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Chapter 29
Safety, Infection Control, and Hygiene
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Creating a Culture of Client
Safety
• National Patient Safety Goals:
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Identify patients correctly
Improve staff communications
Use medicines safely
Prevent infection
Check patient medicines
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Creating a Culture of Client
Safety
• National Patient Safety Goals:
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Prevent patients from falling
Help patients be involved in own care
Identify patient safety risks
Watch patients closely for changes
Prevent errors in surgery
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Factors Affecting Safety
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Age
Lifestyle
Sensory and perceptual alterations
Mobility
Emotional state
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Types of Accidents
• Client behavior
• Therapeutic procedure
• Equipment
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Potential Occupational Hazards
• Nurses at risk in workplace
– Latex allergies
– Work-related musculoskeletal disorders
• OSHA
– Enforces safety standards
– Cites and disciplines agencies not in compliance
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Infection Control Principles
• Pathogens
– Microorganisms that produce disease
• Infection
– Invasion and multiplication of microorganisms
– Results in injury
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Infection Control Principles
• Colonization
– Invasion and multiplication of microorganisms
without tissue injury
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Chain of Infection
• Agent, host, and environment
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Biological agents
Chemical agents
Physical agents
Susceptible host
Compromised host
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Chain of Infection
• Modes of transmission
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Contact
Airborne
Vehicle
Vector-borne
• Break chain
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Normal Defense Mechanisms
• Nonspecific immune defense:
– Skin and normal flora
– Mucous membranes and sneeze, cough, and
tearing reflexes
– Elimination and acidic environment
– Inflammation
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Normal Defense Mechanisms
• Specific immune defense:
– Humoral immunity
– Acquired immunity
• Vaccination
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Stages of the Infectious Process
• Infectious responses:
– Localized
• Limited to defined area or single organ
– Systemic
• Affects entire body and multiple organs
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Stages of the Infectious Process
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Incubation period
Prodromal stage
Illness stage
Convalescent stage
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Emerging Infections
• Tuberculosis
• Severe acute respiratory syndrome
(SARS-CoV)
• Hepatitis
• West Nile virus
• Viral hemorrhagic fevers
• Human immunodeficiency virus (HIV)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Health Care-Associated
Infections
• Acquired in hospital or other health
care facilities
• Hospitalized clients at risk for
nosocomial infections
• Multidrug-resistant organisms
(MDROs)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Hygiene
• Factors influencing hygienic practice:
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Body image
Social and cultural practices
Personal preferences
Socioeconomic status
Knowledge
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Safety, Infection Control,
Hygiene and the Nursing Process
• Assessment
– Health history
• General health perception and management status
– Physical examination
• Risk factors
• Client in inpatient setting
• Client in home
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Safety, Infection Control,
Hygiene and the Nursing Process
• Assessment
– Diagnostic and laboratory data
• Blood profile
– Altered clotting
– Anemic conditions
– Leukocytosis
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Safety, Infection Control,
Hygiene and the Nursing Process
• Diagnosis
– NANDA statements
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Risk for injury
Risk for infection
Self-care deficits
Others
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Safety, Infection Control,
Hygiene and the Nursing Process
• Outcome identification and planning
– Manipulate external environment to reduce risk
of injury and infection
– Client and caregiver education
• Identification of hazards
• Health promotion practices
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Safety, Infection Control,
Hygiene and the Nursing Process
• Implementation
– Raise safety awareness and knowledge
– Prevent falls
• Restraints
– Physical
– Chemical
• Environment
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Safety, Infection Control,
Hygiene and the Nursing Process
• Implementation
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Prevent fire
Ensure safe operation of electrical equipment
Reduce exposure to radiation
Prevent poisoning
Reduce noise pollution
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Safety, Infection Control,
Hygiene and the Nursing Process
• Implementation
– Ensure asepsis
• Medical
– Reduces number, growth, and spread of microorganisms
– Clean technique
– Hand hygiene
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Safety, Infection Control,
Hygiene and the Nursing Process
• Implementation
– Ensure asepsis
• Surgical
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Eliminates microorganisms and spores
Sterile technique
Sterile gloves
Surgical attire
Surgical hand antisepsis
Gown and closed glove
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Safety, Infection Control,
Hygiene and the Nursing Process
• Implementation
– Reduce or eliminate infectious agents
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Cleansing
Disinfection
Sterilization
Home health care
Disposal of infectious waste
Sharps-related hazards
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Safety, Infection Control,
Hygiene and the Nursing Process
• Implementation
– Practice standard and isolation precautions
• Contact
• Droplet
• Airborne
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Safety, Infection Control,
Hygiene and the Nursing Process
• Implementation
– Employ alternative therapies
• Herbal baths
– Bath for specific body part
– Full body bath
• Herbs for infections
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Safety, Infection Control,
Hygiene and the Nursing Process
• Implementation
– Provide for client bathing needs
• Cleaning baths
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Shower
Tub bath
Self-help bath
Complete bed bath
Partial bath
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Safety, Infection Control,
Hygiene and the Nursing Process
• Implementation
– Provide for client bathing needs
• Therapeutic bath
– Hot or warm water tub bath
– Cool or tepid bath
– Sitz bath
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Safety, Infection Control,
Hygiene and the Nursing Process
• Implementation
– Provide clean bed linen
• Unoccupied
• Occupied
– Provide skin care
• Perineal care
• Back rubs
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Safety, Infection Control,
Hygiene and the Nursing Process
• Implementation
– Provide foot and nail care
– Provide oral care
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Fluoride
Flossing
Brushing
Care for unconscious client
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Safety, Infection Control,
Hygiene and the Nursing Process
• Implementation
– Provide hair care
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Brushing and combing
Shampooing
Shaving
Mustache and beard care
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Safety, Infection Control,
Hygiene and the Nursing Process
• Implementation
– Provide eye, ear, and nose care
• Eyes
– Contact lenses
• Ears
– Hearing aids
• Nose
(continued)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Safety, Infection Control,
Hygiene and the Nursing Process
• Evaluation
– Client free from injury
– Client free from infection
– Self-care needs met
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.