Report of the Council on Scientific Affairs. Biohazardous waste management: what the physician needs to know. American Medical Association.

Sources of biohazardous waste include not only large hospitals and laboratories, but also physicians' offices, dental offices, clinics, research facilities, surgery centers, veterinary offices, funeral homes, and a growing number of settings where home health care is delivered. State and local municipality definitions and regulations on biohazardous waste vary widely. Most regulations exempt home health care settings, but include physicians' offices. Although the infectious public health risk posed by medical waste is exceedingly low, this fact is not well understood by the general public. Physicians should develop biohazardous waste management programs that fulfill their county, state, and municipal regulations and that consider the difference between health risks to employees and risks to the general public. Physicians can considerably reduce the amount and costs of biohazardous waste disposal by proper identification and segregation of waste in a manner that meets their state's criteria. Using products that can be recycled may reduce the amount and costs of disposal of biohazardous waste. Processing costs also may be reduced by cooperative arrangements among medical groups or health care facilities to negotiate group disposal rates with vendors.

Positive tuberculin skin test reactions among house staff at a public hospital in the era of resurgent tuberculosis.

BACKGROUND: The number and significance of tuberculin skin test reactions were compared with self-reported baseline values among house staff working in a public hospital. High-risk medical specialties, locations, and infection control practices were examined. METHODS: House staff interviews, tuberculin skin test applications, review of employee health service records, and environmental monitoring of high-risk areas were performed. RESULTS: Among house staff self-reported as having negative tuberculin skin test status, 46.2% (95% CI 27.0% to 65.4%) of internal medicine house staff, compared with 4.8% (95% CI 4.3% to 13.9%) of house staff from other areas (p < 0.005), had positive results on a repeat tuberculin skin testing before graduation. These differences were not entirely explained by the use of surgical masks, year of training, or previous vaccination with bacille Calmette-Guérin. Most skin test reactions (69%) occurred among house staff who had not been vaccinated with bacille Calmette-Guérin. Increased skin reactivity probably represented excess conversions from unprotected exposure. Tuberculosis transmission was facilitated by delays in diagnosis, inadequate isolation facilities, and suboptimal ventilation. House staff did not comply with recommended tuberculosis surveillance because of time constraints, fear, and misunderstandings about tuberculin skin test interpretations in light of previous bacille Calmette-Guérin vaccination. CONCLUSIONS: House staff in high-exposure settings with suboptimal environmental controls are at increased risk for tuberculosis infection. Participation in surveillance programs can be increased by enlisting the participation and advocacy of respected medical colleagues, screening house staff differentially according to exposure and job classifications, and more accurately interpreting subsequent test results from baseline two-step testing.

Hearing threshold shifts, white-cell count and smoking status in working men.

The association between cardiovascular risk factors and high-frequency hearing loss (HFHL) was examined using medical records from 699 employees with low workplace noise exposure. High-frequency hearing (averaged frequencies of 4000, 6000 and 8000 Hz) was significantly associated with white-blood-cell (WBC) count, smoking status, mean corpuscular volume and the globulin/albumin ratio, especially in men < or = 40 years old. The association with WBC count remained significant after controlling for smoking, cholesterol, blood pressure, and determinants of blood viscosity. An increase in WBC count of 10(3)/mm3 was associated with a 1.9 decibel (dB) decline in hearing (95% Cl: 0.9, 3.0). Controlling for WBC count reduced the association between high-frequency hearing loss and smoking. Ever-smokers (former and current) compared with never-smokers demonstrated a 6.8 dB decline in hearing (95% Cl: 2.4, 11.1). Associations between HFHL and cardiovascular risk factors are most apparent in younger adults with less cumulative noise exposure. HFHL may be a population marker for susceptibility to cardiovascular and cerebrovascular disease.

Prophage induction and mutagenicity of a series of anti-tumour platinum(II) and platinum(IV) co-ordination complexes.

11 platinum compounds with nitrogen donor ligands, previously tested for anti-tumour activity, were studied for induction of prophage lambda and for mutagenicity in the Ames assay, with various strains of Salmonella. The compounds included cis and trans isomers of Pt(II) and Pt(IV) complexes and were tested with and without metabolic activation. All the cis compounds elicited prophage induction, whereas the trans compounds were inactive. Mutagenicity was found only in strains containing the R factor, indicating that SOS-type repair processes are required for the conversion of initial DNA lesions into mutations. Mutation induction was also influenced by the excision-repair process. The 2 trans compounds were not, or only slightly, mutagenic; all other compounds were mutagenic in at least one strain, exhibiting a 2-20-fold increase over the spontaneous background level. Addition of liver homogenate had no significant effect on the number of mutants. One compound induced exclusively frameshift mutations. The other mutagenic compounds induced frameshift mutations as well as base-pair substitutions. 7 compounds were more mutagenic for the repair-proficient than for the repair-deficient strains; only one showed the opposite effect. This suggests that for mutagenicity testing of platinum compounds, repair-proficient strains are more sensitive indicators. The differences in response of the various strains are more sensitive indicators. The differences in response of the various strains toward the compounds suggest the formation of different DNA lesions and/or a selective action of repair processes on these lesions. In general, a good qualitative correlation was observed between prophage-inducing capacity, mutagenicity in bacterial and mammalian cells and anti-tumour activity.