Yet many small business owners are unsure about how to get the most out of their Yellow Pages advertising. is that business owners shell out more than 11 billion dollars every year on Yellow Pages advertising... Remember, effective Yellow Pages advertising design has only one objective: to bring you new business by generating phone calls. If you've got a local business, make no mistake about it: Done well, yellow pages advertising, while competitive and "tricky" ... Place your business under the Yellow Page advertising spotlight and listen to your phone and cash register sing!
Remember, with Yellow Page advertising you are at a much different point in the sales process the close. Clever headlines can be extremely effective early on in the sales process, but statistically speaking, they don't generate huge Yellow Page advertising response. He is also adamant on the importance of setting an advertising budget before talking with the Yellow Pages sales rep. In all reality, it's just best to ignore any advice your Yellow Pages advertising sales rep might give you.
While the purchase of other advertising media can often be simple and straightforward, the same thing cannot be said about yellow page renewals. If a media, such as the Yellow Pages, loses its effectiveness, I'll shift my client's advertising dollars to a more that is more effective. Finally, consider eliminating your advertisement in the Yellow Pages and placing your money in a more effective advertising media. The Yellow Pages medium provides a powerful return on investment for advertisers and can serve as the cornerstone of an integrated advertising media mix.
If you're advertising now and don't think you are getting the response you should be, talk with your Yellow Pages representative. They may even make the leap and assume that they aren t getting any calls from their Yellow Page advertising program at all. I get calls every week from lawyers saying they're not getting calls anymore from yellow page advertising. I get calls every week from lawyers saying they're not getting calls anymore from yellow page advertising.
Visit Yellow pages Philippines an online yellow page in the Philippines.
Tuesday, April 27, 2010
How to Get Your Ex Back When it Was You Who Dumped Him
Getting an ex back is difficult if you were dumped. Think how you would be feeling if you were had done the dumping? That is the position that Susan put herself in, and she was determined to get her ex back.
Susan thought she had a best girlfriend called Marie. Marie was envious of Susan and Jimmy and she told Marie that her boyfriend Jimmy had been sleeping with another person. Without confirming the story or even talking to Jimmy about it, Susan confronted Jimmy and said she knew he had been sleeping with another woman.. Poor Jimmy was completely taken aback. He knew nothing of a rumor that concerned him. In fact Jimmy defended himself rather badly and Susan dropped him there and then.
Just a few days later, Susan discovered that Marie had lied to her just for the fun of it. Thus Susan found herself in a very in a quandary. Getting her ex back was primordial to her, but how could she do this without losing face? The very thought of this terrified her.
Susan rang Jimmy to explain what had happened. But Jimmy had decided he would not have her back. He had been very hurt because Susan had not trusted him and had not even discussed things with him.
Susan now had her work cut out to get her ex back, particularly as she had dumped Jimmy so unceremoniously..
The first thing that Susan decided to do was to write a long letter and apologies to Jimmy.
She said what had happened between them was all her fault and that she would never let it happen again. She talked about their long life they had had together and the good times that they had had. She said that she didn't want to sacrifice all this because of her rashness. She said the reason she reacted like this was she adored him and could not accept that he was frequenting another woman. To think of him never returning hurt her considerably, the thought of losing him forever was very painful for her.
Susan dispatched the letter Jimmy and decided not to bother him or have any contact with him at all for some time. She wanted to give Jimmy the space he needed to recover from what she had done..
When she next met Jimmy she was very kind to him. She casually reminded him of all the pleasant times that they had had together. She didn't start apologizing again as she considered she had already done so both verbally and in writing..
One day, Susan bought two tickets to a rock band that she knew Jimmy liked hearing and which was in town for one single concert. She suggested that Jimmy come with her as his friend. In this way, she let him see that she would like him back but was leaving him the time to make his own decision.
Getting an ex back after you have misbehaved yourself and dumped him can become very complicated. Not only do you have to apologize because you behaved foolishly, but you almost have to start from zero with rebuilding the relationship. In the period when you come back together, reinstating trust becomes the most important component. Your relationship should grow from such an experience.
This is "How to get your ex back when it was you who dumped him"
Joe Bisley
For further information click here http://mylove-breakup-makeup.com
Joe Bisley writes articles about human relationship problems
Get Your Ex Back Product Reviews
The Magic Of Making Up
Monday, April 26, 2010
Money Making Opportunities Are Everywhere, Do You See Them?
You are where you are today because of what you did or failed to do yesterday. We all at some time or the other have come across life changing opportunities and our state today is a reflection of our acceptance or rejection of those opportunities.
This is yet another opportunity knocking at your door. Do yourself the favor of going through it. Now it is up to you to read, take advantage and attain financial freedom or reject it and remain where you are receiving peanuts called ‘monthly pay checks’.
That said, it is true that all of us want to make money but only few are willing to put in small effort that would produce big results.
Only 20% of the things you do give you 80% of your result and 80% of some other things you do give you 20% of your result-says a certain principle. Therefore, you do not need to know 100% of facts about money. You need to know only 20% of the facts that will give you the 80% of your results
Do it now! Get the habit of doing things now. In many people, it is not the knowledge that is lacking. What is lacking is the courage. Put the much you know into action. ‘The greatest gap in the world is the gap between knowing and doing,’ says John Maxwell.
To be successful in today’s business world, you have to be able to shift gears and cope with change effectively. You have to be able to make decisions without knowing all of the details or be able to see the big picture. Today’s entrepreneurs have to be able to function in an atmosphere of ambiguity in order to be successful.
So do it wrong the first time! If you wait until time is right- until your ducks are all in a row, it will never be done. You must be willing to fail your way to success. However, get me right. I am not saying you just jump into every opportunity that stares in the face without proper examination. Do your research! ‘When you change the way you look at things, the things you look at change.’ – Dr. Wayne Dyer.
All I did so far was to pinch you and wake you up to the reality of More Money, Time and Freedom that is obtainable on the internet. But I’m sure you are justifying your situation by saying something like, ‘you know, money is not really important. After all the love of money is the root of all evil.’ Well if you said your husband, or your wife or that your boyfriend or girlfriend or whoever wasn’t important, would they be around for very long? Well, neither would money!
So it is up to you to say if money is really important or not.
Neksummi Matthias is the President and CEO of Neksummi Global Services (RC 012799) He is am a strong believer in this principle: “I can achieve all of my goals if I help enough other people achieve theirs!” He believes in running his business without all the hype associated with the interbet market. Feel to distribute this article as long you include this resource box.
Read some reviews on Online Money Making Opportunity.
Money Making Opportunities Are Everywhere, Do You See Them?
You are where you are today because of what you did or failed to do yesterday. We all at some time or the other have come across life changing opportunities and our state today is a reflection of our acceptance or rejection of those opportunities.
This is yet another opportunity knocking at your door. Do yourself the favor of going through it. Now it is up to you to read, take advantage and attain financial freedom or reject it and remain where you are receiving peanuts called ‘monthly pay checks’.
That said, it is true that all of us want to make money but only few are willing to put in small effort that would produce big results.
Only 20% of the things you do give you 80% of your result and 80% of some other things you do give you 20% of your result-says a certain principle. Therefore, you do not need to know 100% of facts about money. You need to know only 20% of the facts that will give you the 80% of your results
Do it now! Get the habit of doing things now. In many people, it is not the knowledge that is lacking. What is lacking is the courage. Put the much you know into action. ‘The greatest gap in the world is the gap between knowing and doing,’ says John Maxwell.
To be successful in today’s business world, you have to be able to shift gears and cope with change effectively. You have to be able to make decisions without knowing all of the details or be able to see the big picture. Today’s entrepreneurs have to be able to function in an atmosphere of ambiguity in order to be successful.
So do it wrong the first time! If you wait until time is right- until your ducks are all in a row, it will never be done. You must be willing to fail your way to success. However, get me right. I am not saying you just jump into every opportunity that stares in the face without proper examination. Do your research! ‘When you change the way you look at things, the things you look at change.’ – Dr. Wayne Dyer.
All I did so far was to pinch you and wake you up to the reality of More Money, Time and Freedom that is obtainable on the internet. But I’m sure you are justifying your situation by saying something like, ‘you know, money is not really important. After all the love of money is the root of all evil.’ Well if you said your husband, or your wife or that your boyfriend or girlfriend or whoever wasn’t important, would they be around for very long? Well, neither would money!
So it is up to you to say if money is really important or not.
Neksummi Matthias is the President and CEO of Neksummi Global Services (RC 012799) He is am a strong believer in this principle: “I can achieve all of my goals if I help enough other people achieve theirs!” He believes in running his business without all the hype associated with the interbet market. Feel to distribute this article as long you include this resource box.
You can get the Best Online Money Making Opportunities.
Tuesday, April 20, 2010
Choosing Rainwear - Raincoat Versus Umbrella
Choosing the right rain gear is important. There are many different types of rainwear available, but umbrellas are still a very popular means of keeping one's self dry. If you live in a climate that does not include very much rain, or one that only sees minimal rainfall, an umbrella might work just fine. On the other hand, if you live in an area where rain is frequent, you may want to consider purchasing a raincoat or some other form of rainwear that will help keep all of you both warm and dry.
Raincoats have several advantages over umbrellas. While an umbrella will keep more than one person dry at a time, it is often difficult to hold it over two heads simultaneously. Add to that an additional person and you can seethe chances of anyone staying dry quickly diminishing. Raincoats, however, will keep all who wear them dry. Should you choose to wear a rain jacket and couple it with rain pants, you are increasing your chances of staying dry because more of you is covered. Add to that a pair of rain boots and you are good to go.
Umbrellas also have the uncanny ability to flip inside out in even the slightest of breezes let alone when the wind is really blowing. They are also difficult to hold on to while carrying other items such as a bag or a purse. Raincoats free up your hands, thereby allowing you to carry multiple items. Granted these items won't stay dry, but if you own a waterproof backpack, you may want to consider using it when it rains.
You may even decide to wear a raincoat and carry an umbrella. This is not a bad idea, especially if you have an aversion to hoods. This way you will be able to keep your entire body dry from head to toe without the need for a hood.
While there is certainly nothing wrong with using an umbrella, after all they have become very popular, a raincoat might be a good choice if you plan to be out in a rain quite a bit. The type you choose will depend on your activities as will whether or not you use other types of rainwear. The good news is you will have many options from which to choose so should have no problem making the right decision.
Women's Raincoats
Women's Rainwear
Monday, April 19, 2010
Digital Hearing aids: Why Do They Cost So Much?
Don't worry though; deals on digital hearing aids are available to a thrifty shopper. Keep in mind that there is a lot of competition between hearing aid suppliers. Also, the internet is allowing people to get much better deal. It is easy to save money if you take your time and shop around.
We all know that hearing aids are insanely expensive. However, if you look around you will be able to find some low cost alternatives out there. The Cost of digital hearing aids is based on the brand and model of hearing aid and what features it has.
For those people that have already wear analog devices, an upgrade to a digital model will provide stunning sound quality in normal day to day situations. A drastic improvement in hearing of normal everyday sounds is just the start. Where digital hearing aids really earn their money is eliminating background noise. Adjustments can be made without having to mess with the volume control.
The more money you are willing to spend the more you'll be impressed with the detail and quality of the sounds you can hear. If you are willing to get into the high end of digital hearing aids, you will be totally impressed with the things you can hear. Users report that they can hear even the faintest noises, and perhaps the most talked about results are the way these high end models are able to eliminate all feedback. These high tech devices also have a directional microphone which can be directed at the users front which will eliminate any surrounding noises.
If you decide that a digital hearing aid is for you then consult an audiologist. The audiologist will run test to find the degree and cause of your hearing impairment. Digital hearing aids are programmable so don't be surprised if you have to return to the doctor's office a number of times to get the device tuned in just to your liking. It might take some patience on your part but the advantages are very much worth it. Hearing aids are expensive, but you should not cut corners with something as important as your hearing.
Best of luck!
Affordable Hearing Aids Austin TX
Hearing Aid Styles Review Austin TX
Friday, April 9, 2010
Needle Stick Injury - Who Bears the Brunt?
A hospitalized patient with AIDS became agitated and tried to remove the intravenous (IV) catheters in his arm. During the struggle, an IV infusion line was pulled. A nurse at the scene recovered the connector needle at the end of the IV line and was attempting to reinsert it when the patient kicked her arm, pushing the needle into her hand. The nurse who sustained the needle stick injury tested negative for HIV that day, but she tested HIV positive several months later. This is not the only case. Everyday healthcare workers are exposed to dangerous and deadly blood-borne pathogens and are at risk of occupational acquisitions of blood-borne illnesses. Occupational exposure to blood-borne pathogens among healthcare workers include percutaneous exposure i.e. exposure to needles and other sharp objects, and mucocutaneous exposure i.e. contact with intact or nonintact skin, the contact with mucous membranes. In the healthcare settings, percutaneous injuries are the most common form of occupational exposures and most likely to result in infection. Needle stick injuries account for upto 80 per cent of accidental exposure to blood-borne pathogens. It is one of the greatest risks faced by the front line healthcare workers in the light of HIV/ AIDS pandemic and Hepatitis B and C. Yet, these exposures have often been considered as part of the job and neglected.
You may be among the thousands of health care workers who annually receive a needlestick contaminated with HIV. According to a recent report, more than one million needlestick injuries to health care workers occur every year. Anecdotal information considers that this exposure figure is under reported. The use of intravenous cannulae is generally regarded as representing the highest risk of transmission of blood-borne disease to health care workers. Hypodermic needles are commonly used in medical, veterinary and laboratory work and needlestick injuries are a known risk for people who work in these areas. Carelessly or maliciously discarded needles can present a risk to people who clean or service such areas. Although an unusual event, hypodermic needles may also be found in areas frequented by the general public. Hypodermic needles are hollow needles designed to penetrate the body and either introduce or remove liquids. Thus, as well as causing a puncture wound, needlestick injuries can introduce into the body harmful materials or micro organisms from the skin, from contaminants on the outside of the needle and from the needle bore (and syringe if attached).The risk of suffering further injury or an infection from a needlestick injury depends to what use the needle was put prior to the injury: clean and sterile needles present a low risk; if needles have been used to transfer chemicals or microorganisms then the risk will depend upon the properties of the chemical or characteristics of the microorganism; if needles are contaminated with human blood or other body fluids then they may be a source of blood borne viruses (BBV); needles contaminated with animal body fluids can be a source of zoonoses and needles contaminated with soil may be a source of tetanus. Needlestick injuries can also cause mental trauma as the injured person may have to cope with the fear that they have been infected.
The use of safety devices, such as guarded needles, resheathable needles, bluntable vacuum systems, and blunt suture needles, could reduce the risk of injury. The effectiveness of each varies considerably; however, the use of blunted suture needles showed a significant reduction in the number of glove punctures compared with cutting needles. Staples and glue are also safer methods of wound closure because there is no exposure to suture needles and should be encouraged when appropriate. Relatively new intravenous systems are available such as safety cannulae and needleless IV systems, and these can significantly reduce the risk of needlestick injuries.
What are the Fact Sheet on Needle Stick Injury?
-Health care workers (HCWs) suffer between 600,000 and one million injuries from conventional needles and sharps annually. These exposures can lead to hepatitis B, hepatitis C and Human Immunodeficiency Virus (HIV), the virus that causes AIDS.
-At least 1,000 HCWs are estimated to contract serious infections annually from needlestick and sharps injuries.
-Registered nurses working at the bedside sustain an overwhelming majority of these exposures.
-Needlestick injuries are preventable. Over 80% of needlestick injuries could be prevented with the use of safer needle devices.
-In 1992, the Food and Drug Administration issued an alert to all health care facilities to utilize needleless IV systems wherever possible. This alert is merely a recommendation, not a mandate. Therefore, health care facilities are under no legal obligation to comply.
-The first safe needle designs were patented in the 1970s and the FDA has approved over 250 devices for marketing as safety devices.
-More than 20 other infections can be transmitted through needlesticks, including: tuberculosis, syphilis, malaria and herpes.
What is your role when someone presents to your practice after a needlestick injury or any other hazardous exposure to blood or other body substance?
-Your initial efforts need to be directed at reducing the risk of the exposed patient contracting an infectious illness. Immediate first aid is required if the event is recent:
-Contaminated needlestick, sharps injury, bite or scratch - encourage bleeding, wash with soap and running water.
-Blood or body fluid in eyes or mouth - irrigate with copious quantities of cold water
-Blood or body fluid on broken skin - encourage bleeding if possible, and wash with soap under running water (but without scrubbing)
-Report incident and discuss with local public health consultant immediately.
-The next step is to collect blood from the patient for baseline testing after counseling and obtaining informed consent.
-A thorough assessment of the exposure is then required to determine the risk of disease transmission. Reassure the patient that only a small proportion of blood exposures result in infection. It is impossible to precisely determine this risk, but factors that have been identified as being associated with HIV transmission include:
-terminal AIDS illness in the source person,
-deep injury, visible blood on device, procedure involving needle placed directly into a vein or artery.
The following estimates of disease transmission rates from percutaneous injuries have been made for occupational exposures and these may be used as a guide in explaining the risk to the patient.
HIV 0.2-0.5%
Hepatitis B - HBeAg absent 2%
- HBeAg present (prompt administration of HBIG and hepatitis B vaccination can prevent transmission in most cases) 40%
Hepatitis C 3-10%
(If this urgent preliminary risk assessment considers there is a significant risk of HIV, post exposure prophylaxis (PEP) needs to be started as soon as possible - ideally within 1 hour. This reduces risk of transmission by 80%. It may be appropriate to give the first dose of PEP pending a fuller assessment after the HIV status of the 'donor' is known. Where the donor is unknown, epidemiological likelihood of HIV in the source needs to be considered, although in most cases PEP will not be justified.)
-Your next step is to advise the patient about the precautions to take until final testing confirms lack of disease transmission. Counseling should be offered during this worrying period. Finally, in the unfortunate event of disease transmission occurring, the patient may call on you for evidence in support of their claim that transmission was related to the exposure injury. Your documentation and the patient's negative baseline test results provide this evidence.
Is Prevention possible?
According to the CDC, up to 86% of needlestick injuries can be prevented by using safer needlestick devices. Advances in engineering controls have made it possible to eliminate sharps from many uses-such as IV piggybacks-and to blunt or retract the needle so it's no longer a danger. Placing sharps containers within reach and at eye level in every patient room also reduces the risk of injury. You can be active on several levels in order to help prevent needlestick injuries. Review needlestick injury data in your facility and ask the following questions:
- In what areas have needlestick injuries increased, and where has there been a decrease?
- Have nurses and other health care workers been reporting injuries?
- What happens at your workplace in the event of a needlestick incident?
- Can you receive support, including immediate evaluation for postexposure prophylaxis?
- What is being done to reduce the injury rate?
General preventive measures:
- Wash hands before and after contact with each patient, and before putting on and after removing gloves.
- Change gloves between patients.
- Cover existing wounds, skin lesions and all breaks in exposed skin with waterproof dressings, wear gloves if hands are extensively affected.
- Wear gloves where contact with blood can be anticipated.
- Avoid sharps usage where possible, and where sharps usage is essential, exercise particular care in handling and disposal.
- Avoid wearing open footwear in situations where blood may be spilt, or where sharp instruments or needles are handled.
- Clear up spillage of blood promptly and disinfect surfaces.
- Pre-employment occupational health assessment should identify those with damaged skin e.g. fissured hand eczema, who may be at higher risk of occupationally acquired infection, and ensure that advice is given about minimizing any occupational health risk to which they may be exposed.
- Wear gloves when cleaning equipment prior to sterilization or disinfection, when handling chemical disinfectant and when cleaning up spillages.
- Follow safe procedures for disposal of contaminated waste.
Specific measures:
- This will obviously depend on the procedure being undertaken, but may include:
- Use of new, single-use disposable injection equipment for all injections is highly recommended. Sterilisable injection should only be considered if single use equipment is not available and if the sterility can be documented with Time, Steam and Temperature indicators.
- Discard contaminated sharps immediately and without recapping in puncture and liquid proof containers that are closed, sealed and destroyed before completely full.
- Document the quality of the sterilization for all medical equipment used for percutaneous procedures.
- Wash hands with soap and water before and after procedures; use of protective barriers such as gloves, gowns aprons, masks, goggles for direct contact with blood and other body fluids.
- Disinfect instruments and other contaminated equipment.
- Handle properly soiled linen. (Soiled linen should be handled as little as possible. Gloves and leak proof bags should be used if necessary. Cleaning should occur outside patient areas, using detergent and hot water)
Can we reduce the risk?
Risks to the healthcare workers of the future are rising because of increasing rates of viral infection in patients. This is particularly relevant to medical and nursing students undertaking electives abroad in areas where procedures for infection control are sometimes poor; standards of supervision vary; and students often take part in invasive procedures that may place them at increased risk of bloodborne infections. Also unfortunately many students and even senior staff are indifferent to these injuries and often don't report them. Often injuries are not reported because the exposure is not deemed "significant." Students are also often embarrassed by these injuries and may be afraid to implicate another healthcare worker, particularly a faculty member who is responsible for their evaluation. Failure to report an injury, however, can delay essential medical evaluation and treatment and leave doubt as to where the infection was transmitted.
In summary, needlestick injuries among HCWs in training are common and often not reported to an employee health service.
These findings underscore the need for ongoing attention to strategies to reduce such injuries in a systematic way and to improve reporting systems so that appropriate medical care can be delivered. With considerable lifetime risks for health care workers contracting serious bloodborne diseases and the greatest risk in a long career occurring at the start, there is a greater need for sharps safety and training in medical schools and affiliated hospitals. The introduction of devices designed to reduce needle exposure during suturing and phlebotomy would help protect students, particularly in units where safety methods are not well enforced. Clearly, there is much room for improvement in protecting the healthcare workers from needle stick injury, which can be accomplished through a comprehensive programme that addresses institutional, behavioral, and device-related factors that contribute to the occurrence of these injuries. Apart from this, greater collaborative efforts by all stakeholders are needed to prevent such injuries and the tragic consequences that can result.
Dr. Rubina Lone
Consultant Clinical Microbiology and Research Wing
SKIMS Medical College
Srinagar, Kashmir
India
[http://www.rubinalone.blogspot.com/]
Phlebotomy Certification | Phlebotomist Training
You may be among the thousands of health care workers who annually receive a needlestick contaminated with HIV. According to a recent report, more than one million needlestick injuries to health care workers occur every year. Anecdotal information considers that this exposure figure is under reported. The use of intravenous cannulae is generally regarded as representing the highest risk of transmission of blood-borne disease to health care workers. Hypodermic needles are commonly used in medical, veterinary and laboratory work and needlestick injuries are a known risk for people who work in these areas. Carelessly or maliciously discarded needles can present a risk to people who clean or service such areas. Although an unusual event, hypodermic needles may also be found in areas frequented by the general public. Hypodermic needles are hollow needles designed to penetrate the body and either introduce or remove liquids. Thus, as well as causing a puncture wound, needlestick injuries can introduce into the body harmful materials or micro organisms from the skin, from contaminants on the outside of the needle and from the needle bore (and syringe if attached).The risk of suffering further injury or an infection from a needlestick injury depends to what use the needle was put prior to the injury: clean and sterile needles present a low risk; if needles have been used to transfer chemicals or microorganisms then the risk will depend upon the properties of the chemical or characteristics of the microorganism; if needles are contaminated with human blood or other body fluids then they may be a source of blood borne viruses (BBV); needles contaminated with animal body fluids can be a source of zoonoses and needles contaminated with soil may be a source of tetanus. Needlestick injuries can also cause mental trauma as the injured person may have to cope with the fear that they have been infected.
The use of safety devices, such as guarded needles, resheathable needles, bluntable vacuum systems, and blunt suture needles, could reduce the risk of injury. The effectiveness of each varies considerably; however, the use of blunted suture needles showed a significant reduction in the number of glove punctures compared with cutting needles. Staples and glue are also safer methods of wound closure because there is no exposure to suture needles and should be encouraged when appropriate. Relatively new intravenous systems are available such as safety cannulae and needleless IV systems, and these can significantly reduce the risk of needlestick injuries.
What are the Fact Sheet on Needle Stick Injury?
-Health care workers (HCWs) suffer between 600,000 and one million injuries from conventional needles and sharps annually. These exposures can lead to hepatitis B, hepatitis C and Human Immunodeficiency Virus (HIV), the virus that causes AIDS.
-At least 1,000 HCWs are estimated to contract serious infections annually from needlestick and sharps injuries.
-Registered nurses working at the bedside sustain an overwhelming majority of these exposures.
-Needlestick injuries are preventable. Over 80% of needlestick injuries could be prevented with the use of safer needle devices.
-In 1992, the Food and Drug Administration issued an alert to all health care facilities to utilize needleless IV systems wherever possible. This alert is merely a recommendation, not a mandate. Therefore, health care facilities are under no legal obligation to comply.
-The first safe needle designs were patented in the 1970s and the FDA has approved over 250 devices for marketing as safety devices.
-More than 20 other infections can be transmitted through needlesticks, including: tuberculosis, syphilis, malaria and herpes.
What is your role when someone presents to your practice after a needlestick injury or any other hazardous exposure to blood or other body substance?
-Your initial efforts need to be directed at reducing the risk of the exposed patient contracting an infectious illness. Immediate first aid is required if the event is recent:
-Contaminated needlestick, sharps injury, bite or scratch - encourage bleeding, wash with soap and running water.
-Blood or body fluid in eyes or mouth - irrigate with copious quantities of cold water
-Blood or body fluid on broken skin - encourage bleeding if possible, and wash with soap under running water (but without scrubbing)
-Report incident and discuss with local public health consultant immediately.
-The next step is to collect blood from the patient for baseline testing after counseling and obtaining informed consent.
-A thorough assessment of the exposure is then required to determine the risk of disease transmission. Reassure the patient that only a small proportion of blood exposures result in infection. It is impossible to precisely determine this risk, but factors that have been identified as being associated with HIV transmission include:
-terminal AIDS illness in the source person,
-deep injury, visible blood on device, procedure involving needle placed directly into a vein or artery.
The following estimates of disease transmission rates from percutaneous injuries have been made for occupational exposures and these may be used as a guide in explaining the risk to the patient.
HIV 0.2-0.5%
Hepatitis B - HBeAg absent 2%
- HBeAg present (prompt administration of HBIG and hepatitis B vaccination can prevent transmission in most cases) 40%
Hepatitis C 3-10%
(If this urgent preliminary risk assessment considers there is a significant risk of HIV, post exposure prophylaxis (PEP) needs to be started as soon as possible - ideally within 1 hour. This reduces risk of transmission by 80%. It may be appropriate to give the first dose of PEP pending a fuller assessment after the HIV status of the 'donor' is known. Where the donor is unknown, epidemiological likelihood of HIV in the source needs to be considered, although in most cases PEP will not be justified.)
-Your next step is to advise the patient about the precautions to take until final testing confirms lack of disease transmission. Counseling should be offered during this worrying period. Finally, in the unfortunate event of disease transmission occurring, the patient may call on you for evidence in support of their claim that transmission was related to the exposure injury. Your documentation and the patient's negative baseline test results provide this evidence.
Is Prevention possible?
According to the CDC, up to 86% of needlestick injuries can be prevented by using safer needlestick devices. Advances in engineering controls have made it possible to eliminate sharps from many uses-such as IV piggybacks-and to blunt or retract the needle so it's no longer a danger. Placing sharps containers within reach and at eye level in every patient room also reduces the risk of injury. You can be active on several levels in order to help prevent needlestick injuries. Review needlestick injury data in your facility and ask the following questions:
- In what areas have needlestick injuries increased, and where has there been a decrease?
- Have nurses and other health care workers been reporting injuries?
- What happens at your workplace in the event of a needlestick incident?
- Can you receive support, including immediate evaluation for postexposure prophylaxis?
- What is being done to reduce the injury rate?
General preventive measures:
- Wash hands before and after contact with each patient, and before putting on and after removing gloves.
- Change gloves between patients.
- Cover existing wounds, skin lesions and all breaks in exposed skin with waterproof dressings, wear gloves if hands are extensively affected.
- Wear gloves where contact with blood can be anticipated.
- Avoid sharps usage where possible, and where sharps usage is essential, exercise particular care in handling and disposal.
- Avoid wearing open footwear in situations where blood may be spilt, or where sharp instruments or needles are handled.
- Clear up spillage of blood promptly and disinfect surfaces.
- Pre-employment occupational health assessment should identify those with damaged skin e.g. fissured hand eczema, who may be at higher risk of occupationally acquired infection, and ensure that advice is given about minimizing any occupational health risk to which they may be exposed.
- Wear gloves when cleaning equipment prior to sterilization or disinfection, when handling chemical disinfectant and when cleaning up spillages.
- Follow safe procedures for disposal of contaminated waste.
Specific measures:
- This will obviously depend on the procedure being undertaken, but may include:
- Use of new, single-use disposable injection equipment for all injections is highly recommended. Sterilisable injection should only be considered if single use equipment is not available and if the sterility can be documented with Time, Steam and Temperature indicators.
- Discard contaminated sharps immediately and without recapping in puncture and liquid proof containers that are closed, sealed and destroyed before completely full.
- Document the quality of the sterilization for all medical equipment used for percutaneous procedures.
- Wash hands with soap and water before and after procedures; use of protective barriers such as gloves, gowns aprons, masks, goggles for direct contact with blood and other body fluids.
- Disinfect instruments and other contaminated equipment.
- Handle properly soiled linen. (Soiled linen should be handled as little as possible. Gloves and leak proof bags should be used if necessary. Cleaning should occur outside patient areas, using detergent and hot water)
Can we reduce the risk?
Risks to the healthcare workers of the future are rising because of increasing rates of viral infection in patients. This is particularly relevant to medical and nursing students undertaking electives abroad in areas where procedures for infection control are sometimes poor; standards of supervision vary; and students often take part in invasive procedures that may place them at increased risk of bloodborne infections. Also unfortunately many students and even senior staff are indifferent to these injuries and often don't report them. Often injuries are not reported because the exposure is not deemed "significant." Students are also often embarrassed by these injuries and may be afraid to implicate another healthcare worker, particularly a faculty member who is responsible for their evaluation. Failure to report an injury, however, can delay essential medical evaluation and treatment and leave doubt as to where the infection was transmitted.
In summary, needlestick injuries among HCWs in training are common and often not reported to an employee health service.
These findings underscore the need for ongoing attention to strategies to reduce such injuries in a systematic way and to improve reporting systems so that appropriate medical care can be delivered. With considerable lifetime risks for health care workers contracting serious bloodborne diseases and the greatest risk in a long career occurring at the start, there is a greater need for sharps safety and training in medical schools and affiliated hospitals. The introduction of devices designed to reduce needle exposure during suturing and phlebotomy would help protect students, particularly in units where safety methods are not well enforced. Clearly, there is much room for improvement in protecting the healthcare workers from needle stick injury, which can be accomplished through a comprehensive programme that addresses institutional, behavioral, and device-related factors that contribute to the occurrence of these injuries. Apart from this, greater collaborative efforts by all stakeholders are needed to prevent such injuries and the tragic consequences that can result.
Dr. Rubina Lone
Consultant Clinical Microbiology and Research Wing
SKIMS Medical College
Srinagar, Kashmir
India
[http://www.rubinalone.blogspot.com/]
Phlebotomy Certification | Phlebotomist Training
Tuesday, April 6, 2010
List Building and a Profitable Opt-In List!
In building your keyword list, you want to "get into your customer's head". Therefore, you have to approach building a list with a tool like Desktop Lightning as a long-term process. Do you want to find out how the affiliate marketer mentioned above, started building an email list and stopped losing money? This site consists of a landing page to collect email addresses, a package of products that teach about building an email list, and a few pages with articles I've written about building an email list.
Building a profitable opt-in list does not just happen overnight. Building a mailing list for your niche market is a painstaking and time consuming process. BUT, if you want to start building a list quickly, here's one technique that works. Find one or two in the areas of Internet Marketing you need help with: SEO, Mini Sites, Affiliate Marketing, List Building, Google AdSense/AdWords, Copy Writing, etc.
You'll save time and money by building a prioritized list of those reasons, understanding must-haves and trade-offs, and using that list to spec, evaluate, plan and build a VMS solution tailored to your business. Building a mail list manually is not easy, it can be done, but you have to work at it everyday, adding names - addresses - phone- numbers etc, it is a lot of hard work, and it was just a pain to keep up to date, and then if you wanted to do a promotion it meant preparing a sales letter, then getting it printed, stuffing the sales letter into envelopes, paying for the postage, phew, it was a huge amount of work.
Building a list gives you opportunities to sell to the same customers over and over again. Start building your optin email list in an area in which you have some knowledge. If you're a smart article marketer, you don't consider your list building and article marketing project complete until you have thanked key online editors, and invited them to discuss other marketing opportunities.
Generating traffic, nor building an Opt-In list, nor is it finding products to market and it's not a lack of Cash. JV Your List-Building: Small List - Ok, if your existing list isn't large enough to warrant a cross JV mailing as described above, here's a clever way to build your list up quickly. Your list is vital to building your business. The well known guru Mark Joyner has been known to sit back for7 to 9 months, building his list and cautiously targeting his audience, giving away freebies and bonuses.
Consider the double opt--in method you are in the early stages of building your list or want to increase to your existing list. Not only does building a website give you the opportunity to build a list, set you apart from your competitors and allow you to offer more value to your visitors, but it also (and very importantly) gives you the option (which you should take advantage of - by the way) of marketing more than just one affiliate product/program. There are many nuances and very effective initiatives that could be added to this list, as well, but these provide a good starting point for building stronger results. When you click through to the webpage you will see that I am building a list.
Know more about list building software.
Monday, April 5, 2010
Why Online Adult Dating Services Work
Online adult dating services work great. Many people are finding that it's an easy way to find someone who shares your interests. This is a reason why it is becoming so popular. Now there are several adult dating services online to help you discover your soul mate. It is not surprising that you won't succeed the first time around. No worries; there certainly are plenty of fish in the sea, as they say.
Still remember those cubbing routine you made on any Thursday, Friday or Saturday night back in college life? You could easily find a fixed portion of the college students in the local hot spots. You and I perfectly knew that most of them were just out to have a good time. And few may have been searching for something more. Club and bar scenes are definitely those great places to search for potential. Why, because you can find a lot of singles hanging around there.
However, it is never easy to find the other half who can shares your beliefs, hobbies and goals in life.
This is why adult dating services come into the picture in here instead. If you're looking for a beer and a random conversation with a cigarette-puffing stranger, a bar or night club is the place to be, period. But if you're searching for something more profound, you're likely to find it with the assistance of online adult dating services.
With the modern technology, it simply takes you less than a few minutes to browse for some adult dating service site, singing up for their dating service, putting up your personal profiles, search for your perfect mates by some filtering service by the adult dating site. Best thing is you don't even have to leave the comfort of your home. Find a local single that shares your passion for life. This is the future of dating. That's why adult dating services online are becoming so popular.
While no adult dating service website can guarantee 100% safety, at least there is some screening process. Using online adult dating services is also a lot safer than a random chat room. They'll also have a credit card number of the person you're meeting. Come to think of it, that's even safer than meeting a stranger in a club or bar.
[http://www.successdatingguides.com/Why-Online-Adult-Dating-Services-Work.html]
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