Safety and Infection Control
Safety and infection control in nursing involves measures to protect the well-being of both patients and healthcare providers. It encompasses practices and protocols aimed at preventing accidents, injuries, and the spread of infections within healthcare settings. These measures include proper identification of patients, following treatment orders accurately, maintaining a safe environment, promoting staff safety, adhering to infection prevention techniques, educating patients and staff about safety and infection control, and reporting and addressing unsafe practices promptly. The goal is to ensure the highest level of safety and reduce the risk of harm to patients and healthcare personnel.
Ensuring Client Safety:
- Staff should be knowledgeable about safety procedures and take safe actions.
- Identify factors influencing client safety, including age, developmental level, lifestyle, mental status, health conditions, and high-risk behaviors.
- Implement measures to protect at-risk clients from injury.
- Ensure clients understand how to contact the nurse.
- Evaluate the client care environment for hazards and remove them.
- Verify prescriptions for treatments that could contribute to accidents or injuries.
- Inspect equipment for hazards and report malfunctions.
- Conduct a home safety assessment with clients and families to identify home hazards.
- Provide education to prevent falls.
Measures to Prevent Falls:
- Assess the client’s fall risk.
- Assign high-risk clients (e.g., those with cognitive impairment) to rooms near the nurses’ station.
- Inform all personnel about the client’s fall risk.
- Frequently assess the client.
- Orient the client to their physical surroundings.
- Instruct the client to seek assistance when getting up.
- Explain the use of the nurse activation system.
- Use safety devices like bed or chair alarms to alert staff when clients attempt to get up.
- Keep beds in a low position with side rails adjusted as per agency policy.
- Lock the wheels of beds, wheelchairs, and stretchers.
- Ensure the client’s personal items are within reach.
- Remove clutter and obstacles from the client’s room.
- Provide adequate lighting.
- Eliminate bathroom hazards.
- Maintain the client’s toileting schedule throughout the day.
Car Safety for Infants:
Motor vehicle safety is of paramount importance for infants to prevent injuries and fatalities. Infants are particularly vulnerable in car accidents due to their small size and underdeveloped musculature. Proper restraint and seating are crucial to ensuring their safety.
Nursing Interventions: Client Education:
- Importance of Approved Restraints: All infants must be secured in federally approved restraints specifically designed for their age and size. Placing infants on car seats without appropriate restraints or holding them in the car is not safe.
- Types of Infant Restraints: Infant restraints are available as infant-only models or convertible infant-toddler models. These seats are semireclined and face the rear of the car, offering optimal protection for infants. Rear-facing seats distribute crash forces over the back, neck, and head, reducing stress on the neck and head.
- Recommended Rear-Facing Position: It is now recommended that infants and toddlers ride in rear-facing car seats until they reach 2 years of age or meet the height and weight limits specified for their car seat. This recommendation is based on safety studies.
- Installation and Anchoring: Car seats are anchored to the vehicle using the vehicle’s seat belt. Some seats have harness systems, and clips may be required to keep shoulder straps in the correct position. Vehicles manufactured after 1999 may have tether straps for added security.
- LATCH System: The LATCH (lower anchors and tethers for children) system provides anchors between the front cushion and backrest to secure the car seat without using the seat belt. However, there are weight limits for using the LATCH system.
- Safety of Rear Seats: The back seat is the safest area for children. Front passenger seats with airbags can pose a risk, so infants and young children should be placed in the back seat whenever possible.
- Proper Dress and Padding: Dressing infants in outfits with sleeves and legs allows the harness to secure them effectively. Rolled blankets or towels can be used to support the head and minimize movement. Proper padding is essential to prevent slouching.
- Overheating Caution: Parents should never leave infants unattended in a vehicle, especially in hot weather. Infants have difficulty regulating body temperature and can quickly succumb to hyperthermia when left in hot cars.
- Reminders for Parents: Parents should use reminders, such as signs or placards in the rear-view mirror, to avoid accidentally leaving their child in the back seat when running errands or during busy schedules.
Emergency Response Plan and Disasters:
An emergency response plan is a vital component of a healthcare agency’s preparedness and response strategy in the face of a disaster. Disasters can be either human-made or natural events, resulting in significant destruction or injury that requires assistance, often from medical, local, or federal government sources. These disasters can occur within the healthcare agency (internal) or in the surrounding community (external).
Examples of Disasters:
- Human-Made Disasters: These include events such as dam failures leading to flooding, exposure to hazardous materials (e.g., chemical spills), release of radioactive substances, resource shortages (e.g., food, water, electricity), structural collapses, fires, explosions, terrorist attacks (e.g., bombings, bioterrorism), riots, and mass transportation accidents.
- Natural Disasters: Natural disasters encompass events like blizzards, epidemics, cyclones, droughts, earthquakes, floods, forest fires, hailstorms, hurricanes, landslides, mudslides, tornadoes, tsunamis, and volcanic eruptions.
Phases of Disaster Management:
The Federal Emergency Management Agency (FEMA) outlines four phases of disaster management:
- Mitigation: This phase involves actions and measures taken to prevent disasters or reduce their damaging effects. It includes identifying community hazards and risks, identifying available resources and healthcare personnel, and assessing the needs of vulnerable populations such as infants, older adults, people with disabilities, and those with chronic health conditions.
- Preparedness: Preparedness involves formulating plans for rescue, evacuation, and disaster victim care. It includes training disaster personnel, gathering necessary resources and equipment, assigning responsibilities, establishing community disaster plans, setting up communication systems, and regularly assessing and replenishing emergency supplies. Mock-disaster drills are essential to ensure preparedness.
- Response: The response phase is when disaster plans are put into action to save lives and prevent further damage. It focuses on ensuring the safety and well-being of victims and disaster response teams. Immediate actions are taken to address the needs of those affected by the disaster.
- Recovery: Recovery is the phase where efforts are made to return to normalcy after a disaster. This includes preventing long-term negative effects, restoring personal, economic, and environmental health, and stabilizing the community.
Personal and Professional Preparedness:
Individuals should take personal and family preparations seriously by being aware of disaster plans in their workplaces and communities. Maintaining certifications in disaster training and cardiopulmonary resuscitation (CPR) is crucial. Participation in mock-disaster drills helps ensure readiness.
Emergency Response Plans and Supplies:
- Family Preparedness:
- Agree on a meeting place for family members.
- Determine evacuation routes and destinations if needed.
- Learn how to turn off water, gas, and electricity in your residence.
- Identify safe areas within your home for different types of disasters.
- Replace stored water supply every 3 months and stored food every 6 months.
- Clean clothing and sturdy footwear.
- Potable water (1 gallon per person per day for at least 3 days).
- Non-perishable, no-cooking-required food.
- Battery-powered flashlight with extra batteries and/or chemical light sticks.
- Pocket knife or multi-tool.
- Personal identification with emergency contacts, medical information, and essential documents.
- Towel, washcloth, towelettes, soap, and hand sanitizer.
- Paper, pens, pencils, and regional maps.
- Cell phone.
- Emergency blanket, sleeping bag, and pillow.
- Work gloves.
- Personal first aid kit with OTC and prescription medications/vitamins.
- Rain gear.
- Roll of duct tape and plastic sheeting.
- Battery-powered or hand-crank radio.
- Toiletries (e.g., toothbrush, toothpaste, comb, razor, deodorant).
- Plastic garbage bags, ties, and re-sealable plastic bags.
- Matches in a waterproof container.
- Household liquid bleach for disinfection.
The Role of the Nurse in Disaster Preparedness:
In healthcare settings:
- Activate the agency’s disaster preparedness plan.
- Follow directions in the plan and use clinical decision-making skills.
- Determine which clients can be safely discharged to make beds available for disaster victims.
- Prioritize clients based on their needs (high-priority vs. intermediate- or low-priority).
- Collaborate with community resources to support discharged clients.
In community settings:
- Be the first responder for disaster victims with life-threatening problems.
- Coordinate immediate triage plans once rescue workers arrive.
- Rank clients based on the severity of injury and urgency of treatment.
- Use the ABCs (Airway, Breathing, Circulation) as a guide for assessment.
- Follow CAB (Chest compressions, Airway, Breathing) guidelines during CPR if necessary.
Security Plans and Evacuation Procedures:
- Understand the agency’s security plan and evacuation procedures.
- Follow agency protocols in case of a security threat (e.g., bomb threat, explosion, fire).
- Implement evacuation procedures as directed.
- Ensure clients’ safety during evacuation, including those on life support.
Agents of Biological and Chemical Warfare:
- Be aware of bioterrorism attacks that may mimic natural outbreaks.
- Recognize indicators of a warfare agent attack and implement safety precautions.
- Stay informed about changes in microorganisms that may increase virulence or resistance.
Examples of Warfare Agents:
- Biological: Anthrax, Botulism, Hemorrhagic fever, Plague, Smallpox, Tularemia.
- Chemical: Ionizing radiation, Mustard gas, Phosgene, Sarin.
Emergency Response Plans, Disasters, and Triage Points to Remember:
- Disaster preparedness plans are crucial for coordinating responses to disasters.
- Nurses should be familiar with disaster, security, and evacuation plans in their workplace and community.
- Primary assessment focuses on immediate or potential life-threatening problems.
- Secondary assessment is conducted after addressing primary issues to identify additional life-threatening problems.
- Triage categorizes clients based on severity and urgency of care. Different systems may be used, such as color coding or numbers.
Standard precautions, transmission-based precautions, and asepsis are fundamental concepts in infection control and prevention in healthcare settings. Here are key points to remember about these infection control measures:
- Universal Practice: Standard precautions must be practiced with all clients in all healthcare settings, regardless of their diagnosis or presumed infectiousness.
- Components: Standard precautions include handwashing, glove use, mask and eye protection, and gown use when necessary, based on the type of client contact.
- Objective: These precautions are designed to prevent exposure to:
- Blood and all other body fluids (whether or not they contain blood).
- Secretions and excretions.
- Non-intact skin.
- Mucous membranes.
- Hand Hygiene: Wash hands thoroughly between client contacts, after contact with contaminated items, and immediately after removing gloves.
- Glove Use: Wear gloves when in contact with blood, body fluids, secretions, excretions, non-intact skin, mucous membranes, or contaminated items. Change gloves and wash hands between client care contacts.
- Personal Protective Equipment (PPE): Use masks, eye protection, or face shields when there is a potential for splashes or sprays of blood or body fluids. Wear gowns if clothing soiling is likely, and remove gowns and wash hands afterward.
- Equipment Management: Clean and reprocess client care equipment appropriately and dispose of single-use items properly.
- Contaminated Linen: Place contaminated linen in leak-proof bags and handle it to prevent skin and mucous membrane exposure.
- Needle Safety: Use needleless devices or safety needle devices when possible to reduce the risk of needle-stick injuries. Dispose of needles safely in puncture-resistant containers.
- Spill Cleanup: Use a bleach and water solution (diluted 1:10) or an agency-approved disinfectant for cleaning up spills of blood or body fluids.
Transmission-based precautions are additional precautions used in addition to standard precautions for clients with known or suspected infectious diseases. There are three types:
- Used to prevent diseases transmitted through airborne droplets.
- Place the client in a private room with negative airflow pressure, and use respiratory protection (e.g., masks or HEPA respirators).
- Diseases include tuberculosis, chickenpox, and measles.
- Used to prevent diseases transmitted through large-particle droplets.
- Place the client in a private room or with a cohort client, and use masks for close contact.
- Diseases include influenza, meningitis, and mumps.
- Used to prevent diseases transmitted through direct client contact or contact with contaminated objects or surfaces.
- Place the client in a private room or with a cohort client, and use gloves and gowns for all interactions.
- Diseases include MRSA, Clostridium difficile, and skin infections.
Health Care-Associated Infections:
- Nosocomial or hospital-acquired infections occur in healthcare settings and are not present at the time of client admission.
- Infections can be transmitted through healthcare personnel and contaminated equipment.
- Clients at higher risk include those with impaired immune systems.
- Infection control measures include hand hygiene, equipment sterilization, and education of both clients and staff.
Common Drug-Resistant Infections:
- Examples of drug-resistant infections include CRE (Carbapenem-resistant Enterobacteriaceae), C. difficile, MRSA (Methicillin-resistant Staphylococcus aureus), MDR-TB (Multidrug-resistant tuberculosis), and VRE (Vancomycin-resistant enterococci).
- Asepsis refers to the absence of disease-producing microorganisms.
- Medical asepsis (clean technique) aims to reduce the spread of microorganisms using practices like hand hygiene and clean gloves.
- Surgical asepsis (sterile technique) involves eliminating all microorganisms from an area, such as using sterile gloves and maintaining a sterile field during procedures.
- Assess client for allergies and intervene as needed:
- Healthcare professionals should routinely ask clients about allergies to medications, foods, environmental substances, and any adverse reactions they have experienced in the past.
- This information is critical to prevent allergic reactions, which can range from mild rashes to life-threatening anaphylaxis.
- Interventions may include ensuring the client is not exposed to allergenic substances, using alternative medications or treatments, and being prepared with appropriate treatments (e.g., epinephrine) in case of severe allergic reactions.
Ergonomic Principles for Healthcare Workers involve the optimal use of anatomical, physiological, psychological, and mechanical factors to ensure efficient and safe utilization of energy while preventing injuries. Here are key points to consider:
- Staff Understanding: Ensure that healthcare staff understands the principles of good body mechanics and encourage their proper application.
- Use of Slide Board and proper body mechanics: When transferring a client onto a stretcher, consider using a slide board to facilitate a smooth and safe transfer process. Employ proper body mechanics when moving patients.
- Workstation Ergonomics: When documenting patient information or using computers, have ergonomically designed workstations with adjustable chairs, monitors, and keyboards to maintain proper posture and reduce the risk of musculoskeletal injuries.
- Regular Breaks: Take regular breaks during long shifts to rest, stretch, and prevent fatigue and discomfort. Use break times for self-care and relaxation.
- Patient Education: Educate patients about their role in safe transfers and mobility. Encourage patients to assist as much as possible when moving to reduce the strain on healthcare providers.
- Continuous Training: Participate in ongoing training programs that focus on safe patient handling techniques and ergonomic practices. Stay up-to-date with the latest best practices and guidelines.
Handling Hazardous and Infectious Materials:
- Identify Potential Exposure Situations: Recognize situations where healthcare workers may be exposed to hazardous or infectious materials, such as radiation, infectious waste, or contaminated needles.
- Follow Agency Protocols: Adhere to your healthcare agency’s established protocols and guidelines for handling biohazardous and infectious materials. Ensure that all staff members are aware of and follow these protocols.
- Treat Infectious Materials as Hazards: Handle all infectious materials with the same level of caution as other hazardous materials.
- Proper Waste Disposal: Dispose of infectious waste in designated areas using the appropriate containers for disposal. Ensure that containers are leak-proof and properly labeled.
- Labeling: Properly label all infectious materials to clearly indicate their contents and associated hazards.
- Sharps Disposal: Immediately dispose of all sharps (e.g., needles) after use in a closed, puncture-resistant disposal container. Ensure that the container is leak-proof and appropriately labeled or color-coded.
Internal Radiation Implant Safety:
- Private Room: Place the client in a private room with a private bath and post a caution sign on the door.
- Minimize Exposure: Organize nursing tasks to minimize exposure to the radiation source. Rotate nursing assignments to limit exposure time to 30 minutes per care provider per shift.
- Protective Measures: Wear a dosimeter film badge to measure radiation exposure. Additionally, use a lead shield to reduce the transmission of radiation.
- Pregnancy Precautions: Pregnant nurses should not care for clients with internal radiation implants. Likewise, pregnant women and children under 16 years of age should not visit the client.
- Visitor Limitations: Limit visitor access to 30 minutes per day and advise them to remain at least 6 feet from the source of radiation.
- Radiation Source Handling: Do not touch a dislodged radiation source directly. Use long-handled forceps to safely place the source in a lead container.
Assessing the Home Environment:
- Client Assessment: Assess the client’s home environment, taking into account their specific condition and limitations. Look for the presence of essential safety features such as fire alarms, adequate lighting, handrails on stairs, and grab bars in bathrooms.
- Modifications: Initiate necessary modifications to the client’s home to enhance safety. This may include installing safety devices, removing tripping hazards, and improving accessibility for individuals with mobility issues.
- Client Education: Educate the client about safety measures relevant to their condition and any equipment they are using. For example, provide guidance on the safe disposal of items like insulin syringes.
- Safety for Children: When dealing with parents and caregivers of children, emphasize safety measures for toddlers, preschoolers, and young school-age children. Preventing accidental poisoning and ensuring car safety, including proper car seat use, is crucial.
- Safety for Older Adults: Older adults may face challenges such as diminished eyesight and memory impairments. Ensure their safety by providing tools like medication organizers to prevent medication errors. Display the poison control center’s phone number near the telephone.
Instructions for Laypersons in the Event of Poisoning:
In the event of suspected poisoning, follow these steps:
- Assessment: Assess the victim for airway patency, breathing, and circulation.
- Remove Foreign Material: Remove any obvious foreign material from the mouth, eyes, or body immediately.
- Identify Substance: Identify the type and amount of the ingested substance.
- Contact Poison Control Center: Call a poison control center, such as the emergency department, before attempting any interventions.
- Vomiting: If the poison control center requests it, save the vomitus and deliver it to them.
- Seek Medical Help: If advised by the poison control center operator, call for an ambulance or take the victim to an emergency department.
Providing a Secure and Safe Environment – Points to Remember:
- Agency Policies: Always follow agency policies and procedures related to client care and safety interventions.
- Prescription Verification: Verify unclear, incomplete, or inaccurate prescriptions with the primary healthcare provider.
- Client Identification: Identify clients who are at risk for injury and implement necessary safety measures to protect them.
- Staff Training: Ensure that all staff members have adequate knowledge of safety measures and procedures.
- Incident Reporting: Complete an incident report when an accident, error, or unusual event occurs to identify risk situations and improve client care.
- Fire Safety (RACE): Use the RACE mnemonic (Rescue, Alarm, Confine, Extinguish) to prioritize actions in the event of a fire.
- Fire Extinguisher Use (PASS): Remember the PASS mnemonic (Pull the pin, Aim at the fire, Squeeze the handles, Sweep the nozzle) for using a fire extinguisher.
- Electrical Equipment: Ensure that electrical equipment is well-maintained and properly grounded to prevent electrical hazards.
- Accidental Poisoning: In cases of accidental poisoning, assess the client’s airway, breathing, and circulation. Contact the Poison Control Center before attempting any interventions.
- Home Environment Assessment: Continuously assess the client’s home environment for any unsafe conditions and take appropriate measures to address them.
Incident reports: play a crucial role in healthcare by helping identify risk situations, improve client care, and ensure patient safety. Here are key points to understand regarding incident reports:
Definition and Purpose:
- Incident Report Definition: An incident report is a document completed following an unanticipated occurrence or event within a healthcare setting, such as an accident, mistake, injury, or unusual event. It is also known by other terms like “unusual event,” “irregular occurrence,” or “variance.”
- Purpose: The primary purpose of an incident report is to serve as a tool for recognizing and addressing risk situations and improving the quality of client care. It is not meant to assign blame but to facilitate learning and prevent similar incidents in the future.
- Awareness: Nurses should be aware of situations that require the completion of an incident report. This includes accidental omissions of prescribed therapies, events leading to or having the potential for client injury, falls, medication errors, needlestick injuries, procedure or equipment-related accidents, and illnesses in visitors.
- Agency Guidelines: Follow specific agency guidelines and policies for documenting incidents. These guidelines may vary from one healthcare institution to another.
- Thorough Documentation: When completing an incident report, provide a complete, accurate, and factual account of the incident. Include all relevant details, such as what happened, who was involved, the location, date, and time.
- Reporting to Primary Healthcare Provider: Contact the client’s primary healthcare provider to report the incident. In some cases, the primary healthcare provider may need to complete and sign the incident report.
- Confidentiality: Ensure that the incident report form is not copied or placed in the client’s medical record, and avoid making any reference to the completion of an incident report in the client’s official record.
- Client Record Documentation: Document a complete entry in the client’s official medical record regarding the incident. The incident report is not a substitute for documenting the event in the client’s record.
- Client Assessment: When an incident results in client injury or an error in care, assess the client frequently to monitor their condition and provide necessary care and interventions.
Incidents Requiring Documentation:
Examples of incidents that should be documented include:
- Accidental omission of a prescribed therapy.
- Circumstances leading to injury or risk of client injury.
- Client falls.
- Medication administration errors.
- Needlestick injuries.
- Procedure- or equipment-related accidents.
- Illness occurring in a visitor.
- Clutter-Free Environment: Keep open spaces, such as hallways, free of clutter to allow for easy movement and evacuation in case of a fire.
- Clear Markings: Ensure that fire exits are clearly marked and easily accessible.
- Know Emergency Resources: Familiarize yourself with the locations of all fire alarms, exits, and fire extinguishers within the facility.
- Emergency Number: Be aware of the telephone number to call for reporting fires and emergencies within your healthcare facility.
- Drill Plans: Know and understand your agency’s fire drill and evacuation plans, including your role in these procedures.
- Elevator Use: Never use elevators during a fire; they may become inoperative or take you to a dangerous location.
- Oxygen and Appliances: Turn off oxygen and any electrical appliances in the vicinity of a fire to minimize the risk of combustion.
- Life Support: If a client is on life support, maintain their respiratory status manually using an Ambu bag (resuscitation bag) until they can be safely moved away from the fire.
- RACE Mnemonic: Use the RACE mnemonic to set priorities during a fire emergency:
- R (Rescue): Remove clients from the vicinity of the fire.
- A (Alarm): Activate the fire alarm and report the fire.
- C (Confine): Close doors and windows when a fire is detected to contain it.
- E (Extinguish): Attempt to extinguish the fire using the appropriate fire extinguisher only if it is safe to do so.
- PASS Mnemonic for Fire Extinguishers: Remember how to operate a fire extinguisher with the PASS method:
- P (Pull the pin)
- A (Aim at the base of the fire)
- S (Squeeze the handles)
- S (Sweep the nozzle from side to side over the fire)
- Equipment Maintenance: Ensure that all electrical equipment is properly maintained and in good working order. It should also be grounded as needed.
- Client Equipment: Inform clients that any electrical equipment they bring into the healthcare facility must be inspected for safety before use.
- Cord and Outlet Checks: Regularly inspect electrical cords and outlets for exposed, frayed, or damaged wires and any loose or missing parts.
- Avoid Overloading Circuits: Do not overload electrical circuits with multiple devices or appliances.
- Read Warning Labels: Always read and adhere to warning labels on equipment and never operate unfamiliar devices without proper training.
- Safety Extension Cords: Use safety-type extension cords only when necessary, and secure them to the floor with electrical tape to prevent tripping hazards.
- Wiring Under Carpets: Avoid running electrical wiring under carpets, as it can pose a safety risk.
- Safe Plug Handling: Never pull a plug out of an outlet by the cord; always grasp the plug itself.
- Water Safety: Do not use electrical appliances near sinks, bathtubs, or other water sources to prevent electrical shock.
- Disconnect Before Cleaning: Always disconnect a plug from the outlet before cleaning equipment or appliances.
- Responding to Electrical Shocks: If a client sustains an electrical shock, turn off the electricity before touching the client to avoid being shocked yourself.
- Malfunctioning Equipment: If a piece of electrical equipment malfunctions, remove it from the client’s vicinity and notify hospital maintenance personnel for repair or replacement.
- Wash hands when visibly soiled, before and after each client contact, after contact with potential sources of microorganisms, before and after procedures, and before donning/removing gloves.
- Follow infection control principles during handwashing.
- Use plenty of lather and friction for at least 10 to 15 seconds, interlacing fingers, and rubbing palms, backs of hands, and fingertips.
- Dry hands from fingertips to forearms.
- Avoid splashing water on the uniform.
- Turn off faucets with a clean, dry paper towel to prevent contamination.
Donning and Removing Protective Equipment:
- Don PPE, including head caps, masks, eyewear, and gowns, as necessary, depending on the type of isolation precautions.
- Tie upper strings of the mask first, then lower strings, and pinch the metal band around the bridge of the nose.
- Ensure eyewear fits snugly.
- Tie gowns at the neck and waist.
- Remove gloves first (dirtiest items), followed by eyewear and cap, and finally, untie gown strings and remove the gown.
Donning and Removing Sterile Gloves:
- Remove the outer glove wrapper.
- Lay the inner package on a clean, flat surface.
- Put on gloves one at a time, touching only the inside surface.
- To remove gloves, grasp the outside of one cuff with the other gloved hand and pull the glove off, turning it inside out.
Setting Up and Maintaining a Sterile Field:
- Check the sterile package for integrity.
- Place the package on a clean, dry, flat work surface higher than waist level.
- Open the sterile field’s outermost flap away from your body.
- Continue opening flaps, keeping the sterile field intact.
- Add sterile items to the field without touching the field’s sterile surface.
Maintaining a Sterile Field:
- Sterile objects or fields must be touched only by sterile objects.
- Sterile objects become contaminated with prolonged exposure to air.
- Sterile objects below waist level are considered contaminated.
- If a sterile field becomes wet, it is contaminated.
- The edge of a sterile field is also considered contaminated.
Precautions for Immunocompromised Clients:
- Use strict aseptic technique for all procedures.
- Place the client in a private room with HEPA or laminar airflow filtration, keeping the door closed.
- Limit the number of staff entering the client’s room.
- Keep supplies separate and equipment for the client’s use only.
- Promote handwashing for the client, family, and healthcare providers.
- Staff and visitors with infections or exposure to communicable diseases should avoid contact.
- Reduce exposure to environmental organisms, eliminate fresh flowers, and ensure proper room cleaning.
- Assist the client with daily bathing and oral hygiene.
- Monitor vital signs, temperature, and white blood cell counts.
- Notify the primary healthcare provider of signs/symptoms of infection.
- Standard precautions should be followed with all clients in all settings.
- Transmission-based precautions are used in addition to standard precautions.
- Asepsis refers to the absence of disease-producing microorganisms.
- Medical asepsis (clean technique) aims to reduce the spread of microorganisms.
- Surgical asepsis (sterile technique) eliminates all microorganisms from an area.
- Handwashing is the most crucial technique for infection prevention.
- The order of removing protective clothing: gloves, eyewear, cap, and gown.
- Maintain a sterile field’s integrity, and never reach over it or turn your back on it.
- Sterile fields or objects can become contaminated with prolonged exposure to air or if they become wet.
- Protect immunocompromised clients by practicing strict aseptic techniques and taking measures to reduce exposure to potential contaminants.
Use of Safety Devices (Restraints):
- Safety devices are physical appliances used to limit a client’s movement or immobilize them for safety purposes.
- The goal is to create a restraint-free environment, but safety devices may be used temporarily in specific situations.
Situations for Temporary Use of Safety Devices:
- When less restrictive measures have failed.
- To ensure the physical safety of the client and others.
- Only with a prescription from the primary healthcare provider.
Types of Safety Devices (Restraints):
- Belt Restraint: Secures the client to the bed or stretcher.
- Extremity (Wrist or Ankle) Restraint: Immobilizes extremities.
- Mitten Restraint: Prevents pulling on equipment or dressings.
- Elbow Restraint (Freedom Splint): Prevents elbow flexion, often used in infants.
- Mummy Wrap or Swaddle: Restrains infants during head or neck procedures.
Complications of Safety Devices (Restraints) May Include:
- Entanglement, which can lead to asphyxiation or strangulation.
- Pressure ulcers.
- Respiratory infections.
- Urinary and fecal incontinence.
- Nerve damage.
- Circulatory impairment.
- Humiliation or loss of self-esteem.
- Fear and anger.
Devices That Allow Free Movement:
- Ambularm Device: Signals when the leg is moved into a dependent position.
- Alarmed Armband: Signals when the client wanders outside a safe area.
Alternatives to Using Safety Devices:
- Maintain client orientation to surroundings.
- Explain procedures and treatments to reduce anxiety.
- Encourage a family member or sitter to stay with the client.
- Evaluate medications for potential adverse effects.
- Limit environmental stimuli for confused or agitated clients.
- Place confused clients in rooms near the nurses’ station.
- Provide familiar objects and maintain toileting routines.
- Use relaxation techniques and promote exercise if suitable.
Legal and Ethical Guidelines on Restraints:
- Follow federal, state, and agency policies on restraint use.
- Restraints should be used only when less restrictive measures have failed.
- Restraints should not interfere with treatment or exacerbate the client’s health problem.
- Assess the appropriateness of the type of restraint.
- Informed consent may be required from the client and family.
- Renew prescriptions for safety devices as per agency policy.
Prescriptions for Using Safety Devices:
- Require a prescription from the primary healthcare provider.
- The prescription should specify the type of device, client behaviors, and a limited time frame.
- Emergency use may occur, but a prescription must be obtained as soon as possible.
Application of Safety Devices:
- Follow manufacturer’s instructions.
- Ensure the area where the device is applied won’t affect tubes or equipment.
- Pad skin and bony prominences.
- Attach the device to the bed frame, not side rails.
- Use quick-release ties for easy removal.
- Allow some slack for movement.
- Assess skin, neurovascular, and circulatory status frequently.
- Remove the restraint every 2 hours for 30 minutes for exercise and circulation.
- Continuously assess the need for the restraint and document accordingly.
Documentation of Safety Devices:
- Reason for the restraint.
- Alternatives considered.
- Method of restraint.
- Application procedure.
- Client’s response.
- Condition of restrained body part.
- Assessments of skin, neurovascular, and circulatory status.
- Duration of use, removal, and client’s response.
Points to Remember:
- Restraints should be used only when necessary, as a last resort.
- Follow legal and ethical guidelines, including obtaining prescriptions.
- Ensure safe application, frequent assessment, and documentation.
- Strive for a restraint-free environment whenever possible.
Refer to Neurological for Seizure precations
Reporting, intervening, and escalating issues related to substance abuse, improper care, and staffing practices are essential for maintaining patient safety and ensuring the quality of care. Here are the steps to follow:
- Observation and Documentation:
- Pay close attention to any signs or behaviors that indicate substance abuse, improper care, or unsafe staffing practices. Document your observations, including dates, times, locations, and individuals involved. Be as objective and detailed as possible.
- Evaluate the severity and potential risks associated with the observed issue. Consider how it may impact patient safety, the quality of care, or the overall functioning of the healthcare team.
- Immediate Response:
- If you witness an immediate threat to patient safety or care quality, take immediate action to address it. This may include:
- Intervening directly to prevent harm.
- Informing a supervisor or charge nurse.
- Initiating emergency procedures if necessary.
- If you witness an immediate threat to patient safety or care quality, take immediate action to address it. This may include:
- Discuss your observations and concerns with your immediate supervisor or charge nurse. Share the documented evidence and be prepared to provide as much information as possible.
- Report to the Appropriate Authorities:
- If the issue persists or involves substance abuse, follow your facility’s policies and procedures for reporting to higher authorities. This may include contacting your facility’s risk management, ethics committee, or an Employee Assistance Program (EAP) for substance abuse cases.
- Document the Report:
- Keep a record of your report, including the date, time, individuals involved, and the details of your communication with higher authorities.
- Follow Organizational Protocols:
- Adhere to your facility’s established protocols for addressing these issues. This may involve internal investigations, disciplinary actions, or intervention programs for substance abuse cases.
- Supportive Approach:
- Encourage individuals involved in substance abuse to seek help through Employee Assistance Programs or other appropriate channels. Ensure their privacy and confidentiality are maintained during this process.
- Advocate for patient safety and quality care by reporting and escalating concerns when necessary. Focus on the best interests of patients and the healthcare team as a whole.
- Documentation of Outcomes:
- After taking action and reporting, document the outcomes of the situation. Ensure that any necessary corrective actions have been implemented, and follow up as needed to monitor progress and prevent recurrence.
- Education and Prevention:
- Promote education and awareness within the healthcare team to prevent future occurrences of substance abuse, improper care, or unsafe staffing practices. Encourage a culture of reporting and accountability.
- Continuous Monitoring:
- Continuously monitor the situation and remain vigilant for any signs of recurrence. Report any new concerns promptly.
Remember that reporting and escalating issues related to substance abuse, improper care, and staffing practices are critical for maintaining patient safety and the integrity of healthcare services. Follow your facility’s policies and procedures and prioritize the well-being of patients and the healthcare team.
Interventions are crucial for maintaining a safe and protective environment for newborns and promoting their well-being in the healthcare setting.
Protective Environment for Newborns:
- Compliance with Regulations: Ensure that the hospital’s nurseries and neonatal care areas comply with regulations set by professional organizations such as AAP, The Joint Commission, OSHA, and local or state governing bodies.
- Mother-Baby Model of Care: In facilities implementing the mother-baby model of care (rooming-in), ensure that the newborn stays in the mother’s room to minimize the need for a separate nursery.
- Lighting and Safety: Provide adequate lighting in nurseries and eliminate potential fire hazards. Ensure the safety of electrical appliances and maintain a hazard-free environment.
- Ventilation and Temperature Control: Maintain adequate ventilation and control temperature and humidity levels within the nursery to provide a comfortable environment for newborns.
- Infection-Control Standards: Adhere to infection-control standards, including ensuring that bassinets are spaced appropriately to prevent cross-contamination.
- Hand Hygiene: Promote proper hand hygiene among healthcare workers and visitors. Ensure that healthcare workers wash their hands and use gloves as needed.
Preventing Infant Abduction:
- Infant Security Precautions: Discuss infant security precautions with mothers and their families, emphasizing the importance of checking the identity of anyone attempting to remove the baby from their room.
- Security Systems: Implement security measures to prevent infant abduction.
- Limited-Entry Systems: Many birthing facilities have limited-entry systems, including locked doors and controlled access points. These systems restrict entry to authorized personnel only, reducing the chances of unauthorized individuals gaining access to the maternity ward or nursery.
- Identification Badges: Hospital staff members, including nurses and security personnel, are required to wear identification badges prominently displayed. These badges typically include a recent photograph of the staff member, their name, and their role. This practice helps visitors and parents easily identify legitimate hospital personnel.
- Closed-Circuit Television (CCTV): Hospitals may have CCTV systems in place throughout the maternity and nursery areas. These cameras provide continuous monitoring and recording of activities, making it easier to track the movement of individuals within these units.
- Computer Monitoring Systems: Some healthcare facilities utilize computer monitoring systems that track the location of infants within the unit. These systems may include electronic tags or bracelets on infants that trigger alarms if they are taken outside specified boundaries or if they are separated from their mothers without proper authorization.
- Fingerprint Identification: In some cases, healthcare facilities use fingerprint identification pads or biometric systems to verify the identity of individuals accessing the maternity and nursery areas. This technology adds an extra layer of security.
- Infant Bracelet Security Systems: Newborns are often fitted with electronic bracelets that trigger alarms if they are moved beyond designated areas or if they are removed from the maternity ward without proper authorization. These bracelets are matched to the mother’s identification bracelet to ensure that the correct infant is placed with the correct parent.
- Security Personnel: Hospitals employ security personnel who are responsible for monitoring access points, conducting regular rounds, and responding to security alerts. They play a critical role in ensuring the safety of newborns.
- Parent Education: Hospitals educate parents about infant security precautions. Mothers and their families are taught to verify the identity of anyone attempting to remove the baby from their room. Parents are also instructed not to leave their newborn unattended in the birthing facility room.
- Infant Safety Pledge: Some healthcare facilities ask both parents and staff to sign an infant safety pledge, committing to following established security protocols and ensuring the safety of newborns.
- Staff Vigilance: Hospital staff members, including nurses and other caregivers, are trained to be vigilant and proactive in ensuring infant security. They are responsible for verifying the identity of anyone requesting access to newborns and reporting any suspicious activities promptly.
- Regular Drills and Training: Hospitals conduct regular drills and training exercises to prepare staff for potential security breaches or infant abduction attempts. These drills help staff members respond effectively in emergency situations.
- Collaboration with Law Enforcement: Healthcare facilities collaborate with local law enforcement agencies to establish protocols for responding to infant abductions. Rapid communication and coordinated efforts are crucial in such situations.
- Community Awareness: Hospitals often involve the local community in security measures. They may raise awareness about the importance of reporting suspicious activities and engaging the community in helping protect newborns.
Preventing Newborn Injury:
- Risk Assessment: Identify risk factors for newborn falls and assess the mother’s condition before allowing her to hold the infant.
- Safe Positioning: Instruct parents to place their newborns in the recommended position for sleep and educate them about potential risks.
Safe Skin-to-Skin Positioning:
- Observation: Closely observe mothers and newborns during skin-to-skin contact to ensure safety.
- Positioning: Ensure that the newborn is positioned correctly during skin-to-skin contact to maintain safety.
- Definition: A sentinel event is a significant, unexpected, and often serious adverse event that results in death or major harm to a patient. These events are considered “sentinels” because they signal the need for immediate investigation, analysis, and corrective actions to prevent their recurrence.
- Examples: Sentinel events can vary widely but often include:
- Wrong-site surgery: Performing surgery on the wrong body part or patient.
- Medication errors: Administration of the wrong medication or dosage resulting in severe harm or death.
- Patient suicide in a healthcare facility.
- Maternal death during childbirth.
- Infant abduction from a healthcare facility.
- Hemolytic transfusion reactions: Incompatible blood transfusions leading to severe harm.
- Severe burns or electrical shock incidents within the healthcare setting.Interventions For Sentinel Events:
- Notification: When a sentinel event occurs, promptly notify the appropriate hospital or healthcare organization leaders and regulatory agencies as required by policy or law.
- Immediate Response: Provide immediate care and support to the affected patient. Stabilize the patient’s condition and address any immediate healthcare needs.
- Preservation of Evidence: Preserve any physical evidence related to the sentinel event, such as medical records, lab results, equipment, and medication vials. Ensure that evidence is not tampered with or altered.
- Root Cause Analysis (RCA): Initiate a formal RCA process. Assemble an interprofessional team to conduct a thorough and unbiased analysis of the event. RCA aims to identify the root causes and contributing factors that led to the sentinel event.
- Data Collection: Collect all relevant data, including interviews with involved individuals, medical records, incident reports, and any available surveillance or monitoring data.
- Documentation: Document all findings and actions taken during the RCA process. Maintain a comprehensive record of the investigation.
- Notification to Patient and Family: Inform the affected patient and their family about the sentinel event, its causes, and the actions being taken to prevent recurrence. Provide support and answer their questions.
- Regulatory Reporting: Report the sentinel event to relevant regulatory bodies, such as The Joint Commission (TJC), state health departments, or other accrediting agencies, as required.
- Corrective Action Plan: Develop a corrective action plan based on the RCA findings. Identify specific actions to address the root causes and prevent similar events in the future.
- Implementation: Implement the corrective actions, assigning responsibilities and establishing timelines for completion. Monitor progress closely.
- Ongoing Monitoring: Continuously monitor and assess the effectiveness of the corrective actions. Make adjustments as needed to ensure sustained improvement.
- Disclosure and Transparency: Maintain open and honest communication with the patient, their family, and staff throughout the process. Foster a culture of transparency and learning from sentinel events.
- Definition: A near miss, also known as a close call or a near-hit, is an incident or situation where an error or adverse event almost occurs but is intercepted or prevented before it reaches the patient or causes harm. Near misses provide opportunities for learning and proactive prevention.
- Examples: Near misses can encompass a wide range of situations, such as:
- A nurse catching a potential medication error (e.g., wrong drug or dosage) before administering it to the patient.
- An equipment malfunction detected and addressed before it leads to harm.
- Miscommunication among healthcare providers that is corrected before affecting patient care.
- A laboratory result that is identified as erroneous and retested before diagnosis or treatment decisions are made.
- An alarm system alerting to a potential issue (e.g., oxygen saturation drop) that is addressed promptly to prevent harm.
- An incorrect patient identifier discovered before a procedure is initiated.Interventions For Near Misses:
- Identification: Identify and recognize the near-miss incident as soon as possible. Anyone involved in patient care or healthcare operations can report a near miss.
- Reporting: Encourage staff to report near misses through an established reporting system. Ensure that the reporting process is confidential, non-punitive, and easily accessible.
- Documentation: Document the details of the near-miss incident, including date, time, location, individuals involved, and a description of what happened. Accurate documentation is crucial for analysis.
- Analysis: Investigate the near miss to understand its root causes and contributing factors. Use techniques such as root cause analysis (RCA) or Failure Mode and Effects Analysis (FMEA) to determine why the near miss occurred.
- Data Collection: Gather relevant data and evidence related to the near miss. This may include interviews, documentation reviews, incident reports, and any available surveillance or monitoring data.
- Risk Assessment: Assess the potential harm that could have occurred if the near miss had not been intercepted. Use a risk assessment tool to categorize the near miss in terms of severity.
- Recommendations: Develop recommendations and corrective actions to prevent a similar near miss in the future. These actions should address the identified root causes and may involve changes to policies, procedures, training, equipment, or communication processes.
- Implementation: Implement the recommended corrective actions promptly. Assign responsibilities to individuals or teams for each action item, and establish timelines for completion.
- Monitoring: Continuously monitor and track the effectiveness of the implemented corrective actions. Ensure that they have the desired impact on preventing future near misses.
- Feedback: Provide feedback to the individuals or teams who reported the near miss and those involved in the investigation. Encourage a culture of safety and reporting.
In both cases, sentinel events and near misses, healthcare organizations typically conduct thorough investigations to understand the root causes and contributing factors. The goal is to implement corrective actions and system improvements to prevent similar incidents from occurring in the future. Reporting and analyzing these events are essential components of a culture of safety and quality improvement in healthcare. Near misses, in particular, offer valuable opportunities for proactive risk reduction and system enhancement, as they highlight vulnerabilities before harm can occur.