[Pharmwaste] Re: Pharmwaste Digest, Vol 47,
Issue 6 - Hand Sanitizer
Gressitt, Stevan
Stevan.Gressitt at maine.gov
Thu Oct 1 16:41:07 EDT 2009
There is no proof that that experiment ever occurred , except possibly
from our video surveillance security system...forgot about that.
Stevan Gressitt, M.D., Medical Director
Office of Adult Mental Health Services
Department of Health and Human Services
Marquardt Building, 2nd Floor
11 State House Station
32 Blossom Lane
Augusta, ME 04333-0011
Ph: (207)287-4273
Fax: (207)287-1022
Cell Phone: (207) 441-0291
E-Mail : stevan.gressitt at maine.gov <mailto:stevan.gressitt at maine.gov>
http://www.maine.gov/dhhs/mh/ <http://www.maine.gov/dhhs/mh/>
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________________________________
From: pharmwaste-bounces at lists.dep.state.fl.us
[mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of
TBadrick at aol.com
Sent: Thursday, October 01, 2009 10:50 AM
To: pharmwaste at lists.dep.state.fl.us
Subject: Re: [Pharmwaste] Re: Pharmwaste Digest, Vol 47,Issue 6 - Hand
Sanitizer
I think it would be a great eco-footprint project....I smell a college
class project
well we are on the topic, lets not forget a couple of the reasons behind
the new push on hand sanitizers
1. The federal government making a huge deal about pandemics as a
national security issue...I'm not saying good or bad here but in the
hospitals I worked in it became a "program" and in the hands of a
skilled director trying to climb the ladder becomes a "cause" and
although causes are fun they typically fade quickly in terms of efficacy
and then you have 5 trillion soap and gel and foam containers everywhere
and common sense typically gets pushed out of the way when its a cause.
We had one project where the issue of "litter" in the hallways (very
little btw) was addressed by installing dozens of wall mounted boxes of
gloves and paper towel dispensers with the assumption being that people
did not pick up littler in the hall for fear of contamination, you know
gum wrappers being a major risk and all. End result was dispensers were
always out of paper towels and people stole boxes of gloves with great
regularity...much easier to grab that box than order from supply or buy
at the store.
One of the assumptions I saw pushed aside was the expectation that
health care workers absolutely should be expected to wash hands between
patients....now the idea that a trained healthcare worker who is trying
to help patients deliberately chooses to disregard one of the most basic
precautions both to themselves and their patients.....this is an
educational issue but also a professional disciplinary issue...if they
give the wrong meds repeatedly its treated that way...its a basic core
competency, period. No debate.
2. The focus is always on nurses and docs but lets not forget that
support staff such as housekeepers touch many things and often are far
more capable of transmitting....we had a guy who picked up the med waste
from within the facility...older, nice, rigid, etc....it was a big win
to get him to take his gloves off when he went to the cafeteria...you
inherently have to recognize he probably didn't do that in the
prescribed method either. This is not a rare situation. Sick people
come to hospitals, the bottom line is you cannot maintain sterility in a
public facility designed to treat sick people for the most part and we
should stop obsessing about that aspect and be rational about what we
can accomplish. Hand washing should be an easy win....and many
facilities show a compliance rate of around 50%. More soap types and
putting it everywhere does not fix that type of problem.
3. Last, but not least...the changes in regulations that says Medicare
and Medicaid will not pay for hospital acquired infections...make no
mistake about it this is huge bucks at stake. This makes it a
"management crisis" and rational science based discussion stops right
there when its becomes a thing to fix, not a cultural change. Every
month there is a new "crisis" and the old one is forgotten quickly.
Tom Badrick
Badrick Consulting
who is shocked that such a blatantly unsafe experiment as lighting gel
on fire could occur ;-)
In a message dated 9/30/2009 7:04:55 A.M. Pacific Daylight Time,
merylklein at earthlink.net writes:
Has anyone thought of doing a life cycle analysis on resources
used (soap and water [remember that water is fast becoming a commodity])
vs. sanitizer and comparing the effectiveness of both. I know there was
a study back in the early 2000s comparing handwashing and alcohol-based
sanitizers and they found that the sanitizers with moisturizers were
better for hospital employees who had to wash often as the soap and
water and plain sanitizer dried the hands too much and let in infection.
Triclosan should definitely be banned. Period.
Perhaps there are times when small children, unless strictly
monitored, are not up to the task of properly washing their hands. I
watch my own four year old wash mostly properly and then cringe when she
touches the sink and just about every other surface there is in the
public restroom despite my explanations of why we should not do this
after she washes her hands.
I think there is a place for both proper handwashing and
sanitizer.
On Sep 29, 2009, at 6:52 PM,
pharmwaste-request at lists.dep.state.fl.us wrote:
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Today's Topics:
1. RE: hand sanitizer (Suhr, Marcus W.)
2. RE: RE: hand sanitizer (Lyle Milby)
3. RE: RE: hand sanitizer (Gressitt, Stevan)
4. Re: RE: hand sanitizer (TBadrick at aol.com)
5. RE: RE: hand sanitizer (Matthew C. Mireles)
6. RE: RE: hand sanitizer (Volkman, Jennifer)
7. RE: RE: hand sanitizer (Matthew C. Mireles)
----------------------------------------------------------------------
Message: 1
Date: Tue, 29 Sep 2009 15:19:33 -0400
From: "Suhr, Marcus W." <MSuhr at ChristianaCare.org>
Subject: [Pharmwaste] RE: hand sanitizer
To: <pharmwaste at lists.dep.state.fl.us>
Message-ID:
<D69AAE0446628A44B9869C47841645FF0D85FD18 at eschrmb01.mcd.pri>
Content-Type: text/plain;
charset="us-ascii"
I read an article where a child was poisoned by alcohol
sanitizer
recently. Its only a matter of time before a child dies, or
they start
getting the swift idea of lighting it. My own step-son was
required by
the school to bring a bottle to begin the year. This is a clear
example
of bringing an item to market, and not enough controls.
Everyone thinks
sanitizer is so great.
Anyone else being requested to bring it to school?
Marcus Suhr, ASP
Industrial Hygienist
Christiana Care Health Services
Occupational Safety Department, Office L840J
4755 Ogletown-Stanton Road
Newark, DE 19718
302-733-3787 (office)
302-573-7662 (pager)
302-733-3771 (fax)
MSuhr at christianacare.org
------------------------------
Message: 2
Date: Tue, 29 Sep 2009 14:27:37 -0500
From: "Lyle Milby" <Lyle.Milby at NormanOK.gov>
Subject: RE: [Pharmwaste] RE: hand sanitizer
To: "Suhr, Marcus W." <MSuhr at ChristianaCare.org>,
<pharmwaste at lists.dep.state.fl.us>
Message-ID:
<178AEFF1493D434386CF580401CFED0F449BB5 at ponyexpress.ci.norman.ok.us>
Content-Type: text/plain;
charset="us-ascii"
Our school system is putting these out in all of the schools at
the
recommendation of the County Health Department in response to
H1N1. Our
Fire Department expressed reservations but they decided to go
ahead with
it. I assume it is an alcohol based product because of the fire
department concern.
Lyle Milby
City of Norman
Environmental Services
P.O. Box 370
Norman, OK 73070
(405) 292-9731
lyle.milby at normanok.gov
-----Original Message-----
From: pharmwaste-bounces at lists.dep.state.fl.us
[mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of
Suhr,
Marcus W.
Sent: Tuesday, September 29, 2009 2:20 PM
To: pharmwaste at lists.dep.state.fl.us
Subject: [Pharmwaste] RE: hand sanitizer
I read an article where a child was poisoned by alcohol
sanitizer
recently. Its only a matter of time before a child dies, or
they start
getting the swift idea of lighting it. My own step-son was
required by
the school to bring a bottle to begin the year. This is a clear
example
of bringing an item to market, and not enough controls.
Everyone thinks
sanitizer is so great.
Anyone else being requested to bring it to school?
Marcus Suhr, ASP
Industrial Hygienist
Christiana Care Health Services
Occupational Safety Department, Office L840J
4755 Ogletown-Stanton Road
Newark, DE 19718
302-733-3787 (office)
302-573-7662 (pager)
302-733-3771 (fax)
MSuhr at christianacare.org
---
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------------------------------
Message: 3
Date: Tue, 29 Sep 2009 15:39:07 -0400
From: "Gressitt, Stevan" <Stevan.Gressitt at maine.gov>
Subject: RE: [Pharmwaste] RE: hand sanitizer
To: "Lyle Milby" <Lyle.Milby at NormanOK.gov>, "Suhr, Marcus W."
<MSuhr at ChristianaCare.org>, <pharmwaste at lists.dep.state.fl.us>
Message-ID:
<0F9DE263E5900443A7E41D68717431670360206B at SOM-TEAQASMAIL6.som.w2k.state.
me.us>
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Let's see, 62% Ethyl Alcohol= 124 proof? Jack Daniels is what?
Stevan Gressitt, M.D., Medical Director
Office of Adult Mental Health Services
Department of Health and Human Services
Marquardt Building, 2nd Floor
11 State House Station
32 Blossom Lane
Augusta, ME 04333-0011
Ph: (207)287-4273
Fax: (207)287-1022
Cell Phone: (207) 441-0291
E-Mail : stevan.gressitt at maine.gov
http://www.maine.gov/dhhs/mh/
Confidentiality Notice: This e-mail message, including any
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is for the sole use of the intended recipient(s). It may
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-----Original Message-----
From: pharmwaste-bounces at lists.dep.state.fl.us
[mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of
Lyle
Milby
Sent: Tuesday, September 29, 2009 3:28 PM
To: Suhr, Marcus W.; pharmwaste at lists.dep.state.fl.us
Subject: RE: [Pharmwaste] RE: hand sanitizer
Our school system is putting these out in all of the schools at
the
recommendation of the County Health Department in response to
H1N1. Our
Fire Department expressed reservations but they decided to go
ahead with
it. I assume it is an alcohol based product because of the fire
department concern.
Lyle Milby
City of Norman
Environmental Services
P.O. Box 370
Norman, OK 73070
(405) 292-9731
lyle.milby at normanok.gov
-----Original Message-----
From: pharmwaste-bounces at lists.dep.state.fl.us
[mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of
Suhr,
Marcus W.
Sent: Tuesday, September 29, 2009 2:20 PM
To: pharmwaste at lists.dep.state.fl.us
Subject: [Pharmwaste] RE: hand sanitizer
I read an article where a child was poisoned by alcohol
sanitizer
recently. Its only a matter of time before a child dies, or
they start
getting the swift idea of lighting it. My own step-son was
required by
the school to bring a bottle to begin the year. This is a clear
example
of bringing an item to market, and not enough controls.
Everyone thinks
sanitizer is so great.
Anyone else being requested to bring it to school?
Marcus Suhr, ASP
Industrial Hygienist
Christiana Care Health Services
Occupational Safety Department, Office L840J
4755 Ogletown-Stanton Road
Newark, DE 19718
302-733-3787 (office)
302-573-7662 (pager)
302-733-3771 (fax)
MSuhr at christianacare.org
---
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------------------------------
Message: 4
Date: Tue, 29 Sep 2009 18:01:30 EDT
From: TBadrick at aol.com
Subject: Re: [Pharmwaste] RE: hand sanitizer
To: pharmwaste at lists.dep.state.fl.us
Message-ID: <c0a.649e2680.37f3ddba at aol.com>
Content-Type: text/plain; charset="us-ascii"
I refer to them as little bombs in the hospital. In an age
where fire
marshals freak out over recycling containers size due to fire
risk....its okay
to put aerosol containers (otherwise known as compressed gas
cylinders) of
flammable materials every twenty feet or so along a wall?.. gee
I feel
safe now. Whatever happened to soap and water and proper
technique? is that
too complicated? This is what happens when rampant uneducated
fear trumps
science and logic.
I clearly remember the day, sitting in the Reno airport bar and
Wolf
Blitzer comes on TV with a special report about deadly
MRSA...all I could think
about was how this would put a halt to all other hospital
projects to solve
a problem that really wasn't a problem, because guess what MRSA
is already
everywhere and that just employing proper hand washing would do
just
fine....sigghhhh, I must be getting older ;-)
Tom Badrick
Badrick Consulting
In a message dated 9/29/2009 12:28:22 P.M. Pacific Daylight
Time,
Lyle.Milby at NormanOK.gov writes:
Our school system is putting these out in all of the schools at
the
recommendation of the County Health Department in response to
H1N1. Our
Fire Department expressed reservations but they decided to go
ahead with
it. I assume it is an alcohol based product because of the
fire
department concern.
Lyle Milby
City of Norman
Environmental Services
P.O. Box 370
Norman, OK 73070
(405) 292-9731
lyle.milby at normanok.gov
-----Original Message-----
From: pharmwaste-bounces at lists.dep.state.fl.us
[mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of
Suhr,
Marcus W.
Sent: Tuesday, September 29, 2009 2:20 PM
To: pharmwaste at lists.dep.state.fl.us
Subject: [Pharmwaste] RE: hand sanitizer
I read an article where a child was poisoned by alcohol
sanitizer
recently. Its only a matter of time before a child dies, or
they start
getting the swift idea of lighting it. My own step-son was
required by
the school to bring a bottle to begin the year. This is a
clear example
of bringing an item to market, and not enough controls.
Everyone thinks
sanitizer is so great.
Anyone else being requested to bring it to school?
Marcus Suhr, ASP
Industrial Hygienist
Christiana Care Health Services
Occupational Safety Department, Office L840J
4755 Ogletown-Stanton Road
Newark, DE 19718
302-733-3787 (office)
302-573-7662 (pager)
302-733-3771 (fax)
MSuhr at christianacare.org
---
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Message: 5
Date: Tue, 29 Sep 2009 18:19:44 -0400 (EDT)
From: "Matthew C. Mireles" <mirelesmc at earthlink.net>
Subject: RE: [Pharmwaste] RE: hand sanitizer
To: "Gressitt,Stevan" <Stevan.Gressitt at maine.gov>, Lyle Milby
<Lyle.Milby at NormanOK.gov>, "Suhr,Marcus W."
<MSuhr at ChristianaCare.org>, pharmwaste at lists.dep.state.fl.us
Cc: linkfilion at yahoo.com, Elizabeth Smith <smithce at flash.net>,
jamiller at communityofcompetence.com
Message-ID:
<33222853.1254262784422.JavaMail.root at elwamui-rubis.atl.sa.earthlink.net
>
Content-Type: text/plain; charset=UTF-8
Dr. Jerry Miller, an epidemiologist, at our Foundation would be
a good person to consult with. He did a fellowship at CDC in Atlanta
and is now our VP for Research.
For schools and some clinical facilitites, we recommend simple,
proper handwashing with soap and warm water as well as prudent hygiene
and sanitation practices. Some school districts are presenting learning
lessons with practices in the lavatory for the correct handwashing. I
heard one school has kids reciting the alphabet A-Z (approx 15
sec--about same time recommended by CDC for kids) to time how long they
should lather hands with soap before rinsing. Paper napkins or
motion-sensed driers are used to dry hands. Some even instruct kids to
avoid touching door handles and open the door with a paper napkin and
throw the napkin the waste basket right outside the restroom.
Kids are reminded to cover their nose and mouths with tissue
when they sneeze or cough. If tissue paper is not available, they are
instructed to cough or sneeze into their folded upper arms so they won't
spread germs. It's hoot to walk into a classroom as see kids practicing
how to cough into their arms. Many lessons that I'm mentioned are
strategies being used mainly on the west coast as an introduction to
personal hygiene as well as proper etiquette.
Hand sanitizing, disinfecting gels, liquids, ointments, etc. are
useful in some occasions but probably not too wise as an effort to
prevent infection and cross contamination. to require parents to
provide the product to their kids without sufficient rationale for the
parents or the kids might be interpreted as an extraneous attempt to
combat the H1N1 epidemic. There's already a misplaced fear of H1N1
being spread by pork products. Please save the bacon!
Reliance on only these liquids or gel sanitzers may produce some
unintended consequences. CDC reports 2 million cases of nosocomial
infections in our hospitals resulting in 90,000 deaths of our patients
each year. Hospitals are frantically investing money into putting
dispensers with hand sanitizers on the floors, in patients' rooms,
waiting rooms, etc. Some hospitals hire secret monitors to observe
handwashing and record noncompliance; some even pay staff members to
wash their hands correctly out of sheer desperation. in addition to
carrying the stethoscope and cheat sheets in their pockets, many nurses
and docs are given courtesy of the medical supply companies personal
bottles of hand sanitzers. Hence, many are skippping the standard sink
and soap routine.
The results have not been too impressive: infection rate has not
gotten better. As a matter of fact, healthcare professionals' behavior
and attitude with proper handwashing have worsen.
We were contracted by a major company in Austin TX to provide a
health education and promotion poster for handwashing--we recommended
soap and water and hygiene. We thought about inviting those kids to do
a demo for the company's execs and remind them that sometimes simple is
best, like the ABCs.
Matthew C. Mireles, PhD, MPH
President and CEO
Community Medical Foundation for Patient Safety
-----Original Message-----
From: "Gressitt, Stevan" <Stevan.Gressitt at maine.gov>
Sent: Sep 29, 2009 2:39 PM
To: Lyle Milby <Lyle.Milby at NormanOK.gov>, "Suhr, Marcus
W." <MSuhr at ChristianaCare.org>, pharmwaste at lists.dep.state.fl.us
Subject: RE: [Pharmwaste] RE: hand sanitizer
Let's see, 62% Ethyl Alcohol= 124 proof? Jack Daniels is
what?
Stevan Gressitt, M.D., Medical Director
Office of Adult Mental Health Services
Department of Health and Human Services
Marquardt Building, 2nd Floor
11 State House Station
32 Blossom Lane
Augusta, ME 04333-0011
Ph: (207)287-4273
Fax: (207)287-1022
Cell Phone: (207) 441-0291
E-Mail : stevan.gressitt at maine.gov
http://www.maine.gov/dhhs/mh/
Confidentiality Notice: This e-mail message, including
any attachments,
is for the sole use of the intended recipient(s). It
may contain
confidential and privileged information. Any
unauthorized review, copy,
use, disclosure, or distribution is prohibited. If you
are not the
intended recipient, please note that any dissemination,
distribution or
copying of this is strictly prohibited. Please contact
me by reply
e-mail or telephone and destroy all copies of this
message.
-----Original Message-----
From: pharmwaste-bounces at lists.dep.state.fl.us
[mailto:pharmwaste-bounces at lists.dep.state.fl.us] On
Behalf Of Lyle
Milby
Sent: Tuesday, September 29, 2009 3:28 PM
To: Suhr, Marcus W.; pharmwaste at lists.dep.state.fl.us
Subject: RE: [Pharmwaste] RE: hand sanitizer
Our school system is putting these out in all of the
schools at the
recommendation of the County Health Department in
response to H1N1. Our
Fire Department expressed reservations but they decided
to go ahead with
it. I assume it is an alcohol based product because of
the fire
department concern.
Lyle Milby
City of Norman
Environmental Services
P.O. Box 370
Norman, OK 73070
(405) 292-9731
lyle.milby at normanok.gov
-----Original Message-----
From: pharmwaste-bounces at lists.dep.state.fl.us
[mailto:pharmwaste-bounces at lists.dep.state.fl.us] On
Behalf Of Suhr,
Marcus W.
Sent: Tuesday, September 29, 2009 2:20 PM
To: pharmwaste at lists.dep.state.fl.us
Subject: [Pharmwaste] RE: hand sanitizer
I read an article where a child was poisoned by alcohol
sanitizer
recently. Its only a matter of time before a child
dies, or they start
getting the swift idea of lighting it. My own step-son
was required by
the school to bring a bottle to begin the year. This is
a clear example
of bringing an item to market, and not enough controls.
Everyone thinks
sanitizer is so great.
Anyone else being requested to bring it to school?
Marcus Suhr, ASP
Industrial Hygienist
Christiana Care Health Services
Occupational Safety Department, Office L840J
4755 Ogletown-Stanton Road
Newark, DE 19718
302-733-3787 (office)
302-573-7662 (pager)
302-733-3771 (fax)
MSuhr at christianacare.org
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------------------------------
Message: 6
Date: Tue, 29 Sep 2009 17:22:54 -0500
From: "Volkman, Jennifer" <Jennifer.Volkman at state.mn.us>
Subject: RE: [Pharmwaste] RE: hand sanitizer
To: <TBadrick at aol.com>, <pharmwaste at lists.dep.state.fl.us>
Message-ID:
<6246727221874A4FB8D3F9BBC37D9BD5079D9258 at s-sp22.pca.state.mn.us>
Content-Type: text/plain; charset="us-ascii"
My kids haven't been asked to carry concealed yet. They used to
get an
extra credit point for bringing a box of tissues to class, but
the
school disallowed that practice this year because they felt it
might be
unfair to those who could not afford to supply the school with
tissues.
So, the kids are packing their own or using the back of the
hand, wall,
desk or whatever is handy. Management at our state agency (and
probably
all of them in MN) issued each desk a 4 oz bottle (apparently
this
equals about 8 martinis) and a container of wipes. I've heard
they will
be installing dispensers outside all of our conference rooms,
just like
hospitals. A nurse friend of mine said they had to switch to
another
type of sanitizer at her hospital because too many employees
(they like
to blame the janitors) were adding a shot to their morning
coffee. It
fits right in with all the other craziness...must be something
in the
water...
From: pharmwaste-bounces at lists.dep.state.fl.us
[mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of
TBadrick at aol.com
Sent: Tuesday, September 29, 2009 5:01 PM
To: pharmwaste at lists.dep.state.fl.us
Subject: Re: [Pharmwaste] RE: hand sanitizer
I refer to them as little bombs in the hospital. In an age
where fire
marshals freak out over recycling containers size due to fire
risk....its okay to put aerosol containers (otherwise known as
compressed gas cylinders) of flammable materials every twenty
feet or so
along a wall?.. gee I feel safe now. Whatever happened to soap
and
water and proper technique? is that too complicated? This is
what
happens when rampant uneducated fear trumps science and logic.
I clearly remember the day, sitting in the Reno airport bar and
Wolf
Blitzer comes on TV with a special report about deadly
MRSA...all I
could think about was how this would put a halt to all other
hospital
projects to solve a problem that really wasn't a problem,
because guess
what MRSA is already everywhere and that just employing proper
hand
washing would do just fine....sigghhhh, I must be getting older
;-)
Tom Badrick
Badrick Consulting
In a message dated 9/29/2009 12:28:22 P.M. Pacific Daylight
Time,
Lyle.Milby at NormanOK.gov writes:
Our school system is putting these out in all of the schools at
the
recommendation of the County Health Department in response to
H1N1. Our
Fire Department expressed reservations but they decided to go
ahead with
it. I assume it is an alcohol based product because of the fire
department concern.
Lyle Milby
City of Norman
Environmental Services
P.O. Box 370
Norman, OK 73070
(405) 292-9731
lyle.milby at normanok.gov
-----Original Message-----
From: pharmwaste-bounces at lists.dep.state.fl.us
[mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of
Suhr,
Marcus W.
Sent: Tuesday, September 29, 2009 2:20 PM
To: pharmwaste at lists.dep.state.fl.us
Subject: [Pharmwaste] RE: hand sanitizer
I read an article where a child was poisoned by alcohol
sanitizer
recently. Its only a matter of time before a child dies, or
they start
getting the swift idea of lighting it. My own step-son was
required by
the school to bring a bottle to begin the year. This is a clear
example
of bringing an item to market, and not enough controls.
Everyone thinks
sanitizer is so great.
Anyone else being requested to bring it to school?
Marcus Suhr, ASP
Industrial Hygienist
Christiana Care Health Services
Occupational Safety Department, Office L840J
4755 Ogletown-Stanton Road
Newark, DE 19718
302-733-3787 (office)
302-573-7662 (pager)
302-733-3771 (fax)
MSuhr at christianacare.org
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------------------------------
Message: 7
Date: Tue, 29 Sep 2009 18:52:30 -0400 (EDT)
From: "Matthew C. Mireles" <mirelesmc at earthlink.net>
Subject: RE: [Pharmwaste] RE: hand sanitizer
To: "Volkman,Jennifer" <Jennifer.Volkman at state.mn.us>,
TBadrick at aol.com, pharmwaste at lists.dep.state.fl.us
Cc: jerrymiller at communityofcompetence.com, Elizabeth Smith
<smithce at flash.net>, mcmireles at communityofcompetence.com,
linkfilion at yahoo.com, Douglas Dotan <ddotan at crgmedical.com>
Message-ID:
<20595462.1254264751012.JavaMail.root at elwamui-rubis.atl.sa.earthlink.net
>
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End of Pharmwaste Digest, Vol 47, Issue 6
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