Safety/Hygiene/Infxn Control

• Asepsis: lack of infxn
• Sepsis: infxn

• all components are interdependent; control infection by breaking a chain connection
• --infectious agent
• --reservoir
• --portal of exit
• --means of transmission
• --portal of entry
• --susceptible host

• Incubation Period: organisms growing and multiplying
• Prodromal Stage: person is most infectious, vague and nonspecific signs of disease
• Full Stage of Illness: presence of specific signs and symptoms of disease
• Convalescent Period: recovery from infections

• Bacteria: most significatnt and most prevalent in hospital settings, treated with anitbodies
• Viruses: smallest, common cold
• Fungi: plantlike organisms present in water, air, soil
• Factors: number, virulence, immunocompetence, length and intimacy of contact between person and microorganism

• natural habitat of the organism
• Other humans, animals, soil, food, water, milk, inanimate objects (fomites), carriers

• point of escape for the organism
• Respiratory, gastrointestinal, genitourinary tracts, breaks in sking, blood
• Can be transmitted by direct contact (person is touched by infected person or carrier), or indirect contact (person touches inanimate object that has organism on it—fomites), or airborne (only stays short time in air)
• Organisms can enter through some portal it exits through

direct contact, indirect contact, airborne route

points at which organisms enter a new host

must overcome resistance mounted by host’s defenses

Factors: intact skin and mucous membranes, normal pH levels, body’s WBC, age/sex/race/hereditary, immunization (natural or acquired), fatigue/climate/nutritional and general health status, stress, use of invasive or indwelling medical devises

• Body’s normal flora
• Inflammatory response: most rapid
• Immune response
• Humoral immunity: Antigen/ Antibody
• Cell mediated immunity: increased WBC’s including lymphocyte

• Exogenous: acquired from other people
• Endogenous: comes from microbial life harbored in the person
• Iatrogenic: infection resulting in treatment or diagnostic procedure

• redness
• swelling
• warmth
• pain
• decrease in function

• Systemic infection: fever, change in lab values, gone through and affected body
• --Lethargy, anorexia, enlarge lymph
• Lab Data: can show systemic infection
• -- Normal WBC 5,000-10,000
• --Elevated WBC = infection

• Clean Technique: reduce number of organisms (through hand hygiene, gloves, PPE)
• -- Transient bacterial flora: easily removed by handwashing
• --Resident bacterial flora: hand is the carrier
• --Cleansing agents can be non-antimicrobial, antimicrobial, or alcohol run (60-90% alcohol)

• Sterile Technique: zero organisms
• for indwelling catheter, IV catheter

• Standard Precautions: (Tier 1)
• --always used
• --Personal Protective Equipment and Supplies: Gloves, gowns, masks, protective eye gear
• Transmission-Based Precautions: (Tier 2) Isolation Category
• --specific instructions
• --1. Airborne Precautions
• --2. Droplet Precautions: mask within 3 feet of patient
• --3. Contact Precautions

• Disinfect: agent, get rid of most pathogenic organisms; destroy all pathogenic organisms, except spores
• Sterilization: destroy all microorganisms, including spores

• improve the accuracy of patient identification
• improve the effectiveness of communication among caregivers
• improve the safety of using medications
• reduce the risk of healthcare-associated infections
• accurately and completely reconcile medications across the continuum of care
• reduce the risk of patient harm resulting from falls

• Physical and cognitive changes, problems at certain age groups
• Disabilities: increased risk for falls

• Risk of Falls: medications increase risk for falling, incident reported in QMM, not in pt file
• Safety considerations for older adults
• Restraints: always under physician order, least necessary measure, physical restraints, chemical restraints, long-term facilities have very strict guidelines, concern in circulation/skin/nerve damage
• Medication Errors: mechanisms for reducing errors (machines that alert warnings before administering medications)

• doesn’t go into patient’s chart
• aim is only for institution quality care purposes, not in the patient’s purposes
• Record in Chart: fall, status of patient, notification of physician, nursing intervention, and explanation of incident
• (Don’t mention QMM)

• Fires: (RACE: rescue, activate alarm, contain, evacuate)
• Poisoning: avoid by medications well labels, no access to children, carbon monoxide detector
• Suffocation and Choking: drowning (swimming, bathtub)
• Firearm Injuries: lock up firearms

• #1 is previous incident of falling
• confusion
• medication
• impaired judgment
• over 65 yrs
• sensory deficit
• incontinence
• meds affecting blood pressure (orthostatic [postural] hypotension/dizziness)
• attached equipment (IV, catheter)

identifies risks and develops standards to prevent serious injury/illness caused by work-related musculoskeletal disorders

• protection
• secretion
• excretion
• temp regulation
• sensation
• psychosocial
• hygiene related to skin care

• pressure ulcer caused by lack of blood circulation to area
• black, dead tissue

• soap cleansers
• topical emollients
• moisturize
• establish protective barrier

• Nails: nail base may have redness, swelling, bleeding, discharge, tenderness
• Feet: cleanliness, intactness of skin; note swelling, inflammation, lesions, tenderness; wash/dry feet thoroughly, avoid soaking, clean interdigital area

inflammation of the gingival (gums)

• (periodontal disease)
• marked inflammation of the gums
• degeneration of the dental periosteum and bone

hard deposits along the gum lines that eventually attacks bone tissue

• strong mouth odor or persistent bad taste in mouth
• (first indication of periodontal diease)

• inflammation of oral mucosa
• (heat, pain, increased flow of saliza, halitosis)

• inflammation of the tongue
• (B12, folic acid, iron deficient)

• ulceration of the lips
• (vitamin B complex deficient)

• itching
• flaking
• (daily brushing and shampooing)

• hair loss
• (partial, complete, local, or generalized loss)

• hair lice
• pediculosis humanus capitis: on hair and scalp
• pediculosis humanus coporis: on the body, especially pubic hair

• Lyme disease
• Rocky Mountain spotted fever
• tularemia

• Identify patient personal hygiene habits, special measure
• Assess position, alignment, appearance
• History of related problems or related treatments

• wear gloves
• patient lays on same side as eye being cleaned
• one cotton ball (water, saline) per swipe
• inner to outer canthus

• cerumen (wax)
• dry outer ear/not inner
• battery-check for hearing aid

• blow debris out both nostrils same time
• loosen hardened crusts

• SocialPpractices
• Personal Preferences
• Body Image
• Socioeconomic Status
• Health Benefits and Motivation
• Cultural Variables
• Physical Condition

all different parts and functions of inflammatory and immune response are working well

• meet human need for protection
• eliminate, neutralize, destroy invaders
• protection action only: distinguishes own cells

• NonSelf: infected by cells, cancer cells, all invading cells/organisms
• Self-Tolerance: determines self fro nonself so self cells are not destroyed w/invaders
• each self has a cellular fingerprint unique to that person

proteins capable of stimulating an immne response

• protects from effects of invasion
• recognizes self vs. nonself
• destroy invaders, debri, unhealthy/abnormal self cells
• produce antibodies to invaders
• complement activation
• produce cytokines to incr. leukocyte formation and specific activity

• (natural immunity)
• provides immediate protection against effects of tissue injury and invaders
• immediate but short term
• nonspecific: anything can start it
• PURPOSE: ridding body of harmful organisms, start antibody/cell mediated actoin to activate full immune response

• neutrophil
• macrophage
• basophil
• eosinophil