PRESENTATION ON STANDARD

SAFETY MEASURES

Submitted To Submitted By
Mrs. Ragini V. Bhulaxmi
Faculty M. Sc (N) 2nd year
Govt college of nursing Govt college of nursing
Hyderabad Hyderabad
 STUDENT PROFILE

Name of the student teacher : V. Bhulaxmi

Course : M.Sc.(N) 2nd year

Subject : Nursing management

Topic : standard safety measures

Unit : 11th unit

Group : M.Sc. (N) 2nd year, classroom

Date : .03.2021

Time : 2pm to 4pm

Duration : 2 Hours.

AV Aids : Black Board, ppt,Charts, Flash

Cards.

Method of teaching : lecture cum discussion.

Supervised by : Mrs.Ragini
General objective:

By the end of the class the students/group will be able to gain in depth
knowledge regarding “standard safety measures”.

Specific objectives:

 Define standard safety measures

 Describe aseptic techniques
 Explain prevention of injuries
 Discuss the outpatient department
 Explain dietary services
 Discuss the termination of disinfection
 Explain the management of patient care Equipment’s
 Discuss the prevention and control of infections.
 STANDARD SAFETY MEASURES

PEOPLE

It is the people in hospitals rather than the physical environment which constitutes
the reservoir of infection. Nurses should follow hand washing techniques properly and they
should also guide other staffs, students to follow the procedure of hand washing which
includes social handwashing, followed by procedural hand wash. All the steps of hand
washing should be followed properly. Following the habit of procedural hand wash after
touching each child will helps to prevent cross infection. Always use liquid soap instead of
solid soap for hand washing

ASEPTIC TECHNIQUES

Strict adherence to aseptic techniques in various invasive procedures. Insertion and

removal of catheters, surgical tubings, drainage tubes and packs need strict no-touch
techniques even while they are done outside of operation theaters in nursing units.

SEGREGATION OF CONTAMINATED INSTRUMENTS

There must be a system for keeping the contaminated pieces of linen, sputum cups,
bedpans, urinals, and similar items separately to minimize chances of getting mixed up with
clean items. Isolation policy Availability of adequate number of trained nurses is crucial for
prevention of nosocomial infection. Isolation facilities for patients with communicable
diseases and those vulnerable to infection. Such facilities must be made available in ICU,
nurseries, burn unit, transplant unit, etc. Strict control on wearing of mask, gown and gloves
must be exercised while attending to such patients. All articles taken for patient use must be
treated appropriately.

MASKING AND GOWNING AND GLOWING

• Gloves should be worn especially while dealing with HIV infected patients..

• As for any surgical procedure lumbar puncture Gown and Glove should be worn by the
person who conducts the procedure.

• Gowns should be washed and Autoclaved daily.

DISINFECTION PRACTICES

Different kinds of disinfectants vary in their reaction to different kinds of

microorganisms. Phenolic compounds are active against gram-negative organisms.
Quaternery ammonium compounds against staphylococci, streptococci, and lodophores and
hypochlorites have a broad spectrum of action. Selection of appropriate disinfectant for
different purpose is important. The following should be checked.

 Appropriate choice

 Appropriate concentration

 Appropriate contact time

 Appropriate method of use

STERILIZATION PRACTICES

An efficient CSSD ensures supply of properly sterilized articles to all users in the
hospital. Each sterilisation must be monitored through the use of heat- sensitive tapes. All
steam and ethylene oxide sterilizers should be checked at least once each week with a
suitable live spore preparation by the laboratory. Instruments which come in contact with
mucous membranes but are disinfected rather than sterilized before use, such as endoscopes,
and anesthesia equipment may be bacteriologically sampled on a spot check basis to ensure
adequacy of disinfection.

PREVENTION OF INJURIES.

• After using the disposable needles, never recap them to potential risk of injury they should
be disposed off uncapped.

• Injection files and cotton swabs should be used for breaking ampoules.

• Scissors and blades should be handled with extreme care.

• Needles should never be left on the bed, table, chair, nurse‘s station etc.

• Heavy duty gloves should be used while handling and washing sharp instruments and glass
ware.
POST EXPOSURE PROTOCOL FOR NEEDLE STICK INJURY

• Don‘t panic.

• Don‘t squeeze the injured site

• Wash with soap and water immediately.

• Report to the casualty and provide proper history of exposure for immunization.

POST EXPOSURE PROTOCOL REGIMEN FOR HIV

(Basic regimen)

• Zidovudine [There is risk for79% of infection] (Expanded regimen) It goes for 28 days +
basic regimen Post exposure prophylaxis regimen for Hepatitis infection

• If vaccinated no problem.

• If not vaccinated previously take Immunoglobulin‘s immediately then take hepatitis

vaccine regimen for 6 months.

OUTPATIENT DEPARTMENT

In outpatient department separate arrangements for receiving and examining patients

suspected of having significant acute communicable condition should be made.

DIETARY SERVICE

Storage of food articles and appropriate temperatures in refrigerators and deep

freezers must be checked. Control of rodents and insects is a must to prevent contamination
of stored food and supplies Fruits and vegetables eaten raw must be thoroughly washed
before consumption.

HANDLING THE LABORATORY SPECIMENS

➢ The specimens should be collected in screw capped plastic disposable container without
soiling laboratory forms.

➢ Never pipette blood or other body fluid with your mouth. Handling the blood spills

➢ The spill should be covered with cotton, news paper or other absorbent material.
➢ Pour 1% of Hydro chlorate solution or bleach solution over the spill

➢ Wipe the spill soaked area after 20 minutes.

➢ Discard the soiled materials in a polythene lined waste bag(red bag)

➢ The soiled floor should be cleaned with the detergents.

HOUSEKEEPING ROUTINES

➢ Dry dusting and sweeping should be avoided; it is preferable to vacuum cleaner to suck
the dust from the floor, walls and equipments.

➢ Wet mopping of floors with soap and water containing 3% phenol should be carried out
at least thrice daily

➢ The waxing of surfaces and use of oil in water for mopping may limit dissemination of
microorganisms.

➢ The walls should be wiped or sprayed with 2% bacillocide once a week

➢ The sinks should be washed with 3% phenol or 5% Lysol at least once a day.

AIR HYGIENE IN OPERATION THEATERS

Clogging of air filters of the AC system renders the ventilation in operation theatres
and such other areas infective. Air filters should be frequently cleaned. Periodical smoke
studies should be carried out for air movement in operation theaters and checking that the
AC system is achieving the desirable number of air changes per hour.

TERMINATION DISINFECTION

Termination disinfection of isolation rooms must be carried out thoroughly on the

principle as operating rooms before permitting the room for reuse. At such times, the staff
must use the same precautions (cap, mask, gown, gloves) used for nursing in such isolation
rooms.
DEVELOPING A SENSE OF AWARENESS

Developing in all hospital workers a high sense of awareness, and training and
retraining in the precautionary measures, prevention and control.

➢ Prevention of occupational exposure

➢ Cover all the cuts and abrasions with water proof dressings.

➢ Use gloves when handling instruments or equipments.

➢ Do not recap needles after use

➢ Never manipulate any sharp that involves directing the point of the needle towards any
part of the body.

➢ Disposal sharps immediately.

➢ Refer to the needles stick injury guidelines.

➢ Health care workers with skin condition must seek the advice of occupational health

nurse. ➢ Advice junior staffs and students to inform to seniors to be reported for any sign of
occupational exposure.

MANAGEMENT OF PATIENT CARE EQUIPMENTS

➢ Don not re use single patients equipments to other patients.

➢ Patient care equipments should be decontaminated as per the decontamination policy.

➢ Wear protective clothing‘s when handling the contaminated articles.

➢ Do not use single use equipments again

➢ Patient related equipments such as pumps, Drip stands etc must be kept clean.

WASTE DISPOSAL

➢ Nurses should have thorough information and knowledge regarding Biomedical and
general waste management.
➢ There should be provision for foot operated bins adjacent to each baby unit for disposal
of used materials and soiled linens

➢ Plastic bags should be kept as hampers in the dust bins and they should be sealed before
their removal.

➢ The dust bin should be mopped with 3% of phenol every day.

➢ To have supervision over segregation of waste in appropriate color bags according to

CDC recommendations

➢ Knowledge and practice regarding transportation of waste should be essential.

EXAMPLE: POLICY GUIDELINES RELATED TO INFECTION CONTROL

RECOMMENDED STANDARDS

This set of standards, adapted mainly from ―Guidelines for Perinatal Care, 4th
Edition by the American Academy of Pediatrics and the American College of Obstetricians
and Gynecologists, focuses on the following areas:-

I. Physical Setup
II. Administrative arrangement
I. Physical Setup

(with additional reference to ―Recommended Standards for Newborn ICU Design by

The Committee to Establish Recommended Standards for Newborn ICU Design1

SPACE

1. Each infant care space in the Neonatal Intensive Care Unit shall preferably contain a
minimum of 11.2 square meters (120 square feet), excluding sinks and aisles

2. There shall be an aisle adjacent to each infant care space with a minimum width of 0.9
meters (3 feet).

3. Traffic to other services shall not pass through the unit

VENTILATION.

1. A minimum of 6 air changes per hour is required for the NICU, with a minimum of 2
changes being outside air.
2. The ventilation pattern shall inhibit particulate matter from moving freely in the space
and intake and exhaust vents shall be situated as to minimize drafts on or near the infant
beds.

3. Ventilation air delivered to the NICU shall be filtered with at least 90 % efficiency.

4. Fresh air intake shall be located at least 7.6 meters (25 feet) from exhaust outlets of
ventilating systems, combustion equipment stacks, medical/surgical vacuum systems,
plumbing vents, or areas that may collect vehicular exhausts or other noxious fumes.
[IB] SCRUB AREAS

1. In the NICU, there should be at least 1 hands-free handwashing sink for 4 beds.

2. In single bedroom, a hands-free handwashing sink shall be provided within each

infant care room. [II]

3. Hand washing facilities that can be used by children and people in wheelchairs shall
be available in the NICU

4. Sinks for hand washing should not be built into counters used for other purposes

5. Sink location, construction material and related hardware (paper towel, covered trash
receptacle, and soap dispensers) should be chosen with durability, ease of operation and
noise control in mind

6. Minimum dimensions for a hand washing sink are 61 cm wide X 41 cm front to back
X 25 cm deep (24 in. X 16 in. X 10 in.) From the bottom of the sink to the top of its rim;
so as to minimize splashing.

7. Pictorial hand washing instructions should be provided above all sinks.

8. Sinks should be designed so as to control splashing and avoid standing or5 retained
water.

9. Faucet aerators may be useful to reduce water splashing in sinks, but they are
notoriously susceptible to contamination with a variety of hydrophilic bacteria. They
should not be used.

10. Sinks should be scrubbed clean daily with a detergent.

AIR-BORNE ISOLATION ROOM(S)

1. Isolation rooms adequately designed to care for airborne infection should be available
in any hospital with an NICU. In most cases, this is ideally situated within the NICU;
but, in some circumstances, utilization of an isolation room elsewhere in the hospital
would be suitable.

2. An area for handwashing, gowning, and storage of clean and soiled materials shall be
provided near the entrance to the room

3. Isolation rooms should have a minimum of 13.94 sq metre (150 square feet) of clear
space, excluding the entry work area. Single and multibedded configurations are
appropriate based on use.

4. Ventilation systems for isolation room(s) shall be engineered to have negative air
pressure with air 100% exhausted to the outside. Air exhaust to outside the building do
not need to be filtered but the exhaust vent needs to be away from air-intake vents,
persons or animals.

5. A hands-free two-way emergency communication system is required within the

isolation room to connect to the outside.

6. Remote physiologic monitoring of an isolated infant should be considered.

7. Isolation rooms should have observation windows with blinds for privacy. Choice and
placement of blinds, windows, and other structural items should allow for ease of
operation and cleaning.

II. ADMINISTRATIVE ARRANGEMENT

Surveillance for Nosocomial Infection

1. With appropriate resources allocated from the hospital/ HAHO, the infection control
committee of each hospital should work with perinatal care personnel to establish
workable definitions of nosocomial infection for surveillance purposes, with particular
reference to the definitions/ guidelines set out by this Working Group.

2. The definition selected should be applied consistently to allow uniform reporting and
analysis of nosocomial infections
3. With appropriate resources from the Hospital/ HAHO, NICU personnel should
cooperate with hospital infection control personnel in conducting and reviewing the
results of surveillance programs for nosocomial infections in a confidential manner.

Prevention and Control of Infections Staff Health

1. Health care workers should be immune to rubella, measles and chicken pox

2. Yearly influenza vaccination is available

3. Ideally, individuals with a respiratory, cutaneous, mucocutaneous or gastrointestinal

infection should not have direct contact with neonates.

Handwashing

1. Medical and hospital personnel must follow careful hand-washing techniques to

minimize transmission of disease

2. Personnel should remove rings, watches, and bracelets before washing their hands and
entering the neonatal nursery.

3. Fingernails should be trimmed short and no false fingernails or nail polish should be
permitted.

4. Antiseptic preparations (e.g. chlorhexidine 4 %) should be used for scrubbing before

entering the nursery, before providing care for neonates, before performing invasive
procedures, and after providing care for neonates

5. Before handling neonates for the first time, personnel should scrub their hands and
arms to a point above the elbow thoroughly with an antiseptic soap. After vigorous
washing, the hands should be rinsed thoroughly and dried with paper towels.

6. A 10-second wash without a brush, but with soap and vigorous rubbing, followed by
thorough rinsing under a stream of water, is required before and after handling each
neonate and after touching objects or surfaces likely to be contaminated with virulent
microorganisms or hospital pathogens.

7. Handwashing is necessary even when gloves have been worn in direct contact with
the infant. Handwashing should immediately follow removal of gloves, before touching
another infant.
8. Alcohol-containing foams kill bacteria satisfactorily when applied to clean hands and
with sufficient contact (in accordance with manufacturers‘ recommendations). They can
be used in areas where no sinks are available or during emergency. [III] But they are not
sufficient in cleaning physically soiled hands, because transient organisms are not
removed.

SIBLING VISITS

1. Guidelines for visits should be established to maximize opportunities for visiting and
to minimize the risks of nosocomial spread of pathogens brought into the unit by these
young visitors.

2. No child with fever or symptoms of an acute illness, including an upper respiratory

tract infection, gastroenteritis, or dermatitis, should be allowed to visit. Siblings who
recently have been exposed to a known communicable disease and are susceptible
should not be allowed to visit. These interviews should be documented in the patient‘s
record, and approval for each sibling visit should be noted

3. Children should carefully wash their hands before patient contact

DRESS CODE

1. Dress codes should be established for regular and part-time personnel who enter the
neonatal unit

2. Sterile long-sleeved gowns to be worn by all personnel who have direct contact with
the sterile field during surgical and invasive procedures in the neonatal unit.

3. Gloves are to be worn when handling the neonate until blood and amniotic fluid have
been removed from the skin.

4. When a neonate is held outside the bassinet by nursing or other neonatal intensive
care unit personnel, a gown should be worn over the clothing and either discarded after
use or maintained for use exclusively in the care of that neonate. If one gown is used for
each neonate, the gowns should be changed regularly

5. Caps, masks and sterile gloves are to be used during surgical and invasive procedures.
GENERAL HOUSEKEEPING

1. Cleaning should be performed in the following order – patient areas, accessory areas
and then adjacent halls

2. In the cleaning procedure, dust should not be dispersed into the air.

3. Standard types of portable vacuum cleaners should not be used in the neonatal ICU or
SCBU because particulate matter and microbial contamination in the room may be
disturbed and distributed by the exhaust jet. Vacuum cleaners that discharge outside the
patient care area (ie, central vacuum cleaning systems or portable vacuums) should be
used so that only the cleaning wand, floor tool, and high-efficiency, particulate air
filtered vacuum hose are brought into the patient care area.

4. Once dust has been removed, scrubbing with a mop and a disinfectant/detergent
solution should be performed. Mop heads should be machine laundered and thoroughly
dried daily. 5. Cabinet counters, work surfaces, and similar horizontal areas should be
cleaned once a day and between patient use with a disinfectant/detergent and clean
cloths; as they may be subject to heavy contamination during routine use. Friction
cleaning is important to ensure physical removal of dirt and contaminating
microorganisms.

6. Surfaces that are contaminated by patient specimens or accidental spills should be

carefully cleaned and disinfected.

7. Walls, windows, storage shelves and similar non-critical surfaces should be scrubbed
periodically with a disinfectant/detergent solution as part of the general housekeeping
program.

8. Sinks should be scrubbed clean at least daily with a detergent

CLEANING & DISINFECTING PATIENT CARE EQUIPMENT

Incubators, Open Care Units & Bassinets

1. When the incubators, open care units or bassinets are being cleaned and disinfected,
all detachable parts should be removed and scrubbed meticulously
2. If the incubator has a fan, it should be cleaned and disinfected; the manufacturer‘s
instructions should be followed to avoid equipment damage.

3. The air filter should be maintained as recommended by the manufacturer.

4. Mattresses should be replaced when the surface covering is broken, because such a
break precludes effective disinfection or sterilization

5. Portholes and porthole cuffs and sleeves are easily contaminated, often heavily; cuffs
should be replaced on a regular schedule or cleaned and disinfected frequently with
freshly prepared mild soap or disinfectant solutions

6. Incubators not in use should be thoroughly dried by running the incubator hot without
water in the reservoir for 24 hours after disinfection

7. Infants who remain in the nursery for an extended period should be transferred
periodically to a different, disinfected unit so that the originally occupied unit can be
cleaned

NEONATAL LINEN – CLEAN AND SOILED CLEAN LINEN

1. Procedures for laundering, making up packs and delivering linen to the nursery should
be established by the medical, nursing, laundry and administrative staffs of the hospital

2. Each delivery of clean linen should contain sufficient linen for at least one 8- hour
shift 3. Linen should be cleaned and transported in covered carts or laundry bags to the
nursery areas

4. No new garments or linen should be used for neonates without prior laundering.

SOILED LINEN

1. An established procedure for the disposal of soiled linen should be strictly followed

2. Chutes for the transfer of soiled linen from patient care areas to the laundry are not
acceptable unless they are under negative air pressure.

3. Soiled linen should be discarded into bags that prevent leakage.

4. Sealed bags of reusable, soiled nursery linens should be taken to the laundry at least
twice each day.
5. Impervious bags of soiled diapers (reusable or disposable) and other linen should be
sealed and removed from the nursery at least every 8 hours.

6. All personnel should be aware that handling dirty diapers with bare hands can result in
heavy contamination and transient colonization of the hands with microorganisms that
cannot be easily eliminated with hand-washing and can be readily transmitted to the next
neonate for whom they provide care.

LAUNDERING:

1. The chemicals trichlorocarbanilide or sodium salt of pentachlorophenol should not be

used in hospital laundering because they may be harmful.

2. To avoid the hazards associated with the use of such chemicals or enzymes in the
hospital laundry, the physician in charge should be aware of all agents in use and should
be informed before any changes are made in laundry chemicals or procedures. Caution
should be exercised when new laundry or cleaning agents are introduced into the nursery
or when procedures are changed.

CATHETER-RELATED SEPSIS

1. Meticulous attention should be given to aseptic insertion and maintenance of the

cannula and to aseptic techniques of fluid administration.

2. All parenteral nutrition fluids should be mixed in the pharmacy, under a laminar flow
hood.

3. If bottles of lipid emulsions are kept in the neonatal unit refrigerator, care should be
taken to prevent contamination, as they are susceptible to contamination with a wide
variety of bacteria and fungi that can proliferate to high concentrations within hours.
Open bottles must be discarded no later than 24 hours after the seal has been broken.

4. Intravenous tubing, stopcocks, flush syringes should be changed.

Bibliography:

1. A text book of nursing management, Deepak. K published by JAYPEE

publications.

2. Google search of PubMed, slide share.

3. A textbook of “fundamentals of nursing” published by JAYPEE publications.

4. A text book of Medical surgical nursing “brunner and siddarth” published by

JAYPEE publications.