Persius/hicric huggingface dataset:
Low water volumes combined with high temperatures and heavy bather loads make public hot tub operation challenging. The result can be low disinfectant levels that allow the growth and spread of a variety of germs (e.g., Pseudomonas & Legionella) that can cause skin and respiratory Recreational Water Illnesses (RWIs). Operators that focus on hot tub maintenance and operation to ensure continuous, high water quality are the first line of defense in preventing the spread of RWIs.#
- Ensure availability of trained operation staff during weekends when hot tubs are used most.
- Maintain free chlorine (2-4 parts per million or ppm) or bromine (4-6 ppm) levels continuously.
- Maintain the pH level of the water at 7.2-7.8.
- Test pH and disinfectant levels at least twice per day (hourly when in heavy use).
- Maintain accurate records of disinfectant/pH measurements and maintenance activities.
- Maintain filtration and recirculation systems according to manufacturer recommendations.
- Inspect accessible recirculation system components for a slime layer and clean as needed.
- Scrub hot tub surfaces to remove any slime layer - Enforce bather load limits
- Drain and replace all or portions of the water on a weekly to monthly basis, depending on usage and water quality. Depending on filter type, clean filter or replace filter media before refilling the hot tub.
- Treat the hot tub with a biocidal shock treatment on a daily to weekly basis, depending on water quality and frequency of water replacement.
- Institute a preventive maintenance program to replace equipment or parts before they fail (e.g., feed pump tubing, sensor probes).
- Provide disinfection guidelines for fecal accidents and body fluid spills.
- Develop a clear communication chain for reporting operation problems.
- Cover hot tubs, if possible, to minimize loss of disinfectant and reduce the levels of environmental contamination (e.g., debris and dirt).
- Educate hot tub users about appropriate hot tub use.

# Additional Hot tub Safety Measures
- Prevent the water temperature from exceeding 104 F (40 C).
- Exclude children less than five years old from using hot tubs.
- Maintain a locked safety cover for the hot tub when possible.
- Recommend that all pregnant women consult a physician before hot tub use, particularly in the first trimester.
- Prevent entrapment injuries with appropriate drain design and configuration.
The Occupational Safety and Health Act of 1970 emphasizes the need for standards to protect the health and provide for the safety of workers occupationally exposed to an ever-increasing number of potential hazards. The Division of Criteria Documentation and Standards Development, National Institute for Occupational Safety and Health (NIOSH), had primary responsibility for the development of the criteria and recommended standard for nitriles. Sonia Berg of this Division served as criteria manager. Equitable Environmental Health, Inc. (EEH) developed the basic information for consideration by NIOSH staff and consultants under contract CDC 210-77-0148. The Division review of this document was provided by Jon R. May, Ph.D. (Chairman), and J.# Ceiling (b) Sampling and Analysis
Workplace air samples shall be collected and analyzed for nitriles as described in Appendix I or by any method shown to be at least equivalent in accuracy, precision, and sensitivity.

# Section 2 -Medical
Medical surveillance shall be made available as specified below to all employees subject to exposure to the compounds covered by this standard.    ------>
- U.S. GOVERNMENT PRINTING OFFICE: 1918-6 5 7 -0 6 1 / 1 8 5 3

# D E P A R T M E N T O F H E A L T H , E D U C A T IO N , A N D W E L F A R E P U B L IC H E A L T H S E R V IC E
CENTER
114.    difference in area is to be expected.

# Documentation of

# (e) Measurement of Area
The area of the sample peak is measured by an electronic integrator or some other suitable form of area measurement, and preliminary results are read from a standard curve prepared as discussed in the following sections.

# Determination of Desorption Efficiency (a) Importance
The

# (c) Gas Chromatographic Conditions
The typical operating conditions for the gas chromatograph are:
(1) 50 ml/minute (60 psig) nitrogen carrier gas flow.
(2) 65 ml/minute (24 psig) hydrogen gas flow to detector.
(3) 500 ml/minute(50 psig) airflow to detector.    (3) Keep the patient comfortably warm but not hot.

# MATERIAL SAFETY DATA SHEET PRODUCT IDENTIFICATION

# _________________ V HEALTH HAZARD INFORMATION H E A L T H H A Z A R D D A T A R O U T E S OF EXPO SUR E IN H A L A T IO N S K IN C O N T A C T S K IN A B S O R P T IO N EYE C O N T A C T IN G E S T IO N E FFEC TS OF O V E R E X P O S U R E
XII.

# TABLES AND FIGURE
Cryptosporidium (or "Crypto") is an extremely chlorine-tolerant parasite, so even well-maintained pools and interactive fountains can spread Crypto among swimmers. If an outbreak of Crypto infections occurs in your community, the health department might ask you to hyperchlorinate. Additionally, to help keep Crypto levels low, you might choose to hyperchlorinate periodically (for example, weekly). If necessary, consult an aquatics professional to determine or identify the feasibility, practical methods, and safety considerations before attempting to hyperchlorinate at your facility. Step 1: Close the pool to swimmers. If you have multiple pools that use the same filtration system -all of the pools will have to be closed to swimmers and hyperchlorinated. Do not allow anyone to enter the pool(s) until hyperchlorination is completed. Step 2: Raise the water's free chlorine concentration (see Table ) and maintain pH 7.5 or less and the temperature at 77F (25C) or higher.#
Step 3: Achieve a concentration time inactivation value (Ct) of 15,300  to kill Crypto. The Ct refers to the concentration of free chlorine in parts per million (ppm) multiplied by time in minutes at a specific pH and temperature (see footnote  for guidance if chlorine stabilizer is used). Step 4: Confirm that the filtration system is operating while the water reaches and is maintained at the proper free chlorine level for disinfection.

# Use the formula below to calculate the time required for Crypto inactivation
Step 5: Backwash the filter thoroughly after reaching the Ct. Be sure the effluent is discharged directly to waste and in accordance with state or local regulations. Do not return the backwash through the filter. Where appropriate, replace the filter media.
Step 6: Allow swimmers back into the water only after the required Ct has been achieved and the free chlorine and pH levels have been returned to the normal operating range allowed by the state or local regulatory authority. of Crypto. This level of Crypto inactivation cannot be reached in the presence of 50 ppm chlorine stabilizer, even after 24 hours at 40 ppm free chlorine, pH 6.5, and a temperature of 77F (25C). Extrapolation of these data suggest it would take approximately 30 hours to kill 99.9% of Crypto in the presence of 50 ppm or less cyanuric acid, 40 ppm free chlorine, pH 6.5, and a temperature of 77F (25C) or higher. Shields JM, Arrowood MJ, Hill VR, Beach MJ. The effect of cyanuric acid on the chlorine inactivation of Cryptosporidium parvum in 20 ppm free chlorine. J Water Health. 2009;7(1):109-14.  Many conventional test kits cannot measure free chlorine levels this high. Use chlorine test strips that can measure free chlorine in a range that includes 20-40 ppm (such as those used in the food industry) or make dilutions for use in a standard DPD test kit using chlorine-free water.
 CDC does not recommend testing the water for Crypto after hyperchlorination is completed. Although hyperchlorination destroys Crypto's infectivity, it does not necessarily destroy the structure of the parasite.
Botswana suggests that an increased risk of neural tube defects was associated with exposure to antiretroviral (ARV) regimens that include dolutegravir (DTG) at conception. i,ii,iii   #
CDC makes the following interim recommendations for the use of HIV PEP (occupational or nonoccupational) while the agency prepares a more detailed review of the evidence and recommendations.
Health care providers prescribing PEP should avoid use of DTG for:
- Non-pregnant women of childbearing potential who are sexually active or have been sexually assaulted and who are not using an effective birth control method; and,
- Pregnant women early in pregnancy since the risk of an unborn infant developing a neural tube defect is during the first 28 days.
The preferred PEP regimen for these women is raltegravir, tenofovir, and emtricitabine. iv,v However, individual circumstances may dictate consideration of alternatives (e.g., raltegravir is not available). Health care providers seeking advice can call the National Clinical Consultations Center's PEPline at (888) 448-4911.
CDC currently recommends that prior to starting PEP all women of childbearing potential should have a pregnancy test performed. iv,v If the PEP regimen for a non-pregnant woman of childbearing potential must include DTG , she should use an effective birth control method until the PEP regimen is completed. Guidance for health care providers regarding contraceptive options for women can be found here: .
Insufficient dietary folate can increase risk for neural tube defects. All women who are of childbearing potential, regardless of pregnancy status, should be provided at least 400 mcg of folic acid daily. Further information regarding folate for women who may become pregnant or are pregnant can be found here:
# CRITERIA DOCUMENT: RECOMMENDATIONS FOR AN OCCUPATIONAL EXPOSURE STANDARD FOR SODIUM HYDROXIDE

# Table of Contents
PREFACE
(1) For the purpose of determining the type of respirator to be used, the employer shall measure, when possible, the airborne con centration of sodium hydroxide in the workplace initially and thereafter whenever process, worksite, climate, or control changes occur which are likely to increase the airborne concentration of sodium hydroxide.

# Less than 10X
(1) Single use respirator with dust filter, quarter or half mask, with valves.
(2) Quarter or half mask respirator with replaceable dust, mist, or high efficiency particulate filter.
(3) Type C supplied air respirator, demand (negative pressure) mode with quarter or half mask faceplece.

# Less than or equal to 100X
(1) Full faceplece respirator with chin style or front or back mounted canister with high efficiency particulate filter.
(2) Powered air-purifying respirator with half or full faceplece, hood, or helmet, with high efficiency particulate filter.
(3) Supplied air respirator with full facepiece, hood, or helmet in continuous flow mode or with full faceplece in demand (negative pressure) or pressuredemand (positive pressure) mode.
(4) Self-contained breathing apparatus with full faceplece in demand (negative pressure) mode.
A combination respirator which includes a Type C supplied air respirator with a full faceplece operated in continuous or pressure-demand (positive pressure) mode and an auxiliary self-contained breathing apparatus.  (5) In the preparation of solutions from sodium hydroxide, the following practice shall apply:       It should be noted that even 1 minute of exposure to 0.5 N sodium hydroxide was sufficient to produce descemetoceles or perforations of corneas In 65-91% of the eyes which were Inadequately washed.    "safety solvent," or "aliphatic hydrocarbon" when the specific name is known.

# Greater than 100X (1) (Immediately dangerous to life or health)

# Shapiro
The "%" may be the approximate percentage by weight or volume (indicate basis) which each hazardous ingredient of the mixture bears to the whole mixture. This may be indicated as a range or maximum amount, ie, "10-40% vol" or "10% max wt" to avoid disclosure of trade secrets.
Each year, the Advisory Committee on Immunization Practices (ACIP) publishes immunization schedules that summarize recommendations for currently licensed vaccines for children aged 18 years and younger, and for adults (1,2). In February 2009, ACIP approved a listing of standardized vaccine abbreviations for use in these immunization schedules.
Workers conducting environmental sampling that places them at risk for exposure to Bacillus anthracis, the organism causing anthrax, should wear protective personal equipment (PPE), including respiratory devices, protective clothing, and gloves. The items described below are similar to those used by emergency personnel responding to incidents involving letters or packages. Emergency responders need to use greater levels of protection in responding to incidents involving unknown conditions or those involving aerosol-generating devices.# Powered Air-Purifying Respirator with Full Facepiece and High-Efficiency Particulate Air (HEPA) Filters
- The constant flow of clean air into the facepieces is an important feature of this respirator because contaminated air cannot enter gaps in the face-to-facepiece seal. These respirators also give wearers needed mobility and field of vision. - Respirators should be used in accordance with a respiratory-protection program that complies with the OSHA respiratory-protection standard (29 CFR 1910.134).
- Respiratory facepieces for investigators should be assigned on the basis of results of quantitative fit testing. - Wearing a properly functioning and powered air-purifying respirator with a full facepiece that is assigned to the wearer on the basis of quantitative fit testing will reduce inhalation exposures by 98% of what they would be without wearing this type of respirator.

# Disposable Protective Clothing with Integral Hood and Booties
- Wearing protective clothing not only protects the skin but also can eliminate the likelihood of transferring contaminated dust to places away from the work site. - Wearing disposable rubber shoe coverings with ridged soles made of slip-resistant material over the booties of the disposable suit will reduce the likelihood of slipping on wet or dusty surfaces. - All PPE should be decontaminated immediately after leaving a potentially contaminated area. - Protective clothing should be removed and discarded before removing the respirator.

# Disposable Gloves
- Disposable gloves made of lightweight nitrile or vinyl protect hands from contact with potentially contaminated dusts without compromising needed dexterity. - A thin cotton glove can be worn inside a disposable glove to protect against dermatitis, which can occur from prolonged exposure of the skin to moisture in gloves caused by perspiration.
# Multistate Fungal Meningitis Outbreak -Interim Guidance for Treatment
CDC and the Food and Drug Administration (FDA) continue to work closely with state and local public health departments on the multistate meningitis outbreak investigation of fungal infections among patients who received a steroid injection of a potentially contaminated product into the spinal area. The investigation also includes possible fungal infections associated with injections in a peripheral joint space. These cases are associated with a potentially contaminated steroid medication prepared by New England Compounding Center (NECC) in Framingham, Massachusetts.
Fungal meningitis pathogens that have been found in the investigation include Exserohilum and Aspergillus. Exserohilum rostratum (a brown-black mold) is the predominant pathogen in this outbreak, and expert opinion and published literature indicate that voriconazole might be effective in treating infections caused by brown-black molds and infections caused by Aspergillus species. CDC interim guidance for treatment of adult patients with central nervous system and/or parameningeal infections associated with injections of potentially contaminated steroid products from NECC and CDC interim guidance for treatment of adult patients with septic arthritis associated with intra-articular injections with potentially contaminated steroid products from NECC recommend empiric antifungal therapy.
Additional information is available at / hai/outbreaks/clinicians/guidance_cns.html and . cdc.gov/hai/outbreaks/clinicians/interim_treatment_options_ septic_arthritis.html.
# PREFACE

# R E S P I R A T O R SELECTION GUIDE FOR M E T A L L I C V A N A D I U M AND V

# IV FIRE AND EXPLOSION

# FIG U R E X l l -l C A LIB R A TIO N SETUP FOR PERSONAL SAM PLING W ITH FIL TE R CASSETTE

# TTHTTTTTTTT D E P A R T M E N T O F H E A L T H , E D U C A T IO N , A N D W E L F A R E P U B L IC H E A L T H S E R V IC E CENTER FOR D ISE
(1) Beakers, 50-ml, w i t h covers.
(2) Pipettes, delivery, 1, 5, and 10 ml and other convenient sizes for m a k i n g standards.
V olumetric flasks, 10-ml, 25 ml, 1000 ml.
(4) Automatic m i c r o l i t e r pipette.
Suspected cases of reportable vaccine-preventable diseases or outbreaks to the local or state health department y Clinically significant postvaccination reactions to the Vaccine Adverse Event Reporting System at www.vaers.hhs.gov or 800-822-7967 Download the CDC Vaccine Schedules App for providers at www.cdc.gov/vaccines/schedules/hcp/schedule-app.html.# Injury claims
All vaccines included in the adult immunization schedule except pneumococcal 23-valent polysaccharide and zoster vaccines are covered by the Vaccine Injury Compensation Program. Information on how to file a vaccine injury claim is available at www.hrsa.gov/vaccinecompensation or 800-338-2382.

# Questions or comments
Contact www.cdc.gov/cdc-info or 800-CDC- , in English or Spanish, 8 a.m.-8 p.m. ET, Monday through Friday, excluding holidays.

# Helpful information
The Advisory Committee on Immunization Practices (ACIP) provides advice and guidance regarding effective control of vaccine-preventable diseases, including guidance for special populations that might warrant modification of routine recommendations (1). One such special population is pregnant and breastfeeding women. Formulation of recommendations for vaccination of pregnant and breastfeeding women is challenging because the available scientific evidence needed to guide decisions is limited. To promote use of a consistent process and uniform terminology, the ACIP Workgroup on Vaccines during Pregnancy and Breastfeeding was established in 2007 to develop guiding principles for drafting of ACIP recommendations for vaccination of pregnant and breastfeeding women. Workgroup members included ACIP members, members of professional medical organizations, experts in the field, and CDC consultants.
During April 2007--March 2008, the workgroup reviewed existing policies on use of vaccines in pregnant and breastfeeding women. On the basis of this review, opinions of workgroup members, and feedback from partner organizations, the workgroup prepared the document Guiding Principles for Development of ACIP Recommendations for Vaccination during Pregnancy and Breastfeeding, which was approved by ACIP in March 2008. This document provides guidance to help standardize procedures for policy formulation and presentation of the rationale and recommendations for vaccination of pregnant and breastfeeding women. Topics in Guiding Principles include 1) guidance for structure of the background section, 2) guidance for structure and language of recommendations, 3) clarification of the definitions of precautions and contraindications in the context of pregnant and breastfeeding women, 4) suggestions for approaches to policy decision-making in the absence of adequate data, and 5) description of a consistent process to gather expert opinion. These principles will be applied to future ACIP vaccine statements and routine updates of existing statements in which vaccination of pregnant and breastfeeding women is considered. Guiding Principles is available at .
References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed in MMWR were current as of the date of publication.
All MMWR HTML versions of articles are electronic conversions from typeset documents. This conversion might result in character translation or format errors in the HTML version. Users are referred to the electronic PDF version () and/or the original MMWR paper copy for printable versions of official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices. Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.
# Personal P ro tective E quipm ent fo r Use by Postal Em ployees D elivering A ntibiotics D o o r-to -D o o r Follow ing an A n th rax A tta ck
Preventing Recreational Water Illnesses (RWIs) is a multifaceted issue that requires participation from aquatics facility designers as well as pool staff, swimmers, and health departments. Pool designers can ensure that operators are starting with the most current technology and design features. Although designers alone cannot completely prevent these complex problems, they play a key role in assuring that facilities have an RWI prevention foundation in place on opening day. By considering the following suggestions, based on contributing factors found during RWI outbreak investigations, designers can lead the way to a "Healthy Swimming" facility.#
- Install supplementary, optimally-designed, in-line disinfection (e.g., ultraviolet light, ozone) that can inactivate Cryptosporidium and potentially improve water quality.
- Install automatic chemical feeders to improve the uniformity of chemical addition.
- Install filters that are sized and optimized for particle and microbe removal.
- Avoid co-filtered pools. In particular, wading pools for young children should have dedicated filters to prevent cross-contamination of other general use pools.
- Adopt "kiddie" pool turnover rates that decrease the length of time that swimmers are exposed to germs and include safety considerations for avoiding suction injuries.
- Ensure adequate ventilation for indoor facilities to decrease exposure to chloramines and other pool water by-products.
- Provide adequate numbers of easily located, close, and safe restrooms, diaper changing areas, and shower facilities to promote good swimmer hygiene.
- Install diaper changing and hand washing facilities near children's pools to promote good hygiene and diaper changing practices among parents.
Healthy Swimming
C enters fo r D isease C o n tro l a n d P re v e n tio n MMWR M o r b id ity a n d M o r ta lity W e e k ly R e p o rt S u p ple m e nt / Vol. 60 A p ril 15, 2011 G u id e lin e s fo r Biosafety Laboratory C om petency C D C a n d th e A s s o c ia tio n o f P u b lic H e a lth L a b o ra to rie s# Competencies and Skill Domains

# Conclusion
T