Appendix 1: Glossary

Glossary

• 2 x 2: Small, commonly used gauze pad measuring 2 inches by 2 inches, or approximately 5 cm x 5 cm.
• 4 x 4: Medium size, commonly used gauze pad measuring 4 inches by 4 inches, or approximately 10 cm x 10 cm.
• Absorption atelectasis: A form of lung collapse that occurs when high concentrations of oxygen displace nitrogen in the alveoli and, as a result, reduce alveolar volume.
• Additional precautions: Practices in addition to routine practices for certain pathogens or clinical presentations. These precautions are based on the type of transmission, such as contact, droplet, or airborne.
• Adverse reaction (also known as adverse event): An undesirable effect of any health product such as prescription and non-prescription pharmaceuticals, vaccines, serums, and blood-derived products, cells, tissues, and organs; disinfectants; and radiopharmaceuticals. An adverse reaction may occur under normal use and conditions of the product.
• Air embolism: The presence of air in the vascular system that occurs when air is introduced into the venous system and travels to the right ventricle and/or pulmonary circulation.
• Airborne precautions: Precautions used in addition to routine practices for patients with known or suspected illness that is transmitted by the airborne route.
• Alcohol-based hand rub (ABHR): A liquid, foam, or gel formation of an alcohol-based solution used to reduce the number of microorganisms on the hands when the hands are not visibly soiled. A form of hand hygiene.
• Ambulation: Moving from one place to another.
• Ampule: A glass container that holds a single dose of medication in liquid form in 1 ml to 10 ml sizes.
• Antibiotic-resistant organisms (ARO): Microorganisms that have developed resistance to the action of various antibiotic agents. Common AROs are MRSA and VRE.
• Arterial blood gas (ABG): Analysis of an arterial blood sample to evaluate the adequacy of ventilation, oxygen delivery to the tissues, and acid-base balance status.
• Asepsis: The absence of infectious material (microorganisms) or infection.
• Aspiration: The action of pulling back on the plunger of a syringe for 5 to 10 seconds prior to injecting medication.
• Assistive device: An object or piece of equipment designed to help a patient with activities of daily living, such as a walker, cane, gait belt, or mechanical lifts.
• Base of support: The space between the feet that bears the weight of the body, and the centre of gravity that falls within the base of support.
• Blood or body fluid (BBF) exposure: A splash or puncture exposing you to another person’s blood, urine, feces, vomit, or secretions.
• Body alignment: The optimal placement of the body parts, working with the pull of gravity to contribute to body balance. Without this balance, the risk of falls and injuries increases.
• Body balance: A state of equilibrium achieved by creating a wide base of support, the space between the feet that bears the weight of the body, and the centre of gravity that falls within the base of support.
• Body mechanics: The coordinated effort of muscles, bones, and the nervous system to maintain balance, posture, and alignment during moving, transferring, and positioning patients.
• British Columbia Patient Safety and Learning System (BCPSLS): A web-based tool used to report and learn about safety events, near misses, and hazards in health care settings.
• C & S swab: Swab for culture and sensitivity blood test to determine if a bacterial infection is present in the blood.
• Capillary refill: The process whereby blood returns to a portion of the capillary system after its blood supply has been interrupted briefly. For example, depress the nail edge to cause blanching and then release. Colour should return to the nail instantly or in less than three seconds. If it takes longer than three seconds, this suggests decreased peripheral perfusion and may indicate cardiovascular or respiratory dysfunction.
• Catheter embolism: Occurs when a small part of the cannula breaks off and flows into the vascular system.
• Catheter-related blood stream infection (CR-BSI): An infection caused by microorganisms that are introduced into the blood through the puncture site, the hub of the needle, or contaminated IV tubing or IV solution, leading to bacteremia or sepsis.
• Catheter-related thrombosis (CRT): The development of a blood clot related to long-term use of CVCs. Mostly occurs in the upper extremities and can lead to further complications such as pulmonary embolism, post thrombotic syndrome, and vascular compromise.
• Central venous catheter (CVC) (also known as central line or central venous access device): An intravenous catheter that is inserted into a large vein in the central circulation system, where the tip of the catheter terminates in the superior vena cava (SVC).
• Centre of gravity: The point at which the mass of a body or object is centred when weight on all sides is equal.
• Cerebral vascular accident (CVA): Also known as a stroke, a CVA is the interruption of blood flow to the brain (i.e., an ischemic stroke) or the rupture of a blood vessel (i.e., a hemorrhagic stroke) causing brain cells in the affected area to die. This event usually results in the loss of some brain function.
• Chain of infection: The transmission of microorganisms and subsequent infections is often referred to as the chain of infection. This infectious process can be thought of as a circular chain with six links that represent the specific circumstances needed for the infectious process to occur.
• Chest tube: A sterile tube with a number of drainage holes that is inserted into the pleural space. Also known as a thoracic catheter.
• Chest tube drainage system: A sterile, disposable system that consists of a compartment system that has a one-way valve, with one or multiple chambers, to remove air or fluid and prevent return of the air or fluid back into the patient.
• Clean technique: See medical asepsis.
• Clostridium difficile infection (CDI): Infection caused by a bacterium that causes mild to severe intestinal problems and diarrhea. It is the most frequent cause of diarrhea in the hospital setting.
• Clubbing: A description of nails, usually presenting in the early stages as being straightened out to 180 degrees, with the nail base feeling spongy. Clubbing occurs with heart disease, emphysema, and chronic bronchitis.
• Cohorting: Placing patients with the same infections in the same room if a private room is not available.
• Colloid solutions: Solutions made up of large molecules that cannot pass through semi-permeable membranes and are used to expand intravascular volume by drawing fluid from extravascular space via high osmotic pressure. Examples include albumin, dextrans, and hydroxyethyl starches.
• Colostomy: The creation of a stoma from part of the colon (large bowel), where the intestine is brought through the abdominal wall and attached to the skin, diverting normal intestinal fecal matter through the stoma instead of the anus.
• Contact precautions: Precautions used in addition to routine practice for patients who are known or suspected to be infected with microorganisms that can be transferred by the direct or indirect contact route.
• Continent ileostomy: Made from part of the ileum and is flushed a number of times each day to clean out the effluent.
• Continent urinary reservoir: Where a pouch is created from part of the intestine, and a catheter is inserted a number of times during the day to remove the urine.
• Continuous intravenous infusion: The infusion of a parenteral drug over several hours (continuous drip) to days. It involves adding medication to sterile IV solution (100-1,000 ml bag) and hanging the IV solution as a primary infusion.
• Crystalloids solutions: Solutions made up of solutes such as electrolytes or dextrose that are easily mixed and dissolvable in solution. Crystalloids contain small molecules that flow easily across semi-permeable membranes, which allows for transfer from the bloodstream into the cells and tissues.
• CWMS: An initialism used to remember “colour, warmth, movement, sensation of extremities.”
• Cyanosis: A bluish, mottled discoloration that signifies decreased perfusion and indicates that the tissues are not being adequately oxygenated.
• D50W: Fifty-percent dextrose in water.
• D5W: Five-percent dextrose in water.
• Dacron cuff: An antimicrobial cuff surrounding a tunnelled CVC near the entry site, which is coated in antimicrobial solution to help prevent infection and holds the CVC in place.
• Deep venous thrombosis (DVT): The formation of a blood clot within a deep vein, predominantly in the legs.
• Droplet precautions: Precautions used in addition to routine practices for patients who are known or suspected to be infected with microorganisms that are spread by large droplets.
• Effluent: The output from the stoma (urine, feces, or mucous).
• Extension tubing: Short, 20 cm, flexible sterile tube with a positive fluid displacement/positive pressure cap attached to the hub of the peripheral cannula.
• Extravasation: When vesicant solutions (medication) are administered and inadvertently leaked into surrounding tissue, causing damage to surrounding tissue.
• Fowler’s position: The patient’s head of bed is placed at a 45-degree angle. Hips may or may not be flexed. Common position to provide patient comfort and care.
• Fraction of inspired oxygen (FiO₂): Fraction or percentage of oxygen being measured. Natural air includes 20.9% oxygen, which is equivalent to FiO2 of 0.21.
• Gait belt or Transfer belt: A two-inch-wide (5 mm) belt, with or without handles, that is placed around a patient’s waist and fastened with Velcro. A transfer belt can be used with patients who are a one-person pivot transfer, a two-person pivot transfer, or a transfer with a slider board.
• Gauge of a needle: The diameter of the needle.
• Gestational diabetes: A form of diabetes that develops in women during pregnancy and disappears after delivery. Gestational diabetes affects about 4% of all pregnancies and increases the risk of developing Type 2 diabetes.
• Hand hygiene: A general term used to describe any action of hand cleaning. It refers to the removal of soil and oil, and the killing or removal of transient microorganisms from the hands. Hand hygiene may be accomplished using an alcohol-based hand rub or soap and water. Surgical hand scrub is also a method of hand hygiene.
• Hand hygiene with soap and water: Hand hygiene using friction, soap, and water to remove microorganisms from hands.
• Health care associated infection (HAI): An infection that develops as a result of contact with a pathogen in the health care setting or from a health care worker, that was not present at the time of admission. Also known as a nosocomial infection.
• High alert medications: Medications that are most likely to cause significant harm, even when used as intended. Mistakes may or may not be more common with high alert medications, but the harm to patients is more serious.
• Hypertonic solution: An IV solution that has a higher osmolality than plasma (serum), with an osmolality greater than 375 mOsm/L.
• Hypotonic solution: A solution that has an osmolality of less than 25 mOsm/L, a lower osmolality than intravascular space.
• Hypoxemia: A condition where arterial oxygen tension or partial pressure of oxygen (PaO₂) is below normal (<80 mmHg).
• Hypoxia: The reduction of oxygen supply at the tissue level, which is not measured directly by a laboratory value but by pulse oximetry and SpO₂.
• Hypoxic drive: A condition found in some patients with a chronically high level of PaCO₂, such as those with chronic obstructive pulmonary disease (COPD), where the stimulus and drive to breathe is caused by a decrease in PaO₂, not by an increase of CO₂.
• Ileal conduit: See urostomy.
• Ileoanal ostomy: A pouch created above the anal sphincter and is also created from a portion of the ileum.
• Ileostomy: Created from the ileum (small bowel), which is brought through the abdominal wall and used to create a stoma.
• Implanted central venous catheter (ICVC): A CVC inserted into a vessel, body cavity, or organ and attached to a reservoir or “port” located under the skin. The device may be placed in the chest, abdomen, or inner aspect of the forearms. Also known as an implanted venous access device (IVAD), port a catheter, or port a cath.
• Infection prevention and control (IPAC) practices: Evidence-based procedures and practices that, when used consistently in a health care setting, can prevent and reduce disease transmission, eliminate sources of potential infections, and prevent the transfer of pathogens from one person to another.
• Infiltration: When non-vesicant solutions (IV solutions) are inadvertently administered into surrounding tissue.
• Injection pens: A new technology used by patients to self-inject insulin using a syringe, needle, and pre-filled cartridge of insulin.
• Intradermal (ID) injection: An injection that places the medication into the dermis, just under the epidermis.
• Intramuscular (IM) injection: An injection that places the medication into the body of a muscle.
• Intravenous (IV) injection: An injection that places the medication/solution into a vein through an existing IV line or a short venous access device (saline lock). Medications given by the intravenous route can be given as an IV bolus, as an intermittent (piggyback) medication, or in a large-volume continuous infusion.
• Intravenous therapy: Treatment that infuses intravenous solutions, medications, blood, or blood products directly into a vein.
• Isotonic solution: A solution in which the concentration of the dissolved particles is similar to that of plasma, with an osmolality of 250 to 375 mOsm/L.
• Keloid formation: A firm scar-like mass of tissue that occurs at the wound site. The scarring tends to extend past the wound and is darker in appearance.
• Kussmaul respiration: Deep, rapid, and laboured breathing that is characteristic of patients with acidosis (excess acidity of tissues).
• Lateral position: The patient lies on the side of the body with the top leg over the bottom leg. This position helps relieve pressure on the coccyx.
• Latex allergy: A reaction to latex products made from natural rubber in which people become allergic (or sensitive) to the proteins found in natural rubber.
• Line of gravity: The vertical line extending from the centre of gravity to the base of support, down the centre of the body. If the line of gravity moves outside the base of support, the amount of energy required to maintain equilibrium is increased.
• Lumen: A small, hollow channel within the CVC tube.
• Mechanical lift: A hydraulic lift, usually attached to a ceiling, used to move patients who cannot bear weight, who are unpredictable or unreliable, or who have a medical condition that does not allow them to stand or assist with moving.
• Medical asepsis (also known as clean technique): Includes procedures used for reducing the number of microorganisms and preventing their spread.
• Medication incident: Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer.
• Methicillin-resistant Staphylococcus aureus (MRSA): A strain of Staphylococcus aureus that is resistant to beta-lactam classes of antibiotics such as penicillin, cloxacillin, and cephalosporin.
• Musculoskeletal injury (MSI): An injury or disorder of the muscles, tendons, ligaments, joints or nerves, blood vessels, or related soft tissue including a sprain, strain, or inflammation related to a work injury.
• Nasogastric (NG) tube: A flexible plastic tube inserted through the nostrils, down the nasopharynx, and into the stomach or the upper portion of the small intestine.
• Needles: Hollow cylindrical objects, made of stainless steel, with a sharp point used to inject medications into or draw fluids from the body. Needles are made up of the hub, shaft, and bevel.
• No-Interruption Zone (NIZ): A place where health care providers can prepare medications without interruptions.
• Nosocomial infection: See health care associated infection (HAI).
• Obturator: A small plastic device used as a guide during tracheostomy tube insertion.
• Oral suctioning: The use of a rigid, plastic suction catheter, known as a yankauer, to remove pharyngeal secretions through the mouth.
• Orthopneic or tripod position: The patient sits at the side of the bed with head resting on an over-bed table on top of several pillows. This position is used for patients with breathing difficulties.
• Orthostatic hypotension: A form of low blood pressure that occurs when changing position from lying down to sitting, making the patient feel dizzy, faint, or lightheaded.
• Ostomy: A surgically created opening from the urinary tract or intestines, where effluent (fecal matter, urine, or mucous) is rerouted to the outside of the body using an artificially created opening called a stoma.
• Oxygen therapy: Treatment to provide oxygen according to target saturation rates (as per physician orders or hospital protocol) in order to achieve normal or near normal oxygenation saturation levels for acute and chronically ill patients.
• Oxygen toxicity: A condition caused by excessive or inappropriate supplemental oxygen, which can lead to severe damage to the lungs — ranging from mild tracheobronchitis to diffuse alveolar damage — and other organ systems.
• Parenteral medications: Refers to the path by which the medication comes in contact with the body. Medications that enter the body by the parenteral route enter the tissue and circulatory system by injection.
• PaCO₂: The partial pressure of carbon dioxide in the arterial blood, which is measured by using a PaCO₂ analyzer.
• Percutaneous central venous catheter: A CVC inserted directly through the skin into the internal or external jugular, subclavian, or femoral vein. The tip of the catheter is located in the superior vena cava (SVC).
• Peripheral IV (PIV): A short intravenous catheter inserted by percutaneous venipuncture into a peripheral vein.
• Peripherally inserted central catheter (PICC): A central line inserted through the antecubital fossa or upper arm (basilic or cephalic vein) and threaded the full length until the tip reaches the superior vena cava (SVC).
• Personal protective equipment (PPE): Clothing or equipment worn to protect against hazards.
• Phlebitis: The inflammation of the vein’s inner lining, the tunica intima.
• Pinch-off syndrome: An internal pinching of a central line between the first rib and clavicle; can contribute to a mechanical occlusion of a CVC.
• Port a catheter/port a cath: See implanted central venous catheter (ICVC).
• Primary infusion tubing/administration set: A thin, flexible plastic sterile tubing used to infuse IV therapy.
• Primary intention: A type of wound healing where the wound edges are sutured or stapled closed, and the wound heals quickly with minimal tissue loss. Examples of wounds healing by primary intention are simple surgical wounds that heal without complications.
• p.r.n.: From the Latin pro re nata and means “as needed.”
• Prone position: When the patient lies on the stomach with the head turned to the side.
• Pulmonary edema (also known as circulatory overload or fluid overload): A condition caused by excess fluid accumulation in the lungs, due to excessive fluid in the circulatory system.
• Refeeding syndrome: Caused by rapid refeeding after a period of under-nutrition, leads to metabolic and hormonal changes characterized by electrolyte shifts (decreased phosphate, magnesium, and potassium in serum levels), which may lead to widespread cellular dysfunction.
• Routine practices: A system of prevention and control practices recommended by the Public Agency of Canada to be used for all patients/residents/clients during all care to prevent and control all transmission of microorganisms in all health care settings.
• Saline lock (also known as heparin lock): A peripheral intravenous cannula with extension tubing attached to the hub, usually inserted in the arm or hand.
• Secondary intention: A type of wound healing where the wound is left open to heal by scar formation. Healing is slow, which places the patient at risk for infection, there is a loss of skin, and granulation tissue fills the area left open. Examples of wounds healing by secondary intention include severe lacerations or massive surgical interventions.
• Secondary tubing administration set: Flexible, sterile tubing used to hang a secondary IV medication, which connects to an access port on the primary IV tubing.
• Semi-Fowler’s position: The patient’s head of bed is placed at a 30-degree angle. This position is used for patients who have cardiac or respiratory conditions, and for patients with a nasogastric tube.
• Sims position: Patient lies between supine and prone with legs flexed in front of the patient. Arms should be comfortably placed beside the patient, not underneath.
• Slider board or Transfer board: Board used to transfer immobile patients from one surface to another surface while the patient lies supine. The board allows health care providers to move immobile, bariatric, or complex patients in a safe manner.
• Speed shock: A systemic reaction caused by the rapid injection of a medication into the circulatory system, resulting in toxic levels of medication in the plasma.
• Sterile asepsis: See sterile technique.
• Sterile field: A sterile surface on which to place sterile equipment that is considered free from microorganisms.
• Sterile gloves: Gloves that are free from all microorganisms; required for contact with any invasive procedure and when contact with any sterile site, tissue, or body cavity is expected.
• Sterile technique (also known as sterile asepsis): A set of specific practices and procedures performed to make equipment and areas free from all microorganisms and to maintain that sterility.
• Stoma: See ostomy.
• Subcutaneous (SC) injection: An injection that places medication/solution into the loose connective tissues just under the dermis.
• Supine position: In this position, patients lie flat on their back. Additional supportive devices may be added for comfort.
• Surgical asepsis: The absence of all microorganisms within any type of invasive procedure.
  
• Surgical hand scrub: An antiseptic surgical scrub or antiseptic hand rub performed prior to donning surgical attire.
• Surgical site infection (SSI): An infection that occurs after surgery in the area of surgery.
• Syringe: A sterile, single-use device with a Luer lock or non-Luer lock tip, which influences the name of the syringe. Syringes come in various sizes from 0.5 ml to 60 ml.
• Tertiary intention: A type of wound healing where the wound closing is intentionally delayed. On occasion, wounds are left open (covered by a sterile dressing) to allow an infection or inflammation to subside. Once the wound is closed with staples or sutures, the scarring is minimal.
• Total parenteral nutrition (TPN): The infusion of nutrients, including amino acids, vitamins, electrolytes, dextrose, fat, and trace elements. It is most commonly administered through a central venous catheter.
• Transfers: Moving a patient from one flat surface to another, such as from a bed to a stretcher.
• Transfusion medical services (TMS): Blood bank.
• Trendelenburg position: A position that places the head of the bed lower than the feet. Used in situations such as hypotension and medical emergencies. Helps promote venous return to major organs such as the head and heart.
• Tunnelled central venous catheter: A long-term CVC with a proximal end tunnelled subcutaneously from the insertion site and brought out through the skin at an exit site. It is a surgical procedure, where the catheter is tunnelled subcutaneously under the skin in the chest area before it enters the superior vena cava (SVC).
• Type 1 diabetes: A condition that usually develops in childhood or adolescence, and used to be called juvenile-onset diabetes. It occurs when the beta cells of the pancreas are destroyed by the immune system and no longer produce insulin, or produce very little insulin.
• Type 2 diabetes: A condition that used to be called non-insulin-dependent diabetes or adult-onset diabetes. With Type 2 diabetes, the body does not make enough insulin or does not respond well to the insulin it makes.
• Urostomy or ileal conduit: A stoma created using a piece of the intestine to divert urine to the outside of the body.
• Vancomycin-resistant Enterococci (VRE): Strains of Enterococcus faecium or Enterococcus faecalis that are resistant to antibiotics. A type of ARO.
• Vertigo: A sensation of dizziness.
• Vial: A single- or multi-dose plastic container with a rubber seal top, covered by a metal or plastic cap.
• Volume-controlled intermittent set: A small device attached below the primary infusion to regulate the mini bag. The medication is added to a small amount of IV solution and administered through an IV line.
• Workaround: A process that bypasses a procedure, policy, or problem in a system. For example, nurses may “borrow” a medication from another patient while waiting for an order to be filled by the pharmacy.
• Wound dehiscence: A mechanical failure of wound healing; remains a problem and can be affected by multiple factors.
• Z-Track method: A method of administrating an intramuscular injection that prevents the tracking of the medication through the subcutaneous tissue and seals the medication in the muscle, minimizing irritation from the medication.