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The joint memorandum circular provides a chart for a safety seal that includes the logo of the issuing authority, a safety seal number, the date of issuance, and the date the seal is no longer valid. The chart is intended to standardize the information included on safety seals issued by relevant government agencies to ensure equipment and facilities meet required safety standards.

Healthcare

Livelihood Center, Poblacion Sibuco, Zamboanga del Norte
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JOINT MEMORANDUM CIRCULAR NO. 21-01
Series of 2021

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Damage to the spinal cord above the sacral region causes reflex incontinence. This condition causes loss of voluntary control of urination; but the micturition reflex pathway often remains intact, allowing urination to occur without sensation of the need to void Overflow incontinence occurs when a bladder is overly full and bladder pressure exceeds sphincter pressure, resulting in involuntary leakage of urine. Causes often include head injury; spinal injury; multiple sclerosis; diabetes; trauma to the urinary system; and postanesthesia sedatives/hypnotics, tricyclics, and analgesia Hyperreflexia, a life-threatening problem affecting heart rate and blood pressure, is caused by an overly full bladder. It is usually neurogenic in nature; however, it can be caused functionally by blockage Diseases that cause irreversible damage to kidney tissue result in end-stage renal disease (ESRD). uremic syndrome- An increase in nitrogenous wastes in the blood, marked fluid and electrolyte abnormalities, nausea, vomiting, headache, coma, and convulsions characterize this syndrome. As the uremic symptoms worsen, aggressive treatment is indicated for survival Nocturia - awakening to void one or more times at night An excessive output of urine is polyuria. . A urine output that is decreased despite normal intake is called oliguria. increased urine formation (diuresis) a stoma (artificial opening) Urinary Retention. Urinary retention is an accumulation of urine resulting from an inability of the bladder to empty properly. URINE OVERFLOW- The sphincter temporarily opens to allow a small volume of urine (25 to 60 mL) to escape. With retention a patient may void small amounts of urine 2 or 3 times an hour with no real relief of discomfort or may continually dribble urine. pain or burning during urination (dysuria) as urine flows over inflamed tissues blood-tinged urine (hematuria) Urinary incontinence is the involuntary leakage of urine that is sufficient to be a problem. It can be either temporary or permanent, continuous or intermittentUrinary elimination depends on the function of the kidneys, ureters, bladder, and urethra. Kidneys remove wastes from the blood to form urine. Ureters transport urine from the kidneys to the bladder. The bladder holds urine until the urge to urinate develops. Urine leaves the body through the urethra. All organs of the urinary system must be intact and functional for successful removal of urinary wastes. Intact efferent and afferent nerves from the bladder to the spinal cord and brain must be present INTAKE AND OUTPUT OF URINE Assess the patient’s average daily fluid intake. at home, ask him or her to estimate his or her intake by showing a measurement on a commonly used glass or cup Special receptacles (urimeters) that attach between indwelling catheters and drainage bags are a convenient means of accurately measuring urine volume. A urimeter holds 100 to 200 mL of urine. After measuring urine from a urimeter, drain the cylinder

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M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028. According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.” There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation. The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs. In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.

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Advanced Gum Health Prebiotic: A Breakthrough in Oral Care Maintaining oral health is crucial for overall well-being. Beyond traditional methods like brushing, flossing, and regular dental check-ups, recent advancements in dental science have introduced the concept of prebiotics for enhancing gum health. Advanced gum health prebiotics represent a promising frontier in oral care, offering a novel approach to preventing gum disease and promoting a healthy oral microbiome. Understanding the Oral Microbiome The oral cavity hosts a complex ecosystem of microorganisms, collectively known as the oral microbiome. This community includes bacteria, fungi, viruses, and protozoa, which coexist in a delicate balance. A healthy oral microbiome plays a crucial role in maintaining oral health, aiding in digestion, and protecting against pathogens. However, disruptions to this balance can lead to oral health issues such as gum disease, tooth decay, and bad breath. The Role of Prebiotics in Oral Health Prebiotics are non-digestible food components that selectively stimulate the growth and activity of beneficial microorganisms in the gut. Unlike probiotics, which introduce live beneficial bacteria into the system, prebiotics serve as nourishment for the existing beneficial bacteria, promoting their growth and activity. This concept is now being applied to oral health. How Advanced Gum Health Prebiotics Work Advanced gum health prebiotics are designed to support the beneficial bacteria in the oral microbiome, creating an environment that discourages the growth of harmful bacteria. By promoting a balanced microbiome, these prebiotics help prevent gum inflammation, reduce the risk of periodontal disease, and enhance overall oral health. Reduction of Gum Inflammation: By fostering a healthy oral microbiome, prebiotics can reduce inflammation and irritation in the gums, preventing conditions like gingivitis. Prevention of Periodontal Disease: A balanced microbiome can help prevent the progression of gum disease, which, if left untreated, can lead to tooth loss. Enhanced Oral Hygiene: Regular use of prebiotics can complement traditional oral hygiene practices, leading to fresher breath and healthier gums. Natural and Safe: Prebiotics are naturally occurring substances found in various foods, making them a safe and natural addition to oral care routines. The Science Behind Prebiotics Prebiotics work by providing a food source for beneficial bacteria. These substances, often dietary fibers, are not digested by human enzymes but are fermented by the gut microbiota. In the context of oral health, prebiotics promote the growth of beneficial bacteria in the mouth, which can outcompete harmful bacteria for resources and adhesion sites on the teeth and gums. Studies have shown that prebiotics can help reduce levels of harmful bacteria, such as those responsible for periodontal disease and dental caries.

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When a patient uses a bedpan, promote comfort and normalcy and respect the patient’s privacy as much as possible. Be sure to maintain a professional manner. In addition, provide skin care and perineal hygiene after bedpan use Regular bedpans have a rounded, smooth upper end and a tapered, open lower end. The upper end fits under the patient’s buttocks toward the sacrum, with the open end toward the foot of the bed . A special bedpan called a fracture bedpan is frequently used for patients with fractures of the femur or lower spine Fracture bedpan - used for patients with fractures of the femur or lower spine. The fracture pan has a shallow, narrow upper end with a flat wide rim, and a deeper, open lower end. The upper end fits under the patient’s buttocks toward the sacrum, with the deeper, open lower end toward the foot of the bed. Ordinary Bedpan EQUIPMENTS Bedpan (regular or fracture) Toilet tissue Disposable clean gloves Additional PPE, as indicated Cover for bedpan or urinal (disposable waterproof pad or cover) ASSESSMENT Assess the patient’s normal elimination habits. Determine why the patient needs to use a bedpan (e.g., a medical order for strict bed rest or immobilization). Assess the patient’s degree of limitation and ability to help with activity. Assess for activity limitations, such as hip surgery or spinal injury, which would contraindicate certain actions by the patient. Check for the presence of drains, dressings, intravenous fluid infusion sites/equipment, traction, or any other devices that could interfere with the patient’s ability to help with the procedure or that could become dislodged. Assess the characteristics of the urine and the patient’s skin Assisting With Use of a Bedpan When the Patient Has Limited Movement Patients who are unable to lift themselves onto the bedpan or who have activity limitations that prohibit the required actions can be assisted onto the bedpan in an alternate manner using these actions

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Stewardship is the act of taking good care of something. Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms. WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels. ACCORDING TO apic.org, Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms. ACCORDING TO pewtrusts.org, Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate According to WHO, Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis. Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance. According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites VISION Being proactive Supporting optimal animal and human health Exploring ways to reduce overall use of antimicrobials Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way GOAL to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come. being to preserve human and animal health and the effectiveness of antimicrobial medications. to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory to prevent antimicrobial overuse, misuse and abuse. to minimize the developme

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Defecation Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool. Normal defecation is painless, resulting in passage of soft, formed stool CONSTIPATION Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces IMPACTION Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon. DIARRHEA Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration HEMORRHOIDS Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal. FLATULENCE As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus) FECAL INCONTINENCE Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY, An enema is the instillation of a solution into the rectum and sig

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The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer. Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer. The speakers included: Professor Orazio Schillaci, Minister of Health, Italy Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden

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