Safety and Infection Control

NURS 330

what is National Patient Safety Goals (NPSG)

• Initiated in 2002 by the Joint Commission

• identify established relevant safety practices health care institutions should accomplish

Standards of Compliance - Joint Commission

• since most health care organizations embrace and routinely practice there goals they are cataloged into a register of adopted “Standards of Compliance” that must be met on a consistent basis

• there are now over 250 standards of compliance

National Patient Safety Goals (NPSG) - Goals

• identify patients correctly

• use medicines safely

• alarm safety

• prevent infection

• promote a culture of safely

• surgical safety

• medication safety

NPSG Client identification

• two patient identifiers

  • name

  • date of birth

  • MR#

• Identify patient verbally

  • use barcode scanning of ID band for med admin (still confirm verbally with patient)

NPSG: Reporting Critical Results

• lab or diagnostic testing results that are outside the expected range and can be potentially fatal if not addressed

Critical Results - Hospital guidelines should include

• definition of critical result

• defined time frame

• requirement for written documentation of results to provider

NPSG - Alarm Safety

• use of call lights

• alarms on equipment (IV pumps, monitors, vents)

• alarm fatigue is real

NPSG: Surgical safety

• surgical time out

  • use two identifiers to confirm patient

  • mark the surgical site

  • perform time out in the OR

Near miss - Culture of safety

• a potential error or event or circumstance that could have caused harm but was caught and avoided

Client Safety Event

• An unexpected event or circumstance that occurred with our without injury to the patient

Adverse Event

• situation that causes unexpected harm to a patient

Sentinel Event

• a critical unexpected adverse event that caused severe physical or psychological harm to a patient, including death, dismemberment, or permanent injury

how do nurses help in building a culture of safety

• nurses are key

  • safe nurse staffing; patient-nurse ratios; availability of nursing resources; management responsiveness to nurses concerns

• hourly rounding

• standardized communication tool (ISBARR)

• Bedside report

• rapid response team

Event Reporting

• administration, risk management, and nurse leaders should advocated that all team members report unexpected events and near misses

Barriers to reporting

• fear of repercussions or backlash to the reporting individual or the team

• lack of time to write the report

• unclear facility policies and standards

• bullying

• lack of understanding of the roles and responsibilities of team members

• favoritism and influence of some employees

Improve staff communication “I” ISBARR

• I - introduce - state your name, role

Improve staff communication “S” ISBARR

• S - situation - what is the patients main compliant/why are they here?

Improve staff communication “B” ISBARR

• B - background - what pertinent health history or information do you need to share to make things more clear

Improve staff communication “A” ISBARR

• A - Assessment - what have you found that is concerning you? what is your assessment revealing about the patients condition

Improve staff communication “R” ISBARR

• R - what recommendations do you have? what do you believe needs to happen in order to accomplish your goals

Improve staff communication “R” ISBARR

• R - readback - if necessary, read back verbatim orders/instruction received

NPSG : prevent hospital acquired infections

• nosocomial infections - aka HAI (healthcare associated infection

• hand hygiene

• standard precautions

• usually have protocols in place; guidelines to follow

  • examples of HAI : CAUTI, CLABSI, VAP, SSI

NPSG - safe informed care

• informed consent

  • includes type of treatment, expected benefits, potential risks, side effects, and any alternatives that exist

• interpreters

• obligation to report abuse and neglect

NPSG: reduce risk of suicide

• screening protocols

• initiate suicide precautions if risk is identified

  • no sharp objects

  • no cords

  • 1:1 observation

  • gown with no strings

  • remove outside clothes/belongings

NPSG medication safety

• label all meds

• decrease the possibility of med errors with HIGH alert meds (anticoagulants, insulin, chemo, etc)

  • two RNs co-sign prepared med

  • verify correct dose, route, rate, patient, etc

• medication reconciliation

• medication education

Braden Scale for predicting pressure sore risk

Hospital-acquired injury - screening tools

• morse fall risk scale

• braden scale (pressure injury)

• suicide risk

• sepsis

Injury Prevention: Strategies for clients

• general safety interventions

  • video monitoring - telesitter - need a provider order

  • bed safety

    • side rails, call light, bed alarms, low bed, bed locked, belongings close

  • direct observation

  • hourly rounding

• identify clients at risk for falls

  • non-skid socks, bed safety, de clutter room

RACE

• Rescue patients * always priority

• alarm/alert that floor/hospital

• contain the fire (closing doors)

• extinguish

PASS

• Pull the pin

• aim

• squeeze

• sweep

Safety: Universal opening

• knock

• hand hygiene

• Don gloves

• introduce yourself & position

• identify the pt using 2 identifiers

  • verify with the pt’s arm band & chart

• ask about allergies and reaction

Safety: Universal opening : assessing LOC

• Awake? alert? oriented to person, place, time, situation (AA0 ×4)

Safety: Universal opening: environment safety

• side rails x2

• bed locked

• HOB appropriate (head of bed)

safety: universal closing

• summary

• give pt any belongings (cell phone, water, etc)

• work on leaving pt safety

  • bed in lowest position

  • call light in hand

  • bed locked

  • belongings within reach

• ask pt “what can I do for you before I leave? I will be back at ?? (pain, potty, positioning, possessions, personal needs)

• doff gloves

• hand hygiene

what are factors that increase patients susceptibility to infection

• age

• underlying disease

• HIV/AIDS

• malignancy

• transplant

• medications - immunosuppressants, corticosteroids, chemo

• surgical procedures

• radiation

• indwelling devices

contact mode of transmission

• occurs when microorganism move from an infected person to another person

droplet mode of transmission

• occurs when airborne droplets from the respiratory tract of a client travel through the air and into the mucosa of a host

airborne mode of transmission

• occurs when small particulates move into the airspace of another person

direct contact transmission

• occurs when microorganisms are directly moved from the infected person to another person without having a contaminated object or person between the two

indirect contact transmission

• occurs when mircoorganims are moved from the infected person to another person with a contaminated object or person between the two

droplet transmission

• droplets from people can travel through air and come in contact with mucosa of a host

• sneezing, coughing, singing, and talking - disperse droplets into the air

  • Ex: influenza, B pertussis, rhinoviruses, adenovirus

Respiratory etiquette

• clients should be wearing surgical mask when out of their room

• coughing and sneezing into a disposable tissue and throw it away immediately

• cough or sneeze into sleeve when no tissue

airborne transmission

• occurs when small particulates found in the air move , into the airspace of another person and carry infectious agents; can travel long distances

• patients need private room with negative air pressure

  • pulls air into the room, but filters the air before moving it outside the room

• needs to wear a mask any time leaving room

• ex: TB, rubeola (measles), varicella (chickenpox), smallpox

hand hygiene

• is a broad term to cover any type of cleansing of the hands

  • soap and water

  • alcohol-based sanitizer

standard precautions

• a term used to describe the infection prevention practices applied to all clients whether or not they are known to have an infectious agent

• use PPE (mask, gloves, face shield, gowns, glasses

contact precautions

• is used when needing to prevent transmission of infectious agents by direct or indirect contact

  • ex: MRSA, VRE, C.diff, norovirus, RSV, GI diseases

• minimum PPE= gown & gloves

Droplet precautions

• used when needing to prevent transmission of infectious agents by droplets

  • Ex: influenza, pertussis, adenovirus, SARS-CoV1, rhinovirus & mycoplasma pneumoniae

• minimum PPE= surgical mask, gloves; try to maintain 3 feet between you & client

airborne precautions

• used when needing to prevent transmission of infectious agents that can travel through the air

  • private room; negative pressure room

  • ex: TB, varicella

• Minimum PPE = N95 respirators

PPE

• its the nurses responsibility to know what types of personal protective equipment (PPE) are needed to care for clients and to don and doff PPE appropriately

Donning

1. perform hand hygiene

2. gown

3. surgical mask or N95

4. Googles or face shield

5. gloves

Doffing

1. gloves

2. googles/face shield

3. gown

4. surgical mask or N95

5. hand hygiene

medical asepsis (clean technique)

• a term that is used to describe decreasing the number of microorganisms on surfaces as a means to reduce infection risk

  • usually entails: hand hygiene, wearing appropriate PPE, cleaning/disinfecting the environment

surgical asepsis

• term used when performing surgical or invasive procedures to prevent transmission of pathogens to the client

• ensures everything is sterile

  • goal is to prevent transmission of pathogen to client

  • consider rules of sterility

sterile fields

• designated area completely free of all microorganism created to prevent infection during medical procedures

sterile fields sequence

1. peel back the first flap away from the nurses body

2. peel the sides back one at a time

3. peel the flap closest to the nurses body

sterile technique principles

1. Allow only a sterile object to touch another sterile object. Unsterile touching sterile means contamination has occurred.

2. Open sterile packages so that the first edge of the wrapper is directed away from the worker to avoid the possibility of a sterile surface touching unsterile clothing. The outside of the sterile package is considered contaminated.

3. Avoid spilling any solution on a cloth or paper used as a field for a sterile setup. The moisture penetrates through the sterile cloth or paper and carries organisms by capillary action to contaminate the field. A wet field is considered contaminated if the surface immediately below it is not sterile.

4. Hold sterile objects above the level of the waist. This will ensure keeping the object within sight and preventing accidental contamination.

5. Avoid talking, coughing, sneezing, or reaching over a sterile field or object. This helps to prevent contamination by droplets from the nose and the mouth or by particles dropping from the worker’s arm.

6. Never walk away from or turn your back on a sterile field. This prevents possible contamination while the field is out of the worker’s view.

7. Keep all items sterile that are brought into contact with broken skin, or used to penetrate the skin to inject substances into the body or to enter normally sterile body cavities. These items include dressings used to cover surgical incisions, needles for injection, and tubes (catheters) used to drain urine from the bladder.

8. Use dry, sterile forceps when necessary. Forceps soaked in disinfectant are not considered sterile.

9. Consider the edge (outer 1 inch) of a sterile field to be contaminated.

10. 10. Consider an object contaminated if you have any doubt as to its sterility.