Safety and Infection control
What is Safety?
It is freedom from danger, harm, or risk and is considered a basic human need.
Developmental Factors Affecting Safety -Infants/Toddlers
– tactile expiration of environment before they can judge danger, totally dependent, very curious, outside play, active, aspiration, suffocation, poisoning, falls, MVC, burns
Developmental Factors Affecting Safety -Preschoolers
adventurous, independent, impulsive, over-confident, outside play, drowning, guns and weapons due to being adventurous, MVC injuries, burns, poisons, stranger safety, bicycle safety, playground safety
Developmental Factors Affecting Safety - School-Age Children
– swimming, fire, child in booster seat, sunscreen, better coordination without cognitive skills, outside the home more, at risk for traumatic brain injury, creating an environment that is well designed and maintained, broken bones, inhalation or ingestion, provide drug/alcohol/sex education, teach to wear safety equipment
Developmental Factors Affecting Safety -Adolescents
– increased risk for vehicle accidents, STI’s, STD’s, pregnancies, psychomotor skills are high but not enough judgement, think they are indestructible, don’t realize the consequences to their actions, alcohol and drug use, high risk sexual activity, increased risk for peer pressure and suicide, no common sense, don’t realize consequences
Developmental Factors Affecting Safety -Adults(35-54)
– drug/alcohol abuse, workplace injury, less time for physical activity, depression, suicide, stressful work environment, lifestyle choices, sun exposure, water safety, dangers of social networking
Developmental Factors Affecting Safety -Older Adults
– experience altered sense of balance, episodes of confusion, impaired thinking, slower reflexes, sensory loss, risk for falls, burns, abuse, accidents, decline in cognitive abilities, visual changes
Individual Risk Factors - Lifestyle
– smoking, unprotected sex, sleep, occupation, hazardous chemicals, infectious disease, drinking, drugs
Individual Risk Factors - Occupation
-excessive noise, pollution, toxic chemicals or vapors, infectious agents
Individual Risk Factors - Social
– peer pressure, stress, safety – seatbelts
Individual Risk Factors - Environment
– high crime rates, acts of terrorism, unsafe water, pollutants
Individual Risk Factors - Mobility
– recent surgery or illness, unsteady gait, prolonged illness, balance and strength
Individual Risk Factors - Sensory Perception
– impairment to sight, hearing, smell, taste, or touch can reduce a person’s sensitivity to the environment
Individual Risk Factors - Knowledge
– awareness of safety and security precautions is crucial for promoting and maintaining wellness throughout the lifespan
Individual Risk Factors - Ability to Communicate
– fatigue, stress, medication, aphasia, and language barriers
Individual Risk Factors - Physical Health State
– anything that affects the patient’s health state potentially can affect the safety of the environment. Chronic conditions, extended periods of sleeping, decrease in appetite.
Individual Risk Factors - Psychosocial Health State
– Stressful situations tend to narrow a person’s attention span and make the person more prone to accidents. Stress, depression, and social isolation are all devastating to a patient and hurt the body more than help it. Loss of control, helplessness, suicide
Fire and Burn Safety
– cooking, heating, smoking, occur when sleeping and cause usually smoking, home oxygen puts them at risk for fire especially if smoking with oxygen on.
Prevention of fire
– smoke alarms, caution with cigarettes, fire extinguisher, no unattended candles, safety with electrical cords, burns are significant because of diminished senses, consider mental age with safety assessment, confused and forgetful, stop drop and roll
Carbon monoxide poisoning
– CO is a poisonous gas that is also colorless, odorless, and tasteless, which makes it especially dangerous. CO toxicity can cause severe organ damage in a very short period of time. Proper ventilation when using burning devices, inspect gas appliances annually, install CO2 detectors.
- poison control number , antidotes, carbon monoxide, lock medicine cabinet and chemical cabinets, food poisoning
Preventing Falls and Other Injuries
– handrails in the bathroom, non skid socks on feet, form fitting clothing, bright lights, no throw rugs, leading cause of non-fatal injury in children from 9-19
- keep guns locked up and keep ammunition separate
Preventing Asphyxiation or Choking
– small removable parts, hard candies, pay attention to strings and cords, guard pool, know CPR, know Heimlich maneuver, no blankets in crib, place sleeping infant on its back, cut food into small pieces, keep plastic bags out of reach
Take Home Toxins
– virus illness, remove work clothing, shower, gloves, hand hygiene
Healthcare facility: Never Events (Review AHRQ Website)
– serious medical errors or adverse events that should never happen to a patient. Consequences include both patient harm and increased cost to the institution. Ex – wrong surgery on wrong body part
Healthcare facility safety: Falls
– bed low to the floor, bed and wheelchairs locked, make sure they have non skid socks on, call light in reach, adequate lighting, make sure floors are free from clutter, fall risk bracelet on arm, hourly rounding, place near nurses station, communicate fall risk during shift report, document changes in condition and reassess fall risk, check for tubes, iv lines
Healthcare facility safety: Procedure/Equipment Related Accidents
– results from malfunction, disrepair, misuse of equipment or from an electrical hazard. Caused by healthcare providers and include medication and fluid administration errors, improper application of external devices and accidents related to improper performance of procedures
Healthcare facility safety: Fires and Electrical Hazards
– patient knows smoke free environment, know color for fires in your facility, Know where alarms and exits are, activate the code, clean environment.
ABC fire extinguisher is
universal fire extinguisher
What does RACE stand for
rescue alarm confine evacuate
What does PASS stand for
pull pin aim spray sweep
Healthcare facility safety: Restraints
– make sure they are tied in the right spot, chemical restraints should be a medical reason, increase risks of injury, check for circulatory impairment, pressure ulcers, contractions, loss of strength, side rails can be a restraint if all 4 are up, half and quarter rails are fine, make sure restraints aren’t too tight, check on patient every 1-2 hours, make sure knot is easily undone in case of emergency, sign a consent form , never leave patient alone without restraints
Healthcare facility safety: Biological Hazards
– bioterrorism, cyberterrorism (locking down system and ransom needs to be paid to unlock it), the spread of pathogenic pathogens into a community to cause a widespread illness. Call the code for hazardous liquid, know your surroundings.
Hazards to Healthcare Workers: Back Injury
– lift with your legs, lift/support and move patients properly, using equipment properly, slips, trips and falls (physical hazards) ask for help
Hazards to Healthcare Workers: Needle Stick Injury
– sharps in sharps container, not in trash or in bed with pt., HIV exposure, bloodborne pathogen exposure (biological hazards)
Hazards to Healthcare Workers: Radiation Injury
– wear lead gown or step out, chemical hazards, x-rays, CT, PET scans, wear guards
– workplace violence, bomb threats, bullying, harassment, stress (psychosocial hazards), staff and patient families, know your resources
– microorganisms produce disease to invade body. A disease state that results from pathogens in or on the body. Disease that infects the body.
- clean technique. Procedures and practices that reduce the number and transfer of pathogens.
- sterile technique. Used to keep and render all objects and areas free from microorganisms.
- the most significant and most commonly observed infection causing agents in healthcare institutions, it can be categorized in many ways
– smallest of all microorganisms, can only be seen by using an electron microscope
– plant like organisms that can cause infection, they are present in air, soil, and water.
– organisms that live on or in a host and relies on it for nourishment.
Goals of Infection Prevention and Control
- good hand hygiene, wear PPE if needed, use additional protective gear when necessary, avoid recapping needles, place needles and other sharp objects in puncture proof disposable containers, protecting our patients, educate client about immunizations and where to obtain them, good oral hygiene, teach and use respiratory hygiene
Chain of Infection: Infectious Agent
– bacteria, virus, fungus, prion, parasite
Chain of Infection: Reservoir (think about the following and how they act as a reservoir)
- source of infection where the host can eat and multiply
Chain of Infection: Nutrients
– when undercooked can cause outbreaks of E. coli
Chain of Infection: Moisture
– changing the dressings on a patient when they are soiled or wet to help prevent spread of infection
Chain of Infection: Temperature
– normal range to divide
Chain of Infection: Oxygen
– to live and grow
Chain of Infection: pH and Electrolytes
– pH between 5 and 8
Chain of Infection: Light
– dark environment
Chain of Infection: Portal of Exit
– The portal of exit is the point of escape for the organism from the reservoir. The organism cannot extend its influence unless it moves away from its original reservoir. Each type of microorganism has a typical primary exit route, ex. GI tract, respiratory tract
Mode of Transmission: Direct Contact
– requires close proximity between the susceptible host and an infected person or a carrier, and includes activities such as touching, kissing, and sexual intercourse
Mode of Transmission: Indirect Contact
- involves personal contact with either a vector or fomite
Mode of Transmission: Fomite
– inanimate object, countertops
Mode of Transmission: Droplet
– sneezing, coughing or speaking, greater than 5mcm
Mode of Transmission: Airborne
– travels by dust particles or small respiratory droplets. Less than 5 mcm, heat and air vents
Mode of Transmission: Vector
– living creature that transmits an infectious agent to a human, usually an insect, biting or stinging
Portal of Entry
– the portal of entry is the point at which organisms enter a new host. The organism must find a portal of entry to a host or it may die
– microorganisms survive only in a source that provides shelter and nourishment, which is the host, and only if the microorganisms overcome any resistance mounted by the hosts defenses
Classifications by Location and Duration: Local
– limited to one area
Classifications by Location and Duration: respiratory infection
– an infection in which the pathogenic organisms remain confined to a particular area, abscessed tooth, limited region of the body
Classifications by Location and Duration: Systemic
– through the whole body – spread via blood or lymph, many regions
Classifications by Location and Duration: Primary – first infection
– the initial (first) infection of a mixed infection
Classifications by Location and Duration: Secondary
– follows the primary infection, ex. Thrush, c. diff. , immunocompromised, the second and generally more complicating infection in a mixed infection
– a HAI acquired from other people, an infection in which the causative agent comes from outside the body, healthcare environment
– a HAI from something harbored within a person, ex. Colonize from MRSA, an infection which is caused by microorganisms which are normally present within the body, chemo
– short term, an infection of sudden onset
– slowly, days or weeks – an infection of slow onset and long duration
– no symptoms, asymptomatic – a seemingly inactive infection, it is apparently held in check by the body’s defense but may spread when the body resistance is reduced. Ex. Cold sores, syphilis infection is present but no symptoms
– time of infection until the manifestation of symptoms, can still infect others during this time and bacteria is multiplying.
– when you first start to not feel well, most infectious period
– actually have symptoms, may last a few days to a few weeks
– signs and symptoms disappear and person returns to a healthier state.
Body’s Defenses Against Infection : Primary Defenses
–physical and chemical barriers that are always ready and prepared to defend the body from infection, skin, mucous membranes, normal flora of GI and GU tract, crying
Body’s Defenses Against Infection :Secondary Defenses (inflammatory defenses) Phagocytosis
– WBC’s engulf and destroy the pathogen, ingest and destroy all microbes that pass into body tissues
Body’s Defenses Against Infection: Secondary defenses Complete Cascade
– secondary defense that specialized proteins release chemicals that rupture that pathogens cell membrane
Body’s Defenses Against Infection: Secondary defenses Inflammation
– eliminates pathogen and allows for tissue repair, redness, warmth, edema and pain, fever.
Body’s Defenses Against Infection: Tertiary Defenses (immune response) – antibodies
lymphocytes, b lymphocytes and t lymphocytes, immunity antibodies - when the body develops immunity, invaders that pass through the first and second line of defense
What factors increase the host susceptibility to infection?
Age, environment, broken skin, nutritional status, sleep, illness, injury, chronic disease, medication, multiple sex partners, chronic disease, immunosuppressant drugs. Very young and very old are at the highest risk, young because they haven’t gotten the defenses yet and old because they are more immunocompromised
What factors support the host’s defenses?
Rest and exercise, balanced hygiene, nutrition, manage stress levels, immunizations
– clean technique, includes procedures and practices that reduce the number and transfer of pathogen. Maintaining a clean environment, clean things properly, clutter, maintain clean hands.
Why is handwashing important?
– most effective way to prevent spread of infection.
When should you wash your hands?
before eating, after eating, bathroom, after touching patient, going into patient room, hands are visibly soiled, wash hands when arriving on unit, before putting gloves on, after taking gloves off
How should you wash your hands?
- warm water, use friction, wash for 15-20 seconds, clean under fingernails
Healthcare Associated Infections
– prevent because we don’t want to make pts sicker than they already are, we don’t get reimbursed for HAI’s.
catheter associated uti (most common)
– central line associated blood stream infection
– surgical site infection
– methicillin resistant staph infection
– colostrum difficile
Methicillin-Resistant Staphylococcus Aureus (MRSA)
– using a broad system of antibiotics and the bacteria becomes resistant to the antibiotic. Normally found in nasal mucousa membrane, on the skin, and in the respiratory and gastrointestinal tract.
Colostridium Difficile (c-diff)
– wash hands with soap and water, alcohol does not kill c. diff. – resides in the intestinal tract, when antibiotics are taken for a long period of time it creates a bacteria imbalance causing C.Diff to grow out of control. Organisms are not killed with alcohol based hand rubs
Vancomycin-Resistant enterococci (VRE)
- complete resistant to antibiotics, patients who have DM or kidney disease are more at risk, and previous MRSA infection, spread via contact with poop, urine, or blood of an infected person. **Only certain antibiotics will treat this infection**
– used in all hospitalized patients regardless of diagnosis, wash hands, use PPE (gloves)
Transmission-Based Precautions (what are they and when do you use them?)
– used in addition to standard precautions for patients in the hospital with suspected infection with pathogens that can be transmitted by airborne, droplet, or contact routes.
– gloves and gown, for pts. Who are infected by a multidrug resistant organism
– splash mask, gown, gloves, for pts who have an infection that is spread by large particle droplets such as rubella, mumps, diphtheria, and the adenovirus infection in infants and young children
– N95, goggles, gown, gloves, patients who have infections that spread through the air such as tuberculosis, varicella, and rubeola
- gown, gloves, mask, aims to protect an immunocompromised patient who is at high risk of acquiring micro-organisms from either the environment or from other patients, staff or visitors
What is included in PPE?
gown, gloves masks, protective eyewear
How do you Don PPE?
1. Gown 2. Mask 3. Goggles 4. gloves
How do you Doff PPE?
1. Gloves 2. Goggles 3. Gown 4. mask