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Decontamination in Children

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62. Medication impregnated dressings for central venous catheters reduce the number of bloodstream infections, but the quality of the research is low

dressings halved the frequency of bloodstream infections per 1000 patient days compared with standard polyurethane dressings (RR 0.51, 95% CI 0.33 to 0.78). This was from a meta-analysis of four studies. There was no difference in skin irritation or damage between chlorhexidine gluconate-impregnated dressings and polyurethane dressings. However, this outcome was only examined in two studies in children and new born infants. There was not enough evidence to assess other devices or dressings (...) , such as those impregnated with silver or iodine. What does current guidance say on this issue? NICE guidance from 2012 recommends that the central venous catheter insertion site and surrounding skin should be decontaminated during dressing changes using chlorhexidine gluconate in 70% alcohol, and that a sterile transparent semipermeable (polyurethane) membrane dressing should cover the vascular access device insertion site. NHS England’s “epic3” guidance similarly recommends cleaning the skin

2018 NIHR Dissemination Centre

63. Guidelines for the Management of Severe Traumatic Brain Injury (4th edition)

¶University of Pittsburgh, Pittsburgh, Pennsylvania Search for other works by this author on: Robert C. Tasker, MBBS, MD ¶¶Harvard Medical School & Boston Children's Hospital, Boston, Massachusetts Search for other works by this author on: Monica S. Vavilala, MD ‖University of Washington, Seattle, Washington Search for other works by this author on: Jack Wilberger, MD ‖‖Drexel University, Pittsburgh, Pennsylvania Search for other works by this author on: David W. Wright, MD ##Emory University, Atlanta

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2016 Congress of Neurological Surgeons

64. Management of scabies

is spared except in children. Palms and soles are also affected in the elderly and in infants and young children. The pathognomonic lesion is the burrow, which is a linear intra-epidermal tunnel produced by the moving mite and appears as short wavy greyish/ white threadlike elevations of 2-10 mm in length. Burrows are difficult to find if there is excoriation or secondary eczematisation. Nodular lesions may also be seen especially on the penis and scrotum in men, buttocks, groin, and the axillary (...) four days before treatment should be decontaminated by washing at high temperature (60°C) and drying in a hot dryer, by dry-cleaning, or by sealing in a plastic bag for at least 72 hours 5,9 . Scabies mites generally do not survive more than 72 hours days away from human skin. Patients must be given information about scabies, including proper application of topical scabicides. Recommended regimens Permethrin 5% cream. 37 (Level of evidence 1b A) ? apply to the whole body from the chin and ears

2016 British Association for Sexual Health and HIV

65. Biopatch for venous or arterial catheter sites

randomised controlled trials in a total of 3,674 adults and children in secondary care settings. Results are mixed with some evidence showing reductions in rates of bacterial colonisation and the number of CRBSIs compared with standard dressings in patients with venous or arterial catheters, and some showing no difference between Biopatch and standard care. K Ke ey uncertainties y uncertainties around the evidence and technology are whether it is as effective at reducing the number of CRBSIs (...) the catheter. After catheter insertion, a sterile transparent semipermeable membrane dressing should be used to cover the insertion site. This should be changed every 7 days, or sooner if moisture collects under the dressing or there are signs of infection. The same skin decontamination process should be used whenever the dressing is changed. NICE also advices maintenance of the catheter itself by cleaning it with 2% CHG in 70% alcohol before accessing the system and also flushing and locking the catheter

2017 National Institute for Health and Clinical Excellence - Advice

66. Healthcare-associated infections: prevention and control in primary and community care

feeding 22 1.4 Vascular access devices 24 2 Research recommendations 29 2.1 Standard principles of infection prevention and control 29 2.2 Hand decontamination 29 2.3 Intermittent urinary catheters: catheter selection 30 2.4 Indwelling urinary catheters: catheter selection 31 2.5 Indwelling urinary catheters: antibiotic prophylaxis 31 2.6 Vascular access devices: skin decontamination 32 More information 32 Update information 33 Healthcare-associated infections: prevention and control in primary (...) and community care (CG139) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 3 of 33This guideline replaces CG2. This guideline is the basis of QS61. Ov Overview erview This guideline covers preventing and controlling healthcare-associated infections in children, young people and adults in primary and community care settings. It provides a blueprint for the infection prevention and control precautions that should be applied

2012 National Institute for Health and Clinical Excellence - Clinical Guidelines

67. Acute pain management: scientific evidence (3rd Edition)

PATIENT 339 10.1 Developmental neurobiology of pain 339 10.2 Long-term consequences of early pain and injury 340 10.3 Paediatric pain assessment 340 10.3.1 Pain assessment in neonates 341 10.3.2 Observational and behavioural measures in infants and children 342 10.3.3 Self-report in children and adolescents 342 10.3.4 Children with cognitive impairment 343 10.4 Management of procedural pain 346 10.4.1 Procedural pain in the neonate 347 10.4.2 Procedural pain in infants and older children 347 10.4.3 (...) Immunisation pain in infants and children 349 10.4.4 Procedural pain management in the emergency department 349 10.5 Analgesic agents 351 10.5.1 Paracetamol 351 10.5.2 Non-selectiv e non-steroidal anti-inflammatory drugs 352 10.5.3 Coxibs 353 10.5.4 Opioids and tramadol 354 10.5.5 Cortic osteroids 356 10.5.6 Other pharmacological therapies 356 10.6 Opioid infusions and PCA 357 10.6.1 Opioid infusions 357 10.6.2 Patient-controlled analgesia 358 10.6.3 Nurse-controlled analgesia 358 10.7 Regional analgesia

2015 National Health and Medical Research Council

68. Gastric lavage in the diagnosis of pulmonary tuberculosis in children: a systematic review. (PubMed)

years;" "gastric lavage and tuberculosis and childhood" or "gastric washing and tuberculosis and childhood." There were retrieved 80 articles and their analysis was based on information on the gastric lavage protocol for the diagnosis of pulmonary tuberculosis in children: preparation of children and fasting; time of gastric aspiration; aspiration of gastric residues; total volume of aspirate; solution used for aspiration of gastric contents; decontaminant solution; buffer solution; and time (...) Gastric lavage in the diagnosis of pulmonary tuberculosis in children: a systematic review. To analyze standardization of gastric lavage protocols in the diagnosis of pulmonary tuberculosis in children.A systematic review was conducted for the period between 1968 and 2008 in the following databases: LILACS, SCIELO and MEDLINE. The search strategy included the following terms: "gastric lavage and tuberculosis" or "gastric washing and tuberculosis" with the restriction of "children aged up to 15

2010 Revista de saúde pública

69. A Pilot Study of Filtrum-STI in Children With Viral Gastroenteritis

A Pilot Study of Filtrum-STI in Children With Viral Gastroenteritis A Pilot Study of Filtrum-STI in Children With Viral Gastroenteritis - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. A Pilot Study (...) of Filtrum-STI in Children With Viral Gastroenteritis (F-GE-09) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT01113346 Recruitment Status : Unknown Verified July 2010 by Avva Rus, JSC. Recruitment status was: Recruiting First Posted : April 29, 2010 Last Update Posted : July 14, 2010 Sponsor: Avva Rus

2010 Clinical Trials

70. David Nott: Crossing red lines in Syria

, a field hospital was shelled 20 times in two days. In Aleppo, military aircraft completely destroyed the Children’s Hospital and attempted to destroy all the other well known hospitals in the city. This necessitated the construction of secret field hospitals given secret names to try to continue treating the wounded. In 1953, Syria signed the Geneva conventions and fully understood the implications of breaches of humanitarian law. It then follows that by the end of 2012, the first red line was crossed (...) ”. He warned that Assad would be held accountable by the international community if he deployed chemical munitions. On 21 August 2013, the Syrian government used rocket launchers to propel sarin gas into a suburb of Eastern Ghouta killing nearly 1,500 civilians including at least 426 children according to US assessments. The international community was in uproar and this prompted the British government to obtain legal advice by the British attorney general who confirmed that military action would

2018 The BMJ Blog

71. Tropical Travel Trouble 011 Tonsillitis and the Bull

included in the childhood vaccination schedule since the 1920s in most developed countries. Therefore, those most at risk are the unimmunised. Sporadic outbreaks are seen in mostly in disadvantaged groups who live in crowded conditions. Adults and children under 5 are most at risk of dying from diphtheria with a mortality rate of up to 20%. ** Q7. How does diphtheria present clinically? Answer and interpretation C. diphtheriae can infect any mucosal cell. There are two main forms of the disease (plus (...) only after discussion with a specialist. Complications as seen with snake antivenom : anaphylaxis and serum sickness. ** Details on Diphtheria and Diphtheria . Q9. How do you prevent diphtheria? Answer and interpretation Mass vaccination is the best form of prevention. WHO recommends a 3-dose primary vaccination series with diphtheria toxoid, followed by a booster dose. Children in Australia and New Zealand receive up to 6 doses of DTPa vaccine (diphtheria, tetanus and acellular pertussis toxoid

2018 Life in the Fast Lane Blog

72. Axicabtagene ciloleucel (Yescarta) - diffuse large B-cell lymphoma (DLBCL); primary mediastinal large B-cell lymphoma (PMBCL)

Patients with human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) infection There is no clinical experience in patients with active HIV, HBV or HCV infection. Paediatric population The safety and efficacy of YESCARTA in children and adolescents below 18 years of age have not yet been established. No data are available. Elderly No dose adjustment is required in patients = 65 years of age. Efficacy was consistent with the overall treated patient population. Method (...) not irradiate. For intravenous use only. Gently mix the contents of the bag while thawing. Do not filter. STOP confirm patient ID prior to infusion. 6. SPECIAL WARNING THAT THE MEDICINAL PRODUCT MUST BE STORED OUT OF THE SIGHT AND REACH OF CHILDREN Keep out of the sight and reach of children. 7. OTHER SPECIAL WARNING(S), IF NECESSARY For autologous use only. 8. EXPIRY DATE EXP: 25 9. SPECIAL STORAGE CONDITIONS Store frozen in vapour phase of liquid nitrogen = -150°C. Do not refreeze. 10. SPECIAL PRECAUTIONS

2018 European Medicines Agency - EPARs

73. Button Battery Update

ingestion more frightening is the fact that the ingestion may go unwitnessed, the child may have vague symptoms like ‘off food’ and later haematemasis can result from erosion of the battery through the oesophagus and into the thoracic aorta. Peer reviewer Dr Ruth Barker, Director, Queensland Injury Surveillance Unit and Emergency Paediatrician, Lady Cilento Children’s Hospital, Brisbane. Mechanism of injury: The button battery generates hydroxide ions at the negative pole once ingested (...) to lodge in the oesophagus and cause complications (although relatively bigger batteries in small children increases risk despite being <20 mm). Batteries >20 mm can cause severe local damage within 2 hours. Smaller batteries can also cause localised damage when placed in aural or nasal cavities. Age and time of presentation Age is a risk factor as most fatalities occur in the under 4 year old age group. But consider non-mobile infants can be fed by siblings, patients who are autistic can have

2018 Life in the Fast Lane Blog

74. Varicella Zoster Virus glycoprotein E antigen (Shingrix) - Herpes Zoster

varicella vaccination immunization programs will impact the incidence of herpes zoster, theoretically by reducing exposure to circulating wild virus and subsequent boosting. Whilst an increase in herpes zoster incidence has been observed in the US and in other countries with childhood varicella vaccine programs, increasing trends have been noted in countries not using varicella vaccine universally in children. Additionally, in the US, the trend precedes the introduction of universal varicella (...) occur intermittently in immunocompromised and immunocompetent individuals with detection of VZV DNA in the blood with consequent boosting in immunity (endogenous boosting) or after exposure to varicella or HZ (exogenous boosting). Some studies have found that re- exposure to varicella-zoster virus or to children 20 skin lesions outside a single dermatome), secondary bacterial infection with Staphylococcus aureus and, rarely, purpura and necrosis are also reported. 2.1.5. Management Treatment of HZ

2018 European Medicines Agency - EPARs

75. Tourniquet: surgical

drapes are applied ( ). The use of an adhesive occlusive dressing should not be used on children suffering from epidermolysis bullosa ( ). Avoid over prepping of the required surgical area ( ). If the limb is elevated during prepping ensure any excess prep solution that comes in contact with the tourniquet is dried prior to draping ( ). Attach the tubing to the correct pressure regulator on the tourniquet machine, ie the left inflation tubing from the left cuff is attached to the left pressure (...) regulator. Exsanguinate the limb by using one of the following methods ( ): an Esmarch bandage a roll cylinder limb elevation prior to inflation ( ) If an Esmarch bandage is to be used it should be applied from the extremity tip towards the tourniquet cuff. The bandage should overlap by 2.5 cm (1 inch) and continuous pressure must be applied during application ( )( ). An Esmarch bandage should not be used on children suffering from epidermolysis bullosa, the limb should be elevated instead ( ). During

2015 Great Ormond Street Hospital

76. Practice Parameters for the Management of Clostridium Difficile Infection

hands after each patient encounter. 67 a lcohol hand rubs are commonly used and can be used in conjunction with gloves for avoidance of contamination, as well as soap and water every few hand-cleansing sessions. h owever, for any potential contamination, alcohol hand rubs are insuf- ficient, because they do not kill spores and therefore should not be used alone to decontaminate hands. 67–69 in addition to diligent hand hygiene with warm water and scrubbing, when providing care for patients with C (...) . appropriate cleaning of rooms vacated by patients and equipment used on patients with C difficile is required. s odium hypochlo- rite solutions have proven efficacy in decontaminating surfaces. 72,73 identification of asymptomatic chronic colonization with C difficile occurs in ~8% to 20% of patients admitted to the hospital, 74,75 and up to 50% (2.1%–51%) of patients in rehabilitation and long-term care facilities. 76–80 t his rate increases with factors such as recent hospitalization, recent antibiotic

2015 American Society of Colon and Rectal Surgeons

77. Acute Pain Management: Scientific Evidence

Paediatric pain assessment 412 9.3.1 Pain assessment in neonates 413 9.3.2 Observational and behavioural measures in infants and children 414 9.3.3 Self-report in children and adolescents 415 9.3.4 Children with cognitive impairment or intellectual disability 416 9.4 Analgesic agents 421 9.4.1 Paracetamol 421 9.4.2 Nonselective NSAIDs 424 9.4.3 Coxibs 429xix CONTENTS 9.4.4 Opioids and tramadol 430 9.4.5 Ketamine 438 9.4.6 Alpha-2-delta ligands (gabapentin/pregabalin) 440 9.4.7 Alpha-2 adrenergic agonists (...) 441 9.4.8 Corticosteroids 443 9.5 Opioid infusions and PCA 444 9.5.1 Opioid infusions 444 9.5.2 Patient-controlled analgesia 445 9.5.3 Nurse-controlled analgesia 447 9.5.4 PCA by proxy 447 9.5.5 Overall safety of parenteral opioid use in children 448 9.6 Regional analgesia 449 9.6.1 Continuous and single-injection peripheral nerve blocks 449 9.6.2 Neuraxial blocks 453 9.6.3 Topical therapies 464 9.7 Management of procedural pain in children 465 9.7.1 Procedural pain in the neonate 466 9.7.2

2015 Clinical Practice Guidelines Portal

78. Guidelines for caring for an infant, child, or young person who requires enteral feeding

……………………………………………………………………………………………………………………………………..34 APPENDIX 4……………………………………………………………………………………………………………………………………..35 APPENDIX 5 36 REFERENCES 37 LITERATURE SEARCH 41 EQUALITY SCREENING 42 GUIDELINE DEVELOPMENT GROUP 43 3 Preface There are a large number of children and young people in settings such as hospitals, homes, schools and respite facilities, who require various enteral feeding regimes to achieve effective nutrition. Enteral feeding can have a big impact on family life resulting in both psychological and practical problems which should (...) be addressed regularly. Multi professional teams provide support to ensure the safe and effective management of all aspects involved with enteral feeding. It is therefore essential that all staff, families and carers have the necessary knowledge and skills to provide safe, effective, person centred care. GAIN has identified the need to develop guidelines. The objective is to ensure that a consistent approach is provided for the management of enteral devices in children and young people across all Health

2015 Regulation and Quality Improvement Authority

80. Infection: management of outbreaks, including diarrhoea and vomiting

. Additional appropriate staff may be drawn from: Consultant – Communicable Diseases Control (HPU) Consultant and Nurse Manager from the Occupational Health department Bed Managers Catering Manager or Deputy – if associated with food or water Chief Dietician or Deputy – if associated with food or water Director of Estates or Deputy – if associated with water, air conditioning, sewage or environment Head of Decontamination – if associated with sterilisation or disinfection Medical Director Divisional (...) Ormond Street Hospital for Children NHS Foundation Trust Great Ormond Street London WC1N 3JH © 2019, Great Ormond Street Hospital for Children NHS Foundation Trust

2014 Great Ormond Street Hospital

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