Low-dose acetylsalicylic acid use and hemoglobin levels. Effects in a primary care population.

OBJECTIVE: To determine the prevalence of acetylsalicylic acid therapy and effect of the drug on hemoglobin concentration over time. DESIGN: Retrospective, observational study. SETTING: Primary care population in a university-affiliated family medicine clinic. PATIENTS: A population-based sample of 80 patients receiving low-dose ASA for secondary prevention of cardiovascular disease was studied. Of 84 patients receiving the drug after a cardiovascular problem, four were excluded: one man died of a recurrent stroke during the study; the file of a second man was unavailable; another man developed a bleeding ulcer; and one woman had been taking ASA for only 1 month when the data were collated. MAIN OUTCOME MEASURES: Demographic variables of patients taking low-dose ASA, duration of ASA use, and two successive measures of hemoglobin level. RESULTS: The frequency of ASA administration was 7.7% for men aged 60 and older and 2.9% for women. Women had no significant change in hemoglobin levels, while men had a mean loss of 0.472 g/dL (95% confidence interval, .198 to .746; P = .009). For the study population as a whole (80 patients), the average decline was 0.294 g/dL (95% confidence interval, .039 to .549; P = .029). CONCLUSIONS: Although the clinical significance of these findings is uncertain, they suggest the need for a prospective investigation of the influence of low-dose ASA on hemoglobin levels.

Tuberculosis cases in the Negev 1978-1987: ethnicity, sex, and age.

BACKGROUND: The incidence of tuberculosis (TB) in Sub-Sahara Africa is considered to be one of the highest in the world. During the past decade thousands of Jewish refugees from Ethiopia were settled in the Negev and might constitute a potential reservoir of infection for the indigenous populations. This study provides some baseline information about TB in the Negev just prior to and after an Ethiopian immigration peak. METHODS: The files of every case of TB diagnosed during the decade 1978-1987 at Soroka Medical Center were reviewed and each diagnosis was validated by rigorous clinical and microbiological criteria. The age, gender, and ethnic background of each case were recorded, and approximate population denominators were estimated from Ministry of Health and Census data. Annual and decade incidence rates were then calculated for the different demographic categories. RESULTS: 279 cases of TB were verified. The main 10-year incidence rate per 10,000 Israeli Jews was 0.28; for the Negev Beduins it was 1.52; for the Ethiopian Jews, 91.9. In the Jewish population, cases among males (59) far exceeded those among females (7), but the reverse was observed, both among the Beduins (47 female and 31 male cases) and the Ethiopian immigrants (79 female and 56 male cases). In all three groups TB incidence increased with age, ranging from 0.03 per 10,000 for young non-Ethiopian Jews to a remarkable 623.8 per 10,000 for elderly Ethiopian Jews. CONCLUSIONS: The results of this study indicate the existence of a potentially large TB reservoir in the Negev. Health workers must be alerted to the importance of continued case finding, effective case management, and the control of infection transmission. The unique integration of the Negev Health Delivery System should help monitor intervention strategies.

Extrapulmonary tuberculosis in an immigrant society: clinical and demographic aspects of 92 cases.

Extrapulmonary tuberculosis accounted for 33% of all new cases of tuberculosis identified at the Soroka Medical Center in Beer Sheva, Israel, during a 10-year period. The most common types of extrapulmonary infection diagnosed were genitourinary tuberculosis (54% of patients), lymphadenitis (13%), pleural tuberculosis (9%), and tuberculosis of bones and joints (8%). Of 92 patients, 51% were Jews of Ethiopian origin, 29% were Jews of non-Ethiopian origin, and 20% were Bedouins. Thus, extrapulmonary tuberculosis remains a significant problem for Israel's heterogeneous population.

Microbial contamination associated with routine aseptic practice.

We have studied the rate of fortuitous contamination associated with routine aseptic technique under operational conditions. Stainless steel strips, as simulators of surgical instruments, were contained in sterilized surgical packs and assayed by nursing personnel during surgical and other invasive procedures at three different hospitals. The rates of contamination observed for the 36 investigators ranged from 0% to 11.3%, with an overall rate of 2.7%. Assays conducted in a clean room environment, under conditions approaching industrial sterility standards, showed a contamination rate of 0.16%. We concluded that aseptic practices, as routinely performed without any noticeable breaks or transgressions, do not guarantee sterility. The concept of surgical sterility implies low level, but measurable, microbial contamination.

Effect of long-term storage on sterile status of devices in surgical packs.

We investigated the effect of the following on the sterile integrity of surgical packs: four wrapping materials (two-ply reusable, nonbarrier wovens, both new and previously used; disposable, barrier nonwovens; and polypropylene peel pouches), dustcovers, two storage locations, and storage times ranging from 2 to 50 weeks. Two hundred sixty-three packs containing stainless steel coupons were prepared, wrapped, sterilized, and stored. Half of the packs were dustcovered prior to storage. At monthly intervals for a year, packs of each type were opened in a laminar flow hood, and the coupons inoculated into trypticase soy broth. The coupon contamination probabilities were 0.019 for reusable, woven packs; 0.017 for disposable, nonwoven packs; and 0.016 for peel pouches. These differences were not significant. The probability of finding a contaminated coupon in any pack after 50 weeks was 0.018. No trend toward increased probability of contamination over time was observed for any of the pack types studied.

Interhospital transportation. Monitoring sterility of instrument packs.

The Minneapolis-St Paul area is currently experiencing an increase in health care mergers among hospitals. As new facilities are acquired, whether through merger or the building of satellite hospitals, economic considerations often instigate the consolidation of certain departments and services. Thus, hospitals are confronted with a new set of management problems. One such problem might be determining if the probability of contamination increases when a sterile pack is transported from the central sterile supply department of one hospital to the operating room of another hospital. This study indicates that interhospital transport of surgical packs, using a specially designed transfer system, can be accomplished without compromising the sterile status to a significantly greater degree than that associated with transport within a hospital. Many more samples would have to be assayed before these results could be considered conclusive. This study proposes a simple, reproducible, microbiologically sensitive and statistically satisfactory test to monitor the sterile integrity of surgical packs. In the past, different sterility monitoring methods proposed have required either special equipment, specially trained personnel, or complicated procedures. The assay method described here can be easily used by central sterile supply department personnel to monitor the sterile status of transported or stored surgical packs.

Maintaining sterile integrity of hospital produced packs.

Our own experiences, and those of many others over the years, have contributed to the development of practices to prevent the transmission of disease. These practices may vary from country to country and this Symposium will enable us to exchange ideas and information to bring us closer together.

Reuse of disposable medical devices: historical and current aspects.

The "plastics revolution" of the last quarter century disrupted a hospital tradition. Since the 1890s, hospitals processed, packaged, and sterilized most of the medical-surgical items they needed in their own sterile supply departments--a "cottage industry" developed specifically for recycling. Only those consumable items that were too difficult, expensive, or inconvenient to reprocess were purchased from outside manufacturers as presterilized, single-use "disposables." Since the plastics revolution, however, the "disposables" started to displace the "reusables," and while claiming to be an economical innovation, have become a significant item in the budget. Some hospitals feel that if disposables save money, reusing the disposable several times will save more. The practice is spreading. The manufacturers, in turn, claim that hospitals do not have adequate quality assurance programs or skills to reprocess their items properly. The debate is further complicated by legal and ethical ramifications, as well as commercial and economic arguments.

Aseptic transgressions among surgeons and anesthesiologists: a quantitative study.

The extent of compliance with 44 specific aseptic precautions by 18 surgeons and ten anesthesiologists was recorded during a series of 36 clean herniorrhaphies. Anesthesiologists as a group had an aseptic infraction rate nearly twice that of the surgeons, but a relatively small number in each group was responsible for most of the transgressions observed. The most frequent aseptic breaks involved scrubbing techniques (32.4% infraction rate) followed by dress and preparation breaks (12.9% infraction rate). Once physicians were inside the operating room and working, the infraction rate dropped considerably. The number of clinical wound infections observed (two) was too small to draw any conclusions about the association between asepsis and infection.