UNIT 4: Quality and patient safety; Infection control; Hygiene; Mobility and immobility Flashcards
Risks in the Healthcare Institution:
Chemicals (disinfectants, meds, etc)
Microorganisms (nosocomial infections)
Equipment (breaks, clean, etc)
Perception of safety
Risk for medical/procedural errors (incident reports)
Falls
What are the main causes of falls?
Medications
Delirium
Limited mobility
How to prevent falls:
- check Pts frequently
- use brakes on beds, commodes, wheel chairs, etc
- use shoes/rubberized slippers
- keep necessary items w/in reach
Restraints:
A means to control (use as a last resort). 3 main types:
- Physical Restraints (e.g. side rails, wrist restraints, etc)
- Chemical Restraints (e.g. meds)
- Environmental Restraints (e.g. closing door, etc)
Restraints should always be a ________?
Last resort
What 2 main factors affect safety?
- the environment
- our/the Pts developmental stage
Quality of Care:
Defined as the degree to which healthcare services for individuals + populations increase the likelihood of desired health outcomes and are consistent w current professional knowledge
Patient Safety Incident/Adverse Events:
An event or circumstance that could have/did result in unnecessary harm to a Pt. There are 3 types of Pt safety incidents:
1) Harmful Incident - Incident that resulted in Pt harm
2) Near Miss - Incident that did not reach the Pt (no harm resulted)
3) No-Harm Incident - Incident that reached the Pt, but no harm resulted
5 Goals to drive Patient Safety and Quality:
1) Pt-centred care - Pts are = partners in planning/developing care to make sure it meets their needs.
2) Self Care - health services are safe & free from preventable harm
3) Accessible Care - timely & equitable access to quality health services
4) Appropriate Care
5) Integrated Care - health services are continuous and well coordinated, promoting smooth transitions
Cultural Safety:
an outcome based on respectful engagement that recognizes & strives to address power imbalances in the health system
The 3 purposes for infection control:
- protecting patients from acquiring infections
- protecting healthcare workers from becoming infected
- protecting entire populations from contracting infectious diseases
Microorganisms
typically a single cell (includes bacteria, protozoa, algae, + fungi) that = infection or an etiological agent
- can be non-pathogens (do not cause illness or
- can be pathogens (cause disease)
Infection
a disease state resulting from the entry and multiplication of a pathogen in the tissues of a host, causing clinical signs and symptoms
Communicable (infectious/contagious) disease
means the infection can be transmitted from 1 person to another
Immunocompromised
When an individual has an impaired immune system.
The Chain of Infection:
the development of an infection occurs in a cycle that is dependent on the presence of ALL the elements in the chain:
a) Infectious agent (pathogen)
b) Reservoir (source for growth)
c) Portal of exit from reservoir
d) Mode of transmission
e) Portal of entry into host
f) A susceptible host
Step 1: Infectious Agents
a.k.a. microorganisms/pathogens
The ones that = infection or an etiological agent and depends on certain factors.
The potential for microorganisms to cause disease depends what factors?
of organisms
Virulence (ability to produce disease)
Ability to enter/survive in host
susceptibility of host
Step 2: Reservoir
a place where a pathogen is stored/can survive but may or may not multiply.
Pathogens require a specific environment for survival
To survive pathogens require a reservoir with…?
Food
Sometimes oxygen (aerobic vs anaerobic)
Water
Temperature
pH
Minimal Light
Step 3: Portal of Exit (path to leave reservoir)
The path by which the pathogen leaves the reservoir. Portals of exit in the human body include:
- Body Openings: mouth, nose, rectal, vaginal, urethral, + artificial openings
- Breaks in Skin: scrapes, cuts, or other wounds
- Breaks in Mucous Membranes: the skin in the mouth, eyes, nose, vagina, + rectum
Pathogens are carried through portals of exit/entry via?
blood
bodily fluids
excretions/secretions
urine
stool
vomitus
saliva
mucus
pus
semen
vaginal discharge
Step 4: Modes of Transmission
The transfer of microbes in various ways (C.A.V.V)
i) Contact Transmission: transfer of microbes via Physical touch (D.I.D)
ii) Airborne: small airborne particles remain suspended in the air for long periods of time + susceptible host inhales them.
iii) Vehicle: single contaminated source (e.g. food, water) transmits infection to multiple hosts, possibly resulting in an outbreak.
iv) Vector borne : insects or pests transmits microbes/pathogens to humans (e.g. ticks, mosquitoes, etc)
Contact Transmission
the transfer of microbes via physical touch; may be by direct contact, indirect contact, or droplet (D.I.D)
Direct Contact: physical skin-to-skin contact b/w an infected or colonized individual and susceptible host.
Indirect Contact: contact b/w susceptible host + a contaminated intermediate object (e.g. soiled linen, dressings, etc)
Droplet Transmission: large particles from infected respiratory system are dispelled + deposited onto a susceptible host
Step 5: Portal of Entry
Same as portal of exit
i.e. via body openings, breaks in skin, + breaks in mucous membranes
Step 6: Susceptible Host
Susceptibility depends on an individuals degree of resistance to a pathogen. The more virulent an organism is, the greater likelihood that a person will be susceptible to it.
Can/may be enhanced by vaccines or exposure
Pathogenicity:
the extent of the infection, ability to cause disease, + the severity of the disease
Localized Infection:
infection that is restricted to a limited area and Pt may only experience symptoms as the site of infection
Systemic Infection
An infection that affects the entire body (can be fatal)
Defenses Against Infection:
- The immune response (nonspecific and/or specific)
- Normal flora (nonspecific)
- Body system defenses
- Inflammation response
The Immune Response:
a protective reaction that neutralizes pathogens and repairs body cells. The immune system is composed of cells + molecules that help resist disease
- some responses are nonspecific (protect against pathogens w/o previous exposure)
- some responses are specific (defend against specific pathogens)
Body System Defenses:
A # of the body organ systems have unique defenses for infection.
Each body system has its own defenses mechanisms physiologically suited to its own structure and function
The Inflammatory response:
A protective vascular reaction that delivers fluid, blood products, + nutrients to an area of injury. this neutralizes and eliminates pathogens/necrotic (dead) tissue
Can be triggered by physical events, chemical reactions, or microorganisms & consists of various events:
1. Vascular/cellular responses
2. Inflammatory exudates
3. Tissue repair
Inflammatory Response: Vascular & Cellular Responses
increased blood flow to the site of injury; localized warmth, & more white blood cells to the site
Inflammatory Response: Inflammatory Exudates
The accumulation of fluid, dead cells, + WBC’s. There are different types of exudate.
- Serous = clear, watery plasma
- Sanguineous = bloody drainage
- Serosanguineous = watery drainage that is blood-tinged (pink)
- Purulent = thick drainage, sometimes yellow or green (aka pus)
Inflammatory Response: Tissue Repair
Healing
Involves 3 stages; inflammation, proliferation, + remodeling
Localized Inflammation Signs/Symptoms
swelling
redness
heat
pain/tenderness
loss of function
Systemic Inflammation Signs/Symptoms
fever
leukocytosis
malaise
anorexia
nausea/vomiting
lymph node enlargement
Healthcare-Associated Infections (HAI)/Nosocomial Infections:
an infection acquired after admission to a healthcare facility that was not present at the time of admission (e.g. C-Diff). Can be exogenous or endogenous infections
Exogenous Infection
comes from microorganisms external to the individual that do not exist as normal flora (e.g. salmonella)
Endogenous Infections
occurs when some of the Pts flora become altered and overgrown (e.g. Yeast infections)
Asepsis
the process for keeping away disease-producing microorganisms
Aseptic Technique
refers to practices that are designed to render an area and objects as free from microorganisms as possible (2 types: medical and surgical)
Medical Asepsis/Clean Technique
includes procedures used to reduce/prevent the spread of microorganisms (e.g. hand hygiene, cleaning equipment + environment)
Disinfection/Disinfecting
the elimination of all pathogens except bacterial spores. Used on inanimate objects (antiseptics = living tissue)
Sterilization
The destruction of all microorganisms (including spores)
Common sterilizing agents include; steam under pressure, ethylene oxide gas, hydrogen peroxide, + other chemicals
Routine Practices/Standard Precautions
Applies to ALL clients, in ANY setting and includes limiting exposure to blood, body fluids, non-intact skin, or mucous Membranes.
Routine practices include: Hand washing, clean equipment, gloves, masks + eye protection, gowns, containing used linen, use of sharps containers, and private rooms
Isolation Precautions/Additional Precautions
- Airborne: private room, N95 mask/respirator, negative pressure room, Pt wears mask when outside room.
- Droplet: private room, limit Pt movement outside room, Pt wear mask outside room, mask
- Contact: private room, disinfect adequately, gown, gloves, designate equipment to room
The 4 Moments for Hand Hygiene:
- before initial contact w the Pt or Pt’s environment
- after contact w the Pt or Pt’s environment
- before aseptic procedures
- after body fluid exposure risks
Common Bed Positions
Fowlers
Semi-Fowlers
Low Fowlers
High Fowlers
Trendelenburg’s
Reverse-Trendelenburg’s
Flat
Supine
Prone
Side-Lying
Modified Left Lateral Recumbent
Fowler’s Position
head of the bed raised to an angle of 45 degrees or more; semi-sitting position
Semi-Fowler’s Position
head of the bed raised to an angle of around 30 degrees (less than fowler’s)
Trendelenburg’s Position
entire bedframe is tilted w head of the bed down (used for postural drainage)
Reverse-Trendelenburg’s Position
entire bedframe tilted w foot of the bed down
Flat Position
entire bedframe horizontal w floor
Prone Position
lying chest-down w head often turned to the side
Side-Lying Position
Pt is resting on the side w majority of their body weight on their hip and shoulder.
Modified Left Lateral Recumbent Position
similar to side-lying but the weight is placed on the anterior ilium, humerus, + clavicle
Positioning Devices
Pillows
Wedge (or abductor) Pillow
Foot Boot
Trochanter Roll
Sandbags
Hand Rolls
Hand-Wrist Splints
Trapeze Bar
Equipment needed for making a bed?
Linen bag(s)
Drawsheet (optional)
Bottom Sheet (flat/fitted)
Top Sheet
Blanket
Bedspread
Pillowcases
Soaker Pad (optional)
Towel
Disposable gloves
Disinfectant
