Cleaning
- Removal of visible dirt
- Reducing levels of harmful
microorganisms
Risk-Based Environmental Cleaning
Frequency Principles
- Probability of Contamination
- Vulnerability of Patients to Infection
- Potential for Exposure to pathogens
Cleaner to Dirtier Cleaning Strategy –
prevent the further spreading of dirt and
microorganisms
1. Shared equipment and common
surfaces
2. Items touched during patient care
3. Patients and direct contact items
➢ Techniques
o Terminal cleaning (low touch
vs b4 high touch)
o Patient zone b4 toilets
o Top to bottom (prevent dirt
and microorganisms from
contaminating already
cleaned areas)
o Methodical/Systematic
Manner (avoids missing
areas)
Damp Dusting – is the removal of dirt and
bacteria from hard, flat surfaces, with a damp
cloth or sponge
➢ Low dusting – easily reached by
standing; done everyday
➢ High dusting – areas over windows,
pipes, wall and ceiling
➢ Varnished – do not use soap
➢ Unvarnished – do not use mineral oil
Body Mechanics – coordinated efforts of the
musculoskeletal system and NS to maintain
balance, posture and body alignment during
lifting, bending, moving and performing
ADL’s; application of mechanical laws
Alignment and Balance
➢ Positioning of the joints, tendons,
ligaments, and muscles while
standing, sitting, and lying
➢ To keep the body aligned, the
individuals center of gravity should
always be stable
➢ Reduces incidence of muscle strain
Gravity and Friction – The greater the
surface area the greater the friction
➢ Gravity – invisible force that
pulls objects toward each other
➢ Friction – is a force that occurs in
a direction to oppose movement
Skeletal System
➢ Provides attachments for muscles and
ligaments
➢ Supporting framework as it allows
movement of the body
o Ligaments – white, shiny,
flexible bands of tissue that
bind joints together, connect
bones and cartilages, and aid
joint flexibility and support
o Tendons – are white,
glistening, fibrous bands of
tissue that connect muscle to
bone and are strong, flexible
and inelastic
o Cartilage – non-vascular,
supportive connective tissue
located chiefly in the joints
and thorax, trachea, larynx,
nose and ear
Nervous System – regulates movement and
posture
Postural Abnormalities – congenital or
acquired postural abnormalities affect the
efficiency of the musculoskeletal system and
body alignment, balance, and appearance.
1. Torticollis – inclining head to
affected side
2. Lordosis – exaggeration of anterior
convex curvature of lumbar spine
3. Kyphosis - increases convexity in
curvature of thoracic spine
4. Scoliosis – lateral- S or C – shaped
spinal column with vertebral rotation
5. Congenital Hip Dysplasia – hip
instability with limited adduction
contractures
6. Knock-knee (genu valgum) – legs
curved inward so knees come
together
7. Bowlegs (genu varum) – one or both
legs bent outward at knew; normal
until 2-3 years of age
8. Clubfoot – 95% medial deviation and
plantar flexion; 5% lateral deviation
9. Foot drop – inability to dorsiflex and
invert foot
 10. Pigeon toes – internal rotation of
forefoot/entire foot; common in
infants
Muscle Abnormalities – injury and disease
lead to numerous alterations in
musculoskeletal function
➢ Direct trauma to the musculoskeletal
– results in bruises, contusions,
sprains and fractures
➢ Damage to the CNS – results in
impaired body alignment, balance
and mobility
Hand Washing
5 Moments for Hand Hygiene
1. Before touching the patient
2. Before an aseptic task/procedure
3. After body fluid exposure
4. After touching the patient
5. After touching patient surrounding
Bed Making - Attempt to make patients
room as comfortable as home. It needs to be
safe and large enough to allow the patient and
visitors to move about freely. Removal of
barriers along walkways reduces risk of falls.
Control room temperature, ventilation, noise
and doors. Keeping the room nest and orderly
also contributes to the patient’s sense of well-
being
➢ To provide patients comfort
➢ To provide a clean environment for
the clients
➢ To provide a smooth, wrinkle free bed
foundation, thus minimizing sources
of skin irritation
➢ To conserve a client’s energy and
maintain current healthy status
➢ To prevent and avoid microorganism
to come intact with the patients
Maintaining Comfort
➢ What makes a comfortable
environment depends on a patient’s
age, severity of illness and level of
normal daily activity. Depending on
age and physical condition,
maintaining room temp between 20
and 23 degrees Celsius (68 to 73.4
degrees Fahrenheit). Infants, older
adults and the acutely ill often need a
warmer room
Points to Remember:
➢ An effective ventilation system keeps
stale air and odor from lingering in a
room
➢ Protect the acutely ill, infants, and
older adults from drafted by ensuring
that they are dressed adequately and
covered with a lightweight blanket
➢ Always empty and rinse commodes,
bedpans and urinals promptly
➢ Room deodorizers help remove any
unpleasant odors but before using
deodorizers, determine first if the
patient is not allergic or sensitive to
the deodorizer
➢ Ill patients seem to be more sensitive
to noises and lighting commonly
found in health care settings
➢ Try to lower the noise level;
especially when a patient is trying to
sleep
➢ Explain the source of unfamiliar
noises such as an IV pump or pulse
oximeter alarms
➢ Proper lighting provides safety and
comfort
Room Equipment’s
1. Over-bed table
2. Bedside stand
3. Chairs
4. Patient’s Bed - seriously ill patients
often remain in bed for a long time.
Because a bed is the piece of
equipment used most by a
hospitalized patient. It is designed for
comfort, safety and adaptability for
changing positions. A typical hospital
bed has a firm mattress on a metal
frame that you can raise and lower
horizontally
Types of Linens
1. Bottom Sheet – used to cover the bed
after mattress cover
2. Rubber Sheet – used to protect the
bottom sheet from soothing due to
patient secretions. It is usually placed
over the center of the bottom sheet
3. Cotton Draw Sheet – a piece of cloth
spread over the rubber sheet and is
used to absorb moisture
4. Top sheet – used to cover the patient
to provide warmth, made of thick
cotton, thermal material
5. Blanket – a large piece of cloth soft,
wooden and is used for warmth as a
bed cover
Instructions for Folding Linens
 ➢ Bed Spread and Blanket – fold linen
lengthwise; wrong side out
➢ Top Sheet – fold linen lengthwise;
right side out and the wider hem
should always be on the head part
➢ Draw and Rubber Sheet - fold
crosswise at the center; wrong side
out
➢ Bottom Sheet – fold lengthwise;
wrong side out
➢ Pillow Case – fold linen crosswise;
wrong side out
2 Types of Bed
1. Occupied Bed – made when the
patient is unable to or not permitted to
get out of bed.
2. Unoccupied Bed – when there is no
patient confined in bed, while the
patient is I the bathroom or waiting
for a newly admitted patient arriving
from the ER
a. Open Bed – the top covers are
folded back so the patient can
easily get back into bed
b. Closed Bed – the top sheet
blankets and bed spreads are
drawn up to the head of the
mattress and under the pillow;
this is prepared before a new
patient is admitted to the room
c. Post-operative/ Surgical
Bed – Aka recovery
bed/anesthetic bed
Definition of Terms
➢ Bed Making – the technique of
preparing different types of bed,
making patients/clients comfortable
➢ Fan Folding – folding the edge of the
sheet 6-8 inches outwards
➢ Mitered Corner – anchoring the
sheet on mattress
➢ Top Pleat – a fold made in the sheets
that allows a patient in bed move his
feet
➢ Foot Drop – plantar flexion of the
foot with permanent contracture of
the calf muscle
➢ Foot Board – used to support the
immobilized client’s foot in a normal
right angle to the legs to prevent
plantar flexion contractures
➢ Intravenous Rods – usually made of
metal, support intravenous (IV)
containers while fluid is being
administered
Patient Transferring and Positioning
Ankle-foot Orthotic (AFO) – device that
helps maintain dorsiflexion
Patient Transferring:
1. Trochanter Roll – prevents external
rotation of the hips when patient is in
a supine position. Under buttocks
counterclockwise
2. Trapeze Bar – is a triangular device
that hangs down from a securely
fastened overhead bar that is attached
to the bed frame. Allows patient to
pull with the upper extremities.
Patient Positioning
1. Fowler’s Position – head of the bead
is elevated
a. Low Fowler – 15-30 degrees
b. Semi Fowler – 30-45 degrees
c. Standard Fowler – 45-60
degrees
d. High Fowler – 80-90
degrees; best for eating
2. Supine Position – for sleeping; after
operation (2 hours); on the back
3. Prone Position – face or chest down
4. Sim’s Position – patient places
weight on the anterior ileum,
humerus, and clavicle; used for rectal
exam
5. Side-lying Position – patient rest on
the side with the major portion of
bodyweight on the dependent hip and
shoulder. For pressure ulcers, 30-
degree lateral is recommended.
6. Logrolling – for transferring the
patient from bed to stretcher and vice
versa; for patient’s who have spinal
injury or recovering from neck, back,
or spinal surgery. Repositioning is
done every 2 hours, without it patient
will develop ulcers
7. Orthopneic Position – client sits in
bed on a high fowler position; best for
patients who have difficulty breathing
since it allows for maximum lung
expansion.
8. Lithotomy Position – in supine, both
knees are flexed and placed close to
the hips, widely separated; used for
vaginal exanimation or labor
9. Knee Chest (Genupectoral)
Position – patients kneel on the bed
then leans forward with the hips in the
air; used for procedure in the spine or
rectal
 10. Trendelenburg Position – pt is in development
supine, head of the bed is down (in of pressure
reverse the foot is down) and entire ulcers
body frame is tilted downwards. ➢ Smooth linen
11. Jackknife of Bozeman Position – out to remove
prone position, hip directly over the sources of
mechanical
break in the table
irritation
12. yung pang check ng hernia
➢ Remove rings
and bracelets
to not injure
Skin the patient’s
skin
➢ Functions as protection, secretion,
➢ Water is not
excretion, body temp regulation, and excessively
cutaneous sensation hot/cold
➢ Primary layers: epidermis and dermis. 3.Temp Regulation
Just beneath the skin is the ➢ Radiation ➢ Wala
subcutaneous tissue (Hypodermis) (electromagnetic
radiation),
Function/Description Implications for Care
evaporation
1.Protection (water vapor),
➢ Relatively ➢ Weakening conduction
impermeable occurs by (transfer), and
layer that scraping or convection (air)
prevents stripping its
4-5. Excretion and
entrance of surface
Secretion
microorganisms. ➢ Excessive
➢ Sweat promotes ➢ Perspiration
Relative dryness dryness causes
heat loss by and oil harbor
of surface of cracks and
evaporation. microorganism
skin inhibits breaks where
Sebum ➢ Bathing
bacterial growth. bacteria can
lubricates skin removes
Sebum removes enter
and hair excess body
bacteria from ➢ Constant
secretions; of
hair follicles exposure of
excessive it
skin to
causes dry skin
moisture
causes
softening, Epidermis
interrupting
dermal ➢ Outermost layer of the skin
integrity, ➢ Comprises of several thin layers of
promoting epithelial cells (protects the skin
ulcer and against water loss and injury and
bacterial prevent entry of disease providing
growth microorganisms)
➢ Keep bed linen
and clothing
dry
Bathing and Skin Care
➢ Misuse of
chemicals Hygiene – science that deals with the
causes preservation of health/science of health and
chemical its maintenance
irritation
2.Sensation Hygienic Care – promotes cleanliness,
➢ Skin contains ➢ Minimize provides for comfort and relaxation,
sensory organs friction to improves self-image and promotes healthy
for touch, pain, avoid loss of skin
heat, cold and stratum
pressure corneum,
which results
in
Early Morning Care (AM Care) ➢ To stimulate circulation to the skin
➢ To promote a sense of well-being
➢ Nursing personnel on the night shift
➢ To produce relaxation and comfort
provide basic hygiene to patients
➢ To prevent and eliminate unpleasant
getting ready for breakfast, scheduled
body odors
tests, or early morning surgery
➢ Offering a bedpan or urinal if the 2 General Baths
patient is not ambulatory (able to
1. Cleaning bath – provided as routine
walk around), washing the hands and
client care; main purpose is patient’s
face, helping with oral care
hygiene
Routine Morning Care (Complete AM o Complete Bed Bath
Care) ▪
o Partial Bed Bath
➢ After breakfast, offer bedpan/urinal;
o Sponge Bath
provide a full or partial bath or a
o Tub Bath
shower, including perineal care and
o Shower
oral, foot, nail, and hair care; give a
o Bag Bath (Travel Bath)
back rub; change gowns/pajamas; bed
o Chlorohexidine Gluconate
making is performed; and straighten
Bath (CHG Bath)
the patient’s bedside unit and room
2. Therapeutic Bath
Afternoon Care
➢ Hospitalized patients often undergo
exhausting diagnostic tests or
procedures in the morning. In
rehabilitation centers, patients
participate in physical therapy in the
morning. Afternoon hygiene care
includes washing the hands and face,
helping with oral care, offering a
bedpan or urinal, and straightening
the linen
Evening Care (PM Care)
➢ Before bedtime after personal
hygiene care that helps patients relax
and promotes sleep
➢ Changing solid linens, gowns, or
pajamas; helping patients wash the
face and hands; providing oral
hygiene; giving a back massage and
offering the bed bedpan or urinal

4 Types of Urinals and Bedpan

1. Fracture Bedpan
2. Bedpan
3. Female Urinal
4. Male Urinal
Bed bath – is given to provide cleanliness
and comfort who is unable to get out of bed
because of physical or mental limitations
Purpose:
➢ To remove transient microorganisms,
body secretions and excretions and
dead skin cells