This document provides an orientation for new patients at High Desert Hospitals regarding patient rights and responsibilities. It outlines numerous rights that patients have, including the right to considerate care, to make decisions about treatment, and to privacy and confidentiality. It also lists responsibilities of patients such as following treatment plans and rules of the hospital. The document reviews policies regarding advance directives and violations of patient rights. It concludes with information on customer service and various emergency codes.

1. WELCOME
General Orientation
To All
High Desert Hospitals
SPRING 2014
Presenter:
Renate Longoria, RNc, MSN, PHN

2. You have the right to:
 Considerate, respectful, safe care, & to be made
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
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
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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.

3. You have the right to:
 Formulate advance directives.
 Have personal privacy respected.
 Confidential treatment of all communications and records
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


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.

4. You have the right to:
 Be informed by the physician or continuing health care
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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.

5. Patient Responsibilities
 You, 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.

6. Patient Responsibilities
 You 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.

7. Patient Responsibilities
 You 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.

8. 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, coworkers or Hospital property.

9. Violation of Patient Rights
 Examples:
 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.

10. 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.

11. 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.

12. 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 !!!

13. Customer Service
 AIDETS
 Acknowledge
 Introduce
 Duration
 Explain
 Thank
 Survey
You

14. Customer Service
AIDETS
Acknowledge

15. Customer Service
AIDETS

Introduce

16. Customer Service
AIDETS

Duration

17. Customer Service
AIDETS

Explain

18. Customer Service
AIDETS

Thank You

19. Customer Service
AIDETS

Survey

20. 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

21. 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

22. Customer Service
ARMC DVD
Customer Service
for Students

23. 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

24. 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.

25. 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.

26. What should you do when
confronted with a violent person?
 Call a Code “Gray” and maintain selfcontrol.
 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.

27. 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.

28. 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

29. 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

30. 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)

31. 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

32. 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.

33. 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.

34. 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.

35. EMTALA
 Emergency Medical Treatment and Labor Act
 Patient 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.

36. 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.

37. 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.


38. 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.

39. EOC-General Hospital Safety



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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.

40. EOC-Fire Safety
R- Rescue
 A- Alarm
 C- Contain
 E- Evaluate/Extinguish
Evacuate (only if directed)


41. 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 called
 Help
close all doors to patient’s rooms

42. EOC-Emergency Codes
CODE RED
Fire
What do you do if the alarm goes off?
CODE GREEN
Evacuation
“Missing Person –Elopement”

43. EOC-Emergency Codes
Code Gray
Combative/Disruptive Person
G = Go get help
Code Yellow
Bomb Threat
Code Silver
Person w/Weapon – Hostage Situation
S = Stay away

44. EOC-Emergency Codes
Code Blue
Medical Emergency
(Adult)
Code White
Medical Emergency
(Pediatrics)
Code Pink
Infant Abduction
Code Purple Child Abduction
Code Orange Hazardous Materials Spill

45. EOC-Emergency Codes
Triage Internal
Triage External
Code Triage Alert
Safe Surrender Site
Internal Disaster
External Disaster
Activation of Personal

46. Electrical Safety


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All electrical equipment must have a threeprong 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.

47. EOC-Compressed Gas Cylinder
Safety
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

48. EOC-Compressed Gas Cylinder
Safety
Since 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.
Careful procedures are necessary for handling the
various compressed gases, the cylinders containing
the compressed gases, regulators or valves used to
control gas flow.

49. EOC-Compressed Gas Cylinder
Safety
Gas cylinders must be secured at all times
to 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.

50. 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.

51. 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.

52. 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.

53. 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


54. 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.

55. 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.

56. EOC-Emergency Preparedness
HICS

Hospital Incident Command System
(HICS)
 Designated
to minimize the confusion and
chaos that swirls around disaster
 During a incident listen and do as
assigned
 Keep your cool and pay attention

57. 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

58. 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 bioterrorismrelated 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


59. 
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.

60. ◦ 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





61. ◦ 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”

62. ◦ 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.

63. ◦ 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.

64. ◦ 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.

65. ◦ 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

66. ◦ 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)

67. 



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 reevaluated every 4 hours.
Perform and document ongoing assessment for
continued need for restraints and when patient
meets criteria for release form restraints.

68. Patient Safety
Is
everyone's
RESPONSIBILITY!

69. Introduction to the
Operating Room
Purpose
 Policy


70. Entrance to the Operating
Room
Traffic patterns
Proper Surgical attire

71. Proper Surgical Attire

Correct and Incorrect
application of Attire

72. Positive air pressure
Air flow
 Humidity
 Temperature


73. Unoccupied surgical suite

74. Anesthesiologist’s
domain
Active in Patient safety
 Controls normothermia especially in
the elderly


75. Surgical Hand Scrub

76. Good and bad behavior with
sterile technique

Scrubbed & sterile gowned person‟s
behavior

77. Sterile Technique Principles

Notice the distance between the two:

Minimum 12 inches

78. Emphasis on keeping your distance between
sterile and unsterile fields

Emphasis of keeping your distance
between sterile and unsterile fields
Emphasis of keeping your distance between sterile and
unsterile fields

79. The Five “Rights”

Final Patient Identification and “Timeout”

SIGN IN: Before beginning of Anesthesia


TIME OUT: Before skin Incision


(Identity of patient; procedure, consent, Allergies)
(Baseline Sponge count – Surgical team reviews:
Pt. procedure; Site)
SIGN OUT:

Before patient leaves Operating Room
(Correct Sponge & Needle count; specimens correctly labeled)

81. Keeping your distance

Assumption:
If sterile is blue, it must be true

82. Fire safety

Fire triangle

83. Surgical Team grouped around
operative site, displaying surgical
etiquette

84. Conclusion
Allay anxiety
Specific focus
•
•

85. Abuse Reporting

Abuse

Every Healthcare Worker is a mandated reporter for
the following types of abuse:
CHILD ABUSE
ELDER ABUSE
DOMESTIC VIOLENCE
REMEMBER:
Student Nurses report any suspicion of abuse to
their clinical instructor !!!!

86. 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

87. 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.

88. Abuse Reporting

Neglect:


Sexual Abuse:


Most common type of reported and substantiated
maltreatment.
“ 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.

89. 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.

90. 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.

91. 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 agent
 Vector-borne route – West Nile Virus, Bird Flu, Malaria

92. 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.

93. Infection Control:
Student Responsibility
 Stay home from clinical if you have a contagious
illness (follow VVC policy on contacting clinical
instructor)

94. MRSA TODAY – It’s faces
Slides: Courtesy of Arrowhead Regional Medical Center – Infection Control

95. MRSA TODAY – It’s consequences
Slides: Courtesy of Arrowhead Regional Medical Center - Infection Control

96. Epidemiology of MRSA
Slides: 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

97. 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 JanSept „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

98. TYPES OF INFECTIONS CAUSED BY MRSA
Slides: Courtesy of Arrowhead Regional Medical Center - Infection Control
Catheter-associated blood
stream infections
Wound
infections
Surgical site
infections
Sepsis,
septic
shock
Ventilatorassociated
Urinary
pneumonia
tract
infections

99. INFECTION CONTROL PRACTICES
Hand Hygiene
Standard Precautions
Personal Protective Equipment
Isolation Precautions
Proper care of invasive devices
Removal of devices when no
longer medically necessary
Proper care of surgical sites

100. 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!

101. 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

102. 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

103. 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

104. Isolation Precautions
Airborne Infection
Isolation
For tuberculosis,
chickenpox and
measles only
Droplet Isolation
For MRSA, MDRO in
sputum, bacterial
meningitis, mumps
Contact Isolation
For drug resistant
organisms in wounds,
abscesses, RSV

105. 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

106. 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

107. 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:


Respiratory Infections in children and infants:



RSV, para-influenza virus, or enteroviral infections
Skin infections such as:


MRSA, VRE, or Clostridium -Difficille
Herpes simplex, Varicella, Impetigo, Scabies
Conjunctivitis (pink eye)
Private room, gloves, gowns, mask as needed,
equipment dedicated for single patient use

108. 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.

109. Remember…
Slides: Courtesy of Arrowhead Regional Medical Center - Infection Control

110.  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)

111.  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

112.  SHARPS:
 CONTAINERS
w/Biohazard Label
 1. Needles & Syringes
 2. Scalpels w/blades,
lancets
 3. Broken contaminated
glass
 4. Staples & wires
 5. Disposable suture sets &
biopsy forceps
 Pharmaceutical
Waste
(non-hazardous):
 BLUE/WHITE
CONTAINERS
 1. Syringes (w/o sharps)
containing meds
 2. Wasted Narcotics
 3. Propofol – Diprovan
 4. Partial Tubes/Bottles
of:
Creams/Ointments
Oral Liquids
Eye or Ear Drops/Ointments
 5. Ampoules with
Medications
 6. Vials with Medications
 7. Tablets, Capsules

113. 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.

114. Infection Control:
Student Injury

If an injury or exposure occurs at the
clinical site do the following:
 Immediately contact your clinical
instructor

115. Dress Code
 Personal 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 followed
 Clean body
 No body odor – after smoking (mints)
 No strong perfume or cologne (VVC dress code)

116. 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 ear
Makeup worn in moderation
Fingernails must be clean and trimmed (not > ¼ inch
long);
 Nail overlays (silk, acrylic, gel) are not allowed





117. Dress code
 Common Sense –
 Tattoos must not be visible
 Leather-like shoes (closed toes & heels) –
clean, no logos
 No gum chewing
 Cellular Telephones
 Should 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.

118. Harassment
 Includes 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.

119. 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.

120. 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.


121. THE END
THE END