Identifying and preventing harm from deterioration in patients

Identifying and preventing harm from deterioration in patients This study will discuss what a nurse needs to know in relation to identifying and preventing harm from deterioration in patients in a hospital ward setting. A review of current literature will be carried out in order to find the best available evidence on the subject. The key issues arising from the literature will be critically analysed to provide a balanced and objective consideration of the strengths and limitations of current practice in relation to the recognition and communication of patient deterioration. Finally the study will use the evidence to attempt to make recommendations for practice in this area and discuss the nurses role in the development of the new practices which could enhance the management of patient deterioration and ultimately ensure safer care for patients. Rationale for Subject Choice As a student nurse about to become a registered and accountable practitioner, one of my main concerns is that I have the knowledge and skills to recognise deterioration in the condition of my patients and the ability to communicate my concerns effectively to ensure they are seen promptly by a more senior clinician and any further decline is prevented. Therefore my rationale for choosing to study this topic was to try to find evidence which would support me in contributing to safer care of acutely ill patients. Background The increasing complexity of healthcare, an ageing population and shorter length of stay, means that hospital patients today need a higher level of care than ever before. Therefore, it is essential that hospital staff are equipped to recognise and manage deterioration (Department of Health 2009). Many patients who experience cardiopulmonary arrest show signs of deterioration for more than 24 hours before arrest, and it has been estimated that approximately 23,000 in-hospital cardiac arrests in the United Kingdom (UK) could be avoided each year with better care (Smith et al 2006). Furthermore, evidence has shown that delays in recognising deterioration or inappropriate management can result in late treatment, avoidable admissions to intensive care and in some cases, unnecessary deaths National Confidential Enquiry into Patient Outcome and Death (NCEPOD) (2005) National Patient Safety Agency (NPSA) (2007) (2007a). These studies highlighted the magnitude of the problem in the UK, they s howed that hospital staff do not understand the disturbances in physiology affecting the sick patient, they frequently ignore signs of clinical deterioration and lack skills in the implementation of oxygen therapy, assessment of respiration and management of fluid balance NPSA (2007) (2007a). NCEPOD (2005) reported that approximately 50% of ward based patients receive substandard care prior to Intensive Care Unit (ICU) admission, and 21-41% of ICU admissions are potentially avoidable. Analysis of 425 deaths that occurred in general acute hospitals in England showed that 64 deaths occurred as a result of patient deterioration not being recognised due to observations not being undertaken for a prolonged period leading to changes in vital signs not being detected, and delay in patients receiving medical attention even when deterioration was detected (NPSA 2007). Despite considerable economic investment there is continued evidence of suboptimal care and the Department of Health (DoH) (2 009) have acknowledged that the recognition and management of acutely ill patients need attention. They say there are many factors influencing a patients ability to receive appropriate and timely care including the failure to seek advice, poor communication between professional groups, and a lack of clinical supervision for staff in training (DoH 2009). The following literature review will attempt to find evidence of the factors which contribute to sub optimal treatment of deterioration. Literature Review A literature search was undertaken using the electronic databases CINAHL, ESCBO host, Internurse, Medline, Science Direct and Swetswise through the Liverpool John Moores University search engine, and also the British Nursing Index via Ovid using the Royal College of Nursing search engine. The keywords used were: deterioration, hospital deterioration, communication of deterioration and early warning systems. A total of thirteen articles were found to be of use, two of these were published outside the UK (Australia and Italy) however after reading them it was decided that the evidence was relevant and they were deemed appropriate for use. As the study developed a further search was performed using the terms deterioration tools, communication tools, SBAR and RSVP communication tool two articles from this subsequent search were used in this study. Additionally and as mentioned above useful references were also sought from the Department of Health, the National Patient Safety Agency, the National Confidential Enquiry into Patient Outcomes and Death, and the National Institute of Clinical Excellence. The search revealed the topic had been fairly well researched, especially in recent years and the articles seemed to have stemmed from the reports by NPSA (2007) (2007a) and NICE (2007). Smith (2010) recently proposed a Chain of Prevention to assist hospitals in structuring their care processes to prevent and detect patient deterioration and cardiac arrest. The five rings of the chain represent staff education, monitoring, recognition, the call for help and the response and it was found that the themes of education, and recognition were well documented in the literature. Nurse Education Preston and Flynn (2010) say in order to avoid unrecognised patient deterioration and therefore enhance patient safety nurses must review their knowledge and skills in measuring the physiological parameters of temperature, blood pressure, blood glucose levels, oxygen saturation levels, and neurological function, and in particular identified the respiratory rate as a particularly sensitive indicator of clinical decline. In addition nurses also need to recognise the significance of physiological compensatory mechanisms that are activated in clinical deterioration, so they can report their findings accurately and with confidence to doctors and senior staff. Steen (2010) agrees that nurses require the knowledge and skills to be able to provide critical care in the general ward setting, as accurate assessment using a systematic approach can aid timely detection and intervention and can help to stabilise the individuals condition preventing organ dysfunction, multi organ failure and furthe r deterioration, thus reducing morbidity and mortality rates and admission to ICU. However, Odell, Victor and Oliver (2009) feel that recognising deterioration of a ward patient and referring to critical care teams is a highly complex process, requiring skill, experience, and confidence. Preston and Flynn (2010) suggest that nurses can be helped to develop these skills by attending the Advanced Life Threatening Events Recognition and Treatment (ALERT) course, they considered the possibility of nurses undertaking the ALERT course whilst a student, they say this will help newly qualified nurses to promote their skills, abilities and rationale for recognizing and responding to patient deterioration. They also recommend the further development of acute illness simulation programmes in both pre and post registration courses to help nurses to become more confident and expert in responding and reporting acute illness to medical and more senior staff. They say what is needed is a closer col laboration between education and health service partners to deliver these programmes and competent clinical teaching staff to facilitate these simulated exercises in a safe environment that utilises accurate patient scenarios, equipment and charts that are currently used in practice (Preston and Flynn 2009). Monitoring Accurate monitoring of patient condition featured highly in the literature. The NPSA (2007) revealed that in 14 of the 64 incident reports they studied, no observations had been made for a prolonged period before the patient died therefore vital signs such as blood pressure, pulse and respirations were not detected. But the literature revealed the crucial importance of regular observations in the recognition of deteriorating patients. Preston and Flynn (2010) said doing the observations is crucial for detecting early signs of deterioration in acute care as closely monitoring changes in physiological observations can identify abnormalities before a serious adverse event occurs. Early identification is important to reduce mortality, morbidity, length of stay in hospital and associated healthcare costs (NICE 2007). Preston and Flynn (2010) also stipulated that close supervision of unqualified nursing staff doing the observations in acute care should be a high priority and should follow both the NICE (2007) guidelines and recommendations from the NSPA (2007) (2007a). However following an observation of care by Morris (2010) an issue was identified where observations were incomplete, with recording of respiratory rate and oxygen saturations omitted and although an early warning score chart had been used, a score had not been recorded (Morris 2010). Recognition The importance of nurses utilising an early warning system was highlighted. Cei, Bartolomei and Mumoli (2009) say using the Modified Early Warning Score (MEWS) when recording patient observations is a simple but highly useful tool to predict a worse in-hospital outcome and aid identification of patients at risk of clinical adverse events such as cardiac arrest, sepsis and raised intracranial pressure. Nonetheless a study by Donohue and Endacott (2010) revealed that participants did not look for trends in the MEWS data and few used MEWS data in the manner it was intended i.e. it was used to confirm whether the patient met the trigger criteria, rather than as a routine component of assessment, the study found that MEWS was used infrequently, used too late and not employed to communicate patient deterioration. Mohammed, Hayton, Clements, Smith, and Prytherch (2009) felt the significant advantage of an early warning or track and trigger system like MEWS was that they use a visual scale t hat gives a score if a physiological recording enters a colour zone. But they found that there are disadvantages to using these systems in practice if nurses add up the scores incorrectly. In their study (Mohammed at al 2009) found that calculating scores could be improved by using a handheld computer and this approach was more accurate, efficient and acceptable to nurses than using the traditional pen and paper methods in acute care. The Department of Health (2009) say early warning systems play a key role in the detection of deteriorating patients; however, clinicians need to be aware that in some clinical situations these systems will not reflect clinical urgency (Department of Health 2009) and effective assessment skills must be employed. Call for Help and Response The NPSA (2007) report revealed that in 30 of the 64 incident reports they audited, despite recording vital signs, the importance of the clinical deterioration had not been recognised and/or no action had been taken other than the recording of observations (NPSA 2007). This could be due to ineffective communication of the deterioration. The literature review showed that communication of deterioration was a more recently well documented subject. Steen (2010) Tait (2010) feel that a vital component of the management of the acutely ill patient is the ability to communicate clearly and precisely with all members of the multidisciplinary team to aid timely and appropriate help and intervention for the patient. Still there is much evidence of communication breakdown between disciplines, Beaumont (2008) states communication between medical and nursing staff can be problematic, nurses may not communicate clearly enough and struggle to convey information in a manner that would convince doctor s of the urgency of the situation, sometimes there is failure by doctors to perceive, understand or accept the source of nurses clinical and professional judgement, less experienced nursing staff might not feel comfortable or confident to call more senior staff because they fear doing the wrong thing or crossing occupational and hierarchical boundaries. These problems can result in conflict between professional groups as they attempt to work towards positive outcomes and may prevent patients from receiving assistance and support when required (Beaumont 2008). Endacott, Kidd, Chaboyer and Edington (2007) agree that formal divisions of labour and professional boundaries can cause gaps or discontinuities in patient care and feel communication between clinicians must improve. Donahue and Endacott (2010) say the failure of nurses to recruit senior support to deal with acutely ill patients is a contributing factor to the sub-optimal care of critically ill patient, it may be due to a lack of experience or knowledge on the part of the doctor but may equally be due to the nurses inability to articulate the seriousness of the situation. Their data identified that nurses have an awareness of the need for a succinct story but they continue to make calls for assistance with little relevant information (Donohue and Endacott 2010). As stated above suboptimal communication between health professionals has been recognised as a significant causative factor in incidents compromising patient safety and the use of a structured method of communication has been suggested to improve the quality of information exchange (Marshall, Harrison and Flanagan 2009). A number of communication tools are available; some hospitals use the SBAR (situation, background, assessment, recommendation) tool to structure conversations between members of the multidisciplinary team, which uses standardised questions to prompt the conveyor of information to share the necessary details (Steen 2010). In a simulated clinical scenario Marshall et al (2009) described the positive effect of this method on students ability to communicate clear telephone referrals. However, Featherstone, Chalmers and Smith (2008) feel that SBAR is not a memorable acronym and they prefer the use of the RSVP (Reason, Story, Vital Signs, Plan) system used in the ALERT cou rse as framework for the communication of deterioration, the authors say SBAR does not easily slip off the tongue, and RSVP is much easier to remember in an emergency. They say the reason for the call can be explained in clear simple language, and the story gives a time line of important events, they feel nurses will be familiar with a narrative style of communication and are used to giving a brief summary as part of the handover process. The vital signs must be given in figures, and can include the early warning score, or summarized in words that convey the deterioration effectively and the plan for the patient should be outlined by the caller or expected from the receiver (Featherstone et al 2008). Smith (2010) says the use of standardised method of communication, such as the RSVP system will improve communication about patient decline. Recommendations for Practice Constant change within the National Health Service is essential to advance care quality and ensure the provision patient focused care that is evidenced based. Ensuring the latest and best available evidence is put into practice is a is a crucial way of ensuring that people get the treatments and services that are the most effective and will have the best health outcomes, it ensures that the public funding that supports the NHS is used wisely and that the treatments and services offered are cost effective, and both of these factors lead to the provision of clinically effective care. Everyone involved in healthcare provision must ensure quality is enhanced and must be willing to change current practices for the benefit of patients. Nurses have a professional responsibility to keep up to date with changes and developments within their field and to deliver care based on the best available evidence or best practice (Nursing and Midwifery Council 2008). Larrabees (2009) Model for Evidence Based Practice Change suggests that there are six steps towards implementing change in practice, firstly practitioners should assess need for change in practice, and this study has found evidence which clearly points to the need for changes in practice in order to reduce avoidable harm to patients. The next steps of Larabees Model (2009) are to locate the best evidence, and critically analyse the evidence, and from the evidence found in this study it is evident there are several recommendations for changes in practice which would help nurses in acute care to develop their skills in recognising and reporting deterioration. To keep the Chain of Prevention suggested by Smith (2010) strong he suggests that staff education, monitoring, recognition, the call for help and the response must all be robust in order to prevent harm from unrecognised and unassisted illness. Recommendations to enhance these areas would be to ensure that the recognition of life threatening illness is taught from an early stage in a nurses career by attending the ALERT course earlier in their training and by the teaching of patient scenarios in the clinical area and facilitated by staff who are trained in critical care. With regards to the call for help and the response rings of the Chain of Prevention (Smith 2010), it has been shown that the use of communication tools help nurses to get an earlier response when calling for assistance, so it seems sensible to implement the standard use of a communication tool in acute care when communicating deterioration. The next step in Larabees Model for Change (2009) is to design the practice change, and it is recommended that use of the RSVP communication tool (see appendix) should become hospital protocol when calling for assistance; this is because it is easy to remember and it is used as part of the ALERT course which many acute care nurses have attended. Nurses should receive training on the use of this tool and it should be displayed near the tele phone in every acute area. In order to implement and evaluate this change, which are the next steps in the Model (Lara bee 2009) a nurse should firstly let people know about it, this can be done by using various means of communication i.e. trust intranet, ward meetings, discussion with senior nursing staff and managers. They must then get people to take on the change by involving enthusiastic team members and organising a pilot test of the use of the RSVP tool. Crucially the rate in which more senior practitioners respond must be audited find out if the tool is working in practice and if not why not, is more information or training required is the tool not displayed clearly enough. The final step of the Model for Change (Larabee 2009) is to integrate and maintain the change in practice, to do this a nurse must ensure all new staff are trained to use the system and continuously evaluate its use to ensure it is working in practice. Conclusion This study has highlighted the evidence base and resources available to support nurses in contributing to safer care of acutely ill patients it has found that in order to facilitate accurate detection of changes in condition, nurses working in acute care must acknowledge the importance of observations and early warning systems in the identification of patients at risk of adverse events and ensure patients are assessed using a sound knowledge of physiological compensatory mechanisms, to enhance this knowledge they should attend an ALERT course, the evidence pointed to nurses attending these courses early in their career and that clinical scenarios could also help increase their knowledge of acute illness. It was found that communication tools help nurses when calling for senior assistance and the implementation of a standard tool within acute hospital settings could help to prevent harm from deterioration.

Sanity: Boundaries of the Mind Essay -- essays research papers fc

Sanity: Boundaries of the Mind   Ã‚  Ã‚  Ã‚  Ã‚  The mind is a beautiful thing. The boundaries that someone can extend their rationality is different in each and every person. In Shakespeare’s Hamlet, the balance of sanity and madness is tested. Hamlet’s way of thinking is changed, but in a way that his personality is only a front. By looking at the different events that Hamlet overcame, we can observe the passion for acting that many readers do not come across; knowing the importance of acting is imperative when questioning Hamlet’s sanity, since he is only acting insane, and is rational and in control of himself throughout the play.   Ã‚  Ã‚  Ã‚  Ã‚  For those who do not recall the story of Hamlet, this play is one of revenge, scandal, and lies. Hamlet, the prince of Denmark, is living a life that one would not want to live. His father, the King, was murdered by his brother, who is now married to Hamlet’s mother. Hamlet beings his brilliant acting and conniving when he learns that he must avenge his father’s murder. Not only does Hamlet fool his family when acting insane, but the genius of his work has fooled critics all along.   Ã‚  Ã‚  Ã‚  Ã‚  As the play begins, the ever popular question â€Å"Who’s there?† â€Å"Betrays the insecurity of Hamlet’s world† (Salkeld and Shakespeare). Starting the play with a question was pure genius on Shakespeare’s part; the symbolism of the questionable state of Denmark which is â€Å"in a state of shock and confusion,† along with the people in it, leads the readers right into the questionably unstable life of Hamlet (Salkeld, Strachey). In act I, scene V of the play, the audience learns of the â€Å"antic disposition† that Hamlet will be putting on (Shakespeare). In this scene, he tells the audience that he plans to act insane in order to get away with killing Claudius. He believes that by acting insane no one will suspect him of doing anything such as that. To many critics the â€Å"whole conduct of Hamlet’s madness is too ludicrous† and in fact he has really gone mad ( Stubbers). For Hamlet to come out and say that he is planning to act insane is, on the other hand, â€Å"purely and adequately a man of genius† (Strachey). Hamlet’s ability to imitate someone who is insane is astonishing. His ability to do so is what has confused readers and critics. Not only can his sanity be seen, but throughout different scene... ...g into the performance to fool all. Being able to fool even his mother is what gave Hamlet the ability to complete his plans of murdering Claudius. Hamlet eventually avenged his father’s death and accomplished that by keeping his thoughts and emotions in order. The mind is a beautiful thing, which wasn’t wasted. Works Cited â€Å"Overview of Hamlet.† Gale 2003 Gale Research. Student Resource Center. Blinn College Library, Bryan TX. 28 Nov. 2004 < http://galenet.galegroup.com/servlet/SRC >. Salkeld, Duncan. â€Å"Madness in Shakespearean Tragedy.† Shakespearean Criticism vol.35. Shakespeare, William. Hamlet. Roberts, Edgar V., Henry E. Jacobs, Eds. Literature: An Introduction to Reading and Writing, Seventh Edition, Upper River, Pearson, 2004. 1306-1406. Strachey, Edward. â€Å"Essay on Madness (Hamlet).† Gale 2003. Gale Research. Student Resouce Center. BlinnCollege Library, Bryan, TX 28 Nov. 2004 < http://galenet.galegroup.com/servlet/SRC >. Stubbers, George/ Thomas Hanmer. â€Å"Critical Heritage.† Shakespearean Criticism vol. 1. 1975. vol. 71 Zeffirelli, Franco, Dir. Hamlet. Perf. Mel Gibson, Helena Bonham Carter, Alan Bates, and Glenn Close, Warner Bros, 1991.

Clostridium Difficle Infection In Health-Care Workers Essay

According to Bouza (2005), Clostridium Difficile is a bacillus that is gram positive and forms spores. Its main mode of distribution is the environment whereby it also colonizes 3-5% of all healthy adults without causing any symptoms that can be noticed. At infancy, clostridium difficile colonizes between 2% and 70%, but the rates decrease with advancement in age and falling to about 6% when the infant grows to two years. Above the age of two, the rate of clostridium difficile is much similar to that of an adult, around 3% (APIC, 2008). The strains responsible for the production of clostridium difficile are characterized by their ability in the production of both toxins A and B. The most common and rampant symptom of CDI is diarrhea that is not always bloody, but can range from the soft and unformed stools to the watery and mucoid stools. Other outstanding symptoms include abdominal pains and fever and cramping in others. Clostridium difficile spores are highly resistant to destruction by most of the environmental agents and conditions. Their resistance can go as far as resisting some of the chemicals used in disinfection (Zanotti-Cavazzoni, 165). Therefore, this gives clostridium difficile the ability to survive for months or longer in the environment and even in healthcare facilities and the surrounding community. Mainly, the spread of clostridium difficile is through the transfer of spores from a contaminated environment to the patient, or perhaps through the hands of health care givers who do not follow proper hygiene and gloving practices. The only proper control measure that can be adopted is the thorough disinfection and cleaning of the patient’s environment and also through the physical removal of the spores. In recent decades, there has been a recorded increase in the number of reported rates of clostridium difficile-associated disease (CDAD). There has also been a recording in the increase in the number of outbreaks accompanied by severe disease and also an increase in mortality. The increase in CDAD is mainly characterized by the following; changes in the use of antibiotics, a change in infection control practices or the emergence of new strains of clostridium difficile that have increased virulence or antimicrobial. It is also important to comprehend the life cycle of clostridium difficile in order to understand how to control it and if possible, prevent it. Its life cycle begins in the spore form whereby they are because they are resistant to heat, antibiotics or even acid. In a hospital setting, clostridium difficile can be found in bedding, medical equipment, and furniture and on the caregivers. Upon ingestion, the spores pass through to the intestines whereby they germinate and later colonize the colon. Studies have indicated that this bacterium colonized about 21% of patients who are in the process of receiving antibiotics and at the same time admitted to a general hospital. Through the release of both toxins A and B, clostridium difficile later induces diarrhea and colitis. However, the major risk factors associated with clostridium difficile are advancement in age, hospitalization, and antimicrobials. There are two major reservoirs of clostridium difficile in the healthcare setting, which are humans (asymptomatic and symptomatic) and inanimate objects (medical equipment and furniture). The level of environmental contamination depends primarily on the severity of the disease of the patient. However the asymptomatic colonized patients should be regarded as the potential primary source of the contamination. Clostridium difficile infection is more rampant among the elderly in the society. The main reasons for this are not fully, but it can be attributed to the fact that the elderly patients have a much less effective barrier to infection. The importance of having age as a risk factor is characterized by the age distribution in lab reports as was received by CDSC during the research period of 1990-1992. Results showed that there was a bias for adults over the age of 65 and they were more susceptible to having severe cases of clostridium difficile infections. There have also been suggestions that clostridium difficile is endemic in facilities that are considered long-stay for the elderly. However, other studies indicate that the difference in the endemic nature of clostridium difficile may be as a result of case mix whereby patients are from other facilities whereby the infection rate was high. Also, clostridium difficile is endemic in many of the long-stay facilities because the elderly t end to stay longer in the acute wards than the other younger generations. Therefore, their increased risk of infection is attributed to the increased exposure to antibiotics and nosocomial pathogens. There are several patient care activities that provide a rife opportunity for the fecal-oral transmission of clostridium difficile (CDC). Such activities include; sharing of electronic thermometers that have been used for measuring rectal temperatures, oral care or suctioning whereby the hands or equipment have been contaminated, administration of contaminated food, medication or with contaminated hands and emergency procedures like intubation. Other factors like poor hand hygiene, improper environmental and equipment cleaning and disinfection have also been reported as a cause for infection and spreading of clostridium difficile. It has been rubber stamped that the environment is the major medium of spreading for clostridium difficile whereby it has been spread so widely that that it is impossible to point out a single location that has not been contaminated. However, the environment of the infected patients is rifest with clostridium difficile, for instance, the toilets, floors, si nks and linen. Despite disinfection, clostridium difficile spores are found to exist longer than five months. Prevention and control of clostridium difficile is the responsibility of every individual who is aware of its existence. Therefore, prevention measures must be endorsed by everyone, and especially in care giving facilities whereby individuals are more likely to spread the infection. Standard precautions refer to those practices at work that are applied to every person regardless of their confirmed or perceived infectious status. Standard precautions are the front line in the war against clostridium difficile. They help control the rate of infection from person to person, even in the most prolific risk scenarios. They include; hand hygiene before and after contact with the patient, the safe use as well as disposal of sharps, the use of protective equipment and the processing of reusable medical equipment. The proper handling of linen, safety in the management of waste as well as aseptic non-touch technique should also be in the standard precautions to be implemented in hospital facili ties. However, when the first line of defense does not seem to work efficiently, there should be a backup plan in place. Thus, when standard precautions do not seem to do the job, transmission based precautions should be implemented. These are additional work practices for individually identifiable situations that are put in place to interrupt the transmission of clostridium difficile. These precautions are tailored to specific infections and their mode of transmission. They include; continued implementation of standard precautions, having patient dedicated equipment, proper handling of equipment, enhanced cleaning and disinfection of the patient’s environment and the restriction of patients within the facilities. Since healthcare settings differ greatly in terms of their day-to-day functioning, it is hard to come up with a management proposal that would fit all facilities. Therefore, all healthcare facilities should conduct infection prevention risk assessment on a regular basis alongside adoption of detailed protocols and processes for infection control. In acute care setting, personal protective equipment should be provided for nurses and visitors outside the room of a patient who has confirmed clostridium difficile infection. Healthcare givers should use gloves and gowns in order to prevent further spread of infection. Conducting effective hand hygiene is necessary for limiting the spread of clostridium difficile. They should be performed frequently and with the following considerations; should be performed using the Four Moments of Hand Hygiene, should be performed at the point-of-care using a dedicated staff sink or the use of hand wipes that have been impregnated with antimicrobials or alcohol and soap. In acute care setting, especially where the elderly are residing proper care has to be considered primarily because they are more susceptible to infection (Rupnik, 2007). One such measure of preventing clostridium difficile infection is placing the suspected or confirmed patients with CDI in a confined room that has dedicated toilets, sinks and personal equipment. Moreover, there is little need for special treatment for linen in an acute setting for both confirmed and suspected patients. Linen for symptomatic and asymptomatic patients should be in the same way. The soiled linen should be carefully. For example, it should be placed in a no-touch receptacle in order to avoid contamination of both the environment and the persons around. In cases of outbreaks, routine infection control measures are of grave importance in order to prevent the spread of the clostridium difficile infection to patients who have not yet been affected. The antibiotic policies have to be monitored as well as their compliance in order to successfully control the spread of infection. Hand washing procedures should be followed to the latter by any person who is in contact with infected patients such as doctors, nurses, paramedical staff and students. Nurses present challenges in combating clostridium difficile outbreaks especially because of the necessity to create a homely environment for the patients. This means that they have to constantly check in with the patients and therefore they become constantly at risk of infection themselves in proper precaution is not taken. For patients in the elderly acute care wards, the surroundings are also tailored to ensure a comfortable stay in the hospital. Therefore, their soft furnishings and carpeted floors provide a challenge in cases of outbreaks. For instances like this, preventive methods of combating the spread of clostridium difficile have to be implemented. One such measure that should be used during cleaning is steam. Although the heat does not kill the pathogen, it helps in the containment of its spread. Patients are also susceptible to contracting infection from the care devices used in the hospital. Such devices include electronic thermometers or glucose measuring devices. These devices are in constant use and may be used by a variety of patients. These devices are with pathogens derived from body fluids. Thus it is important to have measures in place to sterilize these devices especially more thoroughly in times of outbreaks. Another piece of communal apparatus used in wards is the linen, clothing, uniforms, lab coats and isolation gowns. Because clostridium difficile is commonly in the environment and can last for more than five months, these pieces of clothing are always in contact and possible contaminations are likely (Dubberke, 17). However indirect contact of such clothing comes from bedpans, toilets and sinks of patients who are either suspected or confirmed to be infected. The presence of soiled linen is also an area of importance that should be looked into carefully. Because bed linen is in hospitals and wards, they should be cleaned and sanitized before they can be issued to a different patient. In order to help combat the spread of clostridium difficile, the CDC has come up with the Spaulding classification system, which identifies three risk levels that are associated with surgical and medical instruments (Michel, 1095). These levels are; critical, semi-critical and noncritical. Critical items include needles, indwelling urinary catheters and intravenous catheters. These are the items that normally enter the sterile tissue, the vascular tissue or through which blood flows. Based on one of the accepted sterilization procedures, the equipment has to be sterile before penetrating any tissue. Semi-critical items include thermometers, electric razors and podiatry equipment and they are as those that touch mucous or skin which is not intact. They require meticulous cleaning and thereafter followed by high-level disinfection. Disinfection is done using a chemo sterilizer agent that is approved by the FDA. In conclusion, clostridium difficile has been on the rise in recent decades and it is only through proper prevention and control measures that it can be. Since it can live in an environment in spore form for up to five months, it poses a challenge in terms of containment. On the other hand, the elderly are more susceptible to clostridium difficile primarily because of their low immunity and their prolonged stay in hospitals. However, with proper care, chances of outbreaks can be kept at a minimum and more lives can be through prevention instead of cures. References DelmÃÆ' ©e, Michel. â€Å"Clostridium Difficle Infection In Health-Care Workers.†Ã‚  The Lancet  334.8671 (1989): 1095. Print. Dubberke, Erik. â€Å"Strategies for prevention of Clostridium difficile infection.†Ã‚  Journal of Hospital Medicine  7.S3 (2012): S14-S17. Print. â€Å"Patient Cloth Chairs and Clostridium difficile Outbreak.†Ã‚  American Journal of Infection Control  37.5 (2009): E102-E103. Print. Rupnik, Maja.  Abstract book: Clostridium difficile : organism, disease, control & prevention. s.l.: [Organizing committee ICDS], 2007. Print. Zanotti-Cavazzoni, S.l.. â€Å"Analysis of an outbreak of Clostridium difficile infection controlled with enhanced infection control measures.†Yearbook of Critical Care Medicine  2010 (2010): 164-166. Print. â€Å"clostridium difficle.†Ã‚  Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 1 Mar. 2013. Web.  30 Apr. 2014. http://www.cdc.gov/HAI/organisms/cdiff/Cdiff_infect.html Source document

Napster1 essays

Napster1 essays In order to find out why problem arouse in music industry around the Napster, we need to find out what is Napster? Napster is a database program that located on a computer server in San Mateo, CA. Napster community have more than 38 million users. Each of these 38 million users include in their computers variety of songs in MP3 format. The songs range from every musical type from classical to rap. Consumers use compact discs to make their own MP3 files, and then add them to their shared music profile in their Napster software. Again, Napster does not hold the copyrighted material on their servers; it is stored on the computer of users. The people are controlling what music they share among each other. Napster has a disclaimer on its transfer page warning people not to break copyright laws. Napster also has the right to prevent anyone from using their database service if they are found to have broken the copyright laws. I believe that people should be able to download music off Napster because it's just like the VCR, radio, and tape, it is a good way to promote music and a way for new artists to be heard. According to David Grohl (napster.com) "it's the same as turning on the radio." You listen to different songs, except you choose which ones you want to listen to. If they shut down Napster, will they shut down the radio? You're doing the same thing on Napster that you would do at the concert. It's just more suitable to do it in your own home. Why would artists want to ban Napster when it promotes their music? Napster could help people hear your new songs and if they like them you'll make money and become famous. In addition, according to Madonna "Napster could be a great way for people to hear your music who wouldn't have the chance to hear it on the radio." Chuck D, (napster.com) says, "We should think of Napster as a kind of radioa promotional tool that can help artists who don't have their musi c played on mainstream radio ...

China Revolution essays

China Revolution essays In the 19th century, China had a lot new treaties and wars breaking out, all throught the 19th century. Some are like the Opium War(s), The Boxer Rebellion, and Sphere of Influence. These things were a big part of Chinas history. The Opium War was two wars fought between Great Britain and China in whom Western powers gained significant commercial privileges and territory. The Opium Wars began when the Chinese government tried to stop the illegal importation of opium by British merchants. The First Opium War started in 1839 when the Chinese government confiscated opium warehouses in Guangzhou (Canton). Britain responded by sending an expedition of warships to the city in February 1840. The British won a quick victory and the conflict was ended by the Treaty of Nanking (Nanjing) on August 29, 1842. By this treaty, and a supplementary one signed on October 8, 1843, China was forced to pay a large indemnity, open five ports to British trade and residence, and cede Hong Kong to Great Britain. The treaty also gave British citizens in China the right to be tried in British courts. Other Western powers demanded, and were granted, similar privileges. In October 1856, Guangzhou police boarded the British ship Arrow and charged its crew with smuggling. Eager to gain more trading rights, the British used the incident to launch another offensive, precipitating the Second Opium War. British forces, aided by the French, won another quick military victory in 1857. When the Chinese government refused to ratify the Treaty of Tianjin, which had been signed in 1858, the hostilities resumed. In 1860, after British and French troops had occupied Beijing and burned the Summer Palace, the Chinese agreed to ratify the treaty. The treaty opened additional trading ports, allowed foreign emissaries to reside in Beijing, admitted Christian missionaries into China, and opened travel to the Chinese interior. Later negotiations legalized the ...

Five Guys Burger Essay Example | Topics and Well Written Essays - 750 words

Five Guys Burger - Essay Example This has helped the food chain beat other fast food cafes to become one of the leading cafes in USA. Five Guys Burger is guided by the philosophy that if someone is going to sell burgers and fries in a restaurant in an industry crowded with fast food chains selling burgers and fries, then they better do the products better than anyone else (Kurtz, 2012). They believed that they were in the business to sell burgers and the customers were the most important part of the business.They believed that the customers were favoring them by giving the five guys an opportunity to serve them. This helped the owners develop over 250,000 ways of ordering burger in order to reach the maximum number of customers. The chain produces burgers from freshly ground beef, which is never frozen. They also filled their menu with fat-free products, which have attracted preference from several customers. The original aim of the food chain was to provide healthy burgers and fries to customers, which would also b e ordered easily. The entrepreneurs introduced ingredients that were fat free and used meat that was not frozen (Longenecker, 2012). This created the need for fresh food that drew several customers. The food chain also targeted customers from all age groups. They introduced food that caters for the taste and preference of every person, including vegetarians. Serving customers was also part of their core values and they introduced thousands of ways of ordering burgers and fries. Customers receive unlimited free refills of their drinks and are served with peanuts as they wait for their orders to be processed (Motz, 2008). These aspects have made Five Guys Burgers a preferred source of fast food compared to other restaurants. Their burgers are larger than those of competitors and they have introduced naked pizza that is prepared locally. Food products such as burger buns are prepared at the stores from scratch to ensure freshness. Freshness is a major factor that has led to success for Five Guys Burgers. The food chain utilizes natural ingredients to prepare the burgers and fries. Potatoes are peeled in the stores and buns are prepared by the chefs from scratch (Rust and Raffetto, 2010). They utilized whole grain crusts, hormone-free meat, and fresh vegetables to prepare their food. Customer service has also contributed to success for the Five Guys Burger. The owners have developed applications for their phones that enable them to access customer invoices at any time and from any place. Technology has introduced several ways of ordering burgers and fries from the food chain at any location. Customers receive refills and peanuts as tokens as they wait for their orders, a move that has established the food chain as the most favorite among other restaurants. The activities of Five Guys and other local fast food restaurants have made competitors such as KFC and Mc Donald lose part of their market share. Five Guys and other locally established burger places give custo mers a better value for money, which has increased pressure on global competitors. Five Guys restrains from using frozen and dehydrated products for customers in order to set its taste apart from competitors. A business organization has to set itselfapart from competitors in order to gain a competitive advantage. Five Guys consider the customer to be the best sales man, a strategy that is not incorporated in other restaurants

ECON ARTICLE Essay Example | Topics and Well Written Essays - 750 words

ECON ARTICLE - Essay Example The LCD-panel manufactures had been producing flat screens faster than the TV industry could absorb and thus were forced to cut their wholesale prices by as much as 30%, which lowered their profits. Now they demand that TV makers, distributors, and retailers should cut their margin in order to generate more sales. On the other hand retailers complain that their margins are not really much because the high cost of storefront display and marketing TVs does not leave high profits for them. In addition, they have to invest heavily in training sales personnel also. They further have a lot of money tied up in inventories of the costly TVs. Moreover, the average selling price of flat screen TVs have dwindled to about $3000 from $5000 two years ago. The LCD panel makers, meanwhile, face stiff competitive pressure from other screen technologies such as Plasma and High Resolution Projection TVs. Since September 2004, plasma TV prices have plummeted and contributed to high market share gains over LCD sets. Retailers of plasma screen also apply a similar margin to plasma sets as well. But plasma screen factories are not as costly to erect as LCD screen plants, and there is less competition among plasma screen makers, so the profit squeeze is not as bad. A slightly encouraging trend that the flat TV producers can find relief in is that the low price is likely to increase the sales volume. Though there is a gradual decrease in prices and an increase in sales of flat screen TVs, most analysts predict that it won’t take off as quickly as flat screen computer monitors. Monitors primarily being used for commercial purposes, the purchasing has been driven by businesses while TVs are chiefly purchased for domestic use by consumers. These customers rather tend to be more sensitive to price than any other consideration. Due to increased production, the supply of flat TVs has