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Safety and Asepsis
NP1 Unit 1 Safety and Asepsis Lecture
| Question | Answer |
|---|---|
| Pathogen | Microorganism that causes a disease. |
| Sepsis | Poisoning of tissues |
| Asepsis | To be without disease-producing microorganisms. |
| Signs of Localized Infection | Localized swelling Localized redness Pain or tenderness with palpation or movement Palpable heat in infected area Loss of function of the body part affected, depending on the site and extent of involvement. |
| Signs of Systemic Infection | Fever Increased pulse and resp. rate if the fever is high. Malaise, loss of energy. Anorexia and sometimes nausea and vomiting. Enlargement and tenderness of lymph nodes that drain infected area. |
| Signs of infection | Lab data Elevated WBC count Increase in specific WBC types Elevated ESR Cultures of urine, blood, sputum, or other drainage. |
| Medical asepsis | AKA "Clean technique" Involves procedures and practices that reduce the number and transfer of pathogens. |
| Surgical asepsis | AKA "sterile technique" Includes practices used to render and keep objects and areas free from all microorganisms. |
| Resident flora | Microorganisms that habitually live in/on one part of the body. |
| Bacteria | Most common type of infection-causing microorganism. |
| Fungi | Includes yeast and molds. |
| Viruses | Consist primarily of nucleic acid and must enter living cells in order to reproduce. |
| Parasites | Live on other living organisms |
| Nosocomial infections | Hospital acquired Affects 6% of hosp. patients. |
| Common types of nosocomial infections | UTI - 40% Surgical wound infection - 25% Resp. tract infection - 15% Skin/SQ tissue infection - 15% Septic thrombophlebitis - <5% |
| Chain of infection | etiologic agent reservoir (source) Portal of exit from reservoir Method of transmission Portal of entry to susceptible host Susceptible host Back to beginning |
| Nonspecific defenses against infection | Resident flora Skin Mouth Resp. Tract GU Tract GI Tract Tears |
| Specific defenses against infection | Immune system |
| Factors increasing the risk of infection | Virulence and resistance of microorganisms Lowered body defenses due to: medical treatment, age, heredity, stress. # of ill patients # of different pathogens # of health care workers High risk patients. |
| Medical asepsis actions | Wash hands Rinse re-usable supplies with cold water, then disinfect Place soiled linen/supplies in proper bags Roll soiled linen, don't allow contact w/uniform. Don't touch floor w/ uniform/knees Remove gloves B4 touching phone, doorknobs, pens, etc. |
| How is infection control accomplished? | Use of medical asepsis, universal precautions, and category specific isolation |
| What are isolation precautions? | Refers to measures designed to prevent spread of infection by potentially infectious microorganisms to health personnel, clients, and visitors. |
| Category specific isolation | Based on routes of transmission for diseases. Includes: contact precautions, enteric precautions, strict isolation, respiratory/TB isolation, protective (reverse) isolation |
| Disease-specific isolation | Precautions based on specific diseases, including using private rooms with ventilation, or shared rooms with same organisms. |
| Universal Precautions | Application of precations to blood and all body fluids containing traces of blood from all clients regardless of their diagnosis. |
| What is the purpose of universal precautions? | Protects providers from bloodborne pathogens. |
| True or false - You should consider all clients as being potentially infected with bloodborne pathogens such as HIV or HBV. | True. |
| Universal precautions includes protection against what body fluids? | Includes, but not limited to: Blood, semen, vaginal secretions, breast milk, body tissues, CSF, synovial fluid, pleural fluid, peritoneal fluid, and amniotic fluid. |
| Body Substance Isolation | Focused on isolation of all moist and potentially infectious body substances - precautions for all clients, except those with diseases transmitted through air. Includes blood, some body fluids, urine, feces, wound drainage, oral secretions. |
| When should you use gloves? | Just before contact with mucous membranes, non-intact skin, and/or anticipated contact with moist body substances. |
| Standard Precautions combines major features of ________ and ________. | Universal precautions and body substance isolation. |
| Standard precautions applies to all _____ ______, secretions and excretions, except _______. | body fluids, sweat. |
| True or False - Standard Precautions are used on some clients, depending on their diagnosis or possible infections. | False. Standard precautions are used on all clients, regardless of diagnosis or possible infections. |
| What determines the effectiveness of handwashing? | Adequate friction, thoroughness of surface cleansing and duration of use. |
| When should you perform handwashing? | Begin/end of shift. B4/after contact w/ client Between contact with different clients B4 performing an invasive procedure. B4/after contact with wounds, specimens, linen B4 administering meds After removing gloves B4/after blowing nose, using res |
| T or F - It's OK to store your lunch in the meds refrigerator. | False. Never store food and drink in refrigerator with blood or meds. |
| T or F - You shouldn't eat or drink in client care areas | True. |
| T or F - It's OK to recap a needle | False. You should never recap, bend, or break needles. |
| T or F - You should place sharps in the biohazard bag. | False. Sharps should be placed only in sharps containers (puncture resistant containers). |
| T or F - If you have chapped lips, it's OK to apply while in the client's room, just before you wash your hands. | False. Don't apply cosmetics, lip balm, or handle contact lenses in client care areas. |
| What should be placed in bio-hazard bags | Soiled linen, specimen containers, contaminated re-usable equipment. |
| Airborne Precautions | Use negative pressure room Do not share equipment Keep door closed. Wear respiratory mask. |
| Diseases requiring airborne precautions | TB, SARS, measles, chickenpox/shingles. Transmitted by droplets smaller than 5 microns or by dust particles. Remains in air for long periods of time. |
| Droplet precautions | Wear mask if working within 3 feet. Private room only. Examples - mumps, pertussis, rubella, some pneumonias. |
| Droplet precaution transmission | Transmitted by particle droplets larger than 5 microns from the conjunctivae or the MM's of the nose or mouth of infected person. Droplets generated by coughing, sneezing, talking. Requires close contact between persons. Remains in air for short peri |
| When are contact precautions used? | When client has an illness that is easily transmitted by direct contact with the client or equipment used on the client. |
| What PPE is used for contact precautions? Can you share equipment used by a contact precaution client? | Gloves and gowns. Do not share equipment. |
| Protective (Reverse) Isolation | Used to prevent infection for people with compromised body defenses. |
| Measures to maintain Protective Isolation | Private room, positive pressure room, meticulous handwashing, gown, gloves and mask, disinfect equipment. |
| Examples of clients who may need protective isolation | clients on chemotherapy, radiation, immunosuppressive meds, extensive burns or dermatitis |
| PPE needed for protective isolation | Gown, gloves, masks. |
| Negative pressure room | Air moves into the room when door is opened, preventing possibly infected air from escaping room and infecting others. |
| Positive pressure room | Air moves out of the room when door is opened, prevented possibly infected air from entering the room and infecting the client. |
| How should isolation be communicated? | Signs on HOB, stickers on front of chart, signs on door, notify personnel in receiving area |
| True or false - A client on isolation precautions can be transported freely | False. Client should be transported only when there is no other alternative. |
| What are the psychological considerations of a client on isolation precautions? | Clients may feel dirty or untouchable. Decresed self-esteem May lead to sensory deprivation r/t feelings of inferiority |
| Interventions to reduce risk for infection | Proper hand hygiene environmental controls Sterile technique when warranted Identification and management of clients at risk |
| Health Agencies | WHO, CDC, OSHA, JCAHO |
| What does WHO stand for? | World Health Organization |
| What does CDC stand for? | Centers for Disease Control |
| What does OSHA stand for? | Occupational Safety and Health Administration |
| What does JCAHO stand for? | Joint Commission on Accreditation of Healthcare Organizations. |
| What factors may affect safety? | Age Development Lifestyle Mobility Health Status Environmental Factors |
| Assessment of Safety | Sensory/Perceptual Alterations Cognitive Awareness Emotional state Ability to communicate Safety awareness Ai |
| Qualities of safe environment | No smoking, 60-70% humidity, proper nutrition, Safe H2O, room temp., provide for elimination, decrease noise level, adequate lighting, room space clutter-free |
| What does NPSGs stand for? | National Patient Safety Goals. |
| Where can the list of NPSGs be found? | Kozier, pg. 715. or at www.jointcomission.org/nationalpatientsafetygoals |
| What are the NPSGs added in 2009? | Goal 15 - Organization identifies safety risks inhernet in its patient population. Goal 16 - Improve recognition and response to changes in a patient's condition. |
| What are the consequences of a safe environment? | Decrease length of stay, Decreases treatment-related accidents, reduces potential for lawsuit, decreases work-related injuries, decreases cost of health care, allows staff to function efficiently |
| Nurse's responsibilities for safety and asepsis? | Educate clients regarding safe practices Prevent or control spread of disease protect clients from injury |
| Who should the nurse be especially concerned by regarding safety and asepsis? | Elderly and young children. |
| Nursing interventions for clients at risk of injury | Help client and family accomplish the following: - Identify environmental hazards - Demonstrate safe practices - Demonstrate safe child-rearing practices - Demonstrate safe lifestyle practices |
| Common Injuries in Health Care settings | Falls, Punctures/cuts, burns, ingestion of foreign substances, medication errors, improper application of PD, Improper body mechanics, fires, use of unfamiliar equipment, improper use of medical equipment |
| Fall Prevention - A weak client is scheduled for ambulation. What should nurse do? | Assist in ambulating weak clients. |
| Fall Prevention - Before client ambulates, what should client wear? | Rubber sole shoes/socks |
| Fall Prevention - Before client uses a walker, what should nurse do? | Inspect rubber tips of canes/walkers. |
| Fall Prevention - When client is using a shower, tub, or toilet, what should the nurse instruct the client to do? | Use safety bars in the bathroom. |
| Fall Prevention - What should the nurse do to the client's bed? | Keep bed in low position unless performing a skill. Never leave the client without lowering the bed. |
| Fall Prevention - What should the nurse to to ensure the client can get help if needed? | Orient the client to his or her surroundings, keep call bell within reach. |
| Fall Prevention - What precautions should be taken during transport? | Side-rails and safety straps used. |
| Fall Prevention - What precautions are taken during mopping? | Use wet floor signs, inform client that floor has been mopped. |
| Fall prevention - What should be done with electrical cords? | Tape them to the floor, keep them out of walking areas if possible. |
| Fall prevention - What should be done to the bed of a confused client? | Use padded side-rails. |
| What general precaution should be taken for a client at risk for falls? | Supervise the client closely, especially at night. |
| What are the two types of restraints? | Chemical and Physical |
| Chemical restraints | Medications used to control disruptive behavior |
| Physical restraints | Any manual method used to restrict a client's movement. |
| Physical restraints considerations | Last resort only Must have MD's written order Must re-assess need for restraint q 24h. DO NOT delegate responsibility to a family member. Assess underlying reason for client's restlessness, agitation, or confusion. |
| Alternatives to restraints - Staffing | Assign nurses in pairs |
| Restraint alternatives - placement | Place unstable clients in area that is closely supervised. |
| Restraint alternatives - relocation | Prepare client before a move to limit relocation shock |
| Restraint alternatives - toileting | Stay with a client using a bedside commode or bathroom if confused, sedated, gait disturbance, high risk score for falling. |
| Restraint alternatives - Meds | Monitor all medications, if possible lower or eliminate dosages of sedatives or psychotropics. |
| Restraint alternatives - bed | Position bed in lowest position |
| Restraint alternatives = side rails | Replace full-length side rails with half or three-quarter length rails. |
| Restraint alternatives - energy expenditure | Use rocking chairs to help confused clients expend some energy |
| Restraint alternatives - wheelchair | Wedge pillows or pads against sides of wheelchairs, place removable lap tray on a wheelchair. |
| Restraint alternatives - restlessness or sundowner's syndrome | Try a warm beverage, soft lights, back rub or a walk. Place picture or other personal item on door to client's room. |
| Legal implications of restraints | Restraints restrict the client's freedom. |
| Two standards of the US Centers for Medicare and Medicaid Services | Behavior management standard Acute medical and surgical care standard |
| Behavior Mangement Standard (Restraints) | Nurse may apply restraints, but MD must see client w/i 1 hour for evaluation. Written restraint order for an adult, following evaluation, valid for 4 hours. Must be continual visual and audio monitoring if client restrained and secluded. |
| Medical Surgical Care Standard (Restraints) | Up to 12 hrs. for obtaining MD's written order. Orders renewed daily Order must state reason and time period PRN order prohibited. Used only as last resort. Nurses must document need for restraint made clear to both client and family. |
| Documentation of restraints | Must document behavior, type of restraint, time applied, frequent assessments (Q2hrs), client/family education performed. |
| Restraints must not: | Impair circulation Interfere with existing treatments Be attached to bed side rails |
| Restraints must: | Pad bony areas Be removed q2h to assess skin, circulation, sensation, movement. Maintain body alignment. |
| What are the usual causes for fires in health care settings? | 1. Malfunctioning electrical equipment 2. Combustion of anesthetic gases. |
| What does RACE stand for? | Remove from danger Alarm, report fire Contain, close doors Extinguish, fight the fire if possible. |
| Fire safety - what is the nurse responsible for knowing? | Fire alarm system and locations Placement of fire fighting equipment Placement of fire exits Types of fire extinguishers and their uses |
Created by:
christyness
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