Safety and Infection Control

I. Safety: safety is the primary concern when caring for clients

A. Fire, electrical and radiation safety
1. Fire safety
a. prevention
b. types of fire extingishers and their ses
c. fire containment
1. !now the instittion"s fire evacation rotine
A. #ist the phone nmber for reporting fires close to all
phones in the facility or $now the location of fire
alarms.
%. !now where fire exits are.
C. !now where fire extingishers are and $now how to
se them.
&. Chec$ 'hang tag' for data of last inspection (sally annally)
*. +ost signs: In Case ,f Fire, -o .ot /se 0levators
4. In a fire the nrse ac ions are to inclde PRC or RACE or
ARCE 1 note that the se2ence of actions may vary by policy
in different agencies
PRC
Protect clients from in3ryReport the fire
Contain the fire
ARCE
Activate fire alarm system
Resce or remove clients
Contain fire by closing windows and doors
Extingish flames with fire extingishers
RACE
Resce or remove clients
Activate fire alarm system
Contain fire by closing windows and doors
Extingish flames with fire extingishers
d. response to fire
i. examples of facility resce plans:
+4C
o Protect clients from in3ry
o Report the fire
o Contain the fire
4AC0
o Resce or remove clients
o Activate fire alarm system
o Contain fire by closing doors and windows
o Extingish flames with fire extingishers
A4C0
o Activate fire alarm system
o Resce or remove clients
o Contain fire by closing doors and windows
o Extingish flames with fire extingishers
e. electrical safety
Check for:
1. Cords
A. Frayed or damaged
%. 5angled
C. 5aped to floor
-. 0xtension cords overloaded (too many)
&. 0lectrical e2ipment
A. /ngronded
%. .ear water
C. -amaged
*. Circits 6 overloaded
f. chemical safety
i. for all health care instittions, the ,ccpational Safety and
7ealth Administration (,S7A) sggests following its
8aterial Safety -ata Sheets (8S-S)
g. radiation safety
Radiation Safety Precautions
1. 8ar$ the client"s room with appropriate signage
&. Client mst be placed in a private room
*. +lace wristband on client indicating that the client is
receiving internal radiation therapy
9. +lan care to minimi:e time at the client"s bedside 6
maximm of one hor every eight hors
;. +repare meal trays otside the room
<. +osition items within client"s reach so as to facilitate as
mch self care as possible
=. Schedle only one radioactive client to a nrse at a
time
>. 0nsre a long handled forceps and a lead container
are in the client"s room in case of implant dislodgement
?. /se the forceps to pic$ p the implant to pt in lead6
lined container shold it become dislodged
1@. Aear gloves when handling secretionsBexcretions of
client receiving systemic isotopesC flsh toilet twice
11. Aear gloves while changing linens of clients receiving
systemic isotopes
1&. Aear a film badge while caring for client to monitor
exposreC have it chec$ed per agency policies
1*. .o pregnant nrses, visitors, or children allowed near
client
%. +oison control
1. 7igh ris$ grops are yong children and older adlts
&. Doals of therapies
a. before the body absorbs poison, remove it (e.g., vomiting, gastric lavage)
or netrali:e it (e.g., activated charcoal)
b. give spportive care (manage shoc$, sei:res, aspiration)
c. give the correct antidote to netrali:e poison
d. speed the elimination of any absorbed poison
C. Fall prevention
1. Assess client for ris$ factors
Risk Factors for Falls
1. %rain6related physiological changes and ris$ factors
A. -ecreased vision
%. -ecreased hearing
C. -ecreased circlation to the brain
-. 0ffects of tran2ili:ers, sedatives, anesthesia, hypertensives,
medications casing diarrhea, hypoglycemic medications
0. Confsion
F. Impaired memory or 3dgment
D. Inability to follow directions
7. 7istory of falls
I. Age over =@
&. 8scle6related physiological changes
A. Impaired mobility
%. -ecreased mscle strength
C. Incontinence
-. Fre2ency
0. /rgency
F. .octria
D. +oor balance when standing
7. %alance problems when wal$ing
*. Deneral Information
A. Age over =@
%. 7istory of falls
C. 0lderly living alone
-. .eed to se stairs in home
&. Didelines to prevent client falls
Guidelines to Prevent Client Falls
1. Assess client for ris$ of falling.
&. If ris$ is high:
A. Inform staff.
%. ,bserve client fre2ently.
C. !eep client"s call light and personal items within the client"s reach.
-. Instrct client to call for help when getting p.
0. Answer client"s call lights 2ic$ly.
F. !eep client"s bed in low position.
D. 5oilet client on a reglar schedle.
7. #oc$ the bed wheels and wheelchair bra$es to $eep them from
rolling.
I. +rovide a night light.
E. 0ncorage se of grab bars for the shower and bathtb.
!. +lace high6ris$ clients close to the nrse"s station.
#. Stay with confsed or nsteady client at all times when client is
ot of bed.
-. +rotect yorself from falls and in3ries: body mechanics
1. Ahen moving ob3ects: avoid plling, psh instead
&. Ahen moving clients
a. arrange for help
b. lift simltaneosly with yor helper
c. if there"s no helper, se mechanical aids
d. flex yor $nees
e. $eep bac$, nec$, pelvis, and feet aligned
f. widen the base of spport, $eeping feet apart
g. avoid twisting yor body
h. don"t lift with yor bac$, se yor arms and legs
i. balance load and $eep it centered on yor trn$
*. /se of safety devices (restraints)
9. -isaster planning
;. %ioha:ards
%iologic agents harmfl to an individal"s health. ,S7A classifies
materials in the wor$ environment according to degree of health ha:ard.
See ,S7A for gidelines on handling and disposal of ha:ardos
materials.
1. Secrity plan
II. Infection
A. 5ypes of infections
1. Commnity ac2ired
2. 7ospital ac2ired, also called nosocomial
B. Stages of an infectios process
1. Incbation +eriod
A. 5ime between entrance of pathogen and first
symptoms
%. 0xamples:
1. 8mps incbate in 1> days
&. Chic$en pox incbate in & to * wee$s
&. +rodromal Stage
A. 5ime from onset of nonspecific findings (sch as
fatige, malaise) to more specific findings.
%. 5he pathogen is mltiplying.
C. 5he host is most contagios.
*. Illness Stage
A. Ahen a client exhibits the specific findings of a disease
%. 0xamples:
1. 5he parotid gland swelling of mmps
&. 5he sore throat of a cold
9. Convalescence 6 when the acte findings begin to disappear
C. Complications of infection
1. 4elapse: some infections may reactivate, often becase they were not
treated thoroghly or the client did not comply with treatment
&. #ocal complications: local infections may form abscesses
*. Systemic complications: pathogen may enter bloodstream and case
septicemia
-. Chain of transmission
1. Casative agent (e.g. pathogen): fngs, parasite, bacterim, virs
&. 4eservoir host
*. +ortal of exit: way to get ot of reservoir of host
9. 5ransmission rote: way to reach ssceptible host
;. +ortal of entry: gain entrance
<. Ssceptible host
=. After the pathogen enters the host, illness depends on for factors
a. nmber of pathogen organisms
b. dration of the exposre
c. health stats of host, inclding age, physical, mental, and
emotional health
d. genetic stats of host"s immne system
&. Infection Control
%. 8edical and srgical asepsis
1. 8edical asepsis
a. Is a clean techni2e
b. Incldes procedres to redce the nmber and spread of
microorganisms
c. 0xamples: hand washing, changing bed linens daily
&. Srgical asepsis
Principles of Surgical Asepsis
1. A sterile ob3ect remains sterile only when toched by another
sterile ob3ect.
Sterile toching sterile remains sterile.
Sterile toching clean becomes contaminated.
Sterile toching contaminated becomes contaminated.
Sterile toching 2estionable is contaminated.
,nly sterile ob3ects may be placed on a sterile field.
&. A sterile ob3ect or field ot of range of vision, or an ob3ect held
below a person"s waist, is contaminated.
*. .ever trn yor bac$ on a sterile field.
9. A sterile ob3ect or field becomes contaminated by prolonged
exposre to air.
;. Ahen a sterile srface comes in contact with a wet, contaminated
srface, the ob3ect or field becomes contaminated by capillary
action.
<. Always hold yor hands above the level of yor elbows.
=. 5he edges of a sterile field or container are considered
contaminated.
C. +recation types
1. Standard (niversal) precations
Guidelines for Using Standard Precautions
1. Aear clean gloves when toching:
%lood, body flids, secretions, excretions, and items containing these body sbstances
8cos membranes
.onintact s$in
&. +erform handwashing immediately:
Ahen there is direct contact with blood, body flids, secretions, excretions, and contaminated
items
After removing gloves
%etween client contacts
*. +revent in3ries with sed needles, scalpels, and other sharp devices by:
.ever removing, recapping, bending, or brea$ing sed needles
.ever pointing the needle toward a body part
/sing a one6handed "scoop" method, special syringes with a retractable protective gard or
shield for enclosing a needle, or blnt6point needles
9. /se a private room or conslt with an infection control professional for the care of clients who
contaminate the environment, or who cannot or do not assist with appropriate hygiene or environmental
cleanliness measres.
a. sed for care of all clients
b. sed to prevent the spread of microorganisms
c. synthesi:e the ma3or featres of
1. niversal (blood and body flid) precations (designed to
redce the ris$ of transmission of bloodborne pathogens)
and
&. body sbstance isolation (designed to redce the ris$ of
transmission of pathogens from moist body sbstances)
d. apply to
1. blood
&. all body flids, secretions, and excretions, except seat,
regardless of whether or not they contain visible blood
*. nonintact s$in
9. mcos membranes
e. designed to redce the ris$ of transmission of microorganisms
from both recogni:ed and nrecogni:ed sorces of infection in
hospitals
1. Dloves
&. 8as$s
*. Downs
9. +rotective eyewear
;. 7ead coverings
-. Immni:ation: raises host resistance, defenses, and immnity
1. Ac2ired immnity
a. any form of immnity that is not innate
b. obtained dring life
c. natral or artificial
1. natrally ac2ired immnity is obtained by
1. the development of antibodies reslting from an
attac$ of infectios disease
&. the transmission of antibodies from the mother
throgh the placenta to the fets or to the infant
throgh the colostrm
&. artificially ac2ired immnity is obtained by
1. vaccination
&. in3ection of an antiserm, also called an immne
globlin sch as a hepatitis immne globlin, after
hepatitis exposre
d. thoght to be indced by passive or active (vaccine) means
1. passive immnity, a form of ac2ired immnity, reslts
from antibodies that are transmitted naturally throgh
1. the placenta to the fets
&. or the colostrm to an infant ,4
*. artificially by in3ection of antiserm (immne
globlin) for treatment of prophylaxis
&. passive immnity is not permanent and does not last as
long as active immnity
&. Active immnity: body prodces its own antibodies as a reaction to
exposre to an antigen
*. +assive immnity: prodced by in3ection of serm that contains
antibodies formed by another host
9. Immni:ations 6 for immni:ation tables please clic$ on the lin$s below
0. -isease reporting
Points to re!e!"er
Safety
Safety is the primary concern when caring for clients
Falls are the most fre2ent case of in3ry for elderly clients in acte care
!now the instittion"s plan for fire drills and evacation
!now the emergency phone nmber for reporting fire
!now locations of all fire alarms, exits, and extingishers
A4C0, 4AC0, or +4C 6 find ot which is the procedre sggested by yor instittion
5rn off all oxygen spplies in the area of the fire
In a fire, never se an elevator 6 se stairs
In a fire, close all doors and windows
In a power failre, only certain electrical otlets access the emergency generators. !now
which ones they are
!now yor agency"s policy for cleaning p a bioha:ardos spill
Safety devices, sch as restraints, are sed only as a last resort
/se the least restrictive immobili:ing device possible for the sitation
Poisons
.ever indce vomiting nless instrcted to do so by a poison center or health care
provider
If yo sspect someone has ta$en poison, ta$e the poisonos sbstance with yo to the
emergency room
Call the local poison control center to determine appropriate treatment for the specific
poison
#nfection
Infection control with the se of standard precations, transmission precations and
medical and srgical asepsis decreases the spread of infection
5he ma3or sites for nosocomial infections are rinary and respiratory tracts, blood, and
wonds
All nosocomial infections that occr in hospitals mst be trac$ed and recorded by ris$
management
5he single most effective way to prevent infection is hand washing
7andwashing is the most effective method of preventing infectionC friction is the most
important variable
Standard precations are sed for contact with all body flids except sweat
Standard precations are sed for all clients, and transmission precations are sed for
all clients with transmittable organisms
Special (.?;) respirator mas$s are necessary to care for clients nder airborne
precations who have tberclosis
+rotective (netropenic) isolation is sed for clients with immnosppression and low
white blood conts