Environmental Management Carol P. Wiseman Nurse Educator

Objectives At the end of this session students will be able to: 1. Explain the importance of environmental management in the healthcare setting. 2. Identify factors in the healthcare environment that pose a threat to patient safety.

Objectives 3. List the important measures that can help prevent accidents in the healthcare setting. 4. Discuss the relationship between housekeeping procedures and patient safety.

Healthcare Environment 1. Physical environment  interior (inside the ward) and  exterior (hospital grounds) 2. Emotional environment

Environmental Management Purpose: 1. Ensure the safety of patients, visitors and staff. 2. Prevent spread of nosocomial or healthcare associated infection (HCAI).

Environmental Management  Environmental Health is the measurement, evaluation and control of factors within our environment that have an effect on the health and well being of the public.

Environmental Management Prevention is the key!  Prevent accidents among patients, staff and visitors.  Prepare for emergency situations.

Environmental Assessment Environmental Assessment (Macro)  Fire Exits/ extinguishers  Muster Points  Evacuation Plan  Number of beds (occupied/unoccupied)  Equipment

Environmental Assessment Environmental Assessment (Micro)  Condition of ward space – tidiness, smell, repairs.  Patient care Equipment – B/P apparatus, IV poles, trolleys ….  Cleaning – floors, bedside lockers, beds, drapes, sluice

Classification of Hazards 1. Physical:  Falls  Noise  Electricity  Fire

Classification of Hazards 2. Chemical:  Cleaning agents  Toxic fumes  Cytotoxic drugs

Classification of Hazards 3. Biologic:  The patient (as host for or a source of pathogenic microorganisms)  Infectious waste  Cuts or needle stick injuries

Physical Hazards Falls  Bedrails  Restraints  Wet Floors  Loose tiles  Furniture Placement Back Injury  Body mechanics  Lifting and handling

Physical Hazards Fire/ Electrical Safety :  Fire Triangle 1. fuel 2. oxygen 3. heat

Preventing Falls and Fires 1. Keep exits, stairways, storage areas, staff rooms and work areas free from debris. 2. Keep floors dry and clean 3. Get adequate assistance to move and walk patients

Preventing Falls and Fires 4. Provide adequate lighting 5. Use side rails for patients who are elderly, very young, disoriented, confused or sedated. 6. Check all equipment routinely to ensure it is working properly.

Preventing Falls and Fires 7. Allow air to circulate around heat producing equipment. 8. Replace electrical cords that have cracked insulation or broken connectors.

Preventing Falls and Fires 9. Do not overload electrical circuits. 10. Never run extension cords where they can be stepped on or cause falls. 11. Visible No Smoking signs and regular reminders to patients and visitors.

Chemical Hazards Misuse may result in:  Chemical burns  Inhalation of toxic fumes  Eye irritation  Skin irritation

Chemical Hazards Source:  Cleaning agents  Cytotoxic agents  Expired medication

Chemical Hazards All chemicals used in the workplace should come with manufacturers guidelines which state the following:  The composition and common name of the chemicals.  Chemical and physical properties.

Chemical Hazards  Known acute and chronic health effects – carcinogenic, mutagenic, or allergenic  Exposure limits  Protective measures – PPE, mixing, ventilation etc  Antidote or First Aid measures

Preventing Chemical Hazards 1. Do not leave medication carts unattended. 2. Check the expiration dates of all medications and chemicals to be used in patient care.

Preventing Chemical Hazards  Double check medications with another RN before administration.  Wear appropriate PPE when handling chemicals with toxic fumes.

Biologic Hazards Patient Protection: HCAI Control  Minimizing adverse outcomes of health care for inpatients.  A very significant indicator of quality care is the nosocomial infection rate.

Biologic Hazards Patient Protection: HCAI Control  Ward Cleaning  Waste Management  Care of equipment  Positioning of beds

Biologic Hazard Management 1. Pay attention to proper hand washing. 2. Wear appropriate PPEs when performing routine care involving blood and body fluids. 3. Utilize universal precautions when handling non infectious cases.

Biologic Hazard Management 4. Utilize expanded precautions as indicated when dealing with infectious cases. 5. Ensure proper disposal of biomedical waste in appropriate color bags.

Biologic Hazard Management 6. Nurse infectious cases in isolation area. 7. Ensure adequate ventilation on the ward. 8. Dispose of hypodermic needles and other sharps in puncture resistant containers.

Biologic Hazard Management 9. Timely removal of spillages – blood and body fluids (urine, faeces, vomitus…) 10. Appropriate cleaning, disinfection and sterilization of bedpans, urinals, wash basins, suction bottles, oxygen humidifiers...

Biologic Hazard Management 11. Cleaning and disinfection of beds and lockers between patient uses. 12. Routine changing of bed linens. 13. Turning and inspection of mattresses for cracks and tears.

Biologic Hazard Management 14. Utilize sterile packages and gloves when performing aseptic procedures. 15. Ensure that sterile packages are intact and not expired before utilizing them.

Conclusion  Recap major points.  Questions?

Inspiration Our circumstances do not cause us to act the way we do. They only expose the true condition of our hearts, revealed in our words and actions.