Safe injection practices IAP ppt

It was decided to bring out the IAP Guide Book on Safe Injection Practices and conduct workshops all over the country in the year 2005 with a set of slides and the Guide Book.This is a part of the Presidential Action Plan of 2005. Preface To The First Edition IAP Guide Book on Safe Injection Practices vii 11 Identify safe injection practices and safe handling and disinfection of point of care devices. Outbreaks Linked to Unsafe Injection Practices. In the last 10 years, 33 infectious disease outbreaks, such as Hepatitis C, have been reported; thousands of patients have been notified that they may have been harmed PowerPoint Presentation Last. Safe Injection Practices 6. If multi-dose vials must be used, both the needle or cannula and syringe to access the multi-dose vial must be sterile. 7. Do not keep multi-dose vials in the immediate patient treatment area and store in accordance with the manufacturer's recommendations; discard if sterility is compromised or questionable. 8 National Centre for Disease Control (NCDC), New Delhi, had issued guidelines for safe injections in the form of a Hand book on Safe Injection Practices, in July 2014, under NHM. 16. Risk to patients to contract infection. Risk to provider to contract infection. Poor BMWM: Risk to community. Increase in treatment cost. Loss of productivity. Safe Injection Practices Confirmed patient-to-patient transmission of blood borne & other pathogens in US healthcare facilities Transmission have been - A free PowerPoint PPT presentation (displayed as a Flash slide show) on PowerShow.com - id: 3da3ee-YTU2

safe injection practices IAP - SlideShar

IAP Workshop on Safe Injection Practice : Recommendations and IAP Plan of Action A two-day IAP workshop was held in New Delhi on 12th-13th June, 2004 with the objective of bringing out recommendations and guidelines on safe injection practices Injection Safety. Measures taken to perform injections in a safe manner for patients and providers susceptible Staphylococcus aureus Infections after intra-articular injections. - PowerPoint PPT presentation. PowerShow.com is a leading presentation/slideshow sharing website. Whether your application is business, how-to, education. Safe injection practices are part of Standard Precautions and are aimed at maintaining basic levels of patient safety and provider protections. As defined by the World Health Organization, a safe injection does not harm the recipient, does not expose the provider to any avoidable risks and does not result in waste that is dangerous for the. OUTBREAKS AND SAFE INJECTION PRACTICES IN OUTPATIENT SETTINGS Statewide Program for Infection Control and Epidemiology (SPICE) UNC School of Medicine Module D OBJECTIVES 1. Discuss the consequences of unsafe injection practices 2. Describe outbreaks 3. Discuss safe injection best practices 4. Describe One and Only Campaig Safe Injection Practices Memo The Emergency Medicine Patient Safety Foundation has a free patient safety memo on safe injection practices Available at www.empsf.org and click on resources 12 page memo which summarized important issues including the CDC and CMS guidelines on safe injection practices Discusses recommendations for hospital

Safe Injection Champion Course. The course is applicable to all types of healthcare providers and is 68 minutes in length. Included are key points for injection safety, safe sharps disposal and point of care testing. Continuing education (CE) is available. The details and a description of the types of CE are in the Continuing Education. 1. Safe Injection Practice For Doctors and Nurses Dr Ketan Ranpariya (MBBS, PGDHM,PGDHIVM,HIVM) HIV / AIDS CONSULTANAT Mobile: 0 75 75 88 70 70 Dr Ketan Ranpariya 2. Disclaimer • This information is for Awareness of Health Care Personnel as part of Safe Injection Practice Campaign 10 K. • I do not have anything for financial disclosure Safe injection practices are part of Standard Precautions A good rule to remember is One Needle, One Syringe, Only One Time. Campaign Resources . SIPC created these educational resources to remind healthcare providers—across all settings and specialties—about the basics of injection safety. It is the responsibility of every provider who. Preventing Unsafe Injection Practices. Safe Injection Practices are a set of recommendations within Standard Precautions, which are the foundation for preventing transmission of infections during patient care in all healthcare settings including hospitals, long-term care facilities, ambulatory care, home care and hospice. The most recent.

The Safe Injection Practices Coalition (SIPC) is a partnership of health care organizations, patient advocacy organizations, industry partners, and other public health partners, led by the Centers for Disease Control and Prevention (CDC) CDC One & Only Campaign Safe Injection and Infusion. practices Safe Injection Practices WHO states that a safe injection is one that Reuse of equipment Does not harm the recipient. Unsafe collection Does not expose the healthcare worker to any risk; and. Unsafe Does not result in waste that is dangerous disposal to the community Unsafe Injections Can Cause Infections Pathogens are transmitted as they ar Getting Started with Safe Injection Practices. The Centers for Disease Control and Prevention (CDC) added safe injection practices to Standard Precautions in the 2007 Isolation Precaution guidelines as a result of 4 outbreaks in the United States. The hepatitis B virus (HBV) and hepatitis C virus (HCV) outbreaks occurred among patients at a private medical practice, a pain clinic, an endoscopy.

injection practices can lead to transmission of bloodborne pathogens, with their associated burden of disease. To ensure rational and safe use of injections globally, better injection safety practices are needed. The responsibility for ensuring injection safety rests with national governments Vaccination for Contagious Diseases. Overview . Adapted from the FAD PReP/NAHEMS Guidelines: Vaccination for Contagious Diseases (2014). The control of a foreign animal disease outbreak may require large-scale vaccination of livestock and other domestic animals to minimize the impact on animal and public health, ensure continuity of the U.S. food supply, and minimize the economic impact on. MODULE 6 — Safe Injection Practices Slide 10 Safe Injection Practices - Recommendations • Prepare injections using aseptic technique in a clean area. • Disinfect the rubber septum on a medication vial with alcohol before piercing. • Do not use needles and syringes for more than one patient

Safe injection practice - SlideShar

  1. safe-injection equipment 34 3.3 Collection of waste 38 4. Monitoring and supervision 40 4.1 Indicators to monitor vaccine and safe-injection supplies 40 4.2 Stock management 42 4.3 Temperature monitoring 44 4.4 Using the VVM to monitor the quality of vaccine vials 45 4.5 Reducing vaccine wastage 46 4.6 Supervision 47 Annex 1:Key references 4
  2. OUTBREAKS AND SAFE INJECTION PRACTICES IN DENTAL SETTINGS Statewide Program for Infection Control and Epidemiology (SPICE) UNC School of Medicine Module D OBJECTIVES 1. Discuss the consequences of unsafe injection practices 2. Describe outbreaks 3. Discuss safe injection best practices 4. Describe One and Only Campaig
  3. Unsafe injection practices are caused by avoidable risky situations and practices including: Lack of awareness of the risks of unsafe injections. Overuse of injections for illnesses for which effective oral medications exist. Needle-stick injuries to health care workers from recapping needles. Lack of clean work spaces. Re-use of syringes.
  4. Safe Injection Practices Coalition (SIPC) The Safe Injection Practices Coalition (SIPC) is a partnership of healthcare -related organizations, patient advocacy organizations, industry partners, and other public health partners, led by the Centers for Disease Control and Prevention (CDC) CDC The One & Only Campaig

Safe injection practices - SlideShar

Here is a checklist of 12 rules provided by Ms. Segal which ASCs should follow to better ensure compliance with safe injection requirements. 1. Pre-drawn medications must be labeled properly. Medications pre-drawn at the beginning of the day need to be labeled specifically with the time of the draw, initials of the person drawing up the. CMS Memo on Safe Injection Practices June 15, 2012 CMS issues a 7 page memo on safe injection practices Discusses the safe use of single dose medication to prevent healthcare associated infections (HAI) Notes new exception which is important especially in medications shortages General rule is that single dose vial (SDV)can only b

Oregon.gov : State of Orego Safe Injection and Point of Care Testing Practices Long Term Care/Nursing Home Ambulatory Surgical Facility Healthcare Personnel Safety Influenza (Flu) Environmental Infection Control Resources to assist with evaluation and response to breaches in infection control Catheter-associated Urinary Tract Infection (CAUTI IAP each operational period, the time scheduled for . property. For the purposes of this guide, executing a given set of actions as specified in the IAP, the term incident is used to refer to . using the standard ICS incident action planning process. incidents in which FEMA is involved, The IAP itself communicates the incident objectives an the meeting, paying close attention to the safety information and the photos showing the proper techniques for each injection method. 3. Use the information in Table 1 to decide whether to have the participants practice giving intramuscular (IM) and subcutaneous (SC or SQ) injections on chicken breast meat (with or without skin), yello

BEST PRACTICE GUIDELINE TO SUPPORT CORRECT INJECTION TECHNIQUE IN DIABETES CARE PAGE 7 Health professionals must teach best practice injection technique when insulin and GLP-1 RAs are initiated including: 1. Storage: Store unopened insulin and GLP-1 RA in the fridge, as per manufacturer's instructions at 4-8 degrees. 2 ers that might inhibit safe practices, and sought to identify and standardize critical quality control prac - tices needed for preparing and verifying the quality and safety of the final CSP. The summit resulted in a set of guidelines and safe practices, that were agreed upon by consensus to ensure the safe prepara - tion of CSPs Safe injection practices are a key part of Standard Precautions that provide protocols to perform injections, and are aimed at maintaining basic levels of patient and resident safety and provider protections. 1 Click on a tab below to access resources specific to your healthcare facility

Safe Injections Practices INCLEN study (2002-2004) pointed out that 2/3 of all injections are administered in unsafe manner in India, which is a big number. We have introduced Auto disable syringes for curative purpose also in the central government. Such practices need to be adopted by all states injection molding shop Safety rules for injection molding follow: 1. Do not operate the machine unless you have been instructed in its operation and safety devices. 2. Be certain all safety devices are working properly before operating the machine. 3. If any safety equipment is missing, damaged, or inoperative, notify your supervisor. physiology, pharmacology, suitable injection sites and injection techniques for children, clinical holding and effective communication skills. The introduction of alternative analgesia techniques, (epidurals, patient and nurse controlled analgesia) has reduced the volume of injections administered

PPT - Safe Injection Practices PowerPoint presentation

In practice, workplace situations are often less than ideal. Large numbers of people crowding the area may cause safety issues, as well as confusion and stress, not just for the health worker, but also for everyone concerned. Careful preparation and a positive, welcoming manner help ensure a successful immunization session Infection control principles and practices for local health agencies [accordion] Standard Precautions Standard precautions are a set of infection control practices used to prevent transmission of diseases that can be acquired by contact with blood, body fluids, non-intact skin (including rashes), and mucous membranes. These measures are to be used when providing care to all individuals. BibTeX @MISC{India_iapguide, author = {Becton Dickinson India and Editorial Board and Kailas Darshan and Kennedy Bridge (nana Chowk and Dr. S. Sachidan and A Kamath and National Convenor and Printek Ways and Dr. C. P. Bansal and Editorial Board}, title = {IAP Guide Book on Safe Injection Practices IAP GUIDE BOOK ON SAFE INJECTION PRACTICES}, year = {} patient safety and worker health and safety activities. This monograph is designed to bridge safety-related concepts and topics that are often siloed within the specific disci-plines of patient safety/quality improvement and occupational health and safety. This monograph includes information about the following

PPE safety Closed system transfer devices Post-treatment care Day-to-day cleaning Wipe testing Spill management Safe handling in the home Medical surveillance References and additional resources p.1 p.2 p.3 p.3 p.4 p.5 p.6 p.8 p.10 p.12 p.13 p.14 p.15 p.16 p.17 p.20 p.22 p.23 Toolkit for Safe Handling of Hazardous Drugs for Nurses in Oncolog Safety and Health, DHHS (NIOSH), U.S. Department of Health and Human Services CfDCaP; 2014 September 2014. Report No.: 2014-138 Contract No.: 2014-138. 3. National Research Council Committee on Prudent Practices in the L. The National Academies Collection: Reports funded by National Institutes of Health - Identify at least one key issue found on survey relating to the top four challenging medication management standards. - Identify 5 medication- related standards change

Best Injection PowerPoint Templates. CrystalGraphics is the award-winning provider of the world's largest collection of templates for PowerPoint. Our beautiful, affordable PowerPoint templates are used and trusted by both small and large companies around the world. Look around. You'll like what you see practices, PPE, work practices and emergency procedures in case of spill or possible exposure. Review of the safety data sheet/material safety data sheet (SDS/MSDS) is required and practice with less hazardous materials is recommended prior to work with the agents. Section 7 of th of contaminated injection solution. Some respondents to an ISMP sur-vey erroneously suggested this prac-tice was safe because they discarded the solution after 24 hours. However, limiting use to 24 hours doesn't pre-vent disease transmission if the bag becomes contaminated.8 The CDC's guideline for safe injection practices Ask about safe injection practices. Safe injection practices are steps that your healthcare providers should follow when they give injections. For example, not using the same needle or syringe on more than one patient. Remember: One needle, one syringe, only one time. Ask to have your room or equipment cleaned

Injection safety practice is an important component of basic infection control but in low income settings like the prisons where the seroprevalence of blood borne infections are significantly higher. These remains neglected under the pressure of overwhelming social, economic and political challenges and put the patients and healthcare providers at risk of infectious and non-infectious adverse. Vaccinations for 11 to 18-year-olds with a focus on the 16-year-old visit. August 2019 | Size: 101 slides. Download 6 slide/page PDF handout. Request the PowerPoint slide set (includes presenter's notes) View Dr. Humiston's webinar from August 14, 2019 g. Practice injections. h. Read Vaccine Information Statements. i. Be mentored by someone who has demonstrated appropriate immunization skills. j. Role play (withcompletion, as well as other staff) interactions with parents and patients, including age appropriate comfort measures. k. Attend a skills training or other appropriate courses. as reported in a 2007 Institute for Safe Medicine Practices study. 4. Identify important safety precautions when administering heparin. 5. Identify important safety precautions when administering warfarin. Potassium chloride for injection 93% Potassium phosphates injection 87% Anesthetic agents, general, inhaled and IV, such as propofol 86%.

Safe-injection-practices--PPT Powerpoint Presentations

Safe infection practices are available on the CDC Injection Safety website.. The Safety Institute is a member of the Safe Injection Practices Coalition (SIPC), a partnership of healthcare-related organizations, patient advocacy organizations, industry partners, and other public health partners, led by the Centers for Disease Control and Prevention (CDC) perianesthesia nursing practice. RATIONALE Patient safety is the primary focus of perioperative nurses and other health care providers. One of the most important responsibilities of the perioperative RN administrator is to develop an effective staffing plan that is relevant to the individual practice setting and meets the safety need

Unsafe injection practices and improper reuse of needles, syringes, and single-use devices, as well as the increase in multiple-drug resistant organisms (MDROs) have also contributed to a rise in emerging infections. 1. In 2011, there were over 721,000 cases of infections attributed to improper infection control practices in healthcar Safety needles should be used for IM injections to reduce the risk of needle-stick injury (Health and Safety Executive, 2013). Needle size is measured in gauges (diameter of the needle). A 21G is commonly used but selection depends on the viscosity of the liquid being injected (Dougherty and Lister, 2015) • Safe injection practices prevent the infection transmission/ outbreaks of bloodborne diseases to both patients and healthcare providers • Healthcare facilities should evaluate their injection safety practices and, as needed, implement a 6-step program to improve injection safety . 3

Injection safety - SlideShar

The Institute for Safe Medication Practices (ISMP) recommends that technology for PCA be developed that can alert clinicians to unsafe dose settings, programming errors, and RD. 31. The APSF urges health care professionals to consider the potential safety value of continuou This policy has been developed to promote safe work practices for all employees who prepare or administer hazardous drugs or clean up spills of these drugs. It is important to minimize occupational exposure to these drugs because of the risk of adverse health effects Injection Safety Injection safety, or safe injection practices, refers to the measures taken to perform injections in the safest manner possible for patients, health care providers, and others. Cover Your Cough Poster for the Community Posters that you can use to help teach people to cover their cough As part of its continuing effort to improve the Outreach Training Program, the Occupational Safety and Health Administration (OSHA) will be eliminating the authorized trainer 90-day grace period described in Sections III.B.1.,2, and 4 of the OSHA Outreach Training Program Requirements.This change will be included in the next published revisions of the OSHA Outreach Training Program. Official U.S. government health recommendations for traveling. Provided by the U.S. Centers for Disease Control and Prevention (CDC)

Background In the Yemeni healthcare setting, basic infection control measures are necessary to reduce the rates of hospital-associated infections. Methods A descriptive cross-sectional study was conducted from April to May 2016. A non-probability sample of 100 nurses working in the private hospitals located in the capital city of Yemen was selected as study participants. A 45-item. About APIC. 1400 Crystal Drive, Suite 900 Arlington, VA 22202 202-454-2646 Phone 202-789-1899 Fax info@apic.org For the Medi Basic safe practices for medication administration . The hospital's policies and procedures must reflect accepted standards of practice that require the following be confirmed prior to each administration of medication: • the patient's identity. Acceptable patient identifiers include but are not limited to: th

Safe Injection Practices FAQs Infection Control

  1. ated specimen will produce a misdiagnosis. Clerical errors can prove fatal. The new WHO guidelines provide recommended steps for safe phlebotomy and reiterate accepted principles for drawing, collecting blood and transporting blood to laboratories/blood banks
  2. National Health Portal Helpdesk for implementation of Electronic Health Record Standards (EHR) IAP Growth Monitoring Guidelines for Children from Birth to 18 Years. IAP guidebook 2007. The fourteenth meeting of the Indian expert advisory group for Polio Eradication. IAP workshop on safe injection practice : Recommendations and IAP Plan of Action
  3. key references and resources for each area of focus including sterilization, safe injection practices and hand hygiene in dental settings. The new recommendations 3 emphasize the importance of having one person in every dental practice assigned to be the infection prevention coordinator. The coordinator would develop written infection.
  4. g injections should be used in a way that would reduce the risk of needlestick injuries. This is possible with a needle guard as well as an automatic retraction device or non-removable needles with a fixed-dose
  5. Unsafe injection practices (especially needle and syringe re-use) are commonplace in low-income country health settings, and place both staff and patients at risk of infection with blood-borne viruses (BBVs). It is estimated that up to 160 000 human immunodeficiency virus (HIV), 4.7 million hepatitis C and 16 million hepatitis B infections each.
  6. 4. Dolan SA, Felizardo G, Barnes S, et al. APIC position paper: safe injection, infusion, and medication vial practices in health care. Am J Infect Control. 2010;38(3):167-172. [Context Link] 5. The Institute for Safe Medication Practices. ISMP survey reveals user issues with Carpuject prefilled syringes. ISMP Medication Safety Alert! 2012;17.
  7. Adverse event following immunization (AEFI) is a critical component of immunization program. The risk of AEFI with vaccination is always weighed against the risk of not immunizing a child. There is an evolving AEFI surveillance system in India for the vaccines delivered through universal immunizatio

IAP Workshop on Safe Injection Practice : Recommendations

  1. Safety and Reactogenicity 12 Local reactions within 7 days occurred in ~50% vaccine recipients -Pain at the injection site most common Systemic reactions within 7 days occurred in ~55% vaccine recipients -Headache, fatigue, and myalgia most common Most symptoms resolved after 1-2 day
  2. al pressure (IAP) < 5 mmHg. CO2 most commonly used gas. Noncombustible= safe to use with electrosurgical devices. Solubility in blood and reactivity w/ soluble buffering systems
  3. istration of insulin is by an injection (shot) or by an insulin pump that gives insulin constantly in varying doses. Type 2 : Insulin can and is often used to manage, but life style changes of meal plan, activity level or oral medications are used

PPT - Injection Safety PowerPoint presentation free to

Injection of blood-borne viruses is the major hazard of needle stick injuries, especially the viruses that cause AIDS Schools need to adopt practices that minimize the risk of students, staff or others coming into contact as the Custodians in the safe handling and disposal of needles/syringes. Educate students regarding how to identify. Insulin Injection Technique. Ensure patients and/or caregivers receive adequate education and understand correct insulin injection technique to optimize glucose control and safety. Inject into appropriate body areas (abdomen, thigh, buttock, upper arm) Injection site rotation to avoid lipohypertroph Practice Safe - Medication Management - Practice Safe Medication Management healthcare professionals in USA are highly trained, dedicated and caring Our medication management training course creates a safe and more responsible healthcare worker when administering any form of medication. | PowerPoint PPT presentation | free to vie 6.2 Safe Medication Administration. In the Institute of Medicine's often-cited book To Err Is Human: Building a Safer Health System (Kohn, Corrigan, & Donaldson, 2000), it is estimated that approximately 1.5-million preventable adverse drug events (ADEs) occur annually. The Joint Commission (TJC) defines medication errors as any preventable.

Injection Safety CD

  1. Ensures incident responder safety. Protects health and safety of the general public and the environment. Manages the planning process. Compiles and develops the Incident Action Plan. Manages the activities of Technical Specialists. Works closely with the Incident Commander and General Staff. PowerPoint Presentation Author: Mark Askey.
  2. Safe Work Practices . 1. Wear appropriate personal protective equipment (PPE) when using pneumatic tools and equipment, such as hearing protection and safety glasses with side shields or goggles. Additional PPE such as a face shield, gloves or steel-toed shoes, may also be required, depending on the hazards encountered. 2
  3. Best Practices in the Use of Iodinated Contrast Media in the Clinical Setting: and safety profile. Specific clinical situations for which use of a particular agent would be advantageous will also be explained. Effective approaches to screening and managing patients at risk of developing < 600 mOsm/Kg ‐no injection site pain.

Safe Injection Progra

Safe work practices are generally written methods outlining how to perform a task with minimum risk to people, equipment, materials, environment, and processes. Safe job procedures are a series of specific steps that guide a worker through a task from start to finish in a chronological order. Safe job procedures are designed to reduce the risk. Safer sex (often called safe sex) means taking steps to protect yourself and your partner from STDs when you have sex. There are lots of ways you can make sex safer. One of the best ways is by using a barrier — like condoms, internal condoms, dental dams, and/or latex or nitrile gloves — every single time you have oral, anal, or.

Safe injection practices for Doctors and nurse

  1. Access public safety . Dispatchers . Obtain information and dispatch resources. Emergency medical dispatch (EMD) system. Provides medical instruction. Lecture Outline . B. Public access. 1. Easy access to help in an emergency is essential. 2. The 911 system is the public safety access point. 3
  2. Lockout/tagout is the process employing specific safety procedures and practices to control hazardous energy during the service and maintenance of machinery and equipment What is Lockout Tagout? Protects workers from: - The unexpected powering or start up of machinery or equipment - The unexpected release of hazardous energ
  3. istration (FDA). Food and food packaging must be manufactured under a GMP program that prevents conta
  4. Employee Fire and Life Safety Training, describes some of the train-ing techniques employers use.) Maintenance. The employer must regularly and properly maintain the equipment and systems installed on heat-producing equipment to prevent the accidental ignition of combustible materials and thes

Video: One and Only Campaign Injection Safety CD

200 Transportation & Safety Bldg. 5 1 1 Washington Avenue, S.E. Minneapolis, Minnesota 5.5455-0220 _I_ -IS. Supplementary Notes _I I- Best Practices Handbook on ASPHALT PAVEMENT MAINTENANCE February 2000 Spray Injection Patching. Welcome to Indian Academy of Pediatrics. During 2020, the generation-defining fight has been the ongoing Covid-19 Pandemic. It's disrupted lives on a global scale, and people, more than ever, are looking at their doctors for guidance and aid. Our job, our responsibility, and our privilege as pediatricians, is to handhold our patients and. New Employee OSHA Orientation Checklist Top 5 downloads for 2012. Quick Training Guide Top 5 downloads for 2012. Training Program Evaluation Form. Safety Recordkeeping Requirements. Hazard Communication. Chemical Incompatibility Chart. Determining when an MSDS is necessary. Emergency Eyewash Equipment

A procedure mask (also called an isolation mask) is a disposable mask that protects the wearer from droplets that might be infectious. A version of this mask with a built-in face shield to protect against splashes is also available. An N95 respirator is a tight-fitting cover that when properly fitted to the face protects the wearer from very. the details of how to implement each coding practice, developers will either need to have the prior knowledge or have sufficient resources available that provide the necessary guidance. This guide provides coding practices that can be translated into coding requirements without the need for the developer to have a Radiation is simply a type of energy; the most familiar form of radiation is visible light (like that produced from the sun or a light bulb). Other forms, like X-rays and gamma rays, are employed in a number of beneficial applications, including medicine. Natural radiation exposure comes from the earth (rocks, soil) and outer space (cosmic rays) Glassware must, of course, be clean, and CGMP regulations consider laboratory equipment to be included within the scope of 21 CFR 211.67. Cleanliness is best assessed by inspecting laboratory. FEMA's Center for Domestic Preparedness (CDP), located in Anniston, Alabama, is the United States Department of Homeland Security (DHS)'s only federally chartered Weapons of Mass Destruction (WMD) training center. Through its courses and integrated programs, EMI serves as the national focal point for the development and delivery of emergency.