Download UNIT 2

UNIT 4
CLEAN AND SAFE
ENVIRONMENT
Unit Two Objectives
• Describe safety of the resident
• Identify Situations which require
Emergency Action
• Describe principals of Body Mechanics
• Describe principals of infection control
• Describe standard precautions
• Identify care giver precautions with
infectious diseases
Objectives
• Identify common pathogens and resulting
diseases or conditions.
• Describe pre and post steps for resident
care.
• Discuss admission and transfer policies’
Skills for Unit Two
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Handwashing
Resident Unit order
Unoccupied bed making
Transfer Belt placement
Waist restraint Application
Clear obstructed airway on Conscious
Resident
• Gown, glove and bag linen
Describe Safety of the Resident
• It’s necessary for All staff to be alert to
SAFETY concerns for the resident.
• Adjustments to environment are necessary
for individual needs, such as light, noise, air
temperature and type of furniture.
Identify residents at risk for
injury
• Those with sensory impairments: vision,
hearing or loss of sensation
• The confused or mentally impaired resident
• The weak or frail resident
• The resident recently admitted to the
facility.
Hazards to Safety
• Disoriented and new residents are at the
greatest risk
• FALLING IS THE GREATEST THREAT
• HAZARDOUS SUBSTANCES
• LACK OF PROPER LIGHTING
• UNSAFE EQUIPMENT
• SLIPPERY FLOORS
• UNLOCKED BRAKES
MORE….
• ERRORS-WRONG MEDICATION,
TRAY,TREATMENT
• UNSAFE BEDRAILS
• IMPROPERLY PLACED CALL LIGHT
OR NOT WORKING CALL LIGHT
• IMPROPERLY DONE PROCEDURES
• IMPROPER USE OF SMOKING
MATERIALS
MORE….
• CLUTTERED HALLWAYS
WAYS TO PREVENT INJURY
• Respond to emergency care immediately
• Follow care plans at all times
• Be alert to resident safety at all times.
– Answer call lights as soon as possible
– Many injuries occur in the bathroom: be alert
when toileting residents: do not leave
unattended.
– Use locks on wheelchairs, lifts and beds
More:
– Use safety devices when indicated
– get help when necessary
– report unsafe equipment
Use transfer belts
• A transfer belt or gait belt is used to support
the resident
• Prevents falls by providing a secure method
of support for the resident
• promotes correct body alignment for the
resident
• Prevents injury such as shoulder dislocation
• May be part of a facility uniform policy
• Improves body mechanics for the NAR
Know Resident Care Procedures
• Perform procedures accurately as learned
• Ask questions if unsure of the tasks.
• DO NOT perform tasks you have not been
taught.
Know fire safety policies
• Be alert to fire safety violations (smoking
rules, oxygen safety, electrical equipment,
unsafe wires)
• Extension cords are not allowed in long
term care facilities
Other safety Rules:
• Recognize some residents have limitations
on sun exposure due to medications. They
may burn very easily.
• Maintain your own health.
– Follow rules of healthy life style. Accidents
increase when caregiver is ill or emotionally
upset.
– Call facility at least two hours before if illness
prevents you from being available to work.
Workers must know The Right to
Know Law
• Right to Know law is a Minnesota law
which informs workers when working with
hazardous substances or infectious
substances and control measures necessary
• Hazardous Substances are substances which
could cause harm to worker if precautions
are not used. Know location of MSDS.
• Chemicals, blood, noise are some examples
Use of Physical Restraints
• A physical restraint is any manual method
or physical or mechanical device, material
or equipment attached to or adjacent to the
residents body that the individual cannot
remove easily which restricts freedom of
movement or normal access to ones own
body.
Examples of Restraints
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Vest or jacket restraint
Restraint belt devices
Hand Mitts
Side rails
Geriatric Chairs
Physical Restraints are only used as a last
resort to keep the resident safe.
Use Alternatives instead of
restraints
• The benefits of less restraint use include:
– The resident is not isolated and can move about
the facility
– It decreases confusion
– Reduces injuries from falls as muscle and bones
work better
• Restraints are only used with a doctors
order and then only if alternatives have
been tried and documented.
Alternatives to physical restraints
• Provide meaningful activities for the
resident, such as small chores or group
activities.
• Arrange furniture to prevent falls
• Place stop signs or visual barriers to restrict
doorways
• Anticipate resident needs such as toileting.
• Use TABS monitors or electronic bracelets
The residents Unit
• The residents unit is
their personal space or
home. The personal
items they have are
valuable to them.
Treat them with care
and respect. Knock on
residents door before
entering their Home!
Check the Unit daily for safety
• Check call lites. Make sure they work.
• NAR’s are responsible to wipe up spills and
keep the unit neat and orderly.
• Assist the resident to straighten closets and
bedside tables and dresser drawers.
• Respect personal preferences and privacy
when assisting with personal belongings.
Fire and Major causes
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Improper use of smoking material
defects in heating systems
improper trash disposal
misuse of electrical equipment
spontaneous combustion
Action to take if fire is discovered
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R = RESCUE AND REMOVE
A = ALERT OTHERS
C = CONFINE
E = EXTINGUISH OR EVACUATE IF
DIRECTED
• all facilities conduct fire drills monthly.
Know how to use fire
extinguishers
• Most fire extinguishers are the dry chemical
type, suitable for all types of fires. To Use:
• Remember PASS
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P - pull the safety pin
A - Aim the nozzle at the base of the fire
S - squeeze the trigger handle
S - sweep side to side at the base of the fire
Fire Safety
• Know the facility code word for FIRE
• When moving an immobile resident to
safety follow facility policy. Which may
include placing residents on a blanket and
pulling them out of danger or removing the
entire bed.
Finding a resident on the floor
• Stay with resident and
call for help
immediately
• DO NOT attempt to
move resident til a
nurse has assessed.
• If a resident is walking
and begins to fall, ease
them to the floor with
a T.B.
Actions to take if a resident is
choking
• If a resident is coughing, but able to breathe
DO NOT INTERVENE.
• Clutching the neck with one or both hands
is the universal sign for choking.
– Ask the resident, “are you choking?”
– If resident nods yes, begin procedure for
obstructed airway.
Actions to take if finding an
unresponsive resident
• Call the resident by name to determine
unresponsiveness.
• Call for nurse immediately and stay with
resident.
• Assist the nurse as directed.
Seizures
• Seizures are sudden involuntary movement
of muscles. Persons may be partially
conscious or unconscious.
– Stay with resident and move obstacles out of
the way.
– Call for nurse immediately
– Ease resident to the floor
– Roll resident on their side, do not restrain
movements.
Actions to take for wandering or
lost residents
• Report to nurse immediately.
• Follow facility policies and nurses
instructions.
Actions to take for severe
weather
• Follow facility policies for tornado watches
and warnings.
• Close windows and drapes
• Move resident away from windows
• Protect and reassure residents.
BODY MECHANICS
• PROPER USE OF THE BODY TO MAKE
THE BEST USE OF STRENGTH, AVOID
FATIGUE AND INJURY TO SELF AND
OTHERS…...
Importance of Proper Body
Mechanics
• NAR’s will be moving, lifting, and turning
residents often during a routine day.
• Using proper body mechanics can prevent
injuries, minimize strain and fatigue.
• Using proper body mechanics involves
good posture, balance and the strongest
muscles of the body.
• Using proper body mechanics enhances
safety for residents and workers.
PRINCIPLES OF BODY
MECHANICS
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EXPLAIN PROCEDURES
GET HELP
FEET 12-14 INCHES APART
MOVE CLOSE TO OBJECT
TIGHTEN ABDOMEN
SQUAT
USE THIGH MUSCLES TO LIFT
WORK SMOOTHLY
MORE….
• DO NOT TWIST BODY
• PUSH OR PULL IF POSSIBLE
• MECHANICAL LIFTS OR AIDS WHEN
POSSIBLE
MEDICAL ASEPSIS
• PRACTICES THAT PREVENT THE
GROWTH AND SPREAD OF DISEASE
PRODUCING MICROORGANISMS
CALLED PATHOGENS OR GERMS IS
KNOWN AS MEDICAL ASEPSIS OR
INFECTION CONTROL.
How do the germs get into our
bodies?
• Body openings such as
mouth, nose, eyes,
urinary tract
• Body cuts (broken
skin)
• Tubing such as IV,
catheters, feeding
tubes
The chain of infection:
• The route pathogens
travel to spread
disease is known as
the chain of infection.
• There are six parts to
the chain of infection.
Chain of Infection Includes:
• Pathogen -cause of
infection
• Reservoir - where the
pathogen lives
• Exit point - body
secretions or wounds
• Method of
transmission - hands
or supplies
Chain of Infection
• Entry point - such as
broken skin
• Host - person receives
pathogen and harbors
it. Disease will occur
more often in persons
at risk such as those
who are ill.
What germs need to grow:
• Food: found on body, body discharges,
equipment or trash
• Moisture
• Air
• Temperature ( best between 40 to 110
degrees
• Darkness: Direct sunlight can kill some
germs.
STANDARD PRECAUTIONS
• Basic Infection control practices for all
health care facilities in the United States
and any industry which could affect the
health of citizens were developed by the
CDC in Atlanta. The practices are called
Standard Precautions or Universal
precautions and are designed to reduce the
risk of transmission of disease causing
microorganisms.
Standard Precautions Include:
• Handwashing often
• Gloves: wear when
touching body fluids
or items contaminated
with body fluids.
Change gloves
between tasks or
touching cleans items
Standard Precautions Include
• Gown: Wear to
protect skin and
clothing if possibility
of coming in contact
with body fluids.
• Mask, Eye, face
shield: Wear if there is
possibility of contact
with body fluids.
Standard Precautions Include:
• Linen and trash:
Handle, transport and
dispose in a manner
that avoids transfer of
pathogens.
• STOP THE SPREAD
OF INFECTIONS!!
Isolation:
• Isolation procedures
are implemented with
persons who have
easily transmitted
diseases. The rules to
be followed are based
on the method of
transmission of the
pathogen.
• Airborne: The germ is
in the air and inhaled
by the host.
• Contact: person to
person touch.
• Droplet: occurs within
3 feet of person and is
spread by cough,
sneeze or talking.
Isolation Procedures Include:
• Restrict resident to
own room
• Double bag linens and
trash
• Keep equipment in
room (thermometers)
• Special cleaning of
room when resident is
removed from
precautions.
Importance of handwashing
• Handwashing is the
most effective way to
prevent the spread of
disease.
• Handwashing should
be done
– when beginning work
– Before and after caring
for the resident
When to do handwashing
• After using the bathroom, combing your
hair, using a tissue, eating, drinking or
smoking.
• After handling a residents belongings
• After working with anything soiled.
– REMEMBER TO USE FRICTION WHEN
WASHING HANDS TO REMOVE GERMS
Infectious Diseases
• There are many types of disease producing
microorganisms. These are usually
identified by special features such as their
shape and how they grow, multiply and
spread.
Types of Bacteria's
• This germ grows in
groups and a culture
sample helps to
determine the best
medicine for
treatment. There are
many antibiotic
medications.
• Strains of
streptococcus - “strep”
which can cause a sore
throat
• Strains of
staphylococcus
“staph” which causes
infections in cuts and
surgery sites,
Mycobacterium tuberculosis
• Bacteria which causes TB is transmitted
from the cough or sneeze of an infected
person. Usually attacks the lungs. A
mantoux skin test identifies exposure to the
germ. All health care workers are screened
annually. Residents in facilities are
screened upon admission to the facility.
Fungus
• The most common disease producing
fungus is yeast infections.
– Candida albicans occurs in mouth and vagina
– Tinea capitis “ringworm” occurs on the skin
– Tinea pedis “athletes foot” also occurs on the
skin.
Virus:
• The virus is the smallest microorganism in
the world. The germ needs a host to
multiply. There is no specific medications
for viruses. Medications are usually
developed to control the specific features of
the pathogen. Viruses are able to change
their features.
Examples of viruses:
• Common colds, which
affect the respiratory
system
• Influenza, affects the
respiratory system
with additional
symptoms of
headache, body aches.
Flu shots are given
yearly.
• Herpes Simplex, cold
sore or fever blister on
mouth or lips.
• Herpes zoster
“shingles” which are
blister like sores along
the route of a nerve.
• Hepatitis - a systemic
infection affecting the
liver.
Types of Hepatitis
• Hepatitis “A” reservoir (Where it lives) is
stool or feces. It is spread stool to mouth
route by food or water contaminated by the
virus.
• Hepatitis “B and C” reservoir is blood. It is
spread by direct contact with body fluids.
Immunizations are available to protect
against exposure.
Human Immunodeficiency Virus
• HIV
– The final stage of the infection is called
Acquired Immune Deficiency Syndrome or
AIDS. The body’s immune or defense system
is unable to fight off infections and is
vulnerable to opportunistic infections, which
are usually eliminated in people with healthy
immune systems.
Drug Resistant Infections
• Pathogens or germs
can become resistant
to the medications that
were developed to
fight them in people
who got the infection.
• Examples include:
– MRSA - methicillin
resistant staph aureus
– VRE vancomycin
resistant enterocci
• Most people who
develop drug
resistance are people
who are weak or have
a chronic condition
such as AIDS.
Ways to prevent Infections
• WASH HANDS
• SEPARATE CLEAN
AND DIRTY ITEMS
• DISINFECT
SUPPLIES AND
EQUIPMENT
• CORRECT
HANDLING OF
FOOD
Prevent Infections
• CORRECT
HANDLING OF
LINENS
– DO NOT HAVE
LINEN TOUCH
UNIFORM
– DISPOSE OF LINEN
IF IT TOUCHES THE
FLOOR
– PRERINSE SOILED
LINENS
Prevent Infections
• Correct handling of
body wastes. Dispose
of correctly according
to facility policy.
• Maintain your own
good health.
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Well balanced diet
rest
exercise
good mental health
Pre and Post steps for resident cares
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Check your assignment sheet
K = knock on resident door
W= wash hands
I= introduce, inform and identify
P= close door and privacy curtain
E= Equipment for skill
S = Safety items ( call lite, bed position, gloves,
body mechanics)
Admission and transfers
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Introduce self
Demonstrate equipment (call lite. Bed)
Help resident put personal belongings away
Label personal belongings. Complete inventory
sheet.
• Explain facility dining times, location of
bathroom, location of personal supplies.
• Any other procedures according to job description.
Home Health Aide
Unit Two
Safe and Clean Environment
Unit Two Objectives
• Describe safety in Clients home
• Discuss emergencies in the home
• Describe Homemaking duties
Safety differences in healthcare
facilities vs client home
• Healthcare facilities
are regulated by state
and federal agencies.
They receive routine
inspections.
• Private homes: It’s
owner responsibility
for clean safe
environment.
Safety and Infection Control in
clients home
• Follow agency
policies and
procedures. Use good
body mechanics.
• Report unsafe
situations to
supervisor.
• Identify habits which
may promote the
spread of germs.
– Clients or family not
washing hands.
– Spoiled food
– dirty dishes, clothing,
linen piling up
– Poor cleaning of home
– pet wastes not
contained
Disinfection and sterilization
• Disinfection is the
process which
removes most disease
causing
microorganisms.
– 1:10 bleach water can
be used to clean.
– There are many
commercial
disinfecting products
• Sterilization destroys
all microorganisms.
– Boiling: Clean items
covered with water and
boil for 20 minutes. If
container is covered
boiled water will
remain sterile for 36
hours.
– Baking: wrap items in
clean towel and bake
for one hour at 350.
Describe emergencies
• Emergencies call for immediate action.
They are sudden, unexpected events, which
are often life threatening. Home Health
agencies have emergency procedures which
include a plan for calling emergency
services.
Common home emergencies:
• Poisoning - Any
substance taken into
the body by ingestion,
inhalation, injection or
absorption which
interferes with normal
body function.
• Call 1-800-poison-1
Minnesota poison
control system
Common Home Emergencies
• Burns: Skin-tissue injury from excessive
heat, chemical, electrical, or radioactive
agents.
• Allergic Reactions: Abnormal response to a
substance which normally does not cause a
reaction.
• Respiratory Emergencies: Any situation
which interferes with breathing.
• Falls: Most common injury
Emergencies:
• Stroke: Blood supply to part of the brain is
interrupted.
• Heart attack: Blood supply to part of the
heart is interrupted.
• Diabetic reaction: Physical responses due
to imbalance of food and insulin.
• Seizures: Involuntary muscle twitching
related to brain injury or condition.
Call 911
• Life threatening events such as breathing
problems, severe pain, profuse bleeding,
loss of consciousness and extensive burns
CALL 911.
– Stay calm
– Remove client and family
– Follow directions of 911 operator.
Weather and Fire Emergencies
• Follow agency policy and procedures.
• Know location of smoke alarms and fire
extinguishers.
• Have an evacuation plan for client.
• Know community alarm systems.
• Discuss with supervisor as part of client
care plan.
Home making duties
• Part of the home
health aide job
responsibilities include
combining client
personal care with
housekeeping
tasks.Each clients
home will require
different schedules
and challenges.
Housekeeping duties:
• Light house keeping
includes daily and
weekly tasks to
maintain the
environment for the
client.
– Meal preparation
– surface cleaning
– laundry
• Heavy housekeeping
duties are often
contracted out or done
by family members.
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House painting/repair
shoveling snow
mowing lawn
washing windows
appliance maintenance
Light housekeeping schedules:
• Daily tasks;
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Pick up clutter
empty waste baskets
make beds
wash dishes
clean up spills
pick up toys, clothing,
newspaper
• Weekly tasks:
– Change bed linens
weekly and as needed
– Do laundry weekly and
as needed
– dust and vacuum
– wet mop floors
– remove garbage
– clean bathroom
– water plants
Monthly or Periodic Cleaning
• Remove cob webs
from corners
• vacuum drapes
• Clean cabinets, closets
and drawers
• Hand wash table
ornaments
• Damp wipe light
fixtures