CHAPTER 3 - SAFETY PRACTICES

BOOKLETS Define: Antiseptic Ergonomics Sterile Asepsis Pathogen Nosocomial pathogens Contaminated Standard Precautions Disinfectant Transmission Based Precautions What are the three elements of infection, and write out a scenario, with examples, of how this could occur (first sentence of chpt) Please list the different types of isolation, what diseases require which level of isolation, & what is worn for each Medical asepsis can be evaluated in which 5 levels; please write what each level involves (see table 3-1) What are OBRA & OSHA, & what do they oversee? What do RACE & PASS stand for Compare the signs & symptoms of a local vs. general infection

Disease Transmission • Infection requires several elements: Pathogenic agent A reservoir Method of escape from the reservoir Mode of transmission or transferring to the host A way of entry into the host A susceptible host

The Infection Process The microbe/agent is anything that can cause communicable disease such as bacteria, virus, fungi, or animals like worms The source or reservoir may be the patient, other people, or inanimate objects like a doorknob Modes of transmission are contact (touching contaminated object), droplet (sneeze), airborne (TB, Chicken Pox), and vectors like mosquitoes or ticks Method of entry could be a mosquitoes bite, an open sore or a mucus membrane A susceptible host that does not have enough resistance to fight infection, due to illness or poor health

Primary Methods of Transmission Contamination: Soiled, unclean, or infected by pathogens Contact: Direct or indirect through an inanimate object Droplet: Spread thru droplets (sneeze/cough; ex: pneumonia) Airborne: in the air Common vehicle: Water, food, contaminated equipment Vectors: mosquitoes, rats, vermin

Disease Transmission The infectious process

Signs and Symptoms of a General Infection Fever Chills Pain An ache or tenderness General feeling of tiredness Night sweats

Signs and Symptoms of a Local Infection Redness Heat Swelling Pain Fluid

Standard Precautions Standard Precautions are applied to ALL patients, ALL body fluids, ALL the time! Designed to reduce the transmission of microorganisms. Isolation Precautions are applied to patients with known or suspected infections http://www.youtube.com/watch?v=VlUWsNC3ibs

http://www.dnatube.com/video/2829/Hand-Washing--About-the-Hand-Washing-Technique-for-Nurses

Table 3-1 Isolation Precautions Airborne--Measles, varicella, tuberculosis Droplet--pneumonia

Requirements of Isolation Precautions If an employee is contaminated with body fluids from a patient with a known disease, employee must be seen in the ER within 2 hours

Box 3-3 Bioterrorism Agents Ex: Anthrax, Plague, Smallpox http://www.youtube.com/watch?v=1iXfZ1eYdtA

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) multi drug resistant Most relevant nosocomial pathogen in the United States Main mode of transmission is via hands

Box 3-4 Diseases Connected to Antibiotic Resistance

Factors Associated with Development of Antibiotic Resistance Overuse of antibiotic treatment Incomplete cycles of prescribed antibiotics Taking another person’s antibiotics http://www.youtube.com/watch?v=zjR6L38yReE

Handwashing Technique Primary Protection from Infection 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 Wet hands Apply soap Keep hands below arms Use friction / rubbing Dry with paper towels Paper towels are NOT sterile Turn off faucet with towel

Principles of Asepsis freedom from infection/to prevent the spread of microorganisms Medical asepsis can be evaluated on three levels: Antiseptics, which deters or inhibits the growth of bacteria; they can be used on the skin Disinfectants are agents that kills most bacteria. Disinfection can be accomplished by boiling as well as by using chemical agents (do not kill viruses or spores). Sterile (surgical asepsis), is a state of sterility or the use of sterile technique - Free of any living organism. An autoclave is used to remove all microorganisms by using steam under pressure to sterilize materials

Omnibus Budget Reconciliation Act (OBRA) Regulations OBRA requires training for nursing assistants. This includes: Completion of a written competency test. 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

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

Safe Movement Body mechanics and ergonomics 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 refers to the design of equipment that minimizes fatigue and discomfort

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

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

P.A.S.S. Guidelines for Fire Extinguisher Use

Fire Extinguisher Types A B C D

Lab Activity: Ecosystems of the Human Body

Lab 12a allows students to collect and grow bacteria from the mouth Lab 12a allows students to collect and grow bacteria from the mouth. They will be using cotton swabs to obtain a buccal sample and place on nutrient agar. The same student who provided the sample will then rinse with mouthwash and a second buccal swab will be taken. In a similar fashion, students will wipe their finger on the nutrient agar, wash their hands and then wipe their finger on the agar again. The samples on the nutrient agar plates will then be allowed to grow and students will observe bacterial growth from the mouth and skin in unwashed and washed conditions. The concept of normal flora and bacteria interactions will be covered in the analysis.  

Number of Different Organisms   Plate Area Number of Different Organisms Skin Washed (SW) Skin Unwashed (SU) Mouth Washed (MW) Mouth Unwashed (MU)