Bruce A. Fenderson, PhD

• Professor of Pathology, Department of Pathology, Anatomy, and Cell Biology, Jefferson Medical College,
• Thomas Jefferson University, Philadelphia, Pennsylvania

A Method for Detecting and Characterizing Outbreaks of Infectious Disease from Clinical Reports erectile dysfunction treatment bangalore order 50 mg suhagra fast delivery. Detecting the start of an influenza outbreak using exponentially weighted moving average charts erectile dysfunction treatment mn purchase suhagra us. Detection of epidemics in their early stage through infectious disease surveillance buy erectile dysfunction pills online uk buy suhagra 50mg low cost. Infectious Disease Informatics: Syndromic Surveillance for Public Health and BioDefence: Springer Science; 2010 impotence tumblr order generic suhagra line. Hand, foot and mouth disease in China: evaluating an automated system for the detection of outbreaks. Applying cusum-based methods for the detection of outbreaks of Ross River virus disease in Western Australia. Syndromic Surveillance for Emerging Infections in Office Practice Using Billing Data. Personal information Workplace Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Thailand Current positions Medical Doctor, Professional Level Graduate student, Division of Health Sciences Informatics. Johns Hopkins University School of Medicine Telephone:14434805518, +66819100146 Email:sthawil1@jhmi. Ferry boat injuries and death in Pattaya, November 2013; Its time for Thailand to reclaim its safe travelling. Dengue cluster investigation in two districts, Ubon Ratchathani, January-July 2013:Epidemiological characteristics and key vector containers. Thailand conference Poster presentation Presented Dengue cluster investigation in two districts, Ubon Ratchathani, January-July 2013:Epidemiological characteristics and key vector containers at the 22nd National Epidemiology Seminar, February 2015. Lead exposure surveillance, prevention and eradication in preschool child committee, 2015, Department of Disease Control, Ministry of Public Health, Thailand Medical Consultant Committee Member 4. Driver license examination revision committee 2015, Department of Land Transport, Ministry of Transport, Thailand Medical Consultant Surveillance system evaluation 46 Data analysis and management team leader 1. Malaria Surveillance System Evaluation, Ubon Ratchathani, Thailand, 2014 Outbreak Investigator Principal Investigator 1. An Investigation of Influenza A H1N1 (2009)deaths, Chiang Dao District, Chiang Mai 4. Meningococcemia in Prison, Nonthaburi Teaching Assistance) Short Course and Seminar(Data analysis workshop, the 22nd National Epidemiology Seminar, 2-3 Feb 2015 Prepare Assignment and Application Help Participant for Technical Problem Invited instructor Presented the example of injury investigation to Marine Officers, Kanchanaburi. Single versus Multiple Defects among Live Births and Stillbirths 28 Pregnancy Outcome Comparison Figure 2. Prevalence of Birth Defects by Plurality of Live Births and Stillbirths 37 Table 6. Plurality of All Live Births and Births Defect Cases, Live Births Only 44 Figure 4. Prevalence of Selected Birth Defects by Plurality among Live Births and Stillbirths 45 Table 7. Prevalence of Selected Birth Defects by Sex of Infants among Live Births and Stillbirths 46 Table 8. Prevalence of Birth Defects by Maternal Race / Hispanic Ethnicity for Live Births 76 Table 12. Researchers are looking at a wide variety of environmental exposures and risk factors as possible causes. Because most of the structural development of the fetus occurs during early pregnancy, studies usually focus on the periconceptional period, the month before and three months after conception. For the developing pregnancy, the environment includes any exposures to the fetus as well as any exposures to the mother. The Massachusetts combined lifetime costs for babies born with any of 12 major structural birth defects are an estimated $122 million in 2003 dollars (Harris, 1997; see Technical Notes for inflation adjustment). These figures include direct costs of medical treatment, developmental services and special education, as well as indirect costs to society for lost wages due to early death or occupational limitations. Over the past ten years, the Massachusetts Center for Birth Defects Research and Prevention has developed and refined its surveillance program. The first full year of population-based, active statewide surveillance data was 1999. The primary focus of the state surveillance system is the identification of major structural birth defects, with or without a chromosomal abnormality, and non-chromosomal malformation syndromes. Inborn errors of metabolism are monitored separately by the state newborn screening program. This report presents statewide data on the prevalence of birth defects in live births and stillbirths in Massachusetts primarily during the years 2002 and 2003. The first annual report presented Massachusetts birth defects data for the year 1999. Our ability to find and identify infants born with birth defects to Massachusetts residents has improved over time and is reflected in increased prevalence rates. The 2002-2003 data are presented in combined form since the numbers are relatively small for individual defects. Among the 160,791 live births to Massachusetts residents in 2002-2003, 2,476 had one or more birth defects. Three of the ten most common defects were cardiovascular defects: Atrial Septal Defects, Ventricular Septal Defects and Pulmonary Stenosis (Valvular). Common non cardiovascular defects included Trisomy 21, Polydactyly/Syndactyly, Hypospadias, Clubfoot, Cleft Lip with and without Cleft Palate, Cleft Palate alone, and Obstructive Genitourinary Defects. Massachusetts was one of 11 states with population-based monitoring programs to contribute birth defect data. The lower rates for the other defects may reflect differences in defect criteria between surveillance systems and regional differences. Spontaneous deliveries of stillbirths >= 20 weeks of gestation were reported by birthing hospitals but limited information about the stillbirth is included in the maternal record. Thus some birth defects are not well documented and are unable to be confirmed for inclusion in state surveillance. Birth defects which appeared more often in conjunction with other defects included the majority of Cardiovascular Defects, Limb Reductions, Hydrocephalus, Esophageal Atresia/Tracheoesophagela Fistula, Intestinal Atresias, and Obstructive Genitourinary Defects. Selected Pregnancy Outcomes We compared selected pregnancy outcomes (C-sections, birthweight, gestational age, multiple birth and infant death) among infants born with birth defects to those born without birth defects in 2002-2003. While numbers of 2 infants with birth defects are relatively small, it is important to recognize the impact of these outcomes when diagnosing and treating a baby with a birth defect. Plurality Examining the birth defect rate by plurality is important since birth defects are more common among multiple births and the number of multiple births has been increasing over time in Massachusetts. Birth defects that more commonly occurred in multiple births included Esophageal Atresia/Tracheoesophageal Fistula, Hypospadias, Coarctation of Aorta, Diaphragmatic Hernia and Polydactyly/Syndactyly. Maternal Age Monitoring birth defects by maternal age is important since the number of births to older mothers has been increasing over time in Massachusetts. As expected, there was a strong association of Down Syndrome with advanced maternal age. Although more babies with Down Syndrome were born to women under 35, the Down Syndrome rate of 29. Maternal Race / Hispanic Ethnicity the prevalence of birth defects varied by maternal race and Hispanic ethnicity. The most common defects in Whites included Septal Defects, Hypospadias, Down 3 Syndrome, Polydactyly/Syndactyly and Clubfoot. Severity A severity scale was developed by the Center in collaboration with our partners at Boston University and the Massachusetts General Hospital. If a case had multiple defects with equal severity, it was reviewed in detail by the Center Clinical Geneticist to determine severity category. These cases needed intensive medical care and planning for continuing care and long-term disability. Coordination between the Birth Defect Monitoring Program and maternal and child health programs helps to ensure services for identified children and to provide population-based information to inform program planning and prevention strategies. Two resource lists: "Selected National Resources" and "Public Health Resources in Massachusetts" accompany this report. One in every 28 families of a newborn is forced to deal with the reality that their baby has a birth defect (March of Dimes).

Sleep in children with cancer: case review of 70 children evaluated in a comprehensive pediatric sleep center erectile dysfunction caused by diabetes cheap suhagra 100mg with mastercard. Health care of young adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study erectile dysfunction treatment yoga order 50 mg suhagra with visa. Health insurance coverage in survivors of childhood cancer: the Childhood Cancer Survivor Study erectile dysfunction books cheap generic suhagra uk. A case of childhood hepatitis B virus infection related primary hepatocellular carcinoma with short malignant transformation time erectile dysfunction yeast infection generic suhagra 50 mg with mastercard. Hepatitis A and B immunization Tattoos is associated with risk of in patients lacking immunity. The epidemiology of chronic hepatitis C infection in survivors of childhood cancer: an update of the St Jude Childrens Research Hospital hepatitis C seropositive cohort. Hepato-biliary late effects in survivors of childhood and adolescent cancer: a report from the Childrens Oncology Group. An updated follow-up of chronic hepatitis C after three decades of observation in pediatric patients cured of malignancy. Association of hepatitis C virus infection with chronic liver disease in paediatric cancer patients. Knowledge of hepatitis C virus screening in long-term pediatric cancer survivors: a report from the Childhood Cancer Survivor Study. Prevalence and natural history of hepatitis C infection in patients cured of childhood leukemia. Hepatic steatosis is a risk factor for hepatocellular carcinoma in patients with chronic hepatitis C virus infection. Chronic hepatitis C virus infections in leukemia survivors: prevalence, viral load, and severity of liver disease. Estimated risk of transmission of the human immunodefciency virus by screened blood in the United States. Baseline Treatment Factors Oral exam panorex prior to dental procedures to evaluate root development. Association of cyclophosphamide use with dental developmental defects and salivary gland dysfunction in recipients of childhood antineoplastic therapy. Long-term effects of antineoplastic chemotherapy and radiotherapy on dental development. Recovery of fertility may occur Cisplatin abdomen/pelvis Semen analysis years after therapy. High risk of infertility and long term gonadal damage in males treated with high dose cyclophosphamide for sarcoma during childhood. Males with low normal testosterone should have Melphalan Pelvic radiation Abdomen/pelvis Tanner staging until sexually mature periodic re-evaluation of testosterone as they age or if they Procarbazine Neuroaxis radiation Testes Testicular volume by Prader orchiometer become symptomatic. Testicular function of survivors of childhood cancer: a comparative study between ifosfamide and cyclophosphamide-based regimens. Refer to at higher cumulative doses clinical signs and symptoms of estrogen endocrinology/gynecology for delayed puberty, persistently than males. Growth and endocrine function in children with acute myeloid leukaemia after bone marrow transplantation using busulfan/cyclophosphamide. Fertility of female survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. Premature menopause in survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. Risk of therapy-related myelodysplastic syndrome/acute leukemia following high-dose therapy and autologous bone marrow transplantation for non-Hodgkins lymphoma. Secondary myelodysplastic syndrome and acute myelogenous leukemia are signifcant complications following autologous stem cell transplantation for lymphoma. Low risk of secondary leukemias after chemotherapy without mechlorethamine in childhood Hodgkins disease. Acute myelogenous leukemia after treatment for malignant germ cell tumors in children. Monitoring pulmonary complications in long-term childhood cancer survivors: guidelines for the primary care physician. Cataract in children after bone marrow transplantation: relation to conditioning regimen. Busulfan plus cyclophosphamide compared with total-body irradiation plus cyclophosphamide before marrow transplantation for myeloid leukemia: long-term follow-up of 4 randomized studies. Histological changes in bladders of patients submitted to ifosfamide chemotherapy even with mesna prophylaxis. Bladder and kidney cancer following cyclophosphamide therapy for non-Hodgkins lymphoma. Ifosfamide-induced renal tubular dysfunction and rickets in children with Wilms tumor. A prospective evaluation of ifosfamide-related nephrotoxicity in children and young adults. Risk factors for long-term outcome of ifosfamide-induced nephrotoxicity in children. Renal toxicity of ifosfamide in pilot regimens of the intergroup rhabdomyosarcoma study for patients with gross residual tumor. Ifosfamide-induced nephrotoxicity in 593 sarcoma patients: a report from the Late Effects Surveillance System. Radiation involving ear Complete audiological evaluation provision of educational resources. Platinum compound-related ototoxicity in children: long-term follow-up reveals continuous worsening of hearing loss. Ototoxicity in children receiving platinum chemotherapy: underestimating a commonly occurring toxicity that may infuence academic and social development. Hearing loss, quality of life, and academic problems in long-term neuroblastoma survivors: a report from the Childrens Oncology Group. Analysis of ototoxicity in young children receiving carboplatin in the context of conservative management of unilateral or bilateral retinoblastoma. Early changes in auditory function as a result of platinum chemotherapy: use of extended high-frequency audiometry and evoked distortion product otoacoustic emissions. Ototoxicity from high-dose use of platinum compounds in patients with neuroblastoma. Severe ototoxicity following carboplatin-containing conditioning regimen for autologous marrow transplantation for neuroblastoma. Ototoxicity following pediatric hematopoietic stem cell transplantation: a prospective cohort study. Consider treatment with agent effective for commonly occur and usually neuropathic pain. Gabapentin for relief of neuropathic pain related to anticancer treatment: a preliminary study. Peripheral neuropathy due to therapy with paclitaxel, gemcitabine, and cisplatin in patients with advanced ovarian cancer. Nephrology consultation for patients with hypertension, Medical Conditions Urinalysis proteinuria, or progressive renal insuffciency. Renal function following combination chemotherapy with ifosfamide and cisplatin in patients with osteogenic sarcoma.

Infections of unspecified site due to these agents are classified elsewhere in Chapter I erectile dysfunction injections youtube generic 100 mg suhagra overnight delivery. A neoplasm erectile dysfunction beat filthy frank discount 100 mg suhagra with mastercard, whether primary or metastatic erectile dysfunction solutions pump cheap suhagra 50 mg on line, that is the focus of care during a relevant episode of health care erectile dysfunction drugs covered by medicare buy suhagra 100 mg overnight delivery, should be recorded and coded as the main condition. Example 6: Main condition: Carcinoma of prostate Other conditions: Chronic bronchitis Procedure: Prostatectomy Code to malignant neoplasm of prostate (C61) as the main condition. Example 7: Main condition: Carcinoma of breast resected two years ago Other conditions: Secondary carcinoma in lung Procedure: Bronchoscopy with biopsy Code to secondary malignant neoplasm of lung (C78. C80 Malignant neoplasm without specification of site C97 Malignant neoplasms of independent (primary) multiple sites C80 should be used for main condition coding only when the health care practitioner has clearly recorded the neoplasm in such a manner. C97 should be used when the health care practitioner records as the main condition two or more independent primary malignant neoplasms, none of which predominates. Additional codes may be used to identify the individual malignant neoplasms listed. Example 10: Main condition: Multiple myeloma and primary adenocarcinoma of prostate Code to malignant neoplasms of independent (primary) multiple sites (C97). E10-E14 Diabetes mellitus In coding the main condition, the selection of an appropriate subcategory from the list that applies to all of these categories should be based on the main condition as recorded by the health care practitioner. Codes for any individual complications listed may be added as optional additional codes. Example 12: Main condition: Renal failure due to diabetic glomerulonephrosis * Code to unspecified diabetes mellitus with renal complications (E14. Chapter V: Mental and behavioural disorders the definitions of the categories and subcategories in this chapter are provided to assist the health care practitioner in establishing diagnostic labels; they should not be used by coders. The main condition code should be assigned on the basis of the diagnosis recorded by the practitioner, even if there appears to be a conflict between the condition as recorded and the definition. G09 Sequelae of inflammatory diseases of central nervous system this code is not to be used as the preferred code for the main condition if the nature of the residual condition is recorded. When coding to the residual condition, G09 may be used as an optional * * * * additional code. Note that sequelae of categories G01, G02, G05 and G07 should not be assigned to G09, but rather to the categories established for sequelae of the underlying condition. If there is no sequelae category for the underlying condition, code to the underlying condition itself. Example 14: Main condition: Deafness due to tuberculous meningitis Specialty: Speech and hearing clinic Code hearing loss, unspecified (H91. Example 15: Main condition: Epilepsy due to old brain abscess Specialty: Neurology Code epilepsy, unspecified (G40. G09 (Sequelae of inflammatory diseases of central nervous system) may be used as an optional additional code. Example 16: Main condition: Mild mental retardation after postimmunization encephalitis Specialty: Psychiatry Code mild mental retardation (F70. Example 18: Main condition: Cerebral infarction three years ago Other conditions: Paralysis of left leg Patient receiving physical therapy Code monoplegia of lower limb (G83. It may be used as an optional additional code with categories O00-O02 to identify associated complications and with categories O03-O07 to give fuller details of the complication. Note that the inclusion terms provided at the subcategories of O08 should be referred to when assigning the fourth-character subcategories of O03-O07. Example 19: Main condition: Ruptured tubal pregnancy with shock Specialty: Gynaecology Code ruptured tubal pregnancy (O00. Example 20: Main condition: Incomplete abortion with perforation of uterus Specialty: Gynaecology Code incomplete abortion with other and unspecified complications (O06. Example 21: Main condition: Disseminated intravascular coagulation following abortion performed two days ago at another facility Specialty: Gynaecology Code delayed or excessive haemorrhage following abortion and ectopic and molar pregnancy (O08. No other code is required since the abortion was performed during a previous episode of care. O80-O84 Delivery Use of these codes to describe the main condition should be limited to cases where the only information recorded is a statement of delivery or the method of delivery. Codes O80-O84 may be used as optional additional codes to indicate a method or type of delivery where no separate data item or procedural classification is being used for this purpose. Example 23: Main condition: Pregnancy delivered Other conditions: Failed trial of labour Procedure: Caesarean section Code failed trial of labour, unspecified (O66. The pertinent codes from other chapters may be used as optional additional codes to allow specification of the condition. Example 26: Main condition: Toxoplasmosis Other conditions: Pregnancy undelivered Specialty: High-risk antenatal clinic Code protozoal diseases complicating pregnancy, childbirth and the puerperium (O98. In the case of the exceptions mentioned, in addition to the main condition code, the associated injury may be identified either by an optional additional code or by one of the digits provided for this purpose. The open intracranial wound may be indicated, if desired, by the addition of the code S01. T90-T98 Sequelae of injuries, of poisoning and of other consequences of external causes these codes are not to be used as the preferred codes for main condition if the nature of the residual conditions is recorded. When coding to the residual condition, T90-T98 may be used as optional additional codes. Those responsible for the analysis of the data should be involved in the development of the protocol for processing (including coding), not only of the diagnostic data but also of the other items to be cross-tabulated with them. The medical certificate of cause of death should be in line with the international recommendation (see section 4. Administrative procedures should ensure the confidentiality of data from the death certificate or other medical records. In the case of deaths certified by coroners or other legal authorities, the medical evidence supplied to the certifier should be stated on the certificate in addition to any legal findings. They are sometimes used to produce reference tables covering a whole range of data, which may not be published but retained in a central office where, on request, information can be extracted concerning specific diagnoses. The classification at this level is also used by specialists interested in the detailed study of a limited range of diagnoses. Where this is so, it is necessary either to include the three-character rubrics (and their totals) or to use specially adapted titles for the four-character rubrics, which are intelligible when they stand alone. There are over 2000 rubrics at the three-character level, identifying all conditions likely to be of public health interest. There are also special tabulation lists in Volume 1 which are intended for circumstances in which the three-character list is too detailed, and are designed so that international comparison of significant diseases and groups of diseases is not frustrated by different groupings having been used in different countries. Chapter totals are not provided and only a few chapters have residual rubrics that enable such totals to be obtained. They also facilitate comparison over time and observation of shifts in the relative frequencies of, for example, infectious diseases and degenerative diseases, as health programmes take effect. In addition, they make possible meaningful international comparisons of causes of death. When there is no need for international comparison, lists similar to the special tabulation lists can be designed for use locally.

Contact sites for instruments may be classified as critical erectile dysfunction treatment new drugs discount suhagra 50 mg with amex, semi-critical or non-critical erectile dysfunction main causes cheap suhagra 100 mg overnight delivery. The level of reprocessing required is based on the classification and level of risk over the counter erectile dysfunction pills uk generic 50mg suhagra amex. Any instrument or equipment entering into a sterile part of the body must be sterilized impotence remedy buy suhagra 100mg lowest price. Where the instrument or equipment will be in contact with mucous membranes or non-intact skin, it must have undergone disinfection, and where there will be contact with intact skin, disinfection or cleaning should be used. Level of disinfection/cleaning required for patient care equipment2,3,8 Spaulding Level Level of Examples Storage of Application Classi of reprocessing reprocessed fication risk required instrument Entry or Critical High Sterile Surgical Sterility must be penetration Sterilization by procedure, maintained. Staff Training Staff who work in the sterilizing service department and are responsible for the reprocessing of instruments and equipment must have undergone formal training in how to clean, disinfect and sterilize instruments and equipment. The level of training must be appropriate for the level of responsibility that the staff member is expected to undertake. Appropriate Level of Reprocessing As described above it is essential that the correct level of reprocessing of an instrument/equipment is chosen according to its intended use. This decision is made not according to what the instrument or equipment is, but rather what it is intended use is. Steam sterilization is recommended as the most effective method to achieve sterility. However, this may not always be possible as some instruments may not be able to withstand the temperature or moisture required for sterilization using steam. Other methods may be used to achieve sterility such as ethylene oxide or automated low temperature chemical sterilant systems, provided the manufacturer of the instrument / equipment agrees that this is an effective means to sterilize them. Servicing of instruments and equipment Prior to sending medical devices for service they should be reprocessed appropriately. If however they are unable to be reprocessed before being repaired, they should be placed in a fluid resistant plastic bag or container and labelled appropriately before being sent for repair. Instruments and equipment like these may not be able to withstand the heat or the moisture of steam or thermal disinfection or even some chemical agents. It is essential that equipment that will not withstand the regular types of Environmental Management Practices 29 reprocessing must only be reprocessed in a department that has the proper facilities. Storage Storage of instruments and equipment is an essential component in ensuring the product maintains its level of sterilization or disinfection. Most instruments and equipment are dry and packaged once they have been sterilized. Correct storage of sterile instruments and equipment is a critical component in keeping them sterile. Patient care equipment Any equipment that is used for a patient, and touches only their intact skin, such as bedpans, urinals, commode chairs, blood pressure cuffs etc. If not cleaned properly, organic matter may prevent the disinfectant or sterilant from having contact with the instrument/equipment and may also bind and inactivate the chemical activity of the disinfectant. After an instrument has been used, prior to it drying, it should be washed to remove any gross soiling. Manual cleaning All surfaces of the instrument/equipment must be cleaned taking care to reach all channels and bores of the instrument. Enzymatic cleaners Used for fibreoptic instruments and accessories, and other items that are difficult to clean. Ultrasonic cleaners and automated washers Ultrasonic cleaners and automated washers are recommended for cleaning basic instruments that can withstand this process. Using a machine to wash the instruments will cut down on the handling of the instruments. These cleaners must be compliant with national guidelines and standards, and must be used according to the manufacturers instructions. By causing high frequency, high-energy sound waves to hit the instrument/equipment, the soiling matter drops off the instrument, or becomes easy to remove during the rinsing process. These cleaners are not appropriate for use on cannulated instruments (they cannot clean inside the instrument), plastic materials, two or more different metals, or some glass instruments, syringes and lenses. Disinfection is used to destroy organisms present on delicate or heat-sensitive Environmental Management Practices 31 instruments which cannot be sterilized or when single use items are not available. Disinfection is not a sterilizing process and must not be used as a convenient substitute for sterilization. Thermal disinfection is not appropriate for instruments that will be used in critical sites (see Table 1) as these instruments must be sterile. These levels are classified as:2,3 (a) High-level disinfection: Destroys all micro-organisms except some bacterial spores (especially if there is heavy contamination). Thermal disinfection (pasteurization) If an instrument is able to withstand the process of heat and moisture and is not required to be sterile, then thermal disinfection is appropriate. By using heat and water at temperatures that destroy pathogenic, vegetative agents, this is a very efficient method of disinfection. The level of disinfection depends on the water temperature and the duration the instrument is exposed to that temperature. Minimum surface temperature and time required for thermal disinfection3 Surface Temperature Minimum disinfection time required o (C) (minutes) 90 1 80 10 75 30 70 100 Practical Guidelines for Infection Control in Health Care Facilities 32 2. Chemical disinfection the performance of chemical disinfectants is dependent on a number of factors including: temperature, contact time, concentration, pH, presence of organic or inorganic matter and the numbers and resistance of the initial bioburden on a surface. Only instrument grade disinfectants are suitable to use on medical instruments and equipment. Hospital grade or household grade disinfectants must not be used on instruments, they are only suitable for environmental purposes. It is important that it is stored correctly and according to the manufacturers instructions. Glutaraldehyde is generally the most appropriate chemical disinfectant that will provide high-level disinfection. This chemical must be used under very strict controlled conditions and in a safe working environment. Environmental Management Practices 33 Glutaraldehyde 2% is an appropriate high level disinfectant for endoscopes, respiratory therapy equipment and for material that is destroyed by heat. Flexible endoscopes are very easy to damage and particularly difficult to disinfect. It is extremely important that meticulous mechanical cleaning must always precede sterilization or disinfection procedures. Before any instrument or equipment goes under the process of steam sterilization, the following should be checked: (1) Ensure that the instrument can withstand the process. Instruments and equipment will only be sterile if one of the following sterilizing processes is used: (1) Steam under pressure (moist heat), (2) Dry heat, (3) Ethylene oxide, (4) Automated environmentally sealed low-temperature peracetic acid, hydrogen peroxide plasma and other chemical sterilant systems or sterilants, or (5) Irradiation. The above sterilizing methods are designed to give a sterility assurance level of at least one in a million or 10-6 (see glossary) as long as the process is validated and is according to the manufacturers guidelines. Practical Guidelines for Infection Control in Health Care Facilities 34 Ultraviolet light units, incubators, microwave ovens and domestic ovens must not be used for sterilizing. Steam under pressure (moist heat) sterilization this is the most efficient and reliable method to achieve sterility of instruments and equipment. There are several types of steam under pressure sterilizers (also called autoclaves): Downward (gravity) displacement sterilizers (jacketed and non-jacketed) these are designed for the sterilisation of waste, solutions and instruments. Benchtop sterilizers do not take wrapped items and therefore items must be used immediately after they are removed from the sterilizer.

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