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Medical asepsis

Also known, as Clean Technique based on maintaining cleanliness to prevent the spread of pathogenic microorganism and to ensure that the environment is free of microbes as possible. It involves confining microbes to specific areas and rendering objects as either clean or dirty. 1. Practices that reduce pathogens include a. Interrupts chain at level of causative agent and reservoir b. Hand washing the single most effective and important way to prevent spread of microorganisms 1. Occurs through friction loosening the microorganisms so they can be removed 2. Use of antiseptic soap killing numbers of microorganisms c. Use of disinfectants and antiseptics on people and objects 1. Disinfectant substance that reduces the number of microorganisms, but does not eliminate them. 2. Antiseptic substance that can be applied to skin to reduce the number of microorganisms. 2. Practices that interrupt transmission a. Interrupts chain at level of portal of exit, transmission, and portal of entry b. Use of personal protective equipment 1. Latex gloves 2. Gowns 3. Mask, goggles 4. Equipment i.e. one-way valves c. Use of isolation procedures 3. Antibiotics can also interrupt the infection cycle. These are medications that kill many types of bacteria.

Surgical Asepsis
Also known, as Sterile Technique requires strict adherence to order and specific procedures, which render an area free from all microorganism including spores. An object or area is described as being sterile or not sterile. Principles of Surgical Asepsis: a.Only a sterile object can touch another sterile object. Unsterile touching sterile is contamination. b.Open sterile packages so that the first edge of the wrapper is directed away from the worker to avoid the possibility of a sterile surface touching unsterile clothing. The outside of the sterile package is considered contaminated. c.Avoid spilling any solution on a cloth or paper used as a field for a sterile set up. The moisture penetrates through the sterile cloth or paper and carries organisms by capillary action to contaminate the field. A wet field is contaminated if the surface immediately below it is not sterile. d.Hold sterile objects above the level of the waist. This will help ensure keeping the object within sight and prevent accidental contamination. e.Avoid talking, coughing, sneezing or reaching over a sterile field or object. This will help to prevent contamination by droplets from the nose and the mouth or by particles dropping from the workers arm. f. Never walk away from or turn your back on a sterile field. This will prevent possible contamination while the field is out of the workers view. g.All items brought into contact with broken skin, or used to penetrate the skin or in order to inject substances into the body, or to enter normally sterile body cavities, should be sterile. These items include dressings used to cover wounds and incisions, needles for injection, and tubes used to drain urine from the bladder. h.Use dry, sterile forceps when necessary. Forceps soaked in disinfectant are not considered sterile. i. Consider the outer 1-inch of a sterile field to be contaminated. j. Consider an object contaminated if you have any doubt as to its sterility.

Use of Restrains
1. Allow the patient as much freedom to move as possible and at the same time serve the purpose of the restraint. 2. The patients circulation must not be occluded by the restraint. 3. Pad bony prominences under a restraint in order to avoid skin abrasions. Preferably use soft restraint. 4. The restraint needs to permit the body to assume its normal position, for example, slight flexion of the arms. Attach restraint to the bedframe, not to the siderails to prevent trauma. 5. Use at least conspicuous type of restraint possible. Even if the patient is not aware of the restraint, visitors often find them disturbing. 6. At the first indication of occluded peripheral circulation (pallor, blueness, cold, tingling or pain) the restraint needs to be loosened and the limb exercised. 7. Remove restraint at least every 2 hours for 30mins. Exercise the limbs and provide skin care to prevent skin abrasions. 8. Restraints application requires doctors order. 9. Secure doctors order for each episode of restraints application. PRN orders for restraints application in unacceptable. 10. Ideally, application of restraints requires consent from relatives or significant others.

Handling Hazardous and Infectious Materials


A hazardous material is a material capable of causing a harmful physical or health effect. Hazardous wastes can be liquids, solids, contained gases, or sludge. Resource Conservation and Recovery Act (RCRA) identifies a hazardous waste as one that exhibits at least one of the four characteristicsignitability, corrosivity, reactivity, or toxicity. Federal, state, and local agencies oversee the handling of hazardous materials to protect the public from harm. A. HANDLING AND STORAGE 1. Hazardous materials need to be stored correctly to prevent spills and uncontrolled reactions, and to minimize employee exposure. 2. Three principles form the basis of the plan for safe handling of hazardous materials: a. Minimize exposure to harmful materials through product substitution and keeping limited quantities on hand. b. Assume all chemicals are hazardous and handle accordingly. c. Use proper control measures, such as, written policies and procedures, education, and protective equipment. 3. Hazardous materials need to be stored based on their compatibility and not necessarily in the alphabetical order. Substances need to be stored in their original containers. 4. To decrease individual exposure to hazardous materials, common engineering controls, such as, local exhaust and general ventilation can be used. Other protective items that could be employed are safety glasses, gloves, and/or hearing protection. 5. Development of a plan for safe handling of the hazardous or infectious material needs to include five elements. 1) Element one requires maintenance of a current hazardous- waste inventory listing, which should include the full chemical name, storage location, quantities, and

information regarding the hazard. 2) Element two speaks of the labeling of all containers. 3) Element three addresses maintaining a Material Safety Data Sheet(s). 4) Element four plans for employee education and training. 5) Element five provides for regular review and updating of the plan. B. BIOLOGICAL AGENTS 1. Agents of concern are highly pathogenic bacteria and viruses. 2. The Center for Disease Control (CDC) has classified specific agents as category A, B, or C. 1) Category A agents are the most dangerous (anthrax, botulism, plague, smallpox, tularemia, viral hemorrhagic fever viruses, etc.). These agents are given the highest priority in disaster planning as they pose the most potential threat to the public. 2) Category B agents are the second most dangerous agents (brucellosis, salmonella, melioidosis, psittacosis, Q fever, typhus fever, viral encephalitis, etc.). 3) Category C represents emerging agents (Nipah fever, Hantavirus, etc.) 3. Client history and physical condition are key tools in assessing the clients exposure to a biological agent, when making a diagnosis. 4. Principles of infection control, beginning with universal precautions, are essential to managing the client. C. Radiation 1. Radiation is energy emitted by atoms that are unstable. 2. Radioactive contamination is the presence of radiation emitting substances in a place where it is not desired. 3. Radiological incident is when people or the environment is exposed to radiation or radioactivity through accident or misuse. The exposure may lead to death but more commonly; exposure only requires decontamination and monitoring of the client. 4. Nurses need to limit the time spent with radioactive clients, to remain at a distance whenever possible, and to wear

protective devices.

Injury Prevention
In hospitals nurses need to be very much aware of patients who may fall or possible for injury. A number of safeguards are generally taken to try to prevent these accidents. Bedside table and overhead tables are placed near the bed or chair so that patients do not need to overreach and consequently lose their balance. Patients who have had surgery or have been in bed for some time are advised to have assistance when first getting out of bed. Footstools are supplied with rubber feet, which do not slip, and wheelchairs with locks on the wheel. Floors have nonslip surface; rugs and carpeting are fixed securely in place so that they will not slip. The environment is kept tidy so that people do not trip over lights cords, toys or misplaced furniture. Some hospitals provide ambulating patients with railings along the corridors and in the bathrooms. Use of protective devices such as siderails and restraints may be indicated in certain situations.

Home Safety
Safety Tips for Kitchen Keep papers, plastic bags, curtains and dishtowels at least three feet away from range top. Put matchbox and lighters in locked cabinet Clean chimneys, fireplaces and central ovens periodically. Store harmful cleaning products in locked cabinets and keep them away from childrens reach. Install smoke alarms in kitchen but never install it near windows and doors, as it will create problem during functioning. Never pour poisonous material in drinking glasses and in food containers. Never place any hot objects on towels, napkins or tablecloths. Never leave knives or any sharp objects in a sink as they create injury while washing utensils. Put knife in knife guards or a butcher block. Always put cooking utensil in the center of stove while cooking. Take care while working in the kitchen that no oily or other material is dropped on stove or oven as sometimes cooking material flows out which sticks to the oven or stove and catches fire. Clean stove, oven or any cooking objects before starting cooking. Keep kitchen utensils clean as well. Make sure that the cords of appliances are not hung over kitchen counters and the cords are wrapped or coiled so that it doesnt harm any one. Always keep fire extinguisher in kitchen. Leave space at the back of refrigerator for proper ventilation. Safety Tips for Bathroom Never leave child in bathtub alone. Keep shampoos, lotions and soap dish away from the Childrens reach. Keep electrical appliances wrapped. Put non-slip strips in the bath tub or shower place. Make use of lights in the night in bathroom.

Place non-skid bathroom mats to avoid injury. Always keep bathroom floor clean and dry. Install grib bars or rails in bathroom as they help in standing from bath tub. Install sink with cabinet in bathroom as it is used to store floor cleaner, drain openers under the sink. Keep heaters, electrical products away from bathtubs, shower place and sinks. Set up water heaters at a degree of 120.

Safety Tips for Bedroom Never smoke in bedroom. Keep clothes, curtains, bed sheets at least three feet away from room heater. Especially fire occurs in winter season because of much use of heating appliances and lighting. Use safe light bulb wattage for each fixture. Use mattress with open flame resistant protection in bedroom for the safety because these mattresses have 30 minutes ignition power to control fire. Never put extension cords under carpet or rugs as it causes short- circuit. Never place sharp edges furniture in bedroom. Always place round edges furniture. Place smoke alarms in your bedroom. Safety Tips for Living Room Use Safety-proof plugs to cover electrical outlet in your home. Keep living room clutter free to avoid falls. Place furniture of round edges instead of sharp edges. Cover fireplace with metal fire frame. Never place lighting fixtures near curtains, clothes etc. Switch off light when not in use. Make proper arrangement for ventilation. Safety Tips for kids Room Dont place furniture near window in kids room. Keep heavy, small and breakable things away from childrens reach. Never use halogen lamps in kids room for study as it creates danger of fire. Keep curtains, clothes, paper stuff three feet away from light to avoid fire Never place sharp edges furniture, as it can be harmful to kids. Always place round edges furniture.

Safety Tips for Stairs Keep stairs clean and wet. Make proper arrangement of lights on or around stairs to avoid fall. Use handrails to move up and down the stairs. It is better to have railing on both the sides of stairs. Install gate at the top or bottom of the stairs. Dont make stairs slippery.

Error Prevention
Where Errors Occur Medical errors happen when something that was planned as a part of medical care doesn't work out properly, or when the wrong plan was used in the first place. Medical errors can occur anywhere in the health care system:4

Hospitals. Clinics. Outpatient Surgery Centers. Doctors' Offices. Nursing Homes. Pharmacies. Patients' Homes. Medicines. Surgery. Diagnosis. Equipment. Lab reports.

Errors can involve:


Types of Errors The following seven categories summarize types of medical errors that can occur: 1. Medication Errors, such as a patient receiving the wrong drug 2. Surgical Error, such as amputating the wrong limb. 3. Diagnostic error, such as misdiagnosis leading to an incorrect choice of therapy, failure to use an indicated diagnostic test, misinterpretation of test results, and failure

to act on abnormal results. 4. Equipment failure, such as defibrillators with dead batteries or intravenous pumps whose valves are easily dislodged or bumped, causing increased doses of medication over too short a period. 5. Infections, such as nosocomial and post-surgical wound infections. 6. Blood transfusion-related injuries, such as a patient receiving an incorrect blood type. 7. Misinterpretation of other medical orders, such as failing to give a patient a salt-free meal, as ordered by a physician.

10 GOLDEN RULES FOR ADMINISTERING DRUGS SAFELY


1. Administer the right drug. 2. Administer the right drug to the right patient. 3. Administer the right dose. 4. Administer the right drug by the right route. 5. Administer the right drug at the right time. 6. Document each drug you administer. 7. Teach your patient about the drugs he is receiving. 8. Take a complete patient drug history. (There is a risk of adverse drug reactions when a number of drugs are taken or when patient id taking alcohol drinks.) 9. Find out if the patient had any drug allergies. 10. Be aware of potential drug drug or drug-food interactions.