Serratia marcescens bacteremia traced to an infused narcotic.
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BACKGROUND: From June 30, 1998, through March 21, 1999, several patients in the surgical intensive care unit of a hospital acquired Serratia marcescens bacteremia. We investigated this outbreak. METHODS: A case was defined as the occurrence of S. marcescens bacteremia in any patient in the surgical intensive care unit during the period of the epidemic. To identify risk factors, we compared patients with S. marcescens bacteremia with randomly selected controls. Isolates from patients and from medications were evaluated by pulsed-field gel electrophoresis. The hair of one employee was tested for fentanyl. RESULTS: Twenty-six patients with S. marcescens bacteremia were identified; eight (31 percent) had polymicrobial bacteremia, and seven of these had Enterobacter cloacae and S. marcescens in the same culture. According to univariate analysis, patients with S. marcescens bacteremia stayed in the surgical intensive care unit longer than controls (13.5 vs. 4.0 days, P<0.001), were more likely to have received fentanyl in the surgical intensive care unit (odds ratio, 31; P<0.001), and were more likely to have been exposed to two particular respiratory therapists (odds ratios, 13.1 and 5.1; P<0.001 for both comparisons). In a multivariate analysis, receipt of fentanyl and exposure to the two respiratory therapists (adjusted odds ratio for one therapist, 6.7; P=0.002; adjusted odds ratio for the other therapist, 9.5; P=0.02) remained significant. One respiratory therapist had been reported for tampering with fentanyl; his hair sample tested positive for fentanyl. Cultures of fentanyl infusions from two case patients yielded S. marcescens and E. cloacae. The isolates from the case patients and from the fentanyl infusions had similar patterns on pulsed-field gel electrophoresis. After removal of the implicated respiratory therapist, no further cases occurred. CONCLUSIONS: An outbreak of S. marcescens and E. cloacae bacteremia in a surgical intensive care unit was traced to extrinsic contamination of the parenteral narcotic fentanyl by a health care worker. Our findings underscore the risk of complications in patients that is associated with illicit narcotic use by health care workers. (+info)
Breast cancer mortality among female radiologic technologists in the United States.
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We evaluated breast cancer mortality through 1997 among 69 525 female radiologic technologists who were certified in the United States from 1926 through 1982 and who responded to our questionnaire. Risk of breast cancer mortality was examined according to work history and practices and was adjusted for known risk factors. Breast cancer mortality risk was highest among women who were first employed as radiologic technologists prior to 1940 (relative risk [RR] = 2.92, 95% confidence interval [CI] = 1.22 to 7.00) compared with risk of those first employed in 1960 or later and declined with more recent calendar year of first employment (P for trend =.002). Breast cancer mortality risk increased with increasing number of years of employment as a technologist prior to 1950 (P for trend =.018). However, risk was not associated with the total number of years a woman worked as a technologist. Technologists who first performed fluoroscopy (RR = 1.69, 95% CI = 1.02 to 3.11) and multifilm procedures (RR = 1.87, 95% CI = 1.04 to 3.34) before 1950 had statistically significantly elevated risks compared with technologists who first performed these procedures in 1960 or later. The high risks of breast cancer mortality for women exposed to occupational radiation prior to 1950 and the subsequent decline in risk are consistent with the dramatic reduction in recommended radiation exposure limits over time. (+info)
The impact of anthrax attacks on the American public.
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CONTEXT: Incidents involving anthrax (Bacillus anthracis) through the mail in 4 metropolitan areas have raised concerns about the public's response nationally and locally. OBJECTIVE: To examine public response to these incidents and what it reveals about the demand placed on health professionals and public health officials nationally, in affected areas, and by affected people. DESIGN: Random-digit-dialed telephone surveys of samples of households nationally and in 3 specific metropolitan areas where cases of anthrax were reported: the District of Columbia; Trenton/Princeton, New Jersey; and Boca Raton, Florida. OUTCOME MEASURE: Respondents were asked a series of questions measuring their level of concern and their behavior in response to threats of anthrax and potential bioterrorist acts. RESULTS: The lives of a large share of people were affected in 3 metropolitan areas where anthrax incidents occurred. Residents of those 3 areas and people there who were affected by the incidents expressed a higher level of concern and took more precautions handling their mail. However, these incidents did not lead to great demands on the health system. CONCLUSIONS: The incidents of anthrax created anxieties, especially in areas where incidents occurred. There was some increased demand on the health system, but the demands were not large-scale. In the event of a major outbreak of disease, most Americans will rely heavily on their own physician for advice. Both national and local systems of population-based information gathering about the public's response to bioterrorist attacks are needed. (+info)
Skill mix in the health care workforce: reviewing the evidence.
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This paper discusses the reasons for skill mix among health workers being important for health systems. It examines the evidence base (identifying its limitations), summarizes the main findings from a literature review, and highlights the evidence on skill mix that is available to inform health system managers, health professionals, health policy-makers and other stakeholders. Many published studies are merely descriptive accounts or have methodological weaknesses. With few exceptions, the published analytical studies were undertaken in the USA, and the findings may not be relevant to other health systems. The results from even the most rigorous of studies cannot necessarily be applied to a different setting. This reflects the basis on which skill mix should be examined--identifying the care needs of a specific patient population and using these to determine the required skills of staff. It is therefore not possible to prescribe in detail a "universal" ideal mix of health personnel. With these limitations in mind, the paper examines two main areas in which investigating current evidence can make a significant contribution to a better understanding of skill mix. For the mix of nursing staff, the evidence suggests that increased use of less qualified staff will not be effective in all situations, although in some cases increased use of care assistants has led to greater organizational effectiveness. Evidence on the doctor-nurse overlap indicates that there is unrealized scope in many systems for extending the use of nursing staff. The effectiveness of different skill mixes across other groups of health workers and professions, and the associated issue of developing new roles remain relatively unexplored. (+info)
Acute sensory irritation from exposure to isopropanol (2-propanol) at TLV in workers and controls: objective versus subjective effects.
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OBJECTIVES: Phlebotomists occupationally exposed to isopropanol (IPA) (2-propanol) and naive controls (n = 12 per group) were exposed to the time-weighted average threshold limit value of 400 p.p.m. IPA for 4 h in an environmental chamber to investigate: (i) acute effects of sensory irritation using subjective health symptom reports and objective, physiological end-points; and (ii) differences in measured effects in relation to exposure history. METHODS: Before, during and after exposure subjects gave self-reports of health complaints. During exposure subjects rated the intensity of the odor, sensory irritation and annoyance. Objective end-points of ocular hyperemia, nasal congestion, nasal secretion and respiration were obtained at various times before, during and after exposure. Results were compared with exposure to phenylethyl alcohol (PEA), a negative control for irritation, and to clean air (CA), a negative control for odor and irritation, using a within-subjects design. RESULTS: Significantly higher intensity ratings of odor, irritation and annoyance were reported during the exposure to IPA, when compared with exposure to CA or PEA. Nevertheless, the overall level of reported sensory irritation to IPA was low and perceived as 'weak' on average. Health symptom ratings were not significantly elevated for IPA as compared with PEA or CA exposure. The only physiological end-point that showed a change exclusively in the IPA condition was respiration frequency: relative to baseline, respiration frequency increased in response to IPA in both groups. No differences were encountered between the occupationally exposed and the control groups. CONCLUSIONS: The increase in respiration frequency in response to IPA may reflect either a reflexive change due to sensory irritation (an autonomic event) or a voluntary change in breathing in response to perception of an unpleasant, solvent-like odor (a physiological event caused by cognitive mediation). Our findings on objective end-points, including nasal and ocular sensory irritation, did not confirm subjective irritation reports. Irritation reports and odor intensity decreased, rather than increased, over time, lending credence to the cognitive argument and suggesting that the elevated subjective responses to IPA may be mediated by responses to its odor. (+info)
The effect of PACS on the time required for technologists to produce radiographic images in the emergency department radiology suite.
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The purpose of this study was to evaluate the effect of a switch to a filmless image management system on the time required for technologists to produce radiographic images in the emergency department (ED) after controlling for exam difficulty and a variable workload. Time and motion data were collected on patients who had radiographic images taken while being treated in the emergency department over the 3 1/2-year period from April 1997 to November 2000. Event times and demographic data were obtained from the radiology information system, from the hospital information system, from emergency department records, or by observation by research coordinators. Multiple least squares regression analysis identified several independent predictors of the time required for technologists to produce radiographic images. These variables included the level of technologist experience, the number of trauma-alert patient arrivals, and whether a filmless image management system was used (all P <.05). Our regression model explained 22% of the variability in technologist time (R2 Adjusted, 0.22; F = 24.01; P <.0001). The regression model predicted a time saving of 2 to 3 minutes per patient in the elapsed time from notification of a needed examination until image availability because of the implementation of PACS, a delay of 4 to 6 minutes per patient who were imaged by technologists who spent less than 10% of their work assignments within the ED, and a delay of 18 to 27 minutes in radiology workflow because of the arrival of a trauma alert patient. A filmless system decreased the amount of time required to produce radiographs. The arrival of a trauma alert patient delayed radiology workflow in the ED. Inexperienced technologists require 4 to 6 minutes of additional time per patient to complete the same amount of work accomplished by an experienced technologist. (+info)
Interpretation and reporting of myocardial perfusion SPECT: a summary for technologists.
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Interpretation of cardiac perfusion SPECT images, and the subsequent reporting of results to referring physicians, are sometimes taken to be outside the sphere of the nuclear medicine technologist. However, all personnel involved with nuclear medicine procedures contribute to the timeliness and usefulness of the final report. The goal of this article is to review the principles of scan interpretation and reporting, from the standpoint of what technologists need to understand about these processes. In addition, software tools to aid these processes will be discussed, including quantitative image analysis, telemedicine, computer-aided scan interpretation, databases, computer-aided reporting, and Internet-based reporting. Finally, the accuracy of the scan report will be related to the tasks normally performed by technologists, such as the acquisition and processing of images and the entry, transfer, and networking of data. After reading this article, the reader will be able to describe the principles of scan interpretation and reporting, the software tools for telemedicine and computer-aided interpretation, and the role of the technologist in this process. (+info)
Open source handheld-based EMR for paramedics working in rural areas.
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We describe a handheld-based electronic medical record (EMR) for use in certain rural settings. The system is based on the Linux operating system and allows access to large mobile databases. The open source system is designed for paramedical health workers serving remote areas in rural India. A PDA loaded with the handheld-based EMR provides workers who have little access to medical doctors with different kinds of decision support and alerts. It addresses two important problems in developing countries: prenatal care and child health. This paper describes the technical challenges and innovation needed in the design, development, adaptation and implementation of the handheld EMR in a real setting in India (+info)