Hospital Housekeeping – Nurse’s Role and Responsibilities.
A Simple Nursing Procedure
Good House Keeping:
The housekeeping department has the function of keeping the hospital clean. A well-managed housekeeping department can reduce the cost of hospital operation considerably. For the smooth functioning of the housekeeping department, the cooperation of all the hospital staff is necessary. If the hospital housekeeping is of poor quality, nursing care suffers, nursing education is adversely affected, efficiency is lowered and the morale is impaired.
Principles of Good Housekeeping:
1. Dust clings to the moist surfaces. Therefore, the dusting can be done best by a damp duster or by an oiled cloth. A dry duster scatters the dust.
2. Dusting is done after sweeping and not before.
3. Soap and water are used for cleaning. Soap emulsifies the fat and lowers the surface tension of the water. The water acts as a good solvent.
4. Friction aids in mechanical cleaning. Use brush when cleaning a grooved surface. Dusting should be done with a firm and even stroke.
5. Abrasives are harmful to the painted and polished surfaces.
6. Albuminous materials (e.g. body discharges) are coagulated by the heat. So, it should be removed with cold water.
7. Bacteria grow in dark, moist and unclean places.
8. Exposure to sunlight destroys some bacteria.
9. Disinfection by chemicals depends upon the cleanliness of the article, the strength of the disinfectant and the length of the exposure.
10. Effective sterilization depends upon the cleanliness of the articles, the degree of heat and the length of exposure.
11. Heat, chemicals, abrasives and solvents are harmful to some materials.
12. Choosing the correct and the simplest method of cleaning, saves time, material and energy.
13. Equipment suitable for the purpose for which it is used and in good condition, conveniently located and arranged, saves time, material and energy.
14. The cleaning articles are stored in a placement only for that purpose. Leave the unit neat and tidy always.
Cleanliness and Orderliness
Clean equipment, clean linen, clean floors and walls are relatively free from pathogenic organisms. Nothing will more quickly lower the confidence of the public in hospitals than the lack of cleanliness of the wards. Therefore, they must know the principles of good housekeeping and the best methods of caring of the equipment and physical environment of the client including the floors, furnishings, painted surfaces and sinks.
Purpose of Cleaning
To leave a clean polished surface where possible, so that dirt may not be accumulated.
To remove all dust, dirt and breeding places of microorganisms with least disturbance to the client.
To prolong the life of articles.
To keep the articles in such a condition that they are ready for use at any time.
To maintain the aesthetic factors.
Care of Rubber Goods
The rubber goods in common use are air cushions, mackintoshes, hot water bottles, ice caps, ice collars rubber tubes, catheters, rectal tubes, gloves and rubber beds.
The nurses should make all efforts to prolong the life of the rubber goods. They should be purchased only after their nature and durability have been investigated. Natural and synthetic rubber deteriorate with age, exposure to heat, light, moisture and by chemicals. They should not be creased or folded. Never expose them to sunlight. Boiling water ruins rubber (a hot water is not a boiling water bottle). Rubber goods should never be dried by artificial heat or by contact with a radiator or stove. They should be free from grease and acids. These should not come in contact with metal goods. Any fluid split on them should be wiped off at once. When storing, care must be taken so that no two surfaces come in contact with each other. They should not be pressed out of shape by any weight. They should be tied in knots. They should not be hung on hooks or nails. Before subjecting rubber goods to disinfection by chemical process, its reaction to the disinfecting agent should be determined. If boiling process is used, put them to boiling water. If autoclaving is used, short periods of exposure are recommended (10 to 15 min) with less pressure.
Cleaning of Rubber Mackintosh
1. Spread the mackintosh on a table or a flat surface and wet it with cold water.
2. Rub the upper surface with soap and water using a clean cloth or towel.
3. Turn the other side and repeat the process as above.
4. Wash both surfaces under running water.
5. If stains are present, care should be taken to remove them by appropriate methods.
6. For disinfection, use Lysol or Dettol 1:40.
7. Hang them on a horizontal cylindrical pole in shade to dry. Spread them without wrinkles.
8. When both surfaces are absolutely dry, powder them lightly with French chalk powder.
9. Store them either flat or rolled and never folded, taking care to see that two mackintosh surfaces do not lie together, but are separated by old linen or paper. Store them in a dark cool place in airtight containers whenever possible.
Care of Rubber Gloves
Since they are costly items they deserve special care.
1. It is desired that the wearer of the gloves should wash them on their hands just before they are removed to prevent adherence of blood and other organic materials.
2. After removing from the hands, they are washed with soap and cold water, first on the outside, then invert and repeat on the inside.
3. Rinse well with water both inside and outside as described above.
4. Holes and tears are discovered by submerging the glove filled with air in the water. If there are holes the bubbles will pass up through the water. Separate torn gloves.
5. Hang them to dry. When the outside is dried, turn inside out and dry.
6. When both sides are dried, they are powdered inside and outside and packed in pairs of the same size, right and left gloves in glove wrapper. A small lump of gloves powder in a gauze mesh for powdering the hands is kept in the cuff of the gloves.
7. The torn gloves are patched or vulcanized and may be reused.
8. Steam under pressure is the best method of sterilizing gloves. The pressure is kept minimum to prevent melting of the gloves.
Care of the Rubber Tubes
(catheters, rectal tubes, flatus tubes, Ryle’s tubes, and infusion sets).
Catheters vary in size and quality according to the special needs. Size of the catheters is marked on it either in French or English scales. When it is exposed to force or suction, a heavy walled tube is desirable. When a great flexibility is wanted, a tube with thin wall is indicated. The points to remember in cleaning of the tubes are:
1. After use, wash them under running water, holding the eye end upwards and allowing the water to run through.
2. A small quantity of organic matter may be lodged at the eye end. Remove them using a swab stick.
3. Clean them with soap and warm water to remove the dirt and grease.
4. Wash them again under running water.
5. Boil the tubes for 5 min by putting them in the boiling water. Dry them by hanging.
6. When dried, powder and store them in airtight containers, lengthwise.
Reboil or autoclave them before use.
Cleaning of the Air Cushion, Rubber Beds, Hot Water Bottles, Ice Caps and Ice Collars
To clean the air cushion and airbeds, do not pour water into them. It is sufficient to clean the outside. During cleaning it should not be filled with air, because while rubbing there is a tendency to exert pressure on the seams at the sides of the articles and they may crack or weaken. The valves of the air cushions or beds should never be immersed in water as it spoils them, and is one of the reasons why they get out of order. Cleaning and storing are done like other rubber goods except that they should be slightly inflated to prevent the two surfaces to come in contact with each other.
In case of hot water bottles, ice caps and ice collars, empty the contents immediately after use. Wash and dry as in the case of other rubber goods. Hang the bags upside down to drain the water. The ice bags, which cannot be hung, are dried with a piece of cloth. When the bags are completely dried inflate them with air.
The covers of the air cushion, ice bags and ice collars are disinfected and sent to the laundry for washing.
CARE OF ENAMEL CARE
The articles commonly used are bedpans, urinals, kidney trays, sputum cups, feeding cups and trays. The polishing on the enamel ware is eroded by heat, mercuric salt, acids, alkalis and by chemicals. They are subject to chipping if dropped on the floor or handled carelessly. Scraping with sharp instruments also result in chipping.
Care of Bedpans
1. Before emptying the bedpan, inspect the contents. If there are cotton sponges or sanitary pads thrown into bedpans, they are removed by using a forceps kept for that purpose only.
2. Empty the bedpan into a lavatory pan, care being taken to avoid soiling the sides of the basin.
3. Rinse the bedpan with cold water under force.
4. Wash with soap and warm water using a brush. Vim may also be used to remove the stains. Rinse it well.
5. To disinfect the bedpans, soak them in Lysol 1:40 for 1 hour or they are sterilized in bedpan sterilizers.
6. Bedpans may be placed in direct sunlight for few hours to deodorize and to disinfect.
7. Keep them dry for the next use on the bedpan rack.
Care of Urinals
The urinal should not be left standing for a long time with urine because a deposit will form on the inside, which is almost impossible to remove. Cleaning and disinfection are done in the same way as for the bedpans.
Care of the Kidney Trays
Kidney trays are treated in the same way as for the bedpans.
Care of Sputum Cups
Non-infectious sputum may be emptied into the lavatory pan, care being taken not to soil the sides of the pan. Infectious sputum (e.g. the sputum of a tuberculosis client) should be rendered harmless by boiling or disinfection by chemicals or it may be disposed by burning.
Cleaning and disinfection of the sputum cup is done as for the bedpans. Before the sputum cups are given to the client, add a small quantity of antiseptic lotion, main purpose of which is to prevent the sputum sticking to the sides.
Care of Instruments
Care of Sharp Instruments
The knives and scissors are the most commonly used sharp instruments. The sharp edges are dulled by rough use, exposing them to high temperature and moisture. The sharp instruments are sterilized by hot air sterilizer, exposing them to a temperature of 160 degree celcius for 1 hour. Chemical disinfection can be done by submerging them fully under pure dettol or other disinfectants which are not corrosive. The effect of any chemical disinfectant should be carefully investigated before it is used.
Care of Other Instruments
A wide variety of instruments are used in the operation theatre which may be dangerously contaminated. The soiled instruments may be unhinged (opened) with gloved hands and dropped into a basin or bucket. Rinse the instruments thoroughly with cold water to remove the blood and other organic matter. Clean the instruments with sodium carbonate (to make 2% solution) and hot water. All instruments should be examined for cleanliness and orderliness before they are sent to sterilization. Those instruments which are not clean should be treated separately. Abrasives and soaps tend to remove the protective film of corrosion resistant metal put on by the manufacturer and their removal shortens the life of the instruments.
Steam under pressure should be used to sterilize instruments whenever possible. When the steam under pressure is not available, boiling water is the best agency for sterilizing instruments. The longer is the boiling period, the greater the likelihood that all organisms will be killed.
Care of Glassware
To facilitate cleaning, the glassware should have a hard smooth surface. Ground glass is very susceptible to erosion by water or steam. Therefore, it should be sterilized with dry heat. Brush and abrasives of all sorts are to be avoided in cleaning glass as they cause streaking. Immediate rinsing under cold running water to remove organic matter from the glass articles is essential in prolonging their usefulness. Glassware used for the parenteral therapy should be rinsed with freshly distilled water. If the distilled water leaves an unbroken film on the glass surface, it shows that the glass is clean. If any grease is present, the film will be broken and droplets will form. Exposure of the glass to sudden variations of temperature is likely to cause crack in the glass. When sterilizing glass containers, they are to be kept inverted in the autoclave. If they are kept in upright position, air trapped in them prevents steam penetration of all surfaces. A small amount of distilled water in the vessel will force out the air. When the glass goods are sent for boiling or autoclaving, they should be adequately padded to prevent breaking by rubbing with hard surfaces.
Care of the Stainless Steel Goods
Stainless steel utensils are suitable for almost every other purpose, because they are easily cleaned, heat resistant and unbreakable. When storing, these utensils are to be kept dry, lest the water on them leaves a mark.
Care of Crockeries and Cutleries
The crockeries and cutleries, used for the clients need special attention. They should be rinsed in cold water and then washed with soap and warm water. Disinfect them by boiling. Store them after drying. It is advised to have individual articles for every detail.
Care of Linen
Care of linen is important, as it is an expensive item, in the running of a hospital. It costs much to buy and much to launder it.
Spoiling and wastage of linen will be avoided if the following rules are observed:
1. The linen cupboard should be kept in perfect order, with different items stocked separately and labeled to prevent confusion and loss of item.
2. The cupboard should be locked when hot in use.
3. Care should be taken to avoid linen being taken home by the clients on their discharge.
4. Stocks should be checked at regular intervals, the inventory properly kept and losses reported promptly.
5. All items should be used for the purpose for which they are made.
6. Torn linen should not be used on the bed but sent for mending.
7. Soiled linen should not be placed on the floor.
8. Damp linen should be dried, if they are not immediately washed, lest it becomes mildewed.
9. If soiled with urine or motion, these should be rinsed with cold water first to remove the stain.
10. If there are stains, remove them by using an appropriate stain remover.
11. Where staining is unavoidable, old linen should be used.
12. The linen used for an infectious client, should be disinfected first before they are sent to the laundry.
13. Use of mackintosh, wherever it is necessary can economize the use of linen.
Blood Stains – soak immediately in cold water. Hot water coagulates; wash them in warm soapy water. If it is an old blood stain, soak it in a mixture of hydrogen peroxide and ammonia for several hours and then wash it in cold water and then with soap and warm water.
For the thick blood stains on the mattress, apply a thick paste of starch and water, and allow to stand in the sun. when the paste is dry and discolored, brush off the stain.
Tea, Coffee and Cocco – linen, as soon as it is stained with tea, coffee and cocco, remove it by pouring milk over it. Washing them in cold water or washing them in hot water and sodium carbonate will remove the stain. If not completely gone, lemon juice may be rubbed or hydrogen peroxide may be applied.
Aniline Dyes, Gentian Violet and Methylene Blue – Firstly, Wet the cloth and bleach them in the sunlight. Chlorine water bleaches the dyes. If chlorine water is used, rinse the bleach thoroughly with warm water after the stain disappears.
Candle Wax Stains
Scrape off the wax. Place a cloth pad or blotting paper under and over the stain and press it with a hot ironing box.
Curry Stains
Wash them immediately in cold water. Then apply soap and hot water. If the stains are remaining, bleach it in the sunlight. When the stains are completely bleached, wash them in cold water.
Ink Stains
When the stain is fresh, wash it in cold water. Sprinkle some salt and lemon juice and lay in the sun to bleach the stain. Application of hydrogen peroxide and dilute ammonia will remove most of the stains.
Rust Marks – apply salt and lime juice and expose it to sunlight.
Iodine – dip the linen in rice water or apply a starch paste until the stain is removed completely.
Perspiration – wash them with soap and hot water containing a few drops of ammonia or bleach them in the sunlight.
Paint or Varnish – these are removed with turpentine, alcohol or ether.
Mildew – soak in chlorine water and lay it in the sunlight. Wash them thoroughly. Acetic acid is also useful to remove the mildew.
Care of Blankets
These are expensive articles and do not stand washing or steam disinfection without shrinkage. The blankets should be protected by sheets under and over it. They should never be exposed to dust. When a blanket is to be used next to the client’s body, old ones or cotton blankets are used. Occasional brushing will remove the dust. Though costly, blankets are cleaned by dry cleaning. To disinfect them, expose them to sunlight.
When storing, blankets should be carefully protected from moths using naphthalene balls. They should be covered with dust-proof sheets.
Care of Mattresses and Pillows
It is important to prevent the mattress from becoming wet and stained. This is done best by the use of long mackintoshes. The mattress should be brushed at regular and frequent intervals to prevent collection of dust along the seams. As far as possible washable covers which fit and completely cover the mattress should be used and these can be changed at regular intervals.
Pillows should be protected from becoming wet with blood, bodily discharges or by other fluids. They should be protected with mackintoshes when they are used for clients with bleeding, vomiting, etc. they should be protected by pillow covers which are changed at regular intervals.
Maintenance of Ward Inventory
An inventory is a detailed list of articles in the ward, their specifications, standard number or quality. We speak of ‘taking inventory’ by which is meant making a count of the materials at hand. When inventory is taken, it provides a good chance to determine the condition of articles and to order repair or replacement if necessary. It is also an ideal time to return articles to their proper place. Frequent counts are an aid in maintaining and tracing equipment. Such articles as flash lights, scissors, syringes and needles, B.P. apparatus etc., may require a daily count. These items may disappear and are also easily broken hence, early discovery of loss makes tracing the articles easier. Some articles may be counted weekly. For others such as furniture, a monthly count is sufficient. The actual count of articles which is made in the wards is known as physical inventory.
Equipment which is out of order or not ready for use is often more troublesome than if it were missing altogether. To prevent such occasions, the articles are checked early and sent for repairs if necessary. If repairing is not possible, replacement should be done.