Promotion of Safety and Infection Control
Everyday safety
Most injuries in long-term care are preventable. For fall risk: bed low and locked, call light within reach, non-skid footwear, clear path, prompt answers to call lights, and scheduled toileting. Never leave a resident unattended in a bathtub or on a toilet. Restraints, physical or chemical, require a physician's order and alternatives must be tried first; a restraint is never punishment or convenience. Fire response uses RACE (Rescue, Alarm, Contain, Extinguish or Evacuate) and PASS for extinguishers. With oxygen: no smoking, no petroleum products, tanks secured upright. Incident reports are factual, completed for any unusual event, and never used to assign blame.
Breaking the chain of infection
Chain of infection: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host. Hand hygiene breaks the chain better than anything else: before and after every resident contact, before donning and after removing gloves, and after touching body fluids or equipment. Alcohol-based rub is acceptable for routine care except with C. difficile or norovirus, which require soap and water because spores survive alcohol. When donning PPE: gown, mask, goggles, then gloves. When removing: gloves, goggles, gown, then mask, with hand hygiene last. Standard precautions apply to every resident; transmission-based precautions add Contact (C. diff, MRSA), Droplet (influenza), or Airborne (tuberculosis, requiring an N95).
Traps to watch
'Gloves replace handwashing' is false. 'Wear gloves for all contact with every resident' is false - gloves are for anticipated exposure. 'Alcohol rub is fine after caring for a resident with C. diff' is false. Rule of thumb: if you touched it, or might touch it, wash your hands.