Analysis of Some Risk Factors of Active Tuberculosis in Three South Florida Counties.

Background With tuberculosis (TB) being among the top 13 leading cause of death and second leading infectious disease killer next to COVID-19 globally, there is a need for continued study and a better understanding of the risk factors and management approaches. One in five tuberculosis (TB) deaths occurs in individuals who have contracted human immunodeficiency virus (HIV). However, other risk factors play a role in its morbidity pattern. Therefore, descriptions of these comorbidities between TB, HIV, and other risk factors such as diabetes are needed. Method A retrospective, descriptive study was conducted to evaluate the prevalence of TB and its relationship with some risk factors (HIV, diabetes, race, ethnicity, end-stage renal disease, post-organ transplant, recent contact with active TB, and other non-HIV immunosuppressive conditions) using data from three South Florida counties (Dade, Broward, and Palm Beach) from 2010 to 2019 retrieved from the CDC's Report of Verified Case of Tuberculosis (RVCT). Results A total of 2437 cases of TB were reported between 2010 and 2019. There was approximately a 14% positive rate among the three counties for HIV. In contrast, 47% of the individuals with active TB in all three counties were also diagnosed with diabetes mellitus. An average of 25% of the active TB cases in these counties had a concurrent immunosuppressive condition other than HIV. Known contact with another active TB case was an identified risk factor in 18%, 17%, and 29% of reported TB cases in Dade, Broward, and Palm Beach counties, respectively. Discussion The HIV status of patients with TB in these three counties was predominantly negative, in contrast to initial theories. The presence of diabetes mellitus was associated with a diagnosis of TB or latent tuberculosis infection (LTBI) within the studied population. Conclusion Screening for latent tuberculosis infection (LTBI), compliance, and promotion of LTBI management in newly diagnosed and uncontrolled diabetics may be a successful prevention strategy for this high-risk group.

Contribution of a winged phlebotomy device design to blood splatter.

BACKGROUND: Despite a proliferation of phlebotomy devices with engineered sharps injury protection (ESIP), the impact of various winged device designs on blood splatter occurring during venipuncture procedures has not been explored. OBJECTIVES: To evaluate the potential for blood splatter of 6 designs of winged phlebotomy devices. DESIGN: A laboratory-based device evaluation without human subjects, using a simulated patient venous system. METHODS: We evaluated 18 winged phlebotomy devices of 6 device designs by Terumo, BD Vacutainer (2 designs), Greiner, Smith Medical, and Kendall (designated A-F, respectively). Scientific filters were positioned around the devices and weighed before and after venipuncture was performed. Visible blood on filters, exam gloves, and devices and measurable blood splatter were the primary units of analysis. RESULTS: The percentages of devices and gloves with visible blood on them and filters with measurable blood splatter ranged from 0% to 20%. There was a statistically significant association between device design and visible blood on devices ([Formula: see text]) and between device design and filters with measurable blood splatter ([Formula: see text]), but not between device design and visible blood on gloves. A wide range of associations were demonstrated between device design and visible blood on gloves or devices and incidence of blood splatter. CONCLUSIONS: The results of this evaluation suggest that winged phlebotomy devices with ESIP may produce blood splatter during venipuncture. Reinforcing the importance of eye protection and developing a methodology to assess ocular exposure to blood splatter are major implications for healthcare personnel who use these devices. Future studies should focus on evaluating different designs of intravascular devices (intravenous catheters, other phlebotomy devices) for blood splatter.

A multifaceted pilot program to promote hand hygiene at a suburban fire department.

BACKGROUND: Firefighters (FFs) and Emergency Medical Services (EMS) personnel provide care in uncontrolled settings, where the risk of hand contamination is great and opportunities for handwashing are few. Knowledge, attitudes, and beliefs about hand hygiene in this group have not been well reported. METHODS: Written surveys were administered to FFs and EMS personnel to assess their practices, attitudes, and beliefs before and after installation of alcohol hand gel dispensers, hanging of reminder posters, and completion of PowerPoint training. RESULTS: A majority of the participants (n = 131; 58.5%) indicated they had not received any training on hand hygiene from the fire department before the intervention. Responses to Likert scale questions about attitudes, practices, and beliefs regarding handwashing did not reveal any statistically significant differences between preintervention and postintervention surveys; however, responses to direct questions about the impact of the intervention were more promising. CONCLUSIONS: Implementation and evaluation of an intervention to target groups of EMS personnel and FFs can guide future efforts to improve hand hygiene practices in this distinctive group.

Impact of organizational structure on vaccination of first responders: a case study.

The experience of H1N1 vaccine delivery to public safety personnel in a suburban county in Florida suggests a relationship between the degree of hierarchy of an agency and successful implementation of a vaccination program for novel 2009 H1N1 influenza virus. This case study describes the structural organization of the Sheriff's Office and Fire Rescue in County X, provides timelines for vaccine program implementation and numbers of personnel vaccinated, and illustrates the impact of autonomy on the timeliness of vaccine implementation. An "emergency approval pathway" is recommended for organizations or departments that are likely to encounter delays in disaster or pandemic response due to organizational structure.