Robber baron industrialist Even before academic studies began, Americans were enthralled by the Robber baron debate. As the United States industrialized very rapidly after the Civil War, a few hundred prominent men made large fortunes by building and controlling major industries, such as railroads, shipping, steel, mining and banking.
Summary The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers HCWs with a review of data regarding handwashing and hand antisepsis in health-care settings.
In addition, it provides specific recommendations to promote improved hand-hygiene practices and reduce transmission of pathogenic microorganisms to patients and personnel in health-care settings. CDC guideline for handwashing and hospital environmental control, APIC guideline for handwashing and hand antisepsis in health care settings.
Am J Infect Control ; New studies of the in vivo efficacy of alcohol-based hand rubs and the low incidence of dermatitis associated with their use are reviewed.
Recent studies demonstrating the value of multidisciplinary hand-hygiene promotion programs and the potential role of alcohol-based hand rubs in improving hand-hygiene practices are summarized. Recommendations concerning related issues e. Review of the Scientific Data Regarding Hand Hygiene Historical Perspective For generations, handwashing with soap and water has been considered a measure of personal hygiene 1.
The concept of cleansing hands with an antiseptic agent probably emerged in the early 19th century. As early asa French pharmacist demonstrated that solutions containing chlorides of lime or soda could eradicate the foul odors associated with human corpses and that such solutions could be used as disinfectants and antiseptics 2.
In a paper published inthis pharmacist stated that physicians and other persons attending patients with contagious diseases would benefit from moistening their hands with a liquid chloride solution 2. InIgnaz Semmelweis observed that women whose babies were delivered by students and physicians in the First Clinic at the General Hospital of Vienna consistently had a higher mortality rate than those whose babies were delivered by midwives in the Second Clinic 3.
He noted that physicians who went directly from the autopsy suite to the obstetrics ward had a disagreeable odor on their hands despite washing their hands with soap and water upon entering the obstetrics clinic.
He postulated that the puerperal fever that affected so many parturient women was caused by "cadaverous particles" transmitted from the autopsy suite to the obstetrics ward via the hands of students and physicians.
Perhaps because of the known deodorizing effect of chlorine compounds, as of Mayhe insisted that students and physicians clean their hands with a chlorine solution between each patient in the clinic.
The maternal mortality rate in the First Clinic subsequently dropped dramatically and remained low for years. This intervention by Semmelweis represents the first evidence indicating that cleansing heavily contaminated hands with an antiseptic agent between patient contacts may reduce health-care--associated transmission of contagious diseases more effectively than handwashing with plain soap and water.
InOliver Wendell Holmes concluded independently that puerperal fever was spread by the hands of health personnel 1.
Although he described measures that could be taken to limit its spread, his recommendations had little impact on obstetric practices at the time.
However, as a result of the seminal studies by Semmelweis and Holmes, handwashing gradually became accepted as one of the most important measures for preventing transmission of pathogens in health-care facilities.
Inthe U. Public Health Service produced a training film that demonstrated handwashing techniques recommended for use by health-care workers HCWs 4.
|US-Pakistan Relations: Common and Clashing Interests | World Affairs Journal||Qazi The last calendar year was by far the most tumultuous in a decade of tense and mistrustful relations between Pakistan and the United States.|
|Quick Search||The United States and Pakistan had the sixth round of their strategic dialogue in Washington recently.|
|Top Military News||Since the emergence of these states, the relationships between the two have never been friendly.|
At the time, recommendations directed that personnel wash their hands with soap and water for minutes before and after patient contact. Rinsing hands with an antiseptic agent was believed to be less effective than handwashing and was recommended only in emergencies or in areas where sinks were unavailable.
In andformal written guidelines on handwashing practices in hospitals were published by CDC 5,6. These guidelines recommended handwashing with non-antimicrobial soap between the majority of patient contacts and washing with antimicrobial soap before and after performing invasive procedures or caring for patients at high risk.
Use of waterless antiseptic agents e. Recommended indications for handwashing were similar to those listed in the CDC guidelines. The APIC guideline included more detailed discussion of alcohol-based hand rubs and supported their use in more clinical settings than had been recommended in earlier guidelines.
In andthe Healthcare Infection Control Practices Advisory Committee HICPAC recommended that either antimicrobial soap or a waterless antiseptic agent be used for cleaning hands upon leaving the rooms of patients with multidrug-resistant pathogens e.
These guidelines also provided recommendations for handwashing and hand antisepsis in other clinical settings, including routine patient care. Recent developments in the field have stimulated a review of the scientific data regarding hand hygiene and the development of new guidelines designed to improve hand-hygiene practices in health-care facilities.
Normal Bacterial Skin Flora To understand the objectives of different approaches to hand cleansing, a knowledge of normal bacterial skin flora is essential. Normal human skin is colonized with bacteria; different areas of the body have varied total aerobic bacterial counts e.
Total bacterial counts on the hands of medical personnel have ranged from 3. Inbacteria recovered from the hands were divided into two categories:Pakistan’s relations with the U.S.
were established and progressed during the rigid cold war period. In start, Soviet influence on Afghanistan and Iran forced Pakistan’s first Prime Minister Liaqat Ali Khan to cement a pro-American and pro-western policy.
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This chapter tries to analyze different phases of Pak-Afghan relations in chronological order with a view to identify challenges hindering rapprochement process and continue to enflame the geo-strategic and geo-political environment amongst two Pakistan-Afghan brethrens.
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