Risk factors for latex sensitization among health care workers.

Health care workers, children with spina bifida and rubber industry workers show higher prevalence of latex sensitization compared to the general population, and they are considered at-risk groups. Our aim was to establish the prevalence of latex allergy among health care workers at the Clínica Universitaria of Navarra and to analyze potential risk factors, including personal and family history of atopy, sex, as well as factors leading to enhanced exposure to latex, such as being a nurse, belonging to surgical departments, having undergone previous surgery and the number of gloves employed per week. Health care workers (n = 1,150) (doctors, nurses, assistant nurses, laboratory technicians and practicing medical and nursing students) were evaluated using a questionnaire and skin prick test (SPT). Serum specific IgE was determined by CAP-FEIA (Pharmacia, Sweden) in those with positive SPT. The participation index was 26.17%: 301 volunteers answered the questionnaire and underwent SPT. Fifteen subjects presented positive SPT to latex. It was found that 5% of the health care workers from the Clínica Universitaria were sensitized to latex allergens. Thirteen were females and two males. Mean age was 38.4 (+/- 7.09) years. Nine were nurses, three assistant nurses, one nursing student and two medical doctors. Eight belonged to medical, five to surgical and two to laboratory departments. There were no significant differences among the subjects in the prevalence of latex sensitization. Fourteen reported symptoms related to latex, mostly pruritus, dryness and/or redness of the hands (n = 12) and rhinitis (n = 6). Only one subject reported no symptoms when using latex products. Eight were atopic; personal history of atopy was the only significant (odds ratio = 5.10, p < 0.01) risk factor for latex sensitization. It was concluded that atopic health care workers show a more increased risk of latex sensitization than those who are nonatopic.     

Screening for latex sensitization by questionnaire: diagnostic performance in health care workers.

BACKGROUND: Latex allergy has emerged as a major cause of allergic reactions in health care workers. However, information is limited regarding the diagnostic methods available. OBJECTIVE: The aim of this study was to investigate diagnostic performance (sensitivity, specificity, and predictive values) of screening for natural rubber latex sensitization by questionnaire among health care workers, using skin prick test (SPT) as the gold standard for diagnosis. METHODS: The study population consisted of 260 randomly selected health care workers from the public health units in the city of Florianopolis, Brazil. The subjects were recruited from 2 groups: those who used latex gloves in their work (140) and those who were not exposed to latex (120). The mean (SD) age of the study population was 38.6 (0.6) years. Logistic regression analysis was used to predict SPT result from the questionnaire on previous symptoms of latex sensitization. RESULTS: Symptoms of (1) dryness, fissuring, swelling, pruritus, or cutaneous rash on the hands, and (2) pruritus of the oral mucosa or local redness after eating certain fruits (avocados, bananas, kiwis, chestnuts, mango, melons, or peaches) were the most sensitive and specific questionnaire items, respectively. The combination of these items with a cutoff point derived from the logistic regression led to 100% sensitivity and specificity for the prediction of SPT results in the population studied, with 95% confidence intervals of 51.7% to 100% for sensitivity and 98.1% to 100% for specificity. CONCLUSION: A questionnaire applied in a group of health care workers displayed excellent screening performance for latex sensitization.     

Using peer feedback to improve handwashing and glove usage among Thai health care workers

BACKGROUND: Without protective practices such as Universal Precautions, health care workers are at substantial risk for bloodborne infection, especially in areas such as Thailand with high prevalence of HIV infection. The purpose of this study was to evaluate the effectiveness of a peer feedback program (PFP) on handwashing and glove wearing (HW/GW) among Thai health care workers. METHODS: Subjects (N = 91) were randomly assigned to receive PFP versus no treatment. By using a checklist, peer observers rated HW/GW compliance in their coworkers during patient care. For 1 month, the investigator posted a report of compliance behaviors from each 3 days of observations. HW/GW was also assessed by the investigator by direct observation at 1 month before the intervention, during the intervention period, and 1 month after the intervention. RESULTS: Baseline HW/GW rates for the PFP and control groups were 49.2% and 61.5%, respectively. The PFP group had a significantly higher adjusted compliance rate than the control group during the intervention period (P =.0001). However, there was no significant difference in the compliance scores obtained 1 month after the intervention. CONCLUSIONS: The PFP was effective during the intervention period, but there was no retention of effect. Therefore, adjunct methods should be sought to promote retention of effect.     

重症监护室医院获得性肺炎发病及预后危险因素分析

目的 了解教学医院监护室（ＩＣＵ）内获得性肺炎的发病及预后危险因素，为制定相应防治措施作参考。方法 以近２年上海中山医院外科监护室（ＳＩＣＵ）、呼吸监护室（ＲＩＣＵ）及华山医院综合监护室（ＧＩＣＵ）１０８例医院获得性肺炎及同期各ＩＣＵ未发生肺为的５０例患为对象，采用回顾性病例对照分析，用ＳＰＳ软件，作Ｌｏｇｉｓｔｉｃ回归，筛选和分析ＩＣＵ相关危险因素。结果 综合分析医院内获得性肺炎（ＨＡＰ）发病     

Prevalence and risk factors for latent tuberculosis infection among health care workers in Georgia.

BACKGROUND: Tuberculosis (TB) is a major public health problem in Georgia, but few TB infection control measures have been implemented in health care facilities. OBJECTIVE: To assess the prevalence and risk factors for latent TB infection (LTBI) among Georgian health care workers (HCWs) using two diagnostic tests, the tuberculin skin test (TST) and the QuantiFERON-TB Gold In Tube test (QFT-3G), an interferon-gamma release assay. METHODS: A cross-sectional study was conducted between June and August 2006 among HCWs at the Georgian National TB Program. RESULTS: Of 265 HCWs enrolled, 177 (67%) had a positive TST and 159 (60%) had a positive QFT-3G; 203 (77%) had a positive result for at least one of the tests and 50% tested positive for both tests. There was moderately good agreement between the tests (74%, kappa = 0.43, 95%CI 0.33-0.55). In multivariate analysis, employment for >5 years was associated with increased risk of a positive TST (OR 5.09, 95%CI 2.77-9.33) and QFT-3G (OR 2.26, 95%CI 1.27-4.01); age >30 years was associated with an increased risk of a positive QFT-3G (OR 2.91, 95%CI 1.32-6.43). DISCUSSION: A high prevalence of LTBI was found among Georgian HCWs and longer duration of employment was associated with increased risk. These data highlight the need for effective TB infection control measures and provide important baseline information as TB infection control measures are implemented.     

Latex and vinyl examination gloves. Quality control procedures and implications for health care workers

In December 1987, we investigated an increased number of cases of herpetic whitlow in medical intensive care unit nurses who routinely gloved for secretion contact. One particular brand of vinyl examination glove had been used in the medical intensive care unit. Restriction endonuclease mapping established the similarity of employee isolates with one patient isolate of herpes simplex virus type I. When initial viral assay demonstrated 2.5% to 10% penetration of herpes simplex virus type I across unused gloves, an evaluation of glove quality was undertaken. In a 300-mL watertightness test, seven brands of vinyl gloves failed 4% to 28% (average, 11.1%; 132/1200), while seven brands of latex gloves failed 0% to 2.6% (average, 1.4%; 24/1750). The brand of vinyl glove that had been in use in the medical intensive care unit failed 28% of the time. Watertight gloves were then tested for permeability to herpes simplex virus type I. None of the latex gloves failed (n = 1726), while only 10 of the vinyl gloves failed (n = 1068, 0.95%). Extreme variability in glove quality was observed. However, gloves made from intact vinyl may provide similar protectiveness as those made from intact latex. As the demand for gloves increases, emphasis should be placed on the production of plentiful, better quality latex and vinyl gloves.     

Occupationally acquired infectious diseases among health care workers in Brazil: use of Internet tools to improve management, prevention, and surveillance

BACKGROUND: Education is a major component of prevention strategies to reduce the risk of occupational transmission of bloodborne pathogens to health care personnel. METHODS: This study describes the results of an Internet-based project, "Projeto Riscobiologico.org", for which the main objectives are to disseminate information in the Portuguese language about occupational exposures to bloodborne pathogens through a mailing list and Web site as well as to increase case reports of these events in Brazil. RESULTS: The mailing list expanded quickly with a total of 2078 participants (from 337 different cities and all Brazilian states), and 5613 messages were exchanged over a 5-year period. Mean length of participation was almost 2 years (697 days). Most of the participants (74%) reported that they frequently manage occupational exposures. Nevertheless, results showed an important lack of basic knowledge regarding this issue. In contrast with the high participation in the mailing list, a small number of institutions started to participate in the voluntary surveillance system. CONCLUSION: The Internet can be used as a tool to increase knowledge and improve practices in the prevention of occupational bloodborne pathogen exposures. In addition, it may represent a unique opportunity to implement a national surveillance system.     

Prevalence and risk factors of latent tuberculosis infection among health care workers in Malaysia

Background  

Health care workers are exposed to patients with tuberculosis and are at risk of nosocomial infection. The aim of this study was to determine the prevalence and factors associated with latent tuberculosis infection among health care workers in Malaysia and also to evaluate the agreement between Quantiferon TB Gold in tube test with Tuberculin Skin Test.     

Prevalence of latex sensitization in health care workers of a general hospital in Palermo, Sicily.

STUDY OBJECTIVE: To assess the prevalence of latex sensitization in a group of hospital employees in a general hospital. DESIGN: Cross-sectional study on hypersensitivity to latex gloves among health-care workers. SETTING: A general hospital in Palermo, Sicily. PATIENTS: 196 health-care workers answered a questionnaire about their case history of allergic diseases (i. e., rhinitis and/or asthma) and about symptoms after wearing latex gloves. All subjects were tested by skin prick test (SPT) with commercial latex extract and aeroallergens and had blood draw for total serum IgE and latex-specific IgE testing and glove-use test. MAIN RESULTS: 42% of the subjects who answered the questionnaire reported at least one symptom after wearing latex gloves. All symptoms were local, and none of the subjects reported systemic reactions. The most common symptom was itching, but none of subjects with only itching presented a positive SPT or specific serum IgE to latex. The SPT to latex was positive in 19 of 196 subjects (9.7%). Specific IgE to latex were found in 15/196 subjects (7.6%). Glove-use test was positive in 14/196 (7.1%). CONCLUSIONS: The overall prevalence of latex sensitivity in health-care workers in our epidemiological setting is 7.1%. An accurate diagnosis must take in account the integration of in vivo and in vitro tests with previous history of allergic disease.     

High risk of tuberculosis in health care workers in Romania.

SETTING: The main university hospital in Iasi, Romania. OBJECTIVE: To assess whether health care workers (HCWs) have a higher risk of acquiring tuberculosis (TB) than the general population, and if TB incidence varies between departments, to develop adequate infection control measures. DESIGN: All records of TB cases among HCWs were reviewed by cross-checking laboratory and medical records (retrospectively, 1971--1996; prospectively 1997--2003, following the implementation of the first World Health Organization pilot project in Romania). Annual TB incidence rates among HCWs were calculated and compared with those of the general population; relative and attributable risk with 95% confidence intervals (CI) were calculated. RESULTS: Fifty TB cases were diagnosed in HCWs; 42% were nurses, 24% ancillary staff, 12% physicians, 10% laboratory staff, 10% administrative staff and 2% radiology technicians. The mean incidence of TB in Romania during the study period was 96.8 per 100,000 persons/year (95%CI 83.5-110.1); the mean incidence among HCWs was 942.8/100,000 persons/year (95%CI 726.3-1159.3, P < 0.001); comparing the two previous absolute risks, the mean relative risk was 11 (95%CI 8-14) and the attributable risk 846. CONCLUSION: TB is a major occupational hazard in Iasi, Romania, where a great potential exists for further development of an effective infection control plan.     

Latex gloves use and symptoms in health care workers 1 year after implementation of a policy restricting the use of powdered gloves

BACKGROUND: Latex sensitization related to glove use is a complex problem, and glove use policies that restrict exposure to powdered latex gloves alone may not provide adequate safety. This study explored health care workers' (HCWs') latex glove use and reports of related health symptoms 1 year after implementation of the latex glove replacement policy. METHODS: Two cross-sectional surveys. One was a population-based survey of HCWs at the institution (National Surveillance System for Hospital Health Care Workers); the second, a detailed survey of HCWs stratified by exposure to latex gloves (Latex Symptom Survey). RESULTS: The prevalence of symptoms of dermatitis reported by latex glove users was 40.3% (National Surveillance System for Hospital Health Care Workers) and 50.0% (Latex Symptom Survey). Symptom reports increased as exposure to latex gloves increased (pairs used per day, occupations with more glove use, working in higher exposure areas, more tenure, and more hours of use per day). Aerosol symptoms and urticaria related to latex glove use were reported much less frequently than were rash, chapping, itching, or redness. HCWs, even those with skin symptoms, continued to choose latex gloves in more than 80% of the cases. CONCLUSIONS: Stepwise preplacement evaluation at employee health clinics is recommended to identify and protect employees sensitized to latex. The medical community needs more understanding and education about latex gloves, latex sensitization, and available alternatives.     

Glove use by health care workers: results of a tristate investigation.

The Center for Devices and Radiological Health, in collaboration with the state health departments of Iowa, Maryland, and Massachusetts, conducted a multi-state, multi-institutional investigation of glove use by health care workers (HCWs). Twenty-two hospitals and four ambulatory care centers were included in the investigation. All 26 health care facilities were found to have adopted universal precautions policies for glove use by HCWs, per Centers for Disease Control guidelines. Four hundred five observations were made of HCWs performing procedures that may involve contact with patient body fluids, particularly blood. The prevalence of glove use during selected procedures was as follows: arterial blood gas procedures, 92.3%; intravenous line initiation/maintenance, 77.6%; and phlebotomy, 70.6%. Glove use during phlebotomy (p less than 0.001) and intravenous line procedures (p less than 0.05) was significantly lower in the state with a prevalence of the acquired immunodeficiency syndrome (AIDS) below the national average than in the states with a higher AIDS prevalence. The investigation suggests that health care facilities have responded to the Centers for Disease Control and Occupational Safety and Health Administration campaign to adopt universal precaution policies for glove use by HCWs. Actual glove use by HCWs appears to be substantial but not universal. Glove use by HCWs is significantly related to statewide AIDS prevalence.     

Delayed access to health care: risk factors, reasons, and consequences

OBJECTIVE: To determine characteristics of patients reporting delays in care before hospitalization and the reasons for those delays. DESIGN: Survey; personal interviews. SETTING: Five hospitals in Massachusetts. PATIENTS: Subjects were drawn from a consecutive sample of all adult patients (excluding obstetrics or psychiatry patients) hospitalized during the first 6 months of 1987 as part of a larger study of hospital costs. For the current study, if patients were re-admitted, we included in our analysis only data on the first admission during the study period. We obtained usable survey data from 12,068 of 17,231 eligible patients. RESULTS: Delays in care were reported by 16% of patients. The odds of reporting delays in care among patients who were black, poor, uninsured, or without a regular physician were 40% to 80% greater than those for other patients (P less than 0.01). Most patients who reported delays thought that their problem was not serious (64%). Cost was an important factor in delaying care for patients in lower socioeconomic positions; the odds of delaying care because of cost for patients who were both poor and uninsured were 12 times greater than the odds for other patients (P less than 0.001). After controlling for diagnosis-related groups (DRGs) and severity, patients who reported delays had 9% longer hospital stays compared with others (P less than 0.001). CONCLUSIONS: Patients generally thought to be disadvantaged are at especially high risk for delaying care for conditions that eventually lead to hospitalization. Because these delays are associated with longer hospital stays and potentially poorer health outcomes, interventions that reduce delays seem especially important.     

Occupational HIV infection among health care workers exposed to blood and body fluids in Brazil

BACKGROUND: Exposure to bloodborne pathogens poses a serious risk to health care workers (HCWs). Surveillance systems of occupationally acquired human immunodeficiency virus (HIV) infection have been developed in several countries, mainly in the developed world. The purpose of this study was to identify cases of occupationally acquired HIV infection among HCWs in Brazil. METHODS: A systematic literature review was conducted. The databases searched were MEDLINE and LILACS (1981 to 2004), academic dissertations and theses (1987 to 2004), abstracts from national and international meetings during the last 10 years, and local and national bulletins. Reference lists to identify other relevant articles were checked. RESULTS: The database searches generated a total of 60,770 titles. Two hundred and nineteen references were finally analyzed. Four documented cases of occupational HIV infection were identified. All of the cases involved nursing staff and were percutaneous exposures. Seventy-five percent occurred after a procedure involving a needle placed directly into a vein or artery. Most (75%) had source patients with probable high viral load and low CD4 count. Two cases represented HIV seroconversion despite initiation of postexposure prophylaxis. Only one case (1/4; 25%) presented acute retroviral illness. CONCLUSION: After an extensive literature search, 4 documented occupational HIV infection cases were identified, only 1 of which had been published in a scientific journal. Our findings were consistent with the majority of documented infections worldwide. Surveillance systems are indispensable to establish and formulate rational policies for minimizing the risk of occupational infection, not only from HIV but also from hepatitis B and C viruses and other bloodborne pathogens.     

Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis. A risk to patients and health care workers.

OBJECTIVE: To determine the factors associated with the development of multidrug-resistant tuberculosis among patients at a New York City Hospital and to investigate possible nosocomial transmission. DESIGN: A retrospective case-control study and tuberculin skin test survey. PATIENTS: Twenty-three patients with tuberculosis whose isolates were resistant to at least isoniazid and rifampin (case patients) were compared with patients with tuberculosis whose isolates were susceptible to all agents tested (controls). Tuberculin skin test conversion rates were compared among health care workers assigned to wards where patients with tuberculosis were frequently or rarely admitted. SETTING: A large, teaching hospital in New York City. MEASUREMENTS: Mycobacterium tuberculosis isolates from case patients and controls were typed by restriction fragment length polymorphism analysis. RESULTS: Case patients were younger (median age, 34 compared with 42 years; P = 0.006), more likely to be seropositive for HIV (21 of 23 compared with 11 of 23 patients; odds ratio, 11.5; 95% CI, 1.9 to 117), and more likely to have had a previous hospital admission within 7 months before the onset of tuberculosis (19 of 23 compared with 5 of 23 patients; odds ratio, 17.1; CI, 3.3 to 97), particularly on one ward (12 of 23 compared with 0 of 23 patients; odds ratio, undefined; P = 0.002). Health care workers assigned to wards housing case patients were more likely to have tuberculin skin test conversions than were health care workers assigned to other wards (11 of 32 compared with 1 of 47 health care workers; P less than 0.001). Few (6 of 23) case patients were placed in acid-fast bacilli isolation, and no rooms tested had negative pressure. Of 16 available multidrug-resistant isolates obtained from case patients, 14 had identical banding patterns by restriction fragment length polymorphism analysis. In contrast, M. tuberculosis isolates from controls with drug-susceptible tuberculosis had patterns distinct from each other and from those of case patients. CONCLUSIONS: These data suggest nosocomial transmission of multidrug-resistant tuberculosis occurred from patient to patient and from patient to health care worker and underscore the need for effective acid-fast bacilli isolation facilities and adherence to published infection control guidelines in health care institutions.