PROVIDING SAFE AND CLEAN ENVIRONMENT
Safety
Safety
is defined as freedom from psychological and physical injury.
Healthcare provided in a safe manner and safe
environment is essential for a patient's survival and wellbeing.
Importance of safety
·
Reduces the risk for illness and injury
·
Helps contain cost of healthcare
·
Improves/maintains patient's functional status
·
Increases sense of wellbeing
Environmental
safety
Environment
includes the settings on which the nurse and patient interact such as the
hospital, long term care facility, clinic, community center, school and home.
A
safe environment includes meeting basic needs, reducing physical hazards,
transmission of pathogens and controlling pollution, Physiological needs
include sufficient oxygen, nutrition, optimum temperature.
i.
Oxygen:
Supplemental oxygen is sometimes needed to meet the oxygenation needs. Medical
oxygen is stored in healthcare settings. Smoking is the leading cause of burns,
fire, injuries and deaths involving medical oxygen use.
ii.
Nutrition:
Healthcare facilities are required to meet state board of health regulations
such as Food Safety and Standards Authority of India. Foods that are
inadequately prepared or stored under unsanitary conditions increase the
patients risk for infections and food poisoning.
iii.
Temperature:
Temperature extremes affect comfort and safety. Severe cold causes frostbite
hypothermia and extreme heat-heat stroke & heat
exhaustion. Temperature of 68-72degree F (20-22degree C) should be maintained.
iv.
Humidity:
It is the amount of moisture in the air. Humidity of 40-60% is considered
comfortable.
v.
Ventilation:
Ventilation means movement in the air. Ventilation can be maintained by opening
doors and windows, use of conditioners etc.
vi.
Noise:
Noise produces irritability, restlessness, fatigue and exhaustion in an acutely
ill patient. Noise caused by friction can be reduced by lubrication. Other
methods include use of
rubber tyres for wheel chairs, sound proof rooms, avoid
dropping objects, loud talking, TV & radio sounds etc.
vii.
Unpleasant
odour & pests: Maintain good ventilation, cleanliness, proper disposal
of excreta, use of room fresheners, use of insecticides for pests, mosquito
repellents, use of sprays etc.
viii.
Lighting:
Provide natural light or artificial light, dim light at night, prevent glare,
artificial light should not be too strong.
ix.
Physical
hazards: Reduce motor vehicle accidents, poisons, falls, fire, disasters.
Factors influencing patient safety
·
Age and development
·
Lifestyle
·
Impaired mobility
·
Sensory/communication impairment
·
Lack of safety awareness
·
Emotional state
·
Environmental factors
Preventing
specific hazards
1. Fire:
a)
Be aware of the fire safety regulations and fire
prevention practices of the agency in which they work
b) Protect
clients who are in immediate danger.
c)
Report the fire
d) Contain
the fire.
e)
Extinguish the fire.
2. Falls:
a)
People of any age can fall, but infants and
elders are particularly prone to falling and causes serious injury.
b)
Ensure eyeglasses are functional.
c)
Ensure appropriate lighting.
d)
Mark doorways and edges of steps as needed.
e)
Keep the environment tidy.
f)
Set safe limits to activities.
g)
Remove unsafe objects.
h)
Wear shoes or well-fitted slippers with non-skid
soles.
i)
Use ambulatory devices as necessary (cane,
crutches, walker, braces, wheelchair).
j)
Provide assistance with ambulation as needed.
k)
Monitor gait and balance.
l)
Adapt living arrangements (o one floor if
necessary.
m) Encourage
exercise and activity as tolerated to maintain muscle strength, joint
flexibility, and balance.
n)
Ensure uncluttered environment with securely
fastened rugs.
o)
Keep the bed in the low position.
p)
Install grab bars in bathroom.
q)
Attach
side rails to the bed if appropriate.
r)
Keep the rails in place when the bed is in the
lowest position.
s)
Monitor orientation and alertness status.
3. Seizures: A seizure is a sudden onset
of excessive electrical discharges in one or more areas of the brain. Clients
are at risk for injury if they experience seizures that involve the entire body
or any seizure that includes loss of consciousness.
a) Pad
the bed of any client who might have a seizure. Secure blankets or other linens
around the head, foot, and side rails of the bed.
b) Put
oral suction equipment in place and test to ensure that it is functional. Rationale:
Suctioning may be needed to prevent aspiration of oral
secretions.
c) If
a seizure occurs: Remain with the client and call for assistance. Do not
restrain the client,
d) If
the client is not in bed, assist client to the floor and protect the head
e) e)
Loosen any clothing around the neck and chest.
f)
Turn the client to a lateral position if
possible. Rationale: Turning to the
side allows
secretions to drain out of the mouth, decreasing the risk of
aspiration and helps keep the tongue from occluding the airway
g)
Move items in the environment to ensure the
client does not experience an injury.
h)
Do not insert anything into the client's mouth.
i)
Time the seizure duration.
j)
Observe the progression of the seizure,
k)
Apply oxygen.
l)
Use equipment to suction the oral airway if the
client vomits or has excessive oral secretions.
m) Administer
anticonvulsant medications, as ordered.
4. Poisons:
i
Identify the specific poison by searching for an
opened container, empty bottle, or other evidence.
ii
Lock potentially toxic agents
iii Do
not remove container labels or reuse empty containers
iv Place
poison warning stickers
v
Do not refer to medicine as candy or pretend false
enjoyment when taking medications in front of children
vi Provide
antidotes
vii If
poisoning is caused by skin or eye contact, irrigate the skin or eye with large
amounts of water for 15-20 mins.
viii In
case of inhalational exposure remove the victim from the potentially dangerous
environment
ix If
patient has collapsed initiate CPR if indicated
x
Position head turned to one side
xi Never
induce vomiting in an unconscious or convulsing patient
5. Suffocation or choking: Suffocation, or
asphyxiation is lack of oxygen due to interrupted breathing. The emergency
response is the Heimlich manoeuvre or abdominal thrust, which can dislodge the
foreign object and re-establish an airway.
6. Electrical hazards:
i
Check cords for signs of damage before using an
appliance
ii
Place protective covers over wall outlets
iii Never
use electric appliances near sinks, bathtubs, showers, or other wet areas,
iv Keep
electric cords and appliances out of the reach
7, Radiation:
Radiation injury can occur from overexposure to radioactive materials used in
and therapeutic procedures. Exposure to radiation can be minimized
by:
a) Limiting
the time near the source,
b) Providing
as much distance as possible from the source,
c) Using
shielding devices such as lead aprons when near the source.
Safety devices
·
Restraints: restraints are protective devices
used to limit the physical activity of the client or part of the body.
·
Physical
restraints: mechanical device, material or equipment is attached
to the body
·
Chemical
restraint: medications e.g. sedatives
·
Side rails: side rails help to increase a
patient's mobility or stability when in bed or moving from bed to wheel chair.
Side rails are used to prevent fall from bed. Always ensure the latches
securing the bed rails are stable
·
Airway: When a patient's airway is at risk
of being obstructed or is obstructed an artificial airway is inserted to
maintain airway patency
·
Trapeze: Used for getting up in bed, for
support,
Role
of a nurse in providing safe and clean environment:
·
Ensure optimum temperature of the ward
·
Ensure units are well ventilated
·
Ensure noise is within prescribed levels
·
Provide sufficient light
·
Ensure rodent/ pest control
·
Update safety precautions for fire breakout
·
Risk factors for falls are eliminated
COMMENTS