Substituting the forest for the trees: social networks and the prediction of romantic relationship state and fate.

This research focused on perceptions held by heterosexual couples' friendship network concerning the couple's relationship. In a three-wave longitudinal study, we examined (a) whether these perceptions were similar to the couple's views of the relationship, (b) whether they predicted current relationship state and future fate, and (c) how they compared with the couple's perceptions in predicting fate. Consistent with within-dyad idealization, results from a North American sample indicated that network perceptions of relationship state were significantly more negative than those held by a couple. Although both the couples' and the total networks' perceptions predicted fate, friends of the female couple member were particularly successful at predicting relationship dissolution. An examination of possible mechanisms whereby friends may come to possess particularly predictive perceptions supported the role of couple-disclosure in this process.

An outbreak of needlestick injuries in hospital employees due to needles piercing infectious waste containers.

OBJECTIVES: To investigate the cause of an outbreak of needlestick injuries (NSIs) in hospital employees. SETTING: A 700-bed university hospital. DESIGN: Outbreak investigation, laboratory evaluation of a medical waste disposal device, cost analysis. METHODS: Employee health department records were reviewed of workers suffering sticks from needles piercing fiberboard-contaminated material containers (CMCs). A laboratory evaluation of needle-puncture resistance properties of the CMCs was performed using a testing apparatus. The cost of a hospital waste disposal program using fiberboard CMCs was compared with the cost of a program using rigid plastic (polypropylene) boxes. RESULTS: During 40 months of surveillance in 1986 and from 1989 to 1991, only one NSI had occurred from a needle piercing a CMC. During 9 months in 1993, 13 NSIs occurred due to needles piercing CMCs (P < .001). No clinical illness resulted from the NSIs. The outbreak was halted by a temporary change to plastic (polypropylene) boxes for sharps disposal ($4.92 to $23.33/cu ft) until receipt of a box with a newly designed solid fiberboard liner ($1.25/cu ft). CMC liners used during the epidemic had a mean needle puncture resistance of 527 g, as compared with 660 g for liners used before the outbreak (P < .001). The new solid fiberboard liner has a mean puncture resistance of 1,765 g. A program of waste disposal using fiberboard CMCs was found to cost approximately one-seventh the cost of a program using plastic boxes for disposal of infectious waste. CONCLUSION: A program for infectious waste disposal using fiberboard CMCs can be safe and cost-effective if appropriate standards for puncture resistance are met.

EtO personnel monitoring devices: the state of the art.

Results from a single monitor worn by an employee become a part of his record of previous EtO exposure and a measure of the conditions in the central sterile supply area. It is obviously important that these results be accurate. Random errors in the results of analytical measurements are allowed for in the NIOSH criteria for overall accuracy of a technique. The sensitivity and accuracy of devices used to monitor TWA personnel exposure to EtO are only as good as the collection efficiency of the technique and the analytical instrumentation it utilizes. The active sampling charcoal absorption tube, impinger, and Tedlar bag methods are common air quality monitoring tools within the occupational health field. In the hands of experienced industrial hygienists and analytical chemists, these devices may be used with accurate EtO collection and analytical results. Passive sampling diffusion monitoring devices obtain the same results through simplicity of use and ease of providing analysis. However, the user must be careful to follow the manufacturer's instructions exactly if the results are to be accurate and meaningful. With these facts in mind, and in light of recent studies showing continued improvements in the technique's precision, it is likely that most hospitals will turn to the diffusion monitor methods as their primary means of documenting compliance with the new OSHA monitoring standard.

An evaluation of the accuracy and reliability of ethylene oxide diffusion badge monitors.

Ethylene oxide (EO) gas is widely used in hospitals to sterilize certain moisture- and heat-sensitive materials. Based on scientific studies indicating its potential as a human carcinogen and mutagen, and the possible genotoxic, reproductive, neurologic, and sensitization hazards associated with EO exposure, the Occupational Safety and Health Administration has recently lowered the permissible exposure limit (PEL) from 50 ppm to 1 ppm as an 8-hour time-weighted average (TWA). This standard also established an "action level" of 0.5 ppm for an 8-hour TWA, below which employers are exempted from such requirements as periodic employee exposure monitoring or medical surveillance. These much lower concentrations of EO in air now place greater demands upon the analytical techniques used to monitor exposure of hospital personnel to EO. In this study, the capabilities of five EO diffusion monitors were examined in the TWA concentration range of 0.25-3.7 ppm. Both accuracy and precision were tested by exposing these devices simultaneously to measured concentrations of EO in a stainless steel exposure chamber. Temperature and humidity conditions were controlled, as was the flow rate of the gases across the sampling areas of the diffusion monitors. All of the monitors tested were sensitive enough to measure EO at the new PEL level, but in this laboratory investigation only one type of monitoring badge was able to meet the National Institute for Occupational Safety and Health criteria of +/- 25% overall system accuracy at the 95% confidence level in the exposure range of 0.5-2.0 X the OSHA PEL.