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COVID-19 school health and safety protocols: good practices and lessons learnt to respond to Omicron

The COVID-19 pandemic and the recent Omicron variant wave have dramatically impacted societies in all sectors and at all levels. After near universal school closures in March 2020 that affected 1.6 billion learners and more than 100 million teachers and educators worldwide, countries around the world have developed health and safety protocols in an effort to safely keep schools open and protect students, teachers and other educational staff from the transmission of COVID-19. However, since the emergence of the Omicron variant in December 2021, these protocols have been disrupted and are being reevaluated as schools struggle to address a new set of challenges marked by staff shortages, threats to school safety and political battles over health measures. Based on an analysis of 35 countries, this brief report aims to provide a current overview of national health and safety protocols to keep schools open, their dimensions and how they are designed, implemented and regulated to ensure the continuation of education. It also aims to guide education systems by outlining some lessons learnt and effective practices on how the reopening of schools might be achieved safely and successfully. Finally, the report seeks to contribute to a better understanding of the impacts of the protocols on learning as well as the social and emotional wellbeing, health and development of learners and teachers. In a changing environment where infection rates are increasing at an exponential rate, it also explores how the Omicron variant is affecting current operations and what education systems should do to keep schools open while ensuring that all students are safe and learning.

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by Katherine J. Igoe

Ensuring health and safety in the workplace is already a critically important issue; organizations that invest in occupational safety perform better, reduce turnover, and help workers do their jobs more effectively. But COVID-19 has forced companies to act quickly and decisively to keep workers safe. As employers endeavor to slow the spread of the virus while keeping a supportive and productive work environment, they’ve had to adapt new business processes and address existing structures that are lacking.

“COVID-19 has stressed the system. All the flaws that have been in place are totally exposed and have come to the forefront of our daily conversations,” says Jack Dennerlein , adjunct professor of ergonomics and safety in the Department of Environmental Health and co-director of Work Health and Well-being: Achieving Worker Health at the Harvard T.H. Chan School of Public Health. From distancing procedures to the availability of remote work, the pandemic has metaphorically ripped off the mask covering the flaws in organizations’ working conditions. How has COVID-19 changed the standards of worker safety and health, and how can employers adapt to these changes?

Total Worker Health and Its Impact in the Workplace

Total Worker Health (TWH) aims to address, reactively and proactively, the challenges of worker safety, health, and well-being. At its core, it measures and assesses what a worker experiences, collects data to understand what to change, provides approaches on how to modify an environment, and encourages collaboration across traditional organizational boundaries to ensure a safe workplace. It’s both an acknowledgement of workers’ existing health, and initiatives to keep them healthy.

“These two general fields — protecting and promoting health — work together in a single workplace. It makes sense to think about this as an integrated effort instead of two siloed efforts that act in parallel,” says Nico Pronk , adjunct professor of social and behavioral sciences, president of the HealthPartners Institute, chief science officer at HealthPartners, Inc., and co-director of Work Health and Well-being: Achieving Worker Health .

As an example, he explains, “If you have diabetes, your eyesight might be diminished, and you might end up with an injury because your work is putting you at risk.” Critically, though, TWH focuses more on an organization’s framework rather than solely on an individual: “the conditions of work rather than on the behaviors of the work. You set the environment — physical, social, economic — which shapes how the workplace is organized. Within that, these factors start to drive the behavior of the individuals within it.”

COVID-19 has fundamentally uprooted assumptions about worker safety, health, and well-being and been an accelerant of addressing these issues. The pandemic has also highlighted classic social issues that workers face, like childcare, sick leave, and disability issues, and underlined safety concerns in health care environments where professionals need to treat patients. The absence of TWH — where workers don’t feel safe in their workplace — is also much more visible. Implementing TWH effectively helps make organizations more resilient during this time.

Even though COVID-19 can be used as a leverage point, Dennerlein notes, “We should be doing it for the good of the people, not just because of COVID-19. If we want this country to be productive, we have to invest in the health and safety of our workforce.” Adds Pronk, “What if you didn’t get sick? What if you didn’t get injured? The benefits come back in spades. You cannot be successful if you don’t have healthy workers, but that recognition is still hardly there.”

“Protecting and promoting health work together in a single workplace. It makes sense to think about this as an integrated effort instead of two siloed efforts that act in parallel.”

Applying and Adapting Total Worker Health During the COVID-19 Pandemic

While the values of TWH may not change, the implementation has evolved to protect workers against COVID-19. In a paper titled “ An Integrative Total Worker Health Framework for Keeping Workers Safe and Healthy During the COVID-19 Pandemic ,” Dennerlein, Erika Sabbath, Susan Peters, and Glorian Sorensen outlined six key characteristics that are essential for applying TWH in this context:

• Focusing on working conditions for infection control and supportive environments for increased psychological demands
• Utilizing participatory approaches involving workers in identifying daily challenges and unique solutions
• Employing comprehensive and collaborative efforts to increase system efficiencies
• Committing as leaders to supporting workers through action and communications
• Adhering to ethical and legal standards
• Using data to guide actions and evaluate progress

In this way, organizations can address the unique demands (including physical, ethical, and legal) of counteracting COVID-19 alongside the needs of workers to complete their tasks in a safe space, while using data and feedback to make changes.

According to the researchers, the most challenging aspect of using a TWH framework is getting top-level support. “Overall organization engagement towards this shared vision of a goal is critical — some key performance indicator for the institution has to include TWH or recognizing its impact. You have to think about that at the systems level,” says Dennerlein.

“If we want this country to be productive, we have to invest in the health and safety of our workforce.”

The Practical Implications of Implementing Total Worker Health in a Pandemic

The researchers have worked with companies to take these theoretical constructs and translate them to practical insights in the workplace. “It took companies as much as six months to learn how to bring health and safety together. Health is in HR, safety is in Operations, and the two don’t usually interact,” Pronk says. Not rushing the organizations and giving them up to a year to develop an implementation plan was key.

After buy-in from leadership, the next step is to test these six characteristics using data and feedback. Previous studies show that program design principles or characteristics are correlated with good health outcomes. “The business units that scored the highest had the lowest number of health risks in their populations. The more they followed these characteristics, the healthier their group was,” Pronk says. Following implementation, organizations would then be able to make changes and use a team-based approach to maintain awareness and continue to evaluate efficacy.

Thus, TWH can be effective, and not just in the short-term. Even after COVID-19 is no longer an immediate threat, the challenges of worker health and safety remain. “What are we doing to create a more resilient workforce ? When we start thinking about the work of the future, workers are going to have to continually reinvent themselves, because work is constantly changing. COVID-19 was a big slap in the face for that. How do we all adapt?” says Dennerlein.

“We rely on the human element in the workforce so much because humans are problem-solvers. TWH tries to broaden that and realize what a great resource we have here. Why aren’t we using that element better? Why aren’t we weaving it more effectively into our organizations to help them make better decisions to affect the bottom line?”

Harvard T.H. Chan School of Public Health offers Work Health and Well-being: Achieving Worker Health , which provides the full set of skills needed to improve worker health, safety, and well-being in the workplace .

Assessing the effectiveness of healthcare protocols in epidemics

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With the current COVID-19 pandemic, enormous disruptions have occurred to social and economic activity, besides the high toll of human life. In attempts to reduce the spread of the virus, different authorities have adopted a variety of non-pharmacological interventions (NPI). These include face shields, hand-cleansing, social distancing, and widespread restrictions on mobility.

Figure 1. Outcomes of the simulations of COVID-19 infection curves. On the left: green, yellow, and red circles indicate low, intermediate, and high levels of model parameters β, v, and k for each of the 27 simulation scenarios. Parameter values are depicted in the box on the right panel. On the right: grey shades portray the progression of the infection across simulation time steps, which was obtained through the smoothing of all simulations under each scenario. The width of each shade is scaled to the height of each infection wave. Blue horizontal bars represent the period when the healthcare system is simulated as overloaded, according to empirical data on available beds. Red circles with crosses portray the peaks of infections.

The need for NPIs is urgent since the clinical course of the outbreak makes it clear that an uncontrolled increase in the number of cases will inevitably overwhelm the healthcare system. Therefore, the most effective measures need to be identified.

The type of NPI used ranges from physical barriers to the passage of the virus, such as plastic face shields and masks, to social distancing and restrictions on travel. The opponents of such NPIs cite the disruption of economic interests. The researchers concur with the view that the right containment measures need to be devised with respect to public welfare and the weight of scientific evidence.

The study: modeling epidemic spread with various npis

The current study is aimed at modeling the spread of the epidemic when these strategies are in place to help policymakers to make the right decisions.

The researchers focus on the perception that the virus spreads through a network of human contacts over time and within different spaces. Therefore, they seek to make use of a model that will take into consideration this type of change, as well as individual characteristics that affect disease spread. They also account for the difference in disease severity and mortality with age.

Using network models that are based on the individual but are stratified by age, the researchers constructed city-level simulations to try out the effects of each NPI on weakening the outbreak.

They used different health protocols and COVID-19 parameters to arrive at different scenarios considering the time to infection peak, waning of case numbers and relatively low-risk activities.

Higher exposure/contact levels, higher rate of spread

Considering the probabilities of personal exposure to the virus, and local as well as contact among people, in terms of low, intermediate and high levels, they found that an increase in all three of these parameters was linked to a faster and higher peak of infection. When the parameter values were high, the peak was at 6-8 weeks from the first case, with a narrow high shape.

When they were moderate to high, early wave peaks emerged. At lower values, the peak occurred later, and almost two peaks were found at about 14-16 weeks from the first case. Therefore, the infection pattern showed a flatter profile.

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In the simulation used, in almost all the scenarios, the healthcare system was overwhelmed. When the wave was steeper and smoother in outline, corresponding to higher parametric values, the hospital capacity recovered more quickly.

Secondly, the researchers examined the simulation in terms of changing values for each parameter. The results showed that the infection grows rapidly with higher values. When both parameters are reduced in value, the interventions become consistently more effective in reducing the burden of infection. Importantly, this is a non-linear relationship.

Models that had a low exposure rate and high social distancing inputs showed later infection peaks and fewer overall infections.

Higher contact/exposure, higher hospital overwhelm

When healthcare systems were studied, with respect to the first and last day of the over-capacity period, and the percentage of bed deficit, the model shows that both social distancing over large scale (but not neighborhood scale) and exposure rate influence the saturation significantly.

When both these parameters were at high values, the saturation-related aspects of the infection wave increased. The model also predicts a 3-5 times higher requirement for healthcare units than the current potential.

Individual exposure: a first-line risk factor

A dramatic finding of the model, which puts the responsibility for preventing viral spread squarely on the individual’s shoulders, is that the exposure of each individual is among the most critical factors propelling the wave upwards and forwards.

This includes the use of face masks, face shields, hand sanitizers and other personal protective equipment (PPE). These have been recommended for general use by the World Health Organization (WHO).

However, there is no general agreement on whether all workers should use them, or if they should be restricted to essential workers. It is also not known if everyone will have access to them once the demand rises worldwide.

The researchers favor legal measures to promote mask use and hand hygiene in a rational manner , but point out that so far no studies have shown concrete scientific evidence that masks and hand sanitation do reduce the spread of the virus. Moreover, unnecessary demand for masks has led to their incorrect use, which could push the risk higher and lead to overpricing.

The researchers recommend that PPE should be used when there is a potential threat of virus spread or contact with air droplets. However, they emphasize, “ Social distancing protocols seem considerably more effective. ”

Implications and applications

The study found that when a single intervention protocol is changed, the pattern of spread of the infection and the number of cases undergoes significant change. Secondly, without effective NPI use, healthcare facilities will be overwhelmed.

Thirdly, social distancing, increased mass testing and hospital investments are the best ways to fight the pandemic.

There are many ways such as stay-at-home recommendations, home-based offices, and online teaching classes, ranging from voluntary to context-dependent mandatory reasons, which can greatly contribute to reducing the spread of the new coronavirus. Our results reinforce that these may be the best current strategies .”

Simultaneously, the model suggests that essential activities that must be repeated regularly, such as shopping for grocery necessities, or errands to the bank, pharmacy or gas station, have little impact when carried out within the same neighborhood.

Early adoption of such protocols within a few days of the first case is essential to reduce the spread of the infection, but, the researchers say, “ Many people tend to underestimate this protocol since its effects may take weeks to appear.”

At the same time, they call for more research to understand the variation in the need for social distancing based on the social and economic context and the financial hardship suffered by the people involved. They conclude, “ Models with a real-time structure accounting for this dynamic would be more appropriate to build an evidence-based political framework .”

Baumgartner, M. T., and Lansac-Toha, F. M. (2020). Assessing the Relative Contributions Of Healthcare Protocols For Epidemic Control: An Example With Network Transmission Model For COVID-19. medRxiv preprint doi: https://doi.org/10.1101/2020.07.20.20158576 . https://www.medrxiv.org/content/10.1101/2020.07.20.20158576v1

Posted in: Disease/Infection News

Tags: Coronavirus , Coronavirus Disease COVID-19 , covid-19 , Healthcare , Hospital , Hygiene , Mortality , Pandemic , Pharmacy , Research , Virus

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.

Please use one of the following formats to cite this article in your essay, paper or report:

Thomas, Liji. (2020, July 23). Assessing the effectiveness of healthcare protocols in epidemics. News-Medical. Retrieved on June 11, 2024 from https://www.news-medical.net/news/20200723/Assessing-the-effectiveness-of-healthcare-protocols-in-epidemics.aspx.

Thomas, Liji. "Assessing the effectiveness of healthcare protocols in epidemics". News-Medical . 11 June 2024. <https://www.news-medical.net/news/20200723/Assessing-the-effectiveness-of-healthcare-protocols-in-epidemics.aspx>.

Thomas, Liji. "Assessing the effectiveness of healthcare protocols in epidemics". News-Medical. https://www.news-medical.net/news/20200723/Assessing-the-effectiveness-of-healthcare-protocols-in-epidemics.aspx. (accessed June 11, 2024).

Thomas, Liji. 2020. Assessing the effectiveness of healthcare protocols in epidemics . News-Medical, viewed 11 June 2024, https://www.news-medical.net/news/20200723/Assessing-the-effectiveness-of-healthcare-protocols-in-epidemics.aspx.

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Business sectors’ initiatives on health and safety protocols and vaccination program among employees during the COVID-19 pandemic

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Alma V Yutuc, Danzen B Olazo, Philip Joseph D Sarmiento, Business sectors’ initiatives on health and safety protocols and vaccination program among employees during the COVID-19 pandemic, Journal of Public Health , Volume 43, Issue 4, December 2021, Pages e751–e752, https://doi.org/10.1093/pubmed/fdab139

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In a recent correspondence, the author discussed the issues of ‘no-jab, no job’ policy, which is planned to be implemented by governments and companies in many countries. This paper highlights the business sectors’ initiatives in ensuring the implementation of health and safety protocols and vaccination program among employees during the COVID-19 pandemic.

When the COVID-19 outbreak started spreading across the world, thousands of people started facing severe health issues and death rates increased. In such a scenario all business activities, across all industries were completely stopped. The lockdown impacted various sectors to a varying degree. Millions of people in these sectors are likely to lose jobs. Nonetheless, businesses are trying to cope up with the economic turbulence caused due to COVID 19 through modified work. As today’s extreme circumstances test the ability of businesses to operate and manage rapid change in a time of uncertainty, what should global mobility leaders and their organizations be doing to maintain employee welfare and business continuity? In a recent correspondence, the author discussed the ethical and legal impediments of ‘no-jab, no job’ policy, which is planned to be implemented by governments and companies in many countries. 1 Consequently, the author emphasized that the human person is the subject and never the object of every companies and governments. Thus, we agree with this perspective and we also want to emphasize that the employees’ health and well-being should be at the top of agenda of business sectors in ensuring the implementation of health safety protocols and support to the COVID-19 vaccination rollout.

The business has an important role to play in addressing the health and safeguarding the welfare of employees. 2 While many employers may be concerned about their bottom line and the loss of productivity, the reality is that loss will be even greater if employees come in sick, potentially with the coronavirus. Business leaders have to think about not only how to cope with the current changes but also what to do to prepare for future scenarios. 3 Management also needs to check in often and consistently to learn how people are dealing with transitioning to remote work. It is also critical to give employees a place to feel seen and heard. Scholars of strategic marketing attest that internal marketing will empower employees to perform in a more market-oriented manner and motivate them to accomplish their job tasks. 4

Employees are the backbone of every company and the major responsibility of an organization is to keep the employees safe and secured especially in this trying time of the pandemic. The COVID-19 pandemic highlights the need for businesses to take their duties seriously in protecting employees and the rolling-out of COVID-19 vaccines to secure their health even amid vaccination hesitancy. 5 In a recent study, businesses of all sizes must act responsibly to do no harm, care for employees and allow the government to do its job in protecting people and every company should make concentrated efforts to meet employee needs and desires cost-effectively, so that company performance will be improved. 6 By delivering safe and healthy working conditions, including proper protective equipment and training, personal hygiene habits such as washing hands or coughing etiquettes to mitigate exposure to COVID-19, especially for workers. Collecting updated information is the first step to planning and implementing practical actions to protect your worker. Reducing direct human-to-human contact in the work procedure is possible in many ways. Keep workers informed about the coronavirus and the vaccination program through proper information dissemination. Governments and business sectors must protect the health of employees at this time, but this crisis also offers the opportunity for a turning point in our economy.

All authors contributed to all aspects of the manuscript.

The authors declare no conflict of interest.

Corpuz JCG . No-jab, no-job clause: ethical issues and legal impediments . J Public Health 2021 . doi: doi: 10.1093/pubmed/fdab089

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Tamir I . What’s the Role of Business in the COVID-19 Crisis? Oxfam America Inc. , 2020 . https://politicsofpoverty.oxfamamerica.org/whats-the-role-of-business-in-the-covid-19-crisis/ (7 April 2021, date last accessed).

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Donaldson L, Ricciardi W, Sheridan S, et al., editors. Textbook of Patient Safety and Clinical Risk Management [Internet]. Cham (CH): Springer; 2021. doi: 10.1007/978-3-030-59403-9_1

Textbook of Patient Safety and Clinical Risk Management [Internet].

Chapter 1 guidelines and safety practices for improving patient safety.

Walter Ricciardi and Fidelia Cascini .

Affiliations

Published online: December 15, 2020.

This chapter explains why clinical practice guidelines are needed to improve patient safety and how further research into safety practices can successfully influence the guideline development process. There is a description of the structured process by which guidelines that aim to increase the likelihood of a higher score are created. Proposals are made relating to (a) the live updating of individual guideline recommendations and (b) tackling challenges related to the improvement of guidelines.

1.1. Introduction

Actions to improve patient safety have shown widely varying degrees of effectiveness. Usually hospitals are focused on the occurrence of adverse events and the level of adversity to the patient in the contexts of insurance premiums and the costs of malpractice. Furthermore, even risk management units within hospitals focus on these factors, when comparing the performance of departments or wards. However, for the improvement of patient safety in clinical practice, a different approach is required, in which the prevention of patient harm and effectiveness of clinical actions is standardized and assessed on the basis of scientific evidence.

Recommendations that have been translated into guidelines are the best possible evidence-based solutions to clinical practice issues. However, it appears that there are very few clinical guidelines focused on patient safety, particularly in the risk management sector. Furthermore, when using clinical guidelines for quality and safety improvement, practices often seem to diverge. Higher quality and safer clinical practice are consequently difficult to achieve, share, and promote.

Existing knowledge of patient safety essentially covers the nosography of threats and causes of patient harm, as opposed to possible evidence-based solutions that can (a) prevent risks, (b) address healthcare incidents, and (c) which can be compared. This means that etiology, pathogenesis, and observations of safety issues in clinical departments, and, more broadly in healthcare organizations, are often investigated while proven solutions to patient safety issues are rarely discussed. To give an appropriate analogy, it is like saying that there are many papers that have examined perioperative complications, type of surgeries, and patient characteristics. However, no research is available on how the occurrence of these complications have been managed in different settings according to organizational and human factors.

It is essential that healthcare professionals acquire proficiency in producing evidence that can be used for making improvements to patient’s safety and managing the risks of adverse events. To successfully achieve this goal, the first step is for them to have a clear idea of what guidelines and practices are. Definitions of these terms will be the content of the first section of this chapter. Once these concepts have been introduced, the second section will show the current picture regarding patient safety and why a greater number of valuable clinical guidelines are needed. The third section will then consider possible solutions, lessons to apply in practice, and will explain how to prepare and update a guideline. The challenges we are facing along with the limits of the current guidelines will be considered at the end, which will assist in managing patient safety in future.

1.2. The Need to Understand Guidelines Before Improving Safety

The World Health Organization (WHO) regards guidelines as tools to help people to make decisions and particularly emphasize the concept of choosing from a range of interventions or measures. A WHO guideline is any document developed by the World Health Organization containing recommendations for clinical practice or public health policy. A recommendation tells the intended end-user of the guideline what he or she can or should do in specific situations to achieve the best health outcomes possible, individually or collectively. It offers a choice of different interventions or measures that are intended to have a positive impact on health and explains their implications for the use of resources. Recommendations help the user of the guideline make informed decisions on whether to undertake specific interventions or clinical tests, or if they should implement wider public health measures, as well as where and when to do so. Recommendations also help the user to select and prioritize across a range of potential interventions [ 1 ].

With a greater emphasis on clinical practice, the U.S. Institute of Medicine (IOM) defines guidelines as “statements that include recommendations, intended to optimize patient care, that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options” [ 2 ]. This definition emphasizes that the foundation of a guideline is a systematic review of the scientific evidence bearing on a clinical issue. The strength of the evidence leads the clinical decision-making process through a set of recommendations. These concern the benefits and harms of alternative care options and address how patients should be managed, everything else being equal.

The U.S. National Guideline Clearinghouse (NGC) of the Agency for Healthcare Research and Quality (AHRQ) also uses the definition of clinical practice guidelines developed by the IOM, stating that “clinical practice guidelines are statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options” [ 3 ].

The British National Institute for Health and Care Excellence (NICE) stresses scientific evidence as the basis of guidelines. It states: “NICE guidelines make evidence-based recommendations on a wide range of topics, from preventing and managing specific conditions, improving health, and managing medicines in different settings, to providing social care and support to adults and children, safe staffing, and planning broader services and interventions to improve the health of communities” [ 4 ].

The Italian National Center for Clinical Excellence (CNEC) that is responsible for the National Guidelines System (SNLG) uses essentially the same definition as NICE, stressing the importance of evidence-based medicine as the foundation of recommendations in guidelines.

The recent report on healthcare quality improvement published by the European Observatory on Health Systems and Policies [ 5 ] reiterates that clinical guidelines focus on how to approach patients with defined healthcare problems, either throughout the entire care process or in specific clinical situations. As such, they can be considered as a tool to inform healthcare delivery, with a specific focus on the clinical components, in the context of medical practice as an applied science. Clinical guidelines have the potential to reduce unwarranted practice variation and enhance translation of research into practice; a well-developed guideline which is also well implemented will help improve patient outcomes by optimizing the process of care [ 6 , 7 ].

From the perspective of international accreditation societies such as Joint Commission International (JCI), guidelines that help healthcare organizations to improve performance and outcomes are part of the foundation of processes aimed at reaching the goal of safe and high-quality care [ 8 ]. JCI maintains that clinical practice guidelines are truly major and effective tools in the practice of delivering evidence-based medicine to achieve more effective patient outcomes and safer care. These guidelines, which must be used in all JCI accreditation programs, can achieve their maximum potential when they are both well developed and effectively introduced into clinical practice.

All of the definitions mentioned are consistent. Guidelines are not presented as a substitute for the advice of a physician or other knowledgeable healthcare professionals or providers. They are tools describing recommended courses of intervention whose key elements are the best available scientific evidence and actions according to this evidence. The goal is the promotion of health and consequently, the quality and safety of care. However, it is also desirable for professionals to share within the scientific community the results from using clinical practice guidelines in the context of valuable, real-world experience to inform safety interventions. Professionals are expected to share their current practice to help them apply guidelines to real-life situations and also to improve guidelines in the light of that experience.

Ensuring the quality of healthcare services and making improvements to patient safety require that evidence-based recommendations from guidelines, and their application in the form of practical interventions (best practices), always function as synergetic tools. Nevertheless, there is no consensus on what constitutes practice-based evidence (which is what emerges from routine hospital activities) and what metrics can be used to ensure the quality of this evidence. Healthcare interventions that have been shown to produce desirable outcomes and that are suitable for adaptation to other settings can be called “best practices.” A best practice is “ an intervention that has shown evidence of effectiveness in a particular setting and is likely to be replicable to other situations ” [ 9 ]. Moreover, a best practice is not a synonym of a good practice or, simply, of a practice: it is an already existing and selected intervention whose effectiveness has already been established. This concept is widely applicable in health care, from patient safety to public health, including the quality of care. In fact, a best practice is based on evidence from up-to-date research and it has the added value of incorporating experience acquired in real-life settings.

A best practice provides tangible solutions as the most effective process or method to achieve a specific objective, with results that are shareable. As a consequence, the practice can then become a model. Some organizations are working on creating best practice models, in particular, on selecting techniques or methodologies that have been proven to be reliable in achieving desired results through consolidated and updated experience and research. The British Medical Journal (BMJ), for example, funds a service (available at https://bestpractice.bmj.com/info/ ) that collects the latest evidence-based information to support professional decisions and brings together regularly updated research evidence and the knowledge of international experts. According to the BMJ, its best practice tool is “a clinical decision support tool that offers a step-by-step approach to help manage patient diagnosis, prognosis, treatment and prevention.”

1.3. The Current Patient Safety Picture and the Demandfor Guidelines

• Four out of every 10 patients are harmed in primary and outpatient (ambulatory) health care, with up to 80% of the harm considered to have been preventable.
• Patient harm may account for more than 6% of hospital bed days and more than 7 million admissions.
• The most detrimental errors are related to diagnosis, prescription, and the use of medicines.

Moreover, there are other serious consequences. The WHO report also included the following criticisms concerning the “health status” of patient safety worldwide: the costs from unsafe medication practices or medication errors [ 14 , 15 ] and from delayed diagnosis [ 16 , 17 ], the costs of treating the effects of patient harm, the complications from surgery that cause more than 1 million patient deaths every year [ 18 ], and the inappropriate or unskilled use of medical radiation leading to health hazards to both patients and staff [ 19 ].

Approaches to improve patient safety have already been suggested. Evidence-based care positively affects healthcare practice and patient outcomes. For example, the United States Agency for Healthcare Research and Quality (AHRQ) [ 20 ] stated that the chances of a patient receiving safer care when entering a hospital have increased; an estimated 87,000 fewer patients died from hospital-acquired conditions between 2010 and 2014 in the USA. This not only represents a major improvement in patient safety, but also resulted in estimated savings of $19.8 billion. The US Agency reminded noted that hard work to reduce undesired outcomes had been performed by everyone from front-line staff to nurses, physicians, and hospital administrators. Further, theoretical financial savings from safety improvement and patient involvement were identified by WHO [ 13 , 21 ].

Additional measures to implement safety in practices should be mandatory, such as tools that are mainly evidence-based as well as the education of and outreach to providers and patients, and the widespread use of hospital-based electronic health records. Nevertheless, the practical implementation of evidence-based research to treat unsafe situations remains uncertain. One paradigm case is that of the healthcare-related infections where, although a standardized evidence-based approach to patient safety seems accessible and extremely useful in this field (e.g., hand hygiene guidelines) [ 22 ], WHO recently reported [ 10 ] that the numbers of healthcare-associated infections remain high, affecting up to 10 out of every 100 hospitalized patients, and that a large proportion were preventable [ 23 – 25 ]. A recent systematic review [ 26 ] also observed that 35–55% of healthcare-associated infections were preventable. This suggests that there remains much to be desired in terms of implementation of evidence-based best practices. Further, the levels of reductions in such infections attributable to the implementation of multifaceted, evidence-based interventions are in line with previous estimates [ 27 , 28 ].

Even in high-income countries where a high level of adherence to current recommendations is expected, and despite the existence of evidence-based strategies, a further reduction in the occurrence of these infections of 30–50% is achievable [ 26 ]. In reality, a large discrepancy is emerging between the intention to effect change by employing standard operating procedures and the accurate implementation of such practices in daily practice [ 29 ]. Great potential exists to further decrease hospital-acquired infection rates in a variety of settings. Relevant factors in the success of such programs include the study design, baseline infection rates and type of infection [ 30 ]. Other factors such as global aging trends and comorbidity are likely to require additional efforts to reduce the risk of infections while medical innovations may also reduce this risk due to the emergence of less invasive techniques (e.g., minimally invasive surgery or noninvasive ventilation).

Suggestions for how to address safety improvement in health care can be derived from a literature review of evaluations of interventions. The negative impact of failing to improve quality and safety in health care is a public health issue [ 9 ]. Instead of simply moving onto the next new paradigm, it is worth considering what deficiencies exist in the literature and how these might be rectified [ 31 ].

1.4. Implementing the Research on Patient Safety to Improve Clinical Practice

Evidence-based medicine is the use of the best available evidence to inform decisions about the care of individual patients [ 32 ]. This means that clinical care choices undergo rigorous evaluation instead of having their effectiveness presumed on the basis of subjective experience or arguments relating to the etiopathogenesis of diseases. Despite this, it has been noticed [ 31 ] that implementation efforts typically proceed on the basis of intuition, anecdotal stories of success, or studies that exhibit little of the methodological sophistication seen in the research that established the intervention’s benefit, even after multiple rigorously designed and well-conducted clinical trials have established the benefit of a particular care process.

Systematic reviews of the evidence and clinical practice guidelines that synthesize studies addressing important clinical decisions have been underestimated in clinical practice. A variety of factors have prevented clinicians from acquiring evidence in a reliable and timely fashion. Such evidence would include factors that have been the object of only limited study so far. Other elements of implementing evidence-based medicine that have been glossed over include the following: disagreement with the content of guidelines, which could quickly become out of date or have wide variations in methodological quality; the personal characteristics of providers, for example, their resistance to perceived infringements on physician autonomy; and logistical or financial barriers [ 33 ].

It has also been noted [ 31 ] that research into quality improvement (including patient safety) and the related literature differ from the other biomedical research in two major respects. First, evaluations of specific interventions often fail to meet basic standards for the conduct and reporting of research. Second, and more fundamentally, the choices of particular interventions lack compelling theories that can predict their success or be applied to specific features during their development. Methodological shortcomings in the quality improvement research literature include basic problems with the design and analysis of the interventions as well as poor reporting of the results.

In light of this, a recent review [ 34 ] highlighted that delivering improvements in the quality and safety of health care remains an international challenge. In recent years, quality improvement methods such as plan-do-study-act (PDSA) cycles have been used in an attempt to drive such improvements. This method is widely used in healthcare improvement however there are little overarching evaluations of how it is applied. PDSA cycles can be used to structure the process of change iteratively, either as a standalone method or as part of a range of quality improvement approaches, such as the Model for Improvement (MFI), Total Quality Management, Continuous QI, Lean, Six Sigma or Quality Improvement Collaboratives [ 35 – 37 ].

Despite the increased use of quality improvement methods, the evidence base for their effectiveness is poor and unsubstantiated [ 31 , 38 , 39 ]. PDSA cycles are often a central component of quality improvement initiatives; however, few formal objective evaluations of their effectiveness or application have been carried out [ 40 ]. Some PDSA approaches have been demonstrated to result in significant improvements in care and patient outcomes [ 41 ] while others have demonstrated no improvements at all [ 42 – 44 ]. Thus, evidence of effective quality improvement interventions remains mixed, with literature concluding that quality improvement interventions are only effective in specific settings and are used as “single-bullet” interventions that cannot deliver consistent improvements. Conversely, effective interventions need to be complex and multifaceted [ 45 – 47 ] and developed iteratively to adapt to the local context and respond to unforeseen obstacles and unintended effects [ 48 , 49 ].

Finding effective quality improvement methods to support iterative development to test and evaluate interventions in clinical care is essential for the delivery of high-quality and high-value care in a financially constrained environment. However, in the field of quality and safety improvement, strategies for implementing evidence-based medicine require an evidence base of their own, unlike in other medical disciplines [ 50 ]. Progress in researching quality improvement requires an understanding of the factors driving provider and organizational change. Moreover, possible elements affecting the results of research when implemented in practice, such as organizational factors and human features related to both professionals and patients, have to be considered. Additionally, research into patient safety improvement and its implementation requires looking at the healthcare system as a whole, including professionals, patients, and features of facilities.

Once an intervention to improve safety has been developed, the next step should be a pilot study to confirm that it works or, in other words, a Phase I of clinical studies [ 51 ]. The pilot study should start from a study design that includes the formulation of the hypothesis, the method of sampling the population involved in the study, the choice of and correlations between dependent and independent variables, and the analysis and reporting of results. It is important to ensure that the interpretations and explanations of the efficacy and value of interventions adopted to manage specific patient safety issues are shareable.

Researchers and clinicians working on patient safety improvement should take into consideration the following: how to carry out this particular type of research; if it is correct to consider just a sample or the whole population of patients; what techniques to use in data collection and observation processes; and how to describe the data. All of these elements are essential to support the hypothesis of the study, and to give credibility to both the research methodology adopted and the conclusions of the trial. This kind of research is needed to produce informative, reliable, and evidence-based conclusions that ultimately lead to, from a wider point of view, a change of perspective. To be precise, the aim is to switch the focus from the statistics on patient injuries, damages, and claims, to data derived from clinical trials. Ultimately, the purpose of collecting this data is to propose actions and solutions to deal with the lack of safety in healthcare organizations, and medical treatments.

Empirically-derived models are needed to inform decisions to select specific implementation strategies, based on clinical features of the quality target, organizational or social context, and relevant attitudes and beliefs of providers and patients. These models thereby contribute to improvements to quality and the value of the services delivered, and so help to reduce dramatic statistics that can overshadow the vision of a safer healthcare system. It must be noted that although the iterative development of change (PDSA cycle) is the most validated model to improve quality and safety, no single quality improvement tool can absolutely be considered the best. Preferences depend on the skills of professionals and the type of setting which means choosing one method over another for an organization can be difficult.

The choice of the model is an important decision as it can involve serious risks and costly consequences for healthcare organizations. The integration and adaptation of different models to healthcare settings is generally preferable to choosing only one model. However, the problem is that no formal criteria for evaluating the application or reporting of PDSA cycles currently exist. It is only in recent years, through SQUIRE guidelines, that frameworks for publication that explicitly describe PDSA applications have been developed [ 52 , 53 ]. Such frameworks are necessary to support and assess the effective application of PDSA cycles and to increase their legitimacy as a scientific method for improvement.

1.5. Working Towards Producing Guidelines That Improve Safety Practices

As documents that synthesize current evidence on how to most effectively organize and deliver health services for a given condition [ 54 ], guidelines inform healthcare decision-making and can serve as a basis for policy, planning, evaluation, and quality improvement. “Working towards producing guidelines that improve safety practices” means developing structured processes to write, update, and apply guidelines. The most important element to take into account is the methodology. Consequently, it is fundamental to have a plan that is divided into different steps and that can be summarized as a checklist. In fact, a checklist for developing guidelines should contain a comprehensive list of topics and items outlining the practical steps to consider. The checklist is intended for use by guideline developers to plan and track the process of guideline development and to help ensure that no key steps are missed. Following the steps outlined in the checklist ensures that key items are covered and increases the likelihood of the guideline achieving higher scores when evaluated with credibility assessment tools. Checklists for developing guidelines can be combined with guideline credibility assessment tools like AGREE 1 (Appraisal of Guidelines for Research and Evaluation) [ 55 ] and other tools that may reflect standards established by the Guidelines International Network 2 (GIN) [ 56 ] or Institute of Medicine (IOM).

Organization, budget, planning, and training . These involve outlining a detailed plan describing what is feasible, how it will be achieved, and what resources will be required to produce and use the guideline. The plan should define a specific completion date and be expressed in formal, measurable terms.

Priority setting. This refers to the identification, balancing, and ranking of priorities by stakeholders. Priority setting ensures that resources and attention are devoted to those general areas where healthcare recommendations will provide the greatest benefit to the population, jurisdiction, or country, e.g., chronic obstructive pulmonary disease, diabetes, cardiovascular disease, cancer, and prevention. A priority-setting approach needs to contribute to future plans while responding to existing, potentially difficult circumstances.

Guideline group membership. This defines who is involved and in what capacity, how the members are selected, and in which steps of the development of the guidelines each of them will participate.

Establishing guideline group processes. This defines the steps to be followed, how those involved will interact, and how decisions will be made.

Identifying target audience and topic selection. This involves defining the potential users or beneficiaries of the guidelines and defining the topics to be covered in the guideline (e.g., the diagnosis of chronic obstructive pulmonary disease).

Beneficiary and other stakeholder involvement. This describes how relevant people or groups who are not necessarily members of the panel (e.g., as the beneficiaries or users) will be affected by the guidelines and involved in their development.

Conflict of interest considerations. This focuses on defining and managing the potential divergence between an individual’s interests and his or her professional obligations. These considerations lead to questions about whether actions or decisions are motivated by gain, such as financial, academic advancement, clinical revenue streams, or community standing. Financial, intellectual, or other relationships that may affect an individual’s or organization’s ability to approach a scientific question with an open mind are included.

Question generation. This focuses on defining key questions the recommendations should address using the PICO (patient/problem, intervention, comparison, outcome) framework, including the detailed population, intervention (including diagnostic tests and strategies), and outcomes that will be relevant in decision-making (e.g., in chronic obstructive pulmonary disease, should test A or treatments B, C, D, or E be used?).

Considering the importance of outcomes and interventions, values, preferences, and advantages. This includes integrating how those affected by recommendations should assess the possible consequences into the process of developing guidelines. These considerations can include: (a) patient, caregiver, and healthcare provider knowledge, attitudes, expectations, moral and ethical values, and beliefs; (b) patient goals for life and health; (c) prior experience with the intervention and the condition; (d) symptoms experienced, e.g., breathlessness, pain, dyspnea, weight loss; (e) preferences relating to and importance of desirable and undesirable outcomes; (f) perceived impact of the condition or interventions on quality of life, well-being, or satisfaction; (g) interactions between the work of implementing the intervention, the intervention itself, and patient experiences; (h) preferences for alternative courses of action; and finally, (i) preferences relating to communication content and styles, information and involvement in decision-making and care.

Deciding what evidence to include and searching for evidence. This focuses on outlining inclusion and exclusion criteria based on types of evidence (e.g., rigorous research or anecdotes), study designs, characteristics of the population, interventions, and comparators. It also covers deciding how the evidence will be identified and obtained, which should not be limited to evidence about values and preferences, local data and resources.

Summarizing evidence and considering additional information. This focuses on presenting evidence in a synthetic format (e.g., tables or brief narratives) to facilitate the development and understanding of recommendations. It also involves identifying and considering additional information relevant to the question under consideration.

Judging quality, strength, or certainty of a body of evidence . This consists of assessing the confidence one can place in the evidence obtained by transparently evaluating the research (individual- and group studies) and other evidence applying structured approaches. This may include, but is not limited to, evidence about baseline risk or burden of disease, the importance of outcomes and interventions, values, preferences, benefits and drawbacks, use of resources (e.g., finance), estimates of effects, and accuracy of diagnostic tests.

Developing recommendations and determining their strength. Developing recommendations involves the use of a structured analytical framework and a transparent and systematic process to integrate the factors that influence a recommendation. Determining the strength of the recommendations refers to judgments about how confident a guideline panel is that the implementation of a recommendation will exert a greater number of desirable consequences than undesirable ones.

Wording of recommendations and of considerations about implementation, feasibility, and equity. This refers to choosing syntax and formulations that facilitate the understanding and implementation of the recommendations, accounting for the views of the guideline panel.

Reporting and peer review. Reporting refers to how a guideline will be made public (e.g., print, online). Peer review refers to how the guideline document will be reviewed before its publication and how it can be assessed (e.g., for errors), both internally and externally, by stakeholders who were not members of the guideline development group.

Dissemination and implementation. This focuses on strategies to make relevant groups aware of the guidelines and to enhance their uptake (e.g., publications and tools such as mobile applications).

Evaluation and use. This refers to formal and informal strategies that allow the evaluation of (a) the guidelines as a process and product; (b) their use or uptake, or both; and (c) their impact and whether or not they will lead to improvements in patient or population health or other consequences.

Updating. This refers to how and when a guideline will require revision because of changes in the evidence or other factors that influence the recommendations.

Is there enough evidence to make recommendations?

How should we apply recommendations to individual patients?

With respect to the evidence to make recommendations, guideline development tools have, since their inception in 2003, increasingly included the GRADE approach [ 58 – 60 ]. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was created by the eponymous working group ( www.gradeworkinggroup.org ), which is a collaborative project, consisting mainly of methodologists and clinicians. It provides a framework for assessing the quality (or “certainty”) of the evidence supporting, inter alia, guideline recommendations and therefore their resulting strength [ 61 ]. Essentially, GRADE classifies recommendations as “strong” when a specific, recommended intervention or management strategy would be chosen, on reasonable grounds, by a majority of patients, clinicians, or policymakers in all care scenarios. In contrast, such recommendations would be classified as “weak” when there is a reasonable range of choices, reflecting the following possible factors: limited evidence quality, uncertain benefit-harm ratios, uncertainty regarding treatment effects, questionable cost-effectiveness, or variability in values and preferences [ 62 ]. Further, the GRADE evidence-to-decision framework helps guideline developers to structure their process and evaluation of available evidence [ 59 ]. Nonetheless, a trade-off between methodological rigor and pragmatism is required [ 63 , 64 ].

Concerning the issue of applying recommendations to individual patients, it has been observed that practices from guidelines vary considerably and translating guidelines into practice can fail to close gaps that have been identified, both in the scope and the follow-up of interventions [ 65 ]. Education for professionals and/or patients is a good strategy to ensure the implementation of guidelines. Nonetheless, another substantial influence on the ability to implement guidelines is how their implementation has already been built into the guideline development process. The planning of implementation provides a set of concrete, actionable steps to take during the implementation phase [ 66 , 67 ]. The central elements of successful implementation approaches appear in: their target-oriented dissemination, education and training, social interaction, decision support systems and routine procedures, thereby tailoring implementation strategies to settings and target groups [ 68 ]. To assist guideline developers regarding implementation, a tool with context-specific implementability features for the whole guideline process has been developed [ 69 ].

Further, clinicians must balance the risks and benefits of any guideline recommendation for an individual patient and consider that patient’s preferences. If the patient does not adhere to care recommendations, health benefits will not be maximized or perhaps even realized. Clinical decisions should be based on guideline recommendations, but all decisions must be individualized according to a patient’s risk-benefit ratio and incorporate patient preferences through shared decision-making. Clinician leadership in quality improvement efforts and administrative support are key drivers of quality and safety improvement through care-integrated tools and aligned incentives aimed at achieving meaningful guideline implementation.

One of the most prominent developments in the area of guideline implementation in recent years has been the increased utilization of information technologies to facilitate: (a) push mechanisms for guideline adherence, such as decision support components integrated into clinical management software, for example, alerts, reminders, or routine procedures [ 70 ]; (b) the use of guidelines at the bedside, available on, for example, mobile guideline apps; (c) the faster and potentially real-time updating of individual guideline recommendations as new evidence emerges, for example, by adding “living guidelines” [ 71 , 72 ]. Observational data is necessary to describe current health provision and its quality, pinpoint potential patient groups that are adequately covered by guideline recommendations, and identify gaps and issues to be resolved by clinical research. This data is also vital for identifying late onset treatment harms and drug safety issues.

1.6. The Challenges of Improving Safety and the Current Limits of Guidelines

Guidelines are expected to be focused on broad and complex topics, on developing standards to guide healthcare organizations, on providing best practice recommendations for patient care, and on informing the clinical decision-making of health professionals. Successfully incorporating all of these factors into features of guidelines is particularly difficult in today’s age of complexity and multimorbidity. This is an age which is also characterized by the desire for personalized medicine and the ambition to push the frontiers of modernization, for example, by introducing artificial intelligence into health care. Thus, beyond the methodological quality of the guideline itself, there are many relevant aspects which represent challenges or limits to take into account regarding guidelines and their applicability.

The first challenge is to improve the effectiveness of a guideline—especially regarding how it improves the safety of care—while also focusing on patient-centeredness; this principle consists of (a) properly taking into account the needs and preferences of patients and of their caregivers and (b) supporting professionals in improving their practice. These dimensions are fundamental to the delivery of care and to patient outcomes as well [ 73 – 75 ]. Patient-centeredness constitutes a more recent focus of the discussion around the development and use of guidelines [ 76 ]. Guidelines can facilitate patient education, engagement, and shared decision-making, thus assuring that individual patient values are balanced against the desired outcomes, which are embedded in the trials that form the basis of guideline recommendations. Different modalities of patient involvement exist in different contexts. The two most studied ones are (a) patient group representatives, who are sometimes involved in the guideline development process and (b) guideline documents, which are increasingly produced in different formats for practitioners and patients [ 77 – 81 ].

Another challenge is related to the speed with which medical knowledge progresses and the pace of knowledge production at the primary research level. Guideline recommendations are expected to be kept up to date but a relatively recent, comprehensive review of this issue [ 82 ], concluded that 1 in 5 recommendations is out of date 3 years after being launched and that longer updating intervals are potentially too long. Additionally, the development and updating of clinical guidelines represents a challenge because of the speed and resources required for producing and especially updating them. Approaches that can result in efficient and potentially real-time updating of guideline recommendations as new evidence emerges have been discussed, particularly in the form of living systematic reviews and living guidelines [ 71 , 83 – 85 ].

With regard to limitations, there are different aspects to consider. Maybe the most restrictive limitation regards the evaluation of the costs of the guideline development process, compared with the effectiveness of guidelines, once they are implemented. This limitation particularly relates to the use (or under-use) of cost-effectiveness analyses as a part of the development process of clinical guidelines and their related challenges or opportunities [ 86 ]. A comprehensive cost-effectiveness analysis should cover the costs of the development and of the guideline dissemination/implementation processes, and the change in the effectiveness of health service by putting the guideline into practice. However, data on the costs of guideline development is scarce and, given the vast variability of settings and practices, likely not generalizable [ 87 ]. As has been already pointed out [ 88 ], only 27% of 200 studies on guideline implementation strategies (of which only 11 were from Europe) had some data on cost and only 4 (2%) provided data on development and implementation. Most of the relevant studies only partially accounted for the costs incurred in the process of guideline production. In some contexts, active implementation seemed to require a substantial upfront investment compared to general dissemination practices. Furthermore, the results regarding optimized processes of care and improved patient outcomes were not sufficient to render them cost-effective [ 89 , 90 ].

Another relevant limitation is that the concept of a guideline-based quality indicator framework has so far been inadequately elaborated, despite the fact that performance measurement sustains the relationship between clinical guidelines and healthcare data. More and more guideline groups have developed quality indicators along with sets of recommendations [ 91 ]. Usually, these indicators are primarily intended as general performance measures. However, a closer look at measurement results can provide insights into the extent to which practice reflects guideline recommendations. In other words, the indicators inform us on the extent of guideline adherence, and consequently feed into how they are shaped. Moreover, an overview of country-specific practices [ 5 ] clearly demonstrates how divergent guideline practices can be, especially when viewed as strategies for the improvement of healthcare quality. The context-specific nature of guidelines persists, despite their adaptability to the practices of different countries. In the past, the quality of clinical guidelines was narrowly defined according to how closely recommendations were linked to scientific and clinical evidence [ 92 ]; however more recently, researchers have explicitly addressed the question of whether guidelines should be systematically pilot-tested in care delivery settings before being finalized [ 93 ].

Switching the focus to how guidelines are implemented, newer studies have shown mixed results regarding the effect of guidelines on outcomes but established a clear link between implementation modalities and patient outcomes [ 94 – 97 ]. Barriers to the adoption of or adherence to guidelines by clinicians have been discussed in the literature. Substantial gaps were found in the evidence on the effectiveness of implementation interventions, especially regarding clinical outcomes, cost-effectiveness, and contributory contextual issues [ 98 ]. Barriers included time constraints, limited staffing resources, clinician skepticism, clinician knowledge of guidelines, and the age of the clinician. The characteristics of guidelines, such as format, resources, and end-user involvement, were identified as facilitating factors, along with stakeholder involvement, leadership support, and organizational culture (including multidisciplinary teams and electronic guidelines systems).

Beyond challenges and limits, there is the issue of editorial independence in clinical guideline development. Implementing guideline recommendations that have been created in irregular conditions is not only ethically questionable but may also endanger quality of care, as the content may not actually reflect best available evidence. To give an example of irregular conditions, an international survey of 29 institutions involved in clinical guideline development found variability in the content and accessibility of conflict of interest policies; some institutions did not have publicly available policies and, of the policies available, several did not clearly report critical steps in obtaining, managing, and communicating disclosure of relationships of interest [ 99 ]. While financial conflicts of interest seem to have been adequately disclosed in the most rigorously developed guidelines, active management of existing conflicts of interest has lagged behind [ 100 – 103 ]. Beyond measures to address direct financial conflicts of interest, the management of indirect conflicts of interest is also important in guideline development. Such indirect conflicts can include issues related to academic advancement, clinical revenue streams, community standing, and engagement in academic activities that foster an attachment to a specific point of view [ 104 ]. Ensuring that guidelines are developed on the basis of robust consensus processes by a multidisciplinary panel can contribute to mitigating the effects of such conflicts [ 105 ].

Systematically developed, evidence-based clinical guidelines are in widespread use as a strategy to improve the quality of healthcare services and consequently the safety of care. However, the rigor of their development, their mode of implementation, and the evaluation of their impacts should be improved in many settings to enable their goal of achieving safer healthcare practices. One of the most important knowledge gaps in this respect is the extent to which guidelines affect patient outcomes and how this effect can be enhanced to ensure better care. For that purpose, both quantitatively measured parameters and patient experience should be taken into account. Today, technology and clinical decision support solutions are readily available to help transform research into practice and recommendations. These solutions take clinically approved best practice guidelines and match them with each patient to provide a recommended and customized care pathway for optimal outcomes. They can also be configured to meet the needs of each organization, taking into consideration local needs and practices [ 8 ].

1.7. Recommendations

The improvement of patient safety should be based on evidence-based recommendations included in well-developed guidelines, which should in turn be rigorously implemented in clinical practice as the best safety practice.

More scientific research into healthcare quality and safety improvement is needed, the results and effectiveness of which should be shared across the scientific community worldwide.

To face the challenges of a changing healthcare sector in today’s age of multi-morbidities, tutors, researchers, caregivers, and patients should work together to address the current limits of clinical guidelines.

The AGREE (Appraisal of Guidelines for Research and Evaluation) Collaboration developed the most commonly used instrument to assess the quality of a guideline. The instrument comprises 23 criteria grouped in six domains (addressed by the AGREE II): scope and purpose; stakeholder involvement; rigor of development; clarity and presentation; applicability; and editorial independence.

The work of the Guidelines International Network ( http://www ​.g-i-n.net/ ) promotes the dissemination of guideline-related content and provides an exchange platform for guideline developers and users. Further, the GIN provides reporting guidance for guideline-based performance measurement tools.

Open Access This chapter is licensed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

The images or other third party material in this chapter are included in the chapter's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the chapter's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

• Cite this Page Ricciardi W, Cascini F. Guidelines and Safety Practices for Improving Patient Safety. 2020 Dec 15. In: Donaldson L, Ricciardi W, Sheridan S, et al., editors. Textbook of Patient Safety and Clinical Risk Management [Internet]. Cham (CH): Springer; 2021. Chapter 1. doi: 10.1007/978-3-030-59403-9_1
• PDF version of this page (352K)

In this Page

• Introduction
• The Need to Understand Guidelines Before Improving Safety
• The Current Patient Safety Picture and the Demandfor Guidelines
• Implementing the Research on Patient Safety to Improve Clinical Practice
• Working Towards Producing Guidelines That Improve Safety Practices
• The Challenges of Improving Safety and the Current Limits of Guidelines
• Recommendations

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CDC’s Respiratory Virus Guidance  provides strategies you can use to help protect yourself and others from health risks caused by COVID-19 and other respiratory viruses. These actions can help you lower the risk of COVID-19 transmission (spreading or catching COVID-19) and lower the risk of severe illness if you get sick.

Core Prevention Strategies

CDC recommends that all people use core prevention strategies to protect themselves and others from COVID-19:

• Although vaccinated people sometimes get infected with the virus that causes COVID-19, staying up to date on COVID-19 vaccines significantly lowers the risk of getting very sick, being hospitalized, or dying from COVID-19.
• Practice good hygiene  (practices that improve cleanliness)
• Take steps for cleaner air

When you are sick:

• Learn when you can go back to your normal activities .
• Seek health care promptly for testing and/or treatment if you have risk factors for severe illness . Treatment may help lower your risk of severe illness, but it needs to be started within a few days of when your symptoms begin.

Additional Prevention Strategies

In addition, there are other prevention strategies that you can choose to further protect yourself and others.

• Wearing a mask and putting distance between yourself and others  can help lower the risk of COVID-19 transmission.
• Testing for COVID-19 can help you decide what to do next, like getting treatment to reduce your risk of severe illness and taking steps  to lower your chances of spreading COVID-19 to others.

Key Times for Prevention

Using these prevention strategies can be especially helpful when:

• Respiratory viruses, such as COVID-19, flu, and RSV, are causing a lot of illness in your community
• You or those around you have risk factors  for severe illness
• You or those around you were recently exposed to a respiratory virus, are sick, or are recovering

Check Your Community

Find out if respiratory viruses are causing a lot of illness in your community. Data updated weekly.

Learn more about all three of these respiratory viruses, who is most at risk, and how they are affecting your state right now. You can use some of the same strategies to protect yourself from all three viruses.

Get the Latest on COVID-19, Flu, and RSV

• COVID-19 Testing
• COVID-19 Vaccines
• COVID-19 Treatments and Medications
• Preventing Respiratory Viruses
• Protect Yourself from COVID-19, Flu, and RSV

Additional Resources

• Respirators and Masks
• Improving Ventilation in Your Home
• Improving Ventilation In Buildings

Search for and find historical COVID-19 pages and files. Please note the content on these pages and files is no longer being updated and may be out of date.

• Visit archive.cdc.gov for a historical snapshot of the COVID-19 website, capturing the end of the Federal Public Health Emergency on June 28, 2023.
• Visit the dynamic COVID-19 collection  to search the COVID-19 website as far back as July 30, 2021.

To receive email updates about COVID-19, enter your email address:

Exit Notification / Disclaimer Policy

• The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.
• Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
• You will be subject to the destination website's privacy policy when you follow the link.
• CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website.

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Safety Strategies Every Nurse Leader Needs to Know

3 min read • September, 12 2023

Establishing a culture of safety in health care is essential to the security and well-being of your patients, staff, and organization. Effective nurse leaders embrace safety protocols that ensure their organization delivers a secure, protective environment that prioritizes patients and caregivers.

Establish Effective Communication Protocols

Open dialogue and team collaboration are ways nurses can improve patient care. Establishing a solid rapport with patients and listening to their concerns can help prepare the nursing staff to identify potential safety issues. Clear communication within and across teams is essential. When nurses, physicians, and support staff collaborate on patient care, they can clarify roles and responsibilities and eliminate potential mistakes or misunderstandings. Shared communication is especially crucial during shift changes. Transitions require smooth handoffs of a patient’s records, medication updates, and ongoing treatment plans. Make sure to also communicate with your health care team and ask about and quickly address their safety concerns. Communication with your facility’s safety professionals, risk managers, and employee health providers is essential to understanding and preventing safety lapses, accidents, and injuries.

Stay Current on New Procedures and Equipment

When new procedures are being planned, such as switching from paper records to electronic files, it’s essential to thoroughly train staff before implementation. The same is true with new equipment. Proper training on a device is essential before it’s put into use. Consider step-by-step directions on using new equipment for training and as a refresher for staff.

Understand and Follow Regulatory Safety Guidelines

To promote a culture of safety in the health care field, nurse leaders ensure staff members adhere to guidelines and recommendations established by the American Nurses Association (ANA) as well as the Centers for Disease Control and Prevention (CDC) , the Occupational Safety and Health Administration (OSHA) , The Joint Commission , and The Centers for Medicare & Medicaid Services (CMS) . These organizations provide guidelines for infection control measures, accurately documenting patient records, implementing proper medication safety guidelines, and cover many additional topics to promote a culture of safety in health care.

Utilize Evidence-Based Practice

A nurse’s role in patient safety involves keeping up with the latest research findings from reputable sources, including clinical practice guidelines and journals. Nurses can provide safer patient care and better outcomes by learning how to incorporate evidence-based practice into daily routines.

For staff safety, familiarize yourself with your unit’s staff injury records, and speak with the person who maintains your facility’s OSHA 300 Log of recordable illnesses and injuries. This will give you vital information on the number, type and severity of the injuries reported in your unit and help you better target prevention efforts.

Be Diligent and Proactive

Nurse leaders must always remain attentive to potential risks and safety issues within their unit. They should encourage their staff to report incidents that could harm patients, staff, and others. Fostering an open communication environment empowers nurses toward corrective actions.

Think Like a Safety Professional

Safety professionals work hard to ensure untoward events never happen. They do this by using the Hierarchy of Controls for hazards in the workplace . Whenever possible, these safety experts remove the risk (elimination). If they can’t eliminate it, they can try to switch the hazard to something less harmful (substitution). If that isn’t possible, they can take measures to keep people away from the hazard (engineering control) or change how people interact with it (administrative control). The least effective method is using personal protective equipment (PPE). Health care professionals used all these methods during the pandemic to combat COVID-19. They separated suspected COVID-19 patients from non-COVID-19 patients, used isolation rooms with negative airflow, non-essential staff worked remotely, and frontline caregivers wore isolation gowns and N95 masks.

Initiate a Workplace Safety Response Team

Assembling a multidisciplinary response team with staff representation throughout the organization advances a safe culture in health care. Getting perspectives on safety-related issues from a diverse group reinforces teamwork and collaboration and ensures all voices are heard. Be sure to collaborate with your current safety committee and security team.

Manage Workloads and Staff Burnout

When nurses are overworked, stressed, and fatigued, errors are bound to happen. Nurse leaders must recognize the signs of fatigue and burnout that can compromise patient safety and take steps to alleviate these issues. Nurse leaders can be the support system their staff and patients deserve by advocating for flexible schedules, wellness programs, and adequate staffing .

Implement Safety Protocols

There are several ways to establish a culture of safety in the nursing environment. Nurse leaders can implement protocols that put the safety and well-being of their staff and patients at the forefront.

Patient Identification Procedures

Ensure strict protocols are in place for accurate patient identification. Incorporating a two- or three-step proof of identity before administering medications or care can help avoid potentially serious mistakes.

Fall Prevention

A fall can be devastating for a patient with compromised health. Establish strategies for preventing falls, such as assessing and monitoring high-risk patients, using assistive equipment, and keeping patient surroundings free from clutter and hazards.

Safe Medication Administration

Every nurse learns the “five rights” of administering medication through education and training. This safety protocol covers:

• The right patient
• The right drug
• The right dose
• The right route
• The right time

By strictly adhering to this protocol, you can eliminate medication errors. Additional procedures, like double-checking drug orders and using barcode scanning systems, further reinforce a safety culture in healthcare.

Sharps Injury Prevention

The safe use and disposal of sharps is a critical health and safety issue, and blood-borne pathogens present a significant level of risk in the health care work environment. It’s essential to review and update your sharps injury prevention program annually.

Safe Patient Handling

Injuries and musculoskeletal disorders (MSD) are often caused by manually lifting patients, and nurses are at high risk every day. MSDs are responsible for more lost work time, long-term medical care needs, and permanent disabilities than any other work-related injury. Having a robust Safe Patient Handling program is essential to prevent patient handling injuries.

Workplace Violence Prevention

Workplace violence (WPV), incivility, and bullying in the workplace are serious issues in nursing. This under-reported epidemic has devastating results on the health care industry. Studies show that WPV can affect the quality of care and outcomes, contribute to the development of psychological conditions, and reduce the RN's level of job satisfaction and organizational commitment. Find support and resources to improve your WPV Prevention Program .

Nurses are frontline health providers and face daily safety risks. By training and empowering your nursing staff to advocate for protecting their patients — and themselves — you’re fostering a caring and transparent culture of safety that instills greater staff satisfaction and better patient outcomes .

Explore more safety tips from ANA’s Health & Safety resources and the ANCC Pathway to Excellence team .

Images sourced from Getty Images

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Coronavirus Tips: Prevention and Safety For Everyday Life

A comprehensive guide of coronavirus tips

The coronavirus (COVID-19) pandemic is over half-a-year old and while daily case numbers have come down from their mid-summer peak, they still remain at high levels across the country.

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Meanwhile, the transition to flu season is underway, meaning it’s more important than ever to stay on top of guidelines, best practices and your health to prevent the spread of both COVID-19 and influenza.

While there are still so many unknowns about the coronavirus and information is constantly evolving, a set of guidelines and coronavirus tips have long since solidified that will help protect you and your family as much as possible in the fight to stay COVID-free.

General coronavirus tips for public places

Throughout the pandemic, several practices have been established as a cornerstone of coronavirus protection. And while many of us have made these part of our routine, it’s still important to remind ourselves — and others — of their importance.

Wearing a mask is vital to protecting yourself and those around you from spreading the virus. Because so many coronavirus cases can be asymptomatic, wearing a mask protects others in close proximity in case you’re exhaling virus-laden droplets into the air around you.

A mask should also help with another precaution: don’t touch your face. While it’s not the primary way the virus is spread, it’s still possible to pick up the virus off a surface and infect yourself by touching your mouth, nose or eyes.

Also be sure to wash your hands regularly and thoroughly with soap, especially after returning to your home from being out in public. It’s important, too, to lather your hands with soap for at least 20 seconds to get them fully clean. A good practice is to keep a small bottle of hand sanitizer handy, especially if you’re out and about without immediate access to a bathroom.

Finally, be sure to socially distance yourself from others, staying at least 6 feet away. Because of the distance that exhaled droplets can travel, you want to make sure you’re not too close to someone, even if they don’t show any symptoms. And, yes, that includes even when you’re wearing a mask.

Coronavirus tips for going to restaurants

Going out to eat is a luxury we had to do without in the early days of the pandemic with restaurants largely reduced to offering take-out options only. In recent months, though, more eateries have reopened for dining-in.

But a recent CDC study found that “Adults with positive SARS-CoV-2 test results were approximately twice as likely to have reported dining at a restaurant than were those with negative SARS-CoV-2 test results.”

Those results applied to people eating at any place in the restaurant, both inside and outside. The reason, according to the report, is because proper social distancing is often difficult in a restaurant setting and that masks are removed to eat and drink, meaning the chances of spreading the virus via respiratory droplets are increased.

Still, many feel comfortable returning to dine-in options, so here are some rules to follow.

Eat on the patio

Many restaurants are offering additional outdoor spaces. Some municipalities have even allowed for expanded outdoor seating areas so restaurants can seat more customers outdoors. And for good reason: there’s less risk of transmission of the virus via recirculated droplets expelled by infected eaters.

Being in the open air of a patio cuts down on the risk of virus-infected air droplets recirculating as it can indoors, especially if tables are spaced out appropriately.

If you’ve got a restaurant in mind, call ahead to see what policies the restaurant has and if they offer patio dining. If not, see what their policy is for dining indoors and what reservation options, if any, are available. Also, ask about hours and consider going at off-peak times for visiting, meaning a less crowded restaurant and lower exposure risks.

Wear a mask

This is a tricky one because, as mentioned before, you have to take your mask off to actually eat and drink. Do your best to wear a mask at all points when you’re not eating and drinking and when you walk through crowded parts of the restaurant, such as when you’re waiting in the lobby or going to the restroom.

Get delivery or takeout

Delivery and takeout are still the best, safest options right now. Even eating on an outdoor patio doesn’t diminish the risk of exposure considering social distancing and mask issues that come with eating at a restaurant. In any situation where you have to remove your mask for prolonged periods of time, there’s going to inherently be a better chance of contracting the virus.

Coronavirus tips for travel

Whether for a vacation, work or another matter, traveling is still happening across the country via all the usual methods. Some means of transportation have higher risks than others and there are many other factors to consider when hitting the road.

But, says pulmonary and critical care physician Joseph Khabbaza, MD , there are still ways to plan for safe travel. “By following the guidelines and precautions as they’ve been laid out over the past several months, like social distancing and wearing masks, it’s possible to have safe travel experiences,” he says.

Consider where you’re coming from…

First, be sure to be aware of what the COVID-19 levels are for the community in which you live. Because of the risk of asymptomatic spread, you could carry the virus from a high-spread location to a low-spread location.

…And consider where you’re going

Just as you want to know the levels of spread where you live, you need to know what the COVID-19 levels are like where you’re going. If they’re particularly high or have seen a sharp rise recently, reconsider your visit. You’d be traveling into a hot zone that will put you at greater risk of catching the virus.

Check travel restrictions

Many states and local governments have also implemented travel restrictions that may require a quarantine period once you arrive so be sure to check your destination’s guidelines. Likewise, check the guidelines for your home locale because your destination may be on a travel restriction list requiring you to quarantine when you get back, which has additional logistical consequences.

The same goes for international travel since many countries have put heavy restrictions on accepting visitors from the United States due to our high caseload.

Car trips are best

If you’re up for it, hitting the road in your car is best, especially when limiting your passengers to those in your immediate circle, like family members. Just be sure to clean and disinfect your car thoroughly before, during and after your trip.

Designate a low-risk person to be the gas-pumper and food-runner for most stops; this helps limit the exposure of everyone in your traveling party. Just make sure anyone who leaves the car wears a mask and washes their hands before returning. And, for good measure, take the time to wipe down and disinfect the car again after longer stops.

While wearing a mask in the car isn’t as imperative if you’re traveling with members of your household, consider wearing them if you’re traveling with people from outside that circle or people who are at high-risk.

Staying safe on planes

Not every trip can be handled by car, of course. And with airlines offering deep discounts to encourage people to fly, it can be a much cheaper option. But there are still risks involved, particularly in terms of contact before and during the flight.

While there may be fewer people flying these days due to the virus, you’ll still find yourself in security and boarding lines as well as potentially crowded seating areas. Be sure to follow the standard protocol when in these situations — as much distance as possible, wear a mask and wash your hands after.

As for the flight itself, most airlines are disinfecting planes and taking distancing precautions. And airplanes use circulated and filtered air from outside to help keep air in the cabin scrubbed, lowering the chances of the virus spreading. Just be sure to wear a mask, even if the airline you’re flying doesn’t require it.

“Flying can be done safely,” says Dr. Khabbaza. It’s simply up to you to determine your risk factor. “Whether or not you choose to fly should be based on your own considerations of what risks you’re willing to tolerate, including COVID-19 rates both at your destination and where you’re traveling from.”

Coronavirus tips for grocery shopping

Grocery shopping is an essential part of our lives that can’t stop in the face of a pandemic. That means we have to take a new approach for shopping trips, be it for food or other supplies like toilet paper.

Designate a shopper

In the pre-pandemic days, the whole family might load up in the car for a trip to the store. Under the new coronavirus reality, though, it’s time to reconsider how you shop .

That means limiting the number of people from your household who make the trip. While it can be helpful to have multiple people on a grocery trip, by designating one person as the regular shopper, you limit the potential exposure. It’s also helpful in keeping high-risk people home and away from that danger.

Minimize your shopping trips

Scaling back the number of trips is also key to limiting potential exposure to the virus. While you might be used to running out to the store several times a week whenever the need for something arises, the fewer trips now the better. Meal-planning and creating a list beforehand can both help you make fewer trips and help make those trips shorter so you can get in and out quickly.

Also, ask yourself if what you want to get at the store is really necessary. More milk for the kids? Sure. A box of candy to satisfy a craving? You’re safer (and a bit healthier) skipping that one.

Choose a low-traffic time

Many grocery store chains are offering special hours for older and at-risk shoppers to keep exposure risks low. If you don’t fall into this category, though, picking a low-traffic time can be a bit trickier since so many people have the same idea.

“Everybody’s going shopping early or late not to avoid those peak times,” says infectious disease expert Frank Esper, MD . He adds, though, that the main objective isn’t so much about how many other shoppers there are but about keeping your distance. “The primary thing is to stay a safe distance from others, to avoid contact and try to give each other plenty of space in the aisles.”

Wear a mask and avoid touching too many surfaces

As with all the other activities, wearing a mask is important not just because it protects you but because it also protects those around you given the possibility of asymptomatic spread. It’ll also help keep you from touching your face.

Speaking of touching, while you may be used to picking up items off the shelf just to examine them, try to limit this to only products you intend to put in your shopping basket. While picking the virus up from a surface isn’t the primary means of transmission, it’s still possible.

This goes for the handle on your cart, too. While many stores are working hard to keep them clean and sanitized, be sure to wipe the cart handle both before and after you use it for shopping, if possible. And keep a travel bottle of hand sanitizer on hand so you can give your hands a quick clean throughout your trip and as soon as you leave the store.

Get delivery or curbside pickup

The safest option for grocery collection is, still, using a delivery service or a curbside pickup option. There are logistical hurdles with this method, of course, like picking a substitute if the store doesn’t carry the product you’re looking for or even changing your mind about what you want or need mid-trip.

Still, many delivery and pickup options allow for substitution selection and this method is the safest way, greatly limiting your exposure to anyone who may be carrying the virus.

Coronavirus tips for going to the gym

A source of healthy activity and exercise for many, gyms have an added hurdle when it comes to safe reopening. Just by the nature of these spaces — dozens of exercisers sweating profusely and huffing and puffing in an indoor setting for hours at a time — there’s an elevated risk of transmission.

As sports medicine specialist Caitlin Lewis, MD , notes, it can be hard to maintain social distancing measures at a gym. “People are crowded together more in a gym and it’s a relatively confined space,” she says. “You’re at risk of being in closer contact with people coughing, sneezing and breathing heavily.”

Think of those rows of treadmills and elliptical machines. On a busy day, those parts of the gym can create a stew of respiratory and sweat droplets, not exactly the safest environment. Many gyms have responded by imposing social distancing rules which include limiting the number of these machines available but there are still inherent risks in heading in for a workout.

Here’s what you can do to keep yourself safe during your workouts .

Check your gym’s guidelines

Every gym is different when it comes to coronavirus guidelines. Before you head out, be sure you know what new standards your gym has set. Whether it’s social distancing rules, closing down locker rooms and other portions or special hours, know the new rules so you can more easily navigate your workout.

Wear a mask and stay distant

All the social distance measures you’re following everywhere else should especially be followed at the gym. Stay at least six feet from others even if the gym’s guidelines already implement these practices. Make sure you steer clear of everyone as you maneuver your way through the various weights, machines and the locker room.

Bring your own water and towel

Bringing your own water isn’t just about ensuring your safety as it helps avoid shared water fountains where germs can easily spread, it’s also practical. Besides, many gyms (and other public spaces) have shut down water fountains due to the pandemic.

If you use a towel to wipe away sweat during heavy-duty workouts, be sure to bring your own from home. Just be careful where you use it; you don’t want to wipe your face with it after you’ve wiped away another exerciser’s sweat.

Wipe down EVERYTHING

Most gyms already offer wipes or paper towels and spray for cleaning equipment after use, which is a safer option than that aforementioned towel of yours. Be sure to familiarize yourself with your gym’s offerings and wipe down shared equipment both before and after use for the safest workout.

Be flexible with your workout plan

Because of restrictions many gyms have in place — from different hours to a limited number of machines — you’ll need to be flexible when heading in for a workout. It may also be hard to main proper social distancing guidelines while doing a particular workout so you might have to switch up exercises. So while you may have a plan going in, it’s a good idea to have a Plan B and Plan C, too.

Work out at home

While you may be craving getting in your reps at your trusty gym, the fact is that, right now, the safest place for any workout is your home. While you might not have the same equipment that your gym does, there are still plenty of options for making your abode the center of your exercise routine.

And if you need a change of scenery, there are plenty of outdoor activities — hiking, running, cycling — that are safe and are easily doable within social distancing guidelines. Even if it’s not at a gym, Dr. Lewis says, “Movement of any kind, even just a short walk with family, is good for both our mental and physical health.”

Coronavirus tips for personal care appointments

The pandemic has also thrown a curveball in terms of keeping up physical appearances and other points of body care. Some are a bit more difficult to take care of than others but they’re all worth considering.

Haircuts and salon visits

Given what we’ve learned about the virus since the start of the pandemic, getting a haircut or hair treatment at your salon is probably safe — as long as your salon or barbershop is taking the proper precautions. Because of the length of time these visits take, masks and social distancing are extremely important.

Call ahead and see what guidelines your preferred salon is following. And, if it feels like a safe environment, consider booking an appointment at an off-peak time, if possible, to limit potential exposure. Ultimately, though, it’s up to you and how comfortable you feel — and how good you are (or aren’t) at cutting your own hair.

Massages and spas

In the days of immense stress, getting a massage or taking a spa day can bring not just physical release but also emotional relief. The downside? The close, physical contact that’s required. Before you book a massage or spa day, call ahead to see what guidelines are being taken and what options are available.

Nail salons

Like spas and massages, getting a manicure or pedicure can offer an emotional uplift, something that makes you feel good about yourself and provides a bit of stress relief.

But, also like massages, the amount of contact can raise the risk of exposure. Call ahead and see what your nail salon’s guidelines are and, specifically, if they require masks and social distancing. As with massages, getting a manicure or pedicure will put you in close contact with someone so be sure to take the potential risks into account.

Going to your favorite cosmetics store to re-up on makeup or other supplies should generally be pretty safe, very similar to visiting a grocery store, as long as all precautions and guidelines (social distancing, mask-wearing) are followed. And, like grocery store visits, try to keep these shopping trips short and to a minimum. The more you linger and the more you go, the more exposure you’re risking.

One aspect, though, that’s inadvisable is sampling anything. While most locations and counters already had sanitizing precautions in place before the pandemic and many locations have discontinued sampling, you may come across a location that still does. It’s best to avoid this altogether given the risk such activity would place on exposure.

Coronavirus tips for going to back-to-school

One of the more complicated questions facing parents is how to manage their kids’ education during the pandemic. Some school districts are holding in-person classes while some are doing only remote-learning and yet others are taking a hybrid approach. And there’s the even more complicated nature of maneuvering life on campus for college students.

Here are coronavirus tips for helping the students in your household deal with learning during the pandemic .

The at-home mindset

If your kids are doing school from home, you don’t have to worry about exposure to the virus in the classroom. But you do have to worry about keeping kids motivated . Create boundaries, both physical and emotional, to get them in the mind-set to keep school life and home life separate. Make sure they have a desk or workspace fully dedicated to learning and where non-school things don’t intrude.

Boundaries for kids and home-schooling also includes creating a schedule for them and getting them to stick to it while also allowing for some flexibility. “When you allow your child to have input into their schedule, it helps motivate them and makes them feel like they have a say,” says pediatric psychologist Emily Mudd, PhD .

If you’re working from while your kids are doing at-home learning, it’s also important to set boundaries regarding interruptions of your workday. It’s an incredibly tough balance, especially with younger children, but it’s also important to help you preserve your sanity and keep them focused on school work.

And remember: cut yourself some slack . This is an incredibly difficult time and perfection can’t be expected.

Back in the habit

If your kid is returning to in-class instruction, it’s important to prepare both them and yourse l f for what’s to come. Stay informed of what your school’s guidelines are and make sure you explain the importance of these rules to your kids. Be patient if your kid has trouble taking it all in; we’re all having issues wrapping our minds around this pandemic. And by doing all the things your kid should be doing — wearing a mask, constantly washing your hands — you can help reinforce these routines for them.

It’s also important to check in with your kids to see how they’re feeling and do what you can to talk through their feelings with them. We’ve all adjusted to changing conditions in different ways and children are no different. This includes keeping an eye out for red flags like complaints of stomachaches and headaches, changes in attitude and changes in sleeping or eating habits. These are all potential indications of added stress for a child.

Take care of your child’s mental health

Besides those aforementioned stress-related symptoms, be sure to keep an eye out for school-related anxiety and school refusal behavior . These can be things like refusing to go to school, calling home claiming to be sick or other changes in behavior. School can certainly be a stressful, anxious situation for kids during the best of times, let alone during a pandemic.

Consider talking to your kids about mindfulness. Whether it’s sitting and watching the clouds roll by or relaxing and listening to peaceful music, it can create a space for your kid to get a little mental break from all of the stress. Just be sure to practice what you preach, says child psychologist Ethan Benore, PhD: “By seeing you do the same thing, that sends a positive message to your kid that these are healthy habits for them to engage in, too.”

If necessary, reach out to your kid’s healthcare provider to see if treatment, like cognitive behavioral therapy or medication, is necessary. And be proactive; don’t minimize what your kid is experiencing. Talk to them about it and remove the stigma from it. Let them know it’s okay to feel this way and encourage them to talk about it.

Remind your kids of the new normal

There’s no getting around the fact that our current reality is a very different world than before and is likely to be that way for some time. That makes it extremely important to help get your kids used to new routines.

If your kid is returning to in-school classes, be sure to check with the school for their set of safety guidelines. Even if they don’t require masks, it’s still best for your kid to wear one. And remind them to wash their hands frequently and use hand sanitizer when they aren’t able to get to a washroom.

Maintain a healthy diet

No matter which method of learning your kids are doing, their diet is still an important staple of their health. Be sure to get vitamins and minerals (like zinc and Vitamin C) into their diet to help boost their immune system . For kids going back to physical school buildings, the general principles still apply for packing healthy lunches : fruits and veggies are key, go light on sugar.

If they’re learning at home, it can be a bit trickier. Being at home more means they’re probably going to be tempted to snack a bit more, too. Simple steps like setting a meal plan and a meal schedule can make managing these things much easier.

Maintain vaccination schedules

While so much attention is focused on the coronavirus pandemic, other illnesses still lurk in the halls of your kid’s school. It’s extremely important that your kids, especially younger ones, maintain their regular vaccination schedule to protect them from infectious diseases like measles and whooping cough. Healthcare providers are working hard to make their offices a safe place for patients to visit.

Stay safe on campus

It’s not just K-12 students who face all of these new challenges; college students, too, are going back to class with the pandemic hanging over their head . While some universities have elected for remote-learning or a hybrid approach, others are still letting students live in dorms and attend classes in person.

Make sure your college student knows their school’s guidelines and restrictions, especially when it comes to visitors. And make sure they know to follow the new routine: social distance, wear a mask and, yes, wash your hands. Even if they have to sit six feet away with masks on, they can still get in some quality time with friends hanging out on the quad.

Clean the dorm room

A clean dorm room is not exactly something you might equate with the typical college student, but these aren’t typical times. Students living on campus should follow the same cleaning procedures they would at home: keep their dorm rooms clean and wiped down, especially when returning from being out, and limit the people they allow inside.

Communication with roommates is especially important, keeping everyone on the same page as to their risk exposures and maintaining a safe, virus-free lifestyle while living in such close quarters.

Embrace video chats

One hallmark of college is the study group. While crowding a dozen students around a table for an all-night cramming session was once the norm, it’s not the safest approach these days. But technology helps, giving students different options for gathering online to keep these study sessions going, albeit virtually.

And, if your college offers it, consider attending class virtually, especially if you or your roommate aren’t feeling well.

Coronavirus tips for going to healthcare appointments

Despite the challenges presented by the pandemic, it’s still important to keep up with your healthcare appointments, especially if you have a condition that requires regular maintenance check-ups. For many providers, virtual visits are now widely available and a great option if you don’t feel comfortable going into your healthcare provider’s office.

If an in-person visit is necessary, be sure to call ahead or check with your provider’s website to see what guidelines and restrictions are still in place. While the usual protections should always be followed — stay socially distanced, wear a mask — each office might have different policies on whether or not additional visitors are allowed to accompany patients or other precautions.

Your healthcare provider can also advise you on what to do if you have a surgery or other procedure scheduled.

Coronavirus tips for going to dental appointments

Given the intimate nature of what dental appointments entail, it’s understandable that some patients are nervous about visiting the dentist. But, as with your doctor’s office, precautions are being taken to make sure your experience is as comfortable and as safe as possible.

Be sure to check with your dentist’s office before your appointment to see what guidelines are in place which can allow you to make a judgment call as to whether or not you want to go through with the appointment or reschedule for a few months down the road. Just remember: your dental health is as important as other aspects of your health so you’ll eventually need to get in to see your dentist.

Learn more about our editorial process .

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Safety and Health, Essay Example

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In Chapter 24, the focus is on chemical compounds.  The interest in chemicals by the general public has become greatly increased recently due to chemical catastrophes in India, Michigan, New York, and other locations.  In India in 1988, methyl isocyanate gas leaked from a chemical plant and settled over a 15 square mile area.  The chemical killed 2,500 people and injured 20,000 others.  Because of events like this, the public has become rightly concerned with chemicals.  There are a multitude of chemical compounds, greater than 3,000,000 registered compounds, of which approximately 60,000 have economic value in the marketplace.  Another estimated 700-1000 compounds enter the marketplace each year.  According to NIOSH, 5000 chemicals have some inherent hazards.  However, only 500 chemical compounds have published exposure standards.  So, many chemicals are lacking published hazards.

The three main types of hazards for chemicals are: 1. health effects , 2. fires and explosions, and 3. reactivity with other materials.  Chapter 24 mainly focuses on the different health effects of chemical compounds.  It is important to note that the hazards are interrelated.  That is, a fire can cause a chemical to become less stable and more reactive.  As the chemical becomes more reactive it can cause more serious health effects, so it becomes very important to understand how to properly address each of the hazards without causing greater hazards.

Since the focus of this chapter is health effects, this summary will mainly address those concerns.  There are three main entries into the body for chemicals, inhalation, ingestion, and absorption.  To understand the health effects of inhalation, one must understand the two forms of airborne contaminants: particulates and gases or vapors.  Particulates are classified by their size and chemical makeup and include dusts, fumes, smoke, aerosols, and mists.  The shape of the particulate is also important as some are spherical while others are long and fibrous.  Dusts are made of fine particulate matter created from processes that break matter into smaller pieces.  Fumes are fine solids often formed from the condensation of vapors.  Smoke is carbon or soot particles that result from incomplete combustion of carbonaceous materials.  Aerosols are solid or liquid particulates that are dispersed in the air.  Mists are liquid droplets that are suspended in or falling through air.  Gases are a different state of matter from solids or liquids.  Lastly, vapors are the gaseous phase of a substance that is a liquid at normal temperature and pressure.

When chemicals enter the body, they often affect particular organs of the body.  The effects on the organs can cause physical change, such as headache and nausea, and behavioral change, such as hallucinations and confusion.  Three factors determine the damage that the chemical will cause.  One is the type and form of the substance, two is the type and rate of exposure, and three is what happens to the substance in the body.  The time of exposure affects the latency period.  Some chemicals cause immediate effects while others may not have effects for years, as is the case with carcinogens.  Time also determines if an exposure is acute or chronic.  An acute exposure is one that causes damage in a single short exposure.  A chronic exposure is one that causes damage over a long period of multiple exposures.  Additionally, health effects can be local or systemic.  A local effect is one that causes injury to eyes, skin, or the respiratory tract after one or more exposures.  A systemic effect occurs when a substance enters the body and disrupts organs or other biological functions.  Interestingly, chemicals known as asphyxiants do not directly affect the body.  Instead, they displace oxygen which then causes damage to the organs and tissues of the body.  Some of the most serious health effects from chemicals are carcinogens, mutagens, and teratogens.  A substance that falls into one of these three categories causes damage to the DNA of a person resulting in a wide-range of effects for a long period of time.

Interestingly, not every person reacts the same to a chemical.  Some people have allergies to chemicals that cause increased responses.  Others become desensitized through exposure and do not show health effects until they are placed in repeated exposures.

So, what methods are used to assess the toxic properties of these chemicals, given that they have sometimes serious and wide-ranging effects?  The first method is through human experimentation.  However, it is unethical to test chemicals on humans for toxicity.  So, human experimentation is no longer used to test chemicals if the chemical is suspected to be toxic.  Another more useful method of assessing toxicity is through human experience.  While we do not allow humans to be exposed on purpose, sometimes they are exposed through accident.  By studying the outcomes of these accidents, the effects of the chemicals involved can be gauged.  Most toxicity data comes from the use of animal experimentation.  When chemicals are tested on animals that are similar in physiology to humans, much can be learned about their effects.  There are some drawbacks to this procedure.  For instance, a chemical with a long latency time must be tested at higher doses than a human would normally encounter in order to speed up the effects.  This process means that the animal experiments are useful for the study of toxicity in humans but not completely reliable.  Lastly, chemicals can be tested on microorganisms in order to more quickly get results.  These tests are generally short-term as microorganisms have such a short life.  The most common of these tests is the Ames test.

Chemicals are some of man’s greatest inventions, but they have the potential for great harm.  One must understand how the chemical works and how it can be toxic to a human in order to handle it safely.

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Eating and activity guidelines

On this page, current guidelines, december 2020 update, summary of guidelines statements and key related information, topical questions and answers, what’s changed, issue-based documents on eating and activity.

These documents are an important tool for health practitioners and others who provide advice on nutrition and physical activity.

Each guideline has an accompanying health education resource for the general public.

Infants and Toddlers (0–2)

• Healthy Eating Guidelines for New Zealand Babies and Toddlers (Aged 0-2 years old) (September 2021)
• Sit Less, Move More, Sleep Well: Active play guidelines for under-fives (Ministry of Health, 2017)
• Healthy Eating for Babies and Toddlers from Birth to 2 Years Old – HealthEd website

Children and Young People (2–18 years)

• Food and Nutrition Guidelines for Healthy Children and Young People (Aged 2–18 Years) – A background paper (Aug 2012)
• Physical Activity Guidelines for Children and Young People
• Eating for Healthy Children aged 2 to 12 – HealthEd website
• Healthy Eating for Young People – HealthEd website

Adults including those who are pregnant and breastfeeding

• Eating and Activity Guidelines for New Zealand Adults (Updated 2020 to include advice for pregnant and breastfeeding women)
• Healthy Eating, Active Living – HealthEd website
• Eat healthy food and move more every day – HealthEd website
• Eating for Healthy Breastfeeding Women – HealthEd website
• Eating for Healthy Pregnant Women – HealthEd website

Older People

• Food and Nutrition Guidelines for Healthy Older People – A Background Paper (2010, revised January 2013)
• Guidelines on Physical Activity for Older People (aged 65 years and over)
• Eating Well for Healthy Older People – HealthEd website

Eating and Activity Guidelines for New Zealand Adults

• Eating and Activity Guidelines for New Zealand Adults (PDF, 4.4 MB)
• Eating and Activity Guidelines for New Zealand Adults (Word, 3.3 MB)

The Eating and Activity Guidelines for New Zealand Adults were updated in December 2020 to include advice for pregnant and breastfeeding women. The Eating and Activity Guidelines Statements for adults remain the same and were not reviewed. Where possible data has been updated. 

The updated advice for pregnant and breastfeeding women replaces the previous Food and Nutrition Guidelines for Healthy Pregnant and Breastfeeding Women: A background paper published in 2006 and partially revised in 2008. This advice, along with recommendations on physical activity for pregnant women, have been integrated into the adult guidelines.  

It is also significant to note a change in the tools used to describe what a healthy eating pattern looks likes. New Zealand has updated its serving size advice by adopting the evidence based Australian serve size advice and a new food model has been developed. 

Eating and Activity Guidelines for Adult New Zealanders contain recommendations which apply in most cases to the whole population. The recommended eating pattern is the same for almost all groups, with some variation based on the amount of food and nutrients needed at different life stages. 

Advice for pregnant women focuses on the importance of a nutrient-rich diet and healthy weight gain during pregnancy, increased need related to folate/folic acid and iodine, and the importance of food safety given the lowered immunity during pregnancy. Advice for breastfeeding women also focuses on the need for a nutrient rich healthy diet, and the importance of an environment that supports women to breastfeed.

This resource summarises the key information from the Eating and Activity Guidelines for New Zealand Adults. It covers what the guidelines recommend, why and gives suggestions on how to put the recommendations into practice.

• Summary of Guidelines Statements and key related information (PDF, 739 KB)

This resource provides answers on some topical issues around eating (nutrition) and physical activity. The responses are based on the Ministry of Health’s monitoring of international research. Any new research is considered alongside the existing body of evidence and best international population health advice.

• Topical Questions and Answers (PDF, 125 KB)

In December 2020, the Ministry of Health published updated Eating and Activity Guidelines for New Zealand Adults. The following resources describe the key changes from the old to the new edition of the Guidelines. 

• What’s Changed? ( PDF, 163 KB ),   ( Word, 164 KB )
• New Serving Size Advice ( PDF, 222 KB ), ( Word, 676 KB )

These documents provide in-depth information on eating and activity issues, beyond what is covered in the Guidelines document.

• How We Eat – Reviews of the evidence on food and eating behaviours related to diet and body size   (Gerritsen and Wall, 2017)
• Guidance for Healthy Weight Gain in Pregnancy   (Ministry of Health, 2014)
• Consensus Statement on Vitamin D and Sun Exposure in New Zealand   (Ministry of Health, 2012)
• Companion Statement on Vitamin D and Sun Exposure in Pregnancy and Infancy in New Zealand   (Ministry of Health, 2020)

Red Cross Blood Donation Safety Protocols

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Share Your Health

As Coronavirus concerns continue, we need healthy blood donors more than ever

Is it safe to give right now?

Each red cross blood drive and donation center follows high standards of safety and infection control. we are taking precautions to help ensure the safety of our employees, volunteers and donors., safety at blood drives, red cross employees implemented added precautions to ensure blood drives and donation centers are safe for donors and staff..

Spacing beds 6 feet apart

Wiping down donor touched areas

Having hand sanitizer available

We provide a call back number donors should call if they become sick with any illness in the days after their donation.

Frequently Asked Questions

Donors should call our Donor Support Center at 1-866-236-3276 if they become sick with any illness in the days after their donation.

You must be fully recovered from COVID-19 and symptom-free for a least 10 days before donating blood.

If you have had a positive diagnostic test in the past 10 days for COVID-19 but didn’t have symptoms, you will need to wait 10 days after the COVID-19 test.

If you have a pending COVID-19 diagnostic test for COVID-19, you are not able to donate during this time. Once you have tested negative or been symptom-free for 10 days, you will be eligible to donate blood. 

You may still donate blood, platelets and plasma after receiving a COVID-19 vaccine. Knowing the name of the manufacturer of the vaccine is important in determining your blood donation eligibility. Learn more about COVID-19 vaccines and blood donation.

At this time, we are allowing additional guests or children to accompany donors to their donation appointment. Guests are expected to follow our safety protocols such as social distancing. The safety of our donors, volunteers, and employees is of the utmost importance.  Children who do not require supervision and are not disruptive are welcome to sit in the waiting or refreshment area.  If they require supervision another adult must be present.

If you are quarantined for any reason, you are not eligible to donate during the quarantine time period. If you are past the quarantine time and have been symptom-free for 10 days, you will be eligible to donate blood.

If you're healthy and well, we're urging you to make a donation appointment.

Masks Strongly Recommended but Not Required in Maryland, Starting Immediately

Due to the downward trend in respiratory viruses in Maryland, masking is no longer required but remains strongly recommended in Johns Hopkins Medicine clinical locations in Maryland. Read more .

• Vaccines  
• Masking Guidelines
• Visitor Guidelines  

COVID-19 Vaccine: What You Need to Know

The COVID-19 vaccine is very good at preventing serious illness, hospitalization and death. Because the virus that causes COVID-19 continues to change, vaccines are updated to help fight the disease. It is important to check the Centers for Disease Control and Prevention (CDC) COVID-19 vaccine information for the latest details. (Posted 11/22/23)

What is the COVID-19 vaccine?

The COVID-19 vaccine lessens the severity of COVID-19 by teaching the immune system to recognize and fight the virus that causes the disease.

For fall/winter 2023–2024, the updated COVID-19 vaccine is based on the XBB.1.5 variant. The updated vaccine is made by Pfizer-BioNTech, Moderna and Novavax. This season, only one shot of the vaccine is needed for most people, and there are no boosters. (People who are immunocompromised or ages 6 months to 4 years may need more than one 2023–2024 vaccine.)

How is the 2023–2024 COVID-19 vaccine different from previous COVID-19 vaccines?

The 2023–2024 COVID-19 vaccine targets XBB.1.5, a subvariant of Omicron. While none of the variants currently circulating are exact matches to the vaccine, they are all closely related to the XBB.1.5 strain. Studies show that the updated vaccine is effective against the  variants currently causing the majority of COVID-19 cases  in the U.S.

Who should get a COVID-19 vaccine?

Because the 2023–2024 vaccine is effective for recent strains of COVID-19, it is recommended that everyone stay up to date with this vaccine. Previous vaccines or boosters were not developed to target the more recent strains. For 2023–2024, the CDC recommends:

• Everyone age 5 and older receive one shot of the updated vaccine.
• Children ages 6 months to 4 years may need more than one shot to be up to date.
• People who are moderately or severely immunocompromised may need more than one shot.

You can review the full recommendations on the CDC’s Stay Up to Date with COVID-19 Vaccines webpage . Be sure to talk to your primary care doctor or pediatrician if you are unsure about vaccine recommendations.

What are the side effects of the COVID-19 vaccine?

Side effects vary and may last one to three days. Common side effects are:

• Soreness at the injection site

COVID-19 Vaccine and Pregnancy

COVID-19 vaccines approved by the Food and Drug Administration (FDA) are safe and recommended for people who are pregnant or lactating, as well as for those r intending to become pregnant.

People who are pregnant or were recently pregnant are at a greater risk for severe COVID-19. Having a severe case of COVID-19 while pregnant is linked to a higher risk of pre-term birth and stillbirth and might increase the risk of other pregnancy complications.

What should parents know about the COVID-19 vaccine and children?

The CDC recommends the 2023–2024 vaccine for adolescents and teenagers ages 12 and older, and for children ages 6 months through 11 years.

• Children age 5 and older need one shot of the updated vaccine.

Children are less likely to become seriously ill from COVID-19 than adults, although serious illness can happen. Speak with your pediatrician if you have questions about having your child vaccinated.

If I recently had COVID-19, do I need a 2023–2024 vaccine?

If you recently had COVID-19, the CDC recommends waiting about three months before getting this updated vaccine. If you encounter the virus again, having the updated vaccine will:

• Lessen your risk of severe disease that could require hospitalization
• Reduce the chance that you infect someone else with COVID-19
• Help keep you protected from currently circulating COVID-19 variants

How long should I wait to get this vaccine if I recently had an earlier version of a COVID-19 vaccine or booster?

People age 5 years and older should wait at least two months after getting the last dose of any COVID-19 vaccine before receiving the 2023–2024 vaccine,  according to CDC guidance .

Is natural immunity better than a vaccine?

Natural immunity is the antibody protection your body creates against a germ once you’ve been infected with it. Natural immunity to the virus that causes COVID-19 is no better than vaccine-acquired immunity, and it comes with far greater risks. Studies show that natural immunity to the virus weakens over time and does so faster than immunity provided by COVID-19 vaccination.

Do I need a COVID-19 booster?

The 2023–2024 vaccine is a one-shot vaccine for most people, and there is no booster this season. (People who are immunocompromised or ages 6 months to 4 years may need more than one 2023–2024 vaccine.)

The FDA calls this an updated vaccine (not a “booster” like previous shots) because it builds a new immune response to variants that are currently circulating. This change reflects the current approach of treating COVID-19 similarly to the flu, with preventive measures such as an annual vaccination.

When should I get a COVID-19 vaccine?

Like the flu and other respiratory diseases, COVID-19 tends to be more active in the fall and winter, so getting a vaccine in the fall is recommended.

How quickly does the COVID-19 vaccine become effective?

It usually takes about two weeks for the vaccine to become effective. The CDC website provides more information on how the COVID-19 vaccines work .

How long does the COVID-19 vaccine last?

Studies suggest that COVID-19 vaccines are most effective during the first three months after vaccination.

Is it safe to get a flu and COVID-19 vaccine at the same time?

Yes, it safe to get both shots at the same time. Keep in mind that each has similar side effects and you may experience side effects from both.

Is the COVID-19 vaccine safe?

Yes. COVID-19 vaccines approved by the FDA meet rigorous testing criteria and are safe and effective at preventing serious illness, hospitalization and death. Millions of people have received the vaccines, and the CDC continues to monitor their safety and effectiveness as well as rare adverse events.

Where can I get a COVID-19 vaccine?

The COVID-19 vaccine is available at pharmacies. See vaccines.gov to find a convenient location.

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Arlington, VA – Today, the U.S. Trade and Development Agency signed a feasibility study grant to support the Alexandria Petroleum Company (APC) in its efforts to improve the health, safety, and environmental protocols of its El Max refinery in Alexandria, Egypt. The grant will fund a series of studies to identify and address the facility’s priority safety and fire protection needs. APC is a subsidiary of the Egyptian General Petroleum Corporation, under the Ministry of Petroleum and Mineral Resources.

“Egypt’s commitment to bolstering the safety and health of its workers creates new opportunities for collaboration between organizations like USTDA and APC,” said Enoh T. Ebong, USTDA’s Director. “This grant will help create opportunities for U.S. companies to supply the technologies and services that Egypt’s refineries will require.”

The USTDA-funded feasibility study will advance APC’s priority to upgrade and expand its safety programs and equipment, augment forecasting and emergency response capabilities, and update protocols and trainings. By adopting these cutting-edge technologies and best practices, the El Max refinery, founded in 1962, will increase safety for workers and limit greenhouse gas emissions and environmental damage in the event of a fire or other emergency. The feasibility study will also serve as a model as Egypt considers similar upgrades for its other refineries.

“Today’s agreement between APC and USTDA is another example accentuating the continuous successful strategic partnership between Egypt and the United States in the energy domain,” said Egyptian Minister of Petroleum and Mineral Resources, H.E. Tarek El Molla. “Our common objectives for furthering safety and sustainability have paved the way for this important signing today. Health, Safety, and Environment have been key elements of the sector’s modernization since 2016. Today, they remain strong among the sector’s core principals, along with upgrading our refineries to enhance safety and operational excellence.”

APC Chairman Alaa Amin said, “Partnering with USTDA on this feasibility study marks an important step forward for APC. This study demonstrates our unwavering commitment to excellence in process safety, ensuring the highest safety standards for our operations in line with the Ministry of Petroleum and Mineral Resources strategy.”

U.S. Ambassador to Egypt Herro, Mustafa Garg, said: “Today’s grant signing between APC and USTDA illustrates the breadth of the partnership between Egypt and the United States, a partnership that enhances productivity and prosperity for both our peoples. This collaboration will improve health and safety for Egyptian workers through state-of-the art U.S. technologies and will reduce potential environmental impacts in Egypt’s petroleum sector,” said U.S. Ambassador to Egypt Herro Mustafa Garg.

U.S. businesses interested in submitting proposals for the USTDA-funded feasibility study should visit www.ustda.gov/work/bid-on-an-overseas-project .

USTDA’s grant advances Biden-Harris Administration priorities including the Partnership for Global Infrastructure and Investment .

The U.S. Trade and Development Agency helps companies create U.S. jobs through the export of U.S. goods and services for priority infrastructure projects in emerging economies.  USTDA links U.S. businesses to export opportunities by funding project preparation and partnership building activities that develop sustainable infrastructure and foster economic growth in partner countries.

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Pregnancy and Breastfeeding

Pregnancy and breast­feeding.

Back to Life Stages

Make your health a priority during this special time.

Making healthy food choices and staying active will support your baby’s growth. This will also help you stay healthy during your pregnancy and while breastfeeding/ lactating.

Eat Healthy

Get Your Plan

Ask About Supplements

Make Safe Choices

• Healthy choices include fruits, vegetables, whole grains, protein foods, and low-fat or fat-free dairy milk or yogurt (or lactose-free dairy or fortified soy versions).
• Include a variety of protein foods such as seafood, lean meats, poultry, beans, peas, lentils, nuts, and eggs.
• Limit foods and beverages higher in added sugars, saturated fat, and sodium.

Should I eat seafood during pregnancy? Eating seafood during pregnancy may help your baby's growth. Seafood is a healthy protein source for you during pregnancy and while breastfeeding/ lactating. Choose options lower in methylmercury, like cod, salmon, tilapia, or herring. 

Learn more at FDA’s Advice About Eating Fish webpage.

You may have different calorie needs during pregnancy and while breastfeeding/ lactating. Get your  MyPlate Plan  to learn how many calories you may need. Work closely with your healthcare provider to learn the right eating plan for you.

In addition to eating a healthy diet, your doctor may want you to take a prenatal supplement. This is to make sure you get enough of the vitamins and minerals that you need for a healthy pregnancy.  

After pregnancy, your need for some vitamins and minerals may decrease. Your doctor may advise you to switch to a multivitamin supplement while breastfeeding/ lactating. Talk to your healthcare provider about what is right for you.

• Make sure that seafood, meat, poultry, or eggs have been cooked to the recommended safe internal temperatures. See this guidance from the FDA on safe food handling and safe minimum internal temperatures .
• Unpasteurized (raw) juice or milk
• Raw sprouts
• Some soft cheeses made from unpasteurized milk
• Reheat deli and luncheon meats and hot dogs to steaming hot or 165 °F.
• More information is available at CDC's Maternal, Infant, and Early Childhood Nutrition  webpage.
• Food Allergies in Your Child Unless advised by your doctor, you do not have to restrict your food and drink choices during pregnancy or while breastfeeding/ lactating to keep your child from getting food allergies.
• Alcohol Pregnant women and women who may become pregnant should not drink alcohol. Drinks that have alcohol include beer, wine, liquor, mixed drinks, and malt beverages. No amount of alcohol is safe for your baby when you are pregnant. Talk with your doctor if you are thinking about drinking alcohol while you are breastfeeding/ lactating.
• Caffeine Caffeine is found in coffee, tea, and soda. Ask your healthcare provider about having caffeine during pregnancy and while you are breastfeeding/ lactating.

Healthy Eating for Women Who Are Pregnant or Breastfeeding/ Lactating Tip Sheet

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Tips for Breastfeeding Moms

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Nutrition While Breastfeeding

Breastfeeding Basics

Breastfeeding Basics for Dads

Breastfeeding Basics for Grandmas

Your Guide to Breastfeeding

Food Safety for Moms-to-Be

Storage and Preparation of Breast Milk

How to Keep Your Breast Pump Kit Clean

How to Clean, Sanitize, and Store Infant Feeding Items

WIC Infant Nutrition and Feeding Guide

Tips for Pregnant Moms

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Build healthy eating habits one goal at a time! Download the Start Simple with MyPlate app today.

MyPlate.gov is based on the Dietary Guidelines for Americans, 2020-2025

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Elektrostal

Elektrostal Localisation : Country Russia , Oblast Moscow Oblast . Available Information : Geographical coordinates , Population, Altitude, Area, Weather and Hotel . Nearby cities and villages : Noginsk , Pavlovsky Posad and Staraya Kupavna .

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Elektrostal Demography

Information on the people and the population of Elektrostal.

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Geographic Information regarding City of Elektrostal .

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COVID-19 transmission

COVID-19 spreads primarily from person to person in several different ways:

• It can spread through small liquid particles. These particles range from larger respiratory droplets to smaller aerosols released when an infected person coughs, sneezes, speaks, sings or breathes.
• It spreads mainly between people who are in close contact with each other, typically within 1 metre.
• It can also spread in poorly ventilated and/or crowded indoor settings where aerosols remain suspended in the air or travel farther than 1 metre.
• It can also spread if a person touches surfaces that have been contaminated by the virus.

Last updated: 8 August 2023

Aerosol transmission

COVID-19 transmission person to person

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• About company
• GENERAL CONTRACTOR

+7 (495) 526-30-40 +7 (49657) 0-30-99

THE HISTORY OF THE COMPANY CREATION

1993 how the construction company remstroy was created   the year 1993 was a period when a lot of construction companies, which had been working successfully during the soviet times and had rich staff capacity, were forced to cease their activity for various reasons. a lot of capable specialists either had to look for another job or change their field. but there were also those who were willing to realise their potential in the field of construction in accordance with the received degree and the experience they had accumulated. thus, in 1993 in elektrostal (moscow oblast) a group of specialists and people sharing each other’s ideas, who had enormous educational background and the highest degree in architecture, organized and registered ooo firm erg which began its rapid development and successful work, offering its service both on the construction market and other areas. 2000 industrial construction is the main area   seven years of successful work have shown that combining different types of activities in the same company is not always convenient. and in the year 2000 the founders of ooo firm erg decided to create and register a monoprofile construction company ooo remstroy construction company. industrial construction was chosen as the priority area. it was in this area that the directors of ooo sk remstroy began their working life and grew as specialists. in order to achieve the set goal, they selected a mobile team of professionals in the field of industrial construction, which allows us to cope with the tasks assigned to ooo sk remstroy throughout russia and the near abroad. 2010 manufacturing of metal structures   we possess modern equipment that allows us to carry out the entire cycle of works on the manufacture of metal structures of any complexity without assistance. designing – production – installation of metal structures. a staff of professionals and well-coordinated interaction of the departments let us carry out the work as soon as possible and in accordance with all customer’s requirements.” extract from the list of members of self-regulatory organizations, construction.

LICENSE OF MINISTRY OF EMERGENCY SITUATIONS

Certificates, system of managing quality.

SYSTEM OF ECOLOGIAL MANAGEMENT

SYSTEM OF OCCUPATIONAL SAFETY AND HEALTH MANAGEMENT

LETTERS OF RECOMMENDATION

THE GEOGRAPHY OF CONSTRUCTION SITES

YOU CAN FIND MORE INFORMATION ON THE CONSTRUCTION SITES OF OOO REMSTROY ON THE PAGE OF THE SITE

OUR CLIENTS

http://remstroi.pro/yandex-promyshlennoe-stroitelstvo

Geographic coordinates of Elektrostal, Moscow Oblast, Russia

City coordinates

Coordinates of Elektrostal in decimal degrees

Coordinates of elektrostal in degrees and decimal minutes, utm coordinates of elektrostal, geographic coordinate systems.

WGS 84 coordinate reference system is the latest revision of the World Geodetic System, which is used in mapping and navigation, including GPS satellite navigation system (the Global Positioning System).

Geographic coordinates (latitude and longitude) define a position on the Earth’s surface. Coordinates are angular units. The canonical form of latitude and longitude representation uses degrees (°), minutes (′), and seconds (″). GPS systems widely use coordinates in degrees and decimal minutes, or in decimal degrees.

Latitude varies from −90° to 90°. The latitude of the Equator is 0°; the latitude of the South Pole is −90°; the latitude of the North Pole is 90°. Positive latitude values correspond to the geographic locations north of the Equator (abbrev. N). Negative latitude values correspond to the geographic locations south of the Equator (abbrev. S).

Longitude is counted from the prime meridian ( IERS Reference Meridian for WGS 84) and varies from −180° to 180°. Positive longitude values correspond to the geographic locations east of the prime meridian (abbrev. E). Negative longitude values correspond to the geographic locations west of the prime meridian (abbrev. W).

UTM or Universal Transverse Mercator coordinate system divides the Earth’s surface into 60 longitudinal zones. The coordinates of a location within each zone are defined as a planar coordinate pair related to the intersection of the equator and the zone’s central meridian, and measured in meters.

Elevation above sea level is a measure of a geographic location’s height. We are using the global digital elevation model GTOPO30 .

Elektrostal , Moscow Oblast, Russia

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