Surveillance for the emergence and dissemination of antimicrobial resistance in bacteria

Effective surveillance of antimicrobial-resistant bacteria is important for developing rational empiric therapy guidelines and for guiding public health efforts to control and prevent the spread of infective agents. Surveillance must include a timely and thorough review of the test results generated in clinical microbiology laboratories because this data serves as the core of surveillance activities. Besides ensuring data accuracy and optimizing detection of emerging resistance, the role of clinical microbiology also includes supporting the production of informative surveillance reports, providing laboratory resources for outbreak investigations, and monitoring the performance of commonly used susceptibility testing methods. Once the accuracy of susceptibility results has been validated, the data are used by public health agencies and professional societies to monitor resistance trends on a local, state, national, and international level. This information is also used to develop policies for prudent antimicrobial use locally and nationally.     

Guidelines for optimal surveillance of Clostridium difficile infection in hospitals

The availability of surveillance data on C. difficile infection in hospitals in England and Wales is being jeopardised by the trend not to culture the organism for diagnostic purposes. NHS trust laboratories that no longer have the ability to isolate C. difficile cannot investigate putative outbreaks or monitor antimicrobial susceptibilities. These laboratories may now need to rely on their local public health laboratory for such investigations. Recent recommendations from the Department of Health(DH)/PHLS have highlighted the need for culture in outbreak investigations, for surveillance purposes, and for monitoring antimicrobial susceptibilities. It is important, therefore, that NHS diagnostic laboratories and public health laboratories, in particular, retain the ability to isolate C. difficile. A cost-effective approach is described that will facilitate surveillance by typing of strains and also enable their antimicrobial susceptibilities to be monitored.     

Clinical microbiology quality assurance program: a Taiwan experience

Quality assurance programs have been established during the last two decades in developed countries to promote high quality performance in clinical laboratories. In Taiwan, such a program for clinical microbiology laboratories has been in place since July 1987. It has been supported by the Department of Health, Executive Yuan, R.O.C. and was set up by the authors. The manpower status, facilities and equipment, and performance of clinical laboratories were investigated during the first year and standards of laboratory quality were recommended. Since then, under a continuing education program, we have conducted seminars, symposia, workshops, short-courses or panel discussions approximately 4 times a year. There have been about 150 participants per session and they have come from local hospitals (primary care hospitals), regional hospitals (secondary care hospitals) and medical centers (tertiary care hospitals). Proficiency test specimens or external unknown specimens were sent to all the laboratories twice a year and approximately 3 specimens were used each time for the evaluation of each laboratory's diagnostic capability and quality of service. Results indicated that there were tremendous improvements in the quality of laboratory performance. At the same time, several laboratory manuals describing the methods of quality control of clinical specimens, test procedures, media and reagents, personnel management and a compilation of reports etc. were published as guidelines of basic requirements for each level of the laboratories. For local hospital laboratories in remote areas, several regional hospitals or medical centers with high quality laboratories were selected to serve as back-ups. Our evaluation has shown that the performance and quality of service provided by most clinical microbiology laboratories in Taiwan have now reached nearly the level of those found in the so-called "developed countries".     

Agricultural safety efforts by county health departments in Wisconsin

OBJECTIVE: The authors sought to improve the agriculture safety prevention efforts of county health departments in Wisconsin by examining current programs, staffs' perceptions of the farm safety problem, and the need for new resources. METHODS: A survey instrument was completed by a professional staff member of the local health department in each of Wisconsin's 69 counties. RESULTS: Usable responses were obtained from 84% of the counties. Forty-five percent of the responding staff members conducted some agricultural safety and health programs, most often health screenings or group meetings conducted collaboratively with county agricultural Extension agents. There were no major differences in county demographics or other service provision variables between staff members who conducted programs and those who did not. Staff members perceived the largest barriers to better safety as lack of staff time and difficulty getting farmers to attend safety programs. Most failed to place more emphasis on training agricultural workers to permanently correct hazards than on training them to work safely around hazards. However, the staff members ranked safety inspection checklists as the most needed new material and ranked Extension agents and farmers as the most appropriate people to conduct inspections using such checklists. CONCLUSION: County public health professionals want more staff time and new materials to increase the effectiveness of their agricultural safety efforts. Encouraging agricultural workers and family members to identify and correct hazards would be a more effective use of staff time than training people to work safely around hazards.     

济钢210t转炉协力检修模式安全管理

济钢210t转炉区域设备维修采用以协力为主的检修模式,针对协力单位数量多、人员变动大等问题,采取明确双方安全管理责任、理顺安全制度体系、实施协力单位人员实名制管理、强化协力人员安全教育等措施,使协力检修质量持续提高,保证了设备安全稳定运行。     

Site Safety Management in Hong Kong

The construction industry is well known for its complexities and inefficiencies in dealing with human safety and construction processes. The industry itself has been notorious for its high casualty records over many years. Especially in Hong Kong, the concept of improving safety in construction sites has only started to be developed in recent years. The government has set up new ordinances and regulations, and companies are willing to invest more on this issue before the construction commences. Nowadays in Hong Kong, from the small to the sizable, nearly all construction companies have their own site safety plans indicating safety guidelines and protective measures to achieve certain safety standards on the project sites. However, when viewing the past records published by the Labour Department, no trend in injury frequency reduction was noted. Consequently, an effort has been made in this report to compare three different site safety plans of three renowned civil and building contractors were investigated. Moreover, in order to review the effectiveness of the prevailing site safety plans and the safety performance of the contractors, a questionnaire survey targeting some site staff was conducted to solicit their opinions on the implementation of site safety plans. From the results of the questionnaire survey the authors determined that the construction companies are now regarding occupational health and safety as prerequisites of all the site operations.     

与核技术应用项目有关的环境评价问题及对策

本文从辐射安全防护措旅和建设单位制定的规章制度两方面对核技术应用项目环境风险评价进行分析,针对放射源暂存库、换源事故、运输安全和源回收安全各个环节的关键问题以及人员培训和应急预案提出相应建议和对策,为确保辐射环境安全提供参考和借鉴。     

Comparison of styrene-7,8-oxide adducts formed via reaction with cysteine, N-terminal valine and carboxylic acid residues in human, mouse and rat hemoglobin

Protozoan parasites were the most frequently identified etiologic agents in waterborne disease outbreak from 1991 to 1994. The waterborne parasites Giardia lamblia, Naegleria fowleri, Acanthamoeba spp., Entamoeba histolytica, Cryptosporidium parvum, Cyclospora cayetanesis, Isospora belli, and the microsporidia are reviewed. For each parasite, the review includes history, life cycle, incidence, symptoms, and therapy. Clinical detection methods are compared, and emerging technologies are discussed. Information on the association of these parasites with waterborne outbreaks is reviewed. Current information on protozoan parasites identified as etiological agents in waterborne outbreaks is discussed. Water industry issues related to recent disease outbreaks are examined in the context of water quality testing regulations for G. lamblia and those proposed for C. parvum. The review identifies the limitations of the American Society of Testing and Materials water-testing method for these parasites. An overview of federal regulations affecting the water industry and laboratories that test for water quality is also provided. The article highlights the importance of the clinical laboratory as a frontline defense for the detection of infectious organisms. The review points to the need for clinical laboratories, physicians, and public health personnel to cooperatively plan and assess the challenge of meeting this potential public health threat.     

Legislation relevant to perinatal care

The legislative process is one route to follow in the attempt to change and improve perinatal care. Payment by the State Crippled Children's Service for medical care of certain costly high-risk neonatal conditions, only to qualified specialists and in centers meeting acceptable standards has had a snowball effect on upgrading neonatal care in this state. Not only has a large network of neonatal care centers and infant transport systems been developed, but there has been a rush especially on the part of nurses, to get special training in neonatal care. This has included not only the care of the sick neonate, but a look at newborn evaluation and resuscitation in the delivery and newborn areas. It is expected that this same center development and education and training process will now be extended to obstetrical care, as there is renewed interest in special care for high-risk mothers because of Assembly Bill 1326. The new hospital perinatal regulations mandate improvement of care in community hospitals where the majority of deliveries take place. The emphasis is on a larger and better educated staff, more concern with patients rights, and provision of a more humanistic family centered care as well as continual evaluation of maternal and neonatal outcome. The greatest limitation has been lack of Health Department staff to provide adequate consultation and surveillance of these services for compliance with the new laws. There has been an approximate 10 per cent reduction in the number of hospitals with maternity services- from 416 in 1968 to 369 today. While much of this consolidation may have been due to the fall in birth rate, these regulations have also contributed to the process. Most important of all, these laws have kept perinatal care constantly in the consciousness of California health care providers and consumers.     

Use of a customer satisfaction survey by health care regulators: a tool for total quality management

OBJECTIVES: To conduct a survey of health care providers to determine the quality of service provided by the staff of a regulatory agency; to collect information on provider needs and expectations; to identify perceived and potential problems that need improvement; and to make changes to improve regulatory services. METHODS: The authors surveyed health care providers using a customer satisfaction questionnaire developed in collaboration with a group of providers and a research consultant. The questionnaire contained 20 declarative statements that fell into six quality domains: proficiency, judgment, responsiveness, communication, accommodation, and relevance. A 10% level of dissatisfaction was used as the acceptable performance standard. RESULTS: The survey was mailed to 324 hospitals, nursing homes, home care agencies, hospices, ambulatory care centers, and health maintenance organizations. Fifty-six percent of provider agencies responded; more than half had written comments. The three highest levels of customer satisfaction were in courtesy of regulatory staff (90%), efficient use of onsite time (84%), and respect for provider employees (83%). The three lowest levels of satisfaction were in the judgment domain; only 44% felt that there was consistency among regulatory staff in the interpretation of regulations, only 45% felt that interpretations of regulations were flexible and reasonable, and only 49% felt that regulations were applied objectively. Nine of 20 quality indicators had dissatisfaction ratings of more than 10%; these were considered priorities for improvement. CONCLUSIONS: Responses to the survey identified a number of specific areas of concern; these findings are being incorporated into the continuous quality improvement program of the office.     

Electronic data processing system for clinical microbiology

A computerized clinical microbiology data storage and retrieval system, which was introduced at the Institute of Medical Microbiology 14 month ago, is described. This institute has to perform routine diagnostic microbiology for hospitals in the Kanton of Zuerich including the university hospital. In addition, it serves as a public health laboratory for Zuerich and adjacent districts. Patient and physician data are entered into a data station IBM 3741 and stored on discettes. Each afternoon, these data are printed on special report forms, which then are transferred to the diagnostic laboratories. After completion of the investigation, a copy of this form containing the results is sent to the physician. Every two weeks, the information stored on the discettes are converted onto the magnetic tape "discette". In addition, the original report form, containing the codified results and the fees, are read by an optic reader, which transfers the information onto the tape "report". Both tapes then serve the computer to print the accounts as well as to summarize the results monthly in form of the medical statistics. These provide valuable information to enhance patient care. All data are stored in a cumalative microbiology data bank for later retrieval.     

Aldehyde disinfectants and health in endoscopy units. British Society of Gastroenterology Endoscopy Committee

Summary of main recommendations(1) Glutaraldehyde, used in most endoscopy units in the United Kingdom for the disinfection of flexible gastrointestinal endoscopes, is a toxic substance being an irritant and a sensitiser; symptoms associated with glutaraldehyde exposure are common among staff working in endoscopy units.(2) The Control of Substances Hazardous to Health Regulations 1988 (COSHH) obliges the employer to make a systematic assessment of risk to staff of exposure to glutaraldehyde and institute measures to deal effectively with exposure.(3) At present glutaraldehyde remains the first line agent for the disinfection of flexible gastrointestinal endoscopes. Other agents are being developed; a standard means of assessment for flexible endoscope disinfectants should be devised.(4) Equipment and accessories that are heat stable should be sterilised by autoclaving; disposable accessories should be used wherever possible.(5) Flexible gastrointestinal endoscopes should be disinfected within automated washer/disinfectors; trays, bowls or buckets for this purpose are unacceptable.(6) Local exhaust ventilation must be used to control glutaraldehyde vapour. Extracted air may be discharged direct to the atmosphere or passed over special absorbent filters and recirculated. Such control measures must be regularly tested and records retained.(7) Endoscope cleaning and disinfection should be carried out in a room dedicated to the purpose, equipped with control measures to maintain the concentration of glutaraldehyde vapour at a level certainly below the current occupational exposure standard of 0.2 ppm and preferably below the commonly used working limit of 0.1 ppm. Sites other than the endoscopy unit where endoscopy is regularly performed, such as the radiology department, should have their own fully equipped cleaning and disinfection room.(8) COSHH limits the use of personal protective equipment to those situations where other measures cannot adequately control exposure. Such equipment includes nitrile rubber gloves, apron, chemical grade eye protection, and respiratory protective equipment for organic vapours.(9) Monitoring of atmospheric levels of glutaraldehyde should be performed by a competent person such as an occupational hygienist; the currently preferred method of sampling uses a filtration technique, the commercially available meters being less reliable.(10) Health surveillance of staff is mandatory; occupational health records must be retained for 30 years.(11) Endoscopy staff must be informed of the risks of exposure to glutaraldehyde and trained in safe methods of its control. Only staff who have completed such an education and training programme should be allowed to disinfect endoscopes.(12) The unsafe use of glutaraldehyde has significant health and legal consequences; the safe use of glutaraldehyde may have revenue consequences that contribute significantly to the cost of gastrointestinal endoscopy.     

Special considerations for the clinical microbiology laboratory in the diagnosis of infections in the cancer patient

The clinical microbiology laboratory faces enormous challenges in diagnosing infections that cause morbidity and mortality in cancer patients. Such laboratories face several issues that surpass those faced by laboratories that perform more routine work. Issues such as sources of clinical specimens, need for correlation and interaction between laboratory and clinical services, blood cultures, susceptibility testing, and the role of new molecular diagnostic techniques are considered in this article.     

Changes in the American health care system: crisis in the clinical laboratory

American medicine is undergoing unprecedented changes, and the resulting distortions are affecting the economics, organization and operations of all clinical laboratories. Professionals who work in these laboratories are facing administrative and economic pressures to reduce costs, to increase productivity, and to comply with proliferating new statutes and regulations. The medical 'cottage industry' in which the patient was the focus of the medical professionals' attention and endeavours is being replaced by the corporate management of many health care activities in which financial profits are being given first priority. Medical facilities, including clinical laboratories, are being bought and sold, being consolidated, or simply being closed. The clinical laboratories may be at the vortex of the maelstrom affecting American medicine. Cost pressures are encouraging further automation and retraining of laboratory staffs. If the leaders in laboratory medicine are unable to accomplish the necessary tasks to meet the new challenges, there inevitably is a non-medical, non-scientific financial manager at hand who is willing to define the changes and the desired outcome. Because of the rapidity of the changes taking place, it is not possible to predict with any confidence the modifications that will achieve a permanent status or the degree to which medical professionals will remain masters of their fates. The evolving health care system will become less costly, more technologically advanced, and a more challenging system in which to work.     

浅谈影响接受罐水位变化因素及易发事故

通过对高炉齿轮箱水循环系统工艺流程了解,分析影响接受罐水位变化的各种内外部因素,了解由此容易引起的人身安全事故,避免在进行设备检查和处理设备缺陷时出现人身伤亡事故,同时保证循环水系统正常冷却。     

Ecosystem health as a clinical rotation for senior students in Canadian veterinary schools

A research nurse interviewed 55 practice staff in 11 general practices to ascertain their views about their needs for occupational health care. In a second parallel study, a specialist in occupational medicine undertook an in-depth audit of occupational health provision in five other general practices with respect to the organization, the health and safety process, the services and the working environment. In the first study, the majority of practice staff reported the need for various aspects of occupational health care, particularly stress at work. In the second study, general practitioners and practice managers possessed a basic awareness of occupational health matters such as Health and Safety legislation, but their limited knowledge was not translated into effective management. General practice staff did not know where to obtain occupational health advice; most practices had no policies or procedures in place to manage health and safety. Both studies illustrate the need for expert occupational health advice in primary care.     

The design of today's operating rooms

With the exception of radiation therapy, the surgical suite is still the most costly area in a health care facility to renovate or construct. It is also the most needs intensive, as far as staff, equipment, material, and building system. Health care providers need an environmentally sensitive area that meets the needs of today, as well as the future. It is equally important to create a working environment that promotes staff comfort, while streamlining time and cost.     

Reducing the levels of formaldehyde exposure in gross anatomy laboratories

BACKGROUND: A method is described in which formaldehyde levels are greatly reduced in our gross anatomy laboratory in order to comply with increasingly severe safety and health regulations. METHODS: A novel type of dissection "bed" has been introduced which incorporates an internal motor that causes a downflow of formaldehyde-rich vapors, which are absorbed by a replaceable active carbon filtration system. RESULTS: Use of the new dissection "beds" has resulted in the recirculated air being virtually formaldehyde-free. Formaldehyde vapor levels in our gross anatomy laboratory have been greatly reduced and are typically in the range of 0.03-0.09 ppm. CONCLUSIONS: The new system allows us to comply with safety and health regulations and provide a dissection room with an excellent working environment.     

Cigarette smoking and other risk factors for silent cerebral infarction in the general population

Control dried organisms as lenticules are a dependable and convenient alternative to wet cultures for quality assurance and process controls in routine food microbiology. Lenticules are designed to give a fixed, reproducible inoculum over an extended period of time without loss of cultural characteristics or viability. During a period of 23 months, 596 paired counts were performed by both Miles and Misra and spiral plating techniques on lenticule controls. Correlation between the two methods and within batches was excellent. Only 14 counts (2.5%) fell outside the standard operating limit of 0.5 log10. All were within 1.0 log10. On two separate occasions, replicate runs were performed on five reconstituted lenticules from a batch. The counts obtained showed variation within and between lenticules only slightly in excess of what is expected by chance. Lenticule replicates performed by three other laboratories also produced satisfactory results. It is thought that lenticules could improve the accuracy of total plate counts and lead to a better standardization of quantitative methods in food microbiology within and between laboratories.