Evaluating the link between the management of clinical waste in the National Health Service (NHS) and the risk of the spread of infections: A case study of three hospitals in England.

This study aimed to evaluate waste management practices in three case study NHS Trusts in England and the potential risks of the spread of pathogens causing healthcare associated infections (HCAIs). Using a combination of microbiological techniques, interviews and questionnaire surveys, four target microbes were studied, namely: meticillin resistant Staphylococcus aureus (MRSA), meticillin sensitive Staphylococcus aureus (MSSA), Clostridium difficile (C. difficile) and vancomycin-resistant enterococci (VRE). Waste Flow Diagrams (WFDs) were used to map the flow of the waste. While there was a perceived link between the management of the waste and the spread of the microbes by staff, none of the target organisms were isolated. The findings suggest that when the waste is properly contained and managed that it should not pose a significant risk in terms of the spread of the four bacteria tested in this study. In addition, the results demonstrate that there is a need for staff perceptions and beliefs to be addressed in the development of policies and training related to infection control and its link to waste management.

Domestic radon remediation of UK dwellings by Sub-Slab Depressurisation: evidence for a baseline contribution from constructional materials.

To quantify the effectiveness of Sub-Slab Depressurisation, widely used in the United Kingdom (U.K.) to mitigate indoor radon gas levels in residential properties, a study was made of radon concentration data collected from a set of 170 homes situated in Radon Affected Areas in Northamptonshire and neighbouring counties, remediated using conventional sump/pump technology. A high incidence of satisfactory remediation outcomes was achieved, with 100% of the houses remediated demonstrating post-remediation radon concentrations below the U.K. domestic Action Level of 200 Bq m(-3), while more than 75% of the sample exhibited radon mitigation factors (defined as the ratio of radon concentrations following and prior to remediation) <0.2. Two systematic trends are identified. Firstly, absolute radon concentration reduction following remediation is directly proportional to initial radon concentration, with a mean reduction factor of 0.96 and a residual component of around 75 Bq m(-3). Secondly, houses with lower initial radon concentrations demonstrate poorer (higher) mitigation factors. These observations support a model in which the total indoor radon concentration within a dwelling can be represented by two principal components, one susceptible to mitigation by sub-slab depressurisation, the other remaining essentially unaffected. The first component can be identified with radon emanating from the subsoil and bedrock geologies, percolating through the foundations of the dwelling as a component of the soil-gas, and potentially capable of being attenuated by sub-slab depressurisation or radon-barrier remediation technologies. The second contribution can be identified with radon emanating from materials used in the construction of the dwelling with a further contribution from the natural background level, and is essentially unaffected by ground-level remediation strategies. Modelling of a multi-component radon dependency using ground-radon attenuation factors derived from the experimental data, in conjunction with typical background and structural-radon levels, yields behaviour in good agreement with the observed dependence of mitigation factor on initial radon concentration.

Health implications of radon distribution in living rooms and bedrooms in U.K. dwellings--a case study in Northamptonshire.

Environmental radon exposure of residents of domestic premises in the United Kingdom (UK) and elsewhere in Europe is estimated on the basis of the measured radon concentrations in, and the relative occupancies of, the principal living room and bedroom. While studies on radon concentration variability in the individual units in apartment blocks in various countries have been described, little data has been reported on variability in two-storey single-family dwellings, and the majority of extant studies consolidate living room and bedroom data early in the analysis. To investigate this further, detailed analysis was made of radon concentration data from a set of thirty-four homes situated in areas of Northamptonshire known to exhibit high radon levels. All homes were of typical UK construction of brick/block/stone walls under a pitched tile/slate roof. Approximately 50% of the sample were detached houses, the remainder being semi-detached (duplex) or terraced (row-house). Around 25% of the sample possessed cellars, while 12% were single-storey dwellings (bungalows), reflecting the typical incidence of this type of dwelling in England. In the two-storey homes, all monitored bedrooms were on the upper floor. Distribution of the ratios of bedroom/living room radon concentrations (BR/LR ratio) in individual properties was left-skewed (mean 0.67, median 0.73, range 0.05-1.05) with a tail extending to just above 1.0. The mean is consistent with the outcome of earlier extensive studies in England, while the variability depends principally on the characteristics of the property, and not on seasonal factors. In a small set of homes, the BR/LR ratio was anomalously low, (mean 0.3). BR/LR ratios in single-storey homes clustered around a value of 1.0, indicating that house design, rather than lifestyle, is the dominant factor in determining bedroom radon concentrations. Homes with higher mean annual radon concentrations showed lower BR/LR ratios, supporting our proposal that, in some homes, radon emanation from building materials may comprise a significant component of the overall radon level.

The value of Seasonal Correction Factors in assessing the health risk from domestic radon: a case study in Northamptonshire, UK.

Following an intensive survey of domestic radon levels in the United Kingdom (UK), the former National Radiological Protection Board (NRPB), now the Radiation Protection Division of the Health Protection Agency (HPA-RPD), established a measurement protocol and promulgated Seasonal Correction Factors applicable to the country as a whole. Radon levels in the domestic built environment are assumed to vary systematically and repeatably during the year, being generally higher in winter. The Seasonal Correction Factors therefore comprise a series of numerical multipliers, which convert a 1-month or 3-month radon concentration measurement, commencing in any month of the year, to an effective annual mean radon concentration. In a recent project undertaken to assess the utility of short-term exposures in quantifying domestic radon levels, a comparative assessment of a number of integrating detector types was undertaken, with radon levels in 34 houses on common geology monitored over a 12-month period using dose-integrating track-etch detectors exposed in pairs (one upstairs, one downstairs) at 1-month and 3-month resolution. Seasonal variability of radon concentrations departed significantly from that expected on the basis of the HPA-RPD Seasonal Correction Factor set, with year-end discontinuities at both 1-month and 3-month measurement resolutions. Following this study, monitoring with electrets was continued in four properties, with weekly radon concentration data now available for a total duration in excess of three and a half years. Analysis of this data has permitted the derivation of reliable local Seasonal Correction Factors. Overall, these are significantly lower than those recommended by HPA-RPD, but are comparable with other results from the UK and from abroad, particularly those that recognise geological diversity and are consequently prepared on a regional rather than a national basis. This finding calls into question the validity of using nationally aggregated Seasonal Correction Factors, especially for shorter exposures, and the universal applicability of these corrections is discussed in detail.

Radon mitigation in domestic properties and its health implications--a comparison between during-construction and post-construction radon reduction.

Although United Kingdom (UK) Building Regulations applicable to houses constructed since 1992 in Radon Affected Areas address the health issues arising from the presence of radon in domestic properties and specify the installation of radon-mitigation measures during construction, no legislative requirement currently exists for monitoring the effectiveness of such remediation once construction is completed and the houses are occupied. To assess the relative effectiveness of During-Construction radon reduction and Post-Construction remediation, radon concentration data from houses constructed before and after 1992 in Northamptonshire, UK, a designated Radon Affected Area, was analysed. Post-Construction remediation of 73 pre-1992 houses using conventional fan-assisted sump technology proved to be extremely effective, with radon concentrations reduced to the Action Level, or below, in all cases. Of 64 houses constructed since 1992 in a well-defined geographical area, and known to have had radon-barrier membranes installed during construction, 11% exhibited radon concentrations in excess of the Action Level. This compares with the estimated average for all houses in the same area of 17%, suggesting that, in some 60% of the houses surveyed, installation of a membrane has not resulted in reduction of mean annual radon concentrations to below the Action Level. Detailed comparison of the two data sets reveals marked differences in the degree of mitigation achieved by remediation. There is therefore an ongoing need for research to resolve definitively the issue of radon mitigation and to define truly effective anti-radon measures, readily installed in domestic properties at the time of construction. It is therefore recommended that mandatory testing be introduced for all new houses in Radon Affected Areas.

Time-integrating radon gas measurements in domestic premises: comparison of short-, medium- and long-term exposures.

To identify the most applicable technology for the short-term assessment of domestic radon levels, comparative assessments of a number of integrating detector types, including track-etch, electret and activated charcoal were undertaken. Thirty-four unremediated dwellings in a high-radon area were monitored using track-etch detectors exposed for one-month and three-month periods. In parallel, one-week measurements were made in the same homes at one-month intervals, using co-located track-etch, charcoal and electret detectors exposed simultaneously, while three of the homes were also monitored by continuous-sampling detectors at hourly intervals over extended periods. Calibration of dose-integrating devices against each other and against continuous-monitoring systems confirmed good responsivity and linearity. Although track-etch, charcoal and electret devices are suitable in principle for one-week measurements, zero-exposure offset and natural radon variability cause many one-week results to be equivocal, necessitating repetition of the measurement. One-week exposures can be reliable indicators in low-radon areas or for new properties, but in high-radon areas, the use of three-month exposures is indicated. This analysis also established confidence limits for short-term measurements.