2. You have the right to:
Considerate, respectful, safe care, & to be made
comfortable.
Know the name of your physician …
Receive information about your health status, course
of treatment and prospects for recovery in terms you
can understand.
Make decisions regarding medical care, and receive as
much information ….. As you need in order to give
informed consent or to refuse a course of treatment.
Request or refuse treatment, without coercion,
discrimination or retaliation …
Reasonable responses to any reasonable requests
made for service.
Request or reject the use of any or all modalities to
relieve pain, including opiate medication, if you suffer
from severe chronic intractable pain.
3. You have the right to:
Formulate advance directives.
Have personal privacy respected.
Confidential treatment of all communications and records
pertaining to your care and stay in the hospital.
Access information contained in your records within a
reasonable time frame….
Receive care in a safe setting, free from all forms of abuse or
harassment …
Be free from restraints and seclusion of any form that are
not medically necessary or are used as a means of coercion,
discipline, convenience, or retaliation by staff.
Reasonable continuity of care, right to know the reasons for
proposed change in the Professional staff, and to know in
advance the time and location of appointments as well as
the identity of the persons providing the care.
4. You have the right to:
Be informed by the physician or continuing health care
requirements and to know the reasons for transfer or
discharge from the hospital.
Know the hospital rules and policies apply to your conduct
while a patient.
Be informed of the source of the hospital’s reimbursement
for services and/or limitations which maybe be placed upon
care.
Designate vis8tiors of your choosing….
Have your wishes considered….
Examine and receive and explanation of the hospital[s bill
regardless of the source of payment ….
The patient’s family has the right of informed consent of
donation of organs or tissues.
Exercise these rights and have impartial access to treatment
without regard to gender, age, …..
File a grievance/complaint with the hospital, a state agency
regarding quality of care or premature discharge.
5. Patient Responsibilities
You, your family, and visitors are responsible for
following the rules involving patient care and
conduct. These include hospital visitation and no
smoking policies.
You are responsible for providing a complete and
accurate medical history. This history should
include all prescribed and over-the-counter
medications that you are taking (including herbs
and vitamins).
You are responsible for informing us about all
treatments and interventions that you are involved
in.
6. Patient Responsibilities
You are responsible for following the suggestions
and advice prescribed in a course of treatment by
your health care providers.
Your refusal of treatment prevents us from
providing care according to ethical and
professional standards, we may need to end our
relationship with you after giving you reasonable
notice.
You are responsible for being considerate of the
rights of other patients and hospital personnel and
property.
7. Patient Responsibilities
You are responsible for providing information
about unexpected difficulties you have involving
your health care.
You are responsible for making it known whether
you clearly understand your plan of care and the
things you are asked to do.
You are responsible for providing us with correct
information about your sources of payments and
ability to pay your bill.
8. Violation of Patient Rights
Examples:
Altering, falsifying, miss-statements of facts or making a
material omission on any patient chart … or any other
Hospital chart or record.
Disclosure of confidential information pertaining to
patients, physicians, volunteers, other employees, or any
other organization etc., (Up to $ 25.000 in fines to individual
and/or hospital; hospital rejects nursing school attendance
for clinical).
Use of private cell phones while on duty for the purpose of
outside communications, taking pictures of patients, co-
workers or Hospital property.
9. Violation of Patient Rights
Examples:
Negligence or willful in-attention in
performance of duties.
Soliciting tips, gifts, or other gratuities or favors
from patients or their families or accepting gifts
with more than a nominal value.
Offering unauthorized medical or health advice.
10. Advance Directives
Patient Self-Determination Act of 1991
Health Care Facilities are obligated to:
Inform Patients
Honor Patients Advanced Directives
Advance directives are legal documents that allow the
person to convey their decisions about end-of-life care
ahead of time.
They provide a way for the person to communicate their
wishes to family, friends and health care professionals, and
to avoid confusion later on.
11. Advanced Directives
A Living Will: tells how the person feels about care
intended to sustain life. The person can accept or refuse
medical care. Issues that can be addressed, include:
The use of dialysis and breathing machines
Wanting to be resuscitated if breathing or
heartbeat stops
Tube feeding
Organ or tissue donation
A durable power of attorney for health care is a
document that names the health care proxy. A proxy is
someone the person trusts to make health decisions if
they are unable to do so.
12. Advanced Directives
Process:
DECIDE – What is important ! – Right to “revoke” at any time
What type of care – palliative care, hospice care etc.
DISCUSS – With Family, Friends, Physician
DESIGNATE – The person you want to make
important medical decisions for you if you
are unable to make them
DOCUMENT – Forms – Your Signature, Two witnesses
(Students can not be a witness)
DISTRIBUTE – Copies to Important Folks -- Bring a copy
with you every hospital visit
Don’t keep a secret !!!
20. Customer Services
Internal vs. External Customer
Answer call lights promptly – “Hour Rounder”
Intervene to assure patient comfort is
achieved – Be proactive rather than
reactive: 5 P’s
Potty
Pain
Position
Property
Problem
21. Customer Services
Respect:
Patients
Privacy & Confidentiality
Diversity –
“We may have different religions, different languages, different
colored skin, but we all belong to one human race.” (Kofi Annan)
Physicians
Colleagues
Maintain a neat, and clean environment
(NOT MY JOB !!!)
Patient room, bathroom
Nurses’ station
23. Workplace Violence
Healthcare workers are at a greatly increased risk
(85%) of being victims of workplace assaults than
are private sector workers.
Workplace violence ranges from offensive or
threatening language to homicide.
National Institute of Occupational Safety & Health
defines workplace violence as violent acts directed
toward persons at work or on duty. This includes:
Verbal, written, or physical threats
Destroying property
Using weapons
Robbery
Stalking
Physical acts such as slapping, punching,
kicking
24. What can you do to prevent
Workplace Violence?
REMEMBER – violence can happen
anywhere.
Be aware of warning signs and recognize
signs of trouble early.
Treat co-workers, patients, and visitors
appropriately and with respect.
Take all threats seriously.
Do not try to handle situations alone.
25. Recognize the Warning Signs
of Violence
Use of an angry or threatening tone of voice, shouting,
screaming or cursing.
Abrupt movement, restlessness or nervous pacing.
Unreasonable demands.
Postural position tense with clenched fists, tightly
gripping objects.
Facial expressions usually red face, scowling or
frowning with clenched jaws.
Verbal threats.
Violent gestures, throwing, breaking or pounding on
objects.
Staggering, slurred speech, irrational speech or other
signs of being under the influence of alcohol or drugs.
26. What should you do when
confronted with a violent person?
Call a Code “Gray” and maintain self-
control.
Take immediate action to protect yourself,
keep your distance.
Leave yourself an escape path.
Stay calm and alert, talk calmly and
slowly.
Listen to the person, this alone can diffuse
the situation.
27. What should you do when
confronted with a violent person?
Do not try to restrain or disarm the person.
Your goal is to prevent harm to yourself and
others.
Be also aware of “Lateral Violence.”
Regardless of how “small” or meaningless
the attack may seem, report the incident to
your instructor immediately.
28. Performance Improvement
A process that identifies areas of
concern in a hospital or on a nursing
unit, and the goal is to improve quality
of services.
Performance Improvement focuses on:
– What is important to the customers
– Improving processes -- ongoing
– Identifying problems
– Preventing problems
– The Ultimate Goal: Quality Patient Care
29. National Quality Care:
CORE Measures
As defined by Regulatory Agencies (i.e. HFAP, Medicare)
– “Core Measures are standardized performance measures that
can be applied across health care; they are comprised of
precisely defined data elements based on uniform medical
language.”
Accredited Health care organizations that wanted to keep
their accreditations were required to look at their hospital’s
performance and report statistical data.
The ORYX Performance Measurement Requirements started
1998 – hospitals began to collect and report monthly
statistics for specific measures.
Medicare is looking at the compliance percentage –
reimbursement to hospitals
30. National Quality Care:
CORE Measures
The CMS/Core Measures Initiatives covers
five focus areas:
– Acute Myocardial Infarction (AMI)
– Congestive Heart Failure (CHF)
– Community Acquired Pneumonia (CAP)
– Surgical Care Improvement Project (SCIP)
– Stroke (Stroke)
31. Patient Confidentiality/ HIPAA
Health Insurance Portability and
Accountability Act (HIPAA)
Law was designed to protect the
privacy of certain health
information
Information that relates to the health of
an individual and identifies or can be
used to identify, the individual
There are penalties both civil ($10,000
or $25,000) and criminal for failure to
comply with HIPAA requirements.
32. HIPAA-Student’s responsibilities
All discarded paperwork that contains
patient information must be shredded,
and never placed in the regular trash.
If the HIPAA standards are not
followed, the hospital is put in
jeopardy of receiving a fine.
Never discuss patient or patient health
information in public areas such as
hallways, cafeterias and elevators.
33. HIPAA-Student’s responsibilities
Never discuss patient or patient health
information with your family or friends.
Patient’s charts should always be placed
in a secured area.
Never write name of patient on any of
your forms. Use only initials.
Never photocopy patient information.
34. EMTALA
Emergency Medical Treatment and Labor Act
Patient Anti-dumping Law
Hospital must provide appropriate medical
screening examination… to determine whether
or not a medical emergency exists.
If a medical condition exists, the patient must
be stabilized before transfer or discharge.
35. Risk Management
Goal
To minimize the risk to the institution from an error or
problem that could result in legal action or liability.
Risk Management:
A formal process of identifying, analyzing, treating and
evaluating real and potential hazards or pt. issues.
It addresses liability and financial losses.
Grievance → departmentally resolved → report to Charge Nurse and
Instructor
Include wellness and prevention of injury programs for staff.
Risk management is part of continuous performance
improvement program.
36. Environment of Care (EOC) –
General Hospital Safety
Report any unsafe condition to your
clinical instructor or the nurse you are
working with.
When walking in the halls and stairway,
keep to the right and use special
caution at intersecting corridors and at
door openings.
Use a ladder or stepstool to reach
items higher than you can reach.
37. EOC-General Hospital Safety
If there is a spill, stay in the area, call for help,
then clean or block area until environmental
services can get there.
Follow “Wet floor” caution signs by walking only
on areas that are dry.
Remove all defective equipment and furniture
from service immediately. Tagging the item as
“Defective, Do not use”. Report equipment to
the Engineering Department.
38. EOC-General Hospital Safety
Lock all medication cabinets, and supply
cabinets when not in use.
Student injuries must be reported immediately to
clinical instructor.
Find out where students should park their car
prior to clinical day and comply with facility
policy.
Patients & Patient’s Families always have the
right-of-way.
40. EOC-Fire Extinguishers
A
Trash, paper or wood fires
ABC
Flammable liquid, trash, wood or electrical
fire
P- pull
A- aim
S- squeeze
S- sweep
Student role when code red is called
Help close all doors to patient’s rooms
41. EOC-Emergency Codes
CODE RED Fire
What do you do if the alarm goes off?
CODE GREEN Evacuation
42. EOC-Emergency Codes
Code Gray Combative/Disruptive Person
G = Go get help
Code Yellow Bomb Threat
Code Silver Person w/Weapon – Hostage Situation
S = Stay away
43. EOC-Emergency Codes
Code Blue Medical Emergency
(Adult)
Code White Medical Emergency
(Pediatrics)
Code Pink Infant Abduction
Code Purple Child Abduction
Code Orange Hazardous Materials Spill
44. EOC-Emergency Codes
Triage Internal Internal Disaster
Triage External External Disaster
Code Triage Alert Activation of Personal
Safe Surrender Site
45. Electrical Safety
All electrical equipment must have a three-
prong safety plug.
All red electrical receptacles are emergency
powered.
Patient beds must be plugged into the marked
“bed” receptacles.
Grasp plug not cord when unplugging
equipment from the wall.
All electrical equipment brought into the hospital
by patient or visitors must have bio-med
approval before use.
Become familiar with the equipment before you
use it.
46. EOC-Compressed Gas Cylinder
Safety
Many industrial, medical and
laboratory operations require the use
of compressed gases for a variety of
different operations. Compressed
gases present a unique hazard. Gases
may be:
▬ Flammable or combustible
▬ Explosive
▬ Corrosive
▬ Poisonous
47. EOC-Compressed Gas Cylinder
Safety
Since the gases are contained in heavy, highly
pressurized metal containers, the large amount of
potential energy resulting from compression of
the gas makes the cylinder a potential rocket or
fragmentation bomb.
Careful procedures are necessary for handling the
various compressed gases, the cylinders containing
the compressed gases, regulators or valves used to
control gas flow.
48. EOC-Compressed Gas Cylinder
Safety
Gas cylinders must be secured at all times
to prevent tipping:
● During Patient transport:
Put Oxygen tanks in the appropriate space under the bed
or gurney or a properly designed wheeled cart to ensure
stability.
● Cylinders should never be rolled or dragged.
49. EOC-Radiation Safety
Radiation is a part of our natural environment
(Cosmic, salt substitutes, fertilizers, pottery).
The radiation risk incurred by a person working in
a hospital, depends on the magnitude of the
radiation dose received.
The biggest man-made contribution to radiation
exposure in a hospital are from medical x-rays
and from radioactive materials for diagnoses and
treating diseases.
50. EOC- Radiation Safety:
ALARA Concept
To reduce exposure to radiation the “As low
as reasonable achievable” concept
(ALARA) is followed:
Limit time in the area where radiation
exposure may occur.
Increase your distance from areas where
radiation exposure may occur.
Use appropriate shielding in radiation areas.
51. EOC-Radiation Safety
Guidelines for students
Use protective gear or distance yourself when
the portable x-ray machine is activated in a
patient room. (stand behind the X-ray
technician).
If asked to assist during an x-ray you should
always wear a shielding apron.
Follow all instructions posted on a patient’s door
who has a radiation sign, do not ignore the signs.
52. EOC-Material Safety Data
Sheets (MSDS)
MSDS are available to you for review on each
unit, on computers, or via a 1-800 telephone #.
Information on all possible substances that
are used
What the substance is
What danger rating it has
Storage guidelines
What to do when it enters your body
Any necessary phone #s for further information
53. EOC-Security
Personal Safety:
Best way to be safe is to remain alert, aware and
responsive to your surroundings.
Call Security if you see someone that does not
belong in your area or is a suspicious person.
Always wear your Victor Valley College badge.
When you leave at the end of your clinical day use
the buddy system to go to your car or have
Security escort you.
54. EOC-Security
Belongings Safety:
PatientBelongings: Dentures, Hearing Aids,
Glasses, Money.
Student Belongings:
Do not bring large sums of money or credit cards to the
hospital.
If you bring books, purses or other belongings into the hospital
find out from your instructor where it would be safe to leave
them.
Some people do not respect what belongs to you – the less
you bring into the hospital the less temptation is there for it to
be taken.
55. EOC-Emergency Preparedness
HICS
Hospital Incident Command System
(HICS)
Designated to minimize the confusion and
chaos that swirls around disaster
During a incident listen and do as
assigned
Keep your cool and pay attention
56. EOC-Emergency Preparedness
Earthquake Safety
During Earthquake
Inside
Protect yourself first:
Take shelter under tables (breathable space), desk, doorways
Stay away from windows
Do not leave building until safe to do so
Outside
Step into a doorway (do not hold unto the door frame) or
move to an open area
After
Use phone only for emergency
Check on patients and assist where possible
Expect aftershocks
Do not use elevators
57. EOC-Emergency Preparedness
Bioterrorism Response
This is a newer area of terrorism:
Hospitals and clinics may be the first opportunity to
recognize and initiate a response to a bioterrorism-
related outbreak.
Hospital staff is trained in decontamination
Reporting (Infection Control, CDC, FBI)
Potential Agents
Anthrax, Botulism, Plague, Smallpox
Isolation Precautions – follow directions
Psychological aspects of bioterrorism
58.
59. GOAL #1: Improve the accuracy of patient
identification:
Identify patients with at least two identifiers
Name
Date of Birth
when providing care, treatment, and service.
If using armbands, they must be attached to the
patient.
60. ◦ GOAL #2: Improve the effectiveness of
communication among caregivers
Read back telephone or verbal orders
Limit the number of abbreviations, acronyms, symbols:
U = write units
IU = write international units
QD, QOD = write daily, every other day
MS, MGSO4, MSO4 = write out morphine and magnesium
sulfate
0.1mg = always use a leading zero when using a decimal
point
Never use a trailing zero 1.0mg write 1mg
61. ◦ GOAL #2: Improve the effectiveness of
communication among caregivers
Utilize the SBAR (Situation, Background, Assessment,
Recommendation) process for “hand off” communication
RN to RN communication.
Shift to shift reports.
Lunch breaks.
Physician calls.
Patient Transfers to higher or lower levels of care.
“Ticket to Ride”
62. GOAL #3: Improve the Safety of Using High Alert
Medications:
Remove concentrated electrolyte medications from
patient areas, review look-a-like/sound-a-like drugs
Medications and solutions labeled even in only one being
used.
Unlabeled medications/solutions are immediately
discarded.
Labeling not required if medication / solution is drawn
and immediately administered. Preparing two medications
at the same time does not meet this definition; therefore
each would have to be labeled.
63. GOAL #3: Improve the Safety of Using High Alert
Medications:
Reduce the likelihood of patient harm associated with
the use of anticoagulation therapy.
All orders for warfarin (Coumadin) must include an
indication for use.
A baseline INR is to be obtained and reviewed before the
first dose is given.
Dose to be given at 1700 and to be documented on MAR
with corresponding INR result.
64. ◦ GOAL # 7: Reduce the risk of health care
associated infections:
Comply with the current Centers of Disease Control
and Prevention (CDC) hand hygiene guidelines,
prevent HAI’s due to multiple drug-resistant
organisms.
Encourage your patients to ASK if you have sanitized or
washed your hands.
◦ GOAL # 8: Accurately and completely reconcile
medications across the continuum of care:
Compare patient’s current medications with those
ordered for the patient while in the hospital,
complete list of medications to the patient upon
discharge.
65. ◦ GOAL # 9: Reduce the risk of patient harm
resulting from falls:
Fall reduction program – Every hospital has a
process in place to prevent patient falls.
Morse Fall risk assessment:
Once per shift.
Any time there is a change is status.
Includes a Medication Assessment.
Patient / family educated on fall reduction program and
individual strategies to reduce fall risk.
66. ◦ GOAL # 10: Reduce the risk of influenza &
pneumococcal disease in hospitalized older adults:
Patients are screened and if they have not received an
immunization, with their consent, will receive these
vaccinations.
◦ GOAL # 13: Encourage patient’s active involvement
in their own care as a safety strategy:
Patients are asked to report concerns about safety.
Condition H or Condition HELP “Speak –Up”
Condition H allows for patients and family members to call
for immediate help if they become concerned about a
patient’s condition.
67. ◦ GOAL # 14: Prevent Health Care Associated
Pressure Ulcers:
Every hospital has a process in place to prevent skin
breakdown on their patients (Hospital acquired
Stage III & Stage IV pressure ulcers – are reportable
to state agencies).
Risk Assessment on every patient on admission and every
shift.
Skin Breakdown/Decubitus Prevention Protocols
Treatment of skin ulcers and/or pressure ulcers
Documentation of skin ulcers and/or pressure ulcers
68. ◦ GOAL # 15: The organization identifies risks
inherent in its patient population:
Identifying patients at risk for suicide if they are
treated for emotional or behavioral disorders.
◦ GOAL # 16: Improve recognition and response
to changes in a patient's condition:
Health care staff can request additional assistance
form a specially trained individual when the
patient’s condition appears to be worsening.
Rapid Response Team /Code Assist (DVH)
69. The use of restraints is considered only after less
restrictive means have been attempted and the
results of such efforts have been documented.
A Dr’s order is required – each order may not
exceed 24 hours (Restraints may not be written as
a PRN order).
Behavioral restraints – patients need to be
evaluated by a physician within one hour and re-
evaluated every 4 hours.
Perform and document ongoing assessment for
continued need for restraints and when patient
meets criteria for release form restraints.
80. Emphasis on keeping your distance between
sterile and unsterile fields
Emphasis of keeping your distance
between sterile and unsterile fields
Emphasis of keeping your distance between sterile and
unsterile fields
81. The Five “Rights”
Final Patient Identification and “Timeout”
SIGN IN: Before beginning of Anesthesia
(Identity of patient; procedure, consent, Allergies)
TIME OUT: Before skin Incision
(Baseline Sponge count – Surgical team reviews:
Pt. procedure; Site)
SIGN OUT: Before patient leaves Operating Room
(Correct Sponge & Needle count; specimens correctly labeled)
87. Abuse Reporting
Abuse
Every Healthcare Worker is a mandated reporter for
the following types of abuse:
CHILD ABUSE
ELDER ABUSE
DOMESTIC VIOLENCE
REMEMBER:
Student Nurses report any suspicion of abuse to
their clinical instructor !!!!
88. Abuse Reporting
According to the National Child Abuse and
Neglect Data System (1999);
of the estimated 826,000 victims of child
abuse –
58 % suffered from neglect
21 % were physically abused
11 % were victims of sexual abuse
89. Abuse Reporting
Types of Abuse:
Physical Abuse
Is intentional injury to a child by the caretaker.
It may include but is not limited to burning, beating,
kicking, and punching.
It is usually the easiest to identify because it often leaves
bruises, broken bones, or unexplained injuries.
Physical abuse is not accidental, but neither is it
necessarily the caretaker’s intent to injure the child.
90. Abuse Reporting
Neglect:
Most common type of reported and substantiated
maltreatment.
Sexual Abuse:
“ employment use, persuasion, inducement, enticement, or
coercion of any child to engage in, assist any other person
to engage in any sexually explicit conduct or stimulation of
such conduct for purpose of producing a visual depiction of
such conduct.”Any type of touching of a child for sexual
gratification.
Emotional Abuse:
Can be defined as verbal , psychological, or mental abuse in
which the damage inflicted leaves lasting emotional scars.
It can include blaming, belittling, or rejecting a child;
constantly treating siblings unequally; and a persistent lack
of concern by the caretaker for the child’s welfare.
91. Social Services
Types of Elder Abuse:
Physical -- assault or injury from inappropriate transfers etc.
Financial – misusing funds, having an elder sign financial
documents they do not understand.
Neglect – failure to provide food, clothing, hydration,
showers etc.
Self-Neglect – the person does not provide for their own
care.
Emotional – ridicule, taunting.
Sexual – any unwanted physical touching, sexual comments,
requests or simply glaring at the person’s body.
92. Social Services
Domestic Violence
Is the physical assault or threat of doing bodily
harm to a spouse, domestic partner, or
roommate.
Perpetrators can be prosecuted under the
domestic violence statute or criminal statutes
from assault and battery to attempted murder.
93. Infection Control: Modes of Transmission
Microorganisms are transmitted by various routes, and the same
organism may be transferred by more than one route:
Contact route
Direct - physical transfer between a susceptible host and infected or
colonized person;
Indirect - personal contact of susceptible host with a contaminated
intermediate object;
Droplet - as a result of coughing, sneezing, walking by an infected
person;
Vehicle route – diseases transmitted through contaminated
items such as water, food, drugs etc.
Airborne route – dissemination of either droplet nuclei or dust
particles in the air containing an infectious agent
Vector-borne route – West Nile Virus, Bird Flu, Malaria
94. Infection Control:
Respiratory Hygiene/Respiratory Etiquette
Prevent transmission of all respiratory infections
(H1N1 virus, influenza)
Cover nose/mouth when coughing or sneezing.
Use tissues to contain secretions – dispose in nearest waste
receptacle.
Perform Hand Hygiene – after having contact with secretions
& contaminated objects/materials.
Hospitals to provide tissues and waste receptacles for
used tissue disposal.
Hospitals to provide alcohol-based hand rub
dispensers.
96. MRSA TODAY – It’s faces
Slides: Courtesy of Arrowhead Regional Medical Center – Infection Control
97. MRSA TODAY – It’s consequences
Slides: Courtesy of Arrowhead Regional Medical Center - Infection Control
98. Epidemiology of MRSA
Slides: Courtesy of Arrowhead Regional Medical Center - Infection Control
• For every infected
patient with MRSA,
there are many more
who carry the
organism without any
symptoms (colonized)
• Colonized patients
can serve as a
source of infection
or colonization for
others through
direct or indirect
contact
98
99. The human and financial impact of MRSA is high:
• Over 126,000 hospitalized persons are infected by MRSA annually
• 3.95 MRSA infections occur per 1,000 hospital discharges nationally
• 1.25 infections per 1,000 discharges at ARMC for 2006-2007, .39 Jan-
Sept ‘08
• Over 5,000 patients die as a result of these infections annually
• Over $2.5 billion excess health care costs are attributable to MRSA
infections
• Non-reimbursement from CMS for treating healthcare-acquired
infections
On average, for each patient with MRSA infection this means:
• 9.1 days excess length of stay
• Over $20,000 in excess cost per case (range $7,000 – $32,000)
• 4% in excess in-hospital mortality
100. TYPES OF INFECTIONS CAUSED BY MRSA
Slides: Courtesy of Arrowhead Regional Medical Center - Infection Control
Catheter-associated blood
stream infections
Wound
infections
Surgical site
infections
Sepsis,
septic
shock
Ventilator-
associated
Urinary
pneumonia
tract
infections
101. INFECTION CONTROL PRACTICES
Hand Hygiene
Standard Precautions
Personal Protective Equipment
Isolation Precautions
Proper care of invasive devices
Removal of devices when no
longer medically necessary
Proper care of surgical sites
102. Hand Hygiene
CDC Hand Hygiene Guidelines:
Before patient contact
After patient contact
Before donning gloves
After removal of gloves
Hand washing
Washing hands with plain soap & water for 15 sec.
Antiseptic hand rub agent to all surfaces of hands
Surgical hand antiseptic
Performed pre-op by surgical personnel with antiseptic hand
wash/rub to eliminate or reduce hand flora
The CDC recommendation for healthcare workers who have direct
contact with patients, food, or patient care equipment not wear
artificial nails or natural nails over 1/4” long.
Hand hygiene is still the #1 way to stop the spread of infection!
103. When to perform hand hygiene:
Slides: Courtesy of Arrowhead Regional Medical Center - Infection Control
After contact with patients or
patient care equipment
After contact with environmental
surfaces
AFTER GLOVE REMOVAL
Before & after any procedure
involving patient care
After coughing/sneezing into hands
After using restroom
104. Standard Precautions
Work practices that help prevent the spread of
infections and infectious diseases.
ALL PATIENTS SHOULD BE CONSIDERED
INFECTIOUS!!!
And don’t forget:
• students
• employees
• vendors
• registry staff
• contractors
• visitors
• physicians
105. Standard Precautions
Standards for every person admitted to
the Hospital:
Hand Hygiene
PPE – Personal Protective Equipment: (come in
contact w/blood, body fluids, secretions, excretions, non-intact
skin, and mucous membranes)
Gloves
Mask, eye protection, or face shields
Gowns
Sharps Safety
106. Isolation Precautions
Airborne Infection For tuberculosis,
chickenpox and
Isolation measles only
For MRSA, MDRO in
Droplet Isolation sputum, bacterial
meningitis, mumps
For drug resistant
Contact Isolation organisms in wounds,
abscesses, RSV
107. Infection Control:
Isolation Precautions
Airborne
Transmitted by small droplet
Measles
Varicella
Shingles
Tuberculosis
Private room, negative airflow, door closed
at all times, staff wears N95 respirator
mask, visitors wear a regular mask
If patient leaves room, must wear a
regular mask
108. Infection Control:
Isolation Precautions
Droplet
Transmitted by large droplets
Haemophilus influenza type B
Bacterial Meningitis
MRSA, MDRO in sputum
Bacterial respiratory infections such as:
Pertussis (whooping cough) or
Streptococcal infection
Viral infections such as:
Adenovirus, Mumps, Rubella, Scarlet Fever
Private room, mask, goggles, keep 3 ft distance
when possible, if patient transported must wear
mask
109. Isolation Precautions
Contact
Transmitted by direct contact with patient or
indirect contact with contaminated objects or
persons
GI, Resp, Skin, or wound infections especially if
infected with:
MRSA, VRE, or Clostridium -Difficille
Respiratory Infections in children and infants:
RSV, para-influenza virus, or enteroviral infections
Skin infections such as:
Herpes simplex, Varicella, Impetigo, Scabies
Conjunctivitis (pink eye)
Private room, gloves, gowns, mask as needed,
equipment dedicated for single patient use
110. Slides: Courtesy of Arrowhead Regional Medical Center -
Infection Control
Environmental cleaning
Extremely important that all staff
assist in maintaining a clean and
sanitary patient care environment.
Please clean up after yourselves.
Clean up spills promptly or call EVS
for large spills.
Dispose of all waste
properly.
112. Regular Garbage: (found in Patient Rooms)
EXAMPLES:
a. Empty IV bags, bottles & tubing without needles (take
patient identification off)
b. Empty urine cups, Foley bags/tubing, diapers, chux
c. Exam & cleaning gloves
d. Disposable basins, paper towels, band aids, cotton
balls
e. Disposable bedpans, urinals
f. Sanitary napkins & tampons (personal)
g. PPE (worn, but not soiled w/blood)
h. Paper & plastic boxes, wrappers, office waste,
packaging
i. Food products & waste (i.e. pizza boxes, soda cans,
paper cups, plastic utensils)
113. Biohazard Bags (Red Bags)
1. Blood-saturated items: bloody gauze, bloody
dressings, bloody gloves
2. Bags and IV tubing containing blood products
3. Isolation Waste: discarded materials/contaminated with
excretions or secretions from humans who are required
to be isolated.
4. Containers, catheters, or tubes w/fluid blood
or blood products:
Suction Canisters
Hemovacs
Chest drainage units
5.Hemodialysis products
6. Microbiology specimens, used culture plates,
tubes, bottles, & devices
7. Blood spill clean - up materials
115. Student Health/Certificates
All students must have in their file:
Current TB
MMR titer
Hepatitis B titer
Varicella (Chickenpox) titer
Physical
Student must have their CPR card with
them on clinical days.
Random urine drug screen – requirement
by hospitals.
116. Dress Code
Personal Hygiene
Uniforms must be clean and wrinkle free
(VVC dress code)
Hair must be up and off collar to prevent
contamination of self or patient – Natural hair color
Mustache and beards must be trimmed and neat
(VVC dress code)
Personal basic hygiene measures must be followed
Clean body
No body odor – after smoking (mints)
No strong perfume or cologne (VVC dress code)
117. Dress code
ID Badges –
Must be worn at all times while in the hospital.
Must be worn above the waist.
Picture must be visible with no stickers or pins covering
the face.
Common Sense –
Undergarments not visible (male & female)
Piercing – one post in each ear
Makeup worn in moderation
Fingernails must be clean and trimmed (not > ¼ inch
long);
Nail overlays (silk, acrylic, gel) are not allowed
118. Dress code
Common Sense –
Tattoos must not be visible
Leather-like shoes (closed toes & heels) –
clean, no logos
No gum chewing
Cellular Telephones
Should not be used in patient care areas where we serve
customers (including texting)
Bluetooth devices – not acceptable
If kept on your person, cell phones should be on silent or
on vibrate at all times.
119. Infection Control:
Student Injury
If an injury or exposure occurs at the
clinical site do the following:
Immediately contact your clinical
instructor
120. Harassment
Includes any behavior or conduct that unreasonably interferes
with an individuals work performance or creates an intimidating,
hostile or offensive work environment.
Verbal Harassment – jokes, negative stereotyping,
using words like ‘honey’ or ‘sweetheart’.
Physical Harassment – impending, unwelcome
physical contact, intimidating.
Visual Harassment – offensive materials such as
photos, posters, cartoons or drawings; unwelcome notes
or letters.
Threats & Demands to submit to sexual requests as a
condition of continued employment or benefits.
Retaliation for having reported or threatened to report
harassment.
121. BODY MECHANICS
Use your strongest muscles to do the job
Shoulders, upper arms, hips and thighs
Maintain a broad base of support when
assisting patients.
Point your toes the direction of movement.
Bend from the hip and knees and keep your
back straight.
Use the weight of your body to push or pull
an object, and push instead of pull
whenever possible.
122. BODY MECHANICS
Carry heavy objects close to your body
Avoid twisting your body as you work
Pivot with your feet, and use your legs to do the
work
If a patient or object is too heavy for you to lift
alone, always get help
Tighten stomach muscles without holding your
breath when lifting objects.
