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The potential for spread of COVID-19 infections in skilled nursing facilities and other long-term care sites poses new challenges for nursing home administrators to protect patients and staff. It is anticipated that as acute care hospitals reach capacity, nursing homes may retain COVID-19 infected residents longer prior to transferring to an acute care hospital. This article outlines 5 pragmatic steps that long-term care facilities can take to manage airflow within resident rooms to reduce the potential for spread of infectious airborne droplets into surrounding areas, including hallways and adjacent rooms, using strategies adapted from negative-pressure isolation rooms in acute care facilities.

Objectives: Section 136 of the Mental Health Act 1983 empowers the police to detain those suspected of being mentally ill in public places, and convey them to a place of safety. In practice, accident and emergency (A&E) departments are often used. The authors assessed levels of knowledge of section 136 between A&E doctors, senior nurses, and police constables. Methods: Doctors and senior nurses in all (A&E) departments in the Yorkshire region were asked to complete a multiple choice tick box type questionnaire, as were police constables from the Humberside Police Force. Results: 179 completed questionnaires were returned, of which 16 were completed by consultants, 14 by SpRs, 24 by SHOs, 33 by senior nurses, and 92 by police officers. Some 24.1% of A&E staff and 10.9% of police failed to recognise that a person has to appear to be suffering from a mental disorder to be placed on a section 136; 40.2% of police did not know that section 136 is a police power; 55.2% of A&E staff and 14.1% of police incorrectly thought that a person could be placed on a section 136 in their own home; 43.75% of consultants and 50% of SpRs did not consider A&E departments to be a place of safety; 49.4% of A&E staff and 29.3% of police thought that patients could be transferred on a section 136. Only 10.3% of A&E staff and 22.8% of police had received any formal training. Conclusions: The knowledge among A&E staff and the police of this difficult and complex piece of mental health legislation is poor and requires action through formal education and training. This study not only reflects the levels of knowledge within the groups, it may also reflect the different perceptions of each group as to their role and duties within section 136 of the Mental Health Act 1983.

Objectives-To examine the profile of regular attenders to an accident and emergency (A&E) department, and to estimate the percentage of the overall departmental workload attributed to this group of patients, together with the resultant cost to the department of these attendances. The aim of this study was to profile our "regular attenders" to identify how many actually fit the category of "regular attenders" and estimate the percentage of the overall workload of the department attributed to this group of patients. In addition, we also aimed to examine the number of alcohol related attendances and the proportion of patients classified as having no fixed abode. The range of presenting complaints, investigations performed and the cost of these together with the disposal of these patients were also analysed. MethodsThere seems to be no standardised definition of a regular attender. Several definitions have been proposed, all of which have been arbitrarily chosen, ranging from two or more visits per year 6 to more than 10. 7 We defined a regular attender as anyone attending the department on average at least once per month over the study period. Therefore, anyone with at least six attendances over the six month period was included for analysis.A retrospective observational study was performed over the period 1 January 1998 to 30 June 1998 to identify all patients with at least six attendances to the accident and emergency (A&E) department at Hull Royal Infirmary.These patients were identified by means of a thorough search of the departmental computer database together with an examination of the "regulars folders" kept in the department. Patients were allocated "regulars folders" based on the number of previous attendances. Finally, all A&E cards were examined to avoid missing any eligible patients.Data collected included age, sex, marital status, accommodation, number and variety of presentations, history of concurrent alcohol or drug use, investigations performed and disposal from A&E.The cost of the investigations undertaken was calculated on the basis of these being carried out both in hours and out of hours, as it was not always possible to accurately establish when these had been performed. Each department responsible for performing these investigations was contacted to establish their cost. The cost of admission was based on an average cost for an inpatient episode of £200 per night. The inpatient case notes were retrieved to identify the duration of inhospital stay. ResultsA total of 191 "regular attenders" folders are kept in our A&E department, however of these only 40 (20.9%) met the criteria of at least one presentation each month for six months. Eighty one patients (42.4%) attended less than six times while 70 (36.6%) did not present at

A one-year Back Injury Prevention Program was initiated at a 440-bed acute care hospital in 1996 in response to concerns over high incidence and severity of back injuries among nursing staff and others. The program included an ergonomic evaluation of patient handling, pilot testing and purchase of new equipment, a train-the-trainer program, and training of 374 nurses and other patient handling staff (approximately one-half of the nursing staff). An impact evaluation, measured by comparing self-reported knowledge, work practices, and back pain among a subset of trainees and controls revealed an increase in knowledge of risk factors, a marginal increase in the use of mechanical devices to transfer patients, and a significant decrease in repositioning of patients in bed among trained versus control subjects (p = .017). Over the course of the program, the number of back injuries was 30% below the average of the prior 3 years, with the number of reported injuries in the final quarter (immediately following the training program) approximately one-seventh of the three prior quarters. It is concluded that back injury training may increase knowledge of risk factors and controls and may impact behaviors over which individuals have control (e.g., how often they move patients). However, training effectiveness is limited when engineering controls such as patient transfer devices are unavailable.

Bone lead was associated with slower speed of processing while exposure to lead and/or solvents reduced efficiency of verbal learning.

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