1. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 1 CHAPTER 3 SAFETY PRACTICES

2. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 2 Chapter 3 Learning Objectives  Define at least 10 terms relating to safety practices in health care.  Describe the infectious process and methods to prevent infection.  Describe the signs and symptoms of general and localized infection.

3. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 3 Chapter 3 Learning Objectives  Describe the methods of Standard and Transmission-Based Isolation Precautions that prevent the spread of microorganisms.  Describe three levels of medical asepsis.  List at least three principles of surgical asepsis.

4. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 4 Chapter 3 Learning Objectives  Identify the functions of OBRA and OSHA.  Describe the guidelines for using good body mechanics.

5. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 5 The Infectious Process  Infection requires several elements:  A disease microbe (agent)  A reservoir where the microorganism can live  A way of exit or escape from the reservoir  A way for transmission or transfer to the host  A way of entry into the host  A susceptible (vulnerable) host

6. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 6 Methods of Transmission  Contact  Direct or indirect through an inanimate object  Droplet  Airborne  Common vehicle  Water, food, or contaminated equipment  Through vectors  Mosquitoes, flies, rats, and other vermin

7. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 7 Infectious Process FIGURE 3-1 Infectious process

8. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 8 Infection  Symptomatic  Asymptomatic  Local infection  Limited to a small area of the body  Systemic infection  Located throughout the body

9. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 9 Signs and Symptoms of a General Infection  Fever  Chills  Pain  Ache or tenderness  General feeling of tiredness  Night sweats

10. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 10 Signs and Symptoms of a Local Infection  Redness  Heat  Swelling  Pain  Fluid

11. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 11 Isolation Precautions  Standard Isolation Precautions are applied to all patients.  Transmission-Based Precautions are applied to patients with known or suspected infections.

12. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 12 Evolution of Infection Control Procedures

13. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 13 Transmission-Based Universal Precautions

14. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 14 Requirements of Standard Precautions

15. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 15 Personal Protective Equipment (PPE) Used in Universal Precautions  Gloves  Gowns  Aprons  Masks  Protective eyewear Signs are placed outside a patient’s room to indicate which type of PPE is needed.

16. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 16 Gloving  Sterile gloves  May be required to protect the patient during care or procedures  Nonsterile gloves  Worn when contact is made with Body fluids Body fluids Mucous membranes Mucous membranes Wet secretions Wet secretions

17. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 17 Antibiotic-Resistant Diseases  In 2005, the Centers for Disease Control Prevention (CDC) listed eight diseases exhibiting antibiotic resistance.  Methicillin-resistant Staphylococcus aureus (MRSA)  Most relevant nosocomial pathogen in the United States  Main mode of transmission is on hands

18. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 18 MRSA

19. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 19 Diseases Associated with Antibiotic Resistance

20. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 20 Factors Associated with Antibiotic Resistance  Overuse of antibiotic treatment  Incomplete cycles of prescribed antibiotics

21. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 21 Handwashing Technique  Hands are washed thoroughly  At the beginning of the work period  Between each client contact  Before and after eating  Before and after using the restroom  Before leaving the work environment  Gloves are worn when contact is made with body fluids, mucous membranes, or wet secretions.

22. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 22 Handwashing Technique FIGURE 3-2 Handwashing technique. A, Keep the hands lower than the arms during the procedure. (From Kinn MF, Woods M: The medical assistant, ed 8, Philadelphia, 1999, Saunders.)

23. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 23 Handwashing Technique FIGURE 3-2 Handwashing technique. B, In addition to soap and water, friction or rubbing also cleans the skin. (From Kinn MF, Woods M: The medical assistant, ed 8, Philadelphia, 1999, Saunders.)

24. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 24 Handwashing Technique FIGURE 3-2 Handwashing techniqueC, Rinsing hands thoroughly prevents skin irritation from soap. (From Kinn MF, Woods M: The medical assistant, ed 8, Philadelphia, 1999, Saunders.)

25. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 25 Principles of Asepsis  Medical asepsis can be evaluated on three levels:  Antiseptics, which inhibit the growth of bacteria Can be used on the skin Can be used on the skin  Disinfectants, which are agents that destroy most bacteria and viruses Agents can be caustic or harmful to the skin. Agents can be caustic or harmful to the skin. Disinfection can be accomplished by boiling and by using chemical agents. Disinfection can be accomplished by boiling and by using chemical agents.  Sterility, also referred to as surgical asepsis, is a state of sterility or the use of sterile technique.

26. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 26 Omnibus Budget Reconciliation Act (OBRA) Regulations  OBRA requires training for nursing assistants:  Completion of a written examination  Demonstration of ability to perform skills correctly  Continuing education  Periodic evaluation of performance  Retraining if the nursing assistant does not work in the field for 2 years or more at one time

27. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 27 Occupational Safety and Health Administration (OSHA) Regulations  To establish standards of safety for the workplace and to enforce the standards  To research and provide documentation to OSHA regarding the safe level of exposure to hazards in the workplace

28. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 28 Material Safety Data Sheet (MSDS)

29. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 29 Workplace Hazards

30. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 30 Safe Movement  Body mechanics  Refers to the way the body is moved to prevent injury to oneself and to others  Accomplished by using knowledge of proper body alignment, balance, and movement  Posture is the position of body parts in relation to each other.

31. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 31 Safe Movement  Balance is the ability to maintain a steady position that does not tip.  Ergonomics refers to the design of equipment that minimizes fatigue and discomfort.

32. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 32 Assistive Devices  Devices allow mobility while preventing injury.  Gait belt Worn by the patient when transferring or ambulating Worn by the patient when transferring or ambulating Strong cloth belt Strong cloth belt  Provides a firm grasping area  Protects patient from trauma to the skin  Health care worker may also wear a belt to prevent back injury.

33. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 33 Symbols of Access  Wheelchair ramps  Doors wide enough to accommodate a wheelchair  Elevators that have Braille indicators  Telephones and drinking fountains placed at a lower height

34. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 34 Identifying and Reporting Fire Hazards  Health care workers are responsible for preventing and reacting to fires to protect patients  Be familiar with the policy for fire response.  For a fire to burn, it must have oxygen, fuel, and heat.  Fire may be controlled or extinguished if one of these factors is removed.

35. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 35 RACE  R = Rescue  Move patients from the point of origin of the fire. Horizontal – moving patients through one set of fire doors on the same floor Horizontal – moving patients through one set of fire doors on the same floor Vertical – moving patients down stairs to a lower level Vertical – moving patients down stairs to a lower level  A = Alarm  Use emergency call box or pull station.  C = Contain  Confine or contain the fire to one area if possible.  E = Extinguish  Use a fire extinguisher.

36. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 36 Four Classes of Chemical Fire Extinguishers  Class A  For use on paper, wood, trash, cloth, upholstery, rubber, and similar materials  Class B  For use on fuel oil, gas, paint, solvents, and other flammable liquids  Class C  For use on electrical equipment, fuse boxes, wiring, and appliances  Class D  For use on metals

37. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 37 PASS Guidelines for Fire Extinguisher Use

38. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 38 Hazardous Waste Waste is divided into two categories:  Biomedical Hazardous and infectious waste is placed in sealed bags before removing it from the area of use. Hazardous and infectious waste is placed in sealed bags before removing it from the area of use. The bag is sealed and labeled to alert workers. The bag is sealed and labeled to alert workers.  General

39. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 39 Chemical Safety  Chemicals should be stored in a way to prevent exposure, property damage, and liability.  Chemicals are stored in amounts that can be used in a reasonable period.  Some chemicals change over time.  The amount stored should meet fire code limits.

40. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 40 Chemical Safety  Workers using these chemicals must be aware of correct use, proper disposal, and the risks associated with them.  Emergency treatment and procedures for improper exposure should be known.

41. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 41 Equipment Maintenance  Report any equipment that is not working correctly or that is defective.  If defect is hazardous, equipment should not be used for patient care until it is replaced or repaired.  Equipment should be returned to the designated storage area.  Emergency equipment should be restocked immediately after use.

42. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 42 Emergency Disaster Procedure  Personnel from all areas of health care are asked to assist the community during a natural disaster, severe weather, or bioterrorism.  Department of Homeland Security has established the National Response Plan to be implemented, if necessary.

43. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 43 Types of Natural Disasters and Weather Events

44. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 44 Emergency Preparedness

45. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 45 Summary  A local infection is limited to a small area of the body and may cause redness or warmth at the site.  A systemic infection may cause fever, chills, or a feeling of tiredness.

46. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 46 Summary  Standard Precautions include the procedures used to prevent the spread of microorganisms.  Primary method used is good handwashing technique.  Transmission-Based Precautions are used in addition to Standard Precautions and are determined by the type of infection present.

47. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 47 Summary  Three levels of asepsis include  Antiseptic  Disinfectant  Sterile  OBRA is the federal agency that regulates training of nursing assistants.  OSHA establishes and enforces standards of safety for the workplace.

48. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 48 Summary  Guidelines for maintaining good body mechanics include  Using bent knees  Keeping a broad base  Keeping the back straight