Safety & Infection Test NSG 100

Pathogen or Infectious Agent

A bacteria, virus, or parasite that causes infection or disease. Also Normal flora

sharp end

Active Errors Direct Patient Care - at bedside/point of care

Joint Commission

An independent, not for profit organization that accredits and certifies health care organizations. Achieving certification improves quality of patient care. Help organizations establish a consistent approach to care, reducing risk of error.

Nursing Assessment Examination Findings

Appearance - fever, swelling, chills, malaise, redness or drainage in or around a wound, pain & respiratory congestion

----- infections are frequently indicated on a CBC by elevated B and T lymphocytes, neutrophils, and monocytes

Bacterial and Viral

Nursing Assessment Diagnostic tests

CBC with WBC/Radiographic tests/Culture & Sensitivity (blood, urine, sputum tells us type of organism & what ABT will kill this bacteria)

most common safety issues at blunt end

Care coordination, documentation, electronic records

Contact as a mode of transmission

Direct - person-to-person (fecal/oral) physical contact Indirect - personal contact of host with contaminated object Ex: needles, dressing, environment

Swiss cheese model

Every step in a process has the potential for failure, to varying degrees. Each layer is a defense against potential error impacting the outcome.

Barriers to a culture of safety

Fear of professional or personal punishment, concern about malpractice implications

Culture of Blame

Focus is on WHO is the problem; points the finger at the individual involved in the error. This approach leads to hiding rather than reporting errors and is the opposite of a culture of safety

HAI's

Healthcare Associated Infections; result from delivery of health services in a health care facility - UTI, CAUTI, Pneumonia, Surgical WOund Infections, MRSA, CLABSI

Chain of infection

Infectious agent →reservoir (people, equip) → portal of exit (droplets, excretions) → mode of transmission (airborne, direct, ingestion) → portal of entry (broken skin, GI tract, resp tract, mucous membranes) → susceptible host (burns, CVD, DM, immunosuppression)

IHI

Institute for Healthcare Improvement; uses improvement science to advance & sustan better outcomes in health & health care.

IOM's definition of patient safety

Institute of Medicine; freedom from accidental injury

blunt end

Latent Errors Organizational/System level

microorganisms

Living creatures that are too small to see with the naked eye - bacteria, viruses, fungi, and protozoa

----- infections are frequently indicated on a CBC by elevated basophil and eosinophil levels.

Parasitic

Vascular - physiological compensation

Permeability increases & allows shift of fluid from intravascular compartment to extravascular/extracellular spaces in tissues, leading to hypovolemia (decreased volume of circulating blood in the body) and hypotension (low blood pressure).

Process Information Cycle

Plan, Do, Check, Act

QSEN

Quality and Safety Education for Nurses; minimizes risk of harm to patients and providers through both system effectiveness and individual performance

Aims for Improving Health Care Safety and Quality

STEEEP - Safe, Timely, Effective, Efficient, Equitable, Patient Centered

Elements of a Culture of Safety

Safety as an organizational priority, Teamwork, Openness/Transpareny, Patient Involvement, Promotion of Safety through education and training, Accountability (STOPPA)

SRE

Serious Reportable Event aka "Never Event" an error so serious it should never happen - pressure ulcers acquired after admission to a healthcare facility, pt death associated with a fall, pt death or serious injury after a med error

Individuals of low socioeconomic status are at an increased risk for infection because of

Uninsured or underinsured status, high cost of medications, and inadequate nutrition

Adverse Event

Unintended harm by an act of commission or omission rather than as a result of disease process

Stress

Whether physical, emotional, or environmental - challenges the immune system and makes it more vulnerable to damage, less able to respond effectively and efficiently to pathogen invasion, and more difficult for the body to respond to treatment for an infection

Mode of transmission

a way that the infectious agent can be transmitted to another reservoir or host where it can live - major route is unwashed hands

port of exit from the reservoir

after they find a reservoir, must exit : blood, skin, mucous membranes, respiratory tract, GU tract, GI tract, transplacental (mother to fetus).

Near-miss

an error or commission or omission that could have harmed the patient, but serious harm did not occur as a result of chance

Sentinel event

an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof; signal the need for immediate investigation and response

Nutrition

and rest are necessary for the body to respond to active infection treatment regimens and support the work of an immune response.

Reservoir or source for pathogen growth

anywhere pathogen may live and multiply- humans, plants, animals, environment, water, food -Break Link: change dressing when soiled, appropriate hygiene, cover fluid containers

Elevated neutrophil count

bacterial infection

CAUTI

catheter associated urinary tract infection

CLABSI

central line associated blood stream infection

patients with ----- are also more susceptible to infection because of general debilitation and nutritional impairment.

chronic disease such as diabetes mellitus

Nervous system - physiological compensation

compensates for hypotension with peripheral vascular constriction and shunt blood from non-essential organs to essential organs

Respiratory - physiological component

compensates for oxygenation/hypoxemia (abnormally low concentration of oxygen in the blood) by increase rate of RR

automatic alerts

computer-generated alarms that can be programmed to occur with such things as allergies and incompatible medications.

5 modes of transmission of infection

contact, droplet, airborne, vector, vehicle

Immunity

critical in providing a level of surveillance for early identification of pathogen entry into the body

Tissue Integrity

critical to avoiding infection with the skin being the largest component of the immune system. Intact tissues are less vulnerable to pathogen entry and form natural barriers to infection

The ---- will grow the microorganisms in the sample for identification of specific type of pathogen

culture

Susceptible host

depends on individuals degree of resistance to pathogens. Factors that affect our defenses: age, nutritional status, chronic disease (ex: DM), trauma, meds, decreased immunity

computer order entry systems

designed to include components of standard medication order

communicable disease

disease that is transmitted directly from one individual to another

elements of a standard order to verify medication

drug name, metric dose/strength, frequency and duration, route, and indication.

by maintaining intact tissue, the patient and nurse have broken the chain of infection by

eliminating a portal of entry

First line of defense against pathogens

external barriers, skin and mucous membranes; Chemical Barriers - saliva pH, Normal flora)

Exudate

fluid, such as pus, that leaks out of an infected wound

Collaborative care

goal is to eradicate infection, prevent secondary infections and limit damage to body.

single most important thing to prevent the spread of infection

hand washing

Primary prevention

hygiene (especially hands), standard precautions & immunizations.

third line of defense against pathogens

immune system

Structural Indicators of Nursing Sensitive Indicators

include the supply of nursing staff, the skill level of nursing staff, and the education and certification levels of nursing staff

Populations at risk for infection

infants, young or middle-aged adults, elderly, healthcare workers. Individuals with chronic illnesses, low socioeconomic status, certain geographic locations and exposure to unsafe sanitary conditions

localized infection

infection contained to one area of the body

systemic infection

infection involving more than one organ sytem - s/sx effect entire body - malaise(general sense of being unwell), fever, myalgia (muscle pain), arthralgia (joint pain)

Second line of defense against pathogens

inflammatory response

Physiologic compensation

inflammatory response initiates host defense mechanisms - Vascular, Renal, Nervous system, Respiratory

incubation period in course of infection

interval between body invasion of pathogens and appearance of symptoms

Tallman lettering

is the practice of writing part of a drug's name in upper case letters to help distinguish sound-alike, look-alike drugs from one another in order to avoid medication errors.

Droplet as a mode of transmission

large particles that travel up to 3 ft during coughing, sneezing, or talking and come in contact with susceptible host Larger particles have to be in close proximity to spread respiratory

aspects that contribute to a culture of safety

leadership, teamwork, evidence base, communication, learning, a just culture, and patient-centered care.

Vital signs for patient with severe infection

low BP, elevated pulse and respiration rate, decrease of urine output

Nursing Sensitive Indicators

measures & indicators that reflect structure, processes and outcomes of nursing care

Process indicators of Nursing Sensitive Indicators

measures methods of patient assessment and nursing interventions. Nursing job satisfaction is one

communication errors

occur from failure to communicate

treatment error

occur in the performance of an operation, procedure, or test; in administering a treatment; in the dose or method of administering a drug; or in avoidable delay in treatment or in responding to an abnormal test

preventive errors

occur when there are failures to provide prophylactic treatment and inadequate monitoring or follow-up of treatment.

airborne transmission

occurs through contact with contaminated respiratory droplets spread by a cough or sneeze or carried on dust particles Respiratory, smaller particles in air

port of entry to a host

organisms enter the body though the same routes that they use to exit. blood, skin, mucous membranes, respiratory tract, GU tract, GI tract, and contaminated food and water

Inflammation

part of the body's response to a foreign antigen, with many of the symptoms of infection being those of the body's inflammatory response (redness, swelling, and pain)

Disease or infection only results if

pathogens multiply and alter normal tissue function

symptomatic infection

pathogens multiply and cause clinical signs and symptoms - second largest group

prodromal stage in course of infection

person is most infectious now, early signs and symptoms present but are vague and nonspecific

broken or impaired skin creates a ----- for pathogens

portal of entry

Sterile Asepsis

practice to prevent introduction of microorganisms that could cause infection

Medical asepsis

practices to reduce # of pathogens in clients environment

illness stage in course of infection

presence of specific signs and symptoms

most common safety issues at sharp end

prevention of decubitus ulcers, medication administration, fall prevention, invasive procedures, diagnostic workup, recognition of/action on adverse events, and communication.

Nursing Assessment History

questions to identify individuals' risk for infection & recognize symptoms associated with infection. History of illnesses, medications, age, nutritional status, stress, travel

Convalescent in course of infection

recovery from infection, signs and symptoms disappear, the person returns to a healthy state

Outcome indicators of Nursing Sensitive Indicators

reflect patient outcomes that are determined to be nursing-sensitive because they depend on the quantity or quality of nursing care. These include things like pressure ulcers and falls.

just culture

reporting errors is valued and without punishment

right patient, right education, right time, right medication, right documentation, right dose, right route (PETMDDR)

right patient, right medication, right dose, right route, right time, right education, right documentation (PETMDDR)

human factors

science of the interrelationship between humans, the technology they use and the environment in which they work; fatigue, distraction, interruptions, work-arounds, short-cuts

Secondary prevention

screening

Smallest infection group

shows classical signs and symptoms of the disease

Describe nursing interventions that reduce the client's risk for injury

taking ownership of pt, minimize risk of harm to pts, have good inter-collaborative relationships within team, root cause analysis

Root Cause Analysis

technique for identifying prevention of error strategies and developing a culture of safety

what information will a CBC identify

that the patient has an infection

Infection

the invasion of a susceptible host by pathogens or microorganisms, resulting in disease

colonization

the presence and growth of microorganisms within a host but without tissue invasion or damage

diagnostic error

the result of a delay in diagnosis, failure to employ indicated tests, use of outmoded tests, or failure to act on results of monitoring or testing

A CBC with differential will identify

the white blood cells being used by the body to fight an infection

Purpose of National safety goals

to improve safety care for all patients - Identify Patients Correctly, Improve Staff Communication, Use medicines safely, Use alarms safely, prevent infection, and prevent mistakes in surgery (IIUUPP)

vector transmission

transmission of an infectious agent by an insect, arthropod, or animal - mosquito, tick, flies

bar coding

used with medication administration systems that can be programmed to match patient identification bracelets with documentation

Inflammatory/immune response to infection

vascular and cellular responses, formation of inflammatory exudates (pus/serum) and tissue repair. vascular reaction delivers fluid, blood products, and nutrients to an area of injury. Process neutralizes and eliminates pathogens or dead (necrotic) tissues and establishes a menas of repairing body cells & tissues.

Renal - physiological compensation

vasodilatory (dilation of blood vessels) response of glomeruli (cluster of nerve endings, spores or small blood vessels/capillaries) to maintain pressure and continue filtration

what information will a sample of exudate provide

what specific type of pathogen is causing an infection

asymptomatic infection

when the infection does not cause any signs or symptoms, making the diagnosis difficult - largest group

Inspection and radiography will help identify

where an infection is located