Week 4: Safety for All

Week 4: Safety for All Readings: Chapter 20, PPE document Learning Objectives: 1. 2. Discuss factors that can impact patient safety such as the nurse patient relationship, communication, team work, and self-care nurse’s role and responsibility regarding safety for all (patients) using the interrelated concept of routine practices, infection control, and chain of infection 3. Discuss the importance of hand hygiene and personal protective equipment and when these should be performed or applied 4. Discuss effective hand hygiene technique (hand washing and alcohol hand rub) 5. Practice communication and team exercises which exemplify the importance of safety Notes on Chapter 20: Asepsis: the absence of bacteria, viruses, fungi, and other microorganisms. Elimination of infection is the goal of asepsis, not creating a sterile field Principles of Asepsis: 1. All surgical items have been sterilized, so don’t touch with your bare hands. Sterile instruments can only be touched with sterile gloves 2. If in doubt about the sterility of anything, consider it unsterile. If you think you may have contaminated a glove, consider it contaminated and get a new glove 3. The edge of anything that encloses sterile contents is not considered sterile 4. Moisture may cause contamination. Avoid spilling cleaning solutions as they can easily transmit organisms Medical asepsis: also known as clean technique, the goal is to keep the area as clean as possible in order to reduce the transmission of disease Surgical asepsis: also known as sterile technique, this technique is used to ensure no transmission of microorganisms to the patient WHO Practice Standards - published in 2009 - When should nurses and HCW perform hand hygiene? 1. Before touching a patient 2. Before clean/aseptic procedures 3. After body fluid exposure/risk 4. After touching a patient 5. After touching a patients surroundings The Chain of Infection - In order for disease or infection to be present, the pathogen must first enter a host through portal of entry and be able to live and replicate within the susceptible host - Each link must be present and in sequential order for an infection to occur: 1. an infectious agent or pathogen 2. A reservoir or source for pathogen growth 3. A portal of exit from the reservoir 4. A mode of transmission 5. A portal of entry to the host 6. A susceptible host Factors that Influence Disease or Infection: • Type of organism • Source of transmission and destination • • Number of organisms present Size and virulence of microorganisms Reservoir: in order for infection or disease to occur, the microorganism needs to be housed somewhere. The house/reservoir must be an environment that supports the life of the microorganism and allows it to remain in its current state, or perhaps even multiply Portal of Exit: a nurse must assume that any and all body fluids have the potential to carry microorganisms, and all are considered a portal of exit Modes of Transmission - Contact transmission: can be direct or indirect, direct is physical contact, indirect would be fomites - Droplet transmission: large droplets that come from the respiratory try when coughing or sneezing - Airborne transmission: microorganisms being carried by dust or small particles in the air - Vehicle transmission: contamination of a “vehicle” such as contaminated meat or food - Vector-Borne transmission: carriers such as mosquitos, skunks, or bugs that transmit disease - a normal defence mechanism of the body includes inflammation which can be acute or chronic - specific responses occur when specific pathogens are encountered and can lead to serious illness or death if the immune system does not engage - nonspecific responses occur regularly and protect against microorganisms regardless of previous exposure - nosocomial infections occur inside of hospitals and are often due to urinary tract infections, respiratory pneumonia, surgical site wound infections, and gastrointestinal and skin infections (S. aureus, Pseudomonas aeruginosa, and E. coli) - exogenous infections: when transient flora are introduced to the susceptible host - endogenous infections: when resident flora become altered and proliferate Patient Susceptibility • Age - the young and the elderly • Nutrition • • Stress - short term boosts immunity, long term suppresses it Known microorganisms - aka illness or disease that is already present makes you susceptible PPE Equipment • Gowns: worn to prevent soiling of clothing during procedures where activities are likely to generate • Masks: the purposes of standard surgical/procedure masks is to protect the mucous membranes • splashes of bodily fluids, and when recommended by infectious disease departments of the nose and mouth during procedures and patient care activities that are likely to generate splashes, sprays, aerosols of blood, body fluids, secretions, or excretions Sterile Gloves: sterile gloves are used for procedures such as catheterization or when trying to access a sterile part of the body. Sterile gloves protect against microorganisms because the skin is no longer a barrier that is able to provide protection