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February 2007

January 2007

Laws don't save people, people save people

I am told by one of our best sales and service guys that he has observed something disturbing in the field...

Companies will purchase area monitoring equipment for toxic gases, supposedly to protect their people, or at least to comply with regulatory requirements, but then will either not maintain it, or sometimes turn it off!

We have always emphasized the necessity of proper calibration and maintenance, and have promulgated best practices for where to set system alarms, as well.

We all know that the mere existence of a sign establishing a 45 miles per hour speed limit, will not—in and of itself—prevent someone from doing 80.  Thus, it is also true that the most restrictive limits that regulatory agencies might put on allowable levels for air contaminants mean nothing, unless they are enforced, and unless they are actually monitored in real time.

Yet, the current preoccupation of most regulatory agencies is rule making, not enforcement.

No surprise then, that the current preoccupation of many regulated businesses and workplaces is superficial compliance only:  They may purchase the air monitor and install it, but that's where it ends—far too often.

A riff on this problem explains why the touted EPA mileage figure for cars is almost never achieved in real life:  The cars are designed to perform on the EPA mileage tests, and are not engineered to achieve a particular mileage on the road.

Giving rise to the all too familiar "Your mileage may vary."

One wonders how difficult it would be to create a real-life mileage test, or for workplaces to diligently monitor for air contaminants.

Like everything else, it comes down to the people.

Eco-friendly diamonds

My Health News Digest article this week, mirrored here, tells you how you can save kids from slave labor, prevent your hard-earned money from financing warlords in Africa, and slow down the environmental damage caused by conventional diamond mining.

Although synthetic diamonds have been around for a long time, only recently has the technology given us true gem quality stones.  Is the cartel worried?  Oh, yeah...

They are worried enough that they are GIVING AWAY expensive lab equipment to detect the synthetics, which are indistinguishable from mined diamonds to the naked eye, and have the exact same chemical and physical properties.

A diamond is a diamond!  A retailer jeweler puts it this way:

Do you care that the beautiful orchid you just purchased was grown in a hothouse, instead of coming from deep in the jungle, where it exists naturally?

I didn't think so.

Stretching--The right way

Until I found Dr. Steven Stark's book, The Stark Reality of Stretching, I always wondered why those important lower body stretches I was doing seemed ineffective and even harmful.

Stark explains it all, and also shows why much of the conventional wisdom out there on stretching is just plain wrong.  And, he's not just whistling Dixie—the book is quite scientific, and is filled with scholarly references.

HIghly recommended by this aging athlete...

White Memorial whitewash

Late last year, we reported on the tragic and needless death of two preemies at White Memorial Hospital in Los Angeles.

The bug that killed the two babies was Pseudomonas aeruginosa, a bacterium infamous for its ability to thrive in numerous environments, its tendency to cause disease in immunocompromised individuals, and its resistance to antibiotics. P. aeruginosa produces toxic proteins that can destroy tissue and interfere with the immune system, and is said to be responsible for 10 percent of the 2 million hospital-acquired infections that happen each year. Of the 2 million infections, nearly 100,000 are fatal.

My article took strong exception to the way this matter was reported to the public, especially since it did not include the rather astounding finding that the very organizations promoting the voluntary standards for sterilization and disinfection were at least partially to blame for the tragedy.

I quoted acclaimed infection control guru Dr. Lawrence F. Muscarella, who believes that AORN's guidelines (Association of periOperative Registered Nurses) have lowered the levels of diligence, vigilance, compliance, and concern regarding the potential for disease transmission associated with improper reprocessing of endoscopes (including laryngoscopes). The guidelines seem to be disproportionately influenced by cost factors and the peculiarities of certain manufacturers' reprocessing equipment, rather than patient safety.

Fast forward a few weeks, and the LA Times confirmed that inadequate reprocessing of laryngoscope blades was to blame for the deaths. 

According to the Times--The blades were cleaned with soap, tap water and alcohol wipes, which was not in accordance with the manufacturer's recommendations to sterilize them. The hospital's director of risk management and infection control told inspectors that "the practice was unapproved, and there was no training, no competency and no monitoring of the procedure."

But, let's not be so quick to blame the underpaid techs...

Muscarella does not agree that White Memorial Hospital and its staff members were entirely to blame for the reprocessing missteps that led to this outbreak.  He notes that:

The use of soap and water and wiping with 70% alcohol to reprocess rigid laryngoscope blades, while inadequate, is reported to be an all too common practice.

Failure of the health care community to have published formal and multi-society endorsed step-by-step guidelines for reprocessing the rigid laryngoscope's blade and handle, in Muscarella's opinion, may have played a role in this outbreak at White Memorial.

What's more, Muscarella believes that "mixed signals" regarding the minimum reprocessing requirements for rigid laryngoscopes may have also played a role in this outbreak.  Some guidelines all but endorse the use of 70% alcohol for reprocessing laryngoscope blades, which might have confused reprocessing staff members at White Memorial.

One guideline recommends the following for reprocessing laryngoscope blades:

"Wash (the blade) with detergent solution and dry. If disinfection is indicated, immerse (the blade) in 70% alcohol for 10 minutes."

For the handle, this guideline recommends no more than cleaning with a detergent solution. Guidelines that not only recommend inadequate measures for the blades of laryngoscopes, but that also recommend a different, and lower, level of disinfection for the handle do little to resolve the confusion surrounding the minimum reprocessing requirements for rigid laryngoscopes.

Noted in my original article--

As any undergraduate microbiology student will tell you, once a surface that started off at a higher level of disinfection is touched by a surface that is at a lower level—such as a laryngoscope blade touching a laryngoscope handle—the higher level surface has been compromised.  Indeed, this would be a fundamental violation of aseptic technique.

Where was AORN?  The silence is deafening.

Some thoughts on what should be posted here

There is more to ecology than saving the whales, using less energy, debating global warming, and making fun of Laurie David.

Let's start with the definition of "ecology"

A branch of science concerned with the interrelationship of organisms and their environments especially as manifested by natural cycles and rhythms, community development and structure, interaction between different kinds of organisms, geographic distributions, and population alterations

Mark well that bit about "interaction between different kinds of organisms," since the entire notion of managing infectious diseases—a giant portion of health care—flows directly from that.

Thus, you'll see numerous postings on that subject.

Likewise, community development and structure, geographic distributions, and population alterations give us a pretty wide area of relevant subject matter.

Note that "the Earth" got along just fine for eons without any life on its surface, let alone human life.  So, when you think about it, ecology should not be touted as "Saving the Earth," any more than we would care if some distant uninhabited planet were to explode.  Instead, it should focus on the best possible outcomes for all inhabitants of this Earth, with mankind's well-being taking precedence.

Finally, beware the term "natural."  Hurricane Katrina was natural, deaths from cholera were natural, and starvation was natural before the advent of agriculture.  Indeed, agriculture is completely UN-natural in that evil mankind is messing with Mother Nature's order of things.  Better we should be hunters and gatherers, right?

Of course, human intelligence is natural, as well, and it is ultimately up to us to be stewards of life and of all the resources this Earth has to offer.

Health News Digest

Media good guy Mike McCurdy's Health News Digest is now updated daily.  Yes, there are many health sites out there, but this is one of the best.

Why?  You'll be amazed at the variety of content and the overall quality.  From diet to disease prevention to exercise tips to environmental issues to book reviews to plastic surgery and lots more, you will definitely find something here of interest.

Give it a spin!

Evaluation of the Carcinogenicity of Ethylene Oxide

The US EPA's Draft, entitled "Evaluation of the Carcinogenicity of Ethylene Oxide" was subjected to a rigorous public review, January 18-19—in Washington—by EPA's Science Advisory Board.

Also present were several public commenters, including me.  The American Chemistry Council, and Ethylene Oxide Sterilization Association were well represented.  The draft was pretty much universally condemned, and when you consider that the SAB members were hand-picked by the Agency, this alone speaks volumes.

Sad to say, this draft was an example of advocacy "science" gone amok.  Indeed, one of EPA's presenters, Dr. Jennifer Jinot, is no stranger to this sort of controversy, having been accused of tweaking the data in environmental tobacco smoke studies. 

The report was full of statistical errors, including thowing out all the female data (nearly half of the population) in a large cohort of people exposed to ethylene oxide (EtO) in the workplace.  Jinot gave no reasonable explanation for this, and it was rather apparent that she wanted to extrapolate the worse male data (although it was not all that bad) on the entire population.

Beyond that, models using the odds ratio, rather than the available actual data, drastically overstated the effects.  Problems with relying on odds ratios are well-known, or should be well-known to biostatisticians.

Not surprisingly, based on this methodology, recommended values for EtO came in well below the lowest ambient air concentrations that occur in nature, and below endogenous levels in humans and laboratory animals.

As I've noted before, we have to be very careful when we talk about danger and risk.  Reasonable people want to act prudently regarding all hazardous substances, but in the case of EtO, attention must be paid to its essential use as a sterilant.

Thus, we must balance the very real and immediate danger of infecting the patient with the long-term effects of the chemical.  This balancing act is not helped one bit with overblown risk assessments.

It is clear that this draft will be re-done, but the Agency's credibility—already not at the highest level—took a big hit on this one.

Stay tuned for further details...