One of the most important aspects of patient care is to ensure safety for each patient throughout the day. It is impossible to prevent accidents completely. However, there are ways to limit the potential for accidents that may cause injury to the patient or health care personnel and the unnecessary loss of equipment.

1. Use electrical equipment for the intended purpose only.

2. Keep television sets, telephones, radios, hair dryers, electric shavers, and all other electrical equipment and appliances away from bathtubs and washbasins.

3. Test all small appliances before use to see that they are in good working order. Ensure periodic service checks of all electrical equipment.

4. Remove a plug from a wall socket by grasping the plug, not the cord.

5. Use plugs and outlets with a ground when possible. Do not overload an electrical outlet.

6. Do not kink electric cords; this may cause the fine wires inside the cord to break.

7. Never use faulty equipment. If an appliance overheats, produces a shock or gives off an odor while being used, remove the appliance from the area. Follow procedures to have the appliance evaluated by medical maintenance. NOTE: An electric spark near a high concentration of oxygen or certain anesthetic gases may cause an instant and serious fire.

1. Despite the use of fire retardant material, and compliance with fire regulations, fires still occur. Health care facilities should have regular fire drills so that all personnel know exactly what to do. Health care personnel should be trained and drilled in:

   • Fire prevention.

   • Location and use of fire alarms.

   • Location and use of fire extinguishers.

   • Location of emergency exits.

   • Evacuation procedures.

2. Oxygen supports combustion. Post signs to show that oxygen is in use where applicable. If a patient is receiving oxygen as part of his treatment, be sure that the patient, his roommates, and visitors know that smoking is prohibited. NOTE: Smoking is prohibited in treatment areas of most health care facilities.

3. If a fire occurs, follow these steps:

   • Activate the fire alarm procedures.

   • Turn off oxygen, lights, and any electrical equipment in the vicinity of the fire.

   • Remove the patients who are in immediate danger.

   • Notify the hospital "switchboard" of the location of the fire.

   • Close windows and doors to reduce ventilation.

   • Using the fire extinguisher, attempt to extinguish the fire.

   • Return patients who are not endangered to their rooms.

   • Post a guard to direct the fire department.

1. Identify patients at risk for injury. Those at special risk include:

   • Elderly or confused patients.

   • Patients with impaired vision or hearing.

   • Patients with impaired mobility (wheelchairs, walkers, and partial paralysis).

   • Patients with a history of falls.

   • Patients with a history of substance abuse.

   • Patients receiving medication that interferes with reasoning or motor functions.

2. Protect the patients at risk for injury.

3. To prevent falls:

   • Place the bed in the low position.

   • Keep the side rails up when the patient is not receiving bedside care.

   • Advise the patient to wear low-heeled shoes that fit well when walking.

   • Ensure that nonskid strips or mats are affixed to the bottom of bathtubs and shower floors.

   • Ensure that bathtubs have sturdy handrails and shower stools are in place when needed.

   • Warn patients and visitors when floors are wet and slippery. Also see that signs are posted.

4. Protective restraints (see figures 6-1 through 6-3).

   • Use restraints when careful assessment indicates that these are needed. (Some facilities require a doctor's order for restraints).

   • Movement is essential to the patient's well being. Use the least restrictive type of restraint, which will protect the patient.

   • Apply the restraint for the shortest amount of time necessary. The vest restraint (figure 6-2) may only be necessary while a patient is sitting in a wheelchair.

   • Provide for as much movement as possible. The waist restraint (figure 6-3) protects the patient from falling out of bed but still allows the patient to change position independently.

   • Restrain the fewest limbs or body parts possible. However, if leg restraints are necessary, use wrist restraints also. If this is not done, the patient may remove the leg restraints or he may accidentally hang by his heels in the restraints.

Figure 6-3. Waist restraint.

• Tie the restraint with a knot that is not likely to come loose, yet can be released easily by the nurse in an emergency. A half-bow knot (figure 6-4) meets these criteria.

• Explain to the patient the reason for the restraint. Position him comfortably and change his position every 2 hours. Feed the patient who must remain restrained during meals. Help him use the toilet, bedpan, or urinal at regular intervals.

5. Prevent scalds and burns.

   • Place coffee, tea, and other hot liquids where the patient can reach them easily and safely.

   • Assist the patient if there is any doubt about whether he can safely regulate the temperature of water in tubs or showers.

   • Carefully follow policy when using hot-water bags or heating pads. Because of the danger of burning patients, many health care facilities do not allow their use.

6. Prevent the spread of infection. A health care facility may adopt its own infection control policies and practices. However, the procedures generally follow the recommendations from the Centers for Disease Control (CDC). This is a federal agency that studies pathogens, outbreaks of contagious diseases, and methods used to control these outbreaks.

   • Preventing disease, including infections, is a high priority in health care. Nurses should use techniques that prevent microorganisms from living, growing, and spreading.

   • Two methods are used to reduce or eliminate the presence of microorganisms and thus prevent infections. These two methods are called surgical asepsis and medical asepsis.

     • Surgical asepsis refers to the practice that eliminates the presence of all microorganisms (bacteria, viruses, fungi, yeasts, molds, rickettsia, and protozoa). This practice is sterilization.

     • Medical asepsis refers to practices that help reduce the number and inhibit the growth of microorganisms, especially pathogens (those that cause infections or contagious diseases). Medical asepsis, also called clean technique includes use of antimicrobial agents, hand washing, cleaning supplies and equipment, and disinfection.

   • Infections and infectious diseases begin in a reservoir and move full circle to a susceptible host (see figure 6-5).

     Figure 6-5 The Infectious Process Cycle

     • Reservoir. This is the place on which or in which organisms grow and reproduce. Examples include man and animals.

     • Exit from reservoir. Escape routes for organisms include the nose, throat, mouth, ear, eye, intestinal tract, urinary tract, and wounds.

     • Vehicle of transmission. The means by which organisms are carried about include hands, equipment, instruments, china and silverware, linens, and droplets.

     • Portal of entry. The part of the body where organisms enter include any break in skin or mucous membrane, the mouth, nose, and genitourinary tract.

     • Susceptible host. A person who cannot fight off the organism once it enters his body and therefore, he becomes ill.

• It is important that the nurse teach patients facts and practices about surgical and medical asepsis. When teaching a patient you should:

  • Observe the patient to identify areas where instruction would be helpful in controlling the spread of infection.

  • Act as a model by using sound practices of asepsis when giving care.

  • Provide guidance to the patient who must give himself care at home in the proper way to handle sterile equipment and supplies and in how to sterilize reusable items.

1. Report infections. Health care workers must report any infection that occurs. The Infection Control Committee will investigate any case of infection to determine the cause. If a break in nursing technique is identified, the committee will propose different procedures to eliminate the problem.

Maslow states that our safety and security needs are second only to the need for food, air, and water. The daily responsibility for protecting the patient from additional injury or illness rests with the nursing team. The skillful and knowledgeable nurse can be just as dangerous as the incompetent one if safety measures are not applied in the health care environment.

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