SAFETY AND INFECTION CONTROL 07/29/2021

EMERGENCY RESPONSE PLAN (INTERNAL) Squeeze

Sweep
STEPS:

 KNOW: AGENCY DISASTER PLAN (ADP)

 ACTIVATE: ADP
 ACTIVATE: PERSONNEL
 PRIORITIZE: PATIENTS

RESCUE/DISCHARGE/EVACUATION:

Ambulatory
Bedridden
Critically ill

GOAL: RESCUE as many as possible

Fire safety Electrical safety
EMERGENCY RESPONSE PLAN (EXTERNAL)  Turn off oxygen and  check electrical cords
appliances in the and outlets for
STEPS: vicinity of the fire exposed, frayed, or
 Know the telephone damaged wires
 KNOW: AGENCY DISASTER PLAN (ADP) number of fire  PRIO: Removing
 ACTIVATE: COMMAND CENTER department potentially hazardous
 ACTIVATE: PERSONNEL PER UNIT  Maintain respiratory equipment
 ALERT: OFF DUTY STAFF (CALL-IN) status manually with  In case of electrical
 IDENTIFY: POTENTIAL DISCHARGES an ambu bag for shock, turn off the
patients on life electricity before
ALL HOSPITALS: support, until the touching the client
client is moved away
COMMAND CENTER: from the threat of the
fire and can be placed
 Controlled by external agencies that responds back on life support.
to the external disaster (e.g. fire and rescue  Bedridden clients are
personnel, police, swat teams, FBI) moved from the scene
 Responsible for the major decisions regarding of a fire by stretcher,
safety of both clients and staff their bed or
wheelchair.
FIRE (INTERNAL)
FIRE (HOME SETTING)
All employees need to know what to do in the event
of a fire: Fire / Burns prevention
 Lint traps should be cleaned after each use
 Location of fire alarms  Space heaters need space at least 3 feet 0.91
 Locations of and how meters) away from anything that can burn,
including furniture, drapes, and rugs
IN CASE OF FIRE REMEMBER RACE  Home hot water should be set at a maximum
Rescue of 120 F (48.8c), especially when small
Alarm children, the elderly, or diabetics are in the
Contain home
Extinguish  Chimney should be professionally inspected
every year prior to use, & cleaned if necessary
PASS (fire extinguisher)  Cleaning supplies, table cloths, matches and
Pull lighters should be placed high away from
Aim
 SAFETY AND INFECTION CONTROL
child’s reach or stored in a cabinet with
childproof locks
 Never microwave a baby bottle. The formula
inside the bottle can become scalding hot in
the center.
 Fire extinguisher should be placed on each
level of the home, near an exit, but out of
reach of children
 Carbon monoxide smoke alarms should be
tested every month and repaired or replaced
immediately if malfunction occurs
 Carbon monoxide is an odorless gas that can
kill quickly
ELECTRICAL SAFETY
An electrical shock is always unpleasant, but it can be
lethal in the intensive care unit (ICU) or an operating
suite
 Gamma rays
 Alpha particles
 Non-ionizing radiation
 Ionizing radiation
*when patient is anxious patient is tagged RED in
triage
*when fire is outside patient’s room
Close doors
Activate
Contain
Extinguish
ERGONOMIC PRINCIPLES (PROPER BODY
MECHANICS)
General Lift / Transfer Technique
 Bend knees with feet placed apart, keeping
back and arms straight
 Move in a slow, controlled manner and avoid
quick, jerky movement
 Grasp object/patient firmly.
 Rotate by moving feet, do not twist back
 If working with other staff to complete
transfer, go in unison with “1,2,3, go”
 If carrying objects, distribute the weight
evenly in both arms
Proper body mechanics
 Place bed at correct height (waist level)
 Bend from the hips and knees (not the waist)
 Use a broad base of support with feet apart

07/29/2021
Transferring from bed to wheelchair
 Wheelchair should be placed on the side of
the bed where the equipment (IV pole) is
located
 Wheelchair needs to face the head of the bed
so the client can reach the chair with the
strong arm to help with the transfer
 If it is facing the foot of the bed, then the
client will have to use the weaker right hand
to grab hold of the wheelchair
 The client should grab the wheelchair arm
with the strong arm for stability
RADIATION SAFETY
For clients
 Mark the client’s
For HCW
 Apply shoe covers and protective gloves
before entering client’s room
 Wear gloves
 Maintain the greatest distance possible from
the client consistent with effective care
 Restrict care to a maximum of one hour
 Prepare meal trays outside the room
 Limit exposure time to 30 minutes per care
provider per shift
 Wear a dosimeter film badge to measure
radiation exposure
 Wear a lead shield to reduce the transmission
of radiation
 Do not allow a pregnant nurse to care for the
client
 Position items within client’s reach
 Schedule only one radioactive client to a
nurse at a time
 Ensure a long handled forceps and a lead
container are in the client’s room in case of
implant dislodgement
 Do not attempt to handle the dislodged
implant unless trained to do so
 Wear a film badge (dosimeter)
 Know your agency’s policy for cleaning up a
biohazardous spill
 Limit visitors to 30 minutes per day and advise
them to remain at least 6 feet from the source
of radiation
 Keep all bed linens and dressings ion the
client’s room until the implant is removed
SAFETY AND INFECTION CONTROL 07/29/2021

POISON CONTROL SAFETY RISK FACTOR: ACCIDENT PREVENTION

1. Call the local poison control center INFANT

 To determine appropriate FREUD: ORAL PHASE
treatment for the specific poison AVOID:
 Never induce vomiting unless  FOOD: grapes, hotdogs, nuts
instructed to do so  TOY: rounded, too small parts
2. Take the poisonous substance with you to Cause of death:
the emergency room #1 Motor Vehicular Accident
3. Unintentional (or accidental) poisoning is  3-6 months: peak of SIDS / crib death
one of the leading causes of death NI: X prone position
4. Do not induce vomiting  9 months : falls 9crawling)
 Corrosive alkalis (including oven NI: close supervision
cleaners, liquid drain cleaners)
 Disk batteries, various household TODDLER & PRESCHOOLERS
cleaners and dishwasher  Burns
detergents  Choking
Drug Antidote  Falls
Acetaminophen N-acetylcysteine  Playground/ street related activities
Anticholinergic Physostigmine salicylate  Poisoning
Arsenic, gold, lead, copper Chelation therapy w/
or mercury dimercaprol
ERIKSON: AUTONOMY VS. SHAME & DOUBT
Benzodiazepines Flumazenil
Beta blockers Glucagon
ACCIDENTS:
Calcium channel blockers Glucagon, calcium 1. MVA
chloride, calcium 2. FALLS
gluconate 3. DROWNING
Cholinergics Atropine, pralidoxime 4. BURNS
Cyanide Amyl nitrate, followed by 5. CHILD ABUSE
sodium nitrate, followed 6. ORAL INGESTION OF POISON
by sodium thiosulfate;
hyperbaric oxygen Toddler: poisoning
chamber ACETAMINOPHEN
Digitalis/digoxin Digoxin immune fab
Ethylene glycol Ethanol and fomepizole
BEST: Poison control center
Heparin Protamine sulfate
 Remove any obvious materials from the
Iron Deferoxamine
Magnesium sulfate Calcium gluconate
mouth, eyes or body area immediately
Methanol Ethanol and fomepizole  Identify the type and amount of substance
Organophosphate nerve Atropine ingested
agent  Never induce vomiting in an unconscious
Cholinergics Atropine, pralidoxime victim
Organophosphate or Atropine  Never induce vomiting
carbamate insecticide
poisoning PRE-SCHOOL 93-6 y/o) & SCHOOL AGES (6-12 y/o)
Opioids naloxone Accident: MVA
Snakes Antivenin (micrurus Cause: use of roller blades / skates
fulvius) crotalidae
polyvalent immune fab
Spiders Antivenin (micrurus
fulvius) crotalidae
polyvalent immune fab
Vasopressor extravasation Phentolamine mesylate
Warfarin Vitamin K
 SAFETY AND INFECTION CONTROL 07/29/2021

HAI AND CAI DOFFING

1. GLOVES
HOSPITAL ACQUIRED INFECTION 2. GOGGLES
3. GOWN
Common HAIs include: 4. MASK
 Central line-associated bloodstream infections
(CLABSI) Needle stick / pierce / cuts
 Catheter-associated urinary tract infections
(CAUTI) 1. Wash hands
 Ventilator-associated pneumonia 2. Report
 Surgical site infections 3. Assess (blood of the nurse and patient)
4. Prophylaxis
COMMUNITY ACQUIRED INFECTION
Medical and surgical asepsis
Common HAIs include:
 Influenza A sterile object will become contaminated under the
 Asymptomatic bacteriuria following circumstances
 Bacterial pneumonia  Sterile touching clean
 Antimicrobial-resistant infections becomes…contaminated
 Sterile touching contaminated
MEDICAL ASEPSIS becomes…contaminated
 Sterile touching “questionable”
 REEDUCES NO OF PATHOGENS is…contaminated
 Referred to as “clean technique”  A sterile object or sterile field that is not in
 Used in administration of: the range of vision is….contaminated
a. Medications  An object held below the waist
b. Enemas is…contaminated
c. Tube feeding  A sterile object that comes in contact with a
d. Daily hygiene wet, contaminated surface is…contaminated
 A sterile object becomes contaminated with
Surgical ASEPSIS prolonged exposure to air

 Eliminates all pathogen Standard based precaution

 Referred to as “sterile technique”
Standard precautions guidelines include:
Standard (universal) precautions
1. Wash hands with soap and water when visibly
 For care of all clients at all times dirty or contaminated
 For prevention of the spread of infection 2. Wash hands or use as antiseptic hand rub
 Use of personal protective equipment (PPE)  Immediately when there is direct
 Hand washing: before and after patient contact with blood, body fluids,
contact secretions, excretions or
contaminated items
DONNING VS DOFFING  After contact with a person’s intact
skin, such as when taking a pulse or
DONNING blood pressure, or moving or
1. GOWN repositioning a client
2. MASK  After contact with inanimate objects,
3. GOGGLES including medical equipment, the
4. GLOVES immediate vicinity of the client
 After removing gloves
 Between client contact
3. Wear gloves before toucjing anything wet or
before perfoming invasive procedures
SAFETY AND INFECTION CONTROL 07/29/2021

TRANSMISSION-BASED PRECAUTIONS: Clostridium difficile assoc. diarrhea (CDAD)

AIRBORNE Respiratory syncytial virus
Impetigo / influenza
Particles: Bronchiolitis
 <5 microns MRSA
Room: VRSA / VRE / varicella zoster
 Private Hepatitis BCDG (consonants / herpes simplex
Cohort: Others (skin infection: cutaneous diphtheria,
 Same causative agent pediculosis, scabies
Protection:
 N95 particulate respirator / HEPA filter TRANSMISSION-BASED PRECAUTIONS: ENTERIC
mask
Particles:
Measles (rubeola)  Fecal-oral
Tuberculosis Room:
Varicella (chicken pox)  Private with own handwashing facility
Herpes zoster (shingles/ disseminated var zoster) Cohort:
Severe acute respiratory syndrome (SARS)  Same causative agent
Protection:
TRANSMISSION-BASED PRECAUTIONS: DROPLET  GG (gloves, gown)

Particles: Salmonella
 >5 micorns Shigella
Room: Rotavirus
 private Rotavirus
Cohort: Norwalk virus
 same causative agent Hepa A, E
Protection: Cryptosporidium muris
 surgical mask
Distance: DRUG RESISTANCE DISEASES
 3 ft away (36 inches)
ABC’s of MRSA
Diphteria  Avoid monotype use of antibiotic
Rubella  Bodily secretions must be properly
Oral pharyngitis handled
Pertussis / pneumonia  Contact precaution
Erythema infectiosum / epiglottitis  Drug of choice: vancomycin
Tonsillitis  Equipment will be used solely by patient
Influenza, swine flu  Fingernails must be kept short
Scarlet fever / sepsis  Gloves, gown, goggles / face shield
Meningitis / mumps  Handwashing
 Isolation precaution: private room
TRANSMISSION-BASED PRECAUTIONS: CONTACT (cohort: same microorganisms)

Particles: NEUTROPENIC PRECAUTIONS

 bodily secretions
Room: 1. Handwashing
 private with own PPE 2. Isolation: reverse isolation, private room,
Cohort: cohort with non-infectious
 Same causative agent 3. No fresh flowers
Protection: 4. Change water in containers every shift
 GG (gowns, gloves) 5. Low microbial diet
Distance: 6. Maintain skin integrity: avoid injections,
 3 ft away (36 inches) rectal temp, enemas, suppositories
 SAFETY AND INFECTION CONTROL 07/29/2021

7. Provider total body oral hygiene  PRECAUTION: STANDARD

8. Inspect IV site. Monitor for s/sx of
infection

NEUTROPENIC PRECAUTIONS

Vector
 Mosquito
Causative agent:
 Flaviviridae virus
Signs and symptoms:
 fever
 body aches
 neck stiffness
Complications:
CNS complications PLAGUE
 Paralysis BUBONIC
 Seizures  Flu-like symptoms
 Coma  Swollen lymph nodes
Septicaemic
BIOTERORISM  “black plaghue
 Flu-like symptoms
 A biological attack or bioterrorism  Abdominal pain
 Intentional release of viruses, bacteria, or  Tissue bleeding
other germs that can sicken or kill people, Pneumonic plague
livestock, or crops  Pneumonia-like symptoms
 Biological agents can be spread through the  Flu-like symptoms
air, water or in food  Chest pain
 PRIORITY: COMMUNITY SAFETY  Shortness of breath

Botulism: neurotoxin Standard and droplet precaution

 Standard precaution
 Foodborne
 Usually from canned goods SMALL POX
 Hypotonia (decreased muscle tone) Small pox Chickenpox
Distribution of Centrifugal More covered
Anthrax pox presentation parts of the
Zoonotic infection (spores): Face body, trunk
 Person handles infected animals or Arms
contaminated animal products like wool, Legs
hides, or hair (slaughterhouses, wool mills) Stages of pox All at the same Various stages
 Starts primarily in their lymph nodes in the development stage of of
chest before spreading throughout the rest of development development
the body, ultimately causing severe breathing Unique Pox found on Uncommon to
problems and shock presentation palms and find pox on
 Affects skin and tissue around the site of soles of feet palms and
infection, most common on the head, neck, soles of feet
forearms and hands
 Affect upper GI tract Precaution: standard + airborne + contact
 Identified in heroin-injecting drug users in
northern Europe, infection deep under the
skin or in the muscle
 Flu-like symptoms
 SAFETY AND INFECTION CONTROL 07/29/2021

INCIDENT REPORTS
1. Situations that require completion of an
incident report
2. Accidental omission of a prescribed therapy

General guidelines
 Date, time, and exact location of occurrence
 Names of persons involved in the incident and
any witnesses
 Direct quotes from the persons involved in
the incident
 Objective information describing the incident
 Who was notified about the error
 Orders received
 If indicated, corrective actions taken

TRIAGE AND MASS CASUALTIES

Community setting
Victims are categorized based on the severity of the
injury, the urgency of needed treatment and an
available place for treatment:

Treated first
 Individuals who have life-threatening injuries
that are readily correctable

Treated last
 Individuals who have no injuries (noncritical
injuries) who are ambulatory

Healthcare setting
Triage in the emergency department usually
involves dividing those who need care into one of
the following three categories:
Emergent
 Individuals who have life threatening injuries
and need immediate attention are given the
highest priority
Urgent
 individuals with non life-threatening injuries
nonurgent
 individuals with no immediate complictions
and who can wait for treatmwent

green – 6-12 hrs

yellow 4-6 hrs
red immediately
black no priority