Hospitals, exposures

With the increasing capacity of the medical establishment to treat the most serious life-threatening conditions, the in-hospital exposure to nephrotoxic drugs will increase as will the risk of drug-induced ARF. 

Intrinsic asthma, also called idiopathic asthma, usually develops in adulthood. In intrinsic asthma allergic factors are not demonstrable. Episodes of intrinsic asthma may be triggered by a variety of stimuli, eg, emotional state, exposure to cold air, or inert dusts. Both intrinsic and extrinsic asthmatics can be prone to exercise-induced attacks. Individuals who experience a combination of extrinsic and intrinsic asthmatic reactions have mixed asthma. Status asthmaticus refers to an especially acute life-threatening asthma attack which is resistant to normal treatments and which may require hospitalization in order to stabilize the patient. 

Table 3. Minimum Exposure Periods for Sterilization of Hospital Supplies ...

Because hospital loads are not uniform, certain assumptions were made by the manufacturers of sterilizers in arriving at recommended cycles. These recommendations include a safety factor, as well as allowance for heatup time. Exposure recommendations for various types of articles are available (12). 

It should be noted that the primary purpose of the ventilation systems described for abrasive blasting rooms and hospital isolation rooms is to prevent or minimize exposure to hazardous substances in those persons working outside the blasting or isolation room. The ventilation system may also reduce exposure for workers inside these rooms, but often the reduction is not sufficient to eliminate the need for respiratory protection. 

Many malodorous compoimds are not only nuisance, but also a health threat under prolonged exposure [1]. Ammonia (NH3) is emitted from landfill and sewage treatment plant and associated with many agricultural activities (e.g. poultry and piggery). Ammonia is also a problem in public toilets, hospitals and nursing homes. Selective eatalytie oxidation (SCO) can convert NH3 to N2 at mild temperature (i.e. 473-673 K) as shown in equation 1, however nitrous oxides (N2O) and nitrogen oxides (NOj) are often produced cf. Eqn. 2 3). 

Nakajima 1978). Three men accidentally exposed to trichloroethylene vapors (unspecified levels) for less than 30 minutes were hospitalized with acute symptoms and had venous blood levels ranging from 380 to 700 pg/L 4.5 hours after exposure (Kostrzewski et al. 1993). 

In degreasing operations, there may be exposures to carbon monoxide, which may compound symptoms reported by workers (NIOSH 1973). Illnesses of certain employees, documented at a neighboring hospital, included headache, nausea, dizziness, and chest pain. The NIOSH report concluded that the first employee illness reports were due to toxic effects of carbon monoxide complicated by trichloroethylene exposure. The... 

Ask the patient about the frequency and severity of symptoms, when symptoms occur, and whether or not the symptoms are associated with exposure to known allergens. Ask the patient about previous emergency department visits and hospitalizations due to asthma. 

Most health care workers are at risk for exposure to many diseases in the normal course of their work. Additionally, health care workers may transmit vaccine-preventable diseases to their patients. At the time of employment and on a regular basis, health care workers should be screened for immunity to measles, rubella, and varicella if found to be non-immune, the measles, mumps, and rubella, and varicella vaccines should be administered. The hepatitis B series should be given if not already completed. Tetanus should be updated and given every 10 years. Health care personnel in hospitals and ambulatory settings with direct patient contact should receive Tdap if not already received an interval as short as 2 years from the last tetanus-containing vaccine should be used. Priority for receiving Tdap should be given to personnel with direct contact with infants less than 12 months of age. 

Inhalation Move victims to fresh air. Emergency personnel should avoid self-exposure to amiton. Evaluate vital signs including pulse and respiratory rate, and note any trauma. If no pulse is detected, provide CPR. If not breathing, provide artificial respiration. If breathing is labored, administer 100% humidified oxygen or other respiratory support. Obtain authorization and/or further instructions from the local hospital for administration of an antidote or performance of other invasive procedures. Transport to a health care facility. 

Three of five men, who lost consciousness within a few minutes of entering a partially drained underground liquid manure storage tank, died before reaching the hospital autopsy showed that two had massive liquid manure pulmonary aspiration, while the third had fulminant pulmonary edema without manure aspiration (Osbem and Crapo 1981). Markedly elevated heart-blood sulfide-ion levels indicated significant hydrogen sulfide exposure. Air samples analyzed about a week after the accident detected only 76 ppm of hydrogen sulfide, but the study authors noted that the environmental conditions were probably different (e g., warmer weather, less-concentrated manure). 

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