Publications

Ian Blenkharn: Publications

Reprints of listed publications, and of publications not listed here which may be found using PubMed, Google Scholar or other bibliographic search systems, are available on request. Please contact Ian Blenkharn for further information.

Waste management – some selected publications

Healthcare Wastes. Blenkharn JI. In, Reference Module in Earth Systems and Environmental Sciences. Elsevier Inc, 2015. 25pp http://dx.doi.org/10.1016/B978-0-12-409548-9.09488-4

Getting to the point of sharps injury prevention. Blenkharn JI. J Operating Dept Practitioners 2014 ; 2:113-9

Sharp Awakening. Blenkharn JI. CIWM J 2012 July; 34-6

Clinical hazards? Blenkharn JI. CIWM J 2012 January; 54-6

Healthcare waste management – a partnership of equals? Blenkharn JI. J Inf Prevent 2011; 12: 177-8

Clinical waste management. Blenkharn JI. In: Nriagu JO (ed) Encyc Envir Health 2011; 1: 716–731. Burlington: Elsevier

Nine deaths is nine too many. Blenkharn JI, Gladding T, Moffatt T. CIWM J 2011 August; 34-5

Green shoots of recycling. Blenkharn JI. BMJ. Mar 29,  2009. http://www.bmj.com/rapid-response/2011/11/02/green-shoots-recycling

Waste management requirements of community iv therapy services. Blenkharn JI. Brit J Community Nursing 2009; 14: 38-9

Clinical Wastes. Blenkharn JI. Health Service Risks Special Report: Croner’s Health Service Risks. 2008, Issue 140, 14 November 2008. pp 2 – 7. Publ Wolters Kluwer (UK) Ltd

Sharps disposal – A universal responsibility. Blenkharn JI. Brit J Dermatol 2008 159: 1212

Quo vadis? Science and regulation as uneasy bedfellows. Blenkharn JI. Open Waste Manag J 2008; 1: 1-3

In the waste management field and the wider environmental sciences arena, science and regulation have become increasingly uneasy bedfellows. Scientific research should create the bedrock that underpins environmental legislation, shaping its construction, interpretation and implementation. It is the currency of investment in the future of waste management. Society must be assured that scientific knowledge has been subject to rigorous peer review to ensure its credibility and high standard. The architects of our waste management legislation must be similarly rigorous and fully transparent in their application of that knowledge and its use in the shaping of the legislative framework.

The interface of science and policy presents both opportunities and challenges. Imposing penalties under regulations structured without satisfying a reasonable burden of scientific proof in their construction is questionably as wrong as seeking prosecution without evidence of fact. Science has its own professional standards and a universal Code of Practice for scientific conduct to which all investigators must adhere. Regulators must do likewise, to ensure that the need for an effective scientific foundation to legislation is properly met at all times, managed effectively and applied objectively and with uniformity.

Luminol-based forensic detection of latent blood: an approach to rapid wide-area screening combined with Glo-Germ™ oil simulant studies. Blenkharn JI. J Hosp Infect 2008; 69: 405-406

Bloodborne virus infection is a constant threat for those working with clinical wastes. Sharps injury is the obvious hazard, but infection may be transmitted also by splashes to the eyes or mucous membranes, or contamination of pre-existing skin lesions.

Basic safety and hygiene precautions should suffice. Proper packaging of wastes, puncture-resistant gloves or gauntlets, and effective hand washing when gloves are removed should be sufficient. But are hygiene standards acceptable?

Testing for latent blood contamination is now available. This can be used as part of a specific or more general environmental hygiene appraisal, to evaluate the efficacy of cleaning regimens, to assist in the training of staff, or to ensure compliance with hand and environmental hygiene and safety protocols.

Clinical wastes in the community: local authority management of discarded drug litter. Blenkharn JI. Pub Health 2008; 122: 725-728

The inexorable spread of intravenous drug abuse has resulted in increasingly common finds of drug litter in the community. This may include used syringes and hypodermic needle along with other paraphernalia, creating a particular risk of sharps or needlestick injury and the transmission of bloodborne virus infection.

Local Authorities have a statutory duty to manage the prompt collection and safe disposal of these hazardous items.

Only 353 of 526 (66.9%) Local Authorities provided information concerning the collection of drug litter discarded in the community. Though 25 LAs indicated that the retrieval of needle finds would be managed as a matter of urgency actual response times, though infrequently specified, ranged from within 1, 2 or 4 hours up to within 7 days. Safety and healthcare guidance provided to the public was infrequent, and often incomplete or confusing, with no consensus of the correct approach to be taken. ‘Do not touch’ was the advice of 89 Local Authorities, though 18 others invited the public to pick up needles and take them home to await collection, or to a local GP or Pharmacy where a suitable sharps bin would be available. Others advised the finder to pick up needles only if there was any immediate danger (n=89), but gave no indication of safe methods for retrieval or the arrangements for later safe disposal.

The arrangements for the prompt collection and safe disposal of discarded drug litter by Local Authorities is generally inadequate, may not comply with current guidance, and may be unsafe.

Airport Dermatophytoses. Blenkharn JI. Pub Health 2008; 122: 1291-1292

Community-acquired needlestick injuries – rapid and safe retrieval of discarded needles is essential. Blenkharn JI. Pediatrics 2008; 122: 1405

Sharps injury in healthcare waste handlers. Blenkharn JI & Odd C. Ann Occupat Health 2008; 52: 281-6

Sharps injury is a constant and most serious risk for healthcare waste handlers. In this comprehensive study of healthcare waste handlers, the incidence of sharps injury was approximately 1 in 29000 man hours. The use and value of ballistic protective gloves and trousers is examined, and the underlying causes for sharps injury examined.

There appears to be some lack of understanding among waste handlers of the risks of sharps injury, and of those wastes that may be most hazardous. Glove use and hand hygiene was in some cases deficient, in part due to this lack of recognition of the risks involved. This echoes similar deficiencies in glove use and had hygiene among healthcare staff. This identifies additional training needs that are presently not met. However, it is clear from the results that healthcare staff are failing in their Duty of Care to ensure correct and safe disposal of sharps with 36 or 40 injuries caused by sharps placed in thin-walled plastic waste sacks intended only for soft wastes.

Needlestick injuries in primary care. Blenkharn JI. J Pub Health (Oxf) 2008; 30(4): 514

In response to a paper from Wales that examined the risks to community healthcare staff including GPs and practice nurses, it is apparent that the risks to waste handlers are significantly greater and that the incidence of sharps injuries may in fact be higher.

This brings to the attention of community medical groups the risks to waste handlers, identifying the need for prompt specialist care that is rarely if ever available in the Community, and of course the need for greater care from sharps users.

Clinical wastes in the community: Local authority management of clinical wastes from domestic premises. Blenkharn JI. Pub Health 2008; 122: 526-31

The increasing numbers of patients receiving often complex home-based health care, and the growing number of insulin-dependent diabetic, home haemodialysis and continuous ambulatory peritoneal dialysis patients, contributes to the substantial volumes of clinical waste generated from domestic premises.

Arrangements for the collection and safe disposal of these potentially hazardous wastes, generally managed by local authorities, may be inadequate and, in part, unsafe. An audit of the websites of the 526 local authorities in England, Wales, Scotland and Northern Ireland was performed. This evaluated the information provided concerning clinical waste collections from domestic premises, the limits and constraints on this service, service accessibility, the practical arrangements for collection of wastes, and the health and safety issues of clinical waste management for patients who manage their own care in the community.

Weekly collections were most common, although several local authorities offered additional flexibility depending on need. Limits on the minimum or maximum volumes of waste to be collected, or on the types of clinical wastes accepted for disposal, do not support domiciliary health care and create an additional burden for patients and their carers. Of particular concern was the health and safety implication of instructions to place potentially hazardous clinical wastes in a freely accessible location outside the home, at the doorstep or on the footpath, as early as 4 am on the day of collection or the night before collection.

The arrangements for local authority clinical waste collections from domestic premises are, in part, inadequate and may be unsafe. The arrangements do not properly support domiciliary patients or their carers.

Hygiene and waste management in UK hospitals: are self-reported compliance scores always valid? Blenkharn JI. J Pub Health (Oxf) 2007; 29(4): 472-3

Evidence from audits of healthcare (clinical) waste management in UK hospitals performed in 2005 and 2006 had revealed generally poor standards of performance. In many hospitals, unlocked clinical waste carts were common, with many carts overflowing, with gaping lids and spilled items lying free at their base. Individual clinical waste sacks and sharps containers were frequently left on the floor, both within hospital buildings and in the hospital grounds, apparently due to a lack of sufficient waste carts and an inadequate frequency of collections for transfer of wastes to a secure central storage compound.

The current annual health check report published by the Healthcare Commission reports that 93% of NHS Trusts (n=368) declared compliance for Core Standard C4e that specifies standards for the safe handling and disposal of waste. Overall, these data sit uncomfortably with the evidence of widespread deficiencies in clinical waste segregation, storage and security noted during successive audits.

The evolving legislative framework and operational standards demand rigorous segregation of wastes, the correct use of an unambiguous segregation scheme and containment of potentially hazardous clinical wastes, and secure storage of those wastes pending onward disposal. Notwithstanding, the fundamental requirement for safe, effective and secure management of potentially hazardous clinical wastes has remained unchanged. With evidence of multiple waste management deficiencies at hospitals that report full compliance with Core Standard C4e, the results of the annual health check process can falsely enhance the record of compliance in some UK hospitals, suggesting that self-reported compliance scores may not always be valid.

Standards of clinical waste management in hospitals – a second look. Blenkharn JI. Pub Health 2007; 121: 540-545

The arrangements for bulk clinical waste handling were audited in 16 UK hospitals, one year after an earlier audit that revealed many deficiencies in performance.

The standard of performance in clinical waste management in UK hospitals remains poor, with evidence of neglect of basic hygiene, housekeeping and safety standards. However, codes of practice exist, and despite implementation of the Hazardous Waste Regulations 2006 that provide further control on all wastes management issues, the reality of clinical waste management in some National Health Service (NHS) hospitals continues to be largely inadequate.

The best and the worst of waste management? Blenkharn JI. CIWM J May 2007 12

These are the questions asked in a short note in CIWM Journal. A simple question perhaps, but the answers will be many and varied. What gets your vote as the best, and the worst, modern developments across the waste industries? A development in policy or legislation, a technological development or a few simple words that have managed to change public perception and practice?

Domestic kitchen recycling – an additional health hazard for householders? Blenkharn JI. J Pub Health (Oxf) 2007; 29: 95-6

The rapid expansion of kitchen waste composting (recycling) schemes for UK households creates a heightened risk of foodborne infection. More than 50% of 102 UK households audited for their approach to the recycling of kitchen wastes kept the food waste bin in or close to the kitchen and rarely, if ever, washed hands after contact with that bin. As contamination of raw foods result in contamination of the waste bin, this becomes a potent reservoir that will perpetuate the cycle of contamination, multiplication and dissemination of foodborne intestinal pathogens.

Classification and management of clinical wastes. Blenkharn JI. J Hosp Infect 2007; 65: 177-178

Avian influenza: a need for forward planning? Blenkharn JI. CIWM Journal December 2006 p12

The disposal of medical wastes. Blenkharn JI. Business Technology Review: Life Sciences, Fall 2006

Be careful in the kitchen. Blenkharn JI. CIWM J 2006; October: 28-30

Most Local Authorities in the UK now insist on the separation of kitchen (food) wastes from domestic premises, with separate collections of these wastes that are now elimination from landfill deposit or municipal incineration in favour of commercial composting.  All good stuff, except that many households face problems with the arrangements pout in place for collections. Reports of fly-blown containers, insect infestations, increases in rodent sightings and nuisance from smell have been common and widespread, particularly during the hot summer months.  If press reports are to be believed, most Local Authorities have resisted the overwhelming clamour of complaints and battle on regardless.

Foodborne infection associated with kitchen waste recycling creates a particular problem for householders.  In a survey of households required by Local Authorities to separate kitchen wastes, most kept the food waste container that had been provided in or close to the kitchen, rather than in a more remote location as for a dustbin. Critically, it appears that this proximity does not promote hand washing that might have been considered after depositing more general wastes in a dustbin.  Since many food products are contaminated with food poisoning organisms at the time of supply, and these multiply in wastes at ambient storage temperatures, the food waste bin becomes a potent source for widespread contamination of the kitchen environment.  in the absence of heightened standards of environmental and personal hygiene, an increase in the incidence of foodborne infection can be expected.

Collection staff may be at similar risk.  Lids and handles of food waste containers will be heavily contaminated; splash contamination is inevitable during emptying of bins.  The correct use of PPE and provision of vehicle mounted hand washing facilities is essential to protect collection staff.  Smoking, eating and drinking must be prohibited prior to removal of PPE and hand sanitation in order o protect staff from acquired infection.

The cost of kerbside recycling? Blenkharn JI. CIWM J 2006; October 11

Most Local Authorities now undertake extensive kerbside recycling of glass bottles and jars, paper, food wastes, and a range of other recyclable materials. Observation of two collection crews leaning far into their vehicles’ glass bins, smashing bottles and jars with a hammer top to secure greater capacity, and reduce the frequency of return to base for unloading makes it apparent that, for those involved, the high cost of kerbside recycling may include the loss of their sight!

Potential compromise of hospital hygiene by clinical waste carts. Blenkharn JI. J Hosp Infect 2006; 63: 423-427

Bulk waste storage carts are common in hospitals, and undoubtedly assist in the day-to-day management of clinical wastes.  Intended for the transport and interim storage of primary clinical waste containers, carts are often located close to or within hospital buildings to receive wastes from wards and clinical departments.

Examination of a random selection of bulk clinical waste carts at 9 acute hospitals across Greater London revealed external soiling in all of 23 carts.  Eight carts were soiled also on the inner surfaces, with some evidence of bloodstains, and free fluids in the base of 5 carts.  Staphylococcus aureus and enterococci were recovered, in low numbers, from the lids (n=7) and wheels (n=10) of carts, with Escherichia coli, Enterobacter species and Pseudomonas aeruginosa from the wheels only of a further 5 carts.  Two carts were heavily contaminated with Aspergillus species.

Pathogens originating from clinical wastes may be transferred from contaminated bulk waste carts to the wider hospital environment.  It may thus be prudent to require that bulk carts be kept outside clinical areas, and preferably outside all hospital buildings. This becomes particularly important in circumstances where carts supplied by contractors are not dedicated to a single hospital or NHS Trust.

A backward step – Landfill disposal of clinical wastes. Blenkharn JI. J Hosp Infect 2006; 63: 105-106

Glove use by ancillary and support staff – a paradox of prevention? Blenkharn JI. J Hosp Infect 2006; 62: 519-520

The use and mis-use of protective gloves by hospital ancillary and support staff are discussed, and the possible implications of failure in correct glove use considered in relation to hospital hygiene and infection control.

Pathology wastes are unquestionably hazardous. Blenkharn JI. Biomed Scient 2006; February p139

Lowering standards of clinical waste management – Do the Hazardous Waste Regulations conflict with CDC Universal Precautions? Blenkharn JI. J Hosp Infect 2006; 62: 467-472

Guidelines for the classification of clinical wastes, produced in support of the Hazardous Waste Regulations 2005 may be less than satisfactory. These guidelines conflict with the universally recognised Standard Precautions for the Prevention of Infection that are intended to ensure the safety of healthcare staff and of patients, reduce the incidence of hospital acquired infection, and to support effective hygiene standards in hospitals. This conflict is explored, with consideration of the health and safety implications for healthcare and support staff and for workers in the waste management sector, and to the broader issues of hospital hygiene and infection control.

Standards of clinical waste management in UK hospitals. Blenkharn JI. J Hosp Infect 2006; 62: 300-303

The arrangements for bulk clinical waste handling were studied in 26 UK hospitals. Storage of carts in areas freely accessible to members of the public and failure to lock individual waste carts was common. Many clinical waste carts and the areas dedicated to their storage were in a poor state of repair. To eliminate the possibility for acquired infection through unauthorised and inappropriate access to clinical wastes and to minimise adverse local or systemic effects resulting from contact with waste pharmaceuticals, to comply with the Duty of Care imposed by UK Health & Safety legislation, and to satisfy concerns regarding the general standard of hospital hygiene, substantial improvement is required in the management of clinical wastes in hospitals.

Medical wastes management in the south of Brazil. Blenkharn JI. Waste Manag 2006; 26: 315-317

What standards for hazardous waste disposal must apply to remote regions of developing countries? Where resources are limited, the imposition of exacting emission control can be counterproductive. Cost-effective local solutions tailored to the available resources of small communities provide achievable goals. International aid, together with carefully targeted research and development, is needed to assist developing countries achieve improved standards in waste disposal.

Natural disasters: a view from afar. Blenkharn JI. Waste Mana 2006: 26: 318

The many natural disasters occurring around the world, together with armed conflict and terrorist action, have implications for and impact upon hazardous waste management. The difficult juxtaposition of the paramount need for immediate humanitarian aid and the rigid pre-existing control and emission standards for hazardous waste disposal is explored, in the context of the devastating consequences of Hurricane Katrina. Can there ever be a right time to cut corners?

Expanding waste lines: Good Management. Blenkharn JI. Health Serv J 2005; 115: 28-29

The impact of changing legal constraints on the management of clinical wastes in healthcare premises is reviewed. Considering in particular the Hazardous Wastes Regulations and prevailing Health & Safety legislation, the impact of changing regulations is considered, and potential pitfalls identified.

Pathology waste – issues, implications and regulations. Blenkharn JI. Biomed Scient 2005; 49: 678-682

When Pathology wastes are removed from the laboratory for onward disposal they will usually join similar waste streams from other areas of the hospital. With implementation of the new Hazardous Waste Regulations and concerns about Health & Safety legislation, laboratory managers should liaise closely with site managers to ensure appropriate streaming of wastes leaving the laboratory. It is proposed that the training of laboratory personnel is supplemented to include more extensive training in aspects of waste disposal, and that mandatory laboratory accreditation is extended to ensure more thorough review of laboratory waste management procedures.

Impact of Hazardous Waste Regulations. Blenkharn JI. Health Estate, J Inst Healthcare Eng Est Manag 2005; 59: 23-25

This paper discusses the practicality of implementation of the Hazardous Waste Regulations in a busy hospital. With limited resources, and often critical constraints in space and manpower, is it practical or appropriate to create separate hazardous and non-hazardous clinical waste streams, predicated on an often inadequate assumption of infection risk?

Safe disposal and effective destruction of clinical wastes [Leading Article]. Blenkharn JI. J Hosp Infect 2005; 60: 295-297

This paper discusses the practicality, and limitations, of proof-of-process testing for destructive waste treatments such as incineration.

Fugitive discharges and waste disposal. Blenkharn JI. Brit J Biomed Sci 2001; 57: 181-182 and 339-341

Autoclave treatment of clinical and laboratory wastes is widely undertaken. The possibility for release of viable micro-organisms from the feedstock, emitted with steam and water (condensate) discharges in the early purging and heating phases of autoclave operation are considered, with recommendations for managing this risk of exposure.

Safe disposal of sharps. Blenkharn JI. Lancet 1998; 351: 760

Further options for the effective destruction of used sharps in developing countries, preventing illicit re-use and providing a low cost, low-tech solution to safe disposal.

The disposal of clinical wastes. Blenkharn JI. J Hosp Infect 1995; 90 (Supplement): 514-520

The many sources for clinical wastes are considered, with a review of the available disposal technologies. Commonly encountered problems often follow inadequate standards of care in disposal and handling of wastes in healthcare premises, that impact profoundly on the safety and well-being of others. A broad team approach to the management of healthcare wastes in healthcare premises is advocated in order to improve standards, reduce or eliminate errors , and prevent high-risk incidents that may result in inoculation injury in ancillary and support staff.

Clinical and laboratory waste incineration. Blenkharn JI. & Oakland D. Med Lab Sci 1992; 49: 149-150

Safety and efficiency of clinical waste incineration. Blenkharn JI. & Oakland D. J Hosp Infect 1991; 17: 311-313

Disposal of clinical waste. Blenkharn JI. Inst Med Lab Sci Gaz 1991; 35: 547-549

A review of the issues, practicalities, and shortcomings of clinical waste disposal in hospitals, with particular emphasis to the management of wastes from Pathology laboratories.

Clinical waste disposal. Blenkharn JI. J Inst Sterile Serv Manag 1990; 1: 20-23

A review of the issues, practicalities, and shortcomings of clinical waste disposal in hospitals.

Emission of viable bacteria with the exhaust flue gases from hospital incinerators. Blenkharn JI. & Oakland D. J Hosp Infect 1989; 14: 73-78

High temperature incineration is widely considered as a definitive process, ensuring the destruction and complete sterilisation of clinical wastes. This paper reports findings from a study of a twin chamber oil fired incinerator operating at temperatures up to 1,000C. From a feedstock of clinical waste, sampling of exhaust gases revealed numbers of viable bacteria up to 400/cu m. The possibility that these bacteria may have originated from the feedstock is discussed.

 

Infection control, hospital hygiene & epidemiology- some selected publications

Hostage to hygiene. Blenkharn JI. J Hosp Infect 2011; 12(4): 166

Airport dermatophytoses? Blenkharn JI. Pub Health 2008; 122: 1291- 1292

Luminol-based forensic detection of latent blood: an approach to rapid wide-area screening combined with Glo-Germ™ oil simulant studies. Blenkharn JI. J Hosp Infect 2008; 69: 405-406

Bloodborne virus infection is a constant threat for those working with clinical wastes. Sharps injury is the obvious hazard, but infection may be transmitted also by splashes to the eyes or mucous membranes, or contamination of pre-existing skin lesions.

Basic safety and hygiene precautions should suffice. Proper packaging of wastes, puncture-resistant gloves or gauntlets, and effective hand washing when gloves are removed should be sufficient. But are hygiene standards acceptable?

Testing for latent blood contamination is now available. This can be used as part of a specific or more general environmental hygiene appraisal, to evaluate the efficacy of cleaning regimens, to assist in the training of staff, or to ensure compliance with hand and environmental hygiene and safety protocols.

Needlestick injuries in primary care. Blenkharn JI. J Pub Health 2008;30(4):514

In response to a paper from Wales that examined the risks to community healthcare staff including GPs and practice nurses, it is apparent that the risks to waste handlers are significantly greater and that the incidence of sharps injuries may in fact be higher.

This brings to the attention of community medical groups the risks to waste handlers, identifying the need for prompt specialist care that is rarely if ever available in the Community, and of course the need for greater care from sharps users.

Hygiene and waste management in UK hospitals: are self-reported compliance scores always valid? Blenkharn JI. J Pub Health (Oxf) 2007; 29(4): 472-3

Evidence from audits of healthcare (clinical) waste management in UK hospitals performed in 2005 and 2006 had revealed generally poor standards of performance. In many hospitals, unlocked clinical waste carts were common, with many carts overflowing, with gaping lids and spilled items lying free at their base. Individual clinical waste sacks and sharps containers were frequently left on the floor, both within hospital buildings and in the hospital grounds, apparently due to a lack of sufficient waste carts and an inadequate frequency of collections for transfer of wastes to a secure central storage compound.

The current annual health check report published by the Healthcare Commission reports that 93% of NHS Trusts (n=368) declared compliance for Core Standard C4e that specifies standards for the safe handling and disposal of waste. Overall, these data sit uncomfortably with the evidence of widespread deficiencies in clinical waste segregation, storage and security noted during successive audits.

The evolving legislative framework and operational standards demand rigorous segregation of wastes, the correct use of an unambiguous segregation scheme and containment of potentially hazardous clinical wastes, and secure storage of those wastes pending onward disposal. Notwithstanding, the fundamental requirement for safe, effective and secure management of potentially hazardous clinical wastes has remained unchanged. With evidence of multiple waste management deficiencies at hospitals that report full compliance with Core Standard C4e, the results of the annual health check process can falsely enhance the record of compliance in some UK hospitals, suggesting that self-reported compliance scores may not always be valid.

A reprint is available in PDF format but cannot be made available for direct download due to copyright limitations. Please contact Ian Blenkharn for further information.

….and where did your baggage end up? Blenkharn JI. J Hosp Infect 2004; 58: 306

Preventing transmission of infection during mouth-to-mouth resuscitation. Blenkharn JI & Zideman DA. J Emerg Med 1992; 10: 624-5

Prevention of transmission of infection during mouth-to-mouth resuscitation. Blenkharn JI, Buckingham SE & Zideman D. Resuscit 1990; 19: 151-157

The risk of transmission of infection during exhaled air resuscitation procedures (mouth-to-mouth resuscitation) can be reduced or eliminated by the use of a barrier protective device incorporating a suitable filter that permits effective air exchange while retaining droplets and free fluids.

Infection risks from electrically operated breast pumps. Blenkharn JI. J Hosp Infect 1989; 13: 27-31

Electrically operated breast pumps may become contaminated following the passage of droplets and finer aerosols into internal tubing and the pump motor. Despite use of a sterile collecting bottle, retrograde contamination of freshly collected milk may occur the collecting bottle may occur from previously contaminated components of the pump.

Contamination of parts not normally accessible for cleansing by the user can be prevented by the use of an efficient hydrophobic air filter and simple overflow prevention device.

Infection during percutaneous transhepatic biliary drainage. Blenkharn JI & Benjamin IS. Surgery 1989; 105: 239

Suction apparatus and hospital infection due to multiply-resistant Klebsiella aerogenes. Blenkharn JI & Hughes VM. J Hosp Infect 1982; 3: 173-178

A major hospital-wide outbreak of infection due to multiple antibiotic resistant Klebsiella aerogenes K21 was associated with the use of clinical suction apparatus, using epidemiological study and supported by molecular and genetic typing of isolates.

Suction apparatus was contaminated internally with epidemic strains of K aerogenes; inlet and outlet connections, and the primary chamber of the suction device were contaminated resulting in some suction units in the ejection of a fine aerosol laden with Klebsiella.

Incorrect equipment use and inadequate maintenance was responsible for the outbreak, that affected 66 patients over a 10 month period. Hospital-wide spread of infection resulted from transfer (sharing) of contaminated equipment between individual wards.

 

Equipment development & device evaluation- some selected publications

Infection risks from electrically operated breast pumps. Blenkharn JI. J Hosp Infect 1989; 13: 27-31

Electrically operated breast pumps may become contaminated following the passage of droplets and finer aerosols into internal tubing and the pump motor. Despite use of a sterile collecting bottle, retrograde contamination of freshly collected milk may occur the collecting bottle may occur from previously contaminated components of the pump.

Contamination of parts not normally accessible for cleansing by the user can be prevented by the use of an efficient hydrophobic air filter and simple overflow prevention device.

Safety devices to prevent airborne infection from clinical suction apparatus. Blenkharn JI. J Hosp Infect 1988; 12: 109-115

A new safety system for air filtration in clinical suction apparatus. Blenkharn JI. J Hosp Infect 1987; 10: 236-242

A low cost “differential pressure indicator” is described, that allows constant pressure measurement across the substance of a standard in-line air filter. A visible or audible warning, optionally combined with automatic shut-down of the vacuum source, is given when the differential pressure rises above a pre-set value proportional to significant loss of filter efficiency.

The indicator promotes best use of in-line filters, and protects against infection and cross-infection hazards associated with clinical suction apparatus and similar clinical equipment.

Prevention of bacteriuria during urinary catheterization of patients in intensive care units: evaluation of the Ureofix 500 closed drainage system. Blenkharn JI. J Hosp Infect 1985; 6: 187-193

In a consecutive study of 1088 patients admitted to a general (medical and surgical) intensive care unit the incidence of catheter-associated urinary tract infection among 512 patients managed with a conventional urine meter drainage system was 26.8%. Introduction of the Ureofix 500 closed system urine meter enabled a reduction of catheter-associated infection to 12.2% of 576 patients.

The unique design characteristics of the Ureofix 500 urine meter drainage system fulfils the criteria for use in the intensive care unit and affords significant protection (p<0.001) against catheter-associated urinary tract infection in the high risk patient.

Septic complications of percutaneous transhepatic biliary drainage: evaluation of a new closed drainage system. Blenkharn JI, McPherson GAD & Blumgart LH. Am J Surg 1984; 147: 318-321

An improved system for external biliary drainage. Blenkharn JI, McPherson GAD & Blumgart LH. Lancet 1981; ii: 781-782

 

Antibiotic studies; chemotherapy – some selected publications

Antibiotic prophylaxis for biliary tract surgery: selection of patient and agent. Aloj G, Bianco C, Covelli I, Blenkharn JI, Benjamin IS & Blumgart LH. Internat Surg 1991; 76: 131-134

Antibakterielle und verwandte Eigenschaften von Taurolin – ein Überlick. Blenkharn JI. In: Reding R. (Ed) Chirurgische Gastroenterologie mit interdisziplinären Gesprächen: Neptun-Symposium Rostock. Publ: TM-Verlag, Hameln. 1991; 4: 143-151

In vitro antibacterial activity of noxythiolin and taurolidine. Blenkharn JI. J Pharm Pharmacol 1990; 42: 589-590

Taurolin-Anwendung bei schweren chirurgischen Infektionen (Peritonitis), ihre Objektivierung durch experimentelle und klinische Methoden. Reding R, Blenkharn JI & Pfirrmann RW. In: Gruenagel, H.H. (Ed) Chirurgische Gastroenterologie mit interdisziplinären Gesprächen: Peritonitis. Publ: TM-Verlag, Hameln. 1990; 2: 251-257

In-vitro-Aktivitat von Taurolidin. Moglichkeiten der Empfindlichkeitstestung im Agar-Diffusiontest. Blenkharn JI. In: Gruenagel HH. (Ed) Chirurgische Gastroenterologie mit interdisziplinären Gesprächen: Pankreatitis. Publ: TM-Verlag, Hameln. 1990; 2: 267-268

Anti-adherence properties of taurolidine and noxythiolin. Blenkharn JI. J Chemother 1989; Suppl 4: 233-234

Antibacterial activity of piperacillin and gentamicin using a dynamic system simulating in vivo pharmacokinetics. Blenkharn JI. J Chemother 1989; Suppl 4: 487-489

Sustained anti-adherence activity of taurolidine (Taurolin) and noxythiolin (Noxyflex S) solutions. Blenkharn JI. J Pharm Pharmacol 1988; 40: 509-511

Comparative per-operative pharmacokinetics of piperacillin and gentamicin. Blenkharn JI, Sinha J, Leather A & Benjamin IS. Surgical Research Communications 1988; 4: 249-256

The differential cytotoxicity of antiseptic agents. Blenkharn JI. J Pharm Pharmacol 1987; 39: 477-479

The cytotoxicity of noxythiolin and chlorhexidine was evaluated in vitro using a range of tissue culture cell lines of differing degrees of neoplasticity. Noxythiolin exerted a marked cytotoxic effect toward established neoplastic cell lines, though this was greatly reduced with normal control (non-neoplastic) cells. By contrast, the toxicity of chlorhexidine against non-neoplastic control cells was similar to that observed against neoplastic cells.

The antimicrobial activity of Taurolin – a possible additive for parenteral nutrition solutions. Blenkharn JI. J Clin Nutr 1987; 6: 35-38

 

 

 

 

Please contact Ian Blenkharn for further information.