Safety and Accident 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, luck Act of God An unfortunate event Injury Epidemiological Model Host Environment • • Agent (energy) • Mechanical • Chemical 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 Prevention Injury 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 Young Children (<1-4) Leading Causes of Unintentional Injury Deaths United States - 2011 Centers for Disease Control And Prevention National Center for Injury Prevention and Control School age Children (5-9) Leading Causes of Unintentional Injury Deaths United States - 2011 Centers for Disease Control And Prevention National 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 Adolescent/Young Adult (10- Leading Causes of Unintentional Injury Deaths United States - 2011 Centers for Disease Control And Prevention National Center for Injury Prevention and Control Adult & Older Adult • Adult – Workplace injuries – Drugs & ETOH – Physical Activity = • The “Weekend Athlete” • Older Adult – Physiological Changes – Balance – Sensory changes Risk of Injury Adults (25-54) Leading Causes of Unintentional Injury Deaths United States - 2011 Centers for Disease Control And Prevention National Center for Injury Prevention and Control Older Adults (65 +) Leading Causes of Unintentional Injury Deaths United States - 2011 Centers for Disease Control And Prevention National Center for Injury Prevention and Control In Summary Total Leading Causes of Unintentional Injury Deaths United States - 2011 Centers for Disease Control And Prevention National 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 Nonmodifiable? Injury Epidemiological Model Host Environment • • Agent (energy) • Mechanical • Chemical 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 Environment • Social • Physical 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 • Community Host – MVCs – Pathogens • Food-Borne • Vector-Borne • Water-Borne – Pollution • • • • Air Water Noise Soil – Mother Nature Environment • • Social Physical Agent (energy) • Mechanical • Chemical • Healthcare Facilities Medication 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 Host • Proper Use & Patient Care • Siderails • Patient Alarm Devices Environment • • Social Physical Agent (energy) • Mechanical • Chemical • More Healthcare Facilities… Environment Mercury Exposure • Social • Physical 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 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 Host Devices from Home Environment • • Social Physical Agent (energy) • Mechanical • Chemical 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 Project We 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 Project Instructions and Group Assignments Infection Control th Tuesday, Sept 30 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 Control Chain 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 DrugResistant 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? CDC 2014 Handwash Handrub CDC 2014 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 Virus Hemorrhagic 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. 2. 3. 4. Gown Mask or Respirator Goggles or Face Shield 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 All CDC & 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?