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The ISIPS Newsletter - Preventing Needlesticks and Sharps Injuries one healthcare worker at a time!
 Welcome to the ISIPS Newsletter
August 28, 2009 
 
USA News

USA Health News

North Miami man to sue Veterans Administration over HIV infection
Attorneys for a North Miami man who claims he contracted HIV during a colonoscopy at a Miami VA hospital said he plans to sue the federal government for $20 million in damages

27 cases of hepatitis C in Colorado now linked to suspect
The state has tentatively linked 27 cases of hepatitis C to a former surgical tech who worked at Rose Medical Center in Denver and Audubon Surgery Center in Colorado Springs, according to a tally released Friday.

Hepatitis cases spur safety measures
By her own admission, Kristen Diane Parker, a surgical technician, cruised for empty operating rooms at the Denver hospital where she worked.

VA Negligence Suits Likely After Botched Colonoscopies
Botched medical procedures at veterans hospitals have left some with dangerous, deadly diseases, such as HIV, hepatitis B, and hepatitis C and others...

HIV-positive drifter gets 15 years for biting Miami cop
For threatening to kill with his illness then biting a Miami cop, HIV-positive drifter Johnson Jamerson will serve 15 years in prison,...

17% of Chicago...Men are HIV-positive
The Chicago Sun-Times reports: About 17 percent of men in Chicago are HIV-positive -- and half of them don't know it. That's according to authoritative...

Global News

Safer Blood Collection For Africa
Safer blood collection is a growing concern for Sub-Saharan African nations and other developing countries severely impacted by the HIV/AIDS pandemic.

South Africa: Massive Twin Burden of HIV And TB
Although South Africa has just a 0.7% of the world's population, it has 17% of the global HIV burden. In addition, our tuberculosis epidemic is one of the...

Indian police raid alleged illegal blood bank
Police in northern India have arrested six men for running a “fake” blood bank, authorities said Monday.

Avian Flu

Officials Test Local Birds for Bird Flu
A team of federal and state wildlife handlers are testing waterfowl throughout the state for the avian flu also known as the "bird flu.

Bird flu leaves the nest -- adapting to a new host
Highly pathogenic avian influenza, commonly known as bird flu, is a strain of the influenza virus that has adapted to infect birds.

Swine Flu

Swine Flu Was a Warning Shot. How Can We Do Better Against the ...
Health organizations were understandably worried more about avian flu.) Jeff Koplan, vice president of Global Health at Emory University,...

H1N1 Flu Fears
“There is that fear that if enough people get it, the swine flu, and it comes into contact with the so-called bird flu there is a concern we'll get a much...

Half the US could get swine flu, report warns
36000 who die in the US from seasonal flu in any given year). Meanwhile, if the swine flu hits hard in September and early October before a vaccine is ready...

Hospitals test readiness for possible swine-flu pandemic
The flu season isn't here yet, but an extensive, special series of exercises Wednesday tested the state's preparedness for a...

How bad will swine flu be, really?
The pendulum between panic and dismissal regarding H1N1 “swine” flu has swung back to panic. Harold Varmus, who co-chairs the President's Council of...

Medical News
CDC mulls routine circumcision of infants to reduce spread of HIV
In an effort to reduce the spread of the AIDS-causing HIV virus, the Centers for Disease Control are currently mulling routine circumcision...
West Nile

Wash. reports its first 2009 human West Nile case
Washington officials are reporting the state's first confirmed case of West Nile virus in a human this year. The Associated Press Washington officials are...

UCR researchers discover what attracts mosquitoes
The researchers tested the mosquito which carries West Nile virus. But Ray said the same receptors are seen in other insect species.

Discovery of natural odors could help develop mosquito repellents
The research has strong implications for control of deadly diseases transmitted by Culex mosquitoes such as West Nile virus disease and filariasis,...


Help protect your staff from sharps injuries with the Allen Needle Triever. This suture needle retrieval system has a large magnetic surface to easily pick up any ferrous needles and sharps as small as .15 mm (.006") diameter.

Our unique design allows this magnetic sweeper to reach under the surgical table and other hard-to-reach places. The lightweight aluminum is easy to use, clean and store. The long handle, more than 3 feet, means you don’t need to bend over to find lost sharps.

For more information click here


Access Scientific

In 1953, the newly introduced Seldinger Technique represented a significant improvement in vascular access technology. Later, the Modified Seldinger Technique further advanced ease-of-access, by using a dilator coupled with a sheath, and eventually evolved into today’s standard, over-wire insertion technique. Despite its advantages, hazards are associated with the Modified Seldinger Technique. These include: accidental needlestick injury, guidewire embolus,contamination, bleeding, lost cannulation during the procedure… and more. The WAND enables healthcare
providers to utilize the new Accelerated Seldinger Technique, representing a quantum leap forward in vascular access technology.

The WAND is an all-in-one (needle-guidewire-dilatorsheath) safety introducer that speeds over-wire vascular access while reducing the risk of guidewire embolus, contamination and accidental needlestick injury. Experienced clinicians are hailing The WAND as the new standard in vascular access technology—faster, safer and simpler.

The Accelerated Seldinger Technique reduces the number of exchanges and steps necessary for vascular access.  It reduces the risk of air embolism, contamination, guidewire embolus, loss of cannulation during the procedure, and accidental needlestick injury.

For more information click here.


EZ Huber® Safety Infusion Set

An Easy-to-Use, Power Injectable Venous Access System

 Safety, Speed and Comfort

  • 5mL/sec. 300 psi Flow Rate/pressure Rating*
    Indicated for contrast-enchanced CT imaging procedures
  • Small Footprint Enhances site visualization
  • Low Profile and Padded Base
    Designed for patient comfort

Special features that enhance clinical safety:

  • Visual and audible confirmation of safety activation
  • Dual-action safety needle designed to shield the tip and shroud the entire needle cannula, reducing the risk of bloodborne pathogen exposure. 
     

Click here for more information

In This Issue

2009 Sharps Injury Prevention Awards

The 2009 Sharps Injury Prevention Award contest,  part of the International Sharps Injury Awareness Month, held in December 2009, will wrap up its nominations on September 30, 2009.

JUST FOUR WEEKS LEFT!

Submit your nomination today!

Notes from the field: YUCK! You got PUS, WHERE?
As I was finishing up an OSHA training class, I saw a physician running down the hall. We all turned around trying to figure out what had happened. I went to see if I could help in any way. I found the physician standing over the sink gulping and spitting out water. The medical assistant proceeded to tell me what had happened.

Probation revoked for woman who gave fake flu vaccine
A Houston woman has been ordered into federal prison for violating the terms of the probation sentence she received two years ago for her part in a phony flu vaccine scam.

Ask the expert: Safety devices and non-contaminated needles
When drawing up medication, must we use a safety needle if it is not to be used to administer to the patient?

Poisoned blood: UP gets tough
As the penetration of the sale and supply of contaminated blood units in the private hospitals and nursing home is getting exposed, the state government is adopting a tough posture by deciding to slap the Gangster's Act against them and seize their properties as well.

Are Some Individuals Deliberately Spreading HIV/AIDS in the...
Well, let me not get too tangential-I promise to stick to the script and keep it an HIV/AIDS related topic. While I understand the potential danger of...

Satellites Used to Predict Infectious Disease Outbreaks
From avian flu to cholera, infectious diseases may not be able to hide for long. Some researchers have their sights trained on predicting their every move...

Swine Flu Could Infect Half of U.S.
Swine flu could infect half the U.S. population this fall and winter, hospitalizing up to 1.8 million people and causing as many as 90,000 deaths -- more than double the number that occur in an average flu season, according to an estimate from a presidential panel released Monday.

EDUCATIONAL OPPORTUNITIES

As promised several weeks ago, ISIPS has teamed up with the Safety Lady® to provide you with a number of educational video products including

  • Personal Protective Equipment

  • Shipping Infectious and Biological Materials

  • Laboratory Ergonomics

  • Chemical Hygiene

  • Bloodborne Pathogen

In addition, two "Game Format" reviews are also available.

  • Bloodborne Pathogen Quiz Show

  • Shipping Infectious and Biological Materials Quiz Show

To find out more information about these products click here.

To purchase the products click here.

OSHA Violations
...recent citations issued
Ferncliff Nursing Home

Rhinebeck, NY

$8,250

When there is occupational exposure, the employer shall provide, at no cost to the employee, appropriate personal protective equipment such as, but not limited to, gloves, gowns, laboratory coats, face shields or masks and eye protection, and mouthpieces, resuscitation bags, pocket masks, or other ventilation devices. Personal protective equipment will be considered "appropriate" only if it does not permit blood or other potentially infectious materials to pass through to or reach the employee's work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of time which the protective equipment will be used.
Advantage Medical Group

Lawrence, KS

$300

Each employer having an employee(s) with occupational exposure shall establish a written Exposure Control Plan designed to eliminate or minimize employee exposure
ISIPS Corporate Members
Please click on any ISIPS member below to view their sharps safety products!

Amgen

Covidien

B. Braun Medical, Inc.

Needlestick Prevention

Becton Dickinson

Inviro Medical Devices, Inc.

Greiner Bio-One GmbH

Immunization Branch-California Dept. of Health Services

Smiths Medical

Retractable Technologies Inc.

Terumo Medical Corporation

ANFIM - Association of Needle-free Injection Mfrs

Angiodynamics

Medi-Dose, Inc. - EPS, Inc.

International Association of EMTs and Paramedics

ITL Corporation

Bemis Manufacturing Company

Maximus Medical

Qlicksmart Pty Ltd

Milestone Scientific

Baxa Corporation

LifeChoice Donor Services

3M

AOHP Association of Occupational Health Professionals in Healthcare

Canadian Intravenous Nurses Association (CINA)

Sarstedt

Myco Medical

Health Care Logistics, Inc.

Center for Phlebotomy Education, Inc.

Managing Infection Control Magazine

The Society of Permanent Cosmetic Professionals

Kawasumi Laboratories America

Starr Systems, LLC

Owen Mumford

West Pharmaceutical Services

Medical Safety Technologies, Inc.

Luminetx Corporation

Advantage Medical

Sandel Medical Industries

Infusive Technologies, LLC

Jai Surgicals Ltd.

Onyx Medical

Allen Medical Systems

AngioTech

DC Surgical Solutions

Bard Access Systems

Access Scientific

Sanofi-AVentis

Navilyst

Purple Surgical International, Ltd.

Cory Bros Ltd.

Advanced Medical Innovations

Kinamed

Unilife

Sharpsfree

Peak Surgical

ICU Medical

Safety Lady LLC

Sharps Inc.

Ethicon, Inc.

Real Needlestick and
Blood Exposure Stories

While trying on a denim jacket at a Macy's department store, the woman put her hand into one of the jacket pockets and pricked her finger on a hypodermic needle, which had apparently been left in the pocket with some other drug paraphernalia. She could not sleep, had panic attacks, cried all the time, and worried constantly about her future and that of her family if she contracted AIDS.  She never tested positive for HIV and as late as three years after the needle stick, had no hepatitis-related infection.

A hotel guest was stuck by a used hypodermic needle concealed in the tube of a roll of toilet paper.  Evidence showed the needle was likely used by a known intravenous drug user on the hotel staff. Two years of biennial AIDS tests and three years of annual tests of the plaintiff were negative for AIDS.


Featured Safety Product

The new VACUETTE® QUICKSHIELD Complete PLUS is now available!

The VACUETTE® QUICKSHIELD Safety Tube Holder with pre-attached VACUETTE® VISIO PLUS Needle sterile and single-packed:

  • A practical, time-saving solution.
  • No longer necessary to thread in the needle.
  • Simply remove the protective cap from the needle and the holder is ready to use.
  • Needle with transparent view window for optical venipuncture control.

To view a video on the new VACUETTE® QUICKSHIELD Complete PLUS click here.


ChaSyr™ Prefilled Syringe

The ChaSyr DDS is a prefilled, multi–chamber, sequential delivery syringe.  In a nutshell, it means that the syringe has more than one medication chamber separated by a rubber stopper with a valve that keeps the medications disparate and prevents air/gas from passing through the valve.  The syringe comes prefilled with saline or heparinized saline in the posterior chamber.  The clinician aspirates medication into the front chamber using conventional practices. 

The ChaSyr DDS is then connected to a Y-site where the multiple medications are then injected into the patient serially.  After infusion of the medication from the front chamber, the clinician simply continues to push the syringe plunger.  When the rubber stopper (ChaSyr valve) comes in contact with the tip of the syringe a valve opens allowing the saline solution in the back chamber to flow through the valve thus flushing the Y-site and IV line of the original medicant and leaving a saline lock in the system.  The ChaSyr DDS with its prefilled inline post-flush simplifies nursing procedure, reduces line manipulations and line breaks by up to 50% thereby reducing contaminations rates and nosocomial infections.

For medications that are patient specific, a pharmacist/nurse is able to easily and accurately prepare and deliver an entire measured dose through a port/spike fluid pathway and into the IV container with safety.  This assures that the entire measured dose reaches the patient.  Let's look at how an infusion of a hazardous drug with the ChaSyr DDS product would work.  Looking at figure 1

It is shown that rear chamber of the ChaSyr  DDS has a prefilled saline flush, the front chamber of the ChaSyr  DDS is filled by the pharmacist with the drug of choice and a saline lock is placed in an extension set with a clamp.  Looking at figure 2 -

The clinician removes the cap from the extension set (only clinician exposure is to saline) and attaches the extension set to the catheter.  After opening the clamp, the syringe plunger is pushed thus infusing the saline pre-flush then the drug through the IV.  Looking at figure 3 -  

The plunger is continued to be pushed until the valve in the first plunger is activated.  Saline then flushes the hazardous medication from the Y-site and the IV catheter thus rendering the catheter free of medicant and filled with the flush solution.

For more information on this exciting product click here.

SPECIAL BOOKMARKS

View Today's Health News click here!

ISIPS Articles

Managing Infection Control articles written by Ron Stoker

Most Recent Articles on Top

May 2009 - Advances in Needleless Connectors-Technologies assist in Prevention of Bloodstream Infections

April 2009 - Safety Enhancements for Blood Culture Processing-Protecting Staff From Harm

April 2009 - Neuropathy Testing - One of the Challenges of Diabetes

April 2009 - Where to Find Safety Products - Part Four

March 2009 - Accelerated Seldinger Technique - A faster, safer method for diagnostic and interventional procedures

March 2009 - Sharps Safety Matters - Where to find Safety Products - Part Three

February 2009 - Advances in Internal Bone Fixation - Sharps Safety for Orthopedic Surgeons

February 2009 - Sharps Safety Matters! - Where to find Safety Products Part 2

January 2009-  Advances in Blood Drawing Using Evacuated Tubes - Improving Patient and Clinician Safety

January 2009 - Sharps Safety Matters! - Where to find Safety Products Part I

December 2008 - 2008 International Sharps Injury Prevention Awards

December 2008 - Zero Sharps Injuries - A Goal we can live with! Reducing Exposures in the Operating Room

November 2008 - Sharps Injuries - just part of the job, right?

October 2008 - Turning Point - New Safety Scalpel Handle System provides safety features and familiar feel

October 2008 - Eye Can See Clearly Now - the Positive use of face shields as PPE

September 2008 - Safety Scalpels - State of the Market Report

August 2008 Revolutionary Designs - New passive, self-sheathing safety syringe

August, 2008 - New Technology Replaces Multiple Syringes-Prevent contamination of IV lines and associated infections.

June 2008 - One Less Problem - Safe Practices When Administering IV Therapy

May 2008 - Scalpel Safety - Protecting patients and clinicians

May 2008 - Innovation in Vascular Access - Accidental needlestick injuries decreased via the utilization of the VeinViewer

April 2008 - Working in Harms Way - Understanding Sharps Safety Compliance

April 2008 - PPE Practices - Use of Personal Protective Equipment in Satellite Locations

March 2008  - Sharps Safety Matters - Where to find safety products? Part 2 of our annual sharps safety product review.

March 2008 - Simply Safe- Providing safety for the needle that saves lives

February 2008 - Sharps Safety Matters - Where to find safety products? Part 1 of our annual sharps safety product review.

December 2007 - Spreading the Word for Safer Sharps- 2007 International Sharps Injury Prevention Awards

November 2007 GET THE POINT? Laparoscopic surgery-protecting healthcare workers from sharps injuries due to trocars

November 2007 - A Fortune to Share -Changing attitudes toward sharps safety.

October 2007-New sheriff in town-common and costly doctors' office blood-borne pathogen standard violations.

September 2007 Advances in Safety in Cardiology
Reducing the potential of bloodborne pathogen exposure for healthcare workers.

September 2007 Safety Doesn’t Just Happen
Staff safety—is there a culture of safety at your facility?

August 2007 - Innovative Syringe Management System -For home users—and some healthcare workers— there’s an exciting development in sharps safety

June 2007 - OSHA’s Most Cited Hospital Violations - Strategies for Creating a Safe Workplace

June 2007 - Safety in the Hospital Pharmacy-Prevent Staff Injury and Exposure to Toxic Materials with Safety Devices

May 2007 - OR Safety - Improvements in Sharps Safety in the Operating Room

May 2007- Safety Product Review - Use Safety Products to Improve Staff and Patient Safety.

April 2007- Needlestick Safety-Not just a U.S. problem.

Feb 2007 A Change Of Heart - Set Goals To Improve Your Teams Safety

Jan 2007 Stuck at Work - Use Safety Blood Draw Products To Avoid Needlestick Injuries

December 2006 - Cutting the Cord  -  cutting, clamping, and obtaining blood samples from the umbilical cord

November 2006  - Don’t You Have Enough to Worry About Already? Single-Use vs. Reusable Sharps Disposal Containers

September 2006 -Evaluating Safety Products - Decision Making in the Selection of Safety Products

August 2006 -Safety Peripheral IV Catheters - State of the market report

June 2006 BESIDE THE POINT: Safety Huber Needles 2006 - State of the Market Report

May 2006 - Zero Needlesticks— A Goal We Can Live With! Current OSHA Bloodborne Pathogen Citations

April 2006 - A Change of Heart - Set Goals to Change Your Team's Sharps Safety

February 2006 - How Can You Tell If Your OSHA inspection is going poorly?  Part II

January 2006 - How You Can Tell If Your OSHA Inspection Is Going Poorly? Preparing for an OSHA Inspection - Part I

January 2006 Sharps Injury Prevention Resource Guide 

December 2005 - The International Sharps Injury Prevention Awards

August 2005 - The Compendium of Infection Control Technologies

June 2005 - Selection of Safety Scalpels

April 2005 - Point Taken - Comply or Pay the Price

January 2005 - May I see your ID, please? Patient and Medication Misidentification

January 2005 - Safety in Urine Sampling

December 2004 Issue - The 2004 International Sharps Injury Prevention Awards

October 2004 Issue - Managing Diabetes without Jabbing Anyone Else!

July 2004 Issue - Steering Clear of Danger - IV Infection Prevention

June 2004 Issue - Smallpox 2004 - Are we prepared if our worst fears come true

April 2004 Issue - Sharps Injury Prevention in the Operating Room

December 2003 Issue - To The Point: Safety Huber Needles

December 2003 Issue - 2003 Sharps Injury Prevention Award Winners (html version) or Click here for pdf version

September 2003 Issue - Focus on ISIPS by MIC staff

June 2003 Issue - End of the Line

May 2003 Issue - A Special Report on Smallpox - Vaccination and Dressings

March 2003 Issue - Stuck in the ER - Sharps Safety in Emergency Rooms

February 2003 Issue - Birth of Occupational Safety in Labor and Delivery

December 2002 Issue - Sharps Safety Matters

October 2002 Issue - Healthcare Managers Re-tooling for Compliance by Dennis J. Ernst

August 2002 Issue - The Use of Protective Devices is More than a Suggestion - It's the Law! Safety Needles for Seldinger Procedures

June 2002 Issue - Retractable Needle Syringes - An Ideal Solution to the accidental needlestick problem

April 2002 - Global Needlestick Prevention Group Formed to Highlight Safety Products

Additional Articles

Anatomy of Needlestick Injury; Ron Stoker, Business Briefing: Global Healthcare- Advanced Medical Technologies 2004- Infection Control and Epidemiology
Needlestick Injury Prevention, Ron Stoker, Business Briefing: Global Healthcare 2003

Specially designed syringes maximize flue vaccine supply - Syringes reduce costs and and increase healthcare worker safety and patient comfort
Evaluation of The BD IntegraTM 3ml Syringe with Retracting BD PrecisionGlide™ Needle at Texas Children’s Hospital and Test-Med

Safety Wound Closure Presentation
Sharps Safety - Gaps and successes of safety device market conversion  By Amber Hogan
Technology and the engineering of safety devices has increased since the promulgation of the Bloodborne Pathogens Standard (BPS) (29 CFR 1910.1030) in 1991. As a result, OSHA revised its enforcement procedures in 1999 (CPL 02-02-069) to include guidance for its compliance safety and health officers to begin citing health care employers for failure to use safety devices where their use is feasible and effective.

Not Just painful, Deadly! Patients aren't the only ones scared of Needles  By Ron Stoker
Future Healthcare, Summer 2006 p 121-3

ISIPS Service

Links

Academy for Safety Excellence

Needlestick Prevention Tour

Eureka! Sharps Disposal

Immunization Branch, California Department of Health Services

ANFIM - Association of Needle-free Injection Manufacturers

International Association of EMTs and Paramedics

LifeChoice Donor Services

AOHP - Association of Occupational Health Professionals in Healthcare  

CINA - Canadian Intravenous Nurses Association

Quality America, Inc.

Center for Phlebotomy Education

Managing Infection Control Magazine

The Society of Permanent Cosmetic Professionals

Academy for Safety Excellence

Terry Jo Gile, MT (ASCP), MA Ed.
The Safety Lady
and
Ronald L. Stoker, MS
Executive Director and Founder - ISIPS
International Sharps Injury Prevention Society
 

The Academy for Lab Safety Excellence is a program designed by Safety Lady LLC to help you make the transition from bench tech to lab safety officer.  You will learn to navigate the world of laboratory safety from the Safety Lady.  You will discover the secrets to lab safety excellence that has taken others years to acquire.  You will be able to network with colleagues to help you solve your most challenging safety issues.


This Academy is a perfect way to advance your safety knowledge if you:

  • Are new to lab safety or have limited experience in lab safety issues

  • Find it frustrating to locate safety information from a variety of sources

  • Want to expand the impact of your lab safety expertise

  • Want to increase your effectiveness in educating staff on lab safety issues

  • Need ready access to colleagues whose expertise in lab safety is well known

  • Would like to network with your peers on a regular basis for lab safety ideas

  • Have a limited budget for safety education

You can expect:

  • A 30 minute personal mentoring phone call to address your specific lab safety challenges

  • A minimum of eight conference calls over a 12 month period with other members of the Academy to brainstorm safety issues and cover a particular safety topic including:

    • Conducting a proper safety audit and why it is important

    • Designing and implementing a comprehensive chemical hygiene program

    • Protecting employees through the use of ergonomic tools and PPE

    • Shipping of infectious and biological substances
      Infection control and prevention

    • Bloodborne pathogens and sharps injury prevention

    • What's new in waste management

    • Training methods that won't put your staff to sleep

    • Timely updates via  email with lab safety information before it is posted on the website or in the Safety Savvy newsletter

    • Special audio conferences with guest experts on a variety of lab safety topics

    • Sample safety templates to make documentation easier

    • Unlimited emails to the ISIPS Executive Secretary

    • Discounts on featured Safety products

    • Ten(10) P.A.C.E. contact hours after successfully completing the Academy

The overall objectives are:

  • At the end of this program, participants will be able to:

    • Locate up-to-date safety information from a variety of expert sources

    • Prepare or modify policies and procedures to improve laboratory safety at your institution

    • Provide effective programs to educate staff on laboratory safety issues

The requirements are:

  • A commitment to join the Academy which begins in October, 2009

  • Time of 1-2 hours per month to learn your craft and become safety savvy

  • An investment of $249 for all sessions

  • Dates for the Academy:
     

    • October 22, 2009

    • November 12. 2009

    • January 14, 2010

    • February 11, 2010

    • March 11, 2010

    • April 15, 2010

    • May 20, 2010

    • June 10, 2010

The scheduled start time for all Academy webinars will be

10 am PDT

11 am MDT

12 pm CDT

1 pm PDT

A preview webinar will be held on September 22 at 11 am MDT.

Preview Webinar - Academy of Safety
Tuesday, September 22nd at 11:00am Mountain
Simulcast! (Attend via Phone or Webcast -- it's your choice)
TO ATTEND THIS EVENT, CLICK THIS LINK NOW...
http://instantTeleseminar.com/?eventid=8575968

For more information please contact Terry Jo Gile, the Safety Lady, at info@safetylady.com or call toll free 877-894-7004.
To register for the Academy click here.

 


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