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Maria, 76 years old, has been admitted to the hospital from home because of dehydration, electrolyte imbalance, and multiple open wounds. She has pressure injuries 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. Halden, her physical therapist, will be cleaning the wounds and applying new dressings at bedside as part of the interventions.

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


What Is Clean?

In the context of healthcare, cleanliness is the practice of minimizing contamination to prevent or control the spread of infection. Maintaining a clean environment requires attention to all aspects of the system: person (e.g., hand hygiene), task (e.g., controlling what touches what), and environment (e.g., image disinfecting surfaces). Although there are different degrees of cleanliness, in the healthcare environment, clean refers to a state of minimized infectious organisms, whereas 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).

Box 4-1 Pathogen

A pathogen (from pathos [disease] and gen [producing]) is an organism that can cause disease. Pathogens are classified according to the nature of the organism. Keep in mind, however, that there may be forms of an organism that are not pathogenic. For example, one strain of Escherichia coli (E. coli) is a probiotic that occurs naturally in human intestines and promotes digestive and immune health. Ingestion of E. coli O157:H7, on the other hand, can cause serious, and sometimes even life-threatening, illness.1

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 rooms.

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 community.

Healthcare-Associated Infections

Patients are often already infected with pathogens when they ...

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