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Amanda Fields

on 26 November 2013

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The University of Oklahoma Health Sciences, Nursing Department
prepared by: Amanda Fields RN, BSN
Fall 2013

The pathogen is present, in a quantity large enough to cause disease.
The pathogen must enter through the appropriate entry site.
The person is susceptible to the pathogen.

Blood-Borne Pathogens

Wash area with soap and water.
If a mucous membrane flush with water.
If eyes involved, flush with water.
Contact designated exposure department for next steps.
Blood-Borne Pathogens

Anti-retroviral drugs.
Starting treatment within 24 hours if possible.
Follow- up care.

Blood-Borne Pathogens

Standard precautions are the best way to prevent
spread of blood-borne pathogens.

OSHA provides standards to facilities to help protect workers from a significant health risk associated with exposure to blood.
Blood- Borne Pathogens

Highly contagious.

There IS a vaccine available to prevent Hepatitis A transmission.

Hepatitis A is transmitted by the fecal-oral route.


Blood-Borne Pathogens

Hepatitis A
What to do if you are exposed?
How are blood-borne pathogens are spread?
Post-exposure treatment may include:

Hepatitis B is transmitted by infected blood or bodily secretions.
Diagnosis is made through blood tests.

a vaccine available.

After infection most adults recover from the disease and are immune.
Up to 90% of babies infected and the other 10% of adults become chronically infected.


Blood-Borne Pathogens

Hepatitis C is transmitted by blood to blood contact.

vaccine is yet available for Hepatitis C.
Diagnosis is made by blood testing.

Acute Hepatitis C – first 6 months after exposure ; 15-25% of people clear the infection from this phase.

Chronic Hepatitis C – life long infection leading to serious liver diseases.


Blood-Borne Pathogens

HIV is the human immunodeficiency virus.
Transmitted by infected blood or bodily secretions.
Attacks and destroys CD4 cells.
Eventually leads to AIDS.

AIDS is the Acquired Immunodeficiency Syndrome.
Immune system badly damaged.
Vulnerable to opportunistic infections.
Life expectancy without treatment about 3 years.


Blood-Borne Pathogens

Drug resistance occurs when available antibiotics are not effective against the microorganism.

Common multidrug resistant organisms are methicillin-resistant staphylococcus aureus (MRSA) and Vancomycin resistant enterococci (VRE).


Multi-Drug Resistant Organisms

Hepatitis B
Hepatitis C
A major cause of drug resistant bacteria is improper use of antibiotics.

To prevent multi-drug resistance, clinical practices should incorporate reporting all contamination errors (in any procedure), optimum management of all catheters, prevention of respiratory infections in intubated patients, and accurate diagnosis of infectious diseases.


Multidrug Resistant Organisms

Unanticipated physiologic falls occur when the physical cause of the falls is not reflected in the patient's risk factor for falls.

Anticipated physiologic falls occur in patients whose score on risk assessment scales.

Fall Precautions

If a person if assessed for a high fall risk and falls while in facility care the incident would be defined as an:

A. Accidental Fall
B. Unanticipated Physiologic Fall
C. Anticipated Physiologic Fall


Fall Precautions

Previous falls
Unsteady gait
Reduced vision
Musculoskeletal diseases
Mental status
And acute or chronic illnesses

Bathtubs/toilets without grab bars
Chair/bed height
Condition of ground surfaces
Inadequate assistive devices among others


Fall Precautions

Anticipated Physiologic
Intrinsic Factors
Extrinsic Factors
The best fall prevention program incorporates many different interventions and targets multiple risk factors individualized to each patient.

Examples of different interventions for fall prevention may include:
Encouragement of patient to ask for assistance.
Using non-skid foot wear.
Use of assistive devices as needed.
Education to patient and family about fall risks.

Fall Precautions

If a standardized fall assessment is utilized upon admission, fall prevention resources can be implemented early to target specific risk factors.

For more fall prevention information visit the website:

Fall Prevention

Direct – person to person
Indirect – object to person


Infection Control

Standard precautions were developed to reduce cross contamination between patients and staff.

Standard precautions include:
Hand washing.
Use of Personal Protective Equipment (PPE).
Handling of potentially contaminated material safely.

Infection Control

Causes of Infection
Modes of Transmission
Transmission Precautions
are used when the routes of transmission are not completely interrupted by Standard Precautions alone.

Contact Precautions
requires all healthcare personnel providing care to the patient to don gown and gloves for all interactions that may involve contact with patient or contaminated surfaces.

Infection Control

Patients admitted with potential influenza should be placed in
Droplet Precautions.

Airborne Precautions
are implemented when the infectious agent (i.e. TB) has the ability to remain in the air over long periods of time.

Hand washing the preferred method of hygiene at the beginning and end of every shift.

Infection Control

Infection Control

1. Apply product to palm of hand and rub onto all skin surfaces of hands and fingers.
2. Allow product to air dry. (No rinsing required)

Hand washing hygiene protocol:

How to use alcohol-based hand hygiene:

Hand hygiene should be performed:

Before every patient encounter.
When exiting each patient room.
If changing hand placement from contaminated to clean site.
After removing gloves.
When hands are visibly soiled, the proper hand hygiene should be to wash with soap and water.

Infection Control

Selecting Personal Protective Equipment should be guided by the potential nature of expected interaction in relation to exposure to blood, bodily fluids , or infectious agents.

Personal Protective Equipment (PPE) includes:
Face mask

Infection Control

1. Wet hands first with water.
2. Apply soap to hands.
3. Rub hands vigorously for at least 15 seconds, covering all surfaces of hands and fingers.
4.Rinse hands with water and dry thoroughly with paper towel.
5. Use paper towel to turn off water faucet.

Restraints are only used to protect a patient.
The least restrictive restraint option should be used.
Must have a written physician order within 24 hours of restraint application.
Staff must release restraints a least every 2 hours to provide fluids, toileting, and range of motion.


Reduce environmental stimuli (if possible).
Allow restless patients to walk or sit in rocking chair.
Move patient closer to nurses station.
Assess pain level, and treat if needed.
Rule out causes of agitation.
Involve family members.


H.I.P.P.A. – Health Insurance Portability and Accountability Act

Protected Health Information (PHI) is health information that is linked to an individual’s past, present, or future physical or mental health condition(s).

HIPPA/Information Security

Restraint Alternatives:
Using PPE:
Gown – procedure where skin/clothing may be contaminated.
Gloves – Anticipated contact with bodily fluids.
Face Mask – Potential contact with respiratory secretions or protection of immunocompromised (neutropenic) patient.
Goggles – Protection from splash or spray of blood/secretions.

Infection Control

HIPPA privacy rules protects ANY communication about a patient including electronic, paper, and verbal discussions.

Improperly accessing PHI may lead to termination.

Violations of HIPPA can be penalized by fines up to $250,000 and/or up to 10 years in prison!!

HIPPA/Information Security

PHI may only be accessed by necessary healthcare personnel providing care to the patient.

Social Media for health care practitioners should maintain profession boundaries (ethics) when engaging online with patients. Under NO circumstance should PHI be disclosed through social media.

HIPPA/Information Security

Fire in the facility
“Code Red”
would alert you t0:
1. Close all fire doors/ doors on your unit. This helps to confine the fire.
2. Follow facility protocol, listen for further instructions.

Types of fire

Class A – wood, paper, cloth, or ordinary combustibles
Class B – oil, gas, paint, or other liquids
Class C – electrical

Emergency Preparedness

R.A.C.E. stands for:
Rescue or remove patients from danger.
Activate alarm system and alert others to fire.
Confine fire by closing doors.
Extinguish fire, if small, or wait for Fire Department.

P.A.S.S. is acronym used by many facilities to remind staff how to use a fire extinguisher
Pull the pin.
Aim at the base of the fire.
Squeeze the trigger.
Sweep the hose from side to side.

Emergency Preparedness

Code Black – Severe weather alert

Code Yellow – External disaster nearby; prepare for influx of patients

Emergency Preparedness

Healthcare workers are trained to respond to many different types of disasters including:
Natural disasters
Technological disasters
Major transportation accidents
Nuclear, biologic, chemical, and radiologic events.

Emergency Preparedness

Pain management is a basic patient right. This right includes:
Pain and pain relief information.
Staff who ask and care about their pain.
Patients should receive pain assessment and treatment even if unable to rate on a scale of 1-10.
Pain Assessment is considered the 5th Vital Sign

Pain Management

If a patient is over-sedated, the pain scale (1-10) is ineffective pain medication should be withheld until the patient can accurately describe their pain.

Non-pharmacological pain management includes:
Repositioning patients
Guided imagery

Pain Management

People at higher risk of respiratory depression are:
The very young
Morbidly obese

Children under 2 years of age have decreased pain sensitivity and limited memory of pain due to underdeveloped nervous systems.

Pain management

Stroke is the 4th leading cause of death in the U.S.

Warning signs for stroke include:

Sudden change in speech or trouble talking.
Sudden numbness on one side of the body.
Sudden onset of facial weakness.

Stroke Identification

F.A.S.T. – Face, Arms, Speech, Time

If stroke symptoms appear:
It’s an emergency, call 9-1-1 as soon as possible.

Stroke can happen to anyone at anytime regardless of race, sex, or age!

Stroke Identification

C.L.E.A.N. – acronym for spills
Confirm and Contain Spill.
Leave area, close door, or restrict access.
Ensure exposed people given medical treatment.
Access MSDS and clean up procedures/protocols.
Notify supervisor or manager.

Hazardous Communication

OSHA regulations require employees:
Be informed of the hazards/chemicals in their workplace.
Ensure hazardous chemical are properly stored, handled, and disposed of to minimize exposure to employees and public.
Be provided criteria for classification of health and physical hazards .

Hazardous Communication

All hazardous solutions should be labeled.

It is the responsibility of the employee to learn emergency procedures for substances in their workplace.

Other physical hazards, including sharps are included in the hazardous waste program.

Hazardous Communication

Sharps are objects used in healthcare environment that may cause wounds or punctures to personnel handling them.

May include, but not limited to:
Scalpel blades
Glass test tubes


NEVER recap a needle before placing in the sharps container.

If a sharps container becomes completely full, change container immediately. Never place a sharp in a biohazard bag.


Purpose of Materials Data Safety Sheets (MSDS’s) is to inform users about product properties and safety.

MSDS’s are found in hospital computer’s or by calling toll-free number, and must contain all the same information.

Each MSDS is a separate entry for each product.


When carrying an object you should hold it close to the body’s center of gravity. The object should be close to the body between the waist and the chest.

Lifting an object from the floor, you should squat close to the object, lift and stand at the same time.

Back Safety

To identify a patient that has a latex allergies, often these patients are also allergic to:

Latex reactions may cause contact dermatitis or an immediate allergic reaction (latex hypersensitivity).


Latex Allergies

The main types of injuries from electrical currents are:
Electric shock
Electrical Safety

Before using any electrical equipment, you should inspect the power cords and electrical outlets for damage.
Do not use damaged power cords or outlets!

Ground Fault Circuit Interrupter’s (GFCI’s) turn off the electricity before severe injuries or electrocution occurs.

For more general electrical safety information please visit:

Electrical Safety

All staff and students are responsible for ensuring others do not “draft” or enter into secure areas when others open doors with badge access.

General Safety

Population specific care is modifying a patient’s care to take into consideration the patient’s culture, age, sex, disability, race/ethnicity, language, religion, and socioeconomic status.

There are cultural competency tools at each hospital for ensure staff are culturally competent and aware.

Population Specific Care

Population specific care is important to patient care because:
Patient’s health needs, reactions to care, dosages needed, etc.…can be affected.
Patient’s have different levels of health literacy.
Competencies must be verified to ensure that the healthcare providers can adjust patient care to meet the needs of the specific population they are serving.

Population Specific Care

For deaf, or non-English speaking patients, an interpreter with competencies on file must be used and documented in the patients chart for determining patient history, obtaining informed consent, explaining patient’s rights, explanation of living wills or power of attorney, explaining procedures or medications (including side effects), discharge instructions/planning, and explanation of advanced directives.

Population Specific Care

Signs of abuse may include:
Physical marks
A statement from a person saying they have been abused.
Extreme withdrawal or agitation.
Unkempt appearance (improper clothing for the weather, extremely poor hygiene, ect…).

Abuse and Neglect

When assessing for physical signs of abuse and neglect:
Look for injuries:
That are inconsistent with story given.
In various stages of healing.
Part of a pattern.

Remember there are not always physical injuries present when there has been abuse or neglect.

Abuse and Neglect

Abuse can take on various forms including:
Child/elder abuse or neglect, domestic abuse, rape/sexual molestation.

Reporting of abuse, neglect, or maltreatment should follow the facility chain of command, or be directly reported to the Department of Human Services (DHS).

Abuse and Neglect

According to the policy Protecting Patients from Abuse or Harassment, if a staff member is suspected of mistreating a patient, immediate action includes:
Removal of the staff member from the situation.
Assessing the patient.
Notifying your supervisor and the clinical coordinator.


NPSG to “Improve the Accuracy of Patient Identification” involves:
Using 2 patient identifiers (name, birthdate, medical record number)
Helping to eliminate blood transfusion errors by requiring 2 qualified staff to verify patient and blood order at the bedside.

The Joint Commission/National Patient Safety Goals

NPSG to “Improve Safety of medications” includes:
Labeling all medications, including syringes, cups, and basins.
Verification by 2 qualified individuals (verbally and visually) when preparing medication, when not the person administering the medication.
Labels include name, strength, amount, expiration, and date/time.
Reducing harm from patients taking anticoagulants.
Maintaining and communicating accurately patient medical information.

The Joint Commission/National Patient Safety Goals

NPSG to “Reduce the Risk of Healthcare-Associated Infections (HAI)” includes:
Always using good hand hygiene.
Washing hands before and after patient contact.
Preventing multi-drug resistant organism infections by using the ABCD and catheter associated urinary tract infection prevention.
Prevent central line bloodstream and surgical site infections.

The 2014 NPSG’s can be found at:

The Joint Commission/National Patient Safety Goals

Inappropriate abbreviations per TJC include:
‘u’ for units. It could be mistaken for a 4.
qd, qod. Write out daily or every other day.
Never use a trailing zero.

Always use standard abbreviations for drug names.

The Joint Commission/National Patient Safety Goals

Patients at risk for suicide:
Require intense observation.
May require a safety assistant to assist with ensuring patient safety.
Staff should notify RN immediately if patient attempts suicide.
Are placed in suicide-safe gowns.

The Joint Commission/National Patient Safety Goals

One of the most significant signs/symptoms of TB is a productive, prolonged cough.

People at higher risk are:
Nursing home residents.
Homeless/low income populations.
Substance Abusers.
Prison population.

Tuberculosis (TB)

The End
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