Preventing Blood Stream Infections Health And Social Care Essay

Preventing Blood Stream Infections Health And Social Care Essay National Patient Safety Goals (NPSG) were introduced in 2002 in order to help address some of the issues that were responsible for causing a majority of the situations that were responsible for creating patient safety issues. These goals were implemented in order to put focus on what were deemed to be the most preventable of these issues. One of these goals is the prevention of central line-associated blood stream infections (Lyles, Fanikos, Jewell, 2009). Literature Review Central venous catheters (CVC) are indispensable in the care of critically ill patients. However, their use is not without risk. Catheter-associated bloodstream infections (CA-BSI) are common healthcare-associated infections in intensive care unit (ICU) patients and have been estimated to occur in 3%-7% of all patients with CVC (Warren, et al., 2006). It is well documented that intravascular catheter related complications are associated with extending hospital length of stay, increasing direct costs and increasing ICU mortality. Clinicians insert approximately 7 million central venous access devices (CVAD) annually in the United States, and of these, 1 in 20 is associated with a CA-BSI, despite the use of the best available aseptic techniques during catheter insertion and maintenance. Overall, an estimated 250,000 CVAD-related CA-BSI occur annually, with an attributed mortality of 12.5% to 25% per occurrence. The national cost of treating CA-BSI equals $25,000 per infection, respecti vely, or $296 million to $2.3 billion in total. While the number of CA-BSI has remained relatively steady, vascular access device use has drastically increased, especially in nonhospital settings (Rosenthal, 2006). A vast amount of research is directed toward reducing these complications in an effort to improve patient outcomes. A review of the literature provides an overview of current recommendations concerning intravascular catheter care and research regarding the use of education programs to promote recommended practice. The Centers for Disease Control and Prevention (CDC) published the Guidelines for the Prevention of Intravascular Catheter-Related Infections in 2002, which is the benchmark for all intravascular catheter care recommendations. The guidelines for CVC suggest the replacement of dressings every 7 days or when soiled or loosened, intravenous tubing changes every 72 hours, and the replacement of tubing used to administer blood products and lipid emulsions within 24 hours of infusion initiation (East Jacoby, 2005). According to the CDC, approximately 53% of adult patients in intensive care units have a central venous catheter on any given day (Rupp, et al., 2005). Skin cleansing of the insertion site is regarded as one of the most important measures for preventing catheter-related infection. Historically, povidone-iodine is an antiseptic that has been used during the insertion and maintenance of the intravascular devices. It works by penetrating the cell wall of the microorganism. More recently, chlorhexidine has been studied and found to be more effective as a skin antiseptic to prevent catheter-related infection. It works in less time, retains its antibacterial effect against flora longer, is not inactivated by the presence of blood or human protein, and causes minimal skin irritation. Chlorhexidine works by disrupting the microbial cell wall. It is active against many gram-positive and to a slightly lesser degree gram-negative bacterium (Astle Jensen, 2005). A multistep process is recommended to prevent CA-BSI that includes: educating staff, using maximal barrier precautions (e.g. a sterile gown and gloves, mask, cap, and large sterile drape), performing infection surveillance, and replacing occlusive dressing every 7 days or when needed (Buttes, Lattus, Stout, Thomas, 2006). Other strongly recommended practices include proper hand hygiene, use of chlorhexidine gluconate for insertion site preparation, and avoidance of routine catheter changes. Catheters impregnated with antimicrobial agents are recommended when infection rates are high or when catheters will remain in place for a considerable time (Krein, et al., 2007). Education of staff on the proper care of CVC is paramount in reducing the amount of CA-BSI. This is perhaps one of the most cost-effective methods of reducing CA-BSI (Ramritu, Halton, Cook, Whitby, Graves, 2007). Implementation A staff education program was initiated for the nursing personnel that primarily deal with CVC. This education program was aimed at training the ICU and step-down unità ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¾Ã‚ ¢s nursing staff proper care and maintenance of the CVC. Education focused on proper care of the CVC, including when dressing changes should be performed e.g. every 7 days or when the dressing is soiled. Nurses were also trained in how to appropriately assist with CVC placement and the documentation tool that infection control utilizes to evaluate adherence to insertion guidelines. Posters were also placed in the nurseà ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¾Ã‚ ¢s break and conference areas that had educational material related to proper care of CVC. Documentation was also placed in the physicianà ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¾Ã‚ ¢s lounges that encouraged utilization of maximal barrier precautions during CVC insertion. The facility that was observed currently utilizes a few different means of measurement with regards to CA-BSI. First, a checklist is utilized during CVC insertion that evaluates adherence to insertion guidelines by the staff. This checklist is sent to infection control and entered into a database which is correlated with patient data regarding CA-BSI. Second, in patients that are identified as having a CA-BSI, after catheter removal, laboratory microbiological studies of the catheter, blood, and insertion site swabs are performed to identify causality of the infection. Implementation Compared to Literature Suggestions Practices that reduce the risk of CA-BSI include the following: (1) use of maximal barrier precautions during CVC insertion (i.e., a surgical mask, sterile gown, sterile gloves, and large sterile drapes), (2) placement of the catheter in the subclavian vein rather than the internal jugular or femoral vein, (3) changing catheters only when necessary, and (4) changing dressings on CVC exit sites when they become nonocclusive, soiled, or bloody. These practices have been incorporated into national guidelines. Currently, the Healthcare Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention (CDC) recommends that hospitals implement comprehensive educational programs that teach proper CVC insertion and maintenance techniques (Warren, et al., 2006). These practices are mostly in line with what is implemented at the observed facility. One difference, which is not in line with these recommendations, is that the observed facility has a high nu mber of internal jugular insertions rather than utilizing the subclavian vein. When asked about this, many of the physicians stated that access was easier to identify utilizing ultrasound during insertion and they preferred this method over subclavian insertion. Recommended Changes First, implementation of an education program for providers that is focused on infection control, especially the recommendation of utilizing the subclavian vein insertion for CVC placement as a first choice in patients that have no contraindications to this placement. Second, procuring the second-generation antiseptic catheter, coated with chlorhexidine and silver sulfadiazine on the internal and external surfaces, to more effectively prevent microbial colonization in patients that are identified as being at risk. Decreased bacterial colonization, a critical step in the pathogenesis of catheter-associated infection, may correlate with prevention of catheter-related bacteremia (Rupp, et al., 2005). Third, education and training needs to be expanded to any nurses that may be responsible for caring for a patient with a CVC. These areas include non-critical care areas such as pediatric and medical floors. Larger numbers of patients with CVC are now found in non-ICUs than in ICUs and that CA-BSI rates in those settings are higher. Catheter types and insertion sites vary greatly among settings. For example, jugular and femoral insertion sites are common in ICUs; subclavian and peripheral sites are more common elsewhere. So strategies for reducing CA-BSI must be tailored to the setting (Hadaway, 2006).

MANAGEMENT :: essays research papers

Building Blocks Known as the 4th largest standing natural gas distributor, Southern Union Gas serves nearly 1.5 million customers Nationally, and Internationally, for over 50 years. They have four divisions in the United States, which are: Ø Southern Union Gas in Texas. (Corporate Headquarters) Ø Missouri Gas in Missouri. Ø PG Energy in Pennsylvania. Ø New England Gas in Rhode Island and Massachusetts. Focus: My focus for this report is the â€Å"building blocks† of the Management, and how it shapes the organizational functions of the Missouri division of Southern Union Gas. James H. Oglesby is the COO and President of the Missouri division. MGE (Missouri Gas) serves approximately 498,000 natural gas customers in central and western Missouri, including Kansas City, St. Joseph, Joplin and Monett. MGE has about 700 employees to serve its customers in 155 communities throughout Missouri. Before accepting the title of COO (Chief of Operations), he was Vice President of Operations. He was promoted to this position after being employed with the company for 34 Years. His effiecency and knowledge company has taken the organization to new heights. Objectives: James Oglesby’s objectives were to successfully achieve the critical mass needed to compete in a challenging, changing energy industry, and was successful in doing just that by offering electric and propane subsidiaries such as the newly opened PEI Power Corporation, a 25-megawatt co-generation plant which uses natural and methane gases to generate steam and electricity, to increase revenue and decrease competition. This compliments the already effective natural gas operations. In doing so annual revenue has increased to more than 10.8 million dollars just within the first quarter results. While continuing to strengthen the core operations, in Missouri, he focused on propelling the organization to the forefront of the gas industry, and amplified the focus on business growth. Of course this built value to shareholders, and created a notable reputation of safety and quality. Under new direction of new management, the Missouri division is expected to result in the annual addition of approximately 16.7 million in the next quarter, in pre-tax income to the company, due to new rates. The accomplishments of Oglesby show dedication to the rapid development, progression and outcome of Missouri Gas. Article: James H. Oglesby Named President and COO of Southern Union's MGE Division February 2002 (Newstream) -- Southern Union Company ("Southern Union") (NYSE: SUG) announces the promotion of James H. Oglesby to president and chief operating officer of its Missouri Gas Energy ("MGE") division. Oglesby joined MGE in 1968 as a service technician.

Digital Rights Management

Technological innovation is drastically taking place in almost every field. Experts and engineers put their extraordinary effort to develop software or products that requires some kind of security to protect it from misuse. Digital Rights Management is the one which is used for technologies that controls the use of digital content. With the advancement of Internet and development of digital content, content owners are being impelled into a new arena where they can enhance their rights by using DRM technologies as a way to control the use of their content.The present paper focuses on DRM, argumentative views of various experts on it and effectiveness of DRM in radically changing Hi- tech world. Digital Rights Management (DRM) facilitates copyright holders to achieve value for their works. DRM is used variably in literature. According to Electronic Frontier Foundation, â€Å"Digital rights management technologies are aimed at increasing the kinds and/or scope of control that rights-ho lders can assert over their intellectual property assets.†DRM allows the copyright holder to control the ways consumer’s access and use the holder's work once the work is made available in a digital format. By controlling the access, a right holder is capable to offers an exclusively competent business model and his work will be protected from infringing uses. It is not possible for DRM at its own level to realize these aims because it is susceptible to the hackers, which is able to avoid DRM safeguards. That’s why, law enforcement is required to avert from hackers.These steps will strengthen DRM technology (Christopher D. Kruger, pg: 281). The focus of the first generation of Digital Rights Management (DRM) was mainly on security and encryption as a way of working out the problem of unauthorized copying of the content. It was performed by locking the content and to limit its distribution to only those who make payment. In the second-generation of DRM, major step s to cover the description, identification, trading, protection, monitoring and tracking of all forms of rights procedures over both tangible and intangible assets.DRM deals with all rights and not only the rights applicable to permissions over digital content. There are two significant architectures which must reflect on while designing and implementing DRM systems. The Functional Architecture is the first. This covers the high-level modules or components of the DRM system that together provide a management of rights till the end user. The Information Architecture is the second critical architecture. This covers the modeling of the entities within a DRM system as well as their relationships.In digital rights management, the licensing authority issues to the DRM licensee a certificate and a public/private key pair for use in service. The client will sign the certificate with the licensing authority private key and send it to the content server along with the public key. The content server then verifies the certificate and thereby authenticates the client. The server also checks the certificate with the list of revocation and if so, the client will not be able to receive or decrypt content. There are two algorithms used in signing.The Windows DRM for Network Devices and HDMI and the Open Mobile Alliance use the RSA algorithm. An Elliptic Curve algorithm being much lighter, are used in Windows DRM for Mobile Devices and DTCP. There are number of companies holding patents, which cause some concern for adopters and have delayed the introduction of ECC to wider use in DRM. Once the authentication of a device is complete and it is determined that it has the valid license authority certificate, then in a DRM design, the last step is to decrypt content – the symmetric cipher key. This is obviously very important.Consumers just can not break their head to manage a key for every song or video that they have licensed under a DRM scheme, nor would the owner of a br and new product wish to enter 40 hex digits into the new console before using it. It is to be noted that one tremendously imperative feature of DRM security design is the processes by which secret DRM values are stored. While these consumer electronic products can be accessed by consumers, hackers will pry the design looking for susceptibilities. It is better to use the key storage on chip non-volatile memory.The major problems with this approach are NVM memory is not available in every process, especially the advanced technology nodes, the license fees for NVM are fairly high and last of all the programming of the secret values in off-shore ODMs may encounter a security issue as the secret values are in plaintext (Al Hawtin, Embedded Technology Journal). DRM has many advantages such as one can make more investment in digital content. Digital copies are perfect no matter how many copies are to be made. Large corporations are not the only creators of content.The Internet provides low -cost distribution network globally from which thousands of software producers get advantage. Strong DRM ensures a revenue stream at lower rate. Furthermore, good DRM means more legal free media, and lower prices. (John Carroll, 2002ZDNet). Even though DRM has many positive aspects and it is legally protected, it is always a matter of argument. Debate over the issues of fair use and DRM at the 12th annual Computers, Freedom and Privacy (CFP) conference in San Francisco summarizes that it is too early in this period of technological modernization to begin locking down digital content.Peter Jaszi, law professor at American University's Washington College of Law referred to copyright holders' attempts to keep tight control over their digital content, such as some record companies' moves to distribute DRM-protected CDs that cannot be played on more than one device. But even more threatening to fair-use advocates is proposed legislation introduced by Senator Ernest â€Å"Fritz† Ho llings, which aims to incorporate a built-in copyright protection measure in all consumer digital devices. Most speakers at CFP established that DRM was not the solution to the copyright difficulty.Many of the advocates agreed that DRM would be more successful in harmonizing the rights of user and copyright holders than would be legislation. Stefan Bechtold, a Stanford Law School fellow and author of a book on digital rights management, argued that even though DRM can slow down fair use and free speech, the technology is more progressive than law. It develops speedily and can be installed on an international level. According to Microsoft Security Architect Barbara Fox, DRM technologies make easy to secure the content and setting rules for consumer use but it is much more intricate to guarantee that users have fair use of that content.Further he noted that copyright law is vague when it comes to fair-use rights and DRM would be incapable to settle on whether a user should be able to use content under certain state of affairs (CNN). Even so many controversies, various industries like the entertainment industry, led primarily by the Motion Picture Association of America (MPAA) and the Recording Industry Association of America (RIAA), are dynamically chasing DRM-friendly policy initiatives through federal legislation and regulations, the courts and standards organizations.Music and movies have grabbed most of the headlines around digital rights management (DRM). The â€Å"killer app† for enterprise DRM is document management, primarily for purposes of regulatory compliance. The relevant regulations include the Health Insurance Portability and Accountability Act (HIPAA), the Gramm-Leach-Bliley Act (GLBA) and the Sarbanes-Oxley Act (SOA). These laws require that the confidentiality and/or integrity of certain types of documents be protected (E.John Sebes, Mark Stamp, Pg: 52). DRM is computer code that can be embedded in music and video files to dictate how th ese files are used. The best-known example is the music Apple Computer sells at its iTunes Music Store. Using a DRM system it invented called FairPlay, Apple has engineered its songs, at the insistence of the record companies, so that they can be played only on a maximum of five computers, which means that one can burn only seven CDs containing the same play list of purchased tracks.In fact, obtaining relatively liberal DRM rules from the labels was the key to Apple's success in selling music. But some other uses of DRM technology are not so benevolent. Some CD buyers are discovering to their dismay that new releases from certain record companies contain DRM code that makes it difficult to copy the songs to their computers, where millions prefer to keep their music.People who buy online music in Microsoft's Windows Media format too often run into the DRM error message â€Å"unable to obtain license† when try to transfer the songs to a music player. The theft of intellectual p roperty on the Internet is a real problem. Millions of copies of songs, TV shows and movies are being distributed over the Internet by people who have no legal right to do so, robbing media companies and artists of rightful compensation for their work (WALTER S.MOSSBERG, 2005). The premier provider of smart mobile content retailing solutions, announced the U. S. Patents and Trademarks Office has issued the company a patent in the area of mobile content and applications Digital Rights Management (DRM). To sum up, DRM standardization is now taking place in a number of open businesses. Digital Rights Management is rising as an alarming new confronts, and it is necessary for DRM systems to provide interoperable services.

Comparing Wide Sargasso Sea by Jean Rhys and Jane Eyre by...

Comparing Wide Sargasso Sea by Jean Rhys and Jane Eyre by Charlotte Bronte In the novels Wide Sargasso Sea by Jean Rhys and Jane Eyre by Charlotte Bronte, the theme of loss can be viewed as an umbrella that encompasses the absence of independence, society or community, love, and order in the lives of the two protagonists. They deal with their hardships in diverse ways. However, they both find ways to triumph over their losses and regain their independence. The women in both novels endure a loss of personal freedom, both mental, and physical. Jane Eyre, in her blind infatuation with Mr. Rochester, allows her emotions to enslave her. She realizes her obsession when she states, My future husband was becoming to me my whole world; and†¦show more content†¦In her search for approval, Antoinette utilizes a voodoo potion to try and force Rochester to love her, which makes him despise her more than ever. He accuses Christophine of acting for Antoinette when he insists â€Å"You tried to poison me† (Rhys 153). Both Jane and Antoinette are prisoners of their intense feelings for the man they adore, leaving them open to pain and betrayal. Jane’s foster family, the Reeds, restrict her rights, refusing to treat her as an equal to the other members of the family. Jane, at a mere eight years old, is chastised by Mrs. Abbott, the nanny, who asserts, â€Å"you are less than a servant, for you do nothing for your keep† (Bronte 11). When Rochester imprisons Antoinette in England, he deprives her of any sense of humanity. The people in their lives who yielded power over them unjustly repressed both women. Jane and Antoinette are both ostracized by their respective communities as a direct result of their social positions. Jane is an orphan with no money and no close relatives. Although she is clearly a bright and unique girl, she is treated as an outcast due to her orphan status. She refuses to accept their low opinion of her however, and maintains â€Å"The more solitary, the more friendless, the more unsustained I am, the more I will respect myself. I will keep the law given by God, sanctioned by man. I will hold to the principles received by me when I was sane, and not mad--as I am now†, illustrating her desire to persevere through