Environmental Hazards and Safety Measures in Nursing Practice

1. Chapter 19 Safety

2. Safety • Major nursing responsibility • Hospital errors: ranked as sixth leading cause of death by Centers for Disease Control and Prevention

3. Age-Related Safety Factors • Infants • Falling off changing tables • Unrestrained in automobiles • Toddlers • Climbing; accidental poisoning; falling downstairs or from high chairs; burns; electrocution; drowning

4. Age Related Safety Factors (cont’d) • School-aged children and adolescents • School-aged children: play-related injuries • Adolescents: sports-related injuries • Adults: ignoring safety issues, fatigue, sensory changes, effects of disease

5. Environmental Hazards • Latex sensitization • Thermal burns • Asphyxiation • Electrical shock • Poisoning • Falls

6. Question • Is the following statement true or false? Poisoning is a common hazard found only in homes.

7. Answer False. Poisoning is a common hazard found in the home and health care environment.

8. Environmental Hazards (cont’d) • Latex sensitization is an allergic response to the proteins in latex • Latex is natural rubber sap • Component of many household items • Predisposition to latex sensitivity

9. Environmental Hazards (cont’d) • Types of latex reactions • Contact dermatitis • Immediate hypersensitivity • Possible cross-reaction to fruits or vegetables

10. Environmental Hazards (cont’d) • Preparing a latex-free room • Stock room with latex-free equipment, including gloves, client care equipment, and resuscitation equipment • Wipe room clean of glove powder • Communicate with other departments the need to use only latex-free equipment

11. Question • Is the following statement true or false? People with latex allergy may develop a cross-reaction to certain foods.

12. Answer True. People with latex allergy may develop a cross-reaction to certain fruits and vegetables.

13. Environmental Hazards (cont’d) • Safeguarding clients and personnel • Prevent latex sensitization • If using latex gloves, avoid oil-based hand creams • Wash hands thoroughly after removing gloves

14. Question • Is the following statement true or false? When using latex gloves, a nurse should use oil-based hand creams.

15. Answer False. When using latex gloves a nurse should avoid the use of oil-based creams.

16. Environmental Hazards (cont’d) • Burns • Thermal burns or chemical burns • Burn prevention: exits identified, lighted, unlocked; ensure functioning sprinkler system • Fire plans

17. Environmental Hazards (cont’d) • Burns (cont’d) • Fire management: RACE • Rescue • Alarm • Contain • Extinguish

18. Environmental Hazards (cont’d) • Burns (cont’d) • Roles and responsibilities at and away from fire’s origin • Use of fire alarm system • Agency fire plan concepts

19. Environmental Hazards (cont’d) • Burns (cont’d) • Rescue and evacuation; proper use of equipment • Building compartmentalization for containing smoke and fire • Fire extinguishers

20. Environmental Hazards (cont’d) • Burns (cont’d) • Fire extinguishers • Class A: wood, paper • Class B: liquids, grease • Class C: electrical • Class ABC: combination

21. Evacuation of Clients

22. Environmental Hazards (cont’d) • Asphyxiation • Airway obstruction • Carbon monoxide (CO) • CO binds with hemoglobin • CO poisoning: symptoms similar to flu, except for cherry-red skin color

23. Environmental Hazards (cont’d) • Drowning • Fluid occupies airway, interferes with ventilation • Accidental drownings • Resuscitation • Immediate CPR • CPR certification in nurses

24. Environmental Hazards (cont’d) • Electrical shock • Body prone to electric shock • Macroshock; microshock • Grounded equipment reduces electrical shock potential • Measures to prevent electrical shock

25. Environmental Hazards (cont’d) • Poisoning • Caused by ingestion, inhalation, or absorption of toxic substance • More common in homes than in health care institutions • Accidental poisonings; medication errors

26. Environmental Hazards (cont’d) • Poisoning prevention • Educate children; teach parents • Cognitive-impaired adults: use prefilled medication containers • American Association of Poison Control Centers

27. Environmental Hazards (cont’d) • Falls • Most common accident with the most serious consequences in older adults • Contributing factors: visual impairments; disorders affecting gait, balance, and coordination; medications to lower blood pressure

28. Environmental Hazards (cont’d) • Falls (cont’d) • Contributing factors (cont’d) • Urinary urgency • Social, environmental factors • Accumulation of clutter • Hospitalization • Confusion, impaired judgment

29. Environmental Hazards (cont’d) • Assessment • Determine risk factors • Fall prevention measures • Keep emergency numbers near phone • Daily phone tree • Personal response services

30. Restraints • Restraints: methods of restricting a person’s freedom of movement, physical activity, or normal access to his or her body • Fall-prevention measures • Use of restraints is closely regulated • Restraints may be used for disciplinary reasons • Last intervention used after all others exhausted

31. Restraints (cont’d) • Risks of use: • Increase client confusion • Cause chronic constipation, incontinence, infections (pneumonia) • May cause pressure ulcers • Experience progressive decline in ability to perform ADLs independently

32. Restraints (cont’d) • Legislation • Law incorporated; compliance mandatory since 1990 • Accreditation standards • Restraint protocol; medical orders; monitoring and documentation

33. Restraints (cont’d) • Restraint alternatives: protective or adaptive devices that promote client safety and postural support which the client can release independently

34. Nursing Implications • Recognize safety hazards • Identify clients at greatest risk for injury • Identify several nursing diagnoses • Client safety; allegations of malpractice

35. General Gerontologic Considerations • Number of falls and severity of injury • Falls robs independence • Well-fitting enclosed shoes, nonskid soles • Most falls occur in clients 65 years or older, at home

36. General Gerontologic Considerations (cont’d) • Factors contributing to falls in older adults: health conditions; situations such as environmental hazards, inadequate lighting, general clutter, assistive devices • Osteoporosis • Fear of falling; history of falling • Cognitive impairment