Safety is positively related to health promotion, disease prevention, accident prevention, injuries, and the cost of health care services. Excellent nursing care begins with safety, a basic need and priority for all. Several factors affect client safety, such as age, lifestyle, sensory and perceptual alterations, mobility, and emotional state. Children and teenagers are increasingly at risk for injuries as they explore their environments. Adult risks are usually related to lifestyle and behavior and older adults are prone to falls.

Sensory function is necessary for accurate perception of the environment. Clients who have impaired mobility, from poor balance or coordination, muscle weakness, or paralysis, are also at increased risk for injuries from falls. Emotional states, such as depression and anger, affect the person’s perception of hazards and degree of risk-taking. Safety incidents in the health care setting are categorized by their cause: client behavior, such as accidental poisoning or burns or self-inflicted cuts and bruises; therapeutic procedure incidents, occurring during the process of care; or equipment incidents, resulting from malfunctions of medical incidents.

Safety incidents can affect health care workers as well as clients. An example is injury from latex allergy. To that end, the National Institute for Occupational Safety and Health (NIOSH) suggests that employers provide workers with nonlatex gloves, keep the environment free of latex-containing dust, provide education programs about latex allergies, and screen workers for latex allergy.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires compliance with its guidelines for the “Environment of Care” necessary for organizational safety. Both JCAHO and the Occupational Safety and Health Administration (OSHA) monitor health care worker safety. In addition to latex allergies, other occupational hazards for health care workers are exposure to disease; exposure to chemicals, lasers, ionizing radiation, and noise; psychosocial stressors, such as overtime or the threat of workplace violence or terrorism, and musculoskeletal disorders caused by ergonomic stressors.

The routes of exposure for chemical and biological hazards are through inhalation, skin absorption, ingestion, and injection. The Material Safety Data Sheet (MSDS) provides information about the health effects of various chemicals, such as corrosives, which erode the skin on contact; carcinogens, which cause cancer; teratogens, which damage the developing fetus; target organ chemicals, which provide stress on a particular organ; and sensitizers, which generate allergy symptoms (such as latex sensitivity).

The protective measures used to prevent injuries are substitution, engineering controls, administrative controls, and personal protective equipment. Substitution means replacing a particular substance with a less hazardous alternative. Engineering controls are strategies that eliminate or minimize the hazard exposure. Administrative controls are strategies that minimize hazard exposure by altering work practices. Examples of administrative controls are policies and procedures that prescribe handwashing techniques and prohibit the use of artificial fingernails. Personal protective equipment includes a variety of clothing and equipment (such as respirators and goggles) used as a barrier between the hazard and the employees. Other personal protective equipment includes surgical masks to prevent transmission of droplets (droplet precautions) or gloves to prevent the transmission of pathogens by personal contact (contact precautions).

Combinations of protective measures are used to ensure safety. For example, standard precautions may include gloves and masks plus the procedures prescribed administratively to reduce the risk of transmission of microorganisms. Transmission-based precautions are specific to certain routes of transmissions, such as precautions against airborne-transmitted pathogens.

Employee safety programs prevent disease and injuries in employees and clients by preventing accidents and injuries, chemical incidents, and the transmission of disease. Some safety efforts are directed entirely to clients, such as assistance with hygiene (the science of health). Hygienic practices depend upon a client’s body image, social and cultural practices, personal preferences, socioeconomic status, and knowledge.

To assess a client’s risk for injury, infection, or a self-care deficit, the nurse performs a health history, including such items as need for assistance with bathing and dressing, use of dental floss, health habits, nutrition, and so on. Risk for falls in inpatient clients can be assessed with a fall-risk appraisal tool. The physical examination includes an assessment of the client’s level of consciousness, range of motion and ability to mobilize, or signs of infection, because deficits in any of these areas could lead to accidents, injury, or infection. Laboratory tests can indicate infection or vulnerability to infection.

The physical environment for both hospitalized and home health care clients should be assessed for hazards and corrective action taken. The nursing diagnoses that are appropriate to safety concerns for clients include Risk for Injury and Risk for Infection. The nursing diagnoses that are appropriate to hygiene concerns include Bathing/Hygiene Self-Care Deficit, Dressing/Grooming Self-Care Deficit, and Toileting Self-Care Deficit. Subcategories of Risk for Injury include Risk for Suffocation, Risk for Poisoning, Risk for Trauma, Risk for Aspiration, Risk for Disuse Syndrome, and Latex Allergy Response. Planning for clients at risk of for injury or infection or a self-care deficit involves establishing goals and expected outcomes with the client. Nursing intervention generally involves identifying clients at risk, teaching clients good hygiene and accident prevention, and assisting clients with hygiene and toileting. The final stage of the nursing process is evaluation, based on whether goals and expected outcomes are met.

Hygiene is important to prevent infection. The types of cleaning baths, provided as routine client care, are shower, tub, self-help (assisted) bed bath, complete bed bath, and partial bath. Therapeutic baths require a physician’s order, stating the type of bath, temperature of water, body surface to be treated, and the type of medicated solutions to use, such as oatmeal, cornstarch, or sodium bicarbonate. A therapeutic bath may be used for skin conditions, to reduce muscle spasms or soreness, to relieve tension, or to lower body area. Sitz baths cleanse and reduce inflammation in the perineal and anal areas. Additionally, skin care (cleansing and conditioning) is used to prevent pressure areas and increase comfort. Back rubs and massages can be used in addition to skin care to improve the circulation, relax muscles, and relieve muscle tension. Perineal care is the cleansing of the external genitalia, perineum, and surrounding area to prevent or eliminate infection and odor, promote healing, remove secretions, and provide comfort. The nurse also gives or assists clients with foot and nail care; oral care; hair care; and eye, ear, and nose care.

The common bathroom hazards related to hygiene are falls, scalds, burns, and poisonings. These risks can be reduced with grab bars, nonslip mats and rugs, checking the temperature of bath or shower water, and storing medications in a locked cabinet. The risk for falls is reduced by supervising clients at risk, having the call bell handy, providing ambulatory aids, placing personal belongings near the client, keeping hospital beds in the lowest position, using nonslip mats and rugs, removing obstacles, and providing sufficient lighting. The use of bed rails remains controversial. Though people have been injured by bed rails, they provide a grasp for repositioning in bed and they provide comfort for some. Other hazards for institutional or home clients are fires, electrical shock, exposure to radiation, poisoning, sensory overload, and noise pollution.

The use of restraints (protective devices used to limit the physical activity of a client or to immobilize a client or extremity) remains controversial because of client injuries from restraints. Both federal and JCAHO regulations require compliance with new restraint standards. These standards require the nurse to document the application and care of the client in restraints and to follow state law for using restraints. Typically, the policies and procedures for restraint use should be clearly stated, geared to providing the least restrictive measure, based on an assessment of client needs, initiated on physician orders, applied and maintained by qualified staff, monitored at least every 2 hours, reviewed every 2 hours, and fully documented.

The two types of restraints are physical restraints (jacket, belt, hand, elbow, limb, or mummy) and chemical restraints (medications). Nurses change and release restraints frequently, using a clove hitch knot; avoid using restraints that interfere with treatment or aggravate a health problem; provide enough slack on straps; assess the restrained limb(s) every 2 hours for circulation or neurological problems; and provide psychological support to the client to reduce the possibility of restraint injuries.