以太坊交易平台_ETH期货合约交

层流手术室如何布局及合理管理

以太坊交易平台_ETH期货合约交净化 2021-11-17 01:50:09 阅读

层流手术室如何布局及合理管理 - 四川以太坊交易平台_ETH期货合约交净化工程公司

以太坊交易平台_ETH期货合约交

层流手术室如何布局及合理管理

随着信息(xi)的(de)(de)(de)(de)发(fa)展(zhan)和(he)自(zi)(zi)动(dong)化(hua)(hua)技术(shu)(shu)(shu)的(de)(de)(de)(de)日趋成熟,研制(zhi)(zhi)集智能(neng)化(hua)(hua)、数字(zi)化(hua)(hua)、信息(xi)化(hua)(hua)于一体的(de)(de)(de)(de)层流(liu)手(shou)(shou)(shou)(shou)术(shu)(shu)(shu)室监控系(xi)统(tong)已(yi)成为必要和(he)可能(neng)[1]。洁(jie)净手(shou)(shou)(shou)(shou)术(shu)(shu)(shu)部以层流(liu)手(shou)(shou)(shou)(shou)术(shu)(shu)(shu)室为核心,并包括各类辅助用(yong)(yong)房、自(zi)(zi)成体系(xi)的(de)(de)(de)(de)功能(neng)区(qu)域。采用(yong)(yong)净化(hua)(hua)空(kong)调系(xi)统(tong),有效(xiao)控制(zhi)(zhi)室内温度(du)、湿度(du)和(he)尘埃含量(liang),实现理(li)想的(de)(de)(de)(de)手(shou)(shou)(shou)(shou)术(shu)(shu)(shu)环(huan)境(jing),降低手(shou)(shou)(shou)(shou)术(shu)(shu)(shu)感染率(lv),提(ti)高手(shou)(shou)(shou)(shou)术(shu)(shu)(shu)质量(liang)[2]。某院自(zi)(zi)2006 -08 启用(yong)(yong)洁(jie)净手(shou)(shou)(shou)(shou)术(shu)(shu)(shu)间15 间,其中百级2 间,千级1间,万(wan)级10 间,正负压切(qie)换(huan)2 间。由于设施完(wan)备,布(bu)局合理(li),充分利用(yong)(yong)了(le)洁(jie)净、净化(hua)(hua)空(kong)间,使工作效(xiao)率(lv)明显提(ti)高,收到(dao)了(le)满意(yi)效(xiao)果。

1 设施(shi)与(yu)合(he)理布局

1. 1 洁(jie)净(jing)系统净(jing)化空(kong)(kong)调系统作(zuo)(zuo)用原理(li)是(shi)洁(jie)净(jing)气(qi)流从天(tian)花板送(song)风(feng)口垂直送(song)入(ru),迅速向下方及四(si)周扩(kuo)散、混合,同(tong)时将等量的(de)(de)气(qi)流从回风(feng)口排出,使(shi)室内(nei)污(wu)染(ran)空(kong)(kong)气(qi)不断得(de)到稀释,直至达到空(kong)(kong)气(qi)洁(jie)净(jing)平衡状态(tai)(tai)(tai)。我院采取的(de)(de)是(shi)中央监(jian)(jian)(jian)控(kong)(kong)(kong)(kong)(kong)工作(zuo)(zuo)站(zhan),现场控(kong)(kong)(kong)(kong)(kong)制(zhi)(zhi)柜(ju)与(yu)(yu)手术室间控(kong)(kong)(kong)(kong)(kong)制(zhi)(zhi)面板共同(tong)组成(cheng)整个手术室净(jing)化空(kong)(kong)调系统的(de)(de)控(kong)(kong)(kong)(kong)(kong)制(zhi)(zhi)、监(jian)(jian)(jian)测系统。中央控(kong)(kong)(kong)(kong)(kong)制(zhi)(zhi)工作(zuo)(zuo)站(zhan)设(she)(she)在(zai)手术室内(nei)集中主控(kong)(kong)(kong)(kong)(kong)制(zhi)(zhi)室中,由监(jian)(jian)(jian)控(kong)(kong)(kong)(kong)(kong)计算机、监(jian)(jian)(jian)控(kong)(kong)(kong)(kong)(kong)软件、通讯装(zhuang)置组成(cheng),完(wan)成(cheng)对(dui)所有(you)手术室的(de)(de)温度(du)、湿度(du)、压(ya)差(cha)的(de)(de)监(jian)(jian)(jian)测与(yu)(yu)调节(jie),并可对(dui)所有(you)空(kong)(kong)调设(she)(she)备的(de)(de)停(ting)机、工作(zuo)(zuo)、故障等进行(xing)控(kong)(kong)(kong)(kong)(kong)制(zhi)(zhi)和监(jian)(jian)(jian)测。空(kong)(kong)调现场控(kong)(kong)(kong)(kong)(kong)制(zhi)(zhi)柜(ju)具(ju)有(you)工作(zuo)(zuo)、值(zhi)班(ban)状态(tai)(tai)(tai)。工作(zuo)(zuo)状态(tai)(tai)(tai)恒温、恒湿控(kong)(kong)(kong)(kong)(kong)制(zhi)(zhi)。值(zhi)班(ban)状态(tai)(tai)(tai)节(jie)能(neng)控(kong)(kong)(kong)(kong)(kong)制(zhi)(zhi)、远程温度(du)调节(jie)、风(feng)机运行(xing)和故障监(jian)(jian)(jian)测、系统工作(zuo)(zuo)监(jian)(jian)(jian)测、系统报警监(jian)(jian)(jian)测等功能(neng)。中央控(kong)(kong)(kong)(kong)(kong)制(zhi)(zhi)面板的(de)(de)空(kong)(kong)调系统控(kong)(kong)(kong)(kong)(kong)制(zhi)(zhi)功能(neng)包(bao)括温度(du)、湿度(du)设(she)(she)定(ding)操作(zuo)(zuo)空(kong)(kong)调系统状态(tai)(tai)(tai)、高效状态(tai)(tai)(tai)的(de)(de)监(jian)(jian)(jian)控(kong)(kong)(kong)(kong)(kong)。通过调控(kong)(kong)(kong)(kong)(kong)保持不同(tong)级别区域的(de)(de)梯次压(ya)差(cha),保持室内(nei)正压(ya)及气(qi)流的(de)(de)定(ding)向流动(dong)。每个手术间配备独立(li)机组,空(kong)(kong)气(qi)过滤系统分初(chu)效、中效、高效3 级,由专业维修人(ren)员进行(xing)监(jian)(jian)(jian)测,定(ding)期清(qing)洗更(geng)(geng)换。回风(feng)过滤网装(zhuang)卸(xie)简单,便于清(qing)洗更(geng)(geng)换。

1. 2 建筑布(bu)局类型我院采用洁(jie)(jie)(jie)、污双通道布(bu)局,洁(jie)(jie)(jie)净手(shou)术通道: 医护人员、无(wu)菌物品、患者(zhe); 非洁(jie)(jie)(jie)净通道: 术后(hou)器(qi)械、敷料。与供应室(shi)有(you)1 部洁(jie)(jie)(jie)净电梯(ti)、1 部污物电梯(ti)相连。患者(zhe)出(chu)入口有(you)对接车(che)处,严格(ge)区分(fen)室(shi)内、外(wai)用车(che),并(bing)有(you)明显标示。设有(you)附属房(fang)间(jian)等。

1. 3 通讯系(xi)统由电话(hua)(hua)、呼(hu)叫对讲、手(shou)术(shu)室广播、家属(shu)等候区广播、可视对讲门(men)禁等系(xi)统组成,每(mei)个附(fu)属(shu)房间(jian)均有电话(hua)(hua),通过呼(hu)叫对讲系(xi)统可以实现中(zhong)央(yang)(yang)控(kong)制(zhi)室与手(shou)术(shu)间(jian)的呼(hu)叫与对讲,紧(jin)急情(qing)况(kuang)可通过手(shou)术(shu)室广播系(xi)统发挥作用。通过门(men)禁系(xi)统,在中(zhong)央(yang)(yang)控(kong)制(zhi)室可控(kong)制(zhi)手(shou)术(shu)室每(mei)个出入口大(da)门(men),实现对讲、可视等功能(neng)。

1. 4 信息(xi)系(xi)统(tong)(tong)由手(shou)术(shu)(shu)(shu)室计(ji)算机管(guan)理系(xi)统(tong)(tong)、手(shou)术(shu)(shu)(shu)信息(xi)屏、视(shi)频(pin)监控(kong)系(xi)统(tong)(tong)、教(jiao)(jiao)学摄像(xiang)系(xi)统(tong)(tong)组(zu)成。手(shou)术(shu)(shu)(shu)计(ji)算机管(guan)理系(xi)统(tong)(tong)可(ke)完(wan)成手(shou)术(shu)(shu)(shu)资料查(cha)询、统(tong)(tong)计(ji)、收(shou)费、医(yi)生(sheng)工作站和(he)排班功(gong)能。教(jiao)(jiao)学摄像(xiang)镜头直接安装在(zai)无影灯臂上,通(tong)过对手(shou)术(shu)(shu)(shu)部位摄像(xiang),在(zai)示教(jiao)(jiao)室完(wan)成手(shou)术(shu)(shu)(shu)教(jiao)(jiao)学任务。通(tong)过每个手(shou)术(shu)(shu)(shu)间和(he)内、外(wai)通(tong)道顶棚板悬(xuan)挂(gua)的全景摄像(xiang)镜头,在(zai)中央控(kong)制室通(tong)过监视(shi)器可(ke)观察(cha)到每个手(shou)术(shu)(shu)(shu)间及走廊(lang)情况。手(shou)术(shu)(shu)(shu)信息(xi)屏可(ke)以使医(yi)生(sheng)很(hen)方便的看到手(shou)术(shu)(shu)(shu)进展情况。

1. 5 手(shou)(shou)术(shu)间设(she)计(ji)(ji)为不等边(bian)八(ba)角形,主控(kong)(kong)板(ban)中央控(kong)(kong)制(zhi)(zhi)(zhi)面板(ban)具有照(zhao)明动力控(kong)(kong)制(zhi)(zhi)(zhi)、气(qi)体压(ya)力监(jian)测、时间显示(shi)、温度(du)、湿度(du)显示(shi)、手(shou)(shou)术(shu)计(ji)(ji)时、麻醉计(ji)(ji)时、空调系(xi)统(tong)控(kong)(kong)制(zhi)(zhi)(zhi)、通讯、背景音乐控(kong)(kong)制(zhi)(zhi)(zhi)等功能。麻醉塔、外科塔、腔(qiang)镜塔,墙壁上有氧气(qi)、二氧化碳、麻醉废气(qi)排放(fang)系(xi)统(tong),压(ya)缩空气(qi)2 套,负压(ya)吸引3套等。恒温柜(ju)可以随时加温液体,3个玻(bo)璃门壁柜(ju)分别存(cun)放(fang)药品、各种液体和体位(wei)垫等,手(shou)(shou)术(shu)间门设(she)有脚(jiao)触(chu)感应控(kong)(kong)制(zhi)(zhi)(zhi),可折叠式写字(zi)板(ban)内备有护理文件、收费(fei)标准等,每个手(shou)(shou)术(shu)间配备1 台(tai)电脑(nao)一体机与医院的计(ji)(ji)算机系(xi)统(tong)联网。

1. 6 物流系(xi)统有气动(dong)管道(dao)传送系(xi)统,可与病(bing)(bing)房(fang)、血库(ku)、病(bing)(bing)理(li)室等进行手术预(yu)约单、病(bing)(bing)理(li)标本等传送。

1. 7 安(an)全(quan)紧急(ji)(ji)疏(shu)散及报(bao)警(jing)(jing)系(xi)统意外(wai)断电时手术室每(mei)个(ge)手术间(jian)不(bu)间(jian)断电源( UPS) 可(ke)保证(zheng)正常工作2 h,门禁(jin)系(xi)统可(ke)保证(zheng)消防(fang)断电门自动全(quan)开(kai); 安(an)全(quan)出口、紧急(ji)(ji)报(bao)警(jing)(jing)、紧急(ji)(ji)开(kai)门标志明显。

2 管理措施

2. 1 规(gui)定不同净(jing)化手(shou)术间的(de)用途(tu)百级适(shi)应(ying)心(xin)脏(zang)手(shou)术、神经外(wai)(wai)科(ke)(ke)(ke)手(shou)术、骨科(ke)(ke)(ke)手(shou)术。千级适(shi)用于眼科(ke)(ke)(ke)、整形外(wai)(wai)科(ke)(ke)(ke)、普通(tong)外(wai)(wai)科(ke)(ke)(ke)( Ⅰ类(lei)) 。万级适(shi)用于妇(fu)科(ke)(ke)(ke)、泌尿外(wai)(wai)科(ke)(ke)(ke)、耳鼻喉科(ke)(ke)(ke)、普通(tong)外(wai)(wai)科(ke)(ke)(ke)( Ⅱ类(lei)) 。正负(fu)压(ya)手(shou)术间适(shi)用于急诊、感染手(shou)术。

2. 2 人员(yuan)控制医(yi)护人员(yuan)是(shi)层流手(shou)术(shu)(shu)室最大的(de)污(wu)染源,手(shou)术(shu)(shu)人员(yuan)的(de)活动是(shi)主(zhu)要(yao)(yao)污(wu)染源的(de)来(lai)源,减少控制污(wu)染源的(de)关键(jian)措施(shi)之一(yi)(yi)是(shi)控制手(shou)术(shu)(shu)人员(yuan)的(de)数量和活动[3],要(yao)(yao)按手(shou)术(shu)(shu)室的(de)大小和级别控制人员(yuan),一(yi)(yi)般不(bu)(bu)允许在(zai)手(shou)术(shu)(shu)间参观手(shou)术(shu)(shu),若实习或进(jin)修等一(yi)(yi)定要(yao)(yao)进(jin)入手(shou)术(shu)(shu)室内(nei),一(yi)(yi)台手(shou)术(shu)(shu)不(bu)(bu)超过3 名[4],不(bu)(bu)能(neng)任意走动,只能(neng)在(zai)指定区域活动。

2. 3 物品(pin)运送

2. 3. 1 无(wu)(wu)菌物品运(yun)(yun)送(song)无(wu)(wu)菌物品经(jing)过供应(ying)室(shi)与手术(shu)室(shi)专用(yong)电梯运(yun)(yun)到(dao)手术(shu)室(shi),用(yong)手术(shu)室(shi)专用(yong)清洁车运(yun)(yun)到(dao)无(wu)(wu)菌物品存放室(shi)。

2. 3. 2 污物处理(li)手术(shu)完毕,污染敷(fu)料及手术(shu)器械(xie)由专职保洁员(yuan)经手术(shu)间后门通过污物走廊至污物间,经污物电梯运送(song)。器械(xie)与供(gong)应室(shi)人员(yuan)交接后,进行清(qing)洗(xi)(xi)、烘干、打包、灭(mie)菌(jun)。敷(fu)料由洗(xi)(xi)衣房人员(yuan)接受、清(qing)洗(xi)(xi)、领(ling)回供(gong)应室(shi)打包灭(mie)菌(jun)。污物在运送(song)过程中必须密闭(bi)。

2. 4 严格管(guan)理手术(shu)(shu)间门户手术(shu)(shu)中保(bao)持(chi)电动(dong)门处(chu)于关闭状态,保(bao)持(chi)一定正压,从而保(bao)证手术(shu)(shu)室(shi)内(nei)的(de)洁净空气向外排出,室(shi)外的(de)空气不会进(jin)入室(shi)内(nei),开门后就破坏了(le)压差系统(tong),手术(shu)(shu)间的(de)净化质量也将受到(dao)影响[5]。特(te)殊(shu)感染(ran)手术(shu)(shu)必(bi)须在感染(ran)手术(shu)(shu)间进(jin)行,切换到(dao)负压状态,室(shi)内(nei)的(de)污染(ran)空气不会进(jin)入室(shi)外。

2. 5 清(qing)洁卫生层(ceng)流手(shou)(shou)术(shu)室的(de)一切清(qing)洁工作采用(yong)(yong)湿式打扫,在净化空调组运行时进行,手(shou)(shou)术(shu)间无影灯、手(shou)(shou)术(shu)床、各种车及物品表面、地面每日于(yu)手(shou)(shou)术(shu)前后用(yong)(yong)清(qing)水、含氯(lv)消毒(du)液擦拭,每周彻底大(da)扫除,包括(kuo)手(shou)(shou)术(shu)间的(de)墙壁擦洗(xi),使用(yong)(yong)的(de)清(qing)洁工具不宜用(yong)(yong)易(yi)脱(tuo)纤维的(de)织(zhi)物材料制作,拖(tuo)把是(shi)细菌(jun)的(de)滋生源(yuan)和传播细菌(jun)的(de)载体(ti),故不得在3 区混合,应在拖(tuo)把上有明显的(de)分区标示,在每次使用(yong)(yong)后用(yong)(yong)流动水反复(fu)冲洗(xi)、清(qing)泡、消毒(du)、晾(liang)干(gan)再用(yong)(yong)。

2. 6 空(kong)气净(jing)化手术(shu)(shu)前(qian)30 min 开(kai)启(qi)净(jing)化空(kong)调(diao)系统(tong),并将温度调(diao)到22 ~ 25℃,湿度控制在50% ~ 60%。术(shu)(shu)毕做好卫生清洁工作,继续30 min 后(hou)关闭(bi)净(jing)化空(kong)调(diao)系统(tong),急诊(zhen)手术(shu)(shu)间、洁净(jing)区内走(zou)廊(lang)的净(jing)化空(kong)调(diao)应调(diao)机24 h 低(di)速运行状

态,以备急诊(zhen)手术。

2. 7 净化空(kong)调(diao)系(xi)统(tong)(tong)的维(wei)护(hu)(hu)整个空(kong)调(diao)系(xi)统(tong)(tong)配有专人维(wei)护(hu)(hu)和保养,定期检查硬(ying)件设施,保洁(jie)员每周彻底清洁(jie)回风口(kou)滤(lv)网,回风口(kou)滤(lv)网每年(nian)更换1 次(ci),初效(xiao)过滤(lv)器(qi)2 周湿(shi)式(shi)清洁(jie)1 次(ci),如系(xi)统(tong)(tong)出(chu)现“过滤(lv)器(qi)报警”应对中效(xiao)过滤(lv)器(qi)清理或更换,高效(xiao)过滤(lv)器(qi)3 年(nian)以上再(zai)更换,保证设备使用完好。

3 体会

重新(xin)制(zhi)订(ding)各(ge)项规(gui)章制(zhi)度(du),按层流(liu)手术(shu)(shu)室要求制(zhi)订(ding)出相应的规(gui)章制(zhi)度(du),如消毒隔(ge)离制(zhi)度(du)、手术(shu)(shu)室无菌管理(li)制(zhi)度(du)、参观制(zhi)度(du)、巡回器械护士及保洁员工作流(liu)程(cheng)等(deng)均重新(xin)制(zhi)定(ding)。

正确使(shi)用层(ceng)流(liu)(liu)手(shou)术(shu)室(shi),护(hu)理人员(yuan)由于对(dui)层(ceng)流(liu)(liu)手(shou)术(shu)室(shi)概(gai)念不(bu)太(tai)了解,所以(yi)岗(gang)前培(pei)训很(hen)重要,首先(xian)请厂家对(dui)技术(shu)进行(xing)专项培(pei)训,其次通过外(wai)出(chu)学(xue)习、上网查阅等了解层(ceng)流(liu)(liu)手(shou)术(shu)室(shi)的管理和使(shi)用,组织(zhi)全体护(hu)理人员(yuan)学(xue)习新制定(ding)的手(shou)术(shu)室(shi)制度(du),避免使(shi)用不(bu)当造成设备(bei)损坏。

严(yan)格区(qu)分洁净(jing)与非洁净(jing)区(qu),加强对(dui)洁净(jing)区(qu)的(de)(de)保护非常重要。层流(liu)手术(shu)(shu)室的(de)(de)人员(yuan)、物品、流(liu)动是影响空气洁净(jing)度的(de)(de)重要媒(mei)介(jie),洁净(jing)手术(shu)(shu)的(de)(de)空气净(jing)化只能保证空气的(de)(de)无(wu)菌,并不能杀(sha)灭手术(shu)(shu)室内(nei)吸(xi)附在物体(ti)表面(mian)的(de)(de)细菌,加强对(dui)手术(shu)(shu)室的(de)(de)保护,控(kong)制(zhi)污染源,减少(shao)手术(shu)(shu)感染发生。

层流(liu)(liu)手(shou)术(shu)室(shi)的(de)(de)安(an)全使用(yong)与(yu)管理(li)对(dui)保证医(yi)疗(liao)质(zhi)量、控(kong)制感(gan)染(ran)起到关(guan)键(jian)性作(zuo)用(yong),我(wo)院(yuan)手(shou)术(shu)室(shi)使用(yong)至今由科(ke)室(shi)和感(gan)染(ran)科(ke)共同对(dui)手(shou)术(shu)室(shi)的(de)(de)空(kong)气质(zhi)量和物体(ti)表面抽(chou)样控(kong)制均达到层流(liu)(liu)手(shou)术(shu)室(shi)的(de)(de)标准,减少了手(shou)术(shu)切(qie)口的(de)(de)感(gan)染(ran)率,提(ti)高了手(shou)术(shu)室(shi)的(de)(de)护理(li)质(zhi)量。

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