Preparation of medical products in the doctor's office

Since the end of the last century, the preparation of medical products which must be applied in a germ-poor or sterile state has been increasingly done by specially trained staff at the hospital. The certification program (specialist training) enables personnel who often have no prior medical training to safely perform quality work both in terms of the patient and the employee's on-the-job safety. With the rapid development of out-patient operative care, the lack of adequately trained specialists in this area of sterile materials supply became obvious. The certification program, offered since 2003, closes this gap by focussing on the specific situation of doctor's offices and private-practice clinics, thus equalizing the discrepancies to the hospital situation. The implementation of the certification program in the quality-control system of private practices helps to reduce to an unavoidable minimum the potential risks to patients and staff posed by hygiene deficiencies.Die Aufbereitung von Medizinprodukten, die bestimmungsgemäß keimarm oder steril zur Anwendung kommen, wird seit Ende des vorigen Jahrhunderts im Krankenhaus zunehmend von speziell geschultem Personal durchgeführt. Die anerkannte Schulung (Fachkundeausbildung) befähigt die oft nicht medizinisch vorgebildeten Mitarbeiter/innen zu qualitätsgerechtem Handeln sowohl im Hinblick auf den Patienten als auch im Hinblick auf die eigene Sicherheit am Arbeitsplatz.Im Zusammenhang mit der rasanten Entwicklung der ambulanten operativen Versorgung fiel auf, dass für diesen Bereich der Sterilgutversorgung kein adäquat anerkannt sachkundiges Personal zur Verfügung steht. Der seit 2003 angebotene Sachkundelehrgang schließt diese Lücke, indem er auf die spezifische Situation der Praxen/Praxiskliniken eingeht und so die Divergenzen zum Krankenhausbetrieb ausgleicht. Die Implementierung des Sachkundekurses in das Qualitäts-sicherungssystem des niedergelassenen Arztes hilft mit, das Gefahrenpotential durch Hygienemängel auf das für den Patienten und das Personal unvermeidbare Restrisiko zu vermindern

Spatially resolved plasma rotation profiles with ICRF on JET

P

Atomic data for modelling fusion and astrophysical plasmas

Trends and focii of interest in atomic modelling and data are identified in connection with recent observations and experiments in fusion and astrophysics. In the fusion domain, spectral observations are included of core, beam penetrated and divertor plasma. The helium beam experiments at JET and the studies with very heavy species at ASDEX and JET are noted. In the astrophysics domain, illustrations are given from the SOHO and CHANDRA spacecraft which span from the solar upper atmosphere, through soft x-rays from comets to supernovae remnants. It is shown that non-Maxwellian, dynamic and possibly optically thick regimes must be considered. The generalized collisional-radiative model properly describes the collisional regime of most astrophysical and laboratory fusion plasmas and yields self-consistent derived data for spectral emission, power balance and ionization state studies. The tuning of this method to routine analysis of the spectral observations is described. A forward look is taken as to how such atomic modelling, and the atomic data which underpin it, ought to evolve to deal with the extended conditions and novel environments of the illustrations. It is noted that atomic physics influences most aspects of fusion and astrophysical plasma behaviour but the effectiveness of analysis depends on the quality of the bi-directional pathway from fundamental data production through atomic/plasma model development to the confrontation with experiment. The principal atomic data capability at JET, and other fusion and astrophysical laboratories, is supplied via the Atomic Data and Analysis Structure (ADAS) Project. The close ties between the various experiments and ADAS have helped in this path of communication

Atomic data for modelling fusion and astrophysical plasmas

Trends and focii of interest in atomic modelling and data are identified in connection with recent observations and experiments in fusion and astrophysics. In the fusion domain, spectral observations are included of core, beam penetrated and divertor plasma. The helium beam experiments at JET and the studies with very heavy species at ASDEX and JET are noted. In the astrophysics domain, illustrations are given from the SOHO and CHANDRA spacecraft which span from the solar upper atmosphere, through soft x-rays from comets to supernovae remnants. It is shown that non-Maxwellian, dynamic and possibly optically thick regimes must be considered. The generalized collisional-radiative model properly describes the collisional regime of most astrophysical and laboratory fusion plasmas and yields self-consistent derived data for spectral emission, power balance and ionization state studies. The tuning of this method to routine analysis of the spectral observations is described. A forward look is taken as to how such atomic modelling, and the atomic data which underpin it, ought to evolve to deal with the extended conditions and novel environments of the illustrations. It is noted that atomic physics influences most aspects of fusion and astrophysical plasma behaviour but the effectiveness of analysis depends on the quality of the bi-directional pathway from fundamental data production through atomic/plasma model development to the confrontation with experiment. The principal atomic data capability at JET, and other fusion and astrophysical laboratories, is supplied via the Atomic Data and Analysis Structure (ADAS) Project. The close ties between the various experiments and ADAS have helped in this path of communication

Luftqualität im OP-Saal: Postoperative Wundinfektionen, RLT-Anlagen und Disziplin - Positionspapier der Deutschen Gesellschaft für Krankenhaushygiene (DGKH)

In recent years, there has been an ongoing discussion about the value of laminar airflow (LAF=low turbulence displacement ventilation) in the operating room for prevention of surgical site infections (SSI). Some publications, e.g., from the WHO, issued the demand to no longer build LAF ceilings in operating rooms. The present statement deals critically with this position and justifies the use of LAF ceilings in different ways: Many of the papers cited by the WHO and others for the case against LAF do not provide reliable data. The remaining studies which might be used for answering the question give quite different results, also in favor of LAF. The size of the LAF ceiling in many studies is not given or mostly too small in comparison to actual technical requirements. LAF in different countries can mean quite different techniques (e.g., the US in comparison to Germany) so that the results of studies that do not take this into account may not be comparable. LAF has positive effects in terms of reducing particulate and bacterial load, associated with increased airflow in the surgical working area. A reduction of carcinogenic substances in the air may also be assumed, which would increase workers' safety. Thus, this paper recommends building LAF ceilings in the future as well, depending on the operations intended.Further, this paper gives an overview of possible reasons for surgical site infections and highlights the importance of discipline in the operating theatre.In den letzten Jahren wird fortwährend über den infektionspräventiven Wert von laminar airflow (LAF=Turbulenz-arme Verdrängungsströmung) im Operationssaal diskutiert. Einige Publikationen, z.B. von der WHO, fordern, keine LAF-Decken in Operationssälen mehr einzubauen. Die Stellungnahme setzt sich kritisch mit dieser Position auseinander und begründet den Einsatz von LAF-Decken auf unterschiedliche Weise: Viele der zitierten Artikel zu LAF sind bezüglich der Datenqualität nicht verlässlich. Die verbleibenden Studien, die zur Beantwortung der Frage herangezogen werden können, ergeben für LAF unterschiedliche Ergebnisse. Die Größe der LAF-Decken ist in vielen Studien nicht angegeben bzw. im Vergleich zu den tatsächlichen technischen Anforderungen meist zu klein. LAF kann in verschiedenen Ländern sehr unterschiedliche Techniken beinhalten (z.B. USA im Vergleich zu Deutschland), so dass die Ergebnisse von Studien, die das nicht erfassen, nicht vergleichbar sind. LAF hat positive Auswirkungen hinsichtlich der Reduktion von Partikeln und Mikroorganismen in der Luft im Bereich des OP-Felds, verbunden mit einem erhöhten Luftvolumenstrom. Daraus kann zugleich eine Reduktion kanzerogenen Substanzen in der Luft abgeleitet werden und damit ein besserer Arbeitsschutz. In der Konsequenz wird empfohlen, in Abhängigkeit von den beabsichtigten Operationen auch in Zukunft LAF-Decken zu bauen.Der Artikel gibt zugleich einen Überblick darüber, welche Ursachen für postoperative Wundinfektionen in Frage kommen und weist auf die Bedeutung der Disziplin im OP hin

The 'neutron deficit' in the JET tokamak

The measured D-D neutron rate of neutral beam heated JET baseline and hybrid H-modes in deuterium is found to be between approximately 50% and 100% of the neutron rate expected from the TRANSP code, depending on the plasma parameters. A number of candidate explanations for the shortfall, such as fuel dilution, errors in beam penetration and effectively available beam power have been excluded. As the neutron rate in JET is dominated by beam-plasma interactions, the 'neutron deficit' may be caused by a yet unidentified form of fast particle redistribution. Modelling, which assumes fast particle transport to be responsible for the deficit, indicates that such redistribution would have to happen at time scales faster than both the slowing down time and the energy confinement time. Sawteeth and edge localised modes are found to make no significant contribution to the deficit. There is also no obvious correlation with magnetohydrodynamic activity measured using magnetic probes at the tokamak vessel walls. Modelling of fast particle orbits in the 3D fields of neoclassical tearing modes shows that realistically sized islands can only contribute a few percent to the deficit. In view of these results it appears unlikely that the neutron deficit results from a single physical process in the plasma

The 'neutron deficit' in the JET tokamak

The measured D-D neutron rate of neutral beam heated JET baseline and hybrid H-modes in deuterium is found to be between approximately 50% and 100% of the neutron rate expected from the TRANSP code, depending on the plasma parameters. A number of candidate explanations for the shortfall, such as fuel dilution, errors in beam penetration and effectively available beam power have been excluded. As the neutron rate in JET is dominated by beam-plasma interactions, the 'neutron deficit' may be caused by a yet unidentified form of fast particle redistribution. Modelling, which assumes fast particle transport to be responsible for the deficit, indicates that such redistribution would have to happen at time scales faster than both the slowing down time and the energy confinement time. Sawteeth and edge localised modes are found to make no significant contribution to the deficit. There is also no obvious correlation with magnetohydrodynamic activity measured using magnetic probes at the tokamak vessel walls. Modelling of fast particle orbits in the 3D fields of neoclassical tearing modes shows that realistically sized islands can only contribute a few percent to the deficit. In view of these results it appears unlikely that the neutron deficit results from a single physical process in the plasma