Sunday, January 26, 2020
Principles of Infection Control in the Operating Department
Principles of Infection Control in the Operating Department Infection control is a vital part of everyday life in Operating theatre departments across the world. It is used to ensure patient and staff safety throughout surgical procedures and patients stay in a hospital. Key issues that effect many if not all trusts across the UK include Methicillin Resistant Staphylococcus Aureus (MRSA) which is found mainly on the skin and in nasal areas of patients. This bacterium has become immune to antibiotics over the years and creates big problems in hospitals all over the world (NHS, 2009). Another infection, which has swept through our hospitals, is Clostridium Difficile (C-Diff). This is a naturally present bacteria which people hold in their gut but when a patient is given antibiotics for another symptom it can multiply the C-Diff bacteria and cause symptoms such as diarrhoea and fever (NHS, 2008). There are many more infection control issues surrounding hospitals and private healthcare trusts across the world. This essay aims to outline good prac tice in preventing some of these infection control issues. There is a set of standard precautions to adhere to when carrying out any surgical procedure. This was originally recommended when a patient was known or to be suspected of being infected with blood pathogens Deane (2000:39). In operating departments today every surgical procedure follows these protocols to ensure the safety of staff and others who maybe exposed during a patients stay in hospital. It is also the responsibility of the Operating Department Practitioner (ODP) to adopt any Personal Protective Equipment (PPE) supplied by the trust to prevent contamination of any kind. Deane (2000:39) suggests regular handwashing is important to prevent spread of any resident germs and also to reduce the risk of transferring any germs to patients. Ventilation is also an important aspect of surgical procedures and how it effects infection control and the prevention of spreading airborne pathogens Gilmour (2005:87). In the majority of NHS trusts in the UK the operating department staff will commence an operating list with a cleaning procedure known as damp dusting before any patient enters the theatre. Damp dusting is the cleaning of flat surfaces (e.g. trolley tops, worksurfaces, anaesthetic machines, etc) to remove dust from the perioperative environment prior to the commencement of the operating list (Plumridge, 2008). This is to reduce the risk of infection whilst the patient is undergoing surgery. Standard precautions recommend the use of Personal Protective Equipment for all theatre staff including aprons, masks, gloves, gowns and eye protection (Gilmour, 2005:91). Each practitioner or healthcare worker will assess the risk of contamination and the appropriate PPE will be applied. This is to ensure safe practice for all theatre staff and to keep the team free from contamination. The control of substances hazardous to health (COSHH) regulations came into force in 1989 and requires employers to assess the risk to staff and patients alike being exposed to and handling substances hazardous to health including blood and bodily fluids (Deane, 2000:41). COSHH is maintained by performing regular audits and staff completing risk assessments when potential risks are noted. I also personally believe that Heat Moisture Exchanging Filter (HMEFs) are invaluable to NHS trusts across the UK. These are little devices that attach to the end of the Anaesthetic machine circuits just before the facemask. It works with the heat and moisture from the patients own respiration by changing anaesthetic vaporises from a vapour to a gas. It also heats the gas up so it does not give the patient any trauma going into the lungs cold. They also have a filter inside, which will not allow any sort of passage for bacteria or virus to get into the anaesthetic machine circuit. A new filter will be used for each new patient again avoiding cross contamination (see Appendix 1). The ventilation system inside operating theatres offers a change of air at least fifteen times an hour (Mardell, 2009:272). This prevents microbial contamination infecting vulnerable patients and also diluting expired Anaesthetic gases. The ventilation system works by pushing clean air downwards, which in turn pushes contaminated air away from the surgical field towards the sides of the operating theatre and out of the exhaust panels. There are two main types of ventilation used in operating theatres the first one I discussed which is called Plenum and is the more financially suitable to NHS trusts. The second main ventilation system used is called Laminar flow this system is mainly used in Orthopaedic procedures. The reason for this is because it can offer in excess of 300 air changes per hour therefore drastically reducing any airborne organisms, which can cause postoperative infection for the patient (Technology assessment team, 2001). The ventilation system also provides the heat ing for the theatre. (Mardell 2009:272) claims that there is no ideal temperature that will be correct as it will depend on the type of surgery taking place. When operating on babies or children the temperature will need to be higher than if operating on adults, this is due to children and babies not being able to maintain their core temperature as well as adults. The use of patient warming devices such as Bair huggers and Blood/Fluid warmers should allow the air temperature to be less of a consideration for the patient and allow staff to set the temperature accordingly. Along with the temperature controls most operating theatres will also have a wall mounted control panel which also allows staff to set the atmospheric humidity. The humidity should be set at no more than 60% but no less than 30% as this minimises the potential for bacterial growth and static electricity (Mardell, 2009:273). The surgical field has to be set up sterile and maintain sterility throughout the procedure. This is usually an invisible box approximately 1 metre square surrounding the operating table which consists of the patient, surgeon and scrub practitioner, and must contain as little equipment as possible to avoid de-sterilising anything or anyone in that area. The surgical field is maintained by people only entering when necessary and to announce to the surgical team when doing so to avoid accidental contamination (Beck, 2009). The sterile field is designed to reduce any risk of infection to a patient or to any staff member involved with the procedure. It is achieved by performing a number of safe practices: staff dress and preparation, patient preparation, utilisation of sterile equipment and theatre etiquette during surgery (Parker, 2004:108). Aseptic Non Touch Technique (ANTT) is a form of rigorous handwashing that frees your hands and arms from living pathogenic micro-organisms (Hart, 2007:43). This is a vital part in preparing for a surgical procedure for the safety of your patient. If any member of the surgical team have a poor asepsis technique this could result in a Healthcare Acquired Infection (HCAI) for the patient. Unfortunately nosocomial infections are not a thing of the past and still effect nearly all of our NHS trusts across the UK. (Heritage, 2006) quotes Hospitals are places where sick people go with the expectation that they will get better. Unfortunately, however, there is a risk that hospital patients may become infected because of their stay in hospital. (Nazarko, 2008) quotes Every two minutes a patient acquires a Healthcare Associated Infection (HCAI). Every two hours a patient dies because of a HCAI. These are very scary figures and should make healthcare workers more aware of regular handwashing be tween patients. You can achieve full asepsis by using sterile equipment and ensuring none of your sterile equipment or indeed yourself come into contact with anything non-sterile. Whilst it is impossible to sterilise your hands the surgical scrub serves to minimise the number of pathogens on your hands (Pirie, 2005). A normal hand wash is considered to be inadequate, as it does not remove enough micro-organisms from your skin. Scrubbing up on the other hand is considered to reduce the amount of micro-organisms on your skin dramatically. Scrubbing up is a longer process and is performed more intensively by going from the hands up to just below the elbow. The difference in the two procedures is simply that scrubbing up actively reduces more micro-organisms on your hands and arms than a normal hand washing procedure, which reduces the spread of infection to your patients (Collins Hampton, 2005). Other types of bacteria that are found in operating theatres are called Spores. These differ from normal forms of bacteria in a way that they are much harder to remove from surfaces as they have a hard shell protecting them. The original cell replicates its genetic material, and one copy of this becomes surrounded by a tough coating. The outer cell then disintegrates, releasing the spore which is now well protected against a variety of trauma, including extremes of heat and cold, radiation, and an absence of nutrients, water, or air (Darling, 2009). These can be an extreme problem in operating theatres as some types of spores are released into the air becoming airborne pathogens which can then travel and settle into surgical wounds causing infection in a patient (Wilson, 2006). Waste materials in operating departments are divided into two main categories. One is Domestic waste, which compromises of non-clinical waste, which has not been in direct contact with any blood or body fluids such as paper, equipment packaging and food remains. This waste is usually placed into a black bin liner and disposed of accordingly. The other is Clinical waste which covers all other waste products that has had direct patient contact such as drapes, surgical gowns, gloves and disposable equipment. Swabs should not go into a clinical waste bag until the end of the procedure when they have been checked and accounted for by the practitioner. This waste is usually placed into orange or yellow bin liners and disposed of by incineration. Sharps on the other hand go into there own special bin provided and must never be disposed of in a bin bag in case of an accidental sharps injury to anybody. Infection control is vital in maintaining patient and staff safety alike. It is the responsibility of healthcare professionals as individuals but also working together as a team to carry out the standard precautions set by their trust. Simple things like handwashing between patients and wiping down monitoring leads can hugely reduce the amount of hospital acquired infections for patients. Always check if the equipment you are using is disposable or reusable laryngoscope blades, laryngeal mask airways etc and after usage dispose of them accordingly. When commencing an operating list always carry out your standard precautions for every patient this will help protect you as a member of staff but more importantly it will keep a patient safe. When disposing of waste especially clinical waste ensure there are no tears in the bag and the bin liners have been zip tied at the top to avoid any spillages, which could result in somebody becoming contaminated with any blood or body fluids. Rememb er only to open the hatch at the end of the procedure avoiding any contaminated air being let into the theatre whilst the patient is still undergoing the procedure. This could result again in an infection to the surgical site and cause severe discomfort to the patient post operatively. So always remember the standard precautions are there to protect staff and patients alike. They should be abided by at all times and hopefully we can reduce the rate of infection control dramatically.
Saturday, January 18, 2020
Alexander Pope’s “The Rape of the Lock†and John Milton’s Paradise Lost Essay
The main female characters in Alexander Pope’s â€Å"The Rape of the Lock†and John Milton’s Paradise Lost are seen at first as extensions of the male characters, at the mercy of supernatural forces. Does their rebellion show that they begin to break the chains of male dominion? A view of the actions of Eve and Belinda can be seen as rebellion against their controllers.            Eve, the main female character of John Milton’s Paradise Lost, comes to the forefront in Book IX, after she has taken her first independent action, that of eating the apple. To understand the actions of Eve, it is important to understand Milton’s view of the interactions between God, Adam and Eve. Roberta Martin states In Paradise Eve, the â€Å"mother of mankind†, is the figure of a contained, â€Å"other†creative energy that is carefully derivative: she herself was â€Å"derived†from Adam’s rib, and she is under Adam’s domination in the hierarchy of the Father’s â€Å"perfect†Symbolic†¦ Eve is subordinate to Adam because she is â€Å"lacking†. The Father intends her to be a deliberately limited and controlled Other. (61) On Eve’s first awakening in the garden, the difference between Adam and herself is made clear. While he wonders who he is, and is aware of himself as a differentiated entity, Eve wonders where and what she is, and is not aware of any difference between herself and her surroundings – as one with no conception of the separateness of her being, she begins life as an Object, rather than as a Person (Martin, 70). From this perspective, it is clear that Eve is at first fully controlled by the desires of Adam and of God, her joint Creators. It is not until, daring to become a Person, she expresses her own desires; then, further defying her masters, she chooses to eat the fruit of the Tree of Knowledge. She begins, tentatively, to have opinions of her own and thoughts as to how the Garden should work – she starts innocently, with a suggestion as to how the work should be done.            Let us divide our labors, thou where choice            Leads thee, or where most needs, whether to wind            †¦            With Myrtle, find what to redress till Noon:            Our task we choose, what wonder if so near,            Looks intervene and smiles, or object new            Casual Discourse draws on, which intermits            Our day’s work brought to so little, though begun            Early, and th’hour of Supper comes unearn’d. (Milton, 209). Adam objects sharply to this suggestion, leaving no doubt that Eve has gone against his wishes for, perhaps, the first time. â€Å"for nothing lovelier can be found In Woman/than to study household good,/and good works in her Husband to promote (Milton, 209).†And yet, he concedes sadly, â€Å"But if much converse perhaps/Thee satiate, to short absence I could yield. /For solitude sometimes is best society/And short retirement urges sweet return (Milton, 209).†Eve has won her first, small battle – that for time on her own, without the companionship of Adam, whom she was conceived as Companion for.            Adam is not yet done attempting to assert his will, and God’s will, over Eve.            But God left free the Will, for what obeys Reason           , is free and Reason he made right, But bid her well beware and still erect, Lest by some fair appearing good surpris’d, She dictate false, and misinform the Will To do what God expressly hath forbid. (Milton, 212) Eve is, here, to be allowed some freedom of her will, but only if it is within the rules already outlined for her. Temptation follows in the form of the Serpent and she defies the wishes of Adam and of God, and eats the Fruit she has been forbidden. This is her greatest act of rebellion, and the point at which she throws off the chains of her Creation. She gains the knowledge that had been forbidden her; she conceives of a desire, that of being an equal. She ponders â€Å"In Female Sex, the more to draw his Love,/ and render me more equal, and perhaps,/ a thing not undesirable, sometime/Superior, for inferior who is free? (Milton, 225)†Suddenly aware of the possibility of her own death, she resolves to share the knowledge she has gained with Adam, for â€Å"So dear I love him, that with him all deaths/I could endure, without him live no life. (Milton 225)†So choosing the path of love over the path of knowledge, she feeds the fruit to Adam, and brings the wrath of the Creator down upon their heads. Milton is not content to let Eve’s transgression, that of throwing off the patriarchal rule and allowing her own will to become paramount, pass lightly. For he closes, â€Å"Thus it shall befall/Him who to worth in Woman overtrusting/Lets her Will rule. (Milton 234).†           If Eve is a creation of Adam and God, Belinda is a creation of Man’s conception of Woman, and the object of a struggle between Man and the supernatural. Rising only late in the morning, she spends hours at her toilet, grooming obsessively in order to meet her admirers. Pope inquires:            Say what strange motive, goddess! Could compel            A well-bred lord t’assault a gentle belle?            O say what stranger cause, yet unexplored,            Could make a gentle belle reject a lord? (Pope, 28) Belinda is the beloved of the sylphs, for her purity and beauty are made in their image. One whispers to her as she lies sleeping â€Å"Know farther yet; whoever fair and chaste/Rejects mankind, is by some sylph embraced:/For spirits, freed from mortal laws, with ease/Assume what sexes and what shapes they please (Pope, 29).†When she ventures out, all fall to her charms, including the Baron; â€Å"Belinda smiled, and all the world was gay (Pope, 32)†. All, that is, except the Sylph, who sees in the Baron a rival for Belinda’s affections. The Baron conceives of a plan – to wrest a lock from Belinda’s unsuspecting head, thus despoiling her. Despite the guardianship of the Sylphs, he succeeds: â€Å"He takes the gift with reverence and extends/the little engine on his finger ends; /This just behind Belinda’s neck he spread, /As o’er the fragrant steams she bends her head (Pope, 38).†The sylphs are enraged – â€Å"Not Cynthia, when her manteau’s pinned awry/E’er felt such rage, resentment and despair,/ As thou, sad virgin! for thy ravished hair. (Pope, 39).†The spirits desert Belinda, and she is left at the mercy of new knowledge of love; bereft of her beauty with the lock of hair, she falls into a dark despair, abandoning her previous beauty regime and descending into slovenliness. Driven to rage, she attacks the Baron for his unforgivably churlish act: See fierce Belinda on the baron flies, With more than usual lightning in her eyes, Nor feared the chief th’unequal fight to try, But this bold lord with manly strength subdued†¦ â€Å"Now meet thy feate,†incensed Belinda cried, And drew a deadly bodkin from her side. (Pope, 45)            Belinda, in rebellion against the desires of Man, throws off the strictures of her previous role as Virgin and takes the persona of Warrior. â€Å"Restore the lock!†is Belinda’s cry – she desires what has been taken from her to be returned, as she desires to return to her previous state of innocence. Belinda is not a puppet of the supernatural nor of Man; her rebellion is against the unending march of maturity and gained knowledge, not against the machinations of those who would control her. Belinda has chosen the supernatural rather than the control of Man, and has wrested control of her Self back from the man who would control her. She is still a creature of Man’s conception, but she is no longer a creature for Man’s desire.            Eve and Belinda represent two very different views of female rebellion and independence. Eve, in choosing to perform an action expressly forbidden by her creators, has chosen the path of opposition; Belinda has chosen the control of one of her creators, rejecting the path of the other, who held himself in opposition to the first’s wishes. Belinda has chosen the path not of rebellion, but of total rejection of the assertion of Man’s control. Works Cited Pope, Alexander. â€Å"The Poetry of Pope: A Selection†. New York: Appleton-Century- Crofts, 1954. Martin, Roberta C. â€Å"How Came I Thus?: Adam and Eve in the Mirror of the Other.†College Literature, 27.2 (2000): 57-79. Milton, John. â€Å"Paradise Lost.†New York: Odyssey Press, 1962.
Friday, January 10, 2020
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Thursday, January 2, 2020
Minimum Wage Is An Issue That Is Causing Uproar Amongst...
Yimaj Sherif ENG 1520 Dr.James 16 August 2015 Minnsincsndcdcsdc Minimum wage is an issue that is causing uproar amongst working class citizens. For many workers, a simple increase of 30% in the federal minimum wage could be the difference between living in or out of poverty. Over the past few decades there have been countless increases in salaries, although none of those went to people who actually needed it. To this day the rich continue to get richer, vastly increasing their wealth, while the poor are struggling to provide basic necessities such as food, shelter, and clothing. While the rich keep get richer and the poor continue getting poorer, we have seen a decrease in the middle class; median income has turned into upper or lower middle class. Establishing legislation that provides workers with a wage that is able to sustain simple necessities is necessary, it would provide ample support for those who may not have been able to afford living to take a step away from poverty and move into the middle class. The minimum wage was set with the passage of The Fair Labor Standards Act of 1938 (FLSA). Its initial price point was $0.25 per hour, and it has been raised twenty-two times since. It allowed for federal protections against employers like minimum wage, overtime pay for time worked over a set number of hours in a workweek, restrictions on the employment of children, and recordkeeping requirements (uc davis). â€Å"In that year, the act applied to industries whoseShow MoreRelatedBhopal Gas Disaster84210 Words  | 337 Pageswhich had taken over the site. Today twenty five years since that fateful night, lakhs of people still living in the vicinity of the factory are exposed to toxic chemicals that continue to leach from tonnes of waste lying within the UCIL premises causing groundwater and soil contamination. As a result a whole new generation continues to get sick, from cancer and birth defects to everyday impacts o aches and pains, f rashes, fevers, eruptions of boils, headach es, nausea, lack of appetite, dizziness
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