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OMS staff nurse Helen Gasser checks a staff member's recent TB skin test. Tuberculosis is no longer a rare disease here. As a result, a multi-departmental team has developed an extensiveTB control plan.

CC News: December 1996

In this issue

 

Protecting patients, employees goal of TB surveillance program

Tuberculosis: Answers to some common questions

Project puts brakes on underground parking

From the director

Physical therapists take workshop to women at D.C.'s House of Ruth

CC holiday events set

Finding a better way

Contract supplements housekeeping efforts

News briefs:

DTM honors Colbert in Dec.

Holiday show to benefit FOCC

Class offered

Make changes with new system

Services held

New resources now online

Gallin elected

Beat the blues

Social workers attend new CC forum

Morrow certified



Clinical Center News, Building 10, Room 1C255, National Institutes of Health, Bethesda, Maryland 20892. (301) 496-2563. Fax: 402-2984. Published monthly for CC employees by the Office of Clinical Center Communications, Colleen Henrichsen, chief. News, articles ideas, calendar events, letters, and photographs are welcome. Deadline for submission is the second Monday of each month.
Editor: Sara Byars sbyars@nih.gov . Staff Writers: Laura Bradbard, Sue Kendall



Protecting patients, employees goal of TB surveillance program

Tuberculosis, once infrequently seen among Clinical Center patients, is no longer a rare disease here. As a result, a CC multi-departmental team has developed an extensive TB control plan to help keep the potential for transmission of this airborne infection to a minimum.

A key aspect of this plan is the newly mandated employee TB surveillance program conducted by the Occupational Medical Service (OMS).

Although OMS had provided testing for years, CC officials note, compliance has been mandatory only for newly hired workers. According to Dr. David Henderson, deputy director for clinical care, "Compliance with the OMS TB surveillance program can no longer be considered optional. The CC is no longer a safe place to hide from TB. In addition, the Occupational Safety and Health Administration is currently enforcing compliance with mandatory annual skin testing, and the Joint Commission on Accreditation of Healthcare Organizations expects 100 percent compliance."

Tuberculosis control is currently one of the hot topics in hospital infection control. NIAID scientists are studying alternative treatments for patients who have multi-drug-resistant TB in protocols currently active here. Other protocols are designed to evaluate and treat patients whose immune systems are weakened. These patients are at higher risk of developing unrecognized TB.

Under the new surveillance program, employees who may be exposed to TB here must be skin tested with purified protein derivative (PPD) during their pre-employment physical or when applying for clinical privileges, and then at least annually.

Employees who work in certain higher-risk areas are tested more often. Persons who have already had positive reactions to the PPD test will be evaluated annually by OMS.

Information from the surveillance program will be crucial to conducting periodic TB risk assessments in the CC, which help epidemiologists evaluate the effectiveness of the overall TB control program.

CC department heads will be asked to identify employees who may be exposed to TB in the Clinical Center and need to be enrolled in the OMS program. Employees who are credentialed for patient care, those who routinely have patient contact, or anyone who enters patient rooms will be included. More than 1,000 employees are currently enrolled in the program, and newly identified employees will be added. OMS has dedicated nurses who will make work site visits where possible to make it convenient for busy health-care workers to be tested.

Other measures to protect against TB infection among CC patients and employees include recently constructed patient isolation rooms and diagnostic/treatment rooms with special ventilation systems that effectively and efficiently remove infectious TB bacteria from the air. Employees who may be exposed to TB patients are also fitted with and trained to use special respirators to prevent inhaling the organisms. (by the Hospital Epidemiology Service)

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Tuberculosis: Answers to some common questions

What is tuberculosis?

Tuberculosis-TB-is an infection caused by bacteria called Mycobacterium tuberculosis. The disease, which most often is seen in the small air sacs of the lungs, can take many years to develop.

What are the symptoms?

There are no obvious symptoms at first. The bacteria can remain dormant for many years and may never cause disease. This is called the passive phase. If the bacteria do grow, these symptoms will be seen during the active phase: cough, low fevers, weight loss, and night sweats. If a chest x-ray is taken, it will usually be abnormal.

How can I tell if I have TB?

A simple skin test-the Mantoux tuberculin skin test-will tell if you are infected with tuberculosis bacteria. Purified protein derivative (PPD) is injected under the skin of the forearm. If the person is infected, redness, swelling, and hardness at the spot should show up about two days after the test. This test only shows infection and cannot prove, by itself, that a person has active disease. Other tests are necessary to determine who has active disease.

Initial screening will be a two-step process, where the CC worker will have a second PPD test one week after the first PPD. This is because infection from the distant past may require two doses of PPD to stimulate the body's dormant TB immune response.

How is it passed to someone else?

When a person in the active phase coughs or sneezes, the bacteria that cause TB are spread through the air on tiny droplets. The bacteria can remain in the air for a long time. Other people can get infected if they breathe these bacteria. Persons in the passive phase of TB cannot spread the bacteria through the air.

Is there a treatment?

Antibiotics are used to treat people in the passive phase. This helps prevent symptoms from developing. The treatment, usually with the drug isoniazid, lasts at least six months.

Is there a treatment for people with active TB?

There are several antibiotics for people who have active disease, including isoniazid, pyrazinamide, ethambutol, and rifampin. Since resistant mycobacteria can be "selected" when a single-drug therapy is used, multi-drug treatment is necessary. The person must take all the medicine and is not considered non-infectious with TB until the chest x-rays clear up, the coughing stops, and the lab tests come back negative. Treatment must be continued for at least six months. Unfortunately, multi-drug-resistant strains have become more common recently because many persons have failed to complete the prescribed course of therapy.

Where can I get more information?

Contact the Hospital Epidemiology Service at 496-2209.


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Project puts brakes on underground parking

The news on parking in the Clinical Center's garage is this: Stay tuned. Parking is going to be tight, and CC officials are working on ways to help patients and staff deal with the crunch.

Urgent and extensive repairs to the three-story, 1,550-space garage got under way last month. That project has claimed and will continue to claim about 400 spaces in different areas at any one time. The work is expected to last three years. The new Clinical Research Center will begin to take its toll on all campus parking, most dramatically the hospital's underground spaces, late next year.

"There will never be a single, three-year solution to the garage parking problem," said Scott Robinson during a Nov. 27 meeting between NIH and CC officials to discuss parking solutions. "There will be a combination of short-term and long-term solutions." Robinson is a team chief in the design and construction branch, NIH Division of Engineering Services.

The first of those short-term solutions came on Nov. 25 when the CC Outpatient Department extended its patient shuttle contract to provide shuttle service for employees hardest hit by the parking crunch.

It's a direct shuttle primarily designed to provide transportation for patient-care shift workers. The CC parking shuttle's route begins at the Clinical Center's front door, stops at the multi-level parking buildings 6 and 8, and loops through Lots 41 A, B, and, C. After 8 p.m., the shuttle will take employees to any parking lot on campus and to the Metro.

The CC shuttle is expected to run 6:30 a.m. to 3 p.m. and 4 p.m.-12:30 a.m., with most service offered during morning, afternoon, and evening rush hours, explains Steve Groban, Outpatient Department chief. "This is for the interim, until we can review the data on ridership."

It supplements NIH's regular campus two-bus shuttle, which make a 40-minute circuit of stops 6:30 a.m.-6:30 p.m. weekdays.

In concert, NIH police have stepped up ticketing of cars illegally parked in P3 areas reserved for patients, patient visitors, CC volunteers, and handicapped employees and patients. One walk-through in late November resulted in 36 tickets.

The lack of garage parking is a safety concern for the shift workers whose ranks are made up primarily of nurses. "We'd like to see a consolidated area set aside for staff who use the shuttle. It's safer when a group of people can travel to their cars together," noted Kathy Montgomery, CC associate director for nursing.

CC officials are looking at several other short-term answers to the parking questions, including:

·Move patient parking from P3, which is the lowest parking level, to P2 and relocate P2 employee parking to P3. Since the garage repairs require extensive shoring from below and most of the contractor's equipment is stored on P3, that level will be most consistently disrupted during the repair project.

  • Evaluate the CC shuttle's use and refine a plan to provide that service.
  • Explore valet and attendant-assisted parking plans for either patients or employees.
  • Devise ways to quickly inform employees as the parking options change.

NIH is looking at longer term solutions, noted George Williams, acting assistant director for design and construction, NIH Division of Engineering Services. On the table are ideas to open new temporary parking lots on campus; offer valet and attendant parking; provide pay-parking areas for visitors; and lease more off-campus spaces.

Even with the loss of 400 parking spaces in the garage repairs, NIH is still more than 400 parking places over the limit allowed on federal installations in this area. This month there are about 8,500 on-campus spaces for 15,800 employees. (by Sara Byars)


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From the director

by Dr. John I. Gallin, CC director

Clinical research is at the heart of the Clinical Center's mission and we do it well. Health professionals from around the country look to the Clinical Center as a model for the design and conduct of clinical research as well as for information on research and patient care in general.

In the past year, we have put into place several programs to strengthen our outreach to the health-care community. One is our partnership with the Association of Academic Health Centers and their television network, CenterNet, that has resulted in live broadcast of the Clinical Center's grand rounds to about 50 health sciences campuses around the country. Five grand rounds were broadcast during last year's pilot. This year's schedule includes 10 broadcasts.

This program, which gives those watching from around the country a chance to question presenters by phone, has been well received. We hope to expand our work with CenterNet and the association next year by developing for broadcast a round-table discussion program featuring NIH physicians and scientists.

Another program that has been enormously popular is the Clinical Research Core Course. It is a series of seminars designed to teach researchers how to effectively conduct clinical research. More than 260 physicians, mostly fellows, are enrolled in the program this year. We also plan to offer the classes through live video conferences and by video to other campuses. The first video-conference presentation was to researchers at the National Institute of Environmental Health Sciences in North Carolina in October. We are working with Dr. Michael Fordis, director of the NIH Office of Education, on some exciting additions to the program, which I will share once the details are final.

There's also our new affiliation with Johns Hopkins Medicine and Suburban Hospital. A major benefit of this collaboration is that it will give medical students and community physicians the opportunity to learn more about the clinical research process and how to participate in it. It also gives our staff a venue to expand clinical skills and collaborations with clinical colleagues. 


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CC physical therapists Jacqueline Gilbert (left) and Micheale Smith presented a workshop on fitness to women at the House of Ruth in Washington.

Physical therapists take workshop to women at D.C.'s House of Ruth

If you're homeless, an exercise program might be the last thing you'd consider, but improved fitness could be an important step in restarting a stalled life.

During National Physical Therapy Month in October, CC physical therapists Jacqueline Gilbert and Micheale Smith presented a workshop to D.C. homeless women at the House of Ruth. Healing the Generations was the theme for the presentation on exercise, fitness, and the benefits of healthier living.

CC Rehabilitation Medicine Department physical therapists also visited an elementary school, a nursing home, and an AIDS clinic. For each audience the message was the same-moderate increase in activity improves health and the quality of life.

"Exercise can help someone who is homeless," says Earllaine Simpler, CC physical therapist. Even though it seems to be the last thing they should worry about, if homeless people improve their fitness level with walking, for instance, they'll be less prone to have colds or musculo-skeletal injuries."

Gilbert and Smith led a lively discussion with about 25 women at the House of Ruth Empowerment Center-a place where classes and workshops are held to help the residents learn new skills. Many women at the shelter are fighting drug and alcohol addiction, some are there to escape domestic violence. All need help turning their lives around and moving in a positive direction toward independence.

The therapists discussed ways to improve health, fitness, and self-confidence. Topics like depression, high blood pressure, and obesity were mentioned as reasons to exercise.

"Listen to your body," Gilbert said. "It talks to you. If you never liked riding a bicycle, then don't chose a stationary bike as your mode of exercise. Dance, walk and talk, do what you enjoy and fitness is fun." (by Laura Bradbard)


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Dinora Dominguez (left) and Elaine Robinovitz are registered nurses who field calls to the Patient Recruitment and Referral Center that number nearly 500 a month.



Dottie Cirelli directs the new Patient Recruitment and Referral Center, a pilot project to develop a more centralized approach to recruiting patients.

Finding a better way

You're a patient with a chronic disease and no available treatment in your community. Or, you're a physician looking for a clinical trial for your patient. What do you do? How do you find out about medical research that could benefit you?

The Patient Recruitment and Referral Center (PRRC), located in a refurbished residence on West Drive, answers 350 to 500 phone calls a month from physicians and patients looking for clinical trials.

Working with institute principal investigators and protocol coordinators, the center was recently opened as a pilot project to develop a more centralized approach to recruiting patients.
"We aren't working in isolation of the institutes. Our strategies involve cooperation and participation to increase patient recruitment for studies," says Dottie Cirelli, director of the center.

Four institutes-NIDR, NHLBI, NICHD, and NIAMS-have signed on with the project to attract patients to 29 pre-selected studies. Pretrial screening for these four institutes is conducted by two full-time registered nurses, Dinora Dominguez and Elaine Robinovitz, who also answer those hundreds of phone calls.

"We provide information about the Clinical Center and NIH research," says Robinovitz. "We describe protocols, send summaries of the studies, and in some cases, contact a patient's physician."

Most of the calls coming in to the center are from patients, but in most cases, patients need a physician's referral. The center mails or faxes information patients can give to their doctors so that the physicians can contact the institute to determine if the study is a good match for the patient's condition.

Physicians calling about research studies usually are transferred directly to the institute contacts who then provide more information about the studies and complete the patient evaluation.

"The Patient Recruitment and Referral Center will make it easier for physicians to refer patients to clinical trials and for patients to participate in them," says Dr. John I. Gallin, CC director. "In turn, clinical investigators here will have the patients they need to conduct their quality trials more easily. We're excited about the possibilities of this initiative."

"This is not a short-term project," Cirelli notes. "It'll take time and resources to develop a large referral base. We are determining what is doable, what will provide the greatest return for the investment, and what support services are necessary for retention."

Community outreach is another aspect of the recruitment center's mission. As a Spanish-speaking nurse, Dominguez is the point person at the center for the Hispanic patients who need clinical trial details in their native language. Information about the center is printed in Spanish and English.

The center is also reaching out to physicians and patient communities with information about the Clinical Center and participating in the clinical research here.

"One of the upcoming outreach efforts will involve contacting rural internists and family practitioners. We want them to think of us when they have a patient who could benefit from research conducted here. Nationally, only two percent of chronically ill patients are involved in clinical trials and the number of clinical trials has increased 10 percent in the last year. We have to make it easier for patients to come to us," Cirelli says.

Flow charts line the walls as the nurses retool their strategies for handling phone calls and email inquiries. "We try something, such as a form or question series, and if it doesn't yield results, we can change it. That's the beauty of a pilot program. We're not stuck, we can change how we work things," says Dominguez.

The CC Information Systems Department is designing a database, Cirelli notes, that will enable the center to keep track of previous patients, patients looking for specific drug trials, and patients interested in certain types of studies. Most of that information is now gathered manually. Having this information will help the center track the number of calls, the number of patients screened, the number of referred patients and those accepted into trials, and will help in evaluating the recruitment strategies.

As part of the recruitment initiative, the Clinical Center Communications Office developed a booklet, Becoming a Patient at the NIH Clinical Center, created a recruitment exhibit, and works with the recruitment center to exhibit at conferences all over the country.

"Patient recruitment is a complex issue and involves much more than placing a couple of newspaper ads. Strategies are being initiated that will help recruit in the short term, but the PRRC staff are cognizant of the fact that we need to do things that will position the CC for the long term," says Cirelli. (by Laura Bradbard)
Next month: A look at the Clinical Research Volunteer Program


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Samuel Stewart is director of environmental services for Sodexho.

Contract supplements housekeeping efforts

A contract to provide housekeeping services to the CC's clinic wing is strengthening efforts to keep the Clinical Center clean.

The contract was awarded to Sodexho USA, a management company that provides maintenance, engineering, and food services for businesses, hospitals, and universities. The company is headquartered in Waltham, Mass.

"Seamless, quality service is the goal of this contract," says Walter L. Jones, CC deputy director for operations and management. "The new workers join a team committed to providing the best in housekeeping services."

"This contract allows us to improve housekeeping services without costing jobs for department members," notes Henry Primas, Housekeeping and Fabric Care Department chief. "The contract workers fill positions that have been left vacant as people have retired or moved on to other jobs."

With the new contract workers now on board, CC housekeeping staff can better cover other areas of the building, Primas adds. "The contract allows us to retrench CC housekeeping staff to provide better services for the hospital and lab areas and to cut overtime costs. I'm very pleased with the way our housekeeping and office staff have worked with this contractor during the transition."

Samuel Stewart is Sodexho's director of environmental services. He's been on site since the contract began Oct. 1. "This is a very important contract for us. We have 45 full-time employees and 15 who serve in on-call and relief positions. All were hired locally."

Stewart and his assistants, Lloyd Booze and Tom Clolletion, have visited each of the hospital areas Sodexho covers meeting department members and surveying the physical space. "Departments can call us to come through again. Learning the facility is a priority for us."

Stewart added, "We exect to bring a quality effort throughout the hospital" Stewart's office is in B1N305. The phone number is 496-2417.

The new workers cover: ACRF floors 3-13; the main entry lobby; Lipsett Amphitheater; the Nuclear Medicine Department and the cyclotron area; the Department of Diagnostic Radiology, including the film library, ultrasound, CT scan, MRI, and special procedures; the Department of Transfusion Medicine; phlebotomy and the echo lab; Social Work Department; Safety; the Outpatient Department, including the travel and voucher offices; Communications; Clinical Pathology; elevators 21-24 and 26-33 and stairwells 6, 10, and 13-19.


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News briefs:

DTM honors Colbert in December

The Department of Transfusion Medicine will honor administrative officer Betty Colbert on her retirement. CC staffers are invited to a reception for her on Dec. 20. Stop by the Visitors Information Center between 2 and 4:30 p.m.

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CC holiday events set

December will be a month of celebrations at the Clinical Center, including a party spotlighting children's holidays around the world, which is set for Dec. 11 at 6:30 p.m. in the 14th floor assembly hall.

A holiday concert featuring traditional and seasonal music will be presented Dec. 12 at 7 p.m. in the 14th floor assembly hall. Musical selections will be presented by the Oratorio Society of Washington, D.C.

A holiday open house is planned for Dec. 17, 2-3:30 p.m., in the 14th floor hall. The Young Dancers of the Washington Ballet will be featured, along with a photo opportunity with Santa and singing around the piano.

Both events, open to patients, guests, and staff, are hosted by the recreation therapy section of the Rehabilitation Medicine Department.


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Holiday show to benefit FOCC

A musical adaptation of "Scrooge" and a special visit with Santa will be presented in Masur Auditorium at 7:30 p.m. on Saturday, Dec. 21. It's the fourth annual AIDS benefit show staged by the Performing Arts Ensemble, founded to showcase talent and benefit worthy causes. Proceeds will support CC patients and their families through the Friends of the Clinical Center.

The cast includes actors, singers, musicians, and dancers. For ticket purchase and information, call 496-4600.

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Class offered

If taking advantage of education opportunities is on your New Year's agenda, give the education and training section a call at 496-1618. Offered in January is:

·Communication: Understanding the Basics. This course, based on real work situations, will help participants recognize, identify, and remove barriers to effective communications; recognize non-verbal behavior that impedes communication; and build assertiveness skills. Jan. 17, 9 a.m.-4 p.m., 6100 Executive Blvd.

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Make changes with new system

Want to make changes to your federal health benefits or Thrift Savings Plan? You can now do it through Employee Express. Call (912) 757-3088 or stop by the kiosk that's located in the lobby outside the second floor cafeteria.

You'll need your Employee Express pin number to make changes. If you've lost or forgotten yours, call 496-4556. There's more information on Employee Express on the World Wide Web: <http://helix.nih.gov:8001/ohrm/express/>.

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Services held

Services were held Nov. 12 in Washington for Lanita Jones-Austin, who died on Nov. 7. She had worked in the CC as an x-ray technician from 1987 until her illness earlier this year. Survivors include her companion, Steven Austin, Sr.; their son, Steven, Jr.; and her father, Arthur Jones.

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New resources now online

Two new resources for staffers are available on the Clinical Center's home page. The Medical Record Department has added a directory of credentialed members of the active medical staff. The information can be searched or browsed. Users can send an email to medical staff members from within the directory. There's also a new listing of symbols and abbreviations approved by the Medical Board for use in medical records. Both are located in the NIH Staff Resources Section on the Clinical Center's home page, <http://www.cc.nih.gov/>.

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Gallin elected

Dr. John Gallin, CC director, was among the 55 new members elected to the Institute of Medicine recently. Also named from NIH this year were Dr. Mitchell H. Gail, head of the epidemiologic methods section and chief of the biostatistics branch, division of cancer epidemiology and genetics, NCI; Dr. Richard Klausner, NCI director; and Dr. Judith Vaitukaitis, director of NCRR.

New members are elected by the institute's 545 active members from candidates chosen for their major contributions to health and medicine or to related fields such as social and behavioral science, law, administration, and economics. Institute of Medicine topics that members are currently working on include studies on care at the end of life; on genetics, health, and behavior; and on new vaccine development.

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Beat the blues

The winter holiday season, with its rushing, planning, and parties, sometimes isn't so jolly. Common causes for those holiday blues include:

  • A heightened sense of loneliness brought on by the emphasis on family celebrations;
  • An unrealistic expectation that holidays should always be happy times;
  • Seasonal affective disorder, depression that may be brought on by short winter days.

Want to learn how to cope with the downside of the holidays? Check out the Employee Assistance Program's seminar on dealing with holiday issues. The program, which will be offered four times this month, is free and requires no registration. It will be presented in the Visitors Information Center's Little Theater on Dec. 10 and 17. On Dec. 11, stop by conference room E at Executive Plaza North, or conference room F on Dec. 18. All sessions will be noon-1 p.m.

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Social workers attend CC forum

Thirty social workers from across the country attended the first educational forum sponsored in October by the CC Social Work Department. The forum focused on the bio-psycho-social approach in working with persons with HIV and AIDS.

The department plans to present three forums for social workers each year, explained Dan Kavanaugh, with topics covering aspects of HIV, cancer, and chronic illness. Social Work's staff development committee coordinated the conference.

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Morrow certified

Karen Morrow, chaplain in the CC Spiritual Ministry Department, has been certified as an associate supervisor for pastoral education by the Association for Clinical Pastoral Education. Morrow trains two groups of pastoral education students each year. "After training here, the students go on into the world with an excellent exposure to Clinical Center research and how it concerns people. These students can speak well of this place and encourage others to consider NIH as a place to come for treatment. Here, the chaplains are part of the health-care team."

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Last modified 12/12/96


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