Occupational exposure to cytotoxic drugs in two UK oncology wards.
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AIMS: To investigate the potential exposure to cytotoxic drugs of staff on two oncology wards in a large district, UK hospital under normal working conditions. METHODS: Cytotoxic drug exposure was monitored in urine samples, surface wipes, and on disposable gloves by using a number of commonly used marker drugs, namely cyclophosphamide, ifosfamide, methotrexate, and the platino coordinated drugs. Questionnaire data on their work practices, potential exposure, use of protective personal equipment, and relevant training were collected from nursing, domestic, and clerical staff on two oncology wards. RESULTS: The majority of staff were female with a mean age of 31 years. Roughly half of the staff studied were specifically trained nurses with an average of 3.5 years experience of administering cytotoxic drugs. No cytotoxic drug preparation or reconstitution was carried out on the wards. Disposable gloves, plastic armlets and aprons, but not eye protection, were invariably worn where there was potential exposure to cytotoxics. No cytotoxic drug was detected in any of the staff's urine samples. Isolated disposable latex gloves from nurses administering drugs showed some contamination, as did some surfaces within the wards' sluice rooms, but not in the ward areas where the drugs were stored and checked prior to administration. CONCLUSIONS: The risk management strategies in place, including use of personal protective equipment, staff training, and other organisational measures, have ensured that internal exposure is lower than the detection limits for the current biological monitoring methods. Levels of contamination appear significantly lower than earlier, non-UK published studies where different risk management strategies were in place and, in particular, ward staff may have been involved in some degree of cytotoxic drug reconstitution. (+info)
Basic microbiologic and infection control information to reduce the potential transmission of pathogens to patients via computer hardware.
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Computer technology from the management of individual patient medical records to the tracking of epidemiologic trends has become an essential part of all aspects of modern medicine. Consequently, computers, including bedside components, point-of-care testing equipment, and handheld computer devices, are increasingly present in patients' rooms. Recent articles have indicated that computer hardware, just as other medical equipment, may act as a reservoir for microorganisms and contribute to the transfer of pathogens to patients. This article presents basic microbiological concepts relative to infection, reviews the present literature concerning possible links between computer contamination and nosocomial colonizations and infections, discusses basic principles for the control of contamination, and provides guidelines for reducing the risk of transfer of microorganisms to susceptible patient populations. (+info)
Workers' compensation claims related to natural rubber latex gloves among Oregon healthcare employees from 1987-1998.
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BACKGROUND: Occupational reaction to natural rubber latex (NRL) glove use by healthcare employees has been an area of increasing concern. Unfortunately, there is little data demonstrating the prevalence and severity of actual reactivity to NRL. METHOD: Occupational reaction to NRL was estimated using workers' compensation claims filed by healthcare employees in Oregon for the period of 1987-1998. For the first ten years, these claims were estimated by source and conditions consistent with NRL glove reactions, while in the last two years a specific code developed in 1997 for NRL glove reactions was also employed. RESULTS: The claim rate was on average 0.58 per 10,000 healthcare workers annually, which constituted 0.29% of all workers' compensation claims. The most common condition experienced was dermatitis (80%) and most common body part affected was the hands (55.4%). The majority of claimants, 45 (69.2%), reported taking less than a month off work, suggesting most reactions were minor in nature, although one fatality was reported. The average NRL claim cost was $8,309.48. Overall the average cost per insured healthcare worker was approximately $0.50 per year. The occupational groups with the highest number of claims were nurses (30.8% of claimants) and nursing aides and orderlies (24.6% of claimants). CONCLUSIONS: In comparison with other workers' compensation claims filed by healthcare workers during this period, 0.25% of the total was potentially related to NRL gloves. The rare incidence of respiratory and ocular claims is inconsistent with the hypothesis that asthmatic or conjunctival reactions to NRL gloves are common. (+info)
Permeability of medical gloves to mono- and dimethacrylate monomers in dental restorative materials.
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Dental personnel manually handle methacrylate-based restorative materials, which can cause skin irritation and allergies. The protection given by different types of medical gloves is not well known. Breakthrough time (BTT, min) was used as a measure of protection according to a European standard, using 2 test mixtures consisting of respectively 3 and 5 monomers. Fourteen gloves representing natural rubber latex, synthetic rubber, and synthetic polymeric material were tested. The BTT ranged from some minutes to more than 2 hrs for the 4 monomers with a molecular mass less than 300. The longest protection was recorded for Nitra Touch (nitrile rubber), Tactylon (synthetic rubber), and Metin (PVC). (+info)
Influence of role models and hospital design on hand hygiene of healthcare workers.
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We assessed the effect of medical staff role models and the number of health-care worker sinks on hand-hygiene compliance before and after construction of a new hospital designed for increased access to handwashing sinks. We observed health-care worker hand hygiene in four nursing units that provided similar patient care in both the old and new hospitals: medical and surgical intensive care, hematology/oncology, and solid organ transplant units. Of 721 hand-hygiene opportunities, 304 (42%) were observed in the old hospital and 417 (58%) in the new hospital. Hand-hygiene compliance was significantly better in the old hospital (161/304; 53%) compared to the new hospital (97/417; 23.3%) (p<0.001). Health-care workers in a room with a senior (e.g., higher ranking) medical staff person or peer who did not wash hands were significantly less likely to wash their own hands (odds ratio 0.2; confidence interval 0.1 to 0.5); p<0.001). Our results suggest that health-care worker hand-hygiene compliance is influenced significantly by the behavior of other health-care workers. An increased number of hand-washing sinks, as a sole measure, did not increase hand-hygiene compliance. (+info)
Have health conditions associated with latex increased since the issuance of universal precautions?
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OBJECTIVES: This study explored whether the prevalence of latex-related health conditions has increased among individuals employed in medical occupations relative to those employed in nonmedical occupations since the issuance of universal precautions in 1987. METHODS: Data derived from the 1983 to 1994 versions of the National Health Interview Survey were used to obtain odds ratios comparing prevalence rates of latex-related symptoms over time. RESULTS: No statistical evidence was found that the universal precautions resulted in increased prevalence rates of latex-related health conditions among medical workers relative to those employed in nonmedical occupations. CONCLUSIONS: Increased use of latex gloves among health care personnel subsequent to the implementation of universal precautions appears to have had no effect on latex allergic reactions experienced by these workers. (+info)
Physician diagnosed asthma, respiratory symptoms, and associations with workplace tasks among radiographers in Ontario, Canada.
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BACKGROUND: Medical radiation technologists (MRTs) or radiographers have potential exposure to chemicals including sensitisers and irritants such as glutaraldehyde, formaldehyde, sulphur dioxide, and acetic acid. AIMS: To determine the prevalence of asthma and work related respiratory symptoms among MRTs compared with physiotherapists, and to identify work related factors in the darkroom environment that are associated with these outcomes. METHODS: As part of a two component study, we undertook a questionnaire mail survey of the members of the professional associations of MRTs and physiotherapists in Ontario, Canada, to ascertain the prevalence of physician diagnosed asthma, and the prevalence in the past 12 months of three or more of the nine respiratory symptoms (previously validated by Venables et al to be sensitive and specific for the presence of self reported asthma). Information on exposure factors during the past 12 months, such as ventilation conditions, processor leaks, cleanup activities, and use of personal protective equipment was also collected. RESULTS: The survey response rate was 63.9% among MRTs and 63.1% among physiotherapists. Most analyses were confined to 1110 MRTs and 1523 physiotherapists who never smoked. The prevalence of new onset asthma (since starting in the profession) was greater among never smoking MRTs than physiotherapists (6.4% v 3.95%), and this differed across gender: it was 30% greater among females but fivefold greater among males. Compared with physiotherapists, the prevalence of reporting three or more respiratory symptoms, two or more work related, and three or more work related respiratory symptoms in the past 12 months was more frequent among MRTs, with odds ratios (ORs) (and 95% confidence intervals) adjusted for age, gender, and childhood asthma, of 1.9 (1.5 to 2.3), 3.7 (2.6 to 5.3), and 3.2 (2.0 to 5.0), respectively. Analyses examining latex glove use indicated that this was not likely to account for these differences. Among MRTs, respiratory symptoms were associated with a number of workplace and exposure factors likely to generate aerosol or chemical exposures such as processors not having local ventilation, adjusted OR 2.0 (1.4 to 3.0); leaking processor in which clean up was delayed, 2.4 (1.6 to 3.5); floor drain clogged, 2.0 (1.2 to 3.2); freeing a film jam, 2.9 (1.8 to 4.8); unblocking a blocked processor drain, 2.4 (1.6 to 3.7); and cleaning up processor chemical spill, 2.8 (1.9 to 4.2). These outcomes were not associated with routine tasks unlikely to generate exposures, such as working outside primary workplace, loading film into processor, routine cleaning of processors, or removing processed film. Males reported that they carried out a number of tasks potentially associated with irritant exposures more frequently than females, consistent with the marked increase in risk for new onset asthma. CONCLUSIONS: These findings suggest an increase of work related asthma and respiratory symptoms shown to denote asthma among MRTs, which is consistent with previous surveys. The mechanism is not known but appears to be linked with workplace factors and may involve a role for irritant exposures. (+info)
Prevalence and correlates of hand dermatitis among nurses in a Japanese teaching hospital.
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BACKGROUND: Although hand dermatitis represents a common occupational disease among hospital nurses, epidemiologic studies of this nature are comparatively rare in Japan. METHODS: We recruited a complete cross-section of nurses from a teaching hospital in central Japan. Data was gathered by means of a self-reported questionnaire, with hand dermatitis symptoms and evaluation criteria drawn from previously validated research. Participants were categorised according to their hospital department during the analysis. RESULTS: A total of 305 questionnaires were successfully completed and returned (response rate: 84%). There were statistically significant differences in hand dermatitis prevalence between the departments (p < 0.05), ranging from 6% in psychiatry to 48% in the surgical unit and averaging 35% across the entire group. A history of allergic disease was shown to increase the risk of hand dermatitis (odds ratio = 3.7, 95% confidence interval: 2.1 - 6.6). Washing their hands more than 15 times per work shift also increased the risk (odds ratio = 2.0, 95% confidence interval: 1.2 - 3.4). CONCLUSION: This study has shown that hand dermatitis prevalence varies among Japanese nurses depending on their hospital department, and is generally quite high when compared to other reports. (+info)