WELCOME

General Orientation To All

High Desert Hospitals

SPRING 2014

Presenter:Renate Longoria, RNc, MSN, PHN

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.

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.

You have the right to:

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.

Patient ResponsibilitiesYou, 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.

Patient ResponsibilitiesYou 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.

Patient ResponsibilitiesYou 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.

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.

Violation of Patient RightsExamples:

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.

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.

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.

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 !!!

Customer Service

AIDETSAcknowledge IntroduceDurationExplainThank YouSurvey

Customer Service AIDETS

Acknowledge

Customer Service AIDETS

Introduce

Customer Service AIDETS

Duration

Customer Service AIDETS

Explain

Customer Service AIDETS

Thank You

Customer Service AIDETS

Survey

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

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

Customer Service

ARMC DVDCustomer Service

for Students

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

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.

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.

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.

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.

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

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

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)

National Quality Care:CORE Measures

How do you improve care with AMI patients?– Follow a set plan -- by physicians– Initiate specific AMI physician orders– ASA is given on arrival and prescribed at

discharge when indicated– A thrombolytic agent is administered within

30 minutes of arrival when indicated– Assessment of left ventricular function – by

a physician– Provide smoking cessation advice and

counseling

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.

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.

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.

EMTALA

Emergency Medical Treatment and Labor ActPatient 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.

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.

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.

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.

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.

EOC-Fire Safety R- Rescue A- Alarm C- Contain E- Evaluate/Extinguish

Evacuate (only if directed)

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 calledHelp close all doors to patient’s rooms

EOC-Emergency Codes

CODE RED FireWhat do you do if the alarm goes off?

CODE GREENEvacuation

“Missing Person –Elopement”

EOC-Emergency CodesCode Gray Combative/Disruptive Person

G = Go get help

Code Yellow Bomb Threat

Code Silver Person w/Weapon – Hostage Situation

S = Stay away

EOC-Emergency Codes

Code Blue Medical Emergency

(Adult)

Code WhiteMedical Emergency (Pediatrics)

Code Pink Infant Abduction

Code Purple Child Abduction

Code Orange Hazardous Materials Spill

EOC-Emergency Codes

Triage Internal Internal Disaster

Triage External External Disaster

Code Triage Alert Activation of Personal

Safe Surrender Site

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.

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

EOC-Compressed Gas Cylinder Safety

Careful procedures are necessary for handling the various compressed gases, the cylinders containing the compressed gases, regulators or valves used to control gas flow.

EOC-Compressed Gas Cylinder SafetySince 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.

Gas cylinders must be secured at all timesto 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.

EOC-Compressed Gas Cylinder Safety

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.

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.

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.

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

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.

EOC-Security Belongings Safety:

Patient Belongings: 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.

EOC-Emergency PreparednessHICS Hospital Incident Command System

(HICS)Designated to minimize the confusion and

chaos that swirls around disasterDuring a incident listen and do as

assignedKeep your cool and pay attention

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

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

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.

National Patient Safety Goals

◦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

National Patient Safety Goals

◦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”

National Patient Safety Goals

◦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.

National Patient Safety Goals

◦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.

National Patient Safety Goals

◦ 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.

National Patient Safety Goals

◦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

National Patient Safety Goals

◦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)

National Patient Safety Goals

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.

Restraints

Patient Safety

Is everyone's

RESPONSIBILITY!

Introduction to the Operating Room

Purpose Policy

Entrance to the Operating Room

Traffic patternsProper Surgical attire

Proper Surgical Attire

Correct and Incorrect application of Attire

Positive air pressure

Air flow Humidity Temperature

Unoccupied surgical suite

Anesthesiologist’s domain

Active in Patient safety Controls normothermia especially

in the elderly

Surgical Hand Scrub

Good and bad behavior with sterile technique

Scrubbed & sterile gowned person’s behavior

Sterile Technique Principles

Notice the distance between the two: Minimum 12 inches

Emphasis of keeping your distance between sterile and unsterile fields

Emphasis of keeping your distance between sterile and unsterile fields

Emphasis on keeping your distance between sterile and unsterile fields

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)

Keeping your distance

Assumption: If sterile is blue, it must be true

Fire safety

Fire triangle

Surgical Team grouped around operative site, displaying

surgical etiquette

Conclusion• Allay anxiety

• Specific focus

Abuse Reporting Abuse

Every Healthcare Worker is a mandated reporter for the following types of abuse:

CHILD ABUSEELDER ABUSEDOMESTIC

VIOLENCE

REMEMBER:

Student Nurses report any suspicion of abuse to their clinical instructor !!!!

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

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.

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.

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.

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.

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 agentVector-borne route – West Nile Virus, Bird Flu, Malaria

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.

Infection Control: Student Responsibility

Stay home from clinical if you have a contagious illness (follow VVC policy on contacting clinical instructor)

MRSA TODAY – It’s facesSlides: Courtesy of Arrowhead Regional Medical Center – Infection Control

MRSA TODAY – It’s consequencesSlides: Courtesy of Arrowhead Regional Medical Center - Infection Control

Epidemiology of MRSASlides: 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

96

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

TYPES OF INFECTIONS CAUSED BY MRSASlides: Courtesy of Arrowhead Regional Medical Center - Infection Control

Catheter-associated blood stream infections

Wound infections

Surgical site infections

Sepsis, septic shock

Ventilator-associated pneumonia

Urinary tract infections

INFECTION CONTROL PRACTICES

Hand HygieneStandard PrecautionsPersonal Protective EquipmentIsolation PrecautionsProper care of invasive devicesRemoval of devices when no

longer medically necessary

Proper care of surgical sites

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!

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

Standard Precautions

Work practices that help prevent the spread of infections and infectious diseases.

ALL PATIENTS SHOULD BE CONSIDERED INFECTIOUS!!!

And don’t forget:

• employees

• registry staff

• visitors

• physicians

• students

• vendors

• contractors

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

Isolation Precautions

Airborne Infection Isolation

For tuberculosis, chickenpox and measles only

Droplet IsolationFor MRSA, MDRO in sputum, bacterial meningitis, mumps

Contact Isolation

Droplet Isolation

For drug resistant organisms in wounds, abscesses, RSV

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

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

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

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.

Remember…

Slides: Courtesy of Arrowhead Regional Medical Center - Infection Control

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)

Hospital Waste Management:Regular Waste

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

Hospital Waste Management:Biohazard Waste

Hospital Waste Management:Sharp SafetySHARPS:

CONTAINERS w/Biohazard Label1. Needles &

Syringes2. Scalpels w/blades,

lancets3. Broken

contaminated glass4. Staples & wires5. Disposable suture

sets & biopsy forceps

Pharmaceutical Waste

(non-hazardous): BLUE/WHITE

CONTAINERS1. Syringes (w/o

sharps) containing

meds2. Wasted Narcotics3. Propofol – Diprovan4. Partial

Tubes/Bottles of: Creams/Ointments Oral Liquids Eye or Ear

Drops/Ointments 5. Ampoules with

Medications 6. Vials with

Medications 7. Tablets, Capsules

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.

Infection Control:Student Injury

If an injury or exposure occurs at the clinical site do the following: Immediately contact your clinical

instructor

Dress CodePersonal 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

followedClean bodyNo body odor – after smoking (mints)No strong perfume or cologne (VVC dress

code)

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 earMakeup worn in moderationFingernails must be clean and trimmed (not > ¼

inch long); Nail overlays (silk, acrylic, gel) are not allowed

Dress codeCommon Sense –

Tattoos must not be visibleLeather-like shoes (closed toes & heels) – clean, no logosNo gum chewing

Cellular TelephonesShould 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.

HarassmentIncludes 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.

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.

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.

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