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 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. If it’s wet and it’s not yours….protect yourself!
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 Gown Mask
Goggles/face shield
Gloves
Gloves
Goggles/face shield
Gown
mask

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?