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D Snashall

Publications and source records attributed to D Snashall.

18 recordsLinked to original sources
PubMed2002

Out of hours management of occupational exposures to blood and body fluids in healthcare staff.

AIMS: To assess and compare the out of hours and in hours management of occupational blood and body fluid exposures in a London teaching hospital. METHODS: The occupational health and accident and emergency records of individuals presenting with occupational body fluid exposures over a six month period at a London teaching hospital were analysed retrospectively. Main outcome measures were the completeness of records, and the appropriate management of body fluid exposures using the Department of Health guidelines as the gold standard. RESULTS: A total of 177 body fluid exposures were reported; 109 (61.58%) were initially assessed in the occupational health department, and 68 (38.42%) in the accident and emergency department. Of those originally assessed in the accident and emergency department, only 21 (30.88%) attended the occupational health department for follow up. Occupational health staff were more consistent in assessing and managing exposures, and in a higher proportion of cases gave more appropriate advice on post-exposure prophylaxis (PEP) against hepatitis B and HIV. Of the 11 individuals prescribed HIV PEP (all by accident and emergency staff), only three subsequently attended occupational health for follow up. In all three cases therapy was discontinued, as the source was HIV negative or the exposure low risk. CONCLUSIONS: Out of hours management of occupational body fluid exposures, particularly the prescribing of HIV PEP, was inconsistent with in hours practice. This may also be the case in other large inner city hospitals offering a similar service.

Blood↗
PubMed2000

Utility of history, examination and laboratory tests in screening those returning to Europe from the tropics for parasitic infection.

OBJECTIVES: To examine the utility of the different elements of screening expatriates and travellers returned from the tropics for parasitic disease (exposure history, symptoms, examination and laboratory tests). METHODS: In phase 1 (conducted prospectively 1990-91), 1029 asymptomatic returnees had a detailed questionnaire and interview on risk-behaviour, physical examination and laboratory tests. In phase 2 (1997-98), 510 consecutive patients referred for routine screening (276 symptomatic and 234 asymptomatic) were screened with laboratory tests. RESULTS: Exposure history did not correlate reliably with parasite burden. In phase 1 physical examination revealed 387 abnormalities, only three of which indicated parasitic disease. Schistosomal serology was positive in 11% (CI 9-13) of these asymptomatic cases including patients with light or no reported freshwater exposure. Stool microscopy was positive in 19% (CI 16-22) of cases not correlated with reported eating habits, and eosinophilia was present in 8% (CI 6-10). In phase 2 reported symptoms did not correlate with parasitic disease. Schistosomiasis was present in 15% (CI 13-24) of asymptomatic and 18% (CI 13-22) of symptomatic individuals (OR 1.2 P = 0.46); stool microscopy was positive in 14% of both symptomatic and asymptomatic patients, and eosinophilia in 9% of symptomatic and 6% of asymptomatic individuals. CONCLUSION: Potentially serious asymptomatic infection is common in travellers. Detailed exposure history, symptom history and physical examination added little to detecting cases. Stool microscopy, schistosomal serology and eosinophil count all had good yield. Filarial serology had low yield in patients without eosinophilia.

Adolescent↗
PubMed1998

An outbreak of multi-drug-resistant tuberculosis in a London teaching hospital.

We describe the epidemiology and control of a hospital outbreak of multi-drug-resistant tuberculosis (MDR-TB). A human immunodeficiency virus (HIV)-negative patient with drug-sensitive tuberculosis developed MDR-TB during a period of unsupervised therapy. She was admitted to an isolation room in a ward with HIV-positive patients, but the room, unbeknown to hospital staff, was at positive-pressure relative to the main ward. Seven HIV-positive contacts developed MDR-TB. The diagnosis in the second patient was delayed, partly because acid-fast bacilli in his sputum were assumed to be Mycobacterium avium-intracellulare. All the available Mycobacterium tuberculosis isolates were indistinguishable by molecular typing. Nearly 1400 staff and patient contacts were offered screening, but the screening programme detected only one of the cases. Despite therapy, the index patient and two of the contacts died. HIV-positive patients are more likely than others to develop tuberculosis after exposure, and the disease may progress more rapidly. In these patients the possibility that acid-fast bacilli may represent M. tuberculosis must always be considered. Patients with tuberculosis (suspected or proven) should not be nursed in the same wards as immunosuppressed patients, and should be isolated. MDR-TB cases must be isolated in negative-pressure rooms. Hospital side-rooms may be positive-pressure as a fire safety measure; infection control teams must be aware of the airflows in all isolation rooms, and must be consulted during the design of hospital buildings. Good communication between infection control teams and clinicians is important, and all medical and nursing staff must be aware of the principles of management of patients with proven or suspected tuberculosis and MDR-TB.

AIDS-Related Opportunistic Infections↗
PubMed1996

Inhaled nitric oxide.

Explore the source record for details and available documents.

Administration, Inhalation↗
PubMed1995

Cardiovascular stress reactivity and job strain as determinants of ambulatory blood pressure at work.

OBJECTIVE: To test the hypothesis that cardiovascular reactivity to laboratory mental stressors interacts with job strain in predicting blood pressure at work. DESIGN: Ambulatory monitoring of blood pressure and heart rate was carried out for an 8-h period on a work day and on an equivalent non-work day in 49 male firefighters. METHODS: Participants were recruited from a larger cohort (n = 90) on the basis of showing high or low systolic reactions to mental arithmetic 15-24 months previously, coupled with high or low ratings of perceived job strain (high demand-low control). Four groups were tested: low job strain-low systolic reactors (n = 12), low job strain-high systolic reactors (n = 12), high job strain-low systolic reactors (n = 12) and high job strain-high systolic reactors (n = 13). RESULTS: Systolic blood pressure (SBP) was higher on work than non-work days, and diastolic blood pressure and heart rate were higher at work in the morning but not in the afternoon. These effects were due partly to posture and physical activity differences between the two days. Neither job strain nor laboratory reactivity independently predicted ambulatory blood pressure. However, SBP was significantly higher during the afternoon at work in the high job strain-high systolic reactors than in the other groups. This was independent of baseline SBP, and was not due to differences in posture or activity at the time of recordings. Ambulatory SBP reactivity (difference between ambulatory values and workplace resting levels) in the afternoon at work was also elevated significantly in high job strain-high systolic reactors compared with in the other groups. CONCLUSIONS: The results support the hypothesis that individual differences in the appraisal of work stress modulate the relationship between stress reactivity and ambulatory blood pressure.

Adult↗