Control of Communicable Diseases

Identifying agencies responsible for control and prevention of communicable diseases

7.03 Patients with Infectious Disease The center adheres to infection control policies to ensure the safety of patients, physicians, and staff members. Patients who are currently being treated for an infectious disease or condition that is transmitted via the contact route may not be treated at the center. Patients with disease spread via droplet (e.g. influenza) or airborne (e.g. tuberculosis, measles) routes will reschedule their procedures in consultation with their physicians. The infection control nurse, in consultation with the infection control consultant, will determine whether the patient requires isolation or other additional precautions. If a patient with current Clostridium difficile-associated diarrhea is treated at the center, all rooms where the patient was housed, even briefly, should be cleaned by housekeeping under supervision of the staff at the center. Physicians must document relevant information in their pre-admission documentation. Standard Precautions will be followed in the care of all patients. Cigarroa Interventional Institute establishes policies to ensure compliance with infection control policies for the care of patients with drug-resistant organisms. The physician will screen patients through the medical history review prior to scheduling a patient at the center. During the pre-operative (pre-op) phone call or interview, a pre-op screening of the patient will be conducted. Strict isolation policies are required to treat patients with active MRSA, VRSA, or tuberculosis. Since this facility has no provisions for strict isolation, those patients with active infections will be referred elsewhere for treatment. Patients who are undergoing or completed a course of antibiotic therapy, are colonized and/or are not actively infected may be treated at the center. Patients with active infections requiring transmission-based precautions are not appropriate candidates for this facility and will be referred to another facility or rescheduled. Procedures cannot be scheduled for patients currently undergoing an infection with transmission based precautions. The patient must finish the course, and they will be rescheduled. Definitions and Standards: The following definitions and standards are provided for informational purposes only: Airborne Transmission and Precautions: This mode of transmission occurs by the spreading of either airborne droplet nuclei (small particle residue of 5 microns or smaller), of evaporated droplets which contain microorganisms that remain suspended in the air for long periods of time) or dust particles containing microorganisms. Patients must be isolated in private rooms with special air handling and ventilation, and the door must remain closed. Patient transport should be restricted to essential transport only. Respiratory precautions must be taken when in the presence of patients with active tuberculosis, including respiratory masks. Droplet Transmission and Precautions: Droplets are transmitted from the host source by coughing, sneezing, talking, or during procedures such as suctioning or bronchoscopy. Patients must be isolated, and a distance of 3 feet maintained between the infected patient and others. Caregivers within 3 feet of the patient should wear a mask. Patient transport should be minimized. Contact Transmission and Precautions: Direct contact transmission involves direct body surface to body surface contact with physical transfer of microorganisms between a susceptible host and an infected person. Indirect contact transmission involves contact with an intermediate object (usually inanimate) and a susceptible host. Patients should be isolated as much as possible. Gloves and hand washing are essential for all contact with the patient and contact with objects, which come in contact with the patient. Gloves should be changed after each contact. Reportable Condition If the patient is determined to have a reportable condition at any time during pre-admission, the Director of Operations/Nurse Manager will be notified. The procedural physician will be contacted and the case will be canceled. The Department of Health will also be notified the same day following state regulations regarding Reportable Communicable Diseases. To report a disease or condition, contact: The City of Laredo Epidemiology 24/7 Reporting Line: (956) 763-2915, if unable to report locally, call The Texas Departmrent of Health Services epidemiology program: 24/7Number for Immediately Reportable – 1-800-705-8868

7.018 Safe Injection Practices (Refer to 7.07 Safe Injection Policy) Environment of Care: Active participation with all identified projects to assess compliance with infection control standards. . Surveillance, Control, and Reporting includes: Baseline information about the frequency and type of nosocomial infections. Identification of patients and/or staff with communicable or potentially communicable infections. Patients identified with a communicable disease will be isolated from other patients in the facility or, if this is not possible, they will be transferred to a local hospital for care or rescheduled. Identification of clusters of microorganisms or significant deviations from endemic level. Reporting to committees and outside agencies, when required. Investigation of infections as needed. Immediate implementation of corrective and preventive measures that result in improvements. The Infection Control nurse or designated staff member will perform facility audits and report results to the QI committee and Board of Managers. EVALUATION Evaluation and improvement of the infection prevention and control activities are important steps in the Center’s efforts to control and prevent infection. Infection prevention and control practices should become a routine part of the care, treatment, or services the center provides to patients. Patients expect and deserve hygienic and safe care even if their contact with the Center does not extend beyond a single visit. Continuous review of the goals, activities, and outcomes of the Center’s initiative are therefore followed by improvement activities that are realistic in expectation and, above all, effective. Evaluation of the plan shall include but not be limited to: Evaluation of the infection prevention and control activities annually and whenever risks significantly change. The evaluation includes a review of the following: The infection prevention and control prioritized risks The infection prevention and control goals. Implementation of infection prevention and control Outcomes of infection prevention and control activities. Findings from the evaluation are communicated at least annually to the Quality Management Committee References: http://oneandonlycampaign.org/content/what-are-they-why-follow-them. Centers for Disease Control and Prevention (CDC). (2004). Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Settings. Retrieved January 29, 2015 from www.cdc.gov/niosh/topics/bbp/sharps.html. Centers for Disease Control and Prevention (CDC). (2003). Guidelines for Environmental Infection Control in Health-Care Facilities 52(RR10);1-42. Retrieved January 29, 2015 from http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5210a1.htm. Centers for Disease Control and Prevention (CDC). (2002). Guideline for Hand Hygiene in Health-Care Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR. 51(RR-16). Retrieved January 29, 2015 from http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5116a1.htm. Centers for Disease Control and Prevention (CDC). (2008). Sharps Safety Workbook. Retrieved April 24 2014 from http://www.cdc.gov/sharpssafety/pdf/workbookcomplete.pdf. Guideline for Infection Control in Healthcare Personnnel available at: Guideline for Infection Control in Healthcare Personnel available at: http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf Immunization of HealthCare Personnel, guidance available at: http://www.cdc.gov/vaccines/spec-grps/hcw.htm Occupational Safety & Health Administration (OSHA) Bloodborne Pathogens and Needlestick Prevention Standards available at: http://www.osha.gov/SLTC/bloodbornepathogens/index.html Sax H, et al. (2007). My five moments for hand hygiene: A user-centered design approach to understand, train, monitor and report hand hygiene. For the World Health Organization. J Hosp Infect 67(1):9–21. World Health Organization (WHO). (2005). World Alliance for Patient Safety. WHO Guidelines on Hand Hygiene in Health Care. Retrieved January 29 , 2015 from http://www.who.int/patientsafety/events/05/HH_en.pdf.

7.012 Employee Health The Center provides a safe working environment for all employees through a collaborative effort with them and the organization’s infection control program to identify infectious conditions that may put staff, patients and visitors at risk. Health evaluations, immunity testing for measles, mumps rubella and chickenpox, tuberculosis screening and immunity testing for hepatitis B and if not immune either signs declination form or accepts 3 dose vaccine series. (Rrefer to the Employee and Occupational Health Section policy Chapter 3.21) It is the center’s policy to monitor Health Care Associated Infections (HAI) in patients and personnel working in the Center as part of its ongoing program in Infection Prevention and Control. Staff should be encouraged to stay home when they have signs and symptoms of an infectious disease. If a staff develops signs and symptoms while at work, the person of other personnel and patients who may have been exposed to a staff member with a communicable disease should be taken into consideration. Patients and personnel can be told that they were exposed to a certain disease without disclosing the index case’s identity. In addition we work together to provide an annual influenza vaccination program that includes all staff who have patient contact, and licensed independent practitioners. Environmental Rounds - Environmental rounds are performed daily by assigned staff members, ie. “safety officer”. Feedback on opportunities for improvement is given to the Infection Control Coordinator and QAPI committee and then reported to the board Education – Employee education includes: General information about infections Techniques for prevention, surveillance, investigation and control Review of policies and procedures related to infection control: (See attachment B, policy and procedure reference list) Employee health practices; refer to Administration 3.16 Orientation and Training Offer of Hepatitis B vaccination & post exposure evaluations Annual TB skin testing Provides access to influenza vaccinations. Educates staff and licensed independent practitioners about influenza vaccination; non-vaccine infection control measures (such as the use of Droplet Precautions); and diagnosis, transmission, and potential impact of influenza. Annually evaluates vaccination participation and non-participation in the influenza immunization program and reports to Department of Health.

New Trends in Agriculture Extension approaches Extension has been, and still is, under attack from a wide spectrum of politicians and economists over its cost and financing. As a result, Extension Systems have had to make changes, by restating the system’s mission, developing a new vision for the future, and formulating plans for the necessary transition to achieve the desired change. 1. Privatization of Agricultural Extension Service Privatization: Process of funding and delivering the extension services by private individual or organization is called Private Extension. Concept: Privatization of extension refers to services rendered in rural area & allied aspects of extension personnel working in private agencies or organization for which farmers are expected to pay a fee & it can be viewed as supplementary or alternative to public extension services (Sarvanan & Shivalinge 1980). Privatization approaches ➢ Share cropping system ➢ Village extension contract system ➢ Public extension through private delivery ➢ Service for vouchers Strengths of Private Extension System ➢ More demand - driven rather than supply – driven ➢ High quality of services in terms of satisfying information needs of clientele, trained manpower, sustained finances and resource allocation ➢ Provides for an information mix and choices available to farmers ➢ Enhanced efficiency of staff ➢ Assure continuous supply and quality agricultural products ➢ More effective because farmer can select an adviser who is the best able to help ➢ Healthy competition among service provider will lead to better quality and lower costs for service Weakness of Private Extension System ➢ Concentrate on area having favorable physical environment ➢ More face-to-face contacts (person oriented) ➢ Increased dependence of farmers and hence exploitation ➢ No education role ➢ Deprivation of small farmers ➢ Hamper the free flow of information 2. Cyber Extension or e-extension Concepts Cyber space: it is the imaginary or virtual space of computers connected with each other on Networks, across the Globe. Cyber extension: it means 'using the power of online networks, computer communications and digital interactive multimedia to facilitate dissemination of agriculture technology. Cyber Extension thus can be defined as the extension over cyber space. Important tools of cyber extension E-Mail, Telnet, File Transfer Protocol (FTP), Gopher, Archie and World Wide Web (WWW) Strengths of Cyber Extension ➢ Access to the astounding information and continuously available ➢ Information rich and instantaneously available of information ➢ Interactive communication ➢ The information is available from any point on the globe ➢ Communication is dynamic ➢ Cut steps from traditional process ➢ Save money, time and effort ➢ Multiplicity of purpose Issues and Concerns of Cyber Extension ➢ Lack of Reliable Telecom Infrastructure in Rural Areas ➢ Erratic or no Power Supply ➢ Lack of ICT Trained manpower (willing to serve) in Rural Areas ➢ Lack of content (locally relevant and in local languages) ➢ Lack of Information Services to Rural Clientele ➢ Low Purchasing power of the Rural communities ➢ Lack of Holistic Approaches ➢ Issues of Sustainability Application of cyber extension ➢ Village information shops Dr. M.S. SwaminathanResearch Foundation, Chennai ➢ Information villagers MANAGE in Ranga Reddy District in Andhra pradesh ➢ Gyandoot net initiative of District Dhar, Madhya Pradesh. ➢ Warna wired village of National Informatics Center (NIC) in Kolhapur- Sangli Districts of Maharashtra 3. Market-Led-Extension (MLE) Concepts Market: A congregation of prospective buyers & sellers with a common motive of trading a particular commodity. Extension: It is the spreading/reaching out to the mass Market-led-extension: Agriculture & economics coupled with extension is the perfect blend for reaching at the door steps of common man with the help of technology. Dimensions of market-led extension ➢ Marketing mix: A planned mix of the controllable elements of a product's marketing plan commonly termed as 4Ps: product, price, place, and promotion. These four elements are adjusted until the right combination is found that serves the needs of the product's customers, while generating optimum income. ➢ Marketing plan: A marketing plan is a comprehensive document that outlines a business and marketing efforts for the coming year. It describes business activities involved in accomplishing specific marketing objectives within a set time frame. A marketing plan also includes a description of the current marketing position of a business, a discussion of the target market and a description of the marketing mix that a business will use to achieve their marketing goals. ➢ Market Intelligence: It is the information relevant to a company’s markets, gathered and analyzed specifically for the purpose of accurate and confident decision making. Market intelligence includes the process of gathering data from the company’s external environment, whereas the business intelligence process is primarily based on internal recorded events – such as sales, shipments and purchases. ➢ Market oriented production ➢ Use of Technology Strengths of market-led extension ➢ SWOT analysis of the market ➢ Organization of Farmers’ Interest Groups (FIGs) ➢ Enhancing the interactive and communication skills of the farmers ➢ Establishing marketing and agro-processing linkages ➢ Advice on product planning ➢ Educating the farming community ➢ Direct marketing ➢ Acquiring complete market intelligence ➢ Publication of agricultural market information Production of video films of success stories ➢ Challenges to market-led extension ➢ Gigantic size of extension system ➢ Information technology Diverse conditions ➢ Market intelligence ➢ Reforms in agricultural extension system Government Initiatives ➢ Central warehousing Corporation-1965 ➢ MSP by Commission for Agricultural Cost and Price (CACP) ➢ Food Corporation of India ➢ Then some others as: Cotton Corporation of India (CCI), Jute Corporation of India (JCI), National Dairy Development Board (NDDB), Agriculture and Processed food Export Development Authority (APEDA) etc. 4. Farmer--Led-Extension (FLE) Farmer--led-extension is defined as 'the provision of training by farmers to farmers, often through the creation of a structure of farmer promoters and farmer trainers' (Scarborough et al., 1997). Philosophy and principles ➢ Farmers and local institutions (e.g. producer organizations or village leaders) should play a key role in selecting farmer-trainers and monitoring and evaluating them. This helps make the programmes more accountable to the community or groups that they serve. ➢ Farmer-trainers are ‘of the community’; they communicate in local languages and are more sensitive to local cultures, mannerisms, farming practices, and farmers’ needs. ➢ Farmer-trainers should be selected on the basis of their skills and interest in sharing information, not just on their farming expertise. ➢ Farmer-trainers need strong linkages with and support from development agents (whether government, non-government organization (NGO), or private), the people who train and backstop them. Farmer-trainers generally serve as a complement to existing extension systems, rather than being a substitute for them. ➢ Facilitating organizations and local institutions need to be proactive in ensuring that women as well as men become farmer-trainers. ➢ Simple and appropriate reference materials should be made available to the farmer trainers. Essential Elements of Farmer--led-extension ➢ The group ➢ The Field ➢ The Facilitator ➢ The curriculum ➢ Programme leader ➢ Financing Special features of Farmer--led-extension ➢ All learning is field based & it is primary venue for learning ➢ FLE group learning constantly over the experimentation period ➢ FLE promotes healthy decisions & quality decisions ➢ Farmers conduct their own field studies with comparisons or treatments ➢ Facilitates Farmer-to-Farmer communication ➢ Field staff serve as facilitators ➢ FLE is a unique way to educate farmers ➢ It is an effective platform for sharing of experiences and collectively solving agriculture related problems. 5. Expert system Expert system is an intelligent computer program that uses knowledge and inferences procedures to solve problems (Daniel Hunt, 1986). Objectives of developing expert system ➢ To enhance the performance of agricultural extension personnel and farmer ➢ To make farming more efficient and profitable ➢ To reduce the time required in solving the problems ➢ To maintain the expert system by continuously upgrading the database Advantages of expert system ➢ Solves critical problems by making logical deductions without taking much time ➢ It combines experimental and conventional knowledge with the reasoning skills of specialists ➢ To enhance the performance of average worker to the level of an expert Limitations of expert system ➢ Expensive computer program ➢ Mostly developed not in regional languages ➢ Requires AC power and internet connection all the time ➢ Complex software requires computer skilled personnel Modules of expert system in agriculture ➢ COMAX: Integrated crop management in cotton ➢ SOYEX: Soybean oil extraction expert system ➢ PLANT/ds: Diagnosis of soybean diseases ➢ MAIZE: Maize expert system for field crop management ➢ SEMAGI: Weed control decision making in sunflowers ➢ Rice Crop Doctor: Developed by National Institute of Agricultural Extension Management (MANAGE) Difference between conventional and expert system of extension Conventional Extension ➢ Universal approachability of same information is a problem ➢ Information is given whatever is available without considering needs and resources ➢ No Cost benefit analysis ➢ Information flow depends on availability of agent ➢ Require users to draw their own conclusion from facts Expert System of Extension ➢ Universal approachability of same information is possible ➢ Information is chosen based on their needs and resources ➢ Cost benefit analysis ➢ Information through Cyber Cafe at any place at any time ➢ Conclusion is drawn based on the decision given by the expert

Health 11/12 Review for Final Exam Core Concepts - Mental and Emotional Health, Substance Abuse Prevention, Safety and Violence Prevention, Family Life and Human Sexuality, Disease Prevention and Control, Healthy Eating Health Education Skills - goal setting, decision making, accessing information/resources, analyzing influences, communication, self-management, advocacy DIMENSIONS of Wellness - social, spiritual, emotional/mental, environmental, financial, intellectual, multicultural, occupational, physical, sexual RISK factors - anything that increases the risk of disease, injury, or illness. PROTECTIVE factors - anything that decreases the risk of disease, injury, or illness. INTERNAL health factors - health factors that can be either hereditary and genetic or acquired elements -- include smoking and personal diet or eating habits. Example – a genetic predisposition to an illness. EXTERNAL health factors - health factors that are part of the direct outer environment, the geographical location, micro-organisms, socio-economic elements that could affect an individual's health. Example – being unable to afford mental health services. Unit 1- Managing Personal and Community Wellness Explain Maslow’s Hierarchy of Needs in your own words using the image provided. Explain how each Social Determinant of Health may impact a person’s health. Levels of Disease Prevention • PRIMARY The goal is to avoid conditions altogether. • SECONDARY The goal is early detection. • TERTIARY The goal is to minimize the damage (manage). Define the following terms. Fads/Trends Sleep hygiene Driver safety Unit 2- Investigating Social Ecological Factors on Well-Being Socio-Ecological Model – The SEM examines how health behaviors form based on characteristics of individuals, communities, nations and levels in between. Each level overlaps with other levels signifying how the best public health strategies are those that encompass and target a wide range of perspectives. Interpersonal (personal) health vs. intrapersonal (relationship) health Health INEQUITY - systemic, ingrained and unjust barriers that prevent segments of the population from having the opportunity of health leading to health disparity. IMPLICIT BIAS - a form of bias that occurs automatically and unintentionally, that nevertheless affects judgments, decisions, and behaviors. Research has shown implicit bias can contribute to unequal access to quality healthcare, negative patient-provider relationships and interactions; and create mistrust in the healthcare system and practitioners among patients. This can contribute to health disparities. Health DISPARITY - represents a difference in health between populations. It is often used to describe disease burden and other negative health outcomes socially disadvantaged groups may face. Health EQUITY - The opposite of health inequity. It describes a system that supports a high standard of health and healthcare for all people. Racism - Beliefs, attitudes, institutional arrangements, and acts that tend to denigrate individuals or groups because of phenotypic characteristics or ethnic group affiliation. DISCRIMINATION - An unjust differential treatment of a person or a group. PRIVILEGE- The unearned access to resources and social power that are only available to some because of their membership within certain social groups. OPPRESSION is the act of taking away choices from others and can be defined as a system that maintains advantage and disadvantage based on social identities and that acts on multiple levels from interpersonal to institutional and societal. (internalized, interpersonal, institutional, structural) Systematic Oppression - Intentional disadvantage of groups of people based on their identity while advantaging members of dominant group (race, gender, sexual orientation, language, size, ability, etc.). Intersectionality - The complex, cumulative way in which the effects of multiple forms of discrimination (such as racism, sexism, and classism) combine, overlap, or intersect especially in the experiences of marginalized individuals or groups Unit 3- Accessing Resources and Communicating to Support Mental and Emotional Health What is anger? What is anxiety? What is stress? STRESSORS are the things that cause stress. Stressors can be internal and external. A stressor may be a one-time or short-term occurrence, or it can happen repeatedly over a long time. INTERNAL Stressors - are made by your belief system and the way you evaluate yourself. Examples include pessimistic attitude, negative self-talk, deep need to be perfect, low self-esteem or body image, unhealthy standards for self. EXTERNAL Stressors - are stressful things that happen in your surroundings and/or in your environment. Examples include busy schedules, work problems, family issues, financial trouble, social problems, injury, unforeseen circumstances. Socio-economic issues are also a part of external stressors such as poverty, violence, and racism. Define the following mental health conditions. Depression Eating disorders NSSI Non-suicidal self-injury Grief/Loss Suicide prevention A.C.T. • ACKNOWLEDGE- Tell them in a caring way that you recognize that they are having a problem • CARE- You can show you care by actively listening - put away anything else you are doing, make eye contact, sit down, ask questions. • TELL-(call 988 for additional help and support) - Tell them it is important that they speak with a trusted adult. Help them figure out who this may be and offer to go with your friend. A social norm is an unwritten, informal rule meant to guide behavior among the of society. It distinguishes between acceptable and unacceptable, good and bad, and so on. Social norms can influence a person with emotional or mental health disorders, access to care and stigmatize their situation. STIGMA- a mark of disgrace associated with a particular circumstance, quality, or person. • Self-stigma - This describes the internalized stigma that people with mental health conditions feel about themselves. • Public stigma - This refers to the negative attitudes around mental health from people in society. • Institutional stigma - This is a type of systemic stigma that arises from corporations, governments, and other institutions. Unit 4- Evaluating Risks of Substance Use and Abuse Harm Reduction - a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Explain how each level of the Social Ecological Model is impacted by addiction. Individual Relationship Community Society SEM Level Contributing/Risk Factors to substance use Preventative/Protective Factors for substance use Individual Interpersonal/Relationship Community Society Unit 5- Analyzing Influences to Examine Ways to Increase Safety and Reduce Violence HATE CRIME - a crime, usually violent, motivated by prejudice or intolerance toward an individual’s national origin, ethnicity, color, religion, gender, gender identity, sexual orientation, or disability. Explain how the media influences violence in society. The Pyramid of Hate Explain the escalation of hate using the Pyramid of Hate visual. List several hate crime motivators. Example: age HEALTHY Relationship Signs - comfortable pace, trust, honesty, independence, respect, equality, kindness, taking responsibility, healthy conflict, fun UNHEALTHY Relationship Signs - intensity, possessiveness, manipulation, isolation, sabotage, belittling, guilting, volatility, deflecting responsibility, betrayal Sexual Assault is a sexual behavior WITHOUT consent. Human trafficking - the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, using force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery. Sex trafficking - commercial sex act induced by force, fraud, or coercion, or in which the person induced to perform such an act has not attained 18 years of age. Trafficking happens using… • Force - using violence to control someone. • Fraud - using lies to control someone. • Coercion - using threats to control someone. Unit 6- Family Life and Human Sexuality Agency - A belief about yourself and the extent to which you can act on that belief. • The ability to choose freely one’s own narrative. • To embrace the idea that I am the cause (or agent) of my own thoughts and actions. • Personal agency is a personal responsibility for who we are, what we experience, what we do about that experience, and how we shape our world to give us more of the experiences we want. SEXUAL Agency • The ability to choose your own interests and desires vs. what we see in the media or others’ perceptions • The ability to identify, communicate, and negotiate one’s sexual needs • The ability to initiate behaviors that allow for the satisfaction of those needs Sexually Explicit Material - photographs, videos, films, magazines, and books whose primary themes, topics, or depictions involve sexuality that may cause sexual arousal. Sexual scripts - thoughts, patterns, or behavior that a person has about themselves in a romantic or sexual context. It is how people picture themselves or want to project themselves in front of others. Reproductive Rights of Teens - In Maryland, teens have the right to an abortion, keep their child, obtain and use birth control, paternity tests, adoption, give up custody of their child within 10 days of birth (Safe Haven Law). • REPRODUCTIVE RIGHTS- legal rights and the freedom of the individual to control decisions regarding contraception, abortion, sterilization and childbirth. • SAFE HAVEN LAW- a distressed parent who is unable or unwilling to care for their infant can safely give up custody of their baby, no questions asked. CONSENT is an agreement between participants to engage in sexual activity. • It is clearly and freely communicated, verbal, and affirmative. Consent CANNOT be given if… • A person is underage, one or both partners is intoxicated or incapacitated by drugs or alcohol, one partner is asleep or unconscious, one partner feels pressured, threatened or intimidated, or one partner holds a position of power or authority over the other. Unit 7- Advocating for Enhanced Nutrition, Food Systems, and Health Outcomes Dietary Guidelines for Americans Guideline 1: Follow a Healthy Dietary Pattern at Every Life Stage Guideline 2: Customize and Enjoy Food and Beverage Choices to Reflect Personal Preferences, Cultural Traditions, and Budgetary Considerations Guideline 3: Focus on Meeting Food Group Needs with Nutrient-Dense Foods and Beverages, and Stay Within Calorie Limits Guideline 4: Limit Foods and Beverages Higher in Added Sugars, Saturated Fat, and Sodium, and Limit Alcoholic Beverages FOOD DESERT- a neighborhood where there is little or limited access to healthy and affordable food such as fruits, vegetables, whole grains, low-fat milk and other foods that make up the full range of a healthy diet. FOOD INSEQURITY lack of access to a sufficient amount of food because of limited funds. More than 49 million American households are considered food insecure and are vulnerable to poor health as a result. PROCCESED FOODS- any raw agricultural commodities that have been washed, cleaned, milled, cut, chopped, heated, pasteurized, blanched, cooked, canned, frozen, dried, dehydrated, mixed or packaged — anything done to them that alters their natural state.

7.017 Fingernail Policy for ASC Personnel with Direct Patient Contact The surgical center applies this policy equitably and inclusively, and management expects staff to do so in good faith. Purpose: To prevent infection by ensuring proper hand and nail hygiene among ASC staff with direct patient contact. Policy: All ASC staff with direct patient contact must maintain clean and well-groomed fingernails and a healthy hand skin condition. Artificial Nails The ASC defines Artificial nails as press-on, extenders, studs, stones, or other objects positioned on top of the natural nail that are elevated and irregular. These are not allowed as they can be a potential source of infection and can also inhibit proper hand hygiene. Nail Enhancements The ASC defines Nail enhancements as nail paint, gel, and shellac. These are allowed, as evidence against them is weak/moderate and inconsistent, as long as they are undamaged, free of chipping, adequately maintained, and do not interfere with proper hand hygiene, job performance, or glove integrity. Staff must ensure that their nails are trimmed, clean, rounded, and at a length that does not inhibit them from performing their duties or putting themselves or their patient at risk for exposure. Staff must wash their hands with soap and water or use an alcohol-based hand rub before and after each patient encounter and after any activity that may contaminate the hands. Staff must report any cuts, sores, or other skin conditions that may prevent them from maintaining proper hand hygiene to the supervisor. Implementation: The infection Control Nurse or designee will educate staff on hand and nail hygiene, proper hand-washing techniques, and alcohol-based rubs. Supervisors will monitor staff compliance with the policy and provide corrective action as needed. The ASC will provide hand hygiene products and education materials for staff. Evaluation: The infection Control Nurse or designee will evaluate the effectiveness of this policy annually and through regular staff education and monitoring of staff compliance. Nurses are reminded of the standards of nursing practice specified in 22 Texas Administrative Code Rule 217.11 (B)(O), which includes Implementing measures to promote a safe environment for clients and others and Implementing measures to prevent exposure to infectious pathogens and communicable conditions. Reference: AORN INC. (2022). Guidelines for perioperative practice.

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