Healthcare Industries

Healthcare Industries

Tuesday, June 2, 2015, 10:30 AM - 12:30 PM

CS-114-01 The Effect of Microcystin Contamination on Drinking and Process Water in Healthcare​​

M. Valigosky, A. Ames, S. Milz, University of Toledo, Toledo, OH F. Akbar-Khanzadeh, UT HSC College of Medicine, Toledo, OH

Situation/Problem: Harmful algal blooms are a worldwide issue and on the rise in Lake Erie. The harmful algal blooms that have been increasing in severity over the last few years affect recreational boating, tourism, and commercial and recreational fishing. While microcystin is generally considered a water quality issue, there are significant public health concerns resulting in a financial burden to the health care industry. Acute effects of microcystin include nausea and diarrhea whereas chronic exposures are associated with illnesses such as liver cancer. On August 2, 2014, the City of Toledo issued a water advisory initially advising against drinking and/or dermal contact due to microcystin affected water. The levels of microcystin in the drinking water were reportedly above the World Health Organization guidelines of 1 part per billion (ppb).

Resolution: Normal microbiological contamination is typically removed by consumers through boiling or other means, however boiling water will not reduce or eliminate microcystin concentrations. Since microcystin is not easily removed from the treated city water, hospitals were forced to initially cease hemodialysis and elective surgeries. High temperature autoclaving of surgical instruments may result in concentrating the microcystin on the instruments that then contact internal tissues. It was necessary for the hospitals to obtain large volumes of water from alternate sources to allow for patient care, food preparation, and general use within the institutions.

Results: The response of the hospital to cancel elective surgeries resulted in financial issues. In general, hospitalizations involving surgery account for nearly half of a typical hospital’s revenue. Nearly $500,000 is lost per day in a typical 200 bed acute care hospital. In this case, the hospital confirmed that its reverse osmosis system for hemodialysis was operational and was able to resume dialysis treatments on the second day of the event.

Lessons Learned: Hospitals and the healthcare industry should be prepared to deal with a water advisory due to water affected by microcystin. This has potential to occur annually in Northwest Ohio until measures are taken to improve water quality of the western basin of Lake Erie accompanied by solutions at the water treatment facilities.

SR-114-02 Evaluation of Legionella Pneumophila Contamination in a Research Center’s Water System by Quantitative Real-Time PCR Isolation and Colony

J. Kominsky, Environmental Quality Management, Inc., Cincinnati, OH

Objective: This study defined the extent of water contamination by Legionella pneumophila in a research center’s water system and compared quantitative real-time polymerase chain reaction (QRT-PCR) with the conventional culture method “Gold Standard.”

Methods: Twenty-four potable water samples were collected in sterile 1-liter polypropylene bottles containing sodium thiosulfate to neutralize the residual-free chlorine. Fourteen sterile cotton-swab (Fishers FinestTM) samples were collected from biofilm on faucet aerators and other surfaces. Samples were processed within 48 hours of collection. Legionella was isolated using “Procedures for Isolation of Legionella from the Environment” (CDC 2005). Real-PCR analysis was performed based on sequences for detecting Legionella pneumophila patented by the U.S. EPA (U.S Patent 6,387,652). Samples were analyzed by a laboratory that successfully participates in the CDC ELITE Program.

Results: Legionella pneumophila was the only species of Legionella detected by QRT-PCR or by plate culture. Real-time PCR detected L. pneumophila serogroup-1 in 42% of water samples compared to 25% by conventional culture. Using conventional culture as the Gold Standard shows that QRT-PCR has a false-positive rate of 24% and a false-negative rate of 14% in potable water samples. Real-time PCR detected L. pneumophila serogroup-1 in 21% of surface swab samples compared to 14% by conventional culture. Using culture as the Gold Standard shows that QRT-PCR has a false-positive rate of 15% and a false-negative rate of 0% for surface swab samples. False-positive rates in QRT-PCR may be due to the presence of viable but non-culturable Legionella, or the presence of nonviable Legionella in the samples.

Conclusions: Real-time quantitative PCR is sensitive enough to detect lower level Legionella contamination in comparison to the culture method, but should be complemented by conventional culture. Real-time PCR could be particularly useful when an outbreak of Legionnaires’ disease occurs because of the short analysis time compared to conventional culture. False-positive readings of Legionella samples may overestimate the risk of infection and could lead to unnecessary decontamination procedures. Hence, positive QRT-PCR results must be interpreted with caution. A combination of thermal-eradication and copper-silver ionization effectively eradicated Legionella in the water system.

SR-114-03 Exposures to Waste Anesthetic Gases: Case Studies during Surgical Procedures

S. Derman, Medishare Environmental Health & Safety Services, Cupertino, CA

Objective: Nitrous oxide and halogenated agents (e.g. Sevoflurane, Desflurane, and Isoflurane) are utilized during surgical procedures to keep patients anesthetized. We evaluated exposures and compliance with NIOSH, ACGIH, and OSHA criteria using real time, direct reading instrumentation. Sources of significant leaks were promptly identified and promptly corrected to minimize exposures.

Methods: Real time exposure monitoring was conducted at over 200 locations during and following surgical procedures to evaluate exposures and identify the sources of significant/noteworthy exposures.

Results: Using primarily direct reading instrumentation, with NIOSH Sampling and Analytical Methods as back-up, exposures were evaluated, sources of noteworthy levels were identified, with prompt feedback to anesthesia and healthcare personnel. Exposures exceeding the NIOSH REL were identified 5% to 7% of the time. Working in conjunction with Anesthesia and healthcare facility personnel, all significant exposure sources were rectified within twenty-four hours of identification.

Conclusions: This is a highly efficient and effective method of evaluating and controlling exposures. Surgery, Anesthesia, Nursing, and Facilities personnel must understand and support the rationale and methods used by the industrial hygienist. The industrial hygienist must understand and apply infection control and surgical techniques and processes. The IH must also have the presence of mind and mindset to work in highly stressful, critical care environments to make this process work.

CS-114-04 Balancing Patient and Employee Safety: Peracetic Acid Use during Disinfection in Healthcare

M. Squillace, Mayo Clinic, Rochester, MN; M. Austin, Mayo Clinic, Rochester, MN; J. Nesbitt, Mayo Clinic, Rochester, MN

Situation/Problem: Healthcare-associated infections (HAI) represent a significant burden to patients and to the entire healthcare industry. It is estimated that in 2011, approximately 1 in 25 hospital patients had at least one HAI and approximately 75,000 of those patients died during hospitalization. Efforts to control HAIs have resulted in new disinfectants and novel applications of existing disinfectants which are being marketed to healthcare. This case study provides an overview of a pilot project using a novel peracetic acid solution, marketed for daily cleaning and disinfection. The project team included representatives from Environmental Services, Infection Prevention, Safety, Industrial Hygiene, Facilities Engineering/Maintenance, and the chemical Manufacturer. The pilot project was initiated on three patient care units, strictly following manufacture recommendations. During this pilot project, management received numerous concerns about pungent odors, dermal and respiratory irritation during use of the disinfectant by Environmental Services staff. In 2014, ACGIH published a TLV STEL of 0.4 PPM for Peracetic Acid based on upper respiratory tract, eye, and skin irritation.

Resolution: An industrial hygiene assessment was performed during dispensing and cleaning operations with a commercially available peracetic acid cleaner/disinfectant. 

Results: The use of peracetic acid during cleaning and dispensing operations resulted in exceedance of the ACGIH TLV in the majority of samples. The pilot project was immediately discontinued and staff informed of exposure data and exposures exceeding the TLV.

Lessons Learned: Lack of familiarity of the sampling method and new TLV by staff, the analytical laboratory, manufacturer of the disinfectant, and the manufacturer of the sampling media led to delays with obtaining valid exposure assessment samples. A flexible, yet comprehensive strategy was needed to evaluate the health and safety implications for introducing new disinfectants into the workplace. 

CS-114-05 Proactive Mitigation to an Anticipated Increase in Occupational Injuries When Opening a New Healthcare Facility

A. Jouras, EORM, San Jose, CA

Situation/Problem: Opening a new healthcare facility is a challenging undertaking that involves managing a variety of new workplace hazards such as the new space design, new equipment, new workflows, staffing changes, etc.

Resolution: While employees naturally figure out the most efficient way to execute their job over time, they inherently lose some of that efficiency when moving to a new space because of these factors.

Results: As employees implement different workarounds to try to regain their lost efficiency as they adjust to the new facility, there is an increased potential for occupational injuries due to both unsafe work practices and unforeseen workflow hazards.

Lessons Learned: During this case study review of opening a new healthcare facility in the California San Francisco Bay Area, we will discuss how implementing a proactive approach to workflow analysis prior to the facility opening can help identity and mitigate unanticipated hazards and prevent an increase in occupational injuries after operations begin.

SR-114-06 Anti-Oxidant Rich Diet, Healthy Life-Style and a Rigorous Radiation Exposure Control Program Protect Healthcare Employees from Radiation-Induced Oxidative Damage

R. Bardhan, M. Richard, R. Heath, E. Maples, C. Lungu, University of Alabama at Birmingham, Hoover, AL

Objective: Reactive oxygen species (ROS) are defined as free radicals of oxygen and hydroxyl ions which at higher concentration create oxidative stress and may cause many diseases including cancer. Antioxidants act to inactivate ROS and minimize oxidative stress. Ionizing radiation (IR) is one of the main sources of ROS generation. Several studies have indicated that prolonged exposure to low dose IR causes ROS generation in cancer patients and preclinical animal models. This pilot study determined potential health risks associated with oxidative stress due to long-term low-dose IR exposure in healthcare personnel in a university hospital setting. The present study also analyzed the effects of dietary habits and lifestyles in radiation-induced oxidative stress.

Methods: Participants were chosen from a healthcare workforce occupationally exposed to IR for more than 10 years. Employees in the non-radiation sector were included as study controls. A total of 30 participants were included in the study following receipt of IRB approval. Responses to study related questionnaires and informed consents were obtained prior to clinic visit. Exposures to IR (measured by personal dosimeter) were obtained from the University Radiation Safety Department. Oxidative Stress is directly measured by intracellular ROS level in the blood erythrocytes and indirectly by decrease in total antioxidant level in urine samples. Genotoxicity was determined from the buccal smears by micronucleus test. Data were analyzed by performing logistic regression and unpaired Student’s t-test. Odds ratios and 95% confidence intervals were calculated. Results were considered significant if p-value is less than 0.05.

Results: Participants’ radiation exposures were below NRC whole body maximum permissible limit (5000 mrem/year). No significant differences were observed between experimental and control participants regarding ROS, anti-oxidant levels, and micronucleus. Responses to questionnaire indicated regular consumption of anti-oxidant rich diet (fruits, vegetables, nutritional supplements) and practicing healthy life-style (nonsmokers, nonalcoholic, regular exercise) by the participants.

Conclusions: Results indicated that regular consumption of antioxidant rich diet, practicing healthy life-style and implementation of a rigorous radiation exposure control program might protect radiation workers from the harmful effects of ROS following long-term low dose radiation exposure.​