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_1

以太坊交易平台_ETH期货合约交净化 2021-11-18 01:31:11 阅读

层流手术室如何布局及合理管理_1 - 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(xin)息的发展和自(zi)动化技术(shu)(shu)的日趋成(cheng)熟,研制(zhi)集智(zhi)能化、数(shu)字(zi)化、信(xin)息化于一(yi)体的层流(liu)(liu)手(shou)(shou)术(shu)(shu)室监控系(xi)(xi)统(tong)已成(cheng)为(wei)必要和可(ke)能[1]。洁(jie)净手(shou)(shou)术(shu)(shu)部以层流(liu)(liu)手(shou)(shou)术(shu)(shu)室为(wei)核心,并包括各(ge)类辅助用(yong)(yong)房、自(zi)成(cheng)体系(xi)(xi)的功能区域。采用(yong)(yong)净化空调系(xi)(xi)统(tong),有效控制(zhi)室内温度(du)、湿度(du)和尘埃含(han)量,实(shi)现理想(xiang)的手(shou)(shou)术(shu)(shu)环(huan)境,降低(di)手(shou)(shou)术(shu)(shu)感染率,提高(gao)手(shou)(shou)术(shu)(shu)质(zhi)量[2]。某院自(zi)2006 -08 启(qi)用(yong)(yong)洁(jie)净手(shou)(shou)术(shu)(shu)间15 间,其(qi)中百级2 间,千级1间,万级10 间,正负压切换2 间。由于设施完备,布局合理,充分利用(yong)(yong)了洁(jie)净、净化空间,使工作效率明显(xian)提高(gao),收到(dao)了满意效果(guo)。

1 设施与合理布局

1. 1 洁净(jing)(jing)系(xi)(xi)统(tong)净(jing)(jing)化空调(diao)(diao)系(xi)(xi)统(tong)作用原理是洁净(jing)(jing)气流(liu)(liu)从(cong)天花板(ban)送(song)风口垂(chui)直送(song)入,迅速向(xiang)下(xia)方及(ji)(ji)四周扩散、混(hun)合,同时将等(deng)量的(de)(de)(de)(de)(de)(de)气流(liu)(liu)从(cong)回风口排(pai)出(chu),使室内(nei)(nei)污染空气不(bu)断(duan)得到(dao)稀释,直至达到(dao)空气洁净(jing)(jing)平(ping)衡状(zhuang)(zhuang)态。我(wo)院采取的(de)(de)(de)(de)(de)(de)是中央(yang)监(jian)(jian)控(kong)(kong)(kong)(kong)(kong)工作站,现(xian)(xian)场控(kong)(kong)(kong)(kong)(kong)制(zhi)(zhi)(zhi)(zhi)柜与(yu)手术室间(jian)控(kong)(kong)(kong)(kong)(kong)制(zhi)(zhi)(zhi)(zhi)面板(ban)共同组成整个手术室净(jing)(jing)化空调(diao)(diao)系(xi)(xi)统(tong)的(de)(de)(de)(de)(de)(de)控(kong)(kong)(kong)(kong)(kong)制(zhi)(zhi)(zhi)(zhi)、监(jian)(jian)测系(xi)(xi)统(tong)。中央(yang)控(kong)(kong)(kong)(kong)(kong)制(zhi)(zhi)(zhi)(zhi)工作站设在手术室内(nei)(nei)集中主控(kong)(kong)(kong)(kong)(kong)制(zhi)(zhi)(zhi)(zhi)室中,由监(jian)(jian)控(kong)(kong)(kong)(kong)(kong)计(ji)算机(ji)、监(jian)(jian)控(kong)(kong)(kong)(kong)(kong)软件、通讯装置组成,完(wan)成对所(suo)有手术室的(de)(de)(de)(de)(de)(de)温(wen)度、湿度、压(ya)差(cha)的(de)(de)(de)(de)(de)(de)监(jian)(jian)测与(yu)调(diao)(diao)节(jie),并(bing)可(ke)对所(suo)有空调(diao)(diao)设备(bei)的(de)(de)(de)(de)(de)(de)停(ting)机(ji)、工作、故(gu)障等(deng)进行(xing)(xing)控(kong)(kong)(kong)(kong)(kong)制(zhi)(zhi)(zhi)(zhi)和监(jian)(jian)测。空调(diao)(diao)现(xian)(xian)场控(kong)(kong)(kong)(kong)(kong)制(zhi)(zhi)(zhi)(zhi)柜具有工作、值(zhi)(zhi)班(ban)状(zhuang)(zhuang)态。工作状(zhuang)(zhuang)态恒温(wen)、恒湿控(kong)(kong)(kong)(kong)(kong)制(zhi)(zhi)(zhi)(zhi)。值(zhi)(zhi)班(ban)状(zhuang)(zhuang)态节(jie)能(neng)控(kong)(kong)(kong)(kong)(kong)制(zhi)(zhi)(zhi)(zhi)、远程温(wen)度调(diao)(diao)节(jie)、风机(ji)运行(xing)(xing)和故(gu)障监(jian)(jian)测、系(xi)(xi)统(tong)工作监(jian)(jian)测、系(xi)(xi)统(tong)报警监(jian)(jian)测等(deng)功能(neng)。中央(yang)控(kong)(kong)(kong)(kong)(kong)制(zhi)(zhi)(zhi)(zhi)面板(ban)的(de)(de)(de)(de)(de)(de)空调(diao)(diao)系(xi)(xi)统(tong)控(kong)(kong)(kong)(kong)(kong)制(zhi)(zhi)(zhi)(zhi)功能(neng)包括(kuo)温(wen)度、湿度设定(ding)操作空调(diao)(diao)系(xi)(xi)统(tong)状(zhuang)(zhuang)态、高效(xiao)状(zhuang)(zhuang)态的(de)(de)(de)(de)(de)(de)监(jian)(jian)控(kong)(kong)(kong)(kong)(kong)。通过(guo)调(diao)(diao)控(kong)(kong)(kong)(kong)(kong)保持不(bu)同级别区域的(de)(de)(de)(de)(de)(de)梯次压(ya)差(cha),保持室内(nei)(nei)正压(ya)及(ji)(ji)气流(liu)(liu)的(de)(de)(de)(de)(de)(de)定(ding)向(xiang)流(liu)(liu)动(dong)。每个手术间(jian)配备(bei)独立机(ji)组,空气过(guo)滤(lv)系(xi)(xi)统(tong)分初效(xiao)、中效(xiao)、高效(xiao)3 级,由专(zhuan)业(ye)维修人员进行(xing)(xing)监(jian)(jian)测,定(ding)期清洗更(geng)换(huan)。回风过(guo)滤(lv)网装卸简单,便于(yu)清洗更(geng)换(huan)。

1. 2 建筑布(bu)局(ju)类型我院(yuan)采用洁(jie)、污双通(tong)道布(bu)局(ju),洁(jie)净手术(shu)通(tong)道: 医护人员(yuan)、无(wu)菌物(wu)品、患者; 非(fei)洁(jie)净通(tong)道: 术(shu)后器械(xie)、敷料。与供应室(shi)(shi)有(you)1 部洁(jie)净电(dian)梯、1 部污物(wu)电(dian)梯相连。患者出入口(kou)有(you)对接车处,严格区分室(shi)(shi)内、外用车,并有(you)明显标示。设有(you)附属房间等。

1. 3 通讯系统(tong)由电(dian)话、呼叫对讲(jiang)(jiang)、手(shou)(shou)术(shu)室(shi)广(guang)(guang)播(bo)、家属等候区广(guang)(guang)播(bo)、可(ke)(ke)(ke)视对讲(jiang)(jiang)门(men)(men)禁等系统(tong)组成,每个(ge)附(fu)属房间均有电(dian)话,通过呼叫对讲(jiang)(jiang)系统(tong)可(ke)(ke)(ke)以(yi)实现(xian)中央控(kong)(kong)制(zhi)(zhi)室(shi)与(yu)手(shou)(shou)术(shu)间的呼叫与(yu)对讲(jiang)(jiang),紧急情况可(ke)(ke)(ke)通过手(shou)(shou)术(shu)室(shi)广(guang)(guang)播(bo)系统(tong)发(fa)挥作用。通过门(men)(men)禁系统(tong),在(zai)中央控(kong)(kong)制(zhi)(zhi)室(shi)可(ke)(ke)(ke)控(kong)(kong)制(zhi)(zhi)手(shou)(shou)术(shu)室(shi)每个(ge)出入口大门(men)(men),实现(xian)对讲(jiang)(jiang)、可(ke)(ke)(ke)视等功能。

1. 4 信(xin)息系(xi)统由手(shou)(shou)(shou)术(shu)(shu)(shu)(shu)室计算机(ji)(ji)管理系(xi)统、手(shou)(shou)(shou)术(shu)(shu)(shu)(shu)信(xin)息屏、视频监控系(xi)统、教(jiao)学(xue)摄(she)像(xiang)系(xi)统组成(cheng)。手(shou)(shou)(shou)术(shu)(shu)(shu)(shu)计算机(ji)(ji)管理系(xi)统可(ke)完成(cheng)手(shou)(shou)(shou)术(shu)(shu)(shu)(shu)资料查询、统计、收费、医生(sheng)工作站(zhan)和排(pai)班(ban)功(gong)能。教(jiao)学(xue)摄(she)像(xiang)镜头直(zhi)接(jie)安装在(zai)无(wu)影灯臂上,通(tong)过对(dui)手(shou)(shou)(shou)术(shu)(shu)(shu)(shu)部位摄(she)像(xiang),在(zai)示教(jiao)室完成(cheng)手(shou)(shou)(shou)术(shu)(shu)(shu)(shu)教(jiao)学(xue)任务。通(tong)过每(mei)(mei)个(ge)手(shou)(shou)(shou)术(shu)(shu)(shu)(shu)间和内、外通(tong)道顶棚板(ban)悬(xuan)挂(gua)的全景摄(she)像(xiang)镜头,在(zai)中央控制室通(tong)过监视器(qi)可(ke)观察到每(mei)(mei)个(ge)手(shou)(shou)(shou)术(shu)(shu)(shu)(shu)间及走廊情况。手(shou)(shou)(shou)术(shu)(shu)(shu)(shu)信(xin)息屏可(ke)以使医生(sheng)很(hen)方便(bian)的看到手(shou)(shou)(shou)术(shu)(shu)(shu)(shu)进展情况。

1. 5 手(shou)(shou)术(shu)(shu)间(jian)设(she)计(ji)为(wei)不等(deng)边(bian)八角形,主控板中央控制面(mian)板具有照明动力控制、气(qi)体(ti)压力监(jian)测(ce)、时(shi)(shi)间(jian)显示、温度、湿度显示、手(shou)(shou)术(shu)(shu)计(ji)时(shi)(shi)、麻醉计(ji)时(shi)(shi)、空(kong)调系(xi)统控制、通讯(xun)、背景音乐(le)控制等(deng)功能。麻醉塔(ta)、外科塔(ta)、腔镜(jing)塔(ta),墙壁(bi)上(shang)有氧(yang)(yang)气(qi)、二氧(yang)(yang)化(hua)碳、麻醉废气(qi)排放系(xi)统,压缩空(kong)气(qi)2 套,负压吸(xi)引3套等(deng)。恒(heng)温柜可以随时(shi)(shi)加(jia)温液体(ti),3个(ge)玻璃门壁(bi)柜分别存(cun)放药品、各种液体(ti)和体(ti)位垫(dian)等(deng),手(shou)(shou)术(shu)(shu)间(jian)门设(she)有脚触感应控制,可折叠式写字板内(nei)备(bei)有护理文件(jian)、收费标准等(deng),每个(ge)手(shou)(shou)术(shu)(shu)间(jian)配备(bei)1 台电(dian)脑(nao)一体(ti)机与(yu)医院的计(ji)算机系(xi)统联(lian)网。

1. 6 物流(liu)系统(tong)有气动(dong)管道传送系统(tong),可与病房、血(xue)库、病理室等进(jin)行手术(shu)预约单、病理标(biao)本等传送。

1. 7 安全(quan)(quan)紧急疏散及报警(jing)系统意外(wai)断电(dian)(dian)(dian)时(shi)手(shou)术(shu)室每个手(shou)术(shu)间不间断电(dian)(dian)(dian)源( UPS) 可(ke)保证正(zheng)常工作2 h,门禁系统可(ke)保证消防断电(dian)(dian)(dian)门自动(dong)全(quan)(quan)开(kai); 安全(quan)(quan)出(chu)口、紧急报警(jing)、紧急开(kai)门标志明显。

2 管理措施

2. 1 规定不同(tong)净化手(shou)术间(jian)的用(yong)(yong)途百级适应心脏手(shou)术、神经外(wai)科(ke)(ke)(ke)手(shou)术、骨科(ke)(ke)(ke)手(shou)术。千级适用(yong)(yong)于眼科(ke)(ke)(ke)、整形(xing)外(wai)科(ke)(ke)(ke)、普(pu)通(tong)外(wai)科(ke)(ke)(ke)( Ⅰ类(lei)) 。万级适用(yong)(yong)于妇科(ke)(ke)(ke)、泌尿外(wai)科(ke)(ke)(ke)、耳鼻喉科(ke)(ke)(ke)、普(pu)通(tong)外(wai)科(ke)(ke)(ke)( Ⅱ类(lei)) 。正(zheng)负压手(shou)术间(jian)适用(yong)(yong)于急诊(zhen)、感染手(shou)术。

2. 2 人员控(kong)(kong)制(zhi)(zhi)(zhi)(zhi)医护人员是层流手(shou)术(shu)室最大的(de)污(wu)染源,手(shou)术(shu)人员的(de)活动是主要(yao)污(wu)染源的(de)来(lai)源,减少(shao)控(kong)(kong)制(zhi)(zhi)(zhi)(zhi)污(wu)染源的(de)关键措施之一是控(kong)(kong)制(zhi)(zhi)(zhi)(zhi)手(shou)术(shu)人员的(de)数量(liang)和(he)活动[3],要(yao)按手(shou)术(shu)室的(de)大小和(he)级别控(kong)(kong)制(zhi)(zhi)(zhi)(zhi)人员,一般不(bu)允许在手(shou)术(shu)间参观(guan)手(shou)术(shu),若实习或进(jin)修等(deng)一定要(yao)进(jin)入手(shou)术(shu)室内,一台手(shou)术(shu)不(bu)超过3 名(ming)[4],不(bu)能(neng)任意(yi)走动,只能(neng)在指定区(qu)域活动。

2. 3 物(wu)品运送

2. 3. 1 无菌(jun)(jun)物(wu)(wu)品(pin)运(yun)送无菌(jun)(jun)物(wu)(wu)品(pin)经过(guo)供应室(shi)与手术室(shi)专用(yong)电梯(ti)运(yun)到手术室(shi),用(yong)手术室(shi)专用(yong)清洁(jie)车(che)运(yun)到无菌(jun)(jun)物(wu)(wu)品(pin)存放室(shi)。

2. 3. 2 污(wu)(wu)物(wu)(wu)(wu)处(chu)理手术完毕,污(wu)(wu)染敷料及手术器(qi)械由(you)专(zhuan)职保(bao)洁员(yuan)经手术间(jian)后门通过(guo)污(wu)(wu)物(wu)(wu)(wu)走廊至污(wu)(wu)物(wu)(wu)(wu)间(jian),经污(wu)(wu)物(wu)(wu)(wu)电梯运(yun)送。器(qi)械与供应室人员(yuan)交接后,进行清洗、烘干(gan)、打(da)包、灭(mie)菌。敷料由(you)洗衣房(fang)人员(yuan)接受(shou)、清洗、领回供应室打(da)包灭(mie)菌。污(wu)(wu)物(wu)(wu)(wu)在运(yun)送过(guo)程中必(bi)须密闭(bi)。

2. 4 严格管理手术(shu)(shu)间门(men)(men)户手术(shu)(shu)中保(bao)持(chi)电(dian)动门(men)(men)处于关(guan)闭状(zhuang)(zhuang)态(tai),保(bao)持(chi)一定正压(ya),从而保(bao)证手术(shu)(shu)室(shi)内(nei)的(de)洁净空(kong)气向外排出(chu),室(shi)外的(de)空(kong)气不会(hui)进(jin)入室(shi)内(nei),开门(men)(men)后就破坏了压(ya)差系统,手术(shu)(shu)间的(de)净化(hua)质量也(ye)将(jiang)受到影响[5]。特殊感(gan)染手术(shu)(shu)必须在感(gan)染手术(shu)(shu)间进(jin)行(xing),切换到负压(ya)状(zhuang)(zhuang)态(tai),室(shi)内(nei)的(de)污染空(kong)气不会(hui)进(jin)入室(shi)外。

2. 5 清(qing)洁卫生层流(liu)手(shou)(shou)术(shu)室(shi)的(de)(de)(de)一切清(qing)洁工作(zuo)(zuo)采(cai)用(yong)湿式打(da)扫,在(zai)(zai)净化空调(diao)组运行时进行,手(shou)(shou)术(shu)间无影灯(deng)、手(shou)(shou)术(shu)床、各种车(che)及物品表面(mian)、地面(mian)每(mei)(mei)日于手(shou)(shou)术(shu)前后用(yong)清(qing)水、含氯消毒(du)液擦(ca)(ca)拭,每(mei)(mei)周彻(che)底大扫除,包括(kuo)手(shou)(shou)术(shu)间的(de)(de)(de)墙壁擦(ca)(ca)洗,使(shi)用(yong)的(de)(de)(de)清(qing)洁工具不宜(yi)用(yong)易脱纤维(wei)的(de)(de)(de)织物材料制(zhi)作(zuo)(zuo),拖把(ba)是细(xi)菌的(de)(de)(de)滋(zi)生源和传(chuan)播细(xi)菌的(de)(de)(de)载体,故不得在(zai)(zai)3 区混合,应在(zai)(zai)拖把(ba)上(shang)有(you)明(ming)显的(de)(de)(de)分区标示,在(zai)(zai)每(mei)(mei)次使(shi)用(yong)后用(yong)流(liu)动水反复冲洗、清(qing)泡、消毒(du)、晾(liang)干再(zai)用(yong)。

2. 6 空气净(jing)化手术(shu)前30 min 开启净(jing)化空调(diao)系统,并将温度(du)调(diao)到(dao)22 ~ 25℃,湿(shi)度(du)控制在50% ~ 60%。术(shu)毕(bi)做好卫生清洁(jie)工作(zuo),继续(xu)30 min 后(hou)关闭净(jing)化空调(diao)系统,急诊(zhen)手术(shu)间、洁(jie)净(jing)区内走(zou)廊的(de)净(jing)化空调(diao)应调(diao)机24 h 低速运行状

态,以备(bei)急(ji)诊(zhen)手术。

2. 7 净化空调系(xi)(xi)统(tong)(tong)的(de)维护整个空调系(xi)(xi)统(tong)(tong)配(pei)有(you)专(zhuan)人维护和保养,定期检查硬件设施(shi),保洁员每周彻(che)底清(qing)(qing)洁回风口滤(lv)(lv)网,回风口滤(lv)(lv)网每年更(geng)换1 次,初效过滤(lv)(lv)器(qi)2 周湿式清(qing)(qing)洁1 次,如系(xi)(xi)统(tong)(tong)出现(xian)“过滤(lv)(lv)器(qi)报警”应对中效过滤(lv)(lv)器(qi)清(qing)(qing)理或更(geng)换,高效过滤(lv)(lv)器(qi)3 年以上再更(geng)换,保证设备使用完好。

3 体会

重(zhong)新(xin)制(zhi)订各项规(gui)章制(zhi)度(du),按层流手术室要求制(zhi)订出相应的规(gui)章制(zhi)度(du),如(ru)消毒隔离制(zhi)度(du)、手术室无(wu)菌管理制(zhi)度(du)、参观制(zhi)度(du)、巡回器械护士及保洁员工作流程等均重(zhong)新(xin)制(zhi)定。

正确(que)使用层(ceng)(ceng)流(liu)手(shou)术室(shi),护理(li)人员(yuan)由(you)于对层(ceng)(ceng)流(liu)手(shou)术室(shi)概念不太了解,所以岗前(qian)培训很重要,首先请厂家(jia)对技术进行(xing)专项培训,其(qi)次(ci)通过外出学习、上网(wang)查阅等了解层(ceng)(ceng)流(liu)手(shou)术室(shi)的管理(li)和(he)使用,组织(zhi)全体(ti)护理(li)人员(yuan)学习新制(zhi)定的手(shou)术室(shi)制(zhi)度,避(bi)免(mian)使用不当造成设(she)备损坏。

严格区(qu)分(fen)洁(jie)净(jing)(jing)(jing)与非洁(jie)净(jing)(jing)(jing)区(qu),加强(qiang)对(dui)(dui)洁(jie)净(jing)(jing)(jing)区(qu)的(de)保护(hu)非常重(zhong)要。层流手(shou)(shou)术室的(de)人员、物品、流动是影响空气洁(jie)净(jing)(jing)(jing)度(du)的(de)重(zhong)要媒介,洁(jie)净(jing)(jing)(jing)手(shou)(shou)术的(de)空气净(jing)(jing)(jing)化只能(neng)保证空气的(de)无菌,并不能(neng)杀灭手(shou)(shou)术室内(nei)吸(xi)附(fu)在(zai)物体表面的(de)细菌,加强(qiang)对(dui)(dui)手(shou)(shou)术室的(de)保护(hu),控制污(wu)染源,减少(shao)手(shou)(shou)术感染发生(sheng)。

层流(liu)手术(shu)室(shi)(shi)的(de)(de)安(an)全(quan)使(shi)用与(yu)管理对保证医疗质(zhi)(zhi)量、控(kong)制(zhi)感(gan)染起(qi)到关键性作用,我院手术(shu)室(shi)(shi)使(shi)用至今(jin)由科室(shi)(shi)和感(gan)染科共同对手术(shu)室(shi)(shi)的(de)(de)空气质(zhi)(zhi)量和物(wu)体(ti)表面抽(chou)样控(kong)制(zhi)均达(da)到层流(liu)手术(shu)室(shi)(shi)的(de)(de)标(biao)准(zhun),减少(shao)了手术(shu)切口的(de)(de)感(gan)染率(lv),提(ti)高了手术(shu)室(shi)(shi)的(de)(de)护理质(zhi)(zhi)量。

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