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Decontamination in Children

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81. Infant feeding: formula

. Please note: re-usable teats must be decontaminated in microwave sterilising bags available from the ward in accordance with the manufacturer’s instructions . Check the temperature of the feed before giving it to the baby, by shaking a few drops of feed onto the inside of your wrist . Feeding the baby Make sure that both you and the baby are comfortable. Loosen or remove some of the baby’s clothing if necessary . Hold the baby securely . Only remove the bottle cap and screw on the teat immediately (...) a baby alone with a bottle . Once the feed has been warmed and the teat attached, it must be used within one hour. Any unused feed must be discarded . Vitamin supplements A daily vitamin D supplement should be given to all breast-fed infants and all infants having less than 500ml of formula . Please note: Sick babies (including premature babies) and children may have different vitamin requirements depending on their underlying condition. Check with your ward dietitian . Rationale Rationale 1

2014 Great Ormond Street Hospital

82. Hand hygiene

of infection ( ). However, studies on hand hygiene compliance among healthcare workers have repeatedly shown poor compliance with hand hygiene ( ). The Trust is committed to increasing and maintaining hand hygiene compliance and is actively promoting education programmes on hand hygiene. Hand hygiene compliance is audited trust wide on a monthly basis. Parents and children/young people should be taught the importance of good hand hygiene in the home environment as well as in hospital. Types of hand hygiene (...) procedures Routine/social hand wash Why should a routine/social hand wash be performed? A routine/social hand wash is performed to remove transient microorganisms and to render the hands socially clean. This level of decontamination is sufficient for general social contact and most clinical care activities ( ) ( ). When should a routine/social hand wash be performed? The occasions when hand hygiene should be performed have been summarised into the ‘5 Moments for Hand Hygiene' document

2014 Great Ormond Street Hospital

83. Breast milk: expressing and handling

Breast milk: expressing and handling Breast milk: expressing and handling | Great Ormond Street Hospital Google Tag Manager Navigation Search Search You are here Breast milk: expressing and handling Breast milk: expressing and handling Introduction Breastfeeding has significant short and long term benefits on the health of the mother and baby beyond the period of breastfeeding itself ( ). Supporting women to breastfeed will improve the quality of life for women and for children through reducing (...) or illness, some mothers cannot begin breastfeeding immediately or continue to breastfeed. They should be encouraged to start expressing their breast milk 8 to 10 times in every 24 hours to establish and maintain a good breast milk supply ( ). Occasionally there are instances when breast feeding is contra-indicated. These include mothers who are: Taking some medications. The British National Formulary for Children (BNF) gives advice about most drugs in common use, or contact Pharmacy for advice

2014 Great Ormond Street Hospital

84. Aseptic technique in theatre

a new sterile field. Rationale 21: The records kept for the decontamination process should be able to prove retrospectively that the instrument has passed through each stage of the sterilisation process. Records need to be kept for traceability purposes . Rationale 22: To prevent personal shedding over the sterile field. The average individual sheds an estimated 4000 to 10,000 viable contaminated particles from the skin per minute. The major areas of microbial shedding include the head, neck (...) 2020 Document version: 2.5 Previous version: 2.4 Policies and legal statements Follow Us Great Ormond Street Hospital Tel: 020 7405 9200 Great 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

85. Aseptic non touch technique (ANTT) for intravenous therapy

focus of ANTT® is to minimise the introduction of micro-organisms, which may occur during preparation, administration and delivery of IV therapy. In order to further reduce the potential for contamination, the technique follows some fundamental rules pertaining to infection control and staff/patient protection such as effective handwashing, the wearing of non-sterile gloves, the principles of key parts/sites and the use of alcohol-based solutions for decontamination with adequate cleaning (...) fingernails, nor too large, as they may impede manual dexterity ( ). Cleaning IV trays Correct decontamination of the IV trays is an essential part of the process. After the IVs have been administered, the IV trays are decontaminated as follows: Prior to use, the tray needs to be disinfected with a 70% alcohol wipe (eg Sani-Cloth70) and allowed to dry naturally. After use and prior to leaving the patient's bedspace or room, the outside of the tray must be decontaminated with a sanitising wipe (eg Clinell®

2014 Great Ormond Street Hospital

86. Surgical diathermy

. A high level of patient dignity must be upheld at all times. Patient positioning devices should be placed under the return electrode mat where applicable. The return electrode mat should not be folded whist in place during surgery or at the end of the list. Storage of the mat should follow manufacturer's guidelines. If the return electrode mat is faulty or broken, it must not be used. It should be decontaminated and sent to the biomedical engineering department. The return electrode mat should (...) not be used on children suffering from epidermolysis bullosa. A return electrode mat or bipolar electrosurgery should be used instead ( ). The power setting should be confirmed verbally between the operator and the user before activation. The power settings are determined in conjunction with the manufacturers written recommendations, patient size and type of procedure ( )( ), It is the responsibility of the surgeon to activate the active electrode ( ). Staff should check the entire ESU circuit

2014 Great Ormond Street Hospital

87. Nasopharyngeal airway (NPA)

is to be sized correctly in patients: if the airway is too short it will fail to separate the soft palate from the pharynx and if too long it can pass into the larynx and aggravate cough and gag reflexes ( ). The NPA primarily acts as a 'splint' which maintains patency of the airway, or keeps the tongue from falling back on the posterior pharyngeal wall and occluding the airway, therefore preventing airway obstruction, hypoxia and asphyxia ( ). NPAs are generally well tolerated by conscious children (...) and are used in the management of children with congenital maxillofacial abnormalities, syndromic craniosynotosis, mid-facial hypoplasia or to support the upper airway post trauma or surgery ( ). Note: While the term 'child' is used throughout this guideline, all procedures are also applicable to young people. Indications for a NPA Indications for a NPA itself and the length required to relieve the obstruction must be determined on an individual basis for each child. Pierre Robin Sequence The child

2014 Great Ormond Street Hospital

88. Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis

: B; Recommendation Strength: Moderate Recommendation). 11a. All people should disinfect hands before and after direct contact with patients, after contact with inanimate objects in the direct vicinity of the patient, and after removing gloves (Evidence Quality: B; Recommendation Strength: Strong Recommendation). 11b. All people should use alcohol-based rubs for hand decontamination when caring for children with bronchiolitis. When alcohol-based rubs are not available, individuals should wash (...) see: Abstract This guideline is a revision of the clinical practice guideline, “Diagnosis and Management of Bronchiolitis,” published by the American Academy of Pediatrics in 2006. The guideline applies to children from 1 through 23 months of age. Other exclusions are noted. Each key action statement indicates level of evidence, benefit-harm relationship, and level of recommendation. Key action statements are as follows: Abbreviations: AAP — American Academy of Pediatrics AOM — acute otitis media

2014 American Academy of Pediatrics

89. Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections

or abscesses who have failed initial antibiotic treatment or have markedly impaired host defenses or in patients with SIRS and hypotension (severe; Figure and Table (strong, low). Table 2. Antimicrobial Therapy for Staphylococcal and Streptococcal Skin and Soft Tissue Infections Disease Entity Antibiotic Dosage, Adults Dosage, Children a Comment Impetigo b ( Staphylococcus and Streptococcus ) Dicloxacillin 250 mg qid po N/A N/A Cephalexin 250 mg qid po 25–50 mg/kg/d in 3–4 divided doses po N/A Erythromycin (...) by MRSA Linezolid 600 mg every 12 h IV or 600 mg bid po 10 mg/kg every 12 h IV or po for children <12 y Bacteriostatic; limited clinical experience; no cross-resistance with other antibiotic classes; expensive Clindamycin 600 mg every 8 h IV or 300–450 mg qid po 25–40 mg/kg/d in 3 divided doses IV or 30–40 mg/kg/d in 3 divided doses po Bacteriostatic; potential of cross-resistance and emergence of resistance in erythromycin-resistant strains; inducible resistance in MRSA. Important option for children

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2014 Infectious Diseases Society of America

90. Bronchiolitis

90%. Continuous pulse oximetry is optional for infants and children with bronchiolitis. Chest physiotherapy should not be used in the management of bronchiolitis. Palivizumab prophylaxis should be administered during the first year of life to infants with hemodynamically significant heart disease or chronic lung disease of prematurity (<32 weeks gestation who require >21% O 2 for the first 28 days of life). To prevent spread of respiratory syncytial virus (RSV), hands should be decontaminated (...) of disease severity should be based on history and physical examination. Laboratory and radiologic studies should not be routinely ordered for diagnosis. Risk factors for severe disease such as age < 12 weeks, premature birth, underlying cardiopulmonary disease, or immunodeficiency should be assessed when making decisions about evaluation and management of children with bronchiolitis. Bronchodilators (albuterol, salbutamol), epinephrine, and corticosteroids should not be administered to infants

2014 American Academy of Family Physicians

91. Xpert MTB/RIF implementation manual

Resistance by Use of On-Demand, Near-Patient Technology. Journal of Clinical Microbiology, 2010 48: 229–237. 2 Automated real-time nucleic acid amplification technology for rapid and simultaneous detection of tuberculosis and rifampicin resistance: Xpert MTB/RIF system for the diagnosis of pulmonary and extrapulmonary TB in adults and children: policy update. Geneva, World Health Organization, 2013 (available at MTB/RIF IMPLEMENTATION MANUAL 1 (...) . 12XPERT MTB/RIF IMPLEMENTATION MANUAL 3 2.4 Summary of WHO’s 2013 policy recommendations 2.4.1 Using Xpert MTB/RIF to diagnose pulmonary TB and rifampicin resistance in adults and children • Xpert MTB/RIF should be used rather than conventional microscopy, culture and DST as the initial diagnostic test in adults suspected of having MDR-TB or HIV-associated TB (strong recommendation, high-quality evidence). • Xpert MTB/RIF should be used rather than conventional microscopy, culture and DST

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2014 World Health Organisation Guidelines

92. STaph Aureus Resistance-Treat Early and Repeat (STAR-TER)

, Chapel Hill Collaborators: University of Washington Cook Children's Medical Center Indiana University National Jewish Health University of Michigan University of Texas Southwestern Medical Center St. Louis Children's Hospital Information provided by (Responsible Party): University of North Carolina, Chapel Hill Study Details Study Description Go to Brief Summary: To evaluate the micro-biologic efficacy and safety of a streamlined treatment for early onset methicillin-resistant staphylococcus aureus (...) (MRSA) in patients with cystic fibrosis. Condition or disease Intervention/treatment Phase Cystic Fibrosis Drug: Trimethoprim Sulfamethoxazole (TMP/SMX) Drug: Minocycline Drug: Mupirocin Drug: Chlorhexidine Gluconate Behavioral: Environmental Decontamination Phase 2 Detailed Description: This is an open-label, multi-center interventional trial in Cystic Fibrosis (CF) patients with new MRSA isolated from the respiratory tract (oropharyngeal (OP) = OP swab, sputum, or bronchoscopy) at a clinical

2018 Clinical Trials

93. Foodborne intestinal protozoan infection and associated factors among patients with watery diarrhea in Northern Ethiopia; a cross-sectional study (PubMed)

Foodborne intestinal protozoan infection and associated factors among patients with watery diarrhea in Northern Ethiopia; a cross-sectional study Intestinal protozoa are parasites transmitted by consumption of contaminated water and food and mainly affect children and elder people and cause considerable health problems. They are the leading causes of outpatient morbidity due to diarrhea in the developing countries. So, assessing water and food source of diarrheal patients and identifying (...) type of recipe to decontaminate salads and fruits (AOR = 2.64, 95 CI: 1.34-5.19, P = 0.005) and using vinegar as a decontaminant (AOR = 2.83, 95 CI: 1.24-6.48, P = 0.014). Eating out (meals at a restaurant) on the other hand was found to be protective for foodborne protozoan infection (AOR = 0.43, 95 CI: 0.23-0.78, P = 0.006).Our study revealed that foodborne protozoa infections are of public health significance in the study area. Vinegar, which is frequently used as a recipe for decontaminating

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2018 Journal of health, population, and nutrition

94. Clinical Guidelines and Integrated Care Pathways for the Oral Health Care of People with Learning Disabilities

the foundation for professional and service development to address inequities in provision of oral care. Data available on oral health status for children and adults with a learning disability relates mainly to specific groups. However, the overall picture is one of poor periodontal health and a greater than normal unmet need of treatment for children and adults (Shaw et al., 1986, Nunn and Murray, 1987 , Hinchliffe et al., 1988, Thornton et al., 1989, Shaw et al., 1990, Francis et al., 1991, Kendall, 1991 (...) to general well being” (Oral Health Strategy Group, 1994). The term ‘oral health’ includes dental health and will be used throughout this document. Prevalence of Learning Disability It is estimated that there are 1.2 million people with a mild to moderate learning disability living in the UK and approximately 210,000 with a severe or profound disability (Valuing people 2001). More males than females are affected, with about one quarter being children aged under 16. Approximately a quarter of the total

2012 Royal College of Surgeons of England

95. Amitraz, an underrecognized poison: A systematic review. (PubMed)

of decontamination methods, namely, gastric lavage and activated charcoal was unclear.Our review shows that amitraz is an important agent for accidental or suicidal poisoning in both adults and children. It has a good prognosis with supportive management. (...) children) of human poisoning with amitraz were included in this systematic review. The most commonly reported clinical features of amitraz poisoning were altered sensorium, miosis, hyperglycaemia, bradycardia, vomiting, respiratory failure, hypotension and hypothermia. Amitraz poisoning carried a good prognosis with only six reported deaths (case fatality rate, 1.9%). Nearly 20 and 11.9 per cent of the patients required mechanical ventilation and inotropic support, respectively. The role

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2017 The Indian journal of medical research

96. Briefs: Cyanide poisoning

Briefs: Cyanide poisoning Briefs: Cyanide poisoning – PEMBlog Search for: Search for: Briefs: Cyanide poisoning The most common scenario in which providers should be concerned about cyanide poisoning in children is in a patient rescued from a structure fire. Cyanide is released from things that burn within a home (wood, fabrics etc,.) and is inhaled. Poisoning essentially results in disruption of the electron transport chain, resulting in depletion of ATP. Therefore you can’t do aerobic (...) , they should present with: Exposure to fire smoke in an enclosed area Soot present around mouth, nose or oropharynx Altered mental status Supportive labs include an elevated lactate (>8 is bad) Patients exposed to smoke only need decontamination of hair (wash it) and remove outer clothing. Ideally the sooner the better. Severe exposures lead to death – but Cyanokits should be given at the scene if possible. This is done in Europe for instance. How do we dose it? Pediatric patient – 70mg/kg IV (max 5g

2017 PEM Blog

97. Bioterrorism: 10 facts about sarin gas

Bioterrorism: 10 facts about sarin gas Bioterrorism: 10 facts about sarin gas Bioterrorism: 10 facts about sarin gas | | April 8, 2017 90 Shares As the civil war in Syria shows no signs of de-escalating, worrisome evidence points towards the deployment of chemical warfare with banned agents recently, resulting in almost a hundred deaths with more than a quarter of them children. Chlorine and Sarin gas are primarily being implicated. Here are ten facts to know about Sarin gas and how it works. 1 (...) . Sarin is heavier than air and sinks to lower levels over the ground. Children are more susceptible to Sarin because they are closer to the ground, have smaller bodies, faster breathing rates, immature organ systems, and . 5. Sarin gas is more potent than liquid and symptoms appear within seconds of exposure to the gas but may take hours with the liquid form. Since it is odorless, victims are unaware of its presence, just like carbon monoxide. Deaths are mostly due to respiratory failure from

2017 KevinMD blog

98. Briefs: Beta Blocker Overdose

of 100 mm Hg and a minimal heart rate of 50 beats per minute.It can take up to 15-60 minutes to see improvements. You’ll want to check blood glucose (every 30-60 minutes) and serum potassium (hourly) frequently. GI decontamination may be indicated in severe cases. Activated charcoal may help in long acting/sustained release agents. You can use whole bowel irrigation in these situations as well. remember gastric stasis occurs in Beta Blocker overdoses so pills can sit in the stomach longer. Other (...) Sobolewski, MD, MEd is an Associate Professor of Pediatric Emergency Medicine and an Assistant Director for the Pediatric Residency Training Program at Cincinnati Children's Hospital Medical Center. He is on Twitter @PEMTweets and authors the Pediatric Emergency Medicine site PEMBlog. All views are strictly my own and not official medical advice. Related Posts October 11th, 2018 July 12th, 2018 June 14th, 2018 May 10th, 2018 February 15th, 2018 December 14th, 2017 November 30th, 2017 October 26th, 2017

2017 PEM Blog

99. Central Venous Access in Oncology

/vte.pdf[62,135,136]. Volume26 | Supplement5 | September2015 doi:10.1093/annonc/mdv296 | v??? AnnalsofOncology clinicalpracticeguidelines? Implementationofbundledstrategies,includingdocumenting and reporting rates of compliance of all components of the bundle,asbenchmarksforqualityassuranceandperformance improvement. ? Implementation of appropriate patient education programmes, which include instructions on hand decontamination and the prevention of cross-contamination in patients with stomas [1, 2 (...) ]. Itisroutine practice to?ushtunnelled cuffed catheters and PICC linesweekly,andsubcutaneousports4-weekly(whennotinuse), using heparin or normal saline 0.9% solution. An aseptic tech- nique by hospital-trained nurses, which includes the use of alco- holic chlorhexidine 2% cleanser, to decontaminate catheter hubs beforeuse,shouldbeused[37,92]. Thereisemergentevidencethatthenewgenerationofneedle- less connectors, which have mechanical valves that generate negative, positive or neutral pressure during

2015 European Society for Medical Oncology

100. Contaminated fingers: a potential cause of Chlamydia trachomatis-positive urine specimens (PubMed)

surrogate specimens were subjected to C. trachomatis assay and quantification in a real-time PCR-based diagnostic system.The amplimer crossing point (Cq) for EB dilutions was 10.0±1.6 less than for corresponding finger contacted urine specimens, which corresponds to ~10 µL of EB suspension transferred. This was largely independent of participant identity, C. trachomatis strain or EB dilution. Hand decontamination led to large reductions in EBs transferred, but transfer remained consistently detectable (...) . Recent Cq data from C. trachomatis-positive clinical urine specimens were collated, and 20% clearly contained sufficient C. trachomatis to detectably contaminate another specimen by finger-mediated transfer, as in this experiment.This study directly demonstrated the potential for urine contaminated fingers to convert a C. trachomatis-negative urine specimen to C. trachomatis positive as a result of contact. Accordingly, procedures for urine specimen collection, particularly from children, need

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2017 Sexually transmitted infections

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