Dermal exposure to chromium in electroplating.
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OBJECTIVES: The aim of the study was to measure the dermal and respiratory exposure levels of hexavalent chromium during electroplating work. METHODS: Potential dermal exposure of the body was measured with patch samples and actual exposure of hands with hand-wash samples. For comparison, personal air samples were also collected. RESULTS: The exposure varied widely between workers. The range of body and hand exposure to the electroplating solution was 0.17-28.1 mg/h and 0.04-6.37 mg/h, respectively. Hands and lower limbs were the most contaminated body parts. CONCLUSIONS: The results of breathing zone samples and dermal exposure did not correlate with each other. In manual electroplating processes, dermal exposure was higher than in semi-automatic and automatic processes. The amount of hexavalent chromium the workers were exposed to is probably high enough to cause a risk of skin sensitization. (+info)
Pro/con clinical debate: isolation precautions for all intensive care unit patients with methicillin-resistant Staphylococcus aureus colonization are essential.
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Antibiotic-resistant bacteria are an increasingly common problem in intensive care units (ICUs), and they are capable of impacting on patient outcome, the ICU's budget and bed availability. This issue, coupled with recent outbreaks of illnesses that pose a direct risk to ICU staff (such as SARS [severe acute respiratory syndrome]), has led to renewed emphasis on infection control measures and practitioners in the ICU. Infection control measures frequently cause clinicians to practice in a more time consuming way. As a result it is not surprising that ensuring compliance with these measures is not always easy, particularly when their benefit is not immediately obvious. In this issue of Critical Care, two experts face off over the need to isolate patients infected with methicillin-resistant Staphylococcus aureus. (+info)
Incidence of occupational skin conditions in a food manufacturing company: results of a health surveillance programme.
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BACKGROUND: The food industry has been associated with a high risk of work-related skin problems. Aim To examine the incidence of work-related skin conditions and the likely causative agents in a single large food company. METHOD: Analysis of a health surveillance programme, conducted over a 7 year period, in a food company with 21 000 employees working in diverse manufacturing processes. RESULTS: The mean incidence of skin conditions, taking all of the different food manufacturing operations together, was 1310 per million employees per annum. The mean incidence was greatest in the manufacturing sector whose operations involved chilled or frozen product (3180 per million employees per annum). Most of the cases reported (184/192 = 96%) were due to primary irritant dermatitis. The two commonest suspected causes of the dermatitis were contact with ingredients and hand washing. Taken together, these factors accounted for 58% of all cases. Although the wearing of gloves is often considered necessary to prevent dermatitis from exposure to ingredients and to lessen the need for hand washing, this factor itself was responsible for 9% of all cases. CONCLUSION: Analysis of a company health surveillance scheme showed the average incidence of work-related skin problems to be lower than previously reported in the food industry. (+info)
Combined use of alcohol hand rub and gloves reduces the incidence of late onset infection in very low birthweight infants.
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OBJECTIVE: To assess the incidence of late onset (> 72 hours) infection and necrotising enterocolitis (NEC) in very low birthweight (VLBW) infants in two 36 month periods using two hand hygiene protocols: conventional handwashing (HW; first 36 month period); an alcohol hand rub and gloves technique (HR; second 36 month period). METHOD: VLBW infants admitted to the neonatal intensive care unit during the period December 1993-November 1999 were eligible. A new hand hygiene protocol using alcohol handrub and gloves was introduced in December 1996. Each patient's case record was reviewed retrospectively by two independent investigators using a standard data collection form. The incidence of NEC and systemic infections, including bacterial or fungal septicaemia, meningitis, and peritonitis, in the two periods were compared. RESULTS: The HW and HR groups contained 161 and 176 VLBW infants respectively. The incidence of late onset systemic infection decreased from 13.5 to 4.8 episodes (including NEC)/1000 patient days after introduction of the HR regimen, representing a 2.8-fold reduction. Similarly, the incidence of Gram positive, Gram negative, and fungal infections decreased 2.5-fold, 2.6-fold, and 7-fold respectively. There was also a significant reduction in the incidence of NEC in the HR group (p < 0.0001). Subgroup analysis revealed that the incidence of methicillin resistant Staphylococcus aureus (MRSA) septicaemia was significantly decreased in the second 36 month period (p = 0.048). The clinical data suggest that infants in the HW group had significantly earlier onset of sepsis (p < 0.05) and required oxygen supplementation for longer (p < 0.05) than those in the HR group. Significantly more VLBW infants were discharged from the neonatal intensive care unit without ever being infected (p < 0.0001), and also significantly fewer infants had more than one episode of infection in the HR group (p < 0.0001). CONCLUSION: The introduction of the HR protocol was associated with a 2.8-fold reduction in the incidence of late onset systemic infection, and also a significant decrease in the incidence of MRSA septicaemia and NEC in VLBW infants. This decrease in infection rate was maintained throughout the second 36 month period. (+info)
Efficacy of organic acids in hand cleansers for prevention of rhinovirus infections.
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Direct hand-to-hand contact is an important mechanism of transmission of rhinovirus infection. The rhinoviruses are inactivated at a low pH. A survey of organic acids in vitro revealed that these compounds have antirhinoviral activity that persists for at least 3 h after application to the skin. In additional studies of salicylic acid (SA) and pyroglutamic acid (PGA), the hands of volunteers were contaminated with rhinovirus at defined times after application of the acid, and then volunteers attempted to inoculate the nasal mucosa with one hand and quantitative viral cultures were done on the other hand. In one study, 3.5% SA or 1% SA with 3.5% PGA was compared with controls 15 min after application to assess the efficacy of the inactivation of virus and prevention of infection. Virus was recovered from the hands of 28 out of 31 (90%) of the volunteers in the control group compared to 4 out of 27 (15%) and 0 out of 27 in the groups administered 3.5 and 1% SA, respectively (P < 0.05). Rhinovirus infection occurred in 10 out of 31 (32%) of the controls and 2 out of 27 (7%) of volunteers in both treatment groups (P < 0.05 compared with control). In a second study, the efficacy of 4% PGA was evaluated 15 min, 1 h, and 3 h after application. Significantly fewer volunteers had positive hand cultures at all time points compared with the control group, but the proportion that developed rhinovirus infection was not significantly reduced. These results suggest the feasibility of the prevention of rhinovirus transmission by hand treatments that are virucidal on contact and have activity that persists after application. (+info)
A new surgical handwashing and hand antisepsis from scrubbing to rubbing.
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In 2002, the Centers for Disease Control and Prevention (CDC) published guidelines for surgical handwashing and hand antisepsis on the Internet. According to these guidelines, we revised our surgical handwashing method from scrubbing with brushes to rubbing with antiseptic. The new method consists of scrubbing around the nails with brushes and rubbing the hands and arms with antiseptic from the elbow to the antebrachium. A total of 182 surgeons and operating-room nurses participated in the current study. Bacterial contamination was investigated using the glove-juice method. The new surgical handwashing method is simple, and requires only a short time to perform (2 minutes 50 seconds). The bacterial examination confirmed that rubbing the hands with antiseptic was significantly more effective than scrubbing with brushes. In terms of sterilization or prolonged effects, 4% chlor-hexidine gluconate (CHG) was superior to 7.5% povidone-iodine (PVI) throughout a 3-hour period after hand antisepsis. Although bacterial counts were increased 3 hours after the beginning of surgery, additional hand rubbing with 0.2% chlorhexidine-83% ethanol (Hibisoft(TM)) was effective in suppressing the number of bacteria. Hibisoft(TM) successfully prolonged sterilization for more than 3 hours. For long surgical procedures, CHG should be used as an antiseptic and gloves should be changed every 3 hours, alcohol-based hand rubbing should also be performed 3 hours after the initial handwashing. This new technique will be included in the OSCE curriculum to ensure its standardization. Moreover, in-depth education regarding central operating-room practices is desired. (+info)
Molecular epidemiology of gram-negative bacilli from infected neonates and health care workers' hands in neonatal intensive care units.
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We sought to characterize the molecular epidemiology of gram-negative bacilli (GNB) causing infections in infants and associated with carriage on nurses' hands after hand hygiene was performed. From March 2001 to January 2003, GNB caused 192 (34%) of 562 hospital-acquired infections in the 2 participating neonatal intensive care units (NICUs) and were isolated from the hands of 45 (38%) of 119 nurses. Five species--Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Serratia marcescens and Enterobacter cloacae, all of which were typed by pulsed-field gel electrophoresis--caused 169 (88%) of 192 of GNB infections. Overall, 58% of infections were caused by unique strains not cultured from other infants or nurses, and 31% of infections were part of unrecognized molecular clusters. In contrast, only 9% of strains that caused infections were cultured from nurses' hands. These data suggest that practices in addition to hand hygiene are needed to prevent horizontal transmission of GNB in the NICU. (+info)
A method for assessing occupational dermal exposure to permanent hair dyes.
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Hairdressers have an increased risk of developing occupational skin diseases due to exposure to skin irritants and sensitizers. In the present work a method of assessing dermal exposure to permanent hair dyes was developed. The sampling performance characteristics of hand wash sampling with bag rinsing were studied for five hair dye compounds. The effect of residence time, sample load and different matrices were studied. Thirty volunteers were exposed to a reference solution of these compounds and to commercial hair dye products. The sampling efficiency after 5 min residence time was between 70 and 90% for the dye components in the hair dye products. Sampling efficiency decreases with increasing residence time, making the time of sampling an important factor. Hand wash sampling should be performed as soon as possible after the work task of interest. We conclude that the sampling efficiency is adequate for measurements of dermal exposure to permanent hair dyes. Hand wash sampling with bag rinsing is a useful tool for field studies of dermal exposure assessment in hairdressers. (+info)