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Mycobacteria in drinking water distribution systems: ecology and significance for human health.

In contrast to the notorious pathogens Mycobacterium tuberculosis and M. leprae, the majority of the mycobacterial species described to date are generally not considered as obligate human pathogens. The natural reservoirs of these non-primary pathogenic mycobacteria include aquatic and terrestrial environments. Under certain circumstances, e.g., skin lesions, pulmonary or immune dysfunctions and chronic diseases, these environmental mycobacteria (EM) may cause disease. EM such as M. avium, M. kansasii, and M. xenopi have frequently been isolated from drinking water and hospital water distribution systems. Biofilm formation, amoeba-associated lifestyle, and resistance to chlorine have been recognized as important factors that contribute to the survival, colonization and persistence of EM in water distribution systems. Although the presence of EM in tap water has been linked to nosocomial infections and pseudo-infections, it remains unclear if these EM provide a health risk for immunocompromised people, in particular AIDS patients. In this regard, control strategies based on maintenance of an effective disinfectant residual and low concentration of nutrients have been proposed to keep EM numbers to a minimum in water distribution systems.

Amoeba↗

Medical office automation integrated into the distributed architecture of a hospital information system.

Patient histories, discharge summaries, and medical consultant reports are made up of written texts. Therefore, the gathering and archiving of these texts in machine-readable form has many characteristics of computer-based medical records. In Geneva, approximately 1,540 PCs are connected to the Hospital Information System DIOGENE 2, with the possibility of accessing all the functions offered by the system without losing any of their MS-DOS word processing capabilities. The UNIDOC system, presented in this paper, takes all these features into account, a real marriage of technologies between the MS-DOS environment and the distributed client-server architecture. The INGRES database management system supports the entire archiving process of the medical patient texts, structured by prelabelled paragraphs and automatically indexed. Both the quality and accessibility of the records are enhanced, while the archiving capacity is neither too limited nor too expensive.

Archives↗

Hospital food service: a comparative analysis of systems and introducing the 'Steamplicity' concept.

BACKGROUND: Patient meals are an integral part of treatment hence the provision and consumption of a balanced diet, essential to aid recovery. A number of food service systems are used to provide meals and the Steamplicity concept has recently been introduced. This seeks, through the application of a static, extended choice menu, revised patient ordering procedures, new cooking processes and individual patient food heated/cooked at ward level, to address some of the current hospital food service concerns. The aim of this small-scale study, therefore, was to compare a cook-chill food service operation against Steamplicity. Specifically, the goals were to measure food intake and wastage at ward level; 'stakeholders' (i.e. patients, staff, etc.) satisfaction with both systems; and patients' acceptability of the food provided. METHOD: The study used both quantitative (self-completed patient questionnaires, n = 52) and qualitative methods (semi-structured interviews, n = 16) with appropriate stakeholders including medical and food service staff, patients and their visitors. RESULTS: Patients preferred the Steamplicity system overall and in particular in terms of food choice, ordering, delivery and food quality. Wastage was considerably less with the Steamplicity system, although care must be taken to ensure that poor operating procedures do not negate this advantage. When the total weight of food consumed in the ward at each meal is divided by the number of main courses served, at lunch, the mean intake with the cook-chill system was 202 g whilst that for the Steamplicity system was 282 g and for the evening meal, 226 g compared with 310 g. CONCLUSIONS: The results of this small study suggest that Steamplicity is more acceptable to patients and encourages the consumption of larger portions. Further evaluation of the Steamplicity system is warranted.

Adult↗

Evaluation of a computer-directed pneumatic-tube system for pneumatic transport of blood specimens.

The results of sending specimens through a computerized pneumatic airtransport system and manually delivering specimens were compared for 15 chemical tests and six hematologic procedures. All specimens were collected from inpatients and outpatients into evacuated glass containers. The specimens traversed a maximum of 829 feet (253 meters) involving 16 bends and eight transfer units at 25 feet/second (7.6 meters/second). Only the activity of lactate dehydrogenase exceeded the precision of the test in pneumatically transported specimens. Ruptured erythrocytes in incompletely filled vacuum tubes were the likely source of the increased lactate dehydrogenase activity. Neither the serum sodium, potassium, chloride, carbon dioxide, total protein, albumin, calcium, glucose, creatinine, total bilirubin, alkaline phosphatase, aspartate transaminase, acid phosphatase, uric acid, leukocyte count, erythrocyte count, hemoglobin, hematocrit, nor the prothrombin time and partial thromboplastin time were affected by pneumatic transport. It is concluded that the pneumatic system tested provides a safe, efficient method of transporting the blood specimens tested.

Blood Specimen Collection↗

Energy costs in food delivery calculated.

Identifying the energy costs and the 10-year life-cycle costs of available food delivery systems helped a hospital to select its new system.

Conservation of Energy Resources↗

Use of a pneumatic tube system for delivery of blood bank products and specimens.

This study evaluated the effect of pneumatic tube transport on blood bank specimens and products. No important differences were found between aliquots transported in the tube system and those stored in the laboratory as controls. ABO, Rh, antibody detection or identification, direct antiglobulin testing, and elution were studied. Further, no differences in plasma hemoglobin and potassium concentration were found between units of whole blood and packed cells handled in either manner. Platelet counts in platelet concentrates were not decreased and coagulation factor levels in units of fresh-frozen plasma and cryoprecipitate did not decrease after pneumatic transport. The system tested is currently providing expeditious transport of specimens and blood between blood banks and patient care areas.

Blood Banks↗

The societal unit cost of allogenic red blood cells and red blood cell transfusion in Canada.

BACKGROUND: There is a dearth of information about the cost of allogenic red blood cells (RBCs) and RBC transfusion in Canada in the aftermath of the Canadian blood system reorganization and the introduction of various safety measures. The unit cost of allogenic RBCs and RBC transfusion in Canada in 1994 was estimated at 152.17 US dollars. The objective of this study was to determine the unit cost of allogenic RBC transfusion in Canada from a societal perspective. STUDY DESIGN AND METHODS: A cost-structure analysis using the cost information from 2001 through 2002 was used. Costs of blood collection, production, distribution, delivery (hospital transfusion service processing and patient administration), transfusion reaction management, and opportunity cost of donor's time were included in the analysis. Canadian Blood Services and Héma-Québec supplied the data for collection, production, and distribution stages. Delivery and transfusion reaction costs were collected from eight hospitals across six Canadian provinces. In-patient costs were assessed for the intensive care unit, emergency, general medicine ward, and operating room. RESULTS: The aggregate mean societal unit cost of RBCs transfused on an inpatient basis in 2002 was 264.81 US dollars (95% confidence interval [CI], 256.29 dollars-275.65 dollars). The mean cost of blood collection, production, and distribution was 202.74 US dollars (95% CI, 199.63 dollars-204.31 dollars), the mean opportunity cost of donor time was 18.21 US dollars (95% CI, 17.11 dollars-21.63 dollars), the mean cost of hospital transfusion service processing was 16.65 US dollars (95% CI, 13.50 dollars-19.79 dollars), of RBC transfusion was 26.92 US dollars (95% CI, 25.33 dollars-28.52 dollars), and of transfusion reaction management was 0.29 US dollars(95% CI, 0.22 dollars-0.36 dollars). There were substantial variations in hospital transfusion service processing and RBC transfusion costs across hospitals. CONCLUSION: The societal unit cost of RBC transfusion has doubled since 1994 to 1995. Further increases in unit costs would be expected as additional safety measures are introduced. This will have important financial implications for treating patient populations that require a high level of RBC transfusions.

Blood Banks↗

Goods handling: tugs, trailers and tractors.

Ease of handling ought to be a priority in any supply and disposal system. Hazel Grayson, senior research officer at the Medical Architecture Research Unit, Polytechnic of North London, suggests that even where driver-operated electric tow tractors cannot be used, other types of electric pulling device should be considered.

Equipment and Supplies, Hospital↗

Evaluation of a soft-handling computerized pneumatic tube specimen delivery system. Effects on analytical results and turnaround time.

A computerized pneumatic tube specimen delivery system with system-wide air cushion soft handling features was evaluated. There were no significant differences in values (largely normal) for components of a standard chemical profile or complete blood count in specimens delivered from the outpatient center or neonatal intensive care unit by pneumatic tube compared to couriers. The pneumatic tube system also did not affect values for pO2, pCO2, and pH over a wide range (pO2, 25 to 438 mmHg) in specimens sent from the operating room during cardiac surgery. The pneumatic tube system decreased the median turnaround time for potassium and hemoglobin results on specimens from the emergency department by 25%. The system evaluated is a rapid, efficient mechanism for sending specimens to the clinical laboratory that produces no significant effects on analytical results and has the ability to decrease turnaround time.

Blood Cell Count↗

Persistent Legionella pneumophila colonization of a hospital water supply: efficacy of control methods and a molecular epidemiological analysis.

After a nosocomial outbreak caused by Legionella pneumophila serogroup 5, the hospital water distribution system, which was found to be colonized by L. pneumophila serogroups 5 and 6, was decontaminated by the superheat and flush method and by installing an additional heat-shock unit in one of the hot water circuits. This unit exposed the recirculated water to a temperature of 80 degrees C. The efficacy of the decontamination measures was evaluated by monitoring the temperatures and legionella concentrations at different parts of the hot water distribution system. The genetic diversity of the colonizing legionella flora was examined using two genotyping methods: amplified fragment length polymorphism analysis (AFLP) and random amplified polymorphic DNA (RAPD) analysis. Selected serogroup 6 strains were also analyzed by sequence-based typing (SBT). The results indicated that long-term eradication of serogroup 5 strains was never achieved. Only one serogroup 6 strain was never isolated after the superheat and flush. In all, according to genetic fingerprints, the diversity of Legionella strains in a hospital water system remains stable over the years regardless of the use of recommended disinfection procedures.

Bacterial Typing Techniques↗

Emergency transport of AS-1 red cell units by pneumatic tube system.

We present a study in which 14 units of AS-1 red blood cells (AS-1RBC) were transported by the Trans-Logic 620 (Denver, CO) pneumatic tube system to determine whether the system could be used without risk of significant hemolysis. Using standard hematologic parameters we detected negligible hemolysis and conclude that the Trans-Logic 620 system can be used to transport AS-1RBC. This may provide time- and labor-saving benefits generalizable to more than 250 U.S. hospitals which presently operate the Trans-Logic 620.

Blood Banks↗

[New blood transfusion system of the Saku Central Hospital--present conditions and problems].

BACKGROUND: It is important for a hospital to have a well organized blood transfusion service. METHODS: Our hospital adopted the maximum surgical blood order schedule (MSBOS) and type and screen (T & S) systems in April 1999 and opened a division of transfusion therapy, thus introducing an integrated control system for blood transfusion. RESULTS: In the year (2002), the crossmatch-to-transfusion (C/T) ratio has dropped from 3.94 to 2.01, and the volume of blood transported outside the central operating room and that of waste blood have decreased. CONCLUSIONS: The new systems are instrumental in saving preoperatively prepared blood and exercising its qualitative control. From now on, our task is to improve measures to cope with cases of transfusion in excess of MSBOS and reevaluate MSBOS on a regular basis.

Blood Grouping and Crossmatching↗