Buy dipyridamole 100mg line
Referred pain p a t t e r n s Thoracic spine - iliocostalis: medially towards the spine pulse pressure therapy cheap dipyridamole 25mg without prescription, and anteriorly towards the abdomen blood pressure 9868 dipyridamole 25mg otc. Origin Longissimus capitis: transverse processes of upper five thoracic vertebrae (T1-T5) arteriogram complications buy 100 mg dipyridamole with visa. Semispinalis cervicis: transverse processes of upper five or six thoracic vertebrae (T1-T6). Semispinalis capitis: transverse processes of lower four cervical and upper six or seven thoracic vertebrae (C4-T7). Insertion Longissimus capitis: posterior part of mastoid process of temporal bone. Semispinalis cervicis: spinous processes second to fifth cervical vertebrae (C2-C5). Semispinalis capitis: between superior and inferior nuchal lines of occipital bone. Helps maintain correct curvature of thoracic and cervical spine in the erect and sitting positions. Basic functional m o v e m e n t Longissimus capitis: keeps upper back straight (with correct curvatures). Referred pain patterns Several areas along the fibres, all radiating superiorly into head, skull and towards the frontal region. Multifidis is the part of the transversospinalis group that lies in the furrow between the spines of the vertebrae and their transverse processes. Origin Multifidis: posterior surface of sacrum, between the sacral foramina and posterior superior iliac spine. Mamillary processes (posterior borders of superior articular processes) of all lumbar vertebrae. Insertion Multifidis: parts insert into spinous process two to four vertebrae superior to origin; overall including spinous processes of all the vertebrae from the fifth lumbar up to the axis (L5-C2). Action Multifidis: protects vertebral joints from movements produced by the more powerful superficial prime movers. Basic f u n c t i o n a l m o v e m e n t Helps maintain good posture and spinal stability during standing, sitting and all movements. Spinous processes of the seventh cervical vertebra, (C7 and upper three or four thoracic vertebrae, (T1-T4). Splenius cervicis: spinous processes of the third to sixth thoracic vertebrae, (T3-T6). Lateral part of superior nuchal line, deep to the attachment of the sternocleidomastoideus. Splenius cervicis: posterior tubercles of transverse processes of the upper two or three cervical vertebrae, (C1-C3). Basic functional m o v e m e n t Example: Looking up, or turning the head to look behind. Referred pain p a t t e r n s Splenius capitis: 3-5cm zone of pain in the centre of the vertex of the skull. Splenius cervicis: a) upper: occipital diffuse pain radiating via the temporal region towards the ipsilateral eye; b) lower: ipsilateral pain in the nape of the neck. A d v i c e t o patient Avoid postural/maintaining factors, answering the telephone. The posterior fibres of the external oblique are usually overlapped by the latissimus dorsi, but in some cases there is a space between the two, known as the lumbar triangle, situated just above the iliac crest. Insertion Anterior half of iliac crest, and into an abdominal aponeurosis that terminates in the linea alba (a tendinous band extending downwards from the sternum). Action Compresses abdomen, helping to support the abdominal viscera against the pull of gravity. Contraction of one side alone bends the trunk laterally to that side and rotates it to the opposite side. Differential diagnosis Visceral pathology including: renal, hepatic, pancreatic, diverticular disease, colitis, appendicitis, hiatus hernia, peritoneal disease - pelvic inflammatory disease, ovarian, bladder. Insertion Xiphoid process and linea alba via an abdominal aponeurosis, the lower fibres of which ultimately attach to the pubic crest and pecten pubis via the conjoint tendon. Nerve Ventral rami of thoracic nerves, T7-T12, ilioinguinal and iliohypogastric nerves.
Buy dipyridamole 100mg amex
Ecological studies point to blood pressure medication at night buy generic dipyridamole 100 mg line a multiplicity of factors concerned in the fluctuating balance that exists between rodents of greater and lesser degree of susceptibility to heart attack now love generic dipyridamole 100 mg online the plague bacillus and in the degree of risk to pulse pressure tachycardia buy 100 mg dipyridamole with mastercard which man is exposed. These transmit the infection to less resistant animal hosts resulting in epizootics. When infection is endemic in sylvatic rodents, it may remain smoldering for a long time before circumstances favour its epidemic spread. During this time human beings in villages may occasionally contract the disease through handling of an infected animal. It occurs when infection is picked up from permanent reservoir hosts by semidomestic rodents which in turn transmit it to the commensal rodents and then to man. The ratfall is the harbinger of domestic 45 rodent plague and a sign of imminent outbreak of epidemic bubonic plague in man. Rodents are also known to transmit the infection to remote areas causing pandemics. It has rounded ends, which on staining give a characteristic bipolar appearance to the organism. The optimum temperature for growth is 280C but at this temperature, capsular material (envelope substance) is not well developed. The capsular material is important for antigenicity and protectivity and is used for preparation of Fraction I antigen for serological test and preparation of plague vaccine. The organism is pathogenic to common laboratory animals like rats, mice, guinea pigs etc. Necropsy findings reveal marked local inflammation at the site of inoculation with enlarged and congested lymphnodes and may show greyish white patches in the tissue. The characteristic coccobacilli are seen in large numbers in films made from local lesions, lymph nodes, spleen pulp and heart blood. Bubonic plague this is the commonest form characterised by high fever, toxemia and painful enlargement of lymph glands, which are called buboes. Buboes may appear commonly in the groin or in the axillary or cervical region depending upon the site of entry of the organism. The glands gradually become soft and suppurate, and there is marked haemorrhagic tendency with variable septicemia. It is a severe form of disease with high fever and cough with blood tinged tenacious sputum. Septicemic plague It is a variant of bubonic plague where there is overwhelming septicemia overrunning the lymph nodes. Consequently, lymph node enlargement is not prominent but the patient is highly toxic. There is pleural effusion, enlargement of spleen with small white areas in the pulp, liver is congested and mottled, congestion and hemorrhages under the skin and in internal organs. When plague is suspected, clinical specimen should be collected urgently and specific antimicrobial treatment begun without waiting for laboratory report. Specimen for Diagnosis Material for laboratory diagnosis of plague can be obtained from the following sources: Human beings suffering from infection Post-mortem specimen Specimen from rodents Flea specimen Soil specimen Human Specimen Appropriate specimen should be examined for evidence of plague if a person resides in, or has a recent travel history to a plague-infected area; and presents with symptoms suggestive of plague (fever, sepsis syndrome, lymphadenopathy and/or acute pneumonitis). As far as possible these should be collected before initiation of antimicrobial therapy. Bacteria may be intermittently released from affected lymph nodes into the blood streams. Therefore, a series of blood specimen taken 10-20/30 minutes apart may be productive in the isolation of Y. Preferably, a bronchial/tracheal washing should be taken from pneumonic plague patient for culture. Rodent and Flea Specimen Appropriate tissues should be taken from animals for detection of Y. Bone marrow from dissected animal carcasses may yield positive results when other tissue are not available. A flea pool is then triturated and inoculated into the laboratory mice for isolation of plague bacteria.
Order 100 mg dipyridamole fast delivery
The right end of the straightedge is now lined up at the appropriate workload for this woman: 450 kg/min arrhythmia quiz online generic 100 mg dipyridamole. Treadmill appropriately used to pulse pressure of 80 cheap dipyridamole 100mg with mastercard document change over time in response to blood pressure chart for 14 year old dipyridamole 100mg without a prescription aerobic training and, given the time and money saved, are clinically useful. For women under the age of 55 and men under the age of 45 with no risk factors or symptoms (as defined previously), physician supervision for maximal and submaximal testing is not deemed necessary. Older clients who have two or more risk factors but no symptoms or disease can undergo submaximal testing without physician supervision. Finally, physician supervision is recommended for submaximal and maximal testing of clients with known cardiovascular, pulmonary, or metabolic disease. Because of the requirement of reproducible workloads, treadmills, bicycle ergometers, and stepping protocols are most commonly used. Test selection should be based on safety concerns; staff familiarity with and knowledge of the testing protocol; equipment availability; and client goals, abilities, and conditions (such as orthopaedic limitations). For example, an unconditioned 40-year-old woman performed the test at a resistance of 75 W (450 kg/min) and Step tests were developed to test large numbers of individuals expeditiously, and they represent another mode of submaximal exercise testing. Females step for 3 minutes at a rate of 22 steps/min, and males step for 3 minutes at a rate of 24 steps/min. After 3 minutes a recovery 15-second pulse is measured, starting 5 seconds into recovery, while the client remains standing. Knowledge of the pulse rate, sex, and work load of a client allows the clinician to determine absolute V O2max. V O2max values obtained from the nomogram should be adjusted for age by a correction factor (Table 12-5). Monitoring All clients should be closely monitored during exercise test performance. Vital signs should be examined before, during each stage or workload of the test, and after the test for 4 to 8 minutes of recovery. The following equations are then used to estimate V O2max: Females: V O2max (mL/kg/min) Males: V O2max (mL/kg/min) 65. Submaximal exercise testing is less accurate than maximal testing but is useful for establishing a baseline before initiating an exercise training program, for documenting improvement as a response to training, for motivating a client to adopt an exercise habit, and for formulating an exercise prescription based on physiologic parameters specific to the client. Field Field tests refer to exercise testing protocols that are derived from events performed outside, or "in the field. Field tests are appropriate when time and equipment are limited and for examining individuals over the age of 40. Although a variety of field tests exist, only the Cooper 12-minute test and the 1-mile walk test are presented. The distance covered in 12 minutes is recorded and V O2max is estimated according to the following equation: V O2max (mL/kg/min) 35. If exercise is prescribed based on V O2max, 50% to 85% is also used as a training range. Health-related benefits can be realized at lower intensities, and thus lower intensities may be appropriate if the goal of exercise is to improve health instead of fitness. The optimal duration recommended for aerobic training is between 20 to 60 minutes per exercise session. That is, several 12-minute bouts can be performed, for example, until the client can tolerate 20 to 30 minutes of continuous exercise. The warmup can include gentle stretching activities and low-intensity training using the mode selected for aerobic conditioning. The client is thus provided with an individualized exercise prescription and treatment plan for safely and efficiently increasing aerobic capacity. Stretching activities are also appropriate as part of the cooldown and enhance flexibility. Frequency A second time-related component of exercise prescription is frequency, or how often exercise should be performed.
25mg dipyridamole with mastercard
Recognize and interpret relevant laboratory and imaging studies for Wilms tumor c arteriosclerosis vs atherosclerosis discount dipyridamole 25mg overnight delivery. Recognize signs and symptoms and life-threatening complications of Wilms tumor and its treatment d high blood pressure medication and zinc buy generic dipyridamole 100mg line. Plan initial management of acute complications of Wilms tumor and its treatment Neuroblastoma a heart attack karaoke order dipyridamole 25 mg with mastercard. Recognize and interpret relevant laboratory and imaging studies for neuroblastoma c. Recognize signs and symptoms and life-threatening complications of neuroblastoma and its treatment d. Plan initial management of acute complications of neuroblastoma and its treatment Central nervous system tumors a. Know the epidemiology and understand the pathophysiology of central nervous system tumors b. Recognize and interpret relevant laboratory and imaging studies for central nervous system tumors c. Recognize signs and symptoms and life-threatening complications of central nervous system tumors and their treatment d. Plan initial management of acute complications of central nervous system tumors and their treatment 9. Know the epidemiology and understand the pathophysiology of soft tissue and bone sarcomas b. Recognize and interpret relevant laboratory and imaging studies for soft tissue and bone sarcomas c. Recognize signs and symptoms and life-threatening complications of soft tissue and bone sarcomas and their treatment d. Plan initial management of acute complications of soft tissue and bone sarcomas and their treatment K. Know the epidemiology and etiology and understand the pathophysiology of bronchopulmonary dysplasia b. Recognize life-threatening complications of bronchopulmonary dysplasia and its treatment d. Recognize and interpret relevant laboratory and imaging studies for sarcoidosis c. Plan management of acute sarcoidosis, including the life-threatening complications 3. Recognize signs and symptoms and life-threatening complications of aspiration pneumonia c. Know the epidemiology and etiology and understand the pathophysiology of pulmonary embolism b. Recognize and interpret relevant laboratory, imaging, and monitoring studies for pulmonary embolism d. Plan management of acute pulmonary embolism, including life-threatening complications 5. Know the epidemiology and etiology and understand the pathophysiology of pulmonary edema b. Recognize and interpret relevant laboratory, imaging, and monitoring studies for pulmonary edema d. Plan management of acute pulmonary edema, including the life-threatening complications 6. Know the etiology and understand the pathophysiology of pulmonary hemosiderosis b. Recognize and interpret relevant laboratory and imaging studies for pulmonary hemosiderosis d. Know the epidemiology and etiology and understand the pathophysiology of pleuritis and costochondritis b. Recognize and interpret relevant laboratory, imaging, and monitoring studies for pleuritis and costochondritis d. Know the epidemiology and etiology and understand the pathophysiology of cystic fibrosis b. Recognize and differentiate by age clinical manifestations associated with cystic fibrosis c.
- Brugada syndrome
- Scott syndrome
- Pancreatic carcinoma, familial
- Duplication of leg mirror foot
- Anophthalmos with limb anomalies
Order 25mg dipyridamole free shipping
Other factors related to heart attack 2013 film purchase dipyridamole 25mg with visa a worse outcome are leukocytosis [22 heart attack karaoke dipyridamole 100 mg with visa, 23] and low platelet counts [22 hypertension 4011 generic 25mg dipyridamole with amex, 24]. The complement abnormality may be a mutation, genetic rearrangement or deletion in a gene encoding a complement factor, or the presence of a homozygous complement gene haplotype or of an autoantibody to complement regulator factor H. Patients may present during childhood or adulthood, and episodes may be triggered by infections, transplants or pregnancy [1, 25]. Recurrences triggered by infections are not associated with one specific pathogen. The course of disease is characterized by recurring episodes of acute disease ultimately leading to end-stage renal failure, although terminal renal failure may already occur at presentation. Extra-renal manifestations may also occur and are, in part, secondary to vascular injury induced by complement activation. These include digital gangrene, cerebral or peripheral vessel stenosis, ophthalmological and neurological involvement as well as pulmonary and pancreatic complications . Patients may be infected by intake of contaminated food including raw, processed or undercooked meat, vegetables, unpasteurized juice or milk products, cross-contamination of food products and utensils, intake of contaminated water, even from swimming pools [5, 3742], person-toperson transmission [43, 44] or contact with animals bearing the strain . Transmission occurs more often in summer , requires a very low number of bacterial organisms  and occurs in outbreaks or sporadically. Very large outbreaks have occurred in Japan  and in Germany , but smaller outbreaks have been reported in numerous countries . Onset may occur at any age but is more frequent in childhood  particularly before the age of 2 years . The onset is usually triggered by a febrile infection in the respiratory or gastrointestinal tract. Patients who do not develop end-stage renal failure during the first episode tend to relapse, and the disease may affect several members of the same family . Biochemical abnormalities may be related to intestinal and renal losses of proteins and electrolytes, as well as extra-renal affection of the liver and pancreas. Our knowledge of renal pathology is therefore obtained either from postmortem specimens or from biopsies carried out in more severe cases, or in those patients in whom the diagnosis is unclear. The capillary endothelial cells are swollen and detached from the basement membrane. Ultramorphological examination reveals subendothelial lucent flocculent material . Mesangial expansion as well as mesangiolysis is observed by light microscopy . Similar lesions are seen in arterioles and arteries of the renal cortex consisting of thrombi and endothelial detachment. The extensive vascular injury with occluded vessels leads to reduced glomerular filtration and ischaemic damage resulting in renal cortical necrosis in the most severe cases. Bacteria initially colonize the terminal ileum  followed by specific attachment to colonic enterocytes generating a so-called attaching and effacing lesion . Colonization is facilitated by an interaction with the intestinal microflora, in a process termed quorum sensing, enabling bacterial communication between strains via genetically encoded mediators [65, 66]. The same mechanism also enables communication 6 Є 2016 the Association for the Publication of the Journal of Internal Medicine Journal of Internal Medicine with host-derived hormones, such as catecholamines, thus promoting adhesion and virulence and the release of Shiga toxin in the intestine . Thus, toxin released into the intestine must translocate via enterocytes, or between the cells, to gain access to the circulation and thus reach its target organs (mainly the kidneys and brain). The presence of toxin in the kidneys of patients and in in vivo models  suggests that the toxin is transferred from the intestine to the kidneys. Alternatively, the toxin may be taken up by macropinocytosis  or within bacterial outer membrane vesicles . The toxin induces intestinal cell apoptosis  and profound intestinal inflammation , which may further promote bacterial colonization and toxin release by means of quorum sensing . During haemorrhagic colitis, Shiga toxin, which has translocated across the intestinal mucosal barrier, will gain access to the circulation. This may be achieved by binding to and injury of intestinal endothelial cells . Free toxin in the bloodstream is minimal [84, 85], but the toxin binds to neutrophils, monocytes, platelets and red D. Review: Haemolytic uraemic syndrome blood cells  demonstrated in vivo on platelets and leukocytes, and thus circulates in the bloodstream. Elevated neutrophil counts are associated with a worse prognosis [22, 23] possibly due to the enhanced ability to transfer toxin as well as the destructive properties associated with proteases released by activated neutrophils.
Cheap dipyridamole 25mg online
Evidence appears to arteria lusoria definition dipyridamole 25 mg for sale show that this therapy offers clinical benefits in a number of (often rare) indications blood pressure ideal cheap dipyridamole 100mg with visa. Countries facing similar challenges (have or) are putting in place frequently updated data registrations systems which allow a continuous evaluation of this complicated and rapidly evolving area blood pressure 9058 generic dipyridamole 25 mg without a prescription. Efforts are currently being placed on the development of international registries. Home-based subcutaneous immunoglobulin versus hospital-based intravenous immunoglobulin in treatment of primary antibody deficiencies: systematic review and meta analysis. High-dose intravenous gammaglobulin for idiopathic thrombocytopenic purpura in childhood. Manufacture of immunoglobulin products for patients with primary antibody deficiencies - the effect of processing conditions on product safety and efficacy. Criteria for the clinical use of immunoglobulin in Australia (the Criteria) [Web page]. National Demand Management Program for Immunoglobulin: National Immunoglobulin Database. Couverture prйvisionnelle des besoins en mйdicaments dйrivйs du plasma sanguin au niveau national [Web page]. Order agreement in execution of public tendering with regard to the delivery of plasma derivatives to hospitals. Polyvalent immunoglobulins for intravenous and subcutaneous administration - Amendments on 1/1/2014 [Web page]. Immunoglobulins for intravenous and subcutaneous administration - amendments on 1st April 2017 [Web page]. Limited Availability of Immunoglobulins: recommendations to hospital pharmacists and physician-specialists [Web page]. An overview of the impact of rare disease characteristics on research methodology. Systematic review of rituximab for autoimmune diseases: a potential alternative to intravenous immune globulin. Clinical indications for intravenous immunoglobulin utilization in a tertiary medical center: a 9-year retrospective study. Subcutaneous immunoglobulin for primary and secondary immunodeficiencies: an evidence-based review. Intravenous immunoglobulin-associated hemolysis: risk factors, challenges, and solutions. The effect of immunoglobulin treatment for hemolysis on the incidence of necrotizing enterocolitis - a meta-analysis. Intravenous immunoglobulin for chronic inflammatory demyelinating polyradiculoneuropathy. Intravenous immunoglobulin vs observation in childhood immune thrombocytopenia: a randomized controlled trial. Immunoglobulin prophylaxis in hematological malignancies and hematopoietic stem cell transplantation. The efficacy of different dose intravenous immunoglobulin in treating acute idiopathic thrombocytopenic purpura: a meta-analysis of 13 randomized controlled trials. A multicenter, randomized, double-blind comparison of different doses of intravenous immunoglobulin for prevention of graft-versushost disease and infection after allogeneic bone marrow transplantation. Evaluation of the Safety, Tolerability, and Pharmacokinetics of Gammaplex<sup></sup> 10% Versus Gammaplex<sup></sup> 5% in Subjects with Primary Immunodeficiency. The effect of two different dosages of intravenous immunoglobulin on the incidence of recurrent infections in patients with primary hypogammaglobulinemia. Treatment of myasthenia gravis exacerbation with intravenous immunoglobulin: a randomized double-blind clinical trial. Low-Dose versus Standard-Dose Intravenous Immunoglobulin to Prevent Fetal Intracranial Hemorrhage in Fetal and Neonatal Alloimmune Thrombocytopenia: A Randomized Trial. Subcutaneous immunoglobulin in responders to intravenous therapy with chronic inflammatory demyelinating polyradiculoneuropathy.
Quality dipyridamole 25 mg
Position the control portion upright arrhythmia blogs cheap dipyridamole 100mg free shipping, especially if the endoscope is placed on a counter arteria jejunales buy 100 mg dipyridamole mastercard. Remove all valves and removable parts from the endoscope to arteria zarobki cheap dipyridamole 25 mg otc prevent the retention of moisture. If applicable, store the endoscope with the bending section straight, in a ventilated cabinet/container. Hang the endoscope with the insertion tube and light guide tube placed vertical (support the body). Temperature variable Humidity 50% Time extended processing time (several hours) Routine testing shall include a biological indicator placed in the centre of each load to be sterilized, and a chemical indicator in each pack. One biological indicator and a chemical indicator shall be placed in a perforated or mesh bottom surgical tray of appropriate size for the sterilizer to be tested. The test tray shall be placed on the bottom shelf of an otherwise empty sterilizer. Refer to product label for time and temperature required to achieve sterilization. Sterilized equipment/devices must be rinsed with sterile water to remove all residual chemical. Sterilized equipment/devices must be handled in a manner that prevents contamination from process through storage to use. Concentration is monitored using test strips provided by the product manufacturer. Chemical test strips are available for determining whether an effective concentration of active ingredients is present despite repeated use and dilution. None Mechanical - diagnostic cycle should be performed each day to ensure that all mechanical components are functioning properly - with each cycle/load there are printouts that document the parameters of the cycle. Completely kills all forms of microbial life including spores Inexpensive Rapid Efficient Non-toxic Good penetration Cannot use for heat or moisture sensitive equipment/devices Unsuitable for anhydrous oils, powders, lensed instruments, heat and moisture sensitive materials Some tabletop sterilizers lack a drying cycle Steam Sterilization Small table top sterilizers Gravity displacement sterilizers High-speed vacuum sterilizers First choice for critical equipment/devices Heat tolerant instruments and accessories Linen Liquids Foot care equipment Raised pressure (preset by manufacturer) to increase temperature to 121°C. Time varies with temperature, type of material and whether the instrument is wrapped or not. Steam must be saturated (narrow lumen equipment/devices may require prehumidification). Loads containing implantable devices shall be quarantined until the results of the biological indicator testing are available. Noncorrosive to metal, plastic, rubber, lens cements Active in presence of organic material Does not kill bacterial spores. Glutaraldehyde (2%) Heat sensitive equipment/devices Lensed instruments that do not require sterilization Endoscopes Respiratory therapy equipment Anaesthesia equipment Fingernail care equipment used on multiple clients/patients/residents Exposure time and temperature must be maintained Test strips for concentration are available from the manufacturer and must be used at least daily (preferably with each load) High-level disinfection is achieved after at least 20 minutes at 20°C. Refer to product label for time and temperature required to achieve high-level disinfection. Hydrogen peroxide (6%) Semicritical equipment used for home health care Disinfection of soft contact lenses Product is time limited following activation, usually maximum 14 days. Chemical test strips are available for determining whether an effective concentration of active ingredients is present. Not currently available Extremely irritating to skin and mucous membranes Need proper ventilation & closed containers- ceiling limit 0. Superior penetration Rapid activity Active in presence of organic materials Non-irritating vapour Does not require activation or dilution Does not kill bacterial spores. Respiratory therapy equipment Anaesthesia equipment Achieves high-level disinfection at 71C (160F) for 30 min. Safe for environment Non-toxic Active in the presence of organic materials Rapid Inexpensive Does not kill bacterial spores. Hydrogen Peroxide Enhanced Action Formulation (2%) Heat sensitive equipment/devices Delicate equipment/devices Test kits to monitor the concentration are available from the manufacturer and must be used with each load. Contraindicated for use on copper, brass, carbon-tipped devices and anodised aluminium Newer formulations achieve highlevel disinfection in 8 minutes at 20°C (refer to product label for time and temperature).
Discount dipyridamole 25mg visa
Indicator: A system that reveals a change in one or more of the sterilization process parameters blood pressure 50 over 70 discount dipyridamole 100 mg with mastercard. Indicators do not verify sterility arteria digitalis palmaris communis discount 100mg dipyridamole with visa, but they do allow the detection of potential sterilization failures due to blood pressure medication toprol buy dipyridamole 100mg amex factors such as incorrect packaging, incorrect loading of the sterilizer, or equipment malfunction. Loaned Equipment: Medical equipment/devices used in more than one facility, including borrowed, shared or consigned equipment/devices, which are used on patients/clients/residents. Loaned equipment may also be manufacturer-owned and loaned to multiple health care facilities. Equipment and surfaces must be thoroughly cleaned prior to low-level disinfection. Manufacturer: Any person, partnership or incorporated association that manufactures and sells medical equipment/devices under its own name or under a trade mark, design, trade name or other name or mark owned or controlled by it. In smaller settings such as clinics or offices in the community, this refers to any segregated area where reprocessing of equipment/devices takes place, away from clients/patients/residents and clean areas. Medical Equipment/Device: Any instrument, apparatus, appliance, material, or other article, whether used alone or in combination, intended by the manufacturer to be used for human beings for the purpose of diagnosis, prevention, monitoring, treatment or alleviation of disease, injury or handicap; investigation, replacement, or modification of the anatomy or of a physiological process; or control of conception. Reprocessing of noncritical equipment/devices involves cleaning and may also require low-level disinfection. Pasteurization (Thermal Disinfection): A high-level disinfection process using hot water at a temperature of 71C (160F) for a minimum exposure time of at least 30 minutes. Physical Monitor: A device that monitors the physical parameters of a sterilizer, such as time, temperature and pressure. Best Practices for Cleaning, Disinfection and Sterilization in All Health Care Settings May 2013 4 Process Control: the management of processes and procedures that affect the quality of products and services, with the goal of ensuring that processes and procedures are performed consistently and as they were intended to be performed in order to produce predictable output. Reprocessing: the steps performed to prepare used medical equipment/devices for use. Reprocessing semicritical equipment/devices involves meticulous cleaning followed by, at a minimum, high-level disinfection. Single Patient Use: A term given to medical equipment/devices that may be used on a single client/patient/resident and may be re-used on the same client/patient/resident, but may not be used on other clients/patients/residents. Single-use/Disposable: A term given to medical equipment/devices designated by the manufacturer for singleuse only. Sterilant: A chemical used on medical equipment/devices which results in sterilization of the equipment/device. Sterilization: the level of reprocessing required when processing critical medical equipment/devices. Equipment/devices must be cleaned thoroughly before effective sterilization can take place. Ultrasonic Washer: A machine that cleans medical equipment/devices by the cavitations produced by ultrasound waves. Washer-Disinfector: A washing system that removes soil and cleans medical equipment/devices prior to highlevel disinfection or sterilization. Noncritical medical equipment/devices that do not require high-level disinfection or sterilization may be reprocessed in a washerdisinfector. Washer-Sterilizer: A machine that washes and sterilizes medical equipment/devices. If used as a sterilizer, quality processes must be observed as with all sterilization procedures. Best Practices for Cleaning, Disinfection and Sterilization in All Health Care Settings May 2013 5 Preamble About this Document this document is intended for health care providers to ensure that the critical elements and methods of decontamination, disinfection and sterilization are incorporated into health care facility procedures. The document describes essential elements and methods in the safe handling, monitoring and auditing, transportation and biological decontamination of contaminated medical equipment/devices. Information in this document is consistent with, or exceeds, recommendations from the Public Health Agency of Canada. It also meets standards developed by the Canadian Standards Association and reflects position statements of the Ontario Hospital Association.