Safe and Effective Care: Safety and Infection Control

1. Safe and Effective Care: Safety and Infection Control Ms. Tina Terpening

2. Accident and Injury Prevention • Identify client allergies • Facilitate correct use infant/child car seats • Rear facing till age 2, car seat /booster till age 8 (till 4’9”) • Be aware of factors that contribute to risk • Altered mental status • Confusion • Age/knowledge level • Always verify client using 2 identifiers • Monitor environment for safety = be safety minded • Provide mechanism to signal staff • Always evaluate appropriateness of each order at this time for this patient

3. Emergency Response Plan • Identify roles of personnel during internal and external disasters • Participate in preparation/planning • Contribute to selection of client(s) to discharge in disaster situation

4. Preventing Injury and Infection • Accidents • LVN’s are legally accountable for prevention of accidental injury • Nosocomial Infections • Hospital acquired infection • Protect clients from other infections • GOOD HAND WASHING!!! • Incident reports • Necessary part of care • Used by safety committee • Never reference in client record

5. Ergonomic Principles • Use assistive devices and lifts when possible • Ask for help when needed

6. Working at Computer • Body should be in neutral aligned position • Hands, wrists, and forearms parallel to ground • Head should be level • Bend elbow 90-120 degrees and close to body • Back should be supported • Knees should be hip level • Adjust position at least every 15 minutes

7. Body Mechanics • Face object being moved • Bend at legs-not back • Work using legs-not back • Turn pivoting body-do not twist • Have object being moved close to you and at waist level • Push instead of pull • Have wide base of support • Move object with smooth, even motion

8. Body Mechanics (continued) • Keep beds or objects close at waist level • Do not lift if you can slide • Do not bend, reach or twist

9. Repositioning Client in Bed • Raise bed to waist level • Lower side rails • Use slide boards or draw sheets • Kneel on bed if needed to maintain body mechanics • Use other staff members for health

10. Transferring Bed to Chair or Chair to Bed • Put bed in low position • Position chair so client moving toward strong side • Position chair so client can stand and then pivot

11. Chemical Agents and Radiation • Determine type and amount of radiation used • Place sign “Caution Radioactive Material” • Wear monitoring badge to record exposure • Dispose of items per facility protocol • Never handle radioactive material with hands

12. Home Safety • Identify fire/environmental hazards (i.e. frayed cords, area rugs, etc.) • Provide client education on home safety • Home disposal of syringes • Lighting • Handrails • Kitchen safety

13. Least Restrictive Restraints & Safety Devices • Demonstrate knowledge of appropriate application of restraints/safety devices • Know protocol for timed client monitoring (i.e. restraint, safety check, etc.) • Maintain documentation throughout the shift • Check proper function of restraint/safety device • Implement least restrictive restraints or seclusion

14. Reporting Incident/Event • May be called Incident/Event/Irregular Occurrence/Variance • Completed for unusual or unexpected events • Acknowledge and document practice errors • Monitor and document client response to error

15. Security Plan • Initiate and/or participate in all security alerts (i.e. infant abduction) • Use principles of triage and evacuation protocols/procedures prn

16. Falls • Identify clients at risk (i.e. older adults, impaired mobility, cognitive/sensory impaired, bowel/bladder dysfunction, medication side effects, etc.) • Nursing interventions: • Complete fall risk assessment on admission and as needed • Clients should be closest to nurses station • Provide nonskid footwear • Avoid clutter • Maintain bed in low position • Orient client to surroundings, keep call light in reach • Answer call lights quickly • Provide adequate lighting • Keep assistive devices in reach

17. Restraints: Not Convenience/Short-Staffing • Current standard = reduce need for restraints • Includes mechanical, chemical, physical devices • Nursing interventions: • Implement non-pharmacologic measures (i.e. distractions, frequent observation, diversion) • Apply correctly • Notify provider immediately when applied • Remove and reassess every 2 hours • Reassess for continued use • Document • Behavior that made restraints necessary • Other alternatives attempted and client response • Type and location of restraint with time applied • Frequency/type assessments

18. Seizure Precautions • Monitor hx, frequency, presence of auras, sequence of events • Identify precipitating factors • Review medication hx • Place rescue equipment at bedside • Remove items that may cause injury • At seizure onset = position for safety and remain with client • Protect head • Pad side rails for safety • Do not put anything in mouth • Loosen clothing • Document timing, precipitating behaviors, description of event • Report to provider

19. Fire • Know facility fire drill and evacuation plan • Keep emergency numbers by phone at all times • Know location fire alarms, extinguishers, exits, oxygen shut-off valves • Rescue-> protect and evacuate clients in immediate danger • Alarm-> activate alarm and report fire • Contain->close doors & windows • Extinguish-> use correct fire extinguisher to eliminate the fire

20. Fire Extinguishers • Class A paper, wood, cloth, trash • Class B flammable, liquids, gases • Class C electrical fires • Review “Stop, Drop and Roll”

21. Equipment Safety • Electrical equipment must be grounded • Do not overcrowd outlets • Equipment should only be used for its intended purpose • Disconnect before cleaning

22. Medical Asepsis (clean technique) • Hand hygiene frequently • Use PPE as needed • Do not put items on the floor • Do not shake linens • Clean least soiled area first • Place moist items in plastic bag • Educate client/caregivers

23. Surgical Asepsis (sterile technique) • Avoid coughing, sneezing, talking over field • Only dry sterile items touch sterile field • 1” border non-sterile • Keep all objects above waist • Don sterile gloves to perform procedure

24. Isolation Procedures • Standard precautions • Handwashing • Gloves • Mask • Eye protection • Face shield • Gown equipment • Environmental control • Linen • If it’s wet and it’s not yours….protect yourself!

25. Standard Precautions • Report communicable diseases • Room placement for client safety • Clean equipment according to policy • Do not recap • Use sharps container • Clean spills with 1:10 bleach solution

26. Droplet Precautions • Large particle • Required: gloves, mask, client placement • Organisms • H. influenza • Diphtheria • Pertussis • Scarlet fever • Adenovirus • Mumps • Streptococcal pharyngitis • Meningococcal pneumonia/sepsis • Pneumonic plague

27. Airborne Precautions • Small particle • Issues: client placement negative airflow, respiratory protection (N-95), client transport, gloves • Organisms • Measles • Varicella • Tuberculosis (TB)

28. Contact Precautions • Issues: client placement, gloves, handwashing, gown, client transport, equipment, mask and goggles as needed • Organisms • Enteric E. Coli • Skin herpes • Pediculosis • Scabies • Herpes simplex

29. Protective Isolation • Standard precautions • Maximum protection may include sterile linens, food, other supplies • Minimize exposure to microorganisms • No flowers, fruits, vegetables brought in • Sterile gloves, gown, mask, protective room

30. Order of Application PPE Application PPE Removal Gloves Goggles/face shield Gown mask • Gown • Mask • Goggles/face shield • Gloves

31. Organisms to Know • AIDS/HIV • Chickenpox • Clostridium difficile • Hepatitis A, B, C • Herpes simplex (oral, skin, genital) • Herpes zoster • Measles • Meningococcal disease • Methicillin-resistant staphylococcus aureus (MRSA) • Pneumonia • RSV (Respiratory syncytial) • Rotavirus • Rubella • Salmonella • Shigellosis • Staphylococcus • Tuberculosis • Vancomycin-resistant enterococci (VRE)

32. Frequent hand hygiene • Dispose of PPE inside client’s room • Monitor psychosocial needs in isolation • Only transport out of room when necessary • Avoid putting clients on contact precautions with clients who are immunocompromised, have open wounds, or have anticipated prolonged length of stay • Ensure clients > 3 ft apart from each other • Change PPE and perform hand hygiene between contact with clients in the same room

33. Question: • An LVN is assisting in planning a community bicycle safety program. Which of the following information should the nurse recommend including? • Demonstrating the correct way to wear a bicycle helmet to parents of preschoolers • Asking school-aged children who have been involved in bicycle accidents to speak to their peers • Informing parents that it is necessary for all children to have a complete physical examination prior to initiating bike riding. • Telling parents that it is safest for children to ride bikes on weekends

34. Questions?