Toxicological profile for o-benzyl-p-chlorophenol

As part of a health-hazard survey on the health risk of hospital cleaning workers from exposure to Lyorthol, a hazard assessment of o-benzo-p-chlorophenol, one of the constituents of Lyorthol, has been prepared. In this paper, the physical and chemical characteristics, kinetics and effects of o-benzochlorophenol are described and discussed, and an overall, summarizing hazard evaluation is presented.

[Preliminary evaluation of the incidence and control of insects--pest control in Polish hospitals]

The evaluation of the infestation and methods of insect disease vectors control in 748 hospitals in Poland in the period of 1990 to 1995 were done. The insect species, places of their occurrence and control agents were analysed. Blattella germanica L. occurred most frequently (71% hospitals). Blatta orientalis and Monomorium pharaonis were found in 40% and 17% hospitals respectively. Kitchens, laundries and baths were most infested. Sometimes insects were found also in central sterilization units and operating theaters. Controls of insects in hospitals were performed one to four times a year mostly by spraying with residual formulation. The control agents contained pyrethroids (mostly permethrin, but also deltamethrin and cypermethrin) and carbamates (bendiocarb, propoxur). Baits with hydramethylnon, boric acid, methoprene and chlorpyrifos were used not very often. The authors suggest reduction in using the spraying agents. The baits are recommended because they delay the development of the resistance to pesticides in controlling insect populations and are safer.

Support services. Domestic bliss

Healthcare assistants had to leave the patients' bedside to do routine housekeeping work. Replacing a healthcare assistant post with a housekeeper has improved the use of personnel, staff morale and patient care. Allowing healthcare assistants to manage the project has ensured ownership.

Serratia marcescens outbreak associated with extrinsic contamination of 1% chlorxylenol soap

OBJECTIVES

To determine risk factors for Serratia marcescens infection or colonization, and to identify the source of the pathogen and factors facilitating its persistence in a neonatal intensive-care unit (NICU) during an outbreak.

DESIGN

Retrospective case-control study; review of NICU infection control policies, soap use, and handwashing practices among healthcare workers (HCWs); and selected environmental cultures.

SETTING

A university-affiliated tertiary-care hospital NICU.

PATIENTS

All NICU infants with at least one positive culture for S marcescens during August 1994 to October 1995. Infants who did not develop S marcescens infection or colonization were selected randomly as controls.

RESULTS

Thirty-two patients met the case definition. On multivariate analysis, independent risk factors for S marcescens infection or colonization were having very low birth weight (< 1,500 g), a patent ductus arteriosus, a mother with chorioamnionitis, or exposure to a single HCW. During January to July 1995, NICU HCWs carried their own bottles of 1% chlorxylenol soap, which often were left standing inverted in the NICU sink and work areas. Cultures of 16 (31%) of 52 samples of soap and 1 (8%) of 13 sinks yielded S marcescens. The 16 samples of soap all came from opened 4-oz bottles carried by HCWs. DNA banding patterns of case infant, HCW soap bottle, and sink isolates were identical.

CONCLUSIONS

Extrinsically contaminated soap contributed to an outbreak of S marcescens infection. Very-low-birth-weight infants with multiple invasive procedures and exposures to certain HCWs were at greatest risk of S marcescens infection or colonization.

Healthcare environmental services infection control: the basics of microbiology

Support service staff members, regardless of their specific work assignment, frequently come into contact with infected patients and contaminated facility surfaces. Their thorough understanding of the basics of microbiology is critical to the development and implementation of an effective infection control program. Workers who have the benefit of appropriate education as well as the most recent, up-to-date information are positioned to make safe and effective decisions as they go about the task of addressing the many and various environmental situations that occur during the course of the day. These decisions often directly affect the patient care delivery process as well as the quality of its outcomes. The following document provides basic information about the science of microbiology and the disease-producing microorganisms commonly found in a health care facility as well as how those organisms are spread and controlled.

An assessment of the introduction of a multi-skilled worker into an acute care setting

The first reengineering project undertaken by the Sunnybrook Health Science Centre after adopting a philosophy of patient-focused care was the introduction of a new category of worker: the multi-skilled service assistant. This article describes the experiences of the first two cohorts of service assistants and assesses the changes made to the work itself and the integration of the new workers into the work environment. It concludes by sharing recommendations for introducing a new work role.

Dermatoses among housekeeping personnel

BACKGROUND

Housekeepers are exposed to irritants and allergens in their work and are at significant risk for developing occupationally induced contact dermatitis.

OBJECTIVE

We studied housekeepers at the Hershey Medical Center to determine the cause and frequency of contact dermatitis and contact urticaria in these workers.

METHODS

All housekeepers were examined. Those with hand dermatitis had an extensive history, patch testing, and latex RAST testing.

RESULTS

Eight of 130 had hand dermatitis. None had a relevant positive patch test or positive RAST test.

CONCLUSIONS

Of our housekeepers, 6.2% had occupationally induced irritant contact dermatitis. None had allergic contact dermatitis or contact urticaria to latex.

[Floor cleaning methods of patients' room. Effect on bacteria, dirt and particles]

The effect of floor cleaning on bacteria, organic materials and particles in the patients' rooms was studied at Ullevål University Hospital, Oslo, Norway. Four cleaning methods were compared; dust-adhesive (dry), humified, wet mopping, and regular wet washing (RWW) without a mop. The following tests were taken from the floor before and after cleaning: bacterial counts (colony forming units = CFU) and ATP (presence of organic materials), and from the air: CFU/m3 air, and particle counts/m3 air. Humified mopping and dry mopping reduced the bacterial counts from the floor by 75% and 55% respectively (p = 0.005 and p = 0.014, using contact medium). The wet mopping had no statistically significant effect, while the wet washing even increased the CFU on the floor by 35-50% (p = 0.017 with contact medium, and p = 0.028 with petrifilm). The two wet methods were the most effective, however, in removing organic materials from the floor; 65% to 70% reduction (p = 0.051 and p =0.008). The CFU/m3 air was low both before (50-130 CFU/m3) and after (70-110 CFU/m3) cleaning. A slight increase in airborne particles was measured after dry mopping. Combined use of humified mopping and wet mopping is recommended, but is dependent on a well prepared and finished floor surface.

Healthcare textile services: infection control

The purpose of this technical document is to acquaint managers with the basic infection control practices that are generally considered to be appropriate for a textile care services operation in a health care facility. An infection control program that provides the information needed by employees to conduct operational activities in a safe manner is essential to avoid the contamination of personnel. This document discusses the responsibilities of various staff members in the department, basic infection control practices, the physical control of organisms, appropriate housekeeping as well as engineering and maintenance and employee health issues relevant to the textile care department.

CLEANING OF HOSPITAL FLOORS WITH OILED MOPS

A comparison was made of three methods for the removal of dust from a hospital ward floor.

The viable bacterial counts of impression plates from the floor showed a mean reduction of 51 % after cleaning with fresh oiled mops, 40 % after cleaning with a tank model vacuum cleaner and 5 % after sweeping with a broom.

The mean proportions of airborne bacteria, compared with viable counts before cleaning, were 192 % during and 194 % after cleaning with a broom; 128 % during and 103 % after cleaning with an oiled mop, and 82 % during and 48 % after cleaning with a vacuum cleaner. On repeated use the oiled mop dispersed almost as much dust as a broom, but this settled rapidly from the air.

The effects of these cleaning methods on counts of presumptive Staph. aureus on the floor and in the air were similar to those found in counts of total organisms.

We wish to thank Mr M. D. Wilkins for valuable assistance, the Domestic Superintendent and staff and the nursing staff for their co-operation, and Messrs Leeming Brothers Limited for supplies of ‘Kex’ mops and equipment.

EVALUATION OF DISINFECTANTS FOR HOSPITAL HOUSEKEEPING USE

A use-dilution procedure and screening method are proposed to aid the hospital bacteriologist in selecting the most effective disinfectants. Sixteen disinfectants were tested with and without organic material on six different organisms. Sporadic results usually obtained with quaternaries tested by the procedure of the Association of Official Agricultural Chemists (AOAC) were eliminated by the methods of this study. The use-dilution procedure employs the material upon which the disinfectant is to be used, rather than stainless steel, as in the AOAC use-dilution test. The importance of testing each disinfectant against several organisms and in the presence of organic material is discussed.

[What is prevention of perioperative infection? Overview exemplified by trauma surgery]

The prevention of perioperative infection requires an interplay of technical equipment, good surgical technique and proper attention to hygiene. The basis for this is a well-structured and well-organized department using well-known, generally practised routine procedures and solid, realistic time planning. The most important technique for supervising and optimizing behaviour (with regard to both operative technique and hygiene) is the example of "being there" ("inter-esse"). In this way, mistakes regarding details are noticed immediately. Moreover, the best form of quality control is a long-term, honest survey of infection statistics that is managed by one responsible person only. Above all, the infection statistics should detect factors predisposing to infection that can be modified by everyday staff attention. The protection of staff against infection is equally as important as the protection of patients. The question of whether routine perioperative antibiotic prophylaxis or treatment in trauma surgery is useful under the present conditions has not yet been answered.

Medical surveillance for ethylene oxide exposure: practices and clinical findings in Massachusetts hospitals

The medical surveillance requirements of the Occupational Safety and Health Administration's (OSHA) ethylene oxide (EtO) standard became effective in 1985. However, little is known about the nature of the response of EtO users to this regulatory requirement. In an effort to begin to understand this, we conducted a survey of EtO health and safety in Massachusetts hospitals (n = 92). We determined the cumulative incidence of provision of EtO medical surveillance, the characteristics of the surveillance interventions provided, and the clinical findings of EtO medical surveillance efforts in Massachusetts hospitals. From 1985 to 1993, medical surveillance for EtO exposure was provided one or more times in 62% of EtO-using hospitals. Sixty-five percent of EtO medical surveillance providers reported performance of all five medical surveillance procedures required by OSHA's EtO standard. Medical surveillance provider certification in occupational medicine or nursing, and a greater extent of coverage of written medical surveillance policies, were related to higher likelihoods of fulfillment of OSHA-required procedures. Twenty-seven percent of medical surveillance providers reported detection of EtO-related symptoms or conditions, ranging from mucous membrane irritation to peripheral neuropathy. These findings reveal wide-spread implementation of OSHA-mandated EtO medical surveillance, with concomitant incomplete fulfillment of OSHA-specified procedures. From the provider-based survey, we estimate that one or more workers at 19% of EtO-using Massachusetts hospitals have experienced EtO-related health effects.

Meeting the training challenge of cross-cultural differences

So if your training and education needs are complicated with a workforce that more and more reflects national origins other than the United States, the following strategies may help: Use a "hands-on" approach. People learn and remember what they do. Use pictures to reinforce and clarify. Be consistent, patient, and respectful. Check regularly for understanding. Promote safety with consistency, careful listening, and a variety of oral, written, and pictorial media. Look for products that are easy to use and that reduce procedural steps. Simplify processes. Use color coding to decrease confusion. The changing demographics of the workforce create both challenges and opportunities. Successfully overcoming challenges such as establishing appropriate systems, training a diverse group of associates, and encouraging safe work habits can increase productivity, reduce costs, and generate a creative work environment. Suppliers and product manufacturers can often be valuable partners in this process.

Latex allergy in housekeeping personnel

BACKGROUND

Latex allergy has been well described in healthcare workers and children with spina bifida. Cost effective measures to avoid latex allergic reactions are possible in these recognized risk groups.

OBJECTIVE

To study the prevalence of latex allergy among hospital housekeepers regularly exposed to latex gloves.

METHODS

Fifty members of the housekeeping staff at a Toronto teaching hospital were screened by questionnaire for latex allergy. Patients with possible atopy or symptoms suggestive of latex allergy (20) were skin tested with latex (Bencard Laboratories) eight common allergens and histamine control.

RESULTS

Four of 20 tested had a positive latex prick skin test representing an 8% prevalence overall within this group, and a 20% prevalence among atopic housekeepers. Based on an expected 1% prevalence in the general population, this was statistically significant (P < .005). Latex-positive patients had extensive exposure to high protein-unlined latex gloves. Positive patients had a similar yet completely unique immunoblot pattern of IgE binding. All four positive patients had unrecognized latex allergic symptoms (hand dermatitis, rhinoconjunctivitis). One housekeeper experienced itchiness of her face, angioedema, and lightheadedness immediately after inflating a latex balloon.

CONCLUSIONS

The 8% prevalence of a positive latex skin test in regularly exposed hospital housekeepers is similar to that observed among healthcare workers suggesting this is a new risk group.

A continuous quality improvement effort

A new method of delivering patient care was implemented on a Critical Care Unit when it was discovered that a large percentage of patients required respiratory care. A task force redesigned staffing to include a Respiratory Care Practitioner (RCP) and a patient/housekeeping aide. It was found that 67% of tasks could be delegated to RCPs, so an intensive inservice concentration on delegating skills was provided for all.

Urinary cyclophosphamide excretion and chromosomal aberrations in peripheral blood lymphocytes after occupational exposure to antineoplastic agents

In this study we have compared the results of a method for the detection of cyclophosphamide in urine and the results of analysis of chromosomal aberrations in peripheral blood lymphocytes of four groups of subjects with various exposure statuses. These groups are 17 Dutch and 11 Czech exposed workers (mainly hospital nurses and pharmacy technicians) handling antineoplastic agents and 35 Dutch and 23 Czech controls (nurses, medical doctors, pharmacy and lab technicians) not handling these drugs. The groups were subdivided into smokers and non-smokers because of a confounding effect of smoking. Within the Dutch groups, the percentage of aberrant cells and the number of breaks per cell were increased for smokers compared to non-smokers. The percentage of aberrant cells was increased in Dutch exposed workers in comparison with Dutch control workers. Within the Czech groups the percentage of aberrant cells and the number of breaks per cell were increased in exposed workers in comparison with control workers. However, both Dutch and Czech smokers mainly contributed to the increase. The results suggest an additive effect of exposure and smoking in the Dutch subjects and a more than additive effect in the Czech subjects. In urine samples of three out of 11 Dutch exposed workers cyclophosphamide was found in a range of 0.1-0.5 micrograms/24 h. Higher levels were detected in the urine of eight out of 11 Czech exposed workers, a range of 0.1-2.9 micrograms/24 h. No correlation was observed between the amounts of cyclophosphamide excreted in urine on the one hand and the percentage of aberrant cells and the number of breaks per cell on the other hand. The present study is the first study showing that hospital workers having an increase in chromosome aberrations related to their work are exposed to at least one antineoplastic agent.