SAFETY ,INFECTION CONTROL AND

HYGIENE
• Safe care is a basic need of all clients,
regardless of the setting.
• Registered nurses (RNs) are responsible for
providing the client with a safe environment
through the delivery of professional, quality
nursing care that incorporates safety
precautions, infection control practices, and
hygiene assistance.
• Client safety is defined as ‘‘freedom from
accidental injury’’ and error as a ‘‘failure of a
planned action to be completed as intended
or the use of a wrong plan to achieve an aim’’
• (Kohn, Corrigan, & Donaldson, 1999, pp. 13–
14).
• In 2003, the Joint Commission established the
.
first National Patient Safety Goals (NPSGs) to
promote specific improvements in client
safety. Based on the data collected annually,
the Joint Commission publishes and revises the
NPSGs as evidence-based recommendations.
The 2009 NPSGs are to:
• Identify clients correctly
• .
Improve staff communications
• Use medicines safely
• Prevent infection
• Check client medicines
• Prevent clients from falling
• Help clients to be involved in their care
• Identify client safety risks
• Watch clients closely for changes in their health
and respond quickly if they need help
• Prevent errors in surgery
.
• This client’s risk of falls has been assessed and
responded to through .the measures shown
here. Do all clients within the hospital setting
need to be assessed for the risk of falls,
regardless of their health status or reason for
hospitalization
• To improve the quality of care during a
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hospital stay, the Centers for Medicare and
Medicaid Services (CMS) identified certain
hospital-acquired conditions (HACs) that are
deemed reasonably preventable by following
evidence based guidelines and are either
costly or common. The HACs are called ‘‘never
events’’ because they are events that should
never happen in a hospital.
The HACs include:
.
• Foreign object (e.g., sponge or needle)
inadvertently left in clients after surgery
• Air embolism
• Transfusion with the wrong type of blood
• Severe pressure ulcers
• Falls and trauma
• Catheter-associated urinary tract infection
• Vascular catheter–associated
. infection
• Manifestations of poor control of blood sugar
levels
• Surgical site infection following coronary artery
bypass graft
• Surgical site infection following certain orthopedic
procedures
• Surgical site infection following bariatric surgery
for obesity
• Deep vein thrombosis and pulmonary embolism
following certain orthopedic procedures
 FACTORS AFFECTING SAFETY
• Client safety is influenced by several factors
such as age, lifestyle, sensory and perceptual
alterations, mobility, emotional state, and
staffing.
 AGE
• As infants mature, their potential for injury
increases. Infants, toddlers, and preschoolers
are explorers of their environment.Most
accidents involving these age groups are
avoidable with careful adult supervision to
prevent falls from bed, burns, electrical
hazards, choking on small objects, and
drowning.
 Lifestyle
• Lifestyle practices can increase a person’s risk
for injury and potential for disease. Individuals
who operate machinery; experience stress,
anxiety, and fatigue; use alcohol and drugs
(prescription and nonprescription); and live in
high-crime neighborhoods are at risk for
injury. Risk-taking activities, driving vehicles at
high speeds, and smoking are factors
associated with accidents
.
Sensory and Perceptual Alterations
Sensory functions are essential for the accurate
perception of environmental safety. If one of the
senses is altered, then the other senses
compensate to facilitate perception of the
environment. For instance, a blind person usually
will develop a keen sense of touch and hearing.
Clients who have visual, hearing, taste, smell,
communication, or touch perception
impairments are at increased risk for injury.
These clients are often not able to perceive a
potential danger.
 Mobility
• Clients who have impaired mobility are at
increased risk for injury, especially falls.
Mobility impairments may be a result of poor
balance or coordination, muscle weakness, or
paralysis
 Emotional State
• Emotional states such as depression and
anger affect a client’s perception of
environmental hazards and degree of risk-
taking behavior. These emotional states alter
a client’s thinking patterns and reaction time.
Usual safety precautions may be forgotten
during periods of emotional stress
 TYPES OF ACCIDENTS
• In the health care setting, accidents are
categorized by their causative agent: client
behaviors, therapeutic procedures, or
equipment:
1.Client behavior accidents occur when the client’s
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behavior or actions precipitate the incident, for
example,
poisonings, burns, and self-inflicted cuts and
bruises.
2. Therapeutic procedure accidents occur during
the delivery of medical or nursing interventions,
for example, medication errors, client falls
during transfers, contamination of sterile
instruments or wounds, and improper
performance of nursing activities.
3. Equipment accidents result from the
malfunction or improper use of medical
equipment, for example, electrocution and fire.
• National and institutional
. policies establish
safety standards; for example, the risk for
equipment accidents can be reduced by
having the biomedical engineering
department check the equipment inspection
label prior to use. All accidents and incident
reports must be fully documented according
to institutional protocol
POTENTIAL OCCUPATIONAL HAZARDS
• Nurses and other health care providers are at
risk for injury in the workplace.
• Numerous hazards exist in today’s workplace,
such as latex allergies, bloodborne pathogens,
work-related musculoskeletal disorders
(MSDs), chemotherapeutic agents,
environmental pollution, and violence.
 INFECTION CONTROL
• Client safety in the health care environment
requires the reduction of microorganism
transmission. Infection control practices are
directed at controlling or eliminating sources
of infection in the health care agency or
home.
• Nurses are responsible for protecting clients
and themselves by using . infection control
practices. Nurses and clients must be educated
about the types of infections, modes of
transmission, risks for susceptibility, and
infection control practices required to control
or prevent further transmission.
 PATHOGENS and INFECTION
• Pathogenicity is the ability of a microorganism
to produce disease.
• Microorganisms that cause diseases in
humans are called pathogens. Five types of
microorganisms can be pathogenic: bacteria,
viruses, fungi, protozoa, and Rickettsia.
Virulence is the degree of pathogenicity of an
infectious microorganism
• Infection is an invasion and a multiplication
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of microorganisms in body tissue that result
in cellular injury. These microorganisms are
called infectious agents.
• Infectious agents that are capable of being
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transmitted to a client by direct or indirect
contact through a vehicle (or vector) or
airborne route are also called communicable
agents. Diseases produced by these agents are
referred to as communicable diseases
• Colonization is the multiplication of
.
microorganisms on or within a host that does
not result in cellular injury. However,
microorganisms that are colonized on a host
may be a potential source of infection,
especially if host susceptibility declines or if the
microorganism’s virulence increases.
• Some microorganisms .reside on the human
body as normal flora. This is synonymous with
colonization. Floras are microorganisms on the
human body.
• Resident floras are microorganisms that are
always present, usually without altering the
client’s health.
• Transient floras are microorganisms that are
.
episodic. They attach to the skin for a brief
period of time but do not continually live on
the skin.
 STAGES OF THE INFECTIOUS
PROCESS
There are two types of infectious responses:
1. Localized infections are limited to a defined
area or single organ with symptoms that
resemble inflammation(redness, tenderness,
and swelling).
2. Systemic infections affect the entire body and
involve multiple organs.
Localized or systemic infections progress through
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four stages of infection:
• Incubation
• Prodromal
• Illness
• Convalescence
• The incubation period is the time interval
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between entry of an infectious agent in the
host and the onset of symptoms. During this
time period, the infectious agent invades the
tissue and begins to multiply to produce an
infection.
• The prodromal stage is the time interval from
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the onset of nonspecific symptoms until
specific symptoms of the infectious process
begin to manifest. During this period, the
infectious agent continues to invade and
multiply in the host. A client may also be
infectious to other persons in this time period.
• The illness stage is when the client is
.
manifesting specific symptoms of an infectious
process.
• The period of time from . the beginning of the
disappearance of acute symptoms until the
client returns to the previous state of health is
referred to as the convalescent stage.
 CHAIN OF INFECTION
• The chain of infection describes the
phenomenon of developing an infectious
process. There must be an interactive process
that involves the agent, host, and
environment.
• Agent of the disease .
– This is a living organism that causes the disease
• The host
– This is the living organism (e.g. a person) that
develops the disease
• The environment .
– This consists of the various elements (i.e.
components) surrounding a person.
– The components of the general environment in
which a person lives include:
• Environmental factors that affect the chain of
infection are water, food, plants, animals,
housing conditions, noise, meteorological
conditions, and environnemental chemicals.
 
 Modes of Transmission
• The mode of transmission is the process that
bridges the gap between the portal of exit of
the biological agent from the reservoir or
source and the portal of entry of the
susceptible ‘‘new’’ host.
 SOURCE OF INFECTION
• The source of an infection can be an infected
person, animal, soil or object from where the
infectious agent comes from to the host.
People and animals may have clinical diseases,
subclinical infection or be carriers (e.g. those
treated of disease but remain with some
infection like in typhoid). Source also includes
reservoirs of infection.
 Transmission route

• This is the way the infectious agent is

transferred from source (i.e. person or
another organism or object (e.g. soil)) to the
susceptible host (e.g. person). 
• The main routes of transmission of
communicable diseases are:
 .
• Direct contact (skin, mucous membrane or
sexual) e.g. syphilis, gonorrhoea, ring worms
• Vector e.g. yellow fever, malaria
• Faecal contamination of soil, food and water
which are ingested. It is also called faecal-oral
route. e.g. cholera, typhoid, hepatitis.
• Contact with animals and their products e.g.
Anthrax, Tetanus.
.
• Air (inhalation) e.g. Tuberculosis, measles,
Anthrax
• Trans placental (during pregnancy) e.g.
Toxoplasmosis, syphilis
• Blood contact (injection, surgery, blood
transfusion)e.g. malaria, HIV,
 Susceptible host

• A susceptible host is an individual who has low

resistance to the particular infection.
• Low resistance may be due to the fact that:
• The person has not been infected before by
the infectious agent, and therefore does not
have any immunity to it
• The person has another. serious illness (e.g.
AIDS) at the same time; whereby such people
have a high risk of developing other disease
like Tuberculosis.
.The body is malnourished or undernourished
thereby making the infections worse
 Breaking the Chain of Infection
• Nurses focus on breaking the chain of
infection by applying proper infection control
practices to interrupt the mode of
transmission. The chain of infection can also
be broken by interrupting or blocking the
agent, portal of exit, or portal of entry or by
destroying the agent or decreasing the host’s
susceptibility.
• Therefore control of communicable disease
.
can be achieved as follows:
– Attacking the source
– Interrupting the route of transmission
– Protecting the host
Attacking the source Interrupting Protecting the host
transmission

Treatment Environmental sanitation Immunisation

Isolation/quarantine Personal hygiene and Chemoprophylaxis
Reservoir control behaviour change Personal protection
Notification Vector control Better nutrition
Screening & Surveillance Disinfection and
sterilization
 HYGIENE
Hygiene is the science of health. Hygienic care
promotes cleanliness, provides for comfort
and relaxation, improves self-image, and
promotes healthy skin. Client hygiene is an
extension of providing client safety and
protecting the client’s defense mechanisms.
The health of the body’s first line of defense
.
(skin and mucous membranes) is promoted by
client hygiene. Nurses are responsible for
ensuring that the client’s hygienic needs are
met. The type of hygienic care provided
depends on the client’s ability, needs, and
practices.
 FACTORS INFLUENCING HYGIENIC
PRACTICE
• Hygienic needs and practices are unique to
each client; nurses should provide
individualized care based on these needs and
practices. Hygienic practices are influenced by
several factors, including body image, social
and cultural practices, personal preferences,
socioeconomic status, and knowledge.
 Body image
• Body image is the client’s subjective belief
about his or her own physical appearance.
Body image is associated with the client’s
emotions, mood, attitude, and values.
• During this time, the nurse should help the
client maintain hygienic practices in
accordance with the client’s pre-illness level
of hygiene and personal preferences.
 Social and Cultural Practices
• In North America, people typically bathe daily
and use numerous deodorant products. In
Europe, people do not bathe daily and seldom
use deodorant products. Europeans do not
consider the smell of human perspiration as
offensive as do North Americans. Nurses
should have a nonjudgmental attitude when
assessing or providing hygienic care to clients
from different social or cultural backgrounds.
 Personal Preferences
• Some clients prefer to bathe in the morning to
facilitate waking, while others prefer to bathe
before bedtime to encourage relaxation and
sleep. Unless a client’s health is affected, the
nurse should permit clients to practice their
usual routine and use the hygienic products
that they prefer.
 Socioeconomic Status
• A client’s hygienic practices may be influenced
by socioeconomic status. Limited economic
resources may affect the type, frequency, and
extent of hygiene practiced
• Some clients may not be able to afford
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deodorants, perfumes, soaps, shampoo, and
toothpaste. The nurse can function as an
advocate for the client by making referrals to
community agencies that provide assistance
to needy persons,
 Knowledge
• Knowledge level influences the client’s
understanding about the relationship
between hygiene and health. Thus, knowledge
should influence a client’s hygienic practices.
• In addition to being knowledgeable, before
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clients perform basic hygiene, they must be
motivated and believe that they are capable of
self-care. Frequently, an illness or a surgical
procedure results in deficient knowledge about
basic hygienic practices. In these situations, the
client may not know the correct procedures or
types of hygiene that can be performed.
• The nurse is responsible for providing the
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necessary education about hygiene
EVERYWHERE as the opportunity is presented
but emphasizing on during an illness.
Sometimes the nurse may have to perform all
hygienic practices for a client during an illness
until the client is able to regain this ability.
Comments and questions