M的SSI解决方案及研究进展v.ppt

* Sessler博士 evaluated several warming modalities to determine their relative effectiveness. Let’s look at what the research has shown us. [Click mouse] Airway heating and humidification were least effective. Only 10% of heat loss occurs through the respiratory tract and, consequently, very little heat can be transferred back to the patient through this method. [Click mouse] One warmed cotton blanket was only slightly more effective than airway heating and humidification. Cotton blankets, as well as thermal drapes, work only as passive insulators and do not provide active warming. [Click mouse] Circulating water mattresses were found to have limited effectiveness because only a small percent of the body’s surface area is in contact with the mattress for heat transfer. [Click mouse] Sessler博士 found that next in effectiveness were three cotton blankets, which provide more passive insulation than one. [Click mouse] Again, as can be seen on this chart, the most effective method for maintaining normothermia is forced-air warming. 21. Sessler DI. Consequences and treatment of perioperative hypothermia. Anesth Clin N Am. 1994;12(3)：425-426. * 关于层流的一些讨论 垂直层流优于水平层流1 在没有使用个人隔离装置时 空气培养与手术部位细菌污染量并不一致2 是否需要常规空气培养？ 层流使用不当，会增加感染风险3 手术人，病人和出风口的位置关系？ Lidwell OM, et al. Effect of ultraclean air in operating rooms on deep sepsis in the joint after total hip or knee replacement: a randomised study. Br Med J (Clin Res Ed) 1982;285:10. Friberg B, Inconsistent correlation between aerobic bacterial surface and air counts in operating rooms with ultra clean laminar air flows: proposal of a new bacteriological standard for surface contamination. J Hosp Infect 1999;42:287. Salvati EA et al. Infection rates after 3175 total hip and total knee replacements performed with and without a horizontal unidirectional filtered air-flow system. J Bone Joint Surg Am 1982;64:525. Annals of Surgery ? Volume 248, Number 5, November 2008 乱流 层流 手术室环境管理——器械准备 在洁净手术间内打开器械包和在普通手术间比较，细菌携带量减少28倍1 普通手术