The CNA Study Guide – Understanding Safety Devices
Section 3 – Safety Devices
The use of safety devices within the nursing field is extremely important as it helps not only with patient safety and prevent harm to them, but also prevent potential harm occurring to the nurse as well. Previously, we’ve already looked at items like non-slip shoes, bed rails and walking assistive devices. Now, we look further at more, healthcare wide devices that are used typically to prevent patients from wandering off, falling or leaving the eloping from the facility.
Bed Alarms – These are alarms attached to the bed in order to notify staff of when a patient is attempting to get out of their bed unassisted.
Video Surveillance – Sometimes referred to as CCTV (closed circuit TV), the video monitoring system makes it possible to check in on patients and other areas of the facility
Resident Guard Wandering Alert System – This system, consisting of a radio frequency bracelet placed on the patient that sends alerts to staff once the patient has moved past an established boundary.
Electronic Tagging – Also used with bracelets, patients can be tracked through the tagging system, similar to that of GPS (only localized).
Preventing and Controlling Infection
Within a closed community such as a healthcare facility, an infection can spread quickly. If one person is sick, others recovering from illness become more susceptible to becoming ill as well as their immune system is weaker and already busy fighting off the other infection. Additionally, senior citizens and people with immunocompromised conditions are at a greater risk of becoming sick. These patients are people who have a weaker than a normal immune system, which increases their ability to become sick by reducing the body’s ability to fight infections. Patients with cancer, immune-system disorders or AIDS fall into this category.
Infections are a serious issue when it comes to seniors in the healthcare industry, as this causes a third of deaths of those people over the age of 65 and older. 90 percent of these deaths are due to pneumonia and influenza infections. The condition is so serious that those two put together to make up the sixth leading cause of death in the U.S.
Keeping the Facility Clean
One of the best ways to prevent the spread of illness is to maintain a clean facility. These locations must stay on top of cleaning to prevent the spread of these infections between patients (and the staff). There are environmental service providers within these locations that clean and do what they can to disinfect and ensure a quality, clean, safe environment for patients and staff members. These employees often work on a daily basis to completely disinfect main areas of the building, including therapy rooms, offices, entrances, lobby, patient rooms and even smaller areas like light switches, door handles, and phones.
It is important to note the definition of disinfection is different from cleaning. Cleaning removes dirt and organic material. Disinfecting removes microbes from the surface using chemicals either/or heat. For this, to work the surface must be cleaned first and then disinfected. Without proper cleaning, disinfection is not able to work through the dirt to disinfect the area. Both of these steps supersede the sterilization process.
Different items and belongings have varying degrees of risk in terms of carrying germs. Lower risk items include those that come in contact with a person’s intact skin. This can be a table, doorknob or stethoscope (for example). These kinds of items require general cleaning with a specialized soap or detergent.
Those items that are considered a medium risk come in contact with mucous within the mouth and nose. These items include anything that is used in the mouth, like a thermometer. Cleaning these objects with a higher-level disinfectant is a must.
Items that are considered high risk are anything that comes in contact with broken skin. Surgical instruments fall into this category and must be both cleaned and sterilized.
There are different ways to maintain a clean facility. This begins with wearing gloves whenever working with patients or items that come in contact with the patient (like clothing or blankets). Washing hands before and after working with a patient are important (even if gloves are work), changing out bedding right away when soiled and placing in the correct bit, while disinfecting wheelchairs, equipment and bed rails between uses are all musts. Following facility guidelines to clean bodily fluids is necessary, as is cleaning a patient’s nightstand and personal area while also knowing their medical history to determine if they have possibly had diseases that might infect other patients.
The Spread of Disease Organisms
Touching surfaces where the organism is currently located spread disease-causing microorganisms. This includes people who have the disease, bodily fluids from these individuals, touching surfaces where the organism has spread to (such as a door handle). The organisms can be spread through airborne droplets in the event an infected person sneezes. Should an individual come in contact with the disease organism and then touch their face, mouth, eyes, or other openings in their body, they are at risk of infection (some organisms can spread simply through pores in the skin. Due to this, cleaning an environment and making sure to wash hands helps protect both workers and patients from the spread of the disease.
Infections come in three different forms. These are fungal, viral and bacterial.
Fungal infections come from fungus spores and typically attack the skin. However, these spores can also enter the respiratory system and affect the lungs and system lining. This can be anything from a yeast infection to athlete’s foot. These kinds of infections can also be spread when coming in contact with infected skin.
Both viral and bacterial are microbes (microscopic organisms) and can affect the body in similar manors, including inflammation, fever, coughing/sneezing, vomiting, fatigue, and diarrhea.
Virus and bacteria are too small to see with a standard microscope, but each infects the body differently, which is why there are two different classifications. For starters, bacteria are a complex organism and are able to multiply on its own. These cells live in varying environments, including both the cold and heat. However, bacteria generally remain in one area it infects. A bacterial sinus infection usually stays within just the sinus and does not spread elsewhere.
There are both good and bad bacteria. Bacteria are a needed element in the body and, for example, helps break down food in the stomach. In order to treat bacterial infections, antibiotics are prescribed and kill off the cells, preventing the further development and growth.
Bacterial infections come in many forms and from many locations. Some come from food, others from infected skin, and boils. With regards to food, the most common foodborne bacteria come from raw meat (especially chicken), eggs and unpasteurized dairy. Bacterial development can also come from not properly handling and caring for food.
Bacterial infections can also come from sexual activity. Syphilis, Chlamydia, gonorrhea, and vaginosis may occur, as well as other skin and body infections, like urinary tract infections and ear infections. Again, these kinds of infections can be corrected with the aid of medication.
Viruses differ from bacteria as that these infections require the aid of other cells to multiply. Viruses connect to other cells within the body and convert these body cells into the virus. Over time, the original cell body dies out. Unlike bacteria, viruses cannot be corrected with medication and are far more difficult to correct. The common cold is the most common form of a virus infection, although it is mild when compared to other viruses. HIV (human immunodeficiency virus) is one of the most known viruses.
It is possible to protect against viruses with the aid of vaccines. Vaccines have protected people from influenza, polio, the measles and chicken pox and there are some antiviral drugs for treating some viruses, although others do not respond to the medication.
The most common forms of respiratory viruses include influenza, respiratory syncytial and rhinovirus. These may develop as offshoots from the common cold. Foodborne virus infections may include hepatitis A, rotavirus and norovirus. As for the skin, skin virus infections are herpes simplex virus-1 (aka cold sores), varicella zoster virus and molluscum contagiosum.
Other serious viruses include HIV, herpes simplex-2, West Nile, Epstein-Barr, genital herpes and hepatitis B.
Regardless of the virus, it can be spread in a host of different ways. This includes contact with contaminated water or food, contact with an infected surface (such as a doorknob), contact with infected animals like pets or livestock, coming in contact from sneezing and coughing, or interacting with infected people. Sexually based viruses can be passed through sexual intercourse and the exchange of bodily fluids in this manner.
Acute infections that occur from microbes have a shorter life while chronic infections may last for months if not years. Infections are known as latent infections often do not display symptoms (it remains dormant) until it appears (or reappears) months or years later. Some sexually transmitted viruses are like this (such as genital herpes).
In order to prevent the spread of viruses and bacteria, hand washing is a must. It is the top way to prevent the spread of any germs. Proper washing techniques and soap remove dirt and germs from hands.
Hand Washing
Proper hand washing techniques require the removal of all jewelry while pulling up sleeves past the wrists. Warm water is needed. The soap should be placed into one hand and rubbed for no less than 20 seconds. The top and palms of the hand need to be cleaned and rubbed. This also includes between fingers and round nails as well. Washing above the wrist should occur. If the individual washing their hands came into contact with any kind of bodily fluid, they need to wash for at least a minute.
Following the hand wash, it is important to not touch the side of the sink, to rinse off fingers facing downward so all soap and germs run down into the sink, instead of back, up the arms and body.
Hands need to be dried with paper towel ideally, although a clean hand towel may be substituted. The towel should then be used to turn off the faucet.
It is important to wash hands after using the restroom, sneezing, both before and after eating, prior and after to entering a patient’s room, feeding a patient, working with a wound or executing a procedure on a patient. Following coming in contact with dirty bedding, bodily fluids or leaving a patient’s room hands to need to be washed as well.
Alcohol-based hand sanitizer is available in most healthcare buildings. However, this should not be used as a substitute for washing hands. Sanitizers do rid the hand of most germs, but some remain. Clostridium difficile (c-diff) remains and can lead to diarrhea. If hands are soiled or if bodily fluids have come in contact with the hands it is necessary to wash and not use hand sanitizer. Additionally, hand sanitizer will eventually remove important oils from the skin.
It is important for the healthcare staff to inform patients about staying clean and washing their hands throughout the day (with extra emphasis on washing hands after using the bathroom and before eating). By improving hand washing within a healthcare facility, the spread of illness will decrease.
Symptoms and Signs to Watch Out For Indicating Infections
Some infections will affect the entire body, while others will affect just one area of the body. Should a wound become infected, it may lead to the infection spreading via the bloodstream, which may cause other areas of the body to become infected. Systematically based infections are far more serious and difficult to correct and treat because of this. Due to this, it is vital to identify possible symptoms before anything spreads. Examples of a systemic infection include tuberculosis, influenza, and pneumonia.
These kinds of infections will occur when the body tries to defend itself against the disease organisms. Seniors become more susceptible to infections as their body is not able to fight off the organisms as quickly. Some symptoms and signs of a localized infection include:
An area that is warm to the touch, demonstrates redness or swelling, hurts the patient when touched, pus is draining from the wound or the patient is experiencing a fever.
In the event of a systemic infection, a patient may demonstrate fever, nausea, vomiting or diarrhea, chills, fatigue, aches, respiratory problems, a decline in their overall function, an increase in falls and a change in mental capability (which is more common in seniors).
One of the top causes of death in seniors is pneumonia. Additionally, illnesses within the lungs are common in older adults, which is what makes identifying pneumonia challenging. Some of the most common symptoms include chest pains, difficulty breathing, weakness, fevers, sweating and a productive cough.
Influenza is another leading cause of death in seniors. Some signs of influenza are similar to systemic infections, although nausea and vomiting are also included. Common cold symptoms may occur as well (a runny nose or a cough).
The flue is a health issue seniors are at greater risk for and can lead to the development of pneumonia. Due to this, it is recommended for seniors to receive a flu shot annually during the fall.
Cutting Disease-Causing Organism Exposure
In order to cut down on disease-causing organisms within a facility and to protect both patients and employees, there are a few different precautions the facility (and those inside) can execute. This will help prevent infection and the spread of disease. Additionally, protective equipment and supplies (gloves) should be standard protocol.
What Are Standard Precautions?
This refers to basic preventative measures designed to prevent the spread of disease when in contact with bodily fluids, broken skin, mucous membranes, and rashes. Body fluids like vomit, stool secretions, urine and saliva fall into this category as well. Mucus comes from the nasal cavity, openings in some genitals and the anus. In order to provide the minimum standard precautions when paring for patients, it is necessary to protect them from microbes, which will reduce the chance of disease.
Some examples of standard precautions include not sharing a drinking glass or sharing food with the same utensils. Hand washing is a must as well as wearing protective equipment. All members of the healthcare facility (including patients and employees) need to follow these procedures to stem the spreading illness. In most cases, standard precautions include wearing gloves while interacting with patients and interacting with items that have touched a patient, executing correct hand washing and educating patients. Other important aspects of standard precautions include (but are not necessarily limited to):
- Proper hand washing
- Wearing gloves
- Wearing facial protection to cover the nose, mouth, and eyes
- Wearing gowns
- Taking care to avoid needle sticks
- Respiratory hygiene (such as covering a mouth when coughing and sneezing)
- Cleaning the facility
- Changing bedding (especially if the bedding has been soiled)
- Properly disposing of waste
- Taking care of patient equipment that may be contaminated with body fluids, blood or other contagious elements.
- Caring for clothing and disinfecting all equipment following the policies established by the facility
What are Transmission-Based Precautions?
These kinds of precautions are brought into effect if a patient has a known illness present and it needs to be contained. These precautions are designed specifically to prevent the microbes associated with the illness from spreading and transmitting to other patients and workers. Transmissions are broken down into three different categories, which are droplet, contact and airborne.
Droplet
When microbes are spread via the droplet form it is due to respiratory secretion. These are infections that generally affect the respiratory system, although it can affect other areas of the body. Coughing and sneezing will increase when this is a factor. Precautions include utilizing protective clothing and equipment, such as gloves and masks. In other cases, eyewear and a gown are necessary as well. A patient who suffers from these conditions need to wear a mask should they want to leave the room.
While there are varying forms of respiratory viruses, some of the most common forms include influenza and a respiratory syncytial virus.
Contact
These kinds of microbes spread through directly contacting and touching an infected surface. This can be anything from touching a table with the bacteria presents all the way to touching an infected individual. That is why wearing gloves during an exam and wearing a proper gown to cover clothing is a must. Additionally, prior to entering the room of a patient, it is necessary to place all equipment on and then remove all equipment before leaving. This way, only the protective clothing is in contact with the room and patient and it never leaves the room.
The contact precautions are carried for patients who are currently suffering from wounds that are draining, exposed rashes, stool incontinence, rotavirus, ostomy tubes and pressure ulcers (just as a few examples).
Airborne
Microbes that fall under this category are spread through the air and can be breathed in. Often times, airborne microbes can remain in the air for long periods of time. Tuberculosis, chickenpox, herpes zoster and the measles are all examples of airborne microbes that may attack and spread to others. When skin conditions develop due to the airborne microbes, such as measles and chickenpox, it is necessary to utilize the airborne precautions until the skin conditions have subsided. Additionally, patients need to wear masks and employees need to wear the protective clothing while within the room. On top of this, a gown, eyewear, and gloves must be work.
In order to help prevent the spread of these illnesses a negative pressure room is used. These rooms prevent air from escaping out while the door is open. This way, the contaminated air will remain in the room and not leave to infect others. When a patient is considered an airborne threat and the airborne precautions are used, a sign or other clear identifying mark will be placed on the door in order to inform anyone who might enter. Additionally, protective clothing and items will be placed on or by the door for easy access.
When a healthcare provider leaves the room, they will need to follow appropriate disinfection protocol, including cleaning tools and equipment used during the visit.
PPE (Personal Protective Equipment)
PPE is used in reference to the equipment worn in order to protect the body from potential injuries and sickness while in the workplace. This commonly includes masks, gloves, eye shields, and gloves (although every healthcare facility is a bit different and might have different objects and requirements on hand). The facilities are mandated to offer the necessary PPEs in order to ensure the proper wellness of the staff. Some training will be provided with regards to when to use the equipment and how to wear it, how it should be removed and also where it should be disposed of.
There is a set order for dressing oneself with the PPE. While it does depend on the level of protective clothing an employee requires, it generally begins with the gown, followed by the mask, eyewear and gloves.
In order to dress in a gown, the opening is located in the back of the clothing. It is then secured at the rear of the neck and along the waist. This clothing needs to be worn along the top of the uniform or other current clothing. It also must cover clothing running from the neck down to the knees. Whenever entering a patient’s room a new gown needs to be worn and, upon exiting, the gown must be removed and throw away. Doing this will prevent any spread of disease or contamination into the hallway, public area, and patient rooms.
When wearing a mask, these are [placed directly over the mouth, nose, and chin. When first applying the mask, it needs to be pulled apart from the top to the bottom in order to ensure it will fit the face. Once this is done, the top ridge of the mask is placed onto the bridge of the nose. This should snugly wrap around the nose. It can be bent and adjusted to provide the appropriate fit. Now, the bottom of the mask should fit down, right below the chin. Once in position, the top ties wrap around the head, located just above the ears. The lower tie is then wrapped around the neck in order to secure it and prevent it from slipping. It is necessary to wear a new mask whenever entering a patient’s room and, like the other personal protective equipment, needs to be discarded upon exiting. In some cases, equipment such as fit-tested respirators (also referred to as an N-95 mask) is positioned onto the face in a similar manner, although the sear is more secure and tighter. If the healthcare facility uses these masks you will receive more direct training when given access to the equipment.
While wearing goggles or other protective eyewear, the equipment should not slip off even when bending over. Glasses and goggles are often attached to a mask in order to secure it into the set position.
Finally, when putting on gloves, it is important to pull the gloves all the way above the wrists and above the sleeves of the gown in order to provide complete arm skin protection and exposure.
Removing the PPE
When taking off the protective clothing, the gloves should always be removed first, followed by goggles, gown and lastly the respirator (or mask).
Gloves should be removed one at a time on the outside of the glove while folding it down. This prevents a possibly contaminated glove from going under the other glove and exposing the skin. By holding the removed glove in the hand and then peeling off the other glove under the cuff ensures neither hand is exposed. The gloves should then be correctly thrown away (as indicated by the facility’s protocol requirements).
With the gloves throw away grabbing hold of the side of the equipment and sliding it off should pull off the eyewear. These should be thrown away as well. While doing this it is important to not touch the front of the eyewear, as this area is considered contaminated.
When focusing on the gown, the wearer should reach behind and untie the ties. The gown can then be pulled off from the inside out right behind the neckline. This way the exposed hands are kept out of the exposed garment. With the gown off, it needs to be rolled up and then disposed of in the correct receptacle.
Lastly, when focusing on the mask, it is necessary to first exit the room and then take the mask off (unless otherwise noted by the facility requirements). Finally, hands must be washed and all clothing objects correctly disposed of.
Members of the healthcare facility will often perform dirty tasks while caring for a patient. When this is the case, it is important to move from clean to dirty. This prevents spreading the dirt to the cleaner areas. It is also necessary to change out all PPE whenever needed in between tasks.
What are “Clean” Tasks?
Clean tasks a healthcare provider will perform on a patient includes (but is not necessarily limited to):
- Lifting a patient onto a bed
- Transferring a patient from bed to chair (or chair to bed)
- Taking vital signs
- Assessing a patient
- Feeding a patient
- Making a clean bed
- Checking the output of urine on a patient who is currently able to control their bladder.
What are “Dirty” Tasks?
Dirty tasks a healthcare provider will perform on a patient include (but are not necessarily limited to):
- Dressing a wound
- Offering oral care
- Emptying a bedpan or changing a diaper
- Changing dirty linens
- Bathing patients
