Measures of Center and Variability

Summarize numeric data with numerical summaries, including the mean and median (measures of center) and the range and interquartile range (IQR) (measures of spread), and use these summaries to describe the center, spread, and shape of the data distribution 6.12(D) summarize categorical data with numerical and graphical summaries, including the mode, the percent of values in each category (relative frequency table), and the percent bar graph, and use these summaries to describe the data distribution

Make three questions based on the passage:"The International Labor Organization says the number of people without jobs is increasing. In its latest update on global employment trends, the agency says projections of the number of unemployed people this year range from 210 million to nearly 240 million people. The report warns that 200 million poor workers are at risk of joining the ranks of people living on less than 2 dollars per day in the past three years. The director general of the International Labor Organization Juan Somavia notes that some countries have taken measures to address the effects of the global crisis. However, he points out that many countries have not done so. And based on past experiences, it takes four to five years after economic recovery for unemployment to return to pre-crisis levels. Mr. Somavia says the International Labor Organization is proposing a global jobs' agreement to deal with unemployment. “Its key objective is to place the center of recovery efforts—measures that would generate high levels of employment and provide basic social protection for the most vulnerable."The International Labor Organization says the number of people without jobs is increasing. In its latest update on global employment trends, the agency says projections of the number of unemployed people this year range from 210 million to nearly 240 million people. The report warns that 200 million poor workers are at risk of joining the ranks of people living on less than 2 dollars per day in the past three years. The director general of the International Labor Organization Juan Somavia notes that some countries have taken measures to address the effects of the global crisis. However, he points out that many countries have not done so. And based on past experiences, it takes four to five years after economic recovery for unemployment to return to pre-crisis levels. Mr. Somavia says the International Labor Organization is proposing a global jobs' agreement to deal with unemployment. “Its key objective is to place the center of recovery efforts—measures that would generate high levels of employment and provide basic social protection for the most vulnerable."

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.

hysical features of Southeast Asia The physiography of Southeast Asia has been formed to a large extent by the convergence of three of the Earth’s major crustal units: the Eurasian, Indian-Australian, and Pacific plates. The land has been subjected to a considerable amount of faulting, folding, uplifting, and volcanic activity over geologic time, and much of the region is mountainous. There are marked structural differences between the mainland and insular portions of the region. Mainland Southeast Asia The mainland is characterized by a series of generally north–south-trending mountain ranges separated by a number of major river valleys and their associated deltas. In many ways these ranges resemble ribs in a fan, where the interstices are deep trenches carved by the rivers. Although the mainland as a whole is similar in a structural sense, its various geologic components and the time periods of their orogenic (mountain-building) episodes differ. Much of the region has been affected by the gradual, continuing collision of the Indian subcontinent with the Eurasian Plate over roughly the past 50 million years, an event that—with diminishing intensity from west to east—has been responsible for deforming the land. Nonetheless, mainland Southeast Asia is relatively stable geologically, with no active or recently active volcanoes and, except in the northwest and north, little seismic activity. The ranges fan out southward from the southeastern corner of the Plateau of Tibet, where they are tightly spaced. A major rib of this system extends through the entire western margin of Myanmar (Burma); describing an elongated letter S, it consists of (from north to south) the Pātkai Range, Nāga Hills, Chin Hills, and Arakan Mountains. Farther to the south the same rib emerges from beneath the sea to become the Andaman and Nicobar Islands of India. Another major system extends along a straight north-south axis from eastern Myanmar east of the Salween River through northwestern Thailand to south of the Isthmus of Kra on the Malay Peninsula. It consists of a series of elongated blocks rather than one continuous ridge. The core of these blocks is granite, which has intruded into previously folded and faulted limestone and sandstone. The altitudes of the ranges diminish from above 8,000 feet (2,440 meters) on the Chinese border in the north to below 4,000 feet on the Isthmus of Kra, and the ranges are spread farther apart toward the south. The easternmost major mountain feature on the mainland is the Annamese Cordillera (Chaîne Annamitique) in Laos and Vietnam. In the portion between Laos and Vietnam, the chain forms a nearly straight spine of ranges from northwest to southeast, with a steep face rising from the South China Sea to the east and a more gradual slope to the west. The mountains thin out considerably south of Laos and become asymmetrical in form. The upland zone is characterized by a number of plateau remnants. The rather neat fanlike pattern of the mountain ranges is interrupted occasionally by several old blocks of strata that have been folded, faulted, and deeply dissected. These ancient massifs now form either low platforms or high plateaus. The westernmost of these, the Shan Plateau of eastern Myanmar, measures some 250 miles (400 km) from north to south and 75 miles from east to west and has an average elevation of about 3,000 feet. The largest of these features is the Korat Plateau in eastern Thailand and west-central Laos. This area actually is more of a low platform, which on average is only a few hundred feet above the floodplains of the surrounding rivers. It consists of a string of hills that direct surface drainage eastward to the Mekong River. The hills range in elevation from 500 to 2,000 feet, with the highest altitudes occurring near the southwestern rim. The broad river valleys between the uplands and the even wider deltas at the southernmost points contain most of the mainland’s lowland areas. These regions generally are covered with alluvial sediments that support much of the mainland’s cultivation and, in turn, most of its population centers. The most extensive coastal lowland is the lower Mekong basin, which encompasses most of Cambodia and southern Vietnam. The Cambodian portion is a broad, bowl-shaped area lying just above sea level, with numerous hill outcrops jutting above the landscape; at its center is a large freshwater lake, the Tonle Sap. To the south the river’s vast, flat delta occupies the entire southern tip of Vietnam. Outside the river deltas, the coastal lowlands are little more than narrow strips between the mountains and the sea, except around the southern half of the Malay Peninsula. The Malay Peninsula stretches south for some 900 miles from the head of the Gulf of Thailand (Siam) to Singapore and thus extends the mainland into insular Southeast Asia. The narrowest point, the Isthmus of Kra (about 40 miles wide), also roughly divides the peninsula into two parts: the long linear mountain ranges of the northern part described above give way just south of the isthmus to blocks of short, parallel ranges aligned north-south, so that the southern portion trends to the southeast and becomes much wider. In areas such as the west coast between southern Thailand and northwestern Malaysia, distinctive karst-limestone landscapes have developed. Peaks on the peninsula range from 5,000 to 7,000 feet in elevation.

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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