2-15 ENVIRONMENTAL HYGIENE

LEARNING OBJECTIVE: Identify environmental hygiene concerns in a medical treatment facility.

Todayís public is very much aware of the environment and its effect on the health and comfort of human beings. The healthcare setting is a unique environment and has a distinct character of its own. You need to be aware of that character and ensure that the environment will support the optimum in health maintenance, care, and rehabilitation.

In the context of the environment, hygiene may best be described as practices that provide a healthy environment. Basically, environmental hygiene practices include the following three areas of concern: safety (which has already been addressed); environmental comfort and stimuli; and, finally, infection control (which will be discussed briefly here, but in greater detail later in this chapter under ďMedical AsepsisĒ). You have certain responsibilities for helping to control the facilityís general environment as well as the patientís immediate surroundings.

CONCURRENT AND TERMINAL CLEANING

Maintaining cleanliness is a major responsibility of all members of the healthcare team, regardless of their position on the team. Cleanliness not only provides for patient comfort and a positive stimulus, it also impacts on infection control. The medical technician is often directly responsible for the maintenance of patient care areas. The management of cleanliness in patient care areas is conducted concurrently and terminally. Concurrent cleaning is the disinfection and sterilization of patient supplies and equipment during hospitalization. Terminal cleaning is the disinfection and sterilization of patient supplies and equipment after the patient is discharged from the unit or hospital. Both concurrent and terminal cleaning are extremely important procedures that not only aid the patientís comfort and psychological outlook, but also contribute to both efficient physical care and control of the complications of illness and injury.

Aesthetically, an uncluttered look is far more appealing to the eye than an untidy one. Other environmental factors, such as color and noise, can also enhance or hinder the progress of a personís physical condition. In the past, almost all healthcare facilities used white as a basic color for walls and bedside equipment. However, research has shown that the use ofcolor is calming and restful to the patient, and, as has been previously stated, rest is a very important healing agent in any kind of illness. Noise control is another environmental element that requires your attention. The large number of people and the amount of equipment traffic in a facility serve to create a high noise level that must be monitored. Add to that the noise of multiple radios and televisions, and it is understandable why noise control is necessary if a healing environment is to be created and maintained.

CLIMATE CONTROL

Another important aspect of environmental hygiene is climate control. Many facilities use air conditioning or similar control systems to maintain proper ventilation, humidity, and temperature control. In facilities without air conditioning, windows should be opened from the top and bottom to provide for cross-ventilation. Ensure that patients are not located in a drafty area. Window sill deflectors or patient screens are often used to redirect drafty airflows. Maintain facility temperatures at recommended energy-conservation levels that are also acceptable as health-promoting temperatures. In addition to maintaining a healthy climate, good ventilation is necessary in controlling and eliminating disagreeable odors. In cases where airflow does not control odors, room fresheners should be discretely used. Offensive, odor-producing articles (such as soiled dressings, used bedpans, and urinals) should be removed to appropriate disposal and disinfecting areas as rapidly as possible. Objectionable odors (such as bad breath or perspiration of patients) are best controlled by proper personal hygiene and clean clothing.

LIGHTING

Natural light is important in the care of the sick. Sunlight usually brightens the area and helps to improve the mental well-being of the patient. However, light can be a source of irritation if it shines directly in the patientís eyes or produces a glare from the furniture, linen, or walls. Adjust shades or blinds for the patientís comfort. Artificial light should be strong enough to prevent eyestrain and diffuse enough to prevent glare. Whenever possible, provide a bed lamp for the patient. As discussed earlier under ďSafety Aspect,Ē a dim light is valuable as a comfort and safety measure at night. This light should be situated so it will not shine in the patientís eyes and yet provide sufficient light along the floor so that all obstructions can be seen. A night light may help orient elderly patients if they are confused as to their surroundings upon awakening.

In conclusion, it is important that you understand the effects of the environment on patients. People are more sensitive to excessive stimuli in the environment when they are ill, and they often become irritable and unable to cooperate in their care because of these excesses. This is particularly apparent in critical care areas (e.g., in CCUs and ICUs) and isolation, terminal, and geriatric units. You must realize and respond to the vital importance of the environment in the total medical management plan of your patients.