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