Blood Spills Research Articles

Medical coverage of high school football in Wisconsin in 1997.

The goals of this study were to assess the health care available to Wisconsin high school football players and to assess high schools' compliance with safety requirements of the Wisconsin Interscholastic Athletic Association (WIAA). The design was a cross-sectional survey-based study. The setting consisted of WIAA high schools. Athletic directors of WIAA high school football programs participated in the survey. The main outcome measures were the prevalence of medical coverage by physicians, certified athletic trainers, and ambulance personnel at football games and practice and the prevalence of compliance with WIAA requirements. Seventy-seven percent (302/392) of surveys were returned. Thirty-six percent of schools had a designated team physician. Eighty-seven percent had a trainer, and 86% were certified athletic trainers (Athletic Trainer Certified, ATC). At practice and scrimmage, 79% had an ambulance available or on call, 52% had a trainer present, and 28% had a physician on call. At football games, 71% had an ambulance, 67% a certified athletic trainer, 48% an emergency medical technician, and 45% a physician present. Regarding WIAA requirements, 9% had no accessible phone, 27% had no written emergency plan of action, 92% had gloves, and 92% had blood spill kits. Larger schools had better compliance with WIAA requirements than did smaller schools. Health care coverage was provided mainly by trainers and ambulance personnel, although physicians were routinely present at almost half of all games. Failure to comply with WIAA medical coverage requirements was not infrequent. This study forms the basis for an informational intervention, providing an opportunity to correct deficits.

Blood loss estimation by out-of-hospital emergency care providers

Objectives. To evaluate emergency medical technicians' (EMTs') ability to estimate spilled blood volume and to determine whether limited training improves estimate accuracy and whether there is a difference in improvement comparing two different training methods. Methods. The study design was a single-blinded, clinical model, utilizing EMTs (basic, intermediate, and advanced) from a local commercial ambulance service. Participants estimated the volume of randomly selected volumes of packed red blood cells reconstituted to a normal hematocrit and poured onto three absorbent (carpet) and three nonabsorbent (vinyl) surfaces. Participants were then randomly assigned to one of two teaching groups. The sitegrp (n = 17) returned to the six testing sites and were told the actual blood volumes. The slidegrp (n = 16) were taught with slides of six similar blood spill sites. Both groups were provided with suggestions for making volume estimates. The same participants were then retested one month later using the same type of sites and six new blood volumes. Results. Thirty-three participants with an average of 7.5 years of prehospital care experience completed testing on both dates. Mean percent error {[(estimated volume - actual volume)/actual volume] ± 100} for all participants decreased from 65% ± 33% initially to 52% ± 20% after retesting (p < 0.05). Mean percent error was 74% ± 41% and 59% ± 20% for the sitegrp (p < 0.15) initially and after retesting, respectively. Mean percent error was 56% ± 17% and 45% ± 17% for the slidegrp (p < 0.05) initially and after retesting, respectively. Conclusion. Prehospital care providers are not accurate at estimating spilled blood volumes. This ability can be improved with limited education. Slides appear to be as effective as viewing actual spill sites.

Uses of inorganic hypochlorite (bleach) in health-care facilities.

Hypochlorite has been used as a disinfectant for more than 100 years. It has many of the properties of an ideal disinfectant, including a broad antimicrobial activity, rapid bactericidal action, reasonable persistence in treated potable water, ease of use, solubility in water, relative stability, relative nontoxicity at use concentrations, no poisonous residuals, no color, no staining, and low cost. The active species is undissociated hypochlorous acid (HOCl). Hypochlorites are lethal to most microbes, although viruses and vegetative bacteria are more susceptible than endospore-forming bacteria, fungi, and protozoa. Activity is reduced by the presence of heavy metal ions, a biofilm, organic material, low temperature, low pH, or UV radiation. Clinical uses in health-care facilities include hyperchlorination of potable water to prevent Legionella colonization, chlorination of water distribution systems used in hemodialysis centers, cleaning of environmental surfaces, disinfection of laundry, local use to decontaminate blood spills, disinfection of equipment, decontamination of medical waste prior to disposal, and dental therapy. Despite the increasing availability of other disinfectants, hypochlorites continue to find wide use in hospitals.

Uses of inorganic hypochlorite (bleach) in health-care facilities.

Hypochlorite has been used as a disinfectant for more than 100 years. It has many of the properties of an ideal disinfectant, including a broad antimicrobial activity, rapid bactericidal action, reasonable persistence in treated potable water, ease of use, solubility in water, relative stability, relative nontoxicity at use concentrations, no poisonous residuals, no color, no staining, and low cost. The active species is undissociated hypochlorous acid (HOCl). Hypochlorites are lethal to most microbes, although viruses and vegetative bacteria are more susceptible than endospore-forming bacteria, fungi, and protozoa. Activity is reduced by the presence of heavy metal ions, a biofilm, organic material, low temperature, low pH, or UV radiation. Clinical uses in health-care facilities include hyperchlorination of potable water to prevent Legionella colonization, chlorination of water distribution systems used in hemodialysis centers, cleaning of environmental surfaces, disinfection of laundry, local use to decontaminate blood spills, disinfection of equipment, decontamination of medical waste prior to disposal, and dental therapy. Despite the increasing availability of other disinfectants, hypochlorites continue to find wide use in hospitals.

Professional: Practice: How to Handle Blood &amp; Body Fluid Spills

(1994). Professional: Practice: How to Handle Blood & Body Fluid Spills. Strategies: Vol. 7, No. 7, pp. 23-25.

Cell sizing in chronic lymphoproliferative disorders: an aid to differential diagnosis.

To determine if leucocyte volume distribution analysis (LVDA), obtained using a Coulter Counter Model S Plus IV, can be used to aid differentiation of chronic lymphoproliferative disorder (CLPD) subtypes. Mean lymphocyte volume and lymphocyte distribution width were measured on each patient (n = 90) using a hard copy of an amplified LVDA histogram. The mean lymphocyte volume was taken as the mean of the values on either side of the peak at half maximum height. The lymphocyte distribution width was taken as the range of cell values between the two values used to calibrate the mean lymphocyte volume. A template showing typical histograms from commonly occurring CLPD was also produced on an acetate sheet. This was used to examine the histogram from each new patient to evaluate its usefulness as an alternative to the calculation of mean lymphocyte volume and lymphocyte distribution width. Mean lymphocyte volume and lymphocyte distribution width were significantly higher in B cell lymphocytic leukaemia of mixed cell type (B CLL/PL), B cell non-Hodgkin's lymphoma with peripheral blood spill, hairy cell leukaemia and T cell prolymphocytic leukaemia than in B cell chronic lymphocytic leukaemia (B CLL). The mean lymphocyte volume, but not the lymphocyte distribution width, was also significantly higher in T cell chronic lymphocytic leukaemia than in B CLL. The template gave an immediate preliminary indication of possible subtype(s) of disorder and could be used as an alternative to measurement of mean lymphocyte volume and lymphocyte distribution width. Electronic haematology analysers producing an LVDA provide a useful, cost effective cell sizing analysis which can aid the differentiation of subtypes of CLPD.

The Eighteenth Century or Fin-de-Siècle Beginnings

The Eighteenth Century or Fin-de-Siècle Beginnings Diane Fourny W HILE WORKING ON THIS ESSAY, I was interrupted one morning by a National Public Radio broadcast reporting what I can only call a fin-de-siècle “happening.” According to the broadcaster a group of concerned French citizens was mounting a cam­ paign to purge France’s national anthem of its bellicose lyrics. This furor over the Marseillaise had arisen over its delivery at the opening cere­ monies of the Olympic Winter Games in Albertville when ten-year-old Séverine Dupelloux, unaccompanied, sang the national anthem before an audience of hundreds present and millions worldwide via satellite tele­ vision. As her small, uplifted voice poignantly resonated throughout the arena, TV viewers everywhere could follow the anthem’s lyrics being simultaneously translated by subtitles flashed across their screens. Some­ how, there arose a certain incongruity between the child’s innocent voice and “ furrows of blood” in the minds of some viewers, suggesting scan­ dal, worse yet—a brutal, erotically charged image of lost innocence fill­ ing an already excited night air of competitive sports. Something had to be done. Yet, no sooner had a campaign to change the anthem’s lyrics formed than a countergroup, calling itself the Committee for the Defense of the Marseillaise, demanded a “ hands off” policy, accusing those reform-minded individuals of totalitarian-type leanings, suggesting that only a regime like the former Soviet Union would dare to “rewrite” history.1 Criticizing the Marseillaise's violent overtures to war and the spilling of enemy blood is hardly new.2 Nor should it come as any surprise that during this our most “ postmodern” hour, political activists on the Left (Danielle Mitterrand being the most striking sympathizer of the reform campaign) should deny their historical debt to the revolutionary rhetoric of 1789. Given a context of fin-de-siècle as such, the Marseillaise “hap­ pening” should be read as a repetition of that simultaneous emergence and reversal of political extremes at both ends of the ideological spec­ trum so frequently expressed under fin-de-siècle Europe a hundred years ago—let it not be forgotten—at a time when the first modern Greek Olympic Games were being initiated internationally in 1894. The irony, or more aptly, discomfort here—that the Marseillaise should create a Vol. XXXII, No. 4 7 L ’E sprit C réateur scandal at these first Olympic Games since the fall of the Berlin Wall— lay in the fact that as the very notion of political animosity had all but been eradicated (so say the proponents of a “New World Order”), up popped the ugly head of political contention once again in the form of censorship by the Left on the one hand and conservative chauvinism on the other. Furthermore, what to make of the lackluster medal showing by the Americans and the oxymoronic presence of the former Soviet Union’s “Unified Team” ? And should the hoarding of the gold, silver, and bronze by “Old Europe” become a new source of speculation (the Germans and Austrians in particular, though France also collected more medals than in recent past Olympics)? Had the spirit of 1992 Games been contaminated with that of the politically charged Games of 1894-1904?3 France’s collective discomfiture with Séverine Dupelloux’s rendition of the Marseillaise—which should also be read as the very eroticization of that voice—points to a deep and often times, mystified filiation to finde -siècle aesthetics and ideology of the French Revolution. In this essay, I will argue that the spirit of fin-de-siècle begins with the French Revolu­ tion as principle of a regenerative force. In many respects, the fin-desi ècle reiterates a desire to rejoin sacred time, the time of violent social upheavals and of new foundations. At the same time it refuses to fulfill such a desire, out of fear or perhaps fatigue, that new foundations remain merely repetitions of the same. If thinkers of modernity are cor­ rect in seeing this period as pivotal—the French Revolution validating a historical consciousness of a new age defined as a present open onto the future...

Risk of transmission of HIV to home care and health care workers

There are only three known routes of transmission of the human immunodeficiency virus (HIV): (1) exposure to blood via transfusion, sharing of contaminated needles by drug abusers, occupational needle stick or blood spill, unsterile needle injections; (2) sexual transmission; (3) perinatal exposure. There is no evidence for transmission by close interpersonal nonsexual contact or insect vectors. Health care workers are at risk for HIV transmission through accidental parenteral inoculation or extensive exposure to blood on nonintact skin or mucous membranes. Fortunately, population studies indicate that this risk is low and may be further reduced by adherence to simple infection control guidelines. The accumulated information on low rates of occupational transmission of HIV makes unwarranted the treatment of patients with acquired immunodeficiency syndrome (AIDS) or HIV infection as if they were highly contagious in the health care setting.

Precautions against HIV transmission in hospitals.

This article deals with the precautions necessary for handling blood in a hospital environment. It is known that most people who present to the hospital setting may be unknowingly infected with HIV virus, and thus exposure to blood should be handled with care. Routinely, anyone who is at risk of coming in contact with contaminated blood should wear gloves. The nature of the gloves should differ according to the responsibility at hand. Thus plastic gloves should be used for vaginal examinations, standard rubber gloves for deliveries and surgical operations, and heavy duty gloves for scrubbing floors. Soap and water should be readily available for personnel in the event that presumed infected blood comes in contact with skin. A concentration of 0.5% sodium hypochlorite should always be available in the clinical setting, to treat unforseen blood spills. Instruments contaminated with blood could be adequately handled by using sterilization methods which are commonly in use. Boiling the instrument for 20 minutes in hot water is adequate disinfection. However, this method is not sufficient for fiber optic instruments; instead manufacturer's instruction should be followed. Steam sterilizers or autoclaves are more efficient for surgical instruments such as artery forceps. Clearly, simple methods of disinfection are adequate in killing HIV virus, and given that many people are already infected with HIV, sterilization would be a useful routine to practice in most hospitals in the developing countries.

A comparison of hypochlorite and phenolic disinfectants for disinfection of clean and soiled surfaces and blood spillages

Suspension test methods were used to compare phenolic and hypochlorite disinfectants under conditions as recommended for use in hospitals. Using plasma to simulate soiled conditions, Clearsol (1% v v ) and Stericol (2% v v ) produced satisfactory disinfection, (i.e. 5 log reduction in 5 mins against Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa in the presence of up to 50% v v plasma (25 mg ml −1 plasma protein). Although sodium dichloroisocyanurate (NaDCC) at 2500 ppm AvCl 2 was effective in the presence of up to 20% plasma, compared to 10% plasma for sodium hypochlorite 2500 ppm, sensitivity of NaDCC to inactivation was greater than for phenolics. In the presence of blood, both hypochlorites and phenolics were substantially inactivated, although here the effectiveness of NaDCC at 10,000 ppm was equivalent to the phenolics. Our results indicate that hypochlorites at 10,000 ppm, Clearsol 1% and Stericol 2% may be ineffective for treatment of blood spills unless applied at v:v ratios of 9 parts disinfectant to 1 part blood. In this situation, chlorine-releasing powder formulations, which produce higher AvCl 2 concentrations and contain spilled material, offer an effective alternative.

The Gospel According to Hanoch

Hanoch Levin, born 1943, is one of Israel's best known and most widely performed playwrights, and the author of some 20 strikingly morbid plays (as well as numerous short stories and many beautiful lyrics). Levin's drama has proved to be both an artistic and a commercial success. His political cabaret shows You, I and the Next War (1968) and Queen of the Bathtub (1970), ridiculed the self-righteous complacency of Israeli society after the overwhelming victory of the Six Day War in 1967. Levin, like the slave in triumphal processions of ancient Rome, stood behind hubrisridden Israel, whispering ‘memento mori’, and so, quite naturally, caused a local scandal. Levin mocks highly esteemed army generals, and he uses (or abuses) the sacred myth of the Akeda, the binding of Isaac, when he is about to be offered as a sacrifice by Abraham (Genesis 22): ‘Dear father, when you stand by my grave … do not be too proud … and ask me to forgive you’, says dead Isaac, a ‘live’ metaphor for the blood spilt in vain, in Levin's sacrilegious version. The Israeli censor found it necessary to ban The Patriot (1983), a reaction to the stupidity and futility of the Lebanon War, until some modifications were entered.

Syndrome de déficit immunitaire acquis: Mesures à prendre dans les établissements de Transfusion Sanguine afin de protéger les personnels

There is presently no evidence of AIDS transmission to laboratory workers. Because transmissible agent is suspected, precautions should be taken in laboratories. As a general rule, procedures appropriate for hepatitis B prevention are advised. These procedures concern blood collection, carrying, and processing. Measures should be taken in order to avoid blood spilling and work surfaces should be decontaminated. Disposable material should be preferred, and all potentially contaminated material should be decontaminated before disposal or reprocessing. All personnel should be aware of usual laboratory procedures concerning pipetting, hand washing, protective clothing and of general precautions against viral contaminations.

Control of Hepatitis B Virus in Environmental Contamination

To the Editor.— We believe that a certain amount of comment and clarification are in order regarding the QUESTIONS AND ANSWERS exchange between Drs. Warrens and Abbott (229: 579, 1974). Dr. Warrens's inquiry as to the best chemical means of disinfecting blood spills from potential carriers of the hepatitis B virus (HBV) is a question of much practical importance and, in turn, gives rise to a second question of an applied nature, which will be mentioned later. First, it should be pointed out that to kill the virus of hepatitis B, one does not have to kill the (hepatitis B surface antigen [HB s Ag]). This is merely a matter of semantics, but Krugman and Giles 1 and Lo-Grippo et al (187:722, 1964) have shown that the inactivation kinetics of the infective particle and the associated surface antigen are not equal when exposed to physical or chemical disinfecting agents, ie,

Letter: Control of hepatitis B virus in environmental contamination

<h3>To the Editor.—</h3> We believe that a certain amount of comment and clarification are in order regarding the QUESTIONS AND ANSWERS exchange between Drs. Warrens and Abbott (229: 579, 1974). Dr. Warrens's inquiry as to the best chemical means of disinfecting blood spills from potential carriers of the hepatitis B virus (HBV) is a question of much practical importance and, in turn, gives rise to a second question of an applied nature, which will be mentioned later. First, it should be pointed out that to "kill the virus of hepatitis B," one does not have to "kill the antigen" (hepatitis B surface antigen [HB_sAg]). This is merely a matter of semantics, but Krugman and Giles¹and Lo-Grippo et al (187:722, 1964) have shown that the inactivation kinetics of the infective particle and the associated surface antigen are not equal when exposed to physical or chemical disinfecting agents, ie,

Théâtre Du Grand Guignol

If too many murders or atrocities are committed in the theatre, if violence is staged with a taste for shocking detail, or if too much blood spills, the name “Grand Guignol” is usually evoked. The image of Grand Guignol as a theatre of horror is just, but the exact nature and magnitude of the violence and horror are not usually understood. By the same token, the history and stage practices of this theatre are not generally known either. Despite a long existence of more than six decades, the Théâtre du Grand Guignol has been disregarded by historians and theoreticians as an insignificant form of entertainment. However, the fact that Grand Guignol represents a highly theatrical and specialized genre, which involved innovative mise en scène techniques and a unique performer-audience relationship, makes it interesting and relevant.

Humane Slaughter

IN the thirteenth annual Benjamin Ward Richardson Lecture which was delivered before the Model Abattoir Society on November 27 and has just been published, Sir Leonard Hill, who had chosen for his subject “Electric Methods of Producing Humane Slaughter”, maintained that Richardson's aim for humane slaughter was fulfilled by the introduction of the electric stunning instrument, which was a safe process and free from the objections made against shooting. The current is obtained from the usual 200 volt 50 cycle A.c. lighting current, and is reduced to 50 volts by a transformer. The electrodes, which are at the ends of the jaws of a tong-like instrument, are applied for 5 seconds in the case of pigs and for 20 seconds in the case of cattle, after soaking in 20 per cent saline, one on each side of the jaw of pigs, and between the eyes and ears of calves and sheep. The old method of electrocution, which caused violent contractions and even rupture of and haemorrhage into the muscles, is avoided by this process, and no spilling of blood occurs.

Research Items

THE RELIGION OF MENTAWEI.—Mentawei Islands, lying west of Sumatra, owing to political conditions, have received more attention from Dutch and German than from English-speaking ethnologists. They were, however, visited in 1926 by Mr. Edwin M. Loeb, as a, research scholar of the University of California, and he has now published an account of the religious organisation of the Pageh group of islands in the Publications in American Archceology and Ethnology, vol. 25, No. 2 of that University. He deals more especially with the punen system. The punen is the community religious festival (as distinct from the lia or family festival) which is attended by all members of the uma, the communal house. The festival is of long duration, sometimes lasting for years. It takes place at the building of a new communal house, the choice of a new priest, the making of a new field, the spilling of blood in the village, an epidemic, and so forth. The main ceremonial acts are the slaughter of pigs and chickens, the sacrifice of their livers and haruspication. The souls of the dead members of the uma are invoked to return, and imitative dances are held, and towards the end of the festival monkeys, deer, and sea turtle are hunted. All men sleep in the uma and sexual intercourse is taboo. The religious beliefs of the Mentawei Islands are animistic. They believe in nature spirits, souls, and ghosts; but the nature spirits, with a few exceptions, are not given names. They are the spirits in the sea, the jungle, and so forth. The exceptions are a god who causes earthquakes, the original meaning of his name being ‘grandfather’. It is on account of this god that a human sacrifice used to be offered at the building of the uma. Other specially designated gods are two water spirits, the first being propitious if due sacrifices are offered and no ritual sin has been committed, and the second is evil. The soul cult is specially directed to the preservation of health and long life, while ghosts are the bringers of disease to whom prayer is offered for purposes of witchcraft, and to whom sacrifice is made only when they have entered a village bringing sickness, to induce them to go away.