Download standard precautions

HEALTHCARE SAFETY
and
STANDARD PRECAUTIONS
Minnesota Healthcare Core Curriculum
Created by: Dede Carr, BS, LDA
 These materials are made available by the Minnesota State
Colleges and Universities through a Creative Commons
Attribution- ShareAlike 3.0 License.
Competency 1
1. List regulatory agencies and the requirements they set for safety
standards for healthcare facilities, their employees, and clients.
a. Identify selected safety terminology relevant to healthcare.
b. Identify the CDC and list its safety requirement(s) as they
pertain to the healthcare environment.
c. Identify OSHA and MDH, and list safety regulations as they
pertain to the healthcare environment.
d. Identify JCAHO and describe its role in regulating safety with
the healthcare environment.
e. Identify the OSHA Bloodborne Pathogens Standard and list its
requirements.
Terminology and Definitions
Review list
AMERICA’S TOP 10
MOST DANGEROUS JOBS
10. Miscellaneous Agricultural Workers
9.
8.
7.
6.
5.
4.
3.
2.
1.
Driver/Sales Workers & Truck Drivers
Roofers
Electrical Power Line Installers/Repairs
Farmers & Ranchers
Refuse & Recyclable Material Collectors
Structural Iron & Steel Workers
Logging Workers
Aircraft Pilots & Flight Engineers
Fishers & Related Workers
REGULATORY AGENCIES
1. CDC – Center for Disease Control & Prevention
2. OSHA – Occupational Safety & Health Administration
3. MDH - Minnesota Department of Health
4. JCAHO – Joint Commission on Accreditation of Healthcare
Organizations
CDC
 CDC as the lookout for the health of the people of the U.S.
and throughout the world, strives to protect people’s health &
safety, provide reliable health information, and improve health
through strong partnerships.
 Established in 1946 to control Malaria outbreaks in post WW2
war areas.
CDC OPERATES TO:
 Study the causes and distribution of diseases.
 •Formulate safety guidelines to help prevent and control the
spread of infectious diseases.
 Identifies Standard Precautions apply to every client in the
healthcare environment
 Identifies Transmission-Based Precautions
 1. Airborne
 2. Droplet
 3. Contact
REGULATORY IMPACT OF OSHA
Permissible Exposure Limits – PEL
 Maximum concentration of chemicals
Hazard Communication
 “Right to Know”
 Requires employers to communicate information about hazardous
chemicals in the workplace.
Bloodborne Pathogens – BBP
 Standard to prevent exposure to healthcare workers.
Personal Protective Equipment – PPE
 Gloves, masks, eye protections, aprons, etc.
MDH
 Hazard Communication Rule: Right to Know
 Informs workers when working with hazardous/ infectious
materials and provides for the availability of infection control
measures if necessary.
 MDH supervises the compliance of facilities to health
regulations
JCAHO
Mission Statement: To continuously improve safety and quality
of care provided to the public through the provision of health
care accreditation and related services that support
performance improvement in health care organizations.
Formed in 1951
JCAHO PROVIDES EVALUATION &
ACCREDITATION FOR:
 General, psychiatric, children’s & rehabilitation hospitals
 Critical access hospitals
 Medical equipment services, hospice services
 Nursing homes & other long term care facilities
 Behavioral health care organizations
JCAHO Role
 Private, non-profit organization whose purpose is to
encourage the attainment of high standards of institutional
medical care.
 Establishes guidelines for operation
 Conducts inspections
JCAHO PATIENT SAFETY GOALS - 2014
 Improve accuracy of patient identification.
 Improve effectiveness of communication.
 Improve safety of using medications.
 Reduce the risk of health care-associated infections.
 Reduce the risk of patient harm from falls.
 Prevent health care associated pressure ulcers
 Reduce safety risks to patients
 Pre-procedure verification process
 Encourage patients’ active involvement in their own case as a patient
safety strategy.
 Reduce harm associated with clinical alarm systems
OSHA Bloodborne Pathogens Standard
 occupational exposure
 non-intact skin
 exposure incident
PREVENTING ACCIDENTS
 OSHA
Two main standards that effect healthcare workers
1. Blood-borne Pathogen Standard
2. Occupational Exposure to Hazardous Chemicals Standard
Exposure control plan (Control methods)
 Engineering controls
 Work practice controls
 PPE (personal protective equipment)
 HBV vaccine
Competency 2
2. Explain the current requirements of standard precautions and the
procedures used at a variety of healthcare facilities to support those
standards.
a. Explain the purpose of standard precautions and when they are
applied.
b. List common pathogens.
c. Identify PPE (personal protective equipment) and usage.
d. List compliance measures for Blood borne Pathogens Standards.
e. Identify types of Isolation Precautions and describe why isolation
is used in a healthcare facility.
f. Identify concerns and needs of clients in isolation.
STANDARD PRECAUTIONS
Purpose:
 Decrease transmission risk of disease producing
microorganisms
 Used on all clients/patients
 Used at exposure to body fluids
 Used at contact with mucous membranes
 HIV or HBV risk
 Caregiver/client has non-intact skin
TRANSMISSION-BASED PRECAUTIONS
 CDC recommends use of Transmission-Based Precautions
with patients who are documented or suspected to be infected
with pathogens.
 Used for ALL clients
When to use Standard Precautions
 Used if client or caregiver has non-intact or broken skin
 Used when there is exposure or potential exposure to body
fluids:
 Blood. Urine, Stool, Saliva, Vaginal secretions
 Contact with mucous membranes
 HIV risk
 HBV risk
 Remember: perspiration is not a body fluid
INFECTION CONTROL
 To prevent the spread of infectious disease
 Infectious disease is any disease caused by the growth of
pathogens.
 Pathogens are disease-causing microorganisms (germs) in
the body.
 Microorganisms are very small, usually one-celled living
plants or animals. They are everywhere.
TYPES OF MICROBES
 Bacteria – one-celled plants

-Staph, whooping cough, strep, TB
 Fungus – large group of simple plants

-Athlete’s foot, candida
 Viruses – smallest of the microbes

-Common cold, herpes simplex, HIV, Hepatitis A, B, C
Drug Resistant Organisms
 MRSA =Methicillin Resistant Staph Aureus
 CMV =Cytomegalovirus
 VRE =Vancomycin Resistant Enterococcus
Types of Transmitted Illnesses
 Food Borne Illnesses
 Sexually Transmitted Diseases (STDs)
 Measles, Mumps, Rubella (MMR)
STANDARD PRECAUTIONS REQUIRED BY HEALTHCARE
WORKERS
 Handwashing
 Personal Protective Equipment (PPE)
 Patient Care Equipment
 Environment Control
 Linen
 Occupational Health & Blood-borne Pathogens
CHAIN OF INFECTION
Conditions for Growth
 Temperature 40 – 110 F
 Moisture
 Air (if needed)
 Darkness
 Food source
 Body secretions
Uses for Isolation Precautions
 To protect the client
 To protect the public and healthcare worker
3 Types of Transmission-Based Precautions
 1. Airborne
+Travels short distance through air
+Deposited on host’s conjunctiva, nasal mucosa, or mouth
+Talking, sneezing, coughing
Examples: Chicken Pox, Rubeola
 2.
Droplet
+Droplet or dust particles containing infectious agent
+Can be widely dispersed
+Talking, sneezing, whispering, coughing
Examples: Mumps, Influenza
 3. Contact
+Most frequent mode of nosocomial infections
+Direct-contact
+Indirect-contact
Examples: Herpes, Scabies, Wounds
ISOLATION
Uses:
-Protect client/patient
-Protect healthcare worker & public
Procedures:-Restriction to a room
-Procedures for disposal of trash/linens
-Special equipment
Clients needs/feelings:-Evidence of acceptance
-Additional checks
-Lonely, unclean, why
DISADVANTAGES OF TRANSMISSION
PRECAUTIONS
1. Patient needs private room
2. Special equipment ?
3. Frequent visits by nurses
4. Forced solitude/isolation
Competency 3
Describe the methods healthcare facilities use to achieve
physical, chemical, and biological safety.
a.
b.
c.
Explain physical hazards and list safe practice guidelines.
Explain chemical hazards and their labeling requirements.
Explain biological hazards & their safety guidelines
A major cause of fires:
 improper use of smoking materials
 defects in heating system
 improper trash disposal
 misuse of electrical equipment
 spontaneous combustion
FIRES & ELECTRICAL HAZARDS
 A serious threat
 Patients with special needs are especially vulnerable
 Healthcare staff must make every effort to prevent fires from
starting
 Healthcare staff must be prepared to respond if a fire breaks
out.
CLASSIFICATIONS OF FIRES
Class A – common combustibles i.e. wood, paper, or plastic.
Class B – flammable gases & liquids. Fire often spreads unless
properly secured.
Class C – involve live electric equipment i.e. computers, fax
machines.
Class D – combustible metals i.e. magnesium & sodium metal
Class K – Combustible cooking materials, i.e. oils, grease
RESPONSE TO A FIRE
1. Know your facilities emergency plan
2. Location of fire alarms & how to operate them
3. How to shut off oxygen machines & other compressed gas
systems.
4. Location of fire extinguishers & how to use them.
5. How to move patients safely & quickly.
RACE
Rescue the individual
Activate the alarm
Confine the fire
Extinguish the fire
FIRE EXTINGUISHERS
1. Air-pressurized water – used on Class A fire only.
2. Carbon dioxide – used on Class B & C fires only.
3. Dry chemical – used on Class B & C fires only.
PASS
PULL the pin
AIM low
SQUEEZE the handle
SWEEP from side to side
Chemical Hazards and Safety Guidelines
 Hazard Types
 Flammable
Toxic
 Corrosive
 Caustic
 Carcinogenic
 Mutagenic

Oxygen
 Can be hazardous
 flammable
SDS ( Safety Data Sheets)
 Chemical Hazard
 National Fire Protection Association
HAZARD LABEL SYSTEM
Purpose – To serve as an immediate warning and reminder to
employees of the more detailed information on the MSDSs,
posters, etc.
MATERIAL SAFETY DATA SHEETS
MSDS
 Hazardous products
 Product identification information
 Protection/precautions
 Instructions for safe use
 Procedures for clean up
 Emergency first aid procedures
MSDS LABEL
 Red = Fire
 Blue = Health
 Yellow = Reactivity
 White = Special
Biological Hazards & Safety Guidelines
 Bloodborne Pathogen
 Standard Precautions
 Employees that are at risk
 Waste Disposal
EQUIPMENT & SOLUTIONS
 Read instructions before using
 Operate only with supervisor present
 Report damage/malfunction
 Read MSDSs
 Use solutions only from bottles that are labeled
 Do NOT mix solutions unless instructed
Competency 4
Describe principals and standards of infection control.
a. Explain the purpose of standard precautions and when
they are to be applied.
b. List guidelines that reduce the spread of infection.
CHAIN OF INFECTION
1. Infectious Agent
2. Reservoir host
3. Portal of exit
4. Transmission
5. Entry
6. Susceptible host
7. Enter the body
Ways microorganisms enter the body
 mouth
 nose
 eyes
 urinary tract
 cuts or injury through a broken skin
 Contaminated material may enter through tubes in the body
indwelling urinary catheters
 IV (Intravenous) tubing
 Tube feedings

Conditions which promote microbial growth
 Temperature (Most microorganisms grow and thrive at
temperatures between 400 to 1100 F)
 Moisture
 Air (If necessary for pathogen growth)
 Darkness (Direct sunlight can kill some germs; Most
pathogens grow in dark areas)
 Food source is available for the pathogen to multiply
 Body secretions
 Food/nutritional intake of the individual
 Body discharge in trach or on equipment
Practice Infection Control
 Handwashing
 Waterless hand
sanitizer
 Application of Standard Precautions
 Aseptic Practices
 housekeeping
 handle/ dispose of soiled materials: separate clean and dirty
items.
 keep linen away from clothing
 never place linen on the floor; If linen falls on the floor place it
in a soiled linen hamper
Biological Waste Disposal
 Biological waste disposal
 Use of gloves
 Antiseptics
 Disinfectants, Methods of supplies and equipment
 Sterilization Methods
Maintain workers own good health
 Well balanced diet, rest , exercise, good mental health
 Do not go to work if ill and teach visitors to stay away from
facility if ill
Competency 5
5. Identify the ways in which healthcare workers can demonstrate
personal and client safety use of Safety Data Sheets (SDS) and
safety signs, symbols and labels.
a. Identify common safety issues/injuries and guidelines for
prevention.
b. List the principles of body mechanics for personal safety
c. List general guidelines for maintain good body mechanics
d. Identify correct techniques when lifting, pulling, pushing, and
turning.
e. Discuss safety equipment utilized in areas of healthcare.
PROMOTION OF SAFETY

Body Mechanics - The way in which the body moves and maintains
balance
4 reasons for using good body mechanics
1. Muscles work best when used
correctly
2. Easier for lifting, pushing, etc
3. Prevents fatigue
4. Prevents injury to self & others
Injuries, Preventive Measures and General
Safety
 Common Client Injuries
 Common Employee Injuries
 Preventive Measures
Housekeeping Measures for Safety
 Rugs
 Carpeting
 Lighting
 Ventilation
 Restraints
 Etc.
General Health of healthcare workers
 Infectious diseases
 when to stay home
ASEPTIC PRACTICES
 NO linen on the floor
 Keep linen away from your clothing
 Separate dirty/clean linen
 Disinfectants, antiseptics, sterilization
Body Mechanics: Personal Safety
 Maintain normal posture
 Be mindful of body mechanics
 Reduce joint injuries
8 Rules of Good Body Mechanics
1. Base of support – feet 8-10” apart
2. Bend at hips and knees
3. Use large muscles
4. Use your weight
5. Keep load close to you
6. Avoid twisting
7. Avoid bending for long periods of time
8. If patient or load too heavy---assistance
CORRECT TECHNIQUE
 Lifting
 Pulling
 Pushing
 Turning
ERGONOMICS
 The
science of designing & arranging things in the working
and living environment for maximum health and safety.
Ex:
Height of chair
Computer keyboard w/wristpad
Equipment
 EX stand
 Ceiling Lift
 Hoyer Lift
 Transfer Belt
Competency 6
6. Describe proper handwashing and gloving.
a. Demonstrate proper handwashing and describe the
principles of the procedure steps.
b. Demonstrate application and removal of clean gloves and
describe the principles of the procedure steps
Hand washing
 most effective way to prevent the spread of disease
 friction or rigorous rubbing removes germs
Hand washing required:
 beginning work and when leaving work
 before and after any care is given to a client
 before and after handling any food
 after using the bathroom, combing hair, using a tissue, eating,
drinking or smoking
 after working with anything soiled
Clean Gloves
 Principles and Technique for Application/Removal for Clean
Gloves
 Skin to Skin
 Glove to Glove
Competency 7
7. Explain the procedures used to respond to client and
healthcare facility emergencies (including fire safety) and natural
disasters.
a. List general guidelines for any emergency.
b. Explain the general protocol/ procedure for a FIRST
RESPONSE to:

Medical emergency

Workplace injury

Response in natural disasters
EMERGENCY GUIDELINES
 Procedures
 Phone numbers
 Remain calm
 Stay in scope of training
FIRST RESPONSE
“First Response” Protocol
 Facility Policy
 Know Job description
Medical Emergency
 Survey environment & victim
 Victim Contact EMS
 Obtain Assistance
 Proceed as facility policy dictates
 ABC awareness
 A = Airway
Work Place Injury
 Notify supervisor
 B = Breathing
 C= Circulation
 Do not move victim
Natural Disasters
 Contact supervisor
 Follow procedure manual (workplace)
 Contact Red Cross if needed
Competency 8
 8. Using a problem solving process applied to healthcare
situations; describe the critical principles and standards
needed to ensure healthcare safety.
a. Discuss the problem solving process as applied to
healthcare safety utilizing a team approach.
PROBLEM SOLVING PROCESS
1. Identify the problem
2. Gather information
3. Create alternatives/solutions
4. Select & Act
5. Evaluate & Revise
GENERAL SAFETY GUIDELINES
 Moving Safely
 Dressing for Safety
 Working Safely with Patients
 Protecting Yourself & Others
 Reporting for Safety
Concern in various situations
 Personal safety
 Worker safety
 Client safety
Questions?