1. Unit 9
MACHINERY, EQUIPMENT AND LINEN
Care of Linen.
Linen management plays a great role in patient's satisfaction, reduces infection operation costs and plays
an important role in physician satisfaction. Efficient supply of linen without any defect and delay in time
becomes a good support towards delivering timely quality of health care services to the patient. If the
hospital does not provide proper supply chain of linen, this may lead to the delay in OT and ICU procedures,
patient care services, delay in CSSD operations and ultimately the entire hospital operations suffers.
Following rules to be observed:
(1) Linen should be kept in perfect order with different items separately locked.
(2) The cupboard should be locked, when not in use.
(3) Care to be taken to avoid linen to be taken home by client after discharge
(4) Stocks should be checked at regular intervals.
(5) The purpose of each linen should be known and should be used for that purpose only,
(6) Torn linen should not be used.
(7) Soiled linen should not be placed on floor.
(8) Damp linen should be dried.
(9) If there are stains, remove using appropriate stain remo ver.
(10) If soiled with urine or motion, they should be rinsed with cold water first to remove stain.
(11) The linen used for infectious, client should be disinfected first, before they are
Sent to the laundry.
(12) Use of mackintosh, whether it is necessary can economize the use of linen.
Care of linen (Removal of stains)
(i) Note the colour of material, the nature of stain and select the correct stain remover.
ii) Try the simple method.
(iii) Try whether the stain can be removed using cold water.
(iv) For coloured material, test the remover first on a small part.
2. (v) For stains contain fatty material, hot water and soap to be used.
(vi) For stains of medicine treated with water or methylated spirit.
(vii) For stains contain protein should be coagulated by the application of heat.
(viii) When the stains do not respond to simple methods bleaching agents may be used lemon juice, H,O,
and bleaching powder.
(ix) Application of same absorptive material such as salt, starch or borax will prevent any liquid from
spreading and thus reduce the ultimate damage of material.
(x) When boiling water is used, stretch the stained part over a bowl and pour the Boiling water with force.
(xi) When acid is used, stretch the part over a bowl of boiling water and applying acid by means of medicine
dropper. When the stain disappears rinse the cloth thoroughly in cold Water.
(xii) When bleaching by sunlight wet the stained area and lay it in the sunlight.
(xii) Use equal parts of H,O, and dilute ammonia and moisten the stain until it disappears.
(xiv) Strong chemicals are used as a last resort as it is injurious to the users
In case of blood stains:
i) Soak the linen immediately in cold water.
(ii) When the stains disappear, wash it in cold water and then with soap and warm
(iii) If it is an old blood stains on mattres: apply a thick paste of starch and water for several hours and wash
it in cold water and then with soap and warm water
(iv) Thick blood stains on mattress: Apply a thick paste of starch and water allow to stand in sun,when the
paste is dry and discoloured,brush off the stain
In case of tea, coffee, cocoa:
(i) Remove the stain using milk
(ii) If not completely gone, lemon iuice mav he rubhed or H,O0, may be aPpi
In case ot aniline dyes, gentian violet, methvlene blue :
i) Wet the clothes and bleach in sunlight.
(i) Chlorine water bleaches the dyes.
(ii) Rinse bleach thoroughly with warm water after stain disappears.
3. In case of candle wax stains:
(i) Scrape off the wax.
(ii) Place a cloth pad or blotting paper under and over the stain and press it with a hot ironing box.
In case of curry stains:
(1) Wash them immediately in cold water.
(i) Apply soap and water hot.
(iii) Bleach it in sunlight.
(iv) Stains are completely bleached, wash them in cold water.
In case of rust marks:
(i) Apply salt and lime juice and expose it to sunlight.
In case of iodine:
i) Dip the linen in rice water or apply a starch paste until the stain is removed.
In case of paint: (i) These are removed with turpentine, alcohol or ether.
Care of rubber goods.
The rubber goods which are commonly used in the hospital settings are air cushions, Mackintoshes, hot
water bottle, ice collars, rubber tubes, catheters, rectal tubes, gloves and rubber beds.
(i) Never use any pins to fix rubber goods in any place.
(i) Never expose them to sunlight.
(iii) Rubber goods should neither be dried by artificial heat nor by contact with radiator or stove.
(iv) They should be free from greases and acids.
(V) They should not come in contact with metal goods.
(vi) They should not be pressed out of shape by any weight.
(vii) They should not be tied in knots.
(Viii) They should not be hung on hooks or nails.
4. (ix) Any fluid split on them should be wiped off at once.
Cleaning of rubber mackintosh:
1. Spread the mackintosh on a table or a flat surface and wet it with cold water.
2. Turn the other side and repeat the process.
3. Wash both surfaces under running water
4. If stains are present, care should be taken to remove them by appropriate methods.
Care of rubber gloves:
1. It is desired that the wearer of gloves should wash them on their hands.
2. Rinse well with. Water both inside and outside.
3. Holes and tears are discovered by submerging the glove filled with air in water
4. Hang them to dry.
5. When both sides are dried. powder inside and outside packed in pairs,
6. The torn gloves are patched and may be reused
5. Care of rubber tubes:
Catheters vary in size and quality according to the needs. The points to remember in cleaning of the tubes
are
1. After use, wash them under running water, holding the eye end upwards and sing the water to run through
2. Clean them with soap and warm water to remove the dirt and grease
3. Wash them again under running water.
4, Boil the tubes for 5 min. by putting them in boiling water, dry them by hanging
5. When dried, powder and store them in airtight containers.
6. Reboil or autoclave them before use.
How to maintain a ward inventory? Or, Importance of ward inventory.
An inventory is a detailed list of articles in the ward, their specifications, standard number or quality.
We speak of "taking in ventory" by which is meant making a count of the materials at hand
I. When inventory is taken, it provides a good chance to determine the condition of articles and to
order, repair or replacement if necessary.
II. It is also an ideal time to return articles to their proper place
III. Frequent counts are an aid in maintaining and tracing elements.
IV. Some articles like flash lights, scissors, syringes and needles, BP apparatus require a daily count
V. These items may disappear and are easily broken, early discovering of loss makes tracing the
articles easier.
VI. Equipments which are out of order or not ready for use is often troublesome than if it were missing.
VII. The situation is not only embarrassing but also wastage of time.
VIII. So to prevent such occasions the articles need to be checked and sent for repairs if required. If
repairing is not possible, then replacement should be done.
6. Housekeeping, principles of good housekeeping
Purpose of taking care of articles used by clients.
Housekeeping is one of the important departments of hospital and functions to Keep the hospital clean. A
well managed housekeeping can reduce the cost of hospital operation.
Principles of good housekeeping:
1. Dust clings to the moist surfaces. Therefore the dusting can be done best by a damp duster.
2. Dusting is done after sweeping and not before.
3. Soap and water are used for cleaning.
4. Soap emulsifies fat and lowers surface tension of water. Water acts as a good solvent.
5. Friction aids in mechanical cleaning. Use brush when cleaning a grooved surface
6. Abrasives are harmful to the painted and polished surfaces.
7. Aluminous materials are coagulation by blood, so it is to be removed with cold water.
8. Bacteria grow in dark, moist and unclean places.
9. Disinfection by chemicals depend upon the cleanliness of article, the strength of the disinfectant and the
length of the exposure.
10. Exposure to sunlight destroys some bacteria.
11, Effective sterilization depends upon the cleanliness of the article, the degree of heat and length of
exposure.
12. Heat, chemicals, abrasives and solvent are harmful to some material.
13. Equipment suitable for the purpose for which it is used and in good condition, eniently 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
Purposes for cleaning:
(i) To leave a clean polished surface where possible so that it may not be accumulated.
7. (ii) To remove all dust, dirt and breeding places of micro-organisms with least disturbance to the client.
(iii) To prolong the life of articles.
(iv) To keep the articles in such a condition that they are ready for use at any time.
(V) To maintain the aesthetic factors.
Indent.
Indent: An indent is an official order or requisition for medicine and supplies from the medical stores. The
nurse acquires the equipment and supplies based on the need estimation, availability and the budget. As the
equipment is received it should be inspected and stored as per the classification and according to the rate
of consumption.
Disposables and Reusable
Disposables
Advantages:
(a) Ensure high- quality, sterile content in both non-hospital and hospital settings.
(b) Are logistically and operationally easier, especially in mobile outreach services.
(c) Reduce initial startup program costs.
(d) Eliminate autoclave maintenance, personnel, training and other costs.
(e) Can combine consumables, disposable instruments, and even client education materials into one kit.
Can be bundled to ease ordering and managing of supplies. Increase service delivery efficiency.
Disadvantages
(a) Create substantial amounts of waste, including stainless steel instruments that require smelting or
burying, thus raising environmental concerns.
(b) Limit the flexibility of clinicians to use their preferred equipment and surgical method.
(c) Are prone to having some pilfered, which could compromise the sterility of the remaining contents.
Reusable
Advantages: (a) Ensure high- quality, sterile content in both non-hospital and hospital settings.
8. (b) Well-maintained re-usable instruments are easier to use than disposable plastic surfaces. Therefore and
stainless steel instruments.
(c) Build health system capacity and infrastructure.
(d) Employ local personnel
(e) Create less waste and there is less need for waste management procedures.
(1) Require fewer long-term resources to procure additional instruments.
Disadvantages:
(a) Require additional staff time for cleaning, sterilizing, and packaging instruments and monitoring
procedures
(b) Require autoclave availability and regular maintenance for sterilization.
(c) Require water and power supply at site of autoclaving
(d) May require additional time for procurement, because kits are secured from multiple sources.
Difference between CSSD and MRD.
CSSD-
i. Central sterile supply department.
ii. Instruments are sterilized.
iii. .
MRD-
i. Medical record department
ii. All the hospital records are kept safely
Oxygen administration.
Oxygen administration is a procedure of O, inhalation via nose by the various techniques used,It is in gas
form present everywhere in the environment in various composition.
Definition: "Oxygen therapy is defined as the administration of oxygen by inhalation from a cylinder piped
in system liquid oxygen reservoir or oxygen concentration by Various methods to relieve anoxemia."
Purpose: (i) To facilitate normal metabolism of the tissues.
(ii) To reduce/correct arterial hypoxemia.
Indications: (i) Breathlessness or labored breathing
9. (ii) High altitudes
(ii) Shock and circulatory failure
(iv) Patients under anesthesia
(v) Critically ill
Contraindication:
(i) Administer with caution to the patient with COPD.
(ii) Atelectasis (Collapse of lung)
(iii) Oxygen toxicity.
Methods of Oxygen delivery:
1. Nasal catheter:
(i) It is inserted into the nostrils reaching up to the vulva and is held by adhesive tapes.
(ii) Flow rate is 1-4 liters of oxygen.
2. Nasal cannula: A nasal cannula is a simple comfortable device. The two cannula is about 1.5 cm long,
protrude from the centre of a disposable tube and are inserted into the nose. Low flow upto 5 liter per
oxygen.
3. Oxygen by mask: Oxygen mask covers the patients nose and mouth. Flow rate is 8-12 liters of oxygen.
4. Oxygen tent:
(i) When a patient has a facial injury or for any other reason cannot tolerate an oxygen mask, then this
method can be used.
ii) It requires 10-12 liters/min volume of oxygen. It creates feeling of isolation.
Sterilization.
Sterilization is defined as destruction of all living organisms as pathogenic or
saprophytic bacteria, vegetative forms and spores.
ENEMA.
A procedure in which liquid or gas is injected into the rectum to expel its con tents or to introduce drugs or
permit X-ray imaging is known as enema.
Composition of normal urine.
10. Urine, a typically sterile liquid by product of the body, is secreted by the kidneys through a process called
urination and excreted through urethra
Composition: Normal urine consists of water, urea, salts and pigments. Urine is a aqueous solution of
water greater than 95%, with a minimum of these remaining constituents, in order of decreasing
concentration
i) Urea 9.3 g/L, (ii) Chloride 1-87 g/L, (iii) Sodium 1-17 g/L, (iv) Potassium 0-750 g/(v) Creatinine 0-670
g/L
Indications for steam inhalation.
Indications:
1. The common cold
2. The flu
3. Sinus infections
4. Bronchitis
5. Nasal allergies
6. Cough.
Enumerate the purpose of splints.
1.The primary purpose of splints is immobilizations.
2. Splinting also supports the muscles of the affected area and reduces pain and swelling due to
inflammations.
3. It promotes the healing process.
4. It allows the broken bones to remain in contact with each other and facilitates healing.
5. To apply reduction and traction to maintain reduction of bone in case of fracture of long bones.
Mobility and Immobility.
Mobility :
(i) It refers to a person's ability to move about freely and immobility refers to the inability to do so.
(ii) Mobility is multi-dimensional. Mobility can be social, spatial and political
11. (ii) Movement up or down through class structures can be an indirect result of
geographical relocation, or staying put.
Immobility:
The most obvious effects of long periods of immobility are seen in
Musculoskeletal system with the loss of muscle strength and endurance and bone weakening. Bones
undergo a progressive loss in mass through a condition known as disuse osteoporosis.
Safety devices.
Safety devices is the best method for safety of patient and provide comfortable
Position to the patient.
List of safety devices:
1. Wheel chair with belt
2. Fixed and strong bed
3. Bed with bed rails
4. Stretcher with belt
Son cannot
5. Indication bend/wrist bend
6. Infusion pump
7. Central line catheter
8. Indwelling urinary catheter
9. Alpha bed (Medical air mattress)
10. Weighing scale
11. Lighting
1. Wheel chair with belt:
(i) It helps to transfer the patient
(ii) Provides proper fit and postural support
(iii) It is safe and durable
(iv) It meets the patients needs and environ mental condition
12. (v) To protect the patient from fall
Initiative: Pull wheel chair with remote.
2. Fixed and strong bed:
Benefits: Better positioning for patients
(i) Improved circulation
(ii) Promote patient safety
(iii) Aid to transfer the patient
(iv) Care giver assistance
(v) To give sound sleep
Initiatives: Electric bed
3. Bed with side rails:
(i) Aides in turning and repositioning within the bed
(ii) Provides a hand hold for getting into or out of bed
(iii) Provides a feeling of comfort and security
(iv) Reduces the risk of patients falling out of bed.
4. Stretcher with belt:
(i) To ensure safety of the patient
(ii) Making patient care safer
(iii) To transfer the patient
(iv) More comfortable for both the patient and medical workers in hospital
Initiatives: Multipurpose treatment stretcher.
5. Identification band: ) ldentify the patient correctly
(ii) Very flexible on the wrist
(i1) To deliver quality care in a safe environment
(iv) Electronical ID band.
Inventory.
Webster's has defined inventory as
1. "The quality of goods or the materials on hand."
13. 2. Goods or the materials are the essential elements of any of the organization right
From hospital, industry, private enterprise or the government department.
3. Thus inventory control is the method of maintaining of stock at a level at which
Purchasing and stacking costs are at the lowest possible without interference with the supply
4. Thus it plays the vital role in maintaining the balance between the two
5. The risk of the out-of-stock is avoided.
6. A large stock will also imply a large storing space and will require a staff to store and handle various
items
7. Following are the various methods to store the items based on their cost and utility.
(A) ABC analysis of the Drugs
1. This is the system of analysis of stored items mainly drugs based on their cost in
Material management.
2. First the list of the drugs showing the expenditure incurred in the previous com-
pleted year is prepared.
3. Their stock consumption, purchase should be critically watched and controlled.
(B) Ved Analysis:
1. V items are vital drugs without alternatives, forming about 10% of the total drugs whose absence cannot
be tolerated
2. E items are essential that constitute 40% of the items and their absence can be
tolerated for the short stretch of time
3. D items are desirable items which are remaining 50% of the drugs and their non-
availability can be tolerated for longer period.
4. They may be required for chronic and less serious patients.
(C) HML analysis: The items are classified according to high cost, medium cost.
Methods of ordering: There are different systems in use to order items:
1. Two bin system, 2. Cyclic system.
14. Factors affecting bowel elimination.
1. Physical activity: Activity promotes peristalsis and immobilization slows
Down peristalsis.
2. Psychological factors: Activity can accelerate peristalsis in some individuals.
Depression can cause slow peristalsis which may result in constipation.
3. Personal habits: Some people prefer personal toilet seats. Busy work schedule,
Facilities etc.
4. Position during defecation: Usually squatting, immobilized or bed bound clients may have to lay down.
5. Surgery and anesthesia: May cause temporary cessation of peristalsis.
6. Medication and Diagnostic test: May promote or control peristalsis. e.g., Laxatives, narcotics.it can
affect bowel elimination; increase gas, loose BMS.
7. Fecal impaction.
8. Pain.
9. Pregnancy.
Factors affecting fluid balance.
1. Body temperature: If the body temperature increases, more water is lost from the body in sweat.
2. Diet: A high salt intake can result in increased water reabsorption.
3. Emotions: Nervousness can result in an increased production of urine.
4. Blood pressure: When the blood pressure inside the kidney tubules rises, less
Water is absorbed and the volume of urine will be increased.
5. Age: Older adults have high risk for fluid and electrolyte imbalance.
6. Decrease in intracellular fluid and total body temperature.
7. Excessive use of medication: Increase use of diuretics can also affect the fluid and a staff to store
electrolyte balance.
8. Sex and body size: Women generally have more body fat and therefore, less body water then men and
obese person has more chance to fluid and electrolyte imbalance.
15. Common problems of mouth cavity. Dentrifrices used in mouth care. Nursing responsibility during
mouth care of unconscious client.
Common Problems: It is also called halitosis, 85% of people with persistent bad Breaths have a dental
condition that is to blame. Gum diseases, cavities, oral cancer, dry mouth are some of the dental problems
that can cause bad breath.
2. Tooth decay: It is also known as cavities. It is the second only to the common cold as the most prevalent
disease in the United States.
3. Gum disease: It is also known as periodontal disease. It is an infection of the gums surrounding teeth.
4. Oral cancer: It is a serious and deadly disease that affects millions of people. The oral cancer foundation
estimates that someone in the United States dies every hour from oral periodontal disease. It is an infection
of the gums cancer.
5. Mouth sores: There are several types of mouth sores and they can be pesky and
Bothersome unless a mouth sore lasts more than two weeks.
6. Tooth erosion: It is the loss of tooth structure and is caused by acid attacking the enamel.
7. Tooth sensitivity: Tooth sensitivity involves experiencing pain or discomfort to
Your teeth from sweets, cold air, hot drinks, cold drinks or ice creams.
8. Tooth ache and Dental emergencies: Having a dental emergency can be very painful and scary. It
requires an urgent trip to your dentist. It includes broken or cracked teeth.
9. Unattractive smile: It is not technically a 'dental problem'. It is a major reason
Why many patients seek dental treatment.
Name of dentifrices "Dentrifices including tooth powder and toothpaste a used along with a toothbrush to
clean and polish natural teeth
1. Toothpaste
2. Tooth powder
3. Mouth wash
4. Tooth soap
Nursing responsibility during oral care
1. Provide semi fowlers or side lateta position to the patient to provide aspiration
16. 2. Inspect the patients’ oral cavity.
3. Choose the appropriate devices and cleaning products for the oral cavities
4. Use Yankaur suction to remove excessive secretion and loose debris.
5. Avoid oral care with hydrogen peroxide, if oral thrush or oral lesions present
6. If dentures present, remove and gently brush and rinse.
7. Use 0-05% cetylpyridinium chloride containing mouth wash to reduce the risk of infection and to remove
plaque.
8. Use tongue depressor to prevent tongue fall and tongue bite.
9. Hold the toothbrush in 45 degree angle when brushing the teeth.
10. Document the following procedure, condition of oral cavity, bleeding. pain, presence of anti lesion
11. Assess the patient risk of oral hygiene problems.
12. Ensure patient privacy.
13. Handle dentures carefully to prevent damage.
14. Oral care done at least 4 hour.
Scientific principles for steam inhalation.
1. The temperature of water should remain between 120-160°F or 54.5-76.7C
2. Water inhaler should remain just below the spout to avoid scalding.
3. The spout of inhaler must be placed in such a way that the patient can touch it or put his face too near.
4. Keep the patient warm and prevent drought before, during and while inhalation.
5. When volatile groups like methods used, keep clients eyes closed to prevent drug
irritation to the conjuctiva.
6. Observe the patient closely throughout the procedure.
intluen
