The body system that filters blood to eliminate waste, helps maintain blood pH, and regulates water balance is the Vitamin C Moisturizing Cream Vitamin C enhances the skin's natural production of collagen and helps to support healthy skin. Guidelines for Preventing Health-Care--Associated Pneumonia, 2003 Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. Aseptic Technique Prepare skin with antiseptic/detergent chlorhexidine 2 percent in 70 percent isopropyl alcohol. Pinch the wings on the Guidelines to Prevent Central Line- Associated Blood Stream Infections. Slide 1. Guidelines to Prevent Central Line- Associated Blood Stream Infections. Slide 2. Why do I need to complete this orientation? Slide 3. Why do I need to complete this orientation? Statistics for CLABSIs. Slide 5. National Nosocomial Infection Surveillance Rates. Slide 6. CLABSI Rates per 1,0. Catheter Days. Slide 7. Risk Factors for CLABSISlide 8. Risk Factors for CLABSI (cont.)Slide 9. Process of Catheter- Related Infections Slide 1. Five Evidence- Based Steps to Prevent CLABSISlide 1. Hand Hygiene Works! Slide 1. 3. Waterless Hand Hygiene Steps. Slide 1. 4. Hand Washing Steps. Slide 1. 5. C- VAD Site Selection. Slide 1. 6. C- VAD Site Selection: Special Considerations. Slide 1. 7. C- VAD Line Selection Slide 1. Aseptic Technique: Goals. Slide 1. 9. Aseptic Technique. Slide 2. 0. Evidence Supporting Chlorhexidine Use: Skin Prep—Meta Analysis. Slide 2. 1. Maximal Barriers Required for C- VAD Insertion. But if you diligently. Read reviews and buy Technic 2in1 Jewellery & Cosmetic Case at Superdrug. Free standard delivery for Health and Beautycard members. Safety, overuse, side effects ? When used as intended, poppers are probably the safest recreational. Title: Practice Basics Author: an MCPS user Last modified by: an MCPS user Created Date: 1/31/2011 6:09:27 AM Document presentation format: On-screen Show (4:3). Slide 2. 2. Maximal Barrier Precautions Decrease CLABSI Infections. Slide 2. 3. Caveats: Catheter Insertion. Slide 2. 4. Post Insertion: C- VAD Care. Slide 2. 5. Replacing C- VADs. Slide 2. 6. Suspected C- VAD Infections. Slide 2. 7. Suspected C- VAD Infections (cont.)Slide 2. C- VAD Line Cultures: Indications. Slide 2. 9. C- VAD Line Cultures: Method. Slide 3. 0. C- VAD Line Cultures: Interpretation. Slide 3. 1. Blood Cultures. Slide 3. 2. Peripheral Blood Cultures: Method. Slide 3. 3. Arterial Line: Site Selection Slide 3. Arterial Lines: Aseptic Technique. Slide 3. 5. Arterial Lines: Barriers. Slide 3. 6. Special Thanks. Slide 1. Guidelines to Prevent Central Line- Associated Blood Stream Infections Guidelines to Prevent Central Line- Associated Blood Stream Infections. Slide 2. Why Do I Need to Complete This Orientation? Problem. Vascular access device- associated infections increase morbidity, mortality, hospital length of stay, and costs. Education of health care workers decreases healthcare- associated infections. Intervention. Mandatory course to achieve standardization of infection control practices during central vascular access device (C- VAD) insertion. Slide 3. Why Do I Need to Complete This Orientation? Slide 4. Statistics for CLABSIs 9. C- VADs. 4. 00,0. CLABSIs occur each year in the United States. CLABSIs are. Associated with increased morbidity. Associated with mortality rates of 1. Associated with prolonged hospitalization (mean of 7 days) and increase in medical costs > $2. Slide 5. National Nosocomial Infection Surveillance Rates In 2. National Nosocomial Infection Surveillance from the Centers for Disease Control & Prevention reported the number of CLABSIs per 1,0. ICU) surveillance. Table 1 compares ICUs from one academic medical center to national benchmark CLABSI rates. Slide 6. CLABSI Rates per 1,0. Catheter Days NHSN 9. Percentile. NHSN 6. Percentile. Pre- VADTraining. Post- VADTraining. SICU9. 1. 5. 3. 6. PICU1. 1. 9. 7. 7. CVICU4. 9. 2. 8. 7. MICU9. 8. 6. 1. 7. CCU7. 9. 4. 6. 5. NCCU8. 3. 4. 9. 6. Onc. ICU9. 3. 4. 7. N/A1. 6. Slide 7. Risk Factors for CLABSI Site of insertion — Subclavian vein poses less risk than internal jugular or femoral vein.*Multiple lumen catheters. Increased tissue trauma predisposes to CLABSIMore manipulation and contamination of multiple ports/hubs. Total parenteral nutrition and/or lipids. Low nurse to patient ratio Merrer, et al. Slide 8. Risk Factors for CLABSI (cont.) Infection elsewhere (remote, i. Colonization of catheter with organisms. IV catheterization longer than 7. Inexperience of personnel inserting the C- VADUse of stopcocks. Slide 9. Risk Factors for CLABSI (cont.) Image: Drawing of an infection site. There are five main areas from which catheter related infections can originate. Infection can occur hematogenously, from a distant local infection. Contamination of the catheter device prior to insertion, skin organisms, or contamination of the catheter hub can all cause infection. Contaminated infusate can also cause infection. Slide 1. 0. Five Evidence- Based Steps to Prevent CLABSI Use appropriate hand hygiene. Use chlorhexidine for skin preparation. Use full- barrier precautions during central venous catheter insertion. Avoid using the femoral vein for catheters in adult patients. Remove unnecessary catheters. Slide 1. 1. Hand Hygiene. Wash hands with soap and water or use a waterless hand sanitizer. Before and after invasive procedures. Between patients. After removing gloves. Before eating. After using the bathroom. If contamination is suspected. Slide 1. 2. Hand Hygiene Works! Year. Author. Setting. Comparison Group. Results. 19. 82. Maki. ICU (U. S.)Crossover. Waterless Hand Hygiene Steps Coat all surfaces of your hands thoroughly with waterless hand sanitizer, including palms, in between fingers, under fingernails, backs of hands, and around wrists. Rub your hands briskly until they feel comfortably dry. It takes about 1. Image to the right of text: Photograph of hands using a waterless hand sanitizer. Slide 1. 4. Hand Washing Steps Wet hands. Obtain soap. Lather for 1. Rinse hands. Turn off faucet handles with paper towel. Image to the left of text: Photograph of hands washing with water under a faucet. Slide 1. 5. C- VAD Site Selection Use the subclavian site unless medically contraindicated (e. Image: Photograph of a shoulder with a subclavian catheter inserted. Slide 1. 6. C- VAD Site Selection: Special Considerations For patients on hemodialysis, the National Kidney Foundation’s 2. VAD unless use of the internal jugular vein is absolutely contraindicated. This is due to the risk of subclavian vein stenosis. If the internal jugular vein is chosen, use the right side to reduce the risk of noninfectious complications. Slide 1. 7. C- VAD Line Selection. Use a single lumen C- VAD, unless multiple lumens are absolutely necessary. Consider a tunneled or implanted C- VAD for patients requiring long- term access (> 3. PICC or cuffed C- VAD for patients requiring therapy for > 1 week. Evaluate the need for C- VAD daily. Aseptic Technique: Goals Remove transient organisms and soil from the skin. Reduce the number of resident microbial flora and inhibit their rebound growth. Create a sterile working surface that acts as a barrier between the insertion site and any possible source of contamination. Slide 1. 9. Aseptic Technique Prepare skin with antiseptic/detergent chlorhexidine 2 percent in 7. Pinch the wings on the “Chlora. Prep” applicator to pop the ampule. Hold the applicator down to allow the solution to saturate the pad. Press the sponge against skin and apply chlorhexidine solution using a back- and- forth friction scrub for at least 3. Do not wipe or blot. Allow the antiseptic solution time to dry completely before puncturing the site. This may take 2 minutes. Image of Chlora. Prep applicator. Slide 2. 0. Evidence Supporting Chlorhexidine Use: Skin Prep- Meta Analysis Image of line chart comparing seven studies conducted between 1. From Ann Intern Med meta- analysis. Slide 2. 1. Maximal Barriers Required for C- VAD Insertion. Use face mask, cap, and sterile gloves. Wear a sterile gown with neck snaps and wrap- around ties properly secured. Instruct anyone assisting you to wear the same barriers. Cover the patient entirely with a large sterile drape. Slide 2. 2. Maximal Barrier Precautions Decrease CLABSI Infections. Author. Design. Catheter Type. OR for Infection. Without MBRMermel/1. Prospective, cross- sectional. Swan- Ganz. 2. 2 (p< 0. Raad/1. 99. 4Prospective, randomized. Central. 6. 3 (p< 0. OR = odds ratio. MBR = maximal barrier precautions. Inserter washes hands and wears mask, cap, sterile gown, and sterile gloves. Patient’s head and body are covered with a large, sterile drape. Slide 2. 3. Caveats: Catheter Insertion IV antimicrobial prophylaxis does not reduce CLABSI.*Insertion of C- VADs through open techniques/cut down increases the risk of CLABSI. Adequate room is needed to perform the procedure without risk of contamination. Ranson. 1. 99. 0; 1. Slide 2. 4. Post Insertion: C- VAD Care Antimicrobial ointments do not reduce the incidence of CLABSI. A sterile dressing should be applied to the insertion site before the sterile barriers are removed. Transparent dressings are preferred to allow visualization of the site. However, if the insertion site is oozing, apply a gauze dressing instead of a transparent dressing. When the C- VAD dressing becomes damp, loosened, or soiled or after lifting the dressing to inspect the site, replace the dressing. Slide 2. 5. Replacing C- VADs Lines should be removed as soon as possible. Routine C- VAD guidewire exchange or site rotation is not recommended.*Guidewire exchange is acceptable for replacing a malfunctioning catheter or downsizing a pulmonary artery catheter to a central venous catheter. Patients who clearly have a CLABSI should not undergo a guidewire exchange. Selected patients with suspected blood stream infections and limited venous access may have their catheter exchanged over a guidewire and the catheter tip should be cultured. Before handling the new catheter, switch to a new set of sterile gloves. Eyer, et al. 1. 99. Slide 2. 6. Suspected C- VAD Infections Remove the C- VAD in a patient with proven CLABSI (i. If a blood stream infection is only suspected, the C- VAD is not known to be the source, or the C- VAD cannot be removed, clinical judgment is necessary. Extensive, evidence- based guidelines exist for the diagnosis and treatment of catheter- related infections.*Mermel, et al. Slide 2. 7. Suspected C- VAD Infections (cont.) Draw two sets of blood cultures from a patient with new episode of suspected C- VAD infection, preferably both sets peripherally. It is not always necessary to remove the C- VAD in a mildly ill patient with unexplained fever. If the catheter is the suspected source of the infection, it can be changed over a wire and cultured. If the catheter culture grows . C- VAD Line Cultures: Indications The utility of catheter cultures is controversial; nonetheless, proper technique is imperative to evaluate the data. Lexicon of alcohol and drug terms published by the World Health Organization Ethanol containing not more than 1% by mass of water. Refraining from drug use or (particularly) from drinking alcoholic beverages, whether as a matter of principle or for other reasons. Those who practise abstinence from alcohol are termed . It is a residual category, with dependence taking precedence when applicable. Because of its ambiguity, the term is not used in ICD- I0 (except in the case of non- dependence- producing substances- see below); harmful use and hazardous use are the equivalent terms In WHO usage, although they usually relate only to effects on health and not to social consequences. Thus the definition published in 1. WHO Expert Committee on Drug Dependence was . Geneva, World Health Organization ,1. WHO Technical Report Series, No. The propensity of a particular psychoactive substance to be susceptible to abuse, defined in terms of the relative probability that use of the substance will result in social, psychological, or physical problems for an individual or for society. Under international drug control treaties (see conventions, international drug) WHO is responsible for determining the abuse liability and dependence potential, as distinct from therapeutic usefulness, of controlled substances. See also: abuse; dependence potential; harmful useabuse of non- dependence- producing substances (F5. Defined in ICD- I0 as repeated and inappropriate use of a substance which, though the substance has no dependence potential, is accompanied by harmful physical or psychological effects, or involves unnecessary contact with health professionals (or both). This category might more appropriately be termed . In ICD- I0, this diagnosis is included within the section . The particularly important groups are(1) psychotropic drugs that do not produce dependence, such as antidepressants and neuroleptics; (2) laxatives (misuse of which is termed the . Despite the patient’s strong motivation to take the substance, neither the dependence syndrome nor the withdrawal syndrome develops. These substances do not have dependence potential in the sense of intrinsic pharmalogical effects, but are capable of inducing psychological dependence. See child of an alcoholicacetaldehyde The principal breakdown product of ethanol. Acetaldehyde is formed by oxidation of ethanol. Acetaldehyde is formed by oxidation of ethanol, the reaction being catalysed principally by alcohol dehydrogenase. It is itself oxidized to acetate by aldehyde dehydrogenase. Repeated use of a psychoactive substance or substances, to the extent that the user (referred to as an addict) is periodically or chronically intoxicated, shows a compulsion to take the preferred substance (or substances), has great difficulty in voluntarily ceasing or modifying substance use, and exhibits determination to obtain psychoactive substances by almost any means. Typically, tolerance is prominent and a withdrawal syndrome frequently occurs when substance use is interrupted. The life of the addict may be dominated by substance use to the virtual exclusion of all other activities and responsibilities. The term addiction also conveys the sense that such substance use has a detrimental effect on society, as well as on the individual; when applied to the use of alcohol, it is equivalent to alcoholism. Addiction is a term of long- standing and variable usage. It is regarded by many as a discrete disease entity, a debilitating disorder rooted in the pharmacological effects of the drug, which is remorselessly progressive. From the 1. 92. 0s to the 1. In the 1. 96. 0s the World Health Organization recommended that both terms be abandoned in favour of dependence, which can exist in various degrees of severity. Addiction is not a diagnostic term in ICD- 1. See also: dependence; dependence syndrome. In the USA in the late 1. The term for a practitioner of addiction medicine is . See also: IDU; IVDUSee child of an alcoholic. In the general medical and pharmacological fields, denotes a toxic physical or (less commonly) psychological reaction to a therapeutic agent. The reaction may be predictable, or allergic or idiosyncratic (unpredictable). In the context of substance use, the term includes unpleasant psychological or physical reactions to drug taking. See also: bad trip Alcohol- or drug- induced changes in affect that persist beyond the period during which a direct effect of the alcohol or drug might reasonably be assumed to be operating. See also: psychotic disorder, residual and late onset, alcohol- or drug- induced. A substance that acts at a neuronal receptor to produce effects similar to those of a reference drug; for example, methadone is a morphine- like agonist at the opioid receptors. See mutual- help group; twelve- step group. In chemical terminology, alcohols are a large group of organic compounds . Ethanol (C2. H5. OH, ethyl alcohol) is one of this class of compounds, and is the main psychoactive ingredient in alcoholic beverages. By extension the term . Ethanol results from the fermentation of sugar by yeast. Under usual conditions, beverages produced by fermentation have an alcohol concentration of no more than 1. In the production of spirits by distillation, ethanol is boiled out of the fermented mixture and re- collected as an almost pure condensate. Apart from its use for human consumption, ethanol is used as a fuel, , as a solvent, and in chemical manufacturing (see alcohol, non- beverage). Absolute alcohol (anhydrous ethanol) refers to ethanol containing not more than 1% by mass of water. In statistics on alcohol production or consumption, absolute alcohol refers to the alcohol content (as 1. Methanol(CH3 OH)), also known as methyl alcohol and wood alcohol is chemically the simplest of the alcohols. It is used as an industrial solvent and also as an adulterant to denature ethanol and make it unfit to drink (methylated spirits). Methanol is highly toxic; depending on the amount consumed, it may produce blurring of vision, blindness, coma, and death. Other non- beverage alcohols that are occasionally consumed, with potentially harmful effects, are isopropanol ( isopropyl alcohol,often in rubbing alcohol) and ethylene glycol (used as antifreeze for automobiles). Alcohol is a sedative/hypnotic with effects similar to those of barbiturates. Apart from social effects of use, alcohol intoxication may result in poisoning or even death; long- term heavy use may result in dependence or in a wide variety y of physical and organic mental disorders. Alcohol- related mental and behavioural disorders (f. ICD- 1. 0 (f. 10- f. See also: alcohol- related brain damage; amnesic syndrome; cardiomyopathy; cirrhosis; delirium; fatty liver; fetal alcohol syndrome; gastritis; hepatitis; myopathy; neuropathy, peripheral; pellagra; pancreatitis; pseudo- Cushing syndrome; scurvy; thiamine deficiency syndrome; Wemicke encephalopathy(I) Most commonly, regulations restricting or otherwise controlling the production and sale of alcoholic beverages,often administered by specific government agencies (alcoholic beverage control. ABC).(2) In some scholarly discussions. The alcohol flush reaction is seen in approximately 5. Mongoloid (Asian) groups and is caused by an inherited deficiency of the enzyme aldehyde dehydrogenase which catalyses the breakdown of acetaldehyde. The reaction also occurs when alcohol is taken by people receiving treatment with alcohol sensitizing drugs such as disulfiram (Antabuse), which inhibit aldehyde dehydrogenase. An individual who suffers from alcoholism. Note that this noun has a different meaning from the adjective in alcoholic beverage. Liquid that contains alcohol (ethanol) and is intended for drinking. Almost all alcoholic beverages are prepared by fermentation, followed- in the case of spirits- by distillation. Beer and ale are produced from fermented grain (malted barley. Wines are produced from fermented fruits or berries, particularly grapes. Other traditional fermentation products are mead (from honey), cider (from apples or other fruits) sake (from rice). Spirits vary in the underlying grain or fruit raw material on which they are based: for instance, vodka is based on grain or potatoes, whisky on rye or corn, rum on sugar cane, and brandy on grapes or other fruit. Sherry, port, and other fortified wines are wines to which spirits have been added, usually to give an ethanol content of about 2. Alcohol can also be synthesized chemically, e. Several thousand congeners- constituents of alcoholic beverages other than ethanol and water- have so far been identified, but ethanol is the main psychoactive ingredient in all common alcoholic beverages. Alcoholic beverages have been used since ancient times in most traditional societies, except in Australia, North America (north, roughly, of the Mexican border), and Oceania. Many traditional fermented drinks had a relatively low a. Most governments seek to license or otherwise control . Alcoholic beverages produced illicitly, notably spirits, often have a distinct identity (e. More specific terms are preferred. Patients typically present with biventricular heart failure; common symptoms include shortness of breath on exertion and while recumbent (nocturnal dyspnoea), palpitations, ankle oedema, and abdominal distension due to ascites. Disturbance of the cardiac rhythm is usual: atrial fibrillation is the most frequent arrhythmia. Alcoholic cardiomyopathy should be distinguished from beri- beri heart disease and from a form of . This is a strictly histological definition, but diagnosis is often made on clinical grounds only. Alcoholic cirrhosis occurs mainly in the 4. Individuals show symptoms and signs of hepatic decompensation such as ascites, ankle oedema, jaundice, bruising, gastrointestinal haemorrhage from oesophageal varices, and confusion or stupor due to hepatic encephalopathy. About 3. 0% of patients are . Liver cancer is a late complication of cirrhosis in approximately 1. Alcoholic cirrhosis is sometimes termed .
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