DOCSLIB.ORG

Infection Control Through the Ages

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Infection Control Through the Ages American Journal of Infection Control 40 (2012) 35-42 Contents lists available at ScienceDirect American Journal of Infection Control American Journal of Infection Control journal homepage: www.ajicjournal.org Major article Infection control through the ages Philip W. Smith MD a,*, Kristin Watkins MBA b, Angela Hewlett MD a a Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE b Center for Preparedness Education, College of Public Health, University of Nebraska Medical Center, Omaha, NE Key Words: To appreciate the current advances in the field of health care epidemiology, it is important to understand History the history of hospital infection control. Available historical sources were reviewed for 4 different Hospitals historical time periods: medieval, early modern, progressive, and posteWorld War II. Hospital settings Nosocomial for the time periods are described, with particular emphasis on the conditions related to hospital infections. Copyright Ó 2012 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. Approximately 1.7 million health careeassociated infections One of the few public health measures was the collection of (HAIs) occur in the United States each year.1 Hospital infection bodies of plague victims. The bodies were left in the street to be control programs are nearly universal in developed nations and have picked up by carts and placed in mass graves outside of town.3,4 significantly lowered the risk of acquiring a HAI since their inception Other infection control measures included hanging people who in the mid 20th century. As we debate the preventability of HAIs, as wandered in from an epidemic region into an uninfected area, well as the ethical and logistic aspects of patient safety, it is impor- shutting up plague victims in their homes, and burning clothing tant to recall the historical context of hospital infection control. and bedding.5 Public health infectious disease contexts are relevant to hospitali- In 1532, during the reign of Henry VIII, the plague was active zation, and we examine 4 time periods in the last half-millennium: throughout England and was especially severe in London. The king medieval, early modern, progressive, and posteWorld War II. For was advised to travel by waterway from London to escape the each time frame, hospitalization-associated infectious diseases are disease. On the order of the Privy Council, the Mayor of London discussed, and a hypothetical infection control agenda is presented. wrote what is believed to be the first bill of mortality,6 an important The selection of time periods is arbitrary but is designed to provide public health precedent. In the 16th century, public health laws a representative overview of infections in hospitals through the started to appear throughout Europe.7 centuries. In addition to plague, epidemics of smallpox, influenza, dysen- tery, and typhus were frequent.3 “English sweating sickness,” an unknown Medieval febrile disease, was usually fatal.8 Smallpox had MEDIEVAL ERA (5TH TO 15TH CENTURIES) a mortality rate of 20%-60%, and many survivors lost their sight. In some towns there were not enough survivors to bury the dead or Public health in the medieval era harvest the crops. Infectious diseases strongly impacted life in medieval times.2 Bubonic plague killed about one-third of all people in Europe Hospitals in the medieval era between 1347 and 1350; some towns were abandoned after losing two-thirds of their population in a single year. A 1471 outbreak The first European hospitals were established in the 12th killed 10% of the British population. Recurrent but less severe pla- century by religious orders. During the Middle Ages, hospitals were gue epidemics persisted up to 1650. called “spittle houses” and provided care for the sick, insane, and destitute.9 Persons of means preferred to receive care at home.10 * Address correspondence to Philip W. Smith, MD, Division of Infectious Diseases, These hospitals were usually small and located outside the city University of Nebraska Medical Center, 985400 Nebraska Medical Center, Omaha, NE 68198-5400. walls, and had large burial grounds. In the 13th century, there were E-mail address: [email protected] (P.W. Smith). thousands of hospitals for the isolation of leprosy patients (lepro- Conflict of interest: None to report. saria) in Europe. These were later converted to “pest houses” to 0196-6553/$36.00 - Copyright Ó 2012 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. doi:10.1016/j.ajic.2011.02.019 36 P.W. Smith et al. / American Journal of Infection Control 40 (2012) 35-42 provide care for plague patients.11 Some hospitals were built over waterways that were used as sewers.12 In medieval times, hospitals were hazardous places (Fig 1). Epidemic infections killed large numbers of hospital patients during this period. Hospital infection and death rates were high. When a sick person entered a hospital, his or her property was disposed of, and in some regions a requiem mass was held, as if he or she had already died.7 In addition to smallpox and plague, “hospital fever” (louse-borne typhus), typhoid, and dysentery killed large numbers of patients. Surgery was generally performed by barber/surgeons with primitive surgical instruments using no asepsis or anesthesia. Postoperative mortality rates of 60%-80% were common, with most deaths due to so-called “hospital” (streptococcal) gangrene. Wound infection rates were also high because of unsanitary conditions and the use of cautery. As described in a medieval surgery text, cautery involved restraining the patient while a burning iron was pushed 13 Fig 1. Hôtel Dieu, Paris, circa 1500. The comparatively well patients (on the right) were into the wound until it reached bone. Alternatively, a boiling separated from the very ill (on the left). mixture of oil and treacle (a medicinal compound) was poured into wounds. Not surprisingly, patients experienced great pain and Problem of vermin in beds. Hospitals were extremely swelling around wound edges.4 unsanitary. Clean sheets were not the norm, and patients were Ground rabbit fur and mummy powder, the ground remains of expected to bring their own blankets and linens with them. In mummies, were the most popular wound dressings, and attempts St. Mary’s Bethlehem hospital in London, a herd of pigs was left at asepsis were crude. Medicine consisted of herbs and various free to root round the facility.15 Mattresses were made of straw, substances given by mouth, by enema, or topically. Typical ingre- and bed coverings were animal furs that were cleaned annually dients requested by pharmacies included snake flesh, laurel berries, at best. These served as traps for all types of vermin, which sheep dung, lye, cow kidney, antimony, alum, and earthworms.13 occupied the beds with patients. Hospital stench: windows. The air in the sick wards was foul, so much so that attendants held vinegar-saturated sponges Hospital infection control in the medieval era over their noses and mouths to combat the odors. Beds in medieval wards usually were placed under windows, which Although knowledge regarding the cause and spread of disease had the disadvantage of extreme cold in winter, but did provide did not come about until the latter half of the 19th century, here we some fresh air and relief from the fetid aromas.7 present a hypothetical Infection Control Committee (ICC) agenda to Policy for corpse removal. The prompt removal of corpses, create a framework to help contemporary infection preventionists which we take for granted, would have been a radical idea at to understand historic problems. This hypothetical medieval ICC that time. Several accounts describe bodies that had been dead agenda might have included the following items: for 24 hours or longer and in a state of rigor mortis occupying a bed with multiple living patients.7,9,14 Review of infections and mortality. A listing of hospital infections would have included many feared diseases, including pneumonic plague, smallpox, tuberculosis (TB), diphtheria, and EARLY MODERN ERA (1500-1800) typhus. The ICC also might have noted a formidable hospital infection rate (90%), clean wound infection rate (80%), and Public health in the early modern era hospitalization-associated death rate (40%-70%), which were typical of the times. Although the plague was no longer a major public health Surveillance denominator: beds or patients? Any good concern, infectious diseases remained the leading cause of death in hospital epidemiologist is concerned with denominator data, Europe and the United States. In 1793, a yellow fever epidemic was but this would be a difficult figure to grasp in the 15th and 16th responsible for the deaths of 10% of the population of Philadelphia, centuries, because in many cases multiple patients occupied as well as 10 of its 80 physicians.16 Smallpox killed 400,000 people a single bed.7,10,14 Accounts describe up to 6 persons in a bed, per year in Europe, and measles killed at least as many people as including a patient with febrile typhus occupying a bed with smallpox. The early 1800s saw massive outbreaks of cholera, a mother in labor and a child next to a patient with TB who was particularly in urban centers.17 One-half to one-third of infected constantly coughing.11 patients died.18 Typhus caused epidemics with a 10% mortality rate; Staffing problems: plague. Hospitals were difficult to staff, typhoid fever and dysentery were other common causes of and in many cases inmates assisted patients. The plague deci- outbreaks. Life expectancy at birth was 19-33 years.19 mated the population, including hospital staff. The position of The only available treatments were purges, emetics, calomel infection control nurse (ICN) would have turned over (a tincture of mercury), opium, quinine, and bloodletting.
Load more

Recommended publications
  • Estimating the Instantaneous Asymptomatic Proportion with a Simple Approach: Exemplified with the Publicly Available COVID-19 Surveillance Data in Hong Kong
    ORIGINAL RESEARCH published: 03 May 2021 doi: 10.3389/fpubh.2021.604455 Estimating the Instantaneous Asymptomatic Proportion With a Simple Approach: Exemplified With the Publicly Available COVID-19 Surveillance Data in Hong Kong Chunyu Li 1†, Shi Zhao 2,3*†, Biao Tang 4,5, Yuchen Zhu 1, Jinjun Ran 6, Xiujun Li 1*‡ and Daihai He 7*‡ 1 2 Edited by: Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China, JC 3 Catherine Ropert, School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China, Chinese University of 4 Federal University of Minas Hong Kong (CUHK) Shenzhen Research Institute, Shenzhen, China, School of Mathematics and Statistics, Xi’an Jiaotong 5 Gerais, Brazil University, Xi’an, China, Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, Toronto, ON, Canada, 6 School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Reviewed by: Hong Kong, China, 7 Department of Applied Mathematics, Hong Kong Polytechnic University, Hong Kong, China Mohammad Javanbakht, Baqiyatallah University of Medical Sciences, Iran Background: The asymptomatic proportion is a critical epidemiological characteristic Changjing Zhuge, that modulates the pandemic potential of emerging respiratory virus, which may vary Beijing University of Technology, China *Correspondence: depending on the nature of the disease source, population characteristics, source–host Daihai He interaction, and environmental factors. [email protected] Xiujun Li Methods: We developed a simple likelihood-based framework to estimate the [email protected] instantaneous asymptomatic proportion of infectious diseases. Taking the COVID-19 Shi Zhao epidemics in Hong Kong as a case study, we applied the estimation framework [email protected] to estimate the reported asymptomatic proportion (rAP) using the publicly available † These authors share first authorship surveillance data.
    [Show full text]
  • Artificial Intelligence in Health Care: the Hope, the Hype, the Promise, the Peril
    Artificial Intelligence in Health Care: The Hope, the Hype, the Promise, the Peril Michael Matheny, Sonoo Thadaney Israni, Mahnoor Ahmed, and Danielle Whicher, Editors WASHINGTON, DC NAM.EDU PREPUBLICATION COPY - Uncorrected Proofs NATIONAL ACADEMY OF MEDICINE • 500 Fifth Street, NW • WASHINGTON, DC 20001 NOTICE: This publication has undergone peer review according to procedures established by the National Academy of Medicine (NAM). Publication by the NAM worthy of public attention, but does not constitute endorsement of conclusions and recommendationssignifies that it is the by productthe NAM. of The a carefully views presented considered in processthis publication and is a contributionare those of individual contributors and do not represent formal consensus positions of the authors’ organizations; the NAM; or the National Academies of Sciences, Engineering, and Medicine. Library of Congress Cataloging-in-Publication Data to Come Copyright 2019 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. Suggested citation: Matheny, M., S. Thadaney Israni, M. Ahmed, and D. Whicher, Editors. 2019. Artificial Intelligence in Health Care: The Hope, the Hype, the Promise, the Peril. NAM Special Publication. Washington, DC: National Academy of Medicine. PREPUBLICATION COPY - Uncorrected Proofs “Knowing is not enough; we must apply. Willing is not enough; we must do.” --GOETHE PREPUBLICATION COPY - Uncorrected Proofs ABOUT THE NATIONAL ACADEMY OF MEDICINE The National Academy of Medicine is one of three Academies constituting the Nation- al Academies of Sciences, Engineering, and Medicine (the National Academies). The Na- tional Academies provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions.
    [Show full text]
  • Infection Control in Dentistry: How to Asepsis Photographic Mirrors?
    Infection control in dentistry: how to asepsis photographic mirrors? Amanda Osório Ayres de Freitas* Mariana Marquezan* Giselle Naback Lemes Vilani* Rodrigo César Santiago* Luiz Felipe de Miranda Costa* Sandra Regina Torres** Abstract: The aim of this study was to evaluate the efficacy of six different methods of disinfection and sterilization of intra­oral photographic mirrors through microbiological testing and to analysis their potential harm to mirrors’ surface. Fourteen occlusal mirrors were divided into seven groups. Group 1 comprised two mirrors as received from manufacturer. The other six groups comprised mirrors disinfected/sterilized by autoclave, immersion in enzymatic detergent, and friction with chlorhexidine detergent, chlorhexidine wipes, common detergent and 70% ethylic alcohol. Microbiological and quality surface analyses were performed. Sterilization in autoclave was microbiologic effective, but caused damage to the mirror surface. Chlorhexidine (in wipes or detergent) and liquid soap were effective disinfectant agents for photographic mirrors decontamination, without harmful effect on its surface. Enzymatic detergent immersion and friction with 70% ethylic alcohol were not effective as disinfectant agents for photographic mirrors decontamination. According to the results, the more effective and safe methods for photographic mirrors disinfection were friction with chlorhexidine wipes or detergent, as well as liquid soap. Results, the most efficacious methods for photographic mirrors disinfection were friction with chlorhexidine wipes and detergent, as well as common detergent. Descriptors: Dental Instruments; Decontamination; Microbiology; Surface Properties. *Doutoranda em Odontologia na Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil **Pós­doutora em odontologia pela University of Washington (UW), Seattle, WA, Estados Unidos ISSN 2236­5843 │ 93 Introduction Dental photography is an important tool for diagnostic and treatment planning, and it’s also a registration of the patient’s condition before and after treatment.
    [Show full text]
  • Chapter 3 Bacterial and Viral Infections
    GBB03 10/4/06 12:20 PM Page 19 Chapter 3 Bacterial and viral infections A mighty creature is the germ gain entry into the skin via minor abrasions, or fis- Though smaller than the pachyderm sures between the toes associated with tinea pedis, His customary dwelling place and leg ulcers provide a portal of entry in many Is deep within the human race cases. A frequent predisposing factor is oedema of His childish pride he often pleases the legs, and cellulitis is a common condition in By giving people strange diseases elderly people, who often suffer from leg oedema Do you, my poppet, feel infirm? of cardiac, venous or lymphatic origin. You probably contain a germ The affected area becomes red, hot and swollen (Ogden Nash, The Germ) (Fig. 3.1), and blister formation and areas of skin necrosis may occur. The patient is pyrexial and feels unwell. Rigors may occur and, in elderly Bacterial infections people, a toxic confusional state. In presumed streptococcal cellulitis, penicillin is Streptococcal infection the treatment of choice, initially given as ben- zylpenicillin intravenously. If the leg is affected, Cellulitis bed rest is an important aspect of treatment. Where Cellulitis is a bacterial infection of subcutaneous there is extensive tissue necrosis, surgical debride- tissues that, in immunologically normal individu- ment may be necessary. als, is usually caused by Streptococcus pyogenes. A particularly severe, deep form of cellulitis, in- ‘Erysipelas’ is a term applied to superficial volving fascia and muscles, is known as ‘necrotiz- streptococcal cellulitis that has a well-demarcated ing fasciitis’. This disorder achieved notoriety a few edge.
    [Show full text]
  • C Semmelweisâ•Žs 19Th-Century Cure for Deadly Childbed Fever Ignored
    Headwaters Volume 29 Article 3 2016 Dr. Ignác Semmelweis’s 19th-Century Cure for Deadly Childbed Fever Ignored in Vienna’s Maternity Wards: His Sympathy for Women Victims and Their Newborns Costs Professional Standing Anna Lisa Ohm College of Saint Benedict/Saint John's University, [email protected] Follow this and additional works at: https://digitalcommons.csbsju.edu/headwaters Part of the History of Science, Technology, and Medicine Commons, and the Women's History Commons Recommended Citation Ohm, Anna Lisa (2016) "Dr. Ignác Semmelweis’s 19th-Century Cure for Deadly Childbed Fever Ignored in Vienna’s Maternity Wards: His Sympathy for Women Victims and Their Newborns Costs Professional Standing," Headwaters: Vol. 29, 23-35. Available at: https://digitalcommons.csbsju.edu/headwaters/vol29/iss1/3 This Article is brought to you for free and open access by DigitalCommons@CSB/SJU. It has been accepted for inclusion in Headwaters by an authorized editor of DigitalCommons@CSB/SJU. For more information, please contact [email protected]. ANNA LISA OHM ____________________________________ Dr. Ignác Semmelweis’s 19th-Century Cure for Deadly Childbed Fever Ignored in Vienna’s Maternity Wards: His Sympathy for Women Victims and Their Newborns Costs Professional Standing For some 19th-century women ready to give birth, even a public street was preferable to a bed in an accredited hospital delivery ward where statistics suggested a massacre of women and newborns throughout Europe and the United States. Puerperal septicemia, commonly called childbed fever, was the culprit, and nobody in the world’s medical or scientific community at the time knew how to control its epidemic proportions.
    [Show full text]
  • Globalization and Infectious Diseases: a Review of the Linkages
    TDR/STR/SEB/ST/04.2 SPECIAL TOPICS NO.3 Globalization and infectious diseases: A review of the linkages Social, Economic and Behavioural (SEB) Research UNICEF/UNDP/World Bank/WHO Special Programme for Research & Training in Tropical Diseases (TDR) The "Special Topics in Social, Economic and Behavioural (SEB) Research" series are peer-reviewed publications commissioned by the TDR Steering Committee for Social, Economic and Behavioural Research. For further information please contact: Dr Johannes Sommerfeld Manager Steering Committee for Social, Economic and Behavioural Research (SEB) UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) World Health Organization 20, Avenue Appia CH-1211 Geneva 27 Switzerland E-mail: [email protected] TDR/STR/SEB/ST/04.2 Globalization and infectious diseases: A review of the linkages Lance Saker,1 MSc MRCP Kelley Lee,1 MPA, MA, D.Phil. Barbara Cannito,1 MSc Anna Gilmore,2 MBBS, DTM&H, MSc, MFPHM Diarmid Campbell-Lendrum,1 D.Phil. 1 Centre on Global Change and Health London School of Hygiene & Tropical Medicine Keppel Street, London WC1E 7HT, UK 2 European Centre on Health of Societies in Transition (ECOHOST) London School of Hygiene & Tropical Medicine Keppel Street, London WC1E 7HT, UK TDR/STR/SEB/ST/04.2 Copyright © World Health Organization on behalf of the Special Programme for Research and Training in Tropical Diseases 2004 All rights reserved. The use of content from this health information product for all non-commercial education, training and information purposes is encouraged, including translation, quotation and reproduction, in any medium, but the content must not be changed and full acknowledgement of the source must be clearly stated.
    [Show full text]
  • Role of the Microbiology Laboratory in Infection Control
    GUIDE TO INFECTION CONTROL IN THE HOSPITAL CHAPTER 3: Role of the Microbiology Laboratory in Infection Control Author Mohamed Benbachir, PhD Chapter Editor Gonzalo Bearman MD, MPH, FACP, FSHEA, FIDSA Topic Outline Key Issues Known Facts Suggested Practice Suggested Practice in Under-Resourced Settings Summary References Chapter last updated: January, 2018 KEY ISSUES The microbiology laboratory plays an important role in the surveillance, treatment, control and prevention oF nosocomial inFections. The microbiologist is a permanent and active member oF the infection control committee (ICC) and the antimicrobial stewardship group (ASG). Since most of the inFection control and antimicrobial stewardship programs rely on microbiological results, quality assurance is an important issue. KNOWN FACTS The microbiologist is a daily privileged interlocutor oF the infection control team (inFection control doctor and inFection control nurse) and the antimicrobial stewardship working group. The First task oF the microbiology laboratory is to accurately, consistently and rapidly identiFy the responsible agents to species level and identify their antimicrobial resistance patterns. Traditional microbiologic methods remain suboptimal in providing rapid identification and susceptibility testing. There is a growing need for more rapid and reliable laboratory results. Important progress made in the fields of instruments, reagents and techniques have made it easier to adapt to the important changes oF the clinical microbiology context e.g. increasing use of microbiology tests, shortage of qualiFied personnel. There is also a growing demand For quality in clinical laboratories and more and more countries are elaborating national regulations. 1 The microbiology processes are becoming increasingly more complex. InFormatics are playing an increasing role in the improvement oF these processes in terms oF workFlow, timeliness and cost.
    [Show full text]
  • Environmental Sanitation and Water Borne Diseases
    ENVIRONMENTAL SANITATION AND WATER BORNE DISEASES Dr.Harpreet Singh MD, DM (Gastroenterology) COMPONENTS OF ENVIRNOMENTAL SANITATION • WATER SANITATION • FOOD AND MILK SANITATION • EXCRETA DISPOSAL • SEWAGE DISPOSAL • REFUSE DISPOSAL • VECTOR AND VERMIN CONTROL • HOUSING • AIR SANITATION WATER SANITATION WATER ANALYSIS CONSISTS OF: • PHYSICAL • CHEMICAL • RADIOLOGICAL • BIOLOGICAL • BACTERIOLOGICAL WATER SANITATION • PUBLIC WATER SUPPLY MUST BE- – SAFE – REASONABLY SOFT – PLENTIFUL – CHEAP WATER SANITATION • HOUSEHOLD TREATMENT OF WATER – BOILING, i.e., beyond 2 minutes – CHLORINATION- 1-5ppm – IODINE TREATMENT- 10 drops per gallon – FILTRATION – AERATION What is a Water-Borne Disease? • “Pathogenic microbes that can be directly spread through contaminated water.” -CDC • Humans contract waterborne infections by contact with contaminated water or food. • May result from human actions, such as improper disposal of sewage wastes, or extreme weather events like storms and hurricanes. Climate Change Promotes Water-borne Disease • Rainfall: transport and disseminates infectious agents • Flooding: sewage treatment plants overflow; water sources contaminated • Sea level rise: enhances risk of severe flooding • Higher temperatures: Increases growth and prolongs survival rates of infectious agents • Drought: increases concentrations of pathogens, impedes hygiene Water Quantity and Quality Issues IPCC, 2007a Burden of Waterborne Disease • 1.8 million deaths (4 million cases) in 2004 due to gastroenteritis (WHO) – 88% due to unsafe water and poor sanitation Prüss-Üstün et al., 2008 Burden of Diarrheal Diseases • Diarrheal diseases are vastly underestimated – 211 million cases estimated in the US annually (Mead et al., 1999) Reported cases Actual cases > 38 x reported cases Diarrheal Disease Pathways Prüss-Üstün et al., 2008 CHOLERA Cholera • Found in water or food Global Prevalence of Cholera (WHO) sources contaminated by feces from an infected person • Transmitted by contaminated food, water • Prevalence increases with increasing temperature and rainfall amounts V.
    [Show full text]
  • Sports Medicine Examination Outline
    Sports Medicine Examination Content I. ROLE OF THE TEAM PHYSICIAN 1% A. Ethics B. Medical-Legal 1. Physician responsibility 2. Physician liability 3. Preparticipation clearance 4. Return to play 5. Waiver of liability C. Administrative Responsibilities II. BASIC SCIENCE OF SPORTS 16% A. Exercise Physiology 1. Training Response/Physical Conditioning a.Aerobic b. Anaerobic c. Resistance d. Flexibility 2. Environmental a. Heat b.Cold c. Altitude d.Recreational diving (scuba) 3. Muscle a. Contraction b. Lactate kinetics c. Delayed onset muscle soreness d. Fiber types 4. Neuroendocrine 5. Respiratory 6. Circulatory 7. Special populations a. Children b. Elderly c. Athletes with chronic disease d. Disabled athletes B. Anatomy 1. Head/Neck a.Bone b. Soft tissue c. Innervation d. Vascular 2. Chest/Abdomen a.Bone b. Soft tissue c. Innervation d. Vascular 3. Back a.Bone b. Soft tissue c. Innervation 1 d. Vascular 4. Shoulder/Upper arm a. Bone b. Soft tissue c. Innervation d. Vascular 5. Elbow/Forearm a. Bone b. Soft tissue c. Innervation d. Vascular 6. Hand/Wrist a. Bone b. Soft tissue c. Innervation d. Vascular 7. Hip/Pelvis/Thigh a. Bone b. Soft tissue c. Innervation d. Vascular 8. Knee a. Bone b. Soft tissue c. Innervation d. Vascular 9. Lower Leg/Foot/Ankle a. Bone b. Soft tissue c. Innervation d. Vascular 10. Immature Skeleton a. Physes b. Apophyses C. Biomechanics 1. Throwing/Overhead activities 2. Swimming 3. Gait/Running 4. Cycling 5. Jumping activities 6. Joint kinematics D. Pharmacology 1. Therapeutic Drugs a. Analgesics b. Antibiotics c. Antidiabetic agents d. Antihypertensives e.
    [Show full text]
  • Lepromatous Leprosy with Erythema Nodosum Leprosum Presenting As
    Lepromatous Leprosy with Erythema Nodosum Leprosum Presenting as Chronic Ulcers with Vasculitis: A Case Report and Discussion Anny Xiao, DO,* Erin Lowe, DO,** Richard Miller, DO, FAOCD*** *Traditional Rotating Intern, PGY-1, Largo Medical Center, Largo, FL **Dermatology Resident, PGY-2, Largo Medical Center, Largo, FL ***Program Director, Dermatology Residency, Largo Medical Center, Largo, FL Disclosures: None Correspondence: Anny Xiao, DO; Largo Medical Center, Graduate Medical Education, 201 14th St. SW, Largo, FL 33770; 510-684-4190; [email protected] Abstract Leprosy is a rare, chronic, granulomatous infectious disease with cutaneous and neurologic sequelae. It can be a challenging differential diagnosis in dermatology practice due to several overlapping features with rheumatologic disorders. Patients with leprosy can develop reactive states as a result of immune complex-mediated inflammatory processes, leading to the appearance of additional cutaneous lesions that may further complicate the clinical picture. We describe a case of a woman presenting with a long history of a recurrent bullous rash with chronic ulcers, with an evolution of vasculitic diagnoses, who was later determined to have lepromatous leprosy with reactive erythema nodosum leprosum (ENL). Introduction accompanied by an intense bullous purpuric rash on management of sepsis secondary to bacteremia, Leprosy is a slowly progressive disease caused by bilateral arms and face. For these complaints she was with lower-extremity cellulitis as the suspected infection with Mycobacterium leprae (M. leprae). seen in a Complex Medical Dermatology Clinic and source. A skin biopsy was taken from the left thigh, Spread continues at a steady rate in several endemic clinically diagnosed with cutaneous polyarteritis and histopathology showed epidermal ulceration countries, with more than 200,000 new cases nodosa.
    [Show full text]
  • ANTT Guidelines
    www.antt.org ANTT Guidelines The ANTT Clinical Guideline for the Preparation & Administration of Peripheral and Central Intravenous Medications (IV Therapy) Rationale and supporting evidence ANTT IV Prep and Administration V3 .0 2013 The Association for Safe Aseptic Technique (ASAP) www.antt.org www.antt .org ® © 2013 Aseptic Non Touch Technique (ANTT) This document is a publication of The-ASAP and all rights of copyright, intellectual property and Trademark are reserved. ANTT is protected to prevent dilution and misrepresentation of the practice framework so as to avoid ANTT becoming another unhelpful generic term for aseptic technique that is variably interpreted. For guidance see [email protected]. This document may however, be freely reviewed, copied and translated, in part, or in whole, for LOCAL, SINGLE ORGANIZATION educational use. It must not be published via the www/internet or its content used for production and publication of dedicated ANTT e-learning resources. ANTT is not for sale or for use in conjunction with commercial purposes. The-ASAP provide a number of free core ANTT resources to help disseminate and train healthcare staff. The- ASAP requests that the balance it determines between free dissemination and protection of the standard is respected in the interests of patient safety. Disclaimer: The-ASAP provides the ANTT Clinical Practice Framework and ANTT Clinical Guidelines to healthcare organizations in good faith in a collaboration to promote effective aseptic technique. It is the responsibility of healthcare organizations to implement ANTT effectively. No guarantee or responsibility for the application or outcome of clinical practice can be, or is, assumed or accepted by The-ASAP/ANTT.
    [Show full text]
  • Year 11 GCSE History Paper 1 – Medicine Information Booklet
    Paper 1 Medicine Key topics 1 and 2 (1250-1500, 1500-1700) Year 11 GCSE History Paper 1 – Medicine Information booklet Medieval Renaissance 1250-1500 1500-1750 Enlightenment Modern 1900-present 1700-1900 Case study: WW1 1 Paper 1 Medicine Key topics 1 and 2 (1250-1500, 1500-1700) Key topic 1.1 – Causes of disease 1250-1500 At this time there were four main ideas to explain why someone might become ill. Religious reasons - The Church was very powerful at this time. People would attend church 2/3 times a week and nuns and monks would care for people if they became ill. The Church told people that the Devil could infect people with disease and the only way to get better was to pray to God. The Church also told people that God could give you a disease to test your faith in him or sometimes send a great plague to punish people for their sins. People had so much belief in the Church no-one questioned the power of the Church and many people had believed this explanation of illness for over 1,000 years. Astrology -After so many people in Britain died during the Black Death (1348-49) people began to look for new ways to explain why they became sick. At this time doctors were called physicians. They would check someone’s urine and judge if you were ill based on its colour. They also believed they could work out why disease you had by looking at where the planets were when you were born.
    [Show full text]