Risk factors for intoxications in the workplace: a case-control study on data from the Poison Control Center of Policlinico Umberto I of Rome

Implementation of an integrated multispecialty poison-control centre in Bangalore, India: results of a pilot implementation

The Role of Clinical Toxicologists and Poison Control Centers in Public Health

Background. The American Association of Poison Control Centers (AAPCC; http://www.aapcc.org) maintains the national database of information logged by the country's 61 Poison Control Centers (PCCs). Case records in this database are from self-reported calls: they reflect only information provided when the public or healthcare professionals report an actual or potential exposure to a substance (e.g., an ingestion, inhalation, or topical exposure.), or request information/educational materials. Exposures do not necessarily represent a poisoning or overdose. The AAPCC is not able to completely verify the accuracy of every report made to member centers. Additional exposures may go unreported to PCCs, and data referenced from the AAPCC should not be construed to represent the complete incidence of national exposures to any substance(s). U.S. Poison Centers make possible the compilation and reporting of this report through their staffs' meticulous documentation of each case using standardized definitions and compatible computer systems. The 61 participating poison centers in 2005 are:1Regional Poison Control Center, Birmingham, ALAlabama Poison Center, Tuscaloosa, ALArizona Poison and Drug Information Center, Tucson, AZ;Banner Poison Control Center, Phoenix, AZArkansas Poison and Drug Information Center, Little Rock, AKCalifornia Poison Control System–Fresno/Madera Division, CACalifornia Poison Control System–Sacramento Division, CACalifornia Poison Control System–San Diego Division, CACalifornia Poison Control System–San Francisco Division, CARocky Mountain Poison and Drug Center, Denver, COConnecticut Poison Control Center, Farmington, CTNational Capital Poison Center, Washington, DCFlorida Poison Information Center, Tampa, FLFlorida Poison Information Center, Jacksonville, FL;Florida Poison Information Center, Miami, FLGeorgia Poison Center, Atlanta, GAIllinois Poison Center, Chicago, ILIndiana Poison Center, Indianapolis, INIowa Statewide Poison Control Center, Sioux City, IAMid-America Poison Control Center, Kansas City, KAKentucky Regional Poison Center, Louisville, KYLouisiana Drug and Poison Information Center, Monroe, LANorthern New England Poison Center, Portland, MEMaryland Poison Center, Baltimore, MDRegional Center for Poison Control and Prevention Serving Massachusetts and Rhode Island, Boston, MAChildren's Hospital of Michigan Regional Poison Control Center, Detroit, MIDeVos Children's Hospital Regional Poison Center, Grand Rapids, MIHennepin Regional Poison Center, Minneapolis, MNMississippi Regional Poison Control Center, Jackson, MSMissouri Regional Poison Center, St Louis, MONebraska Regional Poison Center, Omaha, NENew Jersey Poison Information and Education System, Newark, NJNew Mexico Poison and Drug Information Center, Albuquerque, NMNew York City Poison Control Center, New York, NYLong Island Regional Poison and Drug Information Center, Mineola, NYRuth A. Lawrence Poison and Drug Information Center, Rochester, NYUpstate (formerly Central) New York Poison Center, Syracuse, NYWestern New York Poison Center, Buffalo, NYCarolinas Poison Center, Charlotte, NCCincinnati Drug and Poison Information Center, Cincinnati, OHCentral Ohio Poison Center, Columbus, OHGreater Cleveland Poison Control Center, Cleveland, OHOklahoma Poison Control Center, Oklahoma City, OKOregon Poison Center, Portland, ORPittsburgh Poison Center, Pittsburgh, PAThe Poison Control Center, Philadelphia, PA;Puerto Rico Poison Center, San Juan, PRPalmetto Poison Center, Columbia, SCTennessee Poison Center, Nashville, TNCentral Texas Poison Center, Temple, TXNorth Texas Poison Center, Dallas, TXSoutheast Texas Poison Center, Galveston, TXTexas Panhandle Poison Center, Amarillo, TXWest Texas Regional Poison Center, El Paso, TXSouth Texas Poison Center, San Antonio, TXUtah Poison Control Center, Salt Lake City, UTVirginia Poison Center, Richmond, VABlue Ridge Poison Center, Charlottesville, VAWashington Poison Center, Seattle, WAWest Virginia Poison Center, Charleston, WVWisconsin Poison Center, Milwaukee, WI

Context. Poison control centers (PCCs) and emergency departments (EDs) rely upon telephone communication to collaborate. PCCs and EDs each create electronic records for the same patient during the course of collaboration, but those electronic records are not shared. Objective. The purpose of this study was to describe the current, telephone based process of PCC–ED communication as the basis for potential process improvement. Materials and methods. This study was conducted at one PCC and two tertiary care EDs. We developed workflow diagrams to depict clinician descriptions of the current process, descriptions obtained through interviews of key informants. We also analyzed transcripts of phone calls between emergency departments and the poison control center, corresponding to a random sample of 120 PCC cases occurring January 1–December 31, 2011. Results. Collaboration between the ED and PCC takes place during multiple telephone calls, and the process is unsupported by shared documentation. The process occurs in three phases: notification, collaborative care, and ongoing consultation. In the ED, multiple care providers may communicate with the PCC, but only one ED care provider communicates with the poison control center specialist at a time. Handoffs occur for both ED and PCC. Collaborative care planning is common and most cases involve some type of request for information, whether vital signs, laboratory results, or verification that a treatment was administered. We found evidence of inefficiencies and safety vulnerabilities, including the inability of PCC specialists to reach ED care providers, telephone calls routed through multiple ED staff members in an attempt to reach the appropriate care provider, and exchange of clinical information with non-clinical staff. In 55% of cases, the patient was discharged prior to any synchronous telephone communication between the ED care provider and a PCC specialist. Ambiguous communication of information was observed in 22% of cases. In 12% of cases, a PCC specialist was unable to obtain requested information from the ED. Discussion and conclusion. Inefficiencies and vulnerabilities occur in telephone-based PCC–ED communication. Prudence begs consideration of alternative processes and models of ED–PCC communication and information sharing, including a process that supports collaboration with health information exchange.

Poison control centers (PCCs) reduce health care costs for childhood poisonings by providing telephone advice for home management of most cases. Past research suggests that PCCs are underutilized by low-income minority and Spanish-speaking parents because of lack of knowledge and misconceptions about the PCC. A videotape intervention was designed to address these barriers to PCC use. To evaluate the effectiveness of a videotape intervention (videotape, PCC pamphlet, and PCC stickers) in improving knowledge, attitudes, behaviors, and behavioral intention regarding use of the PCC in a low-income and predominantly Spanish-speaking population in Northern California. Two hundred eighty-nine parents of children <6 years of age, attending educational classes at 2 Women, Infant, and Children (WIC) clinics participated in a randomized, controlled trial. WIC classes were randomized to receive the video intervention (video group) or to attend the regularly scheduled WIC class (control group). Participants completed a baseline questionnaire and 2 to 4 weeks later, a follow-up telephone interview. Changes from baseline to posttest were compared in the treatment and control groups using analysis of variance. Compared with the control group, the video group showed an increase in knowledge about the PCC's function, its hours of operation, and staff qualifications; was more likely to feel confident in speaking with and carrying out recommendations made by the PCC; was less likely to believe the PCC would report a mother for neglect; was more likely to have the correct PCC phone number posted in their homes; and when presented with several hypothetical emergency scenarios, was more likely to correctly answer that calling the PCC was the best action to take in a poisoning situation. This videotape intervention was highly effective in changing knowledge, attitudes, behaviors, and behavioral intentions concerning the PCC within this population. As a result, use of this video may help increase use of the PCC by low-income and Spanish-speaking families.

Regional poison control centers (PCCs) were surveyed nationally to assess their policies and practices in handling work-related exposures. A 24-item survey was mailed to the executive directors of 44 American Association of Poison Control Centers' certified PCCs nationwide. The survey also requested permission to call the PCC to conduct a blinded role-playing exercise of a case of work-related trichloroethane exposure. Responses on the management questionnaire were compared with the actual responses provided by information specialists in the role-playing exercise. Seventy-five percent of PCCs completed the survey; 43% completed the telephone role-playing exercise. Survey respondents generally overestimated what they thought was routinely done to assess work-related calls, compared with what actually occurred at the time of the work-related call in the role-playing exercise. For example, 32% indicated that their PCC asked about the activities of nearby workers, but none of the PCC staff actually did so. Eighty-nine percent of the PCC executive directors surveyed thought that their staff routinely advised callers to notify their employer about work-related exposure concerns, but this occurred in only 11% of the calls. We concluded that PCCs' responses to work-related calls are inadequate. Given the public health impact of work-related calls, PCCs should develop, implement, and monitor written protocols to better address the public health issues of workplace poisonings.

There is limited published literature on the extent to which United States (US) Poison Control Centers (PCCs) are prepared for responding to disasters. We describe PCCs' disaster preparedness activities and compare and contrast these results to those previously reported in the medical literature. We also describe the extent to which PCCs are engaged in disaster and terrorism preparedness planning and other public health roles such as surveillance. An electronic questionnaire was sent via email to the managing directors of the 57 member PCCs of the American Association of Poison Control Centers. Collected data included the population served and number of calls received, extent of disaster preparedness including the presence of a written disaster plan and elements included in that plan, the presence and nature of regular disaster drills, experience with disaster including periods of inability to operate, involvement in terrorism and disaster preparedness/response policy development, and public health surveillance of US PCCs. Descriptive statistics were performed on collected data. Comparisons with the results from a previously published survey were performed. A response was obtained from 40/57 (70%) PCCs. Each PCC serves a larger population (p < 0.0001) and receives more calls per year (p = 0.0009) than the previous descriptions of PCC preparedness. More centers report the presence of a written disaster plan (p < 0.0001), backup by another center (p < 0.0001), regular disaster drills (p < 0.0001), and comfort with ability to operate in a disaster (p < 0.0001) than previously described. PCCs are involved in disaster (34/40, 85%) and terrorism (29/40, 73%) preparedness at the local, state, or federal levels. PCCs (36/40, 90%) are also involved in public health functions (illness surveillance or answering "after hours" public health calls). Despite an increase in calls received and population served per center as compared to previous descriptions, more PCCs report the presence of a written disaster plan, backup by another center, regular disaster drills, and comfort in ability to operate in a disaster. PCCs are actively involved in terrorism and disaster preparedness and response planning and traditional public health responsibilities such as surveillance.

While many previous reports describe injuries to adolescents in the workplace, few focus on toxic substance exposures among such injuries. Yet low-skill, entry-level jobs pose a particular hazard of toxic exposure owing to the frequent use of cleaning agents, solvents, and/or other chemicals in carrying out assigned tasks. To analyze the types and severity of adolescent occupational toxic exposures. Secondary analysis of calls to a single regional poison control center (PCC). Massachusetts PCC poisoning consultations between 1991 and 1996. Children aged 19 years or younger reporting toxic exposures occurring in the workplace. Of 7024 occupational toxic exposures recorded by the PCC in the 6 years of study, 269 incidents (3.8%) involved adolescents aged 14 to 19 years (median age, 18 years; 124 aged 14-17 years and 145 aged 18-19 years; 65% were male). The most frequently involved agents were cleaning compounds (27.8%); paints, solvents, and glues (9.0%); caustics (8.7%); hydrocarbons (8.7%); and bleaches (7.3%). Of 88 cases (32.7%) in which a worksite was identified, food services (30.7%), automotive services (14.8%), and general retail stores (12.5%) were the most common locations. One hundred fifty-six patients (58.0%) were triaged to an emergency department; 7 were hospitalized. Forty-three subjects (16.0%), 18 who were between the ages of 14 and 17 years and 25 who were aged 18 or 19 years, were judged to have moderate to severe injuries. There were no deaths. This study confirmed the usefulness of PCC surveillance as a source of information about adolescent toxic exposures occurring in the workplace. The occupational toxic exposures reported here most commonly involved cleaning agents, solvents, paints, caustics, and bleach used in those entry-level jobs most frequently filled by adolescents. We conclude that occupational toxic exposures are an underrecognized adolescent injury, and that PCC experience can be used to fill a gap in the surveillance of such workplace-associated events.

Introduction: A cross sectional study was carry out on the necessity of creating a poison control center in Cameroon, by evaluating the knowledge and perception of health care professionals in the Laquintinie hospital and the Bonassama District hospital in Douala, based on a 2 years (2014 to 2015) record files reviewed of poison victims. Materials: A4 white sheets, Respiratory mask, Disposable gloves, A data analyzing tool (Microsoft Excel 2010), ruler and pens, Questionnaire. Method: A Questionnaire was used in data collection to access the knowledge of health care professionals on poisoning and poison control center in regard to proper poison management (group I). To further evaluate group I, a 2 years poison victims files (records) were reviewed at the level of the emergency and paediatric units. The data obtained were analyzed using Microsoft Excel 2010 and the results were displaced on frequency tables, and in percentages and figures. Results: The perception and knowledge of the 66 Health care professionals accessed in the study; revealed that none of the participants had a formal training on poison management and none of the hospitals involved, had established poison management guidelines. 23,182 patients’ files were reviewed; of which 245 files were recorded as poison victims: 62% (152) as voluntary, 38% (93) as involuntary, 4% (10) death case recorded inclusive; with a prevalence of 1% been observed for poisoning from the sorted hospitals. Conclusion: The relative low knowledge of health care professionals on poisoning and the absence of poison management guidelines in hospitals still make poison management in Cameroon a complex issue. Cameroon is therefore highly in need for policies on poison management.

Background. Poison control center (PCC) personnel face many challenges in communicating with callers and with each other. The purpose of this study was to identify interpersonal communication issues that affect the work environment within PCCs. Methods. As part of a larger questionnaire study distributed electronically to members of the American Association of Poison Control Centers (AAPCC) to assess communication training needs for PCCs, three questions were included to assess interpersonal communication within the work environment: (1) How important is interpersonal communication within your center to a positive work environment? (not at all to extremely important, 1–7); (2) How disruptive is interpersonal communication to your work? (not at all to extremely disruptive, 1–7); and (3) What communication issues do you find most disruptive to your work? (free-text response). Descriptive and qualitative content analyses were used to identify themes in responses. Results. A total of 537 responses were received from SPIs, directors, medical directors, and other PCC staff. Interpersonal communication within the PCC was rated as extremely important to a positive work environment (median = 7 and IQR = 6–7; 62.3% rated as extremely important). Interpersonal communication was rated as less than moderately disruptive on average (median = 3 and IQR = 2–4). Free-text responses were received from 335 (62%) respondents. Free-text comments were broadly categorized as relating to PCC personnel and work environment and issues related to PCC callers. Categories that emerged from the PCC personnel and work environment category included the following: poor interpersonal communication (n = 104; 31%); background noise (n = 96; 29%); poor work procedures (n = 51; 15%); and poor management communication (n = 38; 11%). Conclusion. Interpersonal communication within PCCs was considered to be important for a positive work environment. Although not found to be strongly disruptive by most respondents, several specific interpersonal communication issues were identified by PCC personnel as disruptive to their work.

While previous research suggests that poison control centers (PCCs) significantly reduce the number of emergency room visits and resultant health care costs for poisonings, little is known regarding the potential impact of the PCC on the length of hospital stay. The aim of this study was to examine whether assistance from a PCC is associated with a shorter length of hospital stay for patients admitted with poisonings. The cases reported to our PCC were matched over a period of 1 yr with the hospital admissions E-coded as poisonings in the Uniform Billing (UB) data maintained by the state health department. The length of hospital stay was then compared between the cases for which a PCC provided assistance (matches) and the cases for which a PCC was not contacted. During the study period, there were 32,245 hospitalizations for poisoning in the UB data and 52,498 poisonings reported to the PCC. The matching process yielded 1719 nonfatal cases. The length of hospital stay for patients who received assistance from a PCC ranged from 0 to 126 d (median = 2.0) and was significantly different compared to a range of 0 to 220 days (median = 5.0) for cases that were never called in to a PCC. The results of this study suggest that patients admitted to hospitals with poisonings who receive PCC assistance have measurable reductions in average hospital stay. Such a decrease may translate into substantial savings in health care costs and resources.

Transportation-Related Hazardous Materials Incidents and the Role of Poison Control Centers

Last editorial of the Asia Pacific Journal of Medical Toxicology addressed the important role of poison control centers in the improvement of public health (1). In Vietnam, poison control center (PCC) of Bach Mai Hospital has been the only national one for civilians. The establishment and activities of this center can be considered as one of the pioneers in the East Asia. History and setting (2,4) The PCC is a division of Bach Mai Hospital, a tertiary general hospital with approximately 2000 beds. The hospital is a public teaching hospital. The department of clinical toxicology or poison treatment center (PTC) was separated from the department of emergency and intensive care of Bach Mai Hospital in 1998. From this treatment center, the PCC of Bach Mai Hospital was established in 2003 and has been working as the only national PCC. Organization (2,4) The Bach Mai PCC is directed by 3 physicians who are specialized in critical care medicine and have been working for PTC from its beginning. Other staff members of the PCC include 7 physicians, 2 bachelors of chemistry, 1 technician, 27 nurses and 3 medical assistants. The PCC has a unit of clinical toxicology with 35 patient beds, toxicology laboratory and poison information unit. In this setting, clinical and scientific measures including management of poisoned patients, toxicology analysis, training and education for healthcare workers in the management and prevention of poisoning, toxicologic research, cooperation with domestic and international agencies regarding the poisonings, public education, providing poison information, treatment and prevention advice and participation in regional and international congresses and associations have been tracked. Achievements (2,3,5,6) Training and education: (a) For healthcare workers in Vietnam; teaching toxicology module or training courses on the management of poisonings at graduate and postgraduate levels for physicians, residents, medical students, and nurses at the center and in different regions of Vietnam is in progress (7094 students). Moreover, 46 CME courses were organized in 42 provinces nationwide. (b) For international healthcare workers; training course on the diagnosis and management of acute poisonings for 27 physicians from India in cooperation with World Health Organization was performed. Clinical activities: Approximately 1700-1800 poisoned patients are annually treated in the center which majority of them includes pesticides, snakebite, hymenoptera evenomation and toxic mushrooms. Treatment protocols and regimens for common and life-threatening poisonings have been developed and brought about great successes, especially with regards to organophosphate poisoning, snakebite, hymenoptera evenomation and nereistoxin insecticide poisoning. Research: Most studies have been focused on devising protocols and application of techniques for decontamination, antidote administration and enhanced elimination of poisons including emulsified charcoal, snake antivenoms, gastric lavage with closed circuit, plasma exchange, continuous veno-venous hemofiltration/hemodialysis and charcoal and resin hemoperfusion. Mortality rate: The PCC has played an important role in the improvement of death rate. The death rate due to poisonings was reduced from 8.5% to 1.9% after the department of clinical toxicology (PTC) was set up in 1998. The mortality was further reduced to 0.37% in 2005 after the establishment of the PCC. The current death rate (2012) is 1.99% primarily contributed by emerging paraquat poisoning. Organization of charity activities: A large number of severely poisoned patients who were in poor economical status and had treatment costs exceeding the payment competency of the health insurance benefited from these activities. Toxicology analysis: Analysis of many common poisons of concern have been carried out including pesticides, pharmaceuticals, drugs of abuse, alkaloids with quick tests, thin layer chromatography and high pressure liquid chromatography. Publications: Nineteen books (in Vietnamese) on toxicology, emergency medicine and intensive care medicine, nursing, accident and injuries prevention (chief author and co-authors) have been published by the PCC, to date. International cooperation: The PCC successfully hosted the 9th Scientific Congress of Asia Pacific Association of Medical Toxicology at Bach Mai Hospital in 2010 which was attended by 200 delegates from 19 countries

Background:There is little data as to what extent national Emergency Medical Services (EMS; 911) utilize poison control centers (PCCs). A review of data from our PCC was done to better understand this relationship and to identify potential improvements in patient care and health care savings.Methods:Retrospective chart review of a single PCC to identify calls originating from 911 sources over a 4-year study period (1/1/08–12/31/11). Recorded variables included the origin of call to the PCC, intent of exposure, symptoms, management site, hospital admission, and death. Odds ratios (OR) were developed using multiple logistic regressions to identify risk factors for EMS dispatch, management site, and the need for hospital admission.Results:A total of 7556 charts were identified; 4382 (58%) met inclusion criteria. Most calls (63.3%) involved accidental exposures and 31% were self-harm or misuse. A total of 2517 (57.4%) patients had symptoms and 2044 (50.8%) were transported to an Emergency Department (ED). Over 38% of calls (n = 1696) were handled primarily by the PCC and did not result in EMS dispatch; only 6.5% of cases (n = 287) with initial PCC involvement resulted in crew dispatch. There were 955 (21.8%) cases that resulted in admission, and five deaths. The OR for being transported to an ED was 45.4 (95% confidence interval [CI]: 30.2–68.4) when the crew was dispatched by the PCC. Hospital admission was predicted by intent for self-harm (OR 5.0; 95% CI: 4.1–6.2) and the presence of symptoms (OR 2.43; 95% CI: 1.9–3.0). The ORs for several other predictive variables are also reported.Conclusions:When 911 providers contact a PCC about poisoning-related emergencies, a history of intentional exposure and the presence of symptoms each predicted EMS dispatch by the PCC, patient transport to an ED, and hospital admission. Early involvement of a PCC may prevent the need for EMS activation or patient transfer to a health care facility.

Context Prior studies have observed shorter lengths of stay when practitioners consult a US poison control center (PCC) regarding hospitalized toxicology patients, but the most recent study used data from 2010. Since then, the implementation of the Affordable Care Act, a trend toward shorter hospitalizations and substantial adjustments in hospital charges have occurred. Methods This is a retrospective study of administrative hospital data and poison center data obtained from the Wisconsin Hospital Association and Wisconsin Poison Center for patients treated from 2010 to 2017. Stratified analysis was used to investigate the potential effects of PCC consultation on hospitalization. Univariate and multivariable regression analysis was used to characterize which factors were associated with an increased rate of PCC consultation. Discussion 127,224 hospitalized cases were found, of which 44,628 were entered into a stratified hospital charge and length of stay analysis. PCC consultation was associated with an 11.6 h (95% CI 10.4–13.0 h) shorter mean length of stay overall, with children aged 0–6 having a larger reduction of 1.18 days. While total charges were higher by $600 in PCC consultation cases in the overall analysis (95% CI $390–$777), mean charges in patients aged 0–6 were $6695 lower when the PCC was consulted. PCC consultation was more likely to occur in cases involving children and adolescents, intentional overdoses (versus accidental or unknown intent), and women. Conclusions Our findings suggest that PCC consultation should be encouraged to potentially shorten hospitalizations of poisoned patients, and for pediatric patients in particular. Intentionality and demographic factors affect the rate of PCC consultation for overdose, but the nature of these relationships is unclear.