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1.  Potentially Infectious Agents Associated with Shearling Bedpads 
Applied Microbiology  1970;19(1):53-59.
Glutaraldehyde-tanned woolskin pads which are used for the prevention of decubitus ulcers in bed patients were experimentally contaminated with polio or vaccinia viruses. Two methods of exposure, direct contact and aerosol, were used in separate experiments. Attempts were made to remove or inactivate these virus contaminants by laundering the woolskins in a quaternary ammonium disinfectant, a phenolic disinfectant, or alkalinized glutaraldehyde, in combination with an anionic detergent or a nonionic detergent. The effect of a commercial detergent-sanitizer was also studied. The virus titers were significantly reduced in all experiments, but only laundering in glutaraldehyde in combination with either detergent lowered the vaccinia virus titers to below detectable limits. High concentrations of glutaraldehyde altered the texture of the wool and leather apparently by precipitating a component of the detergent onto the fibers. In all the poliovirus experiments, the virus was still detectable on either or both the wool and the leather of the pads after laundering. The rinse water from each experiment was tested for the presence of virus. No vaccinia virus was recovered, but poliovirus was demonstrated in titers up to 103 cell culture 50% infectious doses.
PMCID: PMC376608  PMID: 4313311
2.  Potentially Infectious Agents Associated with Shearling Bedpads: Effect of Laundering with Detergent-Disinfectant Combinations on Staphylococcus aureus and Pseudomonas aeruginosa 
Applied Microbiology  1971;21(4):647-652.
Glutaraldehyde-tanned woolskins which are used as bedpads to prevent decubitus ulcers were contaminated with Staphylococcus aureus (ATCC 6538) and Pseudomonas aeruginosa (ATCC 15442). Two methods of exposure, direct contact and aerosol, were used in separate experiments. Attempts were made to decrease the bacterial population placed on the woolskins by laundering them in a quaternary ammonium disinfectant, a phenolic disinfectant, or alkalinized glutaraldehyde, in combination with an anionic or nonionic detergent. The effect of a commercial detergent-sanitizer was also studied. Bacterial populations were significantly reduced in all experiments, but only laundering in glutaraldehyde in combination with either detergent resulted in maximum removal of bacteria. Viable bacteria were usually not detected in the rinse water (<1 viable organism/5 ml of rinse water).
PMCID: PMC377248  PMID: 4995850
3.  Hospital Textiles, Are They a Possible Vehicle for Healthcare-Associated Infections? 
Textiles are a common material in healthcare facilities; therefore it is important that they do not pose as a vehicle for the transfer of pathogens to patients or hospital workers. During the course of use hospital textiles become contaminated and laundering is necessary. Laundering of healthcare textiles is most commonly adequate, but in some instances, due to inappropriate disinfection or subsequent recontamination, the textiles may become a contaminated inanimate surface with the possibility to transfer pathogens. In this review we searched the published literature in order to answer four review questions: (1) Are there any reports on the survival of microorganisms on hospital textiles after laundering? (2) Are there any reports that indicate the presence of microorganisms on hospital textiles during use? (3) Are there any reports that microorganisms on textiles are a possible source infection of patients? (4) Are there any reports that microorganisms on textiles are a possible source infection for healthcare workers?
doi:10.3390/ijerph9093330
PMCID: PMC3499872  PMID: 23202690
textile hygiene; disinfection; hospital-acquired infections; inanimate surfaces; infection transmission vehicles
4.  Microbiological contamination of cubicle curtains in an out-patient podiatry clinic 
Background
Exposure to potential pathogens on contaminated healthcare garments and curtains can occur through direct or indirect contact. This study aimed to identify the microorganisms present on podiatry clinic curtains and measure the contamination pre and post a standard hospital laundry process.
Method
Baseline swabs were taken to determine colony counts present on cubical curtains before laundering. Curtains were swabbed again immediately after, one and three weeks post laundering. Total colony counts were calculated and compared to baseline, with identification of micro-organisms.
Results
Total colony counts increased very slightly by 3% immediately after laundry, which was not statistically significant, and declined significantly (p = 0.0002) by 56% one-week post laundry. Three weeks post laundry colony counts had increased by 16%; although clinically relevant, this was not statistically significant. The two most frequent microorganisms present throughout were Coagulase Negative Staphylococcus and Micrococcus species. Laundering was not completely effective, as both species demonstrated no significant change following laundry.
Conclusion
This work suggests current laundry procedures may not be 100% effective in killing all microorganisms found on curtains, although a delayed decrease in total colony counts was evident. Cubicle curtains may act as a reservoir for microorganisms creating potential for cross contamination. This highlights the need for additional cleaning methods to decrease the risk of cross infection and the importance of maintaining good hand hygiene.
doi:10.1186/1757-1146-3-26
PMCID: PMC2995787  PMID: 21087486
5.  Disinfection of hospital blankets with synthetic phenolic compounds 
Journal of Clinical Pathology  1961;14(1):80-84.
A cheap method by which hospital blankets may be effectively disinfected (approximately 3d. per blanket) is described. A recommendation is made that blankets from the patients' beds be divided into: `socially dirty' blankets to be laundered, possibly at infrequent intervals; and `socially clean' blankets to be disinfected frequently. The wide range of a synthetic phenolic compound is described. This substance is effective against all the common pathogenic bacteria in the presence of organic matter, anionic, or cationic detergents. Details are given of laboratory trials with this method of disinfection and of pilot trials at the Group hospital laundry. The recommended method is simpler and takes less time than ordinary washing.
PMCID: PMC480164  PMID: 13759121
6.  Hospital Sanitation: the Massive Bacterial Contamination of the Wet Mop 
Applied Microbiology  1971;21(4):693-697.
Following the demonstration of massive spread of bacterial contamination throughout the hospital by the wet-mopping techniques in use, quantitative studies were undertaken to determine the source of contamination and to institute measures of control. It was found that mops, stored wet, supported bacterial growth to very high levels and could not be adequately decontaminated by chemical disinfection. Laundering and adequate drying provided effective decontamination, but build-up of bacterial counts occurred if mops were not changed daily or if disinfectant was omitted from the wash-water. Recommendations were based upon the experimental findings.
PMCID: PMC377258  PMID: 4930279
7.  Bacterial Survival in Laundered Fabrics 
Applied Microbiology  1975;29(3):368-373.
Bacterial survival was determined in linens (i) inoculated with Staphylococcus aureus (ii), taken from hospital isolation patients' beds, and (iii) used by students in their homes. Two different washers using temperatures of 38, 49, 54 and 60 C, respectively, for different times were employed along with a commercial tumbler dryer. Findings, after macerating the linens in a Waring blender and enumerating on nonselective media, indicate that acceptable levels of survivors can be achieved in motel and hotel linens by an 8- to 10-min wash cycle at 54 C followed by adequate drying. However, it is recommended that a wash cycle with 60 C for 10 to 13 min be employed for linens in health care factilities. The microbial significance of various laundering practices is discussed.
PMCID: PMC186982  PMID: 1090256
8.  Feather bedding and childhood asthma associated with house dust mite sensitisation: a randomised controlled trial 
Archives of Disease in Childhood  2011;96(6):541-547.
Introduction
Observational studies report inverse associations between the use of feather upper bedding (pillow and/or quilt) and asthma symptoms but there is no randomised controlled trial (RCT) evidence assessing the role of feather upper bedding as a secondary prevention measure.
Objective
To determine whether, among children not using feather upper bedding, a new feather pillow and feather quilt reduces asthma severity among house dust mite (HDM) sensitised children with asthma over a 1-year period compared with standard dust mite avoidance advice, and giving children a new mite-occlusive mattress cover.
Design
RCT.
Setting
The Calvary Hospital in the Australian Capital Territory and the Children's Hospital at Westmead, Sydney, New South Wales.
Patients
197 children with HDM sensitisation and moderate to severe asthma.
Intervention
New upper bedding duck feather pillow and quilt and a mite-occlusive mattress cover (feather) versus standard care and a mite-occlusive mattress cover (standard).
Main outcome measures
The proportion of children reporting four or more episodes of wheeze in the past year; an episode of speech-limiting wheeze; or one or more episodes of sleep disturbance caused by wheezing; and spirometry with challenge testing. Statistical analysis included multiple logistic and linear regression.
Results
No differences between groups were found for primary end points – frequent wheeze (OR 1.51, 95% CI 0.83 to 2.76, p=0.17), speech-limiting wheeze (OR 0.70, 95% CI 0.32 to 1.48, p=0.35), sleep disturbed because of wheezing (OR 1.17, 95% CI 0.64 to 2.13, p=0.61) or for any secondary end points. Secondary analyses indicated the intervention reduced the risk of sleep being disturbed because of wheezing and severe wheeze to a greater extent for children who slept supine.
Conclusion
No differences in respiratory symptoms or lung function were observed 1 year after children with moderate–severe asthma and HDM sensitisation were given a mite-occlusive mattress cover and then received either feather upper bedding (pillow and quilt) or standard bedding care.
doi:10.1136/adc.2010.189696
PMCID: PMC3093241  PMID: 21451166
9.  Encasing bedding in covers made of microfine fibers reduces exposure to house mite allergens and improves disease management in adult atopic asthmatics 
Background
Studies of avoidance of exposure to group 1 allergens of the Dermatophagoides group (Der p 1) have not yielded consistent improvements in adult asthma through avoidance. We explored whether the use of pillow and bed covers and allergen-avoidance counseling resulted in Der 1-level reduction, as measured by enzyme-linked immunosorbent assay, and thus improved asthma symptoms in adult patients.
Methods
Twenty-five adult patients with moderate or severe atopic asthma were randomized into intervention and control groups. Intervention patients slept on pillows and mattresses or futons encased in microfine-fiber covers and were counseled in allergen avoidance through bedroom cleaning. Control patients received neither special covers nor counseling. In the period August to October in 2009 (pre-intervention) and 2010 (post-intervention), dust samples were collected in open Petri dishes placed in bedrooms for 2 weeks and by rapid lifting of dust from bedding and skin using adhesive tape on the morning of 1 day of Petri dish placement. We examined the associations between changes in Der 1 level (as measured by enzyme-linked immunosorbent assay) and clinical symptom score, minimum % peak expiratory flow, and fraction of exhaled nitric oxide.
Results
Der 1 allergen levels on the mattress/futon covers and near the floor of the bedrooms of intervention patients, but not controls, were lower in 2010 than in 2009. From 2009 to 2010, asthma symptom scores decreased significantly, and minimum % peak expiratory flow increased significantly, in intervention patients. The fall in Der p 1 concentration was correlated with a reduction in the fraction of exhaled nitric oxide.
Conclusions
Minimization of Der 1 allergen exposure by encasing pillows and mattresses or futons and receiving counseling on avoiding exposure to indoor allergens improved asthma control in adult patients.
doi:10.1186/1710-1492-9-44
PMCID: PMC3829998  PMID: 24499343
Adult intervention; Allergen; Atopic asthma; Bed cover; Dermatophagoides; Group 1 mite antigen
10.  Backboards are important when chest compressions are provided on a soft mattress☆ 
Resuscitation  2012;83(8):1013-1020.
Aim
Determine the impact of backboard placement, torso weight and bed compression on chest compression (CC) depth feedback in simulated cardiac arrest patients.
Methods
Epochs of 50 high quality CCs with real-time feedback of sternum-to-spine compression depth were provided by a blinded BLS/ACLS/PALS certified provider on manikins of two torso weights (25 vs. 50 kg), using three bed surfaces (stretcher, Stryker hospital bed with Impression mattress, soft Total Care ICU bed), with/without a backboard (BB). Two BB sizes were tested (small: 60 cm × 50 cm; large: 89 cm × 50 cm) in vertical vs. horizontal orientation. Mattress displacement was measured using an accelerometer placed internally on the spine plate of the manikin. Mattress displacement of ≥5 mm was prospectively defined as the minimal clinically important difference.
Results
During CPR (CC depth: 51.8 ± 2.8 mm), BB use significantly reduced mattress displacement only for soft ICU beds. Mattress displacement was reduced (vs. no BB) for 25 kg torso weight: small BB12.3 mm (95%CI 11.9–12.6), horizontally oriented large BB 11.2 mm (95%CI 10.8–11.7), and vertically oriented large BB 12.2 mm (95%CI 11.8–12.6), and for 50 kg torso weight: small BB 7.4 mm (95%CI 7.1–7.8), horizontally oriented large BB 7.9 mm (95%CI 7.6–8.3), and vertically oriented large BB 6.2 mm (95%CI 5.8–6.5; all p < 0.001). BB size and orientation did not significantly affect mattress displacement. Lighter torso weight was associated with larger displacement in soft ICU beds without BB (difference: 6.9 mm, p < 0.001).
Conclusion
BB is important for CPR when performed on soft surfaces, such as ICU beds, especially when torso weight is light. BB may not be needed on stretchers, relatively firm hospital beds, or for patients with heavy torso weights.
doi:10.1016/j.resuscitation.2012.01.016
PMCID: PMC3619975  PMID: 22310727
Backboard; CPR; Resuscitation; Child; Mattress; Displacement
11.  Contamination of hospital linen by Bacillus cereus. 
Epidemiology and Infection  1994;113(2):297-306.
An investigation into two cases of post-operative Bacillus cereus meningitis revealed that hospital linen laundered by a batch continuous washing machine was heavily contaminated by B. cereus spores. The washing machine, detergents, other chemical additives and the water supply were eliminated as the source of contamination. It was found that the linen introduced into the washing machine had a high B. cereus spore content and that this was still present after the wash process. The spores were not killed by either the heat disinfection stage of the wash or the addition of chemical disinfectants and were not removed by the dilution in the process. The multiplication of B. cereus was thought to have occurred on used, damp linen stored in plastic bags, particularly when ambient temperatures were high. An increase in the water flow through the washing machine was the only measure associated with a decrease in B. cereus on laundered linen.
PMCID: PMC2271531  PMID: 7925667
12.  Potentially dangerous sleeping environments and accidental asphyxia in infancy and early childhood. 
Archives of Disease in Childhood  1994;71(6):497-500.
Infants and young children may be exposed to a variety of dangerous situations when left sleeping in cots, chairs, or beds. A review of 30 cases of accidental asphyxia occurring in infants and young children who had been left to sleep unattended was undertaken from the necropsy and consultation files of the Adelaide Children's Hospital. Causes of death included hanging from loose restrainers, clothing, or a curtain cord (12 cases), positional asphyxia/wedging from slipping between a mattress and bed/cot sides or wall, or from moving into a position where the face was covered and the upper airway occluded (16 cases), and suffocation from plastic bed covers (two cases). Cases of co-sleeping in bed with an adult and of non-accidental asphyxia were not included in this review. As the pathological findings were on occasion identical to those that are typically found in sudden infant death syndrome, adequate death scene examination was vital in several cases to allow identification of lethal sleeping environments and to enable steps to be taken to minimise the risk of future deaths due to similar situations. For example, two cases in which infants asphyxiated in rocking cradles led to the investigation of the cradles and to formulation of specific safety recommendations regarding the angle of tilt. Two infants who died after becoming wedged between the back of a couch and a co-sleeping parent in one case and cushions in the other, would indicate that this also represents a potentially lethal sleeping position. Other dangerous situations involved infant car seat restraints, seats with loose harnesses, cots with movable sides or projecting pieces, thin plastic mattress/pillow coverings, and beds with spaces between the mattress and cot side or wall. Lack of supervision at the time of death was a feature of each case.
Images
PMCID: PMC1030084  PMID: 7726607
13.  Bacterial contamination of floors and other surfaces in operating rooms: a five-year survey. 
The Journal of Hygiene  1984;93(3):559-566.
Bacterial contamination of floors and other surfaces in the operating suite has been investigated by contact impression plates during the past five years. Colony counts of the floors of operating rooms, cleaned with disinfectant, were 3.3 c.f.u./10 cm2; on the floors of semi-clean and dirty areas, cleaned with detergent, colony counts were 44.8 and 71.4 c.f.u./10 cm2 respectively. The highest colony counts of 487.4 c.f.u./10 cm2 were found in the dressing rooms, the floors of which were covered with carpets, cleaned with a vacuum cleaner. Mean bacterial numbers on surfaces of various equipment in operating rooms, cleaned with disinfectant, were 2.8 c.f.u./10 cm2. Bacterial numbers on surfaces decreased markedly from 253.2 to 11.9 c.f.u./10 cm2 following the use of disinfectant. Bacterial species found from various surfaces were mainly coagulase-negative staphylococci, derived from human beings. In the light of these findings the regular use of disinfectant for cleaning of the floors and other surfaces in operating rooms is advisable.
PMCID: PMC2129451  PMID: 6512255
14.  Use of Backboard and Deflation Improve Quality of Chest Compression When Cardiopulmonary Resuscitation Is Performed on a Typical Air Inflated Mattress Configuration 
Journal of Korean Medical Science  2013;28(2):315-319.
No study has examined the effectiveness of backboards and air deflation for achieving adequate chest compression (CC) depth on air mattresses with the typical configurations seen in intensive care units. To determine this efficacy, we measured mattress compression depth (MCD, mm) on these surfaces using dual accelerometers. Eight cardiopulmonary resuscitation providers performed CCs on manikins lying on 4 different surfaces using a visual feedback system. The surfaces were as follows: A, a bed frame; B, a deflated air mattress placed on top of a foam mattress laid on a bed frame; C, a typical air mattress configuration with an inflated air mattress placed on a foam mattress laid on a bed frame; and D, C with a backboard. Deflation of the air mattress decreased MCD significantly (B; 14.74 ± 1.36 vs C; 30.16 ± 3.96, P < 0.001). The use of a backboard also decreased MCD (C; 30.16 ± 3.96 vs D; 25.46 ± 2.89, P = 0.002). However, deflation of the air mattress decreased MCD more than use of a backboard (B; 14.74 ± 1.36 vs D; 25.46 ± 2.89, P = 0.002). The use of a both a backboard and a deflated air mattress in this configuration reduces MCD and thus helps achieve accurate CC depth during cardiopulmonary resuscitation.
doi:10.3346/jkms.2013.28.2.315
PMCID: PMC3565146  PMID: 23399985
Backboard; Beds; Cardiopulmonary Resuscitation; Mattresses
15.  Microbial contamination of manually reprocessed, ready to use ECG lead wire in intensive care units 
Background: A number of studies have shown that non-critical medical devices can be contaminated with pathogens, including those resistant to antibiotics and thus become a potential vector for transmission. Electrocardiography (ECG) lead wire are non-critical medical device which are always attached on patient skin during their stay in intensive care unit (ICU). In view of the patient’s critical conditions and exposure to invasive procedures, identification and prevention of possible risks are important to prevent infection in ICUs.
Objective: The objective of this study was to determine the presence of bacterial and fungal contamination on cleaned and disinfected reusable ECG lead wires in intensive care units in a hospital.
Methods: A total of 408 cleaned ECG lead wires from 93 bed-side ECG devices and 43 ECG lead wires from 5 portable ECG devices from 4 intensive care units (ICUs) and 1 post-anaesthesia care unit (PACU) were sampled. ECG lead wires were stirred in 0.89% NaCl with added neutralizer for 30 seconds. Samples of the solutions were cultured directly on blood agar. The remaining solution was cultured on blood agar after sterile filtration. The number of colony forming units (CFUs) was counted and the microorganisms were identified.
Results: More than half of examined ECG lead wires (n=232; 51.4%) were contaminated with >30 CFUs/mL sample of bacteria or with risk pathogens. Gram-positive bacteria were the most frequently isolated organisms; particularly, coagulase negative staphylococci (96%) and aerobic spore forming bacteria (71.2%). Compared to ICUs, PACU had significantly lower proportion of contaminated ECG lead wires (p<0.05). The proportion of contaminated ECG lead wires, as well as mean number of cfus per ECG lead wire, was also significantly lower among multi-wire ECG leads compared to single-wire ECG leads.
Conclusions: Manually cleaned ECG lead wires may serve as a vector for transmission of nosocomial pathogens. The current reprocessing technique for ECG lead wires needs to be improved.
doi:10.3205/dgkh000207
PMCID: PMC3746603  PMID: 23967393
ECG lead wire; microbial contamination; ICU; PACU
16.  Bacterial Contamination of Hospital Bed-Control Handsets in a Surgical Setting: A Potential Marker of Contamination of the Healthcare Environment 
INTRODUCTION
Patients undergoing colorectal surgical resections have a high incidence of surgical site infection (SSI). Many patient-specific risk factors have been recognised in association with SSI in such patients, but environmental contamination is increasingly recognised as a contributor to hospital-acquired infection (HAI). This study set out to describe the bacterial contamination of the patient environment, using hospital bed-control handsets, as they are frequently handled by both staff and patients and represent a marker of environmental contamination.
PATIENTS AND METHODS
On two unannounced sampling events, 1 week apart, 140 bacteriological assessments were made of 70 hospital bed control handsets within a specialist colorectal surgical unit.
RESULTS
Of the handsets examined, 67 (95.7%) demonstrated at least one bacterial species (52.9% grew 1, 30% grew 2 and 12.9% grew 3 or more bacterial species). Of these, 29 (41.4%) bed-control handsets grew bacteria known to cause nosocomial infection, including 22 (31.4%) handsets which grew Enterococcus spp., 9 (12.9%) which grew MRSA, 2 (2.9%) which grew MSSA, 2 (2.9%) which grew coliforms, and 1 (1.4%) handset which grew anaerobes. At 1-week follow-up, 31 bed-control handsets showed evidence of contamination by the same bacterial species.
CONCLUSIONS
This study revealed high levels of bacteria known to cause HAI, contaminating hospital bed-control handsets in a surgical setting. Further study is now required to confirm whether hospital environmental contamination is causally involved in SSI.
doi:10.1308/003588407X209347
PMCID: PMC2121295  PMID: 17959000
Hospital; Surgical; Handset; MRSA; Infection; Bacteria
17.  The Effect of Bedding System Selected by Manual Muscle Testing on Sleep-Related Cardiovascular Functions 
BioMed Research International  2013;2013:937986.
Background. Different types of mattresses affect sleep quality and waking muscle power. Whether manual muscle testing (MMT) predicts the cardiovascular effects of the bedding system was explored using ten healthy young men. Methods. For each participant, two bedding systems, one inducing the strongest limb muscle force (strong bedding system) and the other inducing the weakest limb force (weak bedding system), were identified using MMT. Each bedding system, in total five mattresses and eight pillows of different firmness, was used for two continuous weeks at the participant's home in a random and double-blind sequence. A sleep log, a questionnaire, and a polysomnography were used to differentiate the two bedding systems. Results and Conclusion. Heart rate variability and arterial pressure variability analyses showed that the strong bedding system resulted in decreased cardiovascular sympathetic modulation, increased cardiac vagal activity, and increased baroreceptor reflex sensitivity during sleep as compared to the weak bedding system. Different bedding systems have distinct cardiovascular effects during sleep that can be predicted by MMT.
doi:10.1155/2013/937986
PMCID: PMC3859264  PMID: 24371836
18.  Evaluation of the Petrifilm™ EB and TEMPO® EB systems with ISO 21528-2:2004 method for the count of Enterobacteriaceae in milk 
Brazilian Journal of Microbiology  2014;44(3):771-775.
The development of alternative microbiological techniques is driven by the necessity to meet the current needs to deliver rapid results in the manufacturing process of foods, but it is important that these methods be evaluated for each application. The objective of the present study was to assess the Petrifilm™ EB and the TEMPO® EB systems with ISO 21528-2:2004 for the count of Enterobacteriaceae in pasteurized and UHT milk samples. We analyzed the microflora of 141 pasteurized milk samples, 15 samples of artificially contaminated pasteurized milk and 15 samples of artificially contaminated UHT milk. Investigation of the method Petrifilm™ EB and ISO 21528:2 regression analysis showed a high correlation in the samples, r = 0.90 for the microflora of pasteurized milk, r = 0.98 for artificially contaminated pasteurized milk and r = 0.99 for the artificially contaminated UHT milk. In evaluating the system TEMPO EB ® method and ISO 21528:2 correlation was also significant in the analyzed samples, with r = 0.86 for the microflora of pasteurized milk, r = 0.96 for artificially contaminated pasteurized milk and r = 0.99 for artificially contaminated UHT milk. No statistically significant differences were observed between the three methods conducted to analyze artificially contaminated pasteurized and UHT milk at three inoculum levels. In conclusion, the Petrifilm™ EB system and the TEMPO® EB system may be an alternative to the ISO 21528-2:2004 for the Enterobacteriaceae assay for milk as because of the ease-of-operation and the time reduction achieved for conducting the microbiological assay using these systems.
PMCID: PMC3910187  PMID: 24516444
Enterobacteriaceae; milk; alternative methods; ISO 21528-2:2004; count
19.  Effectiveness of education for control of house dust mites and cockroaches in Seoul, Korea 
We evaluated the efficacy of health education in reducing indoor arthropod allergens in Seoul. The mite control measures comprised the use of mite-proof mattress and pillow coverings, regular washing of potentially infested materials, maintenance of a low humidity, removal of carpets, and frequent vacuum cleaning. Cockroach control measures included trapping, application of insecticides, and protecting food. Of 201 homes enrolled in October 1999, 63 volunteers were included in a 2-year follow-up survey between April 2000 and January 2002. Before intervention, the density of mites/g of dust varied greatly; 27.1/g in children's bedding, 20/g in adult bedding, 7.2/g on the floors of children's bedrooms, 6.8/g in sofas, 5.9/g on the floors of adult's bedrooms, 3.9/g on living room floors, 3.7/g in carpets, and 1.9 mites/g on kitchen floors. The predominant mite species and house percentages infested were; Dermatophagoides farinae 93%, D. pteronyssinus 9%, and Tyrophagus putrescentiae 8%. Comparing 1999 and 2001 infestations, before and after 25 mo of education, mite abundance was reduced by 98%, from 23.7 to 0.57 mites/g of dust. In 1999, cockroaches were detected in 62% homes: 36% Blattella germanica and 35% Periplaneta spp., including 9% double infestations of B. germanica and P. americana. Following intervention, cockroach infestation rates decreased to 22% of houses in 2000 and 23% in 2001. We conclude that continuous and repetitive health education resulted in the effective control of domestic arthropods.
doi:10.3347/kjp.2006.44.1.73
PMCID: PMC2532652  PMID: 16514286
Blattella germanica; Dermatophagoides farinae; Periplaneta americana; Periplaneta fuliginosa; Periplaneta japonica; Tyrophagus putrescentiae; aeroallergens; allergy prevention; cockroaches; house dust mites
20.  Consultative team to assess manual handling and reduce the risk of occupational injury 
OBJECTIVES—To describe the formation of a consultative team to assess the risk of manual handling in the workplace that started in October 1992 within the cleaning services department of a 600 bed hospital, and to evaluate the effectiveness of its recommendations in reducing the rate and severity (time lost and cost) of workers' compensation injury.
METHODS—The consultative team identified, assessed, and recommended controls for manual handling and other injury risks. Data on injuries counted before and after implementation of the team's recommendations were obtained for the cleaning services study group, an orderly services comparison group, as well as cleaners from a peer hospital and for the State of Western Australia. Evaluation of the four groups was undertaken 3 years after the end of the study period, to allow maturation of the costs of the claims (adjusted to July 1998 consumer price index) and hours lost from work.
RESULTS—Statistical analysis showed that implementation of the recommendations significantly reduced numbers and rates of injury, but not the severity of injury, in the cleaning services study group. There was no difference in numbers or severity of injuries for the comparison groups before and after implementation of the recommendations.
CONCLUSIONS—The recommendation of the consultative team can produce a meaningful and sustained reduction in rates of injury within an at risk population. The results support a consultative approach to reducing workplace injuries from manual handling. The team process has potential for application to occupational groups at risk of exposure to other types of hazards.


Keywords: injury; risk assessment; participatory; ergonomics; teams
doi:10.1136/oem.58.5.339
PMCID: PMC1740128  PMID: 11303084
21.  Socioeconomic and occupational risk factors for epilepsy: a nationwide epidemiological study in Sweden 
Objectives
The aim of this study is to investigate associations between hospitalization for epilepsy and two factors: socioeconomic status and occupation.
Design and Setting
A nationwide database was constructed in Sweden by linking the Swedish Census to the Hospital Discharge Register to obtain data on all first-time hospitalizations for epilepsy in adults in Sweden during the study period (1987 to 2004). Standardized incidence ratios (SIRs) were calculated by socioeconomic status and occupation.
Results
A total of 22 638 men and 16 871 women >30 years were hospitalized for epilepsy during the study period. Low education and low income (both men and women) and being an unskilled/skilled worker (only men) was associated with slightly but significantly increased risks. Among men, increased risk was noted for waiters, launderers and dry cleaners, clerical workers, other construction workers, sales agents and drivers. Among women, increased risk was observed among cooks and stewards and administrators and managers.
Conclusions
Socioeconomic status and occupation sometimes carry significantly increased risks of hospital admission for epilepsy.
doi:10.1016/j.seizure.2007.07.011
PMCID: PMC2292825  PMID: 17728158
follow-up study; occupation; socioeconomic status; standardized incidence ratios
22.  An Enhanced Sensing Application Based on a Flexible Projected Capacitive-Sensing Mattress 
Sensors (Basel, Switzerland)  2014;14(4):6922-6937.
This paper presents a cost-effective sensor system for mattresses that can classify the sleeping posture of an individual and prevent pressure ulcers. This system applies projected capacitive sensing to the field of health care. The charge time (CT) method was used to sensitively and accurately measure the capacitance of the projected electrodes. The required characteristics of the projected capacitor were identified to develop large-area applications for sensory mattresses. The area of the electrodes, the use of shielding, and the increased length of the transmission line were calibrated to more accurately measure the capacitance of the electrodes in large-size applications. To offer the users comfort in the prone position, a flexible substrate was selected and covered with 16 × 20 electrodes. Compared with the static charge sensitive bed (SCSB), our proposed system-flexible projected capacitive-sensing mattress (FPCSM) comes with more electrodes to increase the resolution of posture identification. As for the body pressure system (BPS), the FPCSM has advantages such as lower cost, higher aging-resistance capability, and the ability to sense the capacitance of the covered regions without physical contact. The proposed guard ring design effectively absorbs the noise and interrupts leakage paths. The projected capacitive electrode is suitable for proximity-sensing applications and succeeds at quickly recognizing the sleeping pattern of the user.
doi:10.3390/s140406922
PMCID: PMC4029628  PMID: 24747734
flexible projected capacitive-sensing technologies; charge time; guard ring; health care mattress
23.  Quantitative Studies on Fabrics as Disseminators of Viruses 
Applied Microbiology  1971;21(2):227-234.
The effects of laundering with both anionic and nonionic detergents in cold, warm, and hot water on poliovirus-contaminated cotton sheeting, cotton terry cloth, washable wool shirting, wool blanketing, dull nylon jersey, and dacron/cotton shirting were determined. The fabrics were exposed to virus by aerosolization and direct contact (pipette) in separate studies. Although the results varied with each factor used in the study, virus titers on all the fabrics were generally reduced considerably by the laundering process. When the fabrics were dried for 20 hr after laundering, an additional decline in virus titers was seen, often to below detectable levels. The type of detergent used made little difference in effect on virus titer reduction, but the hot wash water markedly reduced the detectable virus. Fabric type was not a major factor in the majority of the experiments, although virus tended to be eliminated more readily from the nylon jersey, and in warm water the virus persisted longer on wool blanketing material laundered in anionic detergent. Sterile fabrics of each type laundered with similar fabrics which contained virus often became contaminated by the virus during the laundering process. Virus titers ranging from undetectable to 103.9 cell culture 50% infectious doses/ml were obtained from samples of the rinse water after warm- and cold-water laundering.
PMCID: PMC377153  PMID: 5544282
24.  MRSA--why treat the symptoms and not the disease? 
The recent debate over MRSA in our community is really getting to the state of the ridiculous. There is no question that this bacterium, which has been around for at least 40 years, is becoming a bigger and bigger menace in hospitals.Prior to the election, the shadow health secretary, Andrew Lansley, claimed that hospitals are being told to push more patients through beds rather than concentrating on hygiene and this is the cause of the epidemic. He calls for a search and destroy strategy to clean up wards.The health secretary, Dr John Reid, blames the increased use of contract cleaners under the last Tory government for the rise in the rates of infection. This is supported by the Public Sector Trades Union. They believe that it is the high input of patients that prevents MRSA and other hospital-acquired infections being tackled effectively. The answer, they feel, is strict hospital hygiene and frequent hand washing, with a higher proportion of single rooms.Now, we are told that matrons should take charge of cleanliness in hospitals. Despite all the hand wringing and washing, the morbidity and mortality are both in an upward spiral.
doi:10.1308/003588405X60650
PMCID: PMC1964113  PMID: 16263016
25.  Childhood Asthma and Environmental Interventions 
Environmental Health Perspectives  2007;115(6):971-975.
Background
Contaminants encountered in many households, such as environmental tobacco smoke, house dust mite, cockroach, cat and dog dander, and mold, are risk factors in asthma. Young children are a particularly vulnerable subpopulation for environmentally mediated asthma, and the economic burden associated with this disease is substantial. Certain mechanical interventions are effective both in reducing allergen loads in the home and in improving asthmatic children’s respiratory health.
Results
Combinations of interventions including the use of dust mite-impermeable bedding covers, improved cleaning practices, high-efficiency particulate air vacuum cleaners, mechanical ventilation, and parental education are associated with both asthma trigger reduction and improved health outcomes for asthmatic children. Compared with valuated health benefits, these combinations of interventions have proven cost effective in studies that have employed them. Education alone has not proven effective in changing parental behaviors such as smoking in the home.
Conclusions
Future research should focus on improving the effectiveness of education on home asthma triggers, and understanding long-term children’s health effects of the interventions that have proven effective in reducing asthma triggers.
doi:10.1289/ehp.8989
PMCID: PMC1892116  PMID: 17589609
childhood asthma; economic impacts; indoor air quality; indoor environments; public health interventions

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