SAFE and QUALITY

NURSING CARE
A. Medical and Surgical Asepsis
Asepsis- is the state of being free from the
disease-causing contaminants (such as
bacteria, virus fungi and parasites or
preventing contact with microorganisms.
2 TYPES OF ASEPSIS

MEDICAL ASEPSIS

SURGICAL ASEPSIS
Medical Asepsis (clean technique)- includes
procedures used to reduce the number of
microorganisms and prevent their spread
through facility practices. It includes hand
washing, bathing, cleaning environment,
wearing mask & gown disinfecting and use
of antiseptics.
Surgical Asepsis (sterile technique)- defined as
the complete removal of microorganisms and
their spores from the surface of an object. It is
also a practice that keeps an area or objects
free from microorganisms non-pathogenic and
pathogenic including viruses. The practice starts
with cleaning the objects using principles of
medical asepsis followed by sterilization process.
Use of Restraints/ Safety Devices
• A "restraint" is defined as any physical or chemical means or
device that restricts client's freedom to and ability to move
about and cannot be easily removed or eliminated by the
client.
• A "physical restraint" is defined as "any manual method or
physical or mechanical device, material, or equipment
attached to or adjacent to the resident's body that the
individual cannot remove easily which restricts freedom of
movement or normal access to one's body", according to the
Centers for Medicare and Medicaid Services.
• A "chemical restraint" is defined as "any drug used for discipline
or convenience and not required to treat medical symptoms",
according to the Centers for Medicare and Medicaid Services.

• A "safety device", also referred to as a protective device, is defined

as a device that is customarily used for a particular treatment.
Safety devices are not considered a restraint, even though they
limit freedom of movement, because they are a device that is
customarily and traditionally used for a particular treatment. An
intravenous arm board that is used to stabilize an intravenous
line is an example of a safety device which is not considered a
restraint.
Alternative Preventive Measures
Some of the preventive, alternative measures that can decrease the
need for restraints to prevent a fall include:
• Accurate client assessment for the risk of falls
• The immediate initiation of special falls risk interventions when a client is
assessed as "at risk" for falls
• More frequent monitoring
• Providing frequent reminders to the client to call for help before arising
from the bed or chair
• Using bed and chair alarms
• Using a companion, sitter, etc.
• Reorienting the person
• Placing the client near an activity hub such as the nursing station so
that the falls risk client gets more monitoring and observation
Some of the preventive, alternative measures that can
decrease the need for restraints in order to prevent the
dislodgment of medical tubes, lines and catheters include:
• Discontinuing or changing the treatment as soon as medically
possible
• More frequent monitoring
• Using a companion, sitter, etc.
• Distraction
• Providing constant reminders about the importance of not
touching the tube, line or catheter
• Keeping the tube, line or catheter out of view
• Reorienting the person
Some of the preventive, alternative measures that can
decrease the need for restraints in order to prevent violent
behaviors that place self and/or others at risk for imminent harm
include:
• Behavior management techniques
• Behavior modification techniques
• Keeping the client away from triggers
• Stress management and relaxation techniques
• Positive and negative reinforcements
Restraint Orders
• A complete doctor's order is needed to initiate the use of
restraints except under extreme emergency situations when a
registered nurse can initiate the emergency use of restraints
using an established protocol until the doctor's order is
obtained and/or the dangerous behaviors no longer exist.
Restraints without a valid and complete order are considered
false imprisonment.
• The minimal components of orders for restraint include the
reason for and rationale for the use of the restraint, the type of
restraint to be used, how long the restraint can be used, the
client behaviors that necessitated the use of the restraints, and
any special instructions beyond and above those required by
the facility's policies and procedure.
Monitoring and Evaluating Client Response to Restraints and Safety
Devices
• When the registered nurse monitors and evaluates the client's
responses to the restraints or safety device, the nurse will assess and
evaluate the client and their:
• Mental Status. Is the person afraid or fearful? Is the person
confused? Is the patient or resident angry, upset or agitated?
• Physical Status. Is the person safely restrained and safe from
strangulation from a vest restraint, for example? Are the client's
respiratory and circulatory systems normal? Is the person clean,
comfortable, and dry? Is the skin showing any signs of irritation or
breakdown?
• Response to the Restraint. Has the person improved to the point
where they may no longer need of the restraint?
HOME SAFETY
• Home safety refers to the awareness and education of
risks and potential dangers in and around a home
which may cause bodily harm, injury, or even death to
those residing in and around the physical structure of a
home. It includes mitigating or preventing the
unwanted dangers through testing, research and
accepted standards of applications and practices.
 Most common risks at home

What are the top home hazards?

• Falls
• Poisoning
• Fires/burns
• Choking and suffocation
• Drowning/submersion
 Home safety practices
A. Slip and trip- falling accidents at home are very common and
can cause serious and life-threatening injuries, so prevention of slip
and trip accidents is essential in the good design of living quarters.
*Pay special attention to staircases. Make sure that they have
handrails, are well lighted, do not have any loose carpeting, and
are always clear of toys and other items.
*Make your shower safe: use non-slip rubber mats and install extra
rails or grab bars if necessary. Also, make sure that the existing
rails and other supports are in good condition and can support your
weight.
B. Poisoning- While we mostly think of poisoning as something
that happens to children when they get into cleaning supplies and
other household products, it’s something that actually affects
people of all ages.
*Place your chemicals high up on shelves rather than down low
under kitchen and bathroom sinks where people commonly put
them. If possible, store them out in a garden shed outside of the
house.
*Never put household cleaners in old drink bottles or food
containers that might confuse a child.
*Get children and pets out of a room before you use pesticides or
other chemicals.
*Always close the packaging on a medication or chemical if you
are interrupted by the phone or the doorbell. Many poisonings
happen when an adult leaves the room for a minute
C. Fires and Burn
• Keep a fire extinguisher in your kitchen.
• Keep clothes irons and curling irons out of reach of children and
don’t balance them precariously on counters or ironing boards.
Teach children that irons and curling irons can remain hot even after
they have been unplugged.
• Keep space heaters at least three feet away from flammable things
like curtains and clothing.
• Keep candles and other open flames out of reach of children.
D. * Suffocation:
• Don’t place an infant facedown on a soft surface like a waterbed,
comforter, or pillow or on a mattress that is covered in plastic.
• Keep your infant’s crib free of soft items like blankets, pillows,
bumpers, and stuffed animals.
* Choking
• Regularly, get down on your hands and knees to inspect play
areas for small choking hazards that are within grabbing range
like pieces of toys, coins, balloons, balls, batteries, jewelry, etc..
Also check in couch cushions.
• Frequently check toys for loose or broken parts.
E. Drowning
• Never leave a baby alone in a bathtub for any amount of time.
Also never leave young children alone in a tub.
• Keep your toilet lid down and keep young children out of the
bathroom unsupervised.
Household Toxins
In addition to the top five household hazards, there are potentially
many toxic compounds hiding in your home. These harmful chemicals
are literally everywhere and you may not realize that they are making
you sick.
• While it is not possible to rid your home of all toxins, you can prevent
short and long term health problems by minimizing their existence.
• Here are six toxins to look out for:
1) Asbestos
• What it is: A natural, fibrous material found in housing insulation,
drywall, and toys that has been known to cause cancer.
• What you can do about it: If your house was built before 1980, it’s likely
that asbestos was used in the construction. Go online to familiarize
yourself with popular asbestos products like insulation, floor tiles, and
textured ceiling tiles. If you do find asbestos, find a professional to
safely remove it.
2.) Carbon Monoxide
• What it is: An odorless, colorless, and flammable gas that is poisonous
to humans and pets and can build up due to a faulty stove, furnace, or
chimney. According to the EPA, low levels can cause headaches,
dizziness, disorientation, nausea, and fatigue. Higher levels can cause
impaired vision, headaches, vomiting, and even death.
• What you can do about it: Install carbon monoxide alarms throughout
your home, make sure that all fuel burning appliances are properly
installed and well ventilated, and never let your car idle in the garage.
3.) Mold
• What it is: Mold spores can easily grow within 24-48 hours when there’s
moisture. It can live on dust, wood, drywall, paint, paper, cotton, or oil.
Mold spores can trigger asthma symptoms and allergic reactions.
• What you can do about it: Keep rooms well ventilated and if necessary,
use a dehumidifier to keep humidity prone rooms below 50%
4.) Radon
• What it is: A cancer causing radioactive gas, which comes from uranium
that is naturally found in soil. One out of fifteen homes have high levels of
the gas.
• What you can do about it: Purchase a kit to test for its existence, but leave
the cleanup to professionals.
5.)Bisphenol A (BPA)
• What it is: A chemical used in plastic production that can often be found
in water bottles, baby bottles, plastic wraps, and food packaging—
especially the liners of canned foods. There is some concern about its
effects on the brains of fetuses and children.
• What you can do about it: Look for BPA free labeling and switch to glass
when possible.
Home safety is a huge part of home ownership. You owe it to yourself and
the people who live in and visit your home to take the responsibility seriously
and handle hazards before they come up.
Handling Hazardous and Infectious Materials
• Hazardous materials are defined as those things that
are not biological but still remain hazardous to human
beings including patients and staff. Examples of
hazardous materials are chemicals and radiation.
• Biohazardous waste is defined as biological waste
that can be hazardous to humans. Items such as
sharps and bed linens that are contaminated with
blood or other bodily fluids, such as feces, are
considered biohazardous medical waste.
Biohazardous Materials
• Biohazardous materials are heavily regulated at the national, state and
local levels. All health care facilities, therefore, are legally mandated to
have complete and appropriate policies and procedures relating to the
labelling, storage, use and disposal of biohazardous, or biomedical,
materials.
• Biohazardous materials place clients, staff and visitors at risk for
exposures to bloodborne pathogens and pathogens transmitted with
bodily fluids.
Flammable and Combustible Materials
• Examples of some of the flammable and combustible materials that are
commonly used within health care settings and facilities are medical
gases, such as oxygen and nitrous oxide, flammable and combustible
liquids such as those contained in some cleaning fluids and aerosol cans.
 Following Procedures for Handling
Biohazardous Materials

Biohazardous materials threats can be decreased and

eliminated with a combination of administrative controls,
work related controls and engineering controls.
Some of the other preventive measures relating to
biohazardous exposures include:

• The use of single patient disposal supplies and equipment

such as a disposable, single use blood pressure cuffs
• Proper handwashing
• Standard and special transmission precautions
• Red biohazardous waste containers and bags
• The safe disposal of sharps not only in health care facilities
but also in the client's home and their community
Safe Use of Equipment
• Equipment safety and the safe use of equipment is
dependent upon both user safety and equipment
safety.
• Equipment safety and the safe use of equipment is
dependent upon both user safety and equipment
safety.
• User safety can be insured when all users of equipment,
including nurses, are instructed on proper use and all
pieces of equipment and then they are then deemed
and validated as competent to correctly and safely
use a piece of equipment PRIOR to using it without
direct supervision and guidance.
• User safety is also insured when the health care provider
asks for the assistance of another and their reinstruction
when they believe that they are not competent to use a
specific piece of equipment as well as when they inspect
the equipment prior to using it with a patient. Some of the
safety inspection components include the inspection of the
piece of equipment for frayed cords, malfunctioning,
missing and/or loose parts, and documented evidence of
preventive maintenance and safety inspections by those
who perform these tasks.
• All equipment that is even possibly unsafe or questionably
safe must be immediately taken out of service and sent to
the department that is responsible for insuring its safety.
• All health care facilities have established protocols
and procedures for the safe use of equipment which
include staff education, competency validation,
preventive maintenance, and safety inspections.

• Most health care facilities prohibit the patient's use of

their own equipment like a radio, television or electric
razor; others permit it but only after it has been
inspected and deemed safe by personnel who have
the knowledge and skills to do so. These personnel do
not include nurses. This inspection is typically done by
the maintenance or equipment department.
Teaching the Client About the Safe Use
of Equipment Needed for Health Care
• Clients, in addition to staff, must be educated about the
safe use of equipment, particularly when they are
performing self-care in the home using medical
equipment.
• Safe and effective equipment such as electrical oxygen
supplementation therapy and continuous passive motion
devices, in addition to nonelectrical equipment such as
walkers, canes and other mobility aids, must be safe and
deemed safe prior to use.
• The rubber tips on a walker, cane and crutches should be
inspected often. All tips that are uneven or worn out must
be replaced immediately; preventive maintenance is
done by replacing all tips at least one a month even when
they are not worn out.
Facilitating the Appropriate and Safe
Use of Equipment
• The appropriate and safe use of equipment
can be facilitated with:
• The complete education and training of all
users
• Validated and documented competency to
use any and all pieces of equipment by a
person qualified to do so
• Preventive maintenance
• The removal of all unsafe equipment from
service
Removing Malfunctioning Equipment from the
Client Care Area and Reporting the Problem to
the Appropriate Personnel
• As stated immediately above, unsafe items must be
immediately removed from the client care area
and then reported and returned to the
department, such as the biomedical department,
that ensures equipment safety. It is also
recommended that items that are questionably
safe also removed and returned so that those who
are more knowledgeable than the nurse can
inspect them and validate their safety.
10 Golden Rules
1. Right Patient
2. Right Drug
3. Right Time
4. Right Dose
5. Right Route
6. Right Patient Education ( About the Drug)
7. Right Patient Drug History
8. Right (known) Drug Allergies
9. Right Drug (to drug) Interaction
10. R ight Documentation