Measures to Provide Safety

Introduction 

Safety means freedom from psychological and physical injury which is a basic human need. Safety need of a client is defined as to provide the safety measure according to client's need to prevent from hazard and early recovery from the illness. According to Maslow's hierarchy needs for safety and security is an essential need for an individual. Safety measures are activities and precautions taken to improve safety, i.e. reduce risk related to human health. Health care provided in a safe manner and a safe community environment is essential for a patient's survival and well-being. One of the most important aspects of patient care is to ensure safety for each patient throughout the day. Everyone has the same basic needs but differ for different persons in different situation. During illness a person's safety and security are interrupted due to reduced coping abilities, new hospital environment and unfamiliar people. The patient thinks that he is alone. He wants somebody to protect him in such a situation. The nurse should therefore, recognize when a patient is looking for this type of help and security. She can give the patient appropriate support or protection. This safety need should be based on client's need and it should be provided according to the Maslow's hierarchy. 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. Health care organizations foster a patient centered safety culture by:

• Continually focusing on performance improvement activities
• Risk management findings and safety reports
• Providing current reliable technology
• Integrating evidence based practice into procedure,
• Designing a safe work environment and atmosphere
• Providing continuing education and access to appropriate resources for staff. The provision of safety and security helps the patient to recover from his illness. The nurse should be alert to all possible hazards for the patient and protect the patient from these hazards.

Factors Affecting Safety

Age and Development: For young children learning about safe environment is very essential. Injuries are leading cause of death in children over 1 year of age. Similarly elderly can have difficulty with movement and diminished sensory acuity that contributes to the injury. 

Lifestyle: Lifestyle factors that place people at risk include unsafe work environment, risky behavior and can lead injury people who drive or operate machinery while under the influence of chemical substances, work in inherently dangerous jobs are at greater risk of injury. In addition people experiences stress, anxiety, fatigue and alcohol are prone to develop accidents.

Emotional State: Stressful situations can reduce person's level of concentration, can cause errors in judgment and may decrease awareness of external stimuli.

Environmental Factors: A safe environment reduces the risk for illness and injury and helps to contain the cost of health care by preventing extended lengths of treatment and hospitalization, improving or maintaining a patient's functional status and increasing the patient's sense of well-being. Physical environment such as well-maintained flooring, avoidance of dangerous substance in environment, adequate lighting, ventilation, warmth, free from noise are examples of safe environment.

Impaired Mobility: a patient with impaired mobility has many kinds of safety risks. Muscle weakness, paralysis and poor coordination or balances are major factors in falls.

Sensory and Communication Impairment: cognitive impairments associated with delirium, dementia and depression place patients at greater risk for injury. Patient with visual, hearing or communication impairment are not always able to perceive a potential danger or express their need for assistance.

Lack of Safety Awareness: some patients are unaware of safety precautions such as keeping medicine away from children. Patients in unfamiliar environment frequently need specific safety information is very crucial to safety.

Hazards in Hospital

Medical Hazards

Medical hazard is a source of potential harm or a situation with the potential to cause harm to people, property or the environment due to medical practices.

Chemical Hazards

A hospital is full of chemical hazards, from the laboratory to the operating room to the central supply. Picric acid, a component of Bouin's fixative and trichrome stain, is extremely explosive when it is crystallized. Recently, a West Coast dentistry school was evacuated while the neighborhood bomb squad cleared multiple spots with long-forgotten picric acid. Benzene, a bone marrow toxin, and mercury, known for its effects on the neurological system, the skin, and the kidneys, may both be identified in labs, depending on the analytical techniques employed. When employed in analysis units, formaldehyde can have negative effects on the eyes, the respiratory system, the skin, and other organs. In cytology laboratories, one might find ethylene dichloride, known for its effects on the kidneys, liver, skin, central nervous system, and cornea, as well as osmium tetroxide, a strong irritant, and other irritants that could cause problems with the central nervous system (xylene, iso-propyl alcohol). Hospital print shops may utilize percholroethylene (tetrachoroethylene), which is known for its effects on the liver, skin, and central nervous system. Anaesthetic gas waste is a cause of infection and is present in operating rooms. A 1977 NIOSH criteria document on the latter examines the gases, their effects on the reproductive, renal, hepatic, and central nervous systems, as well as potential carcinogenic consequences.

In one study, ethylene oxide (ETO), which is used to disinfect equipment that cannot be autoclaved, was connected to the growth of the cancer in female mice. Recent epidemiological and clinical research has also centered on it. Chromosome abnormalities are more common in ethylene oxide-exposed workers than in non-exposed workers, according to the research team. It appears that this has statistical significance. In addition to enhanced quadriradial exchange, these aberrations also involve an increase in sister chromatid exchanges. In workers who have been protected from exposure for a year, these effects have not subsided. Studies are currently being conducted to determine how ethylene oxide affects male fertility. At this point, it is advised to keep exposure to a time-weighted average of 10 ppm for eight hours. Additionally, respirator protection is given to workers to further reduce exposure. The ETO tale, which is still in its early stages, serves as an illustration of the mouthwatering research possibilities in the field of hospital health.

Biological Hazards

One of the main hazards to those reprocessing endoscopes and accessories is that posed by the risk of acquiring an infectious disease from blood and other body fluid exposure.

The risk relates to the handling of a used endoscope and the potential for splashing and the production of aerosols during manual cleaning. Aerosols create three risks during cleaning: 

• The risk of exposure to infectious microorganisms contained in the aerosol.
• The risk of exposure to chemicals contained in the aerosol.
• The risk of environmental contamination due to aerosols from the cleaning process being dispersed and deposited throughout the area.
• It is imperative that techniques of cleaning should be designed to avoid splashing and the generation of aerosols.

Radioactive Hazards

Radiation is created when radioactive materials spontaneously decay. Ionizing and non-ionizing radiation both exist. The most prevalent ionizing radiations include alpha and beta, gamma, and X-ray particles. A beta particle discharged during nuclear plant accidents is radioactive iodine. Each type has a different maximum amount of energy that it can deposit in a particular area. The ability of radiation to penetrate is likewise variable. Gamma radiation spreads energy over a far broader space than alpha radiation does inside the body, where the alpha particle concentrates all of its energy in a very tiny volume of tissue. Public exposure to specific radioactive sources is only permitted at 100 mrem. Typically, medical X-rays produce less than 10 mrem.

Ionizing radiation of any form has a negative impact on health. The type of radiation to which a person is exposed and the method of exposure affect the damages experienced by various types of tissue. While inhalation or ingestion affects internal body tissues, direct exposure to radiation and radiation emitters (radionuclides) can have an impact on the entire body. The radiation-induced harm is being tried to be repaired by the body. However, there are situations when the harm is so extensive and severe that it cannot be repaired. Cancer can develop as a result of radiation damage to the process of normal cell division. Non-ionizing radiation has no impact on molecules. Burns and electrical shocks could result from them. Long-term exposure to non-ionizing microwave radiation can result in cataracts.

One of the body's most radiation-sensitive organs is the thyroid gland, particularly in infants and young children. Radioactive iodine is typically released into the atmosphere during nuclear accidents. It is taken up by the body. Too much radioactive iodine ingested can result in thyroid cancer developing years after exposure.

Electrical Hazards

Electric shock is a constant risk for patients and staff in hospitals due to the expanding use of electric appliances. The patient, the appliances, the electric service, and the user are all contributing factors to the issue. Every one of these adds flaws that combine to endanger life or safety.

Because the patient usually has an illness or is taking medication that is grounded, they are frequently unusually susceptible to electricity. In addition to plumbing, mechanized beds, lights, signaling, and entertainment equipment are so prevalent that the risk they provide to the patient is disregarded. The patient could be exposed to electric currents by these items. Frequently, faulty wiring enables close proximity to line wires. Designers may fail to take into account the special safety needs for caring for hospitalized patients. In fact, the enthusiasm of helping the patient overrides any thought of safety while designing medical electric equipment. Without strict safeguards, the effects of metallic electrodes, liquid current routes, polarity, the capacitance effect, generated surges, and leakage current can all be dangerous.

Facilities for grounding and earthing that are not suitable can be dangerous. It is important to keep accurate records and to document routine maintenance and repairs of medical equipment. Electrical cords left on the ground can trip employees up, and if they are exposed to moist floors, they can electrocute people. Electrical sockets should not be located adjacent to washing machines or any other type of water source, and extension cords should not be used. Electrical risks can result from insecure electrical installations made by inexperienced people. To safeguard electrical equipment from overvoltage and excessive current, all electrical installations should incorporate protection devices such circuit breakers, fuses, and residual current devices. Electrical accidents can result from unsafe working procedures.

Fire Hazards

Ethylene Oxide (EtO) is used for gas sterilising. EtO is a highly flammable gas and improper ventilation system and leakage of the gas-line that can cause accumulation of EtO in the CSSD, the use of cigarettes by staff in addition to the EtO in the air may cause a fire outbreak or even an explosion. Improper storage of flammable gases and liquids can have adverse effects and may result in fire.

Improper maintenance of electrical equipment and aging electrical cords, with the presence of water can be a source of static electricity, sparks or minor combustion which can ultimately lead to a fire due to presence of large amount of combustible materials such as gauze, linen cotton, boxes, and paper wrappers in hospitals.

Liquid Hazards

The host of chemicals in the cleaning agents used in hospitals may present a health hazard to staff, and patients, the products used for common cleaning tasks are typically complex mixtures of solvents, disinfectants and other chemicals that can irritate the airways and skin. Many products also contained solvents known as glycol ethers, which can be absorbed through the skin and irritate the eyes and airways, as well as various alcohols, ammonia and compounds called phenols, all of which can have harmful effects on the body.

Sharp Hazards

Needle sticks and other sharps-related injuries which expose workers to blood borne pathogens continue to be a significant hazard for hospital employees. Any worker handling sharp devices or equipment such as scalpels, sutures, hypodermic needles, blood collection devices, or phlebotomy devices is at risk. Nursing staff are most frequently injured. These injuries may expose workers to blood borne pathogens. Blood borne pathogens are pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include Human Immuno-deficiency Virus (HIV), Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), and others.

Physical Hazards

Exposure to slippery floors can occur to spills of detergents and presence of water on the floors while cleaning and washing of instruments is being done in the decontamination area. In the sterilizing area because of the use of steam in autoclaving processes, the environment inside the room will be humid and may cause the floor to be slippery.

These are the most common and can be present in most workplaces at any time. They include unsafe conditions that can cause injury, illness and death. Sometimes bad working practices are used so often that they become the routine works habits and might be not considered as hazards to workers. But still these hazards cannot be accepted in a workplace. Physical hazards include:

• Electrical hazards
• Constant loud noise
• High exposure to heat
• Slips/trips and falls

Protective and Preventive Measures

Identify the patients at risk for injury:

• Patients' risk for injury includes:
• Patients with impaired vision or hearing.
• Elderly patients.
• Patient with impaired mobility.
• Patients with history of substance abuse.
• Sedated patients.
• Young child.
• Mentally ill patient.

Ensure that the patient is safe and secure: To prevent falls nurses should:

• Use side rails to prevent patient from falling out of bed.
• Place the bed in the low position.
• Make sure that floor is not slippery or wet because mechanical injury can be there.
• Use stretchers and wheel chairs securely while transferring patients.
• Restrain the patient from falling down if the patient is unconscious or bedridden. 

Protect the patient at risk for injury: To prevent from injury, the nurse should:

• Be careful while giving hot water bags, it will prevent burns.
• Use electrical equipment safely and for the intended purpose only.
• Poisonous material should not keep in the patient's room.
• Protect the patient from radiation hazards by having trained operators.
• Place the patient in the correct body alignment while moving or turning to prevent discomfort.

Prevent from Infection: To prevent from infection nurses should:

• Use strict aseptic techniques during the surgical procedure or during any wound dressing procedure.
• Use mosquito nets or mats.
• Keep environment clean and safe.

Side Rails

Bed side rails, also referred to as cot-sides, safety sides, and bed guards, are used extensively in the health and social care sectors to protect vulnerable people from falling out of bed and injuring themselves. Patients who have problems with memory, sleeping, incontinence, pain, uncontrolled body movement, or who get out of bed and walk unsafely without assistance, must be carefully assessed for the best ways to keep them from harm, such as falling. Assessment by the patient's health care team will help to determine how best to keep the patient safe.

Benefits of Bed Rails Include:

• Aiding in turning and repositioning within the bed.
• Providing a hand-hold for getting into or out of bed.
• Providing a feeling of comfort and security.
• Reducing the risk of patients falling out of bed when being transported.
• Providing easy access to bed controls and personal care items.

Potential risks of bed rails may include:

• Strangling, suffocating, bodily injury or death when patients or part of their body are caught between rails or between the bed rails and mattress.
• More serious injuries from falls when patients climb over rails.
• Skin bruising, cuts, and scrapes.
• Inducing agitated behavior when bed rails are used as a restraint.
• Feeling isolated or unnecessarily restricted.
• Preventing patients, who are able to get out of bed, from performing routine activities such as going to the bathroom or retrieving something from a closet.

Bed rails need careful management. Users should ensure:

• They are only provided when they are the right solution to prevent falls.
• A risk assessment is carried out by a competent person taking into account the bed occupant, the bed, mattresses, bed rails and all associated equipment.
• The rail is suitable for the bed and mattress.
• The mattress fits snugly between the rails.
• The rail is correctly fitted, secure, regularly inspected and maintained.
• Gaps that could cause entrapment of neck, head and chest are eliminated.
• Staffs are trained in the risks and safe use of bed rail. 

Use of Restraints 

Restraints are methods used by trained caregivers to stop or limit a patient's movement. A restraint is a device or medication that is used to restrict a patient's voluntary movement. Restraints can help keep patients from harming themselves or anyone else, including their caregivers. Common used devices are belts, vests, jackets, and mitts for the hands. Restraints also keep a patient from being able to move their elbows, knees, wrists and ankles.

Physical Restraints: Physical restraints should be considered when verbal techniques are unsuccessful or inappropriate in controlling a potentially violent patient. The use of restraints can be humane and can facilitate diagnosis and treatment while preventing injury to the patient and medical staff. Use of physical restraint should be used as a last resort; only used when less restrictive mechanisms have been determined to be ineffective; the use of restraint must be in accordance with a written modification to the patient's plan of care; used in accordance with the order of a physician or licensed independent practitioner.

Chemical Restraints: A chemical restraint is a form of medical restraint in which a drug is used to restrict the freedom or movement of a patient or in some cases to sedate a patient. These are used in emergency, acute, and psychiatric settings to control unruly patients who are interfering with their care or who are otherwise harmful to themselves or others in their vicinity. Chemical restraints are also referred to as a "Psychopharmacologic Agent", Chemical restraints may be necessary to control an agitated patient and may be used in conjunction with physical restraints. Rapid tranquilization (or the more clumsy phrase, rapid neuroleptization) is the term applied to quick chemical control of the agitated patient. It allows physicians to  quickly calm patients, allowing proper evaluation and treatment, and prevents the patient from harming him- or herself or others.

Uses of Restraints

• Used to control harmful behavior caused by problems such as drug abuse, head injury, or mental illness.
• Used to keep a patient from removing a feeding tube, catheters or endotracheal tube.
• Used during surgery or when a patient is on a stretcher to hold them in the right position and keep them from falling.

Precautions

• Explain to the patient the reason for the restraint.
• Limit only the movements that may cause harm to the patient or caregiver.
• Be removed as soon as the patient and the caregiver are safe.
• Use restraints when careful assessment indicates are needed.
• Movement is essential to the patient's wellbeing. Use the least restrictive type of restraint which will protect the patient.
• Attempt first to control the patient with verbal counseling.
• Apply the restraint for the shortest amount of time necessary.
• Restrain the fewest limbs or body parts as possible.
• Provide as much movement as possible.