Nclex- Safety and Infection Control PDF

Preview

Summary

shgchfgsdhgfhgjdsgjcgsdgj...

Description

Safety and Infection Control General Information Safety and Infection Control, a key subpart of Safe and Effective Care Environment, addresses the nurse’s ability to manage care with the best practices of reducing hazards while providing both emergent and non-emergent responses to numerous situations.

Prevention Nurses are key players in the prevention of hazards to patient care including infection, accidents, injuries, and medical errors. In addition, nurses must know and practice principles that ensure the safety of healthcare personnel such as proper ergonomics, safe use of all equipment and technology, and proper handling of infectious and hazardous materials. Promoting safe measures begins prior to a patient’s admission. This includes inspecting the environment, planning for potential scenarios, and anticipating where errors may occur. Nurses should understand their role in an emergency response or security emergency situation. When the patient is admitted, the nurse must immediately identify any patient-specific risk factors that may increase the chances of error. Developmental factors, as well as a patient’s lifestyle and knowledge of safety precautions, will factor into this assessment. Finally, nurses should investigate future safety concerns that may impact patients after discharge, in their homes and in the community. Taking measures at every step of the patient admission process helps to prevent catastrophic safety events from occurring.

Age-Related Safety Factors Nursing review of patient safety issues should begin with knowledge of the age-specific or developmental risks associated with each of these age groups: Infants— Parental safety education and implementation are the core of infant safety. Nurses must educate parents on safety measures to take in order to protect their infants. This includes instructing parents on proper carseat placement/strapping, childproofing homes, and safe sleep. The American Academy of Pediatrics recommends that infants stay in a rear facing car seat until age 2. State law may vary and nurses should know the laws for their state. Nurses and parents alike should monitor infants closely to avoid contact with choking hazards, falling hazards, and hot items or liquids. Toddlers— Fully mobile and curious about the world around them, toddlers are at increased risk for poisoning, choking, and drowning. Inform parents and caregivers about proper safety precautions including child-proofing cabinets and drawers where hazardous medications or potential poisonous cleaners are kept. Car seats should be

rear-facing in the back seat of the vehicle until age 2. Toddlers should also remain in a 5-point harness until the child reaches the top height or weight limit allowed by the seat (generally ages 4–7 years). Be sure to follow specific car seat standards in your state. School-age children— Independence grows as more time is spent at school and with friends. This age group needs education and guidance on water, fire, and traffic safety as well as the dangers of strangers. Car seats and/or boosters are typically required by law until the child is 4’9” or 80 pounds (whichever comes first). Although this is usually between the ages of 8 and 12, requirements vary by state. Know the laws that are applicable to the geographic location of practice. Adolescents— Independence, impulsivity, and a sense of invincibility create many risks in this age group. Motor vehicle safety (both as driver and passenger) should be reviewed as well as the dangers of alcohol and substance abuse. Sexual health information and safe sex practices should also be discussed. Adults— Many different risks exist for this group that relate to home, workplace, and leisure activities. In general, review the specific risks as they relate to motor vehicles, fire, and the use of firearms. Older adults— Declines in physical and cognitive abilities increase the risks of falls as well as side effects with medications. In the older population, reaction times become delayed increasing the risk of car accidents, falls, and burns. If caregivers are used or present in the home, the risk of elder abuse must be discussed with the patient to promote awareness and safety.

Environmental Considerations Regardless of patient age, nurses must be familiar with the safety risks and principles of accident prevention relative to the patient’s care environment. Allergies— Patients of all ages can have allergies. Common allergy categories include environmental allergies, medication allergies, food allergies, and latex. Inquire about patient allergies when working with patients to ensure appropriate documentation and avoidance of any possible triggers. Anaphylactic reactions provide serious bodily reactions in response to allergen exposure. If not treated correctly and immediately, these reactions may lead to death. Nurses must learn to recognize early signs of allergic and anaphylactic reactions, including numbness or tingling around a body part (especially lips, mouth, or tongue are extremely serious), swelling, increased work of breathing, tachycardia, and hypotension. Assistive equipment— Nurses will likely encounter patients with medical, assistive equipment, such as hearing aids, visual aids, braces, or other medical aids (i.e., medicine pumps, oxygen, feeding tubes, etc.). Nurses should thoroughly document and support the patient’s equipment as reasonable as possible. Patients able to see, hear, and ambulate safely are less likely to be at risk for injury. Fall prevention program— In the hospital, falls are most common among infants and the elderly. Know the elements of such a program and the steps that are taken based on the age of the patient. Common prevention strategies include clearing any

obstacles in the room (i.e., power cords, unnecessary equipment, and trash), placing infants in high-sided cribs with rails fully elevated, and cleaning up spills and trash from all walkways. Seizure precautions— For those at risk, know the proper steps to ensure patient safety during and after a seizure. Remember to assist patients into a side-lying position if they are seizing to avoid aspiration of secretions or vomit. Suction and oxygen equipment— Ensure that there is proper access to suction and oxygen in every hospital room. Many non-hospital facilities have designated ports for oxygen and suction to support their patients as needed. Patients that may require suctioning or oxygen support include those with seizure disorders, swallowing disorders, respiratory illnesses, artificial airways, and/or cardiac insufficiency. Use of restraints— Restraints may be used to limit mobility in those at increased risk of falls and seizures as well as in those who pose a safety threat to themselves, other patients, or medical staff. In the event of all preventative interventions or therapies, ensure that actions taken have been appropriately documented; the actions are appropriate for the patient population intended; and the actions do not increase the risk of other harmful situations.

Infection Control The definition of an etiologic agent is any pathogen that is capable of causing infection. These may include: bacteria, fungi, protozoa, rickettsiae , and helminths, among others. Understanding the chain of infection or how infection is spread is critical to understanding the methods and precautions used to prevent it. This involves the following six elements: Pathogen— An infection-causing agent, such as a bacteria or a virus. Reservoirs— An animate or inanimate environment that provides a favorable place for pathogens to grow and reproduce. Examples of human systems that serve as reservoirs include the blood, respiratory, gastrointestinal, reproductive, and/or urinary systems. Portal of exit— Any place where an infectious agent leaves a host. The above-named human systems may also serve as portals of exit for the organisms they harbor. Method of transmission— The way that an infectious organism is transferred from the reservoir to another susceptible host. There are three main methods of transmission: direct contact, indirect contact with a vector (carrier item), or via the air (airborne). Portal of entry— The place where an infectious agent enters a susceptible host. Portals of entry may also be systems that act as reservoirs for pathogens. Susceptible host— A patient, medical staff member, or other person who is at risk for infection.

Emergency Response Plan Every healthcare facility is required by the Joint Commission to have an emergency response plan. Every facility and its staff will be required to periodically perform emergency drills to assess the efficacy of the response teams. Fire safety, natural disasters, and mass casualty events are some of the possible scenarios where nurses will need to know their designated emergency response roles. Nurses may also be involved in community outreach and planning of emergency preparation such as natural disaster, bomb threat, and mass casualty.

Nurse Responsibilities Nursing responsibilities in the emergency response plan will vary, but most likely include ensuring the safety of the patients, securing the facility, and/or helping to eliminate the threat of further harm or danger to the patients and staff. Nurses may be assigned to triage, treatment, or discharge roles to ensure appropriate flow and care of patients. Patient safety should always be the priority. Nurses must determine how many and what types of interventions their patients will need. Patients should be identified from most critical to least critical. The least critical patients may be able to ambulate, have decreased equipment needs, and may even heed early discharge in the event of opening bed space for new admissions.

Fire Safety In the event of a fire, patients must first be moved out of harm’s way. After the patients are relocated to a safe space, the nurse may then contain the fire and evacuate patients out of the facility, if necessary. Nurses will need to assess which patients will require bed/stretcher evacuation (horizontal transfer) as well as those who will be able to ambulate or use wheelchairs. A nurse will also be expected to educate and counsel patients on fire safety in the home, including important emergency numbers, installing/maintaining smoke alarms, and acquiring fire extinguishers.

Ergonomic Principles Nurses must utilize proper ergonomic principles when assisting patients to protect themselves from injury. Patients should also be educated on proper ergonomic principles to prevent injury while ambulating or transferring from different surfaces. These principles will be heavily incorporated into the nursing care plan for each patient.

Protecting Patients Assessment of the patient’s baseline abilities will help the nurse design a proper care plan that includes the use of assistive devices such as walkers, crutches, and canes. If the patient has a repetitive stress injury, the nurse will need to instruct him or her as to

the proper body positions to help prevent aggravation or reinjury. For more targeted conditions that involve single skeletal or muscular groups, the nurse can provide instruction on proper positioning and stretches that help relieve stress on the area.

Protecting Yourself Using proper lifting techniques (lifting from the legs and not overextending the body) and assistive devices (gait belts, thera bands, crutches, electronic transfer devices, etc.) for patients will help the patient, nurse, and support staff avoid injury. Be aware of and utilize proper postures and body positions when performing daily functions at technology-based workstations (desktop and/or mobile computers).

Hazardous Materials Nurses have a responsibility to practice safe and proper handling of patient care equipment, potentially infectious/biohazardous materials, as well as hazardous chemicals that are present in the workplace setting.

Identifying Hazardous Materials Prior to handling or disposing of any material, the nurse must first determine if the material is hazardous. Common hazards include biohazardous, flammable, and infectious materials. Biohazardous material includes human body fluids, microbiological waste (lab waste contaminated with concentrated, infectious agents), animal waste, and pathological waste. Flammable items may include equipment, frayed electrical cords, specific medications, oxygen and oxygen tubing. Infectious agents are often also biohazardous and may include human bodily fluids, materials in contact with ill patients, and cross contamination of materials.

OSHA The Occupational Safety and Health Administration (OSHA) is an organization that focuses on work-place safety and health. One of their jobs is to regulate written standards that discuss the proper standard precautions that should be taken to protect against blood-borne pathogen exposure. For example, OSHA has determined protocols for workplaces to follow in the event of patient infection, isolation precautions, standards of environmental infection control, nurse injury (i.e., needle stick), and latex allergy. OSHA also has developed a system of Safety Data Sheets (SDS, previously Material Safety Data Sheets or MSDS) that describe the nature and potential hazards of all chemical agents present in an employment setting. These threats include chemical, environmental, or viral exposures that may increase the risk of specific health concerns or illnesses.The nurse should be aware of their existence and how to access them in the event of an exposure.

CDC and Standard Precautions Part of OSHA’s written standards include the Centers for Disease Control and Prevention (CDC) recommendations for the use of standard precautions. These are patient care standards that detail how to protect staff from blood-borne pathogens. The use of personal protective equipment (PPE), such as gloves as well as face and eye protection, should be utilized and followed in every patient encounter and especially in emergency/disaster response. OSHA also mandates that certain infectious diseases— such as sexually transmitted infections, vaccine-preventable illness, international outbreaks (Ebola, Zika, Yellow Fever, etc.), and others—be reported to the CDC to track concerns for outbreaks, incidence, and prevalence of infection in the population.

Needlestick Safety and Prevention Act The Needlestick Safety and Prevention Act is an important piece of legislation that was enacted to protect workers in the healthcare setting. Safe disposal of all sharps materials should be practiced with the use of mandated, marked biohazardous sharps containers in patient care areas and medication preparation stations. Never recap needles, and avoid bending or breaking them prior to disposal.

Internal Radiation Therapy Internal radiation therapy may increase the risk of radiation exposure to those near to and caring for the patient. This type of therapy is most often used in oncology for the treatment of cancers of the prostate, rectum, or uterus. Internal radiation is a form of implantable therapy where activated pellets, seeds, ribbons, wires, needles, capsules, balloons, and/or tubes are used to slowly administer radiation to the area intended. It helps to provide closer management of cancerous lesions that are difficult to externally radiate. After implantation of the radiated objects, the patient’s body may release low doses of radiation through the duration of therapy. Nurses should educate patients undergoing internal radiation therapy to limit visitors, stay a distance away from others, and avoid pregnant women and children until the implants are removed. The effects of radiation will slowly dissipate over a few weeks to months, and after the removal of the implants, the patient will no longer emit radiation.

Home Safety Nurses play an important role in the identification, recommendation, and implementation of safety practices and equipment that are necessary for patient safety in the home environment. Patients and their families will often be involved in and work with the nurse in this process. Nurses also implement home safety by teaching patients proper selfcare and reviewing issues relating to the safe care of children. In the home, nurses should assess the need for walkway lighting, fire alarm maintenance, handrails, safe kitchen tools, and reduction of fall hazards (i.e., power cords, floor pillows, rugs, etc.). Preventive home safety measures can also include the patient’s use of protective equipment when using potentially dangerous devices at home such as using oven mitts

to avoid burns, donning eye protection goggles when using power tools, and wearing helmets when riding bicycles or ATVs.

Reporting Incidents Incident reporting is another responsibility of nursing staff. Skills of accurately and objectively reporting the events leading up to, during, and resulting from the incident are required to properly document it. Common incidents to report include near misses, medication error, substance abuse, improper care, staffing practices, and other treatment errors. The overall goal of incident reporting is to prevent further injury and repetition of the event in the future. Each facility will likely have its own procedures for this process. Copies of the incident report are never included in the medical record. However, the nurse should still document the simple facts of an incident in the patient’s chart. Unsafe practice reporting— When a nurse witnesses unsafe practices of other healthcare personnel, he or she is responsible for reporting it to the appropriate overseeing agency, both at the nurse’s individual facility and to the state’s credentialing board. Intervention during unsafe practices— To keep patients from harm, the nurse must identify and intervene appropriately when witnessing potentially unsafe actions of other healthcare team members. This may include confronting an individual and/or involving management nursing staff in the event.

Equipment Use Nurses must ensure the safe and proper usage of all equipment involved in patient treatment and care. The nurse may be responsible for regular inspections as well as proper patient instruction if he or she needs to use the equipment at home. Monitor for fraying electrical cords, loose or missing parts on equipment, and broken equipment. If the equipment is found to be unsafe or malfunctions, the nurse must immediately stop using it, label it unsafe to use, and make sure it is placed in a location inaccessible to patient care. If possible, put it in a specially designated area for malfunctioning equipment and notify the proper personnel of the problem.

Security Plan A nurse will be asked to perform the critical task of identifying patients in need of urgent care in the event of a natural disaster or emergency.

The Triage Exam The purpose of the triage exam is to identify patients who need life-saving care and ensure they are the first patients to receive further evaluation and treatment. It will focus on the following areas in order of their importance:

1. Airway— Ensure the patient’s airway is clear and open if necessary. 2. Respiration— Assess for signs and symptoms of respiratory distress. 3. Quality of respiration— Assess the rate and effort of breathing and check for signs of adequate air exchange (capillary refill, color of skin, and lips). Auscultate for breath sounds. 4. Pulse— Identify a pulse and note its rate and strength. 5. External bleeding— Look for signs of significant wounds or injuries in areas with major blood vessels. 6. Blood pressure— Obtain a blood pressure. 7. Consciousness, pupillary response, and state of extremities— Assess the patient’s neurological status with his or her level of consciousness, pupillary response to light and signs of paralysis, or posturing of the extremities.

Specific Emergency Plans Nurses will also have critical roles in the event of facility evacuations, newborn nursery security events/lockdowns , and violence threats or controlled access limitations. Routine drilling may be available at facilities to practice ...