Lesson #2: Safety & Infection Control

What are (4) common Health Acquired Infections (HAI)?

1. Central line-associated bloodstream infection (CLABSI) 2. Catheter-associated urinary tract infection (CAUTI) 3. Ventilator-associated pneumonia (VAP) 4. Surgical Site Infections

What are the (3) categories of Restraints?

1. Chemical 2. Physical 3. Seclusion

What are the (3) types of Transmission-Based Precautions?

1. Contact 2. Droplet 3. Airborne Note: If a disease has multiple routes of transmission (e.g., SARS), then more than one transmission-based precaution may be used.

What (2) ways can Radiation be delivered?

1. Externally (Radiation beam) 2. Internally (Radioactive material inserted close to or into a tumor)

What (3) disease outbreaks are of concern to nurses?

1. Foodborne Illness 2. Highly Infectious Disease Outbreaks 3. Vaccine-Preventable/Communicable Disease Outbreaks

What (2) patient identifiers are commonly used to match the correct client with the correct care?

1. Full Name 2. Date of Birth

What are indications for Contact Precautions?

1. GI Infections (Foodborne illness- Norovirus or C.Diff) 2. Diarrhea of unknown origin 3. Skin Infections or Infestations (impetigo, scabies) 4. Presence of, or colonization with, multidrug-resistant bacteria, e.g., MRSA, VRE, Extended Spectrum Beta-Lactamase (a gram negative bacilli).

How do you take off PPE?

1. Gloves 2. Goggles or Face Shield 3. Gown 4. Mask or Respirator

What PPE is used for Contact Precautions?

1. Gloves 2. Gown 3. Mask and Eye Protection, if splashing or splattering of any contaminated substance is likely.

What (5) precautions should be taken for a patient who requires contact precautions (MRSA, VRE)?

1. Gloves 2. Gown 3. Private Room (or placed in a room with a patient with same disease) 4. Hand Hygiene (after direct contact & before leaving room) 5. Keep all equipment in the client's room for their sole use (stethoscope, etc).

What PPE should be used for a client on Droplet Precautions?

1. Gloves & Gown when in direct contact while delivering care. 2. A regular or surgical mask should be worn if within 6 feet of the client.

What PPE is used for a client on Airborne Precautions?

1. Gloves should be worn when in contact with Respiratory secretions 2. An N95 respirator must be worn by all health care personnel caring for the client.

How do you put on PPE?

1. Gown 2. Mask or Respirator 3. Goggles or Face Shield 4. Gloves

What are the (3) ways in which RN's can prevent Health Acquired Infections (HAI)?

1. Hand Hygiene (Most effective way to prevent spread of microorganisms) 2. Use Disinfectants (reduce microorganisms) & Antiseptics (can be applied to clients to reduce microorganisms; isopropyl alcohol (greater than 50% concentration), povidone-iodine solution such as Betadine, and 2% chlorhexidine solution such as ChloraPrep) 3. Interrupt transmission through use of PPE and transmission-based precautions.

What (2) actions are appropriate for an RN to take if they notice documentation errors in a client's medical record?

1. Identify entry as a mistake ("Mistaken Entry") 2. Enter the time the error was discovered to have a record of the change.

What (6) things should an RN do to reduce the risk of preventable errors?

1. Identify, document and communicate allergies, including latex sensitivity and allergy. 2. Document Timely and Thoroughly 3. Ensure the proper identification of the patient before providing care 4. Verify appropriateness and/or accuracy of treatment orders 5. Monitor compliance by other members of the Interdisciplinary Team (IDT) 6. Report every error or incident, including a near miss

What (3) things are important to remember when using Restraints?

1. If a client can easily remove the device, it does not qualify as a Physical Restraint. 2. A provider order for restraints can never be written in advance for "what if" situations or "as needed (PRN)" 3. Always attempt to use the least restrictive form of restraint and/or safety device. Never apply or use a restraint (chemical, physical, or seclusion) to punish a client.

What is the order of treatment for a client with Acute Radiation Syndrome (ARS)?

1. Initially assist with stabilization of client by evaluating Physiological Functions (airway, breathing, and circulation). 2. Once deemed stable, the decontamination process can begin

What are (8) things that an RN must do when caring for a client receiving Internal Radiation (Brachytherapy)?

1. Mark the client's room with appropriate signs 2. Place in a private room 3. Wristband on the client 4. Make sure long-handled forceps and a lead container are in the client's room in case of implant dislodgement. 5. Apply shoe covers and protective gloves before entering the client's room 6. Minimize time spent at bedside 7. Maintain greatest distance possible from client (while providing care) 8. Wear a film badge (dosimeter) while providing care to monitor exposure.

In which (6) situations is an Incident Report filed by the RN?

1. Medication Administration Errors (even if the error did not reach the client) 2. Any time a client makes a complaint. 3. Medical device malfunction 4. Any time a client, staff member or visitor is injured or involve in a situation with the potential for injury. 5. When a client leaves the healthcare facility against medical advice (AMA) 6. Loss or theft of a client's or visitor's property

What (3) things should an RN do if a Medication Administration error has occurred?

1. Monitor client & watch for adverse effects 2. Report incident to HCP 3. Complete an Incident (or occurrence) report

What are the (2) types of radiation commonly found in health care settings?

1. Non-ionizing radiation (lasers, ultraviolet lights) 2. Ionizing radiation (x-rays, gamma rays, electromagnetic radiation)

What interventions can an RN implement for a client who does not speak English?

1. Note the client's preferred language in their medical record 2. Use an agency interpreter or interpreter services 3. Plan on taking twice as long as usual to complete nursing interventions

What (3) things should be done for a child experiencing a seizure?

1. Place something soft and flat, like a folded jacket, under the child's head to prevent head trauma. 2. Move furniture away from the child 3. Notify Child's Parent or Guardian.

What are the (6) categories listed in the "Chain of Infection"?

1. Portal of Entry (broken skin, mucous membranes, gi tract, respiratory tract) 2. Susceptible Host (surgery, very young/very old, underlying disease, meds, indwelling devices) 3. Infectious Agent (Bacterium, Fungus, Protozoon, Rickettsia, Virus) 4. Reservoir (people, equipment, fomites, water) 5. Portal of Exit (excretion, droplets, secretions, skin) 6. Means of Transmission (airborne, fomites, ingestion, direct or indirect contact)

What are the (2) treatment goals for Acute Radiation Syndrome (ARS)?

1. Prevent further exposure to Radiation 2. Treat Life-Threatening Injuries

What (6) things must an RN do when applying Restraints?

1. Prior to applying restraints, RN must conduct a thorough assessment of the client and document the events leading to use of the restraint (documentation also includes alternatives to restraints that were tried and client's response to those measures). 2. Explain the reason for applying restraints to a client (even if client is confused) 3. Tie wrist restraints to a stationary part of the bed with a quick-release knot. 4. Every 2 Hours, remove restraints to assess skin integrity, allow for range of motion and assess neurovascular status. 5. Ensure that the HCP writes a new restraint order every 24 hours.

What (4) special considerations should be taken for a client on contact precautions?

1. Private Room (or room with clients with same infection) 2. Client should stay in room except for procedures or therapies 3. Dedicated equipment/care items (bp cuff, thermometer) that can be discarded or disinfected after discharge. 4. For Herpes Zoster (shingles) infection: if disseminated (lesions present outside the primary or adjacent dermatomes), implement both contact and airborne precautions until lesions are dry and crusted.

What (3) special considerations should be taken for a client on Droplet Precautions?

1. Private room (or cohort with clients who have same infection) 2. Dedicated equipment/care items (blood pressure cuff, thermometer) that can be discarded or disinfected after discharge 3. Client should be taught to cover their nose and mouth with tissues when coughing or sneezing and to discard tissues into a bag.

What (7) special considerations should be taken for a client on Airborne Precautions?

1. Private room with special ventilation (negative pressure) and the door must be kept closed. 2. Client must stay in room 3. Client should wear a regular/surgical mask when out of room 4. N95 must be worn by all health care personnel when entering the client's room. With chicken pox or measles, a respirator is only required if person entering has not had the disease or has not been immunized. 5. Dedicated equipment 6. Client should cover nose and mouth with tissues when coughing or sneezing 7. Herpes Zoster (shingles) infection: Implement both airborne and contact precautions until lesions are dried and crusted.

What (2) treatment methods are inappropriate for a client with dementia?

1. Reality orientation 2. Use of Medications as Chemical Restraints

What (3) things are required in a Provider's Order for Physical Restraint or Safety device?

1. Reason for the Restraint 2. Type of restraint or safety device to be used 3. Time limit for its use

What does the Decontamination process involve for a client with Acute Radiation Syndrome (ARS)?

1. Removing Radioactive Particles 2. Removing Clothing and Shoes (e.g., double bagging clothes)

What are the (3) elements of Radiation Safety?

1. Time 2. Distance 3. Shielding

What are the (9) Pediatric Communicable Diseases?

1. Varicella (Chicken Pox) 2. Diphtheria 3. Mumps 4. Pertussis (Whooping Cough) 5. Poliomyelitis 6. Roseola 7. Rubella virus 8. Rubeola (measles) 9. Scarlet Fever

What treatment should an RN expect for a client suspected of Carbon Monoxide Poisoning?

100% Supplemental Oxygen and in some cases, Hyperbaric Oxygen Therapy.

What is a patient-controlled analgesia (PCA) pump used for?

A (PCA) pump allows a client to receive a basal rate of pain medication, and also allows them to administer a dose of pain medication to themselves intermittently (i.e., bolus)

What can't a HCP do with regards to Restraint orders?

A HCP can NEVER write a Restraint order in advance for "what if" situations or "as needed (PRN)".

What is a Seclusion Restraint?

A locked room or area away from other clients that the client cannot leave. Primarily used in behavioral settings for violent clients (after all other interventions have failed).

What is a Chemical Restraint?

A medication such as anxiolytics, sedatives, opioids, and paralytics.

What should never be used as a Patient Identifier?

A patient's room number

What can radiation be used for?

A variety of medical conditions, such as cancer or hyperthyroidism.

What are Transmission-Based Precautions?

Additional infection control practices implemented for clients who are known or suspected to be infected or colonized with infectious agents.

How does long will a child have to sit in a child car seat while in an automobile?

All children should ride in a rear- or front-facing seat for as long as possible or until they reach the highest weight or height allowed by the car seat manufacturer. Toddlers who have outgrown the weight or height limit for the rear-facing car seat should use a forward-facing car seat. Many seats can accommodate children up to 65 pounds (29kg) or more.

What is "near miss" event?

An unplanned event that did not result in injury, illness, or damage but had the potential to do so.

What biological agents have a high probability of person-person transmission and high mortality rates?

Anthrax, Botulism, Smallpox, Plague

What are Standard Precautions?

Basic level of infection control precautions used in the care of all clients.

What patient identifier may also be needed for a patient who needs a blood transfusion?

Blood Band Number

What happens in Carbon Monoxide Poisoning?

Carbon monoxide poisoning leads to displaced oxygen from hemoglobin, as carbon monoxide has a stronger affinity for the hemoglobin molecule. Binding of Carbon Monoxide to hemoglobin leads to reduced oxygen delivery to tissues and organs.

What is the leading cause of fire-related injury or death?

Careless smoking

What is one of the more common Health-Acquired Infections (HAI)?

Catheter-associated urinary tract infections (CAUTIs). Note: Surgical site infections, bloodstream infections, and pneumonia are other types of (HAIs), but are less common than (CAUTIs)

What should be given to clients with injuries resulting in non-intact skin or mucous membrane exposure?

Clients should receive Hepatitis B immunization (within 7 days) and Tetanus toxoid vaccine.

What should the RN teach a client taking Antibiotics?

Complete the entire, prescribed course of antibiotic therapy. Don't share doses with others with similar symptoms. Contact the HCP if adverse effects develop to ensure drug therapy is maintained.

What do clients with Physical or Seclusion Restraints require?

Continuous Monitoring by RN and IDT.

What are some examples of Highly Infectious Disease Outbreaks?

Covid-19, Ebola, Avian Influenza, H1N1, Zika Virus

What is the treatment process for a client that has been exposed to Radiation?

Decontamination 1. Remove clothing and shoes 2. Gently wash victim with soap and water Administer Chelating Agents for Internal Contamination 1. Potassium Iodide (KI): An agent used to prevent absorption of radioiodine in the thyroid gland 2. Prussian Blue: A type of dye that binds to particles of radioactive elements (e.g., cesium and thallium).

What is a client with Type 2 diabetes who has an active infection (e.g., cellulitis) at risk for developing?

Diabetic Ketoacidosis People with Type 2 Diabetes can also develop DKA, but it is less common. Can be triggered by severe illness or infection.

How can Arm/Leg Restraints be used on Pediatric clients?

Disposable wrist or ankle restraints may be applied to control movements in children. Sites should be assessed for skin irritation, circulation, and movement. Restraints should be tied to the bed frame rather than side rails.

Why are Elbow Restraints used in Pediatric clients?

Elbow restraints may be used to prevent movement of the hands to the face. Often this type of restraint is used to prevent pulling of tubes, after a cleft palate/lip surgery or to prevent IV removal.

What should be done for a client who has experienced Burns?

Follow ABC treatment algorithm Remove nonadherent clothing Cover burns with dry dressing or clean sheet Prepare for IV insertion and fluid resuscitation

What does the RN do immediately after an (AED) administers a shock to a patient?

Immediately resumes CPR

What is the FIRST action an RN should take after being stuck in the hand by an exposed needle?

Immediately wash their hands vigorously with soap and water.

When are Droplet Precautions used?

Influenza, Meningococcal Meningitis, Mumps, Rubella (german measles), Diphtheria, Pertussis (whooping cough), Infections caused by Streptococcus Pneumoniae.

How can a fire occur due to equipment?

It can occur if equipment malfunctions

What does Hyperbaric Oxygen Therapy do for a client with Carbon Monoxide Poisoning?

It increases the dissociation of carbon monoxide from the hemoglobin molecule.

What is a Chelating Agent?

It is a chemical compound that binds tightly to metal ions. In medicine, chelating agents are used to remove toxic metals from the body, in situations such as lead poisoning.

What is Acute Radiation Syndrome (ARS)?

It is a syndrome caused by irradiation of the body by a high dose of radiation in a very short period of time.

What is a healthcare-acquired or -associated infection (HAI)?

It is an infection a client gets while hospitalized and receiving care for another condition (including a different infection).

What is an Incident (aka unusual occurrence, client safety event)?

It is an unusual event that caused or could have caused injury to a client.

What is Brachytherapy (Internal Radiation)?

It is internal radiation which allows for delivery of radiation to the target tissue through radioactive seeds or ribbons, while minimizing exposure to surrounding healthy tissue.

Is it necessary to notify the HCP, complete an incident report, or notify the nurse manager if a documentation error is found in a patient's medical record?

It is not as long as the RN follows the appropriate policy for correcting documentation errors.

What is the "wandering" management system used for?

It is used to give clients with dementia and other "at risk" clients the ability to move freely where they live.

What should fall-related documentation in the medical record consist of?

It should only consist of objective information, such as a description of client's condition immediately prior to and after the fall, vital signs, provider notifications, any orders received, nursing care rendered, notification of power of attorney for healthcare.

What is a Physical Restraint?

Mechanical devices or equipment that limit the client from moving or from moving an extremity. Ex's: A chair with an attached tray that prevents the client from getting up. Raising all bed rails is a restraint

Why are Mummy Restraints used on Pediatric clients?

Mummy restraints may be used on infants and small children as a temporary restraint for a procedure. A papoose board or blanket may be used to secure the child.

What are some examples of Vaccine-Preventable Disease Outbreaks?

Mumps, Measles, Polio, Pertussis (Whooping cough)

What are the s/s of Very Severe Radiation Sickness?

Nausea and vomiting less than 30 minutes after exposure to radiation, dizziness, disorientation and hypotension; usually fatal.

What are the s/s of Mild Radiation sickness?

Nausea and vomiting, headache, fatigue and weakness, within 24-48 hours after exposure.

Does an RN need special training (certification) to assist in a disaster?

No they do not. However, there are certifications for those who are interested.

If a client has a disease that requires contact precautions, does their room door need to be closed at all times?

No, because these diseases (MRSA, VRE, C.Diff) are not spread by droplet or airborne trasmission.

Is a mask required when performing routine care for a client on contact precautions?

No, during routine care (vital signs) a mask is not required.

Do the terms "sentinel event" and "error" mean the same thing?

No, they do not because not all sentinel events occur because of an error, and not all error result in sentinel events.

What are the (6) P's of Circulation assessment?

Pain, Pallor, Paresthesia, Paralysis, Pulselessness, Polikothermia

What does the RN do after an (AED) has been applied to a client receiving CPR?

Press the Analyze Button when the AED prompts the RN to do so.

What are the (4) Triage Categories (Category, Priority, Color, Conditions)?

Priority 1: Immediate (Red)- Chest Wounds, Shock, Open Fractures, 2-3 degree burns Priority 2: Delayed (Yellow)- Stable ABD wound, eye and CNS injuries Priority 3: Minimal (Green)- Minor burns, minor fractions, minor bleeding Priority 4: Expectant (Black)- Unresponsive, high spinal cord injury

How do you use a Fire Extinguisher?

Pull Aim Squeeze Sweep

What is Radiation?

Radiation can be defined as energy that is emitted from a source and travels through space.

What does an RN do in case of a smoke or fire?

Remove/rescue clients Activate fire alarm system Contain the fire (by closing doors and windows) Extinguish flames (with fire extinguisher)

What are older adults with Influenza at risk for developing?

Respiratory complications such as Pneumonia.

What are the most (4) common foodborne outbreaks?

Salmonella, norovirus, listeria, and e.coli

What should an RN do if it is time for dinner for a client who has been placed in Seclusion (due to acute mania)?

Serve the client's dinner in the Seclusion room (with the nurse continuing 1:1 observation). Meals must be offered on time and should not be withheld.

What is the Triage system used during mass casualty events?

Simple Triage and Rapid Treatment (S.T.A.R.T.) It uses a red, yellow, green, and black tag system.

Why are some bacteria not killed by antibiotics?

Some bacteria are not killed by antibiotics because they have mutations in their DNA that make them antibiotic resistant. Due to: 1. Failure to complete a full course of antibiotics (some bacteria escape after drug exposure) 2. Inappropriate overuse of antibiotics (ex: for a cold)

What does the RN need to do if a Restraint is still needed after the time limit has expired?

The RN is responsible for contacting the HCP for a new order.

Why should an RN wash their hands with soap and water after assisting a client with C.Diff?

The RN should wash their hands with soap and water because antiseptic hand rub is ineffective against the hardy spores produced by this bacterium.

How does the RN determine which is the best candidate for discharge in the event of a disaster?

The best candidate for discharge is the one who has a chronic condition and has an established plan of care.

What should an RN NOT do with an incident report and the client's medical record?

The details of the incident should not be documented in the client's medical record. In addition, no reference should be made in the client's medical record to the fact that an incident report was completed.

How does the electronic alert wristband ensure the safety of a client with dementia in a long-term care facility?

The electronic wristband sets off an alarm that is attached to exterior doors if the client attempts to leave the facility.

What is the goal of Triage?

The goal of triage is to ensure that the most critical clients are treated first.

What is the most common Health-acquired Infection (HAI) in clients caused by?

The most common (HAI) are ones that are transmitted from healthcare workers or staff members to clients.

Why are contact precautions recommended?

They are recommended when there is a risk for transmission or there are wounds that cannot be contained by dressings.

What are Contact Precautions?

They reduce the risk of transmission by direct or indirect contact. Indirect transmission involves contact with a contaminated object.

What are Droplet Precautions?

They reduce the risk of transmission of infectious droplets that are released when the infected person sneezes or coughs. Infectious droplets can spread as far as 6 feet.

What are Airborne Precautions?

They reduce the risk of transmission of infectious microorganisms that remain suspended in the air for long periods of time and are carried on air currents.

What is the term sentinel ("never") event used for?

This term is used for particularly shocking errors in healthcare (surgery on wrong body site, mismatched blood transfusions, a client's suicide while hospitalized). Such an event often results in serious injury to the client and is usually preventable.

Why does an RN vigorously wash their hands with soap and water after being stuck with an exposed needle?

To reduce the risk of potential exposure to bloodborne pathogens.

Which age group is at the highest risk for Poisoning?

Toddlers, aged 1-3 years (e.g., 20-months old), are at the highest risk for poisoning. They are increasingly active, curious, and anxious to explore. They are too young to know what is dangerous.

Diphtheria [Transmission, S/S, Tx, Prevention]

Transmission: Direct Contact Symptoms: Nasal discharge, sore throat, white/grey membranes, hoarseness, cough, potential airway obstruction Tx: Antibiotics, bedrest, tracheostomy with airway obstruction Prevention: Vaccine

Mumps [Transmission, S/S, Tx, Prevention]

Transmission: Direct Contact or Droplets Symptoms: Fever, Headache, Earache, Parotic glands swelling, may cause orchitis (inflammation of one or both testicles) Tx: Analgesics, antipyretics, IV fluids, apply ice packs for orchitis Prevention: Vaccine

Pertussis (Whooping Cough) [Transmission, Symptoms, Tx, Prevention]

Transmission: Direct contact Symptoms: Dry, hacking cough, whooping cough, mucus, difficulty breathing Tx: Antibiotics, Increase fluids, may require ventilator or oxygenation, maintain droplet precautions, suction airways Prevention: Vaccine with booster

Poliomyelitis [Transmission, Symptoms, Tx, Prevention]

Transmission: Feces, Direct contact with contaminated person Symptoms: Fever, sore throat, abd pain, severe pain with stiffness to neck, back, and legs; may cause paralysis of limbs Tx: Mechanical ventilation, maintain contact precautions, physical therapy Prevention: Immunization

Rubella Virus (German measles) [Transmission, Symptoms, Tx, Prevention]

Transmission: Through Nasal secretions Symptoms: Fever, sore throat, cough; rash over face, limbs and trunk Tx: Antipyretics and Analgesics Prevention: Vaccine

Roseola [Transmission, Symptoms, Tx, Prevention]

Transmission: Through Saliva Symptoms: High fever, bulging fontanels, rash, lymphadenopathy Tx: Antipyretics, may cause seizure precautions Prevention: Standard precautions

Varicella (Chicken Pox) [Transmission, S/S, Tx, Prevention]

Transmission: Through contact, droplets, and skin lesions S/S: Rash with papule, vesicle, and crust; may have a temperature and itching. Tx: Diphenhydramine or antihistamines; airborne or contact precautions Prevention: Vaccine

Scarlet Fever [Transmission, Symptoms, Tx, Prevention]

Transmission: Through direct contact and droplets Symptoms: High fever, enlarged and reddened tonsils, strawberry tongue, sandpaper rash Tx: Antibiotic therapy, analgesics, antipruritic, maintain droplet precautions, throat lozenges/rinses, encourage fluids Prevention: Standard Precautions

Rubeola (measles) [Transmission, Symptoms, Tx, Prevention]

Transmission: Through direct contact with droplets Symptoms: Fever, cough, Koplik spots (small irregular red spots with a minute, bluish-white center first seen on buccal mucosa opposite molars approximately 2 days before rash appears), rash, anorexia, abd pain Tx: Bedrest, antipyretics, antibiotics with high-risk children, vitamin A Prevention: Vaccine

What is Triage?

Triage is the process that an RN uses during a disaster to sort clients according to their injuries and chance for survival.

When are Airborne Precautions used?

Varicella (chicken pox), TB, Measles (rubella)

When would a device NOT qualify as a Physical Restraint?

When the client can easily remove the device

Can a soft wrist restraint be applied before a health care provider writes an order (e.g., if patient is confused and attempts to remove their chest tube)?

Yes, a soft wrist restraint can be applied but the RN must contact the HCP immediately after the restraint is applied to obtain the order.