Safety andAccident Prevention (Sept 9th),

Infection Control (Sept 30th)

Marilee Elias, MSN, RN, CNE

June Thompson, DrPH, RN

NF I Fall 2014

True or False

There is no such thing as an accident?

Accident Definition:Chance, fortune, luckAct of GodAn unfortunate event

True

Injury Epidemiological Model

Host

Agent (energy)• Mechanical• Chemical

Environment• Social• Physical

The key to prevention

Unit Outcomes

1. Identify factors that influence accident/injury prevention.

2. Discuss implementation of the National Patient Safety

Goals

3. Identify methods to protect clients from injury.

4. Describe safe use of equipment

5. Use clinical decision making/critical thinking when using

restraint /safety devices.

6. Identify methods to maintain a safe environment

Safety is a Basic Human Need

NCLEX Test Plan 2013

Safe and Effective Care Environment

• Safety and Infection Control 9-15%�

• Reduction of Risk Potential 9-15%�

Safety/Accident PreventionInjury Prevention

• Host factors Affecting Safety– Age– Individual Risk Factors

• Lifestyle• Cognitive Awareness• Sensory/Perceptual Alterations• Impaired Mobility• Physical & Emotional Status• Safety Awareness

What’s age got to do with it?

• Safety concerns across the lifespan– Children– Adolescents– Adulthood– Older Adult

Children: Why are they susceptible to Injury?

• Infants/Toddlers

• Preschooler

• School-age

You

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Leading Causes of Unintentional Injury DeathsUnited States - 2011

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Sch

ool a

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)

Leading Causes of Unintentional Injury DeathsUnited States - 2011

Centers for Disease ControlAnd PreventionNational Center for Injury Prevention and Control

Adolescents

• Look! Up in the air! It’s a “Super Teen”!• Judgment lags behind Strength & Confidence• Drugs & ETOH = More risk with any activity

Ado

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oung

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Leading Causes of Unintentional Injury DeathsUnited States - 2011

Centers for Disease ControlAnd PreventionNational Center for Injury Prevention and Control

Adult & Older Adult• Adult

– Workplace injuries– Drugs & ETOH– Physical Activity = Risk of Injury

• The “Weekend Athlete”

• Older Adult– Physiological Changes

– Balance– Sensory changes

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Leading Causes of Unintentional Injury DeathsUnited States - 2011

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Old

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(65

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Unintentional Injury DeathsUnited States - 2011

Centers for Disease ControlAnd PreventionNational Center for Injury Prevention and Control

In S

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lLeading Causes of Unintentional Injury DeathsUnited States - 2011

Centers for Disease ControlAnd PreventionNational Center for Injury Prevention and Control

Let’s talk About Lifestyle

Is this• Host• Agent• Environment• None of the above

Safety & Injury Prevention Risk

Modifiable vs. Non-modifiable

Modifiable: Those things that may be changed or modified

Non-modifiable: Those things that may not be changed or modified

Why is it important to know the difference?

Adults: Let’s talk about Lifestyles

• Smoking• ETOH• Drugs

– Rx and/or Illegal

• Risk-taking Behaviors– Automobiles– Employment– Recreation/ Sports

Modifiable or Non-modifiable?

Sensory/Perceptual Alterations

• Changes or Loss of First Line Defenses– Vision– Hearing– Smell– Taste– Sensation (think Diabetic Neuropathy)– Can also relate to Cognitive Impairment

Modifiable or Non-modifiable?

Mobility• Changes in:

– Strength– Mobility– Balance– Endurance

• Use of Assistive Devices

Modifiable or Non-modifiable?

Injury Epidemiological Model

Host

Agent (energy)• Mechanical• Chemical

Environment• Social• Physical

The key to prevention

There’s been an Incident!What Happens in Healthcare?

Types of Event– Host / Client Behavior: Behavior precipitates incident

• Falls • Agitation/ Aggression

– Agent / Therapeutic Procedures: Occurs during delivery of medical or nursing interventions

• Radiation• Chemotherapy

– Environment / Equipment: • Failure• Improper Use• Not engaging safety features

Leading causes of medical errors in hospitals

(Becker’s Infection Control & Clinical Quality, Hospital Review, Jan 2014)

1. Adverse drug events (medication errors)

2. Catheter- associated urinary tract infection

3. Central line- associated bloodstream infection

4. Injury from falls and immobility

5. Obstetrical adverse events

6. Pressure ulcers (bed sores)

7. Surgical site infections

8. Venous thrombosis (blood clots)

9. Ventilator- associated pneumonia

Let’s talk Prevention!

Assess & Reduce Risks in All Environments• Home

– Poisonings– CO Poisoning– Scalds & Burns– Fires – Firearm Injury– Suffocation/Asphyxiation– Take-Home Toxins– Home Safety Assessment Scale (SAS)

(vol.2 p.376)- Falls- Choking (let’s rescue)

Host

Agent (energy)• Mechanical• Chemical

Environment• Social• Physical

• Community

– MVCs– Pathogens

• Food-Borne • Vector-Borne• Water-Borne

– Pollution• Air• Water• Noise• Soil

– Mother Nature

Host

Agent (energy)• Mechanical• Chemical

Environment• Social• Physical

• Healthcare FacilitiesMedication Errors

Never Events

Falls• Risk Assessments (Morse Fall Scale) & Fall Prevention

Equipment-Related Injuries

Fires • R.A.C.E.

Electrical Hazards

Restraints• Mechanical and/or Chemical • Proper Use & Patient Care• Siderails• Patient Alarm Devices

Host

Agent (energy)• Mechanical• Chemical

Environment• Social• Physical

• More Healthcare Facilities…

Mercury Exposure

Biological Hazards

Hazards to Healthcare Workers

Needlestick Injury

Back Injury

Radiation Injury

Violence (Who’s at risk for violent behavior?)

Host

Agent (energy)• Mechanical• Chemical

Environment• Social• Physical

Safe Use of Equipment

• Proper Training• When in doubt, ASK!• Lock those Wheels• Inspect and Observe Equipment• Report Problems & Remove Equipment• Facility Policies about Patients bringing Electrical

Devices from Home Host

Agent (energy)• Mechanical• Chemical

Environment• Social• Physical

Now there’s been an Incident!

• Incident Reports– What are they?– What do we report?– Won’t they just get someone in trouble?– Won’t my peers think I’m a snitch?– Won’t it make a big deal out of nothing?– Isn’t it just more paperwork?– What’s the Result of Incident Reports?

Why learn about safety ?

• Estimated 440,000 Americans die annually from preventable hospital errors.

• This makes hospital errors the 3rd leading cause of death in the U.S.*

• Annual cost to society is over $17.1 billion annually **

• Hospital Safety Score, Washington, Oct. 2013• National Institutes of Health, Millwood, Oct 2011

Two initiatives focused on Safety

1. Quality and Safety Education for Nurses

[QSEN]

2. National Patient Safety Goals

[NPSG]

Quality and Safety Education for Nurses Project(QSEN)

• Prepare future nurses with the knowledge, skills and attitudes (KSAs) to improve the quality and safety of healthcare systems

• Defines competencies and proposed targets for the knowledge, skills and attitudes (KSAs) to be developed in nursing pre-licensure programs

QSEN 6 Competencies

• Patient Centered Care• Teamwork and Collaboration• Evidence Based Practice• Quality Improvement • SAFETY• Informatics

www.qsen.org

Promoting Patient Safety

• National Patient Safety Goals (NPSG) brought to us by:

• The Joint Commission (TJC)– Formerly known as the Joint Commission for

Accreditation of Healthcare Organizations (JCAHO)

NPSG Purpose

• The purpose of the Joint Commission’s National Patient Safety Goals is to promote specific improvements in patient safety

• The requirements highlight problematic areas in health care and describe evidence and expert-based solutions to these problems

• The requirements focus on system-wide solutions, wherever possible

The NPSG Safety Goals ProjectWe will focus on:

• Goal1: Patient Identification (NPSG.01.01.01)

• Goal 2: Improve Staff Communication (NPSG.02.03.01)

• Goal 3: Use Medications Safely- Labeling

(NPSG.03.04.01)

• Goal 3: Use Medications Safely- Passing on Info

(NPSG.03.06.01)

• Goal 7: Prevent Infections- Hand Washing

(NPSG.07.01.01)

• Goal 7: Prevent Infections- Catheters (NPSG.07.06.01)

2014 National Patient Safety Goals

1. NPSG.01.01.01 Use at least 2 patient identifiers when providing

care, treatment, and services.

2. NPSG.02.03.01 Report critical results of tests and diagnostic

procedures on a timely basis.

3. NPSG.03.04.01 Label all medications, medication containers, and

other solutions on and off the sterile field in perioperative and other

procedural settings (includes syringes, medicine cups and basins).

4. NPSG.03.06.01 Maintain and communicate accurate patient

medication information.

5. NPSG.07.01.01 Comply with either the CDC or WHO hand hygiene

guidelines.

6. NPSG.07.06.01 Implement evidence-based practices to prevent

indwelling catheter-associated urinary tract infections (CAUTI).

QSEN vs. NPSG

QSEN-Broader Categories NPSG-More Specific Situations

Patient Centered Care Identify Patients Correctly

Teamwork and Collaboration Improve Staff Communication

Evidence-Based Practice Use Medications Safely- Labeling

Quality Improvement Use Medications Safely- Passing on Information

Safety Prevent Infections- Hand washing

Informatics Prevent Infections- Catheters

High Alert Medications

• What’s a high alert medication?

• Do medication worksheets for:– Digoxin (Lanoxin)– Warfarin (Coumadin)

• NPSG 03.05.02 Take extra care with patients who take medicines to thin their blood

Tall Man Lettering

FDA and ISMP 2014

Thinking and Teaching about Safety

• You are making a home health nurse visit to Teresa, her 2 year old

child and her elderly grandmother who is recovering from a hip

fracture. They live in a rural area and Teresa is the primary

caregiver for both of them. Teresa’s husband is a long-distance

truck driver and is often away for a week at a time.

How is Safety Assessed in Acute Care Settings?

• Morse fall risk scale• Braden scale• Sleep apnea scale• Medications• Basic Nursing Care

What do you know?

• Teresa tells you that the toddler is very active

and getting “into everything”

• Teresa tells you that since her grandmother was

discharged from the rehabilitation center she

has been very afraid of falling and does not want

to do anything for herself

What’s a nurse to do?

• Why are Teresa’s child and grandmother at risk

for injuries?

• What will you look for as you assess the family’s

home environment?

• What interventions will you suggest to Teresa to

improve home safety for her and her family?

Safety ProjectInstructions and Group

Assignments

Infection Control Tuesday, Sept 30th

Unit Outcomes

• Describe methods to control the spread of infectious

agents.

• Identify methods to control or eliminate infectious agents.

• Use clinical decision making/critical thinking to ensure

standard/transmission based/other precautions.

Infection ControlChain of Infection• Handwashing

Defense Mechanisms

Types of Infectious Responses

Stages of Infection

Nosocomial Infections• Handwashing

Medical & Surgical Asepsis• Handwashing

Standard & Isolation Precautions• Handwashing

Chain of Infection

What Mechanisms Defend the Body against Infections?

• Primary Defenses– What has the Body got going for itself?

• Secondary Defenses– How does the Body respond to invaders?

• Tertiary Defenses– Specific Immunity

• Humoral Immunity

– Non-specific Immunity• Cell-mediated Immunity

Classifying Infections

• Local vs. Systemic– Types of infectious responses

• Bacteremia vs. Septicemia• Primary vs. Secondary• Acute vs. Chronic vs. Latent

Nosocomial Infections

• Where and How do patients get them?– Exogenous Nosocomial Infections– Endogenous Nosocomial Infections

• Why does Healthcare care?– Patient Outcomes– $$$$$$$$$$$$$$

Stages of Infection

• Incubation– Time between invasion and symptoms

• Prodromal Stage– Vague symptoms

• Illness– Signs and Symptoms appear

Stages of Infection

• Decline– Time period when body defenses and

treatments are working

• Convalescence– Return to health– Can last for long periods of time

Who cares about Drug-Resistant Pathogens?

• MRSA• VRE• Clostridium difficile (AKA C. difficile)

– Why is C. diff so DIFFICULT?

What factors increase the susceptibility of a Host?

• Developmental stage• Breaks in the first line of defense• Illness or Injury• Tobacco Use/ Substance Use• Multiple Sex Partners• Environmental Factors• Chronic Disease• Medications• Nursing & Medical Procedures

Let’s Defend Host Defenses(Promoting wellness)

• Good Nutrition• Good Hygiene• Rest & Sleep• Exercise & Activity• Stress Reduction• Immunizations (herd immunity?)

Medical & Surgical Asepsis

• Medical Asepsis– A state of cleanliness

• Environment• Disinfection vs. Sterilization

– Hands• What do we do?

Hand Wash vs. Hand Rub?(WHO 2009)

• When to hand wash?

• How to hand wash?

• When to hand rub?

• How to hand rub?

Han

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CDC2014

Han

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More food for Handwashing Thoughts

• Things my hands did today:

• Showered me, fed me, brushed my teeth, dressed my body,

scratched the dog, drove me to LSSC, scratched my nose, shook

hands with my friends, picked up the pen I dropped on the floor in

the bathroom, touched door handles, took books off the library

shelves, handed my cell phone to my friend (who still has a cold),

took the phone back and used it to call home, rubbed my eyes, got

a Kleenex from my friend (who still has a cold), fed me lunch,

opened a door for a guy having a sneezing fit, drove me home, fed

me dinner, turned pages while I studied, brushed my teeth, and

pulled back the covers on the bed…

• I wonder what was on all those things I touched?

With all we do & touch, how Long can Viruses live outside of the body?

• Influenza Virus– 72 HRS on Nonporous Surface– 48 HRS on Plastic, Magazines– 24 HRS on Pajamas

• Bird Flu– 144 HRS on all tested surfaces

• RSV Respiratory Syncytial Virus– 8 HRS on Nonporous Surfaces– 2.5 HRS on Cloth

• Rhinovirus-the common cold– 15-85 HRS on Nonporous Surfaces

• Blood Borne Viruses- HIV, HBV – 7 Days or more

Ebola VirusHemorrhagic Virus

When an infection does occur in humans, the virus can be spread in several ways to others. The virus is spread through

direct contact (through broken skin or mucous membranes)

a sick person's blood or body fluids (urine, saliva, feces, vomit, and semen)

objects (such as needles) that have been contaminated with infected body fluids infected animals

Personal Protective Equipment“Standard Precautions”

1. Gown

2. Mask or Respirator

3. Goggles or Face Shield

4. Gloves

1. Gown

2. Mask or Respirator

3. Goggles or Face Shield

4. Gloves

Surgical Asepsis

• Sterile Surgery• Doing the “Surgical Scrub”• Surgical Attire• Sterile Technique• Sterile Fields

Finding the Isolation Precautions in SimChart

• Order entry• General Orders

Infection Protection for AllCDC & two tiers of protection• Standard Precautions

– (Tier One, aka Universal Precautions)

• Transmission-Based Precautions (Tier Two)– Contact Precautions– Droplet Precautions– Airborne Precautions– Protective (or Reverse) Isolation

Tier 2 Precautions

Contact Precautions• Contact precautions are used

when a person has a type of bacteria or virus on the skin or in a sore, or elsewhere in the body such as the intestine, that can be transmitted to someone else if the person touches the infected individual or

contaminated surfaces.

Staphylococcus aureus (MRSA), Salmonella, Clostridium difficile

Tier 2 Precautions

Droplet Precautions• Use droplet precautions

whenever you are in a room with a patient who is infected with a virus or bacterium that is transmissible via the droplets of mucus and saliva. These droplets are generated when a patient coughs, sneezes, or talks

Tier 2 Precautions

Airborn Precautions

• Airborn transmition occurs by

• Airborne droplets containing the microorganisms that remain suspended in the air for long periods of time

• Dust particles that contain an infectious agent

Tier 2 Precautions• Protective or Reverse Isolation

Who is the patient?