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PubMed2002

Demolition of a hospital building by controlled explosion: the impact on filamentous fungal load in internal and external air.

The demolition of a maternity building at our institution provided us with the opportunity to study the load of filamentous fungi in the air. External (nearby streets) and internal (within the hospital buildings) air was sampled with an automatic volumetric machine (MAS-100 Air Samplair) at least daily during the week before the demolition, at 10, 30, 60, 90,120, 180, 240, 420, 540 and 660 min post-demolition, daily during the week after the demolition and weekly during weeks 2, 3 and 4 after demolition. Samples were duplicated to analyse reproducibility. Three hundred and forty samples were obtained: 115 external air, 69 'non-protected' internal air and 156 protected internal air [high efficiency particulate air (HEPA) filtered air under positive pressure]. A significant increase in the colony count of filamentous fungi occurred after the demolition. Median colony counts of external air on demolition day were significantly higher than from internal air (70.2 cfu/m(3) vs 35.8 cfu/m(3)) (P < 0.001). Mechanical demolition on day +4 also produced a significant difference between external and internal air (74.5 cfu/m(3) vs 41.7 cfu/m(3)). The counts returned to baseline levels on day +11. Most areas with a protected air supply yielded no colonies before demolition day and remained negative on demolition day. The reproducibility of the count method was good (intra-assay variance: 2.4 cfu/m(3)). No episodes of invasive filamentous mycosis were detected during the three months following the demolition. Demolition work was associated with a significant increase in the fungal colony counts of hospital external and non-protected internal air. Effective protective measures may be taken to avoid the emergence of clinical infections.

Air Conditioning↗
PubMed1980

The case for abandonment of explosive anesthetic agents.

The use of inflammable anesthetics in the United States has been debated widely over the past several years. Those in favor of continued use of these agents argue for educational use, professional freedom, pharmacologic safety, and the need to retain an option. Those in favor of a ban on such agents cite the lack of demonstrated pharmacologic advantage, diminishing physician expertise, risk of fire, and cost. The use of inflammable anesthetics has declined markedly over the past 15 years; in 1978, only 15 per cent of American hospitals were reportedly using them. However, we estimate that the use of inflammable anesthetics adds approximately $9.4 million to the annual cost of surgical care. As their use declines further, the cost per patient increases because most of the costs are fixed. We advocate a ban on inflammable anesthetics. Without definitive action on the part of policy makers, the use of these agents is likely to continue at a very low, and hence a relatively expensive, rate.

Anesthesia, Inhalation↗