Lesson 5
Environmental Health and the Practical Nurse

5.1 Environmental Health

One of the most important aspects of patient care is to ensure safety for each patient throughout the day. It is impossible to prevent accidents completely. However, there are ways to limit the potential for accidents that may cause injury to the patient or health care personnel and the unnecessary loss of equipment.



An electric spark near a high concentration of oxygen or certain anesthetic gases may cause an instant and serious fire.


a. Despite the use of fire retardant material, and compliance with fire regulations, fires still occur. Health care facilities should have regular fire drills so that all personnel know exactly what to do. Health care personnel should be trained and drilled in:

b. Oxygen supports combustion. Post signs to show that oxygen is in use where applicable. If a patient is receiving oxygen as part of his treatment, be sure that the patient, his roommates, and visitors know that smoking is prohibited.

NOTE: Smoking is prohibited in treatment areas of most health care facilities.

c. If a fire occurs, follow these steps:

  1. Activate the fire alarm procedures.
  2. Turn off oxygen, lights, and any electrical equipment in the vicinity of the fire.
  3. Remove the patients who are in immediate danger.
  4. Notify the hospital "switchboard" of the location of the fire.
  5. Using the fire extinguisher, attempt to extinguish the fire.
  6. Close windows and doors to reduce ventilation.
  7. Return patients who are not endangered to their rooms.
  8. Post a guard to direct the fire department.


a. Identify patients at risk for injury. Those at special risk include:

b. Protect the patients at risk for injury.

c. To prevent falls:

d. Protective restraints (see figures 5-1 through 5-3).

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Figure 5-1. Wrist or ankle restraint.

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Figure 5-2. Vest restraint.


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Figure 5-3. Waist restraint.

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Figure 5-4. Half-bow knot for waist restraints.

e. Prevent scalds and burns.

f. Prevent the spread of infection. A health care facility may adopt its own infection control policies and practices. However, the procedures generally follow the recommendations from the Centers for Disease Control (CDC). This is a federal agency that studies pathogens, outbreaks of contagious diseases, and methods used to control these outbreaks.

(1) Preventing disease, including infections, is a high priority in health care. Nurses should use techniques that prevent microorganisms from living, growing, and spreading.

(2) Two methods are used to reduce or eliminate the presence of microorganisms and thus prevent infections. These two methods are called surgical asepsis and medical asepsis.

(a) Surgical asepsis refers to the practice that eliminates the presence of all microorganisms (bacteria, viruses, fungi, yeasts, molds, rickettsia, and protozoa). This practice is sterilization.

(b) Medical asepsis refers to practices that help reduce the number and inhibit the growth of microorganisms, especially pathogens (those that cause infections or contagious diseases). Medical asepsis, also called clean technique includes use of antimicrobial agents, hand washing, cleaning supplies and equipment, and disinfection.

(3) Infections and infectious diseases begin in a reservoir and move full circle to a susceptible host (see figure 6-5).

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Figure 5-5. Cycle of infectious diseases.

(a) Reservoir. This is the place on which or in which organisms grow and reproduce. Examples include man and animals.

(b) Exit from reservoir. Escape routes for organisms include the nose, throat, mouth, ear, eye, intestinal tract, urinary tract, and wounds.

(c) Vehicle of transmission. The means by which organisms are carried about include hands, equipment, instruments, china and silverware, linens, and droplets.

(d) Portal of entry. The part of the body where organisms enter include any break in skin or mucous membrane, the mouth, nose, and genitourinary tract.

(e) Susceptible host. A person who cannot fight off the organism once it enters his body and therefore, he becomes ill.

(4) It is important that the nurse teach patients facts and practices about surgical and medical asepsis. When teaching a patient you should:

(a) Observe the patient to identify areas where instruction would be helpful in controlling the spread of infection.

(b) Act as a model by using sound practices of asepsis when giving care.

(c) Provide guidance to the patient who must give himself care at home in the proper way to handle sterile equipment and supplies and in how to sterilize reusable items.

g. Report infections. Health care workers must report any infection that occurs. The Infection Control Committee will investigate any case of infection to determine the cause. If a break in nursing technique is identified, the committee will propose different procedures to eliminate the problem.


Maslow states that our safety and security needs are second only to the need for food, air, and water. The daily responsibility for protecting the patient from additional injury or illness rests with the nursing team. The skillful and knowledgeable nurse can be just as dangerous as the incompetent one if safety measures are not applied in the health care environment.