Medicare and Medicaid programs; fire safety requirements for certain health care facilities; amendment. Final rule.
(17/58)
This final rule adopts the substance of the April 15, 2004 tentative interim amendment (TIA) 00-1 (101), Alcohol Based Hand Rub Solutions, an amendment to the 2000 edition of the Life Safety Code, published by the National Fire Protection Association (NFPA). This amendment allows certain health care facilities to place alcohol-based hand rub dispensers in egress corridors under specified conditions. This final rule also requires that nursing facilities at least install battery-operated single station smoke alarms in resident rooms and common areas if they are not fully sprinklered or they do not have system-based smoke detectors in those areas. Finally, this final rule confirms as final the provisions of the March 25, 2005 interim final rule with changes and responds to public comments on that rule. (+info)
Exposure to MTBE, TAME and aromatic hydrocarbons during gasoline pump maintenance, repair and inspection.
(18/58)
The exposure of gasoline pump repairers and inspectors to gasoline was studied at service stations and repair shops in Finland in April-June 2004. The average air temperature ranged from 7 degrees C to 16 degrees C and wind speed from 2.5 to 7 m/s. The gasoline blends contained mixtures of methyl tert-butyl ether (MTBE) and tert-amyl methyl ether (TAME), the total content of oxygenates being 11-12%. The content of benzene was <1%. Breathing zone air was collected during the work task using passive monitors. The mean sampling period was 4.5 h. The mean TWA-8 h concentrations for MTBE, TAME, hexane, benzene, toluene, ethylbenzene and xylene were 4.5, 1.3, 0.55, 0.23, 2.2, 0.26 and 1.1 mg/m3, respectively. None of the individual benzene concentrations exceeded the binding limit value for benzene (3.25 mg/m3). The sum concentration of MTBE and TAME in urine was between 8.9 and 530 nmol/l in individual post-shift samples. The individual sum concentrations of the metabolites tert-butyl alcohol and tert-amyl alcohol collected the following morning after the exposure ranged from 81 to 916 nmol/l. All individual results were below corresponding biological action levels. Exposure to aromatic hydrocarbons was estimated from post-shift urine samples, with benzene showing the highest concentration (range 4.4 and 35 nmol/l in non-smokers). The exposure levels were similar to those measured in previous studies during unloading of tanker lorries and railway wagons. The results indicated a slightly higher exposure for inspectors, who calibrated fuel pump gauges at the service stations, than for pump repairers. No significant skin exposure occurred during the study. (+info)
Sustainable reduction of bioreactor contamination in an industrial fermentation pilot plant.
(19/58)
Facility experience primarily in drug-oriented fermentation equipment (producing small molecules such as secondary metabolites, bioconversions, and enzymes) and, to a lesser extent, in biologics-oriented fermentation equipment (producing large molecules such as recombinant proteins and microbial vaccines) in an industrial fermentation pilot plant over the past 15 years is described. Potential approaches for equipment design and maintenance, operational procedures, validation/verification testing, medium selection, culture purity/sterility analysis, and contamination investigation are presented, and those approaches implemented are identified. Failure data collected for pilot plant operation for nearly 15 years are presented and best practices for documentation and tracking are outlined. This analysis does not exhaustively discuss available design, operational and procedural options; rather it selectively presents what has been determined to be beneficial in an industrial pilot plant setting. Literature references have been incorporated to provide background and context where appropriate. (+info)
Self-reported health problems and sickness absence in different age groups predominantly engaged in physical work.
(20/58)
OBJECTIVES: To study the associations between self-reported health problems and sickness absence from work. METHODS: The results of a questionnaire survey were combined with archival data of sickness absence of 1341 employees (88% males; 62% blue-collar) in the construction, service and maintenance work within one corporation in Finland. Sex, age and occupational grading were controlled as confounders. A zero-inflated negative binomial (ZINB) regression model was used in the statistical analysis of sickness absence data. RESULTS: The prevalence of self-reported health problems increased with age, from 23% in 18-30-year-olds to 54% in 55-61-year-olds. However, in those aged 18-30 years, 71% had been absent from work and in those aged 55-61 years this proportion was 53%. When health problems and occupational grading were accounted for in the ZINB model, age as such was not associated with the number of days on sick leave, but the young workers still had higher propensity for (any) sickness absence than the old. Self-rated future working ability and musculoskeletal impairment were strong determinants of sickness absence. Among those susceptible to taking sick leave, the estimated mean number of absence days increased by 14% for each rise of 1 unit of the impairment score (scale 0-10). CONCLUSIONS: Young subjects had surprisingly high probability for sickness absence although they reported better health than their older colleagues. A higher total count of absence days was found among subjects reporting health problems and poorer working ability, regardless of age, sex and occupational grade. These findings have implications for both management and the healthcare system in the prevention of work disability. (+info)
Breaks and maintenance work in the water distribution systems and gastrointestinal illness: a cohort study.
(21/58)
BACKGROUND: During maintenance work or breaks on the water distribution system, water pressure occasionally will be reduced. This may lead to intrusion of polluted water-either at the place of repair or through cracks or leaks elsewhere in the distribution system. The objective of this study was to assess whether breaks or maintenance work in the water distribution system with presumed loss of water pressure was associated with an increased risk of gastrointestinal illness among recipients. METHODS: We conducted a cohort study among recipients of water from seven waterworks in Norway during 2003-04. One week after an episode of mains breaks or maintenance work on the water distribution system, the exposed and unexposed households were interviewed about gastrointestinal illness in the week following the episode. RESULTS: During the 1-week period after the episode, 12.7% of the exposed households reported gastrointestinal illness in the household, compared with 8.0% in the unexposed households [risk ratio (RR) 1.58, 95% confidence interval (CI): 1.1, 2.3]. The risk was highest in households with higher average water consumption. The attributable fraction among the exposed households was 37% in the week following exposure. CONCLUSION: Our results show that breaks and maintenance work in the water distribution systems caused an increased risk of gastrointestinal illness among water recipients. Better data on the occurrence of low-pressure episodes and improved registration of mains breaks and maintenance work on the water distribution network are needed in order to assess the public health burden of contamination of drinking water within the distribution network. (+info)
Extensive IT outsourcing: advice from providers.
(22/58)
In summary, providers are reporting some benefits related to resources and knowledge, improved service levels/performance and stronger IT staff/leadership. Also, on average, providers are reporting satisfactory experiences with application support and CIO outsourcing. However, not all of their expectations are being met, and some providers have discontinued outsourcing due to unmet expectations. Clearly, outsourcing is an option one must research in depth--it is not for everyone. When one evaluates the results of extensive IT outsourcing, it becomes easier to see what outsourcing mix and firm may be a good match for your organization's needs and expected outcomes. As you decide upon the outsourcing mix and firm that is right for you, providers advise you to pay special attention to contractual arrangements. With adequate research and contractual provisions, organizations can find the outsourcing mix that is right for them. (+info)
Feasibility and costs of water fluoridation in remote Australian Aboriginal communities.
(23/58)
BACKGROUND: Fluoridation of public water supplies remains the key potential strategy for prevention of dental caries. The water supplies of many remote Indigenous communities do not contain adequate levels of natural fluoride. The small and dispersed nature of communities presents challenges for the provision of fluoridation infrastructure and until recently smaller settlements were considered unfavourable for cost-effective water fluoridation. Technological advances in water treatment and fluoridation are resulting in new and more cost-effective water fluoridation options and recent cost analyses support water fluoridation for communities of less than 1,000 people. METHODS: Small scale fluoridation plants were installed in two remote Northern Territory communities in early 2004. Fluoride levels in community water supplies were expected to be monitored by local staff and by a remote electronic system. Site visits were undertaken by project investigators at commissioning and approximately two years later. Interviews were conducted with key informants and documentation pertaining to costs of the plants and operational reports were reviewed. RESULTS: The fluoridation plants were operational for about 80% of the trial period. A number of technical features that interfered with plant operation were identified and addressed though redesign. Management systems and the attitudes and capacity of operational staff also impacted on the effective functioning of the plants. Capital costs for the wider implementation of these plants in remote communities is estimated at about $US 94,000 with recurrent annual costs of $US 11,800 per unit. CONCLUSION: Operational issues during the trial indicate the need for effective management systems, including policy and funding responsibility. Reliable manufacturers and suppliers of equipment should be identified and contractual agreements should provide for ongoing technical assistance. Water fluoridation units should be considered as a potential priority component of health related infrastructure in at least the larger remote Indigenous communities which have inadequate levels of natural fluoride and high levels of dental caries. (+info)
Sphygmomanometer calibration--why, how and how often?
(24/58)
BACKGROUND: Hypertension is the most commonly managed problem in general practice. Systematic errors in blood pressure measurements caused by inadequate sphygmomanometer calibration are a common cause of over- and underidentification of hypertension. OBJECTIVE: This article reviews sphygmomanometer error and makes recommendations regarding in service maintenance and calibration of sphygmomanometers. DISCUSSION: Most sphygmomanometer surveys report high rates of inadequate calibration and other faults, particularly in aneroid sphygmomanometers. Automatic electronic sphygmomanometers produce systematic errors in some patients. All sphygmomanometers should be checked and calibrated by an accredited laboratory at least annually. Aneroid sphygmomanometers should be calibrated every 6 months. Only properly validated automatic sphygmomanometers should be used. Practices should perform regular in house checks of sphygmomanometers. Good sphygmomanometer maintenance and traceable sphygmomanometer calibration will contribute to reducing the burden of cardiovascular disease and the number of patients overtreated for hypertension in Australia. (+info)