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PRELIM NCM 103 FUNDAMENTALS OF NURSING (SL)

Basic Infection Control

 Infection control includes all of the practices used to prevent the spread of microorganisms that could cause
disease in a person.

Asepsis
 The condition of being free from disease-producing microorganisms.
Aseptic technique
 implies all those procedures that reduce or eliminate pathogens and their actions or minimize their areas of
existence.
 a discipline that consists of a series of events to guard the patient against infection.

2 TYPES OF ASEPSIS

1. Medical asepsis
2. Surgical Asepsis

1. Medical Asepsis
 The practice of techniques and procedures designed to reduce the number of microorganisms in an area
or in an object and to decrease the likelihood of their transfer
 It is referred as “CLEAN TECHNIQUE”

Intact skin is an effective barrier to microorganism.

2. Surgical Asepsis
 It includes all the sterile procedures and techniques used to exclude all microorganism from an area
 The skin that is not intact and areas of the body that are normally sterile (such as eyes and inside the
bladder) requires additional precautions to prevent the entry of infection-causing microorganisms.
sterile technique

COMPARISON

Medical Asepsis
 All of the procedures used to protect the patient and his environment from the spread of infectious organisms
 Cleanliness (freedom from most pathogenic organisms).
 To reduce the transmission of pathogenic organisms from patient to another person.
 Patients with a communicable disease are separated from the rest of the patients by room, ward, or unit.
 Hands and forearms are washed for 1 to 2 minutes to remove surface contaminants and soil. Hands and arms
are dried with paper towels
 Clean gowns are worn to protect the worker. Inside of gown is clean; outside of gown in contact with patient
and his environment is contaminated.
 Confine disease organisms and prevent spread to others.

Surgical Asepsis
 All of the procedures used to sterilize and to keep sterile any objects or articles that are to be introduced into a
wound or body cavity or that is to penetrate the skin
 Sterility (freedom from all microorganisms).
 To prevent introduction of any organism into an open wound on the patient or into a body cavity.
 Patients requiring surgery are taken to the operating room of the hospital
 A zone about the site of operation or wound is established as a sterile field. Once a sterile article touches an
unsterile article, it is contaminated (unsterile). Only sterile articles are brought into the sterile field.
 Hands and forearms are scrubbed for 10 minutes to reduce the bacterial count on the skin surface. Hands and
arms are dried with a sterile towel.
 Sterile gowns are worn to protect the patient from the worker. Outside of gown that is in contact with the
sterile field must be kept sterile
 Reduce number of organisms and prevent spread of infection to other

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How microorganism Spread

1. Microorganism move on air currents
2. Microorganism are transferred from one surface to another whenever objects touch
3. Microorganism are transferred by gravity when items is held above another
4. Microorganism are released into the air on droplets nuclei whenever a person breathes or speak
5. Microorganism moves slowly on dry surfaces but quickly through moisture.

Universal Precaution (by: CDC)

 an approach to infection control to treat all human blood and certain human body fluids as if they were known
to be infectious for HIV, HBV and other bloodborne pathogens
 Some of the substances are feces, vomitus and sputum, nasal secretion and other secretion from the body.

Standard Precaution
 The Center for Disease Control and prevention, released a draft of a new infection control standard
 It is similar to Body Substance precaution
 It implements the use of gloves in all the substance being contacted in order to decrease the potential
transmission of bacteria

STANDARD PREACUATIONS IN MEDICAL AND SURGICAL ASEPSIS

 HANDWASHING
 GOWNING
 GLOVING
 MASK/CAP
 DISPOSING CONTAMINATED. EQUIPMENT

OHSA= Occupational Health and Safety Administration

 Established the regulation mandating that health agencies provide educational sessions regarding Universal
precaution before the employee contacts clients.

HAND WASHING
 Refer to hand hygiene
 the act of cleaning one's hands with or without the use of water or another liquid, or with the use of soap for
the purpose of removing soil, dirt, and/or microorganisms
 The most important procedure for preventing the transfer of microorganism and therefore nosocomial infection
(infection originating in a hospital.)

Hand washing should be done in all of the following aspects:

1. At the beginning of every work shift
2. Before and after prolonged contact with a patient
3. Before invasive procedure (endoscopy)
4. Before contact with especially susceptible patients
5. Before and after touching wounds
6. After contact with body substances even when gloves are worn
7. Anytime you are in doubt about necessity for doing so.
8. At the end of every shift before leaving the health facility.

Hand washing has the following health benefits:

 helps minimize the spread of influenza
 diarrhea prevention
 avoiding respiratory infections
 a preventive measure for infant deaths at their home birth deliveries
 improved hand washing practices have been shown to lead to small improvements in the length growth in
children under five years of age

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Hand washing should be done in all of the following aspects:

 At the beginning of every work shift
 Before and after prolonged contact with a patient
 Before invasive procedure (endoscopy)
 Before contact with especially susceptible patients
 Before and after touching wounds
 After contact with body substances even when gloves are worn
 Anytime you are in doubt about necessity for doing so.
 At the end of every shift before leaving the health facility.

For medical aseptic purposes

 Hand washing should be vigorously takes 15-30 seconds (some books 10 sec)
 A deep sink with controls that can be operated by foot, leg, or elbow is ideal for hand washing. Faucets operated
by hand should be use a paper towel to turn off.
 A longer surgical scrub will require extra soap or detergent.

Equipment for hand washing

1. Soap
a. Soap and detergents
 Removal of microorganisms from skin is enhanced by the addition of soaps or detergents to water
 The main action of soaps and detergents is to reduce barriers to solution, and increase solubility
b. Solid soap
 may hold bacteria acquired from previous uses
c. Antibacterial soap
 type of cleaning product which contain chemical ingredients that purportedly assist in killing bacteria
 contain common antibacterial agents such as triclosan,(antibacteria or antifungal) which has an
extensive list of resistant strains of organisms
2. SINK
3. Running Water
 Hot water that is comfortable for washing hands is not hot enough to kill bacteria. Bacteria grow much
faster at body temperature (37 C).
 However, warm, soapy water is more effective than cold, soapy water at removing the natural oils on
your hands which hold soils and bacteria.

A. Hand antiseptics
 A hand sanitizer or hand antiseptic is a non-water-based hand hygiene agent
 alcohol rub non-water-based hand hygiene agents (also known as alcohol-based hand rubs, antiseptic
hand rubs, or hand sanitizers
 Most are based on isopropyl alcohol or ethanol formulated together with a thickening agent such as
Carbomer into a gel, or a humectant such as glycerin into a liquid, or foam for ease of use and to
decrease the drying effect of the alcohol.
 Hand sanitizers containing a minimum of 60 to 95% alcohol are efficient germ killers.
 Alcohol rub sanitizers kill bacteria, multi-drug resistant bacteria (MRSA and VRE), tuberculosis, and some viruses
(including HIV, herpes, RSV, rhinovirus, vaccinia, influenza, and hepatitis) and fungi.
 Alcohol rub sanitizers containing 70% alcohol kill 99.97% of the bacteria on hands 30 seconds after application
and 99.99% to 99.999% of the bacteria on hands 1 minute after application
 Hand sanitizers are most effective against bacteria and less effective against some viruses.
 Alcohol-based hand sanitizers are almost entirely ineffective against norovirus or Norwalk type viruses, the most
common cause of contagious gastroenteritis

4. Paper or Cloth towels

 Use to dry hands at to turn off the faucets
Drying method Effect on bacterial count
Paper towels and roll Decrease of 24%
Hot-air dryer Increase of 12%

 Hand washing using hand sanitizing wipes is an alternative during traveling in the absence of soap and water
 A proper hand-washing takes about 20 seconds, and at least 15 seconds of that should be rubbing your hands
together. That's the friction. Water by itself is not enough to get rid of all germs because your skin naturally

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produces oil that germs can stick to. Soap breaks down that oil and makes it harder for germs to remain on your
hands.

Disinfectants
 antimicrobial agents that are applied to the surface of non-living objects to destroy microorganisms that are
living on the objects
 Disinfection does not necessarily kill all microorganisms, especially resistant bacterial spores; it is less effective
than sterilization, which is an extreme physical and/or chemical process that kills all types of life

The World Health Organization has published a sheet demonstrating standard hand-washing and hand-rubbing in
health-care sectors

The World Health Organization has "Five Moments" for washing hands
a. before patient care
b. after environmental contact
c. after exposure to blood/body fluids
d. before an aseptic task, and
e. After patient care.

SURGICAL HAND SCRUBS

 Human hands are the most important tools for caring.

 Hands feel, diagnose, cure, prod, and provoke as they are placed upon each patient who is hoping for answers,
understanding, and healing remedies.

 The hands can also be a portal and transmitter of infection. While handwashing may be the simplest way to
control infection, it is often not practiced where warranted.

The purpose of surgical hand scrub is to:

 Remove debris and transient microorganisms from the nails, hands, and forearms
 Reduce the resident microbial count to a minimum, and
 Inhibit rapid rebound growth of microorganisms

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Surgical Scrub Techniques

All sterile team members should perform the hand and arm scrub before entering the surgical suite.

The basic principle of the scrub is to wash the hands thoroughly, and then to wash from a clean area (the hand) to a less
clean area (the arm).

A systematic approach to the scrub is an efficient way to ensure proper technique.

There are two methods of scrub procedure

1. numbered stroke method,

 which a certain number of brush strokes are designated for each finger, palm, back of hand, and arm.
2. The alternative method
 the timed scrub, and each scrub should last from three to five minutes, depending on facility protocol.

The procedure for the timed five minute scrub consists of:

 Remove all jewelry (rings, watches, bracelets).

 Wash hands and arms with antimicrobial soap. Excessively hot water is harder on the skin, dries the skin, and is
too uncomfortable to wash with for the recommended amount of time. However, because cold water prevents
soap from lathering properly, soil and germs may not be washed away.
 Clean subungual areas with a nail file.
 Start timing. Scrub each side of each finger, between the fingers, and the back and front of the hand for two
minutes.
 Proceed to scrub the arms, keeping the hand higher than the arm at all times. This prevents bacteria-laden soap
and water from contaminating the hand.
 Wash each side of the arm to three inches above the elbow for one minute.
 Repeat the process on the other hand and arm, keeping hands above elbows at all times. If the hand touches
anything except the brush at any time, the scrub must be lengthened by one minute for the area that has been
contaminated.
 Rinse hands and arms by passing them through the water in one direction only, from fingertips to elbow. Do not
move the arm back and forth through the water.
 Proceed to the operating room suite holding hands above elbows.2
 If the hands and arms are grossly soiled, the scrub time should be lengthened. However, vigorous scrubbing that
causes the skin to become abraded should be avoided.
 At all times during the scrub procedure care should be taken not to splash water onto surgical attire. 2
 Once in the operating room suite, hands and arms should be dried using a sterile towel and aseptic technique.
You are now ready to don your gown and sterile gloves.

 When gowning oneself, grasp the gown firmly and bring it away from the table. It has already been folded so
that the outside faces away. Holding the gown at the shoulders, allow it to unfold gently. Do not shake the
gown.

 Place hands inside the armholes and guide each arm through the sleeves by raising and spreading the arms. Do
not allow hands to slide outside the gown cuff. The circulator will assist by pulling the gown up over the
shoulders and tying it.

 To glove, lay the glove palm down over the cuff of the gown. The fingers of the glove face toward you. Working
through the gown sleeve, grasp the cuff of the glove and bring it over the open cuff of the sleeve. Unroll the
glove cuff so that it covers the sleeve cuff. Proceed with the opposite hand, using the same technique. Never
allow the bare hand to contact the gown cuff edge or outside of glove.

 The scrubbed technologist or nurse gowns the surgeon after he or she has performed the hand and arm scrub.
After handing the surgeon a towel for drying, the technologist or nurse allows the gown to unfold gently, making
sure that there is enough room to prevent contamination by nonsterile equipment. To glove another person, the
rules of asepsis must be observed. One person's sterile hands should not touch the nonsterile surface of the
person being gloved.
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 Pick up the right glove and place the palm away from you. Slide the fingers under the glove cuff and spread them
so that a wide opening is created. Keep thumbs under the cuff.
 The surgeon will thrust his or her hand into the glove. Do not release the glove yet.
 Gently release the cuff (do not allow the cuff to snap sharply) while unrolling it over the wrist. Proceed with the
left glove, using the same technique.

Characteristics of a Surgical Scrub

Performance characteristics for a surgical scrub agent generally fall into four categories:

1. Antimicrobial Action-
 an ideal agent would have a broad spectrum of antimicrobial activity against pathogenic organisms.
 This agent would have to work rapidly.
 An agent that does not work rapidly may not provide adequate bacterial reduction before being rinsed
off.

2. Persistent Activity
 an agent offering persistent activity keeps the bacterial count low under the gloves.
 It is not unusual for a surgery to last in excess of two hours.

3. Safety-
 the ideal agent would be non-irritating and non-sensitizing.
 It must have no appreciable ocular or ototoxicity, be safe for use on the body, and not be damaging to
the skin or environment.

4. Acceptance
 probably most important to achieving compliance in using a new product is its acceptance by the
healthcare worker.
 A product that has ideal antimicrobial action and an excellent safety profile is of little value to good
infection control if the user population fails to support its use.
 Although each is important in its own right, all four characteristics should be present for a complete
package.

Surgical scrub agents come in many forms. Not all forms meet all characteristics.

1. Liquid or foam soaps.

 These are the most common products for surgical scrubs and are used in conjunction with water and
dry scrub brushes or sponges.
 The most common antimicrobial agents in these products are CHG (chlorhexidine gluconate), iodophor,
or PCMX (parachlorometaxylenol).
 These agents are very drying and with repeated scrubbing with the scrub brush can cause skin damage.

2. Impregnated scrub brushes/sponges.

 Scrub brushes/sponges are preloaded with CHG, iodophor, or PCMX and are water-aided products.

3. Brush-free surgical scrub.

 These products use an antimicrobial agent and water but no scrub brush.

Use of brushes
 Scrubbing with a disposable sponge or combination sponge-brush has been shown to reduce bacterial
counts on the hands as effectively as scrubbing with a brush
 It is conceivable that a brush may be beneficial on visibly dirty hands before entering the operating
room. Members of the surgical team who have contaminated their hands before entering the hospital
may wish to use a sponge or brush to render their hands visibly clean before entering the operating
room area.
Drying of hands
 Sterile cloth towels are most frequently used in operating theatres to dry wet hands after surgical hand
antisepsis

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Side-effects of surgical hand scrub

 Skin irritation and dermatitis are more frequently observed after surgical hand scrub with chlorhexidine
than after use of surgical hand antisepsis with an alcohol-based hand rinse.
Required time for the procedure

 For many years, surgical staff frequently scrubbed their hands for 10 minutes preoperatively, which
frequently led to skin damage.
 Several studies have demonstrated that scrubbing for 5 minutes reduces bacterial counts as effectively
as a 10-minute scrub
 20 seconds is the suggested recommendation for proper friction. To make sure you are scrubbing for the
correct amount of time, it is often suggested you sing or hum “Happy Birthday” to yourself twice while
washing.(CDC)

Personal hygiene
 To enhance infection control

Important Guidelines
1. Arranged your hair in a way that does not contribute to contaminating the patient or environment and it will
protect you from contaminating your hair with microbes you may have contacted with your hands.
2. Keep your fingernails clean and trimmed
3. Where minimum of jewelry

DONNING GLOVES
 The key concern is creating a barrier between wearers’ skin and contaminants, pathogens or other hazardous
materials.
2 Broad categories
1. Non-sterile examination
2. Sterile surgical gloves

How to Use and Remove Gloves

Donning Gloves
 Select the proper glove(s) for the type of work and potential hazards.
 Check for visible tears and other defects.
 Remove rings and other jewelry if they may rip gloves.
 Protective ability diminishes as gloves are worn due to stretching and abrasion; change gloves regularly or as
soon as possible if they are overtly contaminated.
 Wash hands immediately before donning gloves.
 Never reuse disposable gloves.
Doffing Gloves
 Grasp the exterior of one glove with your other gloved hand.
 Carefully pull the glove off your hand, turning it inside-out.
 Ball the glove up and hold in your other gloved hand.
 Slide your ungloved finger into the opening of the other glove.
 Carefully pull the glove off your hand, turning it inside out again.
 Discard appropriately.

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STERILIZATION
 Microorganisms (including bacteria, spores, and viruses) can be completely destroyed through the process of
sterilization.
 Surgical instruments, dressings, and certain other items are sterile and remain so until individual packages or
seals are penetrated and contaminants are admitted.
 Sterilization normally is accomplished by use of heat; preferably moist heat under pressure such as is used in
an autoclave.

DISINFECTION

 Disinfectants are used as a means for destroying harmful organisms with the exception of the spore forms of
bacteria.
 In the emergency medical treatment situation, the spore-forming organisms of importance are those that cause
tetanus and gas gangrene.
 Tetanus, in the absence of preventive antitetanus inoculation, and gas gangrene are serious infections which
threaten wounded patients, especially those with deep, dirty wounds in which oxygen supply is very limited.

a. Boiling
 Boiling is considered only when saturated steam under pressure (autoclave) is not available.
 Articles should be well cleaned before boiling and then must be totally immersed, with surfaces
opened to the solution, for 30 minutes of vigorous boiling.
 Needles, metal cannulas, surgical instruments, glassware (including hypodermic syringes), and
similar items may be boiled.
 Rubber goods may not be boiled.
b. Chemical Disinfectants
 Various chemical preparations are effective as disinfectants.
 Chemical disinfectants in common use today include Cidex, Wescodyne, isopropyl alcohol 70
percent, and certain phenol preparations specifically designed as disinfecting solutions for
inanimate objects.
 Materials not harmed by water will not be harmed by disinfectant solutions of these chemicals.
 Use of liquid chemical disinfectant should be severely limited to those occasions when
saturated steam under pressure (autoclave) is not available or when steam sterilization would
damage articles so processed.
c. Antiseptic
 Antiseptics interfere with the growth and development of pathogens without necessarily
destroying these agents.
 Antiseptics are milder than chemical disinfectants, either by nature or by strength, and may be
applied directly to patients.
 Antiseptics included in your aid kit are povidone-iodine topical solution and ointment, surgical
detergent 7 1/2 percent povidone, and isopropyl alcohol 70.

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d. Cleansing Agents
 Cleansing or skin degerming agents may include soap and water or surgical detergent
preparation and water.
 Mixtures of soaps or skin detergents, with or without antiseptic properties, mechanically bind
dirt, grime, and pathogens that are then floated away with rinse water.

PPE PERSONAL PROTECTIVE EQUIPMENT (PPE)

 is clothing or equipment designed to reduce employee exposure to chemical, biological, and physical hazards
when on a worksite. It is used to protect employees when engineering and administrative controls are not
feasible to reduce the risks to acceptable levels.
Importance
 According to the hierarchy of controls by the National Institute for Occupational Safety and Health (NIOSH), PPE
(sometimes also referred to as PPE equipment)—is recommended to be the last level of defense to prevent
occupational injuries, illnesses, and fatalities, but some businesses combined it with other control measures to
ensure a safe and healthy environment for their workers. Here are some benefits of using PPEs:

 prevent unnecessary injury in the workplace;

 protect employees from excessive chemical exposure;
 prevent the spread of germs and infectious diseases including COVID-19;
 help businesses comply with regulatory requirements(e.g., The Personal Protective Equipment at Work
Regulations 1992 that’s recently been extended to limb workers); and
 improve employee productivity and efficiency.

THE 4 BASIC TYPES

 A hazard assessment can help identify which specialized PPE will be required. There are numerous types of
workplace safety equipment available depending on the hazard exposure and work conditions. The following are
basic PPE that can help protect employees:

Face and Eye Protection

 PPE includes safety goggles and face shields and should be used for tasks that can cause eye damage or loss of
vision, sprays of toxic liquids, splashes, and burns.

Safety Tips:
 Check if safety glasses comply with the ANSI Z87.1 eye protection standard.
 Ensure that there are no cracks or deformities on the lenses.
 Ensure the strap is in good working condition and is firmly sealed to the cheek and forehead.
 Clean and disinfect after use.

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Respiratory Protection
 PPE includes full-face respirators, self-contained breathing apparatus, gas masks, N95 respirators, and surgical
masks are used for a task that can cause inhalation of harmful materials to enter the body. This includes harmful
gas, chemicals, large-particle droplets, sprays, splashes, or splatter that may contain viruses and bacteria such as
COVID-19, viral infections, and more.

Safety Tips:

 Ensure that the equipment is fit-tested and the employee has undergone proper training before wearing one.
 Carefully read the instructions to determine if it is designed to help protect against the hazards you may face.
 Change filters on half-mask or full-mask respirators frequently.
 Replace disposable respirators with every use.
 Surgical masks are not to be shared with anyone.
 Avoid touching the surgical mask after wearing it.
 Change surgical mask timely and should be disposed of after use.
 Replace the mask immediately if it is damaged or soiled.

RESPIRATORY PROTECTIVE EQUIPMENT

 Protects workers against contaminants presence in the workplace such as:
1. Harmful gases
2. Chemicals
3. Particles or droplets containing viruses and bacteria

Skin and Body Protection

 PPE includes the following categories to protect employees from physical hazards:

Head Protection
 PPE includes hard hats and headgears and should be required for tasks that can cause any force or object falling
to the head.

Safety Tips:
 Ensure that there are no dents or deformities on the shell and connections are tightened inside.
 Do not store in direct sunlight as extreme heat can cause damage.
 Choose appropriate cleaning agents as it can weaken the shells of hard hats and may eliminate electrical
resistance.
 Always replace a hard hat if it was used for any kind of impact, even if the damage is unnoticeable.

Body Protection
 PPE includes safety vests and suits that can be used for tasks that can cause body injuries from extreme
temperatures, flames and sparks, toxic chemicals, insect bites and radiation.

Safety Tips:
 Ensure that they are clean and free from cuts and burns.
 Always get a good fit to ensure full body protection.
 Ensure bodysuit is heat-resistant clothing when working with high-temperature hazards.

Hands Protection
 PPE includes safety gloves and should be used for tasks that can cause hand and skin burns, absorption of
harmful substances, cuts, fractures or amputations.

Safety Tips:
 Ensure hand protection fits perfectly with no spaces and is free from cuts, burns and chemical residue.
 Always replace them if any sign of contamination was observed.
 Use rubber gloves when working with heat and electricity to reduce the risk of burn or electrical shock.

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Foot Protection
 PPE includes knee pads and safety boots and should be used for tasks that can cause serious foot and leg injuries
from falling or rolling objects, hot substances, electrical hazards, and slippery surfaces.

Safety Tips:

 Ensure boots have slip-resistant soles that can protect against compression and impact.
 Ensure the sole plate is in good condition to prevent punctures.

Fall Protection
 PPE includes safety harnesses and lanyards and should be strictly used for tasks that can cause falling from
heights and serious injury or death.

Safety Tips:

 Ensure that the straps are free from tears, deformities and burn marks.
 Check the buckles if connected securely and tightly.
 Dispose of the equipment if used after a falling incident.

Hearing Protection
 PPE includes ear muffs and plugs and should be used for tasks that can cause hearing problems and loss of
hearing.

Safety Tips:
 Ensure the equipment fit the ear canal perfectly.
 It is recommended to use formable earplugs to fit on different sizes of ear canals.
 Use protectors that reduce noise exposure to an acceptable level to have a room for communication.
 Ensure earplugs are clean and in good condition.

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PPE SAFETY REQUIREMENTS

 To promote PPE safety in their workplace, safety officers will need to do the following:

 Check work sites regularly for the need of PPE.

 If PPE is needed, provide employees with properly-fitted PPE.
 Train employees on OSHA PPE standards.
 Provide protective goggles or face shields when there is a danger of flying particles or corrosive materials.
 Require that safety glasses are worn at all times in worksites that pose risk of eye punctures, abrasions,
contusions, or burns.
 Provide and require protective gloves in situations where employees could be cut or be possibly exposed to
corrosive liquids, chemicals, blood, and other potentially infectious materials.
 Require the use of foot protection when there is risk of foot injury from hot, corrosive, or poisonous substances,
and falling objects.
 Inspect hard hats periodically for damage to the shell and suspension system.
 Maintain PPE in sanitary and ready-to-use conditions.
 Ensure that eyewash facilities and quick drench showers are easily accessible for employees when they are
accidentally exposed to corrosive materials.
 Establish safe work procedures for disposing of or decontaminating PPE after hazardous exposures.

BEDMAKING
 Knowing how to modify them for special situations is of paramount importance for the nurse.
 A clean, wrinkle-free bed that remains intact when a patient moves does a great deal for the patients
physical and psychological comfort.
 It is the techniques of preparing different types of bed in making a patients /client comfortable or
his/her position suitable for a particular condition.

Basic Infection control in Bedmaking

1. Microorganism move through space on air currents, therefore handle linen carefully, avoid shaking or tossing in
laundry hamper
2. Microorganism are transferred from one surface to another wherever one object touches another.
3. Proper handwashing removes many of the microorganism that would be transferred by the hands from item to
another

Body Mechanics in Bedmaking

1. A PERSON OR OBJECT IS MORE STABLE IF THE CENTER OF GRAVITY IS CLOSE TO THE BASE OF Support. So, when
you bend, bend your knees not your back, to keep the center of gravity directly above and close to the base of
support and to help prevent fatigue.
2. Facing in the direction of the task to be performed and turning the entire body in one plane (rather than
twisting,), lessen the susceptibility of the back to injury.
3. Smooth, rhythmical movement at moderate speed require less energy., organize your work.
4. It takes less energy to work on a surface at an appropriate height (usually waist level) than it does to stoop or
stretch to reach the surface., raise the bed to an appropriate height from maximum working comfort for
yourself to prevent fatigue.

PURPOSE
 Provide the client with a safe and comfortable bed to take rest and sleep.
 To keep the ward neat and tidy
 To adapt to the needs of the client and to be ready for any emergency or critical condition of illness
 To economize time, material and effort
 To prevent bedsores
 To observe the client
 For patients’ comfort
 To prevent cross infection
 For treatment of certain conditions
 To establish interpersonal relationship
 To teach relatives how to take care of the patient at home
 To provide active and passive exercise to the patient

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INFECTION CONTROL
 Important to limit movement of organisms and spread of infection while in bed
 Roll the dirty or soiled linen while removing it from bed
 Hold dirty linen away from your body.
 Place dirty linen in hamper /cart /bag immediately
 Never place linen on the floor
 Wash your hands after handling dirty linen
 Never bring extra linen into a patient’s room.
 Linen is considered contaminated once it is in a room and cannot be used for another person.
 Avoid shaking clean sheets to place them on the bed.
 Unfold them gently to inhibit the flow of microorganism.
 Place the open end of pillowcase away from the door
 This looks neater and also helps prevents the entrance of organisms from the hall

UNIVERSAL PREACAUTIONS
 OBSERVE UNIVERSAL precautions if linen is contaminated by blood or body fluids
 Wash hands frequently and wear gloves while handling linen
 Follow agency policy for proper disposal of linen.

BODY MECHANICS
 ESSENTIAL to use correct body mechanics while bed making
 Also, important to conserve time and energy
 Keep linen arranged in order of use
 Make bed completely on one side before doing other side to limit unnecessary movement from one side of bed
to the opposite side.

TYES OF BEDS

1. CLOSED BED
 MADE FOLLOWING discharge of patient
 Purpose is to keep bed clean until new patient admitted.
 It is unoccupied or empty bed made to receive the patient and is fully covered with counter pane to protect
it from dust and dirt.
 On admission of the patient, the closed bed is converted in to an open bed.
PURPOSE
 To keep the bed ready for occupancy
 To provide a neat and tidy appearance to the unit.

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2. OPEN BED
 FANFOLD TOP SHEETS TO FOOT OF THE BED TO CONVERT CLOSED BED TO OPEN BED.
 Fanfold means to fold sheets like Accordian pleats
 Done to welcome a new patient or for patients who are ambulatory or out- of- bed.
 It is a bed , made when it is about to be occupied by either a new patient or an ambulatory patient.

3. OCCUPIED BED
 BED IS MADE WHILE PATIENT IS IN IT .
 USUALLY DONE AFTER THE MORNING BATH
 This bed is made with the patient in it
PURPOSE:
 To make a bed with least possible discomfort to the patient
 To handle the bed clothes skillfully while the patient is on bed , giving least disturbance to the occupant.
 To provide a neat , clean and tidy appearance

4. BED WITH CARDLE

 Cradle placed on bed under the top sheet
 Prevents top sheets from touching parts of the patient’s body
 Used for burns, skin ulcers, lesions, blood clots, fractures or surgery
 Some cradles have light bulbs tom provide heat for special treatment.
5. ADMISSION BED
 This is the bed prepared to receive a newly admitted patient.
PURPOSE:
 To welcome the patient
 To provide immediate care, safety and comfort
 To protect the bed linen while giving bath on admission.
6. POST – OPERATIVE BED
 IT is a bed prepared for a patient who is recovering from the effects of anesthesia following surgery.
PURPOSES:
 To receive the patient conveniently
 To provide warmth and comfort
 To prevent shock
 To prevent injury
 To prevent soiling of the bed
 To meet any emergency.

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7. CARDIAC BED
 A bed prepared for patients with cardiac diseases.
PURPOSE:
 TO PREVENT THE BED FOR THE CARDIAC PATIENTS
 TO RELIEVE DYSPNEA

8. AMPUTATION /DIVIDED/ CRADLE BED

 It is a bed in which top linen is divided into two parts to visualize the amputed part of the lower limbs
without disturbing the patient.
PURPOSES:
 To watch the stump for hemorrhage and apply tourniquet instantly
 To take the weight of the bed clothes off the patient
 To keep the stump in position

9. FRACTURE BED
 It is a bed which is prepared for patients with fracture, bone diseases and deformity .
PURPOSES:
 To prevent undue sagging of mattress
 To immobilize the fractured part
 To restricts sudden jerky movements
 To keep the traction in position.

10. THERAPEUTIC BED

 Renal/ Rheumatism / Blanket bed
 It is a bed made for patients suffering from rheumatism or renal disease

PUPRPOSES:
 TO carry the weight of the bed clothes off the painful joints
 To keep the patients warm
 To induce sweating

NURSES RESPONSIBILITY IN BED MAKING

PRELIMINARY ASSESSMENT
 CHJECK THE DOCTORS ORDER FOR SPECIFIC PRECATIONS REGARTDING THE MOVEMENT AND POSITIONING OF
THE CLIENT.
 ASSESS THE CLIENT S ABILITY FOR SELF CAREW
 CHECK THE FURNITURE AND LINEN AVAILABLE IN THE CLIENT’S UNIT.
 Assess the number of clean linens needed.
 Assess the articles needed for the comfort of the client. EX: BLANKETS, BACKRESTS.

PREPARATION OF THE ARTICLES- OPEN BED

 BOTTOM SHEET
 MACKINTOSH
 DRAW SHEET
 TOP SHEET
 BLANKET
 PILLOW COVER (PILLOW CASE)
 ADDITIONAL ARTICLES:
 LAUNDRY BAG
 DUSTERS
 A BOWL WITH ANTISEPTIC SOLUTION (SAVLON 1:40)
 Kidney Tray
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PREPARATION OF THE CLIENT AND UNIT

 Explain the procedure to the client to win the cooperation and confidence of the client
 Explain how the client can assist
 Screen the client to provide privacy if needed
 Move furniture away from the bed and mover the bed away from the wall.
 Lower the back rest if any
 Place the laundry bag within the reach

MATTRESS
 Used for the client should be form, thick and smooth
 It gives support to clients
 All should have a washable cover
 The size is 190 cm width

PILLOW
 Usually made out of strong cotton or Dunlop
 Size 60 cm long, 45 cm wide and 10 cm thick.

PILLOW CASES
 It should be bigger than size of the pillow for the easy insertion lest they destroy the shape of the pillow.
 The average size is 65 cm long and 50 cm wide

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BLANKET
 a large piece of cloth often soft, woolen and is used for warmth as a bed cover

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TERM:
1. Bed making
 the ability of the nurse to keep the bed clean and comfortable
 the technique of preparing different types of bed in making patients/clients comfortable in his/her suitable
position for a particular condition
 it requires keen inspection to be sure that the linens are clean, dry and wrinkle-free1.

2. Fanfold
 is done by grasping the upper edge of the linen with both hands
 specifically folding the edge of the sheet used in the bed 6-8 inches outward

3. Mitered corner
 a means of anchoring sheets on mattresses
 method of folding the bed clothes at the corners to secure them in place while the bed is occupied
 it is accomplished on the bottom sheet by placing the end of the sheet evenly under the mattress

4. Toe pleat
 a fold made in the top bed clothes to provide additional space for patient’s toes

5. Foot drop
 dropping of the foot from paralysis of the anterior muscle of the leg
 plantar flexion of the foot with permanent contracture of the gastrocnemius(calf) muscle and tendon

6. Bed cradle
 a curved, semi-circular device made of metal that can be placed over a portion of the patient’s body
 sometimes called an Anderson frame, is a device designed to keep the top bed clothes off the feet, legs, and
even abdomen of a client.

7. Magic corner
 corners of a folded linen when upon opening it automatically positions the sheets the way it is placed on the bed

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8. Cradle Bed
 Contains cradle, a device for holding the top covers off.
 The outer cradle is made of wood, metal or at home for a brief period, a cardboard art to shape

9. Postoperative Bed
 Also known as recovery bed or anesthetic bed.
 Used not only for clients who have undergone surgical procedures but also for clients who have given
anesthetics for a certain examination.
 Used for a patient with a large cast or other circumstance that would make it difficult for him to transfer easily
into bed.

SPECIAL TYPES OF BEDS

1. Water bed
 Special mattress filled with water.
 It controls temperature of water, reducing pressure on body parts.
Indications:
 Patients confined to bed for long periods

2.Turning Frames (Stryker Wedge)

 It allows repeated changes between the supine and prone positions without disturbing spinal alignment.
Indications:
 complication of immobility such as atelectasis, pneumonia, decubitus ulcer and renal calculi.

3.Rotation Bed
 promote postural drainage, peristalsis and helps prevent the complications of mobility
Indication:
 patients with spinal cord injury, severe burns

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