The CNA Study Guide – Promotion of Safety
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Section 1 – Promotion of Safety
Possible Healthcare Environmental Hazards
When working in the healthcare industry, safety is and always will be a top priority. This is true for both the patients and the workers as well. Workers are continually exposed to all kinds of health hazards, ranging from contact with infected bodily fluids, working with sick patients and bloodborne pathogens, all the way to injuries that stem from poor lifting techniques and chemical drug exposure. In terms of health hazards, few other industries can compete with what members of the healthcare industry must deal with on a daily basis. This is all on top of potential slip and fall accidents, burns and even violence from patients.
In the healthcare industry, workplace health hazards can be broken down into four different types (with subcategories in each). These four categories include biological, physical, chemical and ergonomic.
Biological Workplace Hazards
Biological workplace hazards come from working directly with people, animals or even plants. One of the most common forms of biological healthcare hazards comes in the form of a patient who is sick and puts others, including nursing assistants, at risk of catching the same sicknesses. A nursing assistant will potentially come in contact with a host of other bodily fluids that may put them in harm’s way. Essentially, anything that comes from a living, biological organism that may cause illness is considered a workplace hazard. It is why a healthcare facility (and the staff) needs to go to great lengths to keep the entire facility sterile.
Physical Workplace Hazards
Physical workplace hazards are relatively self-explanatory. This includes tripping, falling, burns from frayed electrical cords or cut from equipment. These are physical injuries that occur when dealing with on the job elements.
Chemical Workplace Hazards
Chemical workplace hazards occur in the form of toxic cleaning products, breathing in carbon monoxide and other gases or toxic fumes. These issues can usually be corrected by improving ventilation within a room and wearing protecting clothing and respirators to avoid breathing in fumes and coming in contact with the dangerous items.
Ergonomic Workplace Hazards
This kind of an injury is connected with how a nursing assistant performs his or her job using their body. The most common injuries from this health hazard stem from improper lifting techniques. As a nursing assistant will be on their feet for long periods of the day, maintaining proper posture is important as well. This will help avoid back problems. Additionally, if the workplace facility does not have specific tools and equipment for assisting in the carrying of patients and heavy equipment it can lead to injuries to the body. These injuries can range anywhere from sore muscles to entire sprains, tears or broken bones. Depending on the position and where a nursing assistant works, this is another one of the more common forms of healthcare injury.
Top Factors For Workplace Injuries
While there are hundreds of ways a nursing assistant can become ill or become injured, there are three top risk factors for all healthcare workers.
These three risks are:
Repeating the same motion over and over, which can lead to joint and muscular issues.
Putting in too much force into lifting or pulling something. This may aggravate muscles in the body.
Going into awkward positions that increase the chance of injury. For example, standing in an awkward position in order to lift something heavy or to reach something that is high up off the ground.
Best Ways to Cut Chance of Injury When Moving Patients.
When moving a patient, the best ways to avoid injuries include the following :
- Ask for help from additional staff members when available. Using a lift can also prevent injuries
- Ask the patient to assist as much as they are able to
- Never fight gravity. Gravity will almost always win, so if helping a patient out of bed, lower the bed first
- When lifting, lift from the legs with a straight back. Never bend at the waist
- Know how much something weighs before lifting it
- Take advantage of transfer aids like sling pads, chucks or Hoyer lifts whenever available.
When lifting patients with heavy objects, make sure to use the following lifting techniques:
- Position yourself close to the item that will be picked up
- Position both feet shoulder width apart in order to give a wider, stable anchor to the floor. Having one foot slightly in front of the other helps prevent the body from rocking and falling forward or backward helps.
- Make sure to keep both feet flat on the floor and to bend at the knees (never the back)
- Hold the object as close to the body as possible. This way the weight is not transferred to the upper body (while also throwing off the center of gravity)
- Never twist. This over extends the back muscles and increases the chance of injury. Only the lower body should be used for turning
- Avoid lifting objects above the shoulder and lower than the wait, when possible.
- Work surfaces, such as desks and computers, should be positioned slightly higher than waist level when standing in order to help avoid bending over.
- When possible, push heavy objects instead of pulling objects
- Keep the core tight (abdominal muscles) when pushing or pulling
- Always make sure to wear comfortable shoes and to stand on a mat when possible. This helps reduce the amount of continued weight placed on the arches of the feet.
It is vital for nursing assistants to learn how to properly lift and transfer heavy equipment within the work facility. They will likely need to conduct these heavy lifts on a daily basis. Transfer devices and lifting assistant equipment will reduce the chance of injury (especially to the lower back). Transfer devices will cut down on the direct weight placed on the nursing assistant, which helps prevent wearing down the body. When performing a manual lift it is important to reduce the number of steps performed as this also cuts down on the amount of weight placed directly onto the body.
There are different kinds of transfer devices. These include walking belts, walking belts with handles (also known as gait belts), hoists, repositioning devices, weighing devices and shower chains. Some repositioning devices include roller boards, sliding sheets and draw sheets. Some beds will have scales built right into the bed in order to inform members of the staff how much a person weights. This way, they know what they are dealing with before helping the patient move.
Back injuries will prevent a nursing assistant from working and from doing all of their duties, so maintaining a healthy back is important. This is why it is necessary to regularly exercise and to maintain a nutritious diet. Weight training and aerobic exercises at least three times a week will improve strength and reduce the chance of injury. Also, adequate sleep and stretching between workouts will reduce injury potential while increasing flexibility.
Most Common Patient Injuries
Skin Irritation, Shearing, and Tears
Patients face their own possible problems and healthcare issues when in a facility. One of the most common issues involves skin tears. This happens when the skin is pulled, causing separation in the skin. Usually, a tear takes place when a patient is moved from their bed or during a fall. Shearing is caused by friction, which occurs when a patient and bed rub against one another (usually due to illness where a patient is not able to move on their own).
Older patients are more prone to these kinds of injuries because their skin no longer has the same level of elasticity in it.
Some of the best ways to avoid skin tears and shearing are by dressing patients in longer sleeves and when using pillows for added padding. The skin should remain clear, clean and moisturized.
Tears and other skin problems can develop into more serious problems, including ulcers. Turning a patient is essential to preventing these problems. Greater at-risk patients should be turned every two hours with elbows, heels, and head positioned off of the bed with pillows to boost circulation. It’s possible to prevent ulcer development by being on top of a patient’s needs.
Having clean and dry clothes and linens is a must, as is keeping a patient’s skin clean and dry. Wet or soiled bedding needs to be removed immediately. Bodily fluids break down the natural oils of the skin, which cause tears. Once the top layer of skin is damaged or broken it becomes more difficult to protect against further damage.
Treatment for skin conditions depends on the severity of the injury. Additionally, healthcare facilities may offer different products based on availability. Products applied directly to the skin, such as petroleum-based creams and barrier creams are common. These add an additional layer of protection to the skin while it heals. Would dressing utilizing nonstick pads or hydrogel pads can cover tears, while clear dressing should not be used as it may lead to additional skin damage when removed. The damaged skin needs to be kept clean, dry and routinely moisturized.
The top cause of patient injuries leading to death is a fall. Due to this, a considerable amount of tools and equipment are available to prevent falls. One-third of people over 65 will fall at least once per year. 87 percent of these falls result in broken bones. This reduces mobility while healing takes longer. Elderly patients with falls are hospitalized, which can lead to other healthcare problems (including complications from surgery and pneumonia).
A patient falling can lead to everything from broken bones to internal bleeding. If a doctor worries a patient is at risk of falling, they will provide appropriate medication and request physical therapy while continually reviewing the healthcare plan. Occupational and physical therapies can assist a patient in improving their strength to avoid injuries, especially when living at home (or the rehab center). If a patient is deemed at greater risk they should have assistive devices on hand, including reacher/grabbers, walkers, and canes.
In most healthcare facilities there is an increased chance of spilling due to the fast-paced environment and the different kinds of liquids and bodily fluids present. This makes the floor slippery and can lead to major fall hazards, which is why spills need to be addressed right away.
Patients and employees alike will see falls increase if the spill is not addressed. Slipping on a spill can range in severity, from spraining to bruises, contusions, fractures or even lacerations and punctures. These kinds of injuries may occur to anywhere on the body, from the head to lower back, leg, and trunk.
If a nursing assistant falls from a spill, this may result in time off of work, which is lost wages, plus medical bills and even a long-term injury. On the other hand, patients will see extended hospital stays, current medical conditions worsen and a spike in their medical bills. Notifying the necessary workers on staff about the spill can prevent all of this. Additionally, a nursing assistant can help notify others of the spill by placing a wet floor sign in the spill area. Depending on the kind of spill, nursing assistants can assist in the cleanup. When a spill is identified, a nursing assistant needs to cover and clean the area while reporting to the necessary individual.
All healthcare facilities have dress codes in place that are designed to reduce slipping (such as slip-resistant shoes). Socks with rubber treads can help with this as well.
A bruise occurs when there is blunt force or a clotting abnormality that prevents the skin from breaking to bleed. This leads to a blue, purple, brown and even a greenish-yellow color abnormality. Bruises occur in a number of ways, ranging from running into objects, failed intravenous attempts and even from certain medications. If significant bruises occur without any known cause it likely is from a medical condition, like blood-clotting disorder. If a patient appears bruised it might be from physical abuse. If a nursing assistant identifies bruises that appear suspicious they need to ask the resident about the bruises. The family should talk to the staff about bruises as well.
Burns from scalding hot liquids is the most common. This is when meals are too hot and spill on a patient. Supervision needs to be paid when patients require assistance with meal prep and eating. This also occurs when bathing if the water is too hot. Nursing assistants need to always check temperatures. Open flames and candles are generally not allowed within a healthcare facility in order to prevent burns. When radiators are present these should be covered to avoid burning.
If a patient does suffer from a burn they become more open to additional infections, including shock and the loss of body fluids. Burns can result in extended hospital stays in order to treat the burn and replace fluids lost.