CHAPTER 3 SAFETY PRACTICES

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 Discuss why it is important to understand the infectious process. Discuss the terms “agent”, “reservoir”, “host”, and ask students to give examples of each.

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 Ask the students to give examples for each method of transmission. How can these transmission methods be controlled?

Infectious Process For infection to occur, all six of the elements must be present in order. How can the chain of infection be broken? FIGURE 3-1 Infectious process

Infection Symptomatic Asymptomatic Local infection Systemic infection Limited to a small area of the body Systemic infection Located throughout the body Discuss differences between the terms symptomatic and asymptomatic. Discuss differences between a local infection and a systemic infection. Give examples. Ask students to share types of local infections or systemic infections they have experienced.

Signs and Symptoms of a General Infection Fever Chills Pain Ache or tenderness General feeling of tiredness Night sweats Have the students give examples of types of infections that may have these signs or symptoms.

Signs and Symptoms of a Local Infection Redness Heat Swelling Pain Fluid Give examples of infections for these signs and symptoms.

Isolation Precautions Standard Isolation Precautions are applied to all patients. Transmission-Based Precautions are applied to patients with known or suspected infections. Discuss the importance of having isolation precautions in place. How are standard isolation precautions and transmission-based precautions different?

Transmission-Based Universal Precautions

Requirements of Standard Precautions Standard Precautions combine features of Universal Precautions (UP) and Body Substance Isolation guidelines previously used. Standard Precautions apply to all patients at all times. Standard Precautions apply to all body fluids except perspiration. Discuss examples of body fluids.

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. The type of PPE used is determined by assessing the risk of transfer of microorganisms to and from the patients. Discuss the importance of placing PPE signs outside a patient’s room.

Gloving Body fluids Mucous membranes Wet secretions Sterile gloves May be required to protect the patient during care or procedures Nonsterile gloves Worn when contact is made with Body fluids Mucous membranes Wet secretions Why is it important to change nonsterile gloves from one patient to another? Emphasize that hands are washed immediately after removing gloves.

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

MRSA MRSA is the most relevant nosocomial pathogen in the United States. Main mode for transportation of MRSA to patients is on hands.

Diseases Associated with Antibiotic Resistance Discuss prevention and current treatments of each of the diseases associated with antibiotic resistance. (MRSA was discussed in the previous slide.)

Factors Associated with Antibiotic Resistance Overuse of antibiotic treatment Incomplete cycles of prescribed antibiotics Lead a discussion on the overuse of antibiotic treatment. Discuss what can happen with an incomplete cycle of prescribed antibiotics.

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.

Handwashing Technique Discuss step-by-step handwashing technique in this slide and the following two slides. 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.)

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.)

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.)

Principles of Asepsis Medical asepsis can be evaluated on three levels: Antiseptics, which inhibit the growth of bacteria 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. 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.

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 Discuss each of the training regulations, and ask students why is it important to have each these training regulations.

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 How does OSHA function to protect the workplace?

Material Safety Data Sheet (MSDS) What is the purpose of MSDS? What is “right to know” information?

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. Why is the use of proper body mechanics important in the health care environment?

Assistive Devices Devices allow mobility while preventing injury. Gait belt Worn by the patient when transferring or ambulating 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. Discuss how gait belts help prevent injuries to the patient and to the health care worker. Have the students practice using a gait belt.

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. Locate and discuss fire response policy for your facility or school.

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 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. Discuss importance of remembering the acronym RACE.

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 Discuss importance of using different classes of chemical fire extinguishers to extinguish specific types of fires. If possible, have available examples of the four classes of fire extinguishers to show students.

PASS Guidelines for Fire Extinguisher Use Discuss the PASS acronym and have students volunteer to demonstrate how to use a fire extinguisher.

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. • The bag is sealed and labeled to alert workers. General Obtain empty biomedical bags to show to the students. Discuss how they are labelled and sealed.

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.

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.

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.

Emergency Disaster Procedure Personnel from all areas of health care are asked to assist the community during a natural disaster, severe weather, or bioterrorism. Discuss types of emergency procedures that are in place in your own community.

Types of Natural Disasters and Weather Events Discuss what types of natural disasters may occur in your own local area.