Reduction in antibiotic use through procalcitonin testing in patients in the medical admission unit or intensive care unit with suspicion of infection.

We report an evaluation of the utility of serum procalcitonin (PCT) measurement as an additional diagnostic tool to support initiating or withholding antibiotics in clinical situations where there is a clinical suspicion of infection but the diagnosis is uncertain. During a six-month period, 99 patients on the medical admission unit (MAU) with suspected infection, and 42 patients on the intensive care unit (ICU) with clinical signs or physiological parameters suggesting possible new infection, had serum PCT concentration measured with the result available within 90min of the request. The test was initiated by the microbiology/infection team during clinical consultations to support the antibiotic decision. On the basis of low PCT values, antibiotics were withheld in MAU on 52 occasions and in ICU on 42 occasions. Patients were followed up prospectively for a week. There was neither progression of bacterial infection requiring antibiotics, nor complications or infection-related mortality in any patients who were denied antibiotics on either MAU or ICU. Without the PCT value it is likely that all of these patients would have received empirical antibiotics. Reduction in unnecessary antibiotic usage was made without any adverse effects on these patients and there was a clear reduction in antibiotic prescribing with cost reduction implications. PCT has the potential to become a valuable tool in antibiotic management.

Exposure to preservatives used in the industrial pre-treatment of timber.

OBJECTIVE: The research was to survey potential dermal exposure and inhalation exposure of operators to preservative fluids used in industrial timber pre-treatment. RESULTS: Surveys in 1996-98 produced 64 data points. These were taken from 54 sites, and involved 57 timber pre-treatment process operators. Of the data, 38 related to copper chromium arsenic preservative used in vacuum-pressure processes, 19 to solvent-based preservative in double vacuum processes and 7 to water-based preservative in double vacuum processes. Treatment cycle times, preservative concentrations, treatment load sizes and quantities of preservative used per cubic metre of timber are reported. Preservative deposition patterns were similar for all treatments, with about 90% on the legs, and most of the remainder on the arms and chest. The results are quoted as mg preservative preparation (as opposed to active substance), expressed as mg per treatment cycle and mg per minute. Water-based products in vacuum-pressure processes (38 data) showed potential dermal exposure in the range 547-132,000 mg per cycle with a median value 3960 mg per cycle (median cycle time 3 h). Water-based products in double vacuum processes (7 data) showed a range 59-8750 mg per cycle with a median value 4260 mg per cycle; and solvent-based products in double vacuum processes (19 data) showed a range 7.5-449 mg per cycle with a median value 119 mg per cycle (median cycle time 1 h for double-vacuum processes). Contamination of work clothing occurred in nearly all surveys, with around 10% penetration of the preservative as estimated by a sampling patch mounted inside the operator's coveralls. Contamination was measured inside the operator's gloves in nearly all surveys. Wearing fresh gloves was found to reduce exposure to arsenic by 71% and to permethrin by 37%. Contamination on socks was measured and found to be less frequent for double vacuum than for vacuum-pressure processes. Exposure by inhalation for vacuum-pressure processes expressed as preservative, showed a range of 0.06-7.96 mg/m3, with a median value of 1.07 mg/m3, time-weighted average exposure over one or two treatment cycles. Exposure was detected in 68% of the vacuum-pressure process surveys. There was evidence for aerosol generation on transporting timber treated with water-based preservative. For double vacuum processes, two non-zero results only were found, both for water-based preservatives. Aerosols within treatment vessels were found to have dispersed 2.5 min after opening the door. Pilotstudy biological monitoring data for urinary chromium, arsenic, and permethrin metabolites are quoted with reference to creatinine. There are tentative conclusions relating to up take via the skin.