the knowledge.Warm typeIn the classroom can make the class more decorative ornaments, a warm warm feeling of home. Every member of all will participate in the layout and landscaping of the process to use props: collective action. Photos, photos of various kinds of students, small decorations, potted plants and so on.Festival typeA simple method and warm, usually a simple layout of the classroom clean, but in every festival or major activities will be arranged and re decoration cloth on the classroom. The usual props: Jie Qingqing theme decorations, blackboard, ribbon, Christmas tree, window and so on.2, class slogan, logo, class, class songEach class for their struggle direction and goal force and put forward the corresponding slogan, emblem, subject to production class and class song creation is one students of various class loading to highlight the personality mode.3, class logIn the class log records every class of what happened, the true sense of the expression of feelings and thoughts, the exchange of thoughts and feelings. The class log has authenticity, communication flow and rich and colorful, so this to create a healthy, positive class culture and public opinion atmosphere is very important.4, class team, class small band and so on.The students practice according to their own strengths, not only in class, to show a variety of school activities in the skill, but also enhanced the mutual affection and friendship, but also cultivate interest interest and ability, and excellent to enrich students' campus life, this is the students' independent development, very good way to self management.5, class teachingThe formation of teachers, students, teachers in teacher-student interaction scenarios. Understanding the teacher teaching or spare time, and teachers can become friends. When students listen carefully, assiduously, extracurricular foreign teachers and students as a friends sincere exchange flow. Whether it is learning, work is life, have the interaction between teachers and students, enhance the students, friendship, understanding and cooperation.6, class pageThe enthusiasm of the class web fully class students, their photos, photo, articles, etc. according to the information of interest, hobbies, aesthetic beauty and other factors constitute the class of "out with style, encourage each class in the school web game, in the game communicate with each other by the exchange of learning, to explore for expertise in web design students, and excellent web page links to the school homepage, showing the flow characteristics and style of each class, for all to enjoy.7, publicity column, black blackboard newspaperEach class in the classroom layout, beautification process will be in the publicity column, some innovation and breakthrough in the process of the blackboard. Some classes will be used in the social practice, military training, basketball, sports in the photos posted on the bulleti