Tips For ENs To Minimise Hazards During Handling Tasks And Promote A Safe Workplace

Duty of Care and its Examples for ENs

You work on an older person’s rehabilitation ward; your colleague is unwell but has come into work. She makes herself a cup of tea in the staff room coughing and sneezing without covering her mouth or nose.

Name and discuss the mode of transmission that is passed by sneezing and coughing.

The mode of transmission is the airborne transmission as after coughing and sneezing the microorganisms can be in air for long time that can infect other person.

 Droplet contact is the other mode of transmission when person sneezes and cough in public without covering mouth or nose. Droplet can spread in short distance before falling on ground

Indirect physical contact- touching of the contaminated surfaces as the patient is sneezing in workplace while making tea (Gautret et al., 2014).

Is your colleague well enough to stay at work? Justify your reasoning and explain the procedure you would follow if your colleague refused to go home.

My colleague is not well enough to work as she is coughing and sneezing, which can be the sign of flu, common cold, rubella or meningococcal diseases. Working in this condition may cause spread of the disease or infection in the work place that can affect older patients and other staff.

I will discuss with the nurse about the norms of rehabilitation centre to stay at home until recovery and if refused the same will be reported to the ward manger.  I will ensure that the nurse follow the hand washing policy, covering mouth when coughing and sneezing.

Describe ‘immunity’ providing at least 4 examples of clients who may have low levels of immunity.

Immunity is the ability of the body to resist any diseases or infection caused by foreign particles by destroying its products and preventing the development of the microorganism.  Clients who can have low level of immunity are –

• HIV
• Pneumonia
• Colds
• Sinus infection (Owen, Punt & Stranford, 2013)

List 4 examples of respiratory etiquette.

• Covering of mouth  and nose with single use tissues when coughing and sneezing
• Dispose of tissues after use in waste bin
• Proper hand wash after contamination due to respiratory secretions and surface
• Do not contact eyes or nose (mucus  membrane) with contaminated hands (Zayas et al., 2013)

You are working on the obstetric ward caring for a client who had an emergency caesarean 2 days ago. When you enter the room your client is complaining of being cold and achy. You complete a set of vital observations and note that your client is febrile and tachycardic.

You are due to take down the dressing and check the wound site and when you do, you observe that it is very red and hot to touch.

Name and explain the term associated with this type of infection. Your answer must contain details of the possible methods of transfer and be supported with examples.

Legislation Supporting Safe Work Practices in Australia

The type of infection is known as post caesarean wound infection. The possible methods of infection are-

Cellulitis and wound (abdominal) abscess – caused by streptococcal or staphylococcal bacteria at the site of surgery

Thrush- caused in people with low immunity mediated by fungus Candida.

Transmission through urinary tract and bladder infection- caused by E.Coli (Dhar et al., 2014)

You discuss your findings with the Registered Nurse and the Dr is called to review; she asks you to take a wound swab and apply a clean dressing.

• Discuss the type of dressing technique you will use and why.
• Why it is necessary to clean a dressing trolley and when this needs to be undertaken.

I will use the transparent polyurethane dressings that are low adherence. It will protect the wound and allow checking the site for any sign of infection, without disturbing the dressing. It is waterproof and prevents bacterial contamination.

As a part of the aseptic dressing process the dressing trolley should be clean at the time of removing the old dressing, cleansing and dressing the wound again. It will help avoid further infection of wound and reduce the existing infection (Dumville, Gray, Walter, Shar, & Page, 2014).

List the 5 moments of hand hygiene and explain why they are important in the prevention of infection.

Five moments of hand hygiene by WHO recommends cleaning hands- before touching the patient, before cleaning/aseptic procedure, after exposure to body fluid, touching the patient and surroundings”. It helps spread of germs and introduction of infection and is considered important based on evidence.  

Justify the use of ABHR’s in the healthcare setting, include in your answer when the use of ABHR may be contraindicated

1. It is justified to use ABHR as a part of hand hygiene practice as it takes less time, no irritation to skin, significantly reduce the bacterial infection, cost effective and is readily accessible.  It can be contraindicated when the hands are visibly soiled and ABHR does not work against bacterial spores (Salmon, Pittet, Sax & McLaws, 2015).

You are working in an aged care facility which is in lockdown due to Norovirus. You are asked to gather the staff together and explain PPE and how to correctly remove it.

What is your explanation of PPE?

PPE is the personal protective equipment used in health care filed for preventing infections and refers to googles, facemasks, gloves, helmets, face shields, masks or respirators (World Health Organization, 2014).  

You finish showering and changing the bed linen of a client who has active diarrhoea and vomiting, list the removal of PPE in sequence before you leave the room stating when you would complete hand hygiene in this process.

1. Remove most heavily contaminated item
2. Peel of gloves and gown rolling inside out and dispose
3. Perform hand hygiene
4. Remove face shield from behind and dispose
5. Remove goggles  and mask
6. Perform hand hygiene (World Health Organization, 2014)

During the outbreak of norovirus at your facility, Betty, a client with dementia, comes out of her room and vomits on the vinyl in the hallway.

Betty is very distressed and opens the door to Pam’s room, Pam does not have norovirus. Betty leans on the wall in the doorway before staff manage to gently guide her back to her room.

Definition of Fungi and its Role in Infection

Describe in detail the process for removing the vomit in the hallway, include the equipment you will need, any PPE which is to be worn and any safety signs which are to be used.

 Cover the vomit with the disposable paper towels (free HCL solution), it will absorb the spillage, leave for three to five minutes and clear the spillage. Dispose the towel in dustbin and clean the area with the neutral detergent and water.

PPE required for this case are the gowns and gloves, mask and eye protection to avoid splashes (Prieto, Kilpatrick & Randle, 2014).

The safety sign should be used is “STOP ALTO INFECTION ALERT- report to nurse before entering” 

Will Pam’s room need cleaning? Justify your reasoning.

Pam’s room need cleaning as Betty entered the room who is infected with norovirus and recently had vomited. There is risk of infection from body fluids.

Discuss any reporting obligations you may have following this incident.

Reporting obligations includes informing about the diarrhoea like symptoms of Betty and risk of spread of further infection to the immediate supervisor (Health.gov.au. 2018).

Explain the role of signage in the prevention and control of infection and the precautions or measures that may be taken by the facility to limit the spread of norovirus.

With the help of the signage precautions can be taken to isolate the patient infected with the norovirus, and adopt preventive strategies against spread of infection. Signage consists of alert signs and it will limit people’s access to a clinical unit or ward having risk of infection (Health.gov.au. 2018).

Question 5

You are the nurse in charge of a small area on a medical ward. One of the HSA’s comes to you in a distressed state and informs you that whilst carrying a full urine bottle, she tripped and the urine splashed onto her face.

Discuss in order of priority what you would do next, detailing any reporting actions.

I will help her clean her face immediately and send the urine sample for testing to identify, any source of infection. Reporting actions include immediate notification to supervisor about the incident.

Colonisation is the process of establishment of microorganism in a area/host. Whereas, infection is the invasion of the micro-organism in the host by multiplication or by disease causing agent.  A diseases is the disorder or any abnormal condition caused to host body organ by infection. (VanMeter & Hubert, 2015)

Definition of Viruses and their Role in Infection and Disease

Virus is an infective agent that comprise either of RN or DNA in its protein coat and replicates only in the host cell. Virus invades the host cell through attachment, penetration, uncoating of the virus, attachment to the host cell and injection of the genetic material in to the host. During the process of replication, the viral DNA or RNA is also replicated. The newly formed virus then causes either cell lyses or stay in lysogenic state to cause the infection and disease (VanMeter & Hubert, 2015).

Fungi are multinucleated single celled eukaryotic organism that lives by decomposing the host body in which they grow such as mushrooms etc. Fungal infection occurs when it invades and grows into the dead skin or keratin of skin, hair or nails (VanMeter & Hubert, 2015).  

WHS/OHS (acts, regulations and code of practice) legislation supports the safe work practices in Australia (Chan-Mok, Caponecchia & Winder, 2014).

The key principles are-

• Establishment of the health and safety duties to protect an individual from workplace risks and hazards
• Health and safety committees and representatives provide for worker consultation, representation and participation
• Safework SA enable enforcement and compliance
• Provide for creation of codes of practice and regulations (Chan-Mok, Caponecchia & Winder, 2014)

Duty of care is the legal obligation of a health care worker to protect others from harm by avoiding any acts or omissions that are likely to cause the harm to the patients. For example-

• RGN without training and knowledge may only be restricted to provide reassurance to woman in labour, ensure comfort and perform duties that are within competence like emotional support or calling ambulance
• A nurse withoutown medical indemnity insurance may not practice independently to care  patient suffering from injury  

EN may not change the patient’s medication without consent from the RN during delegation   (El Haddad, Moxham & Broadbent, 2013

Enrolled nurse must work in compliance with the “National competency standards for the enrolled nurse” developed by the NMBA Australia (standard 9 safety guidelines). EN must follow the safe work practices of manual handling and security procedures. It may include reporting faulty equipment, safe use of trolleys, raisers, walkers, patient handling hoists, and use of PPE for manual handling of chemicals (Croft & Croft, 2017). 

Give a brief description of the musculoskeletal anatomy and discuss at least 4 ways in which you can reduce the risk of injury to yourself and others during manual handling tasks.  

The primary function of the musculoskeletal system is to allow motion, support the body and protect the vital organs. It comprise of skeleton (bones), cartilage, muscles, tendons, joints and ligaments and other connective tissue for supporting the organs and binding tissues.

• Use of remote controls for automated handling
• Use of mechanical lifting aids
• Use of gloves to handle toxic materials
• Use of shock absorbent shoes for walking on floor (Standring, 2015)

Discuss the link between infection prevention and control, and, compliance with WHS legislation.

Infection prevention requires use of set of control measures. Compliance to the WHS legislation will help implement safety guidines to prevent infection such five moments of hand hygiene.

Discuss how infection is transmitted in the working environment and what practices could you put in place to minimise this risk? Give an example of a common source of infection in your answer

Infection is transmitted in health care setting or any workplace due to  lack of precautions taken by people with flu like symptoms (common source of infection) or any other infection, direct contact such as handshake with contaminated hand. Infection can be prevented by adhering to the safety regulations such as approving leave for seven days to worker with illness and ensure stringent guidines on use of PPE, hand hygiene and  workplace safety standards (Danzmann, Gastmeier Schwab & Vonberg, 2013).