Rationale: Body mechanics is about practicing the most efficient movements to sit, stand, or walk to avoid injury. For tasks that require you to push, pull, lift, or carry, there are three basic concepts that you should observe. The first is Base of Support. Always make sure that you have a broad base of support that will help provide stability with any body position. Second is Center of Gravity. This is the point where your body is at its most balanced. Lastly, maintain your Line of Gravity. This is an imaginary line that passes thru your center of gravity. For example, if you are picking up an object, you should stand directly over top of the object. Then, with your back straight vertically, you would bend at the knees to grab the object, pull the object close into your body, and stand again using your leg muscles. It is critical you use your leg muscles and never your back when lifting to avoid serious injury to your spine.
Rationale: Hand hygiene is the easiest way to protect yourself and the patients from possible contamination. Most care centers have alcohol based sanitizer readily available throughout their facilities. But all patient rooms should have a sink and soap available. It is an important note to remember that alcohol based sanitizers should not replace soap and water completely. There are some types of bacterial spores that can only be removed by using soap and water, such as C-Diff. It should also be noted that your hand hygiene will be far more successful if you wear gloves with every admitted patient and if you keep your nails at a reasonable length. Artificial nails and long nails are a harbor for bacteria and could possibly transmit those bacteria to a patient.
Rationale: Musculoskeletal Disorders (MSD’s) are the most common injuries sustained by healthcare workers. When interacting with patients that typically require additional strength to assist them, healthcare workers incur significant stress on their bodies. OSHA breaks down MSD’s into categories. These include repetitive motion injuries (RMI’s), repetitive strain injuries (RSI’s), and cumulative trauma disorders (CTD’s). RMI’s and RSI’s are caused by continually repeating the same motions, bending, stretching, and holding certain positions for long periods of time. These actions can lead to a break down in the muscle tissue itself. This damage can accumulate into a CTD and lead to more significant musculoskeletal deterioration if left unresolved.
Rationale: Nosocomial infections are the premiere reason healthcare professionals should practice good hand washing techniques before and after every patient. Approximately 2 million patients that spend time in a hospital every year fall prey to a nosocomial infection. The Center for Disease Control (CDC) has published that an estimated 90,000 patients perish from those infections each year. These infections are generally transmitted by contact with the contaminated hands of healthcare workers, contaminated medical instruments, and urinary catheters, which if not closely monitored, can allow pathogens access into the body.
Rationale: Standard precautions were developed to help protect the worker and the patient from the risk of transmission from recognized and unrecognized sources of infection. These precautions for unrecognized sources apply to all body fluids, blood, all secretions and excretions except sweat, mucous membranes, and damaged skin. Recognized sources fall into three categories of transmission: Contact, droplet, and airborne. It is the expectation that care centers should provide their workers with gloves, gowns, masks, boot covers, eye covers, splash guards, and other protective devices to help maintain standard precautions at all points of care.
Rationale: Sterile fields are not just observed in major surgeries. Sterile fields must be observed in minor surgeries such as sutures as well. The first step is to confirm that the equipment is still in a sterile condition. The package needs to be clean and unopened, always double check the expiration date, and make sure the sterile indicators have not become compromised. All sterile equipment is wrapped in a specific manner and requires the same consistent approach to opening them. First place the sterile packaging close to the physician. Do not break the seal of the sterile package until just before the procedure. To unwrap the sterile packaging, begin by opening the first flap away from you; then unfold the sides. Finally, take the last corner and open it toward you. Make absolutely sure you do not touch the contents of the package. This establishes the sterile field.
Rationale: The acronym RACE stands for Rescue, Alarm, Contain, and Extinguish/Evacuate. “Rescue” requires that we move all patients within the fire zone past at least two fire doors, away from the blaze. If it is a major fire, guiding personnel should be on site to assist you. Once the patients are in a safe zone, you must activate the fire “Alarm” or call the appropriate code for your facility. To “Contain” the fire, we must close off all doors leading to the area of the blaze, ensuring that all patients have been evacuated first. All oxygen valves must be turned off, and electrical circuit breakers must be shut down. This not only further diminishes the oxygen supply to the fire, but could potentially save critical equipment from being further damaged. Finally, when dealing with small fires, we attempt to “Extinguish” the flames with a fire extinguisher. But, for larger fires, the priority is “Evacuating” the patients from the area immediately. Always remember, stay calm.
Reservoir of Infection
Rationale: The human body is a perfect reservoir of infection because of the body’s stable temperature, moisture and source of nutrients. Some people can be a reservoir of infection, and be completely unaware of the fact. Some pathogens can lay all but dormant in the host, but still be available for transmission to other people. These hosts are known as carriers. A reservoir of infection does not necessarily have to be a patient. It could be the healthcare worker who has been fighting a cold or an upper respiratory infection. When the healthcare worker accidently coughs in a patient’s presence, those pathogens are now spread onto a new host, and contribute to another reservoir of infection.
Rationale: The human body's immune system is set up in a way to combat illness and infection when it is running optimally. However, when the body is already ill or overcome with an infection, it is much easier for the body to succumb and become overwhelmed after small amounts of exposure. So that being said, the fewer pathogens a patient comes into contact with, the better the chance the patient will be able to resist exposures. This reduction of organisms that come into contact with patients is accomplished a few ways. First, practice simple hand hygiene and keeping a clean environment for the patient including sheets, linens, etc. Second, disinfection is used to destroy pathogens using chemicals. This can be used on surfaces in the patient’s room. Finally, sterilization treats medical tools and items with heat, gas, or chemicals to make them completely free of germs before coming into contact with the patient. These three steps of medical asepsis are known as microbial dilution.
Rationale: There are five common methods in which to administer surgical asepsis. This sterilization can take place by using chemical sterilization, dry heat, conventional gas sterilization, gas plasma technology, and the autoclave. Chemical sterilization takes place by soaking tools in a germicidal solution, followed by a sterile water rinse. Dry heat is required to sterilize certain sharp instruments, powders, and greasy substances. Dry heat is provided by use with specialized ovens. Conventional gas sterilization is used on materials and tools that could otherwise be damaged by high heat such as rubber, electric, or plastic equipment. A typical mixture of freon and ethylene oxide is used in combination with a temperature of 135 degrees. Gas plasma technology is an alternative to conventional gas because of the toxic nature of the Freon and ethylene oxide. Instead, a low temperature hydrogen peroxide gas is used. Autoclaves are devices used to steam sterilize equipment under pressure.