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3
,
Sep
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b
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201
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,
p
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2
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~
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9
I
SS
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8806
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1
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Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8806
I
J
P
HS
Vo
l.
5
,
No
.
3
,
Sep
tem
b
er
20
1
6
:
2
3
3
–
2
3
9
234
in
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k
er
s
m
u
s
t
m
ai
n
tai
n
th
e
h
ea
lt
h
an
d
s
a
f
et
y
o
f
t
h
e
m
s
el
v
es
a
n
d
o
th
er
s
a
n
d
r
esp
o
n
s
ib
le
f
o
r
i
m
p
le
m
en
t
in
g
t
h
e
p
o
licies
es
tab
lis
h
ed
h
o
s
p
ital.
Hea
l
th
w
o
r
k
er
s
ar
e
also
r
e
s
p
o
n
s
ib
le
f
o
r
u
s
i
n
g
t
h
e
m
ea
n
s
p
r
o
v
id
ed
p
r
o
p
er
ly
an
d
m
ai
n
tai
n
th
e
f
ac
ili
ties
t
h
at
ar
e
al
w
a
y
s
r
ea
d
y
to
u
s
e
an
d
ca
n
b
e
u
s
ed
as lo
n
g
a
s
p
o
s
s
ib
le.
T
h
e
r
esu
lts
o
f
th
e
s
u
r
v
e
y
o
n
t
h
e
p
r
ev
en
tio
n
o
f
in
f
ec
tio
n
i
n
h
ea
lt
h
ce
n
ter
s
o
r
h
o
s
p
ital
s
till
g
o
t
s
o
m
e
ac
tio
n
o
f
f
icer
p
o
ten
tial
in
cr
ea
s
e
d
is
ea
s
e
tr
an
s
m
is
s
io
n
to
h
ea
lt
h
ca
r
e
w
o
r
k
er
s
,
p
atien
ts
s
er
v
e
d
an
d
th
e
p
u
b
lic
a
t
lar
g
e,
th
e
lack
o
f
co
r
r
ec
t
h
an
d
w
a
s
h
i
n
g
,
u
s
e
o
f
g
lo
v
es
is
n
o
t
q
u
ite
r
i
g
h
t,
b
ac
k
clo
s
u
r
e
n
ee
d
le
in
j
ec
tio
n
s
ar
e
u
n
s
a
f
e,
d
is
p
o
s
al
o
f
s
h
ar
p
in
s
tr
u
m
e
n
t
s
ar
e
n
o
t
s
a
f
e,
d
ec
o
n
ta
m
i
n
atio
n
an
d
s
ter
ilizatio
n
t
ec
h
n
iq
u
es
ar
e
le
s
s
p
r
ec
is
e
eq
u
ip
m
e
n
t
a
n
d
h
y
g
ie
n
e
p
r
ac
tices
ar
e
n
o
t
ad
eq
u
ate
r
o
o
m
.
T
h
e
lo
w
a
w
ar
e
n
es
s
o
f
h
ea
lth
w
o
r
k
er
s
i
n
t
h
e
h
o
s
p
ital
o
n
th
e
u
s
e
o
f
U
n
i
v
er
s
al
P
r
ec
au
tio
n
ca
n
ca
u
s
e
in
cr
ea
s
i
n
g
o
f
n
o
s
o
co
m
ial
i
n
f
ec
tio
n
s
s
o
th
a
t
th
e
p
r
ev
en
tio
n
o
f
n
o
s
o
co
m
ial
in
f
e
ctio
n
s
les
s
t
h
an
t
h
e
m
ax
i
m
u
m
is
a
p
r
o
b
lem
f
ac
ed
b
y
h
o
s
p
ital
s
to
d
ate.
2.
RE
S
E
ARCH
M
E
T
H
O
D
T
h
is
r
esear
ch
i
s
d
escr
ip
ti
v
e
q
u
alitati
v
e
r
e
s
ea
r
ch
w
i
th
ca
s
e
s
tu
d
y
ap
p
r
o
ac
h
.
T
h
is
r
esear
c
h
s
tu
d
ie
s
t
h
e
p
h
en
o
m
e
n
a
ass
o
ciate
d
w
it
h
th
e
ap
p
licatio
n
o
f
u
n
i
v
er
s
al
p
r
ec
au
tio
n
s
,
k
n
o
w
led
g
e
o
f
h
ea
lt
h
w
o
r
k
er
s
o
n
u
n
i
v
er
s
al
p
r
ec
au
tio
n
s
,
attit
u
d
e
o
f
h
ea
l
th
p
er
s
o
n
n
el
in
i
m
p
le
m
e
n
ti
n
g
u
n
i
v
er
s
al
p
r
ec
au
tio
n
s
,
as
w
ell
a
s
th
e
av
ailab
ilit
y
o
f
f
ac
il
ities
a
n
d
t
o
o
ls
s
u
p
p
o
r
tin
g
th
e
i
m
p
le
m
e
n
tatio
n
o
f
u
n
i
v
er
s
al
p
r
ec
a
u
tio
n
.
T
h
is
s
t
u
d
y
to
o
k
p
lace
in
P
KU
Mu
h
a
m
m
ad
i
y
a
h
Ho
s
p
ital
in
Yo
g
y
ak
ar
ta.
S
u
b
jects
in
t
h
is
s
t
u
d
y
w
er
e
n
u
r
s
e
s
an
d
m
id
w
i
v
es
w
h
o
b
ec
am
e
t
h
e
tea
m
P
P
I
(
No
s
o
co
m
ial
I
n
f
ec
tio
n
C
o
n
tr
o
l
an
d
P
r
ev
en
t
io
n
)
.
Data
co
llectio
n
tec
h
n
iq
u
es
u
s
i
n
g
f
o
c
u
s
g
r
o
u
p
d
is
cu
s
s
io
n
s
(
FGD)
.
T
h
e
r
esear
ch
in
s
tr
u
m
en
t
u
s
ed
in
t
h
is
s
tu
d
y
ar
e:
1
)
FGD
g
u
id
elin
es
f
o
r
o
p
en
d
is
cu
s
s
io
n
w
it
h
r
esear
ch
s
u
b
j
ec
ts
;
2
)
Statio
n
er
y
,
r
ec
o
r
d
s
h
ee
t,
r
ec
o
r
d
er
s
an
d
ca
m
er
as
to
s
u
p
p
o
r
t
th
e
FGD
p
r
o
ce
s
s
w
it
h
in
f
o
r
m
a
n
t
s
(
r
esear
ch
s
u
b
j
ec
ts
)
.
T
h
e
v
ar
ia
b
les
u
s
ed
in
t
h
is
s
t
u
d
y
is
a
n
o
v
er
v
ie
w
o
f
u
n
i
v
er
s
al
ap
p
licati
o
n
o
f
p
r
ec
au
tio
n
,
t
h
e
h
ea
lt
h
w
o
r
k
er
k
n
o
w
led
g
e
ab
o
u
t
u
n
i
v
er
s
al
p
r
ec
au
tio
n
,
th
e
attit
u
d
e
o
f
h
ea
lt
h
w
o
r
k
e
r
s
in
i
m
p
le
m
e
n
ti
n
g
u
n
i
v
er
s
al
p
r
ec
au
tio
n
s
,
as
w
el
l
as
th
e
a
v
ailab
ilit
y
o
f
f
ac
il
it
ies
an
d
to
o
ls
s
u
p
p
o
r
tin
g
t
h
e
i
m
p
le
m
en
ta
tio
n
o
f
u
n
i
v
er
s
al
p
r
ec
au
tio
n
s
.
A
n
al
y
s
i
s
o
f
d
ata
u
s
in
g
s
e
m
io
tic
tech
n
iq
u
e
w
it
h
co
n
ten
t
a
n
al
y
s
is
.
C
h
ec
k
in
g
th
e
v
alid
it
y
o
f
th
e
d
ata
u
s
in
g
d
ata
tr
ian
g
u
l
atio
n
tech
n
iq
u
e.
3.
RE
SU
L
T
S
A
ND
AN
AL
Y
SI
S
3
.
1
.
O
v
er
v
ie
w
o
f
t
he
a
pp
lica
t
io
n
o
f
un
iv
e
rsa
l
prec
a
utio
n
s
in
P
K
U
M
uh
a
mm
a
diy
a
h
ho
s
pita
ls
o
n
Yo
g
y
a
k
a
rt
a
a
s
s
o
cia
t
ed
w
it
h
t
he
prev
ent
io
n o
f
no
s
o
co
m
ia
l inf
ec
t
io
ns
Un
i
v
er
s
al
P
r
ec
au
tio
n
s
(
UP
)
is
v
ig
ilan
ce
ag
a
in
s
t
b
lo
o
d
an
d
b
o
d
y
f
l
u
id
s
th
a
t
ar
e
p
o
ten
tia
ll
y
in
f
ec
tio
u
s
,
b
o
th
f
r
o
m
p
atien
t
s
an
d
h
ea
lt
h
ca
r
e
w
o
r
k
er
s
.
Un
i
v
er
s
al
p
r
ec
au
tio
n
s
s
h
o
u
ld
b
e
d
o
n
e
b
y
all
h
ea
lt
h
p
r
o
f
ess
io
n
al
s
to
r
ed
u
ce
th
e
r
is
k
o
f
s
p
r
ea
d
in
g
in
f
ec
tio
n
.
Her
e
ar
e
s
o
m
e
e
x
ce
r
p
ts
o
f
th
e
i
n
ter
v
ie
w
r
elate
d
to
A
p
p
lied
UP
in
h
o
s
p
itals
ac
r
o
s
s
R
e
g
io
n
o
f
Yo
g
y
a
k
ar
ta
"
Defin
ite
b
efo
r
e
a
n
d
a
fter
th
e
a
ctio
n
,
w
a
s
h
h
a
n
d
s
w
ith
r
u
n
n
i
n
g
w
a
ter a
n
d
s
o
a
p
"
(
P
K
U
Jo
g
ja
)
"
B
efo
r
e
a
n
d
a
fter
th
e
a
ctio
n
to
h
a
n
d
h
yg
ie
n
e
"
(
P
K
U
K
o
ta
Ge
d
e
)
"
Of
yo
u
r
s
elf
tr
y
in
g
to
a
lw
a
ys
w
ea
r
p
er
s
o
n
a
l
p
r
o
tective
eq
u
ip
men
t
a
n
d
p
erfo
r
m
h
a
n
d
h
yg
i
en
e"
(
P
K
U
N
a
n
g
g
u
la
n
)
Fro
m
t
h
e
q
u
o
te
ab
o
v
e
in
ter
v
i
e
w
,
in
d
icati
n
g
t
h
at
t
h
e
h
ea
lt
h
w
o
r
k
er
is
w
o
r
k
i
n
g
to
i
m
p
le
m
en
t
t
h
e
UP
in
cl
u
d
in
g
h
a
n
d
w
as
h
i
n
g
ac
t
io
n
o
n
t
h
e
w
ater
f
lo
w
,
p
er
f
o
r
m
h
a
n
d
h
y
g
ien
e,
a
n
d
al
w
a
y
s
tr
ies
to
w
ea
r
P
P
E
.
I
n
f
ec
ted
p
atie
n
ts
or
n
o
t,
an
y
h
ea
lth
ca
r
e
w
o
r
k
er
s
s
h
o
u
ld
i
m
p
le
m
en
ta
tio
n
p
r
ec
au
t
io
n
s
f
u
ll
y
i
n
r
elate
d
w
it
h
all
p
atien
ts
.
E
v
id
en
ce
-
b
ased
h
a
n
d
h
y
g
ien
e
ca
n
p
r
ev
en
t
tr
an
s
m
is
s
io
n
o
f
th
e
m
o
s
t
i
m
p
o
r
tan
t
n
o
s
o
co
m
ial
p
ath
o
g
en
s
an
d
also
k
ee
p
e
m
p
lo
y
ee
s
s
k
i
n
h
ea
lt
h
y
.
I
n
m
o
s
t
cli
n
ical
s
it
u
atio
n
s
h
y
g
ie
n
ic
d
i
s
in
f
ec
tio
n
is
in
d
icate
d
f
o
r
h
an
d
d
ec
o
n
ta
m
i
n
atio
n
o
n
g
r
o
u
n
d
s
o
f
b
etter
e
f
f
icac
y
a
n
d
cu
ta
n
e
o
u
s
to
ler
an
ce
.
W
as
h
in
g
w
i
th
s
o
ap
an
d
w
ater
i
s
n
ec
es
s
ar
y
o
n
l
y
w
h
en
t
h
e
h
an
d
s
ar
e
v
i
s
ib
l
y
s
o
iled
,
o
r
f
o
llo
w
i
n
g
d
is
i
n
f
ec
tio
n
i
n
t
h
e
ca
s
e
o
f
co
n
ta
m
i
n
atio
n
b
y
s
p
o
r
es
o
f
b
ac
ter
ia
s
u
ch
as
C
.
d
iffi
cile.
C
o
m
p
lia
n
ce
co
u
ld
b
e
i
m
p
r
o
v
ed
b
y
k
n
o
w
led
g
e
o
f
t
h
e
p
r
in
cip
al
clin
ical
cir
cu
m
s
ta
n
ce
s
i
n
w
h
ic
h
h
a
n
d
d
is
in
f
ec
tio
n
s
b
y
h
ea
lt
h
ca
r
e
w
o
r
k
er
s
g
e
n
u
in
el
y
b
en
e
f
it
s
t
h
e
p
atien
t
[
4
]
.
Han
d
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
P
HS
I
SS
N:
2252
-
8806
N
o
s
o
co
mia
l I
n
fectio
n
P
r
ev
en
ti
o
n
th
r
o
u
g
h
Un
ivers
a
l P
r
ec
a
u
t
io
n
in
Yo
g
y
a
ka
r
ta
.
.
.
.
.
(
Tr
iya
n
i Ma
r
w
a
ti
)
235
w
a
s
h
i
n
g
,
t
h
i
s
is
t
h
e
s
i
n
g
le
m
o
s
t
ef
f
ec
ti
v
e
h
y
g
ie
n
e
p
r
ac
tice
f
o
r
m
i
n
i
m
izi
n
g
h
ea
lt
h
ca
r
e
ass
o
ciate
d
in
f
e
ctio
n
s
.
Hea
lth
w
o
r
k
er
s
m
u
s
t
w
as
h
th
eir
h
an
d
s
b
e
f
o
r
e
an
d
af
ter
ev
e
r
y
s
i
g
n
i
f
ic
a
n
t
p
atie
n
t
co
n
tact.
Han
d
w
as
h
i
n
g
w
i
t
h
h
o
t
an
d
co
ld
w
ater
s
u
p
p
lies
,
n
o
n
-
to
u
ch
tap
s
w
it
h
a
n
ti
s
p
las
h
d
ev
ices,
s
u
p
p
lies
o
f
liq
u
id
h
a
n
d
w
as
h
(
p
r
ef
er
ab
l
y
in
n
o
n
-
r
e
f
illab
le
d
is
p
o
s
ab
le
co
n
tain
er
s
)
an
d
d
is
p
o
s
ab
le
p
ap
er
to
w
el
s
o
r
s
in
g
le
-
u
s
e,
clea
n
,
clo
th
to
w
el
s
ar
e
r
ec
o
m
m
e
n
d
ed
to
f
ac
ilit
ate
h
an
d
h
y
g
ien
e
[
5
]
.
T
h
e
ap
p
licatio
n
o
f
u
n
i
v
er
s
al
p
r
ec
au
tio
n
s
ai
m
ed
n
o
t o
n
l
y
p
r
o
t
ec
t
w
o
r
k
er
s
f
r
o
m
ex
p
o
s
u
r
e
to
t
h
e
r
is
k
o
f
in
f
ec
tio
n
b
u
t
al
s
o
p
r
o
tect
clien
ts
w
h
o
h
a
v
e
a
ten
d
en
c
y
p
r
o
n
e
to
all
s
o
r
ts
o
f
in
f
ec
tio
n
s
t
h
at
m
i
g
h
t
b
e
ca
r
r
ied
b
y
o
f
f
icer
s
.
I
n
ad
d
itio
n
to
p
r
ev
e
n
tio
n
ef
f
o
r
ts
u
n
d
er
tak
e
n
b
y
h
o
s
p
ital
s
ta
f
f
also
h
a
v
e
p
r
ev
e
n
tiv
e
m
ea
s
u
r
es
an
d
p
r
o
m
o
tio
n
in
s
u
p
p
o
r
t
o
f
t
h
e
ap
p
licatio
n
o
f
u
n
i
v
er
s
al
p
r
ec
au
tio
n
s
p
r
o
g
r
a
m
,
th
is
is
in
a
cc
o
r
d
an
ce
w
i
th
th
e
f
o
llo
w
in
g
i
n
ter
v
ie
w
e
x
ce
r
p
t:
"
I
n
th
e
n
ei
g
h
b
o
r
h
o
o
d
th
ere
w
ere
h
o
s
p
ita
l’
s
lea
flets
,
b
r
o
ch
u
r
es
a
b
o
u
t
n
o
s
o
c
o
mia
l
in
fectio
n
s
,
b
esid
es
o
fficers
a
ls
o
r
emin
d
th
e
p
a
tie
n
t,
th
e
p
a
tien
t's
fa
mily.
Th
ere
a
r
e
ed
u
c
a
tio
n
a
l
p
r
o
g
r
a
ms
fo
r
p
a
tien
ts
a
n
d
th
eir
fa
milies
,
a
s
n
ev
er
b
efo
r
e
to
w
a
s
h
h
a
n
d
s
p
r
o
p
erly,
th
e
n
u
r
s
e
w
h
o
ex
emp
lifi
es
o
r
P
P
I
o
fficer
".
"
Th
ere's o
u
r
p
r
o
g
r
a
m
ev
ery
n
ew p
a
tien
t e
d
u
ca
tio
n
fo
r
co
r
r
ec
t h
a
n
d
w
a
s
h
in
g
.
Th
ere
is
a
ch
ec
klis
t,
s
o
ea
ch
n
ew
p
a
tien
t
is
o
b
lig
a
ted
to
co
r
r
ec
t
h
a
n
d
w
a
s
h
in
g
e
d
u
c
a
tio
n
to
p
a
tien
ts
a
n
d
a
n
ce
s
tr
y
o
f
p
a
tien
ts
a
n
d
visi
to
r
s
"
.
"
P
r
o
mo
tive
effo
r
ts
b
eg
a
n
fr
o
m
p
r
o
vid
in
g
a
p
la
ce
fo
r
h
a
n
d
w
a
s
h
,
h
a
n
d
r
u
b
s
w
e
p
r
o
vid
e
o
n
s
ite
o
r
a
t
th
e
p
o
in
ts
cro
w
d
ed
.
I
n
a
d
d
itio
n
w
e
a
ls
o
p
r
o
vid
e
lea
flets
a
n
d
b
r
o
ch
u
r
es,
a
n
d
p
o
s
ters
.
”
E
f
f
o
r
ts
s
h
o
u
ld
b
e
m
ad
e
to
m
i
n
i
m
ize
th
e
r
is
k
o
f
i
n
f
ec
tio
n
i
n
h
o
s
p
itals
an
d
o
th
er
h
ea
l
th
ca
r
e
f
ac
ilit
ie
s
is
th
e
p
r
ev
e
n
tio
n
a
n
d
co
n
tr
o
l
o
f
in
f
ec
tio
n
,
ie
ac
ti
v
ities
i
n
clu
d
e
p
la
n
n
i
n
g
,
i
m
p
le
m
e
n
ta
tio
n
,
d
ev
elo
p
m
e
n
t,
ed
u
ca
tio
n
a
n
d
tr
ain
i
n
g
as
w
el
l
as
m
o
n
ito
r
in
g
a
n
d
ev
al
u
atio
n
.
P
r
ev
en
tio
n
a
n
d
I
n
f
ec
tio
n
C
o
n
tr
o
l
in
Ho
s
p
itals
is
v
er
y
i
m
p
o
r
tan
t b
ec
au
s
e
it ill
u
s
tr
ates t
h
e
q
u
al
it
y
o
f
h
o
s
p
ital
s
e
r
v
ices
[
6
]
.
I
n
t
h
e
ap
p
licatio
n
o
f
u
n
i
v
er
s
al
p
r
ec
au
tio
n
s
r
eq
u
ir
ed
ca
p
ab
ilit
ies
as
a
n
u
r
s
e
ex
ec
u
ti
v
e,
i
s
b
ac
k
b
y
f
ac
ilit
ies
a
n
d
i
n
f
r
a
s
tr
u
ct
u
r
e,
as
w
ell
as
Stan
d
ar
d
Op
er
atin
g
P
r
o
ce
d
u
r
es
g
o
v
er
n
i
n
g
th
e
s
tep
s
u
n
i
v
er
s
a
l
p
r
ec
au
tio
n
s
.
T
h
is
is
i
n
ac
co
r
d
an
ce
w
it
h
th
e
f
o
llo
w
i
n
g
i
n
ter
v
i
e
w
e
x
ce
r
p
t:
"
S
t
a
n
d
a
r
d
Op
era
tin
g
P
r
o
ce
d
u
r
es
o
f
cro
s
s
-
in
fectio
n
th
ere,
esp
ec
ia
lly
th
e
lin
en
,
n
u
tr
itio
n
,
ma
in
ten
a
n
ce
,
s
ervicin
g
,
p
h
a
r
ma
ce
u
tica
l,
b
o
d
ies
circu
la
tio
n
,
b
u
t
it
a
ls
o
i
s
a
u
n
iver
s
a
l
s
ta
n
d
a
r
d
p
r
ec
a
u
tio
n
s
".
"
F
o
r
th
e
S
ta
n
d
a
r
d
Op
era
tin
g
P
r
o
ce
d
u
r
es in
r
ela
tio
n
to
th
e
p
r
o
ce
s
s
b
ec
a
u
s
e
of
a
cc
r
ed
ita
ti
o
n
"
.
"
F
o
r
t
h
e
S
ta
n
d
a
r
d
Op
era
tin
g
P
r
o
ce
d
u
r
es
s
a
me
in
o
s
p
r
ev
en
tio
n
i
n
th
e
p
r
o
ce
s
s
,
b
u
t
w
e
a
lw
a
ys
a
p
p
lied
w
h
a
t we g
et
in
in
-
h
o
u
s
e
tr
a
in
in
g
"
.
Fro
m
th
e
q
u
o
te
ab
o
v
e
i
n
ter
v
i
e
w
i
s
n
o
t
all
h
o
s
p
itals
h
av
e
S
OP
s
,
an
d
is
s
till
u
n
d
er
co
n
s
tr
u
ctio
n
,
b
u
t
th
e
n
u
r
s
e
atte
m
p
ted
to
ap
p
ly
t
h
e
s
k
ills
i
n
ac
co
r
d
an
ce
w
it
h
t
h
e
m
ater
ia
l
g
i
v
en
at
t
h
e
ti
m
e
o
f
in
-
h
o
u
s
e
tr
ai
n
i
n
g
.
ap
p
licatio
n
o
f
w
a
s
h
in
g
h
a
n
d
s
n
u
r
s
e
s
m
u
s
t
also
b
e
s
u
p
p
o
r
ted
b
y
a
n
u
r
s
e
co
n
s
cio
u
s
n
es
s
its
el
f
in
p
r
o
tectin
g
th
e
m
s
el
v
es
an
d
p
atie
n
t
s
f
r
o
m
i
n
f
ec
tio
u
s
m
ater
ial
s
a
s
w
e
ll
as
a
w
ar
en
e
s
s
in
r
u
n
n
in
g
t
h
e
co
r
r
ec
t
s
ta
n
d
ar
d
o
p
er
atin
g
p
r
o
ce
d
u
r
e
(
SOP
)
.
H
an
d
w
a
s
h
in
g
n
u
r
s
e
s
in
h
o
s
p
ita
ls
,
a
f
u
n
d
a
m
en
ta
l
b
eh
av
io
r
s
in
th
e
p
r
ev
en
t
io
n
o
f
cr
o
s
s
i
n
f
ec
t
io
n
.
K
n
o
w
led
g
e
is
a
v
er
y
i
m
p
o
r
tan
t
ele
m
en
t
f
o
r
th
e
f
o
r
m
at
io
n
o
f
a
p
er
s
o
n
'
s
ac
tio
n
s
.
N
u
r
s
e
s
m
u
s
t
also
h
a
v
e
k
n
o
w
led
g
e
ab
o
u
t
th
e
co
r
r
ec
t
h
an
d
w
as
h
i
n
g
f
o
r
p
r
ev
en
t
io
n
o
f
n
o
s
o
co
m
ial
i
n
f
ec
t
io
n
s
i
n
h
o
s
p
itals
s
o
as
t
o
i
m
p
r
o
v
e
th
e
q
u
alit
y
o
f
s
e
r
v
ice
[
7
]
.
Han
d
s
w
a
s
h
m
u
s
t
b
e
d
o
n
e
r
ig
h
t
b
ef
o
r
e
an
d
a
f
ter
tak
in
g
ac
tio
n
d
esp
ite
tr
ea
t
m
e
n
t
w
ea
r
g
lo
v
es
o
r
o
th
e
r
p
r
o
tectiv
e
g
ea
r
f
o
r
el
i
m
in
at
i
n
g
o
r
r
ed
u
ci
n
g
m
icr
o
o
r
g
an
is
m
s
w
as
o
n
h
a
n
d
s
o
th
at
th
e
s
p
r
ea
d
o
f
th
e
d
is
ea
s
e
ca
n
r
ed
u
ce
d
an
d
th
e
e
n
v
ir
o
n
m
en
t
p
r
o
tecte
d
f
r
o
m
i
n
f
ec
tio
n
.
i
n
d
icatio
n
s
w
a
s
h
h
an
d
s
s
h
o
u
ld
b
e
d
o
n
e
at
t
h
e
ti
m
e
a
n
ticip
ated
th
e
d
i
s
p
lace
m
e
n
t
o
f
g
er
m
s
t
h
r
o
u
g
h
h
a
n
d
,
ie
b
ef
o
r
e
ac
tio
n
w
h
ic
h
is
p
o
s
s
ib
le
p
o
llu
tio
n
a
n
d
a
f
te
r
ac
ti
on
p
o
s
s
ib
le
p
o
llu
tio
n
[
8
]
.
Han
d
s
w
a
s
h
is
a
b
as
ic
tec
h
n
iq
u
e
t
h
at
is
m
o
s
t
i
m
p
o
r
tan
t i
n
p
r
ev
en
t
io
n
an
d
c
o
n
tr
o
l o
f
in
f
ec
tio
n
[
9
]
.
3
.
2
.
K
no
w
ledg
e
m
ent
o
f
hea
lt
h
wo
rk
er
s
o
n
un
iv
er
s
a
l
pr
ec
a
utio
ns
t
o
prev
ent
t
he
incid
ence
o
f
no
s
o
co
m
ia
l i
nfe
ct
io
ns
in P
K
U
H
o
s
pita
l
s
in
Yo
g
y
a
k
a
rt
a
Nu
r
s
es
ar
e
h
ig
h
l
y
s
u
s
ce
p
tib
le
to
in
f
ec
t
io
n
tr
an
s
m
is
s
io
n
,
b
ec
au
s
e
n
u
r
s
e
s
i
n
p
r
o
v
id
in
g
n
u
r
s
i
n
g
ca
r
e
to
p
atien
ts
w
ill
b
e
in
d
ir
ec
t
co
n
t
ac
t
w
it
h
b
lo
o
d
an
d
b
o
d
y
f
l
u
i
d
s
.
E
f
f
o
r
ts
ar
e
b
ein
g
m
ad
e
to
r
ed
u
ce
th
e
r
is
k
o
f
co
n
tr
ac
tin
g
a
n
in
f
ec
tio
n
,
u
s
i
n
g
u
n
i
v
er
s
al
p
r
ec
au
t
io
n
s
.
He
n
c
e
th
e
i
m
p
o
r
ta
n
ce
o
f
t
h
i
s
ac
tio
n
is
p
er
f
o
r
m
ed
,
th
e
n
u
r
s
es a
r
e
r
eq
u
ir
ed
to
h
av
e
ad
eq
u
ate
k
n
o
w
led
g
e.
Kn
o
w
led
g
e
is
th
e
m
e
m
o
r
y
o
f
t
h
e
m
ater
ial
th
at
h
a
s
b
ee
n
s
t
u
d
i
ed
.
I
n
clu
d
es
th
e
ab
ilit
y
to
r
e
m
e
m
b
er
th
e
r
an
g
e
o
f
m
ater
ial,
f
r
o
m
s
p
ec
if
ic
f
ac
t
s
to
co
m
p
lete
t
h
eo
r
ies.
Kn
o
w
led
g
e
is
th
e
lo
w
e
s
t
lev
el
o
f
lear
n
i
n
g
o
u
tco
m
es
in
t
h
e
co
g
n
iti
v
e
d
o
m
ai
n
.
A
p
r
o
f
ess
io
n
al
n
u
r
s
e
s
a
id
,
if
y
o
u
h
a
v
e
t
h
e
k
n
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e
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a
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9
236
p
r
o
f
ess
io
n
al
attit
u
d
e
ac
co
r
d
in
g
to
t
h
e
co
d
e
o
f
p
r
o
f
es
s
io
n
al
co
n
d
u
ct.
Kn
o
w
led
g
e
n
u
r
s
es
ca
n
co
n
ti
n
u
e
to
in
cr
ea
s
e
i
f
t
h
e
h
o
s
p
ital
ca
n
c
o
n
tin
u
e
to
i
m
p
r
o
v
e
w
i
th
a
v
a
r
iet
y
o
f
tr
ai
n
i
n
g
a
n
d
co
n
ti
n
u
o
u
s
ed
u
ca
t
io
n
f
o
r
all
e
m
p
lo
y
ee
s
o
n
all
asp
ec
ts
o
f
in
f
ec
tio
n
p
r
ev
en
t
io
n
[
1
0
]
.
Kn
o
w
led
g
e
ab
o
u
t
t
h
e
p
r
ev
en
tio
n
o
f
n
o
s
o
co
m
ial
in
f
ec
tio
n
s
i
s
v
er
y
i
m
p
o
r
ta
n
t
f
o
r
h
o
s
p
ital
s
ta
f
f
,
esp
ec
iall
y
n
u
r
s
es,
th
e
ab
ilit
y
to
p
r
e
v
en
t
t
h
e
tr
a
n
s
m
i
s
s
io
n
o
f
h
o
s
p
ital i
n
f
ec
t
io
n
s
a
n
d
p
r
ev
en
tio
n
o
f
i
n
f
ec
t
io
n
is
t
h
e
f
ir
s
t s
ta
g
e
in
t
h
e
d
eliv
er
y
o
f
q
u
al
it
y
s
e
r
v
ices.
"
Dis
ea
s
es
ca
u
s
ed
b
y
micro
o
r
g
a
n
is
ms.
I
n
fectio
n
s
a
cq
u
ir
ed
fr
o
m
th
e
h
o
s
p
ita
l
en
viro
n
men
t,
a
n
d
a
r
o
u
n
d
th
e
h
o
s
p
ita
l
a
s
w
ell
a
s
th
e
p
a
tien
t's
h
o
me
in
th
e
h
o
me
en
viro
n
men
t,
a
n
d
th
e
en
viro
n
men
t
a
r
o
u
n
d
th
e
p
a
tien
t
in
a
d
d
itio
n
,
cro
s
s
-
in
fectio
n
ca
n
b
e
d
ir
ec
tly
tr
a
n
s
mitted
th
r
o
u
g
h
d
ir
e
ct
co
n
ta
ct
w
ith
th
e
d
is
ea
s
e
in
th
e
h
o
s
p
ita
l '
.
"
N
o
s
o
co
mia
l
in
fectio
n
is
a
d
is
ea
s
e
ca
u
s
ed
b
y
micro
o
r
g
a
n
is
ms
w
i
th
b
o
d
ily
r
ea
ctio
n
s
a
n
d
i
n
fectio
n
o
b
ta
in
ed
fr
o
m
th
e
h
o
s
p
ita
l e
n
v
ir
o
n
men
t"
.
"
N
o
s
o
co
mia
l
in
fectio
n
s
ca
n
b
e
tr
a
n
s
mitted
fr
o
m
h
o
s
p
ita
l
e
q
u
ip
men
t
th
a
t
is
n
o
t
s
ter
ile,
o
fficers
w
h
o
d
o
n
o
t
w
ea
r
p
ers
o
n
a
l
p
r
o
tecti
ve
eq
u
ip
men
t
a
n
d
d
o
n
o
t
ma
in
ta
in
h
a
n
d
h
yg
ien
e.
Hea
lth
w
o
r
ke
r
s
w
h
o
d
o
n
o
t
o
r
less
a
tten
tio
n
s
e
p
tic
a
n
d
a
s
ep
tic
tech
n
i
q
u
e
is
in
fecte
d
w
ith
th
e
b
a
cteria
ca
u
s
in
g
n
o
s
o
co
mia
l in
fectio
n
s
"
.
Fro
m
th
e
q
u
o
te
ab
o
v
e
in
ter
v
ie
w
n
u
r
s
e
s
k
n
o
w
led
g
e
o
f
n
o
s
o
c
o
m
ial
in
f
e
ctio
n
s
h
as
b
ee
n
g
o
o
d
,
an
d
f
o
r
p
r
ev
en
tio
n
n
ee
d
to
i
m
p
le
m
en
t
u
n
iv
er
s
al
p
r
ec
au
tio
n
s
b
y
ap
p
ly
in
g
o
n
e
h
a
n
d
h
y
g
ie
n
e
an
d
s
ep
tic
an
d
a
s
ep
tic
tech
n
iq
u
es a
t
ten
tio
n
.
P
r
ev
en
tio
n
o
f
n
o
s
o
co
m
ia
l
th
r
o
u
g
h
h
a
n
d
w
as
h
in
g
h
ea
lt
h
w
o
r
k
er
s
b
ec
o
m
e
v
er
y
i
m
p
o
r
tan
t.
T
h
e
attitu
d
e
o
f
g
o
o
d
n
u
r
s
e
s
in
p
r
ev
en
ti
n
g
n
o
s
o
co
m
ial
i
n
f
ec
tio
n
s
ca
n
i
m
p
r
o
v
e
th
e
b
eh
a
v
io
r
o
f
n
u
r
s
e
s
i
n
i
m
p
le
m
en
t
in
g
u
n
i
v
er
s
al
p
r
ec
a
u
tio
n
s
.
N
u
r
s
es
k
n
o
w
led
g
e
ab
o
u
t
n
o
s
o
co
m
ial
in
f
ec
tio
n
a
f
f
e
cts
t
h
e
n
u
r
s
es
w
h
o
d
em
o
n
s
tr
ated
a
g
ain
s
t
t
h
e
o
v
er
all
p
r
ev
en
tio
n
(
u
n
i
v
er
s
al
p
r
ec
au
tio
n
s
)
w
h
i
le
th
e
a
ttit
u
d
e
o
f
n
u
r
s
es
i
n
a
n
ef
f
o
r
t
to
s
u
p
p
o
r
t
u
n
i
v
er
s
al
p
r
ec
au
tio
n
is
o
f
te
n
s
h
o
w
n
w
it
h
i
n
d
if
f
er
e
n
ce
an
d
o
v
er
r
id
e
w
a
s
h
h
an
d
s
af
ter
ca
r
r
y
in
g
o
u
t
n
u
r
s
in
g
ac
tio
n
s
b
ec
au
s
e
co
n
s
i
d
er
s
n
o
t d
ir
ty
(
n
o
t e
x
p
o
s
ed
p
u
s
o
r
b
lo
o
d
)
.
Nu
r
s
es
k
n
o
w
led
g
e
ab
o
u
t
th
e
p
r
ev
en
ti
o
n
o
f
n
o
s
o
co
m
ial
i
n
f
e
ctio
n
an
d
e
x
ter
n
al
s
ti
m
u
li
t
h
at
ca
n
ca
u
s
e
an
e
m
o
tio
n
al
r
esp
o
n
s
e
to
th
e
ef
f
o
r
t
s
o
f
n
u
r
s
e
s
u
n
i
v
er
s
al
p
r
ec
au
tio
n
s
o
th
at
it
w
il
l
in
cr
ea
s
e
its
p
ar
ticip
atio
n
i
n
th
e
p
r
ev
en
tio
n
o
f
n
o
s
o
co
m
ia
l
i
n
f
ec
tio
n
s
.
T
h
e
r
o
le
o
f
n
u
r
s
es
i
n
th
e
p
r
ev
e
n
tio
n
o
f
n
o
s
o
co
m
ia
l
in
f
ec
tio
n
s
is
v
er
y
i
m
p
o
r
tan
t.
Si
n
ce
th
e
a
v
er
ag
e
d
ail
y
7
-
8
h
o
u
r
s
n
u
r
s
es
m
a
k
e
co
n
tact
w
ith
t
h
e
p
atien
t
s
o
th
at
it
ca
n
b
e
a
m
aj
o
r
s
o
u
r
ce
o
f
ex
p
o
s
u
r
e
/ e
x
p
o
s
u
r
e
n
o
s
o
co
m
ial
i
n
f
ec
tio
n
[
1
0
]
.
Nu
r
s
es
r
ec
ei
v
e
tr
ai
n
in
g
o
n
P
er
s
o
n
al
P
r
o
tectiv
e
E
q
u
ip
m
en
t
h
a
s
5
.
7
ti
m
es
m
o
r
e
o
b
ed
ien
t
o
p
p
o
r
tu
n
itie
s
to
u
s
e
p
er
s
o
n
al
p
r
o
tectiv
e
eq
u
ip
m
e
n
t
w
h
e
n
p
r
ac
tice.
T
o
in
cr
ea
s
e
k
n
o
w
led
g
e
ab
o
u
t
th
e
ap
p
licatio
n
o
f
th
e
Un
i
v
er
s
al
P
r
ec
au
tio
n
n
u
r
s
e
n
u
r
s
es a
r
e
g
i
v
en
tr
ai
n
i
n
g
[
1
1
]
,
it is
ev
id
e
n
ce
d
in
t
h
e
f
o
llo
w
i
n
g
i
n
ter
v
ie
w
e
x
ce
r
p
t:
"
Tr
a
in
in
g
's
b
ee
n
d
o
n
e
2
x
a
ye
a
r
(
b
eg
in
n
in
g
a
n
d
e
n
d
o
f
t
h
e
ye
a
r
)
fo
r
b
o
th
med
ica
l
a
n
d
n
o
n
-
med
ica
l
p
ers
o
n
n
el,
b
u
t it
is
a
ls
o
o
u
r
fir
s
t e
ve
r
in
b
in
a
a
ls
o
by
S
a
r
jito
h
o
s
p
ita
l
a
n
d
o
n
ce
a
ls
o
fr
o
m
J
a
ka
r
ta
".
"
A
ll
h
e
a
lth
w
o
r
ke
r
s
kn
o
w
n
o
s
o
co
mia
l
a
s
s
o
cia
ted
w
ith
in
fec
tio
n
,
w
e
h
a
ve
i
n
-
h
o
u
s
e
tr
a
in
in
g
o
f
P
K
U
Jo
g
ja
to
imp
r
o
ve
o
u
r
s
kills
"
.
"
Yes
-
r
ela
ted
s
kills
w
e
h
a
ve
i
n
h
o
u
s
e
tr
a
in
in
g
o
f
P
K
U
Jo
g
ja
b
u
t
n
o
t
a
ll
h
ea
lth
w
o
r
ke
r
s
r
ec
eive
tr
a
in
in
g
r
ela
ted
to
n
o
s
o
co
mia
l
in
fectio
n
s
".
"
E
mp
o
w
ermen
t
a
n
d
co
n
d
u
cted
p
erio
d
ic
tr
a
in
in
g
to
a
ll
emp
lo
ye
es
ea
ch
ye
a
r
.
By
s
o
cia
liz
a
tio
n
a
b
o
u
t
in
fectio
u
s
w
h
en
s
u
r
ve
illa
n
ce
"
.
Kn
o
w
led
g
e
o
f
n
u
r
s
es
ab
o
u
t
6
4
%
o
f
h
an
d
h
y
g
ie
n
e
k
n
o
w
l
ed
g
e
is
s
t
ill
lac
k
in
g
,
k
n
o
w
le
d
g
e
is
s
t
ill
lack
i
n
g
d
u
e
to
th
er
e
ar
e
s
o
m
e
n
u
r
s
es
w
h
o
h
av
e
n
ev
er
r
ec
eiv
ed
ed
u
ca
tio
n
an
d
tr
ain
i
n
g
o
n
h
an
d
h
y
g
ie
n
e
in
t
h
e
p
ast
y
ea
r
.
So
m
e
n
u
r
s
es
s
a
y
n
e
v
er
r
ec
eiv
ed
ed
u
ca
tio
n
an
d
tr
ain
i
n
g
b
u
t
f
o
r
g
o
tte
n
.
An
o
th
er
p
o
s
s
ib
le
r
ea
s
o
n
f
o
r
th
e
lack
o
f
k
n
o
w
led
g
e
o
f
h
a
n
d
h
y
g
ie
n
e
f
o
r
n
u
r
s
es
is
le
s
s
ex
p
o
s
ed
to
in
f
o
r
m
atio
n
ab
o
u
t
h
an
d
h
y
g
ien
e
an
d
s
cien
t
if
ic
u
p
d
ate
[
1
2
]
.
F
ail
u
r
e
to
co
m
p
l
y
w
it
h
m
ea
s
u
r
e
s
s
u
c
h
as
g
o
o
d
h
an
d
h
y
g
ie
n
e,
i
s
r
a
r
el
y
d
u
e
to
lazi
n
es
s
o
r
lack
o
f
ca
r
e,
b
u
t
d
u
e
to
b
ar
r
ier
s
p
r
ev
en
ti
n
g
e
f
f
ec
ti
v
e
p
r
ac
tice
,
ar
e
ca
u
s
ed
b
y
:
P
o
o
r
k
n
o
w
led
g
e
o
f
t
h
e
g
u
id
eli
n
e
s
;
A
lac
k
o
f
ed
u
ca
tio
n
;
I
n
ad
eq
u
ate
f
ac
i
liti
es
;
T
im
e
p
r
es
s
u
r
es
;
L
ac
k
o
f
ac
ce
s
s
to
h
an
d
h
y
g
ie
n
e
ag
e
n
t
s
[
1
3
]
.
3
.
3
.
At
t
it
ud
e
o
f
hea
lt
h
perso
nn
el
in
t
he
a
pp
lica
t
io
n
o
f
un
iv
er
s
a
l
prec
a
utio
n
t
o
prev
ent
t
h
e
incid
ence
o
f
no
s
o
co
m
ia
l i
nfe
ct
io
ns
in P
K
U
H
o
s
pita
l
s
in
Yo
g
y
a
k
a
rt
a
A
tt
itu
d
e
i
s
a
r
ea
ctio
n
o
r
r
esp
o
n
s
e
is
s
til
l
clo
s
ed
f
r
o
m
s
o
m
eo
n
e
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e
t
h
at
s
u
p
p
o
r
t
th
e
i
m
p
le
m
e
n
tat
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n
o
f
h
a
n
d
h
y
g
ie
n
e
.
Facto
r
o
b
tain
ed
th
e
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eh
a
v
io
r
o
f
th
e
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u
r
s
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w
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co
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er
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an
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ar
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itect
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in
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[
1
6
]
.
Her
e
ar
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th
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r
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l
ts
o
f
t
h
e
i
n
ter
v
ie
w
e
x
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p
ts
r
elate
d
to
th
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av
ailab
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y
o
f
to
o
ls
a
n
d
f
a
cilities
i
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p
o
r
t
of
p
r
ec
au
tio
n
s
i
m
p
le
m
en
tatio
n
:
"
Ou
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it
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ys a
va
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ter a
n
d
h
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n
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a
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s
"
.
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To
t
h
e
a
va
ila
b
ilit
y
o
f
fa
cilities
a
n
d
in
fr
a
s
tr
u
ctu
r
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,
w
e
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ke
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r
t
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o
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t it
is
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ls
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r
ex
a
mp
le
w
e
a
r
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w
o
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kin
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ith
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th
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w
a
s
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s
in
k
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n
d
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u
n
n
in
g
w
a
ter"
.
"
F
o
r
in
fr
a
s
tr
u
ctu
r
e
fr
a
n
kly
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u
r
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h
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u
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s
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a
n
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e
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tr
ive
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b
u
t
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l
s
te
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ili
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er
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e
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till
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in
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te
r
ile
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s
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u
men
t
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r
e
s
till
mo
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est.
w
e
a
r
e
limi
ted
in
o
u
r
p
la
ce
is
s
till
min
ima
l b
u
d
g
et,
b
u
t sti
ll w
e
a
llo
ca
te
".
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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Sep
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238
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p
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ter
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en
t
in
th
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p
r
ac
tice
o
f
t
h
e
r
esp
o
n
d
en
ts
w
er
e
u
n
ab
le
to
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n
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p
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tectiv
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eq
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ip
m
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t
p
r
o
p
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ly
.
T
h
is
i
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co
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s
is
te
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t
w
i
th
r
esear
c
h
o
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x
p
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t
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at
1
7
.
8
%
r
esp
o
n
d
en
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f
ailed
to
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s
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p
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s
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tectiv
e
eq
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w
h
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p
r
ac
tice
d
u
e
to
th
e
li
m
ited
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u
m
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er
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f
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tectiv
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eq
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ip
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en
t i
s
p
r
o
v
id
ed
in
p
lace
o
f
p
r
ac
tice
[
1
7
]
.
I
n
th
i
s
s
t
u
d
y
,
m
o
s
t
h
o
s
p
ital
s
h
av
e
h
ad
th
e
a
v
ailab
ilit
y
an
d
f
a
cilities
to
s
u
p
p
o
r
t
th
e
i
m
p
le
m
e
n
tatio
n
o
f
u
n
i
v
er
s
al
p
r
ec
au
tio
n
w
el
l,
a
n
d
p
ar
tl
y
s
till
e
x
i
s
t
l
i
m
itatio
n
s
in
t
h
e
a
v
ailab
ilit
y
o
f
f
a
cili
ti
es
a
n
d
s
u
p
p
o
r
t
th
e
i
m
p
le
m
en
ta
tio
n
o
f
u
n
i
v
er
s
al
p
r
ec
au
tio
n
.
I
t
n
ee
d
s
s
p
ec
i
al
atten
t
io
n
f
r
o
m
t
h
e
h
o
s
p
i
tal
o
r
lo
ca
l
h
ea
lt
h
d
ep
ar
tm
e
n
t
g
i
v
e
n
th
e
a
v
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b
ilit
y
o
f
to
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ls
an
d
f
ac
i
liti
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to
s
u
p
p
o
r
t
th
e
im
p
le
m
e
n
ta
tio
n
o
f
u
n
i
v
er
s
al
p
r
ec
au
tio
n
s
to
p
r
ev
en
t th
e
i
n
ci
d
en
ce
o
f
n
o
s
o
co
m
ia
l in
f
ec
tio
n
s
is
i
m
p
o
r
ta
n
t to
b
e
p
u
r
s
u
ed
.
I
n
a
n
o
th
er
s
t
u
d
y
s
h
o
w
ed
o
n
e
o
b
s
tacle
s
in
n
o
n
-
co
m
p
lia
n
ce
w
it
h
h
an
d
h
y
g
ien
e
i
s
t
h
e
d
i
f
f
icu
l
t
y
o
f
ac
ce
s
s
to
h
a
n
d
w
as
h
in
g
o
r
s
u
p
p
lies
o
th
er
to
o
ls
u
s
ed
f
o
r
h
a
n
d
h
y
g
ie
n
e.
E
as
y
ac
ce
s
s
to
in
v
en
to
r
y
th
e
to
o
ls
to
p
er
f
o
r
m
h
a
n
d
h
y
g
ien
e,
w
a
s
h
h
an
d
b
asi
n
,
s
o
ap
,
alco
h
o
l
j
ell
is
v
er
y
i
m
p
o
r
tan
t
to
m
a
k
e
o
p
ti
m
al
ad
h
er
e
n
ce
b
e
s
tan
d
ar
d
ized
[1
6
]
.
T
h
e
co
m
p
l
ete
f
ac
ili
t
y
o
f
h
an
d
h
y
g
ie
n
e
i
n
th
e
i
n
p
ati
e
n
t
u
n
it
av
ai
lab
le
with
eit
h
er
,
Facil
ities
an
d
p
r
o
v
id
ed
in
ea
ch
r
o
o
m
in
c
lu
d
e:
s
i
n
k
,
clea
n
r
u
n
n
i
n
g
w
a
ter
,
s
o
ap
,
an
ti
-
m
icr
o
b
ial
an
d
alco
h
o
l
g
l
y
ce
r
in
to
h
an
d
r
u
b
,
An
ti
s
ep
t
ics
a
v
ailab
ilit
y
o
f
liq
u
id
s
o
ap
,
h
an
d
w
a
s
h
d
r
y
er
is
a
v
ailab
le
i
n
t
h
e
f
o
r
m
o
f
a
d
is
p
o
s
ab
le
clo
th
o
r
ti
s
s
u
e
[
1
2
]
.
Hea
lth
ca
r
e
ass
o
ciate
d
i
n
f
ec
tio
n
s
ar
e
as
s
o
ciate
d
w
it
h
m
o
r
b
id
it
y
,
m
o
r
t
alit
y
,
a
n
d
e
n
o
r
m
o
u
s
co
s
ts
to
h
ea
lt
h
ca
r
e
f
ac
ilit
ie
s
,
an
d
in
s
u
r
a
n
ce
p
r
o
v
id
er
s
n
atio
n
w
id
e
ar
e
d
en
y
in
g
p
a
y
m
e
n
t
f
o
r
co
s
ts
ass
o
ciate
d
w
it
h
t
h
ese
i
n
f
ec
tio
n
s
[1
8
]
.
4.
CO
NCLU
SI
O
N
Hea
lth
w
o
r
k
er
s
h
av
e
atte
m
p
te
d
to
im
p
le
m
en
t
u
n
iv
er
s
a
l
p
r
ec
au
tio
n
s
in
cl
u
d
ed
h
a
n
d
w
a
s
h
i
n
g
ac
tio
n
o
n
th
e
w
ater
f
lo
w
,
p
u
l
l th
r
o
u
g
h
h
an
d
h
y
g
ie
n
e,
an
d
al
w
a
y
s
tr
ie
s
to
w
ea
r
p
er
s
o
n
al
p
r
o
tectiv
e
eq
u
ip
m
e
n
t.
T
h
e
n
u
r
s
e
atte
m
p
ted
to
ap
p
ly
t
h
e
s
k
ill
s
i
n
ac
co
r
d
an
ce
w
i
th
t
h
e
m
ater
ial
g
iv
e
n
at
t
h
e
ti
m
e
o
f
in
-
h
o
u
s
e
t
r
ain
in
g
.
N
u
r
s
e
h
a
s
r
ea
ch
ed
th
e
lev
el
o
f
r
esp
o
n
s
ib
i
lit
y
,
at
t
h
is
le
v
el,
th
e
i
n
d
i
v
id
u
a
l
w
il
l b
e
r
esp
o
n
s
ib
le
attit
u
d
e
an
d
r
ea
d
y
to
b
ea
r
all
th
e
r
is
k
o
n
e
v
er
y
th
i
n
g
t
h
at
h
as
b
ee
n
ch
o
s
en
.
Su
p
p
o
r
tiv
e
a
ttit
u
d
e
o
f
n
u
r
s
e
s
i
n
u
n
i
v
er
s
al
p
r
ec
au
tio
n
s
r
elate
d
to
th
e
r
is
k
o
f
tr
an
s
m
i
s
s
io
n
o
f
in
f
ec
tio
n
t
h
r
o
u
g
h
b
lo
o
d
an
d
b
o
d
y
f
l
u
id
s
f
o
r
b
o
th
p
atien
t
s
an
d
n
u
r
s
es.
Av
ailab
ilit
y
o
f
to
o
ls
a
n
d
f
ac
i
liti
es
to
s
u
p
p
o
r
t
th
e
i
m
p
le
m
e
n
tatio
n
o
f
u
n
i
v
er
s
al
p
r
ec
au
ti
o
n
,
m
o
s
t
h
o
s
p
i
tal
s
alr
ea
d
y
h
a
v
e
th
e
a
v
ailab
ili
t
y
o
f
f
ac
il
ities
a
n
d
s
u
p
p
o
r
t
th
e
i
m
p
le
m
e
n
tat
io
n
o
f
u
n
iv
er
s
al
p
r
ec
au
tio
n
w
el
l,
an
d
p
ar
tly
s
till
ex
i
s
t
li
m
ita
tio
n
s
i
n
t
h
e
av
ai
lab
ilit
y
o
f
f
ac
ilit
ie
s
an
d
s
u
p
p
o
r
t
th
e
i
m
p
le
m
e
n
t
atio
n
o
f
u
n
iv
er
s
a
l
p
r
ec
au
tio
n
.
RE
F
E
R
E
NC
E
S
[1
]
Da
r
m
a
d
i
,
“
No
so
c
o
m
ial
In
f
e
c
ti
o
n
p
ro
b
lem
s an
d
c
o
n
tro
l
,
”
S
a
lem
b
a
M
e
d
i
k
a
,
Ja
k
a
rta,
2
0
0
8
.
[2
]
A
.
A
.
Hid
a
y
a
t
,
“
In
tro
d
u
c
ti
o
n
t
o
B
a
sic
Hu
m
a
n
n
e
e
d
s
,
”
S
a
lem
b
a
M
e
d
ik
a
,
Ja
k
a
rta,
2
0
0
6
.
[3
]
M
in
istry
o
f
He
a
lt
h
o
f
th
e
Re
p
u
b
li
c
o
f
In
d
o
n
e
sia
,
“
G
u
id
e
li
n
e
s
f
o
r
Un
iv
e
rsa
l
P
re
c
a
u
ti
o
n
s
in
He
a
lt
h
Ca
re
F
a
c
il
it
ies
,
”
Ja
k
a
rta,
2
0
0
3
.
[4
]
G
.
Ka
m
p
f
,
H.
L
o
ff
l
e
r
,
P.
G
a
s
m
e
ier
,
“
Ha
n
d
Hy
g
ien
e
f
o
r
th
e
P
r
e
v
e
n
ti
o
n
o
f
No
so
c
o
m
ial
In
f
e
c
ti
o
n
s
,
”
J
o
u
r
n
a
l
o
f
De
u
tsc
h
e
s A
rz
teb
la
tt
I
n
ter
n
a
ti
o
n
a
l
,
v
o
l/
issu
e
:
1
0
6
(4
0
)
,
p
p
.
6
4
9
-
5
5
,
2
0
0
9
.
[5
]
Y.
M
e
h
ta
,
A
.
G
u
p
ta
,
S
.
T
o
d
i
,
e
t
a
l.
,
“
G
u
id
e
li
n
e
s
f
o
r
p
re
v
e
n
ti
o
n
o
f
h
o
sp
it
a
l
a
c
q
u
ired
i
n
f
e
c
ti
o
n
s,
”
I
n
d
i
a
n
J
o
u
rn
a
l
Criti
c
a
l
Ca
re
M
e
d
icin
e
,
v
o
l/
issu
e
:
18
(
3
)
,
p
p.
1
4
9
–
1
6
3
,
2
0
1
4
.
[6
]
L
.
S
a
la
wa
ti
,
“
No
so
c
o
m
ial
In
f
e
c
ti
o
n
Co
n
tro
l
i
n
th
e
In
ten
siv
e
Ca
re
Un
it
L
o
u
n
g
e
Ho
sp
it
a
l
,
”
J
u
rn
a
l
K
e
d
o
k
ter
a
n
S
y
i
a
h
Ku
a
l
a
,
v
ol
/
is
su
e
:
12
(
1
)
,
p
p
.
4
7
-
52
,
2
0
1
2
.
[7
]
N.
F
a
u
z
ia,
A
.
A
n
s
y
o
ri,
T
.
Ha
r
y
a
n
to
,
“
Ha
n
d
Hy
g
ien
e
Co
m
p
li
a
n
c
e
a
t
S
tan
d
a
rd
Op
e
ra
ti
n
g
Ro
o
m
Nu
rse
s
in
In
p
a
ti
e
n
t
Ho
sp
it
a
l
,
”
J
u
r
n
a
l
Ke
d
o
k
ter
a
n
Bra
wij
a
y
a
,
v
ol
/i
ss
u
e
:
8
(
1
)
,
p
p
.
9
5
-
9
7
,
2
0
1
4
.
[8
]
M
in
istry
o
f
He
a
lt
h
o
f
th
e
Re
p
u
b
li
c
o
f
In
d
o
n
e
s
ia
,
“
G
u
id
e
li
n
e
s
f
o
r
P
re
v
e
n
ti
o
n
a
n
d
I
n
f
e
c
ti
o
n
Co
n
tro
l
i
n
Ho
sp
it
a
ls
a
n
d
He
a
lt
h
Ca
re
F
a
c
il
it
ies
,
”
Ja
k
a
rta,
2
0
0
8
.
[9
]
P.
P
o
tt
e
r,
“
F
u
n
d
a
m
e
n
tal
Co
n
c
e
p
ts
o
f
Nu
rsin
g
P
ro
c
e
ss
a
n
d
P
ra
c
ti
c
e
,
”
EG
C,
Ja
k
a
rta,
2
0
0
5
.
[1
0
]
M
.
U.
D.
P
u
tra,
“
Kn
o
w
led
g
e
a
n
d
A
tt
it
u
d
e
L
e
v
e
ls
Re
l
a
ti
o
n
sh
i
p
W
it
h
Be
h
a
v
io
r
Us
in
g
P
e
rso
n
a
l
P
ro
tec
ti
v
e
Eq
u
ip
m
e
n
t
A
t
P
ro
f
e
ss
io
n
S
t
u
d
e
n
t
F
a
c
u
lt
y
o
f
Nu
rsin
g
,
”
T
h
e
sis
, U
n
iv
e
rsity
o
f
In
d
o
n
e
sia
,
Ja
k
a
rta
,
2
0
1
2
.
[1
1
]
M
in
istry
o
f
He
a
lt
h
o
f
th
e
Re
p
u
b
li
c
o
f
In
d
o
n
e
sia
,
“
S
tan
d
a
rd
E
q
u
ip
m
e
n
t
o
f
Nu
rsin
g
a
n
d
m
id
w
i
fe
r
y
in
He
a
lt
h
,
”
Ja
k
a
rta,
2001.
[1
2
]
E.
Ern
a
w
a
ti
,
R.
A
.
T
ri
,
S
.
W
i
y
a
n
to
,
“
A
p
li
c
a
ti
o
n
o
f
n
u
rse
’s
h
a
n
d
h
y
g
ien
e
in
h
o
sp
it
a
l’s
In
p
a
ti
e
n
t
Un
it
s,
”
J
u
rn
a
l
Ke
d
o
k
ter
a
n
Br
a
wij
a
y
a
,
v
ol
/i
ss
u
e
:
28
(
1
)
,
p
p
.
8
9
-
9
3
,
2
0
1
4
.
[1
3
]
J.
B.
Ba
ll
,
“
T
h
e
Co
n
tro
l
a
n
d
P
re
v
e
n
ti
o
n
H
o
sp
it
a
l
-
a
c
q
u
ired
I
n
f
e
c
ti
o
n
s,
”
J
o
u
rn
a
l
Nu
rs
i
n
g
T
ime
,
v
o
l
/
issu
e
:
1
0
0
(
29
)
,
p
p
.
2
8
-
2
9
,
2
0
0
4
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
P
HS
I
SS
N:
2252
-
8806
N
o
s
o
co
mia
l I
n
fectio
n
P
r
ev
en
ti
o
n
th
r
o
u
g
h
Un
ivers
a
l P
r
ec
a
u
t
io
n
in
Yo
g
y
a
ka
r
ta
.
.
.
.
.
(
Tr
iya
n
i Ma
r
w
a
ti
)
239
[1
4
]
A
.
P
.
M
a
slo
m
a
n
,
G
.
D.
Ka
n
d
o
w
,
Ch
.
R.
T
il
a
a
r,
“
I
m
p
le
m
e
n
tatio
n
An
a
ly
sis
,
P
re
v
e
n
ti
o
n
,
a
n
d
Co
n
tro
l
o
f
In
fe
c
ti
o
n
,
in
th
e
Op
e
ra
ti
n
g
Ro
o
m
Ho
sp
it
a
l
Dr.
S
a
m
Ra
tu
lan
g
i
T
o
n
d
a
n
o
,
”
J
u
n
a
l
Ilmu
Ke
se
h
a
ta
n
M
a
sy
a
ra
k
a
t
Un
ive
rs
it
a
s
S
y
a
mr
a
t
u
la
n
g
i
,
v
ol
/i
ss
u
e
:
5
(
2
)
,
p
p
.
2
3
8
-
2
4
9
,
2
0
1
5
.
[1
5
]
R.
Nu
g
ra
h
e
n
i,
W
.
S
.
S
u
h
a
rt
o
n
o
,
“
No
so
c
o
m
ial
in
f
e
c
ti
o
n
s
in
h
o
s
p
it
a
ls
S
e
tj
o
n
e
g
o
r
o
Ka
b
u
p
a
e
n
W
o
n
o
so
b
o
,
”
J
u
rn
a
l
M
e
d
ia
Ke
se
h
a
ta
n
M
a
sy
a
r
a
k
a
t
I
n
d
o
n
e
sia
,
v
o
l
/i
ss
u
e
:
11
(
1
)
,
p
p
.
9
4
-
1
0
0
,
2
0
1
2
.
[1
6
]
D.
P
it
tet,
“
Im
p
ro
v
in
g
A
d
h
e
re
n
c
e
to
h
a
n
d
h
y
g
ien
e
P
ra
c
ti
c
e
:
A
M
u
lt
i
d
isc
ip
li
n
a
ry
A
p
p
ro
a
c
h
,”
J
o
u
rn
a
l
Eme
rg
i
n
g
In
fec
ti
o
u
s Dise
a
se
s
,
v
ol
/i
ss
u
e
:
7
(
2
),
p
p
.
2
3
4
-
2
4
0
,
2
0
1
1
.
[1
7
]
T
.
M
.
M
.
M
a
ja,
“
P
re
c
a
u
ti
o
n
u
se
b
y
o
c
c
u
p
a
ti
o
n
a
l
h
e
a
lt
h
n
u
rsin
g
stu
d
e
n
ts
d
u
rin
g
c
li
n
ica
l
p
lac
e
m
e
n
t
,
”
A
d
e
l
a
id
e
,
T
s
w
a
n
e
Un
iv
e
rsit
y
o
f
Tec
h
n
o
lo
g
y
,
2009
.
[1
8
]
Ean
n
ie
P
.
C.
,
L
in
d
a
H.
A
.
,
Do
u
g
las
.
M
.
S
.
,
Ev
a
n
S
.
W
.
,
“
Nu
rse
sta
ff
in
g
,
b
u
rn
o
u
t
,
a
n
d
h
e
a
lt
h
c
a
re
a
ss
o
c
iate
d
in
f
e
c
ti
o
n
,
”
Ame
ric
a
n
J
o
u
rn
a
l
o
f
I
n
fec
ti
o
n
Co
n
tro
l,
v
ol
.
4
0
,
p
p
.
4
8
6
-
4
9
0
,
2
0
1
2
.
Evaluation Warning : The document was created with Spire.PDF for Python.