Care of environment

Care of Environment

In any health program, environmental sanitation is one of the most important factors in eliminating health hazards. Environmental sanitation includes the provision of:

• Adequate water supply,
• Adequate ventilation,
• Adequate lighting,
• Quiet environment,
• Avoid slippery floor,
• Floor free of sharp instruments,
• Temperature and humidity,
• Infection control,
• Disposal of waste.

Provision of Adequate Water: Much of the ill-health which affects humanity, especially in the developing countries can be traced to lack of safe and wholesome water supply. There can be no state of positive health and wellbeing without safe water. Water is not only a vital environmental factor to all forms of life, but it has also a great role to play in socio-economic development of human population. Water is required for drinking, cooking, washing, bathing, etc. In hospital, particular clean and safe water should be provided to keep the environment free from pathogenic and nonpathogenic organisms, etc.

Adequate Ventilation: The modern concept of ventilation implies not only the replacement of vitiated air by a supply of fresh outdoor air, but also control of the quality of incoming air with regard to its temperature, humidity and purify with a view to provide a thermal environment that is comfortable and free from risk of infection. To maintain a safe environment, adequate ventilation is also necessary. The circulation of fresh air in the patient's room provides comfort to the patient.

Adequate Lighting: Good lighting is essential for efficient vision. If the lighting conditions are not ideal, the visual apparatus is put to strain which may lead to general fatigue and loss of efficiency. It is hazardous to patient's vision. If the room is poorly lit, the patient will not be able to see well. If the light is not sufficient, nurses and doctors may also do the wrong thing. They may read the cardex wrongly and give the wrong medication to the patient. Incorrect reading of medication cards may danger the patient's life.

For efficient vision, the following light factors are essential:

Sufficiency: The lighting should be sufficient to enable the eye to discern the details of the object as well as the surroundings without eye strain.

Distribution: The distribution of light should be uniform, having the same intensity, over the whole field of work. bovom

Absence of Sharp Shadows: Slight shadows are inevitable, but sharp and contrasting shadows are disturbing.

Steadiness: The source of light should be constant. It should not be flicker because flickering causes eye strain and may lead to accidents.

Color of Light: Natural light has a soothing effect on the eye, the artificial light should be as far as possible approximate the daylight colour.

Quiet Environment: Noise is often defined as unwanted 'sound'. A better definition of noise is "wrong sound, in the wrong place, at the wrong time. Noise has become a very important 'Stress factor' in the environment of man. The sources of noise are many and varied. In hospital, the sources of noise are- too many visitors, suction machines, automobiles, etc.

Avoid Slippery Floor: It is vital that the floor is not slippery or wet. If somebody slips on the floor, they may fracture any bone in their body such as the hip, spine or head.

Floor Free of Sharp Instruments: Floor free of any substance like water that can cause fall or sharp objects that can injure. Sharp instruments on the floor can cause cuts. Sharp instruments can also cause serious problems, for example, if the patient falls on a sharp instrument, it may pierce his body and injure the internal organ.

Temperature and Humidity: Humans are sensitive to humidity because the human body uses evaporative cooling, enabled by perspiration, as the primary mechanism to rid itself of waste heat. Perspiration evaporates from the skin more slowly under humid conditions than under arid conditions. Because humans perceive a low rate of heat transfer from the body to be equivalent to a higher air temperature, the body experiences greater distress of waste heat burden at high humidity than at lower humidity, given equal temperatures. Sensirion is the world's leading manufacturer of digital relative humidity and temperature sensors. This is a multifunctional sensor that gives you temperature and relative humidity information at the same time.

Infection Control: Infection prevention and control measures aim to ensure the protection of those who might be vulnerable to acquiring an infection both in the general community and while receiving care due to health problems, in a range of settings. The basic principle of infection prevention and control is hygiene. To prevent the spread of infection a health care facility may adopt its own infection control policies and practices.

Disposal of Waste: Disposal of wastes is now largely the domain of sanitations and public health engineers. However, health professional need to have basic knowledge of the subject since improper disposal of wastes constitutes a health hazard.

Body Mechanics

The movements we perform throughout the day when engaging in routine activities, such as sitting, standing, lifting, tugging, and walking, are referred to as "body mechanics." Body mechanics refers to the use of the appropriate muscles to carry out a task in a safe and effective manner without placing undue pressure on any muscle or joint. When doing an activity, maintaining balance, posture, and body alignment requires the coordination of the musculoskeletal and neurological systems. This is known as correct body mechanics. It is the effective use and management of the body, with each bodily part operating normally and in the right position. It is the coordinated use of alignment, posture, and balance to carry out tasks like lifting, bending, and moving. Severe musculoskeletal strains are among the most frequent injuries suffered by healthcare professionals. By deliberately using the right body mechanics when performing manual labor, many accidents can be prevented.

The rules of physics form the foundation of body mechanics. In order to create motion and balance, it makes use of the body's muscles, bones, nerves, and other systems. Body mechanics used correctly encourage safe musculoskeletal function and preserve equilibrium without overworking the muscles. Gravity, mass, and energy are examples of natural principles that control and form the foundation of body mechanics. Gravity is the fundamental idea underlying body mechanics, and it has an impact on both the balance and movement of people and objects. Objects are drawn toward the center of the earth by the force of gravity. When items fall to the ground or where water flows to its lowest point, gravity is at work. The center of gravity, the base of support, and the line of gravity are three fundamental laws of gravity that govern how our bodies move.

The location where an object's mass is concentrated is known as the centre of gravity. The pelvic cavity is where the center of gravity is found when a person is standing. Walking shifts the center of gravity from front to rear and from side to side. Three fundamental components comprise body mechanics:

Body Alignment: It refers to the positioning of the joints, tendons, ligaments and muscles while in standing, sitting and lying positions. Alignment is achieved when the joints and muscles are not experiencing extremes in extension or flexion or unusual stress when the person is lying down and standing. Correct body alignment reduces strain on musculoskeletal structures, maintains adequate muscle and contributes to balance.

Body Balance: Maintaining balance is a complex functioning of counter acting gravity and reflexes to maintain posture. It is achieved when the center of gravity is balanced over a wide, stable of supports and vertical line falls from the center of gravity and the base of support. In human, the centre of gravity when standing located in the center of pelvis admits midway between the umbilicus and the symphasis pubis. The line of gravity is a vertical line that passes through the center of gravity. The base of support is the foundation that provides for objects stability, the wider the base of support, the lower the center of gravity. The nurses can increase body balance when working by spreading their feet further apart and flexing their hips and knees.

Co-ordinate Body Movement: While giving care to the patient, nurses must frequently use the body to assist in positioning, turning and lifting body of clients and equipment. It is important to do this knowledgably to avoid musculoskeletal strain and injury.

Purpose

• To use appropriate technique when moving the patient.
• To provide safety for the patient.
• To perform task efficiently.
• To maintain good body alignment.
• To maintain balance of the body.
• To prevent fatigue and deformities.
• To promote physiological functions of the body.
• To reduce expenditure of energy.
• To prevent and reduce the risk of musculoskeletal injury.

Principles of Good Body Mechanics

• If all body parts are properly balanced, less energy is used.
• Greater stability results from a wider base of support and a lower center of gravity. In order to change the body's position and widen the base of support for efficient utilization of leverage and energy, bend your hips and knees.
• The risk of damage is lower when one faces the direction of work, and aberrant spinal twisting is avoided.
• On a flat surface, moving an object involves less effort. Or lowering the required force for work decreases the chance of injury.
• The amount of force required to move an object increases with its weight. Reducing physical effort and avoiding injury is achieved by using mechanical devices or aid when moving objects.
• It takes less energy to hold something near to the body than to hold something farther away.
• Movements that are gradual and continuous are simpler and safer than those that are abrupt, sharp, or uncontrolled.
• Lifting requires more work than using leverage, rolling, turning, or pivoting.
• Less energy is needed when there is less friction between the thing being moved and the surface it is moving.
• Less energy is expended when using rhythmic movements at a reasonable pace.
• Less force is needed to move an object when friction between the thing to be moved and the surface on which it is moved is minimized.
• Injury risk decreases when labor is done with less force.
• To combat weariness, it is beneficial to alternate intervals of rest and exercise.
• Strain on the back and abdomen is reduced when moving large objects by effectively using the primary muscles.
• Moving the feet in the direction of the thing being carried rather than moving the torso lessens muscle strain on the back and abdomen and prevents twisting.
• When you hold your breath while exercising, your muscles are working too hard and your body mechanics are not being used effectively.

Techniques of Body Mechanics

• Maintain anatomical position in all activities.
• Use the longest and strongest muscles of the extremities to provide the energy needed in the strenuous activities.
• Keep the object close to the body to prevent unnecessary strain on the muscles. Whenever possible sit while working because in standing more muscular effort is needed.
• Move a patient gently and smoothly. Jerky movements put extra strain on muscles and joints and may injure the patient.
• Be realistic about how much can be done safely without much strain.
• Use the weight of the body to pull or push an object by keeping the body, above the object.

While Lifting

• Use the stronger leg muscles for lifting.
• Bend at the knees and hips; keep your back straight.
• Lift straight upward, in one smooth motion.

While Reaching

• Stand directly in front of and close to the object.
• Avoid twisting or stretching.
• Use a stool or ladder for high objects.
• Maintain a good balance and a firm base of support. Place the feet apart to provide a wide base of support.
• Slide, roll or push an object rather than lifting it in order to reduce the energy needed to lift the weight against the pull of gravity. Use elbows, hips and knees as lever when lifting.
• Adjust the level of work surface such as the patient's bed. If possible to a height that prevents straining of muscles.

While Pivoting

• Place one foot slightly ahead of the other.
• When turning move the entire body instead of just twisting the trunk muscle tension that results from altered line of gravity.
• Maintain a good center of gravity while holding or carrying the object.

While Standing

• Use the following guidelines to minimize the risk of injury to your back when doing standing work.
• Wear shoes. They protect your feet from injury, give you a firm foundation and keep you from slipping.
• Avoid standing in one position for prolonged periods of time. This will not only help relieve stress on your spine, it also helps increase circulation and decrease muscle fatigue.
• Make sure the surface you are standing on is firm and level.
• Keep your back straight.

While Walking

• Keep your back straight as you walk. If helping a person to walk, you may need one arm around the back of the person.

While Lifting an Object 

• Feet should be apart, in a standing position. Keep your back straight. Lower your body to get close to the object. Bend from hips and knees. When turning, rotate whole body, not just your back. Hold the object by putting hands around it.
• Keeping knees bent and your back straight, lift the object using your arm and leg muscles. If the object is too heavy, ask another person to help you.

While Carrying an Object

• Hold the object close to your body.
• Always ask for help to move heavy objects.
• There are many devices available to help carry heavy objects.

While Pushing or Pulling

• Use the weight of your body to help push or pull an object.
• Feet should be apart as in the standing position.
• Keep your back straight.
• Lower your body to get close to the object.
• Bend from your hips and knees.
• There are many devices available to help you move, push or pull heavy objects. al triginta dosd my good agi bus on: od te brisa

While Sitting

Whether sitting at a desk or at home watching television, good body mechanics are still important to keep in mind. For deskwork, consider investing in an ergonomically enhanced chair. What does proper sitting look like?

• Place your buttocks at the back of the seat while maintaining a small space between the back of your knees and the seat of the chair.
• Place your feet flat on the floor with your knees bent at a 90° angle.
• Pull your shoulders back and lift your chest.
• Lift your chin until it is level and relax the jaw and mouth.

For prolonged periods of sitting, make sure you have enough support for your lower back. Look for a chair that has adjustable lumbar support. If that is not possible, you can increase your back support by using a lumbar roll or even a rolled up towel or cushion placed behind your lower back. Keep in mind that even sitting in the "correct" position for a long period of time will eventually become uncomfortable. Don't forget to take breaks, get up, move around and stretch. This will reduce the stress on your spine and help prevent muscle fatigue and stiffness.

While Sleeping

We spend about one-third of our time in bed, so we can't ignore how our bodies are positioned during sleep. As during our waking hours, the goal is to maintain a neutral spine even while we are in bed.

• Make sure you are sleeping on a firm mattress.
• Avoid sleeping on stomach or with your head elevated on an oversized pillow. These positions cause the back to arch and places stress on the spine.
• The side and back are the best positions for maintaining a neutral position and a must for anyone with back or neck problems.
• Place a pillow between knees (for side sleeping) or behind your knees (for back sleeping). This will help keep spine in the right position and help ease stress on the lower back.

Moving and Turning a Patients 

A helpless patient is usually unable to move or turn himself. Prolonged lying in one position often brings discomfort, so his/her position needs to be changed frequently. It is essential to keep in mind the following principles while moving or turning a patient:

• Be aware of the patient's limitations and restrictions e.g. if the patient is able to assist, one nurse may be able to move the patient. However, this may not be possible while moving obese and or helpless patient; two persons must be available to move the patient.
• Elevate the height of the bed as necessary so that it becomes less strenuous to work for the nurse herself.
• Observe the principles of body mechanics while moving, lifting or turning a patient.
• See that the patient is in proper body alignment while being moved or turned.

Moving a Patient Up in a Bed

The patients who have slid down in bed from the fowler's position or been pulled down by traction need assistance to move up in bed.

Procedure

• Explain the procedure to the patient, the purpose of procedure and how he can co-operate.
• Wash hands.
• Adjust the bed and the patient's position.
  • Lower the head of the bed to a flat position or as low as the patient can tolerate.
  • Raise the bed to the height of your center of gravity.
  • Lock the wheels of the bed and raise the side rails on the side opposite to you.
  • Remove all pillows and place it at the head of the bed.
• Asses the mobility status and strength of the patient.
• Instruct the patient the on how he can help during the procedure.
  • Ask the patient to flex hip and knees and position the feet flat on the bed so that they can be used effectively for moving the body up in bed.
  • If the patient can pull up holding a trapeze or holding the head of the bed that should be encouraged. This provides assistance and reduces friction.
• Instruct the client to flex the neck with chin on the chest.
• Position 2-3 persons depending on the patient's ability to assist in the lifting and moving efforts.
  •  If there are two nurses, one nurse is positioned at the level of the patient's upper body with the arm closest to the head of the bed, under the neck supporting the head and the sil shoulder on the opposite side. The other arm of the nurse is under the trunk of the patient. The second nurse is positioned against the lower part of the patient's body with one arm under the waist of the patient and the other arm under the thigh just below the buttocks.
  •  Three nurses are needed if the patient is unable to help himself. Ensure adequate and equal distribution of weight among the nurses. If a third nurse is present, she is positioned at the lower extremities, one arm supporting under the thighs and other arm album supporting under the legs.
• Flex at the knees. Support the patient's weight on forearms with forearms resting on bed.
• Stand with feet apart. Position one foot slightly forward.
• Instruct the patient to push with the heels and elevate the trunk if possible thus moving towards the head end of the bed to the count of three.
• On count of three shift your weight from front foot to back foot and at the same time shifting patient to the top of bed. Tighten your gluteal, abdominal leg and arm muscles as you do it.
• Realign and position the patient as required.
• Lower the bed.
• Position the patient comfortably.
• Wash hands.