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PubMed1983

Development of morning self-care routines in multiply handicapped persons.

This study describes the use of reinforcement procedures to develop and maintain a complete morning self-care routine in multiply-handicapped and mentally retarded persons. Following the completion of initial training in each of six skill areas--toileting, showering, dressing, toothbrushing, bedroom cubicle cleaning, and bed linen removal--baseline data were taken on the extent to which 40 institutionalized adolescents and adults completed each task on a daily basis. Token reinforcement was later provided for the completion of each skill (single response contingency) using a multiple baseline design across behaviors. Results showed performance increases in five of the six behaviors, with some response decrement over time. During a final condition in which no tokens could be earned unless all six behaviors were completed (chained contingency), performance of each skill either increased further or was maintained at a high level.

Activities of Daily Living↗

PubMed2005

Bed, bath and beyond: pitfalls in prompt eradication of methicillin-resistant Staphylococcus aureus carrier status in healthcare workers.

Healthcare workers (HCWs) in close contact with patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) were screened for MRSA acquisition. From 1995 to 2001, MRSA was identified from the nasopharyngeal swabs of 87 HCWs, collected one to two weeks after contact with 592 known MRSA-positive patients. These HCWs were withdrawn from work and treated with topical antibiotics/antiseptics. They were advised to disinfect their bathrooms and personal hygiene articles, and to wash bed linen and pillows. They were screened for successful eradication for up to three months. Seventy-three (84%) HCWs lost their carrier status. The eradication regimen failed in 14 cases. In 11 of these MRSA was detected only in later nasopharyngeal swabs (suspected recolonization). Screening identified nasal colonization of close household contacts in eight of these 11 cases. Environmental sampling detected contamination in seven out of eight screened home environments. When eradication treatment was applied to household contacts and when household surfaces were cleaned and disinfected, the carriage cleared in most cases within a few weeks. However, when home environments are heavily contaminated, despite adequate medical treatment, eradication took upto two years. Due to withdrawal from work, the 14 carriers without prompt and lasting eradication after the first course of treatment accounted for about 70% of all lost working days. These experiences support the hypothesis that control measures should not be restricted to antibiotic or antiseptic treatment of long-term carriers (HCWs as well as patients), but must also include cleaning and disinfection of the household.

Carrier State↗

PubMed2005

Environmental contamination with an epidemic strain of Pseudomonas aeruginosa in a Liverpool cystic fibrosis centre, and study of its survival on dry surfaces.

We conducted an environmental survey in the Liverpool adult cystic fibrosis (CF) centre in order to determine the extent of environmental contamination with an epidemic strain of Pseudomonas aeruginosa that colonizes most CF patients in Liverpool, and to identify possible reservoirs and routes of cross-infection. In addition, we studied the survival of this strain on dry surfaces, compared with that of other CF P. aeruginosa strains, to explore factors that might contribute to its high transmissibility. Samples were collected from staff, patients and the environment (drains, bath tubs, showers, dry surfaces, respiratory equipment and air) in the inpatient ward and outpatient clinic. P. aeruginosa strains were tested using a new polymerase chain reaction amplification assay specific for the Liverpool epidemic strain (LES). LES was isolated from patients' hands, clothes and bed linen. Environmental contamination with LES was only detected in close proximity to colonized patients (external surfaces of their respiratory equipment, and spirometry machine tubing and chair) and was short-lived. No persistent environmental reservoirs were found. LES was detected in the majority of air samples from inside patients' rooms, the ward corridor and the outpatient clinic. Survival of LES on dry surfaces was significantly longer than that for some other strains tested, but not compared with other strains shown not to be transmissible. Improved environmental survival on its own, therefore, cannot explain the high transmissibility of this epidemic strain. Our study suggests that airborne dissemination plays a significant role in patient-to-patient spread of LES, and confirms the need to segregate those patients colonized by epidemic P. aeruginosa strains from all other CF patients.

Adult↗

PubMed1984

Survival and infectivity of Sarcoptes scabiei var. canis and var. hominis.

Sarcoptes scabiei var. canis served as a suitable model for the study of S. scabiei var. hominis survival. S. scabiei var. canis and var. hominis mites were found to survive off the host for 24 to 36 hours at room conditions (21 degrees C and 40% to 80% relative humidity [RH]), and the canine variety survived 19 days at 10 degrees C and 97% RH. Female mites survived decidedly longer than male mites at comparable conditions. Generally, higher RH values and lower temperatures favored survival, whereas higher temperature and lower RH led to early death. Most canine scabies mites that were held off the host for 36 hours at 75% RH and 22 degrees to 24 degrees C remained infective and penetrated when returned to the host. Live mites of the human variety that were recovered from bed linen slept on by infested patients would also penetrate a host after being held off a host for 96 hours in alternating 12-hour periods of room conditions and refrigeration. Penetration required less than 30 minutes for all life stages of both varieties, and it was accomplished by a mite secretion that dissolved the host tissue. Dislodged mites, particularly those in close proximity to the source, can be a likely source of infestation.

Animals↗

PubMed1993

The 'ring sign': is it a reliable indicator for cerebral spinal fluid?

STUDY OBJECTIVE: To study the development of a ring sign when blood is mixed with various fluids. METHODS: One drop of blood and one drop of either spinal fluid, saline, tap water, or rhinorrhea fluid were placed simultaneously on filter paper, and the specimens were examined after ten minutes for the development of a ring. A variety of filter paper agents were used, including standard laboratory filter paper, paper towels, coffee filters, and bed linens. RESULTS: All fluids, when mixed with blood, gave rise to a ring sign; blood alone did not. The type of filter paper did not affect the development of a ring. CONCLUSION: In this experimental setting, the ring or halo sign is reliable for detecting cerebrospinal fluids but is not exclusive for cerebrospinal fluid.

Blood Chemical Analysis↗

PubMed1999

Allergy prevalence and causal factors in the domestic environment: results of a random population survey in the United Kingdom.

BACKGROUND: Surveys of the prevalence of allergic diseases associated with domestic allergens (eg, asthma, rhinitis, hay fever, eczema, and dermatitis) are usually undertaken in restricted geographic areas. They are often based on specific demographic subgroups (eg, children) or are derived from treatment data (eg, GP consultations). Causal factors are seldom quantified in these reports. OBJECTIVE: This study was designed to quantify the prevalence of allergic disease among a representative cross-section of population in the United Kingdom. It was also designed to quantify the reported causal factors in terms of domestic allergen and irritant sources and activities leading to exposure. METHODS: Two thousand respondents were selected from across the UK. These respondents were interviewed using a short series of questions that formed part of a larger, more general omnibus questionnaire. The questions required respondents to report on diagnosed allergic disease and causal factors within their household, giving a total sample base of 5,609 people. RESULTS: Asthma and hay fever account for the majority of reported cases of allergic disease in the UK (12% and 10% of total household, respectively). Pollen, house dust mite excreta (HDM allergen), and pet dander are the three most common allergic triggers (42%, 27%, and 17% respectively). Dusting and being near pets each account for about 20% of the reported domestic activities triggering an allergic response. CONCLUSION: The feedback from the general population indicates asthma and hay fever to be the predominant allergic conditions, with dust and pet dander the most common sources of allergen/irritant. Key tasks such as changing bed linen and vacuuming were not perceived as being as important as dusting in terms of activities leading to reaction.

Activities of Daily Living↗

PubMed2006

[Diagnosis of and anthelminthic therapy for enterobius vermicularis infections during pregnancy: review of the literature and case report].

Intestinal infection due to the pinworm Enterobius vermicularis is the most prevalent helminthiasis in Europe and North America. Humans are the only known reservoir and young children are most often affected. The disease is highly contagious and is transmitted via the faecal-oral route. Insufficient hand hygiene, contaminated bed linens and clothes may play a role in transmission. Clinical symptoms often encompass severe nocturnal anal pruritus, when female worms deposit an abundance of eggs in the perianal region. The infection is diagnosed by applying an adhesive tape on the perianal region, followed by microscopic examination. Serious complications, such as extraintestinal infections, occur only rarely. Infections of the female genital tract and the peritoneum are described in the literature, also in pregnant women. We describe a case of a pregnant patient in the 33 (rd) week of gestation with intense anal pruritus in whom an enteral pinworm infection was diagnosed. The patient was successfully treated with mebendazole, an anthelminthic agent. Analysis of the data currently available for the administration of mebendazole during pregnancy did not show an elevated rate of congenital anomalies. However, further studies still have to be performed.

Adult↗

PubMed1983

The effects of resuscitation with hypertonic vs. hypotonic vs. colloid on wound and urine fluid and electrolyte losses in severely burned children.

Thirty-nine children with large burns were resuscitated with either a hypertonic (HLS) (17 patients), hypotonic (11 patients), or colloid (11 patients) fluid regimen. Burn dressings, bed linen, and urine were analyzed for electrolyte content. The group receiving HLS excreted the greatest percentage of the administered sodium load in the urine, significantly more than the other two groups; however, the combined wound and urinary sodium losses were significantly greater for the group receiving colloid. Sodium loss through the burn wound exceeded urinary loss fivefold in the colloid group. The volume of fluid lost across the burn wound was inversely related to the osmolality of the fluid used for resuscitation. Wound sodium loss was a function of both sodium and fluid load. The flux of fluid and electrolytes across the burn wound is a dynamic part of the resuscitation problem and is dramatically effected by the volume and concentration of fluid used.

Burns↗

PubMed2004

Diagnosis and management of bedbugs: an emerging U.S. Infestation.

Bedbug infestations are on the rise in the United States among people of all socioeconomic groups. Bedbug bites typically cause pruritic wheals with central punctum on exposed skin, which are noted upon awakening. The diagnosis is confirmed by identifying fecal smears and blood spots on the bed linens and mattress or by identifying the culprit bug. Extermination of bedbugs using cleaning techniques and pesticides is necessary to prevent recurrence.

Animals↗

PubMedDate not supplied

Impact of cardiac symptoms on self-reported household task performance in women with coronary artery disease.

PURPOSE: Household tasks are highly salient physical activities for women. Inability to perform household tasks may serve as an important marker of limitations imposed by cardiac symptoms. The purpose of this study was to examine the impact of cardiac symptoms on perceived ability to perform household tasks in women with coronary artery disease and to examine relationships among age, whether the woman lived alone, ability to perform household tasks, and cardiac-related quality of life. METHODS: Forty-one women with confirmed diagnosis of coronary artery disease and a mean age of 66 years (SD 12 years) were interviewed about the impact of their cardiac symptoms and perceived ability to perform household tasks (Household Activities Scale) and cardiac-related quality of life (Seattle Angina Questionnaire). The women were primarily white (89.4%) and retired (65.9%). Forty-six percent were married, and 26.8% lived alone. RESULTS: "Washing dishes" (51.3%) was the only task a majority of the sample could perform without limitation. Household tasks most commonly reported as no longer performed included carrying laundry (24.4%), vacuuming (30.0%), and scrubbing the floor (51.2%). The task most commonly modified because of cardiac symptoms was changing bed linens (60%). Of the 14 household tasks, women performed a mean of 3.39 (SD 3.36) activities without difficulty. Total number of household activities performed without difficulty was associated with better quality of life in the area of exertional capacity (r = 0.50, P = 0.001). Women who lived alone reported greater perceived ability to perform household tasks than women who did not live alone (r = 0.31, P = 0.05). Age was not significantly associated with perceived household task performance (r = -0.22, P = 0.17). CONCLUSION: Women with coronary artery disease (CAD) perceived cardiac symptoms as disrupting their ability to perform household tasks. Future research is needed to determine the independent impact of cardiac symptoms on functional limitations, especially in older women with heart disease, and whether changes in ability to perform household tasks could be a marker for coronary artery disease progression in women.

Adult↗

PubMed1995

Costs and management of urinary incontinence in long-term care.

The three aims of the study were (1) to assess the impact and cost of urinary incontinence in long-term care, (2) to determine whether 24-hour incontinence monitoring provides information that improves management, and (3) to ascertain whether costs (nursing time and laundry) could be reduced. The setting was two 24-bed long-term care units in an urban hospital. The research was conducted in three stages. During the initial stage, the impact of incontinence was measured on each unit. Impact was defined as total number of incontinent episodes, nursing time spent changing these patients, and laundry costs, measured during a 7-day period on each unit. After this phase of the investigation, individualized 24-hour incontinence monitoring, followed by recommendations and implementation of care plan, was carried out on one unit. No monitoring or recommendations for care were completed on the other unit, which served as a control. During the third phase of the study, the number of incontinent episodes, nursing time, and laundry costs were again measured on both units. Initially (58%) of residents (24/48) were incontinent, representing 859 episodes of urinary leakage each week that required 45 hours of nursing time to change clothing, containment devices, and bed linens. The direct costs of the nursing time and laundry, expressed in Canadian dollars were $8.60/day per incontinent resident. After 24-hour monitoring of 10 residents one on unit, suggestions were made for various incontinence management programs. An unexpected but simple recommendation was a change to a better containment system for urinary leakage. When impact was measured, a 13% reduction in the number of incontinent episodes was found.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed2006

Radiation safety implications of 131I treatment in a patient with Grave's disease undergoing home hemodialysis.

The radiation safety implications following the administration of 131I for the treatment of Grave's disease to a patient undergoing home-based renal dialysis was investigated. External dose-rate measurements from the patient revealed a peak value at around day 2, post administration. The effective half-life was determined as 6.5 d. From day 3, the clearance of 131I was observed to be fairly constant and equated to 2.7% per day or 5.4% per dialysis session. From this the biological half-life was determined as 15 d. Radiation monitoring of the dialysis unit, disposables, and bed linen found no detectable contamination. For the purpose of useful protection, at a distance of 1 m from the patient, the average dose rate over the effective treatment duration was determined to be 8 microSv h(-1) and at 2 m distance, 2.6 microSv h(-1). Thus, in order to keep below a level of dose constraint of 3 mSv the total allowable time spent at 1 m would be 375 h or 15 h per day. To comply with a 1-mSv constraint, the average daily exposure allowable at 1 m would be 5 h per day. Neither of these time limits would be difficult to achieve for the majority of situations with fairly modest behavioral constraints. Initial discharge concentration rates into the waste water system are estimated at 200 MBq m(-3) and therefore might need to be considered depending upon the regulatory environment.

Female↗

PubMedDate not supplied

Ergonomic and demographic issues reported by palliative care workers in southern Taiwan.

AIM: To investigate ergonomic and demographic issues reported by palliative care workers in southern Taiwan. METHOD: A structured questionnaire was completed by staff members from 11 nursing homes within southern Taiwan. Questions focused on age, sex, height, weight, shift-work details, duration of current employment, nature of current employment, the presence of injury and pain during the past 12 months, the phase lag before the onset of injury, and sick leave details. RESULTS: A total of 125 health-care workers were recruited. Most were female (89.3 percent) and employed full-time (64.8 percent) as patient care assistants (55.2 percent). Most workers were regularly involved in patient-handling tasks (61.6 percent). Almost half (36.8 percent) had suffered a musculoskeletal disorder within the previous year. Lower back injury was reported by 12.0 percent of all employees. Changing patients'clothes and changing their bed linen were associated statistically with musculoskeletal injury (odds ratio (OR) 2.9, 95 percent confidence interval (CI) 1.4-6.3 and OR 2.8, 95 percent CI 1.4-6.1), respectively. Moving the patients was also related to injury during our research (OR 2.5, 95 percent CI 1.2-5.4). CONCLUSION: This study has revealed various ergonomic and demographic issues reported by palliative care workers in southern Taiwan for the first time. The prevalence of certain injuries and symptoms are different from other reports.

Accidents, Occupational↗

PubMed2004

Testing disinfectants in the food factory: phenol coefficient method.

Contamination of foods by the environment has direct public health and keeping quality significance. The food factory environment (with raw materials and processing) governs the numbers and types of microorganisms in finished products. Use of the appropriate sampling procedures permits us to discover the magnitude and type of contamination. Microbiological sampling allows objective evaluation of the disinfectants and the sanitation practices and procedures used in the food factory.Disinfectants are antimicrobial pesticides that are primarily used on inanimate surfaces (such as floors, walls, and countertops) to kill infectious bacteria, fungi, and viruses. Antimicrobial pesticides are substances used to kill or suppress the growth of harmful microorganisms on inanimate objects and surfaces. Products intended for the control of microorganisms in or on people or animals are considered drugs, not pesticides, and are therefore regulated by the Food and Drug Administration (FDA). Antimicrobial pesticides are divided into two broad use categories: 1. Non-public health products include those used to control the growth of algae, odor-causing bacteria, and microorganisms causing spoilage, deterioration, and fouling of materials. Examples include antimicrobials used in cooling towers, paints, and paper products. 2. Public health products are intended to control microorganisms infectious to people. Examples include sterilants, which are used to destroy or eliminate all forms of microbial life including fungi, viruses, and all forms of bacteria and their spores; disinfectants, which are used to destroy or irreversibly inactivate infectious fungi and bacteria, but not necessarily their spores; and sanitizers, which are used to reduce, but not necessarily eliminate microorganisms. Examples range from sterilants used to treat surgical instruments to disinfectants applied to hospital floors, walls, and bed linens and sanitizers used on carpets or in laundry additives.

Disinfectants↗

PubMed1988

Maternal safety first.

Pretty rooms and flowered bed linens are no defense against complications in childbirth. While amenities are nice, and even expected these days, informed consumers are looking beyond decor to the technology and expertise that spells safety for mother and newborn. Hospitals that zero in on the patient's need for reassurance have found the approach successful.

Adult↗

PubMedDate not supplied

[Importance of environmental and preventive measures in the control of asthma in the child].

Among the different factor (allergens, pollutants, infections) related to the genesis of asthma, only the allergens are capable of generating the type of inflammation that is characteristic to the illness, thus being able to take into account the etiological factors of the said illness. The role of the aerial allergens in the development and seriousness of asthma has been shown, the patients improvement if he is separated from the allergen (high altitudes for people allergic to mites). Even with important methodological difficulties, in controlled clinical tests we have been able to establish the effectiveness of the antiallergenic measures in the handling of asthma, if they are effective in the reduction of the allergenic charge. Avoiding allergens for primary and secondary prevention has a logical and clinical basis but tests on a longer term are necessary and using a larger number of patients before making final conclusions. With respect to the tertiary prevention, several controlled clinical tests have demonstrated the efficiency in the reduction of the allergenic charge and the effectiveness in handling asthma. In addition to eliminating or reducing the contact with pets and pollen when indicated, we should also try to reduce the charge of the mites (an etiological factor in more than 80% of asthma in almost all the patients). It is recommended to use impermeable or semi-permeable covers on mattresses and pillows, to avoid upholstered furniture (at least in the patients bedroom), carpets and rugs and to wash bed linen with hot water, to air the room daily and to avoid exposure to tobacco smoke. There are doubts regarding the efficiency and the safety, on a long term basis, of insecticides, and their use is not recommended according to the latest advice on the handling of asthma.

Air Pollutants↗

PubMedDate not supplied

[Primary varicella-zoster virus infection--current knowledge, diagnostic and therapeutic approaches].

INTRODUCTION: It is well known that varicella, a clinical entity of primary varicella-zoster virus infection, is most commonly a mild, benign disease of preschool and school children. However, in spite of progress in diagnostic approach and up-to-date treatment based on specific antiviral agents, many clinicians face cases of life-threatening varicella with uncertain course and prognosis, in adult and immunocompromised patients predominantly. ETIOPATHOGENESIS AND HISTOPATHOLOGY: Varicella-zoster virus (VZV) is a member of the Herpesviridae family. The portal of entry is nasopharyngeal mucosa, sometimes conjunctiva. VZV causes a generalized infection and has dermal tropism. Histopathological findings include degenerative changes of epithelial cells such as ballooning, multinucleated giant cells and eosinophilic intranuclear inclusions. CLINICAL FEATURES AND COMPLICATIONS: The evolution of varicella includes 3 stages of disease and is characterized by gradual onset, constitutional symptoms, signs of upper respiratory tract and polymorphous rash. According to the severity of clinical presentation, there is a number of mild forms and severe, even life-threatening forms of varicella. According to etiology, varicella complications are divided in viral and bacterial ones. Immunocompromised patients often develop serious, life-threatening forms of varicella. Especially the prognosis of visceral dissemination commonly followed by liver and brain involvement is dubious. The course of varicella in pregnancy may be severe because of changed immune response and more frequent appearance of complications in adults. The probability of vertical transmission of VZV is 25%. The early infection of embryo may lead to abortion. The symptomatic intrauterine infection appears in about 3% of all cases of varicella of pregnant women and is called a "congenital varicella syndrome". Vertical transmission of VZV in the late pregnancy may result in preterm delivery or perinatal varicella (varicella in the newborn). DIAGNOSIS: The diagnosis is made by history and physical examination. Atypical cases of varicella require laboratory confirmation of diagnosis including virus/viral antigen detection, virus isolation and identification or serological diagnosis (detection of specific anti-VZV antibodies in patient's sera). PREVENTION: Prevention of varicella includes active and passive immunization. Passive immunization is based on the use of varicella-immunoglobulin (VZIG). A live, attenuated vaccine was developed by Takahashi and colleagues in Japan. This vaccine is recommended, first of all, to seronegative immunodeficient children. Vaccine virus is sensitive to acyclovir and is not transmissible to non-vaccinated children. The duration of vaccine-induced immunity is at least 6-10 years in the majority of vaccinees. THERAPY: Hygiene is the most important principle in the management of varicella, particularly bathing and use of a stringent soaks to avoid secondary bacterial skin infection. The patient should be isolated in a well-ventilated room with regular change of bed, linen and light food should be provided. Indications for, acyclovir (and other antiviral agents) treatment are, individuals who have suffered from severe forms of varicella and those, belonging to the high-risk group of patients (adults, viral, complications, immunocompromised host).

Chickenpox↗

PubMed2002

[The risk of contagious epidemics in geriatric facilities].

THE RISKS OF EPIDEMICS IN INSTITUTIONAL SETTINGS: An epidemic must be suspected when an increase in the number of cases of a same type of infection is observed. Numerous microorganisms are responsible for epidemics in geriatric facilities: viruses, bacteria and parasites. In the case of an epidemic, a certain number of specific measures must be taken in order to prevent the transmission of infection and eradicate the epidemic. IN THE CASE OF INFLUENZA: Other than the vaccination of elderly institutional residents, that of the nursing staff appears essential. If a severe epidemic occurs, specific antivirals can be used, three of which are already available. IN THE CASE OF PNEUMOCOCCI: Examples of epidemics of pneumococcal infections in elderly institutional residents in the United States underlines the interest of pneumococcal vaccines, particularly since the strain responsible corresponded to a serotype contained in the 23 valence vaccine. WITH REGARD TO SCABIES: All the patients and all the staff must be treated on the same day and at the same time their clothing and bed linen. All persons in contact with the patient, the families and friends of the staff, their clothes and the environement must be treated.

Age Factors↗