Increased Adherence to Infection Control Practices Among Medical Laboratory Technicians During the COVID-19 Pandemic: A Self-Reported Survey Study

Background

The adherence of medical laboratory technicians (MLT) to infection control guidelines is essential for reducing the risk of exposure to infectious agents. This study explored the adherence of MLT towards infection control practices during the COVID-19 pandemic.

Method

The study population consisted of MLT (n = 444) who worked in private and government health sectors in Jordan. A self-reported survey was used to collect data from participants.

Findings

More than 87% of the participants reported adherence to hand-washing guidelines and using personal protective equipment (PPE) when interacting with patients (74.5%), and handling clinical samples (70.0%). Besides, 88.1%, 48.2%, and 7.7% reported wearing of lab coats, face masks, and goggles, at all times, respectively. The majority reported increased adherence to infection control practices during the COVID-19 pandemic. This includes increased PPE use at the workplace (94.2%), increased frequency of disinfection of laboratory surfaces (92.4%) and laboratory equipment (86.7%), and increased frequency of handwashing/use of antiseptics (94.6%). Having a graduate degree was significantly associated with increased adherence of participants to the daily use of goggles/eye protection (p = 0.002), and the use of PPE while handling clinical samples (p = 0.011). Having work experience of >10 years was associated with increased adherence to the use of PPE while handling clinical samples (p = 0.001).

Conclusion

MLT reported very good adherence with most assessed infection control practices. In addition, they reported increased conformity with infection control guidelines during the COVID-19 pandemic.

What Industrial Categories Are Workers at Excess Risk of Filing a COVID-19 Workers' Compensation Claim? A Study Conducted in 11 Midwestern US States

OBJECTIVE

Determine the industries with the highest proportion of accepted COVID-19 related workers' compensation (WC) claims.

METHODS

Study included 21,336 WC claims (1898 COVID-19 and 19,438 other claims) that were filed between January 1, 2020 and August 31, 2020 from 11 states in the Midwest United States.

RESULT

The overwhelming proportion of all COVID-19 related WC claims submitted and accepted were from healthcare workers (83.77%). Healthcare was the only industrial classification that was at significantly higher COVID-19 WC claim submission risk (odds ratio [OR]: 4.00; 95% confidence intervals [CI]: 2.77 to 5.79) controlling for type of employment, sex, age, and presumption of COVID-19 work-relatedness. Within healthcare employment, WC claims submitted by workers in medical laboratories had the highest risk (crude rate ratio of 8.78).

CONCLUSION

Healthcare employment is associated with an increased risk of developing COVID-19 infections and submitting a workers' compensation claim.

Gender disparity in scientific publishing: What can we do?

The editors at JEM share their views on gender bias in scientific publishing and their efforts to ensure that JEM remains a bias-free environment for all authors, reviewers, and editors.

Regarding the rights and duties of Clinical Laboratory Geneticists in genetic healthcare systems; results of a survey in over 50 countries

Specialists of human genetic diagnostics can be divided into four groups: Medical Geneticists (MDG), Genetic Nurses and/or Counsellors (GN/GC), Clinical Laboratory Geneticists (CLG) and Laboratory Genetics Technicians (LGT). While the first two groups are in direct patient contact, the work of the latter two, of equal importance for patient care, are often hidden as they work behind the scenes. Herein the first study on the rights and duties of CLGs is presented. We present the results of a survey performed in 35 European and 18 non-European countries with 100 participating specialists. A national CLG title is available in 60% of European countries, and in 77% of the surveyed European countries a CLG can be the main responsible head of the laboratory performing human genetic tests. However, in only 20% of European countries is a lab-report valid with only a CLGs' signature - even though the report is almost always formulated by the CLG, and an interpretation of the obtained results in a clinical context by the CLG is expected in nearly 90% of European countries. Interestingly, CLGs see patients in 30% of European countries, and are also regularly involved in student education. Overall, the CLG profession includes numerous duties, which are quite similar in all regions of the world. Strikingly, the CLG's rights and responsibilities of leading a lab, or signing a report are regulated differently according to country specific regulations. Overall, the CLG is a well-recognized profession worldwide and often working within a multidisciplinary team of human genetic diagnostics professionals.

Assessment of Quality of Medical Laboratory Services Provision and Associated Factors in Public Health Facilities at Gondar Town, Amhara Regional State, Northwest Ethiopia

BACKGROUND

A quality medical laboratory service is an important part of the health care system. In developing countries like Ethiopia, the laboratory quality system remains weak due to several factors. Therefore, assessing the factors affecting quality of medical laboratory service is highly important in order to improve service quality.

OBJECTIVE

Assessment of factors affecting the quality of medical laboratory service in Gondar town public health facilities, Amhara regional state, Northwest Ethiopia, 2018.

METHODS

An institution based cross-sectional study was conducted at Gondar town governmental health facilities from March to April 2018. A pretested, self-administered, semi-structured questionnaire and checklist was used to collect the socio-demographic information of the study participants and to assess factors affecting the provision of quality medical laboratory services. Data were checked for completeness, entered, and analyzed using SPSS version 20 (IBM Corporation, Armonk, NY, USA). Data were reported in tables and figures. The strength of association between the dependent and independent variables was assessed by the chi-square test. A p-value < 0.05 was considered statistically significant.

RESULTS

A total of 103 medical laboratory professionals participated in the study. Of these, 62 (60.2%) were males. The majority of the study participants, 63 (61.2%), were laboratory technologists. Of these participants, 72 (69.9%) did not attend laboratory refresher training and 93 (90.3%) of participants were not satisfied with their salary. Sixty-three (61.2%) of the participants reported that their laboratory did not provide quality laboratory service. Lack of quality and adequate equipment, non-adherence to standard operating procedures, no continuing professional development, unavailability of adequate supplies and reagents, no customer service management, no regular internal and external quality assessment activity, no diagnostic service for all requested tests, no result verification, and laboratory safety were the major factors significantly associated with poor quality laboratory service (p < 0.05).

CONCLUSIONS

A high proportion of the study participants reported that their laboratory did not provide quality laboratory services. The shortage of adequate equipment, reagents, and lack of motivation and employees' recognitions are the major factors that affect the quality of laboratory services.

Payments From Pharmaceutical Companies to Authors Involved in the Valsartan Scandal in Japan

IMPORTANCE

Financial relationships between pharmaceutical companies and physicians can bias the conduct, findings, and reporting of clinical trials. In Japan, the valsartan scandal was a significant event: all 5 key articles on the valsartan clinical trials were retracted after the revelation of data falsification. Consequently, the Japan Pharmaceutical Manufacturers Association issued transparency guidelines, and pharmaceutical payments have been publicly disclosed since 2013. However, the distribution of payments from pharmaceutical companies among authors involved in the valsartan scandal after its revelation has not been studied to date.

OBJECTIVE

To identify the characteristics and distribution of payments from pharmaceutical companies to researchers involved in the valsartan scandal in Japan by using a comprehensive payment database.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective cross-sectional study, conducted from January 1, 2016, through September 30, 2017, used information on payments from 78 pharmaceutical companies to 50 authors of 5 articles retracted after the valsartan scandal: the Kyoto Heart Study, Jikei Heart Study, SMART (Shiga Microalbuminuria Reduction Trial), VART (Valsartan Amlodipine Randomized Trial), and Nagoya Heart Study. Payments from companies to physicians were analyzed during the period from January 1, 2016, to September 30, 2017.

MAIN OUTCOMES AND MEASURES

The main outcomes were the amount and proportion of payments made by pharmaceutical companies to authors, and the forms of these payments.

RESULTS

Of 50 eligible authors, 30 (60%) received payments from pharmaceutical companies in 2016. The payments in the Japanese yen totaled ¥67.15 million (US $590 896) and the mean (SD) payment was more than ¥1.34 million (¥3.01 million) (US $11 817 [$27 292]). Five authors (10%) received more than ¥5 million (US $44 000) and 3 authors (6%) received more than ¥10 million (US $88 000). The total payments to the corresponding author of each article was ¥29 million (US $255 307), accounting for 43.2% of the total payments. Regarding forms of the payments, lecture fees accounted for 81.3% of the total payment (¥54.56 million).

CONCLUSIONS AND RELEVANCE

Many authors involved in the valsartan scandal received payments from the pharmaceutical industry. Although whether such payments to these authors have decreased since the scandal is unclear, the findings appear to demonstrate that their financial relationships with the industry are still prominent. The findings of the study appear to support the need to encourage more transparency in such relationships because misconduct can occur within unclear relationships.

Risk of professional accidental exposure to biological agents in health care workers: a retrospective analysis carried out in a southern Italian tertiary hospital

Worldwide the needlestick injuries of health care workers (HCWs) still represent a major health problem. The authors aimed to evaluate the risk of HCW needlestick injuries in a tertiary university hospital in southern Italy in relation to some HCW characteristics (age, sex, professional profile, work department) and the source of infection. All HCWs of the University Hospital "Federico II" in Naples, Italy, attending the Infectious Diseases Unit after potential accidental contact to blood-borne viruses through needlestick injuries were enrolled during a 22-year period. HCWs underwent clinical analysis and were administered a specific questionnaire to collect (in anonymous fashion) data about age, sex, professional profile and work department. From 1995 to 2016 1,477 needlestick injuries in the same number of people (one accident per person) were recorded by our service. The HCWs were predominately males (n = 806, 55%) and the mean age was 39.4 years (±10.1 SD). The job categories most involved were: physicians (41%), followed by nurses (33%) and healthcare assistants (HCAs, 10%). The incidence proportion was calculated for these highest-risk categories in three defined time points (at the beginning, in the middle and at the end of the study period): 104/2149 (4.86%) in 1995, 41/2498 (1.64%) in 2005 and 25/2057 (1.22%) in 2015. Most injuries occurred in General Surgery (14.21%), Gynecology and Obstetrics (9%) and Pediatrics (6.49%). In about 34% the HCWs had been exposed to HCV infected fluids. Over time, a significant decrease in accidental exposure was recorded for physicians (p= 0.019), nurses (p< 0.0001) and HCAs (p< 0.0001). Our results confirm that some profiles, namely physicians, nurses and healthcare assistants, are still at risk of needlestick injuries, especially in surgical areas, including obstetric wards. Further primary and secondary prevention strategies are needed to decrease the incidence of new cases of needlestick injuries.

Multicenter evaluation of stress-first myocardial perfusion image triage by nuclear technologists and automated quantification

BACKGROUND

A stress-first myocardial perfusion imaging (MPI) protocol saves time, is cost effective, and decreases radiation exposure. A limitation of this protocol is the requirement for physician review of the stress images to determine the need for rest images. This hurdle could be eliminated if an experienced technologist and/or automated computer quantification could make this determination.

METHODS

Images from consecutive patients who were undergoing a stress-first MPI with attenuation correction at two tertiary care medical centers were prospectively reviewed independently by a technologist and cardiologist blinded to clinical and stress test data. Their decision on the need for rest imaging along with automated computer quantification of perfusion results was compared with the clinical reference standard of an assessment of perfusion images by a board-certified nuclear cardiologist that included clinical and stress test data.

RESULTS

A total of 250 patients (mean age 61 years and 55% female) who underwent a stress-first MPI were studied. According to the clinical reference standard, 42 (16.8%) and 208 (83.2%) stress-first images were interpreted as "needing" and "not needing" rest images, respectively. The technologists correctly classified 229 (91.6%) stress-first images as either "needing" (n = 28) or "not needing" (n = 201) rest images. Their sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 66.7%, 96.6%, 80.0%, and 93.5%, respectively. An automated stress TPD score ≥1.2 was associated with optimal sensitivity and specificity and correctly classified 179 (71.6%) stress-first images as either "needing" (n = 31) or "not needing" (n = 148) rest images. Its sensitivity, specificity, PPV, and NPV were 73.8%, 71.2%, 34.1%, and 93.1%, respectively. In a model whereby the computer or technologist could correct for the other's incorrect classification, 242 (96.8%) stress-first images were correctly classified. The composite sensitivity, specificity, PPV, and NPV were 83.3%, 99.5%, 97.2%, and 96.7%, respectively.

CONCLUSION

Technologists and automated quantification software had a high degree of agreement with the clinical reference standard for determining the need for rest images in a stress-first imaging protocol. Utilizing an experienced technologist and automated systems to screen stress-first images could expand the use of stress-first MPI to sites where the cardiologist is not immediately available for interpretation.

Nasal Carriage Rate of Methicillin Resistant Staphylococcus aureus among Health Care Workers at a Tertiary Care Hospital in Kathmandu, Nepal

BACKGROUND

Methicillin-resistant Staphylococcus aureus is one of the most common causes of nosocomial infections. Due to its multidrug resistant nature; infections due to Methicillin-resistant Staphylococcus aureus are often very difficult to treat. Colonized health care workers are the important sources of Methicillin-resistant Staphylococcus aureus. The objectives of this study were to determine the nasal carriage rate of Methicillin-resistant Staphylococcus aureus among health care workers at Kathmandu Medical College and Teaching Hospital, Nepal and to assess their antimicrobial susceptibility patterns.

METHODS

A cross sectional study was conducted among 252 health care workers from July to November 2013. Mannitol salt agar was used to culture the nasal swabs. Antimicrobial susceptibility testing was performed by Kirby-Bauer disc diffusion technique following Clinical and Laboratory Standards Institute guidelines. Methicillin-resistant Staphylococcus aureus strains were confirmed by using cefoxitin disc and by determining the minimum inhibitory concentration of oxacillin by agar dilution method.

RESULTS

Of 252 healthcare workers, 46(18.3%) were positive for Staphylococcus aureus among which 19(41.3%) were Methicillin-resistant Staphylococcus aureus carriers. Overall rate of nasal carriage of Methicillin-resistant Staphylococcus aureus was 7.5% (19/252).The higher percentages of lab personnel were nasal carriers of S. aureus (31.6%) and Methicillin-resistant Staphylococcus aureus (10.5%).The percentages of nasal carriage of S. aureus (35.7%) and Methicillin-resistant Staphylococcus aureus (14.3%) were highest in the health care workers from post operative department. Higher percentage of Methicillin-resistant Staphylococcus aureus were susceptible toward amikacin (100%) and vancomycin (100%) followed by cotrimoxazole (84.2%).

CONCLUSIONS

High rates of nasal carriage of S. aureus and Methicillin-resistant Staphylococcus aureus were observed among the healthcare workers, which indicate the need of strict infection control measures to be followed to control the nosocomial infections.

Changing Patterns in the Performance of Fluoroscopically Guided Interventional Procedures and Adherence to Radiation Safety Practices in a U.S. Cohort of Radiologic Technologists

OBJECTIVE

Information is limited on changes over time in the types of fluoroscopically guided interventional procedures performed and associated radiation safety practices used by radiologic technologists.

MATERIALS AND METHODS

Our study included 12,571 U.S. radiologic technologists who were certified for at least 2 years in 1926-1982 and who reported in a 2012-2013 survey that they ever performed or assisted with fluoroscopically guided interventional procedures. They completed a mailed questionnaire in 2013-2014 describing their detailed work practices for 21 fluoroscopically guided interventional procedures and associated radiation safety practices from the 1950s through 2009.

RESULTS

Overall, the proportion of technologists who reported working with therapeutic fluoroscopically guided interventional procedures, including percutaneous coronary interventions, increased over time, whereas the proportion of technologists who worked with diagnostic fluoroscopically guided interventional procedures, including diagnostic cardiovascular catheterization and neuroangiographic procedures, decreased. We also observed substantial increases in the median number of times per month that technologists worked with diagnostic cardiovascular catheterizations and percutaneous coronary interventions. In each time period, most technologists reported consistently (≥ 75% of work time) wearing radiation monitoring badges and lead aprons during fluoroscopically guided interventional procedures. However, fewer than 50% of the technologists reported consistent use of thyroid shields, lead glasses, and room shields during fluoroscopically guided interventional procedures, even in more recent time periods.

CONCLUSION

This study provides a detailed historical assessment of fluoroscopically guided interventional procedures performed and radiation safety practices used by radiologic technologists from the 1950s through 2009. Results can be used in conjunction with badge dose data to estimate organ radiation dose for studies of radiation-related health risks in radiologic technologists who have worked with fluoroscopically guided interventional procedures.

[RESAOLAB: West African network of laboratories to enhance the quality of clinical biology]

The Fondation Mérieux, in partnership with the Ministries of Health of Burkina Faso, Mali and Senegal, implemented for four years a project to reinforce the laboratory sector in the three participating countries: the RESAOLAB project (West African Network of Biomedical Analysis Laboratories).The objective of RESAOLAB project, in partnership with the WHO Office for West Africa and the West African Health Organization, was to strengthen the systems of biomedical laboratories to improve diagnostic services, access, monitoring and management of infectious diseases. Following the successful results achieved under the RESAOLAB project and due to the demand of the neighbour countries ministries, the RESAOLAB project is now extended to four other countries of the West African region: Benin, Guinea-Conakry, Niger and Togo. The RESAOLAB project has become the RESAOLAB programme, its purpose is to strengthen the quality of the medical biology services thanks to a regional and transversal approach.

Assessment of high-risk human papillomavirus infections using clinician- and self-collected cervical sampling methods in rural women from far western Nepal

Introduction

Nepal has one of the highest cervical cancer rates in South Asia. Only a few studies in populations from urban areas have investigated type specific distribution of human papillomavirus (HPV) in Nepali women. Data on high-risk HPV (HR-HPV) types are not currently available for rural populations in Nepal. We aimed to assess the distribution of HR- HPV among rural Nepali women while assessing self-collected and clinician-collected cervico-vaginal specimens as sample collection methods for HPV screening.

Methods

Study participants were recruited during a health camp conducted by Nepal Fertility Care Center in Achham District of rural far western Nepal. Women of reproductive age completed a socio-demographic and clinical questionnaire, and provided two specimens; one cervical-vaginal specimen using a self-collection method and another cervical specimen collected by health camp auxiliary nurse midwives during a pelvic examination. All samples were tested for 14 different HR-HPV mRNA and also specific for HPV16/18/45 mRNA.

Results

Of 261 women with both clinician- and self-collected cervical samples, 25 tested positive for HR-HPV, resulting in an overall HR-HPV prevalence of 9.6% (95% confidence Interval [CI]: 6.3–13.8). The overall Kappa value assessing agreement between clinician- and self-collected tests was 0.62 (95% CI: 0.43–0.81), indicating a “good” level of agreement. Abnormal cytology was reported for 8 women. One woman identified with squamous cell carcinoma (SCC), and 7 women with high grade squamous intraepithelial lesions (HSIL). Seven of the 8 women tested positive for HR-HPV (87.5%) in clinician-collected samples and 6 in self-collected samples (75.0%).

Conclusion

This is the first study to assess HR-HPV among rural Nepali women. Self-collected sampling methods should be the subject of additional research in Nepal for screening HR-HPV, associated with pre-cancer lesions and cancer, in women in rural areas with limited access to health services.

Cytogenetic endpoints and Xenobiotic gene polymorphism in lymphocytes of hospital workers chronically exposed to ionizing radiation in Cardiology, Radiology and Orthopedic Laboratories

Ionizing radiation (IR) is known as a classical mutagen capable of inducing various kinds of stable and unstable chromosomal aberrations (CA) including the possibility of increasing the incidence of DNA damage. This study aims to assess occupationally induced CA in workers chronically exposed to low doses of IR in Radiology (RL), Cardiology (CL) and Orthopedic (OL) Laboratories in hospitals of Tamil Nadu. We performed the analysis of CA by trypsin G-banding, micronucleus (MN) assay, Comet assay and Xenobiotic-metabolizing gene polymorphisms (GSTM1, GSTT1 and GSTP1) in 56 exposed and 56 control subjects who were matched for gender and age (± 2 years). Higher degree of CA and MN frequencies were observed in exposed groups, especially in CL subjects compared to other exposed groups and controls (p<0.05). Higher frequency of DNA tail length and tail moment was observed in the CL exposed subjects compared to the RL and OL subjects. The frequencies of GSTM1 and GSTT1 null genotypes were 39.3 percent and 14.3 percent, respectively. No significant difference in allele frequencies between exposed subjects and controls were observed (p=0.0128). Using multiple linear regression analysis, statistical significance was determined for work duration and age for the CL, RL and OL workers and the examination of the possible impact by confounding factors showed few significant influences on the radiation exposure, as a specific biomarker. However, the findings from the present study suggest that, awareness should be created among the personnel exposed to radiations in hospital laboratories, highlighting the necessity of applying radiation protection principles against medical radiation exposure.

Knowledge and attitude of health professional students toward patients living with AIDS

INTRODUCTION

What health professional students know of AIDS and their attitudes towards PLWA enrich our knowledge in assuring quality of care administered to AIDS patients.

OBJECTIVES

This study was designed to assess 1) What Nigerian students in various health disciplines know about AIDS and how they behave towards PLWA. and 2) Determine the sociodemographic variables that could influence knowledge of AIDS and behaviour towards PLWA among students of the various health disciplines in a university in North- Eastern Nigeria.

METHODS

This cross-sectional study involving student volunteers (n=644) in the last two years of their professional training drawn from six disciplines were surveyed using a two-part questionnaire. Section I of which elicited students' sociodemographic and previous AIDS encounter information, and section II assessed knowledge and behaviour towards PLWA.

RESULTS

Students in surveyed health professions had an unsatisfactory level of knowledge on AIDS pathophysiology and their behaviour towards PLWA was negative. Gender, clinical year, religious affiliation, discipline, level of satisfaction with AIDS instructions, knowing a family member or another person with a diagnosis of AIDS and willingness to provide care for an AIDS patient influenced the students' knowledge and behaviour.

CONCLUSION AND RECOMMENDATION

The study revealed a real possibility for health professional students to hesitate to care for PLWA, or render uncoordinated or fragmented care at the time of their graduation. It suggests the need for intervention to include methodical and all inclusive clinical clerkship on HIV/AIDS and small group discussions with real life case scenerios involving PLWA while in training.

[Present situation and future prospects of the certification system for medical technologists--from the viewpoint of the Japanese Society of Clinical Cytology]

The circumstances surrounding the certification examination for cytotechnologists in Japan are closely related with the history of the Japanese Society of Clinical Cytology. The examination for cytotechnologists is open only to medical technologists. The examination has two parts: primary and secondary. Qualification for candidacy for the secondary examination requires candidates to have passed the primary examination. The rate of successful applicants in the past 10 years was approximately 25-40%. Certified cytotechnologists are required to renew their qualifications every 4 years for their study and job history. I will present the purpose of the qualification update system, future themes, the reporting system for cytodiagnosis, and the possibility that the certification examination for cytotechnologists will become a national examination.

[Certifying examination which college of laboratory medicine of Japan is sponsoring]

Becoming a Medical Technologist capable of contributing to the clinical field requires an ability to keep up with rapid advances in the field of medicine, as well as the diligence to constantly keep abreast of new discoveries and technologies. To this end, one should forge a social identity as a Medical Technologist, thereby bringing more esteem to the profession. Moreover, applying knowledge of medical laboratory work to not only medicine but also other fields is linked with maintaining and improving public health, which is an important objective for the Medical Technologist. In society, the various certifications held by such Medical Technologists are acquired as part of a lifelong learning process and not only lead to individual advancement but also, presumably, business expansion through the application of prodigious knowledge and skills.

Viral infections in workers in hospital and research laboratory settings: a comparative review of infection modes and respective biosafety aspects

OBJECTIVES

To compare modes and sources of infection and clinical and biosafety aspects of accidental viral infections in hospital workers and research laboratory staff reported in scientific articles.

METHODS

PubMed, Google Scholar, ISI Web of Knowledge, Scirus, and Scielo were searched (to December 2008) for reports of accidental viral infections, written in English, Portuguese, Spanish, or German; the authors' personal file of scientific articles and references from the articles retrieved in the initial search were also used. Systematic review was carried out with inclusion criteria of presence of accidental viral infection's cases information, and exclusion criteria of absence of information about the viral etiology, and at least probable mode of infection.

RESULTS

One hundred and forty-one scientific articles were obtained, 66 of which were included in the analysis. For arboviruses, 84% of the laboratory infections had aerosol as the source; for alphaviruses alone, aerosol exposure accounted for 94% of accidental infections. Of laboratory arboviral infections, 15.7% were acquired percutaneously, whereas 41.6% of hospital infections were percutaneous. For airborne viruses, 81% of the infections occurred in laboratories, with hantavirus the leading causative agent. Aerosol inhalation was implicated in 96% of lymphocytic choriomeningitis virus infections, 99% of hantavirus infections, and 50% of coxsackievirus infections, but infective droplet inhalation was the leading mode of infection for severe acute respiratory syndrome coronavirus and the mucocutaneous mode of infection was involved in the case of infection with influenza B. For blood-borne viruses, 92% of infections occurred in hospitals and 93% of these had percutaneous mode of infection, while among laboratory infections 77% were due to infective aerosol inhalation. Among blood-borne virus infections there were six cases of particular note: three cases of acute hepatitis following hepatitis C virus infection with a short period of incubation, one laboratory case of human immunodeficiency virus infection through aerosol inhalation, one case of hepatitis following hepatitis G virus infection, and one case of fulminant hepatitis with hepatitis B virus infection following exposure of the worker's conjunctiva to hepatitis B virus e antigen-negative patient saliva. Of the 12 infections with viruses with preferential mucocutaneous transmission, seven occurred percutaneously, aerosol was implicated as a possible source of infection in two cases, and one atypical infection with Macacine herpesvirus 1 with fatal encephalitis as the outcome occurred through a louse bite. One outbreak of norovirus infection among hospital staff had as its probable mode of infection the ingestion of inocula spread in the environment by fomites.

CONCLUSIONS

The currently accepted and practiced risk analysis of accidental viral infections based on the conventional dynamics of infection of the etiological agents is insufficient to cope with accidental viral infections in laboratories and to a lesser extent in hospitals, where unconventional modes of infection are less frequently present but still have relevant clinical and potential epidemiological consequences. Unconventional modes of infection, atypical clinical development, or extremely severe cases are frequently present together with high viral loads and high virulence of the agents manipulated in laboratories. In hospitals by contrast, the only possible association of atypical cases is with the individual resistance of the worker. Current standard precaution practices are insufficient to prevent most of the unconventional infections in hospitals analyzed in this study; it is recommended that special attention be given to flaviviruses in these settings.

Research in clinical laboratory science: professionals' involvement

OBJECTIVES

To describe current qualitative and quantitative aspects of research engagement and other scholarly activities conducted by clinical laboratory science (CLS) professionals across a range of employment settings.

DESIGN

A link to a 3-part online survey was sent by electronic mail to 7,572 members of the American Society for Clinical Laboratory Science and 500 program directors.

SETTING

email message, on-line survey

PARTICIPANTS

all ASCLS members and all directors of accredited clinical laboratory educational programs

MAIN OUTCOME MEASURES

Quantitative and qualitative measures of professionals' engagement in research and other scholarly activities

RESULTS

556 of 7572 (7.3%) persons completed the survey. Thirty-two percent of survey respondents reported spending between 1 to > 40 work hours per week conducting research with 68% of respondents not participating in research activities. Conducting research is an employment requirement for 18% of survey participants. Twenty-nine percent of respondents have published at least one research article, and 47% of respondents who conduct research have published studies in the journal Clinical Laboratory Science. More than 57% of respondents participate in non-research scholarly activities as part of their employment. CLS professionals who conduct research are more likely to do applied, clinical, or educational research than other types of research. Fifty-seven percent of respondents who conduct research lack external funding for their work. Ninety-three percent of total research dollars is obtained by respondents who hold the Ph.D. degree. The perception of the importance of conducting research varies by employment position. Barriers to participation in research include lack of inclusion of research in the job description, time constraints, inadequate research funding, limited opportunity, and lack of space and equipment.

CONCLUSIONS

CLS professionals participate in research in limited numbers, and are more likely to engage in non-research types of scholarly activities. Numerous barriers are identified which impose limits to conducting research. Over half of CLS's research efforts lack external funding. Although there was broad representation among participants across educational levels, employment settings, and job positions, the number of survey respondents was limited. Possible directions for future research include conducting this survey using members of additional professional organizations.

Research in clinical laboratory science: professionals' educational preparation

OBJECTIVE

To describe the educational preparation of CLS professionals for conducting research.

DESIGN

A link to 3-part online survey was sent by electronic mail to 7,572 members of the American Society for Clinical Laboratory Science and 500 program directors research project. Barriers to participation in research by undergraduates include time limitations within the curriculum, insufficient faculty time, and lack of funds, space, and equipment. Increased emphasis on developing research skills is found in educational programs at the master's degree level.

CONCLUSIONS

The formal educational background of many CLS professionals may leave them unprepared or underprepared for conducting research. Although there was broad representation among participants across educational levels, employment settings, and job positions, the number of survey respondents was limited. Possible directions for future research include conducting this survey using members of additional professional organizations.

Using qualitative methods to investigate risk perception of Canadian medical laboratory workers in relation to current prion disease infection control policies

The aim of this study was to determine the rationale, methodology, and progress of risk perceptions of laboratory workers in relation to existing prion disease infection control policies in Canadian medical laboratories. This study developed a Web survey that investigated the knowledge, behavior, and attitudes of laboratory staff in order to (1) identify strengths, weaknesses, and gaps of current prion infection prevention and control guidelines and (2) inform the development of national medical lab specific guidelines. The use of qualitative methods to develop a relevant survey is described and future research activities are outlined. Preliminary, qualitative data indicate that, among laboratory staff, there is a high degree of perceived susceptibility toward prion transmission in medical laboratories. Significant barriers to following existing prion infection control guidelines are reported with few benefits of following these guidelines. As a result, laboratories take precautions above those that are required when processing suspect prion-infected specimens, which may result in testing delays. A focused survey for laboratory staff that addresses these issues will provide insight on the necessary steps that will ensure safe and efficient diagnostic testing for suspect prion specimens.

[Protection of medical diagnostic laboratory workers against biohazards]

Medical diagnostic laboratories form a particular occupational environment, in which workers have contact with patients and potentially infectious biological materials thus it should be acknowledged that it poses a significantly increased risk to health of laboratory workers. The risk directly depends on the kind of microbes present in a biological material and natural resistance to infections of individual workers. Therefore, the adopted technical and organizational solutions, properly worked out and obeyed procedures assuring safety work with biological material and microbes and properly trained laboratory staff play an essential role in reducing the risk. The risk of contact with microbes among laboratory workers is higher in Poland than in a number of other countries because hermetic devices for diagnostic analyzes and safety blood sampling systems are not always in use. The most important methods of infectious diseases prevention among laboratory workers are to protect them against direct contact with biological material, to apply vaccinations and to implement proper post-exposure procedures. Appropriate qualifications and habits of workers are of relevance to prevent infections in laboratories. A difficult financial situation of health care in Poland and other economic reasons can significantly increase the risk of infections and endanger health and safety of laboratory workers. It is necessary to develop practical instructions aimed at improving occupational safety to protect this occupational group against harmful effects of biological agents.

Demodex infections in general Polish population, in patients suffering from blepharitis, and among people who work with microscopes

In this study we examined 264 people to estimate the prevalence of Demodex infection. The subjects were divided into 4 groups. First two groups consisted of young people (mean age 22 years) and seniors (mean age 66 years) respectively. The third group included people who work with microscopes (mean age 44 years). Forth group consisted of patients with diagnosed blepharitis (mean age 65 years). From every individual 3-4 lashes were epilated from the eyelids of both eyes and examined under the microscope for Demodex mites. The statistical analysis based on logistic regression was used to estimate the probability of infection. Age was independent variable significant for this model (p < 0.001). Significant relation between age and probability of Demodex infection was showed. The lowest number of infected individuals was observed in the group of young subjects (only 5%), the highest in the blepharitis patients (74% infected). Among microscope users 30% were infected, in the group of seniors 34% were infected.

Are new CLS practitioners prepared to stay?

OBJECTIVE

This study assessed the relationship between the educational preparation and career expectations of CLS students and their subsequent retention in the laboratory profession.

DESIGN

Survey participants were given a list of 32 tasks that may be expected of early career professionals. Participants were asked to rate their educational preparation for and how frequently they performed each task in their current job using a four point Lickert scale. Additional questions addressed the participants' preparation for their current jobs, career satisfaction, plans for staying in the profession, and factors that influence retention.

PARTICIPANTS

The survey sample consisted of 972 Clinical Laboratory Scientists who passed the National Credentialing Agency for Laboratory Personnel (NCA) CLS examination between June 2002 and June 2004.

MAIN OUTCOME MEASURES

The mean rating for the level of preparation and the frequency of use for each of the 32 competencies was calculated. The mean ratings were used to assess the educational preparation in each competency and identify areas in which the level of preparation did not match the need for that skill in current practice. Using analysis of variance, respondents' answers to questions on their number of years of experience, their plans to stay in the profession, and their job satisfaction were compared based on their perceived level of preparation and the degree to which they felt their current jobs matched their career expectations at graduation.

RESULTS

The response rate was 31%. Most of the respondents felt that they were well prepared for the responsibilities of their current laboratory position. There was a good match between the respondents' ratings of their preparation in each competency and the frequency with which they were required to perform that competency. Phlebotomy and flow cytometry appeared to have more preparation than respondents felt they needed. Troubleshooting, resolving problems, and performing multiple tasks were identified as areas in which more preparation was needed. The mean number of years that respondents planned to stay in the profession was 15.5 years and the factors that were most important in keeping them in the profession included interesting work, good salaries, and advancement opportunities. The respondents who rated the match between their career-entry expectations and their current job the highest were more satisfied and planned to stay in the profession the longest.

CONCLUSION

Early career laboratory professionals felt well prepared for their jobs, though teaching of some tasks could be improved to better prepare graduates for the work environment. Most respondents indicated that they were prepared to stay in the profession for at least ten years; however they indicated that interesting work, good salaries, and opportunities to advance in the profession would be important in their decision to stay. A good match between laboratory employees' career expectations at the time of graduation and their work environment appears to improve their satisfaction with their careers and their desire to stay in the profession.

A survey of the UK maxillofacial laboratory service: Profiles of staff and work

We sent questionnaires to 98 maxillofacial laboratories in the United Kingdom and asked about the composition of their staff, the kind of work that they do, and their activities in relation to the treatment of disfigured patients who require facial and body prostheses. We received 59 replies about 193 laboratory staff, most of whom had 10 or more years experience and held basic and advanced qualifications in dental technology. Most laboratories did all sorts of work including maxillofacial, orthodontic, dental prosthetic and crown and bridge work. Only five confined themselves to maxillofacial work. One hundred and eighteen staff (61%) had contact with 4,259 disfigured patients who required prostheses. Fifty-three laboratory managers (89%) thought that maxillofacial prosthetists and technologists gave psychological support to these patients, but only 12 laboratories (21%) had staff with formal training in counselling.

Developing a lean culture in the laboratory

The Director of Pathology at Jackson Memorial Hospital was interested in improving the operational efficiencies of the department in order to enhance the department's level of service in conjunction with the expansion of the overall health system. The decision was made to implement proven Lean practices in the laboratory under the direction of a major consulting firm. This article details the scope of the initial project as well as the operating principles of Lean manufacturing practices as applied to the clinical laboratory. The goals of the project were to improve turnaround times of laboratory results, reduce inventory and supply costs, improve staff productivity, maximize workflow, and eliminate waste. Extensive data gathering and analysis guided the work process by highlighting the areas of highest opportunity. This systematic approach resulted in recommendations for the workflow and physical layout of the laboratory. It also included the introduction of "standard workflow" and "visual controls" as critical items that streamlined operational efficiencies. The authors provide actual photographs and schematics of the reorganization and improvements to the physical layout of the laboratory. In conclusion, this project resulted in decreased turnaround times and increased productivity, as well as significant savings in the overall laboratory operations.

The makeover of the Lakeshore General Hospital laboratories

This article describes the expansion and reorganization of a moderate-sized Canadian laboratory from Day One to "Live Day." The key factors to the success of this project were organized planning by the laboratory staff and the introduction of core lab theories, team building, and organized training sessions. The successful makeover resulted in improved turnaround time for STAT tests, especially those coming from the Emergency Unit. The efforts of the laboratory personnel toward the improvement of laboratory services, in spite of budget, human resources constraints, and resistance to change, are addressed.

Defining the typical work environment for assisted reproductive technology laboratories in the United States

OBJECTIVE

To determine time and staffing requirements as they relate to laboratory personnel in the field of assisted reproductive technology (ART).

DESIGN

Descriptive study.

SETTING

Assisted reproductive technology clinics in the United States.

PERSONNEL

All personnel working in ART laboratories, which included laboratory directors and technicians (those laboratory personnel trained in specific areas of embryology, andrology, and endocrinology).

INTERVENTION(S)

None.

MAIN OUTCOME MEASURES(S)

Frequencies were determined for time and staffing requirements as they pertained to individuals and procedures (e.g., oocyte retrieval, embryo transfer, semen analysis, hormone assay, etc.) performed in embryology, andrology, and endocrine laboratories.

RESULT(S)

Two different surveys of ART clinics in the United States were combined in this report. The average technician worked 40 hours a week, whereas the average laboratory director worked 49 hours per week. The average embryologist performed 181 procedures (not cases) per year. The average andrologist performed 648 procedures (not cases) per year, while the average endocrinologist completed 2,673 procedures (not cases) per year.

CONCLUSION(S)

This is the first report to describe time and staffing requirements as they relate to the laboratory personnel in an ART facility.

Time to pregnancy among Danish laboratory technicians who were a part of the National Birth Cohort

OBJECTIVES

The Danish National Birth Cohort was used to examine whether laboratory work was associated with reduced fecundity.

METHODS

Self-reported data on laboratory work and waiting time to pregnancy (0-2, 3-5, 6-12 and > 12 months) were used for 829 female laboratory technicians interviewed in 1997-2003. Altogether 6250 female teachers formed the reference group. A discrete-time survival analysis with a complementary log-log link was applied to estimate the fecundability ratio between the exposed and unexposed women, with adjustment for maternal age, gravidity, smoking, prepregnancy body mass index, and paternal job.

RESULTS

No difference in time to pregnancy was found between the laboratory technicians and teachers or between the laboratory technicians with different exposures. The adjusted fecundability ratio for the laboratory technicians was 0.94 [95% confidence interval (95% CI) 0.86-1.02] for all pregnancies and 0.98 (95% CI 0.86-1.13) for first pregnancies. A healthy worker effect was found for the laboratory technicians working with the work processes under study.

CONCLUSIONS

The results do not suggest that laboratory work in Denmark at present impairs female fecundity.

Congenital malformations related to maternal exposure to specific agents in biomedical research laboratories

OBJECTIVE

To investigate major congenital and neural crest malformations (NCM; craniofacial and conotruncal defects) in the offspring of laboratory employees.

METHODS

Data for 1951 females was linked to the Medical Birth Register (3003 pregnancies). Exposure information was based on questionnaires. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.

RESULTS

The prevalence of "major malformations" were 2.3% (n = 41; exposed) and 1.9% (n = 23; unexposed). For the major malformations, solvent exposure before the third trimester gave an OR of 1.8 (CI = 1.0-2.9); "laboratory work in general," of 1.2 (CI = 0.7-2.0) unadjusted. OR for benzene use around conception/organogenesis was 5.3 (CI = 1.4-21.1) for NCM.

CONCLUSION

No significant risk for laboratory work in general was seen, but there was an increased ratio for NCM relative to solvents, especially benzene. These results are based on small numbers and should be interpreted cautiously.

An assessment of critical issues facing the clinical laboratory workforce

The National Center for Health Workforce Analysis of the Health Resources and Services Administration (HRSA), Bureau of Health Professions contracted with the University of California at San Francisco Center for the Health Professions to conduct a study of the clinical laboratory workforce. The study utilized existing and new survey data, in collaboration with the American Society for Clinical Pathology (ASCP), as well as interviews with experts in the field. This paper will describe the demographic characteristics, roles, and scope of practice of this workforce, as well as identify factors that influence the current and future demand for and supply of workers. There is ample evidence of a shortage of workers over the past few years, indicated by double-digit vacancy rates, increasing salaries, and the use of other incentives to fill positions. Recent data show a reduction in vacancy rates, although an increase in per diem and contract workers may mask a continuing shortage. There is recent growing interest in the profession, as evidenced by an increase of applicants to educational programs. Several factors make it difficult to predict the future need for and role of clinical laboratory workers, including an aging population and the demand for increased services, the possible retirement of many current workers, automation, new technology and tests, and public health challenges.

Factors contributing to the retention of clinical laboratory personnel

OBJECTIVE

To identify factors contributing to retention of clinical laboratory practitioners.

DESIGN

A paper survey addressing retention was distributed to a potential of 4000 clinical laboratory professionals.

SETTING

The survey was distributed to subjects by their laboratory manager to be completed at the worksite or home.

PATIENTS OR OTHER PARTICIPANTS

599 usable surveys were received from non-supervisory individuals employed in clinical laboratory science (CLS) for five years or more.

INTERVENTIONS

Surveys were mailed to laboratory managers in March 2003 with directions to distribute to practitioners with five or more years of work experience.

MAIN OUTCOME MEASURES

Percentages of respondents agreeing and disagreeing with Lickert-type opinion items were determined. The means, ranges, and standard deviations were calculated for the number of hours of continuing education, years of experience, percentage of time spent on tasks, and years in the current job. The means for job satisfaction were calculated and compared statistically based on respondents' job function, satisfaction with salary, job independence, sense of appreciation, and responsibility for continuing education. Open-ended responses were tabulated and categorized.

RESULTS

Committed practitioners believe their work is important and find it challenging. Those who are most satisfied with their jobs believe they make a good salary (p = 0.000), have work independence (p = 0.000), and feel that their work is appreciated (p = 0.000). Job satisfaction does not differ for CLTs vs. CLSs. Salaries comparable to nurses and appreciation from physicians, nurses, and hospital administrators are cited by respondents as the most important factors to retaining laboratory staff.

CONCLUSION

Committed practitioners believe that salaries comparable to nurses are needed to improve retention of staff. Respondents said that being appreciated by hospital administrators, nurses, and physicians would also contribute to improved retention.

Measurements of occupational exposure for a technologist performing 18F FDG PET scans

Radiation doses to one PET technologist performing 100 18F FDG (18F fluorodeoxyglucose) imaging procedures were measured in a clinical setting using two types of thermoluminescent dosimeter (TLD) badges, one finger-ring TLD and one electronic pocket dosimeter (EPD). 18F FDG was handled either with unshielded or with viewing window tungsten shielded syringes. The resulting doses using unshielded syringes were 13.8 +/- 0.8 microSv/370 MBq and 14.3 +/- 0.4 microSv/370 MBq, measured with TLD 100 and with TLD 700H/600H, respectively. For the same series of measurements, the doses obtained using shielded syringes were 10.7 +/- 0.4 microSv/370 MBq and 7.2 +/- 2.1 microSv/370 MBq with TLD700H/600H and with EPD, respectively. The dose to the right hand from shielded syringes was 69.3 +/- 5.5 microSv/370 MBq. All these values are within the ICRP recommended dose limits. Extrapolated to 725 examinations per year, the resulting effective dose measured with TLD would be 10 mSv with unshielded and 7.5 mSv with shielded syringes, respectively (25% dose reduction). The doses measured by TLD were consistently higher than those measured by EPD, suggesting that EPD measurements might underestimate occupational doses.

Smallpox vaccine: "non-take" responses in previously vaccinated adults

This small, retrospective study of laboratory workers who received smallpox vaccine showed a strong correlation between "non-take" reactions and the presence of prior vaccination scars. Although we cannot exclude technique and vaccine potency as causes, the association we observed may indicate that these workers are displaying residual immunity to smallpox.

Workflow and cost analysis on MODULAR ANALYTICS

Four stand-alone analyzers in a centralized laboratory were replaced by two modular analytical systems processing 45 methods of the general chemistry and specific protein segment. This consolidation led to a reduction of the daily workflow and operational costs. The cost saving with 1.3 million reported results per year was 53,000 Euro, which can be assessed as an important contribution to cost reduction in the health care system.

Cancer incidence rates among Lawrence Livermore National Laboratory (LLNL) employees: 1974-1997

BACKGROUND

In the mid-1970's an excess of malignant melanoma of the skin was noted among employees at the Lawrence Livermore National Laboratory (LLNL). A 1984 cancer incidence study showed a non-significant excess of total cancers among female employees with significant excesses for melanoma, rectum and anus, and salivary gland cancers. For male employees, there was a non-significant deficit of total cancer with significant excesses in melanoma and non-brain nervous system cancers. This paper reports the results of a surveillance effort to update our understanding of the patterns of cancer incidence in this population.

METHODS

We used California Cancer Registry (CCR) data to ascertain employees who had worked for six or more consecutive months at LLNL during the 24-year period of 1974 through 1997 who were diagnosed weith cancer during that time frame. We used the Standardized Incidence Ratio (SIR) in our analyses.

RESULTS

There were 17,785 employees who provided 186,558 person-years of observation: 145,203 were from males and 41,355 were from females. The CCR, through its linkage techniques, identified 541 individuals with invasive cancer and 96 with in situ cancer. A total of 404 males had invasive cancer and 33 had in situ cancer whereas there were 137 females with invasive cancer and 63 with in situ cancer. The SIR for invasive cancer in males was 69 (95% CI 62-76). The overall cancer SIR for males was unaffected by calendar time. There were only two invasive cancer sites with significant excess: melanoma and cancer of the testes. For eight categories or cancer sites, we found a statistical deficit in cancer incidence. The most striking deficit occurred in cancer of the lungs and bronchus with a SIR of 36 (95% CI 26-50). The SIR for invasive cancer in females was 80 (95% CI 67-94). The overall cancer SIR for females decreased over calendar time. There was a statistically significant deficit for cancers of the female genital organs. There were 84 cases of invasive and in situ melanoma in both genders. Time-trend analyses for melanoma showed a significant excess during the years 1974-1985 but a reduction to community rates from 1986 through 1997. There were 21 individuals with testicular cancer with a SIR of 207 (95% CI 129-317). There were no differences in age at diagnosis or cell type with the comparison population. We analyzed the data using the same radiosensitive cancer categories used in the 1984 study. There were no increases in SIRs in any of these categories.

CONCLUSIONS

We found that the LLNL employees had less cancer than expected with males having relatively fewer cancers than females. The lung cancer rate for males was remarkably low. Since 1986 the melanoma rates resemble the community rates. Testicular cancer rates are modestly elevated and appear to have been so for the past 20 years. Lifestyle patterns, including smoking, and cancer screening activities are probably important contributors to the observed low cancer rates.

A seroepidemiological study of the risks of Q fever infection in Japanese veterinarians

The causative agent of Q fever, a widespread zoonotic disease, is the bacteria Coxiella burnetii. Although cases of Q fever have been documented in countries throughout the world, the prevalence of the disease in Japan is not yet known. Q fever is a demonstrated occupational hazard to those employed in zoological professions, but the risk to Japanese veterinarians has not yet been quantified. In order to evaluate the risk to Japanese veterinarians, we performed a serological survey using serum samples from 267 veterinarians. Two control groups consisting of 352 medical workers and 2003 healthy blood donors were also evaluated. The antibody titers of the serum samples were measured by indirect immunofluorescence assay (IFA) using phase II C. burnetii Nine Mile strain as the antigen. The positive rate of IgG antibody was 13.5% in the veterinarians, which was higher than in the blood donors (3.6%, p < 0.001) and medical workers (5.1 %,p < 0.001). These findings suggest that Japanese veterinarians have a higher risk of infection by C. burnetii than other members of the Japanese population. An interesting finding of this study was that positive rates of IgG and IgM antibodies in the blood donor group were higher in younger individuals. The IgM antibody positive rate was the highest in females under 30 years old.

Infection control practices in clinical laboratories in Pakistan

Clinical laboratories in Karachi, Pakistan, were evaluated for adherence to standard precautions using an observational checklist. Among 44 laboratories, gloves were used in 2, protective gowns in 12, disinfectant in 7, and an incinerator in 7. Standard worker safety precautions are not followed at major clinical laboratories in Karachi.

Responding to the medical laboratory staffing shortage: the Canadian perspective

Shortages of qualified medical laboratory personnel have not been a problem in Canada since the early 1960s, when the profession experienced a growth that far exceeded training capacities. Massive immigration, primarily from the United Kingdom, provided a temporary patch for the urgent human resources (HR) supply. Medical laboratory technologist training program enrollments were increased rapidly, and, by the early 1970s, more than 1,200 new graduates were generated each year. In the late-1980s, a trend evolved in Canada that raised concern about the ability to attract suitable applicants to careers in medical laboratory technology. However, that issue quickly faded as a priority when the health reform of the 1990s struck Canada.

Adverse reproduction outcomes among employees working in biomedical research laboratories

OBJECTIVES

The aim of the study was to investigate reproductive outcomes such as birthweight, preterm births, and postterrm births among women working in research laboratories while pregnant.

METHODS

Female university personnel were identified from a source cohort of Swedish laboratory employees, and the database was linked to the medical birth register. The first births of the women were included in the analysis, 249 pregnancies among the women with laboratory work and 613 pregnancies among the women without laboratory tasks. Information about exposure to various laboratory agents was obtained from a previous questionnaire investigation at the research group level according to a specific definition. The ponderal index and ratio between observed and expected birthweights were calculated. Logistic regression models were used for analyses of dichotomous outcomes (preterm, postterrm and birthweight).

RESULTS

Exposure to laboratory work with solvents was associated with an increased risk of preterm births, the estimated odds ratio (OR) being 3.4 (1.0 < 95% confidence interval < 11.9). An association with work with bacteria was also observed for postterm births (OR 2.7, 1.0 < or = 95% confidence interval < 7.4).

CONCLUSIONS

There was a slightly elevated risk for some reproductive outcomes among the women working with certain laboratory tasks, specifically for preterm and postterm births in relation to work with solvents and bacteria.

Brucellosis in laboratory workers at a Saudi Arabian hospital

BACKGROUND

Saudi Arabia is hyperendemic for brucellosis, with more than 8000 cases reported each year to public health authorities. During 1998, brucellosis ranked as the No. 1 reportable communicable disease (22.5%) in Saudi Arabian National Guard communities. King Fahad Hospital is the major referral center for National Guard personnel in the nation's central region.

METHODS AND RESULTS

From 1991 to 2000, brucellosis developed in 7 expatriate hospital employees. Six employees were bacteriology technologists, and one was a pathologist. Each had a clinical syndrome compatible with brucellosis (headache, fever, rigors, sweats, and myalgias) plus elevated Brucella sp serum agglutinin titers > or = 1:1280; one patient also had positive blood cultures. All patients responded to anti-Brucella therapy. Two patients had relapses, and complications occurred in four patients (septic endophlebitis of the leg, infected prosthesis, epididymoorchitis, and lumbar spondylitis). In all these employees except the pathologist, the infection was associated with processing Brucella sp cultures.

CONCLUSION

Despite the enforcement of stringent infection control measures including the use of a class II biosafety hood in the laboratory, the problem of nosocomial brucellosis persists because of the large number of infected specimens handled by the laboratory (17,500 specimens per year). Ultimately, risk reduction depends on efforts to reduce disease endemicity in the country. In the meantime, conversion of the laboratory to biosafety level 3 is under way.

[The European aptitude test for cervical cytopathology]

The EFCS/QUATE aptitude test is an important measure for evaluating quality in cervical cytopathology and for assessing the level of experience and competence in cervical cancer screening. The test, set up in the 1990s by the ECTP/CCS working party, has been performed since 1992 in several European countries: United Kingdom, The Netherlands, Germany, Denmark, Portugal, Slovenia, Hungary and Italy. In Italy, the test has been performed at the Istituto Superiore di Sanità in 1992 and 1993 and in some Italian universities (Padua 1993, Turin 1994, Sassari 1995, Naples 1996, Messina 1998) and in one hospital (Genoa 1997). The minimum passing score is 60/100 (60% in all sections). The aptitude test for cytotechnologists includes: a written test (50 multiple choice questions); a practical test (screening 10 unmarked cervical smears; spot test of 20 slides with a fixed field of view); and an oral test, for borderline candidates when necessary (60%) or for the diploma with 'distinction' (95%). Successful candidates receive the Certificate of Aptitude in Gynecological Cytotechnology and are entitled to use the initials CT (EFCS-GYN) after their names for professional purposes. The aptitude test for anatomopathologists includes an oral test and a practical test (screening 5 unmarked cervical smears, spot test of 20 slides with a fixed field of view, and reading and diagnosing 3 complex cases). Successful candidates receive the certificate of gynecological cytopathology. The first aptitude test for anatomopathologists in Italy, organized and endorsed by the Istituto Superiore di Sanità in collaboration with SIAPEC (Italian Society of Pathological Anatomy and Cytopathology) and in agreement with the European guidelines for cervical cancer screening, was performed on 18 December 1997 in Rome. The total number of aptitude tests carried out in Europe is 15 for cytotechnologists and 4 for anatomopathologists. A total of 317 cytotechnologists and 73 anatomopathologists has taken the test; the success rates are 77% and 70%, respectively.

The quality of medical laboratory practice in Trinidad and Tobago, West Indies

The introduction of automated chemical analyzers in the laboratory service has the potential of adversely affecting professionalism in laboratory practice. The present study assesses the quality of medical laboratory technicians in Trinidad and Tobago using structured questionnaires. Some of the critical questions included job status, years of experience, training, qualification(s) and knowledge of quality assurance and its application. About 82% of laboratory technicians responded to the study. The majority of technicians (62%) had diploma certificates while only one (1.2%) had a postgraduate degree. Although the majority (91.7%) of technicians knew about quality assurance, 36% learnt on the job and 59% knew they were not professionally trained. The results showed that there is paucity of highly trained laboratory technicians in Trinidad and Tobago and this has significant implications on the technical initiative and quality of medical laboratory practice in this country. We recommend the establishment of appropriate professional institutions for training medical laboratory technologists and regular expert inspection and accreditation of all medical laboratories in the country.