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PubMed2003

A comprehensive approach to percutaneous injury prevention during phlebotomy: results of a multicenter study, 1993-1995.

OBJECTIVE: To examine a comprehensive approach for preventing percutaneous injuries associated with phlebotomy procedures. DESIGN AND SETTING: From 1993 through 1995, personnel at 10 university-affiliated hospitals enhanced surveillance and assessed underreporting of percutaneous injuries; selected, implemented, and evaluated the efficacy of phlebotomy devices with safety features (ie, engineered sharps injury prevention devices [ESIPDs]); and assessed healthcare worker satisfaction with ESIPDs. Investigators also evaluated the preventability of a subset of percutaneous injuries and conducted an audit of sharps disposal containers to quantify activation rates for devices with safety features. RESULTS: The three selected phlebotomy devices with safety features reduced percutaneous injury rates compared with conventional devices. Activation rates varied according to ease of use, healthcare worker preference for ESIPDs, perceived "patient adverse events," and device-specific training. CONCLUSIONS: Device-specific features and healthcare worker training and involvement in the selection of ESIPDs affect the activation rates for ESIPDs and therefore their efficacy. The implementation of ESIPDs is a useful measure in a comprehensive program to reduce percutaneous injuries associated with phlebotomy procedures.

Attitude of Health Personnel↗

PubMed2002

[Disposal of animal byproducts, dead and slaughtered animals].

The current state of epidemiological knowledge about BSE clearly indicates that certain practices in carcass rendering had a significant impact on maintenance and spreading of BSE in the cattle population. This awareness did not come up spontaneously. As a reflection community legislation continuously developed and still does. The decisive move was done in the year 2000 by eliminating ruminant tissues with a high infectious potential with regard to BSE (specified risk material--SRM) from the human and animal feed chains. This step as well as the subsequent feed ban for all farm animals dramatically changed the logistical as well as the economical preconditions of the rendering industry. In fact the basic treatment (pressure cooking) remained almost unchanged. But instead of physically recycling the products they are nowadays predominantly used as an energy source in industry. In case of products that originate from the treatment of SRM burning is mandatory. These changes require a well adapted and intensified official supervision.

Animal Feed↗

PubMed2001

[Legal and technical issues of formalin disposition in association with autopsy].

The Ministry of Public Welfare notified on the disposition of formalin, which was used in the histological examination in association with forensic or pathological autopsy. However, those who concerned on the issue had not known exactly how they dispose formalin. The news on the illegal disposition of formalin from our department drew attention to the legal disposition of formalin. These situations led us to investigate the legal and technical aspects of formalin disposition. We examined the legally-described methods such as oxidation, incineration and activated sludge processes and other methods such as formose, supercritical water oxidation, and wet oxidation processes. From legal point of view, we must process poisonous formaldehyde into non-poisonous products under the control of The Poisonous and Peleterious? Substances Control Law. Additionally, the products are under the control of The Sewage Water Law and Water Pollution Control Law, particularly in terms of Biological Oxygen Demand (BOD). After careful investigation, we tentatively conclude that incineration method is the best at present, though the supercritical oxidation and wet oxidation processes may be better in order to cope with the worldwide movement toward the control of environmental hormones and warm climate.

Autopsy↗

PubMed2002

Reducing sharps injuries among health care workers: a sharps container quality improvement project.

BACKGROUND: Many needlestick injuries at Vanderbilt University Medical Center were found to be related to the method of disposal in sharps containers. The "straight-drop" system allowed staff to stuff more needles into a full box, resulting in needlestick injuries. This was also a common problem elsewhere, as reflected in the literature. ANALYZING THE PROBLEM: A multidisciplinary committee reviewed other sharps containers, piloted one, found problems, and then piloted and selected another. Implementation was complex and difficult, but focus was kept on the goal of decreased needlestick injuries. Staff identified other problems, which were taken to the manufacturer of the sharps container selected and resulted in product design changes. RESULTS: Several months after implementation, data analysis showed that the needlestick injury rate was reduced by two-thirds, a statistically significant change (p = 0.002). Despite the increased cost of the sharps container, savings of prevented needlestick injuries represented a total cost savings to the medical center of more than $62,000 a year. DISCUSSION: This experience is an example of real-life implementation--and the problems institutions may have to overcome before success can be realized.

Cross Infection↗

PubMed1993

[Radiographic waste coming from Flemish dental offices. A survey of a representative sample of 373 Flemish dentists].

Apart from amalgam, the materials used for dental radiography also endanger the environment. The debate on toxic chemicals in dentistry is focused on the way these radiographic materials (fixator, developer, the small lead plates and the old roentgenograms) are discharged into the environment. This study investigated the answers to the following research questions: What is the total volume of fixator, developer, small lead plates and old roentgenograms that is used in Flemish dentistry and what part ends up in the household waste? How do Flemish dentists manage (store and dispose of) these radiographic materials? A randomly selected group of 500 dentists working in the Flemish part of Belgium was invited to answer a mail questionnaire. A total of 373 dentists responded (response rate 74.6%), providing a representative sample. Of the 2.1 million roentgenograms made yearly in Flemish dentistry only 160,000 are dropped in the household garbage can. About 70% of the 2.2 million small lead plates used yearly in Flemish dentistry is discharged in the household garbage, to end on the rubbish-dump or in the combustion furnace where the lead vapours will poison the surrounding air. Although the storing and the ecological responsible discharging of the pollutants fixator and developer does not pose any problems, most of these products are discharged into the sewage system: about 80% of the 80,000 liter developer and 75% of the 70,000 liter fixator used each year in Flemish dentistry.

Attitude of Health Personnel↗

PubMed2002

Carcass disposal: lessons from The Netherlands after the foot and mouth disease outbreak of 2001.

The main logistical problems of the foot and mouth disease (FMD) outbreak that occurred in the Netherlands in 2001 were a lack of culling and rendering capacity. Suppressive vaccination formed the basis for the solution to both problems and was primarily used to halt the possible spread of the virus. This allowed culls to take place on vaccinated farms when sufficient culling capacity eventually became available. In addition, the vaccinated cloven-hoofed animals could be removed alive and then killed in central culling places fourteen or more days after vaccination. Using slaughterhouses as central culling places meant that parts of carcasses could be deep-frozen, which solved the lack of rendering capacity. The deep-frozen carcass parts were destroyed later, when rendering capacity became available. To guarantee that all vaccinated, culled and temporarily deep-frozen cloven-hoofed animals were eventually destroyed, a balanced audit trail, partly based on kilogram records, was vital in this situation.

Abattoirs↗

PubMed2000

Drugs, diagnostic agents and disinfectants in wastewater and water--a review.

After administration pharmaceuticals are excreted by the patients into the aquatic environment via wastewater. Unused medications are sometimes disposed of in drains. The drugs may enter the aquatic environment and eventually reach drinking water, if they are not biodegraded or eliminated during sewage treatment. Additionally, antibiotics and disinfectants are assumed to disturb the wastewater treatment process and the microbial ecology in surface waters. Furthermore, resistant bacteria may be selected in the aeration tanks of sewage treatment plants by the antibiotic substances present. Since the 1980s, data on the occurrence of pharmaceuticals in natural surface waters and the effluents of sewage treatment plants have been reported. More recently, pharmaceuticals have been detected in ground and drinking water. However, only little is known about the risk imposed on humans by pharmaceuticals and their metabolites in surface and drinking water. An overview of input, occurrence, elimination (e.g. biodegradability) and possible effects of different pharmaceutical groups such as anti-tumour drugs, antibiotics and contrast media as well as AOX resulting from hospitals effluent input into sewage water and surface water is presented.

Anti-Bacterial Agents↗

PubMed2001

Bacteriological validation of a new apparatus for disinfection of hospital waste at the point of disposal.

OBJECTIVES: To evaluate the ability of a new apparatus (Dipsys 25, Société SGN, Bagnols sur Cèze, France) to disinfect biomedical waste, including both potentially infectious agents and the normal saprophytic flora of the waste. METHODS: Disinfection was assessed using standard methods (reference strains were fixed on reference carriers according to the French AFNOR methods) and nonstandard assays. Assays in conditions of hospital use, evaluations of bacterial survival during storage, sporicidal effect, and spore survival during storage were performed in parallel. Finally, bactericidal effect in extreme conditions (association of high contamination and high bacterial protection conditions) was tested with normal fecal flora. Bacterial counts were performed after treatment by the apparatus and without treatment (controls). All tests were carried out in triplicate. RESULTS: In all treated carriers, a bacterial population decrease of at least 5 log10 was obtained. Assays performed in hospital-use conditions did not show any bacterial growth. Concerning the evaluation of sporicidal effect and spore revival during conservation, a minimum reduction of 5 log10 was observed in all assays performed, without survival. Finally, concerning assays in extreme conditions, the decrease of bacterial population was between 5 log10 and 10 log10 for vegetative anaerobes of normal fecal flora. CONCLUSION: Under our study conditions, the study apparatus reduced the tested microbial populations by a minimal factor of 5 log10. The main advantage of the apparatus is the opportunity to treat contaminated waste inside hospital wards, at the point of initial collection, without pulverization, by nonspecialized staff.

Bacteria, Aerobic↗

PubMed1993

Comparison of a needleless system with conventional heparin locks.

BACKGROUND: Despite the improvements in needle disposal systems, needlesticks to health care workers continue to occur at unacceptably high rates. Needleless systems have been shown to reduce the risk of needlesticks. METHODS: This pilot study examined the safety of such a system for patients by comparing the rates of intravenous infection-related indicators between a conventional heparin lock and a needleless system. Patients (n = 97) were categorized on the basis of the duration of intravenous placement into 24-, 48-, and 72-hour groups. Within each group, half of the patients received conventional heparin locks and half received the needleless system. Intravenous infection-related indicators included catheter tip culture, adaptor fluid culture, intravenous site erythema, induration and tenderness, and elevated oral temperature. RESULTS: Prevalence of one or more indicators was 48% for the conventional and 40% for the needleless system, a difference that was not statistically significant. CONCLUSIONS: The needleless system appeared to pose no greater risk of infection to patients and nurses preferred it for its reduced risk of potential needlesticks.

Accidents, Occupational↗

PubMedDate not supplied

[Unjustified disposal of transfusion blood because of antibodies against brucella].

OBJECTIVES: To compare the slide microagglutination (SMA) test vs a gold standard test (tube agglutination test: SAT) for the detection of Brucella antibodies in order to evaluate the usefulness of SMA to discard transfusion blood units. DESIGN: Prospective, comparative, cross sectional survey. SETTING: City of Leon, State of Guanajuato, an endemic zone of brucellosis. SAMPLES: 48 sera from blood units discarded for transfusion by three blood banks due to Brucella antibodies detected by SMA and 48 controls of accepted units. METHODS: Determination of Brucella antibodies with the SMA and SAT tests. RESULTS: The 48 control samples were negative with both tests; of the 48 discarded samples, in only seven sera we confirmed a titer > or = 1:80 by SAT; thus, 41 blood units (85%) may have been improperly rejected because the only test used by the blood banks was the SMA. In our hands, the SMA showed a sensitivity and negative predictive value of 100%, a specificity of 81%, and positive predictive value of 29%. CONCLUSIONS: There was a high proportion of improper rejection of blood units for transfusion; Brucella antibodies at any titer detected by SMA should be followed by SAT testing.

Agglutination Tests↗

PubMedDate not supplied

Characterization of spirometric function in residents of three comparison communities and of three communities located near waste incinerators in North Carolina.

Waste incinerators are an increasingly common means of solid waste disposal. However, little is documented about the physical health of community members who live close to incinerators. During a 3-yr epidemiological study, spirometric lung function was tested once annually among residents from 3 communities surrounding a hazardous waste, biomedical, or municipal incinerator and among residents in 3 comparison communities. A total of 1,016 nonsmoking individuals, aged 8-80 yr, participated during at least 1 of the 3 yr of the study; 358 individuals participated all 3 yr. Daily air-quality sampling was done for 1 mo/yr in all 6 communities. The average monthly concentrations of particulate matter with diameters of 2.5 microns and less (PM2.5 [range = 14.6-31.5 micrograms/m3]) in all communities were similar during the 3 yr of study. The mean daily PM2.5 concentrations were significantly less than the U.S. Environmental Protection Agency's allowable 24-hr standard of 65 micrograms/m3. Individual incinerators contributed less than 2.5% of the areas' total PM2.5 levels. There was no difference in percent predicted forced vital capacity, forced expiratory volume in 1 sec, or forced expiratory flow rate over the middle 50% of the forced vital capacity among members of the incinerator communities, compared with nonincinerator communities, and there were no significant differences in lung function within the 3 sets of communities. There was no evidence from this study that an association existed between residence in these 3 waste incinerator areas, which met state and federal emissions regulations, and average spirometric pulmonary function of nonsmoking community members.

Adolescent↗

PubMed2004

Organisation of the disposal of radioactive sources from Scottish hospitals.

An amnesty for disposal of sealed radioactive sources from Scottish hospitals has been funded by the Scottish Executive to address problems arising from accumulation of sources. The contract was awarded to a company involved in radioactive source recycling. Coordination of uplifts from several hospitals allowed considerable financial savings to be made, so source amnesties could offer monetary advantages to Health and Education Departments elsewhere in the UK, as well as alleviating the problem from security and storage of sources that are no longer required. The sources originated in 14 hospitals, but were uplifted from five pick-up points. There were a total of 246 sources with 167 of these being caesium-137. The total activity was 16.2 TBq with one large 16.1 TBq blood irradiator source and the activities of all the other sources adding up to 167 GBq. This paper describes organisation of the collection. Options for achieving compliance with the Radioactive Substances Act 1993 are discussed, although in the event, special authorisations were obtained for each hospital. Arrangements for transport of the sources and source security were drawn up including emergency procedures for dealing with foreseeable incidents. The police provided secure overnight storage for the loaded truck and assistance in directing and monitoring progress of the load.

Hospitals↗

PubMed2000

[Waste management as part of self-care: an in-hospital training?].

As a health care professional, I feel concerned by the gap existing between urban and hospital practice concerning the management of waste, even when it is the same objects which are disposed. In the daily practice of the hospital care givers, the patients' education is mainly focused on the prevention measures or the care techniques to be adopted. The waste dumping modes are very seldom taken in consideration, despite the fact that everybody is afraid at the discovery of care material abandoned in a public place. That is why the following hypothesis was formulated: "The better the patient is educated, the better he will manage his self-care waste." The methods used for this diploma work are the documentary research and the investigation interviews with all the actors in and out of the hospital concerned by the patients' education and/or the management of care waste. The pilot study was conducted by means of enquiry questionnaires. It was focused on the hospital care givers and on the insulin-dependent diabetic patients who practice their self-care, through the enquiry technique "before-after" The aims of this research were to assess the quality of the education given by the hospital care giving staff on the management of self-care waste and the impact of this training on the patients. The drawing up of a system of reference (at the end of this research investigation work) should enable the improvement of the present situation. The small size of the sample used for the pilot study did not enable us to invalidate or confirm our working hypotheses. But the results obtained during out pilot study showed the bad quality of the training given by the hospital care givers and the inadequacy of the patients' procedure. That is why our professional project is based on an updating of the knowledge of the hospital care givers for the management of the self-care material in order to improve the quality of the care given by a hospital team and its adequation to the needs of the population at which it is aimed.

Hospitalization↗

PubMed2005

A quantitative assessment of the BSE risk associated with fly ash and slag from the incineration of meat-and-bone meal in a gas-fired power plant in Denmark.

It has been recommended that meat-and-bone meal (MBM) be incinerated at 850 degrees C for at least 2s and the ashes and slag disposed of in controlled landfills, to dispose of animal-derived proteins. Most commonly, the MBM is incinerated in cement works or coal-fired power plants and the ashes and slag are incorporated into the cement or concrete. Our goal was to assess with a Monte Carlo simulation model the bovine spongiform encephalopathy (BSE) risk to cattle and humans posed by the ash and slag. The results will be used by decision makers to evaluate the need for disposal of the fly ash in controlled landfills and the feasibility of use of the ash by the phosphate and fertilizer industries. We assumed that all specified risk material (SRM) and MBM produced in Denmark would be incinerated in this gas-fired power plant. Based on observations in 2001, we assumed that, on average, six (range: 0-15) clinical BSE cases each year were rendered into MBM and incinerated. In addition, SRM or carcasses from 0 to 31 (median=10) BSE-infected-but-undetected animals/BSE case were also incinerated. The simulations were run on a 1-week basis. Our results suggest that if the slag is collected and re-incinerated the median BSE infectivity remaining in the fly ash per week would be 3.1E-11 cattle ID(50). A cattle ID50 is the amount of infectivity that will cause infection in 50% of cattle exposed to it. During the weeks when BSE was infected in the SRM-MBM, the median infectivity in the fly ash was estimated as 8.7E-10 cattle ID50 and 2.9E-12 human ID50. The 95th percentiles were 2.1E-08 cattle ID50 and 5.8E-10 human ID50, respectively. One ton of fly ash would contain<or=1.8E-07 cattle ID50 95% of the time. These are the potential exposures of the cattle or human populations. The potential exposures of individuals are far less.

Animals↗

PubMedDate not supplied

Impact of increased syringe access: preliminary findings on injection drug user syringe source, disposal, and pharmacy sales in Harlem, New York.

OBJECTIVE: To evaluate the New York State Expanded Syringe Access Demonstration Program (ESAP) through injection drug user (IDU) surveys, discarded needles and syringes studies, and pharmacy sales and experiences surveys. DESIGN: Pre-post comparison. SETTING: In Harlem, New York City, risk surveys among street-recruited IDUs, needle/syringe street counts on 27 systematically sampled city blocks, and Harlem pharmacist reports of sales and experiences. MAIN OUTCOME MEASURES: Number and types of IDU syringe sources, block mean counts of discarded needles and syringes, level of pharmacy nonprescription syringe sales (NPSS), and pharmacists' experiences. RESULTS: Comparing 209 pre-ESAP with 396 post-ESAP IDUs, pharmacies as a primary syringe source increased: 3.4% to 5.3% (P < .001, and ever pharmacy use increased: 4.9% to 12.5% (P < .001), respectively. Compared with pre-ESAP IDUs, post-ESAP IDUs tended to be younger and more often black. Harlem pharmacy participation in ESAP increased considerably from March 1, 2001, to March 1, 2002, 49% to 79%, respectively. Among three Harlem pharmacies, there was a modest increase in NPSS; pharmacists reported no problems, and no discarded needles and syringes were observed in pharmacy areas. In the three pharmacies, the proportion of syringe sales that were NPSS was 46% (110 to 240 NPSS/month), 3% (25 to 90 NPSS/month), and 0%. The mean ratios of needles/syringes to background trash have not increased in Harlem since ESAP began. CONCLUSION: To date, no evidence of harmful effects discarded needles/syringes, pharmacy altercations) resulting from ESAP were observed. While NPSS have increased in Harlem, pharmacy use among IDUs remains low. In Harlem, efforts are underway to increase ESAP awareness and reduce socioenvironmental barriers to ESAP.

Humans↗

PubMed2001

Report of the Council on Scientific Affairs: preventing needlestick injuries in health care settings.

Needlestick injuries continue to pose a significant risk to health care workers; however, appropriate use of needlestick prevention devices, especially in comprehensive prevention programs, can significantly reduce the incidence of such injuries. Cost analyses indicate that use of these devices will be cost-effective in the long term. To provide more scientific and cost data on the efficacy of needlestick prevention devices, recording of needlestick injuries must be improved. Federal law now requires the use of safety-engineered sharps devises to protect health care workers, and state-level legislation on the use and evaluation of needlestick prevention devices is under consideration. Health care employers should evaluate the implementation of needlestick prevention devices with the participation of employees who will use such devices and, where appropriate, introduce such devices accompanied by the necessary education and training, as part of a comprehensive sharps injury prevention and control program.

American Medical Association↗

PubMed1999

Risk management and pollution prevention: thinking outside the box.

The Medical University of South Carolina's risk management department received a 12-month grant from South Carolina's General Assembly "Hazardous Waste Management Research Fund" for the purpose of identifying pollution prevention opportunities within South Carolina healthcare facilities. One hundred and one healthcare facilities were invited to participate in this study. Facilities ranged in size from zero-licensed beds (clinics) to more than 300 beds. Seventy-six South Carolina facilities (75%) participated in this project.

Cost-Benefit Analysis↗

PubMed1994

Photolytic destruction and polymeric resin decontamination of aqueous solutions of pharmaceuticals.

Amoxicillin, ampicillin, bleomycin, carmustine, cephalothin, dacarbazine, lomustine, metronidazole, norethindrone, streptozocin, sulfamethoxazole, and verapamil were completely degraded in solution, without the production of mutagenic residues, by photolysis using a medium-pressure mercury lamp in an all-quartz apparatus. A stream of air was passed through the solution and for amoxicillin, ampicillin, bleomycin, lomustine, metronidazole, and norethindrone it was necessary to add hydrogen peroxide. Dilute aqueous solutions of ampicillin, bleomycin, carmustine, cephalothin, lomustine, norethindrone, streptozocin, trimethoprim, and verapamil can be decontaminated using polymeric Amberlite resins.

Animals↗