Principles of Body Mechanics

Key Concepts of Body Mechanics

• Factors contributing to injuries over time are poor body mechanics, life stresses, posture, flexibility, and physical fitness.
• Injuries can be prevented by using proper body mechanics, staying physically fit, using mechanical assist devices like lifts and carts, and asking for help when needed.

Terminology

• Body alignment refers to the positioning of joints, tendons, ligaments, and muscles in different body postures.
• Body balance is achieved when the center of gravity is balanced over a stable base of support.
• Posture describes the position of the body in relation to its environment.
• Mobility refers to the ability to move freely and control body movements.
• Immobility is the inability to move or change positions independently.
• Weight is the force exerted by gravity on a body.
• Friction is a force opposing movement.
• Anatomical position is defined as the body standing erect with arms at the sides and palms facing forward.
• Kyphosis is an abnormal curvature in the thoracic spine, like slouched shoulders.
• Lordosis is an exaggerated lumbar spine curvature.
• Scoliosis is a lateral deviation of the vertebral column.

Body Mechanics Principles

• A base of support is the portion of the body in contact with the floor where a wider base increases stability.
• The center of gravity is located in the mid-portion of the pelvis or lower abdomen.
• The line of gravity is an imaginary vertical line through the center of gravity, providing the most stability when it bisects the base of support.

Rules for Good Body Mechanics

• Maintain a broad base of support by positioning feet 8-10 inches apart with one foot slightly forward.
• Bend at the hips and knees while keeping the back straight to get closer to an object.
• Use the strongest muscles, such as those in the shoulders, upper arms, hips, and thighs.
• Use body weight to push, pull, or slide objects instead of lifting.
• Carry objects close to the body.
• Avoid twisting by turning the body and feet together.
• Avoid prolonged bending.
• Get help with heavy loads.

Sitting and Computer Work

• Proper sitting involves keeping hips, knees, and ankles at 90 degrees, elbows at 90-120 degrees, wrists in a neutral position, and feet flat.
• Computer setup should include a screen at eye level, avoiding slumping, and taking breaks every 60 minutes.

Standing

• Adjust work to a height that keeps it close to you.
• Use comfortable shoes and anti-fatigue mats.
• Avoid standing too long, bending forward, or locking knees.

Pushing, Pulling, or Lifting

• When pushing, keep the head up, knees bent, and back straight.
• Avoid twisting or leaning forward when pulling.
• When lifting, use the legs, not the back, and keep items close to the body.

Reaching

• Keep your back straight, use both hands, and bend your knees slightly.
• Use a stable step stool for high objects.

Patient Movement or Transfer

• Ensure the patient's condition is assessed, and the team is ready with proper equipment.
• Use techniques such as transfer belts, slide boards, and lifts while pivoting feet and avoiding waist twisting.
• Ensure safety by locking wheels, adjusting bed height, and getting assistance for heavy patients.

Complications of Improper Body Mechanics

• Musculoskeletal injuries
• Pressure sores
• Contractures
• Muscle fatigue
• Orthostatic hypotension
• Decreased metabolic rate

Ergonomics

• Ergonomics involves the science of designing equipment to fit human body movements.

Procedures for Moving, Lifting, and Positioning Patients

• Positioning is adjusted to relieve pressure, promote mobility, and meet therapeutic needs.
• Use assistive equipment such as transfer belts, slide boards, wheelchairs, stretchers, and hydraulic lifts.
• Techniques include maintaining good body alignment, using the strongest muscles, keeping the patient close to the body, and sliding or rolling instead of lifting.

Types of Positions

• Supine (dorsal): Lying on the back.
• Prone: Lying flat on the abdomen.
• Lateral: Side-lying.
• Sims: Side-lying with one arm behind the back used for rectal/vaginal exams.
• Fowler’s: Head raised 45-60 degrees, often for eating or breathing.
• Semi-Fowler’s: Head raised 30 degrees.
• Trendelenburg’s: Bed tilted with the head down for postural drainage.
• Reverse Trendelenburg’s: Bed tilted with feet down.
• Knee-chest: Patient kneels with chest on bed, often for rectal exams.
• Dorsal recumbent: Lying on the back with knees flexed for pelvic exams.

After Care

• Ensure patient comfort and proper alignment.
• Check for discomfort or skin issues.
• Monitor vital signs after changing position.
• Assist patient to prevent falls.

General Instructions for Moving and Lifting Patients

• Keep the patient close to the body to prevent strain.
• Flex knees and maintain proper alignment.
• Use mechanical lifts and assistive devices when needed.
• Coordinate team movements with clear instructions.
• Monitor the patient’s condition and comfort.

Infection Control & Standard Precautions in Health Care

• Infection control involves understanding standard precautions, how infections spread, and identifying key elements of standard precautions.

Key Terminologies

• Infection is the invasion of body tissues by microorganisms and their proliferation.
• Asepsis is the absence of disease-producing microorganisms.
• Sepsis is the presence of infection in the body.
• Septicemia is the spread of infection or its products throughout the body via blood.
• Medical asepsis, or "clean technique," includes practices that reduce the number and transfer of pathogens.
• Surgical asepsis, or "sterile technique," includes practices that keep objects and areas free from microorganisms.
• A carrier is a person or animal harboring pathogens without symptoms.
• A reservoir is the natural habitat for microorganism growth and multiplication.
• A pathogen is a disease-producing microorganism.

Modes of Transmission

• Contact transmission occurs through direct person-to-person transfer, such as bathing or dressing changes, or indirect transmission via contaminated objects like needles or surgical instruments.
• Droplet transmission is spread via coughing, sneezing, or talking within 3 feet.
• Vehicle transmission is the transfer via contaminated items like food, water, or medical equipment.
• Airborne transmission involves pathogens suspended in the air for long periods, dispersed by air currents.
• Vectorborne transmission involves transmission via animals (biological vectors) or contaminated objects (mechanical vectors).

How Infections Spread

• The source is infectious agents (viruses, bacteria, microbes) from people, healthcare workers (HCWs), and the environment (e.g., bed rails, medical devices).
• Transmission occurs through contact, sprays/splashes, droplets, inhalation, or sharp injuries.
• A susceptible person is someone who is not immune or has a weakened immune system.

Standard Precautions

• Standard precautions reduce the risk of pathogen transmission and should be applied in all healthcare settings, for all patients.

Key Elements of Infection Control

• Hand hygiene includes washing for 40-60 seconds and rubbing for 20-30 seconds, essential before and after patient contact, after glove removal, handling invasive devices, and exposure to bodily fluids.
• Use gloves when handling blood, body fluids, secretions, excretions, mucous membranes, or non-intact skin, and change between tasks.
• Facial protection involves using masks and eye protection when performing tasks that may generate splashes or sprays of bodily fluids.
• Wear a gown during procedures likely to generate splashes or sprays and remove it immediately if soiled, and then perform hand hygiene.
• Use proper handling, cleaning, and disposal techniques to avoid needlestick injuries.
• Cover the mouth/nose when sneezing/coughing, dispose of tissues and masks, and perform hand hygiene for respiratory hygiene and cough etiquette.
• Environmental cleaning involves the regular cleaning and disinfection of surfaces and equipment.
• Linens should prevent exposure and contamination of clothing to prevent pathogen transfer.
• Dispose of clinical waste contaminated with blood, body fluids, secretions, or excretions safely during waste disposal.
• Patient care equipment should be cleaned, disinfected, and reprocessed before using it with another patient.

Things to Remember

• Promote a safety climate by encouraging a culture of safety to prevent pathogen transmission.
• Conduct a risk assessment to assess healthcare activities to determine appropriate personal protective equipment (PPE).
• Implement source control by promoting respiratory hygiene/cough etiquette for those with respiratory symptoms.
• Always apply standard precautions as the minimum level of precautions universally.

Hand Washing Review

• Asepsis is the state of being free from disease-causing contaminants and preventing contact with microorganisms.
• Hand washing is cleansing hands with water and soap to remove soil or microorganisms to prevent cross-contamination and minimize nosocomial infections.

Purpose of Hand Washing

• Prevent cross-infection in the hospital environment.
• Remove dirt and soil from hands.
• Reduce the risk of hands acting as carriers of disease.
• Break the chain of infection spread.
• Prevent hospital-acquired infections.
• Control infections and ensure patient safety, comfort, and well-being.

Five Moments for Hand Hygiene (WHO)

• Before patient care.
• After environmental contact.
• After exposure to blood/body fluids.
• Before performing any procedure.
• After patient care.

Types of Taps

• Elbow tap
• Foot tap
• Sensor tap

Types of Hand Washing

• Medical hand washing
• Surgical hand washing

Required Equipment

• Antimicrobial soap (liquid or bar)
• Warm running water
• Paper or cloth towels (sterile)
• Fingernail brush/nail cleaner

Before Washing Hands

• Cut nails.
• Avoid nail polish.
• Remove rings, wristwatches, bangles, and threads.

Medical Hand Washing Procedure (40-60 seconds)

• Preparation, Washing, Rinsing and drying
• Wet hands with tepid running water.
• Apply enough soap to cover all surfaces.
• Rub palms together, then rub back of each hand with opposite palm (fingers interlaced).
• Interlace fingers and rub.
• Rub back of fingers to opposing palms (fingers interlocked).
• Rub each thumb clasped in opposite hand (rotational movement).
• Rub tips of fingers in opposite palm (circular motion).
• Rub each wrist with opposite hand.
• Rinse hands thoroughly.
• Turn off tap with elbow.
• Dry hands with single-use towel.

Surgical Hand Washing

• Surgical hand washing removes transient organisms and reduces resident flora of surgical team.
• Surgical hand washing is required for surgeries to ensure no contamination if a glove is punctured or torn.

Gloving Review

• Gloves are garments to cover the hands, with separate sheaths for each finger/thumb.

When to Wear Gloves

• Wear gloves when risk of contact with body fluids like blood, mucous membranes, or non-intact skin.
• Wear gloves during invasive procedures, such as inserting an IV.
• Wear gloves when handling contaminated items, such as waste or surfaces.

Limited Glove Supplies

• Gloves can be reprocessed by soaking in 0.5% chlorine for 10 minutes, then washing, rinsing, and sterilizing via autoclaving or high-level disinfection.

Types of Gloves

• Surgical gloves are for invasive medical/surgical procedures.
• Examination gloves are for routine activities such as basic patient exams.
• Utility gloves are for processing instruments, handling waste, or cleaning surfaces.

Types of Gloves Based on Composition

• Vinyl gloves are made of PVC, latex-free, and are least expensive with limited elasticity.
• Nitrile gloves are made from synthetic latex, puncture-resistant, and preferred for latex allergies.
• Latex gloves are made from natural rubber latex and provide the best protection.

Latex Allergy

• Latex allergy is an allergic reaction to the protein in rubber from tropical rubber trees, ranging from sneezing to anaphylactic shock.
• Symptoms are itchy/red/watery eyes, sneezing/runny nose, coughing and/or rash and chest tightness or shortness of breath.
• Relief involves using non-latex gloves or glove liners and proper hand care.

Glove Requirements for Clinical Procedures

• Gloves required for injection, blood drawing, IV insertion, pelvic exams, vaginal delivery, Cesarean section, and handling/cleaning instruments, contaminated waste, or body fluid spills.
• Gloves NOT required for blood pressure or temperature checks

Accidental Contamination of Sterile Gloves

• Tearing or puncturing the glove.
• Touching non-sterile objects.
• Touching the outside of a glove with ungloved hands.

Gloves: Do's

• Wash hands/use antiseptic hand rub before/after wearing gloves.
• Wear correctly sized gloves to prevent tears and ensure better functionality.
• Change surgical gloves periodically during long cases.
• Trim fingernails short to reduce the risk of glove tears.
• Use water-soluble hand lotions to prevent hands from drying.

Gloves: Don'ts

• Avoid oil-based hand lotions that can damage latex gloves.
• Avoid highly fragrant or perfumed lotions that can irritate skin.
• Avoid storing gloves in areas with extreme temperatures.

Donning and Removing Sterile Gloves (Open Method)

• Assess for latex allergy and assemble all supplies.
• Ensure the package is intact and the gloves' sterility before use.
• Wash hands before wearing gloves.
• Place the sterile glove package on a clean, dry surface, avoid touching inner part of package.
• Hold folded cuff of dominant hand glove, touching only inside of cuff.
• Keep your thumb against the palm to avoid contamination as you insert your hand.
• Use the sterile-gloved hand to pick up the second glove, holding the cuff.
• Adjust gloves for proper fit, ensure proper fit and adjust cuffs.
• If gloves are soiled, remove them by turning them inside out.
• Dispose of used gloves properly and document sterile technique.