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Causation in Research and Epidemiological Study Designs

Share this: Facebook Twitter Reddit LinkedIn WhatsApp Concept of Causation and common Epidemiological study designs. Name: Confucius Aligo Allison Amba Objective of this paper is to explain the concept of ‘Causation’ and explain of some common epidemiological study designs Causation Definition Causation is defined as the capability of one variable to influence another. The first variable may bring the second into existence or may cause the incidence of the second variable to fluctuate. “Causality is a genetic connection of phenomena through which one thing (the cause) under certain conditions gives rise to, causes something else (the effect)” (Alexander 1983)1 The concept of causation was first described by Plato he stated that “everything that becomes or changes must do so owing to some cause, for nothing can come to be without a cause” (Menno)2. The stoics stated that “cause is linked both to an exceptionless regularity and to necessity. They strictly hold to the view that each event has a cause” (Menno). A cause of disease is “an event, condition, characteristics or combination of these factors which plays an important role in producing the disease” (JLI Video Lecture note – 3rd Lesson of Epidemiology). Common Epidemiological study designs The word epidemiology comes from the Greek word “epi, meaning on or upon, demos, meaning people, and logos, meaning study of”3 the Epidemiology is the “study of the distribution of disease and determinants of health-related states or events in specified human population and the application of this study to the control of human health problem”(CDC)3. Epidemiology is “data-driven and relies on a systematic and unbiased approach to the collection, analysis and interpretation of data. It also draws on methods from other scientific fields including biostatistics and informatics, with biologic, economic, social and behavioral sciences” (CDC). Epidemiological studies are conducted using human population to determine causal relation between factors that and individual or population is expose to and the health effect of the exposure. The epidemiological studies designs can be classified either as observational or experimental. (JLI Video Lecture note – 3rd Lesson of Epidemiology). Experimental study designs Experimental studies can be randomized controlled, non-randomized control, field trail studies and community trials. Randomized controlled trail (RCT), alternative name clinical trials (JLI lecture note – 3rd Lesson of Epidemiology) in this study “people are allocated at random to receive one of several clinical interventions”4 one of the group is a control which may be given a placebo or no intervention. This study is “quantitative, comparative, controlled experiments in which investigators study two or more interventions in a series of individuals who receive them in random order. The RCT is one of the simplest and most powerful tools in clinical research” ( This study is termed as “gold standard” ( that determines the effectiveness of treatment. Non-randomized controlled trails this is a study in which is assigned to an intervention alternate and not random. Participants may be volunteers who accept to participate in the study. Field trials are study design where the intervention strategies are assigned to healthy individuals within the community. Community trials alternative name community interventions studies (JLI Video Lecture note – 3rd Lesson of Epidemiology) are mostly preventive; interventions are assigned to all community members in the study area. The advantages include easier changing the community social environment; interventions are tested in actual natural conditions and cheaper (Omar 2006)5 Observational study designs Observational studies can be either descriptive or analytic studies. Observational studies allows nature to take place; “the investigator measures but does not intervene”. (JLI Video Lecture note – 3rd Lesson of Epidemiology). Descriptive studies Descriptive studies are studies that are design to describe occurrence of disease by time, place and person, while analytic studies are studies designed to examine etiology and causal association. “A descriptive study is limited to a description of the occurrence of a disease in a population and is often the first step in an epidemiological investigation”. (JLI Video Lecture note – 3rd Lesson of Epidemiology). Descriptive epidemiological study design describes the occurrence of disease or the determinants within a population. Descriptive epidemiological study generates hypothesis and answer the questions WHAT, WHO, WHERE

Faulkner University Thematic Integration of Faith and Learning Paper

Faulkner University Thematic Integration of Faith and Learning Paper.

Thematic Integration of Faith and Learning Paper InstructionsWrite a thematic integration of faith and learning concept paper using a well-rounded approach to the concepts found in the course texts and current scholarly literature. This paper must be submitted in compliance with the instructions found in the Thematic Integration of Faith and Learning Paper Grading Rubric. You must fully leverage the discussion opportunity in Discussion Board Forum 3 in order to research and outline your approach for this assignment.The paper must contain the following components:A 3–5-page overview that defines the course as an academic field of study (significance of the course to business)A 3–5-page discussion of the top 5–8 questions you believe are critical in order to demonstrate that a student who completes this course can synthesize the key concepts of continuous improvement and propose strategies for improving an organization using recognized quality management tools and best practicesA 3–5-page discussion that integrates the concepts from the Keller (2012) text into a cohesive understanding of why quality management and productivity are significant for advancing God’s purposes for business on earthA minimum of 6 references in addition to the course textsFor this course, the concept of stewardship is especially important. As Van Duzer (2010) posited, a steward is really a trustee of God’s creation. Duby (2009) adds the following:Stevens (2006) observes that Adam and Eve were given the role of stewards who had “the wonderful role of representing the absent monarch’s interests” (p. 6). As stewards, followers of God act as trustees that are to develop and to serve the “unfolding kingdom” of creation (Roels, 1990, p. 27). Further, Roels contends that if one believes that his or her business plays an important role in God’s kingdom, then an important concern is to best determine how to be God’s steward in such business endeavors.Understanding this important role is critical to understanding God’s intentions for business. Thus, in this assignment, the student will link the concept of biblical stewardship to quality management and process improvement, noting how such concepts are tangible manifestations of good stewardship. In Module 1, the presentation addresses the need for those in quality management to see the big picture: that we are called to be regents of our God in every human activity.In Module 4, the presentation builds on this foundation, noting that as regents we are stewards of all that God gives us, and as stewards, we seek the best uses for the resources entrusted to us—including our desire to be productive and to produce quality. Consider these ideas as you develop your paper.Submit your Thematic Integration of Faith and Learning Paper through the provided SafeAssign link by 11:59 p.m. (ET) on Friday of Module 4/Week 8.ReferencesDuby, D. (2009). The greatest commandment: The foundation for biblical servant leadership. Liberty Business Review, 7, 52–57. Retrieved from Duzer, J. (2010). Why business matters to God: And what still needs to be fixed. Downers Grove, IL: IVP Academic. ISBN: 9780830838882.Books for classStrategies Continuous Process ImprovementAuthor:Plenert, GerhardISBN-13:978-0-07-176718-7ISBN-10:0-07-176718-5Edition/Copyright:2012Publisher:McGraw-Hill Publishing CompanyBuilding Engaged Team PerformanceAuthor:Starbird, DoddISBN-13:978-0-07-174226-9ISBN-10:0-07-174226-3Edition/Copyright:2011Publisher:McGraw-Hill Publishing Company
Faulkner University Thematic Integration of Faith and Learning Paper

Multimedia Systems And Applications Computer Science Essay

assignment writing services This report gives the details of multimedia computing. Multimedia computing is one of the major research topics in recent years, this field is widely using in different industries like web, gaming, telecommunications and broadcasting networks. Multimedia computing gives the detailed view of multimedia systems, multimedia applications, and multimedia softwares. It is used in presenting the text, audio, video, and graphics in different fields. The development in multimedia computing has made a strong impact on these fields. Fundamentally multimedia computing use the elements such as audio, video, personal computers, and the storage devices to get the synchronisation of animation, text, video and sound to present the information. The multimedia computing mainly depends on the systems and the human computer interaction. The input and output of the computer has changed to the window oriented display using the bitmapped displays. The stable rate in the continuous media like audio and digital video must be considered in the multimedia input and output. Multimedia applications are now exploring the capabilities of the multimedia computing. Understanding the multimedia functionality in advanced application domains like visualization systems, intelligent interfaces, virtual reality environments, and collaboration environments provides the different possibilities which are not available previously in the human computer interaction. This report discusses the multimedia applications, multimedia systems, technologies and softwares with designs and operating systems. TABLE OF CONTENTS: 1. Introduction 2. Literature Review 2.1. Key Areas 3. Research Section 3.1. Multimedia systems 3.2. Multimedia technologies 3.3. Multimedia applications 4. Conclusion 5. References INTRODUCTION This paper presents the detailed research about multimedia computing and the contents of multimedia computing. The purpose of this paper is to present the detailed review about the multimedia computing which involves the concepts like multimedia systems, multimedia technologies, softwares and multimedia applications. In this presentation about the multimedia computing the challenges are it is difficult give the review because the multimedia computing is the integration of several multimedia concepts and is difficult to present them as a single component. As an MSc student, while developing a research paper the rule and regulations must have to be followed. And all the information which is required for the research has to be accessed in proper way by using the facilities provided by the university. The research paper should not create any controversy in further approach, and the details presented in the paper must be correct and honest. The main aim of this paper is to provide the detailed view about multimedia computing and its concepts including the views like the back ground, current status of multimedia computing and possible advancements in future. To achieve this detailed research is required in the field of multimedia and in the technologies using and in the application domains. And the analysis on existing works in multimedia computing field is needed to get an idea about what currently happening in the field and to find the advantages and disadvantages, so that it is possible to know the future enhancements needed. Multimedia is the well known word and widely using in information industry. “Multimedia means that computer information can be represented through audio, video, and animation in addition to traditional media like text, graphics drawings, and images”. In general Multimedia can be defined as a field that integrates various forms of media such as text, audio, video, graphics with the computer-controlled integration. Multimedia concept is used to display the text, images, graphics and drawings in the form of audio and video presentations. (Dave Marshall, 2001). LITERATURE REVIEW According to Reisman (1994), the multimedia computing is the rapidly using technology to present the data in the audio and video contexts rather than in normal text and graphics format. In the present days the multimedia systems are using to display the presentations of data as a multimedia content. These systems are capable of processing the multimedia data such as audio, video, graphics, text and images. These systems having the window based display with bitmapped processing. The images and the videos presented through this displays are modified by using the different multimedia technologies like image processing, video compression, visualization etc. The present multimedia systems use the elements like audio, video, storage devices such as CD-ROMS, DVD, Hard disk to get the synchronisation of multimedia contents animation, text, video, audio. According to Different multimedia technologies are used in developing the multimedia content like audio, text, images and video. There are different approaches using in each context, like for displaying the image several processes like jpeg encoding, gif encoding and jpg encoding etc..And for video we use the mpeg-4 technology, and digital video technology is used. Similarly different approaches are used in editing graphics and animations etc. The technologies used for animations and graphics are different from the technologies used for editing of text, audio and video. In the presentation of general data as a multimedia data we need to us all these technologies at one instance, because the data is the combination of text, images, audio, video and more. (Fernando Pereira, 1999) The present multimedia is one the major field which is using in a high extent in information industry, because in any information related thing, there is a need of multimedia to present data. The multimedia is given as by the name itself, combining two or more media as one information. The multimedia concepts used in the development of games in high extent because the games developed depends on the graphics and animations, these concepts can be designed by using the different softwares like Maya , 3D max,3dsmax etc these softwares are mainly using in the development of visual effects and graphics animations etc. There are different softwares which are used to display the images, audio, text and video. The softwares like Adobe, Flash are used to edit or display the images, text, audio, video in the required format. These application softwares of multimedia containing different tools and each tool has its own specification in developing, editing or displaying the information. (Mahbubur Rahman Syed, 2008) Key areas: According to Fernando Pereira (1999), In general multimedia computing is the key area in information industry. The key areas in multimedia computing are multimedia systems, multimedia technologies, multimedia softwares and multimedia applications. These areas are explained in detail below. The multimedia computing has more applications and important in several fields. The multimedia computing also includes the topics like multimedia operating systems. Multimedia is mainly depends on the systems and technologies used in displaying the information and also on the multimedia softwares which are used in developing the information. To accept all these technologies and to execute the components of softwares used in developing the multimedia systems must contain the operating system which is capable of processing the multimedia components. The operating system which can capable of processing the multimedia contents like audio, video, text, graphics is known as multimedia software. The multimedia is the hot area with its applications and tools that are used in developing the multimedia components. The presenting of information which consist the audio and video along with images, graphics and animations is difficult to process, because the operating system has to run all the fields like systems and softwares and the technologies of multimedia simultaneously so that it can provides all the information in the display that contains the multimedia components. The key area in multimedia is its life cycle. The life cycle that is followed when a multimedia component is produced is known as multimedia life cycle. The life cycle consists the phases such as analysis, design, implementing, testing and executing. To develop a multimedia application such as presenting the information, gaming applications or animated displays etc, have to follow the multimedia life cycle. First we need to analyse the requirements and identfy the charecterstics and have to to the analysis about the designs . such that we need to clarify which designs has to be use, and which is the best software to develop the designs and the technologies that has to use. From the above analysis the implementaio or the development of the application has to done, the testing is the important phase in development, the testing has to done according to the appliction developed and the performance has to be analysed . (Ralf Steinmetz, Analyzing the Multimedia Operating systems,1995 ). RESEARCH SECTION According to Matthew E. Hodges and Sasnett(1993), Multimedia computing gives the in-depth overview of information design, advances in multimedia technology and system representations to system designers, system planners and to the users. The concepts of multimedia such as multimedia systems, multimedia designs, multimedia softwares and multimedia applications are all parts of multimedia computing. Multimedia computing is responsible for presenting the information in audio and video format. The systems which are able to process the multimedia components like data and applications are called as the multimedia systems. These systems have different characteristics, components. The characterisation of multimedia systems is based on their capability of processing, storage, manipulation, generation of multimedia information. The designs which use the multimedia concepts to present the data containing the text, images, graphics, and drawings as a multimedia presentation like audio and video format are known as multimedia designs. The designs are used based on the requirement in the presentation of data. The softwares that are used in developing the multimedia components of data are known as multimedia softwares. There are different types of softwares like adobe, flash, 3dsmax using for various applications. The multimedia computing has been using in different fields. It has a wide range of applications in various domains like gaming, World Wide Web, interactive TV, virtual reality etc. The Multimedia computing applications use the multiple fields of media sources like text, video, audio as a collection. Multimedia computing is the combination of all the above multimedia concepts. The above all concepts are explained below in detail. Multimedia computing evolved with the concepts of multimedia such as multimedia systems, multimedia technologies, multimedia softwares and multimedia applications. This research section clearly focuses on the detailed views on these multimedia fields. The existing works in these fields are described in the literature review section. 3.1. MULTIMEDIA SYSTEMS According to Dave Marshall (2001), the definition for the multimedia systems can be given as the systems which are able to process the multimedia components like data and applications are called as the multimedia systems. These systems have different characteristics, components. The characterisation of multimedia systems is based on their capability of processing, storage, manipulation, generation of multimedia information. The multimedia systems use the bitmapped windows oriented displays to display the contents. These are capable of processing the multimedia contents. The multimedia computing is more dependent on the configuration of these systems. The configuration of the systems can results in the display of multimedia contents and to process some of the multimedia softwares and technologies the high configurations are required. The characteristics, challenges, key issues and the desirable features of multimedia systems are given below Characteristics of multimedia system The basic characteristics that a multimedia system is, the multimedia system should be computer-controlled. To process the multimedia components the multimedia systems should be integrated. These systems have to represent the information digitally. They have to use the interactive media as an interface for the presentation of final information. These characteristics have to be possessed by the multimedia systems. Challenges of multimedia system The multimedia systems have some challenges such as distributed networks. It is difficult to process the multimedia content over distributed networks, because different types of systems are used in different networks and the configurations are not same, so the content that is displaying may undergoes changes. And the other challenge is temporal relationship between data. This is a problem in presenting the data when there is a relationship between data using in the presenting information. This is like using the audio video for same display needs the lip sync. Key Issues The key issues in the multimedia systems are related to the representation of data such as how to store and represent the temporal data. And the issues in maintain the relationship between the temporal data in multimedia presentation. The other issues involved like data compression and representation. There is a need of compressing the data when it is using large volumes of data. And some other issues are involved related to analogue and digital data representation. (Reisman, S. 1994). 3.2. MULTIMEDIA TECHNOLOGIES According to Mahbubur Rahman Syed(2008), In general the multimedia technologies can be defined as the technologies which are used in processing of the multimedia contents to present the multimedia information. The technologies include video, audio, text, image and graphics. Each of these technologies is responsible for providing the data as multimedia content. These technologies are responsible for processing the images by using the technologies like jpeg encoding and decoding, and like the other formats gif, and jpg. And technologies that are used for encoding and compressing the videos use the MPEG-4 technologies. The technologies are based on the multimedia concepts like generations and the dimension views. The whole technologies of multimedia are responsible for presenting the data in detailed view which consist of the multimedia contents. 3.3. MULTIMEDIA APPLICATIONS According to Ralf Steinmetz and K. N. (2004). The multimedia computing has wide range applications in different fields, because the applications are used to present the information in audio and video formats. The sectors which are dealing with the processing of the information will use the multimedia applications. The applications of multimedia are used in mobiles, televisions, World Wide Web, networks, games, visual effects, digital video processing systems, hypermedia courseware, virtual reality, video conferencing etc. The applications of multimedia are designed on the basis of requirements of multimedia component presentations. The applications designed as discussed above, by using the designs, technologies and softwares. 4.CONCLUSION The present world is dependent mostly on the multimedia and its applications. The developments in this multimedia computing provide various features for the users and developers. With the applications of multimedia the information industry changed a lot. The evolution in multimedia provides the features like games, internet, and presentations of data in variety of formats. The fields of multimedia like systems, technologies, applications and softwares are all used simultaneously in the systems achieving the best results. And by overcoming the drawbacks like memory usage and temporal relationship between data, multimedia applications can processed easily and gives the best results. The above paper discussed the concepts of multimedia and key issues and desirable features of multimedia computing.

You have gathered client and user requirements for the new spa website.

You have gathered client and user requirements for the new spa website.. I’m stuck on a Website Design question and need an explanation.

You have gathered client and user requirements for the new spa website. You have also developed several design deliverables that you will now resubmit after incorporating your instructor’s feedback. You will now create a high-fidelity prototype using Adobe XD. The prototype must incorporate user-centered design best practices and principles. It should also be visually appealing and easy to use and should conform to the client and user requirements. In addition, you will write a report justifying your choices and providing a plan for usability testing.
You have gathered client and user requirements for the new spa website.

Study On Hand Hygiene In Optometry Nursing Essay

Hand hygiene is a term used to describe any act of hand cleansing. There are various methods of decontamination each with their own level of efficacy (Lucet et al., 2002; Kampf, Löffler and Gastmeier, 2009). It is an essential practice among health care workers (HCWs) to prevent the transmission of microorganisms and spread of nosocomial infections in a clinical setting. Despite this knowledge, compliance among HCWs remains low averaging 40% which increases the risk of patients contracting hospital acquired infections (Boyce and Pittet, 2002). The World Health Organisation (2005) recognise hospital acquired infections as being a major cause of death and mortality in hospital bound patients, averaging 5000 deaths a year in England. Improving hand hygiene practice among HCWs is the cornerstone in reducing nosocomial infections such as methicillin-resistant Staphylococcis aureus (MRSA) and Clostridium difficile (C. diff.). However, implementing this change in behaviour is complex and difficult to achieve. An integral factor for improved hand hygiene compliance relies on HCW’s educational training and the introduction of motivational programmes designed specifically to influence behaviour. Monitoring and encouragement will be necessary for these procedures to be successful (Boyce, 2008; Saint et al., 2009). 1.2 Hand hygiene in Optometry There is an apparent lack of research into hand hygiene practice in a primary and community care setting; optometric practice included. Currently there are no evidence based studies directly linked with Optometry to support the recommended guidelines set out by The College of Optometrists. Instead these guidelines are based on expert opinion with little conclusive evidence of efficacy in primary care. The importance of effective hand hygiene in the prevention and control of infection is stressed. They have adopted recommendations set by The National Institute for Health and Clinical Excellence (NICE 2003), which are for the use of professionals in primary and community care. A minimum standard of hand hygiene practice would be to decontaminate hands before each and every episode of patient contact and after any procedure or contact that would cause hands to become contaminated. The College of Optometrists (2009) expand upon this stipulating that there is no set regularity in hand washing episodes and that instead it should be adhered to in circumstances such as contact lens insertion and removal, after going to the toilet, when hands appear visibly unclean, before and after contact with ocular surfaces or the adnexa, before and after administering topical ointments or drops, after any possible microbial contamination, after handling soiled or contaminated materials and before wearing and after removing gloves. Furthermore, an instruction of appropriate hand hygiene technique in clinical practice is suggested: ‘Wet hands under running water. Dispense soap/antiseptic into cupped hand (N.B. bar soap should not be used). Rub hands vigorously and thoroughly for 10-15 seconds without adding more water. Ensure all surfaces of the hands are covered. Rinse hands thoroughly under warm running water. Dry hands with a disposable paper towel. The use of non disposable towels is not good practice.’ Advisory recommendations for optometrists regarding hand hygiene in the community setting remains at a robust level. To improve standards, further research must be conducted as it is widely regarded that sound clinical practice requires conclusive clinical evidence (Smith, 2009). Optometrists in a primary care setting could benefit from adopting higher standards of hygiene expected in hospital environments. 1.3 Hand hygiene guidelines and technique Due to the clinical and economic implications of health-care associated infection the World Health Organisation (WHO) and the US Centers for Disease Control and Prevention (CDC) have formulated guidelines to promote improved hand hygiene adherence among health care workers (Boyce and Pittet, 2002; Pittet, Allegranzi and Boyce, 2009; Sax et al., 2009). These guidelines include specific indications for hand washing and hand antisepsis episodes. A detailed description of appropriate hand hygiene technique is also included. The recommendations are categorised on the basis of published scientific data, theoretical knowledge, applicability in a clinical setting and economic involvement. The CDC/HICPAC created a system for categorising hand hygiene recommendations. These categories are shown in Table 1 Table 1 showing the CDC/ HICPAC categorisation of guidelines (Boyce and Pittet, 2002) Category Criteria IA Strongly recommended for implementation and strongly supported by well-designed experimental, clinical or epidemiologic studies IB Strongly recommended for implementation and strongly supported by certain experimental, clinical, or epidemiologic studies and a strong theoretical rationale. IC Required for implementation, as mandated by federal or state regulation or standard II Suggested for implementation and supported by suggestive clinical or epidemiological studies or a theoretical rationale or a consensus by a panel of experts. No recommendation Unresolved issue. Practices for which insufficient evidence or no concensus regarding efficicacy exist. Sections 1, 2 and 6 of the CDC/HICPAC recommendations advise specifically on handwashing and hand antisepsis indications, hand-hygiene technique and other aspects of hand hygiene. Each guideline is given a classification category relevant to Table 1. These recommendations are as follows: ‘1. Indications for handwashing and hand antisepsis A. When hands are visibly dirty or contaminated with proteinaceous material or are visibly soiled with blood or other body fluids, wash hands with either a nonantimicrobial soap and water or an antimicrobial soap and water (IA). B. If hands are not visibly soiled, use an alcohol-based hand rub for routinely decontaminating hands in all other clinical situations described in items 1C-J (IA). Alternatively, wash hands with an antimicrobial soap and water in all clinical situations described in items1C-J (IB). C. Decontaminate hands before having direct contact with patients (IB). D. Decontaminate hands before donning sterile gloves when inserting a central intravascular catheter (IB). E. Decontaminate hands before inserting urinary catheters, peripheral vascular catheters, or other invasive devices that do not require a surgical procedure (IB). F. Decontaminate hands after contact with a patient’s intact skin (e.g., when taking a pulse or blood pressure, and lifting a patient) (IB). G. Decontaminate hands after contact with body fluids or excretions, mucous membranes, nonintact skin, and wound dressings if hands are not visibly soiled (IA). H. Decontaminate hands if moving from a contaminated-body site to a clean-body site during patient care (II. I. Decontaminate hands after contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient (II). J. Decontaminate hands after removing gloves (IB). K. Before eating and after using a restroom, wash hands with a non-antimicrobial soap and water or with an antimicrobial soap and water (IB). L. Antimicrobial-impregnated wipes (i.e., towelettes) may be considered as an alternative to washing hands with non-antimicrobial soap and water. Because they are not as effective as alcohol-based hand rubs or washing hands with an antimicrobial soap and water for reducing bacterial counts on the hands of HCWs, they are not a substitute for using an alcohol-based hand rub or antimicrobial soap (IB). M. Wash hands with non-antimicrobial soap and water or with antimicrobial soap and water if exposure to Bacillus anthracis is suspected or proven. The physical action of washing and rinsing hands under such circumstances is recommended because alcohols, chlorhexidine, iodophors, and other antiseptic agents have poor activity against spores (II). N. No recommendation can be made regarding the routine use of nonalcohol-based hand rubs for hand hygiene in health-care settings.(Unresolved issue). 2. Hand-hygiene technique A. When decontaminating hands with an alcohol-based hand rub, apply product to palm of one hand and rub hands together, covering all surfaces of hands and fingers, until hands are dry (IB). Follow the manufacturer’s recommendations regarding the volume of product to use. B. When washing hands with soap and water, wet hands first with water, apply an amount of product recommended by the manufacturer to hands, and rub hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers. Rinse hands with water and dry thoroughly with a disposable towel. Use towel to turn off the faucet (IB). Avoid using hot water, because repeated exposure to hot water may increase the risk of dermatitis (IB). C. Liquid, bar, leaflet or powdered forms of plain soap are acceptable when washing hands with a nonantimicrobial soap and water. When bar soap is used, soap racks that facilitate drainage and small bars of soap should be used (II). D. Multiple-use cloth towels of the hanging or roll type are not recommended for use in health-care settings (II). 6. Other Aspects of Hand Hygiene A. Do not wear artificial fingernails or extenders when having direct contact with patients at high risk (e.g., those in intensive-care units or operating rooms) (IA). B. Keep natural nails tips less than 1/4-inch long (II). C. Wear gloves when contact with blood or other potentially infectious materials, mucous membranes, and nonintact skin could occur (IC). D. Remove gloves after caring for a patient. Do not wear the same pair of gloves for the care of more than one patient, and do not was gloves between uses with different patients (IB). E. Change gloves during patient care if moving from a contaminated body site to a clean body site (II). F. No recommendation can be made regarding wearing rings in health-care settings. Unresolved issue.’ These guidelines were developed for the use of health care professionals in a clinical setting and were not specifically designed with optometric practice in mind. However, many of these recommendations remain highly relevant when adopted to an optometric environment and are strongly supported by The College of Optometrists. The World Health Organisation have extended the recommendations on hand-hygiene technique and produced a visual publication poster detailing the hand hygiene technique for use with alcohol-based formulations and the handwashing technique for use with soap and water. These are shown in Figures 1 and 2 respectively. Figure 1 showing recommended hand hygiene technique with an alcohol-based formulation (World Health Organisation 2006) ***online access reference 2 Figure 2 showing recommended handwashing technique using soap and water (World Health Organisation 2006) **online access reference 1.4 Hand hygiene practices among health care workers Hand hygiene practice among health care workers is poor with many observational studies reporting low compliance rates in a number of indicative areas. Hence, understanding current trends among health care workers is critical in planning and implementing the necessary modification in behaviour (Allegranzi and Pittet, 2009). Hand hygiene adherence can be investigated over a range of parameters such as duration spent cleansing or disinfecting, frequency of hand washing episodes over a given time and observing the variations in performance with regard to clinical setting, physician status and gender (Boyce and Pittet, 2002). Employing the appropriate hand hygiene technique is essential. Consider the situation in which hand hygiene episodes per hour compliance is high. If insufficient hand hygiene technique is being performed e.g. inadequate coverage of hand surfaces and a short cleansing time, then the overall standard of compliance will decrease. This confirms that hand hygiene practices among health care practitioners involves both multimodal strategies and multidisciplinary approaches to improve adherence (Pittet, 2001; Dierssen-Sotos et al., 2009). Multiple factors are associated with the suboptimal hand hygiene performance among health care practitioners and they vary in relation to resources available and the setting involved. For example, the lack of appropriate infrastructure, equipment and materials will hinder good hand hygiene practice, the cultural background and perhaps even religious beliefs can also affect performance (Ahmed et al., 2006; Allegranzi et al., 2009). The most commonly reported causes of poor hand hygiene compliance are: (i) physician or nursing status, (ii) clinical care setting e.g. ICU, A