Lori A. Magda

Exposures to transit and other sources of noise among New York City residents.

To evaluate the contributions of common noise sources to total annual noise exposures among urban residents and workers, we estimated exposures associated with five common sources (use of mass transit, occupational and nonoccupational activities, MP3 player and stereo use, and time at home and doing other miscellaneous activities) among a sample of over 4500 individuals in New York City (NYC). We then evaluated the contributions of each source to total noise exposure and also compared our estimated exposures to the recommended 70 dBA annual exposure limit. We found that one in ten transit users had noise exposures in excess of the recommended exposure limit from their transit use alone. When we estimated total annual exposures, 90% of NYC transit users and 87% of nonusers exceeded the recommended limit. MP3 player and stereo use, which represented a small fraction of the total annual hours for each subject on average, was the primary source of exposure among the majority of urban dwellers we evaluated. Our results suggest that the vast majority of urban mass transit riders may be at risk of permanent, irreversible noise-induced hearing loss and that, for many individuals, this risk is driven primarily by exposures other than occupational noise.

Safety in the home healthcare sector: development of a new household safety checklist.

Objectives Unsafe household conditions could adversely affect safety and quality in home health care. However, risk identification tools and procedures that can be readily implemented in this setting are lacking. To address this need, we developed and tested a new household safety checklist and accompanying training program. Methods A 50-item, photo-illustrated, multi-hazard checklist was designed as a tool to enable home healthcare paraprofessionals (HHCPs) to conduct visual safety inspections in patients’ homes. The checklist focused on hazards presenting the greatest threat to the safety of seniors. A convenience sample of 57 HHCPs was recruited to participate in a 1-hour training program, followed by pilot testing of the checklist in their patients’ households. Checklist data from 116 patient homes were summarized using descriptive statistics. Qualitative feedback on the inspection process was provided by HHCPs participating in a focus group. Results Pretesting and posttesting determined that the training program was effective; participating HHCPs’ ability to identify household hazards significantly improved after training (P < 0.001). Using the checklist, HHCPs were able to identify unsafe conditions, including fire safety deficiencies, fall hazards, unsanitary conditions, and problems with medication management. Home healthcare paraprofessionals reported that the checklist was easy to use and that inspections were well accepted by patients. Inspections took roughly 20 minutes to conduct. Conclusions Home healthcare paraprofessionals can be effectively trained to identify commonplace household hazards. Using this checklist as a guide, visual household inspections were easily performed by trained HHCPS. Additional studies are needed to evaluate the reliability of the checklist and to determine if hazard identification leads to interventions that improve performance outcomes.

Evaluation of a pandemic preparedness training intervention for emergency medical services personnel

INTRODUCTION Emergency medical services (EMS) personnel play an integral role during the national response to a pandemic event. To help ensure their health and safety, especially during the early stages of an outbreak, knowledge and adherence with personal protective equipment (PPE) and infection control strategies will be essential. OBJECTIVES The objective of this study was to assess the effectiveness of a multi-method, pandemic preparedness training intervention using a pre-/post-test design. METHODS A convenience sample of 129 EMS personnel participated in a training program on pandemic preparedness. Training consisted of an educational intervention with a focus on the routes of transmission of the influenza virus, proper use of respiratory PPE, agency policies regarding infection control practices, and seasonal influenza vaccination. This was followed by a skill-based drill on respirator fit-checking and proper respirator donning and doffing procedures. RESULTS Pre-/post-test results indicate a significant increase in knowledge and behavioral intentions with respect to respirator use, vaccination with seasonal influenza vaccine, and willingness to report to duty during a pandemic. CONCLUSIONS This method was effective in increasing knowledge and compliance intentions in EMS healthcare personnel. Further research should focus on whether training results in behavior modification.

Prevalence and factors associated with 2009 to 2011 influenza vaccinations at a university medical center

BACKGROUND Information on the rates and factors associated with influenza vaccinations, although limited, is important because it can inform the development of effective vaccination campaigns in a university medical center setting. METHODS A study was conducted in 2011 to identify individual and organizational level barriers and facilitators to influenza vaccination among clinical and nonclinical personnel (N = 428) from a major university medical center. RESULTS Seventy-one percent of clinical personnel (n = 170) reported pandemic H1N1 vaccination compared with 27% of nonclinical personnel (n = 258), even though vaccine was made widely available to all personnel at no cost. Similarly, disparate rates between clinical and nonclinical personnel were noted for the 2009/2010 seasonal influenza vaccine (82% vs 42%, respectively) and 2010/2011 combination (pandemic plus seasonal) influenza vaccine (73% vs 28%, respectively). Factors associated with pandemic vaccination in nonclinical personnel included the following: high level of influenza-related knowledge, concern regarding influenza contagion, history of previous influenza vaccinations or influenza illness, participation in vaccine-related training, and awareness of the institutions written pandemic plan. For clinicians, past history of seasonal influenza vaccination was associated with pandemic vaccination. For all participants, taking any 1 or more of the 3 influenza vaccines available in 2009 to 2011 was associated with intent to take a hypothetical future novel pandemic vaccine (odds ratio, 6.7; 95% confidence interval: 4.32-10.44; P < .001). CONCLUSION Most of the risk factors associated with lack of vaccination uptake are amenable to organizational strategies.

Mass Fatality Preparedness in the Death Care Sector

Objective: To characterize mass fatality preparedness of the death care sector (ie, funeral industry organizations) and to determine the workforces ability and willingness to report to duty during a hypothetical high fatality pandemic event. Methods: Anonymous, Web-based, cross-sectional survey of a national funeral industry sample. Preparedness was characterized using descriptive statistics. Factors significantly associated with ability and willingness were identified using chi-squared bivariate analysis. Results: Respondents (N = 492) generally rated their organizational preparedness planning as suboptimal; only six of thirteen preparedness checklist items were typically in place. In contrast, response intentions were uniformly high; more than 80% of the respondents were willing to report to work, although high prevalence of secondary obligations might hinder this. Conclusions: Preparedness strategies that address interorganizational, surge capacity, and personal emergency planning are likely to be most efficacious. Statement of Clinical Significance: Occupational medicine plays an important role in emergency preparedness and response. Funeral industry organizations could benefit from skills and resources of occupational medicine, including training, fit testing, development of plans, and coordination and hosting of planning exercises.

Web-Based Weapons of Mass Destruction Training for Transit Police

In response to increased terrorist attacks on mass transit systems worldwide, emergency planning and security efforts have intensified. One of the most important planning elements is the provision of training for first-response personnel. Yet few terrorism-related training programs specific to the mass transit sector are available. To address this unmet need, a web-based weapons of mass destruction (WMD) simulation training program, specifically designed for transit police, was recently developed, implemented, and evaluated. Results indicate that this program was effective in improving transit police officers’ ability to recognize and respond to WMD simulations.