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Reduce Injuries and Infections with SPH Medials Air Transfer Mat
CategoriesPatient Handling

The Benefits of Air Transfer Mattress Technology

by sphmedicaladmin

In the United States, hospitals and nursing homes have become deadly businesses. Hospital injury rates, according to the Bureau of Labor Statistics, are approximately double those in all other private enterprises, that is, all non-governmental organizations. For example, in 2016, hospitals reported a rate of 5.9 non-fatal workplace injuries and illnesses per 100 full-time workers, compared to 2.9 non-fatal workplace injuries per 100 full-time workers across all industries in the United States. In addition, hospitals have a greater rate of injuries that need time off work than the construction and manufacturing industries. Safety features in friction-reducing devices such as the SPH Medical Air Transfer Mattress reduce the risk of injury to the patient and nursing staff.

Materials and Methods of Safe Patient Handling

The implementation of safe patient handling programs has helped hospitals reduce patient positioning injuries. Because of these efforts, numerous hospitals and hospital systems have witnessed considerable reductions in patient handling injuries. For example, lateral transfer is one of the most common patient-handling tasks. A lateral transfer occurs when a patient is moved from one surface to another, from a bed to another bed or from a bed to a medical cart. Historically, this movement has been done with a small number of staff members, and much of the force is often exerted by caregivers dragging across the surface to which the patient is being transported; hence putting the caregiver at risk of injury, which is most often to the shoulders and lower back. In addition, caregivers perform lateral transfers without knowing how much force is required, putting them at risk of harm. Some of the ways of handling lateral transfers include:

Draw sheet
Simplification of transfer across horizontal surfaces for lateral transfers was traditionally performed with a draw sheet underneath the patient. However, previous biomechanical studies have shown that utilizing a draw sheet to execute lateral transfers exposes caregivers to high spine pressures and necessitates a significant amount of external force. In addition, when employing a draw sheet, the disc’s compression force can surpass the maximum acceptable threshold of 3,400 Newtons, as defined by the National Institute of Occupational Safety and Health.

Friction-reducing devices
Using a friction-reducing transfer significantly reduces the amount of force required while performing transfers. Therefore, some recommended devices include sliding sheets, sliding boards, slip sheets or roller sheets. Although friction-reducing devices reduce the amount of effort required to perform lateral transfers, the overall force is still much more than the acceptable pushing and pulling limitations. Therefore, the ability of friction-reduction transfer devices is limited to minimizing pull forces and spinal force compression. Many of these devices do not adequately reduce risk of injury for some hospital programs.

Air-assisted devices
Air-assisted devices are a form of friction-reducing devices recommended for safe patient handling. AirPal invented this device, but other companies have created their versions of it. HoverMatt, for example, makes air-assisted devices, and since introducing the disposable or single patient use transfer mattress, their business has grown enormously. Air-assisted systems were developed to improve the safety, efficiency, and security of lateral transfers. As a result, air-assisted devices are rated substantially higher by caregivers than any other helpful equipment. Air-assisted systems not only minimize friction but also give support and comfort. As a result, nurses may more easily boost, reposition, and transfer patients, reducing the risk of strains, sprains, and career-ending back injuries for everyone.

Why Is the Air Transfer Mattress Recommended Over Other Friction-Reducing Devices?

With so many lateral patient transfer devices on the market, deciding one is the best fit for you and your institution can be difficult. The air transfer mattress is one of the most popular transfer devices. Air assist technology’s advantages have been thoroughly documented and proved. When the air blower unit is turned on, the air is blown out via the perforated holes in the bottom of the mattress. Friction between the mattress and the adjacent surface is reduced by the force of air passing through these tiny openings. Because there is less friction, the mattress may be moved more easily.

Safety features in friction-reducing devices such as the SPH Medical Air Transfer Mattress reduce the risk of injury to the patient and nursing staff. To improve patient security during transfer, two safety straps are connected over the patient. Disposable protective covers are available for the mattress which helps keep the transfer mattress clean between procedures. The launderable versions of Air Transfer Mattresses are typically water-resistant and free of latex. Another noteworthy safety aspect is that the mattress first inflates around the perimeter before moving on to the center to inflate and lift the patient safely. Thus, it acts as a cradle for the patient and helps to prevent tipping.

Some of the benefits of using an air transfer system include:
Safety and comfort
During transfers, air-assisted technology increases patient and caregiver safety and comfort. With less skin shear and bruising, lateral air transfer provides the patient with improved comfort and safety. The action of intra-hole communication redistributes the pull/push forces uniformly for a safe and easy transmission.
Stable positioning
The patient is moved into a more secure position by the inflated mattress, which reduces skin shear and bruising. Caregivers may securely move patients without lifting or straining since the mattress and the patient float on a cushion of air. By practically reducing lateral transfers and repositioning-related accidents.
Compatibility
It’s designed to withstand repeated applications and the toughest transfers for a wide range of patient characteristics. For artifact-free imaging, it’s radiolucent and MRI compatible.
Availability
Available in a variety of shapes and widths, with a weight restriction of 1200 pounds to fit most patients. The proprietary technology profiles and self-adjusts to each patient automatically. This allows for a balanced redistribution of the patient’s body weight, resulting in the safest and simplest patient transfer possible.
Significant cost savings
Previously, a significant amount of money was spent on various lateral transfers mechanisms, which were expensive and difficult to keep the appropriate supply on hand. The SPH Medical Lateral Transfer Mattress is a more cost effective option allowing the necessary inventory to be kept on hand to help reduce staff injuries.

Additionally, when you use an air transfer system, the additional expenditures of bearing direct cost of injury are considerably reduced. While satisfying statutory criteria for safe patient care, the Air Transfer System considerably aids in staff retention, improvement in staff morale, and improvement in overall efficiency of patient care and patient throughput for busy surgical departments.
Infection protection
SPH Medical offers a full range of single patient use, launderable and reusable Air Transfer Mattresses in various shapes and sizes that are all compatible with the most common air supplies on the market. The complete Air Transfer System includes the Air Transfer Mattress, an air supply with hose and power cord, and an optional transport stand. For Hospitals that are focused on reducing hospital acquired infections, the single patient use Air Transfer Mattresses have been the most common version implemented. Reducing infections and workplace injuries together is a win-win for everyone.

Contact SPH Medical to discuss reducing risk of injury to staff and patients in your facility.

Back Injury Prevention for Nurses
CategoriesPatient Handling

Nurses and Back Injuries

by sphmedicaladmin

Preventing back injuries to nursing staff is one of the most important things we can do in healthcare and starts with reducing overexertion and modifying predictable manual patient handling tasks like Lateral Transfers and repositioning patients in bed.

Lateral Transfers and The Risks

Lateral transfers have been identified as some of the riskiest tasks in handling of patients in hospitals because patients may be moved from one surface to another several times in a day, and this is mostly done manually. Many healthcare workers are prone to musculoskeletal disorders resulting from manual transfer of patients since the task may be carried out by a few workers which results in having to strain. The equipment used in manual transfer of patients does not have the necessary designs for minimizing friction, and this contributes to increased risk of injury to both healthcare workers and the patients. A repositioning injury could also occur when the nurses are trying to change the position of a patient on the bed or moving them to a different surface.

A recent study found that the prevalence of musculoskeletal disorders and more specifically lower back pains was around 55 percent for nurses and nurse aides annually. Another study involving 22 hospitals and at least 100 clinics with a cumulative of 33000 healthcare workers found that an average of 205 workers experienced some injuries per year, and the average cost of treatment was 1.5 million dollars each year. Manual patient handling is associated with numerous types of injuries such as back pains, shoulder, neck, and wrist injuries among other injuries that could result in permanent disability which makes it unsafe.

Different States have enacted safe patient handling laws that require the use of transfer aids, assistive devices, and engineering controls in the lifting of patients to replace manual tasks of moving patients. These laws are meant to keep both patients and the healthcare workers safe from the common injuries associated with manual transfers. In Washington State, for example, hospitals are required to obtain lifting equipment for the purpose of patient handling, and they are given tax credits for this equipment. Still in the State of Washington, a healthcare worker is allowed to refuse to engage in patient handling activity when the worker believes that the activity may expose the patient or a healthcare worker to an unacceptable risk of getting injured.

Air Powered Patient Transfer Devices Helping Nurses and Back Injuries

The evidence-based safe patient handling procedures emphasize the appropriate use of lifting equipment and assistive devices to make it easier and safer for both nurses and patients during the transfer process. Some of the most popular assistive devices include the Air Powered Patient Transfer Devices like SPH Medical’s Air Transfer System or Hovermatt and AirPal which are designed to reduce friction and simplify the task of repositioning a patient from one surface to another. These Air Powered transfer devices help in minimizing the risk of a repositioning injury and other nursing injury because they are placed underneath a patient and then inflated whenever the patient needs to be repositioned on the bed. Air Powered lateral transfer systems have been designed to release air through the bottom of the mattress surface to create a thin layer of air that reduces the amount of friction during the task of boosting or moving a patient and to evenly distribute pressure.

AirPowered lateral transfer systems have numerous benefits to healthcare workers and the patients including increased comfort. This is because the air transfer devices eliminate the grabbing and pulling from manual transfer methods. In addition the patient’s weight is evenly redistributed in a balanced way to ensure that the patient feels much more comfortable and safe. For patients who are quite heavy, the Air Powered transfer devices provide a sense of dignity to patients of size because they allow fewer people to handle them safely. With the air flow significantly reducing friction a morbidly obese patient or patient of size can be moved with relative ease. Fewer nurses having to assist means that the patient doesn’t have to feel embarrassed about their weight. The devices also make it safer for patients compared to the manual transfer devices by reducing friction and other factors that cause patients to slip and fall when being moved. Some special features are incorporated in the Air Powered lateral transfer systems to increase the safety of patients and nurses such as safety straps for securing the patient during the transfer process.

Many studies have observed that the risk of nursing injury is greatly reduced in hospitals where Air Transfer Systems have been deployed. The fact that most States have enacted safe patient handling laws that demand hospitals to acquire and implement lifting equipment and assistive devices shows that these devices are important in ensuring the safety of patients, nurses, and other stakeholders in the healthcare industry. Where the hospitals are required to have these devices, purchasing reputable brands not only ensures that they remain compliant with the State’s regulations but also they guarantee the well-being of their employees and patients. As noted above, hundreds of injuries occur due to manual transfers, and these injuries require millions of dollars to treat. These costs and other undesirable consequences can be minimized or eliminated by the use of Air Powered transfer devices since they are specifically designed to eliminate the risks associated with handling patients.

Contact SPH Medical to learn more about Air Transfer Technology and begin to reduce injuries in your hospital or healthcare facility.

SPH Medical Chemo Tested Gloves Protect Nurses
CategoriesInfection Prevention

Chemo Tested Nitrile Exam Gloves

by sphmedicaladmin

When given to people, cancer related chemotherapeutic medications can cause mutagenesis, teratogenesis, carcinogenesis, and sterility. The danger varies depending on the substance and its concentration, as well as exposure frequency and duration. As a result, concerns have been raised about the possible dangers to those who work with chemotherapy. Additionally, public health threats coupled with the COVID-19 pandemic and revolutions in the medical industry have expanded the need for Personal Protective Equipment (PPE). According to studies, taking precautions when handling chemotherapy or any other public health threat lowers staff exposure and danger. As new PPE rules for handling chemotherapy drugs are introduced, a chemotherapy glove that adequately protects healthcare practitioners while also making double-gloving compliance simple is essential. COVID-19 protocols have heightened the essential need for the Chemo tested Nitrile exam gloves.

What Raw Material Is Used in Making Surgical Gloves Today?

Reusable surgical gloves were once the most popular in the medical field. Handwashing is equated to the efficiency of reusable gloves in reducing pathogen spread. In the 1800s, surgeons’ hygienic standards were of poor quality. The use of harsh chemicals to disinfect medical instruments, on the other hand, produced a demand for a tough raw material in the surgical glove sector. Rubber sourced from Malaysia was chosen as the best material since it does not become abrasive when exposed to strong liquids. While demand was high at the time, it skyrocketed when the AIDS crisis struck. Rubber, however, could induce sensitivities and allergic reactions, necessitating the development of an alternative.

Nitrile is a replica of rubber used in the manufacture of medical gloves. Ketones, amides, aldehydes, and halogenoalkanes are used to make this synthetic substance. The Nitrile Exam Glove is made from acrylonitrile and butadiene compounds. When manufacturing gloves, flexibility, comfort, puncture resistance, and form-fitting must all be considered.

What Is Chemotherapy Drug Testing, and Why Is It Important?

The use of personal protective equipment, particularly protective medical gloves, is a must to avoid skin contact. Additionally, during their work, emergency responders are likely to touch with a variety of illegal narcotics. Cocaine, methamphetamines, cannabinoids, cathinones, and opioids like fentanyl and heroin are just some of the illicit chemicals found in these mixes. Illicit drug use has the potential to cause harm. Although they may not know the components of illicit drug mixes, emergency responders can learn about safe operating procedures and the right use of personal protective equipment (PPE) when responding to situations involving illicit substances as recommended by the FDA.

The importance of selecting the right gloves cannot be overstated. It is critical to establish basic guidelines for selecting appropriate materials and defining quality requirements in the oncology environment for the best protection. These tips can help with better handling and minimize potential risks and long-term consequences. There are no formal regulations or test techniques in Europe for medical gloves used in oncology. It would be beneficial to establish universal criteria for gloves used when handling chemotherapeutic medications. However, in the United States, medical gloves used to handle chemotherapy medications must meet ASTM International (American Society of Testing and Materials) standard D 6978-05 criteria.

How Is the Demand for Chemo Tested Nitrile Exam Gloves?

Doomsday headlines predicted a shortage of ventilators for critically ill patients in the early months of the Covid-19 outbreak. As borders soon closed, states hurried to find masks and gowns, sparking a bidding war for personal protective equipment. Domestic manufacture eventually came to the rescue, producing everything from respirators to face shields. However, as the pandemic enters its second year, one item remains in low supply: medical gloves.

Hospitals favor nitrile gloves because of their hypoallergenic and chemical-resistant characteristics, but they are becoming increasingly expensive and difficult to find at any price. The national stockpile in the United States reported in December that just 72 million gloves were on hand out of a target of 4.5 billion, forcing individual states to navigate a wild market riddled with shadowy intermediaries and black-market brokers, some of whom were obvious frauds. Prices have risen dramatically due to the increased demand: According to Singapore-based Persistence Market Research, a package of 100 nitrile gloves can now cost up to $32, up from roughly $3 pre-pandemic.

Despite the COVID-19 dilemma, the global market for Medical Gloves is expected to increase at a CAGR of 12.4 percent from 2020 to 2027, from a projected $30.9 billion in 2020 to a revised US$70 billion by 2027. Examination Gloves, one of the sectors examined in the Research and Markets, is expected to grow at an 11.2 percent compound annual growth rate (CAGR) and reach US$42.3 billion by the conclusion of the analysis period. After an early assessment of the pandemic’s commercial effects and the resulting economic crisis, the Surgical Gloves segment’s growth is revised to a revised 14.4% CAGR for the next seven years.

Choosing a recognized supplier helps you avoid substandard gloves. SPH Medical specializes in the supply of Personal Protective Equipment. SPH Medical is delivering Chemo Tested Nitrile Exam Glove and is a trusted supplier by hospitals nationwide.

Citations:

https://onlinelibrary.wiley.com/doi/full/10.1002/ijc.29058
https://www.prnewswire.com/news-releases/global-medical-gloves-market-report-2021-malaysia-is-the-dominant-producer—us-market-is-estimated-at-10-4-billion-while-china-is-forecast-to-grow-at-14-6-cagr-301334928.html

The Epidural Positioning Devices Improves Safety
CategoriesPatient Handling

Epidural Pain Relief and Positioning

by sphmedicaladmin

Epidural Pain Relief and patient positioning occurs in both the hospital and outpatient settings. Epidurals are regional pain analgesics commonly administered before intense pain during labor, surgical procedures, or for chronic pain in the back and neck. Epidural anesthesia blocks pain in an area of the body. Epidurals provide labor pain relief rather than anesthesia, which is total lack of feeling. Proper patient positioning is important to ensure the correct location for the epidural placement but ensuring healthcare worker safety is equally important.

Epidural steroid injections (ESIs) are a treatment for lower back pain and leg pain. For decades, ESIs have been considered a central component of nonsurgical approaches to sciatica and lower back pain. Epidurals and epidural steroid injections involve injecting a local anesthetic (and a steroid medication in the case of ESIs) directly into the epidural space that surrounds the spinal cord and nerve roots.

Today, much emphasis is placed on the positioning of the patient for receiving epidural pain relief for reasons of safety, for both the patient and the medical staff. Being able to quickly and comfortably administer an epidural decreases risks to all involved. To aid in this, the epidural positioning chair (EPD), commonly known as the epidural positioning device (EPD), or epidural chair, has become a valuable piece of equipment. The EPC is used in labor and delivery departments and in surgical areas to position the patient properly for the epidural procedure. The mobile positioning chair is lightweight, easy to move, and locks into place to allow for easier and safer administration of epidural pain relief.

Epidural Pain Relief, Positioning a Patient

Making sure a patient is in the right position can sometimes prove difficult. For instance, a patient’s range of motion may be limited because of pregnancy or injury. A patient’s level of distraction because of pain may also impede proper positioning administration of the epidural.

Positioning a patient for an epidural is an important consideration, as risks exist for the patient and for the medical staff administering the medicine. Throughout history, different positions have been used, and more recently, specific positions are used for specific bodily locations of epidural administration.

The various positions used usually depend on the condition of the patient. Pregnant women, for instance, are often put into a Sims position (left lateral decubitus, left leg straight, right leg bent), but it may be done with the patient sitting with their back arched, often described as an “angry cat” or “boiled shrimp” position. An epidural chair makes properly positioning patients very simple.

Epidural Pain Relief Injection and Risks to the Patient

For the patient, risks include low blood pressure in 10-20% of patients. There is a 1% risk of intravascular injection, puncture in spinal cord, and failure to block. There is less than 1% risk of infection, headache, bleeding, and allergic reaction. Patients are monitored closely during and after epidural placement, especially delivering. As mentioned, administering an epidural safely and comfortably is of utmost importance in reducing risk, and the EPD has come to play a significant role in this.

Healthcare Worker Safety

Providing epidural pain relief has improved healthcare worker safety as well. Often, a professional (or multiple professionals) are holding a patient in place manually. Pain during labor or from injury may cause a patient to unexpectedly move while receiving an epidural. Or, having an adverse reaction to the epidural may cause the patient to move. Any patient motion requires staff reaction and counter, creating musculoskeletal strain for the professional. The pushing, pulling, tugging, lifting and catching required of the healthcare worker can lead to strain injury instantaneously or over time. Very often, healthcare workers use nearby non-medical equipment like stools chairs and tables when trying to make the patient ready and as comfortable as possible for the injection. These stools, tables, and chairs often have rollers, which then require the healthcare worker to counter any movement with adverse pressure or motion. The necessity of this practice, and the risk of injury that comes with it, while being in common practical use all over the world, has been all but eliminated with the EPD or Epidural Chair. Using the EPD eliminates the physical strain on the professional, thereby eliminating much of the risk to healthcare workers associated with administration of epidurals.

Having the patient in the correct position with an epidural positioning device makes quick and safe epidural administration possible with fewer staff members. By reducing manual patient handling the EPD is a simple yet highly effective device that reduces risks for both patients and healthcare staff.

Surgical N95 Respirators provided by SPH Medical
CategoriesPatient Handling

The Future of N95 Masks

by sphmedicaladmin

With the appearance of coronavirus disease 19 (also known as COVID-19) in 2019, the public heightened their concern regarding virus transmission via airborne and aerosolized particles. The concern was accompanied by a slew of contradictory discussions on which types of personal protective equipment best safeguard health care practitioners and the world at large against virus exposure. The thought of wearing facial covers at restaurants, grocery stores, and airports seemed weird when state and local governments began enacting mask mandates in the spring of 2020 in response to the COVID-19 pandemic. Many people did not even own a mask, let alone wear one daily. N95 Masks, currently, are now commonplace and ubiquitous just a year later. So much so that customers who previously did not know masks are now well-versed in the finer details of mask function, fit, and style. Details on the function and practicality of the common types of masks segregate them according to how each mask type protects against airborne and aerosolized disease.

The Past, Present, and Future of N95 Masks

Until 2019, masks existed in the medical rooms only. But the emergence of COVID-19 and the mask mandates instituted in 2020 by both state and local governments changed the story. Everyone is fluent in both the basic and additional aspects of masks. Surgical masks, procedural masks, and filtering respirator facemasks are the most popular mask types used in the medical arena. Other than the types of masks, they know about their effectiveness, CDC recommendations, and different fabrics. Some of the finer details include:

  • For optimal effectiveness, masks must cover the mouth and the nose.
  • For optimal efficiency and maximum protection, you should wear a mask with a close fit rather than a relaxed fit.
  • Synthetic materials with loose weaves are less protective than natural fabrics with tight weaves.
  • Understanding the safety of using masks has been achieved where you should discard disposable masks after one use and wash reusable masks in hot water regularly.
  • On CDC recommendations, multiple-layer masks are better than single-layer masks, and they can increase their protection by wearing two masks instead of one.

Understanding and accepting masks is not the same as loving them. Although masks have been absorbed into our everyday routines, we all look forward to the day we can toss the masks away. However, the truth is that masks are almost certainly here to stay. Masks can guard against various hazards, including seasonal colds and flu, allergies, and even pollution, which will outlast and outlive the COVID-19 pandemic.

Mask Standards, Ratings, and Filtration Effectiveness

N95, KN95, FFP1, P2, or surgical mask: what’s the difference? For each mask type, each country has its certification standard. For surgical masks, Europe utilizes the EN 14683 standard, while China uses the YY 0469 standard. Each country’s norm differs slightly, but they are all roughly comparable. China utilizes the KN standard (e.g., KN95) for respirator masks, while the US uses the N standard (e.g., NIOSH N95 Mask).

Single-use face masks are the standard with the least stringent filtration criteria. Surgical masks have more stringent regulations, while respirators have the most stringent. Respirators (research suggests they score higher on fit effectiveness) also have a tighter fit across the face than surgical masks and single-use face masks. The bottom line on mask standards and effectiveness is as follows:

  1. Single-use masks (usually one layer, very thin) are only good at capturing bigger dust particles.
  2. The requirements for catching virus-sized (0.1 microns) particles are greater in surgical mask standards, although there are variations according to the area.
  3. Virus-sized particles are frequently captured by pollution masks (respirators) such as the N95 mask and the new Makrite N95 Mask over 90% of the time.

NIOSH has approved surgical N95 and Makrite N95 Mask respirators as N95 mask, and the FDA has certified them as surgical masks. Medical respirators, healthcare respirators, and surgical N95s are all terms used to describe these products.

Newmarket Trends

The pandemic has changed our lives and how we interact with others in ways that were unimaginable just two years ago. However, since 2020 the topic of Covid and PPE has been so prevalent in our daily contacts. Life and the economy did not cease because of shutdowns and quarantines, restarts, and stops. Certain industries, such as the PPE industry, experienced an economic boom not experienced in many years. Some of the trends that came with the economic boom include:

  • Before the pandemic, the US market for N95 mask was worth hundreds of millions of dollars, and traditional consumers of masks for non-medical uses have multiplied rapidly. They are having trouble obtaining things that they had no problems obtaining before the outbreak.
  • The Makrite model 9500-N95 is the latest in NIOSH N95 Masks technology, offering both protection and comfort with a Surgical Rating for healthcare workers.
  • Due to a shortage of inventories and the opportunity to purchase PPE before COVID, employers have been “stocking up on inventory” for longer than the CDC recommends, as they are terrified of being caught off guard with no supplies again.

Why Is It Important to Work Through an Authorized N95 Mask Distributor?

Unless you already have a commercial relationship with a specific seller, NIOSH suggests that you do a thorough investigation of the company before purchasing masks. This suggestion applies to companies whose devices have been assessed as NIOSH N95 Mask by NIOSH or are part of an FDA Emergency Use Authorization (EUA). Before making a significant transaction with a third-party intermediate company, have your institution’s finance or accounting department check the third-party company’s financial stability to ensure that they can deliver the products as requested. As hospitals and customers look for comfortable and effective fluid-resistant masks, SPH Medical provides options. Of the Makrite NIOSH certified N95 Masks, we supply models 9500-N95, the 9500-N95S, and Sekura-N95.  Our most popular model is the 9500-N95 Surgical Respirator. These are essential items for frontline caregivers and first responders everywhere. SPH Medical is a trusted source and a global distributor for Makrite Industries and Makrite 9500-N95. Makrite is working to improve the fit and comfort of their N95 respirators to continually improve their products. Contact SPH Medical to learn more about the future of N95 masks and Makrite’s industry leading products.

Improve Epidural Safety with the EPD
CategoriesPatient Handling

Epidural Pain Relief: The Modern Miracle

by sphmedicaladmin

Pain during labor is inevitable, but it doesn’t have to go untreated. Labor can be much less stressful and even enjoyable with the addition of epidural pain relief to control pain during labor. Aside from saving a mother’s sanity, an epidural can help a mother breathe better through contractions and can reduce anxiety surrounding birth.

What is an Epidural?

Getting an epidural isn’t nearly as scary as it sounds. A highly trained anesthetist will first numb the patient’s back, then insert a catheter for the medication. A needle is used to insert the catheter, but it doesn’t stay in there!

Typically, epidurals contain a drug such as Demerol or morphine. These are inserted into a patient’s back between the disks of the spine to block pain directly at the nerves. These drugs promote rest, relax the body, and allow a mother to renew her energy before it is time to push. For those who want to feel some labor, a lighter form of epidural pain relief, often dubbed a “walking” epidural, is controlled by a button that the patient can press at her own discretion. Despite the name, patients are not able to actually walk with a walking epidural. They may however be better able to reposition themselves in bed.

Positioning and Risks

While epidurals are truly a miracle for new mothers, they do require a touch of finesse. To receive an epidural, the patient must be positioned correctly. While in position, she cannot make any movement without endangering herself, her baby, and medical staff. After all, during the procedure, there is a needle hanging directly around very important nerves. If the positioning is off or the patient moves, there could be dangerous effects.

The most common complication is a spinal headache caused from improper puncture, but other more serious complications can arise such as neural disfunction, and dangerous drops in blood pressure. Additionally, improper positioning can cause a woman to have only partial pain relief or create pain which may lead to repositioning the epidural. It’s best to get the job done right so that it only has to be done once.

These risks are explained to the mother prior to the procedure, and rightfully, the order not to move during placement is stressed repeatedly. This can make the patient nervous, which unfortunately means she may be more likely to jerk involuntarily during the procedure. If done correctly, the patient will feel a quick pop like a bee sting then immediate relief.

Usually, a nurse must hold the patient in position. The patient must relax completely, which leaves the nurse supporting her fully. If the laboring patient moves involuntarily or passes out during the procedure, nursing staff can fall or be injured. If a nurse is assisting in the epidural positioning procedure multiple times in a shift, he or she is at an even higher risk of developing musculoskeletal issues. Of course, a workplace injury could affect a staff member’s performance long term.

Epidural Pain Relief and Reducing Risks

Epidural positioning devices, or EPD, reduce the risk of injury to mother and baby, and also to nursing staff. The epidural chair allows a woman to lean forward comfortably and stably without the need for a nurse to hold her up or prop her with pillows which can slip or compress. EPD include the full epidural chair as well as bedside props with adjustable footrests that accomplish a similar task.

Having the stability of the positioning device is great for staff members, but it can also make the mom in the chair more comfortable and more confident in the procedure. Epidurals are very common, and the use of EPD is becoming increasingly more common as well. More stability and more confidence for both the staff and patient results in a smoother, less stressful, and more successful procedure.

Nitrile Exam Gloves Protect Doctors and Nurses
CategoriesInfection Prevention

Nitrile Examination Gloves from Malaysia

by sphmedicaladmin

Nitrile Examination Gloves from Malaysia are in high demand at the moment.  If you work in the food service, beauty, chemical, automotive or health care industry, you likely protect your hands with nitrile gloves. Recent threats to public health, including but not limited to Covid-19, and changes in the medical field have given the exam glove industry a healthy boost.

History of Nitrile Gloves

When doctors began wearing surgical gloves, they reused the same pair. Donning gloves protected the wearer from external pathogens. But reusable gloves are essentially as effective as hand-washing for preventing transmission of germs to others.

Before the 1800s, germ transmission and infection were responsible for a 50-percent mortality rate in surgery patients. Surgeons didn’t always have good hygiene practices. Throughout the 1800s, medical professionals started to use harsh substances to disinfect medical instruments. When these chemicals caused a skin reaction in a Johns Hopkins nurse, Dr. William Halstead collaborated with Goodyear to develop rubber gloves for her.

At the same time, Malaysia was capitalizing on one of its natural resources. The first rubber plantations in the country began to pop up in 1896.

Wearing protective examination gloves became commonplace by the early 1900s. The first disposable examination gloves were made from latex, a type of rubber that comes from a tree that grows well in the Malaysian climate.

Then, the AIDS epidemic hit. The demand for medical examination gloves soared based on recommendations from the Centers for Disease Control and Prevention. Malaysian manufacturers churned out examination gloves.

With so many people using latex gloves, however, the world began to realize that the material could cause sensitivities and allergic reactions in people who came in contact with it. Attempts to replicate natural rubber had been rampant since World War II. Nitrile was first created in 1930, but it wasn’t used for gloves until the 1990s.

Entrepreneurs in Malaysia and other parts of Asia renewed their interest in manufacturing gloves. This time, they made the products from nitrile.

Today, about 75% of the medical gloves on the market come from Malaysian manufacturers.

Raw Materials

Although most people refer to nitrile as rubber, it doesn’t come from a natural source. It is a synthetic material that is formed from amides, aldehydes, ketones and halogenoalkanes. To be effective, nitrile gloves must be flexible, form-fitting, comfortable and puncture-resistant.

The following two compounds are bonded together to make nitrile gloves:

  • Acrylonitrile – A monomer that is created by the ammoxidation of propylene
  • Butadiene – A non-corrosive gas and byproduct of the production of propylene and ethylene

Quality and Benefits of Nitrile Gloves

Nitrile gloves must follow specific quality standards to provide adequate healthcare worker protection. The material is inherently resistant to damage from many noxious chemicals, which makes it ideal for various industries. But it won’t keep users safe if certain quality standards aren’t followed.

In the U.S., the Food and Drug Administration regulates this class I medical device. The gloves must adhere to strict standards regarding the following:

  • Holes
  • Freedom from powder
  • Degree of sterility
  • Tensile strength
  • Ultimate elongation
  • Physical qualities after aging
  • Biocompatibility

Medical gloves have different regulations than all-purpose gloves. They must undergo rigorous testing and require:

  • FDA 510K approval
  • Registration and listing with the FDA

The FDA controls the marketing for this product too. Vague labeling claims are restricted. Only gloves that have the word “examination” on the packaging may be used in the medical field.

Other categories that have labeling or regulatory requirements include:

  • Dental examination or dental surgeon’s gloves – May include the word “dental,” but must include the word “examination”
  • Chemotherapy gloves – Are tested for penetration and permeation from chemotherapy drugs
  • Microsurgery gloves – May have decreased thickness in particular areas but cannot be thinner than the FDA standard
  • Orthopedic surgery gloves – Label must declare the measured thickness
  • Radiation attenuating gloves – Must meet requirements for surgeon’s glove as well as data backing x-ray reducing claims
    Other requirements safeguard the security of nitrile exam gloves. Expiration dates and lot numbers on the label allow consumers to ensure that they’re using safe products.

Today’s Malaysian Nitrile Examination Gloves Production and Market

The COVID-19 pandemic has shaken up the nitrile glove industry in Malaysia and beyond. An initial shortage caused concern among healthcare workers and the public. When the U.S. banned imports of disposable nitrile gloves from certain companies due to forced labor and other labor compliance concerns, some manufacturers claim to have changed their policies.

Amid these allegations, new players are entering the glove game in Malaysia. Property developers are partnering with manufacturers to enter the growing industry. These projects will create new job opportunities for Malaysian residents even though most of the gloves are exported outside of the country’s borders.

Some other factors impacting demand include:

  • Population growth
  • A larger aging population
  • Rapid industrialization of developing countries
  • Growth of the healthcare industry
  • Increasing rates of disease
  • Enhanced healthcare and hygiene education

Market fragmentation is driving competition. But merger, acquisition and partnership strategies are helping key players, such as Top Glove Corporation Bhd, Ansell Ltd. and Hartalega Holdings Berhad, stay in the game and others to enter.

Malaysian exports of nitrile examination grade gloves grew by 51.9 percent in 2020. Moreover, the Asia Pacific consumer market is growing in this category as the development of medical facilities increases. Researchers predict that the nitrile glove market will reach $9.41 billion by 2027.

As a US supplier to hospitals and healthcare facilities SPH Medical is a trusted source for Nitrile Examination gloves from Malaysia.  SPH Medical delivers gloves directly to hospitals including the Chemotherapy Drug and Fentanyl Citrate Tested Nitrile Exam Glove from Hartalega which has been adopted by many leading health systems.  Contact SPH Medical to learn more or to request a quote for your facility.

Reduce Injuries and Infections with SPH Medials Air Transfer Mat
CategoriesPatient Handling

Lateral Transfer Matt: The Dignity and Dangers Of Lateral Transfers

by sphmedicaladmin

The gold standard of Safe Patient Handling today is the single patient use Air-Assisted Lateral Transfer Matt.  This article will provide some background about the daily risks faced by nursing staff when handling patients and the growing trend to implement Safe Patient Handling programs that include the SPH Medical Lateral Transfer Matt.

Medical Professionals Carry Out Dozens of Lateral Transfers Per Day

Though caregivers and medical professionals carry out dozens of lateral transfers per day, this procedure is still far from perfect. In other words, while this practice is commonplace in hospitals, it poses serious risks and challenges. Simply put, lateral transfers involve moving a patient from one surface to another. Since several departments are tasked with performing lateral transfers, countless professionals are susceptible to a nursing injury or repositioning injury. Patients are equally vulnerable to these injuries, which is why lateral transfers are notoriously precarious.

When performing a traditional lateral transfer, nurses reposition patients using the sheet that’s underneath them. However, if there’s limited personnel, this isn’t a viable option. To compensate for insufficient manpower, a plastic board is used to streamline the process. Unfortunately, this approach leaves a lot of room for error, making it inefficient and unpredictable. In essence, if there isn’t enough manpower or resources available, affairs become exceedingly dangerous. After all, patients and caregivers shouldn’t have to rely on their physical abilities to oversee successful lateral transfers.

Lateral transfers are so unsafe that medical professionals are 31 percent more likely to experience musculoskeletal pain.  Pain is often a sign of some injury that has occurred and should not be ignored.  With the repetitive nature of lateral transfers and the fact that patients are continuing to get heavier, nurses, techs, CNA’s and transporters are all at risk of a severe back, neck or shoulder injury which may be career ending. Additionally, these handling injuries are emotionally and financially draining, causing both medical professionals and hospitals distress. If a patient or caregiver has been seriously injured, hospitals could pay hundreds of thousands of dollars to cover medical expenses.  Sound like motivation?  To prevent caregiver injuries, physical discomfort, and to avoid significant financial losses, laws have been passed to improve these practices. Yet, additional efforts need to be made to keep nurses and patients out of harm’s way.

To expedite the adoption of Safe Patient Handling practices, the Bureau of Labor Statistics conducted a study surrounding Safe Patient Handling programs. According to their research, hospitals that employ proven lateral transfer procedures with the appropriate assistive devices, including an Air Assisted Lateral Transfer Matt, are 73 percent less likely to subject patients and nurses to handling injuries. This study served as a catalyst for the Nurse and Health Care Worker Protection Act. The House introduced this bill in 2015, and it requires the Department of Labor to improve patient handling, mobility, and injury prevention standards so that fewer transfer and repositioning injuries occur.

Improving Safety with the Lateral Transfer System

In the hopes of breathing improved safety, efficiency, and security into lateral transfers, air-assisted systems were created. AirPal birthed this invention, but other brands have developed their own versions of this modern device. HoverMatt, for example, manufactures air-assisted systems, and their business has expanded exponentially after developing the disposable or single patient use transfer mattress.  Not only do air-assisted systems reduce friction, but they also provide added support and comfort.  As a result, it’s easier for nurses to boost, reposition and transfer patients, making everyone less vulnerable to strains, sprains, and career ending back injuries.  At SPH Medical, we make this equipment easily accessible so that more hospitals can implement safe patient handling wherever lateral transfers and positioning is occurring.  With more than 15 years of experience implementing Air Transfer Systems, the team at SPH Medical offers expertise in this area to its customers.  SPH Medical offers a complete line of single patient use Air Transfer Mattress options and reusable Air Transfer Mattress options in all sizes compatible with the most common air supplies on the market.

Assisted Transfer Equipment: Is It Worth It?

Air transfer equipment is preferred for its ability to reduce risk of injury and the fast adoption rate by nursing staff. Luckily, the perks don’t end there. In addition to promoting optimal safety, air-assisted systems also make patients more comfortable. Without air transfer equipment, lateral transfers can cause significant discomfort. For patients of size, they may feel embarrassed that so many people have to be involved in a lateral transfer just to move them.  The air-assisted lateral transfer matt gives the patient a sense of dignity. Air-assisted transfer systems do an excellent job of eliminating risks and uncertainty, which is why this equipment is an efficient alternative to old fashioned manual handling practices.

Best of all, patients say that the air transfer matt offers a floating sensation. With that said, it’s evident how much this equipment streamlines the patient transfer process and improves patient throughput in busy departments like the OR and Labor and Delivery. Above all else, when caregivers have the tools they need to ensure patient safety and their own safety, it bodes well for a pleasant experience for all including increased patient satisfaction. Thanks to air-assisted systems, gone are the days of risking a back or shoulder injury while repositioning patients. Instead, you receive a safe and efficient solution to reduce lateral transfer risks.

Contact SPH Medical to get a quote for the Air Assisted Lateral Transfer Matt and realize the benefits of Safe Patient Handling today.

CategoriesPatient Handling

Improving Nursing Safety With The EPD

by sphmedicaladmin

Improving nursing safety is the primary goal in any formalized Safe Patient Handling program being implemented across the country here in the United States and even internationally. This article will discuss the risks associated with manual patient handling that occurs during epidural placement, spinal blocks and thoracentesis.

First, a little background about epidurals. An epidural is regional anesthesia applied to expectant mothers in labor and delivery units to desensitize pain receptors. The success of an epidural depends upon the skills of the anesthesiologist but one could say that patient positioning is the priority and may be equally or more important.

The epidural procedure is vital to manage pain during labor and in surgical procedures. For effective epidural placement, the patient should be in a sitting position or lying on their side.

The nurses and physicians will assist the patient in assuming the correct position. The physicians carry out the procedure using a sterile technique with local anesthesia at the site of injection.

After your skin gets numb, the anesthesiologist will pass the needle between the lumbar vertebrae into the epidural space. A continuous infusion is preferable for most labor epidurals to ensure no wearing off of the anesthesia.

Epidural pain relief produces a numb sensation on the legs and abdomen for patients in labor which masks the discomfort experienced in delivery. Although epidural pain relief lacks a significant effect on mental functions or awareness, patients may rest and even sleep till the time to push in the case of delivery.

Note that labor analgesia aims to relieve the pain sensation but not to block it completely. Pushing is a vital part of vaginal delivery, and the patients must have the muscular strength to make it successful.

Safety of An Epidural

The medications used in labor as epidural analgesia lack significant adverse effects on the newborns. Over decades, no appreciable side effects of the drugs occur in babies.

However, those undergoing surgeries and women in labor may experience mild itching and difficulty in passing urine. Other adverse effects include nausea and mild back pain post-delivery.

Although it is effective in managing pain during labor, it is unsuitable in:

  • Patients with clotting or bleeding disorders
  • Current infections
  • Hypotensive patients
  • Non-cooperative patients
  • Positioning of the Patient

Manually positioning patients and applying static holds has been a known cause of injury in hospitals and specifically in Labor and Delivery departments.  To reduce the chances of injury to the caregivers, an epidural positioning device (EPD) is effective in reducing risk of injury to staff and patients and can also increase patient satisfaction.  The device was invented by an anesthesiologist has been used widely in positioning patients for epidurals, spinal blocks, wound care and more.

Risk to Nurses and Health Care Workers

As COVID-19 continues to spread, the healthcare team is already affected. The pandemic puts an entirely new perspective on the manual handling of patients and the effort of improving nursing safety. Be it in surgical or labor rooms, the manual handling of patients subjects the nursing staff to musculoskeletal injuries and even COVID-19.

In the labor, delivery, outpatient surgery, and peri-operative areas, the staff have in the past had to manually hold the patients in position for epidural placement. Because of the risk of COVID-19 spread, patients and the health care team should minimize the unnecessary contact to prevent illnesses and injuries.  The EPD or Epidural Chair has become an essential tool to prevent the spread of infections, including COVID-19.

Studies indicate that nurses are more prone to overexertion injuries than other occupations in the health sector. Hence, the health care industry and hospitals need to embrace changes that will protect their staff.

Benefits of EPD

The Epidural Chair improves safety and reduces injuries among patients and staff. It creates an ideal patient position for placing the needles during an epidural procedure.  The technique is also applicable in central anesthetic procedures.

The SPH Medical Epidural Positioning Device is an improved positioning chair and has now become famously known as the Epidural Chair.  It has been helpful in improving nursing safety in various departments in the hospital, including the outpatient surgery, pain management center, OR, and of course L&D.

The device helps position the lumbar, thoracic, and cervical flexion while maintaining a stable and solid position. The device is the most suitable for patients undergoing obstetrics, orthopedic surgeries where spinal blocks are common, and now the imaging department and pulmonologists are using it for thoracentesis.

There is are both electric and non-powered EPD options. Both provide a weight capacity of 600 pounds by accommodating various weights and body sizes.  The manual and electric devices have a patented chest cushion that extends toward the patient to promote thoracic, lumbar, and cervical flexion.  The flexed spine position opens up the intervertebral spaces for the appropriate placement.

The electric Epidural Positing Device or E-EPD has an electronic controller for adjusting the upper section of the EPD.  Most importantly the electric EPD has a powered foot plate, or foot rest, that eliminates the need for a nurse to bend over or do any lifting.  To further promote spinal flexion Anesthesiologist prefer the patients’ knees to be slight raised so having this powered feature on the E-EPD can be a real asset.  The Electric Epidural Positioning Device can improve the efficiency of set-up and reduce overall procedure time which can be helpful in a busy department.

A successful mobility program and safe handling of the patient require effective equipment, buy-in, and guidance on the most suitable solutions to improve staff safety and patient mobility.

The adoption of Safe Patient Handling principles including the use of proper body mechanics and assistive devices are critical to reduce the risk of injury to our caregivers.  Proper positioning with the EPD allows the device to do the hard work and nurses can now stand by and assist with the important clinical procedures they have been trained to do.

N95 Masks for Maximum Protection
CategoriesInfection Prevention

Cal OSHA New ETS for N95 Respirators

by sphmedicaladmin

On June 17th, Cal OSHA issued an updated COVID-19 Prevention ETS (Emergency Temporary Standards) requiring employers in California to provide N95 Masks for employees that are unvaccinated. The following topics are discussed in the updated ETS. As a result of the updated ETS we are seeing an immediate increase in demand for NIOSH Approved N95 Respirators.

Summary of June 17th ETS.

  • Physical Distancing – This is being phased out along with barriers.
  • N95 Respirators for employees – Employer must provide access to N95 mask for unvaccinated employees
  • Face Coverings – Face Coverings are still required for unvaccinated employees
  • Vaccines – Employers must document vaccination status of employees
  • Testing – Must be offered at no charge to Employees
  • Outbreaks – More protective measures will be required if an Outbreak occurs
  • Enforcement – Employers should implement the June 17th ETS as soon as possible to avoid being cited

Here are the highlights of the ETS as it relates to N95 Respirators:

Q:  Is an employer’s obligated to provide respirators and to whom?

A:   The bottom line is that there are two scenarios that an employer needs to be prepared for:  (1) An Employer must provide an N95 respirator to any unvaccinated employee who works with others indoors or in a vehicle and who requests one and (2)  If there is a major outbreak the employer must provide an N95 to any employees in the exposed group for voluntary use.  The employer must provide a respirator that is the right size and fit for the employee and they must provide basic instruction on how to get a good fit or seal around their face.

Q:  Does an Employer have to provide N95 respirators “upon request”?

A:  An employer must be able to provide the respirator upon request.  The employer can wither keep the N95 masks in stock or they can take a poll of all their employees to determine which employees will need an N95 respirator before they purchase them.  Once the employer has determined that it has employees that wish to wear respirators it should make sure that it has enough quantity of masks that fit properly for this group of employees and also consider that respirators will have to be replaced if soiled, broken or contaminated.  Employers can also allow employees to purchase their own mask and reimburse the employee.

If an unvaccinated employee asks for an N95 mask at any time, the employer is obligated to provide one.

If there is a major outbreak the employer must offer N95 respirators to all employees whether they have been vaccinated or not.

Q. How soon does a respirator need to be provided after an employee requests it?

A. According to the new ETS employers should estimate their needs immediately and order the required NIOSH Approved N95 respirators to provide to unvaccinated employees as soon as possible.

Healthcare Workers Also Continue to Depend on N95 Masks

While the COVID-19 pandemic is becoming less severe as case counts drop steadily and larger percentages of people become vaccinated from the coronavirus, healthcare workers are still in need of protective equipment to prevent a COVID-19 infection, especially since variants of this virus are spreading worldwide. As such, the NIOSH N95 mask is essential for hospital workers over the coming months.

While there was a severe shortage of health grade N95 masks in the past, now that fewer people in the outside world need to mask up, hospital workers are seeing a more steady stream of the N95 mask in their supplies. This means nurses, doctors, and other healthcare workers will not need to worry about infection risk as much since they won’t need to re-use these supplies.

Who are the hospital workers that are in greatest need of the NIOSH approved N95 respirator? Keep reading to find out.

Hospital Workers are also in Need of This Mask

According to the Centers for Disease Control and Prevention (CDC), surgical N95 respirators are meant only for healthcare personnel who need to be protected from airborne and fluid risks such as splashes and sprays. If N95 respirator masks are not available for use, a face shield can be used instead.

Therefore, any healthcare workers, such as surgeons, physicians, or nurses, who perform procedures on patients that involve transfer of body fluids, particulate matter, and microorganisms need to use N95 respirators, according to the US Food and Drug Administration.

What Different Styles of Masks are in Use Today?

There are several different styles of masks that medical workers use today, such as the cup style mask, a mask with a vertical fold, and a duckbill mask. There are N95 masks in the shape of a cup style, which involves a cone shape.

A vertical fold mask has vertical pleats and can be sewn together by an average stitcher using standard fabric that can be bought at a Michaels store. An N95 duckbill mask poofs out at the front and looks similar to a duckbill.

What is a Surgical Rating for an N95?

NIOSH approves surgical N95 respirators for use as a standard N95 respirator while in the past the FDA approved the respirator as a surgical mask.  Recently NIOSH has updated their surgical respirator approval to a more streamlined process. Research has shown that N95 respirator masks have much lower penetration levels of particles in the air when compared to the blue style 3 ply surgical mask.

Having a proper fit across the face, as determined by a fit test, makes a major difference in keeping air particles from infecting the mask wearer.

Who are the Key Manufacturers in this Space?

Some of the top manufacturers of protective equipment and face masks include:

    • Makrite
    • 3M
    • Honeywell
    • Kimberley-Clark Corporation

SPH Medical is a trusted source for N95 respirators and is a global distributor for Makrite Industries.

The Healthcare Facilities Using N95 Masks

In addition to Hospitals, some other types of healthcare facilities that use N95 respirators that you may not be aware of include long-term care facilities, nursing homes, and assisted living centers, according to the Occupational Safety and Health Administration (OSHA). In particular, healthcare workers who are in contact with a long-term care resident who is suspected or found to have COVID-19 should wear N95 respirators or a higher-level face mask.

New Market Trends

The market trends for N95 respirators positioned the compound annual growth rate (CAGR) of 45.1% from 2020 to 2027, according to a report from Grand View Research. The COVID-19 pandemic along with other infectious diseases led to a significant growth in demand for N95 respirators. North America took up a 32.3 percent share of global revenue in 2019.

Despite the decline in COVID-19 cases, the growth in demand for N95 respirators means there is still a global shortage of protective equipment and these masks, according to the FDA. To mitigate these continual shortages, the US government is taking action such as providing more information about alternative options for protective gear.

US manufacturers have been investing millions of dollars into rebuilding the stockpiles of such protective equipment including masks, isolation gowns, and more. International manufacturing has also played a major role in overcoming these shortages.

The future of the healthcare industry will depend upon N95 respirators and other protective equipment while the COVID-19 pandemic continues to impact the globe.

References:

https://www.cdc.gov/coronavirus/2019-ncov/hcp/checklist-n95-strategy.html

https://www.osha.gov/sites/default/files/respiratory-protection-covid19-long-term-care.pdf

https://www.grandviewresearch.com/industry-analysis/n95-mask-market#:~:text=The%20global%20N95%20mask%20market%20size%20was%20estimated%20at%20USD,USD%206.39%20billion%20in%202020.&text=The%20N95%20mask%20market%20is,USD%2021.57%20billion%20by%202027.

https://www.fda.gov/medical-devices/coronavirus-covid-19-and-medical-devices/medical-device-shortages-during-covid-19-public-health-emergency

 

 

 

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