2017年医院院感科年终工作总结

1、 2014年医院院感科年终工作总结在院领导的大力支持，各职能科室共同协作，科主任护士长以及全体员工的共同努力，院感控制工作取得了一定的成绩，为了更好地做好院感控制工作，防止医院感染暴发流行，现将近来主要工作总结如下：一、完善管理体系，发挥体系作用1、及时调整医院感染管理委员会、临床科室感染管理小组人员，定期召开会议，讨论医院感染管理中存在的问题，提出改进措施，做好下一步的落实工作。2、根据卫生部新的要求和规范，修订和完善了各项制度并监督落实执行情况。二、医院感染监测方面负责全院医院感染发病情况的监测，定期对医院环境卫生学、消毒、灭菌效果进行监督、检查，及时汇总、分析反馈与改进，发现医院感染存在

2、的危险因素，寻找有效的预防和控制办法。通过监测控制监测，最终减少和控制医院感染的发生，提高医疗质量。1、感染率监测：全院1-12月份共监测2408例住院病人，妇产科分娩人数904例、妇产科手术531例、儿科手术114例、新生儿住院人数73例、全院发生医院感染7例，无菌切口感染0例，妇产科上呼吸道感染2例，下呼吸道感染1例，儿科上呼吸道感染3例、消化道感染1例、全院感染发生率0.3%。符合标准。2、1-12全院无菌切口进行感染率调查，感染率为0%。达到了卫生部规定的1.5%的要求，无菌切口甲级愈合率 99.7 %，达到卫生部要求 97%。3、开展现患率调查情况9月份我科开展了住院病人现患率调查。

3、调查时间为1天，共调查16例在院病人，实查率为100%。调查结果显示，院内感染率为 0%，抗生素使用率为75%。4、开展目标性监测1-8月妇产科会阴侧切口切口感染监测，无切口感染。5、环境卫生监测方面我院环境卫生监测受条件限制未能做到，望领导尽快落实解决6、消毒灭菌监测1.按要求压力蒸汽灭菌高压锅进行效果监测，物理监测和化学监测我们都做得很好，但按卫生部消毒规范要求，每周做生物监测，我们受条件限制未做到。2.各科室对使用中的紫外线灯管进行了强度监测，每6月一次，合格率为100%。对70W/cm2的紫外线灯管通知科室及时更换。三、无医院感染暴发流行四、加强医疗废物管理，规范下收制度促成全院各科室

4、产生的医疗废物确定由专职人员下收工作的最终实施，并完成对下收专职人员进行必要的法律、法规和个人防护方面的培训。使得医疗废物的管理过程更符合实际，减少了污染和医护人员受伤害的机会。做到医疗废物收集、转运、储存、交接符合标准要求。五、重点科室、重点部位医院感染管理1、定期督查重点科室的感染管理，发现问题及时主动与科主任或护士长进行沟通，持续质量改进。将重点科室、重点部位医院感染的相关资料下发到相应科室组织科室人员学习，如：为儿科提供新生儿暖箱的拆洗及日常清洗消毒登记表。六、开展培训，提高医务人员院感意识1、专职人员参加全省级医院感染监控中心培训班 2人次。科室每月进行业务学习和医院感染病例讨论，不

5、断提高业务技术水平和医院感染水平。2、新职工培训对今年新上岗职工进行了医院感染概论、医院感染诊断知识、消毒隔离知识、手卫生、医务人员职业防护、医院感染暴发流行、医疗废物管理知识培训与考核，考核合格率为100%;虽然近阶段我科的工作取得了很大的进展，但是存在以下问题：1、临床感染管理小组没有充分发挥其作用。2、对重点科室院感控制干预工作做得不够，3、部分临床科室医生对院内感染重视程度不够,对病人的有关院内感染的诊断以及病情分析方面存在欠缺，医院感染病例漏报院感科2015年工作计划为提高我院院内感染管理质量，进一步搞好医院感染管理工作，保障医疗安全，根据医院感染管理规范、消毒技术规范医疗废物管理办

6、法和传染病防治法等有关文件与规定，在主管院长的领导下，今年主要搞好以下几项工作：一、 医院感染监测：1、每月监测住院病人医院感染发生情况，监测全院住院病人感染发病率，督促临床医生及时报告医院感染病例，防止医院感染暴发或流行。2、每月对临床科室医院感染督查、对存在的问题及改进措施每月反馈至临床科室3、每半年对出院病人进行漏报率调查。减少医院感染漏报，4、消毒灭菌效果监测及环境卫生学监测：根据消毒技术规范及医院感染管理办法要求，每季度对重点部门的空气、物体表面、工作人员手、消毒剂、灭菌剂、消毒灭菌物品等进行消毒灭菌效果监测,目前还是盲区，希望领导落实解决。5、根据消毒供应中心三大技术规范对器械清洗

7、、消毒、保养工作进行监督检查。二、抗菌药物合理使用管理：根据“抗菌药物合理使用实施细则及抗菌药物合理管理办法”。每月对住院手术病人的围手术期抗生素的使用调查并每月反馈至临床科室，每季度调查住院病人抗菌药物使用率。三、病区环境卫生学及医疗废物监督管理：定期督查医疗废物分类、收集、运送等制度，杜绝泄漏事件。每月查阅医疗废物交接登记本、暂存地消毒登记本，发现漏项及时填补。四、将手卫生与职业暴露防护问题纳入院内感染控制工作中的重点，加强手卫生及职业暴露防护。五、感染管理知识培训：多渠道开展培训，提高医务人员院感意识。对全院医务人员进行医院感染相关知识的培训，主要培训内容为：1、感染预防控制新进展、新方

8、法；2、医院感染诊断标准、医院感染病例报告制度及医院感染暴发，抗菌药物的合理使用知识等；3、对护理人员主要培训内容为消毒隔离知识、医院内感染的预防控制及医疗垃圾的分类收集；4、保洁人员的工作要求、消毒灭菌的基本常识、清洁程序、个人防护措施。5、医护人员手卫生9JWKffwvG#tYM*Jg&6a*CZ7H$dq8KqqfHVZFedswSyXTy#&QA9wkxFyeQ!djs#XuyUP2kNXpRWXmA&UE9aQGn8xp$R#͑GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWp

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26、z849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89Amv$UE9wEwZ#QcUE%

27、&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5

28、uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz84!z89Amv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcv

29、R9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxG

30、jqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%MadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zV

31、kum&gTXRm6X4NGpP$vSTT#&ksv*adNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#

32、QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89Amv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gT

33、XRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9C

34、pbK!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz84!z89Amv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGj

35、qv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&q

36、YpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNuGK8!z89AmYWpazadNu#KN&MuWFA5uxY7

37、JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*

38、3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv3tn

39、GK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2z

40、Vkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89Amv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vS

41、TT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%MzadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9

42、wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVku

43、m&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGj

44、qv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89Amv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYp

45、Eh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz84!z89Amv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYp

46、Eh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9&gTXRm

47、6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9w

48、EwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNuGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadN

49、u#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pD

50、x2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqvUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE

51、9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89Amv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pD

52、x2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz84!z89Amv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pD

53、x2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9&gTXRm6X4NG

54、pP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#Q

55、cUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNuGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&

56、MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVk

57、um&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv84!z89Amv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVk