Ian Blenkharn

• Blenkharn Environmental

Confusion and conflict arise when infection prevention and control (IPC) policies lead to allegations of religious discrimination. Many IPC standards are generic in construct, often failing to address wider issues and general policy applicable to all may have unequal impact on minority groups. Achieving uniformity by treating everyone the same is n...

Healthcare wastes are potentially dangerous and polluting, and their safe management and disposal is a matter of continuing public and professional concern. Regrettably, errors in waste management continue to occur at every point of the disposal chain. Bloodborne virus transmission is the greatest concern, though soft tissue, enteric and respirator...

Sharps injury is a constant risk for dentistry staff, cleaners, and waste contractors. Deficient standards of sharps safety and healthcare waste management can be costly in the event of prosecution by the HSE or the Environment Agency, and is devestating for the injured worker

Engineered sharps safety devices have delivered a substantial reduction in sharps injuries to healthcare professionals but disposal-related errors and subsequent injury to ancillary and support staff have remained largely unchanged. Obligations placed on employers by existing health and safety legislation, and more recently by the Health and Safety...

Sharps injury among health professionals is a devastating event, risking severe stress and debilitating post-traumatic anxiety, even in the absence of seroconversion. Effective prevention requires comprehensive training and education of all staff, who must comply with evidence-based policies and procedures based on detailed risk assessment. Safer w...

The presence of blood splashes on the external surface of sharps bins, and across the location where they stand, was investigated using the chemoluminescent Luminol reagent. Luminol is highly sensitive and reacts with minute traces of blood to emit visible blue light permitting the detection of blood traces invisible on direct observation or masked...

The International Health Academy has recently the International Journal of Hospital Environment & Hygiene Management. This is an editorial article outlines the scope, aims and objectives of the journal and call for publication in this new journal.

Dangerous errors in clinical waste management continue to occur and inappropriate items find their way into clinical waste sacks that are not designed to hold sharp or heavy items, or fluids. Although great attention is given to the safe use of sharps, needles still find their way into waste sacks instead of a sharps bin. Sharps injuries among anci...

Healthcare professionals carry a legal and professional responsibility for the safe disposal of clinical wastes. Sharps safety is paramount, and though this is a well-recognized hazard there remains an unacceptably high incidence of sharps injury and of blood and body fluid exposures that are particularly frequent among ancillary and support staff...

In the waste management field and the wider environmental sciences arena, science and regulation have be-come increasingly uneasy bedfellows. Scientific research should create the bedrock that underpins environmental legisla-tion, shaping its construction, interpretation and implementation. It is the currency of investment in the future of waste ma...

Clinical waste disposal carries with it a risk of serious and possibly life-threatening infection. Combining confidential questionnaires and structured interviews with discrete observation, the attitudes and approach to safe handling of bulk clinical wastes by staff in a specialist waste treatment facility were assessed. With particular attention t...

The increasing numbers of patients receiving often complex home-based health care, and the growing number of insulin-dependent diabetic, home haemodialysis and continuous ambulatory peritoneal dialysis patients, contributes to the substantial volumes of clinical waste generated from domestic premises. Arrangements for the collection and safe dispos...

The arrangements for bulk clinical waste handling were audited in 16 UK hospitals, one year after an earlier audit that revealed many deficiencies in performance. Storage of clinical waste carts in areas accessible to members of the public and failure to lock individual waste carts was common. Waste segregation was poor. Many clinical waste carts a...

Bulk waste storage carts are common in hospitals and undoubtedly assist in the day-to-day management of clinical wastes. They are used for the transport and interim storage of primary clinical waste containers and are often located close to or within hospital buildings to receive such wastes from clinical departments. Examination of a random select...

Clinical waste is a costly and troublesome commodity. Comprising the detritus of medical care, the foremost hazard is the risk of infection from micro-organisms present in these wastes. Infection commonly occurs through penetrating injury, the so-called 'sharps' or 'needlestick' injury, although contamination of non-intact skin or splashes to the e...

The arrangements for bulk clinical waste handling were observed in 26 UK hospitals. Storage of waste carts in areas freely accessible to the public, and failure to lock individual carts was common. Many clinical waste carts and areas dedicated to their storage were in a poor state of repair. Substantial improvement is required in the management of...

Medical (clinical) wastes are costly in disposal and carry risks of infection, or physical injury, and of exposure to potentially harmful pharmaceuticals, as well as being aesthetically unacceptable. Technological advances in disposal, together with the introduction of rigorous emission standards for incinerators and similarly stringent control sta...

New waste regulations are largely incompatible with current healthcare. There are questions over how members of staff will be able to classify waste. The regulations also pose logistical problems and space constraints.

New waste regulations are largely incompatible with current healthcare. There are questions over how members of staff will be able to classify waste. The regulations also pose logistical problems and space constraints.

The disposal of clinical wastes is often poorly conducted and inadequately supervised despite the publication of clear and definitive working guidelines and the introduction of increasingly stringent legislative control. The move away from landfill disposal of clinical wastes, and the further development of high temperature incinerators able to mee...

A patient is presented with unilobar biliary obstruction associated with marked liver atrophy and compensatory hypertrophy. Characteristically she was not jaundiced and had no portal hypertension. Quantitative measurements of the degree of hepatocyte hyperplasia showed that over 50% of cells in the hypertrophied lobe were hyperplastic. Surprisingly...

One hundred and three patients undergoing biliary surgery have been entered in a randomized prospective trial for antibiotic prophylaxis. Fifty six received piperacillin (2 gr) and 47 tobramycin (100 mg). Cultures were taken from bile at operation and a clinical and microbiological assessment for infection was carried out postoperatively. Overall i...

The minimum inhibitory concentrations (MIC) of noxythiolin and taurolidine were determined for strains of Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa. Tests were performed in broth alone and in broth plus 25% v/v serum or 25% v/v urine. Inoculum density was either 10(3), 10(5) or 10(7) colony forming units per mL-1. Slight in...

In a prospective study performed between 1977 and 1985, 27 patients with cholangiocarcinoma at the confluence of the hepatic ducts underwent resection aiming at cure. Eleven patients underwent local excision and 16 underwent partial liver resection (extended right hepatic lobectomy in 12, left hepatic lobectomy in 3, and extended left hepatic lobec...

The risk of infection transmitted during mouth-to-mouth or mouth-to-nose resuscitation procedures is difficult to define but is possibly quite low. However, the perceived risk is sufficient to cause serious concern for many individuals, including trained hospital personnel as well as the general public, and may preclude prompt and effective action....

The levels of serum alkaline phosphatase (ALP) were measured in eight patients with bile duct obstruction limited to one lobe of the liver. Although an initial rise of enzyme concentration was documented in every patient, unrelieved biliary obstruction was associated with a gradual return of ALP to normal values. The return to normal levels coincid...

The activity of daptomycin (LY146032) and vancomycin was compared for methicillin-sensitive and methicillin-resistant (MRSA) strains of Staphylococcus aureus and for Enterococcus faecalis, using a semi-automated model that allows examination of time-kill curves with diminishing drug concentrations, thus reflecting in vivo pharmacokinetics. Exposure...

Of 27 patients with primary sclerosing cholangitis, 4 were found on investigation and subsequently at operation to have gross lobar atrophy. The disease was particularly severe in the hilar region. Three of the four patients were asymptomatic prior to the onset of jaundice. The presence of atrophy precipitated laparotomy to exclude cancer in two ca...

The exhaust gases from an oil-fired hospital waste incinerator were examined during normal incinerator operation. The design-specified operating temperature was 800 degrees C in the primary combustion chamber and 1000 degrees C in the secondary chamber. Flue gas temperatures, measured from the sampling point at the base of the exhaust stack, varied...

Twenty-seven of 135 patients with malignant hilar stricture who had associated liver atrophy or hypertrophy or both were treated by the percutaneous insertion of an endoprosthesis in the hypertrophied lobe only. The procedure was successful in 25 patients. Three patients died within 30 days of drainage. Procedure-related nonfatal complications occu...

One hundred and thirty hepatic resections performed over an 8-year period were reviewed for evidence of postoperative intra-abdominal sepsis. Of 126 patients who survived for more than 24 hours after operation, 36 developed culture positive intra-abdominal collections (28.6%). Significant independent variables associated with the development of int...

Using formula milk seeded with Staphylococcus epidermidis as indicator, bacteria were observed to pass beyond the collecting bottles of three electrically operated breast pumps. Bacteria were recovered from sites distal to the level of visible contamination, the incidence increasing with repeated use of the apparatus. Despite use of a sterile colle...

2.5% w/v solutions of noxythiolin (Noxyflex S®) in saline have been used for twice daily irrigation of the biliary tract of patients undergoing external biliary drainage. No adverse effects which could be associated specifically with noxythiolin administration were noted. Noxythiolin appears safe for intra-biliary instillation and may have specific...

Infection related to clinical suction apparatus has been widely recognized. Safety systems available at present include devices to prevent overflow from collecting vessels and in-line air filters. The relative efficiency of these devices for the containment of aerosols generated within the collecting vessel has been evaluated. Although of increased...

Taurolidine (2% w/v) and noxythiolin (1% w/v and 2.5% w/v) solutions inhibit the adherence in-vitro of Escherichia coli and Staphylococcus aureus to human epithelial and fibroblast cells. This effect, demonstrable after 30 min exposure of cells to test drugs, persists after removal of the active compound. Significantly reduced adherence of bacteria...

Presented is a patient with primary sclerosing cholangitis, extrahepatic bile duct obstruction, and associated occlusion of the main portal vein, who was treated by peripheral biliary drainage. Radiological follow-up showed considerable improvement of the ductal strictures and bile excretion through the normal anatomical route. The patient remains...

Perioperative endotoxemia was detected in 24 of 40 patients who underwent operation for obstructive jaundice (bilirubin level greater than 5.8 mg/dl). Endotoxemia was associated with an increased admission serum bilirubin level (p less than 0.05) and white blood cell count (p less than 0.05) and a decreased hematocrit value (p less than 0.05), but...

A highly effective, low-cost silicone-based antifoam emulsion is described which, at a final concentration of 100 ppm, prevents bubble formation during the preparation and dispensing of agar media. The compound is heat-stable, has a long shelf-life and offers considerable savings in cost by reduction in wastage of time and materials. It has no demo...

The design and development of a low cost differential pressure indicator giving continual pressure comparison across the substance of an air filter is described. A hazard warning is given when the differential pressure rises above a pre-set value proportional to significant loss of filter efficiency. The differential pressure indicator affords incr...

Two patients with hydatid cysts of the liver are reported. In both patients the cysts had become infected with Haemophilus influenzae. The route of the bacterial infection and significance of this previously unreported association remain unclear.

Postoperative mortality has been directly attributed to renal failure in approximately 5 per cent of patients after surgery for obstructive jaundice. An analysis of 334 patients undergoing biliary tract surgery was undertaken to identify the perioperative factors associated with the development of renal impairment, and to estimate the contribution...

The cytotoxicity of the antiseptic agents noxythiolin and chlorhexidine has been evaluated in-vitro using a range of tissue culture cell lines of differing degrees of neoplasticity. Noxythiolin appeared more cytotoxic than did chlorhexidine when tested against established neoplastic cell lines. By contrast, noxythiolin was not cytotoxic to normal c...

The anti-staphylococcal activity of Taurolin®, a broad spectrum, non-toxic antimicrobial has been evaluated. Preliminary investigation suggests no adverse interaction with commonly used parenteral nutrition fluids including lipid emulsions. The apparent safety of Taurolin® and lack of pharmaceutical interaction suggests that the incorporation of th...

External biliary and drainage was established in six dogs, with the formation of incomplete distal obstruction in four. Drainage catheters were flushed twice daily with either saline or noxythiolin (2.5% w/v) in saline for alternate periods of four weeks. Saline flushing of drainage catheters was associated with the presence of large numbers of bac...

Three patients with postcholecystectomy unilateral hepatic duct stricture and subsequent liver atrophy were treated conservatively, with a successful outcome of up to three years follow up. A better understanding of the pathophysiological sequelae of segmental hepatic duct obstruction suggests that in such circumstances reconstructive surgery, with...

Forty patients with obstructive jaundice (bilirubin greater than 100 mumol/l) were entered into a randomized trial of oral ursodeoxycholic acid for 48 h before surgery versus no additional therapy. Pre-operative venous and operative portal total bile salt concentrations were higher in the bile salt treated patients (P less than 0.001). Portal endot...

Streptococcus pneumoniae was isolated from the bile of two previously healthy adults presenting with extrahepatic obstructive jaundice. The organism was recovered on two occasions from both patients over periods of at least 10 days indicating established biliary colonisation and at the time of surgery pneumococci were present at multiple sites thro...

The antimicrobial activity of polynoxylin, an alkali urea-formaldehyde condensation product, has been examined. The minimum inhibitory concentration (MIC) for 1000 clinical isolates of bacteria and yeasts was in the range 1024-16,384 mg/l. Cidal concentrations of the drug were within one dilution of the corresponding values for MIC, the results sug...

The biliary excretion of piperacillin has been assessed in 11 patients with obstructive jaundice due to hilar cholangiocarcinoma. After a 1-g intravenous dose administered 30 min before preliminary percutaneous transhepatic cholangiography, no drug was detected in the bile of seven patients; in four others, drug concentrations were far below the co...

A pilot study of 20 patients who underwent colonoscopy was performed to investigate the occurrence of endotoxemia related to the procedure and its clinical significance. With the use of the limulus lysate method of assay, endotoxemia was demonstrated in 25 per cent of the patients during colonoscopy and 65 per cent afterwards, but was not associate...

The antimicrobial activity of polynoxylin, an alkali urea-formaldehyde condensation product, has been examined. The minimum inhibitory concentration (MIC) for 1000 clinical isolates of bacteria and yeasts was in the range 1024-16,384 mg/1. Cidal concentrations of the drug were within one dilution of the corresponding values for MIC, the results sug...

The incidence of fecal streptococci in bile is between 5 and 15 per cent of all positive culture findings. Fecal streptococci are not susceptible to the aminoglycoside or cephalosporin antibiotics, although these drugs are widely favored for prophylaxis during surgical treatment of the biliary tract. Over a three year period, 64 episodes of bactere...

The incidence of post-operative septic complications occurring in 46 patients with pancreatic malignancy and in 49 patients with chronic benign pancreatic disease has been assessed. Infection was more common in patients with benign disease and correlated closely with the presence of bacteria in the bile. Risk factors associated with the development...

In a consecutive study of 49 patients with obstructive jaundice who underwent preoperative percutaneous transhepatic drainage, the incidence of bacteria in bile at the time of insertion of the drainage catheter was 29 percent. Patients drained with a conventional open drainage system showed an increase to 100 percent positive cultures after 20 days...

Following an outbreak of cross-infection with multiply-resistant Klebsiella aerogenes epidemiological studies demonstrated the association of the use of suction apparatus with the distribution of positive cases. Eighty per cent of 66 cases had been exposed to this equipment. Environmental and clinical isolates were compared with strains of klebsiel...