TAKING CARE OF PATIENT'S UNIT
Patient's Unit
It means a room or cubicle (accommodating one or more, i.e. 4 to 6 patients depending upon its capacity) having attached toilet and bathroom or a ward (accommodating 20 to 40 patients) having common toilet and bathroom where the patient is kept during his/her stay in the hospital for the purpose of treatment and care.
Purposes
- To keep the unit clean, tidy and attractive.
- To keep all breeding places especially corners and ledges free from micro-organisms.
- To maintain esthetic sense.
Supplies
The following supplies should be made available to the concerned workers for the care of following:
Unit
- Broom.
- Large dusters—two.
- Buckets—two.
- Soap/any other floor detergent and water.
- Vacuum cleaner.
- Stain remover, abrasive and wax, if needed.
Furniture
- Carbolic solution in a basin.
- Duster—1.
- Soap and water, if needed.
Toilets
- Detergent, brush and water.
- Spot removing agent, i.e. hydrochloric acid, if required.
Vermin and Insects
- Boiling water.
- Insecticides and fumigation supplies if needed.
Guidelines
- The patient's unit and equipment should be kept clean, tidy and attractive and in functioning condition. This responsibility is vested with the head nurse or delegated to the housekeeper managing the housekeeping department.
- Although the sweeping, mopping and cleaning activities have to be performed by the workers meant for them but the head nurse if made responsible, may need to supervise these activities.
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- Clean and dust before the ward routine starts.
- Collect all the cleansing equipment before hand.
- Sweep before making beds.
- Dust after sweeping with a clean and damp duster as under:
- From above downward and high place to low place
- With firm and even strokes
- In such a way as to prevent the dust flying from place to place
- All the places paying special attention to all the corners and ledges with the least disturbance of the patient.
- When cleaning, consider the following points:
- Make use of soap and water as soap emulsifies the fat and lowers the surface tension of water and the water acts as good solvent.
- Make use of abrasives, brushes and other friction methods for mechanical cleaning.
- Remove the stains immediately with a stain remover if necessary, wash off the stain remover with clean water and dry immediately.
- Select the simple but suitable method for cleaning and sterilizing the suitable equipment.
- Clean, dry and arrange all the cleansing material which is in functioning condition before replacing in store, so that it can be easily located when required.
- Discard the cleansing material which is not in functioning condition as per hospital policy.
- Follow the frequency of cleaning as under:
- Daily
- Sweep and mop the floors twice a day and dust the unit once a day
- Remove, clean, dry and replace the toilet accessories in the toilet cabinet
- Keep the locker neat and tidy and it should contain only the equipment needed for the patient
- Place the furniture in order
- Empty the bins two times or more as necessary.
- Weekly
- Dust the walls, windows, doors, roof and ceiling fans
- Wash and carbolize the furniture
- Wash floors thoroughly
- Clean and tidy the lockers and cupboards
- Get the repairs and replacements done, if any.
- Annually
- Get the white wash, paint and polish done
- Get the repairs and replacements done.
- The flies, mosquitoes, bedbugs, cockroaches and rats are dangerous carriers of disease and therefore, all available measures should be used to prevent and control them.
Method of Care
The concerned workers should involve as follows:
Unit
- Sweep and mop the floors at least twice a day.
- Use two buckets of water, one is to wash out the duster while first wiping and the other to rinse the duster for second wiping of the floor. Make use of vacuum cleaner.
- Polish the marble floors with wax if necessary to keep them glazing.
- Keep the unit well-ventilated and do not close the top ventilating windows unless there is storm or heavy wind.
- Dust the walls and roof from time to time in order to remove cobwebs.
- Clean the cement, tile and marble walls in the same way as floors. White wash the white washed walls. Rinse and dry the painted walls.
- Clean the windows and doors regularly.
Furniture
It may be made of wood, iron, steel or plastic. The common furniture used in the patient's unit is as under:
- Bedsteads
- Remove dust every day while making the bed.
- Carbolize or wash with soap and water or any other detergent and dry well after the discharge of the patient.
- Lockers
- Avoid leaving unwanted food, dirty glasses and papers, etc. on the lockers.
- Arrange and dust every morning and evening when tiding the ward.
- Clean in the manner as bedsteads.
- Bed-cradles, back-rests and over bed tables Treat as bedsteads.
- Chairs and stoolsTreat as bedsteads.
- Cupboards
- Keep clean and tidy.
- Line the shelves with paper.
- Arrange the supplies after drying absolutely.
- Use naphthalene balls to protect the moths in the cupboards.
E.g. Iron furniture is cleaned with a dry duster to prevent rusting.
Toilets
- Bathing rooms
- Scrub and wash the floors everyday.
- Avoid stagnation of water on the floors.
- Dispose of the hair, small bits of cotton and dressing material in proper dust bins as these may block the drainage system.
- Lavatories
- See that the flushing system is in working order.
- Avoid throwing things like bits of cotton, pads and dressings into them as these may block them.
- Make the arragement, when there is no water.
- Clean them with cleaning powder using a brush.
- Pay special attention to the drains.
- Pour boiling water or phenyl down them everyday.
- Remove the spots which cannot be easily removed with fine sand mixed with cleaning powder or washing soda. Use hydrochloric acid, harpic or saunifres to remove the spots which are very hard to remove otherwise.
- Scrub and wash the floors daily.
- Teach the patients and relatives regarding the proper use of lavatory.
- Washbasins
- Clean them twice a day with cleaning powder using a brush.
- Remove the spots with some spot removing agent mentioned above.
- Avoid throwing bits of cotton, dressings, food particles and other wastage into them and provide a waste bucket nearby for the purpose.
- Cabinet for sanitary wares
- Keep the racks clean, neat and tidy.
- Store the sanitary wares in racks neat and tidy and ready for use.
Vermin and Insects
- Clean the patient's unit regularly and thoroughly.
- Eliminate all the breeding places.
- Keep garbage well covered and dispose of all refuse as soon as possible.
- Store food properly.
- Use fly screens on windows and doors.
- Use boiling water, insecticides and fumigation as necessary.
Cleansing Material
These are soap, vim, washing soda, many other detergents, rags, abrasives, brushes, brooms and the liquids used for cleaning purposes. Harpic, sanifresh and hydrochloric acid are used to remove the stains in the lavatories, wash basins, etc.
- Use the cleansing material with utmost economy. Avoid leaving the soap lying in water. Use vim, washing soda and other cleansing material with care. Wash and dry rags, abrasives, brushes and brooms. Avoid keeping brooms standing on their heads as it spoils the bristles. Use sanifresh and acids only when other methods fail to remove stains.
- Properly arrange all the cleansing material when stored so that it can be conveniently located when required.
TAKING CARE OF PATIENT'S EQUIPMENT
Patient's Equipment
It means various types of articles which are used for (and by) the patient during his/her stay in the hospital for carrying out his/her treatment and care such has bedding, linen, rubber, plastic enamel, steel and glass articles and dressing material.
Purposes
- To keep the equipment ready for use at all times.
- To prolong the durability of the equipment.
Supplies
Bedding and Linen
Refer procedure “Making Beds”.
Rubber and Plasticwares
- Running water.
- Soapy solution in a basin.
- Disinfectant solution in a basin.
- Applicator and powder.
Hardwares
- Soap.
- Brush.
- Disinfectant solution in a basin/tub.
Perishable Articles
- Newspaper, soap/glass detergent as needed.
- Dry duster and rag.
- Turpentine/kerosene oil/alcohol/ether, if needed.
Dressing Material
Surgical dressing material as needed.
Cleansing Material
None
Inventory and Stores
Guidelines
- The mattresses and pillows may be made of foam, coir or dunlop.
- Sheets, drawsheets, covers (mattress, pillow, blanket and quilt), counterpans, towels, shirts and pyjamas may be made of cotton material which is easily washable, from the linen. See that:
- The sheets are long and wide enough for the type of bed used.
- The drawsheets are slightly thicker, more absorbent and made of warmer cotton material than the bedsheets.
- The covers are long enough to cover the mattresses, pillows, blankets and quilts.
- Every care is taken for these articles and these are used only for the purpose for which these are intended.
- Cupboard used for storing the rubber and plastic goods should be provided with holes at the sides to ensure a steady current of air circulating into all these goods.
- Avoid the use of heat, acids, alkalies, other chemicals, abrasives and brushes on the equipment to which these are harmful.
- Remove the stains immediately with a stain remover if necessary, wash off the stain remover with the clean water and dry.
- Select the simple but suitable method for cleaning and sterilizing the suitable equipment.
Nursing Activity
Take care of equipment as under.
Bedding and Linen
- Mattresses
- Provide even and comfortable mattresses.
- Dust daily with damp duster.
- Cover with cotton covers.
- Brush or wash and disinfect or sterilize according to the type of mattress.
- Lay a canvas sheet or beddari on the bed under the mattress.
- PillowsFollow the above steps except the last one.
- Blankets
- Protect by using a cotton sheet next to the patient and a counterpane on the top of the blankets or cotton covers.
- Avoid frequent washing, as these get deteriorated very quickly.
- Wash yearly or when have been used by an infectious patient.
- When not in use, wrap in plastic envelopes or put in a cupboard preferably of tin lined.
- Put some naphthalene balls in between the layers of blankets to protect from moths.
- Quilts
- Protect by using cotton covers.
- Further care is the same as for blankets.
- Linen
- Change frequently and do not allow to become more dirty.
- Carefully check, when received from laundry and mend before using again.
- Count when sending to the laundry and on receiving from the laundry.
- Carefully check the linen missing.
- Remove the dirty and soiled linen from the unit immediately.
- Place the soiled linen in a tub containing disinfectant solution.
- Immediately attend the soiled and stained linen.
Rubber and Plasticwares
-
- Straighten the tubes.
- Thoroughly flush the used tube under running water holding the eye upwards and allowing the water to run through it.
- Flush with soapy solution if grease or oil has been used.
- Use applicator if necessary to clear ‘eye’.
- Wrap in a clean cloth, boil each one separately for 5 minutes, dry by hanging on a hook under shade, powder and store. All these measures help to preserve the texture of the tube material.
- Send feeding tubes and catheters for autoclaving if facilities are available, otherwise reboil for five minutes before using again.
- Ice caps, collars, air-rings and hot water bottles:
- When not in use, wash with mild soapy solution, rinse and hang upside down to drain.
- Fill in little air when dried to prevent the two surfaces coming in contact.
- Place stopper tightly and store.
- Report if any cracks are seen.
- Gloves
- Store new gloves in their original envelopes, taking care to avoid any kinking of the gloves placed inside them.
- Thoroughly wash the used gloves both inside and outside, check punctures by filling air or water, wrap in cloth, boil for five minutes if required for immediate use in the ward.
- For surgical purposes, dry, powder with chalk or talcum, both inside and outside, then put together in pairs in a wrapper and send for autoclaving.
- Sheets
- Soak soiled sheets in cold water containing some disinfectant, then wash with soapy solution, rinse and hang on a rail in shade in order to dry them.
- When not in use, powder, roll, never fold and store.
- Bedpans and urine pots
- Do not throw cotton sponges, wipette, rags, applicators and sanitary pads into the bedpan. If thrown by mistake, remove before emptying the bedpan.
- Carry the bedpan after use to the sluice room.
- Measure the contents, if necessary with measuring container kept in the sluice room.
- Empty bedpan into the lavatory pan, rinse with cold water under force.
- Clean with soap or detergent using a brush, rinse thoroughly, dry and replace in bedpan rack kept in the toilet cabinet.
- Disinfect or sterilize the bedpans at least once in a week by soaking in a solution, e.g. lysol 1:40 for one hour or carbolic or phenol 1:40 for two hours.
- Treat the urine pots in the same manner.
Hardwares
- Enamel wares
- Sputum mugs and kidney trays
- Empty and treat as bedpans
- Render the infectious contents such as sputum of tuberculosis patient harm less by boiling or using chemicals before emptying or dispose of by burning
- Others
- These are basins, mugs, buckets, tubs, trays, jugs and others
- Clean with vim after use, rinse, dry and replace
- Never scrape with anything sharp.
- Bedpans and urine pots
- Refer point 5 above
- The enamel bedpans and urine pots can also be disinfected or sterilized by placing in a mixture of washing soda and boiling water, bedpan sterilizer or sun.
- Steel wares
- ArticlesClean with soap or detergent, rinse and dry completely ensuring no water marks on them to prevent rusting when stored.
- Instruments
- Open them, place in a deep basin containing cold water and rinse thoroughly to remove organic material. Do not use hot water as it coagulates the organic matter and tends to make it stick to the instruments.
- Scrub those with serrations and lock using a brush, wash in a hot mild soapy or any steel detergent solution, rinse and dry. Soap or detergent has an emulsifying action, reduces surface tension to facilitate the removal of dirt and rinsing helps to remove the dirt away.
- Do not handle unnecessarily.
- Place heavy instruments at the bottom of the tray and the light and delicate at the top.
- Carefully clean the sharp instruments such as knives and scissors, avoiding contact with hard surface. If knives have detachable blades, remove and attach with the help of special forceps when it is to be used.
- Sterilize by autoclaving or boiling and sharp instruments by chemicals.
- Use each instrument for the purpose it is meant specifically and avoid its rough use.
- Dustbins
- Use three bins, each covered with a lid, one for left over food, other one for things like egg shells, tins, tea leaves, skin of fruits, etc. and the third one for dirty dressing material.
- Clean with soap or detergent and warm water, disinfect and dry after emptying.
- Put the refuse into an incinerator or bury it.
- Teach the patient and relatives regarding the purpose and the use of dustbins.
Perishable Wares
- Glass wares
- Mirrors, windows and door panes
- Clean regularly.
- Wash with soap or detergent or any glass detergent, rinse and dry with a clean dry duster or with dry old newspaper which is used wet at first and then dry one.
- Very dirty panes with paint adhering, are cleaned with a rag dipped in turpentine, kerosene oil, alcohol or ether. This also prevents flies settling on the windows.
- Thermometers—see guidelines points 12 and 13 on .
- Syringes and needles—The glass syringes are nondisposable and are replaced almost in all institutions by 8disposable syringes. The advantage of disposable syringes is that these help in safe administration. The glass syringes are still some times used, hence these are sterilized and reused.
- Flush those which need to be reused with cold water, wash with mild soapy or glass detergent solution and rinse thoroughly.
- Open the blocked needles with stylets. Separate the barrels and pistons and keep together when cleaning and sterilizing to prevent interchanging. Warm the stuck needles and syringes to separate them. Dipping in the weak solution of nitric acid, hydrochloric acid or potassium dichromate also helps.
- Take care to avoid needle point coming in contact with any hard surface as it becomes blunt.
- Sterilize by autoclaving as these are best sterilized by this method but when required for immediate use sterilize by boiling.
- When boiling separate the barrel, piston and needle of each syringe to prevent their breakage as a result of expansion of glass by heat. Then wrap the barrel and piston, each separately and keep together along with the needle of each syringe in boiler to prevent their interchanging.
- Others
- Rinse and flush those that need flushing under force, just after use. Clean with soap or detergent using soft rag, rinse, dry and replace.
- Sterilize by boiling after adequately padding them to prevent breakage.
- Earthen wares—Crockeries and cutleries
- Clean as the glass articles.
Dressing Material
These are cotton, gauze, bandages and lint, etc.
- Prepare surgical dressing in sufficient quantities for each particular dressing but any surplus cotton, lint, gauze must be put aside for resterilization.
- Cotton pads which are not soiled but are not suitable to be used again, can be made into swabs and sterilized and used for dressing.
- Use lint and bandages for cleaning purposes.
- Burn the used dressing material.
Inventory and Stores
The inventory which needs daily check is the equipment such as thermometers, instruments, syringes and needles, sphygmomanometer, torch, flash lights, oxygen and emergency drugs, etc.
- Daily check to see that these are not missing, are in working order or need any repair or replacement.
- Weekly, biweekly or monthly checks are made for the furniture and occasionally required equipment.
- Keep the stores clean. Keep things stored in cupboards, tidy and well arranged. Keep new and old things apart.
- Check the stores from time to time atleast every month.
- Condemn the old things from time to time as per hospital policy.
- The nurse is the custodian of the hospital and should do all whatever in her power to maintain it in an efficient manner.
TAKING CARE OF KITCHEN AND PANTRY
Kitchen and Pantry
Kitchen is the room or area in hospital where the food is prepared and cooked for the 9patient and pantry is the area or cupboard in which crockery, cutlery and other kitchen utensils are kept.
Purposes
- To keep the kitchen and pantry clean, tidy and attractive.
- To keep the utensiles ready for use.
- To provide safe food supply to the patients.
Supplies
The following supplies should be made available to the concerned workers for the care of:
- Kitchen equipment—Detergent, brush, dusters, rags.
- Floors—Refer supplies for the care of unit.
- Sinks—Detergents, rags, brushes and spot removing agent, if required.
Method of Care
The concerned workers should involve as follows:
Kitchen, Pantry and Equipment
- Keep them clean. Wipe the floor after each use. Treat the sinks in the same way as wash basins.
- Keep the utensils used for infectious disease patients strictly apart and labelled. If get mixed up with other equipment, boil and disinfect all the equipment.
- People employed in kitchen should have short nails, put on apron and tie, their hair neatly covering with a net.
- Keep food in the covered containers.
- Dispose of all garbages properly.
Refrigerators
- Defrost and wash thoroughly at regular intervals.
- Before cleaning turn to ‘U’ for defrost. Remove all the foods, utensils and medicines, etc.
- Remove shelves and wash them with soap and water, rinse, dry and replace.
- Remove ice trays from ice compartment, wash and dry the ice compartment.
- Wash and dry the inside of the door.
- Replace foods, only those which are in good condition.
- Replace utensils after wiping the outside.
- Replace the medicines which can only be used.
- Wash and dry the outside of the refrigerator.
- Clean the ice trays, fill with clean water putting cube compartments in and keep in the ice compartment.