[Applying Team Resource Management to the Reduction of Ventilator-Associated Pneumonia in the Intensive Care Unit].

BACKGROUND & PROBLEMS: Ventilator-associated pneumonia (VAP) is a common healthcare-associated infection in the intensive care unit. The average VAP rate was .128% in our unit during 2011. Therefore, we designed a project to identify relevant problems, including: inadequate knowledge about VAP care, incorrect techniques for sputum suction, patient head elevation < 30~45 degrees, ventilator humidifier installed with water equipment designed without water-resistant barriers, failure to change the resuscitator and small-volume nebulizer regularly, and possible cross-contamination between respiratory-care devices. PURPOSE: We targeted a VAP rate decrease from the current .128% to less than .1%. RESOLUTION: The improvement measures implemented included team resource management (TRM) with VAP education, promotion, a written reminder regarding sputum accumulation sites, instruction to elevate the head of patients to an appropriate height, introduction of an auto-stop water adding system, and regular changes of related devices at assigned positions. RESULTS: The VAP rate decreased from .128% to .065%. CONCLUSIONS: The risk identification and associated TRM project improved teamwork and the quality of care in the ICU.

Study on the law of heavy metal leaching in municipal solid waste landfill.

Comparative leaching experiments were carried out using leaching medium with different pH to municipal solid waste in the landfill columns in order to investigate the mobility of heavy metals. The leachate pH and oxidation-reduction potential were measured by oxidation-reduction potential analyzer; the contents of heavy metals were measured by inductively coupled plasma mass spectrometry. It is very different in leaching concentrations of heavy metals; the dynamic leaching of heavy metals decreased with the rise of the leaching amount on the whole. Acid leaching medium had definite influence on the leaching of heavy metals in the early landfill, but it had the obvious inhibition effect on the leaching in the middle and late period of landfill; the neutral and alkaline leaching medium are more beneficial to the leaching of heavy metals. Due to the influence of the environment of landfill, the differences of the results in cumulative leaching amount, leaching rate, and leaching intensity of heavy metals are very big. The calculation results of the release rates of heavy metals prove that the orders of the release rates are not identical under different leaching conditions. Acid rain made heavy metals migrate from municipal solid waste to soil and detain in soil more easily; approached neutral and alkaline leaching mediums are more beneficial to leaching of heavy metals in the municipal solid waste and soil with leachate. The field verification of experimental data showed that the law of heavy metal leaching in municipal solid waste revealed by the experiment has a good consistency with the data obtained by municipal solid waste landfill.