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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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!

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

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

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

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

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

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

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)

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

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

Questions?