Abstract
Agriculture has one of the highest occupational fatality rates of all U.S. industries. Since the mid-1970s, traditional small-bale balers have gradually been replaced by large-bale balers in the agriculture industry. Expanded use of these balers has resulted in worker exposure to new hazards not present during handling of traditional small bales; the larger size of the bales increases the potential for serious injury or death while workers handle them. During 1994-1996, seven persons in Minnesota died in separate incidents that involved large round hay bales (i.e., cylindrical bales approximately 5 feet in length with flat ends, diameters of approximately 6 feet, and weights ranging from 750 to 1500 lbs). The Minnesota Fatality Assessment and Control Evaluation program (MN FACE), a program sponsored by CDC's National Institute for Occupational Safety and Health (NIOSH), was notified of these incidents by the Minnesota Extension Service, a newspaper clipping service, and/or by death-certificate review. This report describes three incidents that were reported to MN FACE during 1994-1996, summarizes national surveillance for bale-associated deaths during 1980-1995, and provides recommendations to prevent fatalities associated with large bales.
Highlights
183,000 (78%) received chronic hemodialysis.1 Patients who receive chronic hemodialysis are at increased risk for bloodstream infections (BSIs) because of the need for repeated vascular access
Enterobacter cloacae isolated from all nine infected patients and from the WHOs of 10 of 11 dialysis machines were identical when examined by pulsed field-gel electrophoresis (PFGE)
BSIs in four patients were caused by Escherichia coli, three by P. aeruginosa, two by Enterobacter cloacae, and one by Stenotrophomonas maltophilia; two patients had polymicrobial BSIs
Summary
Infections Traced to Probable Contamination of Hemodialysis Machines—Canada, 1995; United States, 1997; and Israel, 1997. Patients who receive chronic hemodialysis are at increased risk for bloodstream infections (BSIs) because of the need for repeated vascular access. This report summarizes the investigations of three clusters of gramnegative bacterial BSIs at hemodialysis centers in Canada, the United States, and Israel. The investigation indicated that at least one of the two one-way valves in the WHO waste drain lines of seven of 11 machines were incompetent,† potentially allowing drain backflow and contamination of dialysis lines in contact with the WHO port. An epidemiologic investigation demonstrated that case-patients (i.e., the nine patients at the hemodialysis center who had Enterobacter cloacae BSIs) were more likely than control-patients to have received dialysis on a machine that had at least one incompetent valve on the WHO waste drain line (all seven case-dialysis sessions versus 145 [53%] of 272 controldialysis sessions; odds ratio: undefined; p=0.02). Enterobacter cloacae isolated from all nine infected patients and from the WHOs of 10 of 11 dialysis machines were identical when examined by pulsed field-gel electrophoresis (PFGE)
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