CLEAN AND SAFE ENVIRONMENT

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UNIT 4

• CLEAN AND SAFE ENVIRONMENT

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Unit Two Objectives

• Describe safety of the resident
• Identify Situations which require Emergency
  Action
• Describe principals of Body Mechanics
• Describe principals of infection control
• Describe standard precautions
• Identify care giver precautions with infectious
  diseases

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Objectives

• Identify common pathogens and resulting diseases
  or conditions.
• Describe pre and post steps for resident care.
• Discuss admission and transfer policies

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Skills for Unit Two

• Handwashing
• Resident Unit order
• Unoccupied bed making
• Transfer Belt placement
• Waist restraint Application
• Clear obstructed airway on Conscious Resident
• Gown, glove and bag linen

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Describe Safety of the Resident

• Its necessary for All staff to be alert to
  SAFETY concerns for the resident.
• Adjustments to environment are necessary for
  individual needs, such as light, noise, air
  temperature and type of furniture.

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Identify residents at risk for injury

• Those with sensory impairments vision, hearing
  or loss of sensation
• The confused or mentally impaired resident
• The weak or frail resident
• The resident recently admitted to the facility.

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Hazards to Safety

• Disoriented and new residents are at the greatest
  risk
• FALLING IS THE GREATEST THREAT
• HAZARDOUS SUBSTANCES
• LACK OF PROPER LIGHTING
• UNSAFE EQUIPMENT
• SLIPPERY FLOORS
• UNLOCKED BRAKES

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MORE.

• ERRORS-WRONG MEDICATION, TRAY,TREATMENT
• UNSAFE BEDRAILS
• IMPROPERLY PLACED CALL LIGHT OR NOT WORKING CALL
  LIGHT
• IMPROPERLY DONE PROCEDURES
• IMPROPER USE OF SMOKING MATERIALS

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MORE.

• CLUTTERED HALLWAYS

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WAYS TO PREVENT INJURY

• Respond to emergency care immediately
• Follow care plans at all times
• Be alert to resident safety at all times.
• Answer call lights as soon as possible
• Many injuries occur in the bathroom be alert
  when toileting residents do not leave
  unattended.
• Use locks on wheelchairs, lifts and beds

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More

• Use safety devices when indicated
• get help when necessary
• report unsafe equipment

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Use transfer belts

• A transfer belt or gait belt is used to support
  the resident
• Prevents falls by providing a secure method of
  support for the resident
• promotes correct body alignment for the resident
• Prevents injury such as shoulder dislocation
• May be part of a facility uniform policy
• Improves body mechanics for the NAR

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Know Resident Care Procedures

• Perform procedures accurately as learned
• Ask questions if unsure of the tasks.
• DO NOT perform tasks you have not been taught.

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Know fire safety policies

• Be alert to fire safety violations (smoking
  rules, oxygen safety, electrical equipment,
  unsafe wires)
• Extension cords are not allowed in long term care
  facilities

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Other safety Rules

• Recognize some residents have limitations on sun
  exposure due to medications. They may burn very
  easily.
• Maintain your own health.
• Follow rules of healthy life style. Accidents
  increase when caregiver is ill or emotionally
  upset.
• Call facility at least two hours before if
  illness prevents you from being available to work.

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Workers must know The Right to Know Law

• Right to Know law is a Minnesota law which
  informs workers when working with hazardous
  substances or infectious substances and control
  measures necessary
• Hazardous Substances are substances which could
  cause harm to worker if precautions are not used.
  Know location of MSDS.
• Chemicals, blood, noise are some examples

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Use of Physical Restraints

• A physical restraint is any manual method or
  physical or mechanical device, material or
  equipment attached to or adjacent to the
  residents body that the individual cannot remove
  easily which restricts freedom of movement or
  normal access to ones own body.

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Examples of Restraints

• Vest or jacket restraint
• Restraint belt devices
• Hand Mitts
• Side rails
• Geriatric Chairs
• Physical Restraints are only used as a last
  resort to keep the resident safe.

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Use Alternatives instead of restraints

• The benefits of less restraint use include
• The resident is not isolated and can move about
  the facility
• It decreases confusion
• Reduces injuries from falls as muscle and bones
  work better
• Restraints are only used with a doctors order and
  then only if alternatives have been tried and
  documented.

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Alternatives to physical restraints

• Provide meaningful activities for the resident,
  such as small chores or group activities.
• Arrange furniture to prevent falls
• Place stop signs or visual barriers to restrict
  doorways
• Anticipate resident needs such as toileting.
• Use TABS monitors or electronic bracelets

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The residents Unit

• The residents unit is their personal space or
  home. The personal items they have are valuable
  to them. Treat them with care and respect.
  Knock on residents door before entering their
  Home!

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Check the Unit daily for safety

• Check call lites. Make sure they work.
• NARs are responsible to wipe up spills and keep
  the unit neat and orderly.
• Assist the resident to straighten closets and
  bedside tables and dresser drawers.
• Respect personal preferences and privacy when
  assisting with personal belongings.

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Fire and Major causes

• Improper use of smoking material
• defects in heating systems
• improper trash disposal
• misuse of electrical equipment
• spontaneous combustion

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Action to take if fire is discovered

• R RESCUE AND REMOVE
• A ALERT OTHERS
• C CONFINE
• E EXTINGUISH OR EVACUATE IF DIRECTED
• all facilities conduct fire drills monthly.

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Know how to use fire extinguishers

• Most fire extinguishers are the dry chemical
  type, suitable for all types of fires. To Use
• Remember PASS
• P - pull the safety pin
• A - Aim the nozzle at the base of the fire
• S - squeeze the trigger handle
• S - sweep side to side at the base of the fire

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Fire Safety

• Know the facility code word for FIRE
• When moving an immobile resident to safety follow
  facility policy. Which may include placing
  residents on a blanket and pulling them out of
  danger or removing the entire bed.

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Finding a resident on the floor

• Stay with resident and call for help immediately
• DO NOT attempt to move resident til a nurse has
  assessed.
• If a resident is walking and begins to fall, ease
  them to the floor with a T.B.

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Actions to take if a resident is choking

• If a resident is coughing, but able to breathe DO
  NOT INTERVENE.
• Clutching the neck with one or both hands is the
  universal sign for choking.
• Ask the resident, are you choking?
• If resident nods yes, begin procedure for
  obstructed airway.

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Actions to take if finding an unresponsive
resident

• Call the resident by name to determine
  unresponsiveness.
• Call for nurse immediately and stay with
  resident.
• Assist the nurse as directed.

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Seizures

• Seizures are sudden involuntary movement of
  muscles. Persons may be partially conscious or
  unconscious.
• Stay with resident and move obstacles out of the
  way.
• Call for nurse immediately
• Ease resident to the floor
• Roll resident on their side, do not restrain
  movements.

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Actions to take for wandering or lost residents

• Report to nurse immediately.
• Follow facility policies and nurses instructions.

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Actions to take for severe weather

• Follow facility policies for tornado watches and
  warnings.
• Close windows and drapes
• Move resident away from windows
• Protect and reassure residents.

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BODY MECHANICS

• PROPER USE OF THE BODY TO MAKE THE BEST USE OF
  STRENGTH, AVOID FATIGUE AND INJURY TO SELF AND
  OTHERS...

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Importance of Proper Body Mechanics

• NARs will be moving, lifting, and turning
  residents often during a routine day.
• Using proper body mechanics can prevent injuries,
  minimize strain and fatigue.
• Using proper body mechanics involves good
  posture, balance and the strongest muscles of the
  body.
• Using proper body mechanics enhances safety for
  residents and workers.

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PRINCIPLES OF BODY MECHANICS

• EXPLAIN PROCEDURES
• GET HELP
• FEET 12-14 INCHES APART
• MOVE CLOSE TO OBJECT
• TIGHTEN ABDOMEN
• SQUAT
• USE THIGH MUSCLES TO LIFT
• WORK SMOOTHLY

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MORE.

• DO NOT TWIST BODY
• PUSH OR PULL IF POSSIBLE
• MECHANICAL LIFTS OR AIDS WHEN POSSIBLE

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MEDICAL ASEPSIS

• PRACTICES THAT PREVENT THE GROWTH AND SPREAD OF
  DISEASE PRODUCING MICROORGANISMS CALLED
  PATHOGENS OR GERMS IS KNOWN AS MEDICAL ASEPSIS OR
  INFECTION CONTROL.

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How do the germs get into our bodies?

• Body openings such as mouth, nose, eyes, urinary
  tract
• Body cuts (broken skin)
• Tubing such as IV, catheters, feeding tubes

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The chain of infection

• The route pathogens travel to spread disease is
  known as the chain of infection.
• There are six parts to the chain of infection.

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Chain of Infection Includes

• Pathogen -cause of infection
• Reservoir - where the pathogen lives
• Exit point - body secretions or wounds
• Method of transmission - hands or supplies

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Chain of Infection

• Entry point - such as broken skin
• Host - person receives pathogen and harbors it.
  Disease will occur more often in persons at risk
  such as those who are ill.

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What germs need to grow

• Food found on body, body discharges, equipment
  or trash
• Moisture
• Air
• Temperature ( best between 40 to 110 degrees
• Darkness Direct sunlight can kill some germs.

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STANDARD PRECAUTIONS

• Basic Infection control practices for all health
  care facilities in the United States and any
  industry which could affect the health of
  citizens were developed by the CDC in Atlanta.
  The practices are called Standard Precautions or
  Universal precautions and are designed to reduce
  the risk of transmission of disease causing
  microorganisms.

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Standard Precautions Include

• Handwashing often
• Gloves wear when touching body fluids or items
  contaminated with body fluids. Change gloves
  between tasks or touching cleans items

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Standard Precautions Include

• Gown Wear to protect skin and clothing if
  possibility of coming in contact with body
  fluids.
• Mask, Eye, face shield Wear if there is
  possibility of contact with body fluids.

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Standard Precautions Include

• Linen and trash Handle, transport and dispose
  in a manner that avoids transfer of pathogens.
• STOP THE SPREAD OF INFECTIONS!!

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Isolation

• Isolation procedures are implemented with persons
  who have easily transmitted diseases. The rules
  to be followed are based on the method of
  transmission of the pathogen.

• Airborne The germ is in the air and inhaled by
  the host.
• Contact person to person touch.
• Droplet occurs within 3 feet of person and is
  spread by cough, sneeze or talking.

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Isolation Procedures Include

• Restrict resident to own room
• Double bag linens and trash
• Keep equipment in room (thermometers)
• Special cleaning of room when resident is removed
  from precautions.

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Importance of handwashing

• Handwashing is the most effective way to prevent
  the spread of disease.
• Handwashing should be done
• when beginning work
• Before and after caring for the resident

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When to do handwashing

• After using the bathroom, combing your hair,
  using a tissue, eating, drinking or smoking.
• After handling a residents belongings
• After working with anything soiled.
• REMEMBER TO USE FRICTION WHEN WASHING HANDS TO
  REMOVE GERMS

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Infectious Diseases

• There are many types of disease producing
  microorganisms. These are usually identified by
  special features such as their shape and how they
  grow, multiply and spread.

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Types of Bacteria's

• This germ grows in groups and a culture sample
  helps to determine the best medicine for
  treatment. There are many antibiotic medications.

• Strains of streptococcus - strep which can
  cause a sore throat
• Strains of staphylococcus staph which causes
  infections in cuts and surgery sites,

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Mycobacterium tuberculosis

• Bacteria which causes TB is transmitted from the
  cough or sneeze of an infected person. Usually
  attacks the lungs. A mantoux skin test
  identifies exposure to the germ. All health care
  workers are screened annually. Residents in
  facilities are screened upon admission to the
  facility.

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Fungus

• The most common disease producing fungus is yeast
  infections.
• Candida albicans occurs in mouth and vagina
• Tinea capitis ringworm occurs on the skin
• Tinea pedis athletes foot also occurs on the
  skin.

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Virus

• The virus is the smallest microorganism in the
  world. The germ needs a host to multiply. There
  is no specific medications for viruses.
  Medications are usually developed to control the
  specific features of the pathogen. Viruses are
  able to change their features.

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Examples of viruses

• Common colds, which affect the respiratory system
• Influenza, affects the respiratory system with
  additional symptoms of headache, body aches. Flu
  shots are given yearly.

• Herpes Simplex, cold sore or fever blister on
  mouth or lips.
• Herpes zoster shingles which are blister like
  sores along the route of a nerve.
• Hepatitis - a systemic infection affecting the
  liver.

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Types of Hepatitis

• Hepatitis A reservoir (Where it lives) is stool
  or feces. It is spread stool to mouth route by
  food or water contaminated by the virus.
• Hepatitis B and C reservoir is blood. It is
  spread by direct contact with body fluids.
  Immunizations are available to protect against
  exposure.

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Human Immunodeficiency Virus

• HIV
• The final stage of the infection is called
  Acquired Immune Deficiency Syndrome or AIDS. The
  bodys immune or defense system is unable to
  fight off infections and is vulnerable to
  opportunistic infections, which are usually
  eliminated in people with healthy immune systems.

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Drug Resistant Infections

• Pathogens or germs can become resistant to the
  medications that were developed to fight them in
  people who got the infection.
• Examples include

• MRSA - methicillin resistant staph aureus
• VRE vancomycin resistant enterocci
• Most people who develop drug resistance are
  people who are weak or have a chronic condition
  such as AIDS.

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Ways to prevent Infections

• WASH HANDS
• SEPARATE CLEAN AND DIRTY ITEMS
• DISINFECT SUPPLIES AND EQUIPMENT
• CORRECT HANDLING OF FOOD

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Prevent Infections

• CORRECT HANDLING OF LINENS
• DO NOT HAVE LINEN TOUCH UNIFORM
• DISPOSE OF LINEN IF IT TOUCHES THE FLOOR
• PRERINSE SOILED LINENS

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Prevent Infections

• Correct handling of body wastes. Dispose of
  correctly according to facility policy.
• Maintain your own good health.
• Well balanced diet
• rest
• exercise
• good mental health

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Pre and Post steps for resident cares

• Check your assignment sheet
• K knock on resident door
• W wash hands
• I introduce, inform and identify
• P close door and privacy curtain
• E Equipment for skill
• S Safety items ( call lite, bed position,
  gloves, body mechanics)

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Admission and transfers

• Introduce self
• Demonstrate equipment (call lite. Bed)
• Help resident put personal belongings away
• Label personal belongings. Complete inventory
  sheet.
• Explain facility dining times, location of
  bathroom, location of personal supplies.
• Any other procedures according to job description.

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Home Health Aide

• Unit Two
• Safe and Clean Environment

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Unit Two Objectives

• Describe safety in Clients home
• Discuss emergencies in the home
• Describe Homemaking duties

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Safety differences in healthcare facilities vs
client home

• Healthcare facilities are regulated by state and
  federal agencies. They receive routine
  inspections.
• Private homes Its owner responsibility for
  clean safe environment.

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Safety and Infection Control in clients home

• Follow agency policies and procedures. Use good
  body mechanics.
• Report unsafe situations to supervisor.

• Identify habits which may promote the spread of
  germs.
• Clients or family not washing hands.
• Spoiled food
• dirty dishes, clothing, linen piling up
• Poor cleaning of home
• pet wastes not contained

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Disinfection and sterilization

• Disinfection is the process which removes most
  disease causing microorganisms.
• 110 bleach water can be used to clean.
• There are many commercial disinfecting products

• Sterilization destroys all microorganisms.
• Boiling Clean items covered with water and boil
  for 20 minutes. If container is covered boiled
  water will remain sterile for 36 hours.
• Baking wrap items in clean towel and bake for
  one hour at 350.

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Describe emergencies

• Emergencies call for immediate action. They are
  sudden, unexpected events, which are often life
  threatening. Home Health agencies have emergency
  procedures which include a plan for calling
  emergency services.

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Common home emergencies

• Poisoning - Any substance taken into the body by
  ingestion, inhalation, injection or absorption
  which interferes with normal body function.
• Call 1-800-poison-1 Minnesota poison control
  system

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Common Home Emergencies

• Burns Skin-tissue injury from excessive heat,
  chemical, electrical, or radioactive agents.
• Allergic Reactions Abnormal response to a
  substance which normally does not cause a
  reaction.
• Respiratory Emergencies Any situation which
  interferes with breathing.
• Falls Most common injury

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Emergencies

• Stroke Blood supply to part of the brain is
  interrupted.
• Heart attack Blood supply to part of the heart
  is interrupted.
• Diabetic reaction Physical responses due to
  imbalance of food and insulin.
• Seizures Involuntary muscle twitching related to
  brain injury or condition.

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Call 911

• Life threatening events such as breathing
  problems, severe pain, profuse bleeding, loss of
  consciousness and extensive burns CALL 911.
• Stay calm
• Remove client and family
• Follow directions of 911 operator.

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Weather and Fire Emergencies

• Follow agency policy and procedures.
• Know location of smoke alarms and fire
  extinguishers.
• Have an evacuation plan for client.
• Know community alarm systems.
• Discuss with supervisor as part of client care
  plan.

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Home making duties

• Part of the home health aide job responsibilities
  include combining client personal care with
  housekeeping tasks.Each clients home will require
  different schedules and challenges.

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Housekeeping duties

• Light house keeping includes daily and weekly
  tasks to maintain the environment for the
  client.
• Meal preparation
• surface cleaning
• laundry

• Heavy housekeeping duties are often contracted
  out or done by family members.
• House painting/repair
• shoveling snow
• mowing lawn
• washing windows
• appliance maintenance

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Light housekeeping schedules

• Daily tasks
• Pick up clutter
• empty waste baskets
• make beds
• wash dishes
• clean up spills
• pick up toys, clothing, newspaper

• Weekly tasks
• Change bed linens weekly and as needed
• Do laundry weekly and as needed
• dust and vacuum
• wet mop floors
• remove garbage
• clean bathroom
• water plants

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Monthly or Periodic Cleaning

• Remove cob webs from corners
• vacuum drapes
• Clean cabinets, closets and drawers
• Hand wash table ornaments
• Damp wipe light fixtures