CHAPTER 3 SAFETY PRACTICES Copyright 2003 by Mosby, Inc. All rights reserved.

Chapter #3 Safety Practices Objectives: Define terms relating to safety practices in health care. Describe methods of Standard and Transmission-Based Isolation Precautions that prevent the spread of microorganisms. Describe the S/S of general and localized infection Identify functions of OBRA and OSHA. Describe the guidelines for good body mechanics. Describe the levels of asepsis and the principles behind each level. Copyright 2003 by Mosby, Inc. All rights reserved.

Copyright 2003 by Mosby, Inc. All rights reserved. Disease Transmission • Infection requires three elements – Source of microorganisms – A susceptible host – A means of transmission to the host Source of microorganisms – pt., other humans or inanimate objects Susceptible host – lacking sufficient resistance or be susceptible to the infecting agent Means of transmission to the host Copyright 2003 by Mosby, Inc. All rights reserved.

Methods of Transmission Contact Direct or indirect through an inanimate object Droplet Airborne Common vehicle Water, food, contaminated equipment Through vectors Mosquitoes, flies, rats, and other such vermin Contaminated – soiled, made unclear, or infected with pathogens Copyright 2003 by Mosby, Inc. All rights reserved.

Copyright 2003 by Mosby, Inc. All rights reserved. SAFETY PRACTICES Copyright 2003 by Mosby, Inc. All rights reserved.

Copyright 2003 by Mosby, Inc. All rights reserved. Infection Symptomatic (with symptoms) Asymptomatic (without symptoms) Local infection is limited to a small area of the body Systemic infection is located throughout the body Signs and symptoms of a systemic infection include fever, chills, pain, an ache or tenderness, general feeling of tiredness, and night sweats Signs and symptoms of a local infection may include redness, heat, swelling, pain, or fluid Asymptomatic – with or without expression of health S/S of local infection may include…….fluid (exudate) that is white, yellowish, or greenish Copyright 2003 by Mosby, Inc. All rights reserved.

Isolation Precautions Standard Isolation Precautions are applied to ALL patients Transmission-Based Precautions are applied to patients with known or suspected infections In 1996 the Hospital Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control (CDC) established a two-level set of guidelines for isolation precautions designed for acute care hospitals. Standard Isolation Precautions Transmission-Based Precautions Copyright 2003 by Mosby, Inc. All rights reserved.

Table 3-1 Isolation Precautions Diptheria – respiratory – acute contagious disease caused by the bacterium Corynebacterium diphtheriae. Characterized by the production of a systemic toxin and an adherent false membrane lining of the mucous membrane of the throat. The toxin is particularly damaging to the tissues of the heart and CNS, and the dense pseudomembrane in the throat may interfere with eating, drinking, and breathing. Copyright 2003 by Mosby, Inc. All rights reserved.

Box 3-2 Requirements of Standard Precautions Copyright 2003 by Mosby, Inc. All rights reserved.

Box 3-3 Bioterrorism Agents Copyright 2003 by Mosby, Inc. All rights reserved.

Antibiotic-Resistant Diseases In 2005 Centers for Disease Control Prevention listed eight diseases that have been connected to antibiotic resistance Methicillin-resistant Staphylococcus aureus (MRSA) Most relevant pathogen in the United States Main mode of transmission is via hands Copyright 2003 by Mosby, Inc. All rights reserved.

Box 3-4 Diseases Connected to Antibiotic Resistance Of the infections acquired in the hospital, the CDC reports that 70% are resistant to at least one of the drugs commonly used to threat them. 2 Factors that are associated with development of antibiotic resistance are: Overuse of antibiotic treatment Incomplete cycles of prescribed antibiotics Copyright 2003 by Mosby, Inc. All rights reserved.

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 Break the Chain Video: http://www.youtube.com/watch?v=_o9SxDFPUiA&safety_mode=true&persist_safety_mode=1&safe=active Copyright 2003 by Mosby, Inc. All rights reserved.

Handwashing Technique Copyright 2003 by Mosby, Inc. All rights reserved.

Copyright 2003 by Mosby, Inc. All rights reserved. Principles of Asepsis • Medical asepsis can be evaluated on three levels – Antiseptics, which inhibit the growth of bacteria; they can be used on the skin – Disinfectants are agents that destroy most bacteria and viruses. They can be caustic or harmful to the skin. Disinfection can be accomplished by boiling as well as by using chemical agents. – Sterile, also referred to as surgical asepsis, is a state of sterility or the use of sterile technique 3. Sterile – Sterilization is the removal of all microorganisms including viruses and endospores. Sterile technique also includes special methods of handling sterile equipment, maintaining sterile fields, changing dressings, and disposing of contaminated materials Copyright 2003 by Mosby, Inc. All rights reserved.

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 Copyright 2003 by Mosby, Inc. All rights reserved.

Copyright 2003 by Mosby, Inc. All rights reserved. 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 – Balance is the ability to maintain a steady position that does not tip Ergonomics - Design of your work station: desk & chair height. Copyright 2003 by Mosby, Inc. All rights reserved.

Copyright 2003 by Mosby, Inc. All rights reserved. Assistive 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 Copyright 2003 by Mosby, Inc. All rights reserved.

Copyright 2003 by Mosby, Inc. All rights reserved. Symbols of Access Person with a disability international symbol Wheelchair ramps Doors are wide enough to accommodate a wheelchair Elevators have Braille indicators Telephones and drinking fountains are placed at a lower height Physical devices to provide access by disabled individuals Walker Cane Wheelchair Crutches Hydraulic mechanical lifts Copyright 2003 by Mosby, Inc. All rights reserved.

3 Components Necessary for Fire Oxygen Fuel 3. Heat Copyright 2003 by Mosby, Inc. All rights reserved.

Identifying and Reporting Hazards A fire may be controlled or extinguished Oxygen and electrical equipment may be turned off 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 Copyright 2003 by Mosby, Inc. All rights reserved.

What do you do when you discover a fire? R.A.C.E. 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 lower level A = Alarm Use emergency call box or pull station C = Confine or contain fire to one area if possible E = Extinguish Use fire extinguisher Copyright 2003 by Mosby, Inc. All rights reserved.

Copyright 2003 by Mosby, Inc. All rights reserved. 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 labeled and sealed to alert workers – General Copyright 2003 by Mosby, Inc. All rights reserved.

Equipment Maintenance Report any equipment that is not working correctly or defective If defect is hazardous, equipment should not be used for patient care until it is replaced or repaired Equipment should be returned to designated storage area Emergency equipment should be restocked immediately after use Copyright 2003 by Mosby, Inc. All rights reserved.

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 Copyright 2003 by Mosby, Inc. All rights reserved.

Box 3-6 Types of Natural Disasters and Weather Events Copyright 2003 by Mosby, Inc. All rights reserved.