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Case

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Marianna

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. Austin, her physical therapist, will be cleaning the wounds and applying new dressings at bedside as part of the interventions.

What will Austin need to consider about cleanliness before entering the room, while working with Marianna, and upon leaving the room?

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Cleanliness

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What Is Clean?

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

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Box 4-1 Pathogen

A pathogen is an organism that can 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 Escherichia coli bacteria are vital to our blood-clotting ability.

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The level of cleanliness necessary in any given situation is determined by the harmfulness of the pathogen and the vulnerability of the people involved. Because patients bring pathogens into healthcare settings, and they have increased susceptibility to infection with pathogens while they are there, standards of cleanliness are higher in healthcare 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.

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

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Healthcare-Associated Infections

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Patients are often already infected with pathogens when they enter a healthcare facility, but it is possible for patients to become exposed to additional pathogens during their stay.

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Healthcare-associated infection (HAI) refers to infections acquired in any healthcare setting.1 Infections acquired in a hospital are called nosocomial infections. The risk of infection associated with ...

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