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Chapter 31
Safety, Infection Control, and Hygiene
Fundamentals of Nursing: Standards & Practices, 2E
Copyright 2002 by Delmar, a division of Thomson Learning 31-2
Safety
Safe care is a basic need of all clients, regardless of the setting.
Safety has a positive association with health promotion and illness prevention.
A safe environment reduces the risk of accidents, subsequent alterations in health and lifestyle, and the cost of health care services.
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Factors Affecting Safety
AgeLifestyleSensory and perceptual alterationsMobilityEmotional state
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Types of Accidents
Client behavior accidentsTherapeutic procedure accidentsEquipment accidents
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Potential Occupational Hazards
Nurses and other health care providers are at risk for injury in the workplace.
The Occupational Safety and Health Administration (OSHA) has the power to enforce safety standards and to cite and discipline agencies that are not in compliance with the standards.
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Some potential hazards in the workplace• Latex allergy• Blood-borne pathogens• Work-related musculoskeletal disorders• Chemotherapeutic agents• Environmental pollution• Violence
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Infection Control Pathogenicity is the ability of a
microorganism to produce disease. Microorganisms that produce disease are
called pathogens. Infection is an invasion and
multiplication of microorganisms; these microorganisms are called infectious agents.
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Infectious agents that are capable of being transmitted to a client are also called communicable agents.
Colonization is the multiplication of microorganisms on or within a host that does not result in cellular injury.
Flora are microorganisms on the human body: resident flora, transient flora.
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Chain of Infection
Agent, host, and environment• Biological agents• Chemical agents• Physical agents• Susceptible host• Compromised host
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Modes of transmission• Contact transmission• Airborne transmission• Vehicle transmission• Vectorborne transmission
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Breaking the chain of infection• Nurses can apply proper infection
control practices to interrupt the mode of transmission.
• The chain of infection can also be broken by blocking or destroying the agent, blocking the portal of exit or entry, or by decreasing the host’s susceptibility.
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Normal Defense Mechanisms
Nonspecific immune defense• Skin and normal flora• Mucous membranes and sneeze,
cough, and tearing reflexes• Elimination and acidic environment• Inflammation
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Specific immune defense• Humoral immunity• Acquired immunity
Vaccination
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Stages of the Infectious Process
Two types of infectious responses• Localized infection is limited to a
defined area or single organ with symptoms that resemble inflammation.
• Systemic infection affects the entire body and involves multiple organs.
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Four stages of infection• Incubation period• Prodromal stage • Illness stage• Convalescent stage
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Nosocomial Infections
Nosocomial infections are infections acquired in the hospital or other health care facilities that were not present or incubating at the time of the client’s admission.
Hospitalized clients are at risk for nosocomial infections because the environment provides exposure to a variety of virulent organisms.
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Multiple-drug-resistant organisms (MDROs) have developed in both hospital and long term care clients.• Methicillin-resistant Staphylococcus
aureus (MRSA) • Vancomycin-resistant enterococcus
(VRE)• Tuberculosis bacilli• Clostridium difficile
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Blood-borne Pathogens
The risk for blood-borne pathogens in the health care setting is an increasing concern for health care providers.
OSHA issued an updated 1999 directive in an effort to decrease the risks of health care workers exposed to blood-borne pathogens, specifically the human immunodeficiency virus (HIV) and the major hepatitis viruses.
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Hygiene
Hygiene is the science of health. Hygienic care promotes cleanliness,
provides for comfort and relaxation, improves self-image, and promotes healthy skin.
The health of the body’s first line of defense (skin and mucous membranes) is promoted by client hygiene.
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Factors Influencing Hygienic Practice
Body imageSocial and cultural practicesPersonal preferencesSocioeconomic statusKnowledge
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Assessment
Health history• Assess general health perception and
management status to determine how the client manages self-care.
Physical examination• Level of consciousness• Range of motion or total immobilization of
an extremity
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• Localized infection - redness, swelling, warmth, tenderness, pain, loss of movement
• Systemic infection - fever, weakness, anorexia, nausea, vomiting, diarrhea
• Secretions or exudate of the skin or mucous membranes and detection of crackles, rhonchi, or wheezes in lungs
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Risk factors• Use specifically developed risk
assessment tools to detect potential hazards in the environment.
• In-patient clients should be assessed for fall and infection risk factors.
• An injury risk appraisal can be done to determine the client’s level of safety in the home.
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Diagnostic and laboratory data• Assessing risk for injury should also
include an evaluation of blood profile to detect abnormal findings, such as altered clotting factors, anemic conditions, or leukocytosis.
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Nursing Diagnosis
Risk for InjuryRisk for InfectionSelf-Care DeficitClients who are at risk for injury and
infection or have a self-care deficit may have other problems as well.
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Outcome Identification and Planning
The goal is to manipulate the external environment to reduce the risk of injury and infection.
Another critical element of the care plan is client/caregiver education related to the identification of potential hazards and health promotion practices.
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Implementation
Raise safety awareness and knowledge
Prevent falls• Apply restraints - review Procedure 31-
1• Ensure adequate lighting• Remove obstacles
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Reduce bathroom hazardsPrevent fireEnsure safe operation of electrical
equipmentReduce exposure to radiationPrevent poisoningReduce noise pollution
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Ensure asepsis• Medical asepsis
Handwashing - review Procedure 31-2
• Surgical asepsis Sterile field - review Procedure 31-3 Donning sterile gloves - review Procedure
31-4
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Donning surgical attire - review Procedure 31-5
Surgical handwashing - review Procedure 31-6
Gowning and closed gloving - review Procedure 31-7
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Reduce or eliminate infectious agents• Cleansing• Disinfection• Sterilization• Disposal of infectious waste
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Practice standard and isolation precautions - review Procedure 31-8 for initiating strict isolation precautions• Contact precautions• Droplet precautions• Airborne precautions
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Alternative therapies• Herbal baths
Bath for specific body part Full body bath
• Herbs for infections
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Provide for client bathing needs• Cleaning baths
Shower Tub bath Self-help bath Complete bed bath - review Procedure
31-9 Partial bath
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• Therapeutic bath Hot- or warm-water tub bath Cool or tepid bath Sitz bath
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Provide clean bed linen• Unoccupied bed - review Procedure
31-10• Occupied bed - review Procedure 31-
11Provide skin care
• Perineal care - review Procedure 31-12
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Offer back rubsProvide foot and nail careProvide oral care - review Procedure
31-13Provide hair careProvide eye, ear, and nose care -
review Procedure 31-14 for eye care
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Evaluation
Keeping the client free from injury and infection requires frequent reassessment through the use of risk appraisals. Timely adjustments must be made in the plan of care in order for nursing interventions to be effective.
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It is imperative that the client is helped to develop an awareness of the internal and external factors that increase the risk for injury.
Adherence to barrier precautions is critical in preventing the spread of infectious agents.
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The therapeutic value of hygiene is maximized when the client can participate and is kept free from infection and alterations in skin integrity.
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At the time of discharge from the hospital, appropriate referrals should be made to home health care agencies to assist the client in achieving optimum functioning levels for safety and hygienic practices.
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Clients at risk for infection should have follow-up visits by the home health nurse to measure the effectiveness of client teaching and resources in the home to prevent the transmission of infections.
