Weekly Cleaning (In the ward):

• Move the beds from one side of the ward to the other.
• Put lockers outside the ward.
• Proceed on the empty side as follows:
• Brush walls and ceiling and wire gauze of ventilators with long handled brush.
• Wash painted walls with soap and water, cleaning any edges and corners carefully.
• Wash lamp shades.
• The sweeper then sweeps and scrubs the floor.
• Clean windows.
• Replace beds.
• Repeat the same procedure on the other side.
• Scrub lockers and return to the ward when dry.
• Turn out and scrub all cupboards.
• Polish furniture if necessary.

In the ward annexes (kitchen, bathroom, linen room etc) (Weekly):

• Turn out and clean both the room and equipment.
• Refrigerators (Weekly): Defrost weekly, wash interior with hot soapy water, rinse, and replace shelves. Clean ice trays with cold water.
• Suction machines (Daily/Whenever Used): Wash with soap and water daily and whenever used. Replace the lotion in the bottles.
• Autoclaves (Daily): Dump dust daily, check functionality of water and pressure gauges. Unplug from the mains when not in use.
• Boilers and sterilizers (Daily): Empty, clean inside with gumption/hebitane. Refill with clean water and always unplug from the mains when not in use.
• Hot plates (Daily/When Spilled): Wipe any spills immediately with a dump cloth. Unplug from the mains when not in use.
• Oxygen concentrators (Daily): Dump dust daily, check water in wolf’s bottles and check the regulator. Unplug from mains and clean the filter.
• Lamps (Daily): Dump dust shades and bulbs daily.
• Oxygen cylinders (Daily): Dump dust daily, check flow meters, check oxygen level. Label empty cylinders “Empty.”.
• Drainage under water seal gadgets (After Use): Disinfect, clean, and sterilize.
• Beds (Daily/On Discharge): Make beds and dump dust rails daily. On discharge, wash beds with soap and water.
• Bed rests/backrests (Daily): Dump dust daily, wash with soap and water, rinse, and dry when necessary.
• Bed blocks/elevators (Daily/On Discharge): Dump dust daily. On discharge, scrub with soap and water.
• Bed cradles (Daily/On Discharge): Wash with soap and water, rinse, and dry when necessary and on discharge.
• Fracture boards (On Discharge): Scrub with soap and water.
• Drip stands (Daily): Dump dust daily, wash with soap and water whenever necessary and keep dry.
• Trolleys (Daily): Wash daily and after use with soap and water, dry thoroughly. Do not use rough cleaners on food trolleys.
• Enamel ware (After Use): Wash with soap and water after use. If stained, use vim or hebitane/gumption, rinse, and dry.
• Stainless steel ware (After Use): Wash with soap or detergent and water, rinse, and dry. Do not use vim.
• Plastic ware (After Use): Wash with soap or detergent and water, rinse, and dry. Use vim if necessary.
• Shelves (Daily/Whenever Necessary): Wash daily and whenever necessary.
• Sinks and hand washing basins (Daily/After Use): Wash daily and after use with vim.
• Crockery and glass ware (Daily): Wash daily with soap or detergent and water, rinse, and dry.
• Cutlery (Daily): Wash with soap or detergent and water, rinse, and dry.
• Soiled dressing buckets (Keep lid on at all times): Keep outside clean. Thoroughly clean after emptying. Use large basins for dusting; do not use receivers and bowls for this.
• Infusion stands (Daily): Dump and dust daily, wash with soap and water, dry when necessary.

Isolation of infectious patients

Isolation is a key measure in infection control. It means separating a patient who has an infectious disease from other patients, visitors, and staff to prevent the spread of the infection.

The goal is to prevent direct contact (like touching) or indirect contact (like through contaminated objects or air) between the infectious patient and others who might be at risk. Examples of infections that might require isolation include droplet infections or infections spread through contaminated clothing.

Perform Hand Washing

Hand washing is the single most important means of preventing the transmission of infectious agents.

Rules for hand washing: Wash hands;

• On starting and completion of duty shifts.
• Before performing any invasive or non-invasive procedures.
• Between handling of patients and between the procedures on the same patient.
• After handling of patients and procedures.
• After handling contaminated articles like urinals, bed pans etc.
• Nails should be short to avoid the dirt and micro-organisms.
• Remove the watch and jewelry from the hands and wrist before starting to wash the hands.
• Fold back sleeves above the elbow if necessary.
• Stand away from the wash basin.
• Avoid splashing water onto the uniform.

Requirements:

• Soap/antiseptic lotion/detol
• Bowl
• Nail brush
• Hand towel
• Running water/tap water

Procedure:

1. Turn on the tap using the elbow and regulate the flow of water.
2. Wet the hands and lower arms under the running water. Keep the hands, fore arms lower than the elbows during washing.
3. Apply soap to the hands, replace soap in the dish.
4. Scrub the hands, area between the fingers and wrist in rotatory movements for 15-30 seconds.
5. Clean finger nails with a brush or use finger nails of the other hand.
6. Rinse hands and wrist, fore arm and elbow in running water. Ensure that the hand and fore arm are lower than the elbow during washing.
7. Close the tap using the elbow.
8. Dry the hands from fingers to wrist and fore arm, now hold hands above the elbows ready to put on gloves for the procedure.

Surgical Hand Washing (Detailed Procedure)

The hands should be thoroughly cleaned for about 3-5 minutes (in operation room, hands are scrubbed up to 10 minutes.)

Procedure:

1. Wet the hands and fore arms.
2. Apply soap (containing 3% hexachlorophene) to make a good lather/foam e.g. Detol, Protex etc.
3. Clean under the nails for 30 seconds. Nails should be kept very short.
4. Rinse thoroughly.
5. Apply soap to the arms again.
6. Scrub with the brush so that every area receives 15-30 strokes.
7. Add little amount of water frequently and use just enough detergent to maintain the lather.
8. Rinse the arms and hands.
9. In rinsing keep palms higher than the elbow so that the water does not run over them from the arms.
10. Dry on a sterile towel moving from the palms to the arms. Hold hands above the elbow ready to put on gloves for the procedure.

Demonstrate Appropriate Use of Protective Equipment

Understanding and demonstrating the correct use of protective equipment is a crucial practical skill for nurses.

This focuses on the practical demonstration of:

• Proper hand washing technique.
• Proper donning (putting on) of various protective gears like gloves, gowns, masks, and eye protection.
• Proper doffing (taking off) of protective gears to prevent self-contamination.
• Selecting the appropriate PPE based on the type of procedure and potential exposure.

Perform Routine and Weekly Cleaning of the Ward

Maintaining a clean ward environment is crucial for infection prevention and patient well-being. This PEX involves demonstrating the practical skills of ward cleaning.

This focuses on demonstrating:

• Following the established procedures for daily ward cleaning (as described in the ‘Ward Maintenance Practices’ section).
• Following the established procedures for weekly ward cleaning.
• Using appropriate cleaning agents and equipment.
• Maintaining a clean and tidy environment effectively.
• Performing damp dusting correctly.

WARD MAINTENANCE PRACTICES:

Daily Cleaning:

A. Ward Maintenance

• Collect all equipment necessary on the trolley.
• Make the patient’s beds and pull bed and lockers away from the wall.
• Collect and put away all the equipment not necessary on the ward for immediate use.
• The floor is swept and mopped.
• Carry out dump and dry dusting of all ward furniture and equipment, using the ward cleaning trolley.
• Return beds and lockers to their position.
• Replace sputum mugs with clean ones empty the used ones, rinse well in the sluice room, leave soaked in the disinfectant.
• Give out clean drinking mugs and feeding cups. Refill bottles for drinking water if required.
• Clean used equipment and keep in the proper place.

In dressing and treatment rooms:

• Shelves – Wash daily and whenever necessary
• Sinks and wash basins – wash daily and after use with vim or hebitane.
• Sterilizers – empty, clean inside with hebitane when necessary, refill with clean water.
• Trolleys – wash daily and after with soap and water, dry thoroughly. Do not use gumption or vim on food trolleys.
• Lifting forceps – boiled daily and whenever contaminated forceps jars cleaned, boiled and lotion changed daily. Lotion jar inspected daily and more lotion added if required. Or boiled or autoclaved daily and kept in a dry sterile container.
• Soiled dressing buckets – keep lid on at all times, keep the outside clean. And they should be thoroughly cleansed after emptying.

Hygiene in Special Areas (Operating theatre, Intensive care unit (ICU), Pre-mature unit and Labour suit.)

Operating theatre:

• Operating tables, trolleys and shelves – dump dust daily using water and detergent.
• Walls – dump cleaning 2.5-3m downward daily with water and detergent.
• Floors – scrub with water and detergent daily and whenever soiled and leave to dry.
• Floors where there are spillages of body fluids – apply 1% hydrochloride for 15min and spot clean. Clean after every operation. Do weekly cleaning of all equipment and areas.

Note: The same method of cleaning applies to all the rest of the special areas mentioned above (intensive care unit, pr-mature unit and labour suit.)

1. Equipment Maintenance (Detailed Procedures – extracted from your notes): It is the responsibility of every health worker in the hospital to see that all equipment is very well looked after, serviced regularly and given immediate attention when there is any defect. Equipment should be handled with care and breakages reported immediately, this will definitely keep the hospital expenditure very low.
2. Electric machine Have regular servicing of the machines and as soon as they are out of order, make a requisition to the maintenance department, have them inspected and repaired.

• Refrigerators : These are regulated in order to be effective, regulators should be regularly checked and temperatures recorded every day. Defrosting should be carried out weekly, and then the interior is thoroughly washed with hot soapy water, rinsed and the shelves replaced. Ice trays are taken out and washed with cold water.
• Suction machines : Wash with soap and water daily and whenever used. Replace the lotion in the bottles.
• Autoclaves : Dump dust them daily, check the functionality of the water and pressure gauges. Always unplug from the mains when not in use.
• Boilers and sterilizers : Empty, clean inside with gumption/hebitane. When necessary refill with clean water and always unplug from the mains when not in use.
• Hot plates : Any substance spilt on it should be wiped off immediately using a dump cloth. Always unplug from the mains when not in use.
• Oxygen concentrators : Dump dust daily; make sure there is water in the wolf’s bottles and check the regulator daily. Always unplug from the mains when not in use and clean the filter.
• Lamps : Dump then dry and dust shades and bulbs daily.

2. Oxygen cylinders Dump dust them daily. Check whether the flow meters are working; check whether there is oxygen in the cylinder and the far the water level in the wolf’s bottles. Label the empty cylinders boldly with the word ‘Empty.’
3. Drainage under water seal gadgets Disinfect, clean and sterilize.
4. Beds Make them and dump dust the rails daily. On discharge of the patient; wash with soap and water.
5. Bed rests/backrests Dump dust daily, wash with soap and water, rinse and dry when necessary and on discharge on an infectious patient disinfect.
6. Bed blocks/elevators Dump dust daily. On discharge of the patients, scrub with soap and water.
7. Bed cradles Wash with soap and water, rinse and dry when necessary and in discharge of the patient, scrub with soap and water.
8. Fracture boards On discharge of the patients, scrub with soap and water.
9. Drip stands Dump dust daily, wash with soap and water whenever necessary and keep them dry.
10. Trolleys Wash daily and after use with soap and water, dry thoroughly. Do not use vim on food trolleys.
11. Enamel ware

Wash with soap and water after use, if stained use vim or hebitane/gumption, rinse and dry.

12. Stainless steel ware Wash with soap or detergent and water, rinse and dry. Do not use vim.
13. Plastic ware Wash with soap or detergent and water, rinse and dry. Use vim if necessary.
14. Shelves Wash daily and whenever necessary.
15. Sinks and hand washing basins Wash daily and after use with vim.
16. Crockery and glass ware Wash daily with soap or detergent and water, rinse and dry.
17. Cutlery Wash with soap or detergent and water, rinse and dry.
18. Soiled dressing buckets Keep the lid on at all times, keep the outside clean. They should be thoroughly cleaned after emptying.

N.B: Use large basins for dusting; do not use receivers and bowls.

19. Infusion stands Dump and dust daily, wash with soap and water, dry when necessary.

Weekly Cleaning: In the ward:

• Move the beds from one side of the ward to the other
• Put lockers outside the ward Proceed on the empty side as follows;
• Brush walls and ceiling and wire gauze of ventilators with long handled brush.
• Wash painted walls with soap and water, cleaning any edges and corners carefully.
• Wash lamp shades.
• The sweeper then sweeps and scrubs the floor.
• Clean windows.
• Replace beds.

Repeat the same procedure on the other side.

• Scrub lockers and return to the ward when dry.
• Turn out and scrub all cupboards.
• Polish furniture if necessary.

In the ward annexes (kitchen, bathroom, linen room etc)

Turn out and clean both the room and equipment.

Refrigerators: Defrosting should be carried weekly, when the interior is washed thoroughly with hot soapy water, rinsed and the shelves replaced. The ice trays are taken out and washed with cold water.

Bedding and linen: Care of mattress foam-rubber with cotton and plastic:

Do not remove the plastic mattress cover, wash with soap and water, rinse and dry whenever necessary.

Pillows: May be protected by plastic cover under cotton cover, to avoid soiling. The cover is removed for laundry whenever dirty, do not remove the plastic cover, wash with and soap, dry and put on the cover.

Rubber goods: Use only soap and cold water. Before hanging to dry wipe off excess water, do not fold if they are to be out of use for a long time, powder them before storing away. Do not hang on hot pipes or boiling sterilizers or in the sun.

All linen from the infectious patients should be soaked in disinfectant and soiled linen should be sluiced before sending to laundry. If linen has been stained with blood soak in cold water for 2-3 hours then rinse. On discharge of patients all linen should be removed and sent to laundry.

Rubber sheets: Mackintoshes are washed in soapy water and rinsed, hang out to dry, but never folded.

Rubber tubing: Rubber tubing-catheters and long tubing; these should be washed in soapy water, and under running water, rolled in the hands immediately after use. Rinse and roll and hang to dry.

Woolen blankets: Bed blankets; avoid frequent washing, but they should be sent to laundry whenever soiled.

Ward linen: To avoid cross infection in hospitals great care should be taken in handling of soiled linen contain discharges from patients. During bed making soiled linen should be separated and be put in a special dirty container/hamper. A trolley should be used for clean linen.

DAMP DUSTING:

Is the cleaning/brushing off, of the dust from a surface using a slightly wet cloth e.g. as of a table, chair, floor or wall etc.

Requirement (prepare a trolley):

Top shelf:

• Basin of clean water
• Soap and vim
• 2 Clean dusters in bowl
• A jar of clean water

Bottom shelf:

• Container for rubbish
• Bucket for dirty water
• Gloves
• Apron
• Gumboots

Procedure:

1. Wash hands and put on gloves. Put on apron and gumboots.
2. Always start to dust from the highest points or things first and work downward so you do not dirtied surfaces already cleaned.
3. Remove items from the surface to be cleaned.
4. Dampen or rinse the cloth in cleaning water.
5. Wipe away the dust with the damp cloth/duster.
6. Flat surfaces, wipe in straight lines beginning with the edges once each time.
7. Turn the cloth on each side 2nd pass and rinse regularly in clean water.
8. Take care to damp dust the edges and undersides of the surfaces after the tops.
9. Where there are extendable items, such as bedside tables, are to be damp dusted extend the before beginning to work.
10. Polish with the dry duster to clean and dry.
11. Change the cleaning water when it becomes soiled (dirty).
12. Greasy or stubborn deposits may require repeated passes.
13. Replace any items moved on the clean surface when it is dry.
14. On completion, clean and dry all equipment and store safely and tidily in a secure storage area.
15. Remove gloves and wash hands.
16. Document the procedure.

N.B: The basin used for dusting should be large one, receivers and dressing bowls are not to be used.