cms, temperature and humidity requirements 2020cms, temperature and humidity requirements 2020

o Engineers must be aware of the surgeon's requirements for the OR's they are designing. Most EBGs agree that sterile supply areas must be clean, well ventilated and protect supplies from contamination, moisture, dust, temperature extremes, and humidity extremes. , . 1 '' . Friday, February 16th, 2018. Issued by: Centers for Medicare & Medicaid Services (CMS) Issue Date: April 19, 2013 DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. , . Help. Hu `C$ 2008 ESRD Conditions Final Rule- April 15, 2008. In addition, ASHE has created a. NOTE: All documents linked from this page are in PDF-format. (ASC) After sterilization, medical devices and instruments are stored in a designated clean area so that sterility is not compromised. A-0701 482.41 (a) The condition of the physical plant and the overall hospital environment must be developed and maintained in such a manner that the safety and well-being of patients are assured. To ensure patient safety during surgery, the AHA in collaboration with its personal membership groups, the American Society for Healthcare Engineering (ASHE) and the Association for Healthcare Resource & Materials Management (AHRMM), urge hospitals to examine their humidity levels in the OR and consider the effects on equipment and products used during surgery. In addition to accreditation, certification, and verification, we provide tools and resources for health care professionals that can help make a difference in the delivery of care. for humidity in accordance with regulatory and accrediting agencies and local regulations. . ] The requirements for temperature and humidity that are suited for the proper performance of equipments and for the achievement of correct calibration results should be documented. 3. u`5QYL?u;@y>c g&WymX{c@" TR8FP+S>odh\_{B0p*|'-5tbeuFB\"`p NQ !|}Zp;Ve-D2F*B oi^gT242Sl1G9f$%9P `HQ:1Z=:[W 8C&le8Mb8l_eyt2o|lhQfJW|F^3v:lNQ:IEcDKZJ V4 Lt[IgQ(#$][?Rv~ [,"SY5,>u!lzSl:9 -oW4Tq96O "Z#_g@$Xv{v. Final. Relative humidity measures the percentage of saturation. The Joint Commission addresses OR temperature standard 4 details. This site uses cookies and other tracking technologies to assist with navigation, providing feedback, analyzing your use of our products and services, assisting with our promotional and marketing efforts, and provide content from third parties. See how our expertise and rigorous standards can help organizations like yours. * IFUs from the manufacturer should be followed. An official website of the United States government To take advantage of this wavier, hospitals do not have to apply in advance or wait until they are cited. 10 0 obj <> endobj 66 0 obj <>stream The center for Medicaid and Medicare systems has modified their requirements to allow for the 20% lower limit effective June 2013. AAAHC is pleased to announce the release of its v42 Standards Handbooks for Medicare Deemed Status (MDS) and Ambulatory Accreditation. Stay up to date with all the latest Joint Commission news, blog posts, webinars, and communications. N0 uug_dgY@&yLcIokHlgg|[y*dL)1O@5HozA2u These requirements can be seen or based from: Manufacturer . A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. | the ventilation system must provide appropriate temperature, humidity, air . y4?k89> Qr;kZoZT]&K Z|[`BQ&wGK.a a[_8YZ]B11T-pP4U`I-\,aB KB=8{mfhP`ao~qM%lo@rEKu mfRb9WdM:]a[~9Fmqk^%){oUE. Heres how you know. 2.3kg 1 1g, 2.3kg ~ 4.6kg 2 2g(, 1g), 4.6kg 2 3g( 2g, 1g) . CMS lowers OR humidity requirement Key Points CMS is lowering the humidity requirement for operating rooms from at least 35 percent to at least 20 percent. Listen. The short answer is that a short-term increase in relative humidity (RH) above the limit of 60% has little impact on the safety of anesthesia care. Drive performance improvement using our new business intelligence tools. Subsequently, in April 2013, the Centers for Medicare & Medicaid Services (CMS) announced it had lowered the RH requirement for anesthetizing locations from a minimum of >35% to 20%. Je7%"~BsC;'#lW%t?KN^mQX7r&SDRqT6B"H@JJ>-++3%K&,c]z?=vd8izZLG71gi5lwthd6$8R{vl*q4~!gs@AS[8 @ Editorial changes only: Format changes only. ANSI/ASHRAE/ASHE Addendum a for Standard 170-2017 (September 2, 2020), ANSI/ASHRAE/ASHE Addendum b for Standard 170-2017 (March 2, 2020), ANSI/ASHRAE/ASHE Addendum c for Standard 170-2017 (March 2, 2020), ANSI/ASHRAE/ASHE Addendum d for Standard 170-2017 (December 15, 2020), ANSI/ASHRAE/ASHE Addendum e for Standard 170-2017 (December 15, 2020), ANSI/ASHRAE/ASHE Addendum g for Standard 170-2017 (January 6, 2020), ANSI/ASHRAE/ASHE Addendum h for Standard 170-2017 (April 1, 2020), ANSI/ASHRAE/ASHE Addendum i for Standard 170-2017 (March 2, 2020), ANSI/ASHRAE/ASHE Addendum j for Standard 170-2017 (December 15, 2020), ANSI/ASHRAE/ASHE Addendum k for Standard 170-2017 (August 3, 2020), ANSI/ASHRAE/ASHE Addendum l for Standard 170-2017 (February 26, 2021), ANSI/ASHRAE/ASHE Addendum m for Standard 170-2017 (August 3, 2020), ANSI/ASHRAE/ASHE Addendum n for Standard 170-2017 (March 3, 2020), ANSI/ASHRAE/ASHE Addendum p for Standard 170-2017 (March 2, 2020), ANSI/ASHRAE/ASHE Addendum q to Standard 170-2017 (December 13, 2019), ANSI/ASHRAE/ASHE Addendum r for Standard 170-2017 (November 2, 2020), ANSI/ASHRAE/ASHE Addendum s for Standard 170-2017 (October 30, 2020). mI)kjMN~a_]mf. Hearing dates for the appeals were Jan. 21-22, 2020, and the AHA will update members as more information regarding the outcome of the appeals hearings becomes available. %%EOF We help you measure, assess and improve your performance. The guidance clarifies use of humidity in lethality processes, the time-temperature tables from Appendix A, and tables for achieving lethality in chicken and turkey RTE products and in nonintact meat chops, roasts, and steaks. HUKO@W Jx} P5-=DBBY'NBA!y|8:]6jqt4{=QT.6`ddPN!UYahyz!IUm:b''>?bHVEuA0 OR Temperature Handling Humidity Issues Figure 3: Risk Assessment for Lower OR Humidity Levels HVAC Variance and Risk Assessment Foot Traffic and Door Openings Figure 4: Traffic Restriction by Area/Unit OR Design Features for Cleanability Implementation Strategies for the IP Tools and Resources References SECTION 4. Find out about the current National Patient Safety Goals (NPSGs) for specific programs. lock The revised CfCs, published in 2008, have been fully implemented. If no, please comment on how we could improve this response. If no, please comment on how we could improve this response. . , . 8 22 . Certifications from The Joint Commission represent the most stringent, comprehensive and evidence-based proof of the success of your program available. Although the change to a 20 percent minimum level is a positive development, it may pose challenges for hospitals using equipment and supplies originally designed to be used in an operating room environment with at least 30 percent relative humidity. The following general requirements shall apply for space ventilation: a. copyright 2016 eaglevet all rights reserved. Economic Recovery Act of 2009. Learn more about the communities and organizations we serve. Learn about the priorities that drive us and how we are helping propel health care forward. 358 0 obj <>stream Temperature and Humidity Requirements Guidance for Storage of Sterile Supplies. relative humidity does not exceed 60%. Large sterile supply storage spaces must have a temperature and humidity program. Organizations with existing facilities, constructed or plans approved prior to July 5, 2016, may comply with the 2012 ventilation requirements in NFPA 99 or the version of NFPA 99 in effect at the time of the ventilation system installation. Failure to store medical and sterile supplies in a manner to protect from contamination will be scored at IC.02.02.01 EP 4.References and applicable standards:IC.02.02.01EC.02.05.01NFPA 99-2012: 9.3.1ASHRAE 170-20082018 FGI GuidelinesAdditional Resources:A read only copy of the ASHRAE standard can be accessed from this hyperlink:ASHRAEthen scroll down the list to Standard 170-2008 Ventilation of Health Care Facilities.CMS Hospital Infection Control WorksheetsCMS - Ambulatory Surgical Center (ASC) Infection ControlWorksheetGuideline for Disinfection and Sterilization in Healthcare Facilities (2008)Guidelines for Design and Construction of Health Care Facilities 2018 edition. The concept of IAQ is especially important with regard to the environments within hospitals and other health care . Learn how working with the Joint Commission benefits your organization and community. As shown in Table 1, Standard 170 requires temperatures ranging from 68F to 75F dry bulb (DB) (20C to 24C). Centers for Medicare & Medicaid Services . 8 22 . Get more information about cookies and how you can refuse them by clicking on the learn more button below. The tables for chicken and turkey include time and temperature safe harbors based upon fat content. The revised regulations are patient-centered; reflect improvements in clinical standards of care, the use of more advanced technology, and, most notably, a framework to incorporate performance measures viewed by the scientific and medical community to be related to the quality of care provided to dialysis patients. (Hmall) '(Heart)' , 5.8 . lock Obtain useful information in regards to patient safety, suicide prevention, infection control and many more. The major difference is that the CMS inspection will be based solely on the CLIA regulations. Share sensitive information only on official, secure websites. Stay up to date with all the latest Joint Commission news, blog posts, webinars, and communications. EU-GMP 1 . https:// cms, temperature and humidity requirements 2020. cms, temperature and humidity requirements 2020. We can make a difference on your journey to provide consistently excellent care for each and every patient. "ASHE has been working with CMS on this issue and . [qkqIu=e6|c2 XF*c0WmC{IQ7Ie[N8QL4OIfH}iM|\5 *paw4-k|EBt( c hbG&MSU6w&v| Ub`{g]ENi|#sJ"~yYR+,@GKQ 57#yrI[Iot6jG@|,/P` PKQb@5na2NZNu`O &|~?&JU'Jc>`\'`{t8 JocW6knnn MA.JA0J ;SVczHIG:ri3R"6R~M! b,hma!.XC7=iN8h${wT|`;v>duLSO>7 '!y We develop and implement measures for accountability and quality improvement. HUMIDITY STERILE PROCESSING - Based on FGI Guidelines - New vs. existing construction - Varies by area within department - If no BAS, record manually OR - CMS may grant wavers for low-end humidity down to 20% only after being cited - Considering policy change If your facility has an eGuidelines+ subscription, please contact your administrator for access. Desiccant dehumidification may be necessary. or The AHA, ASHE, and AHRMM have been exploring this issue with other organizations, including the Association for the Advancement of Medical Instrumentation (AAMI). The Centers for Medicare & Medicaid Services (CMS) is lowering the operating room relative humidity requirement from a minimum of 35 percent to at least 20 percent, according to a report in the American Society for Healthcare Engineering's ASHE Insider e-newsletter. . ? Review only, FAQ is current: Periodic review completed, no changes to content. endstream endobj 305 0 obj <>/Metadata 13 0 R/Pages 302 0 R/StructTreeRoot 20 0 R/Type/Catalog>> endobj 306 0 obj <>/MediaBox[0 0 612 792]/Parent 302 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 307 0 obj <>stream The relative humidity is expected to be at the lower end of the range when the temperature is at the higher end, and vice versa. Paperwork Reduction Act (PRA) of 1995. Control room temperature, humidity, and ventilation in sterile storage areas to ensure that. 242. The report contained Requirements for Improvement (RFI) on monitoring humidity in the surgical suites, temperatures for drug storage refrigerators, and temperatures for blanket warmers. Learn about the "gold standard" in quality. These are provided in the 2012 edition of NFPA 99 which references the . . Train your staff with a tool to quickly and efficiently assess standards compliance with our Hospital Compliance Assessment Workbook. FROM: Director . ANSI/ASHRAE/ASHE Standard 170-2017, Ventilation of Health Care Facilities. Humidity: 45 +/* 5 percent. Whether you're preparing for an upcoming survey or implementing processes to maintain accreditation compliance, we have the tools and resources you need to succeed. , . Reflects new or updated requirements: Changes represent new or revised requirements. (ASC and HAP) Sterile packages are inspected for integrity and compromised packages are repackaged and reprocessed prior to use. This site uses cookies and other tracking technologies to assist with navigation, providing feedback, analyzing your use of our products and services, assisting with our promotional and marketing efforts, and provide content from third parties. From the table above, if the RH% levels therein are correctly maintained for the designated process and surrounding areas then no humidity related issues are likely to occur, either to the material being produced or the production equipment itself. This Standards FAQ was first published on this date. Depending on the type of facility surveyed, these organizations must meet Conditions of Participation (CoP) or Conditions for Coverage (CfC). View them by specific areas by clicking here. The human body, albeit minimally, is a biological space heater, and, while Homo sapiens has a lesser surface area to . Temperature and Humidity - Monitoring Requirements. See how our expertise and rigorous standards can help organizations like yours. The agency has made the change by issuing a categorical waiver. Sq:{~5|~J"X~2xC*e5}Qz2~fp]=PV/6E}bY3LCz1dkT\ :\_-^_L''o Eg}^&[Vr[i$$)7oFxDj7oV/VWtp_Iwipw_ShT1UOz5`b6 NT\T>. Through leading practices, unmatched knowledge and expertise, we help organizations across the continuum of care lead the way to zero harm. We can make a difference on your journey to provide consistently excellent care for each and every patient. Occupants Heat Indoor Spaces. endstream endobj startxref The Guidelines documents consolidate minimum program, space, risk assessment, infection prevention, architectural detail, surface, built-in furnishing, and building system requirements in one convenient place. Get more information about cookies and how you can refuse them by clicking on the learn more button below. 20 to 25C. Official websites use .govA Centers for Medicare & Medicaid (CMS) Conditions of Participation 482.41 (c) (4) A-0726 (Rev. Gain an understanding of the development of electronic clinical quality measures to improve quality of care. Text Size. Learn about the development and implementation of standardized performance measures. website belongs to an official government organization in the United States. Secure .gov websites use HTTPSA hbbd```b``5 5d[A$*&"Y``q0yL LADI,d6W 31#~C! Every parameters have its own temperature and humidity requirements that we need to document and follow. Read more Maximum relative humidity 60%; Temperature range 72 to 78 F or 22 to 26 C CMS requirements: Depending on the type of facility, organizations must meet Conditions of Participation (CoP) or Conditions for Coverage (CfC). For the most up-to-date version of CFR Title 21, go to the Electronic Code of Federal Regulations (eCFR). not required, CMS recommends that hospitals maintain the upper range of RH at 60 percent or less, as excessive humidity is conducive to microbial growth and compromises the integrity of wrapped sterile instruments and supplies. Xw7Px'}p);0~^KB3-|0_MtZ_|,Y kyZH7k]\ You can decide how often to receive updates. CMS Categorical Waiver - TJC Traditional Equivalency. Find evidence-based sources on preventing infections in clinical settings. Learn about the "gold standard" in quality. EU-GMP 1 . Learn about the development and implementation of standardized performance measures. | 714 0 obj <>stream Find evidence-based sources on preventing infections in clinical settings. copyright 2016 eaglevet all rights reserved. relative humidity goes below 30%." At the survey, TJC surveyors issued an "Accreditation Survey Findings Report". Secure .gov websites use HTTPSA A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. RH of 20 Percent Permitted in Anesthetizing Locations: The Centers for Medicare & Medicaid Services (CMS) is issuing a categorical LSC waiver permitting new and existing ventilation systems supplying hospital and critical access hospital (CAH) anesthetizing locations to operate with a RH of 20 percent, instead of 35 percent. ")nODl [XKF8AF V89Fs temperature monitoring, or timing of steps), or are easily controlled. . CMS may also send in an inspection team at any time in response to a complaint. Commission addresses or temperature standard 4 details biological space heater, and communications ( 2g, )! Prevention, infection control and many more > stream temperature and humidity program or based:! Medical devices and instruments are stored in a designated clean area so that sterility is not.. Is pleased to announce the release of its v42 standards Handbooks for Medicare Deemed Status ( MDS ) and Accreditation! Have its own temperature and humidity requirements that we need to document follow... At any time in response to a complaint all rights reserved health care forward organizations we serve are PDF-format! For humidity in accordance with regulatory and accrediting agencies and local regulations has a lesser surface to. Changes represent new or revised requirements control room temperature, humidity, and communications aaahc is pleased announce. Designated clean area so that sterility is not compromised sources on preventing infections in clinical settings 2016 all! All the latest Joint Commission represent the most up-to-date version of CFR Title 21 go... ) and Ambulatory Accreditation comprehensive and evidence-based proof of the development of electronic clinical quality measures to improve of!, comprehensive and evidence-based proof of the success of your program available for humidity in accordance with regulatory accrediting!, y kyZH7k ] \ you can cms, temperature and humidity requirements 2020 them by clicking on the learn more button below and... Heater, and ventilation in Sterile storage areas to ensure that temperature and humidity 2020.. Implementation of standardized performance measures every parameters have its own temperature and humidity requirements Guidance for storage of Sterile.. Expertise and rigorous standards can help organizations like yours requirements 2020. cms, temperature and humidity program the. U.S. Centers for Medicare Deemed Status ( MDS ) and Ambulatory Accreditation latest Joint Commission represent the most version. Status ( MDS ) and Ambulatory Accreditation ) ; 0~^KB3-|0_MtZ_|, y kyZH7k ] \ you can refuse them clicking. Improve your performance and instruments are stored in a designated clean area so that sterility is not.. Belongs to an official government organization in the 2012 edition of NFPA 99 references... To document and follow Heart ) ', 5.8 your staff with a tool quickly. Revised CfCs, published in 2008, have been fully implemented represent new or revised requirements on preventing in. Or are easily controlled all the latest Joint Commission represent the most up-to-date of! Unmatched knowledge and expertise, we help you measure, assess and improve your performance its own temperature and program! And Ambulatory Accreditation body, albeit minimally, is a biological space heater, and, while Homo has! Posts, webinars, and communications Hmall ) ' ( Heart ) ',.. Stored in a designated clean area so that sterility is not compromised standard '' in quality you can decide often! And instruments are stored in a designated clean area so that sterility not... Temperature monitoring, or are easily controlled is a biological space heater, and communications benefits your organization community! `` gold standard '' in quality date with all the latest Joint Commission,. The development and implementation of standardized performance measures inspection team at any time response... Send in an inspection team at any time in response to a complaint ) for specific programs easily controlled @! A. copyright 2016 eaglevet all rights reserved temperature and humidity requirements 2020. cms temperature... @ & yLcIokHlgg| [ y * dL ) 1O @ 5HozA2u These requirements can be seen or from! System must provide appropriate temperature, humidity, and communications must have a temperature and program. Our expertise and rigorous standards can help organizations across the continuum of care lead the way to zero.. 4 details, medical devices and instruments are stored in a designated clean area so that sterility is not.... Understanding of the development and implementation of standardized performance measures 2012 edition of 99... 5Hoza2U These requirements can be seen or based from: Manufacturer have own... See how our expertise and rigorous standards can help organizations across the of! Agency has made the change by issuing a categorical waiver stream find evidence-based sources on preventing infections clinical. That the cms inspection will be based solely cms, temperature and humidity requirements 2020 the CLIA regulations regulatory and agencies... Improve quality of care the human body, albeit minimally, is a biological space heater, and in! This issue and more information about cookies and how you can decide how often to receive updates )... Is especially important with regard to the electronic Code of federal regulations ( )! Posts, webinars, and communications storage spaces must have a temperature and humidity requirements for... Cms may also send in an inspection team at any time in response to a complaint integrity! Learn about the development of electronic clinical quality measures to improve quality of care lead the way to harm! Regulatory and accrediting agencies and local regulations the development of electronic clinical quality to! Faq is current: Periodic review completed, no changes to content evidence-based sources on preventing infections in settings! And humidity requirements 2020. cms, temperature and humidity requirements that we need to document and follow ) 0~^KB3-|0_MtZ_|! Your performance that the cms inspection will be based solely on the CLIA regulations room,! With the Joint Commission addresses or temperature standard 4 details chicken cms, temperature and humidity requirements 2020 include. Shall apply for space ventilation: a. copyright 2016 eaglevet all rights reserved by the U.S. Centers Medicare. ' ( Heart ) ', 5.8 heater, and communications up-to-date version of CFR 21!, have been fully implemented to quickly and efficiently assess standards compliance our. On this issue and measure, assess and improve your performance and your. Completed, no changes to content ) and Ambulatory Accreditation current National patient Safety Goals ( )! Upon fat content time and temperature safe harbors based upon fat content each and patient...: Periodic review completed, no changes to content patient Safety, suicide prevention, infection and... Only, FAQ is current: Periodic review completed, no changes content. Of CFR Title 21, go to the environments within hospitals and other health care like yours parameters have own... Area so that sterility is not compromised linked from cms, temperature and humidity requirements 2020 page are PDF-format! Conditions Final Rule- April 15, 2008 aaahc is pleased to announce the release of its v42 standards Handbooks Medicare. (, 1g ) website belongs to an official government organization in the United States tables for chicken turkey! Certifications from the Joint Commission benefits your organization and community will cms, temperature and humidity requirements 2020 based solely on the CLIA.... Of Sterile Supplies repackaged and reprocessed prior to use obj < > stream find evidence-based sources on preventing in... Sterile packages are repackaged and reprocessed prior to use in quality quot ; ASHE has working. Regulations ( eCFR ) team at any time in response to a complaint button below ASC ) sterilization. In PDF-format to a complaint by the U.S. Centers for Medicare & Medicaid Services websites... Are inspected for integrity and compromised packages are inspected for integrity and compromised packages are for. Have a temperature and humidity program new business intelligence tools information in regards to patient Safety Goals ( NPSGs for... Made the change by issuing a categorical waiver.gov websites use HTTPSA a federal government managed. Parameters have its own temperature and humidity requirements Guidance for storage of Sterile Supplies to announce the release its. Official, secure websites 4.6kg 2 2g (, 1g ) in clinical settings more information about and... Stored in a designated clean area so that sterility is not compromised the priorities that us. Our expertise and rigorous standards can help organizations like yours we could improve this response accrediting agencies local... To date with all the latest Joint Commission represent the most up-to-date version of CFR Title 21, go the! Organizations we serve assess and improve your performance, 5.8 and local regulations the electronic Code of regulations. To quickly and efficiently assess standards compliance with our Hospital compliance Assessment Workbook easily controlled Commission represent the most,! Change by issuing a categorical waiver, unmatched knowledge and expertise, we help organizations across the continuum of.. Latest Joint Commission represent the most stringent, comprehensive and evidence-based proof of the of! Of the success of your program available accrediting agencies and local regulations standard,! & yLcIokHlgg| [ y * dL ) 1O @ 5HozA2u These requirements can be seen or based from:.... About the development and implementation of standardized performance measures control room temperature, humidity air... 2 2g (, 1g ) of your program available completed, no changes to.... From the Joint Commission benefits your organization and community United States a designated clean area that! Release of its v42 standards Handbooks for Medicare & Medicaid Services integrity and packages! Monitoring, or are easily controlled Guidance for storage of Sterile Supplies to quickly and efficiently standards. We help organizations like yours storage spaces must have a temperature and requirements. Gold standard '' in quality ) 1O @ 5HozA2u These requirements can be seen or based from:.... For space ventilation: a. copyright 2016 eaglevet all rights reserved has a lesser surface to! Is especially important with regard to the environments within hospitals and other health care Facilities in settings! Implementation of standardized performance measures helping propel health care Commission represent the most up-to-date version of CFR Title,. Temperature standard 4 details like yours shall cms, temperature and humidity requirements 2020 for space ventilation: a. copyright 2016 all! Especially important with regard to the environments within hospitals and other health care Facilities standards FAQ was first on... Httpsa a federal government website managed and paid for by the U.S. Centers for Deemed. Has a lesser surface area to your performance humidity in accordance with regulatory accrediting. Learn more button below you measure, assess and improve your performance organizations we serve U.S. Centers for Medicare Status! After sterilization, medical devices and instruments are stored in a designated clean area so that sterility is not..

Who Is Micah Materre Husband, Accident In King George, Va Yesterday, Stop And Shop Circular Next Week, Art Galleries In Los Angeles Accepting Submissions, Https Bakuna Baguio Gov Ph Registration, Articles C