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Inventory and Accountability Material accountability procedures should be established to asthma symptoms for infants buy 25mcg salmeterol free shipping track the inventory asthmatic bronchitis vs acute bronchitis 25mcg salmeterol visa, storage asthma symptoms 35 generic salmeterol 25mcg without prescription, use asthma prevention generic 25 mcg salmeterol with amex, transfer and destruction of dangerous biological materials and assets when no longer needed. The objective is to know what agents exist at a facility, where they are located, and who is responsible for them. To achieve this, management should define: 1) the materials (or forms of materials) subject to accountability measures; 2) records to be maintained, update intervals and timelines for record maintenance; 3) operating procedures associated with inventory maintenance. It is important to emphasize that microbiological agents are capable of replication and are often expanded to accommodate the nature of the work involving their use. Therefore, knowing the exact "working" quantity of organisms at any given time may be impractical. Depending on the risks associated with a pathogen or toxin, management can designate an individual who is accountable, knowledgeable about the materials in use, and responsible for security of the materials under his or her control. For the purpose of these policies, "sensitive information" is that which is related to the security of pathogens and toxins, or other critical infrastructure information. Examples of sensitive information may include facility security plans, access control codes, agent inventories and storage locations. Discussion of information security in this section does not pertain to information which has been designated "classified" by the United States pursuant to Executive Order 12958, as amended, and is governed by United States law or to research-related information which is typically unregulated or unrestricted through the peer review and approval processes. The objective of an information security program is to protect information from unauthorized release and ensure that the appropriate level of confidentiality is preserved. Facilities should develop policies that govern the identification, marking and handling of sensitive information. The information security program should be tailored to meet the needs of the business environment, support the mission of the organization, and mitigate the identified threats. Policies for properly identifying and securing sensitive information including electronic files and removable electronic media. Transport of Biological Agents Material transport policies should include accountability measures for the movement of materials within an institution. Transport policies should address the need for appropriate documentation and material accountability and control procedures for pathogens in transit between locations. Transport security measures should be instituted to ensure that appropriate authorizations have been received and that adequate communication between facilities has occurred before, during, and after transport of pathogens or other potentially hazardous biological materials. Personnel should be adequately trained and familiar with regulatory and institutional procedures for proper containment, packaging, labeling, documentation and transport of biological materials. Accident, Injury and Incident Response Plans Laboratory security policies should consider situations that may require emergency responders or public safety personnel to enter the facility in response to an accident, injury or other safety issue or security threat. The preservation of human life, the safety and health of laboratory employees and the surrounding community must take precedence in an emergency over biosecurity concerns. Facilities are encouraged to coordinate with medical, fire, police and other emergency officials when preparing emergency and security breach response Principles of Laboratory Biosecurity 111 plans. Laboratory emergency response plans should be integrated with relevant facility-wide or site-specific security plans. These plans should also consider such adverse events as bomb threats, natural disasters and severe weather, power outages, and other facility emergencies that may introduce security threats. Reporting and Communication Communication is an important aspect of a biosecurity program. This communication chain should include laboratory and program officials, institution management, and any relevant regulatory or public authorities. The roles and responsibilities of all involved officials and programs should be clearly defined. Policies should address the reporting and investigation of potential security breaches. Training and Practice Drills Biosecurity training is essential for the successful implementation of a biosecurity program. Program management should establish training programs that inform and educate individuals regarding their responsibilities within the laboratory and the institution. Practice drills should address a variety of scenarios such as loss or theft of materials, emergency response to accidents and injuries, incident reporting and identification of and response to security breaches.
The cochairs generated a general outline of the topics to asthma treatment guidelines aafp buy salmeterol 25mcg on-line be covered that was then circulated to asthma 4 month old baby 25 mcg salmeterol fast delivery committee members for input asthma symptoms tracker discount salmeterol 25 mcg with amex. A conference phone call was used to asthma medication ratio definition purchase 25mcg salmeterol fast delivery review topics and to discuss evidence grading and the general aims and expectations of the document. The topics were divided, and committee members were assigned by the cochairs and charged with presentation of their topic at an initial face-to-face meeting, as well as with development of a preliminary document dealing with their topic. An initial face-to-face meeting of a majority of committee members involved presentations of the most controversial topics, including admission decisions, diagnostic strategies, and antibiotic therapy. Prolonged discussions followed each presentation, with consensus regarding the major issues achieved before moving to the next topic. With input from the rest of the committee, each presenter and committee member assigned to the less controversial topics prepared an initial draft of their section, including grading of the evidence. Iterative drafts of the statement were developed and distributed by e-mail for critique, followed by multiple revisions by the primary authors. A second face-to-face meeting was also held for discussion of the less controversial areas and further critique of the initial drafts. Once general agreement on the separate topics was obtained, the cochairs incorporated the separate documents into a single statement, with substantial editing for style and consistency. The document was then redistributed to committee members to review and update with new information from the literature up to June 2006. Recommended changes were reviewed by all committee members by e-mail and/or conference phone call and were incorporated into the final document by the cochairs. Each society independently selected reviewers, and changes recommended by the reviewers were discussed by the committee and incorporated into the final document. Initially, the committee decided to grade only the strength of the evidence, using a 3-tier scale (table 1) used in a recent guideline from both societies . Evidence from well-designed, controlled trials without randomization (including cohort, patient series, and case-control studies). In some instances, therapy recommendations come from antibiotic susceptibility data without clinical observations. The implication of a strong recommendation is that most patients should receive that intervention. Industrial models suggesting that variability per se is undesirable may not always be relevant to medicine . For this reason, the committee members feel strongly that 100% compliance with guidelines is not the desired goal. However, the rationale for variation from a strongly recommended guideline should be apparent from the medical record. Conversely, moderate or weak recommendations suggest that, even if a majority would follow the recommended management, many practitioners may not. One document cannot cover all of the variable settings, unique hosts, or epidemiologic patterns that may dictate alternative management strategies, and physician judgment should always supersede guidelines. In addition, few of the recommendations have level I evidence to support them, and most are, therefore, legitimate topics for future research. Subsequent publication of studies documenting that care that deviates from guidelines results in better outcomes will stimulate revision of the guidelines. Although these guidelines are evidence based, the committee strongly urges that deviations from them not necessarily be considered substandard care, unless they are accompanied by evidence for worse outcomes in a studied population. Protocol design varies among studies, and the preferable randomized, parallel group design has been used in only a small minority. Confirmatory studies that use randomized, parallel groups with precisely defined treatments are still needed, but a consistent pattern of benefit is found in the other types of level I studies. Published protocols have varied in primary focus and comprehensiveness, and the corresponding benefits vary from one study to another. However, the most impressive aspect of this literature is the consistently beneficial effect seen in some clinically relevant parameter after the introduction of a protocol that increases compliance with published guidelines. A decrease in mortality with the introduction of guidelinebased protocols was found in several studies [19, 21]. A 5-year study of 28,700 patients with pneumonia who were admitted during implementation of a pneumonia guideline demonstrated that the crude 30-day mortality rate was 3. Lower mortality was seen in other studies, although the differences were not statistically significant [22, 23].
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