To educate health care professionals on the most recent practices for prevention and treatment of wounds with special consideration towards pressure ulcers as defined by the Centers for Medicare and Medicaid Services regarding Hospital Acquired Conditions (HAC).

TARGET AUDIENCE:

Healthcare professionals involved in providing wound care

OBJECTIVES:

1. Identify the three main layers of the skin and their components
2. Name the three types of wound healing
3. Describe the three phases of wound healing
4. Describe the etiology of pressure ulcers
5. List the six stages of pressure ulcers
6. Understand the role of the Braden Scale in prevention of pressure ulcers
7. Differentiate between Arterial and Venous ulcers
8. Differentiate between neuropathic and neuroischemic ulcers
9. Name three interventions to improve diabetic wound healing
10. Differentiate between colonization and infection of a wound
11. List the stages of skin tears and their treatment
12. Identify three types of ostomies
13. Identify at least 2 characteristics of a healthy stoma
14. Identify at least 2 characteristics of an unhealthy stoma
15. List 3 techniques applicable to all wounds
16. Describe the use of Negative Pressure Wound Therapy

The course fee is $100 for 6.1 contact hours.

Register Online Now!

Some of the Objectives Include:

• Recognize infants at increased risk for becoming hypoglycemic and
hyperglycemic.
• Identify candidates for placement of an umbilical catheter.
• List 3 ways healthcare providers can support parents of sick infants.
• Recognize infants at increased risk of becoming hypothermic, and list 3
necessary precautions to observe when re-warming hypothermic infants.
• Describe how to provide assistance during endotracheal intubation.
• List 2 signs and symptoms of a pneumothorax.
• Describe indications for, and safe administration of, dopamine.
• Identify the initial, appropriate IV fluid therapy for sick neonates.
• Discuss the relationship of thrombocytopenia to possible sepsis.
• List 3 laboratory tests indicated for evaluation of infection

Who Should Attend:
All Labor and Delivery, Postpartum and Newborn Nurses functioning in a “Women’s Services” unit other than NICU.

Allied health professionals may attend as appropriate based on the level of team involvement with sick newborns.

The course fee is $150 for Provider  6.7 Contact Hours and includes the course textbook from Nursing Unlimited’s library.

Please remember to include $5.00 for shipping and handling.

Register online now

The purpose of this course is to provide healthcare professionals with a detailed approach to cardiac dysrhythmia interpretation, as well as cardiovascular anatomy and physiology, electrophysiology and treatments of dysrhythmia, in accordance with the American Association of Critical Care Nurses and the American Heart Association’s ACLS guidelines.  Course includes detailed, in-depth review of clinical diagnosis and treatment of the cardiac patient.

Some of the Objectives Include:

1. Describe the general anatomical structures of the heart.
2. Identify the heart’s electrical properties.
3. Describe the right- versus the left-sided mechanical functions of the heart.
4. Explain proper electrode placement for EKG monitoring.
5. Identify the components of the normal EKG complex.
6. Utilize the 5-step method for EKG interpretation.
7. Identify the criteria for arrhythmias, clinical significance and treatment modalities.
8. Identify the assessment sequence and techniques for pulmonary, cardiac and vascular diseases.
9. Describe different types of vascular diseases and their complications.
10. Outline diagnosis and treatment of acute coronary syndrome (ACS).
11. Perform a 12 lead and right-sided EKG.
12. Identify frequently used telemetry cardiac drugs, mechanism of action, side effects, adverse effects and nursing considerations.

Who Should Attend:

• Anyone who wishes to work in:
  •    Critical care
  •     Stepdown units
  •     Special Procedures

• RNs who would like to expand their marketability

The course fee is $300 for 29.4 Contact Hours. A comprehensive course workbook will be provided on the first day of class.

Register online now

http://www.aafp.org/afp/990700ap/225.html

American Institute of Stress

http://www.stress.org/

Geriatric Depression Scale
University of Stanford

http://www.stanford.edu/~yesavage/GDS.html

Helpguide.org

http://www.helpguide.org/mental/stress_signs.htm

National Alliance on Mental Illness

http://www.nami.org/Content/ContentGroups/Helpline1/Depression_in_Women.htm

National Institutes of Health

http://www.nlm.nih.gov/medlineplus/stress.html

Prevalence of depression and its treatment in an elderly population: the Cache County study
Steffens DC, Skoog I, Norton MC et al
Archives of General Psychiatry 200: 57(6) 601-7

The Cleveland Clinic Foundation

http://www.cchs.net/health/health-info/docs/2200/2268.asp?index=931326

The National Institute of Mental Health

http://www.nimh.nih.gov/healthinformation/depressionmenu.cfm

Stress is a normal physical reaction that occurs when a person feels threatened or overwhelmed.  The perception of a threat is as stressful as a real threat.  The stress response narrows one’s ability to think clearly and function effectively.  It can be disabling both emotionally and physically.  The goal of stress management is to bring the nervous system back into balance, restoring a sense of calmness and control to the stressed individual.

Physical Effects of Stress
There have been many studies indicating that health is greatly affected by how one reacts to stressful events in life.  The common finding is that the number of life changes and stress a person has experienced increases their chances of contracting a physical illness.  A study by Cohen, Tyrrell, & Smith in 1993 showed that the “higher the subject’s reported level of stress, whether measured by negative life change events, perceived stress level, or negative feelings, the higher the likelihood that the subject would actually become infected with a cold.”

Many studies show that being depressed increases the risk of having a heart attack, whether or not the individual has heart disease.  Long-term stress can affect the immune system as well.  Most people with healthy immune systems take their resistance to disease for granted, but the most common causes of weakened immunity in healthy individuals are stress and aging.  Many studies have been done on the physical stress response in the elderly, and it was found that when placed under stress, elderly people experienced loss of appetite, weight loss, a lowered lymphocyte count (which impairs immune function) and an increase in psychological distress and in serum cholesterol levels.  Also, negative stress increases our body’s production of free radicals.  This is because the pituitary stimulates the adrenal glands, which in turn produce the stress hormones cortisol, epinephrine, and norepinephrine.  These chemical reactions set off a chain response, resulting in still more free radicals.

Methods of Preventing and Coping with Stress•
Lifestyle habits that can help avoid or manage stress include:
•    Getting enough sleep:  Adequate sleep fuels the mind, as well as the body. Feeling tired will increase stress because it may cause irrational thinking.
•    Connecting with others and developing a support network.
•    Exercising regularly:  Physical activity plays a key role in preventing and reducing the effects of stress.
•    Eating a balanced, nutritious diet:  Well-nourished bodies are better prepared to cope with stress.
•    Reducing caffeine and sugar:  In excessive amounts, the temporary “highs” they provide often end in fatigue or a “crash” later.
•    Not self-medicating with alcohol or drugs:  While consuming alcohol or drugs may appear to alleviate stress, it is only temporary.  When sober, the problems    and stress will still be there.  It is important not to mask the issue(s) at hand.
•    Doing something for yourself everyday: It is important to take time out from the hustle and bustle of life for leisure time.  Too much work is actually inefficient and can lead to burnout.

Changes in Thinking and Emotional Response to Better Handle Stress
Ways of thinking and responding that can reduce stress include:
•    Having realistic expectations of one’s limits and capabilities.
•    Reframing problems as opportunities.
•    Maintaining a sense of humor.
•    Expressing feelings rather than bottling them up.
•    Not trying to control events or other people.

Compassion Fatigue
Medical professionals often suffer from a type of stress known as “compassion fatigue,” resulting from the day-to-day stress of seeing others suffering, with only limited capacity to alleviate that suffering.  Compassion fatigue may result in poor job performance and plummeting self-esteem, and thus it can even drive some people who experience it out of their professions entirely.  Those who suffer from compassion fatigue can also experience tension in their home lives, or even fall into clinical depression or other mental-health problems.

The signs of compassion fatigue can mimic those of post-traumatic stress disorder, including sleeplessness, irritability, anxiety, emotional withdrawal, avoidance of certain tasks, isolation from co-workers, feelings of helplessness and inadequacy.  It can lead to excessive drinking or other unhealthy behavior.  And vicarious stress can trigger a professional’s memories of trauma experienced first hand, causing an accumulation of symptoms that can prove debilitating.  Those who experience compassion fatigue are often the best and the brightest, those endowed with a high level of sensitivity to the suffering of others.
Compassion fatigue is usually alleviated simply by acknowledging the problem and getting support.  The lifestyle and mental response methods of relieving stress outlined above can also assist in relieving this type of stress.

When Is Professional Help Needed for Stress Management?
There’s a fine line between feeling stressed out while still being able to function effectively, and the debilitating, even paralyzing phenomenon of breakdown.  It’s time to seek professional help if an individual:
·    Feels that stress is affecting their health.
·    Feels that it will never end.
·    Feels so desperate that they think about quitting their job, running away, taking a drug overdose, or injuring themselves.
·    Feels depressed, sad, tearful, or that life is not worth living.
·    Loses appetite and finds it difficult to sleep.
·    Is managing stress level by eating, sleeping, drinking alcoholic beverages, smoking, or using recreational drugs.
·    Has worries, feelings and thoughts that are difficult to talk about.
·    Hears voices telling them what to do.

Conclusion
Stress is inevitable in our lives as we age.  As a person gets older and older, there are more stressors that appear, which can cause extreme side effects, both physically and emotionally.  These effects are not to be taken lightly, since some can result in very serious health problems.  If certain preventive measures are taken and certain coping methods are learned, the effects of stress can be reduced as one ages.

What Is Depression?
Depression seems to be related to an imbalance of certain chemicals in the brain. It may present solely as a major depressive disorder, or as part of a spectrum known as bipolar disorder.  By definition, it cannot be secondary to physical illness or alcohol, medication or street drug use.  It is not a part of the normal bereavement process.

Most of us know about the emotional symptoms of depression.  But depression can cause physical symptoms, too.  The signs and symptoms of depression are myriad and include:
•    Poor appetite
•   Weight loss
•    Lack of sleep
•    Memory problems
•    Lack of interest
•    Poor concentration
•    Lack of energy
•    Feeling of impending doom
•    Financial problems
•    Alcohol or other drug misuse – self medication
•    Psychosomatic presentation
•    Suicidal ideation

Treating Physical Symptoms
Many depressed people never get help, because they don’t know that their physical symptoms might be caused by depression.  A lot of doctors miss the symptoms, too.  Depression can cause real changes in the body, such as slowing down digestion, which can result in stomach problems.  In some cases, treating depression — with therapy or medicine or both — will also resolve physical symptoms.  Since pain and depression go together, sometimes easing pain may help with depression.  Some antidepressants, such as Cymbalta and Effexor, may also help with chronic pain.

Depression may be a precursor to another medical disorder, such as Alzheimer’s or Parkinson’s disease.  It may also be co-morbid with a disease, such as myocardial infarction, or it may follow a disorder, such as stroke.  Depression is common in patients with cancer, and 80% of all cancers occur in persons older than 60 years.

Depression in the Elderly
The risk of depression in the elderly is higher than in the general population for numerous reasons, including social isolation, physical handicap, multi-pathology and poly-pharmacy.  Depression in the elderly is a hugely under-reported and under-diagnosed illness.  Symptoms of depressive illness are often seen as a normal part of the aging process or as a normal response to physical illness or disability that often accompanies old age.  However, depression left untreated can have significant detrimental affects on concurrent illness and general quality of life.  It is estimated that 1 in 3 senior citizens living in nursing homes may be suffering from depression.  Although depression is common among older people, it is not a normal part of getting older.  Depression can and should be treated.

The following table describes factors and their specific statistics that may increase the risk of depression in an elderly patient.

Medical illness
Hypothyroidism (50%)
Myocardial infarction (45%)
Macular degeneration (33%)
Diabetes (8% to 28%)
Cancer (24%)
Coronary artery disease (20%)

Medications
Beta-blockers
Interferon alfa
Many anticancer drugs

Central nervous system disease
Parkinson’s disease (25% to 70%)
Alzheimer’s disease (15% to 57%)
Multiple sclerosis (27% to 54%)
Stroke (26% to 54%)
Huntington’s disease (9% to 44%)
Microvascular ischemic disease of the brain (20%)
Mini-Mental State Examination score <24

Risk of Suicide
The most serious complication of depression is the risk of suicide. Statistics show that older Americans are disproportionately likely to die by suicide.
·    Although they comprise only 12 percent of the U.S. population, people aged 65 and older accounted for 16 percent of suicide deaths in 2004.
·    14.3 of every 100,000 people aged 65 and older died by suicide in 2004, higher than the rate of about 11 per 100,000 in the general population.
·    Non-Hispanic white men aged 85 and older were most likely to die by suicide, with a rate of 49.8 suicide deaths per 100,000 persons.

For every 100,000 people aged 65 and older in each of the ethnic/racial groups below, the following number died by suicide in 2004:
·    Non-Hispanic Whites — 15.8 per 100,000
·    Asian and Pacific Islanders — 10.6 per 100,000
·    Hispanics — 7.9 per 100,000
·    Non-Hispanic Blacks — 5.0 per 100,000

Special Risks for Women
The female to male ratio for depression is 2.5 : 1, and women are more likely to suffer symptoms of sub-clinical depression.

Diagnosing Depression

There is no lab test to diagnose depression, which is why the healthcare professional’s observations and accurate reporting of patients’ behavior are very important.  When diagnosing depression, healthcare providers look for the signs of depression mentioned earlier.  They can also use “screening” tests to diagnose depression and determine its severity.  Sometimes, depression is caused by or made worse by medical problems.  Pain is an example of a medical condition that is associated with depression.  Successful treatment of pain can decrease depression.

Some signs of depression can also be signs of infection.  For example, if someone stops watching television (which he or she once enjoyed very much), the healthcare provider might want to check to see if the patient has a problem hearing or seeing.  Some medications can cause depression.  In these cases, the medication that causes depression can be stopped or the dosage can be decreased.  In general, if no medical cause is found for the patient’s changes in behavior, and if the signs have been present for 2 weeks or more, depression may be diagnosed.

Treatment of Depression
The consequences of undiagnosed and untreated depression are substantial.  Depression increases the risk for eventual development of permanent dementia, so early identification of depression is especially important in cases of reversible dementia. Persistent depression among individuals with physical dependency following a catastrophic illness is associated with failure to improve in physical functioning.  Depression can probably be linked to increased medical morbidity in nursing home residents, and recent data point to increased mortality in nursing home residents with major depressive disorder.

The treatment of depression depends on several factors, such as the severity of the depression, whether or not the person is suicidal, and the person’s ability to reason and participate in conversation.  For example, someone with severe depression should receive an antidepressant medication, whereas someone with mild depression may be treated successfully with non-drug therapies.

Management of depression is multi-faceted.  Depending on the specific signs and symptoms and complications, therapy may include psychotherapy, drugs, electro convulsive therapy, or a combination of these.  A study showed that about 80 percent of older adults with depression recovered with this kind of combined treatment and had lower recurrence rates than with psychotherapy or medication alone.

Psychotherapy – Varying modalities of psychotherapy have been shown to improve symptoms and prevent relapse if used correctly and consistently.

Drugs – Theory suggests that depression is caused by a relative lack of serotonin – the “happy hormone”, a neurotransmitter – in the brain of patients suffering from depression.  Drug therapy currently centers on increasing the amount of serotonin at the terminal ends of neurons in the central nervous system.

There are many classes of drugs available for treating depression, including, most commonly, tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs) and selective serotonin reuptake inhibitors (SSRIs), and in refractory cases, lithium.  Studies have shown that patients aged 70 and older who became symptom-free and continued to take their medication for two more years were 60 percent less likely to relapse than those who discontinued their medications.  The problem with drugs is compliance.  The disease process itself may prevent patients from consistently following a drug regimen.  A large part of the problem is the side effects of drug-therapy, which include dry mouth, drowsiness, dizziness and anxiety.

Electro convulsive therapy (ECT) –  A long-used and feared form of treatment, this modality has a high success rate in the treatment of depression.  It is reserved for patients in whom other therapies have failed or are causing unacceptable adverse effects, or in patients where a positive result is required quickly.
ECT is performed under general anesthesia or sedation.  An electrical current is applied directly to the brain, resulting in a minor seizure.  The exact effects of ECT on the brain are not clearly understood, but it is conjectured that it changes intra-cerebral chemistry, with positive effects on depressed individuals.

Generally a safe form of treatment, ECT may have some side effects due to the anesthesia or the treatment itself.  In the first few hours, the patient may experience headache, muscle aches, nausea and confusion.  There may be a transient amnesia also.

Conclusion
Depression is a serious medical disorder, with important physical and emotional consequences, including exacerbation of other disease processes and an increased risk of suicide, particularly in the elderly.  However, depression can often be treated successfully, using psychotherapy, drugs, electro convulsive therapy, or a combination of all three.

• Distinguish between aspiration pneumonitis and aspiration pneumonia
• List 2 causative organisms of community-acquired aspiration pneumonia
• List 5 risk factors for aspiration pneumonia
• List 4 symptoms of aspiration pneumonia
• Identify 6 tests used to diagnose aspiration pneumonia
• List 3 complications of aspiration pneumonia
• Discuss 3 methods of prevention of this disease

Akritidis, N., Gousis, C., Dimos, G: Fever, cough, and bilateral lung infiltrates. Achalasia associated with aspiration pneumonia. Chest 2003 Feb; 123(2): 608-12.

Bartlett, J.G. Pneumonia: Management of respiratory tract infections, 2^nd ed. (1999) Lippincott Williams & Wilkins, Philadelphia, PA.

Campbell, G.D., Niederman, M.S., Broughton, W.A., et al. Hospital-acquired pneumonia in adults: diagnosis, assessment of severity, initial antimicrobial therapy, and preventive strategies. A consensus statement. American Thoracic Society, November 1995. Am J Respir Crit Care Med 1996;153(5):1711-25.

Drakulovic, M.B., Torres, A., Bauer, T.T., et al: Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet 1999 Nov 27; 354(9193): 1851-8.

Ferri, F.F. Ferri’s Clinical Advisor (2007), 1^st ed. Mosby, Philadelphia, PA..

Goldman, L., Ausiello, D. Cecil Textbook of Medicine, 22^nd ed. (2003). Saunders, Philadelphia, PA.

Marik, P.E., Careau, P: The role of anaerobes in patients with ventilator-associated pneumonia and aspiration pneumonia: a prospective study. Chest 1999 Jan; 115(1): 178-83.

Marik, P.E. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med 2001;344(9):665-71.

Marom, E.M., McAdams, H.P., Erasmus, J.J: The many faces of pulmonary aspiration. AJR Am J Roentgenol 1999 Jan; 172(1): 121-8.

Marx, J.S., Hockberger, R.S., Walls, R.M., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice, 5^th ed. (2002). Mosby, St. Louis, MO.

Russell, S.L., Boylan, R.J., Kaslick, R.S., et al. Respiratory pathogen colonization of the dental plaque of institutionalized elders. Spec Care Dentist 1999;19(3):128-34.

Sasaki, H., Sekizawa, K., Yanai, M: New strategies for aspiration pneumonia. Intern Med 1997 Dec; 36(12): 851-5.

Upon completion of this course, the learner should be able to:
·    Define pandemic influenza
·    List 3 modes of transmission of influenza
·    List the 3 types of influenza virus
·    Discuss the difference and implications of antigenic drift and shift
·    Identify the 3 major influenza pandemics of the 20th century
·    Explain the role of cytokine storm in susceptibility to influenza
·    Explain the role of secondary infection by bacterial pneumonia
·    List 3 means of pandemic control

Bloomberg News article, Scientists Move Closer to Understanding Flu Virus Evolution (August 2006).

Brundage. J.F. and G.D. Shanks, “Death from Bacterial Pneumonia during 1918-19 Influenza Pandemic”, Emerging Infectious Diseases (August 2008).

Fidler, David, “Progress and Problems with Global Health
Governance”, Global Public Health (2007).

Kawaoka, Y (ed.), Influenza Virology: Current Topics. Caister Academic Press (2006).

Lemon, Stanley M. (ed.), The Threat of Pandemic Influenza: Are We Ready? National Academies Press, p. 66 (2005).

Markel, Howard, MD, et al, “Nonpharmaceutical Interventions Implemented by US Cities during the 1918-1919 Influenza Pandemic”, JAMA. 2007; 298:644-654.

Morens, D.M., et al, Predominant Role of Bacterial Pneumonia as A Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness. The Journal of Infectious Diseases DOI: 10.1086/591708 (2008).

Nicholls, H., “Pandemic Influenza: the Inside Story”. PLoS Biol. 4 (2): e50 (February 2006).

Price-Smith, Andrew, Contagion and Chaos, Cambridge, MA: MIT Press (2009).

Roos, Robert and Lisa Schnirring, “HHS Ties Pandemic Mitigation Advice to Severity”, University of Minnesota Center for Infectious Disease Research and Policy (CIDRAP) (February 2007).

Taubenberger, J. and D. Morens, “1918 Influenza: the Mother of All Pandemics”, Emerging Infectious Diseases, 12 (1): 15–22 (2006).

www.cdc.gov/ncidod/diseases/flu/fluvirus.htm
www.clinicaltrials.gov
www.hhs.gov/nvpo/pandemicplan/index.html
www.nih.gov

To educate healthcare professionals about the causes, risks and means of containment of pandemic influenza.

What Is Pandemic Influenza?
An influenza pandemic is an influenza epidemic that spreads on a worldwide scale, infecting a large proportion of the human population.  In contrast to regular seasonal epidemics of influenza, these pandemics occur irregularly, with the 1918 Spanish flu the most serious pandemic in recent history.  Three influenza pandemics occurred in the 20th century and killed tens of millions of people, with each of these pandemics being caused by the appearance of a new strain of the virus in humans.  Often, these new strains result from the spread of an existing flu virus to humans from other animal species.  History teaches that the influenza virus mutates to cause a worldwide epidemic about twice a century, on average.  But scientists have yet to figure out what causes these viral mutations, when they will occur and what makes certain viruses more lethal than others.

Seasonal Influenza
Influenza, commonly referred to as the flu, is an infectious disease caused by RNA viruses of the family Orthomyxoviridae, which affects birds and mammals.  The name influenza comes from the Italian, meaning “influence”.  The most common symptoms of the disease are chills, fever, pharyngitis, muscle pains, severe headache, coughing, weakness and general discomfort.  In more serious cases, influenza causes pneumonia, which can be fatal, particularly for the young and the elderly.  In children the immune responses are still developing, while the elderly immune function tends to be weaker due to the aging process.  Influenza, although often confused with the common cold, is a much more severe disease and is caused by a different type of virus.

Most people who get the flu recover completely in one to two weeks, but some people develop serious and potentially life-threatening medical complications, such as pneumonia.  In an average year, influenza kills an estimated 250,000 to 500,000 people worldwide, with about 36,000 deaths in the United States and many more hospitalizations.  Flu-related complications can occur at any age; however, the elderly and those with chronic health problems are much more likely to develop serious complications.  By contrast, pandemic flus often strike young, healthy people the hardest.

Modes of Transmission
Influenza can be highly contagious, particularly among persons without pre-existing antibodies against influenza, such as young children during the inter-pandemic phase and anyone during a pandemic.  Roughly 50% of all infections are, however, asymptomatic.  Asymptomatic infection is especially common in children.  The influenza virus is transmitted in most cases by droplets through the coughing and sneezing of infected persons, but it can be transmitted by direct contact as well.

Direct Contact
Direct-contact transmission involves skin-to-skin contact and physical transfer of microorganisms to a susceptible host from an infected or colonized person, such as occurs when healthcare personnel turn patients, bathe patients, or perform other patient-care activities that require physical contact.  Direct-contact transmission can also occur between two patients (e.g., by hand contact), with one serving as the source of infectious microorganisms and the other as a susceptible host.  Indirect-contact transmission involves contact of a susceptible host with a contaminated intermediate object, usually inanimate, in the patient’s environment (such as needles or countertops).

Droplet
Droplet transmission occurs when contagious droplets produced by the infected host are propelled a short distance through coughing or sneezing and can come into contact with another person’s conjunctiva, mouth or nasal mucosa. Influenza can be transmitted by large droplets, which generally travel 3 to 6 feet.  Since these droplets are generally greater than 10 micrometers and do not stay suspended in the air, this mode of transmission is not affected by special air handling or control of room pressures. Large droplets appear to be the primary route of nosocomial transmission.

Airborne (Droplet Nuclei)
Droplet nuclei (airborne) transmission entails the production of infectious droplet nuclei, generally 5 micrometers or less in diameter.  In contrast with larger droplets, these droplets can remain suspended in the air and be disseminated by air currents in a room or through a facility, to be inhaled by a susceptible host.  Small droplet nuclei and aerosols can remain suspended in the air for prolonged periods and travel significant distances.  Small particles appear to be more infectious, with both the degree of infectivity and the severity of illness directly related to particle size.  Aerosols smaller than 10 microns have been shown to cause more severe disease and require a smaller inoculum than large intranasal droplets.  Preventing the spread of droplet nuclei requires the use of special air handling and ventilation procedures.

There is no evidence that influenza transmission can occur across long distances (e.g., through ventilation systems) or through prolonged residence in air, as seen with airborne diseases such as tuberculosis.  Organisms transmitted in this manner must be capable of sustaining infectivity, despite desiccation and environmental variation that generally limit survival in the airborne state.  However, transmission may occur at shorter distances through inhalation of small-particle aerosols (droplet nuclei), particularly in shared air spaces with poor air circulation.  An experimental study involving human volunteers found that illness could be induced with substantially lower virus titers when influenza virus was administered as a small droplet aerosol rather than as nasal droplets, suggesting that infection is most efficiently induced when virus is deposited in the lower rather than the upper respiratory tract.

Evidence supporting the relative contribution of each route of transmission for influenza is limited; however, droplet transmission is thought to be the predominant form of spread in a setting with an appropriate number of air exchanges and standard ventilation.  In the absence of appropriate ventilation and air exchange, airborne transmission may play a greater role, such as in a crowded space where air exchange is limited.

Hotlines

National Domestic Violence Hotline 800-799-SAFE

(For speakers of English, Spanish, and Creole)

Florida Domestic Violence 800-500-1119

Domestic Violence Injunction 305-547-3170

Domestic Violence Shelter 305-758-2546

Florida Elder Helpline 800-963-5337

Legal Assistance

Legal Aid (divorce, child custody, support) 305-579-5733

Florida Bar Attorney Referral Service – 800-342-8060

State Attorney’s Office, Domestic Violence Unit 305-547-0150

Financial Assistance

Victim Assistance Program – 305-758-2546

Child Support Enforcement – 305-530-2600

Counseling

Family & Victim Services

(treatment for victims, children, & perpetrators) 305-571-7750

“Common Ground”

(educational support groups for women) 305-758-2546

Rape Treatment Center

(medical & crisis counseling) 305-585-7273

REFERENCE:

Burt, Martha R., Janine M. Zweig, Kathryn A. Schlichter, Stacy Kamya, Bonnie Datz, Adele V. Harrell, “Evaluation of the STOP Formula

Grants 2000 Report: The Violence Against Women Act of 1994″ March 15, 2000.

Evans, Patricia. Verbal Abuse: Survivors Speak Out . Hollbrook, Massachusetts; Bob Adams Inc. Publishing, 1993.

Gerard, M. (2000). Domestic violence: How to screen and intervene. RN , p. 52 – 56.

Gondolf, Edward W. Man Against Woman: What Every Woman Should Know About Violent Men . Blue Ridge Summit, Pennsylvania; Tab Books Inc., 1989.

Island, David & Letellier, Patrick. Men Who Beat the Men Who Love Them: Battered Gay Men & Domestic Violence . New York; Harrington Park Press, 1991.

Jones, Ann and Schechter, Susan. When Loves Goes Wrong: What To Do When You Can’t Do Anything Right . New York; Harper Collins, 1992.

Lobel, Kerry. Naming the Violence: Speaking Out About Lesbian Battering . Seattle; Seal Press, 1986.

Maltar, M. Domestic Violence: the Florida Requirement . ME Resource, Sacramento, CA, 2003

Miami-Dade Advocates for victims. (2000). Information guide for abused women, Miami-Dade Advocates , [Brochure]. Pohlmann, L., Frazee, S., & Cousin, M.

Nicarthy, Ginny. Getting Free: A Handbook for Women In Abusive Relationships . Seattle; Seal Press, 1987.

Paris, Susan. Mommy and Daddy are Fighting: A Book for Children About Family Violence . Seattle: Seal Press.

Renzetti, Claire. Violent Betrayal: Partner Abuse in Lesbian Relationships . Newbury Park, California: Sage, 1992.

Schornstein, Sherri L. Domestic Violence and Healthcare: What Every Professional Needs to Know . Sage, 1997.

White, Evelyn. Chain, Chain, Change: For Black Women Dealing with Physical and Emotional Abuse . Seattle: Seal Press, 1985.

www.batteredmen.com

www.batteredmenshelpline.org

www.batteredwomen.com

www.breakthecycle.org

www.buddybuddy.com

www.crisisprevention.com

www.dateviolence.org

www.elderabusecenter.org

www.endabuse.org

www.fcadv.org

www.glennsacks.com/nowhere_to_go.htm

www.growing.com

www.menstoppingviolence.org

www.menstuff.org

www.menweb.org

www.myfloridalegal.com/directory

www.ncvc.org

www.nccanch.acf.hhs.gov/

www.ndvh.org

www.rainbowdomesticviolence.itgo.com

www.safe4all.org

www.salon.com

www.thehelpline.net/abused.html

www.usda.gov

www.4woman.gov/violence

A. MYTHS ABOUT DOMESTIC VIOLENCE

B. SEXUAL ORIENTATION AND GENDER

C. THE COSTS OF DOMESTIC VIOLENCE

II. TYPES OF ABUSE

A. PHYSICAL

B. PSYCOLOGICAL

C. CHARACTERISTICS OF THE BATTERER

D. CHARACTERISTICS OF THE VICTIM

F. THE CYCLE OF VIOLENCE

G. “RED FLAGS” OF A BATTERING PERSONALITY

H. WHY VICTIMS STAY

III. HELPING AND REFERRING VICTIMS AND PERPETRATORS

A. HOW TO CONDUCT A DIAGNOSTIC INTERVIEW

B. SCREENING QUESTIONS FOR VICTIMS

C. SCREENING QUESTIONS FOR PERPETRATORS

D. HELP FOR BATTERERS

E. SAFETY TIPS FOR VICTIMS WHO LEAVE THEIR ABUSER

F. LEGAL PROTECTION FOR VICTIMS OF DOMESTIC VIOLENCE

IV. ELDER AND CHILD ABUSE

V. FLORIDA REPORTING REQUIREMENTS

This home study is intended to educate health care professionals on domestic violence issues as required by Florida state law, Section 456.031(1)(a), F.S.

Objectives:

Upon completion of this program the learner will be able to:

•  Describe the dynamics of an abusive and/or violent relationship.

•  Identify three “red flags” of a battering personality.

•  Identify three characteristics of the victim of domestic violence.

•  List three reasons that victims may stay in an abusive relationship.

•  Describe screening procedures used to identify and assist both victims and perpetrators of domestic violence.

•  Identify two legal protections available to victims of domestic violence.

•  List three community resources available to assist the victim, the perpetrator and the family.

I. WHAT IS DOMESTIC VIOLENCE?

Domestic violence is a crime in all fifty states. Florida law (741.28, F.S.) defines domestic violence as “any assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, false imprisonment, kidnapping, or any criminal offense resulting in physical injury or death of one family or household member by another who is or was residing in the same single dwelling unit”. Domestic violence may also be defined as a “pattern of controlling behavior by one person who has a personal, intimate or familial relationship with another.” (Governor’s Task Force on Domestic Violence, 2000).

The crime of assault is an intentional, unlawful threat, by word or act, to do violence to someone, coupled with an apparent ability to carry out such threat, creating a well-founded fear in the other person that violence is imminent. Aggravated assault is assault with a deadly weapon.

The offense of battery occurs when a person intentionally touches or strikes another person against their will or intentionally causes them bodily harm. Knowingly causing great bodily harm, permanent disability or disfigurement, using a deadly weapon, or committing battery against a pregnant victim is aggravated battery .

Anyone who willfully, maliciously and repeatedly follows or harasses another person, for no legitimate purpose, causing substantial emotional distress, commits the offense of stalking . Making a credible threat which causes someone to reasonably fear death or bodily injury either for themselves, their child, sibling, spouse, parent, or dependent, is aggravated stalking .

Kidnapping and false imprisonment mean forcibly, secretly, or by threat confining, abducting, or imprisoning another person against her or his will and without lawful authority.

Because violence inflicted by an intimate partner has traditionally been treated more leniently by law enforcement than violence inflicted by a stranger, domestic barterers are not always arrested.

On January 5, 2006, the President signed the “Violence Against Women” Reauthorization Act. This works though the use of STOP grants. As a result, “victims are safer, better supported by their communities, and treated more uniformly and sensitively by first-response workers.”

A. MYTHS ABOUT DOMESTIC VIOLENCE

Myths and misunderstandings about domestic violence abound. Although domestic violence occurs in approximately one out of three relationships , it remains one of the nation’s best-kept secrets. Domestic violence is the most under-reported crime in the country, with the actual incidence probably 10 times higher than reported. It remains a major health concern.

One prevalent myth is that perpetrators of domestic violence strike when angry and out of control. On the contrary, violence is an intentional choice, used to establish power and control in an intimate relationship. (Barterers manage not to beat their bosses or terrorize their friends when they are angry.) Domestic abuse is always about power and control . While the violence may not occur often, it is a constant underlying factor in the relationship. Although the first violent incident may not be severe, once battering begins, it tends to increase in severity and frequency, sometimes leading to permanent injury or death. The occasional slap or shove can evolve into a push down the stairs, a punch in the face or a kick in the stomach.

Another myth is that perpetrators are driven to violence by the behavior of their partners. In fact, perpetrators are unaffected by their partners’ efforts to change their behavior in order to appease them. The behavior the abuser chooses to target at any one time usually cannot be predicted by the partner, and this unpredictability is a major means for the banterer to maintain control.

Most Healthcare professionals are required to have a current CPR credential, and the American Heart Association BLS for Healthcare provider card is the gold standard.  The BLS Healthcare Provider Course is designed to provide healthcare professionals the ability to recognize life-threatening emergencies, provide CPR, use an AED, and relieve choking in a safe, timely and effective manner.  The course is designed for certified, noncertified, licensed and nonlicensed healthcare professionals.

Intended Audience
Healthcare providers such as physicians, nurses, paramedics, emergency medical technicians, respiratory therapists, physical and occupational therapists, physician’s assistants, residents or fellows, or medical or nursing students in training, aides, medical or nursing assistants, police officers, and other allied health personnel.

Here are some of the major changes in 2005 guidelines:

• Increased compression to ventilation rate for adult victims from 15:2 to  30:2.  The goal for the compression rate for any age victim is now 100 compressions per minute.
• location of hands for compressions in now the inter-mammary line.
• Discontinue use of blind finger sweeps.
• For Children and Infant’s, 5 cycles of CPR must be completed prior to calling 911

Steps to complete the CPR Course Online:

1. Register and pay for the Online BLS Part 1 Course ($30)
2. Receive via email an online key within 24 hours of registration.
3. Complete the Online BLS Part 1 Course through the American Heart’s website
4. Attend a skills test at a location close to you (find one close to you)
5. Receive your certification card for the skills testing location.

The course fee for the online CPR class is $30.

Register now for the Online BLS Course! $30

Do you live in South Florida?  Register for the Online Renewal Package which includes the Online class and skills evaluation for $50.

Register now fo the Online BLS Course with Skills Assessment! $50

Don’t forget about our Online Nursing CEU Classes and mandatory requirements.

This CPR course is conducted in affiliation with the American Heart Association, which has updated the guidelines for performance of Basic Life Support. This is the course required by healthcare facilities in order to maintain employment. It is designed for healthcare providers that have taken CPR before and have a current Healthcare Provider card. Our 1 to 1 manikin to student ratio increases the amount of time spent on actual skills resulting in enhanced retention. Upon successful completion a 2-year American Heart Association card will be issued along with a certificate for 3 contact hours.

Course Prerequisite:

A current AHA BLS for Healthcare Provider Card. Pre registration is not required for this program. Just call before class and let us know you are coming and we will save you a seat.

The course fee is $45 for 3 contact hours and includes the AHA textbook from Nursing Unlimited’s Library

Don’t Forget About HIV/AIDS Update, Domestic Violence Mandatory Requirement, and Prevention Of Medical Errors Mandatory Requirement.

Regiser Online Now!

Hypoglycemia

<65 – dizziness, confusion, weakness, tremors.

<40 – coma, seizures, irreversible brain damage.

Treat with quickly absorbed glucose – orange juice, soft drinks, glucose tablets (15-20g), cake icing applied to the inside of the mouth.

Hyperglycemia

Blood glucose >130.

Dangerous when symptomatic, but must be identified and treated to avoid complications. Signs and symptoms are as above. If associated with infection, can lead to diabetic ketoacidosis. This results in severe dehydration, acidosis and sepsis. This is a potentially fatal illness; therefore, early recognition and avoidance is important. It is imperative not to skip insulin if the diabetic is unwell and not eating. Maintain adequate hydration. Get urgent medical help if unable to control blood glucose levels or if patient appears unwell.

Hyperosmolar non-ketotic state

In the elderly, Type 2 diabetes is more prevalent. Because there is no absolute lack of insulin, ketoacidosis does not occur. What does occur is a hyperosmolar non-ketotic state which can lead very quickly to coma. Again, prevention is better than cure.

Skin care

Diabetic patients suffer from skin problems for a number of reasons. First, they are more prone to developing infections due to impaired immunity; secondly, they develop peripheral neuropathies which allow easy disturbance of skin integrity; thirdly, they have microvascular disease, which prevents adequate perfusion and immensely compromises the ability to repair. It is imperative to educate patients in thorough cleansing and inspection of extremities. Good podiatry care is very important. Any injuries should be addressed quickly and treated aggressively to avoid chronic ulcers.

Foot ulcers

The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible. The faster the healing, the less chance for an infection.

There are several key factors in the appropriate treatment of a diabetic foot ulcer:

•  Prevention of infection

•  Taking the pressure off the area, called “off-loading”

•  Removing dead skin and tissue, called “debridement”

•  Applying medication or dressings to the ulcer

•  Managing blood glucose and other health problems

Not all ulcers are infected; however if the podiatric physician diagnoses an infection, a treatment program of antibiotics, wound care, and possibly hospitalization will be necessary.

There are several important factors involved in keeping an ulcer from becoming infected:

•  Keep blood glucose levels under tight control

•  Keep the ulcer clean and bandaged

•  Cleanse the wound daily, using a wound dressing or bandage

•  Do not walk barefoot

For optimum healing, ulcers, especially those on the bottom of the foot, must be “off-loaded.” Patients may be asked to wear special footgear, or a brace, or specialized castings, or to use a wheelchair or crutches. These devices will reduce the pressure and irritation to the ulcer area and help to speed the healing process.

The science of wound care has advanced significantly over the past ten years. The old thought of “let the air get at it” is now known to be harmful to healing. We know that wounds and ulcers heal faster, with a lower risk of infection, if they are kept covered and moist. The use of full strength betadine, peroxide, whirlpools and soaking are not recommended, as this could lead to further complications.

Appropriate wound management includes the use of dressings and topically-applied medications. These range from normal saline to advanced products, such as growth factors, ulcer dressings and skin substitutes, which have been shown to be highly effective in healing foot ulcers.

For a wound to heal there must be adequate circulation to the ulcerated area. The podiatrist can determine circulation levels with noninvasive tests.

Vision and dentation

Diabetics should receive regular follow-up for their vision and dentation. They should also be monitored closely by their primary care physician or diabetology team in order to maintain optimum health and prevent future complications.

Medications commonly used to treat diabetes and their side effects

Sulfonylureas

Sulfonylureas stimulate the beta cells of the pancreas to release more insulin. Sulfonylurea drugs have been in use since the 1950s. Chlorpropamide (brand name Diabinese) is the only first-generation sulfonylurea still in use today. The second-generation sulfonylureas are used in smaller doses than the first-generation drugs. There are three second-generation drugs: glipizide (brand names Glucotrol and Glucotrol XL), glyburide (Micronase, Glynase, and Diabeta), and glimepiride (Amaryl). These drugs are generally taken one to two times a day, before meals. All sulfonylurea drugs have similar effects on blood glucose levels, but they differ in side effects, how often they are taken, and interactions with other drugs.

Meglitinides

Meglitinides are drugs that also stimulate the beta cells to release insulin. Repaglinide (brand name Prandin) and nateglinide (Starlix) are meglitinides. They are taken before each of three meals.

Because sulfonylureas and meglitinides stimulate the release of insulin, it is possible to have hypoglycemia (low blood glucose levels).

It is important to be aware that alcohol and some diabetes pills may not mix. Occasionally, chlorpropamide and other sulfonylureas can interact with alcohol to cause vomiting, flushing, or sickness.

Biguanides

Metformin (brand name Glucophage) is a biguanide. Biguanides lower blood glucose levels, primarily by decreasing the amount of glucose produced by the liver. Metformin also helps to lower blood glucose levels by making muscle tissue more sensitive to insulin so glucose can be absorbed. It is usually taken two times a day. A side effect of metformin may be diarrhea, which can be reduced by taking the drug with food.

Thiazolidinediones

Rosiglitazone (Avandia), troglitazone (Rezulin), and pioglitazone (ACTOS) form a group of drugs called thiazolidinediones. These drugs help insulin work better in the muscle and fat and also reduce glucose production in the liver. Thiazolidinediones are taken once or twice a day with food. Although effective in lowering blood glucose levels, thiazolidinediones can have a rare but serious effect on the liver. For this reason, the physician should perform blood tests regularly to monitor the health of the liver.

Alpha-glucosidase inhibitors

Acarbose (brand name Precose) and meglitol (Glyset) are alpha-glucosidase inhibitors. These drugs help the body to lower blood glucose levels by blocking the breakdown of starches, such as bread, potatoes, and pasta in the intestine. They also slow the breakdown of some sugars, such as table sugar. Their action slows the rise in blood glucose levels after a meal. They should be taken with the first bite of a meal. These drugs may have side effects, including gas and diarrhea.

Oral combination therapy

Because the drugs listed above act in different ways to lower blood glucose levels, they may be used together. For example, a biguanide and a sulfonylurea may be used together. Many combinations can be used. Though taking more than one drug can be more costly and can increase the risk of side effects, combining oral medications can improve blood glucose control when taking only a single pill does not have the desired effect. Switching from one single pill to another is not as effective as adding another type of diabetes medicine.

Insulin therapy

Most insulin in use today is synthetically produced from laboratory cultures. However, a small percentage of people with Type 1 diabetes still use animal-based insulins that are distilled and purified from the pancreases of cows (bovine insulin) and pigs (porcine insulin).

There are six types of synthetic insulin available-rapid-acting, regular, NPH (N), lente (L), ultralente, and long-acting basal. Each has its own unique therapeutic effect. An insulin’s onset of action is how long it takes the hormone to start working at lowering blood glucose levels. The peak is the point at which the dose is at the height of its therapeutic effectiveness, and the duration is how long the insulin’s blood glucose lowering effect lasts from injection to end.

Summary

Diabetes is a multi-systemic disease with grave implications for future health. A multi-disciplinary approach to the care of these patients is important and has proven to improve morbidity and mortality from the disease. Monitoring and maintaining good blood sugar levels is the most important intervention in the care of the diabetic. This involves patient education and a teamwork approach. Long-term complications from diabetes can be delayed and their extent controlled with good evaluation, treatment and management.

go to test.

Barnett, Anthony H., Diabetes – Best Practice & Research Compendium. Saunders 2006. ISBN: 0080446868.

Harmel, Anne Peters and Ruchi Mathur, Davidson’s Diabetes Mellitus , 5th ed. Saunders, 2004. ISBN: 0721695965.

Marso, Steven P. and David M. Stern, Diabetes and Cardiovascular Disease . Lippincott Williams & Wilkins, 2003. ISBN-10: 0-7817-4053-3.

Springhouse , Diabetes Mellitus: A Nurse’s Guide to Patient Care. Lippincott Williams & Wilkins, 2006. ISBN-10: ISBN-10: 1-58255-732-2.

www.cdc.gov/diabetes/statistics/maps/index.htm

www.diabetes.niddk.nih.gov/complications/index.htm

www.diabetes.org/type-2-diabetes/complications.jsp

www.fda.gov/diabetes/related.html

www.ndep.nih.gov/diabetes/WhatIs/WhatIs.htm

I. What is diabetes?

II. Definition of diabetes

III. Signs/symptoms

IV. Prevalence of diabetes

V. Complications of diabetes

A. Heart and blood vessel disease

B. High blood pressure

C. Blindness

D. Kidney disease

E. Foot ulcers

F. Nervous system disease

G. Amputations

H. Dental disease

I. Complications of pregnancy

J. Impotence

K. Other complications

VI.   Management of some common complications

A. Hypoglycemia

B. Hyperglycemia

C. Hyperosmolar non-ketotic state

D. Skin care

E. Foot ulcers

F. Vision and dentation

VII. Medications commonly used to treat diabetes and their side effects

A. Sulfonylureas

B. Meglitinides

C. Biguanides

D. Thiazolidinediones

E. Alpha-glucosidase inhibitors

F. Oral combination therapy

G. Insulin therapy

VIII. Summary

To update health care professionals on the risks, complications and management of diabetes.

OBJECTIVES:

Upon completion of this program the learner will be able to:

•  Explain the difference between Type 1 and Type 2 diabetes

•  Name 5 complications of diabetes.

•  Identify the most important intervention in the care of the diabetic.

•  List four medications commonly used in the treatment of diabetes.

What is diabetes?

Diabetes mellitus is a chronic health condition in which the body is unable to produce adequate insulin to properly break down sugar (glucose) in the blood. Symptoms include hunger, thirst, excessive urination, dehydration and weight loss. Over time, diabetes can lead to heart and blood vessel disease, blindness, kidney failure, and foot ulcers, among other conditions.

Diabetes is a disease of the endocrine system, specifically, the pancreas, and of glucose metabolism. Insulin is normally produced in the pancreas in response to high blood glucose levels; for example, after a meal. The Islets of Langerhan are small areas of tissue within the pancreas that contain beta cells, which produce insulin. In Type 1 diabetes, the beta cells are destroyed, leading to an absolute lack of insulin. In Type 2 diabetes, there is resistance peripherally to the inherent insulin. This leads to a relative lack of insulin and therefore hyperglycemia.

Type 1 diabetes occurs at a very early age, caused, as mentioned above, by a destruction of beta cells in the pancreas. People with Type 1 diabetes have little or no ability to produce insulin and are entirely dependent on injections of insulin for survival.

The cause of Type 1 diabetes is unknown, although childhood infections and a genetic tendency are two possibilities. The pancreas undergoes a change, and cells that normally produce insulin are destroyed. This may be a result of the body’s own immune system believing the pancreas to be a foreign organ. Patients with Type 1 diabetes tend to be very slim people.

Type 2 diabetes tends to be of adult onset, although more and more young people are now being diagnosed with this insulin-resistance syndrome.

In Type 2 diabetes , the pancreas retains its ability to produce insulin , but either the quantity is inadequate for the body’s needs, or insulin cannot be used to its full extent by the tissues. Most people who have this condition suffer from being overweight, and require a strict weight-reducing diet and exercise program, as well as possible treatment with drugs, sometimes including insulin.

Definition of diabetes

•  Random plasma glucose of >200mg/dL

•  Fasting plasma glucose =126mg/dL on 2 separate occasions

•  Fasting plasma glucose 110-125mg/dL is considered Impaired Glucose Tolerance

•  Fasting plasma glucose <110mg/dL is considered normal

•  HbA1c <6.5% indicates good glucose control

Signs/symptoms

At onset, the two types of diabetes present with distinction:

Type 1 – weight loss, polyuria, polydypsia

Type 2 – polyuria, polydypsia, recurrent infections

Prevalence of diabetes

It is estimated that 20.8 million people in the United States –7 percent of the population-have diabetes, including 6.2 million who are undiagnosed. Ninety-five percent of people with diabetes have Type 2. Diabetes was the sixth leading cause of death listed on U.S. death certificates in 2002. Diabetes is also likely to be underreported as a cause of death. Overall, the risk of death among people with diabetes is about twice that of people without diabetes of similar age.

Complications of diabetes

Diabetes is a systemic disease which can have devastating effects on the body as a whole. Diabetes has numerous serious complications.

Heart and blood vessel disease

Heart disease is the leading cause of death for people with diabetes. Heart disease and stroke account for about 65 percent of deaths in people with diabetes.

People with diabetes are 2-4 times more likely to have heart disease than persons without diabetes. Even people with Type 2 diabetes who do not have heart disease have an increased risk of having a heart attack. People with diabetes also tend to have other risk factors for heart disease, including obesity, high blood pressure, and hardening of the arteries (atherosclerosis).

1. Register for the Online BLS for Healthcare Poviders Renewal Class.
2. Complete the Online Class
3. Print your certificate (please bring it with you to the skills assessment)
4. Call our office (800) 852-4126 and register for the skills assessment
5. Demonstrate CPR skills
6. Receive your AHA Provider card good for two years.

The cost for the Skills Assessment is $25.   After demonstrating skills, you will be given your provider card.

Register for the Online CPR Class.

Don’t Forget About HIV/AIDS Update, Domestic Violence Mandatory Requirement, and Prevention Of Medical Errors Mandatory Requirement

Types of Rhythms Where Pacing Is Indicated
• Bradycardias that are unresponsive to drug therapy or are symptomatic
• 2nd degree heart block type II
• 3rd degree heart block

Clinical Note:
Atropine may be given to 2nd degree type II heart block or a narrow complex 3rd degree heart block as a trial but, when detected, the American Heart Association ACLS guidelines recommend that these dysrhythmias be managed by immediate application of the transcutaneous pacer and close observation of the patient for any signs of hemodynamic instability, e.g., shortness of breath – hypotension – altered level of consciousness – chest pain – pallor – nausea & vomiting – profuse sweating. If unstable and in 2nd degree heart block type II or 3rd degree heart block, then the pacer should be used to correct the rate only until transvenous pacing can be accomplished by a qualified person.

Remember from earlier in the reading that if a patient is bradycardic and hemodynamically unstable, as described in the previous paragraph, then transcutaneous pacing should be considered as a first line treatment.
Setting a transcutaneous pacemaker will be discussed in the electrical therapy station on day 1 of ACLS

Three Basic Rhythms
There are 3 categories of abnormal rhythms: too fast, too slow or none. Patients with any dysrhythmia may be stable, unstable or in cardiac arrest. Recognizing which type of patient you have will decide your treatment choices: medicine, electrical, and/or mechanical (BLS).

Too Fast
The first rhythm is too fast. Our goal is to slow it down. We have two methods to slow down a rhythm: electrical therapy and/or medicine. If the patient is hemodynamically stable, pharmacology should be the first line treatment. If our patient were hemodynamically unstable, synchronized cardioversion should be the first line treatment.

Too Slow
The second rhythm is too slow. Our goal is to speed it up. We have two methods of speeding up a rhythm: electrical therapy and/or medicine. If the patient is hemodynamically stable, pharmacology should be the first line treatment. If our patient were hemodynamically unstable, transcutaneous pacing should be the first line treatment.

None
Ventricular fibrillation, pulseless ventricular tachycardia, pulseless electrical activity and asystole are the dysrhythmias associated with cardiac arrest. As these are lethal dysrhythmias, management must be quick and aggressive.

• FROM THE SOUTH: Take I-95 to the Forest Hill Blvd West exit.  Go West to Congress Ave and turn right (North) to NW Collin Drive.  Make a U-turn on Collin Drive the building will be on your right hand side.
• FROM THE NORTH: Take I-95 to Southern Boulevard . West exit.  Go West to Congress Ave. and turn left. Building will be on the right side past Collin Drive.
• FROM THE TURNPIKE: Take Turnpike to Southern Boulevard . East exit.  Go East to Congress Ave. and turn right. Building will be on the right side past Collin Drive.

Classes offered at this location

• CPR Renewal
• CPR Skills Assessment
• ACLS
• PALS
• AIDS/OSHA/TB – BBP
• Domestic Violence
• Prevention of Medical Errors
• Phlebotomy
• Starting and Maintaining IV Certification
• PICC Line Insertion Class

• FROM ANY DIRECTION: Take I-95 to Palmetto Park Road Exit, and go East and the medical center will be on the left

• FROM ANY DIRECTION: The hospital is located West of 441 (also called State Road 7) between Broward and Sunrise Boulevards. Take any major road to 441 and when you get to Broward Blvd. or Sunrise Blvd., follow the Blue Hospital roadway signs. Parking is in the visitor’s lot.

Plantation General Hospital
Medical Office Building II
4101 NW 3rd Court
Plantation, FL

• FROM THE SOUTH: Take I-95 to the Broward Blvd. West exit.  Go West to 441 (State Road 7) and turn right (North) to NW 3rd Court.  Turn left (West) on NW 3rd Court. The Medical Office Building II is the 1st building on your right.  Parking is available underneath the building.
• FROM THE NORTH: Take I-95 to the Sunrise Blvd. West exit.  Go West to 441 (State Road 7) and turn left (South) to NW 3rd Court. Turn right (West) on NW 3rd Court.  The Medical Office Building II is the 1st building on your right.  Parking is available underneath the building.
• FROM ANY OTHER DIRECTION: Take 441 (State Road 7) to North Hospital Drive (NW 4th Street). Turn left (West) on North Hospital Drive. The Medical Office Building II is the 1st building on your left. Parking in under the building.

• FROM THE EAST: Take I-95 to Commercial Blvd (Exit 32). Go west for approximately one mile.  Turn left at NW 17th Way (Spectrum Way).  Keiser University will be on your left.  Please park on the unpaved lot behind the building.
• FROM THE WEST: Take the Turnpike to Commercial Blvd (Exit 62).  Go east for approximately three miles. Turn right at NW 17th Way (Spectrum Way).  Keiser University will be on your left. Please park on the unpaved lot behind the building.

• FROM ANY DIRECTION: Take the Turnpike to Eureka Drive (SW 184 Street) and go east to
  US-1.  Proceed North to SW 174 Street and Gramercy Park is on the right facing US 1. It is a four story, pastel colored building surrounded by a black iron ornamental fence.  Pull up to the gate on
  US-1 and it will open automatically. The classroom is located on the first floor in the education
  center.

Medical Office Building
11760 SW 40th  Street (Bird Road)
Miami, FL

The successful graduate must achieve a 70% score on all final written exams as well as 70% completion/competency on skills, ranging from basic care procedures to more complex procedures.

Since programs range from two to six weeks in total length, academic progress is noted by final exam or skills checklist only. Please see the failure policy below.

Failure Policy

Nursing Unlimited Health Career Training School policy is that students who do not complete a program, with the exception of Nursing Assistant Review, for any reason other than conduct, will be allowed to retake that program once at no additional cost. They will be admitted into the next class with space for them. Students who fail the written portion of the state CNA exam will be allowed to retake the Nursing Assistant Review class one time at no additional cost. Such students will be admitted into the next available class.

All students must demonstrate competency in reading and writing English by achieving a score of 70% or better on Nursing Unlimited Health Career Training School’s Competency Exam. Students unable to demonstrate this required competency will be encouraged to enroll in a county public school ESOL program. The student may choose to be refunded their complete tuition at that time (see cancellation policy, page 28). Upon completion of the ESOL program, the student may return to enroll in the program of their choice.

Students enrolling must be physically able to perform the required functions for successful completion of the program. This includes sitting, standing, stooping, kneeling and lifting 25 lbs.

Nursing Unlimited Health Career Training School does not grant credit or advanced standing for previous education or training. Previous education must be proved only when registering for the Nursing Assistant Review course. This proof shall consist of certificates or diplomas from approved schools in the field of healthcare.

Reasons for denying admission to any prospective student shall be documented and kept on file for at least one year.

Our Purpose

The purpose of Nursing Unlimited Health Career Training School is to enable our students to acquire both the knowledge and the practical skills necessary to obtain gainful employment and to achieve their career goals within the healthcare industry.

Our Mission

Nursing Unlimited Health Career Training School continuously strives to provide an effective learning environment and opportunities for students interested in vocational training in the health care industry.

Our mission is to ensure continuous quality improvement in all areas in order to meet and exceed the needs of our students and the community at large.

Home Health Aide 35 Course Textbook
Sherron Newberry, RN
Nursing Unlimited, 2001

Nursing Assistant Review Course Textbook
Paula E. Glass, RN, BSN
Nursing Unlimited, 2002

Phlebotomy Essentials, 3rd ed., 2003, Lippincott Williams and Wilkins
Ruth E. McCall and Cathee M. Tankersley

Career Development for Health Professionals, 2nd ed., 2006, Elsevier
Lee Haroun

EKG Workout: Exercises in Arrhythmia Interpretation, 5th ed., 2006,
Lippincott Williams & Wilkins
Jane Huff

Nursing Unlimited Health Career Training School has approximately 6800 square feet, 50% of it devoted to actual classroom space. Formal instruction is provided in a modern, comfortable classroom setting designed especially for nursing skill education. The laboratory portion of classes takes place in classrooms that are similar to a working environment, complete with hospital bed, wheelchairs, walkers and other equipment utilized in a healthcare facility. It is here that students learn everything from bed making to taking blood pressure. All of the skills that are needed are practiced before the student is permitted to care for patients, and competency is graded, utilizing a skills competency checklist.

Nursing Unlimited’s media center measures approximately 256 square feet, and contains 6 computers and over 80 medical/nursing reference books and manuals. Additionally, we subscribe to numerous professional journals. Books, journals, a/v materials and laboratory equipment are regularly reviewed and updated as needed. Students have access to the media center at specified times, posted in the lobby. All faculty members have access to the media center to support the students’ education.

Inventory of Equipment

Laboratory equipment includes:

• Hospital beds
• Toothbrush/toothpaste
• Sink/ scale with height Over-the-bed tables
• Dentures/denture cup & personal care items Chux (bed protection pads)
• Bed linens Restraints
• Wheelchairs Walkers
• Gait / transfer belts Teaching (dual) & regular stethoscopes
• Emesis basins Lotion
• Bedside commodes Crutches
• Combs Full patient simulator mannequin
• Gloves Blood pressure cuffs & stethoscopes Canes Thermometers
• Orange stick/emery board Indwelling urinary catheters and collection bags

Administration

Steven W. Pollack
President

Reinaldo Rementeria
General Business Manager

Galen Heneghan
Director of Instructor Relations & Curriculum Development

Jean Wainwright
Administrative Officer

Administrative Hours

Monday – Friday
8:00am – 5:00pm

Steven W. Pollack
President, Secretary and Treasurer

Reinaldo Rementeria,
Vice President

Headquarters

Nursing Unlimited
18405 NW 2nd Avenue
Miami Gardens, FL 33169

9:00 am – 5:00 pm (Day 1)
9:00 am – 5:45 pm (Day 2)

August 12 – 13 (Wednesday & Thursday)
November 11 – 12 (Wednesday & Thursday)

Thursday & Friday
9:00 am – 5:00 pm (Day 1)
9:00 am – 5:45 pm (Day 2)

March 27 – 28
May 29 – 30
July 31 – August 1
September 25 – 26
November 20 – 21

Register now for the 2-day Class

Register now for the 1-day renewal Class

Commission for Independent Education

American Heart Association

Oncology Nursing Society

If you are looking for other types of training, check out the training-classes.com directory of telecommunications career training

Miami Dade County Business List

Top Stories

{column1}CPR – Basic Life Support for Healthcare Providers (Initial Course)
5 Contact Hours – $90

CPR – Basic Life Support for Healthcare Providers (Renewal)
3 Contact Hours – $45

CPR – Basic Life Support for Healthcare Providers (Online Renewal)
N/A Contact Hours – $45

ACLS Preparation
4 Contact Hours – $50

Stress Free Advanced Cardiac Life Support (2-Day Course)
12 Contact Hours – $200

Stress Free Advanced Cardiac Life Support (1-Day Course)
8 Contact Hours – $140

PALS Preparation
4 Contact Hours – $50

Pediatric Advanced Life Support (Initial Course)
16 Contact Hours – $220{/column1}

{column2}Pediatric Advanced Life Support (Renewal Course)
8 – $150

NRP – Neonatal Resuscitation Program
8 Contact Hours – $150

NRP – Neonatal Resuscitation Program (Renewal Class)
4 Contact Hours – $100

American Heart Association Instructor Core
8 Contact Hours – $120

BLS Instructor
8 Contact Hours – $135

ACLS Instructor
8 Contact Hours – $115

PALS Instructor
8 Contact Hours – $115

First Aid
4 Contact Hours – $40{/column2}

MEDS CLINICAL UPDATES

{column1}
HIV/AIDS/OSHA/TB – for Healthcare Workers
2 Contact Hours – $20

Domestic Violence
2 Contact Hours – $20

Prevention of Medical Errors
2 Contact Hours – $25{/column1}

{column2}
Physical Assessment
8 Contact Hours – $90

Med-Surg Update
40 Contact Hours – $300{/column2}

IV THERAPY SKILLS DEVELOPMENT

{column1}
Phlebotomy
8 Contact Hours – $135

Pharmacology Math
8 Contact Hours – $90

Starting and Maintaining IV’s – Nursing Certification
30 Contact Hours $225

Starting and Maintaining IV’s – Skills Update
4 Contact Hours $80{/column1}

{column2}
Oncology Nursing Society’s Cancer Chemotherapy Course
13.5 Contact Hours $350

PICC Line Insertion
8 Contact Hours – $185
{/column2}

CRITICAL CARE SERIES

Telemetry for Nurses and Technicians
40 Contact Hours – $300

12 and 15 Lead ECG
8 Contact Hours – $90

Introduction to Critical Care Nursing
64 Contact Hours – $450

Don’t see the program that you need? Call our office at (800) 852-4126 or contact us via email.  We can design a program to meet your needs or bring one of our contract only programs such as LPN Supervision and Conscious / Moderate Sedation to you.

Nursing Unlimited is delighted to announce the addition of the Neonatal Resuscitation Program to our list of offerings. Neonatal resuscitation skills are essential for all healthcare providers who may be called upon to resuscitate infants at birth or at any time during their initial hospital admission.

The new, extensively updated Neonatal Resuscitation Program (NRP) is based on the 2005 American Academy of Pediatrics (AAP)/American Heart Association (AHA) “Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Neonatal Resuscitation Guidelines.” All program components reflect the AAP/AHA guidelines’ increased emphasis on evidence-based treatment recommendations, as well as the new International Liaison Committee on Resuscitation (ILCOR) evidence-based consensus on science.

The 5th edition of the NRP textbook features new lessons on resuscitating pre-term babies and dealing with ethical issues, as well as case scenarios for each major resuscitation technique. You will enter into a highly interactive, scenario-based learning experience, seamlessly integrating the course material into your life as a healthcare provider dealing with newborns.

The course fee is $150 for 6.1 Contact Hours or $100 for the 3.4 Contact Hour renewal and includes the course textbook from Nursing Unlimited’s library.

NRP – Neonatal Resuscitation Classes in Ft Lauderdale, Plantation and Broward County.

Don’t see the dates you want? Call our office at (800) 852-4126 to schedule a private class around your schedule.

West Broward
Plantation General Hospital
401 N.W. 42nd Avenue
3rd Floor, Classroom 3
Plantation, FL
(Directions)

Renewal Course
Monday
9:00 am – 1:00 pm

February 1 Register now
April 12 Register now
June 7 Register now
August 2 Register now
October 4 Register now
December 6 Register now

Initial Provider Course
Tuesday
9:00 am – 5:00 pm

February 2 Register now
April Register now
June 8 Register now
August 3 Register now
October 5 Register now
December 7 Register now

]]> http://www.nursingunlimited.com/nrp-neonatal-resuscitation-program/feed/ 0 http://www.nursingunlimited.com/aspiration-pneumonia-class/ http://www.nursingunlimited.com/aspiration-pneumonia-class/#comments Wed, 30 Jul 2008 16:25:34 +0000 admin http://www.nursingunlimited.com/?p=227 Definition
Pneumonia remains the seventh leading cause of death in the United States. As the US population ages, healthcare providers may encounter an increasing number of cases of aspiration pneumonia, both community-acquired and nosocomial infections. Awareness of this disease is important, because diagnosis is usually based on clinical findings and initial therapy is primarily empirical.

Aspiration pneumonia is caused by inhaling foreign material (usually food, liquids, vomit, or secretions from the mouth) into the lungs. This may lead to an inflammatory reaction, a lung infection (pneumonia), or a collection of pus in the lungs (lung abscess). Aspiration pneumonia is also known as anaerobic pneumonia; aspiration of vomitus; necrotizing pneumonia; aspiration pneumonitis or chemical pneumonitis.

Aspiration Pneumonitis
Aspiration pneumonitis represents chemical damage to the tracheobronchial tree. Such materials as mineral oil, hydrocarbons, and gastric acid may cause different patterns of injury. The most common clinical scenario is aspiration of gastric contents. Aspiration of low pH gastric secretions is associated with immediate injury to the tracheobronchial tree and lung parenchyma best likened to a “flash burn”.  Bronchoscopy in such cases shows diffuse bronchial erythema. The severity of lung injury is directly related to the pH of the aspirated material and is greatest when the pH is less than 2.5.

Because of the relative sterility of normal gastric contents, bacteria do not play an important role in the early stages of this disease. However, this does not hold true in patients with gastroparesis or small-bowel obstruction, or in those using antacids (PPI, H₂-receptor antagonists). Regardless of the bacterial load of the inoculum, bacterial superinfection may occur after the initial chemical injury.

Aspiration Pneumonia
Aspiration pneumonia results from chronic, usually unwitnessed, inhalation of small amounts of oropharyngeal contents, leading to an infectious process. Aspiration pneumonia is defined as the development of an infiltrate in a patient at increased risk of oropharyngeal aspiration. It occurs when a patient inhales material from the oropharynx that is colonized by upper airway flora.

Causative Organisms
Initial bacteriologic studies into the causative organisms of community-acquired aspiration pneumonia indicated the anaerobic species as the predominant pathogens. However, subsequent studies revealed that Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, and Enterobacteriaceae are the most common organisms implicated in community-acquired aspiration pneumonia. Hospital-acquired aspiration pneumonia, on the other hand, is often caused by gram-negative organisms, including Pseudomonas aeruginosa, particularly in intubated patients.

Risk Factors
Aspiration pneumonia most commonly occurs in individuals with chronically impaired airway defense mechanisms. Thus, any condition that reduces a patient’s gag reflex and/or ability to maintain an airway increases the risk of aspiration pneumonia or pneumonitis.

Risk factors for this disease include:

• Decreased level of consciousness (acute and chronic alcohol abuse; drug overdose; stroke; seizure; head trauma; anesthesia, including conscious sedation for upper gastrointestinal endoscopy)
• Isolated alteration of the swallowing reflex associated with pharyngeal disease
• Dysphagia (esophageal cancer, achalasia, tracheobronchial fistula, neurologic disorders)
• Gastroesophageal reflux
• Neurologic disease (stroke, amyotrophic lateral sclerosis, myasthenia gravis, multiple sclerosis, Parkinson’s disease)
• Mechanical and device-related impairment of upper aerodigestive tract (nasogastric and percutaneous feeding tubes, endotracheal tubes, tracheostomy)
• Vomiting
• Bronchial obstruction due to neoplasm or foreign body
• Bronchiectasis
• Pulmonary infarction

Other risk factors include poor dentition and poor oral care, both of which increase the bacterial burden of oropharyngeal secretions. Some studies indicate that aspiration pneumonia is more common in males than in females, and that it is also more prevalent in extremely young or old patients.

]]> http://www.nursingunlimited.com/aspiration-pneumonia-class/feed/ 0 http://www.nursingunlimited.com/miami-location/ http://www.nursingunlimited.com/miami-location/#comments Wed, 30 Jul 2008 13:09:22 +0000 admin http://www.nursingunlimited.com/?p=216 North Dade
Nursing Unlimited Headquarters
18405 NW 2nd AVE
Miami Gardens, FL 33169

• FROM THE NORTH OR SOUTH: Take I-95 or Turnpike to the Golden Glades Interchange. Exit 441 North. Building will be on the right, after passing Miami Gardens Drive.
• FROM THE WEST: Take SR 826 East exit 441 North. The Building will be on the right after passing Miami Gardens Drive.
• FROM THE EAST: Exit Miami Gardens Drive west to NW 2nd ave make a right Building will be in the right.

Dade County Locations

Nursing Unlimited Headquarters (directions)
Kendall Regional Medical Center (directions) (map)
Gramercy Park Nursing Center (directions) (map)

Broward County Locations

Keiser University (directions) (map)
Plantation General Hospital (directions) (map)

Palm Beach County Locations

Hospice by the Sea (directions) (map)
West Boca Medical Center (directions) (map)
Palm Beach Staffing (directions (map)

Modes of Transmission of HIV

Research has revealed a great deal of valuable medical, scientific, and public health information about the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). The ways in which HIV can be transmitted have been clearly identified. Unfortunately, false information or statements that are not supported by scientific findings continue to be shared widely through the Internet and the popular press. Therefore, the Centers for Disease Control and Prevention (CDC) has prepared a fact sheet to correct a few misperceptions about HIV.

How HIV Is Transmitted

HIV is spread by sexual contact with an infected person, by sharing needles and/or syringes (primarily for drug injection) with someone who is infected, or, less commonly (and now very rarely in countries where blood is screened for HIV antibodies), through transfusions of infected blood or blood clotting factors. Babies born to HIV-infected women may become infected before or during birth or through breastfeeding after birth.

How Does Mother-to-Child HIV Transmission Occur?

Mother-to-child transmission (MTCT) of HIV, also called perinatal or vertical transmission, occurs when HIV is spread from an HIV+ woman to her baby during pregnancy, labor and delivery or breastfeeding. For an HIV+ woman not being treated for HIV, the chance of passing the virus to her child is about 25% during pregnancy, labor and delivery. Breastfeeding increases the risk of transmission by an additional 12%.

In 2005, around 700,000 children under 15 became infected with HIV, mainly through mother to child transmission. About 90% of these MTCT infections occurred in Africa, where AIDS is beginning to reverse decades of steady progress in child survival. In high-income countries, MTCT has been virtually eliminated, thanks to effective voluntary testing and counseling, access to antiretroviral therapy, safe delivery practices, and the widespread availability and safe use of breast-milk substitutes. If these interventions were used worldwide, they could save the lives of thousands of children each year.

Can MTCT be reduced?

Yes. Advances in treatment and new classes of drugs have provided the opportunity to greatly reduce rates of MTCT worldwide. However, these advances have not made their way to developing countries to the extent that is needed, and we have still not addressed the root cause of MTCT, mainly heterosexual HIV transmission. The best way to prevent MTCT is to prevent HIV transmission in the mother and father.

In order to reduce MTCT, all pregnant women should have access to free or low-cost prenatal care and voluntary HIV testing and counseling. If a pregnant woman is HIV+, she should have access to antiretroviral treatment, both to treat HIV and improve her own health, and to decrease the chances of HIV infection in her infant. Treatment options for preventing MTCT include giving antiretroviral drugs to the mother after the first trimester of pregnancy and during labor, and to her infant for the first six weeks of life. In the US, these drug regimens have dramatically reduced the chance of transmission, from about 25% to 4-10% for women who did not breastfeed.

MTCT can be further reduced to less than 2% if a woman is on antiretroviral drugs, has a low viral load, follows the recommended MTCT treatment regimen and does not breastfeed. However, little is known about the long-term impact of these drugs on the child. Taking greater care during labor and delivery can also help reduce MTCT; for example, by not artificially rupturing membranes or doing routine episiotomies, and by providing cesarean delivery when indicated.

HIV Transmission in the Healthcare Setting

In the health care setting, workers have been infected with HIV after being stuck with needles containing HIV-infected blood or, less frequently, after infected blood gets into a worker’s open cut or a mucous membrane (for example, the eyes or inside of the nose). There has been only one instance of patients being infected by a health care worker in the United States; this involved HIV transmission from one infected dentist to six patients. Investigations completed the review of more than 22,000 patients of 63 HIV-infected physicians, surgeons, and dentists, and no other cases of this type of transmission have been identified in the United States.

Some people fear that HIV might be transmitted in other ways; however, no scientific evidence to support any of these fears has been found. If HIV were being transmitted through other routes (such as through air, water, or insects), the pattern of reported AIDS cases would be much different from what has been observed. For example, if mosquitoes could transmit HIV infection, many more young children and preadolescents would have been diagnosed with AIDS.

All reported cases suggesting new or potentially unknown routes of transmission are thoroughly investigated by state and local health departments with the assistance, guidance, and laboratory support from CDC. No additional routes of transmission have been recorded, despite a national sentinel system designed to detect just such an occurrence. The following paragraphs specifically address some of the common misperceptions about HIV transmission.

HIV in the Environment

Scientists and medical authorities agree that HIV does not survive well in the environment, making the possibility of environmental transmission remote. HIV is found in varying concentrations in blood, semen, vaginal fluid, breast milk, saliva, and tears. To obtain data on the survival of HIV, laboratory studies have required the use of artificially high concentrations of laboratory-grown virus. Although these unnatural concentrations of HIV can be kept alive for days or even weeks under precisely controlled and limited laboratory conditions, CDC studies have shown that drying of even these high concentrations of HIV reduces the amount of infectious virus by 90 to 99 percent within several hours. Since the HIV concentrations used in laboratory studies are much higher than those actually found in blood or other specimens, drying of HIV-infected human blood or other body fluids reduces the theoretical risk of environmental transmission to that which has been observed–essentially zero.

Results from laboratory studies should not be used to assess specific personal risk of infection because (1) the amount of virus studied is not found in human specimens or elsewhere in nature, and (2) no one has been identified as infected with HIV due to contact with an environmental surface. Additionally, HIV is unable to reproduce outside its living host (unlike many bacteria or fungi, which may do so under suitable conditions), except under laboratory conditions; therefore, it does not spread or maintain infectiousness outside its host.

Households

Although HIV has been transmitted between family members in a household setting, this type of transmission is very rare. These transmissions are believed to have resulted from contact between skin or mucous membranes and infected blood. To prevent even such rare occurrences, precautions, as described in previously published guidelines, should be taken in all settings, including the home, to prevent exposures to the blood of persons who are HIV-infected, at risk for HIV infection, or whose infection and risk status are unknown. For example,

Businesses and Other Settings

There is no known risk of HIV transmission to co-workers, clients, or consumers from contact in industries such as food-service establishments (see information on survival of HIV in the environment). Food-service workers known to be infected with HIV need not be restricted from work unless they have other infections or illnesses (such as diarrhea or hepatitis A) for which any food-service worker, regardless of HIV infection status, should be restricted. The CDC recommends that all food-service workers follow recommended standards and practices of good personal hygiene and food sanitation.

In 1985, the CDC issued routine precautions that all personal-service workers (such as hairdressers, barbers, cosmetologists, and massage therapists) should follow, even though there is no evidence of transmission from a personal-service worker to a client or vice versa. Instruments that are intended to penetrate the skin (such as tattooing and acupuncture needles, ear piercing devices) should be used once and disposed of or thoroughly cleaned and sterilized. Instruments not intended to penetrate the skin but which may become contaminated with blood (for example, razors) should be used for only one client and disposed of or thoroughly cleaned and disinfected after each use. Personal-service workers can use the same cleaning procedures that are recommended for health care institutions.

The CDC knows of no instances of HIV transmission through tattooing or body piercing, although the hepatitis B virus has been transmitted during some of these practices. One case of HIV transmission from acupuncture has been documented. Body piercing (other than ear piercing) is relatively new in the United States, and the medical complications for body piercing appear to be greater than for tattoos. Healing of piercings generally takes weeks, and sometimes even months, and the pierced tissue could conceivably be abraded (torn or cut) or inflamed even after healing. Therefore, a theoretical HIV transmission risk does exist if the unhealed or abraded tissues come into contact with an infected person’s blood or other infectious body fluid. Additionally, HIV could be transmitted if instruments contaminated with blood are not sterilized or disinfected between clients.

Kissing
Casual contact through closed-mouth or “social” kissing is not a risk for transmission of HIV. Because of the potential for contact with blood during “French” or open-mouth kissing, the CDC recommends against engaging in this activity with a person known to be infected. However, the risk of acquiring HIV during open-mouth kissing is believed to be very low. CDC has investigated only one case of HIV infection that may be attributed to contact with blood during open-mouth kissing.

Biting
In 1997, the CDC published findings from a state health department investigation of an incident that suggested blood-to-blood transmission of HIV by a human bite. There have been other reports in the medical literature in which HIV appeared to have been transmitted by a bite. Severe trauma with extensive tissue tearing and damage and presence of blood were reported in each of these instances. Biting is not a common way of transmitting HIV. In fact, there are numerous reports of bites that did not result in HIV infection.

Saliva, Tears, and Sweat
HIV has been found in saliva and tears in very low quantities from some AIDS patients. It is important to understand that finding a small amount of HIV in a body fluid does not necessarily mean that HIV can be transmitted by that body fluid. HIV has not been recovered from the sweat of HIV-infected persons. Contact with saliva, tears, or sweat has never been shown to result in transmission of HIV.

Insects
From the onset of the HIV epidemic, there has been concern about transmission of the virus by biting and bloodsucking insects. However, studies conducted by researchers at CDC and elsewhere have shown no evidence of HIV transmission through insects–even in areas where there are many cases of AIDS and large populations of insects such as mosquitoes. Lack of such outbreaks, despite intense efforts to detect them, supports the conclusion that HIV is not transmitted by insects.

The results of experiments and observations of insect biting behavior indicate that when an insect bites a person, it does not inject its own or a previously bitten person’s or animal’s blood into the next person bitten. Rather, it injects saliva, which acts as a lubricant or anticoagulant so the insect can feed efficiently. Such diseases as yellow fever and malaria are transmitted through the saliva of specific species of mosquitoes. However, HIV lives for only a short time inside an insect and, unlike organisms that are transmitted via insect bites, HIV does not reproduce (and does not survive) in insects. Thus, even if the virus enters a mosquito or another sucking or biting insect, the insect does not become infected and cannot transmit HIV to the next human it feeds on or bites. HIV is not found in insect feces.

There is also no reason to fear that a biting or bloodsucking insect, such as a mosquito, could transmit HIV from one person to another through HIV-infected blood left on its mouthparts. Two factors serve to explain why this is so–first, infected people do not have constant, high levels of HIV in their bloodstreams, and, second, insect mouth parts do not retain large amounts of blood on their surfaces. Further, scientists who study insects have determined that biting insects normally do not travel from one person to the next immediately after ingesting blood. Rather, they fly to a resting place to digest this blood meal.

Infection Control
All healthcare workers and those at risk for occupational exposure should practice standard Universal Precautions. Hand washing, an integral part of infection control, is recommended before and after any possible exposure to blood or other body fluids. The CDC recommends 10 – 15 seconds of vigorous scrubbing with a bactericidal agent. After proper hand washing, personal protective equipment should be worn to prevent contact with any body fluids. Finally, any personal protective equipment or infectious waste should be disposed of in proper biohazardous warning label bags

Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents

The availability of an increasing number of antiretroviral agents and the rapid evolution of new information has introduced substantial complexity into treatment regimens for persons infected with human immunodeficiency virus (HIV). In 1996, the Department of Health and Human Services and the Henry J. Kaiser Family Foundation convened the Panel on Clinical Practices for the Treatment of HIV to develop guidelines for clinical management of HIV-infected adults and adolescents (CDC Report of the NIH Panel To Define Principles of Therapy of HIV Infection and Guidelines for the use of antiretroviral agents in HIV-infected adults and adolescents. MMWR 1998;47[RR-5]:1-41). The following issues were discussed:

•  Using testing for Plasma HIV ribonucleic acid levels (i.e., viral load) and CD4 + T cell count;

•  Using testing for antiretroviral drug resistance;

•  Considerations for when to initiate therapy;

•  Adherence to antiretroviral therapy;

•  Considerations for therapy in antiretroviral naïve patients;

•  Therapy-related adverse events;

•  Interruption of therapy;

•  Considerations for changing therapy and available therapeutic options;

•  Treatment for acute HIV infection;

•  Considerations for antiretroviral therapy among adolescents;

•  Considerations for antiretroviral therapy among pregnant women; and

•  Concerns related to transmission of HIV to others.

Antiretroviral regimens are complex, have serious side effects, pose difficulty with adherence, and carry serious potential consequences, such as the development of viral resistance because of non-adherence to the drug regimen of antiretroviral agents. Patient education and involvement in therapeutic decisions is critical. Treatment should usually be offered to all patients with symptoms ascribed to HIV infection. Recommendations for offering antiretroviral therapy among asymptomatic patients require analysis of real and potential risks and benefits. Treatment should be offered to persons who have < 350 CD4 + T cells/mm 3 or Plasma HIV ribonucleic acid (RNA) levels of > 55,000 copies/mL (by b-deoxyribonucleic acid [bDNA] or reverse transcriptase-polymerase chain reaction [RT-PCR] assays). The recommendation to treat asymptomatic patients should be based on the willingness and readiness of the person to begin therapy; the degree of existing immunodeficiency as determined by the CD4 + T cell count; the risk for disease progression as determined by the CD4 + T cell count and level of Plasma HIV RNA; the potential benefits and risks of initiating therapy in an asymptomatic person; and the likelihood, after counseling and education, of adherence to the prescribed treatment regimen.

Treatment goals should be maximal and durable suppression of viral load, restoration and preservation of immunologic function, improvement of quality of life, and reduction of HIV-related morbidity and mortality. Results of therapy are evaluated through plasma HIV RNA levels, which are expected to indicate a 1.0 log10 decrease at 2-8 weeks and no detectable virus (< 50 copies/mL) at 4-6 months after treatment initiation. Failure of therapy at 4-6 months might be ascribed to non-adherence, inadequate potency of drugs or sub-optimal levels of antiretroviral agents, viral resistance, and other factors that are poorly understood. Patients whose therapy fails in spite of a high level of adherence to the regimen should have their regimen changed; this change should be guided by a thorough drug treatment history and the results of drug-resistance testing. Because of limitations in the available alternative antiretroviral regimens that have documented efficacy, optimal changes in therapy might be difficult to achieve for patients in whom the preferred regimen has failed. These decisions are further confounded by problems with adherence, toxicity, and resistance. For certain patients, participating in a clinical trial with or without access to new drugs or using a regimen that might not achieve complete suppression of viral replication might be preferable.

There are 3 primary classifications of medications used as antiretrovirals to suppress the replication of HIV. The following lists the name of each approved drug including the potential adverse effects of the medication.

Nucleoside Analogs (Antiretroviral medications):

These drugs incorporate themselves into the enzyme that helps the virus to copy itself, thereby stopping the building process. HIV rapidly develops resistance to more drugs when used individually, so current standards require that they be used in combination with one another.

•  Zidovudine (AZT): FDA approval in 1987. Side effects include headaches, fever, chills, muscle soreness, fatigue, anemia, nausea, and fingernail discoloration.

•  Didanosine (ddI): FDA approval in 1991. Side effects include tingling, burning, numbness/pain in hands or feet, visual impairment, headaches, insomnia, diarrhea, and pancreatitis.

•  Zalcitabine (ddC): FDA approval in 1992. Side effects include chest pain, nausea, fever, rash, mouth sores, and headaches.

•  Stavudine (d4T): FDA approval 1994. Side effects include headaches, nausea, and peripheral neuropathy. This drug is tolerated the best.

•  Lamivudine (3TC): FDA approval in 1995. Side effects include headache, nausea, malaise, fatigue, runny nose, diarrhea, and anemia.

•  Abacavir: FDA approval in 1998. Side effects include headache, nausea, vomiting, malaise, and diarrhea. Clinical note: There have also been severe allergic reactions caused by abacavir. If an allergic reaction is noted, the drug should never be given again, as this may lead to anaphylactic shock and possible death.

•  Combivir: Combination of 3TC and AZT.

Protease Inhibitors:

First introduced in 1995, these drugs work at the last stage of the virus replication cycle by preventing HIV from being successfully assembled and released from the infected T cell.

•  Invirase (Saquinavir Mesylate): Used in combination with Norvir. Side effects include diarrhea, mouth sores, and abdominal discomfort.

•  Norvir (Ritonavir): Side effects include diarrhea, nausea, fatigue, and peripheral and circumoral numbness.

•  Crixivan (Indinavir): Used in combination with Combivir, 80% of patients are maintaining undetectable viral loads for two years or more. Side effects include kidney stones, chapped lips, headaches, and nausea.

•  Viracept (Nelfinavir): Relatively new, early studies show success similar to Crixivan. The main side effect is diarrhea and it is well tolerated by patients.

•  Agenerase (Amprenavir): Approved by the FDA in 1999, this drug can cause life-threatening skin reactions, including blisters. Other side effects include nausea, vomiting, and diarrhea.

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI):

First approved by the FDA in 1996, these drugs prevent the conversion of RNA into DNA inside the infected T cell, thus helping to prevent the virus from multiplying.

•  Viramune (Nevirapine or NVP): Side effects include headaches, nausea, and rash.

•  Rescriptor (Delavirdine): Side effects include headaches, nausea, diarrhea, rash, and fatigue.

•  Sustiva (Efavirenz): Side effects are mild and include rash and mood changes.

Entry-inhibitors (Fuzeon): A new class of drug approved only for compassionate use. Fuzeon binds to a protein on HIV’s surface called gp41. Once it does this, HIV cannot successfully bind with the surface of T-cells, thus preventing the virus from infecting healthy cells. Fuzeon will most likely need to be used in combination with other anti-HIV drugs. Because of its fragile structure (it is a peptide), Fuzeon cannot be taken by mouth. It is currently given in an injectable form and requires two shots a day: one in the morning and one 12 hours later at night. Each shot contains 90mg of Fuzeon. Small hypodermic needles, similar to those used by diabetics to inject insulin, are used.

Fuzeon holds promise for HIV-positive patients who have taken (and failed) numerous anti-HIV drugs in the past. Because Fuzeon targets HIV differently than currently available drugs, chances are that most people living with the virus, regardless of the medications they have taken in the past, will likely benefit from using Fuzeon. Two large clinical trials have determined that Fuzeon, when combined with other drugs, is effective for patients who have failed other anti-HIV drugs in the past. However, Fuzeon worked best when it was combined with at least two other drugs that the virus was sensitive to (patients who used Fuzeon in combination with drugs that their virus was highly resistant to did not experience decreases in their viral load for very long). In this way, it is best to use drug-resistance testing to determine which drugs your virus is sensitive to and to use the results of testing to figure out which are the best anti-HIV drugs to combine with Fuzeon.

Skin irritation (e.g., itchiness and swelling) at the site where Fuzeon is injected has been the most common side effect reported in studies. Less than 5% of patients taking Fuzeon have stopped injections of this drug because of this skin irritation. Other side effects may also occur, including fatigue, insomnia, and peripheral neuropathy.

Prevention of HIV

Sexual Behaviors:

If a person does not engage in any sexual activities, then that person has no risk of sexual transmission of HIV. However, for those people who are sexually active, the following options are available. “Safer sex” includes mutual monogamy, latex condoms, female condoms (also made of latex) and polyurethane condoms, which, because of their composition, are much stronger and thinner, thus aiding in compliance. Latex square (dental dam) is recommended for oral-genital contact male to female or female to female.

Illicit Drug Use:

Non-injecting drug use, while not a direct risk factor for HIV transmission, may lead to risky behaviors that might not be committed if the person was not using recreational drugs. Alcohol can have a similar effect. Judgment is impaired and inhibitions are reduced, potentially leading to unprotected sex or increases in the number of sexual partners.

The use of intravenous drugs and the behavior of sharing needles is another mode of transmission of HIV. The best method to prevent HIV transmission among I.V. drug users is to get them off the drugs and into a substance abuse program. The second best method is to get them to not share needles. Studies have show that needle-exchange programs reduce the incidence of HIV, while not encouraging the use of illegal drugs. The DOH supports the use of these programs, but they are currently illegal in the state of Florida. The third best method to prevent HIV transmission among I.V. drug users is to get them to clean their needles and syringes with bleach. It is important to rinse them with water once the bleach is used, because injecting bleach into the veins can be more deadly than HIV.

The Florida AIDS Law:

Statute 381 addresses most of Florida’s AIDS law with most of the accompanying rules in Chapter 64D-2 of the Florida Administrative Code.

Highlights of the Law Include:

Confidentiality : As with any personal medical record information, results of HIV testing and treatment are confidential (384.29, F.S.). Healthcare providers have a “need to know” as defined in Rule 64D-2.003(2)(d)3.

Discrimination : It is against the law to discriminate against persons on the basis of HIV or AIDS status (381.004, F.S.)

Informed Consent : Written consent must be obtained before an HIV test can be performed. Exceptions to this include convicted prostitutes and their solicitors, after sexual battery where a blood sample has been taken from the defendant, persons desiring to immigrate to the U.S., persons desiring to enlist in the military, and medical personnel who receive a significant exposure to blood or OPIM on the job.

Partner Notification : Florida Statute 456.061 provides that a medical practitioner, acting reasonably and in good faith, shall not be civilly or criminally liable for advising the sex or needle-sharing partner of an HIV-infected patient of a positive test, when done in accordance with the following protocol:

•  Without being asked, the patient discloses the identity of such partners.

•  The practitioner recommends the patient avoid any sexual or needle-sharing activities.

•  The patient refuses to inform the sex or needle-sharing partner of a positive test result and the practitioner informs the patient of his/her intent to inform the partners. Ideally, such notifications shall be done face-to-face and the practitioner may choose not to disclose the name of the infected patient.

•  The practitioner shall not disclose the identity of the partner to anyone else.

Insurance Companies : May not discriminate due to sexual orientation in underwriting policies. They cannot cancel or refuse to renew a policy due to HIV/AIDS.

Noncompliant Carriers : It is against the law for HIV-infected individuals to have sex or share drug needles with others without first informing them of their HIV status. (384.24, F.S.) This law also includes the following sexually transmitted diseases:

•  Chancroid

•  Gonorrhea

•  Granuloma inguinale

•  Lymphogranuloma venereum

•  Genital herpes simplex

•  Chlamydia

•  Nongonococcal urethritis

•  Pelvic inflammatory disease

•  Acute salpingitis

•  Syphilis

Minors’ Consent : Parental consent for the examination and treatment of HIV infected minors is not required (384.30, F.S.).

Pregnant Women : Testing for HIV infection shall be offered to each pregnant woman. If she objects to HIV testing, an attempt must be made to obtain a written statement of objection, signed by the patient and placed in the medical record (384.31, F.S.).

State and Federally Funded Programs for People with HIV/AIDS

Ryan White Comprehensive AIDS Resources Emergency Act of 1990:

•  Project AIDS Care: This provides eligible individuals with outpatient services, such as home delivery of meals and adaptive equipment and home health care.

•  AIDS Drug Assistance Program: Assistance for AIDS-related pharmaceuticals is provided through Florida’s county health departments.

•  Insurance Continuation Program: Eligible individuals can have their private insurance premiums paid for by this program.

•  Housing Opportunities for Persons with AIDS: Funded by HUD, this program provides temporary assistance to eligible individuals in making mortgage, rent, or utility payments.

International Statistics

Acquired Immunodeficiency Syndrome has killed more than 25 million people since it was first recognized in 1981, making it one of the most destructive epidemics in recorded history. According to the Joint United Nations Programme on HIV/AIDS, as of November 2007, n ew data show global HIV prevalence-the percentage of people living with HIV-has leveled off, and the number of new infections has fallen, in part as a result of the impact of HIV programs. However, in 2007, approximately 33.2 million people were estimated to be living with HIV, 2.5 million became newly infected and 2.1 million died of AIDS.

There were an estimated 1.7 million new HIV infections in sub-Saharan Africa in 2007-a significant reduction since 2001. However, the region remains most severely affected. An estimated 22.5 million people living with HIV, or 68% of the global total, are in sub-Saharan Africa. Eight countries in this region now account for almost one-third of all new HIV infections and AIDS deaths globally.

Since 2001, when the United Nations Declaration of Commitment on HIV/AIDS was signed, the number of people living with HIV in Eastern Europe and Central Asia has increased by more than 150%, from 630,000 to 1.6 million in 2007. In Asia, the estimated number of people living with HIV in Viet Nam has more than doubled between 2000 and 2005, and Indonesia has the fastest growing epidemic.

While the global prevalence of HIV infection has leveled off, the total number of people living with HIV is increasing, because of ongoing acquisition of HIV infection, combined with longer survival times, in a continuously growing general population. Global HIV incidence-the number of new HIV infections per year-is now estimated to have peaked in the late 1990s at over 3 million new infections per year, and is estimated in 2007 to be 2.5 million new infections, an average of more than 6,800 new infections each day. This reflects natural trends in the epidemic, as well as the result of HIV prevention efforts. The number of people dying from AIDS-related illnesses has declined in the last two years, due in part to the life prolonging effects of antiretroviral therapy. AIDS is still among the leading causes of death globally and remains the primary cause of death in Africa

HIV/AIDS in the United States

The majority of people living with HIV in the USA are men who have sex with men. Injecting drug use remains a prominent channel of infection for both men and women. However, for women living with HIV, unsafe heterosexual intercourse is the main mode of transmission. For many women with HIV, the main risk factor for acquiring the virus remains the often-undisclosed risk behavior of male partners, such as injecting drug use and sex with other men.

One of the striking facets of the epidemic in the United States is the concentration of HIV infections among African Americans. Despite constituting only 12.5% of the country’s population, African Americans accounted for 50% of all HIV/AIDS cases diagnosed in 2004.

CDC HIV/AIDS Surveillance Report – 2007

Surveillance data on HIV infections provide a more complete picture of the HIV/AIDS epidemic and the need for prevention and care services than does the picture provided by AIDS data alone. Therefore, to better monitor the patterns of HIV infection diagnoses, many states and U.S.-dependent areas have implemented HIV surveillance in addition to AIDS surveillance.

Even though many states and dependent areas conduct HIV surveillance, not all of them collect HIV data the same way. Most states and dependent areas use confidential name-based reporting, but some use other methods. The different methods of collecting data pose a challenge when compiling national data. To address the problem, CDC advised in 1999 that all US states and dependent areas conduct confidential name-based HIV case surveillance as part of their AIDS case surveillance activities. This advice was strengthened to a recommendation in 2005. Compared with HIV reporting systems based on other types of identifiers (such as those based on a code or name-to-code), confidential name-based HIV reporting has proven to be more cost-effective, and it routinely achieves high levels of accuracy and reliability. Confidential name-based HIV infection reporting is consistent with reporting for other infectious diseases, including AIDS. As of February 2007, confidential name-based HIV infection reporting was being conducted by 47 states, the District of Columbia and 5 dependent areas. It is anticipated that all states and US dependent areas will soon use confidential name-based reporting for HIV surveillance.

Highlights of Analyses

Persons Living with AIDS

In 2005, the estimated number of persons living with AIDS in the United States and dependent areas was 433,760. In the 50 states and District of Columbia, this included 418,084 adults and adolescents, and 3,787 children under age 13.

Deaths of Persons with AIDS

In 2005, the estimated number of deaths of persons with AIDS in the United States and dependent areas was 17,011. In the 50 states and District of Columbia, this included 16,316 adults and adolescents, and 7 children under age 13.

The cumulative estimated number of deaths of persons with AIDS in the United States and dependent areas, through 2005, was 550,394 . In the 50 states and District of Columbia, this included 525,442 adults and adolescents, and 4,865 children under age 13.

HIV/AIDS Cases

In 2005, the estimated number of cases of HIV/AIDS in the 33 states and 4 dependent areas with confidential name-based HIV infection reporting was 37,367 . Of these, 37,331 were in the 33 states and 36 were in the 4 dependent areas. In the 33 states, adult and adolescent HIV/AIDS cases totaled 37,163 with 27,455 cases in males and 9,708 cases in females, and 168 cases estimated in children under age 13.

HIV/AIDS Cases by Age

Of the estimated number of HIV/AIDS cases in the 33 states with confidential name-based HIV infection reporting, the person’s age at time of diagnosis were distributed as follows.

HIV/AIDS Cases by Race/Ethnicity

CDC tracks HIV/AIDS information on five racial and ethnic groups: white, black (African American), Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native. Estimated numbers of diagnoses of HIV/AIDS in the 33 states with confidential name-based HIV infection reporting, by race or ethnicity:

HIV/AIDS Cases by Transmission Category

Six common transmission categories are male-to-male sexual contact, injection drug use, male-to-male sexual contact and injection drug use, heterosexual (male-female) contact, mother-to-child (perinatal) transmission, and other (includes blood transfusions and unknown cause).

Following is the distribution of the estimated number of diagnoses of HIV/AIDS among adults and adolescents in the 33 states with confidential name-based HIV infection reporting, by transmission category. A breakdown by sex is provided where appropriate.

*Heterosexual contact with a person known to have, or to be at high risk for, HIV infection.
** Includes hemophilia, blood transfusion, perinatal, and risk not reported or not identified.

The distribution of the estimated number of diagnoses of HIV/AIDS, among children* in the 33 states with confidential name-based HIV infection reporting, by transmission categories follows.

*The term “children” refers to persons under age 13 at the time of diagnosis.
* *Includes hemophilia, blood transfusion, and risk not reported or not identified.

Persons Living with HIV/AIDS

In 2005, the estimated number of persons living with HIV/AIDS in the 33 states and dependent areas with confidential name-based HIV/AIDS infection reporting was 475,871 . In the 33 states only, this included 468,488 adults and adolescents, and 6,726 children under age 13.

Top 10 AIDS Cases by State/Dependent Area

The 10 states or dependent areas reporting the highest number of AIDS cases were:

*Includes persons with a diagnosis of AIDS from the beginning of the epidemic through 2005.

State-by-State HIV/AIDS Data

Statehealthfacts.org provides state-by-state information about new and cumulative AIDS cases, AIDS case rates, persons living with AIDS, AIDS deaths, HIV infections, HIV testing statistics and policies, additional AIDS-related state policies, Ryan White funding and funding for HIV prevention, and AIDS Drug Assistance Programs, including budget, client, and expenditure data from the Kaiser Family Foundation.

Bloodborne Pathogen Standard
In 1991, the Occupational Safety and Health administration (OSHA) published the “Occupational Exposure to Bloodborne Pathogens Standard” C.F.R. 1910.1030.

Purpose
he purpose of the standard is to eliminate or minimize occupational exposure to Hepatitis B (HBV), Human Immunodeficiency Virus (HIV), and other bloodborne pathogens. The intent is to protect employees from potential workplace hazards. All persons, regardless of age, race, gender or perception, are considered infected with HIV/HBV/HCV, and all body fluids are considered infectious, with the exception of sweat.

Scope and Application
The Bloodborne Pathogens Standard applies to all occupational exposure to blood or other potentially infectious materials

Definitions
The following is a list of definitions contained in the standard.

Bloodborne Pathogens
Pathogenic microorganisms that are present in human blood and can cause disease in humans.

Other Potentially Infectious Materials (OPIM)

Human body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural and pericardial fluid, peritoneal fluid, amniotic fluid, and saliva in dental procedures. This also applies to all other body fluids visibly contaminated with blood, such as urine, feces, vomitus, tears, and breast milk. Any unfixed human tissue or organ or HIV or HBV containing cell or tissue cultures.

Hazard Communication
Labels and signs used to communicate warnings of possible exposure to bloodborne pathogens. These should be red in color and/or carry the biohazardous materials symbol:

Contaminated
The presence or anticipated presence of blood or other potentially infectious materials found on an item or surface. For example, HBV may survive on dried work surfaces for up to 7 days.

Exposure Incident
A specific eye, mouth, or other mucous membrane, non-intact skin, or parenteral contact with blood or OPIM that results from the performance of an employee’s duties.

Regulated Waste

Liquid or semi-liquid blood or OPIM-contaminated items that would release blood or OPIM in a liquid or semi-liquid state if compressed; items that are caked with dried blood or OPIM and are capable of releasing these materials during handling; contaminated sharps and pathological and microbiological wastes containing blood or OPIM.

Standard Precautions
The CDC recommends Standard Precautions for the care of all patients, regardless of their diagnosis or presumed infection status. Standard Precautions apply t o all: 1) blood; 2) body fluids, secretions, and excretions, except sweat, regardless of whether or not they contain visible blood; 3) non-intact skin; and 4) mucous membranes. Standard precautions are designed to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection in hospitals. Standard precautions include the use of hand washing, appropriate personal protective equipment such as gloves, gowns, masks, whenever touching or exposure to patients’ body fluids is anticipated.

Body Substance Isolation
An infection control measure that means avoiding contact with any and all human body fluid.

Exposure Control Plan
An exposure control plan is a written plan that spells out exactly what steps a company is taking to comply with the Bloodborne Pathogens Standard. This plan must be reviewed and evaluated annually and updated as needed.

Components of The Exposure Control Plan Include:

Engineering Controls
Contaminated reusable sharps, immediately after use, must be placed in containers that are puncture resistant, leak-proof on both sides and bottom, red in color and labeled with biohazard symbol. A sharps container that is ¾ full is considered filled and should be promptly removed from the work area and placed in the proper place in the facility for disposal. Employees should never be required to reach by hand into the container.

Specimen containers must be closed prior to being stored or transported, and appropriately labeled with the biohazard symbol. If the primary container is soiled, place contaminated primary containers within a secondary container that is red or appropriately labeled with the biohazard symbol.

The following is the specific section of the Code of Federal Regulations 1910.1030 dealing with specimens and their handling:

1910.1030(d)(2)(xiii)
Specimens of blood or other potentially infectious materials shall be placed in a container that prevents leakage during collection, handling, processing, storage, transport, or shipping.

1910.1030(d)(2)(xiii)(A)
The container for storage, transport, or shipping shall be labeled or color-coded according to paragraph (g)(1)(i) and closed prior to being stored, transported, or shipped. When a facility utilizes Universal Precautions in the handling of all specimens, the labeling/color-coding of specimens is not necessary, provided containers are recognizable as containing specimens. This exemption only applies while such specimens/containers remain within the facility. Labeling or color-coding in accordance with paragraph (g)(1)(i) is required when such specimens/containers leave the facility.

1910.1030(d)(2)(xiii)(B)
If outside contamination of the primary container occurs, the primary container shall be placed within a second container which prevents leakage during handling, processing, storage, transport, or shipping, and is labeled or color-coded according to the requirements of this standard.

1910.1030(d)(2)(xiii)(C)
If the specimen could puncture the primary container, the primary container shall be placed within a secondary container that is puncture-resistant in addition to the above characteristics.

Health care workers who use or who may be exposed to needles are at increased risk of needlestick injury. Such injuries can lead to serious or fatal infections with bloodborne pathogens such as hepatitis B virus, hepatitis C virus, or human immunodeficiency virus (HIV).

Employers of health care workers must implement the use of improved engineering controls to reduce the likelihood of needlestick injuries. The following recommendations should be considered when evaluating any needleless system.

The new system will:

• Eliminate the use of needles where safe and effective alternatives are available.
• Implement the use of devices with safety features and evaluate their use to determine which are most effective and acceptable.

Needlestick injuries can best be reduced when the use of improved engineering controls is incorporated into a comprehensive program involving workers. Employers should implement the following program elements:

• Analyze needlestick and other sharps-related injuries in your workplace to identify hazards and injury trends.
• Set priorities and strategies for prevention by examining local and national information about risk factors for needlestick injuries and successful intervention efforts.
• Ensure that health care workers are properly trained in the safe use and disposal of needles.
• Modify work practices that pose a needlestick injury hazard to make them safer.
• Promote safety awareness in the work environment.
• Establish procedures for and encourage the reporting and timely follow-up of all needlestick and other sharps-related injuries.
• Evaluate the effectiveness of prevention efforts and provide feedback on performance.

Health care workers should take the following steps to protect themselves and their fellow workers from needlestick injuries:

• Avoid the use of needles where safe and effective alternatives are available.
• Help your employer select and evaluate devices with safety features.
• Use devices with safety features provided by your employer.
• Avoid recapping needles.
• Plan for safe handling and disposal before beginning any procedure using needles.
• Dispose of used needles promptly in appropriate sharps disposal containers.
• Report all needlestick and other sharps-related injuries promptly to ensure that you receive appropriate follow-up care.
• Tell your employer about hazards from needles that you observe in your work environment.
• Participate in bloodborne pathogen training and follow recommended infection prevention practices, including hepatitis B vaccination.

Work Practice Controls

Readily accessible hand washing facilities with antiseptic hand cleanser and towels must be made available to all employees. Antiseptic towelettes may be used if hand-washing facilities are not readily available. However, employees must wash their hands as soon as possible after any patient contact. Alcohol based gels and solutions are now accepted in hospitals and clinics. The gel contains 60% – 90% ethanol or isopropyl alcohol and is proven to be effective in killing germs. According to the CDC, 10 – 15 seconds of vigorous scrubbing is adequate.

The following is the specific section of the Code of Federal Regulations 1910.1030 dealing with hand washing.

1910.1030(d)(2)(iii)
Employers shall provide hand-washing facilities that are readily accessible to employees.

1910.1030(d)(2)(iv)
When provision of hand washing facilities is not feasible, the employer shall provide either an appropriate antiseptic hand cleanser in conjunction with clean cloth/paper towels or antiseptic towelettes. When antiseptic hand cleansers or towelettes are used, hands shall be washed with soap and running water as soon as feasible.

1910.1030(d)(2)(v)
Employers shall ensure that employees wash their hands immediately or as soon as feasible after removal of gloves or other personal protective equipment.

1910.1030(d)(2)(vi)
Employers shall ensure that employees wash hands and any other skin with soap and water, or flush mucous membranes with water immediately or as soon as feasible following contact of such body areas with blood or other potentially infectious materials.

Disposal of Sharps: Sharps containers should be used when disposing of sharp objects. However, they must be disposed of without breaking or bending objects. Recapping of needles is only done with a mechanical device or a one-handed technique. Eating, drinking, smoking, handling contact lenses or applying cosmetics is prohibited in areas where there is possible exposure. The storage of food is also prohibited in areas where blood or OPIM are found. Finally, appropriate decontamination of equipment must be performed before and after each use. If this is not feasible, the equipment must be labeled with the biohazard symbol.

The following sections of the standard apply to the use of these recommended work practice controls:

1910.1030(d)(2)(vii)
Contaminated needles and other contaminated sharps shall not be bent, recapped, or removed except as noted in paragraphs (d)(2)(vii)(A) and (d)(2)(vii)(B) below. Shearing or breaking of contaminated needles is prohibited.

1910.1030(d)(2)(vii)(A)
Contaminated needles and other contaminated sharps shall not be bent, recapped or removed unless the employer can demonstrate that no alternative is feasible or that such action is required by a specific medical or dental procedure.

1910.1030(d)(2)(vii)(B)
Such bending, recapping or needle removal must be accomplished through the use of a mechanical device or a one-handed technique.

1910.1030(d)(2)(viii)
Immediately or as soon as possible after use, contaminated reusable sharps shall be placed in appropriate containers until properly reprocessed. These containers shall be:

1910.1030(d)(2)(viii)(A)
Puncture resistant;

1910.1030(d)(2)(viii)(B)
Labeled or color-coded in accordance with this standard;

1910.1030(d)(2)(viii)(C)
Leakproof on the sides and bottom

1910.1030(d)(4)(iii)(A)(2)
During use, containers for contaminated sharps shall be:

1910.1030(d)(4)(iii)(A)(2)(i)
Easily accessible to personnel and located as close as is feasible to the immediate area where sharps are used or can be reasonably anticipated to be found (e.g., laundries);

1910.1030(d)(4)(iii)(A)(2)(ii)
Maintained upright throughout use; and

1910.1030(d)(4)(iii)(A)(2)(iii)
Replaced routinely and not be allowed to overfill.

1910.1030(d)(4)(iii)(A)(3)
When moving containers of contaminated sharps from the area of use, the containers shall be:

1910.1030(d)(4)(iii)(A)(3)(i)
Closed immediately prior to removal or replacement to prevent spillage or protrusion of contents during handling, storage, transport, or shipping;

1910.1030(d)(4)(iii)(A)(3)(ii)
Placed in a secondary container if leakage is possible. The second container shall be:

1910.1030(d)(4)(iii)(A)(3)(ii)(A)
Closable;

910.1030(d)(4)(iii)(A)(3)(ii)(B)
Constructed to contain all contents and prevent leakage during handling, storage, transport, or shipping; and

1910.1030(d)(4)(iii)(A)(3)(ii)(C)
Labeled or color-coded accordingly.

1910.1030(d)(2)(ix)
Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are prohibited in work areas where there is a reasonable likelihood of occupational exposure.

1910.1030(d)(2)(x)
Food and drink shall not be kept in refrigerators, freezers, shelves, and cabinets or on countertops or bench tops where blood or other potentially infectious materials are present.

1910.1030(d)(2)(xi)
All procedures involving blood or other potentially infectious materials shall be performed in such a manner as to minimize splashing, spraying, spattering, and generation of droplets of these substances.

1910.1030(d)(2)(xiv)
Equipment which may become contaminated with blood or other potentially infectious materials shall be examined prior to servicing or shipping, and shall be decontaminated as necessary, unless the employer can demonstrate that decontamination of such equipment or portions of such equipment is not feasible.

1910.1030(d)(2)(xiv)(A)
A readily observable label in accordance with paragraph (g)(1)(i)(H) shall be attached to the equipment, stating which portions remain contaminated.

Personal Protective Equipment (PPE): The “last line of defense.” This equipment must be accessible to employees and available in appropriate sizes. Facilities must make sure that their employees use PPE whenever it is needed. One exception to this rule is if, in the employee’s professional judgment, using PPE would pose an increased hazard to their safety or the safety of a co-worker.

All employees must wear gloves whenever hand contact with blood or OPIM is anticipated. Disposable gloves must be replaced as soon as possible if they are contaminated or torn. Disposable gloves cannot be washed or reused. Goggles/face shields, gowns, and masks must be worn whenever splashes, spray, splatter, or droplets of blood or OPIM may occur. The material must not permit fluids to pass through and reach the wearer.

The following sections of the standard apply to the use of Personal Protective Equipment:

Personal Protective Equipment —

1910.1030(d)(3)(i)
Provision . When there is occupational exposure, the employer shall provide, at no cost to the employee, appropriate personal protective equipment such as, but not limited to, gloves, gowns, laboratory coats, face shields or masks and eye protection, and mouthpieces, resuscitation bags, pocket masks, or other ventilation devices. Personal protective equipment will be considered “appropriate” only if it does not permit blood or other potentially infectious materials to pass through to or reach the employee’s work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of time which the protective equipment will be used.

1910.1030(d)(3)(ii)
Use . The employer shall ensure that the employee uses appropriate personal protective equipmen, unless the employer shows that the employee temporarily and briefly declined to use personal protective equipment when, under rare and extraordinary circumstances, it was the employee’s professional judgment that in the specific instance its use would have prevented the delivery of health care or public safety services or would have posed an increased hazard to the safety of the worker or co-worker. When the employee makes this judgment, the circumstances shall be investigated and documented in order to determine whether changes can be instituted to prevent such occurrences in the future.

1910.1030(d)(3)(iii)
Accessibility . The employer shall ensure that appropriate personal protective equipment in the appropriate sizes is readily accessible at the worksite or is issued to employees. Hypoallergenic gloves, glove liners, powderless gloves, or other similar alternatives shall be readily accessible to those employees who are allergic to the gloves normally provided.

1910.1030(d)(3)(iv)
Cleaning, Laundering, and Disposal . The employer shall clean, launder, and dispose of personal protective equipment required by paragraphs (d) and (e) of this standard, at no cost to the employee.

1910.1030(d)(3)(v)
Repair and Replacement . The employer shall repair or replace personal protective equipment as needed to maintain its effectiveness, at no cost to the employee.

1910.1030(d)(3)(vi)
If a garment(s) is penetrated by blood or other potentially infectious materials, the affected item shall be removed immediately or as soon as feasible.

1910.1030(d)(3)(vii)
All personal protective equipment shall be removed prior to leaving the work area.

1910.1030(d)(3)(viii)
When personal protective equipment is removed it shall be placed in an appropriately designated area or container for storage, washing, decontamination or disposal.

1910.1030(d)(3)(ix)
Gloves . Gloves shall be worn when it can be reasonably anticipated that the employee may have hand contact with blood, other potentially infectious materials, mucous membranes, and non-intact skin; when performing vascular access procedures except as specified in paragraph (d)(3)(ix)(D); and when handling or touching contaminated items or surfaces.

1910.1030(d)(3)(ix)(A)
Disposable (single use) gloves, such as surgical or examination gloves, shall be replaced as soon as practical when contaminated or as soon as feasible if they are torn, punctured, or when their ability to function as a barrier is compromised.

1910.1030(d)(3)(ix)(B)
Disposable (single use) gloves shall not be washed or decontaminated for re-use.

1910.1030(d)(3)(ix)(C)
Utility gloves may be decontaminated for re-use if the integrity of the glove is not compromised. However, they must be discarded if they are cracked, peeling, torn, punctured, or exhibit other signs of deterioration or when their ability to function as a barrier is compromised.

1910.1030(d)(3)(ix)(D)(2)
Make gloves available to all employees who wish to use them for phlebotomy;

1910.1030(d)(3)(ix)(D)(3)
Not discourage the use of gloves for phlebotomy; and

1910.1030(d)(3)(ix)(D)(4)
Require that gloves be used for phlebotomy in the following circumstances:

1910.1030(d)(3)(ix)(D)(4)(i)
When the employee has cuts, scratches, or other breaks in his or her skin;

1910.1030(d)(3)(ix)(D)(4)(ii)
When the employee judges that hand contamination with blood may occur, for example, when performing phlebotomy on an uncooperative source individual; and

1910.1030(d)(3)(ix)(D)(4)(iii)
When the employee is receiving training in phlebotomy.

910.1030(d)(3)(x)
Masks, Eye Protection, and Face Shields . Masks in combination with eye protection devices, such as goggles or glasses with solid side shields, or chin-length face shields, shall be worn whenever splashes, spray, spatter, or droplets of blood or other potentially infectious materials may be generated and eye, nose, or mouth contamination can be reasonably anticipated.

1910.1030(d)(3)(xi)
Gowns, Aprons, and Other Protective Body Clothing . Appropriate protective clothing such as, but not limited to, gowns, aprons, lab coats, clinic jackets, or similar outer garments shall be worn in occupational exposure situations. The type and characteristics will depend upon the task and degree of exposure anticipated.

1910.1030(d)(3)(xii)
Surgical caps or hoods and/or shoe covers or boots shall be worn in instances when gross contamination can reasonably be anticipated (e.g., autopsies, orthopedic surgery).

Housekeeping: A written schedule for cleaning and decontamination of areas and equipment that can become contaminated must be implemented. In addition, regulated waste must be placed in containers that are closeable, leak-proof, red or labeled with biohazardous symbol and disposed of in accordance of applicable federal, state & local regulations.

The following sections of the standard apply to the use of Personal Protective Equipment:

Housekeeping –
1910.1030(d)(4)(i)
General . Employers shall ensure that the worksite is maintained in a clean and sanitary condition. The employer shall determine and implement an appropriate written schedule for cleaning and method of decontamination based upon the location within the facility, type of surface to be cleaned, type of soil present, and tasks or procedures being performed in the area.

1910.1030(d)(4)(ii)
All equipment and environmental and working surfaces shall be cleaned and decontaminated after contact with blood or other potentially infectious materials.

1910.1030(d)(4)(ii)(A)
Contaminated work surfaces shall be decontaminated with an appropriate disinfectant after completion of procedures; immediately or as soon as feasible when surfaces are overtly contaminated or after any spill of blood or other potentially infectious materials; and at the end of the work shift if the surface may have become contaminated since the last cleaning.

1910.1030(d)(4)(ii)(B)
Protective coverings, such as plastic wrap, aluminum foil, or imperviously-backed absorbent paper used to cover equipment and environmental surfaces, shall be removed and replaced as soon as feasible when they become overtly contaminated or at the end of the work shift if they may have become contaminated during the shift.

1910.1030(d)(4)(ii)(C)
All bins, pails, cans, and similar receptacles intended for reuse, which have a reasonable likelihood for becoming contaminated with blood or other potentially infectious materials, shall be inspected and decontaminated on a regularly scheduled basis and cleaned and decontaminated immediately or as soon as feasible upon visible contamination.

Laundry
Sorting or rinsing of laundry in patient care areas should be prohibited. Laundry that is contaminated must be placed in red bags/containers or those labeled with the biohazard symbol unless your facility utilizes Universal Precautions in handling all soiled laundry.

Post-exposure Prophylaxis:
Of those healthcare personnel for whom case investigations were completed from 1981-2006, 57 had documented seroconversion to HIV following occupational exposures. Another 140 are considered to have possibly contracted HIV from exposure at work. The risk of HIV after percutaneous exposure is approximately 0.3%. Antibody testing should be done at the time of exposure, and after 6 weeks, 12 weeks and 6 months. Reevaluation at 72 hours should be considered if new information has come up. Drug treatment includes 2 nucleoside analogues (ZDV&3TC: 3TC&d4T; d4T&ddl). The HCP must complete 4-weeks of drug treatment. About 50% of HCP have side effects (n/v, malaise, headache), and 33% stop taking the treatment.

Occupational Exposures to Blood:
Health-care workers are at risk for occupational exposure to bloodborne pathogens, including hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Exposures occur through needlesticks or cuts from other sharp instruments contaminated with an infected patient’s blood or through contact through the eye, nose, mouth, or skin with a patient’s blood . Important factors that may determine the overall risk for occupational transmission of a bloodborne pathogen include: the number of infected individuals in the patient population, the chance of becoming infected after a single blood contact from an infected patient and the type and number of blood contacts.

Most exposures do not result in infection. Following a specific exposure , the risk of infection may vary with factors such as these:

Your employer should have in place a system for reporting exposures in order to quickly evaluate the risk of infection, inform you about treatments available to help prevent infection, monitor you for side effects of treatments, and determine if infection occurs. This may involve testing your blood and that of the source patient and offering appropriate post-exposure treatment.

How Can Occupational Exposures Be Prevented?
Many needlesticks and other cuts can be prevented by using safer techniques (e.g., not recapping needles by hand), disposing of used needles in appropriate sharps disposal containers, and using medical devices with safety features designed to prevent injuries. Many exposures to the eyes, nose, mouth, or skin can be prevented by using appropriate barriers (e.g., gloves, eye and face protection, gowns) when contact with blood is expected.

If An Exposure Occurs
What should I do if I am exposed to the blood of a patient?

Immediately following an exposure to blood :

• Wash needlesticks and cuts with soap and water
• Flush splashes to the nose, mouth, or skin with water
• Irrigate eyes with clean water, saline, or sterile irrigants

Following Any Blood Exposure You Should:
Report the exposure to the department (e.g., occupational health, infection control) responsible for managing exposures. Prompt reporting is essential, because, in some cases, post-exposure treatment may be recommended, and it should be started as soon as possible. Discuss the possible risks of acquiring HBV, HCV, and HIV, and the need for post-exposure treatment with the provider managing your exposure . You should have already received hepatitis B vaccine, which is extremely safe and effective in preventing HBV infection.

Risk of Infection After Exposure
What is the risk of infection after an occupational exposure ? In the case of HBV, healthcare workers who have received hepatitis B vaccine and have developed immunity to the virus are at virtually no risk for infection. For an unvaccinated person, the risk from a single needlestick or a cut exposure to HBV-infected blood ranges from 6-30%, and depends on the hepatitis B e antigen (HBeAg) status of the source individual. Individuals who are both hepatitis B surface antigen (HBsAg) positive and HBeAg positive have more virus in their blood and are more likely to transmit HBV.

With HCV based on limited studies, the risk for infection after a needlestick or cut exposure to HCV-infected blood is approximately 1.8%. The risk following a blood splash is unknown, but is believed to be very small. However, HCV infection from such an exposure has been reported.

Concerning HIV, the average risk of infection after an exposure to HlV-infected blood is 0.3% (about 1 in 300). Stated another way, 99.7% of needlestick/cut exposures do not lead to infection. The risk after exposure of the eye, nose, or mouth to HIV-infected blood is estimated to be, on average, 0.1% (1 in 1,000).

The risk after exposure of the skin to HlV-infected blood is estimated to be less than 0.1%. A small amount of blood on intact skin probably poses no risk at all. There have been no documented cases of HIV transmission due to an exposure involving a small amount of blood on intact skin (a few drops of blood on skin for a short period of time). The risk may be higher if the skin is damaged (for example, by a recent cut) or if the contact involves a large area of skin or is prolonged (for example, being covered in blood for hours).

How Many Health-Care Workers Have Been Infected With Bloodborne Pathogens?

HBV
The annual number of occupational infections has decreased sharply since hepatitis B vaccine became available in 1982 (i.e., there was a 90% decrease in the number of estimated cases from 1985 to1996). Nonetheless, approximately 800 health-care workers become infected with HBV each year following an occupational exposure .

HCV
There are no exact estimates on the number of health-care workers occupationally infected with HCV. However, studies have shown that 1% of hospital health-care workers have evidence of HCV infection (about 1.8% of the U.S. population has evidence of infection). The number of these workers who may have been infected through an occupational exposure is unknown.

HIV
Surveillance of Healthcare Personnel with HIV/AIDS, as of December 2002
Of the adults reported with AIDS in the United States through December 31, 2002, 24,844 had a history of employment in healthcare. These cases represented 5.1% of the 486,826 AIDS cases reported to CDC for whom occupational information was known (information on employment was missing for 362,954 reported AIDS cases).

*Latest data available from CDC as of December 2007

Documented cases of occupationally acquired HIV/AIDS are those in which HIV seroconversion is temporally related to an exposure to an HIV-positive source and in which the exposed worker has no non-occupational risk factors for acquisition of HIV. Possible cases of occupationally acquired HIV/AIDS are those in which a worker is found to be HIV positive, has no non-occupational risk factors for HIV/AIDS, and has opportunities for occupational exposure to blood, body fluids, or HIV-positive laboratory material. Although seroconversion after exposure was not documented for these personnel, occupational acquisition of their infection might have been possible.

Of those healthcare personnel for whom case investigations were completed from 1981-2006, 57 had documented seroconversion to HIV following occupational exposures. The routes of exposure resulting in infection were: 48 percutaneous (puncture/cut injury); five, mucocutaneous (mucous membrane and/or skin); two, both percutaneous and mucocutaneous; and two were of unknown route. Forty-nine healthcare personnel were exposed to HIV-infected blood; three to concentrated virus in a laboratory; one to visibly bloody fluid; and four to an unspecified fluid. In addition, 140 possible cases of HIV infection or AIDS have occurred among healthcare personnel.

The most recent possible new case of occupationally acquired HIV/AIDS was reported to CDC in 2000; no new documented cases have been reported since that time, although several cases are in various stages of investigation. As yet, none can be classified as documented cases.

More than 90% of healthcare personnel infected with HIV have non-occupational risk factors for acquiring their infection.

Treatment For Exposure

Is There a Vaccine or Treatment Available to Prevent Infections with Bloodborne Pathogens?

HBV

As mentioned above, hepatitis B vaccine has been available since 1982 to prevent HBV infection. All healthcare workers who have a reasonable chance of exposure to blood or body fluids should receive hepatitis B vaccine. Vaccination ideally should occur during the healthcare worker’s training period. Workers should be tested 1-2 months after the vaccine series, to make sure that vaccination has provided immunity to HBV infection.

Hepatitis B immune globulin (HBIG) is effective in preventing HBV infection after an exposure . The decision to begin treatment is based on several factors, such as:

• Whether the source individual is positive for hepatitis B surface antigen.
• Whether you have been vaccinated.
• Whether the vaccine provided you immunity.

HCV
There is no vaccine against hepatitis C, and no treatment after an exposure that will prevent infection. Immune globulin is not recommended. For these reasons, following recommended infection control practices is crucial.

HIV
There is no vaccine against HIV. However, results from a small number of studies suggest that the use of zidovudine after certain occupational exposures may reduce the chance of HIV transmission. Post-exposure treatment is not recommended for all occupational exposures to HIV, because most exposures do not lead to HIV infection and because the drugs used to prevent infection may have serious side effects. Taking these drugs for exposures that pose a lower risk for infection may not be worth the risk of possible side effects. You should discuss the risks and side effects with a healthcare provider before starting post-exposure treatment for HIV.

What About Exposures to Blood From an Individual Whose Infection Status Is Unknown?

HBV-HCV-HIV
If the source individual cannot be identified or tested, decisions regarding follow-up should be based on the exposure risk and whether the source is likely to be a person who is infected with a bloodborne pathogen. Follow-up testing should be available to all workers who are concerned about possible infection through occupational exposure .

What Specific Drugs Are Recommended for Post-Exposure Treatment?

HBV
If you have not been vaccinated, then hepatitis B vaccination is recommended for any exposure, regardless of the source person’s hepatitis B status. HBIG and/or hepatitis B vaccine may be recommended, depending on your immunity to hepatitis B and the source person’s infection status.

HCV
Currently there is no recommended post-exposure treatment that will prevent HCV infection.

HIV
The Public Health Service recommends a 4-week course of two drugs (zidovudine and lamivudine) for most HIV exposures, or zidovudine and lamivudine plus a protease inhibitor (indinavir or nelfinavir) for exposures that may pose a greater risk for transmitting HIV (such as those involving a larger volume of blood with a larger amount of HIV or a concern about drug-resistant HIV). Differences in side effects associated with the use of these two drugs may influence which drug is selected in a specific situation.

These recommendations are intended to provide guidance to clinicians and may be modified on a case-by-case basis. Determining which drugs and how many drugs to use or when to change a treatment regimen is largely a matter of judgment. Whenever possible, consulting an expert with experience in the use of antiviral drugs is advised, especially if a recommended drug is not available, if the source patient’s virus is likely to be resistant to one or more recommended drugs, or if the drugs are poorly tolerated.

How Soon After Exposure to A Bloodborne Pathogen Should Treatment Start?

HBV
Post-exposure treatment should begin as soon as possible after exposure , preferably within 24 hours, and no later than 7 days.

HIV
Treatment should be started promptly, preferably within hours, as opposed to days, after the exposure. Although animal studies suggest that treatment is not effective when started more than 24-36 hours after exposure , it is not known if this time frame is the same for humans. Starting treatment after a longer period (e.g., 1-2 weeks) may be considered for the highest risk exposures; even if HIV infection is not prevented, early treatment of initial HIV infection may lessen the severity of symptoms and delay the onset of AIDS.

Has the FDA Approved These Drugs to Prevent Bloodborne Pathogen Infection Following An Occupational Exposure ?

HBV
Yes. Both hepatitis B vaccine and HBIG are approved for this use.

HIV
No. The FDA has approved these drugs for the treatment of existing HIV infection, but not as a treatment to prevent infection. However, physicians may prescribe any approved drug when, in their professional judgment, the use of the drug is warranted.

What Is Known About the Safety and Side Effects of These Drugs?

HBV
Hepatitis B vaccine is very safe. There is no information that the vaccine causes any chronic illnesses. Most illnesses reported after HBV vaccinations are often related to other causes and not the vaccine. However, you should report any unusual reaction after a hepatitis B vaccination to your health-care provider.

HIV
All of the antiviral drugs for HIV have been associated with side effects. The most common side effects include: upset stomach (nausea, vomiting, diarrhea), tiredness or headache. The few serious side effects that have been reported in healthcare workers using combination post-exposure treatment have included kidney stones, hepatitis and suppressed blood cell production. Protease inhibitors (indinaivir and nefinavir) may interact with other medicines and cause serious side effects, and should not be used in combination with certain other drugs, such as prescription antihistamines. It is important to tell the healthcare provider managing your exposure about any medications you are currently taking, if you need to take antiviral drugs for an HIV exposure .

Can Pregnant Health-Care Workers Take the Drugs Recommended for Post-exposure Treatment?

HBV
Yes. Women who are pregnant or breastfeeding can be vaccinated against HBV infection and/or get HBIG. Pregnant women who are exposed to blood should be vaccinated against HBV infection, because infection during pregnancy can cause severe illness in the mother and a chronic infection in the newborn. The vaccine does not harm the fetus.

HIV
Pregnancy should not rule out the use of post-exposure treatment when it is warranted. If you are pregnant, you should understand what is known and not known regarding the potential benefits and risks associated with the use of antiviral drugs, in order to make an informed decision about treatment.

What Follow-Up Should Be Done After An Exposure ?

HBV
Because post-exposure treatment is highly effective in preventing HBV infection, the CDC does not recommend routine follow-up after treatment. However, any symptoms suggesting hepatitis (e.g., yellow eyes or skin, loss of appetite, nausea, vomiting, fever, stomach or joint pain, extreme tiredness) should be reported to your healthcare provider. If you are exposed to HBV and receive post-exposure treatment, it is unlikely that you will become infected and pass the infection on to others. No precautions are recommended.

HCV
You should have an antibody test for hepatitis C virus and a liver enzyme test (alanine aminotransferase activity) as soon as possible after the exposure (baseline) and at 4-6 months after the exposure . Some clinicians may also recommend another test (HCV RNA) to detect HCV infection 4-6 weeks after the exposure . Report any symptoms suggesting hepatitis (mentioned above) to your health-care provider. Because the risk of becoming infected and passing the infection on to others after an exposure to HCV is low, no precautions are recommended.

HIV
You should be tested for HIV antibody as soon as possible after exposure (baseline) and periodically for at least 6 months after the exposure (e.g., at 6 weeks, 12 weeks, and 6 months). If you take antiviral drugs for post-exposure treatment, you should be checked for drug toxicity by having a complete blood count and kidney and liver function tests just before starting treatment and 2 weeks after starting treatment. You should report any sudden or severe flu-like illness that occurs during the follow-up period, especially if it involves fever, rash, muscle aches, tiredness, malaise, or swollen glands. Any of these may suggest HIV infection, drug reaction, or other medical conditions. You should contact the healthcare provider managing your exposure if you have any questions or problems during the follow-up period.

What precautions should be taken during the follow-up period? During the follow-up period, especially the first 6-12 weeks, when most infected persons are expected to show signs of infection, you should follow recommendations for preventing transmission of HIV. These include not donating blood , semen, or organs and not having sexual intercourse. If you choose to have sexual intercourse despite the recommendation against it, using a condom consistently and correctly may reduce the risk of HIV transmission. In addition, women should consider not breastfeeding infants during the follow-up period to prevent exposing their infants to HIV in breast milk.

Modes of Disease Transmission
Contact:This type of pathogen may be transmitted by direct (skin to skin) or indirect (object to skin) contact with microorganisms. Two specific examples of these pathogens are: Staphylococcus and Herpes simplex virus.

Droplet:Coughing or sneezing may transmit this type of pathogen by releasing infectious droplets into the mucus membranes. These infectious droplets, because they are larger in size than airborne droplets, can only travel 3 feet. The general recommendation for avoiding contact with these pathogens is to wear a mask and stay at least 3 feet away from any person who is possibly infected. The influenza virus is an example of this mode of transmission.

Airborne:Coughing, sneezing, or talking releases droplet nuclei into the air, where they remain suspended until breathed in. An example of this type of pathogen is M. Tuberculosis. Tuberculosis (TB) is caused by a mycobacterium that multiplies in the alveolar sacs of the lungs in 85% of cases. The size of the particulate nuclei is less than 5 microns, which can float in the air. Incidence of this disease is on the rise. Due to the mode of transmission, TB is seen in higher numbers among the poor and institutionalized. Once exposed to active TB, an individual will test positive on the TB skin test that is a screening test only. A chest X-ray is done to determine if the disease is active, i.e., the person is infected, as well as sputum cultures for AFB (acid fast bacillus).

Many individuals are exposed to tuberculosis but do not come down with the disease for years, if ever. This is called “latent” infection. As there are no symptoms associated with latent infection, the problem of compliance with a 9-month medication regimen, as is recommended for these individuals, is complex. The person infected with latent TB should undergo prophylactic treatment with INH plus pyridoxine (vitamin B6) for 9 months to prevent the disease.

The TB organism lies dormant in the body and finds “sanctuaries” where it remains in the dormant state, but it has never really left the body, and can re-activate if the immune system becomes impaired. It is important that a person with latent TB infection take all the pills prescribed in order for the treatment to be effective. If you start taking INH, you will need to see your doctor or nurse on a regular schedule. He or she will check on how you are doing. Very few people have serious side effects to INH. However, if you have any of the following side effects, call your doctor or nurse right away:

• No appetite
• Nausea
• Vomiting
• Yellowish skin or eyes
• Fever for 3 or more days
• Abdominal pain
• Tingling in the fingers and toes

What If I Have Been Vaccinated with BCG?

BCG is a vaccine for TB. This vaccine is not widely used in the United States, but it is often given to infants and small children in other countries where TB is common. BCG vaccine does not always protect people from TB.

If you were vaccinated with BCG, you may have a positive reaction to a TB skin test. This reaction may be due to the BCG vaccine itself or to latent TB infection. But your positive reaction probably means that you have latent TB infection if:

• You recently spent time with a person who has TB disease
• You are from an area of the world where TB disease is very common (most countries in Latin America and the Caribbean, Africa, Asia, Eastern Europe, and Russia)
• You spend time where TB is common (homeless shelters, drug-treatment centers, health care clinics, jails, prisons)

Active TB is contagious, and individuals must be isolated for the first two to four weeks of chemotherapy. Observing symptoms of active TB infection such as weakness, malaise, fever, night sweats, weight loss and productive cough typically helps to differentiate active infection from latent infection.

Epidemiology
Reported cases of tuberculosis were on the decline in the U.S. until about 1986, when they began to rise. This is due in part to the susceptibility of HIV-infected individuals. Issues related to compliance with chemotherapy regimes are twofold. Untreated active TB patients can die from this disease and are a potential public health hazard, sometimes requiring “Direct Observation Therapy” to assure compliance. The medications must be taken for six months to a year, and patients tend to quit taking them when they feel better. This can lead to super infections and render the patients infectious once again.

Treatment
When chest X-ray and sputum cultures confirm a diagnosis of TB, patients must begin chemotherapy at once. All patients are started on the following four antibiotics until sputum cultures determine sensitivity. Isoniazid, Rifampin, Pyrazinamide, and Streptomycin are the primary agents for treating infectious TB. Individuals caring for active TB patients must protect themselves with a particulate respirator, such as the N95 mask that must be specially fitted to each person’s face to be effective. Institutionalized patients should be placed in a negative airflow room.

Employer Responsibilities
Employers must immediately isolate any case of active TB to the local public health department. In work environments where the risk of TB transmission may be higher than in the general workplace (i.e., hospitals, prisons), employers should have a TB skin testing program in place for their workers.

Common Vehicle Transmission:
This occurs when food or water sources are contaminated with microorganisms. Two examples of these pathogens are cholera and salmonella.

Vectorborne:
A vector is an organism (such as an insect) that transmits a pathogen. Insects, such as mosquitoes or fleas, can transmit microorganisms through their bite. Three examples of vectorborne illnesses are malaria, typhus and West Nile virus (WNV).

West Nile virus first appeared in humans in the U.S. in 1999. By 2005, WNV had spread to all states in the continental United States. According to the Centers for Disease Control and Prevention (CDC), there were 3000 reported cases in humans, including 119 deaths, in the United States in 2007. Persons over the age of 50 have the highest risk of acquiring the severe form of the disease.

The majority of people infected will not develop any form of the disease. 20% of those infected will develop West Nile fever. Signs and symptoms include headache, fever and body aches, with an occasional skin rash on the trunk and swollen lymph glands. Severe infection may lead to West Nile encephalitis and meningitis. Symptoms include: headache, high fever, neck stiffness, stupor, disorientation, tremors, convulsions, muscle weakness, paralysis and coma. There is a lab test, IgM-antibody, which can detect antibodies produced very early, indicating infection with West Nile virus. There is no specific treatment recommended. The worst infections are aggressively managed.

Three simple actions can help prevent infection: 1) avoiding mosquito bites by using insect repellants with DEET and wearing light, long-sleeved clothing, 2) mosquito-proofing your home by emptying standing water and installing screens, and 3) reporting dead birds to local health authorities (mosquitoes become infected when they feed on infected birds).

In a very small number of cases, WNV also has been spread through blood transfusions, organ transplants, breastfeeding and even during pregnancy from mother to baby. The introduction of routine WNV screening of blood donations should greatly reduce the risk of spread of WNV through transfused blood.

Bloodborne Pathogens:
Those pathogens present in human blood or OPIM that transmit disease to another through a portal of entry. Transmission can occur through sexual contact, IV drug abuse with needle sharing, accidental needlestick, and splashes into mucus membranes or contact with non-intact skin.

HBV:Hepatitis B Virus is the virus known to cause the disease Hepatitis B. This potentially life-threatening disease generally manifests after a 17 to 98 day incubation period.

There Are 3 Stages To The Illness:

• Prodromal: Malaise, anorexia, headache, low-grade fever followed by jaundice in a week or so.
• Icteric: Jaundice and liver enlargement lasting four to six weeks.
• Recovery: Return to normal color but persistent fatigue lasting two to six weeks.

Epidemiology
HBV has been identified in approximately 4.8% of the U.S. population, with .3% having active disease. Of note is the report from OSHA citing that approximately 8,700 health care workers contract the disease through occupational exposure each year. If exposed, they are tested for HBsAG (hepatitis B surface Antigen). If positive, multiple doses of HBIG (hepatitis B immune globulin) are estimated to protect 75%, if given within 1 week after percutaneous exposure.

Vaccination
A safe, effective, and free HBV vaccine is offered to all employees at risk for occupational exposure. Common side effects of the vaccination include: pain at the injection site and mild to moderate fever. A series of three injections will be given on days 1, 30, 180. After the first series of 3 injections you must have titer done. If the titer is <10m1U/mi you should get another series of 3 injections. A booster of Hepatitis B is not necessary, and getting follow-up titer checks are not recommended.

HIV:
Human Immunodeficiency Virus is the virus known to cause the disease AIDS (Acquired Immune Deficiency Syndrome). This is a fatal disease, in which the immune system is decimated, leading to multiple opportunistic infections. It generally takes ten years for an HIV- infected individual to develop life-threatening opportunistic infections, depending on lifestyle and general health.

There Are 3 Stages to the Illness:

• Acute retroviral seroconversion syndrome: Two to six weeks after exposure, 50% of individuals will develop an acute mononucleosis-like syndrome.
• Clinical latency: The majority of individuals in this stage remain asymptomatic.
• Symptomatic disease: This is the onset of opportunistic infections that ultimately lead to death. CD4+ lymphocyte (T cell) levels drop below 200/mm.

ACLS Provider Courses do not teach rhythm identification, pharmacology or algorithms. The American Heart Association requires the prospective student to be familiar enough prior to class with rhythm identification, medications used in resuscitation and ACLS algorithms and flowcharts to be able to apply them to clinical scenarios. This fast-paced, intensive 4-hour class prepares the prospective ACLS student to successfully complete the Provider Course.

State of the art simulation technology and extensive and up-to-date written materials, combined with our unique and common sense teaching approach, enables the participant to interpret basic dysrhythmias, and to understand cardiac electrophysiology and the medications most commonly used for adult resuscitation. We also provide an overview of the American Heart Association algorithms for ACLS.

Some of the Objectives Include:

1. Describe the cardiac electrical conduction system
2. Identify the components of the cardiac cycle
3. Describe the 5-step rapid interpretation method
4. Identify lethal and non-lethal dysrhythmias
5. Identify the adult core algorithms as published by the AHA
6. List the most important medications used in adult emergency resuscitation
7. Recognize the contraindications and most important side effects of ACLS medications

Who Should Attend:

1. Anyone taking ACLS for the first time
2. Anyone renewing ACLS who doesn’t work with cardiac rhythms or lifesaving medications regularly
3. Anyone needing a review in basic ECG interpretation and/or pharmacology

The course fee is $50 for 3.4 Contact Hours

No discounts please.

{column1}
One Day Class
Saturday
9:00 am – 5:30 pm

July 12
August 9
September 13
October 11
November 8
December 13
January 10, 2009

Register Online for 1-day ACLS Class
{/column1}

{column2}
Two Day Class
Saturday
9:00 am – 12:40 pm
Sunday
9:00 am – 5:15 pm

July 12 – 13
August 9 – 10
September 13 – 14
October 11 – 12
November 8 – 9
December 13 – 14
January 10 – 11, 2009

Register Online for 2-day ACLS Class

{/column2}

{column1}
One Day Class
Saturday
9:00 am – 5:30 pm

July 26
August 23
September 27
October 25
November 22
December 27
January 24, 2009

Register Online for 1-day ACLS Class
{/column1}

{column2}
Two Day Class
Saturday
9:00 am – 12:40 pm
Sunday
9:00 am – 5:15 pm

July 26 – 27
August 23 – 24
September 27 – 28
October 25 – 26
November 22 – 23
December 27 – 28
January 24 – 25, 2009

Register Online for 2-day ACLS Class

{/column2}

July 22
August 19
September 23
October 21
November 18
December 16
January 20, 2009

Register Online for 1-day ACLS Class
{/column1}

{column2}
Two Day Class
Wednesday
9:00 am – 12:40 pm
Thursday
9:00 am – 5:15 pm

July 22 – 23
August 19 – 20
September 23 – 24
October 21 – 22
November 18 – 19
December 16 – 17
January 20 – 21, 2009

Register Online for 2-day ACLS Class

{/column2}

{column1}
One Day Class
Saturday
9:00 am – 5:30 pm

July 9
August 6
September 10
October 8
November 5
December 10
January 7, 2009

Register Online for 1-day ACLS Class
{/column1}

{column2}
Two Day Class
Saturday
9:00 am – 12:40 pm
Sunday

July 9 – 10
August 6 – 7
September 10 – 11
October 8 – 9
November 5 – 6
December 10 – 11
January 7 – 8, 2009

Register Online for 2-day ACLS Class

{/column2}

{column1}
One Day Class
Tuesday
9:00 am – 5:30 pm

August 26
October 28
December 29 (Monday)
Register Online for 1-day ACLS Class
{/column1}

{column2}
Two Day Class
Tuesday
9:00 am – 12:40 pm
Wednesday
9:00 am – 5:15 pm

August 26 – 27
October 28 – 29
December 29 – 30 (Monday and Tuesday)

Register Online for 2-day ACLS Class

{/column2}

Complete list of ACLS Classes

South Dade
Kendall Regional Medical Center
11750 S.W. 40 Street
3rd Floor Auditorium
Miami, FL

{column1}
One Day Class
Saturday
9:00 am – 5:30 pm

August 2
September 6
October 4
November 1
December 6 (MOB Building)
January 2, 2009

Register Online for 1-day ACLS Class
{/column1}

{column2}
Two Day Class
Saturday
9:00 am – 12:40 pm
Sunday
9:00 am – 5:15 pm

August 2 – 3
September 6 – 7
October 4 – 5
November 1 – 2
December 6 – 7 (MOB Building)
January 2 – 3, 2009

Register Online for 2-day ACLS Class

{/column2}

{column1}

One Day Class
Saturday
9:00 am – 5:30 pm

July 19
August 16
September 20
October 18
November 15
December 20
January 17, 2009

Register Online for 1-day ACLS Class
{/column1}

{column2}

Two Day Class
Saturday
9:00 am – 12:40 pm
Sunday
9:00 am – 5:15 pm

July 19 – 20
August 16 – 17
September 20 – 21
October 18 – 19
November 15 – 16
December 20 – 21
January 17 – 18, 2009

Register Online for 2-day ACLS Class
{/column2}

North Dade
Nursing Unlimited Headquarters
18405 NW 2nd Ave
Miami Gardens, FL 33169

Course Dates and Times
Monday – Friday
9:00 am – 1:00 pm

September 15, 2008 – September 26, 2008

Monday – Friday
9:00 am – 1:00 pm

July 21, 2008 – August 01, 2008

*Workbook with post-test

**Florida law requires CNAs to complete a minimum of 18 hours of in-service training each calendar year (64B9-15.011, F.A.C.). Every two years, in-service training hours must include:

• HIV/AIDS, Infection Control

• Domestic Violence

• Medical Record Documentation and Legal Aspects Appropriate to Nursing Assistants

• Resident Rights

• Communication with Cognitively Impaired Clients

• CPR Skills

• Medical Error Prevention and Safety

HHAs employed by home health agencies accepting Medicare and Medicaid are required to complete 12 hours of in-service training during each 12-month period (42 C.F.R. §484.36(b)(2)(iii)). Home health aides and CNAs assisting with self-administered medication must receive a minimum of 2 hours of training prior to assuming this responsibility (400.488, F.S., 59A-8.0095(5)(d)(15), F.A.C.).

The objective of this program is to prepare the student to function in the hospital as an electrocardiograph aide. The course of study involves both laboratory and clinical skills evaluations. This program enables the student to complete 80 hours of training in ECG interpretation. The 40-hour career skills development segment of this program includes computer orientation, development of writing, math and people skills, preparation of a professional resume, interview skills and on-the-job skills.

Program Description

The program is designed to train students in ECG interpretation and to enable them to function as electrocardiograph aides through didactic, use of textbook, reading, videos, PowerPoint presentations, instructor demonstration, return demonstration and pre/post quizzes and a final exam to measure learning.

Entrance Requirements or Prerequisites

18 years of age, able to read, write and speak English. Must hold a current certificate of nursing assistant. Must have completed a minimum of 4 hours of HIV/AIDS/BBP training.

Registration

All students entering the Electrocardiograph Aide Program are required to register prior to the class. At the time of registration, a student enrollment agreement is to be completed and a deposit to be paid. This deposit is included in the cost of the program.

Tuition / Payment Schedule

Total program price is $550. This amount includes the cost of books and supplies. Tuition can be paid in full at the time of registration, but a minimum deposit of $150 must be paid at that time. An additional $260 must be paid before the start of the second week of the program and the balance must be paid before the start of the fifth week.

Day Classes

Tuesday – Friday
9:00 am – 2:00 pm

February 02 – March 12, 2010
May 04 – June 11, 2010

Evening Classes

Monday – Friday
6:00 pm – 10:00 pm

February 01 – March 12, 2010
May 03 – June 11, 2010

The objective of this program is to prepare the student to enter the field of phlebotomy in a hospital or clinical setting. This program enables students to complete 80 hours of phlebotomy training and prepares them to take national certification exams. The 40-hour career skills development segment of this program includes computer orientation, development of writing, math and people skills, preparation of a professional resume, interview skills and on-the-job skills.

Program Description

The program is designed to enable the student to function as a phlebotomist through the use of textbook, videos, PowerPoint presentations, instructor demonstration, return demonstration and pre/post quizzes and a final exam to measure learning.

Entrance Requirements or Prerequisites

18 years of age, able to read, write and speak English. Must hold a current certificate of nursing assistant. Must have completed a minimum of 4 hours of HIV/AIDS/BBP training.

Registration

All students entering the Phlebotomy Program are required to register prior to the class. At the time of registration, a student enrollment agreement is to be completed and a deposit to be paid. This deposit is included in the cost of the program.

Tuition / Payment Schedule

Total program price is $600. This amount includes the cost of books and supplies. Tuition can be paid in full at the time of registration, but a minimum deposit of $150 must be paid at that time. An additional $300 must be paid before the start of the third week of the program and the balance must be paid before the start of the sixth week.

Dates and Times

Evenings

Monday – Friday
6:00pm – 10:00pm

January 04 – February 12
April 05 – May 14, 2010

Mornings

Tuesday – Friday
9:00am – 2:00pm

January 05 – February 12<2010
April 06 – May 14, 2010

The cost of the course is $275 and it includes the textbook. Preregistration is required with $125 and $25 registration fee* minimum deposit with full payment of $275 due by 1st day of class.

* If you have taken Home Health 35 with Nursing Unlimited in the last three months, the $25 registration fee will be waived.

Day Classes

Monday – Thursday
9:00am – 1:00pm (unless otherwise specified)

October 12 – October 29 (9:00 am – 1:30 pm)
November 9 – November 25 (9:00 am – 1:30 pm)
December 7 – December 23 (9:00 am – 1:30 pm)
January 4, 2010 – January 21, 2010
February 01 – February 18, 2010
March 01 – March 18, 2010
March 29 – April 15, 2010
April 26 – May 13, 2010
May 24 – June 10, 2010

Evening Classes

Monday – Thursday
6:00pm -10:00pm (unless otherwise specified)

October 12 – October 29 (6:00 pm – 10:00 pm)
November 9 – November 25 (6:00 pm – 10:00 pm)
December 7 – December 23 (6:00 pm – 10:00 pm)
January 4, 2010 – January 21, 2010
February 01 – February 18, 2010
March 01 – March 18, 2010
March 29 – April 15, 2010
April 26 – May 13, 2010
May 24 – June 10, 2010

Get more information about the State of Florida Nursing Assistant Examination by clicking here.

The cost of the course is $165 and it includes the textbook. Preregistration is required with a minimum deposit of $50 and $25 registration fee*. The balance is due before the half way point of the class.

Get a $25 discount when you register for the Nursing Assistant Review course when you complete the HHA course!!

* If you have taken Home Health Aide 40-hour course with Nursing Unlimited in the last three months, the $25 registration fee will be waived.

Day Classes
Monday – Thursday
9:00am – 1:30pm (unless otherwise specified)

October 26 – November 5
November 23 – December 3 (9:00am – 2:00pm)
December 21 – December 30 (9:00am – 2:45pm)
January 18 – January 28, 2010
February 15 – February 25, 2010
March 15 – March 25, 2010
April 12 – April 22, 2010
May 10 – May 20, 2010
June 7 – June 17, 2010

Evening Classes:
Monday – Thursday
6:00pm – 10:30pm (unless otherwise specified)

October 26 – November 5
November 23 – December 3 (5:45pm – 10:45pm)
December 21 – December 30 (5:30pm – 11:15pm)
January 18 – January 28, 2010
February 15 – February 25, 2010
March 15 – March 25, 2010
April 12 – April 22, 2010
May 10 – May 20, 2010
June 7 – June 17, 2010

This advanced training is presented as an 8-hour course and includes theory and simulated practice on the anatomically correct Peter PICC line manikin. Successful completion allows the participant to insert this line according to healthcare facility policy*. This course is intended for the experienced Registered Nurse who wishes to stay current with the latest advancements in IV therapy. As more patients are being discharged earlier from hospitals, ways of decreasing their stay and accomplishing their therapy in alternative settings are being utilized. The use of the peripherally inserted central catheter in managing intravenous therapy in the hospital and home setting is increasing in importance. PICC lines establish venous access in patients in a safe, cost-effective and improved manner. If you want to keep current on the latest technology, register now, as the class size is limited. All classes are taught by RNs certified in PICC line insertion, who share Nursing Unlimited’s “Stress Free” approach to training. All instructors have clinical experience as well as the theoretical knowledge necessary to effectively conduct this program. This course is not affiliated with any manufacturer. We use a variety of different PICC lines and equipment to enable us to review the pros and cons of all product devices. A comprehensive reference manual is included in the course cost and will be given out on the day of the course.

Some of the Objectives Include:

1. List and Describe five components of the nursing care of the PICC line.
2. List complications associated with the PICC line and appropriate interventions.
3. Correctly insert a PICC line in an anatomically correct manikin.

*Hospital and Home Health Agency policies on insertion of PICC lines differ. In almost all cases however, a preceptorship is established in order for the nurse to demonstrate competence. Length of preceptorship is dependent upon the facilities policies regarding PICC line insertion. This certification course is the first step for the learner wishing to master this procedure.

The course fee is $185 for 5.9 Contact Hours and includes PICC Line, Dressing Kit & course workbook for each student provided on the day of class.

Register online now!

Don’t see the dates you want?  Call our office at (800) 852-4126 to schedule a private class around your schedule.

The Oncology Nursing Society Chemotherapy and Biotherapy Course provides a comprehensive review of the knowledge needed to administer chemotherapy.  Nursing Unlimited is proud to offer this program, which is rapidly becoming the standard by which chemotherapy practitioners are measured and accepted.  Topics include:  the theoretical basis for chemotherapy administration, specific chemotherapy drug classifications, safe handling, safe administration, side effect management, and patient teaching strategies.  Case studies related to these concepts will also be presented.

Registered nurses who attend this program in its entirety and successfully complete the post-test (open book) and evaluation form will receive a laminated ONS Cancer Chemotherapy Card.  This card validates that the participant has the theoretical foundation needed to administer chemotherapy. This is NOT a competency or certification course.  The individual employer or institution should determine clinical competency.  The card is valid for two years, and may be renewed by completion of an independent study.

Note: For a complete list of objectives including the new biotherapy components, please call our office.

Who Should Attend:

Participants must be licensed registered nurses who have been employed as such for a minimum of six months. The course content is appropriate for nurses who are new to chemotherapy administration, as well as for those who want a comprehensive review.

The course fee is $350 and includes all course handouts and one copy of the Chemotherapy and Biotherapy Guidelines and Recommendation for Practice, 3rd Ed. which are provided on the day of class.  This course is taught by ONS Trainer, Janet Williams, ARNP, MSN, OCN.

The laminated ONS Chemotherapy Provider Card is mailed by the ONS 6-8 weeks after class along with a certificate for 13.5 Contact Hours.

ONS is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
ONS is approved as a provider of continuing nursing education by the California State Board of Registered Nursing, Provider No. 2850.

Register online

This highly popular 30-hour IV Certification course meets the requirements of the Florida State Board of Nursing for certification of LPNs to administer IV therapy. It also serves as a welcome update for RNs who have been out of clinical practice for a while and want to improve and enhance their IV skills. Divided into 18 home study hours followed by 12 classroom hours, the course consists of both theory and actual practice sessions.

Subjects covered include:

• fluid and electrolyte balance
• blood transfusion therapy
• hyperalimentation
• IV medication administration (including dosage calculations)
• care and use of central lines

Our emphasis is on quality of care issues, employing scrupulous aseptic procedure to prevent infection and proper insertion technique to minimize patient discomfort. There will be numerous opportunities for hands-on practice, including “live sticks” when requested. Join the thousands of LPNs and RNs that we have enabled to confidently and safely insert and maintain IVs.

Some of the Objectives Include:

1. Compare and contrast the RN and LPN scope of practice for IV therapy in the state of Florida.
2. Discuss the care and maintenance of three different types of central venous lines.
3. Demonstrate in simulated practice the starting and maintaining of peripheral IVs.

Who Should Attend:

LPNs & RNs

The course fee is $225* for 30 Contact Hours and includes all home study material.

Register online now

*Please remember to include $5.00 for shipping & handling
See our course discounts.

Dosage calculation is an area of nursing practice that often inspires anxiety, even in the most competent and experienced nurses. Published accounts of alarming numbers of fatal medication errors each year only emphasize the vital importance of correctly calculating dosages to ensure that patients are treated appropriately. This fast-paced, 8-hour course is a must for LPNs and RNs taking our IV therapy courses, and for new nursing grads preparing for state boards and pre-employment pharmacology tests.

Difficulties often arise when converting from one system of measurement to another and when converting standard mathematic calculations (e.g., fractions into decimals, etc.). All of these elements will be reviewed in depth, using common medications to illustrate practical applications of the information presented. Upon successful completion of this course, new nurses seeking employment will be able to navigate any medication test given in South Florida, while the currently employed nurse can proceed to confidently administer medications, assured that patients are being suitably treated.

Some of the Objectives Include:

1. Comprehend basic math skills.
2. Determine the value of “x” in simple equations.
3. Recall from memory the metric and household approximate equivalents.
4. Convert from one unit to another within the same system of measurement.
5. Convert units of measurement between different systems.
6. Convert all units of measurement to the same system and same size units.
7. Consider the reasonable amount of the drug to be given.
8. Use the formula (D/H)Q to calculate p.o. and parenteral dosages.
9. Measure insulin correctly.
10. Convert insulin units to milliliters.

Who Should Attend:

• All students taking IV courses
• Nurses planning a job change
• Inactive nurses wishing to return to the work force

The course fee is $90 for 5.9 Contact Hours

Register online

Today, more people in the United States die from medical errors than from motor vehicle accidents, breast cancer or AIDS. While not all adverse patient outcomes are due to medical error, medical errors represent adverse outcomes that are preventable with our current state of medical knowledge. It is therefore imperative that all healthcare professionals recognize the factors contributing to the occurrence of medical errors, in order to develop more effective processes to prevent their occurrence. This course examines the systemic causes of medical errors and outlines steps that can be taken, both by institutions and by individual care providers, to reduce the incidence of errors. Attention is paid to the particular vulnerabilities of special patient populations, such as children, the elderly and psychiatric patients. This course meets the mandate of the Florida State legislature (Florida Statute 456.013) requiring training on the prevention of medical errors, and follows the curriculum guidelines of the Florida State Board of Nursing for the issuance of 2 contact hours needed for license renewal. Join us and participate in lively class discussions, sharing real-life experiences and solutions as you satisfy your re-licensure requirement.

Some of the Objectives Include:

1. Identify factors that contribute to the occurrence of medical errors.
2. Recognize error-prone situations.
3. Discuss processes and strategies to improve patient outcomes.
4. Recognize responsibilities for reporting medical errors.
5. Discuss the need for public education on the occurrence of medical error

Who Should Attend:
All RN’s & LPN’s

The course fee is $25 for 2 contact hours.

Don’t Forget Your CPR Update, HIV/AIDS Update and Domestic Violence
Mandatory Requirement.

Complete this class online now!

Since domestic violence occurs in approximately one out of three intimate relationships, both heterosexual and homosexual, chances are great that any healthcare provider will encounter both victims and perpetrators of domestic violence on a routine basis. Providers must realize that ignoring domestic violence is essentially an act of collusion with the perpetrator. The price of not intervening may be preventable death, serious injury or persistent mental and physical problems. The role of healthcare professionals is to be fully informed, clear in understanding the destructive nature of domestic violence and available over time to facilitate change. This course meets the mandate of the Florida legislature requiring training on domestic violence, and follows the curriculum guidelines of the Florida State Board of Nursing for issuance of 1 contact hour needed for license renewal. Experienced educators weed through the myths about domestic violence, offering real solutions for positive interventions. Join us for an informative and serious discussion of this problem as you satisfy your relicensure requirement.

Some of the Objectives Include:

1. Identify three “red flags” of a battering personality.
2. List three reasons that victims may stay in an abusive relationship.
3. Describe screening procedures used to identify and assist both victims and perpetrators of domestic violence.
4. List three community resources available to assist the victim, the perpetrator and the family.

Who Should Attend:

All persons required by Florida statute to take a Domestic Violence course

The course fee is $20 for 2 contact hours

Don’t Forget Your CPR Update, HIV/AIDS Update and Prevention Of Medical Errors
Mandatory Requirement.

This dynamic course meets state HIV and federal OSHA requirements regarding training for health care professionals. OSHA requires healthcare facilities to develop an internal Exposure Control Plan and to provide employees with specific training on the Bloodborne Pathogens Standard, the intent of which is to protect workers from potential workplace hazards.

The first one-hour segment of this course provides the learner with crucial information concerning bloodborne and airborne pathogens, including TB, and describes in detail the precautions necessary to minimize or eliminate occupational exposure to such pathogens.

The second segment of this course provides the student with a one-hour update on HIV/AIDS. Acquired Immunodeficiency Syndrome has killed more than 25 million people since it was first recognized in 1981, making it one of the most destructive epidemics in recorded history. Remarkable medical advances, including life-prolonging antiretroviral therapy, have allowed longer survival times, but AIDS is still among the leading causes of death globally. Take a look at the latest national and international statistics, advances in pharmacology, medical management, testing and a variety of other topics of compelling interest to the healthcare professional concerned about an epidemic that currently afflicts over 30 million worldwide.

Some of the Objectives Include:

• Describe Universal Precautions and their application to the healthcare arena.
• Define potentially infectious materials.
• Describe 3 items of personal protective equipment.
• List 4 components of an Exposure Control Plan.
• Describe modes of transmission of TB, HBV, HCV and HIV.
• List 4 symptoms of active TB infection.
• List 3 drugs commonly used in HIV treatment.
• Identify 3 of the most common transmission categories for HIV/AIDS.

Who Should Attend:

All persons required to take HIV / OSHA for employment/licensure purposes, as well as all medical professionals wanting an update on this epidemic.

The Course fee is $20 for 2 Contact Hours.

Don’t Forget Your CPR Update also Domestic Violence Mandatory Requirement
and Prevention Of Medical Errors Mandatory Requirement

Medical emergencies don’t occur every day. But when they do, correctly applied first aid can reduce pain and healing time and can even save lives. Nursing Unlimited’s 4-hour basic first aid class is designed to give you the confidence to respond in an emergency situation with skills that can preserve life, prevent further injury and promote recovery.

Some of the Objectives Include:

We use a systems approach to teaching, combining lecture, group discussion and hands-on practice to help you quickly assimilate these life-saving techniques. After taking this class your skills will include the ability to:

• Differentiate between injuries needing immediate care and those in which treatment may be delayed.

• Describe first, second and third degree burns and their treatment.

• Identify 3 actions that should NOT be performed in cases of snakebite.

• Identify symptoms and describe emergency treatment for heart attack, stroke, spinal injury, heatstroke, frostbite and diabetic emergencies.

Who Should Attend:
You should consider taking this class if you are a home health aide or CNA, a child care worker, health and fitness instructor, anyone else required to have first aid credentials for employment or anyone wishing to have first aid knowledge and skills in order to offer assistance and possibly save a life.

The course fee is $40 for 4 contact hours. Course handouts will be provided on the day of class.

Do you have a group of people that need to be trained? We can come to you. Please call (800) 852-4126 for more information.

Register online

This 8-hour American Heart Association course is intended to give experienced PALS providers the skills necessary to effectively teach others to intervene appropriately in emergency pediatric resuscitation. Successful resuscitations are the result, not only of medical expertise and mastery of resuscitation skills, but also of effective communication and teamwork. The PALS Instructor Course gives instructor candidates an opportunity to practice teaching the dynamics of responding to a code as part of a team.

All prospective instructors must have current AHA PALS provider status, have completed the AHA Core Instructor Course and be aligned with an AHA Training Center.

The course fee is $115 for 5.9 Contact Hours and includes all home study materials and the appropriate textbooks.

Register online

Please remember to include $5.00 for shipping and handling. Cancellation fee is $10 plus the cost of the books ($65.00), unless they are returned in mint condition .

Register online

North Dade
Nursing Unlimited Headquarters
18405 NW 2nd Ave
Miami Gardens, Fl

Thursday
9:00 am – 5:00 pm

April 1 Register now
July 1 Register now
September 2 Register now
November 11 Register now

This 8 hour course is designed to give experienced ACLS providers the didactic and hands-on skills necessary to effectively teach others to provide Advanced Cardiac Life Support.  Candidates will learn how to make effective presentations of ACLS information and materials, manage learning stations according to the resuscitation team concept and function as the leader in all components of an ACLS Provider course.  The class includes role-playing and class discussions of teaching techniques and strategies, including key points to emphasize to students.  This program is approved by and meets the behavioral objectives of the AHA for ACLS instruction and is based upon the most recent guidelines published by the AHA.

All prospective instructors must have current AHA ACLS provider status,  have completed the AHA Core Instructor Course and be aligned with an AHA Training Center. Upon completion of the course, Nursing Unlimited will be able to conveniently monitor instructor candidates in our ongoing ACLS classes.

The course fee is $135 for 5.9 Contact Hours and includes all home study materials and the AHA Instructor Manual.

Register online

Please remember to include $5.00 for shipping & handling.

North Dade
Nursing Unlimited Headquarters
18405 NW 2nd Ave
Miami Gardens, Fl

Wednesday
9:00 am – 5:00 pm

March 31 (Register now)
June 30 (Register now)
September 1 (Register now)
November 10 (Register now)

This 8 hour course is designed to effectively “train the trainer” in the didactic and hands-on skills needed to teach all the new American Heart Association CPR courses created with the introduction of Guidelines 2005. The course is instructor led, with frequent practice-while-watching skills and role-playing sessions. Instructor candidates will be tested for proficiency in core teaching competencies, including communication and presentation skills, ability to stimulate and motivate students, provide clarification and feedback, assess learning and performance and provide remediation.

Prospective instructors must have current AHA BLS provider status, and non-healthcare professionals must also have current first aid provider status. Candidates must also have completed the AHA Core Instructor Course and be aligned with an AHA Training Center. Upon completion of the course, Nursing Unlimited will be able to conveniently monitor instructor candidates in our ongoing CPR classes.

The course fee is $135 for 5.9 Contact Hours and includes all home study materials and the AHA Instructor Manual.

Register online

Please remember to include $5.00 for shipping & handling.

North Dade
Nursing Unlimited Headquarters
18405 NW 2nd Ave
Miami Gardens, Fl

Tuesday
9:00 am – 5:00 pm

March 30 Register online
June 29 Register online
August 31 Register online
November 9 Register online

This 8-hour American Heart Association course is designed to provide consistent and uniform instructor training, regardless of an instructor candidate’s area of specialization. It creates more effective instructors by focusing on core teaching skills, methodologies and strategies. It is based on an adult learning model where participants view various scenarios, compare different instruction techniques and determine through class discussion what needs to be improved upon in order to provide students with the best learning experience.

This course is a prerequisite for all new instructor candidates and for current instructors adding another discipline to their teaching credentials. Anyone who wants to become an AHA instructor may take this course.

Who Should Attend:

* Anyone interested in becoming an AHA instructor
* Current AHA instructors adding a discipline
* Current AHA instructors documented by their TC as having teaching deficiencies
* All National, Regional and Training Center Faculty

The course fee is $120 for 8 contact hours, and includes all home study materials and the appropriate textbooks. Please remember to include $5.00 for shipping and handling.

Register online

North Dade
Nursing Unlimited Headquarters
18405 NW 2nd Ave
Miami Gardens, Fl

Monday
9:00 am – 5:00 pm

July 6 Register online
October 12 Register online

This 8-hour American Heart Association course is designed to provide consistent and uniform instructor training, regardless of an instructor candidate’s area of specialization. It creates more effective instructors by focusing on core teaching skills, methodologies and strategies. It is based on an adult learning model where participants view various scenarios, compare different instruction techniques and determine through class discussion what needs to be improved upon in order to provide students with the best learning experience.

This course is a prerequisite for all new instructor candidates and for current instructors adding another discipline to their teaching credentials. Anyone who wants to become an AHA instructor may take this course.

Course Prerequisite:

• A copy of current provider card (front and back)
• A minimum score of 90% on the Provider written examination without remediation
• A completed Instructor Candidate Application (Call Nursing Unlimited for an Application or download it HERE.)
• Agree to teach at least 4 courses in a 2 year period.
• Be aligned with a AHA training center

Who Should Attend:

• RN’s
• Paramedics
• Physicians
• RRT’s
• Healthcare Providers who may be responsible for advanced resuscitation.

The course fee is $120 for 5.9 Contact Hours and includes all home study materials and the appropriate textbooks. Please remember to include $5.00 for shipping and handling.

Register online

North Dade
Nursing Unlimited Headquarters
18405 NW 2nd Ave
Miami Gardens, Fl

Monday
9:00 am – 5:00 pm

March 29 – April 1 Register online
June 28 – July 1 Register online
August 30 – September 2 Register online
November 8 – 11 Register online

INSTRUCTOR CANDIDATE APPLICATIONS MAY BE OBTAINED BY CALLING THE NURSING UNLIMITED OFFICE OR DOWNLOAD IT HERE.

Course Prerequisites and Preparation
Since the PALS Provider course does not teach algorithms, ECG recognition, pharmacology or CPR, you must identify and remedy any gaps in your knowledge of these topics prior to the class. The following knowledge and skills are required for successful course completion:

• BLS skills
• ECG rhythm identification
• Basic pharmacology
• Practical application of knowledge to clinical scenarios
• Resuscitation team concepts

The course fee is $220 for 12 Contact Hours and includes the PALS Workbook and the PALS Provider manual from our library. Register online

If you are well versed in PALS protocols, you have the option of attending the second day of any class for testing only. A current PALS Provider Card is required.  The fee is $150 for 6 Contact Hours. Register online

* If you are not practicing PALS as a regular part of your professional role in your healthcare facility it is recommended that you take the entire course.

FIRST TIME TAKING PALS? ARE YOU RUSTY?
THE PALS PREPARATION COURSE WILL HELP click here

Please remember to include $5.00 for shipping and handling

BLS for Healthcare Providers is no longer a prerequisite for entry into the PALS program; the AHA requires “BLS SKILLS”.  However, if your BLS card has expired or is about to expire and you wish to renew, we still offer BLS certification within the PALS course for a discounted price of $25.

Register online

Purpose
This Dual Option course is designed to teach the knowledge and skills required to implement the American Heart Association’s ACLS treatment guidelines in the learner’s practice setting.   The curriculum provides the structure to simultaneously educate learners based on their existing knowledge base and associated skill sets.   Learners are categorized into two defined groups and offered the appropriate course option.

Target Audience
The participant in this course is a healthcare provider based in a practice setting that requires ACLS knowledge and skills as a condition of employment. The 1-Day option is targeted to those experienced ACLS providers who routinely use ACLS in their practice setting as a part of their job duties.  The 2-Day option is for all other providers.

Prerequisites
The choice of enrollment option is determined by proficiency in the subject matter.  The participant will be required to self assess their knowledge and skills at time of registration according to the criteria defined below.

Providers enrolling in the 1-Day option are required to be proficient in the following:
•    Performing BLS CPR skills using the most recent American Heart Association Guidelines
•    Reading and interpreting ECGs
•    Understanding ACLS drugs and treatment algorithms
•    Performing the BLS Primary Survey and the ACLS Secondary Survey

Providers enrolling in the 2-Day option are expected to have a basic understanding of the following:
•    Performing BLS CPR skills using the most recent American Heart Association Guidelines
•    Reading and interpreting ECGs
•    Understanding ACLS drugs and treatment algorithms
•    Performing the BLS Primary Survey and the ACLS Secondary Survey

If you do not feel comfortable reading and interpreting ECGs, understanding ACLS drugs or treatment algorithms please refer to our ACLS Preparation course CLICK HERE.

Objectives
Upon successful completion of this course, the student should be able to:
•    Recognize and initiate early management of peri-arrest conditions that may result in cardiac arrest or complicate resuscitation outcome
•    Demonstrate proficiency in providing BLS care, including prioritizing chest compressions and integrating AED use
•    Manage cardiac arrest until return of spontaneous circulation, transfer of care or termination of resuscitation
•    Identify and treat ischemic chest pain and expedite the care of patients with acute coronary syndromes
•    Recognize other life-threatening clinical situations, such as stroke, and provide effective initial care and transfer to reduce disability and death
•    Demonstrate effective communication as a member or leader of a resuscitation team and recognize the impact of team dynamics on overall team performance

The course fee for t he 2-Day option is $200 for 9.2 contact hours and includes a copy of the ACLS Provider Manual (from Nursing Unlimited’s Library) and  Study Guide.

The fee for the 1-Day option is $140 for 6.9 Contact Hours and includes a copy of the ACLS Provider Manual (from Nursing Unlimited’s Library) and  Study Guide..

If you are not practicing ACLS as a regular part of your professional role in your healthcare facility it is recommended that you take the entire course.

Please remember to include $5.00 for shipping and handling.

A current BLS for Healthcare Providers card is no longer a prerequisite for entry into the ACLS program; the AHA requires “BLS SKILLS”.  However, if your BLS card has expired or is about to expire and you wish to renew, we still offer BLS certification within the ACLS course for a discounted price of $25.

Register Online for 2-Day ACLS Class

Register Online for 1-Day ACLS Class

Don’t have time to take a CPR renewal class? Register for the American Heart Association’s online course! Complete the Basic Life Support for Healthcare Providers class at your own pace, in the privacy of your own home. When you pass the online examination, bring your certificate to any American Heart Approved Skills Test (find one close to you).   There you will demonstrate competence in BLS skills and receive your 2-year American Heart Association provider card.

Steps to complete the CPR Course Online:

1. Register and pay for the Online BLS Part 1 Course ($30)
2. Receive via email an online key within 24 hours of registration.
3. Complete the Online BLS Part 1 Course through the American Heart’s website
4. Attend a skills test at a location close to you (find one close to you)
5. Receive your certification card for the skills testing location.

The course fee is $30

Register now for the Online BLS Course! $30

Do you live in South Florida?  Register for the Online Renewal Package which includes the Online class and skills evaluation for $50.

Register now fo the Online BLS Course with Skills Assessment! $50

Don’t forget about our online nursing ceu classes and mandatory requirements.

This 3 hour Basic Life Support Renewal Course focuses on healthcare providers who respond to cardiovascular and respiratory emergencies.  The material covered includes the information and skills needed for adult, child, and infant cardiopulmonary resuscitation (CPR), the information needed to treat cardiac arrest with an automated external defibrillator (AED), the recognition and treatment of choking, and safety factors in training and actual rescue.

Target Audience

The participants in this renewal class are healthcare providers

Prerequisites

Before enrolling in this class the adult learner is required to conduct a self-assessment.  The following are the requirements for entry into the course:

• You have had a previous professional CPR class for healthcare providers
• You are proficient in the basic techniques and progression of the CPR sequence for adults, children, and infants
• You are proficient in the relief of choking for adults, children, and infants and the proper use of an AED
• Healthcare providers who do not meet the prerequisites should enroll in the 5 hour BLS for Health Care Provider Initial Provider Class

Objectives

Upon successful completion of this course, the student should be able to:

Cognitive Skills:

• Describe the steps of CPR (when to give breaths [including barrier devices], when to check for pulse, how to perform compressions at the proper depth and rate with complete chest recoil, and when to use an AED)
• Describe the signs and actions for severe airway obstruction in the responsive and unresponsive victim
• Describe the links in the chain of survival, including the importance of (activating the appropriate emergency response system, performing CPR, providing early defibrillation, and ensuring that arrival of early advanced care by activating the appropriate emergency response system)
• Describe the signs of 4 common life-threatening emergencies in adults (cardiac arrest, choking, stroke, heart attack)

Active skills:

• Activate the emergency response system
• Give breaths for adult, child, and infant victims using:
• Mouth-to-mouth ventilation
• Bag-mask ventilation
• Giving compressions for adult, child and infant victims
• Performing 1 and 2-rescuer CPR for adult, child, and infant victims
• Using and AED for victims 1 yr of age or older
• Relieving choking in the responsive and unresponsive victim of any age

The course fee is $45 for 2.5 contact hours.  Please bring your copy of the AHA BLS for Healthcare Providers Student Manual.  If you do not have a copy you may purchase one from us at a cost of $12.00.

Don’t Forget About HIV/AIDS Update, Domestic Violence Mandatory Requirement, and Prevention Of Medical Errors Mandatory Requirement.

Register Online Now!

This CPR course is conducted in affiliation with the American Heart Association, which has updated the guidelines for performance of Basic Life Support. This is the course required by healthcare facilities in order to acquire and maintain employment. It is designed for healthcare providers that have never taken CPR before or have an expired Healthcare Provider card. We are proud to be offering up-to-date information on CPR that came out of the latest international conference. We cover all aspects of adult, child, and infant resuscitation using didactic, practical and return demonstration methods of training. Our 1 to 1 manikin to student ratio increases the amount of time spent on actual skills resulting in enhanced retention. Upon successful completion a 2-year American Heart Association card will be issued along with a certificate for 4.1 contact hours.

Pre registration is required for this program.

The course fee is $90 for 4.1 Contact Hours and includes the AHA textbook.

Please remember to include $5.00 for shipping and handling.

Register online now

Don’t Forget About HIV/AIDS Update, Domestic Violence , and Prevention Of Medical Errors.

The course fee is $215 and includes the textbook. Preregistration is required with a minimum deposit of $50 and a one-time registration fee of $25*. The balance is due before the half way point of the class. HIV/AIDS is offered at no additional charge with this course.

Course Dates

Day Classes:
Monday – Friday
9:00am – 1:00pm, unless otherwise specified

November 9 – November 20, 2009
December 7 – December 18, 2009
January 4 – January 15, 2010
February 1 – February 12, 2010
March 1 – March 12, 2010
March 29 – April 9, 2010
April 26 – May 7
May 24 – June 4, 2010

Evening Classes:
Monday – Friday
6:00pm – 10:00pm, unless otherwise specified

November 9 – November 20, 2009
December 7 – December 18, 2009
January 4 – January 15, 2010
February 1 – February 12, 2010
March 1 – March 12, 2010
March 29 – April 9, 2010
April 26 – May 7
May 24 – June 4, 2010

Every Monday
9:30am – 12:30pm or
6:30pm – 9:30pm
(CLOSED 9/7/09)

Register Now!

and

1st & 3rd Saturday of every month
9:30am – 12:30pm

(Closed 7/4/09)

Register Now!

LIST OF CLASSES:

Training for Lay Rescuers

Heartsaver CPR

Heartsaver First Aid

Heartsaver AED

Training for Healthcare Providers

BLS for Healthcare Providers – Initial Provider Course

BLS for Healthcare Providers – Renewal Course

BLS for Healthcare Providers – Online Renewal Course

Advanced Cardiac Life Support Course

Pediatric Advanced Life Support Course

Instructor Classes

AHA Instructor Core

BLS Instructor Class

ACLS Instructor Class

PALS Instructor Class