SAFF AND CLFAN

ENVIRONMENT
PREPARED BY-JYOTI
MHA
INTRODUCTION
› Hospitals patients are often fearful and confused and
these feelings may impede recovery. Every effort should be
made to make the hospital stay as unthreatening, comfortable
and stress free as possible.
› The interior design plays a major role in this effort to create a
therapeutic environment.
PHYSICAL AND ENVIRONMENTAL
PLAN OF THE HOSPITAL
› The place should not be densely pnpulated.
› Hospital site should be elevated from surrounding.
› Independent access to a street.
› Away from nuisance such as dust, smoke, bad odour, noise,
and
traffic.
› Adequate lighting.
› Natural ventilatinn.
• Safe drinking water facility.
› Control of noise.
› Collection of safe disposal of refuse and excreta.
› Good drainage system.
› Control nf arthropods, vermin and animal pest.
IMPORTANT POINTS- FOR H
SPITA L
CONSTRUCTION
› Walls and floors- should be nonabsorbent, non-
porous, shock absorbing, attractive, and fire resistant, durable
easy to clean and damp proof.
› Slippery fioor are dangerous.
• The walls and doors should be free cracks and crevices to
prevent breeding of insects.
› The windows and door should be placed in such a
way that natural lighting is available in Room with cross
ventilation.
• The rooms should be constricted in such a way that it
facilitates thermal control fumigation.
CONT.
› Roof:
Flats roofs: They provide protection against weather, roofing
materials used are Tiles, Asbestos, cement, metal.
• The latrines are placed in such a way that it does not
cause bad odour and unpleasant scenes to the patients and
public. It should be placed where direct sunlight enters.
• The receptions counters and out patient Department
should be near to the main entrance of the hospital. For easy
access of public and in palient department can be towards
the back of building.
CONT..
› The kitchen and dinning rooms should be away from the
hospital wards and fly proof.
• There should be central corridor connecting the different
departments and wards.
• There should be provision for the isolation of patient
having
infectious disease.
› Emergency doors are to be provided for the protection of
patient in case of fire hazards.
• There should be railings along the open corridors and
staircases to prevent accidents by falling.
CONT..
› There should be provision for recreational and divisional
activities.
› Centralized work rooms helps to economies materials,
energy & time.
• The staircases, ramps and elevators should be centrally
placed.
The nurse aide's job is to
keep the resident’s unit safe
and clean and to create an
environment that fosters
independence,
contentment and self-
esteem.
 TEMPERATUitF
A room temperature ranging from 20 tO 22
degree C is considered comfouable.
The person should not feel chilly, but it
should be
sufficiently warn.
z1
VENTILATION
Patient care unit should be designed with appropriate
ventilation
system and minimize the microbial contamination in the air.
• Ventilation means replacement of ihe warm or stagnaiTt air
and control the quality of incoming air with reference to
temperature, humidity and purity.
In the operation rooms and critical care source of natural
ventilation are avoided as they spread airborne pathogens.
• Air filtration systems designed to control the physical and
chemical condition, clean the air and adjust the temperature of
particulate air in high risk areas.
Critical parameters for air quality include: maintenance of
filters, air movement, temperature and humidity should be
maintained b/w 20-22 degree C and 30-60%, respectively
to inhibit bacterial multiplication.
• Natural light is imponant in the care of the sick.
› Sunlight usually brightens tljc area and T chs to i»tprpve tl›c mental
wellbeing of the patient.
• However, light can be a source of irritation if it shines directly on
the patient’s eyes ot produces a glare from the furniture, linen or
walls.
i Whenever possible, provide a bed lamp for the patient.
› A dim 1ight is valuable as a comfort and safety measure at
night, This 1ight should be situated as not to shine in the patient's eyes
and yet provide sufficient light along the hoot so thai all ob*tnictions can
be seen.
› A night light may help to orient elderly patients, if they are confused as
to
their surroundings upon awakening.
› Use shades and drapes to control bright, natural light whenever necessary.
› Provide adequate light for reading
ODOR
› To maintain a healthy climate, good ventilation is necessary
in
controlling and eliminating disagreeable odors.
• In cases where airflow does not control odots, room
fresheners should be discretely used.
• Offensive. odor- producing articles (such as soiled
dressings, used bedpans and urinals) should be
removed to appropriate disposal and disinfecting areas as
soon as possible.
• Good personal hygiene practices should be maintained
to controlled the objectionable odors (such as bad
breath or perspiration of patients).
NOISE
› Noise control is another environmental element that
requires
attention.
• The large number of people and the amount of equipment
traffic in a facility serve to create a high noise level that
must be monitored.
› Residents easily disturbed by unfamiliar noises.
› Noise produces irritability, restlessness, fatigue and
exhaustion in acutely ill patient.
• Noise disturb the sleep.
• Staff should avoid loud laughter and loud talking.
• Control the use of radio, television during the rest.
TEST CONTROL
Pest control is the responsibility of hospital housekeeping by
maintenance and repair of building as cracks and defects in
sanitary
pipes or in construction leads to the development of pest in the
hospital.
› So appropriate training for pest control should be
given to the housekeeping staff and there should be regular
sprays and disinfection of the patient care units.
› Regular use of insecticides and pesticides arc used in
hospital to cnsure a clean and pest free hospital environment.
› Remove open food left in units ihat will attract ants and
coaches, as well as microorganisms.
› Family and visitors should consult wiih charge nutse before
bringing in food for residents.
› Ensurc proper disposat of food and wastc materials.
SECURITY AND SAFETY
› In addition to the general safety concerns of all buildings,
hospitals have several particular security concerns:
l Protection of hospital property and assets, including
drugs.
2. Protection of patients, including incapacitated patients
and
staff.
.i Safe control of violeni or unstable patients.
4. Vulnerability to damage from terrorism because of
proximity to high vulnerability targets.
• Maintaining cleanliness is a major responsibility of
all members of the healthcare team.
› Cleanliness not only provides for patient comfort and
a
positive stimulus, it also has an impact on infection
control.
• The nutse is often directly responsible for the maintenance
of patient care areas.
› The management of cleanliness in patient care
areas is conducted concurrently and terminally.
› Concurrent cleaning is the disinfection and
sterilization of patient supplies and equipment during
hospiializaiion, whereas Terminal cleaning is done after
discharged from the unit or hospiiaL
AESTHETICS
› Aesthetics are closely related to create a therapeutic environment.
› It is important in enhancing the hospital's public image and thus
an
important marketing tool.
› Aesthetic consideration include:
1 Increased use of natural light, natural material and
textures.
?. Use of network.
Compatibility of exterior design with its physical
surroundings. Flower vase, picture and curtains add to the
pleasant outlook of the room.
Research has shown that the use of color is calming and
restfiil to the patient and rest is very important healing agent
in any kind of illness.
› There may be different types of injuries which pose a
threat to the comfort of patienis, and thus are considered as
crucial factors determining their safety needs. Some of these
injuries are:
I Mechanical injury
2 Thermal injury
› Chemical injury
4. Radiation injury
Bacteriolngical injury
‹•. Aller@en- induced
injury
Injury induced by small
insects, pests ilnd
vermin
INJURI F.S AND TH E IR
PREVENTION FROM
HAZARDS
 MECHANICAL INJURY
Injury caused by machines, falls and blows. This involves injury
by fall from a bed or window, fall while standing or walking, by
tangled cords or tubing, by the movement of
wheelchair/stretcher/walker or by inadequate protection while
being lifted or moved.
Pre ’ention
It can he prevented h y p i n g milk c›r gnard on bode and wi»dows.
While assisting the patfAs hold whvel chair and stretcher
securely
a 1d lack the wheels.
Keeping fioors dry to prevent slipping.
Lifi patients together with co-workers willi adequatc directional
signals.
Ensure regular checkiilJ Df equipment for its safe and WDrking
condition.
Maintain principles orbo‹Jy mechanics for poiicnt as well as
oneself (nurse).
 THFRMAI INJURY
Injury caused by fires and burns that includes trauma,
asphyxia, bums etc. or injury caused by other sources of
heat,
e.g. application of a hot water bottle, electric heating pads,
a steam inhaler etc. Other causes can be smoking in bed,
defective wiring, explosion of gases or flammable liquids
etc.

gy Prevention
Fires are prevented by repairing defective electrical
equipment. Safe guarding inflammable liquids and gases.
Restrict smoking in the hospital.
Careful observation is necessary while applying hot
application 1ikc elcctric pads, hot water bottles, steam
inhaler etc.
Careful and regular monitoring of electric connection.
 CHEMICAL INJURY
Injury due to use of too strong or poisonous chemical
kept within the reach of the patient. It occurs due to the
caustic effect of strong chemicals on the skin or taken
internally or from an overdose of a prescribed drug.

Prevention
It is prevented by keeping chemicals in separate
cupbDards.
well labeled, under lock and key and out of reach of
patient.
Use chemicals at bedside with carrions e.g.- Disinfectants.
Dose of dnigs should be measured accurately
before administration.
Discard dnigs for which the expiry date is over.
 RADIATION INJURY
Injury that occurs from over exposure to radiation of x-my,
radiuin, infra-red and UV light rays.

Prevention
It is prevented by having trained operators.
Radiation equipment should be handled and
operated by trained
operators.
 BACTERIOLOGICAL INJURY
Injury related to ineffective elimination of disease
causing organisms and dirt that harbor them.

_ _Prevention
It is prevented od and water supply, safe disposal of
byexcrcta, safe disposal refuse and cleaning of the hospital.
Perform hand hygiene before and añ er care of each patient.
Infected patient should be kept under isolation.
Use effective techniques for disinfection and sterilization e.g.
boiling, autoclaving etc.
 AF.LERGEN- INDUCED INJURY
Injury due to allergens may result from insect bites or
material in the environment such as food, cosmetics, soap,
lotion, powders, medicines etc. Manifested by skin reactions
like rashes, and irritation of mucous membrane e.g.
Sneezing, coughing, watery eyes and difficult breathing etc.

Prevention
Prevention of allergy may be accomplished by having
covers
for the mattresses and pillows.
Ensure regular and frequent cleanlines» of unit or hospital
with ihc use of disinfectants.
Do damp dusting before dry dusting.
 INJURY INDUCED BY SMALL
INSECTS PESTS AND
YERMIN
Injury caused by small insects, pests and vermin, viz. due
to rats, flies, moth, bed bugs. cockroaches etc.

Prevention
Ensure regular and frequent spray of insecticides
rind
pesticides.
Preventcd by D.D.T. Spray, revelation, insecticides.
ROLE OF NURSE IN
PROVIDING SAFE AND CLEAN
ENVIRONMENT
i. Identify patients at risk for injurv:-Those at special risk
include:
Elderly or confused patients.
Patients with impaired vision or hearing.
Patients with impaired mobility(wheelchairs, walkers, partial
paralysis).
Patients with a history of falls.
Patients with a history of substance abuse.
Patients receiving medication that interferes with reasoning
or
motor functions.
CONT..
2. To prevent falls:-
. i Place the bed in the low position.
Keep the side rails up when the patient is not receiving
bedside care.
Advise the patient to wear flat shoes that fit well when
walking.
Ensure that nonskid strips or mats are affixed to the bottom
of bath tubs and shower floors.
Ensure that bathtubs have sturdy handrails and shower
stools
are in place when needed.
Warn Patients and visitors when floors are wet and slippery.
Also see that signs are posted.
Maintain dry and uncluttered floors.
The toial care of environment must be equipped
with adequate night lights.
CONT.
3. PROTECTIVE RESTRAINTS:-
Use restraints when careful assessment indicates that tiiese are needed.
Use the least restrictive type of restmint, which will protect the
patient. The vest restraint may only be necessary while a patient is
sitting in a wheelchair.
Provide for as much movement as possible. The waist restraint
protects
the patient from falling out of bed but still allows the patient to
change
position independently.
Restraint the fewest limbs or body parts possible. However, if leg
restraints are necessary, use wtist restraints also. lf this is not done, the
patient may remove the leg restraints or he may accidentally hang by
his heels in the restraints.
i› Tie the restraint with a knot that is not likely to come loose, yct
can be released cesiTy by the nurse in en emergency, A hsTd-bow knot
meets these criteria,
Explain to the patient the reason for the patient restraint. Position
him comfortably and change his position every two hours. Feed the
patient who must remain restrained during meals. Help him in using
the toilet, bedpan or utinaf at regular intervals.
CONT..
4. Prevent scalds and burns:-
Place coffee, tea and other hot liquids where the patient can
reach easily and safely.
Assist the patient if there is any doubt about whether he can
safely regulate the temperature of water in tubs or showers.
Carefully follow policy when using hot water bags or
heating pads. Because of the danger of burning patients,
many health care facilities do not allow their use.
CONT..
5. Prevent the spread of infection:-
A health care facility may adopt its own infection control
policies and practices. However, the procedures generally
follow the recommendations from the CDC. This is a federal
agency that studies pathogens, outbreaks of contagious
diseases and methods used to control these outbreaks.
Preventing disease, including infections, is a high priority in
health care. Nurses should use tcchniques that prevent
microorganisms front living, growing and spreading.
Two methods are used to reduce oi eliminate the presence of
microorganisms and thus prevent infections. These two
methods are surgical and medical asepsis.
c) Infections and infeetious diseases begin in a reservoir end
move
full circle to a susceptible host.

Chain
Infectio
n
CONT..
.o It is important that the nurse teaches patient facts and
practices about surgical and medical asepsis. When teaching
a patient nurse should:-
› Observe the patient to identify areas where instruction would
be helpful in controlling the spread of infection.
› Act as a model by using sound practices of asepsis when
giving care.
› Provide guidance to the patient who must give himself care
at home in the proper way to handle sterile equipment and
supplies and how to sterilise reusable items.
CONT..
6. Report infections:-
› Health care workers must report any infection that occurs.
› The Infection Control Committee will investigate any case of
infection to determine the cause.
› If a break in nursing technique is identified, the
committee
will propose different procedures to eliminate the
problem.
CONT..
7. Universal body substance precautions:-
Blood is the single most important source of transmission of
blood borne pathogens in health care settings. Infection
control efforts must focus on preventing esposures to
blood. Although the risk is unknown, universal precautions
also apply to tissues and to CSF, synovial fluid, pleural
fluid, peritoneal fluid and amniotic fluid.
Precautions are used for all patients. (Rationale: It is
impossible to know which patients are infected with
such conditions as HIV, HBV or other infectious
agents).
Gloves are worn whenever the HCW may come in contact
with blood, body fluids. (Ralionale: Disease can be carried
in the body substances).
CONT..
Change gloves afier each contact with a clieni.
Wash your hand and skin surfaces immediately. (Rationale:
Proper
washing will help to stop the spread of infection).
›› Wear a gown or apron when clothing could become
soiled. (Rationale: To prevent spread of infection to yourself or
others). Wear a mask and eye protection if splashing is possible.
Hospital protocol will determine what type of eye protection is
required for
each specific case. (Rationale: Infection could enter your body
through the mucous membranes of mouth or nose or through eyes).
Dispose off sharp objects carefully. Do not recap or bresk
needles. Needles and sharp objects are placed in a special
container after use. (Rationale: There is possibility of needle stick
injury).