Indirect safety is an important component of a CNA’s duties. Ensuring your patients’ well being is a top priority so it’s important to understand all of the roles and responsibilities of a CNA when it comes to health and safety. Each link below goes into further detail on a number of subjects that a CNA can be responsible for while working with their patients at a hospital or care home. This information can be valuable to aspiring CNAs as well as current nursing assistants just looking for a quick refresher on these important topics.
- Communicable Diseases
- Medical & Surgical Asepsis
- Protective Gear
- Sharps Care and Disposal
- Equipment Care & Maintaining a Safe Environment
- Linen Care
- Resident Safety
- Effects of Aging on Patients
Communicable Diseases
As a nursing assistant, you need to understand the role of microorganisms in causing communicable diseases.
Communicable diseases also called infectious diseases are caused by pathogenic microorganisms such as viruses, bacteria, protozoa, fungi, and rickettsiae. These microorganisms can be inhaled, ingested or injected into the host (affected person). The microorganisms multiply inside the host and cause an infection. Thereafter, the pathogens start exiting through mouth, nose, eyes, ears, intestines, urinary tract and open wounds of the infected person. When this host comes in contact with others, he transmits his infection to another person, that is, a new host. The new host spreads the disease to other unaffected individuals.
To break this chain of communicable disease, you need to break the infectious process. Practicing good hygiene and wearing gloves, surgical masks, face shields are some of the ways in which the spread of communicable diseases can be prevented. Other barrier devices that help nursing assistants from coming in contact with microorganisms include protective glasses, laboratory coats, gowns, mouthpieces, and resuscitation bags.
The most communicable diseases are:
- Common Cold: This is a viral infection. Using good hygienic practices such as hand washing can help the disease from spreading.
- Whooping Cough: This is a highly communicable disease-causing high-pitched uncontrollable coughing, respiratory infection, runny nose, and fever.
- Strep Throat: This is another common communicable disease caused by Streptococcus pyogenes. Avoiding close contact with the infected individual is the only way to prevent this infection. Sneezing, coughing and handshakes spread the throat bacteria easily. Good hygienic practices such as hand washing can avoid the spread of this disease.
- Gastroenteritis: This is a highly contagious disease that can occur due to eating contaminated food. Rotavirus and norovirus cause Gastroenteritis.
- Pink Eye: Pink eye refers to bacterial or viral conjunctivitis, caused by staphylococcus or streptococcus. Avoiding handshakes and hugs with an infected person, and maintaining good personal hygiene helps to control the spread of this disease.
- Gonorrhea: Gonorrhea is transmitted sexually by the Neisseria gonorrhoeae bacterium. Avoiding unprotected sex prevents the spread of Gonorrhea.
- Hepatitis B: hepatitis B virus causes hepatitis B, which causes inflammation of the liver, resulting in liver failure or cirrhosis.
- HIV (human immunodeficiency virus): HIV is present in the vaginal fluids or semen of an infected person and gets transmitted sexually. In the late stages of this infection, it causes AIDS (acquired immunodeficiency syndrome). Sharing needles with HIV or AIDS hosts can also transmit this disease.
- Warts (verruca): This is caused by the Human papilloma virus. There are circumscribed outgrowths on the skin which can be communicated by direct or indirect contact with the affected person.
The spread of communicable diseases can also be prevented by:
- Providing proper education to the patient about the type of disease
- Explaining how the infection works
- Encouraging:
- Hand sanitization
- Appropriate methods of storing and cleaning personal items
- Proper disposal of contaminated items
Medical and Surgical Asespsis
Proper knowledge of medical and surgical asepsis technique helps a nursing assistant to prevent the transmission of infection.
Medical Asepsis
Medical asepsis is about eliminating the spread of microorganisms. It is a state of being free from disease-causing pathogens.
Hand hygiene and using alcohol-based hand rubs are some of the ways in which medical asepsis can be maintained. Let’s look at each of these procedures.
Hand hygiene – Using soap and water
Soap and water are used when hands are visibly soiled or dirt/organic material is present on hands.
- Step 1: Bare the hands, forearms by pushing the gown sleeves above the wrists. Remove all items such as rings or wristwatch from the hands. Clothes and jewelry facilitate bacterial growth.
- Step 2: Turn on the water and wet your hands and wrists.
- Step 3: Apply 3 to 5 ml liquid soap from a soap dispenser to your wet hands. Rub the soap all over your hands.
- Step 4: Rub your hands for 15 seconds. Ensure to lather each finger, by rubbing around them. Also, rub the back of your palms and under the fingernails. This helps to remove microorganisms from the hand.
- Step 5: Rinse and dry your hands thoroughly. Blot with a paper towel to reduce skin irritation. The rubbing motion should be from the fingers to the forearm.
- Step 6: Use the paper towel to turn off the faucet to prevent contamination. Do not touch the paper towel with the opposite hand.
Using Alcohol-based hand rubs
Alcohol-based hand rubs are used when the hands are not soiled, but you suspect the presence of microorganisms.
- Step 1: Bare the hands, forearms by pushing the gown sleeves above the wrists. Remove all items such as rings or wristwatch from the hands. Clothes and jewelry facilitate bacterial growth.
- Step 2: Apply a good quantity of antiseptic hand rub on your hands and wrists.
- Step 3: Rub your hands for 15 to 30 seconds till the solution is dry. Ensure to rub each finger, the back of your palms and under the nails. This effectively disinfects the hand.
Surgical Asepsis
Surgical asepsis is a technique that ensures that sterile items remain sterile.
For instance, once hand hygiene is completed, the nursing assistant dons sterile equipment such as gloves, gown, face mask, hair cover, shoe covers, and face shields. It is important to use proper procedures to handle this equipment so that the sterility of this equipment is maintained to prevent contamination.
Follow these steps for maintaining sterility of the gown and gloves:
- Step 1: Lift the gown at the neckline. Ensure that it does not come in contact with non-sterile areas.
- Step 2: Hold the gown up, so that it falls open. Slide both arms into the gown sleeves. Do not extend the hands beyond the cuffs.
- Step 3: Ask another assistant to stand behind you. Ask him to pull the gown shoulders up and tie the necktie.
- Step 4: With fingers inside the gown sleeves, don the gloves on one hand first. Then with the gloved hand, don the gloves on the other hand. The gloves should be pulled over the gown cuffs. This maintains the sterility of the gown and the gloves.
- Step 5: Hand the waist tie on the gown to the assistant and ask him to hold it with a sterile forceps. Make a turn and take the waist tie from the assistant. Secure the waist tie. Securing the gown ensures that the inside clothing is not exposed to a non-sterile area.
Protective Gear
Personal protective equipment or PPE is the equipment that nursing assistants use to avoid exposure to microorganisms and thereby prevent infection. This equipment includes:
Gloves: Gloves protect the hands by providing a barrier against fluids and blood when caring for patients.
Masks: Pathogens can spread through the respiratory system – the nose and mouth. Respiratory masks have a tight seal that covers the mouth and nose. These are especially useful to protect the nasal and oral mucous membranes against airborne organisms such as the tuberculosis bacillus.
Goggles: Face shields such as goggles can protect fluids from entering the eyes when there is splashing of fluids. Goggles protect the germs from entering the mucous membranes.
Gowns and Aprons: Gowns and aprons protect the inner clothing from getting contaminated. They are usually used during surgery to protect the nursing assistant from infectious secretions such as wound drainage or discharges from the body.
Head and Shoe Covering: Headcovers protect the nursing assistants from sprays and airborne organisms. Similarly, shoe covers provide protection from airborne organisms and are used as a part of full barrier protection.
There are special procedures for donning PPE and removing the equipment after use. The gown, gloves and other equipment should be worn in such a way that it is not contaminated. After use, the equipment should be disposed of in proper waste containers marked for cytotoxic PPE.
Sharps Care and Disposal
A nursing assistant has to regularly handle sharp and pointed objects like needles, syringes, fingerstick devices, infusion sets, and insulin pens for different medical procedures. The following are some of their uses and applications:
- Needles and syringes are used for injecting drugs.
- Fingerstick devices are used to obtain drops of blood for testing, especially for diabetic patients.
- Infusion sets are used to inject medicines.
- Insulin pens are used for self-injection in diabetic patients.
These sharp and pointed devices can cut and puncture the skin. In medical terminology, these devices are called ‘sharps’.
When handling sharps, the following actions should be taken:
- Ensure you are wearing gloves when handling sharps.
- Handle the devices in such a way that does not injure others.
- Where possible, use instruments to grasp sharps, or place them in a basin instead of hand-to-hand passage.
- Announce verbally when passing sharps to each other.
- Do not recap, bend or break needles after use.
Sharps should be disposed of immediately after use and should not be left out in the open, as they contain residual blood and fluids. Used needles are dangerous if not disposed of carefully, as they can injure others and spread infections like Hepatitis B and Human Immunodeficiency Virus (HIV).
As a rule, all used sharps should be dropped and not pushed into an FDA-cleared sharps container. These containers are made of plastic and are puncture-resistant. Sharps should not be disposed of in recycling bins or flushed down the toilet, as doing so can put the janitors or sewage workers at risk.
In case one is accidentally stuck by any used sharps, the following actions should be taken immediately:
- Wash the injured area immediately with water and soap.
- Apply an antiseptic – alcohol or hand sanitizer on the injured area.
- Get medical attention.
Equipment Care and Maintaining a Safe Environment
For infection control, the nursing assistant has to ensure that the hospital area is properly disinfected and the equipment used for procedures or patient care is sterilized effectively.
Maintaining a safe environment
The nursing assistant uses certain strategies for decontaminating, cleaning and sterilizing equipment and hospital areas. The strategies differ for small spots of blood or vomit, and larger spills.
The first step is to promptly remove the spots and spills. The next step is to clean and disinfect the area. In the case of small blood or fluid spills, the area can be cleaned with a detergent solution.
In the case of large blood or fluid spills, the nursing assistants should do the following:
- Use paper towels to remove the spill.
- Use forceps to remove any broken material such as glass.
- Use absorbent material to soak up excess liquid.
- Ensure that the appropriate PPE is worn at all times.
Alcohol is not used to clean any spills. However, sometimes sodium hypochlorite is used to eliminate bloodborne and gastrointestinal viruses, and bacteria.
Equipment care
For equipment care, the nursing assistant should take the following actions:
- Ensure that all items are stored in such a way that their sterility is maintained.
- Dry, sterile and packaged equipment should be stored as instructed, as they may be used for critical procedures. They should be placed in a dry environment and away from sharp objects that may damage their packing.
- Ensure that equipment that is dysfunctional, or cannot be cleaned, disinfected or sterilized is discarded immediately.
- Sterilize equipment such as endoscopes after each patient use, as it is used for invasive procedures.
Linen Care
Nursing assistants should follow the documented policies of the healthcare facilities regarding transport and storage of linen.
When handling used or contaminated linen, there is a risk of the spread of microorganisms on the clothing and in the environment. To avoid these risks, the nursing assistant should do the following:
- Use PPE such as gloves and aprons when handling and transporting used linen. This will prevent exposure of skin to microorganisms.
- Hold the used linen away from the body when transporting it with hands. Avoid shaking it or dropping it on the way, as it can contaminate the area. Carry the linen in a bucket or a container.
- Use appropriate laundry disposal equipment for disposing of used linen.
- Ensure that the used linen is not washed in domestic washing machines, which are used for washing the patient’s personal items.
- Perform hand hygiene after handling used linen.
The used linen is washed with hot water and detergent as specified by the healthcare facility policies.
Ensure that clean linen is stored in a clean and dry place so that they are not contaminated by aerosol, dust, and moisture.
Resident Safety
Resident safety involves providing proper care to the patient to keep him safe.
For this purpose, the nursing assistant should ensure that the resident’s environment is safe:
- Ensure that the patient’s environment does not include slippery floors or objects on the floor that may cause falls.
- Ensure that the proper patient receives the proper medicine, this includes checking name tags and medicine labels before administering medicines.
- Ensure electrical outlets and wires are not damaged or malfunctioning.
- Ensure that the staff knows about a fire safety plan and knows how to operate fire extinguishers.
Resident safety also involves noting and informing any changes that occur in a patient. Each patient shows different symptoms of illness according to age and other factors. Therefore, it is important for nursing assistants to be attentive to the changes that occur in a resident at any point in time. The nursing assistant should watch for physical and non-physical changes in a resident such as:
- Movement: A change in movement such as poor balance, walking with wider steps, shifting balance to one side, indicate that the resident is at risk for falls, or he may be experiencing pain.
- Bowel patterns or urination: If the patient experiences constipation or urinary incontinence, it may indicate dehydration or some other medical condition such as kidney failure.
- Appearance: Changes in the skin should be reported immediately as it may indicate infection, dehydration, or an illness that needs prompt attention. For instance, the resident may have a puffy or swollen skin, rashes on body, red or darkened skin (indicating the resident is bed sore), or dry and cracked lips.
- Activity level: A resident may suddenly feel weak and there may be a decrease in his activity level which calls for immediate attention. Sudden weakness may also be a sign of stroke.
- Vital signs: Change in temperature, blood pressure, pulse rate should be noted and informed immediately, as it may indicate an illness.
- Appetite: Changes in appetite can indicate stomach problems, dental problems or sometimes even depression.
- Sleeping: Poor sleep may indicate anxiety or depression. Medications, chronic problems, pneumonia, can also change sleeping patterns.
The first step for a nursing assistant is to promptly report any such changes to the supervisor. This will ensure that the resident gets prompt medical attention and also protect them from further harm or injury. The nursing assistant should also get information on what should be done and what should be avoided when providing care, to prevent the resident’s condition from becoming serious.
Effects of Aging on Patients
Aging causes different effects, such as physical and mental declines in a person. Knowledge of these effects will help a nursing assistant to provide proper care for the elderly patient.
The following effects are generally seen in all elderly patients:
- Heart size increases and there is a decrease in cardiac output. This reduces the blood flow to the organs. There is also a decrease in the elasticity of blood vessels and reduced blood cell production. Decreased circulation also affects balance.
- Respiratory muscles weaken.
- Bone calcium decreases, and cartilage degenerates.
- Subcutaneous fat decrease and hair and nails grow slowly. Skin becomes thinner and fragile.
- There is a decrease in bladder capacity, metabolic rate, secretion of saliva, peripheral vision and sphincter control.
- Liver function slows down and there is a reduction in the absorption of nutrients.
- Eardrums thicken and there is an increase in wax production.
- There is a decline in the sense of taste, smell and touch.
- Hormone production decreases, sexual responses slow down and there is atrophy of the reproductive organs.
- Hypertension, arthritis, diabetes, heart disease and obesity are commonly seen in older adults.
- There are memory issues, such as loss of memory, unable to recall events, and reduced cognitive function.
Nursing assistants should encourage the following behaviors in elderly patients for a healthy lifestyle:
- Encourage the patient to eat a healthy diet, as it delays aging. Add seasonings to counter the loss of taste.
- Encourage the patient to exercise regularly. Physical activity such as walking, biking, swimming, postpones the effects of aging. Exercise also reduces the risk of osteoporosis, hypertension, and diabetes.
- Encourage the patient to care for themselves and perform activities of daily living (ADLs).
- Encourage cognitive exercises such as reading, writing, solving puzzles, and using a computer, to aid cognitive functioning.