Chapter Three: Promotion of Health and Safety

Medical Term Hotlist

Adverse Drug Events (ADEs)

AIDS

Airborne transmission

Antisepsis

Bacteria

Biohazar dous waste

Blood-borne pathogens

Communicable disease

Contact isolation

Contagion

Droplet transmission

Hepatitis B virus (HBV)

Hepatitis C virus (HCV)

Infection control

Isolation

Medical asepsis

Microorganisms

MRSA (methicillin-resistant Staphylococcus aureus)

OSHA guidelines

Pathogen

Personal Protective Equipment (PPE)

Risk management

Scabies

Shingles

Standard precautions

Sterile

Tuberculosis (TB)

Virus

VRE (vancomycin-resistant Enterococcus)

Review of Body Systems Affected by Aging

Health means that all systems of the body are working normally. Wellness is defined by each person who takes into account how he or she views his or her health and happiness, often described as the sense of well-being, or outlook on the future.

The human body is made up of systems—a group of organs, each with a specific makeup and function. Each organ within a system works with other organs to keep the body healthy. For example, the stomach and intestines are organs of the gastrointestinal system whose function is to take in, digest, and eliminate food and fluids to keep the body nourished. Body systems are the backdrop for this chapter as you review disease, the absence of wellness. More important is your role and responsibility to promote resident health and safety while helping to prevent the spread of disease.

As residents age, their body systems do not function as fully as when they were younger. This “wear-and-tear” theory of stress on each body system makes residents more susceptible to disease or injury. Immunity, the ability to ward off disease, might also decrease due to the natural aging process. Certain diseases can also affect immunity and medical treatment, such as cancer and the drugs used to treat it.

Although health and well-being vary among residents, all share the following common, age-related changes for which they must adapt:

Risk for chronic illness

Changes in mobility

Decreased vision and hearing

Decreased ability to sense pain

Change in sleep habits

It is a myth that healthy older adults, often called elders, lose intellectual abilities; that is, their wisdom, judgment, and common sense. However, research proves that elders over age 60 might have a slight loss of short-term memory, mathematical calculations, word construction, and abstract thinking. Although a bit slower, elders can learn new skills.

Normal aging does not necessarily affect mobility. Age-related changes, however, could affect muscle strength, flexibility, and stability. Joint changes caused by chronic conditions, such as arthritis or muscle tremors from Parkinson’s disease, can also affect the ability to stand, stoop, and walk. When mobility is affected by aging, elders risk falling, which can lead to injury requiring hospitalization. Many elders might never regain fully functional mobility. Injuries from falls are the second leading cause of death in elders over age 65 and are the leading cause of death for those 85 years and older.

The ability to see clearly and at long distances declines with age. Elders have difficulty seeing well in dimly lit areas or at night, which puts them at high risk for falls as well. Cataracts, or a clouding of the lens of the eye, can also contribute to the risk for falls. Unless treated early, glaucoma, a chronic disease affecting the optic nerve of the eye, can put elders at risk for blindness.

Hearing loss is a normal part of aging, especially if persons are exposed to high noise levels at a young age. Meniere’s, a chronic disease affecting the inner ear, can put elders at risk for falls due to dizziness, which interferes with normal movement and ambulation.

Older adults might ignore signs and symptoms of illness or injury due to a less than normal ability to feel pain. This can occur in elders with diabetes, who might develop an open sore or a cut on their foot or lower leg but not feel any discomfort until the injured area becomes infected.

Risk factors for chronic illness (those factors affecting particular persons and not others) can also contribute to illness. These include cultural, racial, and ethnic factors. For example, diabetes is higher among African Americans, Hispanics, Native Americans, and Native Alaskans than for white Americans. Likewise, obesity is becoming a public health crisis for North American populations compared to persons living in other countries. Access to health care, or lack of it, affects how timely persons in one cultural or ethnic group seek treatment for an illness, which, if left untreated, becomes a chronic health problem. Hypertension, or high blood pressure, is an example of a condition that, if left untreated, can lead to a stroke. Economic status also can be considered a risk factor if an individual does not have health insurance and cannot afford health care.

Cultural or religious beliefs might prevent individuals from participating in certain traditional health-care practices. Instead of seeking care from a physician, for example, they rely on others in the community who can provide care through alternative medical therapies or folk remedies.

Other chronic diseases, such as dementia, Alzheimer’s disease, circulation problems, or mental confusion caused by arteriosclerosis or the effects of a stroke, can all affect thinking and reasoning processes. These chronic conditions can put elders at risk for injury.

Communicable Diseases and Their Effect on Health

Diseases can sicken an individual alone or can be communicable, or contagious, in nature, meaning they can spread from one person to another. In the case of long-term residents, communicable diseases or infections are transmitted by a pathogen (disease-causing microorganism) that can infect many residents who live in the same location. Pathogens can include bacteria, viruses, fungi, and parasites. A common bacterial pathogen that is particularly worrisome in the long-term care setting is methicillin-resistant Staphylococcus aureus, often referred to as MRSA. MRSA is an infection of the skin that can spread to the blood stream and become life threatening. MSRA is resistant to certain antibiotics (drugs that kill bacteria), such as Methicillin. It is difficult to kill and, if left untreated or a chronic infection develops, MRSA can strike an entire population of residents. MRSA is also becoming a major health problem in the general community.

Other infectious diseases can infect long-term residents, such as tuberculosis (TB), a bacterial illness; influenza, a viral infection; pneumonia, of viral or bacterial origin; or the most commonly spread virus, the common cold. Pathogens causing these illnesses can enter the body by contamination through direct contact (for example, blood or body fluids or open wounds) or by droplet (for example, inhaled through the air). Specific organ systems become infected, which give rise to signs and symptoms indicating an acute infection or illness. Unfortunately, residents often become contagious before their symptoms appear. Signs and symptoms of infection include but are not limited to fever, chills, elevated white blood cell count, wounds containing a strong odor or drainage, local heat, and redness around a skin sore or other body lesion, a general sense of not feeling well (malaise), and mental confusion.

Infections or conditions involving the skin can become contagious through direct contact. Examples of these conditions are scabies, a skin infestation by a tiny mite that causes a rash and intense itching, and shingles, a skin condition caused by a virus that attacks a nerve path, which causes pain and disability. The drainage from open shingles blisters can infect others by direct contact.

The following is a quick review of common terms regarding communicable disease:

Antisepsis: The prevention of sepsis by preventing or slowing the growth of disease-causing germs.

Infection control: Measures to prevent or limit infection; control methods vary depending on the type of germ and how it is spread.

Isolation: An attempt to limit the spread of disease by its mode of transmission (for example, respiratory precautions for a tuberculosis patient).

Medical asepsis: Procedures to reduce the number of germs in the environment.

Pathogen: Disease-causing microorganism or germ.

Sepsis: Putrefaction; infection. System-wide response to a specific infection.

Role of the Nursing Assistant to Prevent the Spread of Communicable Diseases

You play an important role in reinforcing the nurse’s teaching plan regarding infection control for residents. You can help explain to residents the reasons for limiting their exposure to other residents who are ill, why they must not share equipment or supplies with other residents, how they can avoid cross-contamination when visiting other residents, how to practice good handwashing and self-care practices, and so on. Residents’ families must also be included in the teaching plan to help ensure residents’ health.

You must take responsibility for your own health as well as that of the residents. Following the facility’s policies and procedures for health screening, including TB surveillance, immunizations and health history, not working while you are ill, practicing effective hand hygiene, and other infection control measures are essential for safe practice.

The following sections outline the infection control guidelines, procedures, and precautions you must follow to guard residents and yourself from infection.

Medical Asepsis

Adhere to specific facility policies and procedures regarding infection control when providing care for residents, which applies to patients in acute care facilities as well.

Use of standard precautions: The following standards set guidelines to prevent and control disease as recommended by the Center for Disease Control (CDC):

Hand hygiene and contamination:

Wash hands when visibly dirty or contaminated with blood or other body fluids.

Wash hands with plain soap and hot water using friction for at least 30 seconds.

Wash hands before eating and after using the restroom, before and after entering a resident’s room, and before and after touching a resident’s belongings or personal equipment.

Remember, reinforce handwashing with each resident, encouraging them to wash their hands as needed to prevent the spread of germs.

Apply hand lotion to limit breaks in the skin from frequent handwashing and antiseptic product applications.

Keep nails natural (no artificial nails), with tips trimmed to less than 1/4 inch; no nail polish or decals allowed.

Apply an antiseptic hand-rub product.

Hand hygiene in all other clinical situations: All clinical situations include direct contact with the resident and the resident’s personal articles.

Gloves:

Wear gloves when in contact with blood or other potentially infectious materials, mucous membranes, and non-intact skin.

Change gloves during resident care as needed when moving from a contaminated body site to a clean body site.

Remove gloves when resident care is completed.

Wash hands after removing gloves.

Mask, Eye Protection, Face Shield, Gowns

The risk of being splashed with blood and body fluids (including tears, saliva, semen, vaginal secretions, urine, or fluid drawn from body cavities) is higher in the acute care setting, but splashes can occur in any setting and should be avoided. Wear a mask, eye protection, or gown if you risk exposure. To protect against airborne contamination, wear a mask as directed by the specific isolation procedure required in your facility. You should also protect yourself when such a disease is suspected but not diagnosed. Chapter 6, “Clinical Skills Performance Checklists,” reviews the isolation procedures in detail. Wearing the personal protective equipment (PPE) described is a type of isolation referred to as contact isolation.

Sharp Objects

Make every effort to avoid accidental needle sticks or cuts with sharp objects (often referred to as sharps).

Keep needles or sharp objects away from residents when not in use.

Promptly report to your supervisor any needle stick or puncture wound by a sharp object. You and other health-care workers are at high risk for transmission of Hepatitis B (HBV), a blood-borne pathogen, or human immunodeficiency virus (HIV). Infection with HIV can destroy the body’s immune system and lead to other infections and AIDS. Infection caused by these viruses can result from a needle stick or other skin puncture by an instrument with contaminated blood on it.

Care of residents with HIV infection, AIDS, and other special needs is discussed in Chapter 5, “Specialized Care.”

Resident Equipment

To ensure resident safety, adhere to facility policies regarding the use, care, and disposal of resident care equipment, because equipment used to care for residents can harbor pathogens that put them and you at risk.

Clean and reprocess reusable equipment if used for multiple residents.

Use equipment carefully to prevent exposure to resident blood and body fluids.

Protect other residents from cross-contamination (spreading pathogens from one resident to another).

Environment

Follow facility policies and procedures to keep residents’ environment as safe as possible, which includes keeping equipment, resident furniture, and personal articles free from contamination. Wipe spills from environmental surfaces promptly, disinfect them, and follow established procedures for removal of hazardous wastes, defined as any waste material that can cause infection. Hazardous wastes include any body fluids, such as blood.

Linens

Keep resident linen from touching the floor; if it does, change it promptly. When soiled, remove linen immediately (fold the contaminated side inward and carry linen away from your body), tie the soiled linen inside a plastic bag, and deposit the bag in the facility’s soiled linen area.

Surgical Asepsis

Surgical asespsis means using a sterile technique to protect against infection before, during, and after surgery by removing as many microorganisms as possible. When assisting the nurse with sterile procedures (for example, positioning the resident), avoid touching equipment or other objects placed in the sterile field. Touching such equipment or objects causes the treatment area to be contaminated.

Resident Safety

Residents have a right to feel safe and secure in the long-care environment. An important responsibility of a nursing assistant is to maintain their safety. Safety and security includes the following:

Protection from falls: The most common accident for residents is a fall, often from a wet, slippery floor, or from equipment or supplies left in the resident’s path, or by equipment that is damaged or improperly used. Watch constantly for environmental hazards that can place residents at risk for falls. This includes assuring adequate lighting of the residents’ rooms; providing residents with reading glasses, canes, and other ambulation devices in good working order; removing spills and clutter in residents’ environment; keeping frequently used supplies within easy reach of residents; assisting at-risk residents with ambulation; and keeping residents’ beds in the lowest position. Restraints or other devices used to protect residents from harming themselves or others are discussed in Chapter 5.

Proper identification: Mistakes in care can occur by failing to properly check residents’ identification. Always check residents’ armbands before serving their meals, performing nursing care, or other tasks that can place residents at risk.

Fire safety: Protecting residents from fires is of utmost importance, because many residents cannot protect themselves, especially when a fire requires emergency evacuation. When a fire occurs, remember the R.A.C.E. system:

Remove all residents in the immediate area of the fire.

Activate the fire alarm and notify others of the fire.

Contain the fire by closing all doors in the area of the fire.

Extinguish the fire.

Frequent fire drills using the facility’s fire emergency plan is an important strategy to help prepare all personnel and the residents for a real fire emergency. Residents might also be evacuated in case of a bomb threat or other environmental crisis; follow the facility’s evacuation plan for these situations as well.

Protection against abuse: Residents’ rights have been highlighted in Chapter 2, “The Roles and Responsibilities of the Nursing Assistant.” Be alert for signs of abuse or neglect, and immediately report any suspicions you might have to your supervisor.

Reporting Accidents or Incidents

An incident report must be completed and filed with the facility’s risk manager or other designated employee whether or not injuries resulted from an accident involving a resident. Incident reports serve to accurately record what occurred, when it occurred, and all details of the event, because problems related to the incident might occur sometime later. You must participate in filing the form if you were directly involved in the accident or witnessed it. Incident reports provide a record of the accident and offer valuable information leading to policy changes as needed to improve service to residents.

Exam Prep Questions

  1. What is the second leading cause of death in an individual 65 years of age or older?

A. Car accident

B. Falls

C. Choking

D. Drowning

  2. Which of the following is not an example of contamination caused by droplet transmission?

A. Pneumonia

B. Influenza

C. Cold

D. Hepatitis B

  3. When equipment is used by multiple residents, it is important to decrease the opportunity for contamination. One way to avoid contamination is by cleaning the equipment with the cleanser provided by the institution. When should the equipment be cleansed?

A. Before using the equipment again

B. At the end of the shift

C. After use by every resident

D. At the time of each scheduled cleaning

  4. The nursing assistant notices the smell of smoke as he passes by a resident’s room. He enters the room and sees that a pillow is on fire in the empty bed next to where a resident is sleeping. What should be the nursing assistant’s first action according to the RACE plan?

A. Confine

B. Alarm

C. Extinguish

D. Rescue

  5. Which of the following is not considered appropriate handling of linen?

A. Changing it promptly when soiled

B. Folding the soiled portion inward

C. Depositing the soiled linen on the floor

D. Carrying the linen away from your body

  6. Which of the following are age-related changes?

A. Decreased vision and hearing

B. Lower intelligence level

C. Difficulty communicating

D. Ability to learn a new skill

  7. Which of the following actions is not a part of standard precautions?

A. Washing hands before and after contact with a resident

B. Wearing gown, goggles, and gloves whenever entering a resident’s room

C. Wearing goggles when there is a possibility of splashes

D. Using gloves when there is a possibility of contact with body fluids

  8. Before serving a resident a meal, it is important for the nursing assistant to properly check that the meal belongs to the resident by performing which of the following activities?

A. Checking the resident’s identification according to facility policy.

B. Asking the roommate to identify the resident.

C. Asking the resident to identify self.

D. There is no need to check identification because you see the resident several times a week.

  9. The registered nurse calls for your help to assist with a resident who has fallen on the floor. You know this incident must be reported to the risk manager of the facility. Which of the nurse’s following actions would best relay the events that occurred?

A. Writing a note to the physician

B. Completing an incident report

C. Calling the director for the facility

D. Completing an adverse drug reaction form

  10. A nursing assistant comes to work complaining of a sore throat, fever, and chills. She knows the unit is short a nursing assistant for today, so she did not call in sick. Which of the following is the best action of the nurse who is in charge?

A. Give the nursing assistant who is ill medication.

B. Allow the nursing assistant who is ill to rest after a.m. care is completed.

C. Instruct all the nursing assistants on the unit to work in pairs.

D. Send the ill nursing assistant home.

11. In the R.A.C.E. acronym, the C stands for

A. Collect

B. Call

C. Calm

D. Confine

12. Nursing assistants should always check residents’ armbands before serving their meals, performing nursing care, or other tasks.

A. False

B. True

Answer Rationales

  1. B. The second leading cause of death in the elderly is due to falls or complications resulting from falls. A car accident (A) is a safety issue that is sometimes overlooked in the elderly, but it is not a leading cause of death. Many elders have trouble swallowing due to an illness (C). Drowning (D) is not a leading cause of death in the elderly.

  2. D. Hepatitis B is transmitted through blood that is contaminated with Hepatitis B. Pneumonia (A), Influenza (B), and the common cold (C) are all transmitted via respiratory droplets.

  3. C. Equipment used for more than one resident is cleaned immediately after each use. Before using the equipment again (A) is incorrect because of the length of time that might occur between use from one resident to another. At the end of the shift (B) is incorrect because the nursing assistant on the next shift might not realize the equipment was not cleaned after it was used on the resident. At the time of each scheduled cleaning (D) is incorrect because scheduled cleaning is for regular deep cleaning of all equipment.

  4. D. With RACE, the first action is to rescue any person who might be in danger from the fire. In this case, it is the resident sitting next to the empty bed. Confine (A), alarm (B), and extinguish (C) are all incorrect because they leave the resident in harm’s way.

  5. C. Depositing linen on the floor causes the soiled linen to contaminate the floor and become a hazard. Changing linen promptly when soiled (A), folding the soiled portion inward (B), and carrying the linen away from your body (D) are a part of the procedure for the care of linen. When linen is soiled, it is promptly removed, and then the contaminated side is folded inward and carried away from your body to not contaminate the nursing assistant’s uniform.

  6. A. Decreased hearing and vision are age-related changes. Lower intelligence level (B) is incorrect because the loss of intellectual abilities as you get older is a myth. Difficulty communicating (C) is incorrect because most elders do not have problems with communicating unless they have suffered a stroke. The ability to learn a new skill is not impaired in the elderly (D).

  7. B. Protective equipment is chosen according to the possible substance the health-care worker might have contact with. Washing hands before and after contact with a resident (A), wearing goggles when there is possibility of splashes (C), and using gloves when there is a possibility of contact with body fluids (D) are all part of standard precautions to protect the health-care worker.

  8. A. It is important to follow facility policy of identifying residents. The most common way is by checking the resident’s arm band; some facilities use pictures for identification. Asking the roommate to identify the resident (B), asking the resident to identify self (C), and not checking identification because you see the resident several times a week (D) are sometimes used along with choice A but not as the sole source of identification.

  9. B. An incident report serves to accurately record what occurred, when it occurred, and all the details of the event because problems related to the incident might occur sometime later. Writing a note to the physician (A) is incorrect because the physician is called as soon as possible to update him or her on the condition of the resident. Calling the director of the facility (C) is wrong because the risk manager is responsible to investigate any accidents or incidents. Completing an adverse drug reaction form (D) is wrong because an adverse drug reaction form is completed only when an incident occurred due to a medication.

  10. D. The best action of the nurse is to send the ill nursing assistant home to protect the other employees and the residents from spreading infection. Giving the nursing assistant who is ill medication (A), allowing the nursing assistant who is ill to rest after a.m. care is completed (B), and instructing all the nursing assistants on the unit to work in pairs (C) exposes others to illness, and those in a weakened state of health could contact the illness.

  11. D. The first action if a fire occurs is to Rescue any person who might be in danger from the fire. The second step is to pull the Alarm or call for help. The C in the RACE stands for Confine. The last step is to Extinguish

  12. B. The identity of residents is to be checked before serving their meals, performing nursing care, or any other tasks.