Objective To explore the effectiveness of conservative dressing change method in treating skin necrosis after open reduction with internal fixation (ORIF) of calcaneal fracture. Methods Between November 2007 and June 2010, 21 cases of skin necrosis after ORIF of calcaneal fracture were treated, including 18 cases of Sanders type II and 3 cases ofSanders type III. There were 20 males and 1 female with an average age of 33.1 years (range, 23-60 years). All fractures were close fractures and were treated by ORIF with plate. Skin necrosis occurred at 3-5 days (mean, 4 days) after internal fixation. The interval of internal fixation and conservative dressing change was 3-10 days (mean, 6 days). Of 21 cases, 10 cases had superfacial skin necrosis with a size range of 1-10 cm in length and 0.5-1.5 cm in width, and 11 cases had deep skin necrosis with a size range of 1-8 cm in length and 0.5-1.5 cm in width. The conservative dressing change method was performed. Alcohol (75%) was used at the edge of the zone of skin necrosis, whereas sal ine in the central of the wound every 2-3 days. The necrosed tissue in the wound was reserved as more as possible. No patient was given antibiotic. Results Scab formed and subcrust heal ing was observed after 6-30 days (mean, 16 days) in 20 patients, 1 patient failed for discontinue treatment. No case had deep infection or osteomyl itis. The mean treatment time was 7.8 days (range, 6-14 days) in 10 cases of superfacial skin necrosis, and was 23.1 days (range, 14-30 days) in 10 cases of deep skin necrosis. All cases were followed up 92 days on average (range, 54-123 days). The scar was usually dark red and hard, protruding from the normal skin. No patient had difficulty in weight bearing or walking. Conclusion Skin necrosis after ORIF of calcaneal fracture can be cured by the conservative dressing change method, and this conservative method is effective and economic.
Objectives To compare umbilical cord daily care protocol in the current clinical setting in which 75% alcohol sterile is used daily for the umbilical and surrounding skins with the WHO-recommended method (dry and clean). Methods A total of 283 full-term newborns were randomly divided into two groups: the trial group (n=181) receiving WHO “dry and clean” protocol that the umbilical cord was open to air (with losing clothes), cleaned by clear water instead of alcohol. The control group (n=102) used the traditional method that after the newborns’ bathing, the umbilical cord and surrounding skins were sterilized with 75% alcohol. The basic condition of the newborns, umbilical departure time and complications around the navel were assessed. And bacterial culture from the newborns’ skins was observed. Results There were no significant differences in departure time of the umbilical cord (7.64±3.29 day vs. 8.50±3.45 days t=1.82, Pgt;0.05), complications (6 patients with slight omphalitis in the trial group and 2 patients with slight omphalitis in the control group), and the skin flora culture between the two groups. The umbilical cord of the newborns dropped off safely. And no fever was found. Conclusion This study does not support that 75% alcohol can prevent the umbilical cord from being infected. Keeping the umbilical cord and surrounding skins dry is important for infection control.
目的 观察免冲洗护理清洁液用于重症患者基础护理洗发和擦浴的临床效果。 方法 2012年6月－12月随机选取100 例重症监护患者，应用免冲洗护理清洁液洗发和擦浴，观察患者洗发、擦浴前后清洁情况、生命体征、感观及不良反应，并作微生物检测。 结果 免冲洗护理清洁液清洁效果优良率100%，清洗前细菌数（731.35 ± 49.23）cfu/cm2，清洗后细菌数（7.87 ± 0.39）cfu/cm2，细菌检测下降幅度为99.01%。 结论 免冲洗护理清洁液使用简便、安全，适宜卧床重症患者洁身之用，可在临床推广应用。
ObjectiveTo analyze the status quo, problems and weak points of cleaning compliance in the Intensive Care Unit (ICU), and assess the intervention effects by evaluating the object surface cleaning quality in the ICU. MethodsBetween September 1st and December 1st, 2014, fluorescence marker was used to mark the surfaces of medical instruments and objects in the ward which were supposed to be cleaned by the nursing and cleaning staff. The assessment of cleaning compliance was performed through observing the residual fluorescence. Then, targeted intervention was carried out for situations with a low cleaning compliance. ResultsBefore the intervention, the thorough cleaning rates of medical instruments in the Comprehensive ICU, Neurological ICU (NICU), and Chest ICU were respectively 43.3%, 31.4%, and 23.8%, and the thorough surface cleaning rates for those units in order were 67.1%, 60.5%, and 48.4%, respectively. After the first intervention, the cleaning rate of medical instruments in the Comprehensive ICU was 47.1%, which had no significant change (P=0.345), but the rate in the NICU and Chest ICU reached respectively 65.3% and 35.1%, which was significantly improved (P<0.05). The object surface cleaning rates were 73.3% and 58.1% in the Comprehensive ICU and Chest ICU after the first intervention, and there was no significant difference compared with those before the intervention (P>0.05), but the object surface cleaning rate in the NICU was significantly improved to 85.5% (P<0.05). After the second intervention, the medical equipment cleaning rates were 66.9%, 83.3%, and 57.4%, respectively for those three units, and compared with those before intervention, all the three were significantly improved (P<0.05). The object surface cleaning rates for NICU and Chest ICU were significantly raised to 85.6% and 84.2% (P<0.05), while it was 65.7% in the Comprehensive ICU and was not significantly improved (P=0.767). ConclusionObservation and supervision through a feedback system can raise the cleaning compliance, which is helpful in controlling and preventing nosocomial infection.
ObjectiveTo explore the effect and significance of continuous nursing in patients with clean intermittent catheterization. MethodsFrom July to December 2013, 47 patients with spinal cord injury still relying on clean intermittent catheterization were selected as the control group, whom were given the routine care and guidance. From January to June 2014, 51 patients with spinal cord injury still relying on clean intermittent catheterization were selected as the study group; in addition to routine nursing instruction before leaving hospital, they were also guided with the continuous nursing. In the way of telephone follow-up, we analyzed the results via the questionnaire of the effect of continuous nursing for spinal cord injured patients with clean intermittent catheterization. ResultsThe incidence of catheter related complications such as urinary tract infections in the study group was significantly lower than that in the control group (P<0.05). The caregivers' ability for patients in the study group was significantly higher than that in the control group (P<0.01). ConclusionThe continuous follow-up nursing instruction can improve the nursing ability of caregivers, and effectively reduce the occurrence of catheter related complications.