Budget cuts, technology, and the loss of experienced security personnel: what can be done to stem the tide?

As a result of hospital budget-cutting, the healthcare industry is losing many of its best security directors and managers, some experts warn. This loss is extending to the reduction of security officer complements, partially due to an "overdependence" on technology. And it's not only personnel who are being cut, but training programs as well. In this report, we'll give details on the current trend, its dangers to patient protection, and what changes can be made to operate more effectively in the current economic environment.

Globalization in road safety: explaining the downward trend in road accident rates in a single country (Israel)

A theoretical model is proposed in which road safety in a single country depends upon parochial considerations, such as police enforcement, and upon global considerations, such as international road safety technology. We show that there is a non-spurious relationship between the downward trend in the rate of road accidents in Israel and the road accident rate abroad. We suggest that this reflects the international propagation of road safety technology as it is embodied in motor vehicles and road design, rather than parochial road safety policy. Recent developments in the econometric analysis of time series are used to estimate the model using data for Israel. We make no direct attempt to explain the downward trend in the rate of road accidents outside Israel.

Clinician safety

Clinician safety is a serious concern for health care professionals because of the great risk of violence in health care workplaces, especially emergency and mental health departments. Assaults on mental health staff are often encountered from patients who are intoxicated with, or suffering withdrawal symptoms from, substances. Additionally, violence toward mental health professionals is frequently encountered from patients diagnosed with paranoid schizophrenia, personality disorders, learning disabilities, and mental retardation. Incidents of assault are often ignored by victims and administrators. Administrators must implement several measures to prevent clinician assault.

[Toxicologic risk assessment and prevention: rational and irrational approaches]

Worldwide, the management and evaluation of risks caused by chemical compounds are handled by the aid of threshold concentrations below of which one can be sure that no biological effect whatsoever can be observed. At the working place, we use the maximally tolerated concentration of the chemicals (MAK) and, in addition, the biologically tolerated concentrations (BTC) of the compounds either in blood or in other body fluids to which a male and/or female worker is exposed. These threshold concentrations should cover any toxic effect including on the one hand mere deviations of clinical chemical values without a disturbed function, i.e. symptoms of a disease as well as, on the other hand, carcinogenic, mutagenic and even allergic effects. Threshold concentrations, however, exist only for acute and chronic toxic effects and not for carcinogenic and/or mutagenic effects. In these cases, again, worldwide, the concept of minimizing the risks by the exposure is preferred since no toxicologist can be found to assure a "safe" concentration of a chemical compound that exert carcinogenic and/or mutagenic effects. With respect to these effects a proven carcinogenic and/or mutagenic effect in human beings must be discerned from a suspected effect on the basis of animal experiments or in vitro models. However, there exist also paradigms of a clearcut connection between a chemical substance or its metabolites causing carcinogenic and/or mutagenic effects in model experiments from which a clearcut suspect of similar reactions after the exposure of human beings can be drawn. In general, carcinogenic risks are overestimated in our societies. Following the data of experienced British epidemiologist most tumor diseases can be traced back to food consumption, beverages and tobacco and even sexual behavior must be ranked as cause for tumors before the rare exposure to dangerous chemicals at the working place. It is worthwhile to mention that natural toxins produced by bacteria and even infectious diseases or diseases caused by parasites are far more serious than the exposure to any man made chemical product including the Seveso poison, i.e. 2,3,7,8-TCDD, and related compounds. Vice-versa, the assumption that naturally occurring poisons could be neglected may lead to fatal experiences as for instances the outbreak of St-Anton's fire, i.e. the gangraeneous type of ergot alacaloide intoxication after having swallowed claviceps purpurea poisoned "Müsli" produced by rye collected in the fields and ground in a hand mill. In Middle-Europe, since 1880, when the threshold of 0.1% claviceps purpurea in rye was established, no poisonous epidemia of St. Anton's fire was observed.

[The viewpoint of social workers on the future legislative framework for the prevention of occupational hazards]

The new Prevention of Occupational Hazards Act (P.O.H.A.) has aroused great expectation among social workers and health experts who are working in this field. This article contains a critical commentary of the above-mentioned Act. The conclusion is reached that the P.O.H.A. promotes safety and occupational health in work places: its aim is to improve working conditions; although it guarantees the participation of the social worker, it does not allow for co-management in these matters; and that the deficiencies that are found must be overcome by means of the rulings, collective agreements and specific agreements with social workers.

Special report. Complying with the 1995 JCAHO security and safety standards: Part I

Leading consultants agree that complying with 1995 inspections by the Joint Commission on Accreditation of Healthcare Organizations will amount to the difference between an oral and a written exam: inspectors are expected to place more emphasis on quizzing all kinds of hospital employees about safety and security issues, and less on reviewing security paperwork and documents. The consensus is that hospitals that have been in compliance shouldn't have any worries about meeting the new standards, although there is some disagreement about the extent to which they will have to adapt. Initiated to set standards for patient care, JCAHO has been placing increasing emphasis lately on safety and security. The latest refinements are reflected in its 1995 Comprehensive Accreditation Manual. Terminology has been changed, security and safety standards added, and the responsibility for security has been spread throughout the organization rather than placed just on the shoulders of the security and safety departments. In Part I of this report, we'll present the viewpoints of consultants who have been heavily involved in assisting hospitals to successfully comply with the latest standards, as well as the experiences of one security director. Next month, in Part II, we'll present the latest viewpoints of JCAHO, plus the experiences of other security directors from around the country in meeting the current JCAHO challenge.

What's new in managing health hazards in pathology departments

Health hazards related to activities performed in pathology departments have represented, in recent years, an increasing concern among pathologists and pathology technicians. The major occupational health problems encountered in pathology departments are reviewed. They include biological hazards (tuberculosis, hepatitis, HIV, other infectious diseases), chemical hazards (formaldehyde, xylene(s), aromatic amines, methacrylates, glutaraldehyde, latex) and physical hazards (cut injuries, accidental fires, radiation). Current data suggest that infections (particularly, tuberculosis and hepatitis) still represent the more relevant risk. Exposure to HIV and Creutzfeldt-Jakob agent may be highly harmful but containment measures have been proven to be effective. The actual adverse effects due to chemicals seem to be less alarming than was previously believed. Attaining a safe work environment is an inherent element of good quality assurance management. This task is largely a matter of information, education, organization and common sense. Well-designed premises, efficient equipment and well-trained personnel are the keys to preventing and minimizing hazardous exposures. In order to provide current information that may be used by pathology staff to implement the functional quality of the workplace, organizational and preventive measures are described.