William G. Buchta

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.

Preemployment Screening for Tuberculosis in a Large Health Care Setting: Comparison of the Tuberculin Skin Test and a Whole-Blood Interferon-γ Release Assay

Objective: Determine the performance of an interferon-&ggr; release assay in a health care occupational surveillance program. Methods: From January 11, 2005, through January 31, 2006, all new employees (n = 652) undergoing standard, preemployment evaluation at Mayo Clinic, Rochester, Minnesota were evaluated for tuberculosis using a standard process of symptom screening combined with tuberculin skin test (TST) and QuantiFERON-TB Gold test (QFT-G). Results: Comparing the results of QFT-G directly to TST, QFT-G showed an overall agreement of 92.5%. Conclusions: False-positive TST were the most significant issue affecting agreement, and in a low–tuberculosis prevalence population, the need for an effective strategy offering low false-positive results may be best met by combining the TST with QFT-G.

Protecting health care workers from tuberculosis

The resurgence in cases of active pulmonary tuberculosis (TB) and the emergence of drug-resistant strains of TB have increased the risk that health care workers (HCWs) may acquire serious TB infections which may not respond to usual therapy. Multiple steps are needed to reduce this risk. These include updated periodic training of HCWs to maintain awareness of potential risks of TB; optimizing the design, ventilation, and patient flow in clinical spaces; periodic TB surveillance testing of HCWs; appropriate use of effective respiratory protection; active infection control procedures; and periodic updating of written TB control plans.

Hyperbaric Oxygen Therapy for Chronic Refractory Osteomyelitis of the Sternum

This report describes a 32-year-old woman with chronic refractory osteomyelitis of the sternum after multiple surgical procedures including a sternotomy with underlying colonic interposition that was successfully managed with hyperbaric oxygen therapy. The clinical course is reviewed, and the complexities of this diagnosis are then discussed, including a brief review of the mechanisms of management with hyperbaric oxygen therapy.

Is an occupational examination superior to an occupational health history alone for preplacement screening in health care settings

Objectives: To determine whether preplacement recommendations following an occupationally focused medical history is different from those following an occupational consultation. Methods: This was a retrospective cohort study of 172 applicants to our institution. Results: Following provider review of occupational history survey alone, none of the applicants had restrictions recommended. In comparison, only 163 applicants (94.7%) were recommended to be hired without restrictions following provider review of the same patients occupational history and examination (P = 0.0078). Conclusion: A well-designed questionnaire is useful for screening applicants for preplacement examinations and assures sufficient detail to allow for a large proportion of individuals to proceed to employment without an occupational examination. However, in this study, a small but statistically significant portion (5%) of applicants required occupational examinations for appropriate work recommendations.