Page 1 - Safety and Infection Control Study Guide for the NCLEX-RN Exam
Safety and Infection Control, a key subpart of Safe and Effective Care Environment, addresses the nurse’s ability to manage care with the best practices of reducing hazards while providing both emergent and non-emergent responses to numerous situations.
Nurses are key players in the prevention of hazards to patient care including infection, accidents, injuries, and medical errors. In addition, nurses must know and practice principles that ensure the safety of healthcare personnel such as proper ergonomics, safe use of all equipment and technology, and proper handling of infectious and hazardous materials.
Promoting safe measures begins prior to a patient’s admission. This includes inspecting the environment, planning for potential scenarios, and anticipating where errors may occur. Nurses should understand their role in an emergency response or security emergency situation. When the patient is admitted, the nurse must immediately identify any patient-specific risk factors that may increase the chances of error. Developmental factors, as well as a patient’s lifestyle and knowledge of safety precautions, will factor into this assessment. Finally, nurses should investigate future safety concerns that may impact patients after discharge, in their homes and in the community. Taking measures at every step of the patient admission process helps to prevent catastrophic safety events from occurring.
Age-Related Safety Factors
Nursing review of patient safety issues should begin with knowledge of the age-specific or developmental risks associated with each of these age groups:
Infants— Parental safety education and implementation are the core of infant safety. Nurses must educate parents on safety measures to take in order to protect their infants. This includes instructing parents on proper carseat placement/strapping, child-proofing homes, and safe sleep. The American Academy of Pediatrics recommends that infants stay in a rear facing car seat until age 2. State law may vary and nurses should know the laws for their state. Nurses and parents alike should monitor infants closely to avoid contact with choking hazards, falling hazards, and hot items or liquids.
Toddlers— Fully mobile and curious about the world around them, toddlers are at increased risk for poisoning, choking, and drowning. Inform parents and caregivers about proper safety precautions including child-proofing cabinets and drawers where hazardous medications or potential poisonous cleaners are kept. Car seats should be rear-facing in the back seat of the vehicle until age 2. Toddlers should also remain in a 5-point harness until the child reaches the top height or weight limit allowed by the seat (generally ages 4–7 years). Be sure to follow specific car seat standards in your state.
School-age children— Independence grows as more time is spent at school and with friends. This age group needs education and guidance on water, fire, and traffic safety as well as the dangers of strangers. Car seats and/or boosters are typically required by law until the child is 4’9” or 80 pounds (whichever comes first). Although this is usually between the ages of 8 and 12, requirements vary by state. Know the laws that are applicable to the geographic location of practice.
Adolescents— Independence, impulsivity, and a sense of invincibility create many risks in this age group. Motor vehicle safety (both as driver and passenger) should be reviewed as well as the dangers of alcohol and substance abuse. Sexual health information and safe sex practices should also be discussed.
Adults— Many different risks exist for this group that relate to home, workplace, and leisure activities. In general, review the specific risks as they relate to motor vehicles, fire, and the use of firearms.
Older adults— Declines in physical and cognitive abilities increase the risks of falls as well as side effects with medications. In the older population, reaction times become delayed increasing the risk of car accidents, falls, and burns. If caregivers are used or present in the home, the risk of elder abuse must be discussed with the patient to promote awareness and safety.
Regardless of patient age, nurses must be familiar with the safety risks and principles of accident prevention relative to the patient’s care environment.
Allergies— Patients of all ages can have allergies. Common allergy categories include environmental allergies, medication allergies, food allergies, and latex. Inquire about patient allergies when working with patients to ensure appropriate documentation and avoidance of any possible triggers. Anaphylactic reactions provide serious bodily reactions in response to allergen exposure. If not treated correctly and immediately, these reactions may lead to death. Nurses must learn to recognize early signs of allergic and anaphylactic reactions, including numbness or tingling around a body part (especially lips, mouth, or tongue are extremely serious), swelling, increased work of breathing, tachycardia, and hypotension.
Assistive equipment— Nurses will likely encounter patients with medical, assistive equipment, such as hearing aids, visual aids, braces, or other medical aids (i.e., medicine pumps, oxygen, feeding tubes, etc.). Nurses should thoroughly document and support the patient’s equipment as reasonable as possible. Patients able to see, hear, and ambulate safely are less likely to be at risk for injury.
Fall prevention program— In the hospital, falls are most common among infants and the elderly. Know the elements of such a program and the steps that are taken based on the age of the patient. Common prevention strategies include clearing any obstacles in the room (i.e., power cords, unnecessary equipment, and trash), placing infants in high-sided cribs with rails fully elevated, and cleaning up spills and trash from all walkways.
Seizure precautions— For those at risk, know the proper steps to ensure patient safety during and after a seizure. Remember to assist patients into a side-lying position if they are seizing to avoid aspiration of secretions or vomit.
Suction and oxygen equipment— Ensure that there is proper access to suction and oxygen in every hospital room. Many non-hospital facilities have designated ports for oxygen and suction to support their patients as needed. Patients that may require suctioning or oxygen support include those with seizure disorders, swallowing disorders, respiratory illnesses, artificial airways, and/or cardiac insufficiency.
Use of restraints— Restraints may be used to limit mobility in those at increased risk of falls and seizures as well as in those who pose a safety threat to themselves, other patients, or medical staff.
In the event of all preventative interventions or therapies, ensure that actions taken have been appropriately documented; the actions are appropriate for the patient population intended; and the actions do not increase the risk of other harmful situations.
The definition of an etiologic agent is any pathogen that is capable of causing infection. These may include: bacteria, fungi, protozoa, rickettsiae, and helminths, among others. Understanding the chain of infection or how infection is spread is critical to understanding the methods and precautions used to prevent it. This involves the following six elements:
Pathogen— An infection-causing agent, such as a bacteria or a virus.
Reservoirs— An animate or inanimate environment that provides a favorable place for pathogens to grow and reproduce. Examples of human systems that serve as reservoirs include the blood, respiratory, gastrointestinal, reproductive, and/or urinary systems.
Portal of exit— Any place where an infectious agent leaves a host. The above-named human systems may also serve as portals of exit for the organisms they harbor.
Method of transmission— The way that an infectious organism is transferred from the reservoir to another susceptible host. There are three main methods of transmission: direct contact, indirect contact with a vector (carrier item), or via the air (airborne).
Portal of entry— The place where an infectious agent enters a susceptible host. Portals of entry may also be systems that act as reservoirs for pathogens.
Susceptible host— A patient, medical staff member, or other person who is at risk for infection.
Emergency Response Plan
Every healthcare facility is required by the Joint Commission to have an emergency response plan. Every facility and its staff will be required to periodically perform emergency drills to assess the efficacy of the response teams. Fire safety, natural disasters, and mass casualty events are some of the possible scenarios where nurses will need to know their designated emergency response roles. Nurses may also be involved in community outreach and planning of emergency preparation such as natural disaster, bomb threat, and mass casualty.
Nursing responsibilities in the emergency response plan will vary, but most likely include ensuring the safety of the patients, securing the facility, and/or helping to eliminate the threat of further harm or danger to the patients and staff. Nurses may be assigned to triage, treatment, or discharge roles to ensure appropriate flow and care of patients.
Patient safety should always be the priority. Nurses must determine how many and what types of interventions their patients will need. Patients should be identified from most critical to least critical. The least critical patients may be able to ambulate, have decreased equipment needs, and may even heed early discharge in the event of opening bed space for new admissions.
In the event of a fire, patients must first be moved out of harm’s way. After the patients are relocated to a safe space, the nurse may then contain the fire and evacuate patients out of the facility, if necessary. Nurses will need to assess which patients will require bed/stretcher evacuation (horizontal transfer) as well as those who will be able to ambulate or use wheelchairs. A nurse will also be expected to educate and counsel patients on fire safety in the home, including important emergency numbers, installing/maintaining smoke alarms, and acquiring fire extinguishers.
Nurses must utilize proper ergonomic principles when assisting patients to protect themselves from injury. Patients should also be educated on proper ergonomic principles to prevent injury while ambulating or transferring from different surfaces. These principles will be heavily incorporated into the nursing care plan for each patient.
Assessment of the patient’s baseline abilities will help the nurse design a proper care plan that includes the use of assistive devices such as walkers, crutches, and canes. If the patient has a repetitive stress injury, the nurse will need to instruct him or her as to the proper body positions to help prevent aggravation or reinjury. For more targeted conditions that involve single skeletal or muscular groups, the nurse can provide instruction on proper positioning and stretches that help relieve stress on the area.
Using proper lifting techniques (lifting from the legs and not overextending the body) and assistive devices (gait belts, thera bands, crutches, electronic transfer devices, etc.) for patients will help the patient, nurse, and support staff avoid injury. Be aware of and utilize proper postures and body positions when performing daily functions at technology-based workstations (desktop and/or mobile computers).