Transcript Chapter 3
Fundamentals of Nursing: Standards & Practices, 2E Chapter 31 Safety, Infection Control, and Hygiene Safety Safe care is a basic need of all clients, regardless of the setting. Safety has a positive association with health promotion and illness prevention. A safe environment reduces the risk of accidents, subsequent alterations in health and lifestyle, and the cost of health care services. Copyright 2002 by Delmar, a division of Thomson Learning 31-2 Factors Affecting Safety Age Lifestyle Sensory and perceptual alterations Mobility Emotional state Copyright 2002 by Delmar, a division of Thomson Learning 31-3 Types of Accidents Client behavior accidents Therapeutic procedure accidents Equipment accidents Copyright 2002 by Delmar, a division of Thomson Learning 31-4 Potential Occupational Hazards Nurses and other health care providers are at risk for injury in the workplace. The Occupational Safety and Health Administration (OSHA) has the power to enforce safety standards and to cite and discipline agencies that are not in compliance with the standards. Copyright 2002 by Delmar, a division of Thomson Learning 31-5 Some potential hazards in the workplace • • • • • • Latex allergy Blood-borne pathogens Work-related musculoskeletal disorders Chemotherapeutic agents Environmental pollution Violence Copyright 2002 by Delmar, a division of Thomson Learning 31-6 Infection Control Pathogenicity is the ability of a microorganism to produce disease. Microorganisms that produce disease are called pathogens. Infection is an invasion and multiplication of microorganisms; these microorganisms are called infectious agents. Copyright 2002 by Delmar, a division of Thomson Learning 31-7 Infectious agents that are capable of being transmitted to a client are also called communicable agents. Colonization is the multiplication of microorganisms on or within a host that does not result in cellular injury. Flora are microorganisms on the human body: resident flora, transient flora. Copyright 2002 by Delmar, a division of Thomson Learning 31-8 Chain of Infection Agent, host, and environment • • • • • Biological agents Chemical agents Physical agents Susceptible host Compromised host Copyright 2002 by Delmar, a division of Thomson Learning 31-9 Modes of transmission • • • • Contact transmission Airborne transmission Vehicle transmission Vectorborne transmission Copyright 2002 by Delmar, a division of Thomson Learning 31-10 Breaking the chain of infection • Nurses can apply proper infection control practices to interrupt the mode of transmission. • The chain of infection can also be broken by blocking or destroying the agent, blocking the portal of exit or entry, or by decreasing the host’s susceptibility. Copyright 2002 by Delmar, a division of Thomson Learning 31-11 Normal Defense Mechanisms Nonspecific immune defense • Skin and normal flora • Mucous membranes and sneeze, cough, and tearing reflexes • Elimination and acidic environment • Inflammation Copyright 2002 by Delmar, a division of Thomson Learning 31-12 Specific immune defense • Humoral immunity • Acquired immunity Vaccination Copyright 2002 by Delmar, a division of Thomson Learning 31-13 Stages of the Infectious Process Two types of infectious responses • Localized infection is limited to a defined area or single organ with symptoms that resemble inflammation. • Systemic infection affects the entire body and involves multiple organs. Copyright 2002 by Delmar, a division of Thomson Learning 31-14 Four stages of infection • • • • Incubation period Prodromal stage Illness stage Convalescent stage Copyright 2002 by Delmar, a division of Thomson Learning 31-15 Nosocomial Infections Nosocomial infections are infections acquired in the hospital or other health care facilities that were not present or incubating at the time of the client’s admission. Hospitalized clients are at risk for nosocomial infections because the environment provides exposure to a variety of virulent organisms. Copyright 2002 by Delmar, a division of Thomson Learning 31-16 Multiple-drug-resistant organisms (MDROs) have developed in both hospital and long term care clients. • Methicillin-resistant Staphylococcus aureus (MRSA) • Vancomycin-resistant enterococcus (VRE) • Tuberculosis bacilli • Clostridium difficile Copyright 2002 by Delmar, a division of Thomson Learning 31-17 Blood-borne Pathogens The risk for blood-borne pathogens in the health care setting is an increasing concern for health care providers. OSHA issued an updated 1999 directive in an effort to decrease the risks of health care workers exposed to blood-borne pathogens, specifically the human immunodeficiency virus (HIV) and the major hepatitis viruses. Copyright 2002 by Delmar, a division of Thomson Learning 31-18 Hygiene Hygiene is the science of health. Hygienic care promotes cleanliness, provides for comfort and relaxation, improves self-image, and promotes healthy skin. The health of the body’s first line of defense (skin and mucous membranes) is promoted by client hygiene. Copyright 2002 by Delmar, a division of Thomson Learning 31-19 Factors Influencing Hygienic Practice Body image Social and cultural practices Personal preferences Socioeconomic status Knowledge Copyright 2002 by Delmar, a division of Thomson Learning 31-20 Assessment Health history • Assess general health perception and management status to determine how the client manages self-care. Physical examination • Level of consciousness • Range of motion or total immobilization of an extremity Copyright 2002 by Delmar, a division of Thomson Learning 31-21 • Localized infection - redness, swelling, warmth, tenderness, pain, loss of movement • Systemic infection - fever, weakness, anorexia, nausea, vomiting, diarrhea • Secretions or exudate of the skin or mucous membranes and detection of crackles, rhonchi, or wheezes in lungs Copyright 2002 by Delmar, a division of Thomson Learning 31-22 Risk factors • Use specifically developed risk assessment tools to detect potential hazards in the environment. • In-patient clients should be assessed for fall and infection risk factors. • An injury risk appraisal can be done to determine the client’s level of safety in the home. Copyright 2002 by Delmar, a division of Thomson Learning 31-23 Diagnostic and laboratory data • Assessing risk for injury should also include an evaluation of blood profile to detect abnormal findings, such as altered clotting factors, anemic conditions, or leukocytosis. Copyright 2002 by Delmar, a division of Thomson Learning 31-24 Nursing Diagnosis Risk for Injury Risk for Infection Self-Care Deficit Clients who are at risk for injury and infection or have a self-care deficit may have other problems as well. Copyright 2002 by Delmar, a division of Thomson Learning 31-25 Outcome Identification and Planning The goal is to manipulate the external environment to reduce the risk of injury and infection. Another critical element of the care plan is client/caregiver education related to the identification of potential hazards and health promotion practices. Copyright 2002 by Delmar, a division of Thomson Learning 31-26 Implementation Raise safety awareness and knowledge Prevent falls • Apply restraints - review Procedure 311 • Ensure adequate lighting • Remove obstacles Copyright 2002 by Delmar, a division of Thomson Learning 31-27 Reduce bathroom hazards Prevent fire Ensure safe operation of electrical equipment Reduce exposure to radiation Prevent poisoning Reduce noise pollution Copyright 2002 by Delmar, a division of Thomson Learning 31-28 Ensure asepsis • Medical asepsis Handwashing - review Procedure 31-2 • Surgical asepsis Sterile field - review Procedure 31-3 Donning sterile gloves - review Procedure 31-4 Copyright 2002 by Delmar, a division of Thomson Learning 31-29 Donning surgical attire - review Procedure 31-5 Surgical handwashing - review Procedure 31-6 Gowning and closed gloving - review Procedure 31-7 Copyright 2002 by Delmar, a division of Thomson Learning 31-30 Reduce or eliminate infectious agents • • • • Cleansing Disinfection Sterilization Disposal of infectious waste Copyright 2002 by Delmar, a division of Thomson Learning 31-31 Practice standard and isolation precautions - review Procedure 31-8 for initiating strict isolation precautions • Contact precautions • Droplet precautions • Airborne precautions Copyright 2002 by Delmar, a division of Thomson Learning 31-32 Alternative therapies • Herbal baths Bath for specific body part Full body bath • Herbs for infections Copyright 2002 by Delmar, a division of Thomson Learning 31-33 Provide for client bathing needs • Cleaning baths Shower Tub bath Self-help bath Complete bed bath - review Procedure 31-9 Partial bath Copyright 2002 by Delmar, a division of Thomson Learning 31-34 • Therapeutic bath Hot- or warm-water tub bath Cool or tepid bath Sitz bath Copyright 2002 by Delmar, a division of Thomson Learning 31-35 Provide clean bed linen • Unoccupied bed - review Procedure 31-10 • Occupied bed - review Procedure 3111 Provide skin care • Perineal care - review Procedure 31-12 Copyright 2002 by Delmar, a division of Thomson Learning 31-36 Offer back rubs Provide foot and nail care Provide oral care - review Procedure 31-13 Provide hair care Provide eye, ear, and nose care review Procedure 31-14 for eye care Copyright 2002 by Delmar, a division of Thomson Learning 31-37 Evaluation Keeping the client free from injury and infection requires frequent reassessment through the use of risk appraisals. Timely adjustments must be made in the plan of care in order for nursing interventions to be effective. Copyright 2002 by Delmar, a division of Thomson Learning 31-38 It is imperative that the client is helped to develop an awareness of the internal and external factors that increase the risk for injury. Adherence to barrier precautions is critical in preventing the spread of infectious agents. Copyright 2002 by Delmar, a division of Thomson Learning 31-39 The therapeutic value of hygiene is maximized when the client can participate and is kept free from infection and alterations in skin integrity. Copyright 2002 by Delmar, a division of Thomson Learning 31-40 At the time of discharge from the hospital, appropriate referrals should be made to home health care agencies to assist the client in achieving optimum functioning levels for safety and hygienic practices. Copyright 2002 by Delmar, a division of Thomson Learning 31-41 Clients at risk for infection should have follow-up visits by the home health nurse to measure the effectiveness of client teaching and resources in the home to prevent the transmission of infections. Copyright 2002 by Delmar, a division of Thomson Learning 31-42