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Marianna, 76 years old, has been admitted to the hospital from home because of dehydration, electrolyte imbalance, and multiple open wounds. She has wounds over the sacrum, both greater trochanters, and the inferior angles of the scapulae. It is not yet known whether infection is present in any of the wounds. Your physical therapy intervention will include cleaning the wounds and applying new dressings at bedside. What will you need to consider about cleanliness before entering the room, while working with Marianna, and upon leaving the room?


What Is Clean?

In the health-care context, cleanliness is the attempt to prevent the spread of infection through good hand hygiene, good personal hygiene, and good cleaning and handling techniques to minimize contamination. “Clean” refers to a state of minimized infectious organisms, and “soiled” is used to indicate the presence of pathogens or simply possible exposure to pathogens. Whether a surface or area is “dirty” therefore cannot be judged by visual inspection alone (see Box 4-1).

Image not available.Box 4-1 Pathogen

A pathogen is an organism that is able to cause disease. The term originated in the late 1800s, formed from pathos (disease) and gen (producing). Pathogens are classified according to the nature of the organism. Keep in mind, however, that there may be many forms of an organism that are not pathogenic. For example, Staphylococcus aureus bacteria can be highly infectious, but most bacteria we encounter in everyday life are not pathogenic.

The level of cleanliness necessary in any given situation is determined by the harmfulness of the pathogen and the vulnerability of the person. Because patients bring pathogens into health-care settings and have increased susceptibility to infection with pathogens while they are there, standards of cleanliness are higher in health-care settings than in most other environments. “Clean technique” refers to efforts to reduce the number of infectious organisms in the clinical setting. “Sterile technique” is a specialized process designed to eliminate pathogens from medical equipment, surfaces, and environments. Sterile technique is most commonly used in operating theaters.

Standardized infection control practices known as “Standard Precautions” are required when working with all clients and patients in any health-care setting, including the patient's home. Patients known to be at risk for the presence of pathogens may require additional procedures, “Transmission-Based Precautions,” based on the manner in which the pathogen is transmitted. These infection control practices are designed to protect the patient, the clinician, and all other members of the health-care community.

Health-Care–Associated Infections

Patients are often already infected with pathogens when they enter a health-care facility, but it is possible for patients to become exposed to additional pathogens during the course of their stay.

Infections acquired in a hospital are called nosocomial infections. Health-care–associated infection (HAI) refers to infections acquired in any health-care setting.1 The risk of infection ...

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