PubMed Health⌕ Search

Biomedical subjects

D Vesley

Publications and source records attributed to D Vesley.

At least 19 recordsLinked to original sources
PubMed2001

An evaluation of hospital special-ventilation-room pressures.

OBJECTIVE: To quantitate the magnitude and consistency of positive (airflow out) and negative (airflow in) hospital special-ventilation-room (SVR) airflow. DESIGN: A room-pressure evaluation was conducted during two seasons on a total of 18 rooms: standard rooms, airborne infection isolation rooms, and protective environment rooms. The pressures were measured using a digital pressure gauge-piezoresistive pressure sensor that measured pressure differentials. With doors closed, the rooms were measured a minimum of 30 times each for a cooling season and a heating season. RESULTS: The standard rooms showed the least amount of variability in pressure differential, with an average of -0.2 Pa (median, -0.2 Pa), and an interquartile range (IQR) of 0.4 Pa. Airborne infection isolation rooms showed more variability in pressure, with an average of -0.3 Pa (median, -0.2 Pa) and an IQR of 0.5 Pa. Protective environment rooms had the greatest fluctuation in pressure, with an average of 8.3 Pa (median, 7.7 Pa) and an IQR of 8.8 Pa. Dramatic pressure changes were observed during this evaluation, which may have been influenced by room architectural differences (sealed vs unsealed); heating, ventilation, and air-conditioning zone interactions; and stack effect. CONCLUSION: The pressure variations noted in this study, which potentially affect containment or exclusion of contaminants, support the need for standardization of pressure requirements for SVRs. To maintain consistent pressure levels, creating an airtight seal and continuous pressure monitoring may be necessary.

Calibration↗
PubMed1998

Improved methods for generation, sampling, and recovery of biological aerosols in filter challenge tests.

In preparation for filter efficiency tests and sampler comparison studies, methods of biological aerosol generation, sampling, and filter recovery were modified from previous studies. Methods described include (1) techniques for generating aerosols that reduced nuisance particles to negligible levels and increased the cell culturability of Mycobacterium abscessus by 30%, (2) sampling techniques that lowered the detectable range of biological particle size from 0.65 to 0.45 micron and reduced the sampling flow from the chamber from 28.3 to 1.5 L/min, and (3) development of methods to remove culturable organisms from respirator filter media. These methods were developed for filter challenge tests with M. abscessus and were applied to two other bacteria. They may also have application to a wider variety of organisms and bioaerosol assessments.

Aerosols↗
PubMed1997

Collection of three bacterial aerosols by respirator and surgical mask filters under varying conditions of flow and relative humidity.

A variety of respirator filters and surgical masks were challenged with three aerosolized bacteria: Mycobacterium abscessus (M.a.) (a rod), Staphylococcus epidermidis (S.e.) (a sphere), and Bacillus subtilis (B.s.) (a rod). Tests were conducted at two flow rates (45 and 85 l./min) and two humidity levels (30 and 70%). Aerosols were measured with a total-particle, direct-reading, spectrometer and a viable particle cascade impactor. Measurements up- and downstream of the filter or mask were used in determining aerosol penetration; respirator or surgical mask fit was not evaluated. Bioaerosol penetration measured with two aerosol sampling instruments was found to correlate. Additionally, bioaerosol test parameters were evaluated with respect to their effect on penetration. Increasing flow resulted in increased penetration of all organisms while an increase in relative humidity did not exert a consistent effect on all organisms. Of the respirators approved by the National Institute for Occupational Safety and Health (NIOSH), filter efficiency was as expected with dust/mist respirators having the lowest and HEPA filters the highest efficiency. Surgical masks were the least efficient of all filters tested; these are not certified by NIOSH. Bioaerosol penetration was compared to that of a polystyrene latex sphere (PSL) aerosol. Penetration of the test aerosols was predicted on the basis of particle aerodynamic diameter and was expected to be in this order: PSL > M.a. > S.e. = B.s. The PSL aerosol was the most penetrating, as predicted. However, results showed that B.s. was more penetrating than S.e. The aerodynamic diameter may not be the best parameter for predicting aerosol penetration of non-spherical particles in these filters.

Aerosols↗
PubMed1997

Compliance with universal precautions among physicians.

This study characterized and assessed self-reported levels of compliance with universal precautions (UP) among hospital-based physicians, and determined significant factors associated with both compliance and noncompliance. The physicians (n = 322) were a subgroup of a larger study population of hospital-based health care workers recruited from three geographically distinct locations (n = 1746), and were surveyed using a detailed confidential questionnaire that assessed personal, work-related, and organizational factors. Compliance with UP was measured through 11 items that examined how often physicians followed specific recommended work practices. Compliance was found to vary among the 11 items: they were high for certain activities (eg, glove use, 94%; disposal of sharps, 92%) and low for others (eg, wearing protective clothing, 55%; not recapping needles, 56%). Compliance with all items was low (31% to 38%). Stepwise logistic regression revealed that noncompliant physicians were likely to be age 37 or older, to report high work stress, and to perceive a conflict of interest between providing patient care and protecting themselves. Compliant physicians were more likely to be knowledgeable and to have been trained in universal precautions, to perceive protective measures as being effective, and to perceive an organizational commitment to safety.

Adult↗
PubMed1995

Compliance with universal precautions among health care workers at three regional hospitals.

OBJECTIVE: To assess and characterize self-reported levels of compliance with universal precautions among hospital-based health care workers and to determine correlates of compliance. DESIGN: Confidential questionnaire survey of 1716 hospital-based health care workers. PARTICIPANTS: Participants were recruited from three geographically distinct hospitals. A stratified convenience sample of physicians, nurses, technicians, and phlebotomists working in emergency, surgery, critical care, and laboratory departments was selected from employment lists to receive the survey instrument. All participants had direct contact with either patients or patient specimens. RESULTS: For this study, overall compliance was defined as "always" or "often" adhering to the desired protective behavior. Eleven different items composed the overall compliance scale. Compliance rates varied among the 11 items, from extremely high for certain activities (e.g., glove use, 97%; disposal of sharps, 95%) to low for others (e.g., wearing protective outer clothing, 62%; wearing eye protection, 63%). Compliance was strongly correlated with several key factors: (1) perceived organizational commitment to safety, (2) perceived conflict of interest between workers' need to protect themselves and their need to provide medical care to patients; (3) risk-taking personality; (4) perception of risk; (5) knowledge regarding routes of HIV transmission; and (6) training in universal precautions. Compliance rates were associated with some demographic characteristics: female workers had higher overall compliance scores than did male workers (25% of female and 19% of male respondents circled "always" or "often" on each of the 11 items, p < 0.05); and overall compliance scores were highest for nurses, intermediate for technicians, and lowest for physicians. Overall compliance scores were higher for the mid-Atlantic respondents (28%) than for those from the Southwest (20%) or Midwest (20%, p = 0.001). CONCLUSIONS: This study supports earlier findings regarding several compliance correlates (perception of risk, knowledge of universal precautions), but it also identifies important new variables, such as the organizational safety climate and perceived conflict of interest. Several modifiable variables were identified, and intervention programs that address as many of these factors as possible will probably succeed in facilitating employee compliance.

Blood-Borne Pathogens↗
PubMed1995

Evaluation of a rapid readout biological indicator for 121 degrees C gravity and 132 degrees C vacuum-assisted steam sterilization cycles.

OBJECTIVE: A biological indicator (BI), based on fluorescent detection of a spore-associated enzyme, has been developed. We evaluated the new BI against five conventional self-contained BIs in a 121 degrees C gravity-displacement sterilizer and, packaged in towel packs and disposable steam test packs, in a 132 degrees C vacuum-assisted sterilizer. DESIGN: In the 121 degrees C gravity-displacement sterilizer, rapid readout BIs and conventional BIs were tested together in an otherwise empty chamber. Exposure times were 5, 10, and 15 minutes. In the 132 degrees C vacuum-assisted steam sterilizer, BIs were contained in towel packs or disposable steam test packs. Surgical packs were added to represent a full load. Exposure times were 0, 1, and 2 minutes. RESULTS: In gravity-displacement 5-minute cycles, the rapid readout BIs yielded 100% positive results within 30 minutes. The conventional BIs ranged from 72% to 100% positive in 48 hours. At 10 minutes, the rapid readout BIs were 83% positive after 3 hours, whereas the conventional BIs ranged from 0% to 37% positive after 48 hours. All indicators were negative after 15-minute exposures. In vacuum-assisted cycles, all indicators were negative after 3 minutes. After 1-minute exposures, the rapid readout BIs were 40% to 60% positive, whereas the conventional BIs were 15% to 20% positive. CONCLUSION: The rapid readout BIs are a more sensitive indicator of marginal steam sterilization cycles than conventional self-contained BIs. They yield results within 3 hours, as compared to 24 to 48 hours for the conventional BIs.

Evaluation Studies as Topic↗
PubMed1994

Evaluation of single-use masks and respirators for protection of health care workers against mycobacterial aerosols.

BACKGROUND: The recent increase in multidrug-resistant tuberculosis has spawned a major controversy concerning the degree of respiratory protection needed by health care workers, particularly during sputum-inducing procedures. The objective of this study was to measure the filtration efficiencies of a single-use submicron surgical mask, two disposable dust/mist respirators, a dust/mist/fume respirator, and a high-efficiency particulate air respirator against aerosolized mycobacteria. Facial fit was not addressed. METHODS: In a specially designed enclosed test apparatus, an aerosol was generated with a Collison nebulizer from a known concentration of Mycobacteria chelonae, used as a surrogate for Mycobacterium tuberculosis. Aerosol concentrations were measured with Anderson samplers upstream and downstream of the test masks and respirators, which were heat sealed to a metal plate. RESULTS: Mean efficiencies ranged from approximately 97% for the surgical mask and a dust/mist respirator to more than 99.99% for the high-efficiency particulate air respirator. Measurements of filter efficiency with an Aerodynamic Particle Sizer for the M. chelonae aerosol and independent challenge tests with latex spheres correlated closely with measurements of M. Chelonae collection efficiency determined with Andersen samplers. CONCLUSIONS: Analysis of variance and Tukey's method for multiple comparisons indicated that the dust/mist/fume respirator and the HEPA respirator collected M. chelonae with significantly greater efficiency than did either the surgical mask or the dust/mist respirator. Even the least efficient mask tested, however, had a filter efficiency of more than 97% against particles averaging less than 1 micron in aerodynamic diameter.

Aerosols↗
PubMed1993

Cross-sectional epidemiological study of respiratory disease in turkey farmers.

This study was a cross-sectional epidemiological investigation of respiratory disease in farmers involved in the turkey growing industry. Pulmonary function tests and health history questionnaires were administered to a total of 95 turkey farmers throughout Minnesota. Respiratory symptoms were greatest during the winter months when exposure to environmental agents was highest. Prevalence of symptoms was higher for smokers, personnel who worked in hen barns, and for persons who had worked in the turkey growing industry for more than 10 years. Pulmonary function was found to decrease during the work day. Also, pulmonary function was lowest for personnel working in hen bars, and for persons who had been employed in the industry for more than 10 years. These data support the association between respiratory disease and exposure to the environment in confinement farm buildings.

Adolescent↗
PubMed1992

Significant factors in the disinfection and sterilization of flexible endoscopes.

BACKGROUND: Many nosocomial infection outbreaks have been linked to improper disinfection of the flexible endoscopes used in hospitals and clinics. The objective of this study was to evaluate the efficacy of scope disinfection with glutaraldehyde and hydrogen peroxide in manual and mechanical protocols. METHODS: Bacillus subtilis and Pseudomonas cepacia were the test organisms. Each channel in two different endoscopes was seeded and evaluated separately. Residual chemical germicide levels in the channels and in the work environment were also measured. RESULTS: Parametric analyses were carried out on log transformations of number of colony-forming units recovered. Repeated measures analysis demonstrated that both the type of disinfectant and the method of washing were significant factors for disinfection. CONCLUSIONS: Hydrogen peroxide proved to be more efficacious than glutaraldehyde for killing or removing B. subtilis in a 10-minute contact period. Automatic disinfection was more efficacious than manual disinfection for killing or removing B. subtilis in a 10-minute contact period. The channel being disinfected also proved to be a significant factor, with carbon dioxide and elevator channels the most difficult to disinfect consistently.

Bacillus subtilis↗
PubMed1992

Fluorimetric Detection of a Bacillus stearothermophilus Spore-Bound Enzyme, alpha-d-Glucosidase, for Rapid Indication of Flash Sterilization Failure.

A biological indicator based on fluorimetric detection within 60 min of a Bacillus stearothermophilus spore-bound enzyme, alpha-d-glucosidase, has been developed. Results indicate that the enzyme survived slightly longer than spores observed after 24 h of incubation. The new system shows promise for evaluating flash sterilization cycles within 60 min compared with conventional 24-h systems.

Journal Article↗
PubMed1990

Vapor-phase hydrogen peroxide as a surface decontaminant and sterilant.

The feasibility of utilizing vapor-phase hydrogen peroxide (VPHP) as a surface decontaminant and sterilant was evaluated in a centrifuge application. The prototype VPHP decontamination system, retrofitted into a Beckman L8-M ultracentrifuge, was designed to vaporize a 30% (wt/wt) solution of aqueous hydrogen peroxide continuously injecting and withdrawing VPHP in a deep-vacuum flow-through system. VPHP cycles of 4, 8, 16, and 32 min were examined for cidal activity against spores of Bacillus subtilis subsp. globigii and Bacillus stearothermophilus. Spore inocula (approximately 10(6)/coupon) were dried onto 0.5-in. (1.27-cm)-square stainless-steel coupons, and coupons were suspended in the centrifuge chamber, the space between the refrigeration can and the barrier ring (inner gap), and the space between the barrier ring and the vacuum ring (outer gap). At a chamber temperature of 4 degrees C, B. subtilis subsp. globigii spores were inactivated within 8 min, while inactivation of spores located in the outer gap at 27 degrees C required 32 min. The elevated temperature and high surface area/volume ratios in the outer gap may serve to decompose the gas more rapidly, thus reducing cidal efficacy. Of the two test spores, B. stearothermophilus was more resistant to VPHP. Nonetheless, VPHP was shown to possess significant sporicidal capability. For practical decontamination applications of the type described, VPHP shows promise as an effective and safer alternative to currently used ethylene oxide or formaldehyde vapors.

Bacillus subtilis↗
PubMed1988

Laboratory-acquired infections and injuries in clinical laboratories: a 1986 survey.

A mail survey of all 54 US State and Territorial Public Health Laboratories and the 165 Hospital Clinical Laboratories in Minnesota was carried out, soliciting information on laboratory-acquired infections and injuries for calendar year 1986. The aggregate infection incidence rates were 3.5/1,000 full-time equivalent (FTE) workers for hospital laboratories and 1.43/1,000 for public health laboratories. Injury rates were 21.2/100 FTE workers for hospital laboratories and 7.21/100 for public health labs.

Accidents, Occupational↗
PubMed1987

Microbiological evaluation of wet and dry floor sanitization systems in hospital patient rooms.

A new system for sanitizing floors in hospital patient rooms has been developed. The method consists of dry dusting with a cotton-blend, chemically treated (10% by dry mop weight) dust mop. This method was compared with a conventional cleaning protocol consisting of an initial predusting with the same nongermicidal chemical (3% by dry mop weight) followed by wet mopping with a fresh solution of a quaternary ammonium disinfectant-detergent. Each of six rooms was sampled by using RODAC plates (Becton Dickinson Labware, Oxnard, Calif.) on 10 consecutive days for each of the two methods. The study was initially performed during the summer and then repeated during the winter. Results imply that there is no significant difference between the new dry method (81.9% CFU reduction) and the conventional method (83.1% CFU reduction). Furthermore, the initial dry dusting step in the conventional method accounted for virtually all of the reduction by that method. Thus, wet mopping with a germicidal chemical produced no additional significant reduction of natural microbial populations on environmental surfaces beyond that achieved by dry dusting with dust-suppressant chemicals.

Analysis of Variance↗
PubMed1985

Evaluation of nongermicidal handwashing protocols for removal of transient microbial flora.

A method has been described which can compare the efficacy of different nongermicidal handwashing protocols for removal of transient microbial flora without the necessity of establishing or relying on a previously determined baseline for an individual subject. The wash effluent is collected, and colony counts for the effluent reflect the number removed by the wash protocol. A second standard wash in a handwashing machine is performed, and the test criterion is the percent removed in the test wash based on the sum of total CFU recovered from the two washes. The method was used to compare an 8-s cycle for a newly developed handwashing machine with a conventional 15-s Ivory soap wash. When machine pressure was adequate (42 lb/in2), there was no statistically significant difference in the percent removal of transient flora by the two methods (48.8% from the machine versus 45.1% from the Ivory soap wash). At 32 lb/in2, the Ivory soap wash recovered 60.3%, whereas the machine recovered 45.1%.

Analysis of Variance↗
PubMed1983

Aspergillus fumigatus and other thermotolerant fungi generated by hospital building demolition.

On 13 September 1981, a 51-year-old seven-story building within our hospital complex was demolished by explosives. The concern that this event might release large numbers of thermotolerant fungi (TF), potentially hazardous to immunosuppressed patients, led us to seal hospital windows and doors. The air-handling systems were also manipulated. Concentrations of airborne TF, especially Aspergillus fumigatus, were determined before and after demolition, using Andersen and Cassella air samplers with inhibitory mold agar plates. Two outdoor and two hospital ward locations were sampled. The plates were incubated at 37 degrees C; the CFU per cubic meter were counted at 72 h. The outdoor concentration of TF increased at one site by an average of 1.8 log10 (10(2) to 10(5] over the predemolition level. A. fumigatus increased 3.3 log10 (10(0) to 10(4] at the other outdoor site. The indoor TF concentrations increased about 1 log10 (10(1) to 10(2] after demolition. Counts on the hospital wards were not remarkable when compared with previous surveillance air sampling. Protective measures apparently minimized the infiltration of TF during explosive demolition.

Air Microbiology↗