1 HEALTHCARE ORGANIZATION

Healthcare Organization refers to hospitals, clinics, Nursing Homes, medical

practices, pharmacies, specialty pharmacies. It is made up of healthcare
professionals who work in different units or wards with the aim of providing
healthcare services to the patients. A Healthcare Professional is any person who
interacts with patients has a role in the diagnosis, referral, or treatment of the
patient, and is licensed and qualified by education and training. Examples of
healthcare professionals include; doctors, nurses, nurse practitioners,
pharmacists, therapists, nursing assistants, nutritionists, clinicians, etc.
Hospital A hospital is a healthcare institution that offers or provides patients short
and long-term medical care, including observational, diagnostic, therapeutic, and
rehabilitative services.
Types/Levels of hospitals
Community Facilities - LEVEL 1
They are run by certified Nurses ;
Some of the services: Treatment of minor ailments like diarrhea Tuberculosis (TB)
screening, home visits, contact tracing of TB patients and tracing of TB defaulters
Screening of malnutrition Malaria rapid test Blood pressure and blood sugar
testing HIV testing Health talks with pregnant women and observations of signs of
danger Issuance of referral letters to other facilities
Health Dispensaries -LEVEL 2
These facilities are run by clinical officers. The dispensaries in the cities act like a
health center (see level 3), with the difference that the dispensary does not have
in-patient facilities. These are some of the services you will expect in a dispensary:
Outpatient services VCT services Tuberculosis services Laboratory Services Well
Baby Clinics Antenatal and Postnatal services Pharmacy Counselling Services
Curative treatment They issue referral letters to other facilities
Health Centers - LEVEL 3
These are small hospitals with minimal facilities, yet they offer services like the big
hospitals. They are run by at least one doctor, clinical officers and nurses. These
are some of the services they offer: Maternity in-patient services with a ward
Curative services Laboratory services Dental Counselling Pharmacy TB Clinics
Diabetes & hypertension clinics Comprehensive care clinics for patients living with
HIV Baby well clinics Antenatal and postnatal services They issue referral letters to
other facilities
Sub County Hospitals - LEVEL 4
These are hospitals that offer holistic services and are ran by a director who is a
medic and at best a doctor by profession In many counties there’s just one
hospital but in larger cities like Nairobi there are two They have in principle the
same services as the Level 3 hospitals, plus X-Ray services. They issue referral
letters to other facilities
County Referral Hospitals - LEVEL 5
These are the county referral hospitals formerly the provincial hospitals. They are
run by Chief Executive Officers who are medic by profession and have over 100
beds capacity for their inpatient. They are also do research about health. In
Nairobi Mama Lucy Hospital and Mbagathi Hospital both double up as county
referral hospitals and Level 4 hospitals.
Services include what other hospitals offer, plus Ultrasound
CT-Scan Surgery
Pharmacy
Physiotherapy
Orthopedics
Occupational Therapy
They issue referral letters to other facilities
National Referral Hospitals- LEVEL 6
In Kenya there are three Teaching and Research referral hospitals: Mathari
Hospital, Kenyatta National Hospital, Moi Teaching and Referral Hospital and the
National Spinal Injury Referral Hospital. Their range of services is the same as of
on Level 5, but they offer specialized treatments to patients and are not only
accessed by Kenyans but do serve East Africa and Central Africa. Mathari Teaching
and Referral Hospital offers specialized mental services. Kenyatta National
Hospital and Moi Teaching and Referral hospital offer specialized consultations in
curative care. National Spinal Injury Referral offers specialized services in
orthopedic and spinal injuries. The national government manages these three
hospitals.
1.2 Departments/Units in a Hospital There are many hospital departments,
staffed by a wide variety of healthcare professionals, with Some crossover
between departments. The hospital departments are divided into two: inpatient
departments and the outpatient departments
.  MATERNAL AND CHILD HEALTH (MCH)
Maternal and Child Health (MCH) department offers services aimed to promote
healthy outcomes for children, mothers and fathers. The arrival of a new baby
makes a big difference to family life, bringing both new joys and new challenges.
Even if it is not the first baby, a new baby will mean some changes to the family
lifestyle which creates the need for the whole family to be guided through
adjusting to parenthood. This department monitors the health and wellness of
pregnant mothers all through their pregnancy, prepares them for delivery and
closely monitors the mother and child health for at least 5 years after birth of the
baby. The nurse walks hand in hand with the new parents in monitoring their
child’s milestones and helps them in decision making on reproductive health
issues. Some of the services offered by the MCH department include giving advice
and support on but not limited to:
• Regular Antenatal Check ups
• Advice on Antenatal Exercises (Lamaze classes)
• Exclusive breastfeeding and formula feeding
• Complementary feeding (weaning)
• Nutritional advice
• Immunization (we offer both KEPI and baby friendly vaccines)
• Physical and emotional changes following child birth
• Adjusting to parenthood
• Changing relationships within the family
• Child and health development
• Parenting strategies
• Family planning
• Childhood illness
• Child safety and injury prevention Growth Monitoring and Immunization
❖ ACCIDENT AND EMERGENCY (A&E)
This department (sometimes called Casualty) is where you're likely to be taken if
you've called an ambulance in an emergency. It’s also where you should come if
you've had an accident, but can make your own way to hospital. These
departments operate 24 hours a day, every day and are staffed and equipped to
deal with all emergencies. Patients are assessed and seen in order of need.
❖ CARDIOLOGY
This department provides medical care to patients who have problems with their
heart or Circulation. It treats people on an inpatient and outpatient basis.
❖ CHAPLAINCY Chaplains promote the spiritual and pastoral wellbeing of
patients, relatives and staff. They are available to all members of staff for
confidential counsel and support irrespective of religion or race. A hospital chapel
is also usually available.
❖ CRITICAL CARE
Sometimes called intensive care, this unit is for the most seriously ill patients.
Intensive care units (ICU) and high dependency units (HDU) are specialist wards
providing intensive care (treatment and monitoring) for people who are in a
critically ill or unstable condition. It has a relatively small number of beds and is
manned by specialist doctors and nurses, as well as by physiotherapists and
dietitians. Patients requiring intensive care are often transferred from other
hospitals or from other departments in the same hospital.
❖ DIAGNOSTIC IMAGING
 Also known as X-ray, this department provides a full range of diagnostic imaging
services Including:
- General radiography (X-ray scans)
- Ultrasound scans
- CT scanning (scans that show cross sections of the body) - Magnetic resonance
imaging (MRI) scanning (3D scans using magnetic and radio waves).
❖ EAR NOSE AND THROAT (ENT) The ENT department provides care for patients
with a variety of problems, including:
- General ear, nose and throat diseases
- Neck lumps
- Cancers of the head and neck area
- Balance and hearing disorders
- Snoring and sleep apnea
- ENT allergy problems
- Salivary gland diseases
- Voice disorders
❖ GASTROENTEROLOGY
Endoscopy - Endoscopy involves a small thin tube with a camera on the end. This
is guided down the throat to investigate problems in the esophagus and digestive
system. Small surgical instruments can be guided down in the same way, meaning
it can be used for diagnosis and treatment.
❖ GENERAL SURGERY The general surgery ward covers a wide range of surgery
and includes: Day surgery - Kidney transplants - Colon surgery - Breast surgery -
Accident injuries etc
❖ OBSTETRICS and GYNECOLOGY
These departments investigate and treat problems of the female urinary tract and
reproductive organs, such as endometriosis, infertility and incontinence. They also
provide a range of care for cervical smear screening and post-menopausal
bleeding checks.
These units provide maternity services such as: - Antenatal and postnatal care
- Prenatal diagnosis unit
- Maternal and foetal surveillance.
Overseen by consultant obstetricians and gynecologists, there is a wide range of
attached staff linked to them, including specialist nurses, midwives and imaging
technicians.
❖ HEMATOLOGY
Hematology services work closely with the hospital laboratory. These doctors
treat blood diseases and malignancies linked to the blood.
❖ MATERNITY DEPARTMENTS
Women now have a choice of who leads their maternity care and where they give
birth. Care can be led by a consultant, a doctor, nurse or a midwife. Maternity
wards provide antenatal care, care during childbirth and postnatal support.
Antenatal clinics provide monitoring for both routine and complicated
pregnancies. High-dependency units can offer one-to-one care for women who
need close monitoring when there are complications in pregnancy or childbirth.
❖ NEONATAL UNIT Neonatal units have a number of cots that are used for
intensive, high-dependency and special care for newborn babies. It always
maintains close links with the hospital maternity department, in the interest of
babies and their families. Neonatal units have the philosophy that, whenever
possible, mother and baby should be together.
❖ NEPHROLOGY
This department monitors and assesses patients with kidney (renal) problems.
Nephrologists (kidney specialists) will liaise with the transplant team in cases of
kidney transplants. They also supervise the dialysis day unit for people who are
waiting for a kidney transplant or who are unable to have a transplant for any
reason.
❖ NEUROLOGY
This unit deals with disorders of the nervous system, including the brain and
spinal cord. It's run by doctors who specialize in this area (neurologists) and their
staff. There are also pediatric neurologists who treat children.
❖ NUTRITION AND DIETETICS
Trained dieticians and nutritionists provide specialist advice on diet for hospital
wards and outpatient clinics, forming part of a multidisciplinary team.
The department works across a wide range of specialties such as:
- Diabetes
- Cancer
- Kidney problems Pediatrics
- Elderly care
- Surgery and critical care
- Gastroenterology They also provide group education to patients with diabetes,
heart disease and osteoarthritis etc, and work closely with weight management
groups.
❖ OCCUPATIONAL THERAPY
This profession helps people who are physically or mentally impaired, including
temporary disability after medical treatment. It practices in the fields of both
healthcare and social care. The aim of occupational therapy is to restore physical
and mental functioning to help people participate in life to the fullest.
Occupational therapy assessments often guide hospital discharge planning, with
the majority of patients given a home assessment to understand their support
needs. Staff also arranges provision of essential equipment and adaptations that
are essential for discharge from hospital.
❖ ONCOLOGY
This department provides radiotherapy and a full range of chemotherapy
treatments for cancerous tumors and blood disorders. Staffed by specialist
doctors and nurses trained in oncology (cancer care), it has close links with
surgical and medical teams in other departments.
❖ OPHTHALMOLOGY
Eye departments provide a range of ophthalmic services for adults and children,
including: - General eye clinic appointments - Optometry (sight testing) -
Ophthalmic imaging (eye scans)
❖ ORTHOPEDIC DEPARTMENT
Orthopedic departments treat problems that affect your musculoskeletal system.
That's the muscles, joints, bones, ligaments, tendons and nerves. The doctors and
nurses who run this department deal with everything from setting bone fractures
to carrying out surgery to correct problems such as torn ligaments and hip
replacements.
❖ PHARMACY The hospital pharmacy is run by pharmacists, pharmacy
technicians and attached staff. It's responsible for drug-based services in the
hospital, including: - The purchasing, supply and distribution of medication and
pharmaceuticals - Inpatient and outpatient dispensing - Clinical and ward
pharmacy - The use of drugs
❖ PHYSIOTHERAPY
Physiotherapists promote body healing, for example after surgery, through
therapies such as exercise and manipulation. This means they assess, treat and
advise patients with a wide range of medical conditions. They also provide health
education to patients and staff on how to do things more easily. Their services are
provided to patients on the wards, in the physiotherapy department itself and in
rehabilitation units. Physiotherapists often work closely with orthopedic teams.
❖ RADIOTHERAPY
Run by a combination of consultant doctors and specially trained radiotherapists,
this department provides radiotherapy (X-ray) treatment for conditions such as
malignant tumors and cancer.
❖ RENAL UNIT Closely linked with nephrology teams at hospitals, these units
provide hemodialysis treatment for patients with kidney failure. Many of these
patients are on waiting lists for a kidney transplant.
❖ RHEUMATOLOGY
Specialist doctors called rheumatologists run the unit and are experts in the field
of Musculoskeletal disorders (bones, joints, ligaments, tendons, muscles and
nerves). Their role is to diagnose conditions and recommend appropriate
treatment, if necessary from the orthopedic department.
❖ SEXUAL HEALTH
This department provides a free and confidential service offering: - Advice, testing
and treatment for all sexually transmitted infections (STIs) - Family planning care
(including emergency contraception and free condoms) - Pregnancy testing and
advice - It also provides care and support for other sexual and genital problems.
❖ UROLOGY
The urology department is run by consultant urology surgeons and their surgical
teams. It investigates all areas linked to kidney and bladder-based problems.

1.3 Hospital Staff and Their Roles

There are many people who contribute to your care while you are in hospital.
Numerous people and services work together to provide you with successful
treatment in a hospital, from medical assessments and daily treatment to
medication and catering. The key roles for staff in a hospital can be broadly
categorized into four areas being:  doctors (medical staff)
 nurses
 allied health professionals
 Support staff.
 Administration staff
All these people will play an important role in your treatment and recovery.
Doctors (medical staff) You may be treated by a number of doctors during your
hospital stay – the consultant (specialist), the registrar, and the resident. Together
they assess and manage your medical care. Depending on which hospital you are
in, you may also be treated by interns and student doctors who work under the
supervision of senior doctors.

Roles and responsibilities

Doctors have different roles and responsibilities based on their level of
experience and their medical specialty. Hierarchy of Doctors in the ward
 senior consultants – specialist doctors who see patients at specific times
 registrars – senior doctors who supervise residents, interns and students
 residents – look after patients on the ward and are in training for specialization
 interns – have completed their studies and are now finishing their final year in
hospital
 Student doctors – undergraduate medical students. The resident is based on
the ward and is typically the doctor you will see most often. The registrar is the
ward’s senior doctor and is usually contactable on site, while the senior
consultant (or specialist) attends ward rounds and meetings at specific times.
2. Nurses (Nursing Staff)
Nurses manage most of your ongoing care and treatment in hospital. They assess,
plan and administer your daily treatment and manage your general health. Speak
to them about your immediate needs. They can also direct you to the right people
to speak to about specific medical issues. Roles and responsibilities Nurses have
different roles and responsibilities based on their experience and specialties.
Hierarchy and roles of nurses
 nurse unit manager – runs the ward
 associate nurse unit manager – helps the nurse unit manager to run the ward
and acts as the manager when the nurse unit manager is off site
 nurse practitioners – highly skilled nurses with an advanced level of training
 specialist nurses, such as clinical nurse specialists, clinical nurse consultants,
clinical nurse educators, triage nurses, emergency department nurses
 registered nurses – provide a high level of day-to-day care and perform some
minor procedures
 Enrolled nurses – provide basic medical care under the supervision of more
senior nurses.

3. Allied health professionals

Allied health includes professions in the health care industry that aren't medicine
or nursing. They make up the rest of the health care staff who support health
administration and management, technical issues, diagnostics and rehabilitation.
The term allied health encompasses most professionals who provide health care
by assisting mainstream health care professionals in preventing, diagnosing and
treating a variety of medical conditions and diseases across specialties. Allied
health professionals have education, training and qualifications specifically
relevant to the duties of their job.
Allied health care professionals may work directly or indirectly with patients in
labs, clinics or administrative offices. Those who work with patients often work
with physicians, though they may also work with patients individually as
specialists.
For example, nutritionists and psychologists are allied health professionals.
Some of the common sectors within health care where you find allied health
professionals include exercise and sport, musculoskeletal health, rehabilitative
care, nutrition, chronic disease, mental health, disability and aged care.
Examples
 Dental hygienist: A dental hygienist performs dental cleanings and preventative
dental care under the supervision of a board-certified dentist.
 Nutrition supervisor: A nutrition supervisor is a nutritionist who oversees the
nutritional decisions at an institution.
 Pharmacist: A pharmacist dispenses medicine and sometimes recommends
over-thecounter remedies for customers. They also may oversee the operations
of a pharmacy.
 Community health: A community health professional helps patient’s access
health care when their location or situation makes it difficult for them to receive
care. They act as an intermediary between the community and health or social
services or government systems.
 Health care technician: A health care technician assists doctors and nurses with
medical tasks and makes patients comfortable in clinics or hospital settings.
 Certified nursing assistant : A certified nursing assistant provides care to patients
under the supervision of a certified nurse.
 Health educator: A health educator: teaches about behaviors that promote
health and helps build strategies to improve the health and well-being of
individuals and communities.
 Dietitian or nutritionist: A dietitian or a nutritionist helps their clients
understand how the food they eat affects their bodies.
 Health coordinators: A health coordinator also known as a health service
manager, oversees the organizational or operational aspects of patient care
within health care settings, like establishing relationships with vendors.
4. Support staff
These are non-medics that performs a wide range of functions that keeps the
hospital running. They take care of everything from laundry and meals to patient
transport and maintenance. Hospital support staff you may meet during your stay
include:
 cleaners – take care of ward housekeeping
 Cooks – meals and drinks
 porters – take care of patient lifting and transport
 volunteers – help with fundraising and ward visits
 Ward clerks – staff the ward reception desk
5. ADMINISTRATION STAFF
Hospital administrators are responsible for organizing and overseeing the health
services and daily activities of a hospital or healthcare facility. They manage staff
and budgets, communicate between departments, and ensure adequate patient
care amongst other duties. Some of the hospital administration members include;
Ceo Medical superintendent Nursing service, manager Human resource manager,
Accountants
1.4 MEDICAL OR HOSPITAL EQUIPMENT 
Diagnostic Medical Equipment Equipment or supplies that are used to diagnose,
test, or find patient’s conditions.
The equipment is used to detect any abnormalities in the organs or other parts of
the body that may be causing the symptoms.
Without the diagnostic equipment, medical professionals would not be able to
correctly diagnose the patient and provide the correct treatment.
Common diagnostic equipment used in hospitals and clinics are: Imaging
Machines such as X-Rays, MRI Scans, CT Scans, etc. Medical instruments like
stethoscopes and thermometers.
 Durable Medical Equipment DME is a type of medical equipment that is
designed to be durable and provide support for patients safely and comfortably.
This type of equipment is used predominantly for therapeutic reasons and can be
used in both the hospital and home setting.
They are reusable and designed for long-term use.
Most durable medical equipment are designed with load-bearing strength and
non-slip features.
Common Durable Medical Equipment (DME) include:
Wheelchairs, Mobility assistive equipment - walkers, canes, crutches, Hospital
beds, Ventilators, Lifts &Traction Equipment
Storage and Transport Medical Equipment Equipment that is used to store and
transfer medical supplies. This equipment is used to bring various medical
supplies to patients and medical professionals for differing reasons. The most
common types of storage and transport equipment include: Case Carts, Storage
Carts & Utility Cart
Electronic Medical Equipment Electronic Equipment is designed, monitor, and
record body functions such as the heartbeat and brain waves. There are various
types of electronic medical supplies including: Software: Electronic Medical
Records, Medical Imaging Software, etc. Monitors: Heart Rate Monitors, Blood
Pressure Monitors, Ultrasound, etc. Medication Pumps. Mobile Technology Carts:
Mobile Workstations, Computers on Wheels, etc. Powered Medical Equipment.
Pacemakers. Defibrillators
Surgical Medical Equipment The success of a surgery depends on the accuracy
of the surgical equipment and instruments. There are many different types of
equipment used in surgery, each with their own purpose. The most common
surgical equipment and instruments include: Surgical Tables, Utility Tables,
Instrument Tables , Hampers , Mayo Stands , Solution Stands , Kick buckets ,
Surgical Table Pads , mLeg Supports & Arm Supports
2 INFECTION Infections are caused by germs that enter the body, multiply, and
cause harm or illness.
The main types of germs that can cause infections (pathogens) are:
 Bacteria
 Viruses
 Protozoa (some of which act as parasites)
 Fungal organisms (also called fungi).
2.1 Signs and symptoms of an infection
 Fever (higher than normal body temperature). Your cancer care team will tell
you what temperature they consider a fever.
 Shaking chills or sweats (often goes along with fever)
 Sore throat
 Sores or white coating on your tongue or in your mouth
 Cough or shortness of breath
 Nasal congestion
 Burning or pain when urinating; bloody or cloudy urine
 Redness, swelling, drainage, or warmth at the site of an injury, surgical wound,
or IV such as a central venous catheter (VAD), or anywhere on the skin including
the genital and rectal areas
 Pain or tenderness in the stomach or abdomen (the belly)
 Stiff neck
 Sinus pain, ear pain, or headache
2.2 How infections spread
 skin contact
 the transfer of bodily fluids
 contact with feces
 ingesting contaminated food or water
 inhaling airborne particles or droplets
 touching an object that a person carrying the pathogen has also touched 2.3
Hospital acquired infections
Hospital-acquired infection, also known as a nosocomial infection, is an infection
that is acquired in a hospital or other healthcare facility.
These infections are usually acquired after hospitalization and manifest 48 hours
after admission to the hospital.
These infections include catheter-associated urinary tract infections, central line-
associated bloodstream infections, surgical site infections, ventilator-associated
pneumonia, hospitalacquired pneumonia, and Clostridium difficile infections.
Symptoms that favor an infection include productive cough, shortness of breath,
abdominal pain, rebound tenderness, altered mental status, palpitations,
suprapubic pain, polyuria, dysuria, and costovertebral angle tenderness.
2.4 Prevention of infections / infection prevention practices (IPC)
1. Wash Your Hands. Hand washing should be the cornerstone of reducing HAIs.
Wash hands with warm soap and water vigorously for at least 20 seconds. Also, all
staff members and people in the facility should be encouraged to wash their
hands before drinking, eating, providing care and between caring for patients. 30
2. Create an Infection-Control Policy. The infection control policy details what
patients have the highest risks for contracting or passing along HAIs. The policy
should include information on when patients should be placed on isolation
precautions or otherwise preventing contact with other patients and staff.
3. Waste segregation and disposal Waste segregation is the sorting and
separation of waste types to facilitate recycling and correct onward disposal.
When waste is sorted correctly, it can save your company money. Waste
segregation should be based on: The type of waste. The most appropriate
treatment and disposal.
4. Provide Infection Control Education. Staff members need to know how to
identify common infections and help prevent their spread. Consequently, your
organization should provide continued, recurring education on infection control.
This includes training on blood-borne pathogens and droplet-borne infections.
5. Use Gloves. Health care professionals may not always wear gloves when
interacting with patients. But, if any contact with blood or bodily fluids is possible,
such as when changing sheets or emptying trash, gloves should be worn.
6. Provide Isolation-Appropriate Personal Protective Equipment. Isolation-
appropriate protective equipment includes waterproof gowns, gloves, shoe
covers, face shields and masks. If patients have a contagious illness, appropriate
isolation equipment should be readily available for use.
7. Disinfect and Keep Surfaces Clean. Between patients, every room in a facility
should be cleaned thoroughly with a bleach-containing cleanser. This helps to
prevent accidental transmission of infections as new patients are admitted.
Furthermore, non-patient areas, such as the breakroom and nurses’ station
should be cleaned daily.
8. Prevent Patients From Walking Barefoot. No one really wants to wear shoes
when ill, but all patients should be encouraged to wear slippers or non-slip socks
when walking in the hospital, including in their patient rooms. Although this
seems extreme, nurses and other persons entering individual rooms can carry
pathogens into the room from other areas and patient rooms.
9. Change Linens When Daily and When Dirty. Linens should be properly sanitized
and cleaned in laundry, but they should not be left on patient’s beds for extended
periods. Linens should be changed daily and whenever visibly dirty. Furthermore,
linens that fall on the floor should immediately be sent back to laundry for
cleaning.
10. Make Sure Foods Are Kept at Proper Temperatures. Most hospitals and
health care facilities have refrigerators for patient snacks on individual units. The
temperature such equipment should be checked every shift for food safety
reasons. Furthermore, patients should be encouraged to eat their meals when
they arrive. If food stays out in a patient’s room for several hours, it should be
trashed to prevent spoilage and the possibility of acquiring an infection.
3 MEDICAL ASEPSIS
Medical asepsis includes sanitization, antisepsis, and disinfection.
3.1 SANITIZATION Sanitization refers to cleaning practices and techniques that
physically remove microorganisms. These include hand washing and cleaning of
clients’ personal equipment, clothing, and linens. There are several things that
you should know in order to maintain a sanitary environment. The most
important one is hand hygiene, which includes hand washing and use of alcohol-
based hand sanitizer.
 Always wash your hands before meals, after using the bathroom, and before
and after any contact with your clients.
 Wash your hands after touching your own or your client’s body fluids, such as
urine, feces, blood, saliva, vomitus, or genital discharge.
 When coughing or sneezing, always cover your nose and mouth with a tissue or
your elbow. Teach your clients to do the same. Next up are personal items.
 Each client should have their own soap, cups, toothbrushes, and towels.
 Personal equipment should be regularly cleaned to prevent the growth of
microorganisms.
 When cleaning the room and objects, make sure to not stir up the dust (i.e.,
avoid shaking dirty linens, and use a moistened cloth or mop to wipe dust).
 When disposing of dirty linens to laundry bins, keep them away from your
uniform. This will prevent the contamination of your uniform, and subsequently,
the spread of microorganisms.
 Regularly empty the garbage because trash is a perfect environment for
pathogen growth.
 Finally, maintain good personal hygiene and assist your clients to achieve the
same!
3.2 ANTISEPSIS
Antisepsis is the process of killing microorganisms or limiting their growth on the
skin and nonliving objects. Chemicals used in antisepsis are called antiseptics, and
the most common ones include rubbing alcohol and iodine. Antiseptics can be
used for hand scrubbing; treating cuts, wounds, and burns; and preoperative skin
cleaning.
3.3 DISINFECTION
Disinfection refers to the process of killing microorganisms on objects that are
commonly in contact with your clients, such as overbed tables, wheelchairs,
stretchers, urinals, bedpans, and blood pressure cuffs. It’s important to note that
disinfection cannot destroy spores, which are highly resistant forms of
microorganisms that develop in conditions that are inconvenient for their growth.
Chemicals used in disinfection are called disinfectants. In contrast to antiseptics,
disinfectants are much stronger; therefore, they are not used on the skin!
Moreover, in order to prevent skin irritation, you should always wear household
or utility gloves while handling disinfectants.
3.4 SURGICAL ASEPSIS
Examples of surgical asepsis include the use of disposable sterile supplies, such as
syringes, needles, and surgical gloves; and the use of reusable sterile equipment,
such as surgical instruments. Most commonly, surgical asepsis is acquired through
a process known as sterilization. You can think of sterilization as the highest level
of asepsis because it kills both microorganisms and spores. Just like disinfection,
sterilization is not used on people; instead, it is used on equipment and
instruments that must be totally free of microorganisms. For example, a
commonly used device to sterilize surgical instruments is the autoclave, which
uses high pressure and temperature to kill microorganisms and their spores.
Finally, it’s important to note that before something can be disinfected or
sterilized, organic materials, such as blood, feces or urine, must be removed using
sanitization practices and techniques.
3.5 TRIAGING, ADMISSIONS, TRANSFERS AND DISCHARGE
3.5.1 TRIAGE
Triage is the sorting and prioritization of injured or sick people according to their
need for emergency care. Each organization has its own triage system. They all
create priorities for who gets care or is transported for care. The most common
triage systems use color-coding.
Examples of the five categories or levels of triage that an organization may use:
 Red: The individual needs immediate attention for a critical life-threatening
injury or illness and may be transported first for medical help.
 Yellow: The individual has serious injuries that need immediate attention. In
some systems, yellow tags are transported first because they have a better
chance of recovery than red-tagged patients.
 Green: This could indicate less serious or minor injuries that are non-life-
threatening. Transport may be delayed.
 Black: This could indicate an individual is deceased or mortally wounded. It may
mean that they are beyond help and, therefore, is a lower priority than those who
can be helped.  White: The individual doesn't have an injury or illness.
3.5.2 ADMISSION
Admissions, transfers, and discharges (ATD) are the three types of movements of
patients within a hospital.
Admission is when a patient is first admitted to the hospital. This could be
because they have been referred by their General Practitioner (GP), or they may
have come to the hospital themselves through the Emergency Department.
Hospital Admissions Procedure Hospital Admission Procedure includes
preparation of admitting patient, perform admission procedure, emergency
admission, Routine admission, transfer in and discharge.
Nurses need to follow strict protocol regarding admission and discharge in the
hospital.
1. Preparation of Admitting Patient: Entrance of a patient into the ward or unit for
evaluation or treatment is called admission.
2. 2. Perform Admission Procedure:
A. At the time of admission, the registered nurse perform complete assessment of
the patient.
B. Enter patient name, date and time of admission, chief complains, medical
diagnosis in the admission file or patient file.
C. Document - the source of information (family, patient, care giver or health care
person or significant person).
D. Check the document if patient has previous hospitalization and past major
illness.
E. Indicate if the patient was admitted from emergency room, home, clinic and
accompanied by whom.
F. Take the patient vital signs (pulse, temperature, respiratory rate, height and
weight).
G. Document if the patient and family have valuables brought to the hospital. If
yes, hand it over to the relatives with their signatures.
H. At the time of arrival to the unit or ward patient and family will be given
orientation regarding the unit, visiting rooms, patients’ right and responsibilities.
Emergency Admission: The patient is admitted on an emergency basis for critical
care monitoring. E.g. poisoning, heart attack, accidents, etc. It is unplanned. The
first goal is to Stabilize in the emergency room (chest pain or accidents).
3.5.3 Discharge
It is the preparation of the patient and discharge records to leave the hospital.
This is important to ensure continuity of care to the patient after discharge and to
assist the patient in discharge process.
Types of Discharge:
1. Cured and discharged.
2. Discharged against medical advice (DAMA). A client can decide to leave the
hospital against medical advice. For this client must sign a form that releases the
physician and the healthcare institution from any legal responsibility for his/her
health status? The client is informed of any possible risks before signing the form.
3. Discharged on request.
4. Absconded. To leave quickly and secretly and hide oneself. Often to avoid
arrest or legal prosecution.
5. Transferred to other Ward or hospital (Referral) The act of sending of a patient
to another physician for ongoing management of a specific problem, with the
expectation that the patient will continue seeing the original physician for co-
ordination of total care.
6. 6. Death.
Tips in the Discharge Process
1. Explain the Paperwork Thoroughly Make sure you read through the discharge
paperwork with the patient and their family members to ensure they understand
everything completely. Discharge instructions should be written in patient-
friendly language and should include educational materials to help successfully
transition the patient from the hospital. In 2013, researchers reported that in
adults age 65 years and older, 40% could not accurately describe the reason for
their hospitalization and 54% didn’t accurately remember follow-up appointment
instructions (Horwitz et al, 2013). Remember that after reviewing the discharge
instructions, the patient should be able to “repeat back.” This includes telling you
why they were in the hospital, how they will manage at home, what medications
they are on and why, and follow-up plans (specialist visits, home care, physical
therapy, lab work, diagnostic images, etc).
2. 2. Review medications Medication errors are a top reason for hospital
readmissions. Medication reconciliation should be completed with the patient
when they are first admitted. At discharge, thoroughly review the current
medication list with the patient and family members, as medications may have
changed during the hospitalization.
3. Be sure to discuss:
Any new medications that have been added
 Any changes to medications they were taking prior to the hospitalization
 Plans for obtaining medications from the pharmacy Another thing to keep in
mind is that your patient may not be familiar with the brand name or generic
name of a medication. For example, the patient might not know the generic name
clopidogrel but are familiar with the brand name of Plavix. Encourage the patient
to ask the pharmacist about any medication that is unfamiliar and confirm that it
is correct.
4. Never make assumptions As healthcare professionals, we often assume that
the patient knows certain things about their disease process or medications. It’s
important to review everything with the patient. A good way to make sure your
patient and their family members understand what you have discussed is to ask,
“What questions do you have?” Asking open-ended questions puts the patient at
ease and allows them the freedom to share their thoughts and concerns.
5. Follow Up Often, patients will need follow-up appointments after their
discharge. These may be with their primary care provider as well as any specialists
(i.e. cardiology, wound care, pulmonary, etc). Make sure that the phone numbers
for these providers are included on the discharge paperwork along with the
recommended timeframe for the follow-up. Stress the importance of these visits
and recommend that the patient calls to make the appointments as soon as they
are able. If the patient is to follow up with a specialist they are not already
established with, provide them with a list of providers in your network that is
available.
3.6 BED MAKING
Bed making is one of the important nursing techniques to prepare various types
of bed for patients or clients to ensure comfort and useful position for a particular
condition. The bed is especially important for patients who are sick. The nurse
plays inevitable role to ensure comfort and cleanliness for ill patient. It should be
adaptable to various positions as per patient’s need because they spend varying
amount of the day in bed.
3.6.1 Types of Bed Making in Hospital: Nursing staff make different types of bed
according to patient condition those are listed below:
• Unoccupied beds – The patient is out of bed while it is being made.
• Closed bed or Empty bed - A bed is not being used by bathe patient. The linen is
left to cover the bed.
• Open bed – A bed which is about to be occupied by the patient
• Admission bed – A bed just like an open bed. A long mackintosh and bath
blanket is put over the open bed for giving the bath to patient.
• Occupied bed - The patient remains in the bed.
• Surgical bed - After the Anesthesia.
• Orthopedic bed - For orthopedic patient.
• Renal bed – A bed for the renal patient.
• Cardiac bed - For the heart patient.
3.6.2 PURPOSES OF BED-MAKING
Bed-making is a nursing art. The purpose of the bed-making should be patients or
clientscentered. The main purposes of bed-making are to prevent complications
by ensuring comfort and security to patient.
i. To provide rest and sleep.
ii. To provide physical and psychological comfort and security to the patient.
iii. To give the unit neat appearance.
iv. To establish an effective nurse patients relationship.
v. To provide active and passive exercise to the patient.
vi. To promote fresh and cleanliness.
vii. To develop skill in the posture/body alignment of the nurse in bed-making
viii. To observe, identify and prevent patient’s complications.
viii. To accommodate the patient’s needs.
ix. To reduce patient’s exertion by bed-making.
x. To eliminate irritants to skin from patient’s body.
xi. To dispose soiled and dirty linen properly.
xii. Another purpose of bed-making is to save time, effort and material properly.
3.6.3 BASIC PRINCIPLE OF BED MAKING IN HOSPITAL:
xiii. Skillful bed making contributes patients comfort. Some basic principles of
bed-making are pointed below.
1. It is important to learn that how to make a bed in such a way where least
amount of energy and time is required.
2. During bed-making, use good body movement and make each step purposeful.
3. Keep everything ready on bed side before starting bed-making.
3. Change bed linen frequently to assure cleanliness.
4. To ensure the patient need by providing a safe and comfortable bed.
5. It should have a finished appearance.
6. To make bed tight and free from wrinkles, place all linen straight line on the
bed.
7. Prevent complications of prolonged bed ridden patient such as pressure sore.
8. Soiled linen or linen whether clean or dirty should not be thrown on the floor,
but it is should be kept in a dirty linen box.
9. After cleaning bed, dump soap water and disinfectant properly.
10. Try to prevent cross infection of microorganism during bed-making.
11. Ensure all bed-making in a nursing unit alike for uniformity of appearance
3.6.4 Remember During Bed Making in Hospital: During bed-making we should
remember some knowledge those are useful for us and also to patient.
1. During bed-making, bed position keeps elevated and ensures nursing staff’s
good body alignments.
2. During the procedure, the nurse should study her movements so as to avoid
waste of time and energy.
3. After completing, bed should be lower position.
4. During occupied bed making, confirm patient safety and comfort.
5. Wash hands before and after bed making and use gloves during bed-making.
6. Maintain privacy while making bed.
7. Keep soiled linen away from uniform which may have germs.
8. Do not shake dirty linen to prevent germs spread around room.
9. Do not mix soiled and clean linen during bed-making.
10. For bed ridden patient, mattress must be turned air and ensure free of lumps
and fold.
3.6.5 Occupied Bed Making Procedures
An occupied bed is making the bed where the patient physically available in the
bed or the bed is being retained for patient.
Soiled linen is infectious to patient. If patient is unable to move or leave the bed,
you will need to change the bed sheets while the patient is occupied in bed.
Occupied bed making is tough for the one person.
This is best bed accomplished by two nurses. Before starting procedure, make
sure all supplies are ready beforehand to streamline the process as much as
possible.
The below equipment’s are very important for occupied bed making:
- Bed or cot
- Mattress with cover
- Bed sheet
-2 - Pillowcase
-1 or 2 Protective sheet and cotton draw sheet
- Mackintosh
-1 - Paper bag
- Chair-
1 - Bucket
3.6.6 Procedure of Occupied Bed Making:
All the procedures of occupied bed making have presented in the below:
1. Two nurses/caregivers must work together when the patent is seriously ill or
difficult to Manage.
2. Wash hand before making occupied bed or occupied bed making.
3. Gather all equipment’s at patient bed side and explain procedure to patient.
4. Loosen the tucked linens at the foot part that covers all around the bed.
5. Remove pillow unless inadvisable.
6. Place clean and dry top sheet over dirty top sheet and then remove the dirty
linen one by one.
7. Leave one cover over the patient and maintain privacy by bed side screening.
8. Turn the patient on half of the bed on the other side of the bed and keep side
rails up.
9. Place a pillow between patient and side rails.
10. Work on the unoccupied side of the bed and roll the draw sheet, mackintosh
and bottom sheet if soiled.
11. Rolls the soiled linens toward patient back and tucks the roll slightly under the
patient.
12. Covers dirty and moist areas of the soiled linen with a waterproof pad.
13. Place clean bottom sheet and tuck head part miter corner.
14. Place draw sheet over the mackintosh on near side of the mattress, with the
center vertical fold at the center of the bed.
15. Place the patient on the clean side of the bed.
16. Work on the other side and remove dirty linens.
17. Make the other side of the bed and spread clean linens.
18. Tuck the head part of the bottom sheet, miter at the side.
19. Place patient to the center of the patient.
20. Place the pillow and make the patient comfortable.
21. Spread the top sheet and fold head part up to the patient chest.
22. Arrange blanket if necessary.
3.6.7 Remember during Occupied Bed Making in Hospital/at home: You must
have to remember the below points during occupied bed making in hospital:
1. Maintain privacy as situations requires.
2. Carefully turn the patient to prevent over exertion and feeling insecurity.
3. Carefully observe the patient skin to identify any sign of bedsore.
4. If patient wear glasses, ask for removing to prevent broken and injury.
5. Ensure enough space for the patient to roll without smacking nose on a side
rail. 6. Ensure patient’s arm on the bed is not in an awkward position when
patient is rolled.
7. Ensure bed in flat position and rise to appropriate working height.
8. Remove patient’s personal items from bed and disconnects call devices.
9. Carefully checks that no tubes (such as IVS pole, Foley catheters, oxygen tube,
gastric tube, NG tube, drain) are entangled in the bed linens.
10. Apply diaper when patient in side position.
11. Do not place clean linen on another patient’s bed or furniture. 12. Keep side
rails up when patient turn.
13. Keep bed sheet smooth and wrinkles free to prevent friction.
14. Ask patient help if patient can participate.
15. Place all dirty linens in laundry bag or hamper without contaminating uniform.
16. Never put soiled linen on the floor or other surfaces.
17. Return bed in low and safe position and keep side rails up.
18. After occupied bed making, attaches call light within patient’s reach.
19. Re-position bedside table and over bed table within patient reach.
3.6.8 Making an Unoccupied Bed Required:
- 2 large sheets
- Draw sheet
- Pillow case
- Bath towel & wash cloth
- Pillow & mosquito net
- Additional for private rooms
- Woolen blanket top sheet
- Extra pillow with pillow case
- Hand towel
- Bedspread or coverlet Procedure:
1. Gather all equipment and place at the bedside table and arrange them in the
order of their use.
2. Get bottom sheet and spread it lengthwise on mattress with the center fold at
center of bed, with right side up and with narrow them even with foot of
mattress. Tuck the head part and miter the corner nearest to you by bring the
side of the sheet at night angle to the side of the mattress. Then tuck from the
head part making a boxlike appearance going down to the foot part.
3. Place the rubber sheet 15 to 18 inches from the edge of the mattress. Put the
draw sheet over the rubber sheet giving an allowance of one inch longer than the
rubber sheet at the head part and luck both together.
4. Place the top sheet with the wrong side up wider harm at the head part in line
with the upper edge of the mattress and with the centerfold along the middle of
the bed. Tuck the foot part and miter the corner. Leave the side free.
5. Go to the other side of the bed.
6. Full the bottom sheets firmly, tuck at head part miter the corner and tuck the
sides working towards the foot.
7. Adjust the rubber sheet and draw sheet, pull them firmly and tuck them in
separately.
8. Tuck top sheet at food part and miter the corner. Leave side free. Fold back top
part about 14 inches.
9. Put the pillowcase and lay pillow flat on bed with the open and of case away
from the main door.
10. In the private room fold down the top sheet 18 inches away from the head
part of the bed. Place a bedspread on top.
11. Hang the bath towel, hand towel and washcloth on rack
12. Straighten bed, bedside table and replace chair