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PubMed2000

Manchester Asthma and Allergy Study: low-allergen environment can be achieved and maintained during pregnancy and in early life.

BACKGROUND: Early exposure to dust mite allergens may be critical for primary sensitization. Reducing exposure may offer a realistic chance for primary prevention of sensitization and asthma, but it is essential to implement measures that can achieve and maintain the low-allergen environment. OBJECTIVE: Our purpose was to assess the effectiveness of mite allergen avoidance measures in achieving and maintaining a low-allergen environment during pregnancy and in the first year of life. METHODS: The Manchester Asthma and Allergy Study is a prospective, prenatally randomized study that follows the development of asthma and atopy in a cohort of infants at high risk (both parents atopic) who are randomly allocated to full mite allergen avoidance or to a normal regimen. Avoidance measures comprise (1) mite-proof covers (mattress, pillow, and quilt) for parental bed, (2) high-filtration vacuum cleaner, (3) vinyl flooring in infant's bedroom, (4) new crib and portable crib mattresses encased in mite-proof material, (5) benzyl benzoate (Acarosan) applied on carpets and soft furniture, (6) bed linens washed in hot water weekly, and (7) washable soft toys. Dust samples from the parental bed, bedroom floor, living room floor, infant's mattress, and nursery floor were collected between the 10th and 14th weeks of pregnancy, immediately after birth, and then at age 6 months and 1 year, and Der p 1 levels were determined by mAb-based ELISA. RESULTS: Recovered Der p 1 from maternal mattress was reduced by 97. 25% (95% confidence interval [CI] 95.25%-98.41%) during the second and third trimesters of pregnancy, with the effect persisting for 6 months (98% reduction, 95% CI 97.25%-99.1%) and 12 months (97.6% reduction, 95% CI 95.7%-98.6%) after the birth (active vs control, P <.000001). Total Der p 1 from bedroom floor in the active group was reduced by 53.7% (95% CI 25.7%-71.2%) in samples collected within 4 weeks of the child's birth, with the percentage reduction being 62. 8% (95% CI 39.3%-77.2%) at 6 months and 26.5% (95% CI -24% to 57.1%) at 1 year (active compared vs control, P <.007). Der p 1 levels in crib mattress and nursery floor in the active group were extremely low (crib mattresses geometric mean [95% CI] 2.3 ng [1.6-3.4] at birth, 6.8 ng [4.5-10] at age 6 months, and 15.6 ng [9.8-24.8] at age 1 year [active vs control, P =.001]; nursery 1 ng [0.9-1.1] at birth, 1.7 ng [1.2-2.5] at age 6 months, and 2 ng [1.3-3.5] at age 1 year [active vs control, P <.00001]). The total amount of allergen recovered at age 1 year was 29-fold (95% CI 15.1- to 56.7-fold) higher in the control group than in the active group. CONCLUSIONS: The avoidance measures used in this study achieved and maintained a low mite allergen environment during pregnancy and in the first year of life in homes of infants at risk of atopy.

Allergens↗
PubMed2006

Inhalation and dermal exposure to eight antineoplastic drugs in an industrial laundry facility.

OBJECTIVES: The aims of the study were to quantify levels of dermal and inhalation exposure to antineoplastic drugs in an industrial laundry service in the Netherlands and to test the removal efficiency of the washing procedure for removal of antineoplastic drugs. METHODS: During four workdays dermal and inhalation exposure to eight frequently used antineoplastic drugs (cyclophosphamide, ifosfamide, methotrexate, 5-fluorouracil, etoposide, cytarabine, gemcitabine and chlorambucil) were measured for all job titles involved in handling unwashed laundry. To test the removal efficiency of the washing procedure, 10 x 10 cm sections were excised before and after the washing procedure. These sections were taken from 15 bed sheets that were collected in hospitals of patients who were treated with one of the selected antineoplastic drugs. RESULTS: During none of the four measurement days, detectable levels of any of the eight antineoplastic drugs (cyclophosphamide, ifosfamide, methotrexate, 5-fluorouracil, etoposide, cytarabine, gemcitabine, or chlorambucil) were found on workers' skin of hands or in any of the air samples. Only four out of the 15 bed sheets from patients that were treated with antineoplastic drugs appeared to be contaminated with detectable levels of antineoplastic drugs before the washing procedure (range 13.0-3,060 ng/100 cm(2)). After the pre-washing and after the complete washing procedure, no detectable levels of any of the eight antineoplastic drugs were found anymore in the selected bed sheets. CONCLUSIONS: The implementation of guidelines for working with antineoplastic drugs seems to be successful in reducing exposure to antineoplastic drugs of workers in this laundry facility to an acceptable, non-detectable level and to remove antineoplastic drug contamination from bed linen.

Antineoplastic Agents↗
PubMed1981

A new double-layered launderable bed sheet for patients with urinary incontinence.

In a skilled nursing facility, 36 patients (chiefly elderly) with persistent urinary incontinence were the subjects of this study. In their management, the usual disposable pads were compared with a new launderable bed sheet (Kylie) which absorbs urine in the second layer while maintaining a dry surface next to the patient's skin. There was a 42 percent reduction in the frequency of bedding changes with the new bed sheets. The patients experienced increased comfort due to decreased skin wetness and decreased creasing of the sheets. The reduced frequency of bed linen changes permitted longer undisturbed periods for the patient. Management costs were reduced by 40 percent with the launderable bed sheets. There were no adverse effects on the condition of the patients or in the quality of care.

Adult↗
PubMed1992

Mysterious slapped face rash at holiday centre.

OBJECTIVE: To discover the cause of an outbreak of facial rash in a holiday centre. DESIGN: Questionnaire survey of those with rash; analysis of samples of linen. SETTING: Holiday centre in south west England. PATIENTS: 98 holiday-makers presenting to the first aid post with a facial rash. INTERVENTION: Replacement of bed linen with new linen in selected parts of the site. RESULTS: The attack rate was 7.0-14.2/1000 for most accommodation areas in the centre, but in one accommodation area the rate was zero. The pH of rinse water from sheets varied from 7.4 to 9.0. Those parts of the accommodation provided with new linen had zero attack rates. CONCLUSION: The facial rash resulted from irritation from washing powder retained owing to insufficient rinsing during laundering. Modifications to the rinsing process led to a gradual disappearance of the rash.

Adolescent↗
PubMed2002

Carbapenem-resistant Acinetobacter and role of curtains in an outbreak in intensive care units.

Multiple-antibiotic-resistant Acinetobacter baumanii, including meropenem resistance, was first isolated from a patient in the general intensive care unit of a tertiary-referral university teaching hospital in Birmingham in December 1998. Similar strains were subsequently isolated from 12 other patients, including those on another intensive care unit within the hospital. The outbreak followed an increase in the use of meropenem in both the units. Environmental screening revealed the presence of the multiple-resistant Acinetobacter species on fomite surfaces in the intensive care unit and bed linen. The major source appeared to be the curtains surrounding patients' beds. Typing by pulsed field gel electrophoresis demonstrated that the patients' isolates and those from the environment were indistinguishable. Rigorous infection control measures including increased frequency of cleaning of the environment with hypochlorite (1000 ppm) and twice-weekly changing of curtains were implemented, along with restriction of meropenem use in the units. Isolation of the multiple-resistant Acinetobacter spp. subsequently diminished and it was not detected over a follow-up period of 18 months. To our knowledge, this is the first reported outbreak of carbapenem-resistant Acinetobacter spp. from the UK. This outbreak also highlights environmental sources, particularly dry fabrics such as curtains, as an important reservoir for dissemination of acinetobacters.

Acinetobacter↗
PubMed1975

A comparison of mite populations in mattress dust from hospital and from private houses in Cardiff, Wales.

Fifty mattress dust samples from private houses were examined--all were mite infested. Dermatophagoides pteronyssinus occurred in all samples and accounted for 81% of all mites. In thirty-two paired samples the total mite population of bedroom floor dust was only 10% of that found in the corresponding mattress dust. D. pteronyssinus was the dominant species in both and the population of this mite amounted to 7-5% of that found in the mattress dust. An analysis of mattress dust from 100 hospital beds showed that ninety-four mattresses were mite free; the other six contained only seven mites, all D. pteronyssinus. It is suggested that frequent changing and washing of bed linen and brushing and cleaning of mattresses were the main factors in preventing mite infestation in the Cardiff hospitals.

Bedding and Linens↗
PubMed1999

Do mite avoidance measures affect mite and cat airborne allergens?

BACKGROUND: Effective mite allergen avoidance measures are presumed to reduce airborne allergens yet the quantity in the air is rarely measured. OBJECTIVE: To monitor airborne allergen during a placebo-controlled mite allergen avoidance study. METHODS: Bedrooms of 56 atopic asthmatic children were randomly allocated to hot washing and encasing covers + acaricide (active regime) or placebo treatment. Dust was collected from the mattress, bedding and carpets; airborne allergen was measured using Casella samplers and dust settling in open Petri dishes. Der p 1, Der p 2 and Fel d 1 were measured. RESULTS: After 24 weeks of mite allergen avoidance the Casella air-samplers collected Der p 1 less frequently in active than placebo-treated bedrooms (0 vs. 29%, P<0.05) and Petri dishes in the active group collected less than baseline (0.2 vs. 0.6 ng/day P<0.05). Homes without cats had less cat allergen than cat-owning homes and when actively treated for 24 weeks showed a greater reduction (P = 0.03) in mattress cat allergen than the placebo group. CONCLUSION: Encasing covers and hot washing of bed linen reduced mite aeroallergen (and mattress cat allergen in the absence of cats). This could mean dual benefits to a patient sensitive to both mite and cat.

Air Pollutants↗
PubMed1994

Clinical study: assessing the performance and skin environments of two reusable underpads.

The authors wanted to compare the performance and skin environment provided by a recently introduced reusable underpad (Test Group underpad) to an underpad already well established in the absorbent products market (Reference Group underpad). A controlled, prospective, randomized multi-centered clinical trial was conducted in 18 facilities (6 hospitals, 7 home health agencies, and 5 skilled nursing facilities) and completed by 107 patients. The majority of the patients had a Braden score near 13, were 70 to 80 years of age, and weighed 130 to 138 lbs. The Test Group underpad ranked more favorably overall and in all eight categories of daily assessment. These differences were statistically significant (p < 0.05) in the Total Score and in four of the eight individual categories: Keeping Skin Dry, Keeping Clothing Dry, No Pooling of Fluid, and Patient Comfort. The Test Group underpad also ranked more favorably with statistical significance (p < 0.05) in three of the assessment categories at the conclusion of the study: Pad Absorbency, Pad's Ability to Wick Moisture, and Pad's Ability to Keep Skin Dry. Investigators also noted that 57 patients (53%) exhibited some measure of improvement by the end of the study. Of these, 45 (79%) had been assigned to the Test Group. The Test Group underpad demonstrated better absorbency, kept patients' skin, clothing and bed linens drier, exhibited less pooling of fluid and resulted in higher patient comfort. As a result, it may have contributed to a more beneficial skin environment, allowing for prevention of preexisting skin integrity problems and enhancement of healing.

Adolescent↗
PubMed1989

Bar codes in the U.K.

In summary, by the simple addition of a bar code label to individual items of bed linen or garments the following information becomes available: a total number of items in circulation; a breakdown of individual items and quantity; an average length of stay within locations, i.e., turnaround period; a complete record of all condemned items and costs; a record of overdue items by location; an immediate identification of users with above-average retention periods; quality control of purchases; total cash value of stock. Bar codes are a tremendous security device that has already saved the National Health Service in the U.K. an enormous sum. Perhaps they can help your operation, too.

Bedding and Linens↗
PubMed2006

Socioeconomic, environmental, and behavioural risk factors for leprosy in North-east Brazil: results of a case-control study.

BACKGROUND: Brazil reports almost 80% of all leprosy cases in the Americas. This study aimed to identify socioeconomic, environmental, and behavioural factors associated with risk of leprosy occurrence in the endemic North-eastern region. METHODS: A case-control study in four municipalities. CASES: cases of leprosy diagnosed in the previous 2 years, with no other known, current, or past case of leprosy in the household or in the neighbourhood. CONTROLS: individuals presenting for reasons other than skin problems to the health unit where the case was diagnosed and who lived in the same municipality as the case with whom it was matched. For each case four controls were selected. A semi-structured questionnaire was used to collect demographic, socioeconomic, environmental, and behavioural data. A multivariate hierarchical analysis was performed according to a previously defined framework. RESULTS: 226 cases and 857 controls were examined. Low education level, ever having experienced food shortage, bathing weekly in open water bodies (creek, river and/or lake) 10 years previously, and a low frequency of changing bed linen or hammock (>or=biweekly) currently were all significantly associated with leprosy. Having a BCG vaccination scar was found to be a highly significant protective factor. CONCLUSIONS: Except for BCG vaccination, variables that remained significant in the hierarchical analysis are cultural or linked to poverty. They may act on different levels of the transmission of Mycobacterium leprae and/or the progress from infection to disease. These findings give credit to the hypothesis that person-to-person is not the only form of M. leprae transmission, and that indirect transmission might occur, and other reservoirs should exist outside the human body.

Adult↗
PubMed1998

Recurrence rate of streptococcal pharyngitis related to hygienic measures.

OBJECTIVE: To test the hypothesis that treatment failures of streptococcal pharyngotonsillitis may be caused by reinfection by the patients' own streptococci remaining on a toothbrush or in the bedclothes. DESIGN: To elucidate the role of streptococcal contamination of the environment, hygienic measures regarding change of toothbrush and bed linen and washing of toys were given to half of the patients/families. Throat specimens were taken from all the patients before treatment with phenoxymethylpenicillin for 5 days, and the patients were followed-up for 1 month. At a home visit after 6-10 days, throat specimens were taken from the patients and all permanent residents of the home. Environmental samples were taken from pillowcases, floors, toothbrushes, dummies, and toys. SETTING: Six health care centres. SUBJECTS: 114 patients of all ages suffering from group A streptococcal pharyngotonsillitis, and 289 family members. MEASUREMENTS AND MAIN RESULTS: 54 patients/families received hygiene instructions. The total number of recurrences was 40 (35%). There was no difference in treatment failure rate between patients/families that had taken or not taken hygienic measures. CONCLUSIONS: Hygienic measures have no decisive influence on the risk of recurrence of streptococcal pharyngotonsillitis.

Adolescent↗
PubMedDate not supplied

Innovations in the design and performance of underpads for patients with burns.

The purpose of this study was to determine the biomechanical performance of commercially available underpads and bed linens to reduce the development of pressure sores in patients with burns who are at high risk. The three biomechanical performance parameters examined were coefficient of friction, absorbent capacity, and rewet. Because wetting either cotton or cotton/polyester bedsheets markedly increases their coefficients of friction, underpads should be used routinely to protect the skin against frictional forces. One disposable underpad is ideally suited to protect the skin of the patient at high risk. It has a polyolefin backing with a low coefficient of friction that serves as an effective barrier to moisture transmission while still shifting easily with the patient's movement. In addition, it is the only underpad studied that contains a superabsorbent polymer that provides a far superior absorbent capacity and minimizes rewet. Wet-back is further inhibited by its thick intermediate tissue layer and its spunbonded polypropylene coverstock.

Absorption↗
PubMed1997

Dust mite allergen avoidance in the treatment of hospitalized children with asthma.

BACKGROUND: Asthma is a leading cause of hospital admission in children. The majority of children with asthma are sensitized and exposed to inhalant allergens that may contribute to chronic airway inflammation. OBJECTIVE: To evaluate the practicality and effects of dust mite (D. farinae and D. pteronyssinus) allergen avoidance in homes of children hospitalized with acute asthma. METHODS: Children 5 to 18 years of age who were admitted with asthma to a suburban Atlanta hospital were randomly assigned, without knowledge of allergen sensitization or exposure in their houses, to active (n = 13) or placebo (n = 10) treatment group. Active treatment included encasing mattress, box springs, and pillows in allergen impermeable covers; weekly hot water wash of bed linens; replacement of bedroom carpet with polished flooring; and 3% tannic acid spray to living room carpet. Placebo treatment included permeable encasing for bedding, cold water wash, and water spray for carpet. Dust samples were analyzed for dust mite, cockroach, and cat allergens, while serum samples were analyzed for IgE antibodies to the same allergens. Outcome measures included daily peak expiratory flow rates, spirometry, methacholine inhalation challenge, and hospital readmission. RESULTS: Children in both groups were similar by demographics, sensitization, and exposure to dust mite allergen. Allergen levels fell > 3-fold in many active and placebo homes. Children in the active group had improved PEFR at 3 and 6 months after intervention (P < .04, P < .05, respectively). Six of seven children in the study who were sensitized and exposed to dust mite allergen demonstrated improved PEFR at 3 months when allergen levels fell in both bedding and bedroom floor. There was no difference in FEV1 or methacholine challenge, although a few children in either group could tolerate methacholine because of bronchial hyperreactivity. Six children (four active and two placebo) were readmitted to hospital during the study. CONCLUSION: Increases in PEFR were recorded among children in the active treatment group and also among sensitized patients whose dust mite allergens fell. These results support the hypothesis that avoidance can be effective even among children admitted to hospital. The study was complicated by insufficient numbers of mite-allergic children and poor compliance with diaries and the protocol. Recruitment from the hospital resulted in participants with more severe asthma than anticipated. The results also suggest that many of the patients in this group will continue to have exacerbations triggered by upper or lower respiratory tract infections.

Adolescent↗
PubMed2002

Allergens, Der p 1, Der f 1, Fel d 1 and Can f 1, in newly bought mattresses for infants.

BACKGROUND: To avoid allergen exposure of newborn babies, the use of a new mattress for the baby bed may be recommended. However, it is not certain that new mattresses are always free of allergens. OBJECTIVE: In the present study the allergen content of new infant mattresses was investigated. METHODS: Dust samples were vacuumed from 90 new mattresses for infant beds bought in 50 different Dutch shops, and the concentrations of Der p 1, Der f 1, Fel d 1 and Can f 1 were determined by radioimmunoassays. RESULTS: Most mattresses contained some allergen and often the allergen concentrations were surprisingly high. Only 15 of the 90 mattresses contained no detectable amounts of any of the four allergens. The highest concentration found for each allergen was 3.1, 46.5, 20.2 and 95.7 microg/g of dust, respectively. However, the total amount of allergen in a mattress was still rather low because the new mattresses contained only modest amounts of dust. Baby mattresses more often contained an increased allergen load than the larger, standard-sized, infant mattresses. This may be caused by differences in manufacturing procedure. Also, mattresses that were sold without a plastic encasement more often contained an increased allergen load. CONCLUSIONS: It is advisable to buy a mattress that is wrapped in plastic, but it may still contain a substantial amount of allergen. Thorough vacuuming of a newly bought mattress before it is installed on a child's bed, is also advisable. After instalment, regular vacuuming of the mattress and washing of the bed linen as well as measures to eliminate allergen reservoirs in other parts of the house are important, because our observations indicate that mattresses easily pick up allergens from the environment.

Allergens↗
PubMed1996

Exposure risks related to the management of three wound drainage systems.

BACKGROUND: In response to the Occupational Safety and Health Administration regulations and Centers for Disease Control and Prevention guidelines, health care employers must explore and incorporate new methods to protect staff and patients from blood-borne pathogens. An area directly affected by the new OSHA standards is the postoperative management of surgical drainage systems. This study compared three surgical wound drainage systems: a "closed" system (Tru-Close) and two currently used drainage systems (Hemovac, and Mini-Snyder) for nursing practices and risk of exposure to blood or body fluids in a simulated setting. METHODS: Fifty-eight volunteer registered nurses were asked to choose appropriate personal protection equipment and use recommended universal precautions while measuring and emptying fluid and reactivating each of the drainage systems and to complete a satisfaction questionnaire. Each postoperative wound drainage system was filled with simulated wound drainage and connected to a manikin in an empty patient room. Exposure/contamination was defined as spilling, dripping, or splashing of simulated drainage fluid anywhere in the patient's room or bathroom. RESULTS: Forty-five percent of nurses who emptied bulb evacuator systems and 40% of nurses who emptied Hemovac systems had resulting contamination to the environment or exposure to self. There were no contaminations with the Tru-Close system. Most contaminations were droplets of fluid on environmental surfaces rather than on the nurses themselves. Most nurses chose gloves for personal protection regardless of the system used. Gowns and face shields were rarely used. Most contaminations were due to emptying simulated fluid (27%) or emptying rinse water (29%) into the patient's toilet. Twenty-three percent (23%) of contaminations occurred while simulated fluid was poured into a container at the bedside. The most common object contaminated was the toilet seat (67%). The bed linen was contaminated 16% of the time. Nurse's gloves were exposed in 6% of the trials. CONCLUSIONS: As administrators and researchers explore new methods to protect patients, health care providers, and the environment from blood-borne pathogens, changes should be balanced with the impact on patient care and user satisfaction.

Adult↗