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A-58 January 2007 Infectious Diseases International Association Appendices of Fire Fighters Appendix 14 – Federal Laws Against Discrimination There are federal laws that provide statutory protection against handicapped employees from being discriminated against in the work place generic cephalexin 250mg with visa. Section 504 states that no "otherwise qualified" individual with handicaps shall solely by reason of his handicap buy cephalexin 500mg, be excluded from the participation in, be denied the benefits of or be subjected to discrimination under any program or activity receiving federal financial assistance. Department of Justice has held the idea that the fear of being infected by a person with an infected disease was not covered by the statute. However, today there is little doubt that this statute offers this type of protection to those infected with a contagious disease. This in part is due to a Supreme Court Decision in School Board of Nassau County v. The court said that a person was "otherwise qualified" for employment if he or she did not pose a significant risk of communicating the disease to others in the workplace or if a reasonable accommodation could remove the risk. A reasonable accommodation could include the use of protective equipment or a job duty reassignment. Americans with Disabilities Act The Americans with Disabilities Act was enacted on July 26, 1990 and went into effect for state and local governments in early 1992. This act employs the same ideas as the fore mentioned but includes all employers, not just the ones who receive federal moneys. Persons infected with a contagious disease can be free from symptoms for many years depending on the type of contagion. The most difficult decisions have dealt with determining if infected individuals in the health care industry are "otherwise qualified" January 2007 A-59 International Association Infectious Diseases of Fire Fighters Appendices to continue working when they may expose patients to their blood or body fluid. A-60 January 2007 Infectious Diseases International Association Appendices of Fire Fighters Appendix 15 – Medical Records Confidentiality & Fire Fighters Careful attention must be paid to the means by which employers seek to create an infection free workplace. Principles of public safety and efficient performance must be balanced against individuals’ reasonable expectations of privacy. In particular, the confidentiality of any employee medical records produced from department-required testing should be treated the same as any other medical record. Legal rights of individual employees should not be sacrificed as employers haphazardly rush to implement a testing program. The unauthorized release of personal details which may be recorded as part of a medical evaluation could cause legal and personal problems, either for the employee or for the employer and/or employer’s physician. Examples of such important information are sexual practices, sexually-transmitted diseases, and a history of other contagious diseases such as tuberculosis as well as personal habits. Such an event may provide grounds for a lawsuit against the employer and the employer’s physician. Confidentiality also has legal implications, since failure to maintain confidentiality can result in a lawsuit. Apart from the physical security of records, it is important to consider just how much information is needed for personnel functions. Fire department management needs to know only whether or not a fire fighter can do his/her job, or if not, what specific restrictions apply. If medical surveillance is to be meaningful, records must be as complete as possible. American with Disabilities Act The American with Disabilities Act addresses the issue of confidentiality more directly. It states that all information obtained as a result of medical evaluations be considered confidential and that employers may have access only to information regarding fitness for duty, necessary work restrictions, and appropriate accommodations. The only listed exceptions to this policy are that first aid and safety personnel should be informed of any conditions that may require emergency treatment, and that government officials investigating a complaint about medical examinations may have access to records. This limits the fire department physician to informing the fire department only as to whether or not the candidate or current fire fighter is medically certified to perform as a fire fighter. The specific written consent of the candidate or current fire fighter shall be required to release confidential medical information to the fire department. The relevant sections are as follows: A-62 January 2007 Infectious Diseases International Association Appendices of Fire Fighters 4. Physicians are required by their ethical codes to restrict access to all medical records. If the records location is physically separate from the fire department, a statement in the contractual arrangement stating that only employees or their authorized representatives may have access to records should be sufficient. When medical records are stored within a fire department, as in a health and safety office, care must be taken that all medical records are separated from any other personnel files and kept in a separate, locked cabinet. Care must be taken that only statements of ability to perform job duties are entered into personnel files. The use of computers to record and analyze health databases introduces additional opportunities for breaches of confidentiality.

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Acidosis can also result • serum sodium concentration is elevated (>150 from excessive production of lactic acid when mmol/l); and patients have hypovolaemic shock discount 750 mg cephalexin overnight delivery. These losses are greatest in infants and can be Fluid losses can be replaced either orally or especially dangerous in malnourished children order cephalexin 250mg with visa, who intravenously; the latter route is usually needed are frequently potassium-deficient before diarrhoea only for initial rehydration of patients with severe starts. However, when metabolic acidosis is derived from the breakdown of sucrose or cooked corrected by giving bicarbonate, this shift is rapidly starches) or l-amino acids (which are derived from reversed, and serious hypokalaemia can develop. This can be prevented by replacing potassium Fortunately, this process continues to function whilst simultaneously correcting the base deficit. Manifestations • General muscular weakness Thus, if patients with secretory diarrhoea drink an • Cardiac arrhythmias isotonic salt solution that contains no source of • Paralytic ileus, especially when drugs are taken glucose or amino acids, sodium is not absorbed that also affect peristalsis (such as opiates) and the fluid remains in the gut, adding to the volume of stool passed by the patient. However, when an isotonic solution of glucose and salt is given, glucose-linked sodium absorption occurs and this is accompanied by the absorption of water and other electrolytes. To attain the latter cooled before mixing if there is any doubt); two objectives, salts of potassium and citrate (or • 3. Page 73 Oral rehydration therapy solutions are designed to approximate the composition of gut fluid losses Module 3 Page 73 Use of antimicrobials Antimicrobials should not be used routinely. This antibiotics (furazolidone, co-trimoxazole, is because, except as noted below, it is not possible erythromycin, or chloramphenicol) are usually to clinically distinguish episodes that might effective. Selecting an effective but may also cause delayed clearance of Salmonellae antimicrobial requires knowledge of the causative from the intestinal tract. Prognosis The prognosis of infective diarrhoea depends upon Antimicrobial agents are helpful for the treatment the infecting organism, the development of of dysenteric shigellosis and amoebiasis. Antibiotic usage for selected infections Shigella: Antibiotics to which Shigellae are sensitive provide effective treatment, but antibiotic resistance is a common problem. The most useful antibiotics are co-trimoxazole and nalidixic acid; ampicillin is effective in some areas. Campylobacter jejuni: Erythromycin or clarythromycin shortens the illness if given soon after the symptoms start. However, erythromycin is often ineffective if therapy is delayed until the diagnosis is confirmed by a laboratory. Vibrio cholerae 01: Antibiotics can shorten the duration of the illness and thus simplify case management. Tetracycline (or doxycycline) is most widely used, but resistance has been observed in some areas. When resistance occurs, other Page 74 Module 3 Prevention of spread of diarrhoea This is dependent upon: • improving nutritional status by improving the • prevention of diarrhoea; and nutritional value of weaning foods and giving • interruption of transmission of pathogens. Although a wide variety of infectious agents cause Nursing care diarrhoea, they are all transmitted through common Nursing care of the patient with infective diarrhoea pathways such as contaminated water, food, and requires: hands. Measures to interrupt the transmission • assessment and continuous observation of the should focus on the following pathways: clinical state; • supervision and administration of appropriate • giving only breast milk for the first 6 months of fluid and food; life; • maintenance of a fluid input and output chart; • avoiding the use of infant feeding bottles; • maintenance of a stool chart; • improving practices related to the preparation and • monitoring of temperature, pulse and blood storage of weaning fluids and feeds; pressure; • washing hands after defecation or handling faeces, • monitoring of weight, daily if the patient is a and before preparing food or eating; child; • minimizing microbial contamination and growth • encouraging a scrupulous personal hygiene of foods by preventing breaks in the food hygiene regime; and chain including: use of human excrement as • skin care to prevent excoriation. Rehabilitation may be more protracted • the importance of hand washing, safe disposal in individuals with serious underlying disorders. Giving a nutritious diet, appropriate for the child’s age, when the child is well is important. In addition, the hospital must determine the infecting organism and report it to the relevant public health authority; this is of primary importance in epidemic situations. Role of the community The community is responsible for ensuring the maintenance of good standards of food and water hygiene, educating about careful hand washing and other aspects of personal hygiene, and home Page 76 Module 3 Typhoid Definition approximately 600 000 deaths. Typhoid is Typhoid fever (also known as enteric fever) is a predominantly a disease of countries with poor severe systemic infection caused by the Gram sanitation and poor standards of personal and food negative bacterium Salmonella typhi. Multi-drug resistant strains have been a large number of organisms is usually necessary reported in Asia, the Middle East, and Latin America. The organisms are absorbed from the gut and Manifestations transported via the blood stream to the liver and • In the early stages fever, severe headache, spleen. They are released into the blood after 10 to constipation and a dry cough may be present. The • The fever rises in a “step ladder” pattern for 4 or 5 organisms localise in the lymphoid tissue of the days. This • Abdominal tenderness and an enlarged liver or is the main cause of death from typhoid fever. The • If untreated, complications can occur during the incubation period is from 10 to 21 days. Most patients who have typhoid will excrete • Other complications may affect any patient organisms at some stage of their illness. About because of the occurrence of septicaemia during 10% who have typhoid fever excrete the organisms the first week. These may include cholecystitis, for approximately three months after the acute stage pneumonia, myocarditis, arthritis, osteomyelitis of the illness and 2 to 5% of untreated patients and meningitis.

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Some bacteriophages resemble an insect with an icosahedral head attached to a tubular sheath order cephalexin 250mg with visa. Viroids and Prions Viroids and prions are smaller than viruses cheap 250 mg cephalexin with mastercard, but they are similarly associated with disease. Co- infection with hepatitis B and D can produce more severe disease than can infection with hepatitis B alone. Prions are mutated forms of a normal protein found on the surface of certain animal cells. Virus Classification Viruses are classified according to their type of genetic material, their strategy of replication, and their structure. Hundreds of other viruses remain unclassified because of the lack of sufficient information. Type D affects only those who also have hepatitis B, and hepatitis E is extremely rare in the United States. The sugar component consists of alternating residues of β-(1,4) linked N-acetylglucosamine and N- acetylmuramic acid residues. Attached to the N-acetylmuramic acid is a peptide chain of three to five amino acids. The peptide chain can be cross-linked to the peptide chain of another strand forming the 3D mesh-like layer. The name "cyanobacteria" comes from the color of the bacteria (Greek: kyanós = blue). They are a significant component of the marine nitrogen cycle and an important primary producer in many areas of the ocean, but are also found on land. Some filamentous colonies show the ability to differentiate into several different cell types: vegetative cells, the normal, photosynthetic cells that are formed under favorable growing conditions; akinetes, the climate-resistant spores that may form when environmental conditions become harsh; and thick-walled heterocysts, which contain the enzyme nitrogenase, vital for nitrogen fixation. Heterocysts may also form under the appropriate environmental conditions (anoxic) wherever nitrogen is necessary. Many cyanobacteria also form motile filaments, called hormogonia, that travel away from the main biomass to bud and form new colonies elsewhere. The cells in a hormogonium are often thinner than in the vegetative state, and the cells on either end of the motile chain may be tapered. In order to break away from the parent colony, a hormogonium often must tear apart a weaker cell in a filament, called a necridium. Each individual cell of a cyanobacterium typically has a thick, gelatinous cell wall. They differ from other gram-negative bacteria in that the quorum sensing molecules autoinducer-2[4] and acyl-homoserine lactones are absent. They lack flagella, but hormogonia and some unicellular species may move about by gliding along surfaces. In water columns some cyanobacteria float by forming gas vesicles, like in archaea. An illustrated guide to the species used as biological indicators in freshwater biology. Pollution related structural and functional changes in aquatic communities with emphasis on freshwater algae and protozoa. Microbial pathogens and disinfection byproducts in drinking water: Health effects and management of risks, Conference Conclusions, (pp. A Guidebook for Organizing a Community Collection Event: Household Hazardous Waste. The Road Salt Management Handbook: Introducing a Reliable Strategy to Safeguard People & Water Resources. Soil protozoa: fundamental problems, ecological significance, adaptations in ciliates and testaceans, bioindicators, and guide to the literature. A global decline in microbiological safety of water: A call for action, a report prepared for the American Academy of Microbiology. International Association of Water Pollution Research and Control Study Group on Health Related Water Microbiology, 1991, Bacteriophages as model viruses in water quality control: Water Research, v. An assessment of the condition of North American water distribution systems and associated research needs. Induced cytolethality and regenerative cell proliferation in the livers and kidneys of male B6C3F1 mice given chloroform by gavage. Induced cytotoxicity and cell proliferation in the hepatocarcinogenicity of chloroform in female B6C3F1 mice: comparison of administration by gavage in corn oil vs. Respiratory energy losses related to cell weight and temperature in ciliated protozoa.