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The follow-up service aspect of third-party certification is an advantage, in that the purchaser has the assurance that the product installed is identical to the product evaluated for the certification. Third-party certifiers also maintain close working relationships with the regulatory and user communities. This provides for a more balanced assessment of the product and helps ensure that the product will be accepted by local, regional and national regulatory agencies. In some instances, local, regional or na- tional governmental agencies will require that products be evaluated by the agency or a designated representative organization for compliance with regulations for installation, use and operation. The deployment of lifeguards would normally take the following into consideration: duty spells and structuring of duties maximum uninterrupted supervision period, working day, programmed breaks; lifeguard numbers dependent on the pool type, size and usage; surveillance zones observation and scanning requirements; supervision of changing facilities showers, toilets, seating and other areas of potential hazard. Adapted from Sport England & Health and Safety Commission, 2003 Should the pool be used by groups with their own lifeguards, it is important that the criteria that apply to the professional pool lifeguard be equally applied to the groups lifeguards. Further- more, there should be documentation on the roles and responsibilities of the groups lifeguards: the hazards and the potential negative health outcomes associated with those hazards are no less when supervision and management are undertaken by volunteers. There are a multitude of courses offered for the training and certification of lifeguards. Lifeguard numbers per square metre of pool Approximate Minimum number Minimum number pool size (m) Area (m2) of lifeguards (normal) of lifeguards (busy) 20. Where only one lifeguard is on duty, there should be adequate means of summoning assistance rapidly. The number of lifeguards required for safety can also be calculated based on sweep time and response time. Some lifeguard training organizations, for example, have created general rules for how quickly they believe a lifeguard should be expected to observe a person in distress within their supervision area and how quickly the lifeguard should be able to reach that person. Based on such rules, training and evaluation, appropriate staffing levels can be derived. Assessment Strategy: these learning outcomes are best assessed using the following common assessment methods: Observation (personal, video review) Oral questioning Written examination (short answer, multiple choice) Simulated rescue scenario Range of Variables: There are a number of variables that will affect the performance and assessment of the learning out- comes. These may include: Variable Scope Facilities Swimming pool lengths/depths and measurements (metric/imperial). International Life Saving Federation (2001) International Pool Lifeguard Certificate. Sport England & Health and Safety Commission (2003) Managing health and safety in swimming pools, 3rd ed. These include gram-negative folliculitis, nevus come- donicus, steroid acne, acneiform drug eruptions, rosacea, amineptine acne, chloracne, perioral der- matitis, eruptive vellus hair cysts, sporotrichosis, coc- cidioidomycosis, secondary syphilis, and even tuberous sclerosis. Suppura- tion begins at a deep level and is linked with an in- flammatory exudate. Nevus Comedonicus Comedones may occur alone, congenitally, or later in life as a result of occupational exposure. It is evident clinically as confluent clusters of dilated follicular orifices plugged with ker- atin, giving the appearance of aggregated open come- dones. Infrequently, multiple that can appear as multiple flesh-colored papules on comedones in other unusual contexts may raise ne- the face. Treat- anomalies of vellus hair follicles, appear as multiple ment is difficult, and has included laser ablation, sur- comedo-like flesh-colored papules on the face, chest, gical excision, curettage, cryosurgery, chemical peel, neck, thighs, groin, buttocks, and axillae. Lesions Amineptine Acne may regress spontaneously, form an open pore to the Certain drugs have also been shown as a cause of surface of the epidermis, or undergo degradation of papules and pustules. Amineptine, a tricyclic antide- pressant, at high doses can induce a severe facial acne From Dermatology and Pediatrics, New Jersey Medical School, that may also appear on the thorax, extremities, or Newark, New Jersey. The eruption usually clears after School, 185 South Orange Avenue, Newark, New Jersey 07103- stopping the drug and has responded in some cases to 2714 (Dr. Other Acneiform Drug Eruptions duce an acneiform eruption similar to that of steroid Generalized pustular eruptions of aseptic pustules fol- acne; however, the iodide-induced eruption may be low administration of oral medications, most com- more marked. Other less frequent of- Folliculitis fenders include subcutaneously injected dexametha- Infections may also display an acneiform pattern. It has ized by monomorphous papulopustules with greater been shown to resolve with appropriate antibiotic involvement of the trunk and extremities than the coverage. Isotretinoin is also an effective alterna- face and usually resolves upon discontinuation of the tive treatment. Steroid acne may occur Pityrosporum folliculitis, another type of folliculi- from oral, topical, intravenous, or inhaled therapy. It occurs on the face, trunk, Associated skin findings include xerosis and pig- and extremities as nodules and crusted papulopus- mentary changes. Once present, chloracne may persist for years, even Mycotic infections, such as sporotrichosis or coc- without further exposure. Chemicals that contain cidioidomycosis, may also manifest cutaneously with iodides, bromides, and other halogens can also in- papules and nodules, which may ulcerate and crust. Bogdanowski T, Rubisz-Brzezinska J: Naevus comedonicus rarely from primary inoculation. Eur J rosacea has also been associated with the ingestion Dermatol 9: 491-492, 1999. Vexiau P, Gourmel B, Castot A, et al: Severe acne due to chronic amineptine overdose. Demitsu T, Kosuge A, Yamada T, et al: Acute generalized and periorbital areas and characteristically spares the exanthematous pustulosis induced by dexamethasone in- vermilion border of the lip. Rosenberger A, Tebbe B, Treudler R, et al: Acute general- inhaled corticosteroids, moisturizers, fluorinated com- ized exanthematous pustulosis induced by nystatin. Neubert U, Jansen T, Plewig G: Bacteriologic and immuno- demodicidosis with oral ivermectin and topical permethrin logic aspects of gram-negative folliculitis: a study of 46 pa- cream. In general, Recommendations should be supported by high- to moderate-quality evidence. Interim Measles Infection Control [July 2019] See Interim Infection Prevention and Control Recommendations for Measles in Healthcare Settings. The full-text version of these guidelines (this document) incorporates these updates. Objective: the objective is to develop an environmental infection-control guideline that reviews and reaffirms strategies for the prevention of environmentally-mediated infections, particularly among health-care workers and immunocompromised patients. Some topics did not have well-designed, prospective studies nor reports of outbreak investigations. Perform assays at least once a month by using standard quantitative methods for endotoxin in water used to reprocess hemodialyzers, and for heterotrophic, mesophilic bacteria in water used to prepare dialysate and for hemodialyzer reprocessing. Routine environmental sampling is not advised except in the few situations where sampling is directed by epidemiologic principles and results can be applied directly to infection control decisions, and for water quality determinations in hemodialysis. Reviewers Conclusions: Continued compliance with existing environmental infection control measures will decrease the risk of health-care associated infections among patients, especially the immunocompromised, and health-care workers. Antimicrobial-Impregnated Articles and Consumer Items Bearing Antimicrobial Labeling. Additional Engineering Measures as Indicated by Epidemiologic Investigation for Controlling Waterborne, Health-care associated Legionnaires Disease. Cleaning and Disinfecting Strategies for Environmental Surfaces in Patient-Care Areas. Animal-Assisted Activities, Animal-Assisted Therapy, and Resident Animal Programs. Special Precautions for Wastes Generated During Care of Patients with Rare Diseases. Chinn is a private-practice physician and salaried employee of Sharp Memorial Hospital in San Diego, California. Part I of this report, Background Information: Environmental Infection Control in Health-Care Facilities, provides a comprehensive review of the scientific literature. Use of an infection-control risk assessment is strongly supported before the start of these or any other activities expected to generate dust or water aerosols. Existing structures and engineered systems are expected to be in continued compliance with the standards in effect at the time of construction or renovation. Document whether infection-control personnel are actively involved in all phases of a health-care facilitys demolition, construction, and renovation.
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