3. Hygiene
The Need for Better Hand Hygiene
• In Canada, healthcare associated infections (HCAI's) affect
more than 220,000 people every year and kill 8,000 – 12,000.1
• Hand hygiene, a very simple action, remains the primary
means to reduce HCAI's and the spread of antimicrobial
resistant organisms.
• HCAI's lead to long-term disability, preventable deaths, and
additional financial burden on the healthcare system.2
• Compliance by healthcare workers with optimal hand
hygiene is considered to be less than 40%.3
• Global research indicates that improvements in hand
hygiene activities could potentially reduce HCAI rates by up
to 50%

4. When should hand hygiene be performed?
In health care, hand hygiene is required:
Before and after contact with any patient/resident, their
body substances or items contaminated by them
Between different procedures on the same patient/resident
Before and after performing invasive procedures
Before preparing, handling, serving or eating food or feeding
a patient/resident
After assisting patients/residents with personal care (e.g.
assisting patient to blow nose, toileting or doing wound care)
Before putting on and after taking off gloves
After performing personal functions (e.g. using the
toilet, blowing your nose)
When hands come into contact with
secretions, excretions, blood and body fluids (use soap and
running water whenever hands are visibly soiled)

5. FALLS AND INJURIES
The Nursing best practice guidelines on the CNO and RNAO
websites includes falls and injuries as one of the issues that
needs active awareness and proper education.
On the Safer Health Care Now website they have a Reducing
Falls and Injuries from Falls Getting Started Kit . This kit
explains why Fall prevention awareness is so important.

6. According to the Canadian Institute for Health Information, falls were
the cause of 57% of all injury-related hospitalizations, and more than
three quarters of all in-hospital deaths in those admitted for an
injury.
• Among Canadians age 65 or older, most injury hospitalizations
followed a fall (77% for males, and 88% for females).
• Falls are also the second leading cause of both head and spinal
cord injuries (35% and 37%, respectively).
• The majority of specific fall-related hospitalizations for head
injuries were falls on or from stairs or steps
(25%), slipping, tripping or stumbling (17%) and falls from one level
to another (11%).
• Ninety percent of all hip fractures in seniors are the result of a
fall, and 20% of those suffering such an injury die within a year of
the fracture.
• Families are often unable to provide care, and
• 40% of all nursing home admissions occur as a result of falls by
older people.

7. Falls and injury from falls have a significant impact on the
individual, organizations providing health care services and
the health care system overall.
A PERSON CENTERED APPROACH TO CARE CAN
REDUCE THE RISKS OF FALLS
Biological and medical risk factors
Behavioural risk factors
Environmental risk factors
Social and Economic risk factors

8. Low beds, bed alarms, an emphasis on understanding
patient agitation and behavior, and other non-restraint
interventions introduced at an inpatient geriatric
psychiatry ward reduced the number of falls by close
to 60%,
- according to Ben Inventor, C.N.P., of Rush Medical
Center in Chicago, and colleagues.

9. This is not just an issue for psychiatry units.
There are many in-patients that are high risk
because of environmental factors or because of
symptoms associated with
stroke, dementia, medications, motor skill
deficiencies and mental deficiencies.

10. Helping families, health care providers and patients realize
ALL the factors that contribute to falls will lead to safer care
and support for patients during and after their stay.
Teaching family members or the patients support network to
perform health and safety inspections of their environment
will lead to greater awareness for everyone and help reduce
preventable injuries

11. Many dementia and stroke patients cannot communicate
verbally what they are feeling. Sensations like pain, needing
to use the bathroom, being hungry, being scared are
expressed behaviorally.
This can lead to greater risk of injury to patients and staff.
This can also be true for someone who has a language
barrier.

12. The Canadian Falls Prevention Curriculum notes
that the most effective falls prevention
interventions use a multifactorial approach
targeting selected individuals or groups of older
persons based on their risk profiles.
Taking into account the best evidence and
research, the Curriculum presents a comprehensive
falls prevention model, BEEEACH, incorporating
the following categories:
.

13. B.E.E.E.A.C.H
Behaviour change--a common goal of all strategies
Education--of program participants
Equipment--appropriate use of mobility aids and
assistive devices
Environment--in the home and public places
Activity--physical and social
Clothing and footwear--appropriate for risk
reduction
Health management--including medication
reviews, vision tests, bone health, healthy nutrition
and hydration and chronic disease management

14. Patient Centered care leads to a safer work environment.
Ben Inventor and his colleagues at the Rush Medical Center in Illinois
conducted a study that showed patient centered care can significantly
reduce the amount of falls on a unit.
http://www.medpagetoday.com/MeetingCoverage/DCC/10664)
They conducted a study on a geriatric psychiatric unit where most
patients also had other complex medical issues which led to elevated risk
for falls.
The study was to see if changing the approach of care to one that was
called “Person-centered care” would reduce falls and injuries.
This method of care requires “A deeper understanding and appreciation
for why a person behaves the way he does”

15. Over the course of about two years, the team beefed up
standard fall prevention to include the following:
-Soothing lighting and background music.
-Low beds with bed alarms and soft floor mats on either side of
the bed.
-A six-bed intense monitoring area without other furniture for
patients with a higher risk of falls or under physical restraint due
to medical or behavioral reasons.
-Reconfiguration of staffing to provide a full-time night shift
monitor for the intense monitoring area.
-Cushy chairs (Carefoam) that cradled patients in a reclining
position that both decreased restlessness and made it difficult
to rise without assistance.
-Medication review with modification of psychotropic drugs as
needed.

16. This combination of approaches reduced the number of falls to an average of 6.7 per
month in the unit by the end of the two-year period in February 2007. (prior to this
program the high average was 18 falls per months.)
The frequency has since dropped to an average 4.5 falls per month, said Patrick
O'Brien, R.N., also of Rush and a co-author on the study.
The interventions were unable to eliminate falls entirely, particularly among patients
who were subject to multiple falls, which chart review showed was frequently in
association with agitation, unsteady gait, and attempts to move around without
assistance.
Once the foam chairs were introduced, these frequent fallers did not fall on
subsequent hospitalizations, which resulted in a dramatic drop in the unit's overall
fall rate.
The intense monitoring rooms also were consistently associated with lower fall rates
than regular rooms over time.
But no single intervention accounted for all the benefit, Inventor said. "Therefore, we
recommend ... an interdisciplinary approach tailored to each individual need."

17. Some Ideas for Health and Safety Awareness
FALLS AND INJURIES
Life size snakes and ladder type game on First Aid.- I made
several of these for a young women’s camp that I direct for a
week in the summer. The 190 young women ages 12-18 had fun
moving around the life size game board and answering trivia
questions about first aid and emergency situations. The person
slides down bandaids instead of snakes and climb up either
thermometers, stethescopes or other items instead of ladders.
There are challenge squares where the player has to splint and
sling a person’s arm or show how to treat shock or something
else related to home injuries.
Could work with “operation”,
“Life” style games,

18. Jeopardy type game on home safety- A game designed to help develop awareness
on safety and wellness. Different health and safety categories Have departments
challenge each other and have finals after a few weeks of challenges. Secure a
grand prize for the champion at the end. This gives an opportunity to raise
awareness over months
Health and Safety Trivia game in cafeteria ( on tv screens or trivia cubes “Think
Outside the Box” (trivia facts on Health and Safety on the outside of the box. Show
ways everyone can be active in community wellness)
Fortune Cookie- Give or sell Health and Safety Fortune cookies. Put a health and
safety tip on fortunes as a fun way to raise awareness.

19. Health and Safety awareness design contest. Lots of the
staff, volunteers, patients and visitors at William Osler are very
talented and looking for a reason to show off those talents. Let
them make posters, video submissions, safety songs or other
talents to raise “Wellness and health and safety issues”
.

20. Power point movies created on Health and Safety issues such as Hygiene, fall
prevention, pandemics, etc. to be shown in cafeterias or on Osler net. Have a department
challenge to see who can make the best Health and Safety video. With points for
creativity, knowledge, involvement of unit members and overall best video. Have a “premier
night” and then have the videos on the website. Have a grand prize for the winning department
of Lunch.
“Health and Safety No Joke” Comedy and open mike night. Allow staff and their families
perform their talents, in between acts there will be a power point movie clip or slide on a
safety issue. The MC will tell a joke involving a situation and then goes into the clip on the
safety issue. Could even raise funds for campaign.
Health and Safety blog with tips on safety issues, a forum for staff to share stories and a way
to open even more communication about Health and Safety Issues.
This can include preventative health and wellness issues, work safety, mental and physical
wellbeing, etc.
Health and Safety trivia facts placed on posters in bathroom stalls and on elevators.
Health and Safety flyers and trivia game pages left in common areas and for patient and their
families or handed out to staff. This could also be done with email or a website with
games, facts and tips for Health and Safety both at home and at work.

21. Units should have a portable dvd player with screen so that
patients that are at high risk for falls or bed ridden can still
access patient education videos and could even view .jpg
images of test results when consulting on their care with
physicians. It would also be a method to let patients listen to
music to calm them or lift their spirits.

22. Many prevention practices are in place to protect hospitalized
seniors from falls including educational activities for nursing
and support staff, patient orientation activities, reviews of
prior falls, and modifications to the environment.
Environmental modifications include reducing ward or room
obstacles, adding extra lighting and grab bars in bathrooms,
and lowering bedrails and bed height. Other approaches
address transfer and mobility issues with scheduled
ambulatory and physical therapy activities and attention to
footwear (e.g., non-skid socks).
In addition, hospitals have incorporated strategies to assist
cognitively impaired patients by: educating family members to
deal with confused patients; minimizing sedating medications;
and moving confused patients closer to nursing staff

24. Follow the Minimal Lift Policy so that you work smartly
and safely.
Use another health care worker or a mechanical lift when
needed

26. Since Health Care is such a demanding field it is
Vital to take care of your Joints, muscles, bones,
And entire body.
Proper exercise, nutrition, Stress management and
Other healthy choices can Make the difference

27. Workplace Violence and Harassment
The Ontario Hospital Association’s Health and Safety
bulletin stated
“The prevention of workplace violence and harassment is
not about doing the work safely but rather, it is about
working with each other in an environment of respect and
tolerance. This extends beyond the workplace and considers
the individual’s work-life conditions.”
There are many ways that to help create a more aware and
respectful work place. Education helps everyone realize
how they can make a difference in the environment and
lives of those around them.

28. People are more accepting of each
other and work together more
effectively when they can relate to the
other person. Finding similarities in
each other’s stories and learning of
the struggles that make a person who
they are is a way of breaking down
barriers and creating bonds that may
have never been discovered.

29. When it is co-workers that are causing work
stress it can be an almost overwhelming prospect
for victims to face each day. Research and studies
have shown that workplace bullies and abuse are
a very prevalent issue in hospitals. It can lead to
lack of productivity, absenteeism, stress illnesses
and employees leaving their jobs.
Workshops and awareness campaigns can help
employers work through these situations.

30. Some studies suggest that approximately 50% of the work force have experienced or
Witnessed bullying

32. The Be One Workshop
The workshop is designed for
anywhere from 40 to 100 individuals.
It can be done in smaller groups but
is most effective in an environment
where more employees have
participated.
It will begin with everyone
participating in some “get to know
you” improvisational exercises. This
will hopefully help everyone feel more
comfortable with the group and to
just have fun while “de-stressing” so
that they can more easily open up
and get the most out of the day

33. CHANGE- BE ONE
The participants then break up into small groups
of five. The groups will then complete a “I wish
that people understood about me….”
Participants are asked to write their obituary. To
think of what they want their legacy to be. If you
could share one thing about yourself to the world
what would it be…

34. ”Your greatest fear…” exercise:
Have health care provider participants to close their eyes and
picture their loved one in the hospital, or being a patient
headed for surgery in a hospital…think of the fear you would
face….think of the stress of that scenario….
What would make that better for you? How would staff help
comfort you? Now add not being able to see clearly
anymore, not hearing clearly, not understanding the language
or being able to communicate back…Imagine all of a sudden
needing someone to do everything for you..and not being able
to communicate anything in return that is comprehended by
others. How does that feel? Are you scared?

35. (Each member of the group will have the chance to
experience this through foggy glasses, ear plugs, being
“stuck” in a chair with Velcro, being challenged to
communicate without words.) They will be given
instructions in another language and having stimuli to
create confusion around them…
Think of how a patient feels…

36. Everyone has a story and you can be a bright chapter of it…

37. Be ONE…Every person around you is in need of something
…a comfort- be One, a laugh- be one, a listening ear- Be
One, Compassionate care- Be One.
The world is in need of heroes who will stand up and make
a difference- Be One.
Each participant is then given the opportunity to share how
they intend to “Be One” in their lives and with their “Calling
To Care”.
These health care professionals then take what they
learned and implement it on their unit through example.

38. Health & Safety Slogans
Your good health is your greatest wealth
Even in a hi-tech world, your eyes are still your greatest asse
"You must be the change you wish to see in the world." - Mahatma Gandhi
The door to Safety swings on the hinges of common sense.
Safety is success by purpose - Not Accident.
Safety awareness saves lives.
Check your shoes and don't let your day slip away.
Be aware Take care
Safety begins with No. 1
Safety begins with teamwork
Work smarter not harder
We need you - work safely
Safety starts with S but begins with you
The door to safety swings on the hinges of common sense
Safety is a state of mind - Accidents are an abscence of mind
A wound neglected is a wound infected
Normal speed meets every need
Stop accidents before they stop you
Look sharp don't get cut
Before you start be safety smart
Safety is a full time job - don't make it a part time practice