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Health care services - 1,917 entries found

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2001

CIS 01-1816
Health and Safety Executive
The regulatory requirements for medical exposure to ionising radiation - An employer's overview
This guidance note is aimed at senior managers and clinicians of public and private hospitals, as well as at practicing physicians, chiropractors and dentists who use ionizing radiation. It provides an overview of their responsibilities under the Ionising Radiation Regulations 1999 (IRR99, see CIS 00-617) and the Ionising Radiation (Medical Exposure) Regulations 2000 (IR(ME)R2000). The main provisions of these regulations involve the need for risk assessment, use of appropriate equipment, quality assurance programmes, training of employees and procedures for dealing with incidents.
HSE Books, P.O. Box 1999, Sudbury, Suffolk CO10 2WA, United Kingdom, Nov. 2001. iv, 16p. Illus. 11 ref. Price: GBP 6.50.

CIS 01-1309
Department of Labor - Occupational Safety and Health Administration (OSHA)
Occupational Exposure to Bloodborne Pathogens; Needlestick and Other Sharps Injuries: Final Rule [USA]
This is a revision of the Bloodborne Pathogens standard (for 1991 original, see CIS 93-371) in conformity with the requirements of the Needlestick Safety and Prevention Act. New examples have been included in the definition of engineering controls, along with two new definitions (needleless systems and sharps with engineered sharps injury protections). In addition, employers who are required to establish an Exposure Control Plan must document how the Plan is implemented. Certain employers are also required to establish and maintain a log of percutaneous injuries from contaminated sharps.
Federal Register, 18 Jan. 2001, Vol.66, No.12, p.5318-5325.
http://www.osha.gov/FedReg_osha_data/FED20010118A.html [in English]
http://www.osha.gov/FedReg_osha_pdf/FED20010118A.pdf [in English]

CIS 01-797 Bourbonnais R., Mondor M.
Job strain and sickness absence among nurses in the Province of Quebec
The objective of this longitudinal study was to determine whether nurses exposed to occupational stress had a higher incidence of sick leave. Data on short-term sick and certified sick leaves were collected for 1,793 nurses for a 20-month period. A job content questionnaire was used to measure psychological demands, job decision latitude, and social support at work. Short-term sick leaves were associated with job strain (incidence density ratio (IDR) = 1.20) and with low social support at work (IDR = 1.26). Certified sick leaves were also significantly associated with low social support at work (IDR = 1.27 for all diagnoses and IDR = 1.78 for mental health diagnoses). Results support the association between stress and short-term sick leaves. The association with certified sick leaves is also significant for subgroups of nurses with specific job characteristics.
American Journal of Industrial Medicine, Feb. 2001, Vol.39, No.2, p.194-202. 40 ref.

CIS 01-599 Bulhões I.
Angels also make mistakes - Mechanisms and prevention of human error in hospital work
Os anjos também erram - Mecanismos e prevenção da falha humana no trabalho hospitalar [in Portuguese]
This publication treats the topic of medical error. A first section describes various incidents and accidents having occurred in hospitals. An analysis of the mechanisms of human error and of the types of error (non-intentional, voluntary acts) is then presented, together with proposed solutions for improving their prevention. Prevention involves improvements in working conditions, and more particularly in the working environment (physical environment, work time schedules) and in factors related to the task (complexity, information, training, planning, conflict management, stress), and an analysis of the probability of risk and human reliability.
Ivone Bulhões, Rio de Janeiro, Brazil, 2001. 294p. Illus. Bibl.ref.

2000

CIS 05-232 Herrero A.M., Vila A.M., Pérez-Piqueras P., Pérez-Piqueras N.
Study of work organization and accident indices among health care personnel
Estudio de la organización de trabajo y de los índices de accidentabilidad en el personal sanitario [in Spanish]
The aim of this study was to describe the occupational characteristics of work in service enterprises, and more particularly of health care personnel, on the basis of accident rates. It makes use of the yearly statistical records published by the Spanish Ministry of Labour for the years 1995-1997. The statistics refer to sanitary activities, a broad group which does not precisely reflect the characteristics of health care personnel. However within these services, accident frequency, severity and incidence rates are lower than in service activities in general, while the duration of absenteeism is longer.
Medicina y seguridad del trabajo, 2000, Vol.XLVII, No.186, p.53-67. Illus. 7 ref.

CIS 03-739 Ortega Eslava M.I.
Occupational exposure to antineoplastic agents: Surveillance of the carcinogenic risk
Exposition professionnelle aux antinéoplasiques: surveillance du risque cancérogène [in French]
Antineoplastic agents used in cancer treatment are mutagenic, carcinogenic and teratogenic. This article presents the conclusions of a literature review aimed at analysing available test methods for the surveillance of the cancer risk among exposed workers. There is no single preferred test method, and the article discusses the advantages and scope of application of various methods including: determination of the parent compound or its metabolite in a biological media; DNA or protein adducts; urinary mutagenicity; biomarkers; chromosome aberration test; sister-chromatid exchange test, micronuclei test; comet assay.
Médecine du travail & Ergonomie / Arbeidsgezondheitszorg & Ergonomie, 2000, Vol.XXXVII, No.2, p.57-81. Illus. 156 ref.

CIS 03-470 Work time schedule models - Modern work organization in the health care sector
Arbeitszeitmodelle - Moderne Arbeitsorganisation im Gesundheitswesen [in German]
This document reports on current practice in the area of work time schedules in the health care sector in one of the Länder (States) of Germany. It reviews various work time models and discusses regulations with respect to work time, work breaks, rest time, night work and work on Sundays and public holidays. It also presents the case of a clinic where a new model of work time organization was developed in quality circles and implemented successfully.
Ministerium für Arbeit, Gesundheit und Soziales des Landes Nordrhein-Westfalen, 40190 Düsseldorf, Germany, 2000. 67p. Illus. 46 ref.
http://www.arbeitszeiten.nrw.de/pdf/AZMODELL.PDF [in German]

CIS 03-435 Sobaszek A., Fantoni-Quinton S., Frimat P., Leroyer A., Laynat A., Edme J.L.
Prevalence of cytomegalovirus infection among health care workers in pediatric and immunosuppressed adult units
The objective of this study was assess the prevalence of cytomegalovirus (CMV) infection among health care personnel working with children and immunosuppressed patients. The study involved a clinical examination, a medical and occupational questionnaire, the assessment of tasks performed, and CMV serologic testing of 400 female health care workers. Overall seroprevalence was 44.25%. Prevalence differed significantly with age and parity (number of children) and was higher among personnel who worked in closer contact with the patients (nurse's aides) than among those whose tasks required more technical skills (nurses), 57.3% vs. 34.5%. Logistic regression analysis between prevalence of CMV antibodies, age, parity and type of job showed that contact with patients was as significant a factor as parity.
Journal of Occupational and Environmental Medicine, Nov. 2000, Vol.42, No.11, p.1109-1114. 24 ref.

CIS 03-434 Russi M., Buitrago M., Goulet J., Calello D., Perlotto J., van Rhijn D., Nash E., Friedland G., Hierholzer W.
Antiretroviral prophylaxis of health care workers at two urban medical centers
This study examined the influence of job category, source patient HIV status and exposure type on whether health care workers initiated antiretroviral prophylaxis after potential blood-borne pathogen exposures. Of 639 exposures over an 18-month period, 82 individuals (13%) elected to receive prophylaxis, of whom 66% took medications for fewer than 96 hours and only 12% completed a 4-week course. Reasons for early drug discontinuation included confirmation of source patient HIV negative serological status (65%), gastrointestinal side effects (13%), headache (4%), and personal decision after counseling or other inputs (18%). Individuals exposed to HIV-positive source patients were more likely to initiate prophylaxis (odds ratio (OR), 5.1). Licensed nurses were less likely than others to accept prophylaxis (OR 0.5), whereas physicians and medical students were more likely to accept prophylaxis (OR 1.9).
Journal of Occupational and Environmental Medicine, Nov. 2000, Vol.42, No.11, p.1092-1100. 33 ref.

CIS 02-1944 Nicas M.
Regulating the risk of tuberculosis transmission among health care workers
The relationship between tuberculosis (TB) infection and disease rates is discussed, and a probability framework is introduced for the apportioning of the infection risk between occupational and non-occupational exposure. It is argued that most TB infections among health care workers are work-related. A 0.2% overall annual risk of TB infection is proposed as acceptable, because in the context of an infection surveillance programme it limits the cumulative disease risk faced by health care workers close to the value for the general United States population. Based on the probability framework, an estimate of the background community infection rate and the traditional Wells-Riley risk model it is shown that a target workplace infection risk value can be derived and applied to risk management decision making.
AIHA Journal, May-June 2000, Vol.61, No.3, p.334-339. Illus. 20 ref.

CIS 02-1466 Martí Solé M.C., Alonso Espadalé R.M., Constans Aubert A.
Exposure to biological agents. Management of personal protective equipment in health care services
Exposición a agentes biológicos. La gestión de equipos de protección individual en centros sanitarios [in Spanish]
The management of personal protective equipment (PPE) against biological hazards includes designating a suitably-qualified team for training and informing the personnel on its use, as well as the acquisition, distribution, proper care and storage of PPE. This information note describes the general aspects of managing PPE against biological hazards in health care services. Contents: why PPEs are needed; designating a qualified team; acquiring the PPE; internal use standards; distribution; supervision and implementation. Tables list the biological hazards specific to different hospital or health care services, together with the suitable PPE.
Instituto Nacional de Seguridad e Higiene en el Trabajo, Ediciones y Publicaciones, c/Torrelaguna 73, 28027 Madrid, Spain, 2000. 6p. 25 ref.

CIS 02-1465 Martí Solé M.C., Alonso Espadalé R.M., Constans Aubert A.
Exposure to biological agents: Personal protective equipment
Exposición a agentes biológicos: equipos de protección individual [in Spanish]
There is some confusion, particularly in the health care environment, concerning the use of personal protective equipment (PPE) against biological hazards. This information note describes the possibilities of protection against biological hazards, specifically through the use of appropriate PPE. Contents: classification of PPEs; modes of exposure; appropriate PPE against inhalation, dermal, parenteral and conjunctive exposure.
Instituto Nacional de Seguridad e Higiene en el Trabajo, Ediciones y Publicaciones, c/Torrelaguna 73, 28027 Madrid, Spain, 2000. 6p. Illus. 12 ref.

CIS 02-1452 Vandersmissen G., Moens G., Vranckx R., de Schryver A., Jacques P.
Occupational risk of infection by varicella zoster virus in Belgian healthcare workers: A seroprevalence study
The presence of varicella zoster virus (VZV, chickenpox) antibodies was investigated in health care personnel in Belgian hospitals. The prevalence of VZV seropositivity was 98.5%. Seronegative workers were significantly fewer among nursing than among non-nursing staff. Because of this low overall susceptibility, VZV infection seems not to be an important occupational risk among healthcare workers. A negative history of chickenpox had no value as a predictor of susceptibility in adults.
Occupational and Environmental Medicine, Sep. 2000, Vol.57, No.9, p.621-626. Illus. 28 ref.

CIS 02-746 Bentivenga R., Bertagnolio G., Deitinger P., Deleo M., Giulianelli F, Macciocu L., Rossetti M., Sala A.
The hospital environment - Quality considerations and management of services in relation with safety: Organizational requirements and proposals for a model for identification of specific risks
L'universo ospedaliero - Considerazioni sulla qualità e la gestione dei servizi in relazione alla sicurezza: esigenze formative e proposta di un modello per la rilevazione dei rischi specifici [in Italian]
A cost-benefit analysis with a wide-ranging list of the most frequent problems connected with the running of hospitals in Italy. A number of possible alternative managerial organizational structures and the rational approach of possible psychological and communication problems within the hospital personnel are considered as a model in order to select the most appropriate preventive measures.
Fogli d'informazione ISPESL, Jan.-Mar. 2000, Vol.13, No.1, p.19-42. Illus. 35 ref.

CIS 02-849 Shaffer M.P., Belsito D.V.
Allergic contact dermatitis from glutaraldehyde in health-care workers
Glutaraldehyde is the disinfectant of choice for sterilizing medical and dental equipment, but is known to induce allergic contact dermatitis. In a 5-year study, 468 patients were patch tested to glutaraldehyde. Health-care workers were more than eight times more likely to be allergic to glutaraldehyde than non-health-care workers. Allergic contact dermatitis from glutaraldehyde often causes persistent dermatitis, which frequently forces patients to leave their jobs. Until a less sensitizing disinfectant is developed, it is in the best interest of those in health-care professions and other professions exposed to glutaraldehyde to reinforce occupational hygiene standards with respect to the limitation of exposure, in particular through improved methods of barrier protection.
Contact Dermatitis, Sep. 2000, Vol.43, No.3, p.150-156. 23 ref.

CIS 02-374 Rosenberg N.
Occupational asthma from disinfectants used in hospitals
Asthme professionnel dû aux désinfectants employés en milieu hospitalier [in French]
Contents of this data sheet on occupational allergies and chest diseases caused by disinfectants used in hospitals: physiopathology; prevalence; diagnosis at the place of work; confirmation of diagnosis in a specialised medical institution; evolution; prevention; compensation of occupational diseases.
Documents pour le médecin du travail, 4rth Quarter 2000, No.84, p.435-443. 50 ref.

CIS 02-436 Touche F., Fleury L., Berlie C., Domart M., Pernet M., Leprince A.
Risks of infection in medical laboratories
Risques infectieux dans les laboratoires d'analyses médicales [in French]
Despite the fact that each day, a large number of potentially contaminating samples are handled in medical laboratories, data on the risks of infection are still scanty. A first study was conducted in 1996 in 26 medical laboratories belonging to five hospitals, with the objective of collecting the basic data necessary for hazard evaluation (see CIS 98-954). The study carried out two years later in the same laboratories enabled the assessment of trends with respect to approaches and risk perception. It includes a description of the laboratories, a retrospective inventory of infectious diseases and injuries involving blood exposure and a survey on the perception of the risks of infection. Results highlight favourable trends with respect to facilities, equipment and procedures.
Documents pour le médecin du travail, 3rd Quarter 2000, No.83, p.233-239.

CIS 02-456 Estryn-Béhar M., Bonnet N.
Working at night 8, 10 or 12 hours in hospitals
Travailler la nuit en 8, 10 ou 12 heures à l'hôpital [in French]
A comparison of hospital working conditions on various shifts and of their repercussions on health and social life was made by means of a self-administered questionnaire, using a sample group of 2,241 women. It was possible to distinguish employees working day shifts and starting early or late, afternoon shifts, and night shifts of 8-, 10-, or 12-hour duration. Multiple logistic regression analyses were carried out in order to take socio-demographic and professional characteristics into account. Factors taken into account in the survey included sleep problems, fatigue, irritability, gastro-intestinal problems, stress, obesity, level of responsibility, eating habits, age and the number of children. The study shows a significant effect on sleep and fatigue for 10- and 12-hour night shifts.
Archives des maladies professionnelles et de médecine du travail, Oct. 2000, Vol.61, No.6, p.402-416. 49 ref.

CIS 02-454 Epstein R., Tzsischinsky O., Nave T., Nela C., Dov Z., Peretz L.
Sleep-wake cycles of medical residents working extended shifts in Israel
Schlaf- und Wachzyklen von Assistenzärzten mit langen Arbeitszeiten in Israel [in German]
In Israel residents in hospitals are on duty in shifts up to 32 hours. The purpose of this study was to provide specific information on their sleep-wake cycles. 78 residents completed a self-administered questionnaire survey and their sleep-wake cycle was monitored by a wrist-worn actigraph for one week at the beginning of the study, and after 6 and 12 months. It was found that residents slept significantly less during a night shift compared to a night at home. During the first year of residency, the residents worked at least 9-10 extended shifts a month and suffered from chronic sleep deprivation.
Zeitschrift für Arbeitswissenschaft, 2000, Vol.54, No.5, p.324-329. Illus. 25 ref.

CIS 02-453 Kundi M., Wöckinger G.
Psychosocial aspects of flexible shift work organization among hospital nurses
Psychosoziale Aspekte flexibler Diensteinteilung für das Pflegepersonal in Krankenanstalten [in German]
The influence of the shift work schedule on sleep duration and social life was determined by conducting a questionnaire survey among 134 nurses in various hospitals in Austria. The aim of the study was to assess possible benefits of flexible shift schedule arrangements compared to traditional 12-hour day or night shift and 8-hour 3-shift schedules. Nurses with flexible shift schedule reported less interference with family obligations and leisure time activities and higher sleep duration and quality. They were on average also more satisfied with their schedule. In both groups with fixed schedules, a significant correlation between interference with family and leisure activities and sleep was observed.
Zeitschrift für Arbeitswissenschaft, 2000, Vol.54, No.5, p.306-310. Illus. 8 ref.

CIS 02-194 Federici A.
The security mandate; duties and responsibilities of safety and health professionals: The role of the competent physician
Il debito di sicurezza; compiti e responsabilità delle figure professionali ricostruiti in un'ipotesi tipica: il medico competente [in Italian]
Comment on law (Italian Law 626/94, see CIS 96-1531) and on the variety of responsibilities entrusted to occupational physicians responsible for plant health services. Roles of safety and health committees and of employers' organizations are also discussed.
Difesa sociale, Sep.-Dec. 2000, Vol.79, No.5-6, p.33-66. 60 ref.

CIS 02-451 Macowiec-Dąbrowska T., Krawczyk-Adamus P., Sprunsińska E., Jóźwiak Z.W.
Can nurses be employed in 12-hours shift systems?
Nurses are often obliged to work in 12-hr shifts. To check whether working such long hours constitutes an excessive load for nurses, a questionnaire survey was conducted among nurses working in an 8hr daytime shift system (169 nurses) and in a 12-hr shift (536 nurses). The amounts of physical workload, work stress, and after-work activities were compared. Data analysis shows that a 12-hr shift system is characterized by less significant physical workload but greater mental load. The nurses working in a 2-shift system were more tired after work, but could spend more time on leisure activities and housework. The data suggest that there are no significant contraindications for nurses to work in a 2-shift system.
International Journal of Occupational Safety and Ergonomics, 2000, Vol.6, No.3, p.393-403. 12 ref.

CIS 02-326 Vyas A., Pickering C.A.C., Oldham L.A., Francis H.C., Fletcher A.M., Merrett T., McL Niven R.
Survey of symptoms, respiratory function, and immunology and their relation to glutaraldehyde and other occupational exposures among endoscopy nursing staff
348 current endoscopy nurses from 59 endoscopy units within the United Kingdom and 18 ex-employees (who had left their job for health reasons) were surveyed. Symptom questionnaires, end of session spirometry, peak flow diaries, skin prick tests to latex and common aeroallergens, and measurements of total immunoglobulin E (IgE) and IgE specific to glutaraldehyde (GA) and latex were performed. Exposure measurements included personal airborne biocide sampling for peak (during biocide changeover) and background (endoscopy room, excluding biocide changeover) concentrations. A significant level of symptoms were reported in the absence of objective evidence of the physiological changes associated with asthma. Ex-employees and current workers with work-related symptoms warrant further study to elucidate the cause and mechanisms for their symptoms.
Occupational and Environmental Medicine, Nov. 2000, Vol.57, No.11, p.752-759. 47 ref.

CIS 02-294 Verdun-Esquer C., Laplace V., Brochard P., Ducombs G., Geniaux M.
Pathologies related to disinfectants and detergents in hospitals
Pathologie en rapport avec les produits désinfectants et détergents en milieu hospitalier [in French]
Disinfectants and detergents are widely used in hospitals. Their composition is complex. This article is a review of diseases diagnosed in persons producing, handling or using these products. Irritant and allergic effects are possible on skin and mucous membranes. A wide variety of chemicals is involved. Collaboration between the hospital departments responsible for occupational medicine, hospital hygiene and the dispensary is necessary to improve knowledge and to control the risks due to the use of these products.
Archives des maladies professionnelles et de médecine du travail, Dec. 2000, Vol.61, No.8, p.588-596. 54 ref.

CIS 02-276 Leoni V., Petyx M., Rossini A., Urso M., Materazzo F., Ensabella F., Vitali M., Fabiani L., Giuliani A.R., Testa A., Ranaldi R., De Marco A., Owczarek M., De Simone L., Guidotti M., Serva M.
Occupational and environmental risks related to activities of diagnostic laboratories and their prevention. Cytogenetic and environmental mutagenicity tests
Rischio e prevenzione occupazionale e ambientale correlato [sic] alle attività dei laboratori diagnostici. Test citogenetici e di mutagenesi ambientale [in Italian]
A report on a survey to gather information on types, numbers and techniques of diagnostic analysis and on the collection of waste products in two Italian hospitals. Cytogenetic tests were carried out on 50 exposed workers in the laboratories of these hospitals and on 50 controls. Altogether approximately 150 diagnostic techniques were recorded, together with about 300 reagents used in these procedures and classified according their toxicity and risk potential. Mutagenicity and cytogenicity tests were also carried out for the same substances. Of the reagents recorded, 40% can produce burns, 28% are toxic by inhalation or ingestion, 12% are flammable and 4% are carcinogenic. Among the waste products, the most harmful were those coming from microbiological and enzyme tests. Cytogenetic tests proved their usefulness as aspecific indicators of increased risk of harmful exposures. As useful outcomes of the study, the preparation of two questionnaires should also be noted: one on the analytical methods and substances used and the wastes produced by laboratories, the other on the identification of exposed and non-exposed subjects for epidemiological surveys.
Prevenzione oggi, 2000, Vol.12, No.4, p.35-112. Illus. Bibl. ref.

CIS 01-1865 Menchón Sánchez E., Manzano Sanz F.
Evaluation of psychosocial risk factors: Occupational stress
Evaluación de riesgos psicosociales: el estrés laboral [in Spanish]
A study of stress factors perceived by the 42 employees of a pensioners' home was carried out by questionnaire and through interviews. A second questionnaire on the means of surveillance of stress factors was limited to the management and team leaders of the institution (7 persons). The results differ somewhat according to the levels of the staff. Stress factors perceived by all employees include the workload, the fast pace of work, the physical workload, the mental workload, the lack of decision latitude and the lack of information. The results of the questionnaire on the means of surveillance show that the establishment is capable of identifying stress factors, and therefore capable of implementing corrective measures to improve working conditions.
Editorial Aranzadi SA, Ctra. de Aoiz, Km 3,5, 31486 Elcano, Navarra, Spain, 2000. No.3, 27p.

CIS 01-1862 Kivimäki M., Elovainio M., Vahtera J.
Workplace bullying and sickness absence in hospital staff
Consequences of workplace bullying were examined in a cohort of 674 male and 4,981 female hospital employees aged 19-63 years by focusing on sickness absence. Data on sickness absence were gathered from employers' registers. Bullying and other predictors of health were measured by a questionnaire survey. 302 (5%) of the employees reported being victims of bullying. They did not differ from the other employees in terms of sex, age, occupation, type of job contract, hours of work, income, smoking, alcohol consumption, or physical activity. Victims of bullying had higher body mass and prevalence of chronic disease, and their rates of medically and self certified spells of sickness absence were 1.5 and 1.2 times higher than those of the rest of the staff. The rate ratios remained significant after adjustment for demographic data, occupational background, behaviour involving risks to health and baseline health status.
Occupational and Environmental Medicine, Oct. 2000, Vol.57, No.10, p.656-660. 36 ref.

CIS 01-1303 Joint Decree of the Minister of Health and the Head of Agency for Nuclear Power Control - Safety promotion and control over utilization of nuclear power in area of health [Indonesia]
This Decree establishes a Cooperation Commission in order to supervise the control and safe use of radioactive substances in health-care establishments.
Business News (Indonesia), 17 Nov. 2000, Year XLIV, No.6544, p.19A-20A.

CIS 01-1566 Basso A., Urbano M.L., Soleo L., Serio G., Trerotoli P., Scianaro S., Di Candia O., Ambrosi L.
Fatiguing work, ageing and health: A cross-sectional study of a group of anaesthesiologists
Lavoro usurante, invecchiamento e salute: studio trasversale in un gruppo di anestesisti [in Italian]
A general discussion of the fatigue concept, based on criteria retrieved from Italian laws, is presented. The results are then reported of a questionnaire survey in which 1438 Italian anaesthesiologists and resuscitators (mean age: 45.5 years) were asked if they considered their occupation as fatiguing. A high incidence of stress-related conditions and joint diseases was found, with a positive correlation with age. Other organic diseases did not appear to occur earlier than expected. Overall, the principal risk in this occupational group was that of neuropsychic disease due to physical and mental stress. This paper was presented at an International Seminar on Ageing and Work, held in Verona (Italy) on 7 Apr. 2000.
Medicina del lavoro, July-Aug. 2000, Vol.91, No.4, p.354-365. Illus. 22 ref.

CIS 01-1533 Trad Fager C.
Tuberculosis, AIDS and work
Tuberculosis, SIDA y trabajo [in Spanish]
More than two thirds of the world population is believed to be infected by tuberculosis. The association between tuberculosis (TB) and immunodeficiency syndrome (AIDS) shows characteristic morbidity. This article describes the clinical features of TB, including its association with AIDS. This article reviews transmission factors, susceptibility and resistance to bacilli, treatment and screening, in particular in the Argentinian context. In terms of occupational hazards, TB represents a risk factor for workers in hospitals, veterinary practices, geriatric care institutions and in the meat processing industry. Various screening methods are also discussed.
Salud Ocupacional, Jan.-June 2000, Vol.XVIII, No.76, p.10-17. Illus.

CIS 01-1446 Felknor S.A., Aday L.A., Burau K.D., Delclos G.L., Kapadia A.S.
Safety climate and its association with injuries and safety practices in public hospitals in Costa Rica
In response to growing concerns for occupational health and safety in the public hospital system in Costa Rica, a cross-sectional survey of 1,000 hospital-based health care workers was conducted in 1997 to collect baseline data that are being used to develop worker training programmes in occupational health. The objectives of this survey were to: 1) describe the safety climate within the national hospital system, 2) identify factors associated with safety, and 3) evaluate the relationship between safety climate and workplace injuries and safety practices of employees. The safety climate was found to be very poor. The two most significant predictors of safety climate were training and administrative support for safety. Safety climate was a statistically significant predictor of workplace injuries and safety practices, respectively, and there was an underreporting rate of 71% of workplace injuries. These findings underscore the need for improvement of the safety climate in the public hospital system in Costa Rica.
International Journal of Occupational and Environmental Health, Jan.-Mar. 2000, Vol.6, No.1, p.18-25. Illus. 18 ref.

CIS 01-742 Exposure to blood - What health-care workers need to know
Health care workers are at risk for occupational exposure to bloodborne pathogens, including hepatitis B virus (HBV), hepatitis C virus and human immunodeficiency virus (HIV). Exposures occur through needle pricks or cuts from other sharp instruments contaminated with an infected patient's blood. Aimed at health care workers, this booklet provides guidance on reducing the risks from exposure to blood. Contents include: prevention of exposure; actions to undertake if exposure occurs; risk of developing an infection after exposure; treatment for the exposure; follow-up after exposure.
Department of Health and Human Services, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333, USA, [2000]. 9p.

CIS 01-882 Vonesch N., Tomao P., Signorini S., Palmi S., Papaleo B.
Vaccine prophylaxis for workers exposed to biological hazards
La profilassi vaccinale: contributo per il controllo del rischio biologico nei lavoratori esposti [in Italian]
Occupations with exposure to biological agents have become a matter of discussion, especially after the introduction in Italy of Law 626/94 (see CIS 96-1531), in conformity with the EU directive 90/679/EEC (see CIS 91-29). There are many important biological agents that can have infectious, allergic, toxic or carcinogenic effects on the working population. Large occupational groups are exposed to these biohazards, both in agriculture and industry. Vaccination is one of the most beneficial medical practices, which has led to the eradication of devastating diseases such as smallpox and the almost total elimination of poliomyelitis. Vaccination is also one of the most cost effective prevention measures applicable. This paper describes the possible vaccinations that employers should make available to employees exposed to biological risk, according to article 86 of Law 626/94.
Medicina del lavoro, May-June 2000, Vol.91, No.3, p.226-250. 79 ref.

CIS 01-780 Fenga C., Cacciola A., Grillo O.C., Anzalone C:, Germanò D.
Ocular discomfort and microclimate: Epidemiological and environmental survey in operating theatres
Sintomi da discomfort oculare e microclima: indagine epidemiologica e ambientale nelle sale operatorie [in Italian]
Information on the ocular symptoms of 213 subjects working in the operating theatres of a hospital was gathered via a questionnaire. Microclimate parameters (temperature, relative humidity, number of air changes/hour, air velocity, illumination levels) of the operating theatres were also studied. A total of 154 subjects (72.3%) reported poor eye comfort. The most frequently reported symptoms were fatigue (35.21%) and heaviness (34.27%), followed by burning (25.82%), redness (25.35%), lachrymation (17.84%), itching (2%), blinking (20%), foreign body sensation (19%) and photophobia (10%). The study of the indoor climate of the operating theatres showed that the rate of air changes and the illumination levels were not consistent with those recommended by the Italian regulatory authority. Insufficient lighting may be responsible for eye fatigue and heaviness. The insufficient rate of air exchange, possibly combined with the presence of chemicals and aerosols, is thought to be responsible for the other ocular symptoms experienced by the workers.
Medicina del lavoro, Mar.-Apr. 2000, Vol.91, No.2, p.125-130. 14 ref.

CIS 01-822 Sri-Akajunt N., Sadhra S., Jones M., Burge P.S.
Natural rubber latex aeroallergen exposure in rubber plantation workers and glove manufacturers in Thailand and health care workers in a UK hospital
The aim of this study was to estimate airborne natural rubber latex (NRL) concentrations for three occupational exposure groups, rubber plantation workers and NRL glove manufacturers in Thailand and health care workers in the UK. Two rubber plantations (110 workers), three NRL glove manufacturing factories (583 workers) in Thailand and one UK hospital (490 workers) were selected for the study. A preliminary workplace survey was carried out. Personal sampling was conducted and NRL aeroallergens were measured by an inhibition assay with NRL-specific IgE antibodies from NRL-sensitized people. The highest geometric mean NRL aeroallergen concentration was found in the glove manufacturing factories (7.3µg/m3), followed by the rubber plantations (2.4µg/m3) and the hospital (0.46µg/m3). The highest exposure to NRL aeroallergens is likely to occur in the manufacturing factories. Exposure to aeroallergens for the plantation workers was considered to be moderate and that of health care workers to be low.
Annals of Occupational Hygiene, Mar. 2000, Vol.44, No.2, p.79-88. Illus. 21 ref.

CIS 01-446 Gold D., Geater A., Aiyarak S., Wongcharoenyong S., Juengprasert W., Chuchaisangrat B., Samakkaran A.
The indigenous fisherman divers of Thailand: Strengthening knowledge through education and information
A project team addressed occupational health promotion in Thailand in order to improve the health of a group of indigenous fishermen divers. Educational activities were designed and implemented for public health physicians and workers and diving boat chiefs. Workshops for health physicians included differential diagnosis of decompression illness. Workshops for public health workers included physiology, pathophysiology and treatment of decompression illness, as well as the development of informational tools. An awareness-raising workshop was also held for boat chiefs. 10 information data sheets on safe diving were designed and distributed.
Journal of Safety Research, 2000, Vol.31, No.3, p.159-168. 14 ref.

CIS 01-425 Fritschi L.
Cancer in veterinarians
This is a review of the literature on carcinogenic risks among veterinarians, who are exposed to radiation, anaesthetic gases, pesticides and zoonoses. The levels of exposure to potential carcinogens are examined and evidence is reviewed for carcinogenesis of these substances in humans at doses similar to those experienced by veterinarians. Results indicate that veterinarians have considerable potential for exposure to several known and potential carcinogens. Risks may be posed by work in clinics with poorly maintained X-ray equipment, by use of insecticides, and from contact with carcinogenic zoonotic organisms. Studies suggest that veterinarians have increased mortality from lymphohaematopoietic cancers, melanoma, and possibly colon cancer. Information gathered on the carcinogenic risks of these exposures has implications for many other occupations, in particular veterinary nurses, animal handlers and some farmers.
Occupational and Environmental Medicine, May 2000, Vol.57, No.5, p.289-297. 107 ref.

CIS 01-493 Dawn G., Gupta G., Forsyth A.
The trend of nickel allergy from a Scottish tertiary referral centre
To analyse the change in trend of allergic contact dermatitis (ACD) from nickel in a specialized medical centre, 800 and 860 patients were patch tested in 1982 and 1997, respectively. The frequency of positive reactions to nickel was 16% in 1982 and 22% in 1997. The commonest age of onset in 1982 was in the 11-20 year age group while in 1997, this was 1 decade later. In 1997, a much higher female preponderance (F:M=13:1) was observed than in 1982 (F:M=6:1). The rate of atopy in patients with nickel ACD showed an increase from 23% in 1982 to 33% in 1997. Nickel was considered to be a contributory factor in 27% of patients in 1982 and 24% patients in 1997. The most common occupations were hairdressing in 1982 and nursing in 1997. In 1997 a massive increase in the number of patients showing positive reactions to other allergens in addition to nickel was observed. In both years, the hands were the main sites of involvement. However, in 1997 there was an increase in the number of patients presenting with face and neck involvement.
Contact Dermatitis, July 2000, Vol.43, No.1, p.27-30. Illus. 28 ref.

CIS 01-505 Lindberg M., Silverdahl M.
The use of protective gloves and the prevalence of hand eczema, skin complaints and allergy to natural rubber latex among dental personnel in the county of Uppsala, Sweden
To evaluate the prevalence of acrylate allergy and natural rubber latex (NRL) allergy among dentists, dental nurses and dental hygienists were given a self-administered questionnaire. The most common problem among the 527 respondents was dry skin, fissures and/or itching of the hands. Of the 72 persons reporting to have suffered from hand eczema during the past 12 months, 41 were patch tested. In the patch-tested group, 9.8% reacted to one or more of the acrylates. In addition, 389 persons were tested for NRL allergy with the Pharmacia Upjohn CAP-RAST test, and of these, 7.2% were found to be positive. The prevalence of self-reported hand eczema and the number of positive CAP-RAST tests differed between the 3 occupations, with higher figures for the dentists. There was also a correlation between atopic eczema and hand eczema. Of those reporting skin symptoms, 67.7% associated them with the workplace and 28.8% with the use of gloves.
Contact Dermatitis, July 2000, Vol.43, No.1, p.4-8. 27 ref.

CIS 01-268 Wakui T.
Study on work load of matrons under shift work in a special nursing home for the elderly
For six healthy matrons in a special nursing home for the elderly (SNH), care working time, heart rate, walking steps, estimated energy expenditure and working time in different postures were determined during day and night shift work. Although the time on duty, working and recess were significantly longer in night shift work, the percentages of working and recess time to duty time were similar. The maximum, minimum and mean heart rate were similar. The estimated total energy expenditure was significantly higher in night shift work; however work intensity was significantly higher in day shift work. The longest length and larger percentage of working time were observed in standing posture in each shift work. These findings suggest that physical activity and energy expenditure of matrons under either shift work in the SNH are high.
Industrial Health, July 2000, Vol.38, No.3, p.280-288. Illus. 17 ref.

CIS 01-161 Wallenhammar L.M., Örtengren U., Andreasson H., Barregård L., Björkner B., Karlsson S., Wrangsjö K., Meding B.
Contact allergy and hand eczema in Swedish dentists
The occurrence of contact allergy, in particular in reaction to acrylates and methacrylates, was investigated. Certain consequences of hand eczema were evaluated by a questionnaire mailed to 3,500 Swedish dentists. Among respondents residing in three major cities, 14.9% reported hand eczema during the previous year and were invited to a clinical examination, including patch testing. 83% attended, among whom a diagnosis of hand eczema was confirmed in 94% of the cases. Irritant contact dermatitis was diagnosed in 67% and allergic contact dermatitis in 28%. On patch testing, 50% presented at least one positive reaction. The most frequent allergens were nickel sulfate, fragrance mix, gold sodium thiosulfate and thiuram mix. It is concluded that dentistry is a high-risk occupation for hand eczema, and that irritant contact dermatitis is most common. However, the prevalence of contact allergy to acrylates was below 1% in the population of responding dentists.
Contact Dermatitis, Oct. 2000, Vol.43, No.4, p.192-199. 31 ref.

CIS 00-1409 Kanerva L., Alanko K., Estlander T., Jolanki R., Lahtinen A., Savela A.
Statistics on occupational contact dermatitis from (meth)acrylates in dental personnel
During 1975-1998, 630 cases of occupational dermatosis in dental personnel were reported to the Finnish Register of Occupational Diseases, 70.6% of which were allergic. The number of cases greatly increased during the last decade. No cases of acrylates or methacrylates allergy were reported in 1975-1981. During 1982-1998, 161 cases were reported, 87% being allergic. The largest annual number of occupational dermatoses from acrylates and methacrylates in dental personnel were reported in 1998.
Contact Dermatitis, Mar. 2000, Vol.42, No.3, p.175-176. Illus. 14 ref.

CIS 00-1399 Shaham J., Levi Z., Gurvich R., Shain R., Ribak J.
Hematological changes in hospital workers due to chronic exposure to low levels of ethylene oxide
A cross-sectional study was conducted to determine whether occupational exposure to low levels of ethylene oxide can cause haematological abnormalities. Blood samples were collected from a group of 47 exposed hospital workers and a control group, individually matched by age, sex and smoking habits, consisting of 88 hospital administration employees. Significant differences were found between the exposed and the control group in the frequency of workers with white blood cells lower than the normal range. An elevation in the absolute mean number of monocytes and eosinophils and a decrease in the absolute mean number of lymphocytes in the exposed group compared with the control group was found. An elevation in the percentage of haematocrit and the mean absolute number of the red blood cells, and a decrease in the mean absolute number of platelets, in the exposed group compared with the control group were also observed. A positive dose-response was found between cumulative dose exposure and the absolute mean number of eosinophils.
Journal of Occupational and Environmental Medicine, Aug. 2000, Vol.42, No.8, p.843-850. Illus. 41 ref.

CIS 00-1042 Vincent C., de Mol B.
Safety in medicine
Studies suggest that about 4% of hospital patients are unintentionally harmed by treatment. Aimed at hospital managers, clinicians and others involved in healthcare, this publication shows how medicine and health care management can benefit from approaches to safety in other areas. These key issues are studied under four broad angles, namely: conceptual foundations of safety management; approaches to investigating the nature and frequency of safety problems; analyses of the causes of adverse outcomes and risks to patients; approaches to improving safety and reducing risk.
Elsevier Science Ltd., The Boulevard, Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom, 2000. xii, 268p. Illus. Bibl.ref. Index. Price: EUR 91.21 (USD 99.00).

CIS 00-552 Juntunen J.
Contagious diseases in the working environment - Part 3/5
This videotape is part of a series of five films on contagious diseases (HIV, hepatitis C and B, tuberculosis, etc.) in the working environment (see also CIS 00-550, CIS 00-551, CIS 00-553 and CIS 00-554). This film focuses on infection risk situations, which could be experienced by social workers, bailiffs, pharmacists and pharmacy employees, dentists and nurses, and which could give rise to the possibility of their becoming carriers of a contagious disease through contact with body fluids.
EURO TV-News/Educational films, PL 1243, 96101 Rovaniemi, Finland, 2000. Videotape (VHS) (length: approx. 30min).

CIS 00-551 Juntunen J.
Contagious diseases in the working environment - Part 2/5
This videotape is part of a series of 5 films on contagious diseases (HIV, hepatitis C and B, tuberculosis, etc.) in the working environment (see also CIS 00-550, CIS 00-552, CIS 00-553 and CIS 00-554). This film focuses on infection risk situations which could be experienced by nurses, real estate managers, agricultural workers, health inspectors as well as microbiology laboratory workers, and which could give rise to the possibility of their becoming carriers of a contagious disease through contact with body fluids.
EURO TV-News/Educational films, PL 1243, 96101 Rovaniemi, Finland, 2000. Videotape (VHS) (length: approx. 40min).

CIS 00-448 Saia B., Alessio L., Apostoli P., Bartolucci G.B., Campana C., Catenacci G., Garbelli C., Rabino F., Signorini A., Soave C.
Organization of health and safety activities in hospitals and health care units
Organizzazione delle attività di prevenzione e sicurezza nelle aziende sanitarie [in Italian]
A model for health and safety organization in health care units and hospitals is proposed, which takes into account the risk assessment procedures required by law and the quality assessment of the measures taken. A redefinition is given of the role of Medical Director and of the functions, aims and standards on which health and safety service and the services of an authorized occupational health physician must be based.
Medicina del lavoro, Jan.-Feb. 2000, Vol.91, No.1, p.61-72. 5 ref.

CIS 00-484 de Zotti R., Muran A., Negro C.
Follow-up of allergic symptoms among nurses sensitised to latex
Follow-up dei sintomi allergici in un gruppo di operatori sanitari sensibilizzati al lattice [in Italian]
Hospital workers sensitized to latex and complaining of respiratory symptoms at work were studied. All 28 subjects were women who had worked for 12 years in departments with high, moderate or low exposure to rubber gloves; 20 also complained of latex skin symptoms; 25 were atopical. The specific inhalation test with latex gloves confirmed the diagnosis of asthma in 4 cases and of rhinitis in 13 cases. The workers were reinvestigated 14 months later. Overall, improvement of skin symptoms were observed in 74% and of respiratory symptoms in 56% of the cases. The persistence of symptoms was significantly higher among workers who continued to work in departments with high or moderate latexglove exposure. The results show that skin and respiratory symptoms were related to the use of powdered latex gloves and confirm the importance of primary prevention.
Medicina del lavoro, Jan.-Feb. 2000, Vol.91, No.1, p.53-60. 24 ref.

CIS 00-395 Hernández Calleja A., Guardino Solá X.
Working conditions in health care centres
Condiciones de trabajo en centros sanitarios [in Spanish]
This publication consists of a compilation of theoretical and practical knowledge concerning the prevention of occupational diseases and accidents in health care centres. Main topics: occupational health and safety organization; exposure to chemicals; anaesthetic gases; ethylene oxide (sterilization); cytostatic agents; disinfectants; ionizing and non-ionizing radiation; biological agents; nosocomial (hospital-based) infections; waste management; ergonomics; physical workload; psychosocial factors (stress, shift work or night work); electrical hazards; fire protection; emergency plans; occupational medicine (medical surveillance, organization of first aid services).
Instituto Nacional de Seguridad e Higiene en el Trabajo, c/Torrelaguna 73, 28027 Madrid, Spain, 2000. 529p. Illus. 194 ref.

CIS 00-469 Finch T.M., Muncaster A., Prais L., Foulds I.S.
Occupational airborne allergic contact dermatitis from isoflurane vapour
Case report of a non-atopic anaesthetist with periorbital erythema and oedema who was initially patch tested to a standard series of products used in hospitals. He showed positive reaction to a number of allergens, including cetrimide. Despite strict avoidance of all the identified allergens, he remained symptomatic. The history suggested isoflurane could be responsible for this allergy. Repeated open application tests (ROAT) gave a positive result. The patient could not totally exclude occupational exposure isoflurane vapour; however, the use of protective eye wear has improved his symptoms.
Contact Dermatitis, Jan. 2000, Vol.42, No.1, p.46. 5 ref.

CIS 00-468 Kanerva L., Miettinen P., Alanko K., Estlander T., Jolanki R.
Occupational allergic contact dermatitis from glyoxal, glutaraldehyde and neomycin sulfate in a dental nurse
Case report of a non-atopic dental nurse with work-related hand dermatitis. Two patch test sessions gave positive reactions to glyoxal, glutaraldehyde and neomycin sulfate. The latter had been frequently used to treat her dermatitis. The sensitizations to glyoxal and glutaraldehyde were considered occupational. As the nurse had been exposed to both products, it is not clear if she developed cross-reactivity or concomitant sensitization.
Contact Dermatitis, Feb. 2000, Vol.42, No.2, p.116-117. 10 ref.

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