HSC1101 – Patient Care and Safety – Safety Procedures
This article will discuss the safety measures that are put in place for the well-being of patients.
The learning outcomes are listed as follows:
Understand the chain of infection
Discuss standard precautions
Discuss the maintenance of a safe environment and infection control
Discuss principles of aseptic techniques
Discuss patient safety related to infection control and fall precautions
Discuss the prevention and management of needle-stick injury
Discuss the purpose and components of vital signs
Discuss purpose of oxygen therapy and suctioning
Discuss purpose of lead placement in electrocardiogram
The chain of infection is as follows:
The general idea is that there are factors from both ends of the infection; different types of infectious agents have different properties and mechanisms, hence thriving in different reservoirs. These agents then leave the reservoir via different portals of exit, and get transmitted by various modes of transmission. They then enter the host via portals of entry, and what makes the host vulnerable are the multiple factors of a susceptible host.
There are several precautionary measures to take to break the chain of infection:
To reduce modes of transmission, one of the measures include spatial separation. It is hence important to recognise the different levels of risk posed by different work environments.
For example, office areas have the lowest risk, and areas that carry out cardiology, physiotherapy and respiratory therapy have medium risk. Areas like newborn nurseries, emergency rooms, surgical units or pharmacies have high risk, and in contrast, burn units, intensive care, negative pressure isolation rooms and cardiac catherization labs pose the highest risks.
Standard precautions are defined as the minimum infection prevention practices that apply to all of patient care, regardless of suspected or confirmed infection status of the patient, in any setting where healthcare is delivered. These practices are designed to both protect healthcare personnel (HCPs) and prevent HCPs from spreading infections among patients, especially those due to blood-borne pathogens.
These precautions include:
Hand hygiene
Use of Personal Protective Equipment (PPE) like gloves, masks and gowns
Safe injection practices
Safe handling of specimens and spillages
Safe handling of potentially contaminated equipment or surfaces in patient’s environment
Respiratory hygiene / cough etiquette
The World Health Organisation (WHO) has established that there are five moments when hand hygiene should be carried out:
Before touching a patient
Before aseptic procedures
After handling body fluids
After touching a patient
After touching patient surroundings
There are many types of PPE available, including various types of masks like surgical masks, fluidshield masks, Drager masks, gloves, goggles, overshoes and gloves.
A sharps injury prevention protocol must be in place for all healthcare settings. HCPs should be very cautious when handling sharps, like scalpels, needles and other sharp instruments and devices, during cleaning, process and disposal. As per national protocol, HCPs have to undergo a screening for bloodborne pathogens and follow-ups should they be exposed.
Some precautionary measures are as follows:
Do not recap used needles.
Dispose used needles and syringes as one unit.
Do not remove, bend, manipulate or break a used needle by hand.
Discard all sharps into an appropriate resistant sharp disposal container.
Contaminated instruments should be placed in a puncture-resistant container when transporting to reprocessing area.
“Sharps Injury” refers to a puncture, cut, or otherwise open wound, sustained from a needle or sharp instrument (like scissors, blades) which had been used on a patient, or contaminated with other body fluids. It is important to avoid such injury by strictly adhering to the institutional protocols when handling, cleaning, or disposing of sharps.
Should you ever encounter a sharps injury, you should follow these steps:
Bleed the wound
Wash with soap and water
Flush splashes to the nose, mouth or skin with water
Irrigate eyes with clean water, saline or sterile irrigants
Report incident to supervisor
Immediately seek medical treatment
These are procedures healthcare professionals should follow in the event that they are ever exposed to a needlestick injury or otherwise exposed to contaminants or infectious agents.
For handling of specimens, it is impossible to tell whether it is infectious, so it is important to treat all specimens as potentially infectious, and place them in appropriate containers and into biohazard specimen bag to prevent potential spillage and transmission of pathogens.
In the event of a blood or body fluid spill, pour chlorine based disinfectant over blood or body fluid spills. The dilution should achieve 10’000 ppm (parts per million) chlorine. Ensure that gloves are worn, and paper towels are used. Dispose waste into biohazard bag and mop the area with disinfectant.
For maintenance of environmental hygiene, it is important that routine cleaning, disinfection and maintenance is performed. There should be emphasis for cleaning and disinfection of surfaces that are most likely to be contaminated.
Bedsheets, blankets, linen or gowns with body fluids should be handled or processed in a manner that prevents skin and mucus membrane exposure, be it with the HCP’s or other patients’.
Respiratory hygiene and cough etiquette involves using source control measures to prevent patients with respiratory infections from transmitting their infection to others. As such, the following should be observed:
Cover mouth and nose when coughing / sneezing.
Offer a surgical mask to patients / visitors who are coughing.
Use tissue to contain respiratory secretions and dispose them in a non-touch disposal bin.
Perform hand hygiene after contact with respiratory secretions (a type of body fluid)
A safe environment not only means that patients should not acquire any new conditions from the visit to the healthcare facility, but it also means that patients or HCPs should not get injured while being in the environment. Hence it is important to use signages or other warnings to notify patients or otherwise make obvious the hazards of the environment.
Aseptic Techniques are practices employed by HCPs to prevent contamination and infection during procedures. The principles of asepsis are as follows:
Do not contaminate an open wound or surgical wound.
Do not contaminate patients’ drain sites.
Do not contaminate a sterile operating field when conducting X-Ray for patients in the theatre or procedure rooms.
Differentiate between sterile and unsterile fields.
Differentiate surgical personnel by donning sterile gowns and gloves.
Items to be used in the sterile field must be sterile.
X-Ray boards to be placed within sterile field must be wrapped in sterile drapes.
Personnel moving within or around a sterile field should do so in a manner that maintains the integrity of the sterile field.
Policies and procedures for basic aseptic technique should be reviewed and communicated clearly in the practice setting.
These can be summarised into three main, important points as shown below:
It is also important to access a patient’s fall risk prior to any procedure. Re-assessment must be carried out should the patient’s status change.
The risk level is shown in the following table:
The risk score is computed as shown:
Physical restraints may be used to reduce fall risk. They are defines as any physical or mechanical device, material or equipment attached or adjacent to the patient’s body that cannot be removed easily which restricts freedom of movement.
These restraints are available in a variety of different forms, and pose different advantages and limitations. They include bed rails, waist rests, hand mittens and limb restraints.
A summary of the pros and cons of the types of restraints listed is shown below:
The five vital signs are:
Temperature
Pulse
Respiration Rate
Blood Pressure
Oxygen Saturation
Occasionally, a sixth vital sign is included, the pain score, where the patient is asked to rank his pain level from zero to ten.
There are mainly 4 ways to take a subject’s temperature:
Oral (mouth)
Rectal (anus)
Axillary (armpit)
Tympanic (ear)
While oral and tympanic temperature are considered to be accurate core temperatures, rectal temperature is slightly higher than core temperature, and axillary temperature is known to be slightly lower than core temperature.
The terminology associated with abnormal temperature is as follows:
Pyrexia, higher than normal temperature
Febrile, a state of pyrexia
Hypothermia, lower than normal temperature
Pulse rate is a measure of how many times the heart beats per minute. It reflects the number of ventricular contractions of the patient, and can vary with age, gender and activity. As the blood gets pumped through the arteries, the arteries expand and contract with the flow of blood, and indicates the following:
Heart rhythm
Pulse strength
