Mark Russi

Management of a sabià virus-infected patient in a US hospital

OBJECTIVE To describe the hospital precautions used to isolate a Sabiá virus (arenavirus: Arenaviridae)-infected patient in a US hospital and to protect hospital staff and visitors. DESIGN Investigation of a single case of arenavirus laboratory-acquired infection and associated case-contacts. SETTING A 900-bed, tertiary-care, university-affiliated medical center. PATIENTS OR OTHER PARTICIPANTS The case-patient became ill with Sabiá virus infection. The case-contacts consisted of healthcare workers, coworkers, friends, and relatives of the case-patient. INTERVENTION Enhanced isolation precautions for treatment of a viral hemorrhagic fever (VHF) patient were implemented in the clinical laboratory and patient-care setting to prevent nosocomial transmission. The enhanced precautions included preventing aerosol spread of the virus from the patient or his clinical specimens. All case-contacts were tested for Sabiá virus antibodies and monitored for signs and symptoms of early disease. RESULTS No cases of secondary infection occurred among 142 case-contacts. CONCLUSIONS With the frequency of worldwide travel, patients with VHF can be admitted to a local hospital at any time in the United States. The use of enhanced isolation precautions for VHF appeared to be effective in preventing secondary cases by limiting the number of contacts and promoting proper handling of laboratory specimens. Patients with VHF can be managed safely in a local hospital setting, provided that appropriate precautions are planned and implemented.

Anthropometric measurements, job strain, and prevalence of musculoskeletal symptoms in female medical sonographersf.

OBJECTIVE Principal components analysis (PCA) was used to explore the relationship between anthropometric measurements, job strain and work organization factors and the prevalence of musculoskeletal symptoms/occupational injuries in medical sonographers. METHODS A cross-sectional survey of twenty-six female sonographers at a tertiary medical center completed a standardized symptom questionnaire and underwent anthropometric measurement. First aid events and OSHA reportable injuries were abstracted from employee health records. RESULTS 96% of subjects reported some type of musculoskeletal symptoms within the past year, with shoulders (73%), low back (69%) and wrist/hand symptoms (54%) reported most often. PCA identified seven domains among the predictive variables: physical size, job strain, time on job, abdominal girth, work pace/variability, movement during study, and time spent standing. The magnitude and direction of effect for predicting musculoskeletal symptoms varied by symptom location. Abdominal girth was consistently associated with increased likelihood of reporting symptoms. CONCLUSION Sonographers work in a high demand/low control environment. Future studies of sonographers may need to include measures of both physical size and job strain. Reducing risk factors for one anatomical location may increase the risk at another location in this population.

Antiretroviral prophylaxis of health care workers at two urban medical centers.

We examined the influence of job category, source patient HIV status, and exposure type as predictors of whether health care workers initiated antiretroviral prophylaxis after potential blood-borne pathogen exposures. Of 639 exposures over an 18-month period, 82 individuals (13%) elected to receive prophylaxis, of whom 66% took medications for fewer than 96 hours and 12% completed a 4-week course. Reasons for early drug discontinuation included confirmation of source patient HIV-negative serological status (65%), gastrointestinal side effects (13%), headache (4%), and personal decision after counseling/other input (18%). Individuals exposed to HIV-positive source patients were more likely to initiate prophylaxis (odds ratio [OR], 5.1; 95% confidence interval [CI] 2.6 to 9.9). Licensed nurses were less likely than others to accept prophylaxis (OR, 0.5; 95% CI, 0.3 to 0.8), whereas physicians and medical students were more likely to accept prophylaxis (OR, 1.9; 95% CI, 1.1 to 3.3).

Occupational exposure to machining fluids and laryngeal cancer risk: Contrasting results using two separate control groups

This death certificate-based case-control study linked Connecticut Tumor Registry and Connecticut Division of Vital Statistics death data to determine whether machining fluid exposure is associated with laryngeal cancer risk. Laryngeal cancer cases were compared with oral cancer controls and general population controls. Level of exposure to machining fluids was imputed from the usual occupation and industry on the death certificate. Because exposure was infrequent among females, analysis was limited to males. When cases were compared to oral cancer controls, high exposure to machining fluids was associated with laryngeal cancer (odds ratio = 1.48; 95% confidence interval = 1.01-2.16), with a p-value for trend of 0.08. When cases were compared to population controls, no association between machining fluid exposure and laryngeal cancer was observed. A possible reason for the contrasting results, other than chance, is that exposure data quality for the cases and oral cancer controls may have differed from that of the population controls.

Guidance for Occupational Health Services in Medical Centers.

INTRODUCTION Guidance for Occupational Health Services in Medical Centers is dedicated to the memory of Dr. Geoff Kelafant who was tragically killed in a diving accident in March 2004. Geoff was the original author of a set of guidelines for the practice of occupational health in medical centers; his work established a format and content upon which we continue to expand with the current guidance document. Geoff’s enduring legacy is the profound impact he made upon medical center occupational health care in the United States and Canada.

Exposure to MTBE and Acute Human Health Effects: A Critical Literature Review

Whether use of oxygen-rich gasoline additives to reduce air pollution is a cause of acute adverse health effects is an ongoing concern in the United States. Attention has focused in particular on use of methyl tert-butyl ether (MTBE, CAS #1634-04-4) and, despite considerable published research, debate persists regarding its potential for adverse health effects. To better understand the debate, we critically reviewed published and unpublished reports to assess whether differences in methodological approach or quality could explain the variable results reported. We considered studies on acute human health effects of inhalation exposure to MTBE either alone or in gasoline (19 reports) as well as clinical use of parenteral MTBE to dissolve cholesterol gall stones (12 reports). Each study was reviewed from three perspectives (epidemiology, industrial hygiene, and, clinical diagnostics), judged satisfactory, limited adequacy, or unsatisfactory for each criterion, and grouped into one of three categories from mo...

HIV and AIDS in the workplace.

Since the onset of the HIV epidemic, AIDS and HIV infection have presented tremendous challenges to infected individuals seeking to remain productive in the workplace, to employers coping with the special needs of such individuals, and to physicians who treat and counsel exposed or infected personnel. OEM physicians should strive to ensure that employers are familiar with legislation and guidelines protecting the rights of infected employees, and they should support rational workplace policies applying to employees with HIV infection or AIDS. When the potential for occupational HIV exposure exists, OEM physicians should ensure that adequate training around exposure prevention, triage, and treatment is provided. OEM physicians who treat individuals with occupational HIV exposures should involve themselves in institutional efforts to prevent exposures through the use of safer devices and procedures, and they should ensure that immediate and adequate clinical evaluation of exposures is available at all times.

Interaction of Health Care Worker Health and Safety and Patient Health and Safety in the US Health Care System: Recommendations From the 2016 Summit

Ronald Loeppke, MD, MPH, Jodie Boldrighini, RN, MBA, John Bowe, Barbara Braun, PhD, Erik Eggins, Barry S. Eisenberg, Paul Grundy, MD, MPH, Todd Hohn, CSP, T. Warner Hudson, MD, John Kannas Jr., MSPH, E. Andrew Kapp, PhD, CSP, CHMM, Doris Konicki, MHS, Paul Larson, MS, Stephanie McCutcheon, Robert K. McLellan, MD, MPH, Julie Ording, MPH, Charlotte Perkins, Mark Russi, MD, Cindy Stutts, MS, RN, and Mary Yarbrough, MD, MPH

Risks of brain tumors in rubber workers : A metaanalysis

Objective: To better understand whether rubber industry workers suffer increased risks of brain tumor, a concern that has persisted for over 40 years despite numerous well-conducted studies. Methods: We performed a formal metaanalysis of brain tumor risk estimates reported in cohort studies of rubber and tire workers. Twenty unique cohorts were identified who met a priori inclusion criteria. Metaanalysis was performed using the general variance-based method; the variance of risk estimates was calculated for each study using a chi-squared method. Homogeneity was tested by means of the Q statistic. Results: The metaanalysis determined an overall relative risk of 0.90 (95% CI = 0.79–1.02). Conclusions: The analytical results are consistent with a conclusion that risks of brain tumor are not increased as a result of occupational exposures in the rubber and tire industry.