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Chapter 18: Safety and Infection
Control
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Role of Regulatory Agencies
• Occupational Safety and Health Administration (OSHA)
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Federal agency
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Ensures safety of workers
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Enforces safety & health legislation
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Requires health care facilities to establish practices
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Requires facilities keep practices in policy & procedure manual
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Role of Regulatory Agencies (cont’d)
• Center for Disease Control and Prevention (CDC)
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Federal agency
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Dedicated to prevention of disease, injury, & disability
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Part of Department of Health and Human Services
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Developed guidelines to prevent spread of infection
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Requires that all bodily substances be treated as if infectious
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Principles of Safety
• Developmental Considerations
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Unborn children: exposure to drugs, alcohol, or smoke
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Children: increase in hazards as motor skills develop
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Adolescents: danger from drugs, alcohol, risky sexual activity
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Older adults: risk of abuse & injury from falls
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Principles of Safety (cont’d)
• Factors Affecting Safety: Physiological
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Musculoskeletal system
• Injury to or aging of bones, joints, or muscles
• Affects mobility & increases risk of injury
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Neurological system
• Impairment to brain, spinal cord, or nerves
• Interferes with judgment & motor control
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Fatigue
• Leads to poor perception of danger, faulty judgment, poor
problem solving
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Principles of Safety (cont’d)
• Factors Affecting Safety: Environmental
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Home
• Poor ventilation
• Gas leaks
• Faulty electrical systems & appliances
• Lack of smoke detectors
• Unlabeled toxic substances
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Principles of Safety (cont’d)
• Factors Affecting Safety: Environmental (cont’d)
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Workplace
• Dust
• Chemicals
• Noise
• Heights
• Dangerous machines
• Heavy lifting
• Repetitive motions
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Principles of Safety (cont’d)
• Factors Affecting Safety: Environmental (cont’d)
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Community
• Air pollution
• Crime
• Hazardous waste sites
• Dilapidated housing
• Poor sanitation
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Safety Precautions and Actions
• Patient Safety
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Orientation to facility layout, safety features, & equipment
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Adjustable bed & side rails
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Call system
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Use of safety straps & side rails during patient transport
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Identification bracelets
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Elimination of fall hazards, such as debris or objects on ground
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Proper use & maintenance of equipment
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Safety Precautions and Actions (cont’d)
• Health Care Worker Safety
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Proper posture
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Proper body mechanics
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Proper ergonomics
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Prevention of exposure to:
• Pathogens
• Chemicals
• Radiation
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Safety Precautions and Actions (cont’d)
• Fire: Prevention Measures
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Regular maintenance of electrical equipment
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Strict smoking policies
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Fire safety plan
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Emergency exits
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Fire extinguishers
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Instructions for reporting a fire
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Safety Precautions and Actions (cont’d)
• Fire Response Procedures: RACE
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Rescue anyone in immediate danger
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Activate the fire code system & notify the appropriate person
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Confine the fire by closing doors & windows
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Evacuate patients & other people to a safe area or extinguish
fire, if safe to do so
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Safety Precautions and Actions (cont’d)
• Classes of Fires
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A—Ordinary combustibles: wood, cloth, paper, plastic
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B—Flammable liquids
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C—Live electrical
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Safety Precautions and Actions (cont’d)
• Classes of Fire Extinguishers
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A
• For A fires only; do NOT use on B or C fires
• Cool & smother fire with ordinary water
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BC
• For B or C fires only; do NOT use on A fires
• Use dry chemical or carbon dioxide
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ABC
• For any type of fire
• Uses baking soda-like material
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Safety Precautions and Actions (cont’d)
• Directions for Operating a Fire Extinguisher: PASS
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Pull the locking pin
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Aim the nozzle at the base of the fire
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Squeeze the handle
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Sweep from side to side
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Safety Precautions and Actions (cont’d)
• Electrical Hazards
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Do not handle electrical devices & cords:
• With wet hands
• When wearing wet shoes
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Mop up spilled fluids
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Make sure all plugs are grounded
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Report any equipment damage
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Service equipment regularly
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Safety Precautions and Actions (cont’d)
• Oxygen Equipment
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Avoid open flames near oxygen equipment
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Place “No Smoking” signs nearby
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Make sure all electrical equipment is:
• Grounded
• In good working order
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Avoid synthetic fabrics that build up static electricity
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Avoid use of oils in area
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Safety Precautions and Actions (cont’d)
• Chemical Hazards
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Alcohol
• Used as a disinfectant
• Eye irritant, combustible, flammable
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Ethylene oxide
• Used for sterilizing
• Eye irritant, explosive, flammable
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Cleaning & disinfecting agents: eye, skin, & respiratory tract
irritant
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Gases used for anesthetics or gas-powered equipment
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Safety Precautions and Actions (cont’d)
• Radiation
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Wear radiation detection badge
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Minimize time of exposure to source
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Maximize distance from source
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Use appropriate shielding (lead shields or aprons, gloves)
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Safety Precautions and Actions (cont’d)
• International radiation symbol
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Safety Precautions and Actions (cont’d)
• Workplace Violence: Factors
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Prevalence of handguns & other weapons
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Criminal holds & care of disturbed, violent people
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Release of mentally ill patients without follow-up care
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Presence of drugs & money
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Unrestricted movement of public in clinics & hospitals
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Long waits in emergency or clinic areas
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Presence of gang members, drug/alcohol abusers, trauma
patients, distraught family members
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Isolated work with clients during examinations or treatment
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Safety Precautions and Actions (cont’d)
• Emergency Action Plan
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Method for reporting fires & other emergencies
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Evacuation policy
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Emergency escape procedures
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Names & contact info of key people
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Procedures for shutting down critical operations
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Procedures for operating fire extinguishers
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Designated rescue & medical duties
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Site of alternative communications center
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Secure onsite or offsite location for storing records
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Infectious Disease
• Infectious Microorganisms
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Pathogen: disease-causing microorganism
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Found in almost all environments
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Bacteria: aerobic vs. anaerobic
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Viruses: smallest
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Fungi: plantlike organisms (molds & yeasts)
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Infectious Disease (cont’d)
• Disease-Producing Factors
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Number of organisms in exposure
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Virulence of organism
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Relative strength of person’s immune system
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Length & intimacy of contact between person & microorganism
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Infectious Disease (cont’d)
• The Chain of Infection: Five Links
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Reservoir: person infected (carrier)
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Exit from reservoir: nose, mouth, rectum, open wound
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Vehicle of transmission
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Portal of entry: nose, mouth, GI system, wound
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Susceptible host: person who becomes infected
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Infectious Disease (cont’d)
• Chain of infection
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Infectious Disease (cont’d)
• Modes of Transmission: Direct
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Touching contaminated blood or body fluids
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Shaking hands with contaminated person
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Inhaling infected air droplets
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Intimate contact (kissing, sexual intercourse) with infected
person
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Infectious Disease (cont’d)
• Modes of Transmission: Indirect
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Contaminated food or water
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Disease-carrying insects
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Soil
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Drinking glasses
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Improperly disinfected medical instruments
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Infectious Disease (cont’d)
• Sources of Transmission
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Human hosts with infectious disease
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Carriers of disease who are not ill with it
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Those incubating a disease but not yet showing symptoms
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Infected animals: dogs, cats, birds, cattle, rodents, flies,
roaches, ticks, mosquitoes
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Infectious Disease (cont’d)
• Airborne Diseases
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Tuberculosis
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Chickenpox
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Common cold
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Diphtheria
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Influenza
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Measles
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Meningitis
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Pneumonia
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Whooping cough
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Infectious Disease (cont’d)
• Health care-associated infections
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Infectious Disease (cont’d)
• Blood-Borne Diseases
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Human immunodeficiency virus (HIV)
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Hepatitis B
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Hepatitis C
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Infectious Disease (cont’d)
• Training Points for Prevention of Blood-Borne
Diseases
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Descriptions of diseases
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Methods of transmission
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Related symptoms
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Protective equipment & its location in facility
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Risks of contracting hepatitis B
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HBV vaccine
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Exposure control plan
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Post-exposure procedures & follow-up care
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Preventing the Spread of Disease
• Standard Precautions: Overview
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Procedures to reduce transmission of microorganisms
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Must be used when touching:
• Blood
• Body fluids
• Damaged skin
• Mucous membranes
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Preventing the Spread of Disease (cont’d)
• Standard Precautions: Requirements
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Hand washing
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Alcohol rubs
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Gloves, masks, gowns, & eyewear
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Disposal of single-use items & sharps in proper containers
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Avoiding sharps injuries
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Not recapping, bending, or breaking needles
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Not eating, drinking, or putting anything in your mouth while
working
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Preventing the Spread of Disease (cont’d)
• Medical Asepsis: Hand Washing
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Before & after every patient contact
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After contact with blood, body fluids, or contaminated material
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After handling specimens
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After coughing, sneezing, or blowing your nose
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After using the restroom
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Before & after lunch, taking breaks, & leaving for the day
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Preventing the Spread of Disease (cont’d)
• Cleaning
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Use of soap or detergent & water
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Reduces # of microorganisms to safe level
• Disinfection
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Use of agent to destroy many, but not all, pathogens
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Antiseptics
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Preventing the Spread of Disease (cont’d)
• Sterilization
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Total destruction of all microorganisms on objects & surfaces
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Bactericidal or germicidal means
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4 methods
• Steam under pressure in an autoclave
• Specific gases, such as ethylene oxide
• Dry heat ovens
• Immersion in a chemical agent
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Preventing the Spread of Disease (cont’d)
• Personal Protective Equipment
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Gloves
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Masks
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Gowns
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Eye protection
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Preventing the Spread of Disease (cont’d)
• Regular Waste
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Paper
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Plastic
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Disposable tray wrappers
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Packaging materials
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Preventing the Spread of Disease (cont’d)
• Sharps Waste
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Needles
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Microscope slides
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Used ampules
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Razors
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Preventing the Spread of Disease (cont’d)
• Biohazard Waste
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Soiled dressings & bandages
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Soiled examination gloves
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Soiled examination table paper
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Cotton balls & applications used on body
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Preventing the Spread of Disease (cont’d)
• Reporting an Exposure: Criteria for Submitting Report
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Work-related exposure requiring medical treatment
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Loss of consciousness or medical removal
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Loss of days at work or transfer to other job
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Injury involving sharp contaminated with blood
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Exposure to tuberculosis
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Positive blood test for contagious disease
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