Chapter 33 Safety and Hygiene

33-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Safety Culture  Excellent nursing care is safe for both the clients receiving the care, and the workers involved in the delivery of health care.

33-3 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Factors Affecting Client Safety  Age  Lifestyle  Sensory and Perceptual Alterations  Mobility  Emotional State  Types of Incidents

33-4 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Lifestyle Practices

33-5 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Types of Incidents  Client behavior incidents  Therapeutic procedure incidents  Equipment incidents

33-6 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Safety and the Environment of Care  A safe environment is one in which each facility follows specific safety processes and procedures derived from national and state directives, Joint Commission on Accreditation of Healthcare Organizations (JCAHO) guidelines, and best industry practices.

33-7 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Safety and the Environment of Care  Each nurse is responsible for following the facility’s established safety guidelines.  It is the nurse’s responsibility to report promptly and to document a mishap.

33-8 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Potential Occupational Hazards  Numerous potential hazard exposures exist in today’s health care workplace, placing health care providers at unnecessary risk.

33-9 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Potential Occupational Hazards  Chemical and biological exposures  Physical exposures (lasers, ionizing radiation, noise)  Psychosocial stressors (shift work, overtime, threat of workplace violence)  Ergonomic stressors (lifting and moving clients)

33-10 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Potential Occupational Hazards  Routes of Exposure Methods by which chemical and biological substances are assimilated into the body -Inhalation -Ingestion -Injection -Skin contact -Skin absorption

33-11 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Potential Occupational Hazards  Exposure Prevention and Control Substitution Engineering Controls Administrative Controls Personal Protective Equipment (PPE)

33-12 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Exposure Prevention and Control  Transmission-Based Precautions Standard Precautions and Transmission- Based Precautions -Masks -Respirators -Goggles -Private room with negative pressure ventilation

33-13 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Potential Occupational Hazards  Hazardous Substances Corrosives Carcinogens Teratogens Target organ chemicals Sensitizers

33-14 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Potential Occupational Hazards  Latex Allergy Irritant contact dermatitis Allergic contact dermatitis Immediate hypersensitivity -A systemic reaction also called type 1 IgE- mediated reaction

33-15 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Potential Occupational Hazards  Hand Hygiene Any dermatitis should be promptly reported to Employee Health. Barrier creams or special soaps are available. Strict guidelines on nail care and nail coverings should be implemented and followed.

33-16 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Potential Occupational Hazards  Work-Related Musculoskeletal Disorders (MSDs) OSHA mandatory standards Prevention of work-related MSDs such as back injuries

33-17 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Safety and Health Training  Injury prevention training  Upgraded as client and employee needs change.

33-18 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Hygiene  Hygiene is the science of health.  Promotes cleanliness, provides comfort and relaxation, improves self-image, and promotes healthy skin.

33-19 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Hygiene  The skin and mucous membranes are the body’s first line of defense.  The type of hygienic care provided depends on the client’s ability, needs, and practices.

33-20 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Factors Influencing Hygienic Practice  Body Image  Social and Cultural Practices  Personal Preferences  Socioeconomic Status  Knowledge

33-21 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Assessment to Identify At-Risk Clients  Health History Data regarding client’s routine self-care and health promotion needs -General health perception -Self-care management

33-22 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Assessment to Identify At-Risk Clients  Physical Examination Level of consciousness Range of motion or total immobilization of an extremity Localized infection Systemic infection Secretions or exudate of skin or mucous membranes Presence of crackles, rhonchi, or wheezes

33-23 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Assessment to Identify At-Risk Clients  Diagnostic and Laboratory Data  Client in an Inpatient Setting Fall and infection risk factors  Client in the Home Risk for falls, fires, electrical malfunctions, suffocation, weapons, and household and medication poisonings

33-24 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nursing Diagnosis  Risk for Injury Risk for Suffocation Risk for Poisoning Risk for Trauma Risk for Aspiration Risk for Disuse Syndrome Latex Allergy Response

33-25 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nursing Diagnosis  Risk for Infection Related to (RT) Inadequate primary defenses Inadequate secondary defenses Tissue destruction and increased environmental exposure Chronic diseases and malnutrition

33-26 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nursing Diagnosis  Risk for Infection Related to Invasive procedures Pharmaceutical agents Trauma Rupture of amniotic membranes Insufficient knowledge to avoid exposure to pathogens

33-27 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nursing Diagnosis  Self-Care Deficit Bathing/hygiene Dressing/grooming Toileting

33-28 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Outcome Identification and Planning  Identification of actual or potential hazards  Reduction of the risk of injury and infection  Client/caregiver education regarding safety measures and modification of an unsafe environment

33-29 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Raise Safety Awareness and Knowledge  Bed Safety  Prevent Falls Apply restraints Ensure adequate lighting Remove obstacles

33-30 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Types of physical restraints A.Jacket B.Belt C.Mitten or Hand D.Elbow E.Limb or Extremity F.Mummy

33-31 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Reduce Bathroom Hazards  Prevent Fire Common causes of fire Fire prevention Protection of clients during a fire Institutional policies and procedures for fire containment and evacuation

33-32 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Ensure safe operation of electrical equipment. Three-pronged electrical plug that is grounded Warning labels on all equipment Electrical shock

33-33 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Reduce exposure to radiation. Both the client and the nurse are at risk for injury. Radiation injury can occur from overexposure or exposure to untargeted tissues. General principles of radiation exposure and protection are based on time, distance, and shielding.

33-34 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Prevent poisoning. A poison is any substance that causes an alteration in the client’s health when inhaled, injected, ingested, or absorbed by the body. Antidotes and treatments are available for some but not all types of poisonings. Poison control center Client education

33-35 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Reduce Noise Pollution. Sensory overload can alter a client’s recovery by increasing anxiety, paranoia, hallucinations, and depression. Safety measures include maintaining a quiet environment, traffic control, and providing earplugs.

33-36 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Provide for Client Bathing Needs. Cleaning Baths Shower Tub Bath Self-Help Bath Complete Bed Bath Partial Bath

33-37 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Provide for Client Bathing Needs  Therapeutic Bath Requires a physician’s order. -Type of bath -Temperature of water -Body surface to be treated -Type of medicated solutions to use

33-38 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Provide for Client Bathing Needs  Clean Bed Linen  Skin Care

33-39 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Provide for Client Bathing Needs  Perineal Care (peri-care, perineal-genital care) Provided alone or as part of the bed bath. May be an embarrassing procedure for both the client and the nurse.

33-40 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Provide for Client Bathing Needs  Offer Back Rubs Stimulate circulation Relax muscles Relieve muscle tension Skin assessment

33-41 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Provide for Client Bathing Needs  Foot and Nail Care Prevents infection. Prevents soft tissue trauma from ingrown or jagged nails. Eliminates odor.  Clients with diabetes mellitus need special foot and nail care.

33-42 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Provide for Client Bathing Needs  Oral Care Fluoride Flossing Brushing Oral care for the unconscious patient

33-43 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Provide for Client Bathing Needs  Hair Care Brushing and combing Shampooing Shaving Mustache and beard care

33-44 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Provide for Client Bathing Needs  Eye, Ear, and Nose Care Contact Lenses -Level of assistance required -Hard and soft lenses Hearing Aids -Types -Function -Storage

33-45 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Evaluation  Frequent reassessment of client health risks  Need for timely adjustments to plan of care and expected outcomes