THE UNIVERSITY OF THE WEST INDIES FACULTY OF MEDICAL SCIENCES THE UWI SCHOOL OF NURSING, MONA BACHELOR OF SCIENCE IN NURSING ACADEMIC YEAR 2013/2014 YEAR 3 SEMESTER 1 COURSE OUTLINE COURSE TITLE COURSE CODE DURATION CREDITS CO-REQUISITE : : : : : PATIENT AND HEALTH CARE WORKER SAFETY NURS 75 Hours 3 (2 Theory, 1 Lab) Microbiology COURSE DESCRIPTION This theory and clinical practice course provides the student with key concepts and principles of infection prevention and control, injection safety, and blood safety, which are fundamental to safe nursing practice. LEARNING OUTCOMES At the end of the course, the student will be able to: 1. Review the epidemiology of disease transmission; 2. Demonstrate knowledge of the spread of organisms in health care settings; 3. Apply concepts of microbiology to infection prevention and control; 4. Analyze factors that influence the outcome of an exposure; 5. Demonstrate knowledge of the main components of infection prevention and control; 6. Understand the policies and guidelines of infection prevention and control; 7. Explain the benefits to patients and health care workers of adhering to scientifically accepted principles and practices of infection prevention and control; 8. Explain the nurse’s responsibility for monitoring compliance of infection prevention and control practices of those for whom she/he is responsible; 9. Recognize strategies for preventing transmission of pathogenic organisms; 10. Describe circumstances requiring use of personal protective equipment and other barriers to prevent patient or health care worker contact with potentially infectious material; 11. Describe specific practices and settings that increase the opportunity for exposure to health care workers and patients. 12. Understand occupational control measures and their hierarchy; 13. Demonstrate knowledge of the application of these controls measures and hierarchy in the prevention and management of exposures; 14. Recognize occupational health strategies for preventing bloodborne diseases and other communicable diseases in health care workers. UNIT 1 Hours : : MAJOR COMPONENTS OF INFECTION PREVENTION & CONTROL 5 Theory 5 Practical Specific Objectives At the end of the unit, the student will be able to: 1. Review the modes and mechanisms of transmission of pathogenic organisms in the health care setting; 2. Define major concepts of infection prevention and control; 3. List the main components of infection prevention and control; 4. Discuss each component listed above; 5. Identify specific barriers or personal protective equipment for patient and healthcare worker protection from exposure of potentially infectious material; 6. Discuss the importance of the correct application of reprocessing methods for assuring the safety and integrity of patient care equipment; 7. Discuss the creation and maintenance of a safe environment for patient care through application of infection prevention and control policies and guidelines. Content 1. Review of modes & mechanisms of transmission of pathogenic organisms in the health care settings 2. Definition of terms Asepsis Medical asepsis Surgical asepsis Aseptic technique Isolation Reverse isolation Barrier Barrier nursing Nosocomial infection Bloodborne pathogens/disease Universal precautions Standard Precautions Basic precautions Transmission-based precautions Air-borne precautions Droplet precautions Contact precautions Personal protective equipment (PPE) 3. Main components of infection prevention & control Isolation Standard Precautions Transmission-based Precautions Disinfection & Sterilization Housekeeping Health Care Waste Management Risk Management UNIT 2 Hours : : MANAGEMENT OF INFECTION PREVENTION & CONTROL 10 Theory 20 Practical Specific Objectives At the end of the unit, the student will be able to: 1. Discuss levels of responsibility for infection prevention and control; 2. Identify the individual’s professional responsibility for maintaining a safe patient care environment; 3. Discuss the quality assurance framework for infection prevention and control; 4. Outline the use of occupational controls to reduce the opportunity for patient and health care worker contact with potentially infectious material for bloodborne pathogens. Content 1. Levels of responsibility Ministry of Health Parish District Health care facility Community Individual Health professionals educational institutions Regulatory Bodies Professional Associations 2. Quality assurance framework Infection prevention & control policies Roles & responsibilities of 3. Occupational control measures & hierarchies Elimination of hazards Work practice controls Administrative controls Engineering controls Personal protective equipment. UNIT 3 Hours : : INJECTION SAFETY 5 Theory 15 Practical Specific Objectives At the end of the unit, the student will be able to: 1. Define the term injection safety; 2. Explain the World Health Organization/Safe Injection Global Network (WHO/SIGN) strategies for injection safety; 3. Identify the nine ‘rights’ of injection safety; 4. Discuss ‘best’ practices for injection safety; 5. Discuss adverse events associated with injections; 6. Discuss the role of the provider, administrator, and receiver of injections; 7. Discuss the role of the community in injection safety; 8. Discuss the management process for health care workers with needlestick and other sharps injuries. Content 1. Definition of term injection safety 2. WHO/Safe Injection Global Network (SIGN) safe injection strategies Behaviour change of patient & health care workers Availability of essential supplies & equipment Appropriate & safe waste disposal 3. Nine ‘rights’ of injection safety Right patient Right drug Right formulation Right injection equipment Right dosage Right time Right route Right storage Right method of disposal 4. ‘Best’ practice Definition Associated activities 5. Adverse events Definition Types Management 6. Roles & responsibilities of Prescriber of injections Provider/administrator of injections Receiver of injections Community 7. Needlestick& other sharps injuries Definition Post-exposure prophylaxis (PEP) management. UNIT 4 Hours : : BLOOD SAFETY 10 Theory 5 Practical Specific Objectives At the end of the unit, the student will be able to: 1. Define blood transfusion related terms; 2. Describe the various blood products, uses & storage; 3. Explain the ‘rights’ of blood transfusion; 4. Explain the hospital standard operation procedures for the blood transfusion process; 5. Discuss the respective roles and responsibilities of clinical and blood bank staff in ensuring the safety and availability of blood products for transfusion; 6. Discuss the hospital procedure for ordering, collection, storage, transportation and administration of blood products, and for monitoring the transfused patient; 7. Identify the reactions and infections resulting from blood transfusion; 8. Discuss the management of blood transfusion reactions. Content 1. Definition Blood products Rhesus factor ABO groups ABO blood groups antigens & antibodies Compatibility Incompatibility Blood cold chain 2. Blood & blood products uses & storage conditions Types Uses Storage 3. ‘Rights’ of blood transfusion ‘Right’ blood ‘Right’ patient ‘Right’ time ‘Right’ environment 4. Hospital standard procedures (SOP) for blood transfusion process Ordering blood & blood products for elective surgery Ordering blood & blood products in an emergency Completing blood request form Taking pre-transfusion sample Collecting blood & blood products from blood bank Storing & transporting blood &blood products including storage in clinical area Identity checks Administering blood &blood products including final patient identity check Recording transfusion in patient records Monitoring process for transfused patient ter starting transfusion Monitoring information At each stage, record the following Record 5. Roles & responsibilities of clinical & blood bank staff in blood safety & availability 6. Hospital procedure for ordering, collection, storage, transportation & administration of blood products,& for monitoring the transfused patient 7. Reactions of blood transfusion a. Acute complications Category 1: Mild reactions Moderate–severe hypersensitivity (severe urticarial reactions) Category 2: Moderately severe reactions Febrile non-haemolytic reactions: Possible bacterial contamination (early signs) Pyrogens Category 3: Life threatening reactions Acute intravascular haemolysis Bacterial contamination & septic shock Fluid overload Anaphylactic reactions Transfusion-associated lung injury b. Delayed complications Categories i. Transfusion-transmitted infections HIV-1 &HIV-2 HTLV-I & II Viral hepatitis B & C Syphilis Chagas disease Malaria Cytomegalovirus Other rare infections: e.g. human parvovirus B19 & hepatitis A ii. Other delayed complications of transfusion Delayed haemolytic reaction Post-transfusion purpura Graft vs. host disease Iron overload (in patients who receive repeated transfusions) 8. Infections resulting from blood transfusion Screening Infections -Jakob disease (CJD) 9. Management & investigations of blood transfusion reactions according to category Signs & symptoms Investigation Prevention Management Recording Reporting. Teaching/Learning Methodologies Lecture/Discussion PowerPoint presentation Demonstration Case study Video presentations Role plays Areas used for Learning Classroom Library Clinical Learning Centre (Nursing Skills Laboratory) Clinical areas Learning Experiences Visits to clinical areas to observe injection safety Visits to Blood Bank to observe blood collection and storage process Required Skills 1. Hand hygiene 2. Standard Precautions COURSE ASSESSMENT IN COURSE ASSESSMENT 40% A. GROUP PROJECT AND INDIVIDUAL REFLECTIVE PAPER 20% This is a written assignment that is due for submission by week 7. B. MID SEMESTER EXAMINATION 20% This consist of a thirty items multiple choice examination to be administered under strict examination conditions during week 8. FINAL EXAMINATION 60% This will be a one hundred items multiple choice examination. Required Reading International Labour Organization (ILO). (2005). Joint ILO/WHO guidelines on health services and HIV/AIDS. Geneva: Author. Reid, Una V. (2008). Manual of infection prevention and control policies and guidelines. Port of Spain, Trinidad & Tobago: Author. Available on the Internet. WHO/AFRO/JSI/ Reid, Una V.: (2005). DO NO HARM: Injection safety in the context of infection prevention and control. Facilitators’ guide. Washington, DC: Author. WHO/Una V. Reid (2008). WHO best practices for injections and related procedures toolkit. Geneva: Author. Recommended Reading Berman, A., Synder, S., Kozier, B. &Erb, G. (2008). Fundamentals of nursing: Concepts, process and practice. (8the.d.). New Jersey: Pearson Prentice Hall. WHO.(2011). Patient safety curriculum guide.Multi-professional edition. Retrieved from http://whqlibdoc.who.int/publications/2011/9789241501958_eng.pdf WHO websites on Blood Safety, Injection Safety, Infection Prevention & Control CDC websites: topic related.