Cleanliness and Hygiene

A brief introduction to different microbes

Microbiology

Organisms which can be seen only through a microscope are called micro-organisms. The study of micro-organisms is called Microbiology. We are affected by many diseases such as cholera, malaria, pneumonia and fever which are all caused by micro- organisms because microorganisms often grow rapidly in dark stagnant air. A hospital should let in maximum sunlight and be well ventilated. Basic cleaning such as dusting, sweeping and mopping should be carried out several times a day.

  Among the different kinds of microorganisms, only some are disease causing microorganisms.These are classified as bacteria, fungi and virus.

Bacteria

Bacteria are unicellular living microorganisms. These are reproduced by the process of bifurcation.Conditions favourable for the growth of bacteria are temperatures of about 37o C, humidity, food and acidity in a human body. Some bacteria require oxygen to multiply. These are called ‘Aerobes’. Others that do not need oxygen to multiply are called ‘Anaerobes’ Some bacteria produce spores when conditions are unfavourable.

Conditions that cause bacteria growth

Humidity: Bacteria live by sucking moisture from food. They absorb the moisture from food particles and produce an enzyme or toxin.

Oxygen: This applies only to certain bacteria.

Darkness: Bacteria grow rapidly in dark areas. Certain disease causing bacteria produce toxins that circulate through blood and cause toxemia.

Fungi

Ordinarily fungi cause diseases in the hair, nails, skin and mucous membranes. They can cause corneal ulcers and also affect the mouth region. Fungi are responsible for pus formation in the body. Fusarium and Aspergillus Contida cause ulcers in the cornea. Stye, Madras eye, and preorbital pus formation around the eye is also caused by fungi. Diabetics and those who use excessive antibiotics are easily affected by fungi.

Virus

Viruses are smaller than bacteria and are visible only through an electron microscope. They cause diseases like cold, influenza, pox, herpes zoster, jaundice, AIDS. A virus kills healthy cells by using the cell to get multipled. To control viruses, anti- viral medicines are used. Viruses spread in different ways - for example, the influenza virus spreads through blood vessels to different parts of the body.

Methods of infection control

Control of infection caused by these micro-organisms depends upon breaking what is called the “chain of infection”. This chain consists of the reservoir or the source of infection, such as bacteria laden dust, the vector or the means of transmission such as air, and the host or the patient who becomes infected while in the health care unit.The object of infection control measures is to eliminate reservoirs and to block the means of transmission.

  Disinfectants, when properly used, are very helpful in infection control. Their usefulness goes beyond the normal cleaning process - for example, the use of germicide in mop water. It must be emphasized however, that there is no substitute for careful cleaning.

Disinfection

Disinfection destroys both the microbes that cause diseases and those that do not. It is very important to keep the disinfected materials sterilised under the same conditions until they are ready to be used.

Anti-microbe disinfectant (Antiseptic)

Chemicals that destroy the growth and prevent the multiplication of microbes.

Asepsis

A condition in which there are no disease causing germs. There are three methods of disinfection - natural method, physical method and chemical method.

Methods of disinfection

1.Natural method of disinfection

Sunlight : Direct and continuous exposure to sunlight kills many disease producing organisms.The ultra violet rays of the sun kills the bacteria.

2. Physical method of disinfection

• Moist heat
  • - Boiling
  • - Passing vapour/steam
  • - Compressed steaming
  • - Pasteurization: In this method, certain articles are brought to a certain temperature, then rapidly cooled and maintained at this cooled temperature
• Dry heat
  • - Exposure to heat
  • - Burning the articles that contain germs
• Boiling

  Boiling articles for five minutes in water kills the microbes. It takes 30 minutes for microbes with sperm to die. Before boiling, the articles should be washed and cleaned; otherwise blood and tissue will clot and provide protection for the microbes. Instruments should be put into the water only after reaching the boiling point. Glass articles should be immersed when starting to heat the water.

  By this method, the microbes are destroyed because their protoplasm is reduced or changed.

• Compressed steam

  The principle behind using compressed steam: When steam is pressurized it increases to 100oC from its original temperature. There are two parts in the autoclave - the inner chamber and the outer chamber. The autoclave is made up of heavy metal. The materials to be disinfected are put in the inner chamber. The autoclave is then closed tightly and heated.

  When it is heated, the water from the outer chamber enters the inner chamber as steam. Since there is no outlet, the pressure and the temperature of steam increases to 15lb. and 120oC respectively.

  Articles that are disinfected using an autoclave:

  1. Blunt instruments used for surgery and other purposes.
  2. Clothes that are used in the operation theatre, such as the mask, cap, and the surgical gowns worn by doctors and nurses.

3.Chemical method

This involves killing germs using chemicals such as:

• - Carbolic acid
• - Lysol
• - Dettol
• - Spirit
• - Bleaching powder
• - Formalin
• - Potassium permanganate

Properties of a good disinfectant

• - Has the potential to destroy microbes
• - Must not harm human tissues or the articles that have to be disinfected.

The following are properties and uses of some disinfectants used in hospitals:

- Formalin: Used to disinfect operation theatres and patients’ rooms. Formalin is available in the form of tablets and as a liquid. In the vapour form it is used to destroy air borne microbes. Formalin should be handled carefully as it produces a burning sensation on the skin.

- Potassium permanganate: This is used to cleanse sores and as a mouth wash.

- Spirit: Pure spirit is not a disinfectant; hence spirit as a disinfectant is used in concentrations of 50% or 70%. It takes one hour to destroy ordinary germs, and is used as a hand scrub.

- Bleaching powder: This is used to clean places which are dirtied by faeces and urine.

- Iodine: This is used as 7% tincture iodine to kill germs that are present in the skin.

- Dettol: 10-20 drops of dettol are added to a glass of water to wash and disinfect a room. It is also used to wash hands.

- Lysol: This is a germicide, which contains carbonic acid and soap.

Procedures that will help to control the spread of infection

• Give top priority to the cleaning of horizontal surfaces and also give proper attention to cleaning of walls and other vertical surfaces. Harmful bacteria are air borne only for a short distance before attaching to both horizontal and vertical surfaces, especially the floor.
• Use wet-cleaning methods such as damp-wiping, damp-mopping, and wet-mopping. Dry-dusting may only redistribute the bacteria laden dust. However, the use of properly filtered vacuum cleaners is acceptable for cleaning.
• Add effective germicides or chemicals to the wet-cleaning solutions. The strength of the combination of detergent and chemicals should be sufficiently concentrated to combat both dirt accumulation and contamination. While germicide has some value on the floor, its real value is in the reduction of bacteria levels in the mop bucket. Unless checked, the bacteria multiply rapidly in the warm and moist environment of the mop water and may actually contaminate the floor while it is being cleaned.
• Issue sufficient mops and dust cloths to the employees so that they may use fresh cloths and mops as required.
• Launder the used wet mops and dust cloths every day. Do not leave soiled and moist mops and cloths overnight in the work closet.
• Clean the equipment and storage closet every day.
• Provide plastic film or waxed paper bags for the disposal of infected materials. Contaminated linen should be handled with care.

Odour control

Odour problems arise as a result of poor sanitation in toilet areas, utility rooms and work closets. Deodorizer blocks or sprays which mask the odour are a mark of poor housekeeping. The most effective way to deodorize these areas is with fresh air, removal of the causes, and frequent cleaning with a detergent- disinfectant solution.

  Garbage collection areas and soiled linen storage areas may be sites where bad odours arise. Frequent removal of garbage, cleansing of garbage cans, use of tight lids, and the use of waxed papers or plastic liners in the garbage cans will help minimise the odours. Daily washing of walls and floors in both the garbage and soiled linen rooms will be helpful. Frequent cleaning of drains and weekly flushing with a germicide solution will help reduce the problem.

Waste disposal

Waste constitutes a problem; the size of the problem varying with the size of the institution. The waste must be disposed of in an economical, efficient and sanitary way. Safety against fire, prevention of cross contamination by infectious materials, odour control and pest control are all included in waste disposal procedures. A carefully planned procedure of waste disposal will safeguard not only the patients and personnel, but also the community.

  Waste may be classified into non-combustible waste, combustible waste and chemical waste. In general, the methods of handling waste will depend on the facilities of the institution, the community and the regulations of the health board. Wet waste such as waste from the kitchen may be disposed off in disposal units in the kitchen, if such a facility is available. Wet as well as dry waste can also be burned in an incinerator or placed in special containers for removal by the commercial service. Waste chemicals can be disposed off in the sewer after being neutralized. Burning waste on hospital premises has some advantages over other methods of waste disposal. It eliminates the collection of refuse dumps, thus preventing the breeding of rodents and insects, as well as the cost of commercial services.

  Whatever methods are used, the housekeeper is responsible for developing waste disposal methods. In developing these procedures, various other pertinent factors such as time schedules, equipment required, sanitation standards, problems of odour and noise control, must be taken into consideration. The safety of the housekeeping personnel should not be neglected. They should be furnished with safety gloves and goggles for use while working at the incinerator, caps for the protection of the hair and scalp, masks to keep them from inhaling noxious gases, and rubber aprons or overalls to protect their uniforms. While emptying or sorting out any kind of refuse the personnel should be cautioned against any kind of injurious material such as broken bottles or syringes.

  The housekeeper should make regular tours of the waste disposal area to be sure that the procedures are being followed correctly and that safety measures are being taken.

Personal hygiene

It is always necessary to keep yourself clean. A person who is sloppy in dress, unclean, and emits body odour is not only unhygienic but also aesthetically unpleasant.

When you are working in hospitals where you are surrounded with patients, you tend to become a carrier of disease causing germs which can harm others as well as harmful to yourself. Thus it is very important to follow simple rules of hygiene. Wash your hands thoroughly after your work is done, or before your tea and lunch break. It is advisable to wear gloves when cleaning dirty areas or when disposing waste. Wear clean and washed clothes every day. Preferably dry the clothes in sunlight, as the sun is a natural disinfectant.

Hand washing procedure

Eight step procedure for washing hands:

1. Wet hands
2. Apply soap thoroughly; get under the nails and between fingers
3. If necessary, use a brush to remove any substance offering resistance
4. With a rotating frictional motion, rub hands together while you count 20. Wash at least 2-3 inches above the wrist.
5. To wash fingers and the spaces between them, interlace the fingers and rub up and down.




6. Rinse well
7. Dry thoroughly
8. Make certain that the sink is clean before you leave it (Fig. 3.1)

Student exercise

Answer the following

1. Briefly mention the harm caused by bacteria, virus and fungi
2. Why is disinfection necessary in a hospital? Name some of the disinfectants used in the hospital
3. What are the different methods of disinfection? Write briefly about each of them
4. What are the points you need to remember in order to control infection?
5. What are the aspects to be borne in mind during waste disposal, in order to avoid infection?