Human Occ: INFECTION CONTROL AND SAFETY ISSUES IN THE CLINIC + Chap. Pop Quiz

Safety Recommendations for the Clinic

• Prevention of accidents and subsequent injuries begins with consistent use of generic safety recommendations in any health care setting.

• It is common sense, but it is not as common a practice as it should be. 

Infection control - Precautions

• Universal Precautions - established by the CDC to protect the health care worker from infectious diseases such as HIV, AIDS, and Hepatitis B (HBV).

• Standard Precautions - CDC revised universal precautions and now promotes standard precautions and transmission-based precautions.  See box 3-2 (page 43)

OSHA regulations

• Educate employees on HIV/HBV transmission.

• Provide and locate PPE.

• Train on safe practices for patient care and handling bodily fluids.

• Supply proper waste disposal containers.

• Display biohazard warnings.

• Offer the Hepatitis B vaccine to at-risk employees.

• Provide education and care for exposure cases.

• Employees must follow OSHA guidelines for safety.
  

OSHA Material Safety Data Sheet (MSDS)

Is a document that contains information on the potential hazards (health, fire, reactivity and environmental) and how to work safely with the chemical product.  It is an essential starting point for the development of a complete health and safety program.

Disinfectants and Isolation Systems

Disinfectants - used to clean environmental surfaces and reusable instruments.  Gloves should be worn with liquid disinfectants.  Follow the local health department/hospital infection control department guidelines for the most appropriate product to use for disinfection

Isolation Systems - patient is in a room alone or with another person with the same communicable disease to reduce the possibility of transmitting the disease to others.  

Protective Isolation

(Neutropenic Precautions)- occurs when a patient is more susceptible to infection.  Those entering the room may need to wear protective clothing and the sequence of donning the equipment is more important than doffing the equipment.

Incidents and Emergencies

• General Protocol: Seek help, stay with the patient, prevent further injury, provide emergency care, document the incident per policy, and notify a supervisor.

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• Falls: Lower the patient safely instead of keeping them upright (see page 46 for techniques).

• Burns: Minor burns require basic first aid; severe burns need professional medical attention.

• Bleeding: Prevent contamination and control bleeding (see pages 46-47 for steps).

• Shock: Symptoms include pale, moist skin, irregular breathing, weak pulse, and dizziness (see page 47 for treatment).

• Seizures: Can range from mild staring spells to convulsions; response varies based on severity.

• Choking & Cardiac Arrest: All practitioners should be trained in appropriate emergency response (see page 48 for details).

• Insulin-Related Illnesses: If conscious, give sugar (e.g., candy or juice); if unconscious, IV glucose may be needed. Severe cases (acidosis) require insulin to prevent diabetic coma or death.

Preventive Positioning for Specific Diagnosis

Preventive Positioning for Specific Diagnosis: Staying in one position too long can cause bedsores (decubitus ulcers).

Conditions that need extra attention:

• Impaired sensation

• Paralysis

• Poor skin integrity

• Poor nutrition

• Impaired circulation

• Spasticity

Key Areas to Watch: Pay special attention to bony areas like the sacrum, ischium, trochanters, elbows, and heels. Redness can appear in as little as 30 minutes if in one position too long.

Hospital beds

Can be electric or manual.  The top and bottom parts of the bed can be raised or lowered individually.  The whole bed may also be raised and lowered.  Side rails are now considered a restraint.

Ventilators

moves gas or air into the patient's lungs and maintains adequate air exchange when normal respiration is decreased. OT practitioners should be asking questions that only require a head nod or shake, as tubing interferes with verbal communication

Monitors

Various kinds are used to monitor the physiologic state of a patient that requires special care.  OT practitioners should be aware of precautions to avoid patient distress.

Feeding devices

Used with those who have difficulty swallowing, chew or ingest food. Types of feeding devices include: NG tube, G tube, TPN and IV line.

Catheter

 OT practitioners need to be aware of if patients have a leg collection bag or a larger collection bag that can be hung on a walker or side of the bed.  Be sure to transfer the catheter with the person.

Precautions with Special Equipment

Precautions with Special Equipment:

• Avoid pulling, stretching, or putting tension on drainage tubes or catheters.

• Keep the urine bag below bladder level, except for brief moments.

• Do not place the bag on the patient’s lap during transport.

• Monitor urine for changes in production, color, and odor.

Report to a physician or nurse if you notice:

• Foul-smelling, cloudy, dark, or bloody urine.

• Decreased urine flow or production.

Additional Note:

• Empty the collection bag when full.

• Infection is a major risk, especially with indwelling catheters.

Why is it important to follow standard precautions with all clients? 

Infection control procedures are used to prevent the spread of diseases and infections among clients, health care workers and others. The CDC first established Universal Precautions to protect health care workers from infections diseases such as HIV, AIDS, HBV. Now the CDC has revised the information and now promotes standard precautions that apply to all body fluids, broken skin and mucus membranes. These precautions are effective only when used with all clients, every single time, not only those identified as infected.

OT's and OTA's should use which two ways to identify clients prior to any form of treatment?

Name and DOB

Precautions when treating clients with a urinary catheter:

• Avoid stretching the drainage tube

• Do not allow the bag to be placed above the level of the bladder

• Do not place the bag in the patient's lab when transporting

Special feeding devices may be necessary to provide nutrition for clients who are unable to chew, swallow or ingest food. List 3 common feeding devices: 

• Nasogastric (NG) Tube – A flexible tube inserted through the nose and into the stomach for short-term enteral feeding.

• Gastrostomy Tube (G-Tube) – A tube surgically placed directly into the stomach for long-term enteral nutrition.

• Jejunostomy Tube (J-Tube) – A tube inserted into the jejunum (part of the small intestine) for patients who cannot tolerate gastric feeding.

Improper positioning of client can lead to further harm of the patient. If a client is improperly transitioned or positioned into the bed awkwardly it may cause them pain and worsen their conditions. We may be breaking precautions as well by positioning a client improperly.

improper positioning can cause stiff joints (contractures) and pressure sores (skin breakdown). To prevent this:

• Change positions often (every 2 hours for bed-bound clients).

• Use pillows or supports to keep proper body alignment.

• Follow movement precautions for the client’s condition.

• Encourage safe movement to prevent stiffness.

• Check the skin regularly for redness or sores.

Donning PPE (Putting On)

1. Obtain PPE – Ensure you have all required PPE.

2. Perform Hand Hygiene – Wash hands with soap and water or use hand sanitizer.

3. Put on Gown

   • Pick up the gown at the neck area. Find neck ties and fasten around the neck area.

   • Insert hands into sleeves, working them through the wrist cuffs.

   • Now fasten at the waist.

4. Put on Mask – Secure it over your nose and mouth, ensuring a snug fit.

5. Put on Goggles/Face Shield – Adjust to fit securely.

6. Put on Gloves – Extend gloves over the gown cuffs.

Doffing PPE (Removing)

1. Remove Gloves –

   • Grasp the outside of one glove at the wrist and peel it off inside out.

   • Hold the removed glove in the opposite gloved hand.

   • Slide ungloved fingers under the wrist of the remaining glove and peel it off inside out, containing the first glove inside.

   • Dispose of gloves properly.

2. Remove Eye Protection –

   • Handle only by the earpieces or headband.

   • Avoid touching the front of the goggles/face shield.

3. Remove Gown –

   • Untie the neck and waist ties.

   • Pull the gown away from the body, rolling it down inside out.

   • Dispose of properly.

4. Remove Mask –

   • Grab only the elastics or ties without touching the front.

   • Dispose of properly.

5. Perform Hand Hygiene – Wash hands thoroughly.