The Training in Ophthalmic Assisting Series and Training in Eye Care Support

Services Series were born from the vision and inspiration of one very special man,
Dr. G. Venkataswamy, founder of Aravind Eye Hospitals and guiding light in the
world of eye care and community ophthalmology.

We dedicate this effort to him.

Intelligence and capability are not enough. There must also be the joy of doing
something beautiful. Being of service to God and humanity means going well
beyond the sophistication of the best technology, to the humble demonstration of
courtesy and compassion to each patient.
- Dr. G. Venkataswamy
 Training in E
Eyye Car
Caree SSuppor
uppor
upportt SSer
er vices SSeries
ervices eries (TECSS)
Aravind Eye Care system provides this material for educational and
illustrative purposes only. It is not intended to represent the only or best
method or procedure in the respective support services. It is the
responsibility of the hospital management to determine applicability of
Published by each process and to use them in their hospital according to the prevalence
of local law.
Aravind Eye Hospitals
& Postgraduate Institute of Aravind Eye Care System made best efforts to provide accurate
Ophthalmology
Madurai - 625 020,
information at the time of printing. Aravind Eye Care System ,the series
Tamilnadu, India editors, contributors and publisher disclaim all responsibility and liability
Phone: (0452) 4356100; for any and all adverse medical and legal effects, that may arise, including
Fax: 91-452-2530984
www.aravind.org personal, bodily, property or business injury and for damages or loss of
any kind whatsoever, resulting directly or indirectly, whether from
negligence or otherwise, from the use of the recommendations or other
Aravind Eye Care System
information in this series of modules, from any undetected printing errors
or recommendation errors, from textual misunderstandings by the reader,
Printed at
Leo prints, Madurai or in the light of future discoveries in this field.
Reference to certain equipment and supplies in this publication is made
September 2007 for illustrative purposes only and is not intended to constitute an
endorsement.
Aravind Eye Care System solely owns the copyright for the Training in
Eye Care Support Services Series and does not encourage photocopying
or any other duplication of the manuals.
This series of modules can be improved with your help. If you have
ideas or suggestions for ways the TECSSS could meet your needs, please
write to Aravind Communications, C/O Aravind Eye Hospitals or email
to [email protected]. We welcome your comments and
All photographs and illustrations in this experiences.
manual are the efforts of the Aravind
Publications team
 Foreword

The discipline of eye care requires a number of appropriately trained personnel working as a team
to deliver comprehensive eye care. The services that are delivered must include the promotion of
eye health, the preservation of sight and the prevention of vision loss, restoration of sight when it
is lost, the enhancement of vision and functional vision, where feasible and facilitation of
rehabilitation through vision substitution. Various cadres of trained personnel, with complementary
skills contribute to the work of the team.
In an ideal world, with infinite resources there would be a temptation to use the most highly
trained personnel to carry out these tasks. This is neither appropriate nor cost effective, given that
human resources for health care comprise the most expensive component of the recurring health
budget.
It has been possible to select, train and deploy different cadres of human resources, to carry
out tasks in a safe and effective manner to help achieve the goal of eliminating avoidable blindness.
One of such cadres is variously referred to as Ophthalmic Assistants, mid level personnel or by
their primary functions, such as Nurses, Refractionists etc. Where they exist and function in a
stipulated manner, it is acknowledged that they constitute an effective backbone for eye care
services. However a critical element to their success lies in the adequacy and appropriateness of
the training imparted to them.
There have been several training programmes put in place around the world to train such
mid-level personnel depending on the one hand, on the human resource needs for eye care in the
country, and the local human resource policies, rules and regulations, on the other.
The Aravind Eye Care System, over the years has developed a cadre of Ophthalmic Assistants
who have specific job descriptions. To enable them to perform effectively as part of the eye care
team, their training has been task oriented with defined requisite knowledge, skills, competencies
and attitudes, to carry out the tasks.
This manual sets out in several sections a step by step method for imparting such task oriented
training through didactic, hands on and practical training in real life situations. The sections
relate to tasks required of such personnel in different settings in the eye care delivery system such
as the out-patient department (general and specialist clinics), wards, operating rooms, optical
departments etc. Considerable emphasis has been paid to diagnostic technology, which is
increasingly a part of the armamentarium in eye care practice.
Finally the manuals include sections for self assessment as well as for continuing monitoring of the
achievements of task oriented objectives. The manual lends itself to translation into local languages
where required proficiency in English may not exist. The Human resource Development team at
Aravind Eye Care System need to be complimented on their efforts to share there wide and
successful experience in this field with others who are already involved in or are planning to
venture into such training programmes, particularly in the context of VISION 2020: the Right
to Sight.

Dr
Dr.. R amachandr
amachandraa P
Ramachandr ar
Parar
ararajasegar
arajasegaram MB., FR
ajasegaram CS., FR
FRCS., CP
FRCP ., FR
CP., CO phth. DSc. (H
FRC on)
(Hon)
Past President, IAPB, Co Chair,
Human Resource Programme Committee, IAPB.
 Preface

In recent years there have been significant advances in eye care, both in technology and in the
increasing resolution to address the scourge of needless blindness. Achievements in medical
technology have vastly improved diagnosis, treatment and surgery in all aspects of eye care, and
efforts like the global initiative "VISION 2020: The Right to Sight" -- which calls for the
elimination of avoidable blindness by the year 2020 -- have galvanized support for those working
to improve the quality of eye care at the grassroots level around the world.
It has become increasingly evident that trained personnel is one of the most important elements
in achieving this goal, and that the effective practice of eye care is a team effort that must
combine the talents of ophthalmologists, ophthalmic assistants, ophthalmic technicians, orthoptists,
counsellors, medical record technicians, maintenance technicians, and others.
Currently the focus in human resource development continues to be on the training of
ophthalmologists. But in many successful eye hospitals it has been shown that four or five trained
ophthalmic assistants are engaged to supplement and support the work of an ophthalmologist.
When such assistants are used effectively by eye care centres, doctors can treat more patients in less
time while still ensuring a high standard of care. It is therefore vital that more attention be paid
to the structured training of other ophthalmic personnel.
Over the past three decades, Aravind Eye Hospital has developed and refined a system of structured
training programmes for ophthalmic assistants and support services personnel. These series were
created to bring together the lessons we have learned over the years, and to share our insights
with other eye care programmes and the community at large.

Dr. G. Natchiar
Vice-Chairman, Aravind Eye Care System
Blindness Prevalence

World wide it is estimated that at least 38 million people are blind and that an additional 110 million have
severely impaired vision. In all, about 150 million people are visually disabled in the world today, and the
number is steadily increasing because of population growth and aging. Overall, the data shows that more
than 90% of all blind people live in developing countries and that more than two-thirds of all blindness is
avoidable (either preventable or curable). Unfortunately, little information is available on the incidence of
blindness around the world; it seems probable, however, that there are some 7 million new cases of blindness
each year and that despite every intervention, blindness in the world is still increasing by 1 to 2 million cases
a year. Thus, trend assessment points to a doubling of world blindness by the year 2020 unless more aggressive
intervention is undertaken.
A major cause of preventable blindness is cataract. Presently, an estimated 7 million cataracts are operated
on each year. There is a backlog of 16 million cases that have not yet been operated on. If this backlog is to be
eliminated in the next two decades…a staggering 32 million cataract operations must be performed annually
by the year 2020.
In addition, there must be an improvement in technology because more than 50% of cataract surgeries in
the least developed countries today are still performed without intraocular lens implantation. Thus, most of
the developing countries need more surgery facilities, supplies and equipment, and an increased number of
trained surgeons. Furthermore, particularly in sub-Saharan Africa, India, China and other parts of Asia, the
volume of cataract surgeries must increase greatly. Although considerable progress is being made in some of
these countries, the provision of good quality, affordable cataract surgery to all those in need will nevertheless
remain the main challenge for ophthalmology world wide for many years to come.
An important aspect of combating cataract blindness is human resource development. To increase the
efficiency of ophthalmologists in clinical work, further training of support staff such as paramedical ophthalmic
assistants, ophthalmic nurses and refractionists is essential.

©A R A V I N D E Y E C A R E S Y S T E M
Introduction

Eye care in the past three decades has grown with complexity and many divisions. The core product being
offered in eye hospital is clinical care; however clinical care by itself is not complete unless it is enhanced by
supportive services. This includes services such as housekeeping, medical records, optical dispensing and
delivery.
Housekeeping services are of paramount importance in providing a safe, clean, pleasant, orderly and functional
environment for both patients and hospital personnel. The medical record department helps in rendering
good service to patients, medical staff and hospital administration. Optical delivery and dispensing department
helps in timely delivery of glass prescription to patient making an impact in their vision. Training people in
these cadres make vital contributions to the achievement of high quality, high volume and financially sustaining
eye care in large volume setting.
About Training in Eye Care Support Services Series (TECSSS)

The Training in Eye Care Support Services Series (TECSSS) responds to the desire of many organisations and
institutions around the world to train support services personnel to provide high quality and high volume eye
care.
The Training in Eye Care Support Series is a set of manuals explaining the principles and techniques for the
effective procedures to be followed by the support services personnel.
Each module is based on the practices of Aravind Eye Hospitals in South India.
The intent of this series is to provide a format for Training in Eye Care Support Services based on Aravind Eye
Hospital’s “best practices”, based on over 30 years of growing, changing, and learning from mistakes.

The three modules of TECSSS

three
1. Housekeeping in E Eyye Car
Caree SSer
er vices - A practical guide : The invisible “bottomline” for patient
ervices
safety and satisfaction. Cleanliness, appearance, maintenance, attitude are all essential for the entire hospital
and OPD. Duties, responsiblities and specific tasks are covered.
2. Medical R ecor
Recor ds M
ecords anagement in E
Management Eyye Car
Caree SSer
ervices
er vices - A practical guide : A complete guide to
establishing and running an efficient medical records department: information retrieval, generating statistics,
personnel requirements, importance of accuracy.
3. Optical SSales
ales and Dispensing - A practical guide : This gives clear guidance about the various spectacle
Dispensing
lenses and frames, how to fit the lens into frame, the technical measurement and sales procedure.

©A R A V I N D E Y E C A R E S Y S T E M
About the Ophthalmic Assistant Training Series (OATS)
(OA

The Ophthalmic Assistant Training Series responds to the desire of many organisations and institutions
around the world to provide high quality and high volume eye care.
The contribution of the ophthalmic assistants to this work is fundamental.
The Ophthalmic Assistant Training Series is a set of manuals explaining the principles and techniques for
increasing high quality and high volume eye care through the use of paramedical staff.
Each module is based on the practices of Aravind Eye Hospitals in South India.
The intent of this series is to provide a format for Ophthalmic Assistant Training based on Aravind Eye
Hospitals’ “best practices”, based on over 30 years of growing, changing, and learning from mistakes.

The fiv
fivee modules of OATS
OA
1. Intr oduction to B
ntroduction asics of O
Basics phthalmic Assisting : This is the foundation of the entire Ophthalmic
Ophthalmic
Assistant Training. All the trainees are given general knowledge and training for the fundamentals necessary
for their duties, as well as specific information about all activities required in their work.
2. Handbook for Clinical O phthalmic Assistants, P
Ophthalmic rinciples & Techniques of Clinical O
Principles phthalmic
Ophthalmic
ocedures:
Procedur es: Out-patient Department (OPD): This includes theory and practice of initial patient evaluations.
An introduction to refraction is presented as well as steps for assisting the doctor.
Ward: This contains all the information necessary for the smooth running of a Ward. Pre and post operative
procedures and patient instructions, as well as management of emergency and post operative complications
are discussed. Ward set-up and management and laboratory functions are covered.
3. Handbook for Surgical Ophthalmic Assistants (Operation Room Services) Services): Contains background
and practical steps to the smooth running of a sterile theatre. Personnel requirements, roles and duties of
theatre personnel including management of emergencies and medications, and assisting in specific procedures
are detailed.
4. A text book on Optics and Refraction: All aspects of refractions are covered, including step- by step
instruction for subjective and objective refraction, room set up, and equipment required. All types of refractive
errors are described as well as the methods of assessing them. The theories and practice of visual fields,
ultrasonography, contact lens fitting, low vision aids and optical dispensing are included.
5. Role of Counselling in E Eyye Car
Caree SSer
er vices - A practical guide : Helping patients help themselves.
ervices
The importance and types of patient interaction are discussed in detail. Basics of communication and specific
examples are presented.
HOUSEKEEPING IN EYE CARE SERVICES
- A PRACTICAL GUIDE

Training in Eye Care Support Services Series

 Acknowledgements

We take great pleasure in presenting the Training in Eye Care Support Services Series (TECSSS)
which is the consummation of many years of experience and tireless efforts by Aravind’s ophthalmic
assistant training department.
We acknowledge Seva Foundation’s help through a series of volunteers who coached our team,
helped in designing the structure, edited the contents, ensured academic rigor and making it relevant
for transfer to a larger global audience, under the initiative of Dr.Suzanne Gilbert. In addition
Seva Foundation is covering a part of the production costs. Sight Savers provided the initial stimulus
and support for understanding the role of ophthalmic assistants in a broader context and in the
development of a draft curriculum. We express our gratitude to Ms. Sachiko Yoneyama for editing
the manual.
We express our sincere thanks to Dr.Pararajasegaram for contributing foreword to the series.
We take this opportunity to thank Aravind Publications Department particularly
Mr.K.V.S.Lakshmanan, Consulting Editor, for his contribution to the final edition and to
Ms. Dhanalakshmi whose team effort has resulted in the fruition of this manual. We are grateful
to Ms. Pattammal for co-ordinating the contributions from various sources and also for her contribution
in editing the manual.
Finally we sincerely thank the senior leadership team of Aravind Eye Care System particularly our
Vice - Chairman Dr. Natchiar for the constant support and encouragement.

The Ophthalmic Assistants team

Aravind Eye Care System
HOUSEKEEPING IN EYE CARE SERVICES
- A PRACTICAL GUIDE

CONTENTS

CHAPTER 1 HOSPITAL HOUSE KEEPING

Housekeeping
Housekeeping Department
Dress code for house keepers
Requisite skills of house keepers
CHAPTER 2 HOUSEKEEPING DEPARTMENT AND COMMUNICATION
Methods of communication
Means / medium of communication
Oral communication
Written communication
Housekeeping department and communication

CHAPTER 3 CLEANLINESS AND HYGIENE

A brief introduction to different microbes
Methods of infection control
Odour control
Waste disposal
Personal hygiene

CHAPTER 4 BODY MECHANICS

CHAPTER 5 EQUIPMENT REQUIRED FOR HOUSE KEEPING AND THEIR USES
Purchasing equipment
Maintaining equipment
Equipment and supplies commonly used in Housekeeping
CHAPTER 6 CLEANING PROCEDURES - PART I
Basic cleaning

CHAPTER 7 CLEANING PROCEDURE - PART II

Cleaning a room
Cleaning a room vacated by an infected patient, or where a patient has died
Cleaning the operation theatre
 CHAPTER 8 MAINTAINING A FLOOR
Removing stains
Cleaning different types of stains
Polishing the floors
CHAPTER 9 CLEANING SPECIAL AREAS
Cleaning classrooms and conference hall, stores, library using vacuum cleaner
Cleaning the elevator
Cleaning glass
CHAPTER 10 CLEANING THE HOSPITAL KITCHEN AND DINING AREA
CHAPTER 11 SAFETY AND SECURITY
CHAPTER 12 MAINTENANCE OF DRINKING WATER SUPPLY SYSTEM
Cleaning the drinking water tank
Cleaning the water filter and cooler
Chlorination
CHAPTER 13 CLEANING THE SEPTIC TANK
CHAPTER 14 LINEN MANAGEMENT
Setting up of a linen department
Selecting cleaning agents and detergents
Stain removing
Sample format for systematic running of the linen department
CHAPTER 15 WASTE MANAGEMENT
What is waste management?
Impact of poor waste management system
Segregation
Collection
Transportation
Disposal
CHAPTER 16 PEST CONTROL
Cockroach
Fly
Silverfish
Lizard
Bees, wasps and spiders
Bed bug
Mosquitoes
Rats
Termites
©A R A V I N D E Y E C A R E S Y S T E M
CHAPTER 17 INFECTION CONTROL
Infections and precautions in a hospital
Housekeeping and infection control
Infection control in the linen department
Housekeeping in the isolation ward
Housekeeping in the operation theatre
CHAPTER 18 GENERAL MAINTENANCE DEPARTMENT
Maintenance of electrical equipment
Maintenance of taps, pipes and drains
Maintenance of wooden fixtures/furniture

CHAPTER 19 CREATING GOOD AMBIENCE IN THE HOSPITAL AREA

Factors that decide the interiors
Components that make up interiors
Colours
Making beautiful articles for interiors
CHAPTER 20 HORTICULTURE AND GARDENING
Cultivating a garden
Maintenance of a garden
Expanding the garden
Plants in interior decoration

CHAPTER 21 HOSPITALITY AND EVENT MANAGEMENT

Administration
Publicity and promotion
Financial management
Accommodation and meals
Post-conference wrap-up
CHAPTER 22 HOUSEKEEPING MANAGEMENT
Organising a housekeeping department
Job descriptions
Responsibilities of the housekeeping department
Qualities required for housekeeper
Recruitment, selection and training of manpower
Supervision and evaluation of staff
Organisation of work
Inter departmental communication
Housekeeping and other departments
CHAPTER 1 HOSPITAL HOUSEKEEPING

CONTENTS
Housekeeping
Housekeeping department
Dress code for housekeepers
Requisite skills of housekeepers
GOAL
To familiarize the housekeeper trainee with the concept of housekeeping, its
importance and its role in a hospital
OBJECTIVES
To give the trainees a clear understanding of
- Housekeeping and housekeeping department
- Organisation structure
- Objectives of the housekeeping department
- Dress code for housekeepers
- Skills required for a good housekeeper
- Attitude towards other staff
- Evaluation of workers
- Organisation of work
 CHAPTER 1
Hospital Housekeeping

Housekeeping The housekeeping department is a non-revenue

producing service department. However, a poorly run
Housekeeping is one of the basic functions essential
department results in money needlessly spent, creates
to the operation of a health care institution.
a negative impression on the patients, visitors and
Housekeeping services, also called environmental
staff, and adversely affects their perception of the
services, are of vital importance in providing a safe,
quality of care provided by the hospital. This in turn
clean, pleasant, orderly, and functional environment
will adversely affect frequenting of patients to the
for both the patient and the hospital personnel. A
hospital that would indirectly affect the revenue.
clean and hygienic environment has a tremendous
psychological impact on the patients and the visitors,
and speaks volumes of the quality of service the
Housekeeping department
hospital provides. Since it is difficult for lay people The main objective of the housekeeping department
to judge the quality of medical practice in a hospital, is to keep the hospital clean, safe and infection-free,
opinion about a hospital is often formed on the basis yet maintain a pleasant and friendly atmosphere. The
of its appearance and cleanliness. However, housekeeping department works closely with other
bacteriological cleanliness should not be neglected. departments in making the hospital a pleasant and
Good housekeeping is an asset and a powerful safe place for the patients. It ensures a good ambience,
tool for public relations. It has a direct bearing on makes sure that the patients are comfortable and the
the prestige and reputation of a hospital. As staff has a pleasant environment to work in. It also
housekeeping serves all departments and areas of the controls physical facilities and individual activities to
hospital, minimizing the risk of cross infection and minimize patient, employee or visitor injury and
providing a clean, safe and comfortable environment exposure to infectious disease.
are fundamental to any good housekeeping service. As the patients enter the hospital, they come
The housekeeping department is essential to quality through the reception hall, and as the prescribed basic
service and needs to concentrate on both examinations are carried out, the patients are taken to
bacteriological cleanliness and outward cleanliness. several areas in the hospital. At each of these places the
The housekeeping department’s work has patient notices various aspects of cleanliness and interior
advanced rapidly in recent years and requires not only design that creates a tasteful and pleasant atmosphere.
knowledge of technical skills but also an Housekeepers not only need to pay attention to
understanding of the “Tools of Management”. A large the basic cleanliness and hygiene, but also help in the
part of the house keeper’s time is taken up by efficient functioning of the various sections such as linen,
personnel management, as it is the housekeeper’s pest control, waste management, garden maintenance,
responsibility to manage the cleaners, the largest and electricity, water supply, carpentry and food distribution.
most difficult class of human resource to manage. It is a difficult but important task to set up a
The aim should be to have an efficiently run housekeeping department in a hospital. The staff in
department with operating cost as low as possible. other departments can help to lessen the housekeeping
The housekeeping department should not be department’s workload by maintaining cleanliness in
considered in isolation, as it is an important source their respective areas and co-operating with the
of information for many other departments. Hence housekeepers in their day to day work. This can be
a co-operative and pleasant staff helps to provide a achieved easily with the housekeeper’s ability to
cordial and congenial atmosphere in the hospital. communicate effectively.
 3

Administrative set-up of the housekeeping however be remembered that although authority is

department delegated, the executive housekeeper retains full
Executive housekeeper responsibility for the department.

Chief housekeeper

Assistant housekeepers

Housekeeping trainees

Cleaners Gardeners
Administrative set-up of the department may vary
according to the size of the hospital. The chart given
above is a model. The housekeeping department, as
already mentioned, has multiple functions to
perform. Housekeeping services may be requested at Fig. 1.2 - Fig. 1.3 - Cleaner
any time of the day or night. Hence the staff structure Cleaner (lady) (Male)
must be arranged so as to provide all necessary
services. Personalised services remain an important Dress code for housekeeping staff
part of quality health care and are also largely provided Ladies
by the housekeeping department. - Hair should be neatly combed into a bun,
The executive housekeeper, as head of the neatly tied back or cut short
department, must coordinate the performance of these - No make-up
functions to develop the most efficient department
- Uniform should be neat and clean
possible. However, the executive housekeeper cannot
single-handedly discharge all housekeeping functions - No jewellery, except watch and ring or chain that
such as supervision, requisition, scheduling, and denote wedded status
budgeting. Therefore, delegation of authority through - Clean footwear (Fig. 1.1 & Fig. 1.2)
a clear chain of command is necessary to ensure a
thorough completion of each function/job. It must Gents
- The hair should be worn short and neatly combed
- Should be clean shaven
- Uniform should be neat and clean
- Clean footwear (Fig. 1.3)

Objectives of the housekeeping department

- To ensure a comfortable and infection-free
environment for the patients
- To create a pleasant and friendly atmosphere
- To ensure that everything under their supervision
is kept neat and clean
- To train and supervise effectively those who are
Fig. 1.1 - Housekeeper working with them
Housekeeping in Eye Care Services - A practical guide
4

- Establish a good working relationship with all in front of others or yell at them. Call them aside
other departments. and correct them. If however, they continue to work
- Ensure that all staff is informed of hospital safety in the same unsatisfactory manner, immediate
and security regulations. disciplinary action can be taken.
Building good relationship is essential to develop
Requisite skills of housekeepers a good and loyal staff. This can be done by taking an
In order to work effectively, one must know how to interest in their well-being. Greet them every morning
work efficiently. with a smile, and make polite enquiries about their
families. Try and help them to sort out their problems
Management with work or inter-personal problems with any other
Delegation: Work should be delegated to the staff staff member. Being pleasant to people you are
as per their capabilities. The staff should be supervised working with makes them feel a part of the
regularly, and their work evaluated periodically. “Organisation family”, and will result in their giving
Worork
k management: If several tasks need to be their best to the organisation.
completed on a particular day, the tasks need to be
Evaluation of workers
prioritised, so as to complete the tasks in order of
their importance. In order to ensure continuing efficiency, it is
important that the staff is evaluated from time to
Time management: In order to complete a given
time. This exercise will be effective, if the following
work in the stipulated time, the materials required
points are kept in mind:
for the task should be kept ready and at hand.
- Pay individual attention to each worker and
People management: It is an art to work with others. supervise the work
A good and efficient housekeeper must develop good
- Observe if the worker completes the work in
communication skills, and a pleasant attitude.
the stipulated time
Budgeting - Help the worker if there is a problem related to
A well-run housekeeping department runs at the work
minimum cost to the institution. Hence the good - If needed, plan additional training for the worker
housekeeper has to be good at planning and selecting and give him on the job training
equipment and supplies that are high in quality and - Observe attitude of worker toward other workers
moderate in price. in the department
For demonstration on the dress code of housekeepers
An eye for beauty
and cleaners, please watch the video of the CD.
Creating a beautiful and pleasant ambience is one of
the housekeeping objectives. A housekeeper should Student exercise
therefore have good artistic sense to be able to decorate
the area appropriately. Answer the following
New recruits should undergo training before they 1. Why is it necessary to have a housekeeping
are put on the job. The housekeeper can then delegate department in a health care institution?
work to them, and check the work once it is 2. What are the basic qualities you would look for
completed. It is rude to watch the workers while they
when appointing a housekeeper?
are working. This attitude indicates that you do not
trust them, and will make them uncomfortable. If 3. Why is periodic evaluation of workers necessary for
the workers commit an error, do not criticise them efficient functioning of the department?
©A R A V I N D E Y E C A R E S Y S T E M
CHAPTER 2 HOUSEKEEPING DEPARTMENT AND COMMUNICATION

CONTENTS
Methods of communication
Means / medium of communication
Oral communication
Written communication
Housekeeping department and communication
GOAL
To help the trainees communicate effectively
OBJECTIVES
To give the trainees a clear understanding of
- Methods of communication
- Means of communication
- Skills required for effective communication
- Importance of communication in the housekeeping department
 CHAPTER 2
Housekeeping Department and Communication

Communication - Ascertain that the message has been received and

clearly understood by the receiver.
Communication is the process of transmitting ideas.
Effective communication is an essential requirement - The receiver, on their part, should receive the
for efficient functioning. Hence having good message carefully, and understand it. If the
communication skills is a must in the Housekeeping message is not clear, ask the sender for clarification
department. A housekeeper must be able to effectively Before communicating any information, the
communicate with all administrative personnel, heads means or medium for communication should be
of departments, staff of various departments, considered. This is very important.
patients, and other staff and workers of the
Housekeeping department. Means/medium of sending messages
a. Direct conversation
Methods of communication b. Group discussions
There are two basic methods of communication c. Telephone
d. Written or typed letter
One way communication
e. Memo
Sender Message Receiver f. Handouts

Two way communication Skills required for effective communication

Since the housekeeper must communicate with all
Sender Message Process Receiver different levels of hospital staff she must follow an
effective oral and written communication process and
must have good skills in listening and observation.
Feedback
Oral communication
Successful communication through the spoken word
For effective communication, the following requires careful planning. The speaker must think
points need to be kept in mind; about what she wants to say, concentrate on
- Before sending a message, the sender should communicating one idea at a time, and present the
understand why the message is being sent idea in a logical sequence. The speaker must also be
aware of the effect of her tone of voice, and the
- Collect the relevant data
expression on her face, for all these lend colour and
- Compile the collected data in a concise manner meaning to her words.
which can be clearly understood
- Select an appropriate means or medium of For effective oral communication
communication - Think through what you want to say before
- Send the message through the selected starting to talk
medium - Put the listener at ease; speak in low, pleasant tones
 7

- Speak distinctly in words the listener can understand Listening and observing
- Concentrate on communicating one idea at a Being a good listener is an art and requires practice.
time; avoid rambling
- Look for signs of understanding or confusion To be a good listener
- Stop talking; it is impossible to listen while you
- Ask questions to ensure that the listener has
are talking
understood the message
- Concentrate on what the other person is trying
- Encourage the listener to ask questions to achieve to say; listen also to what he is not saying or what
clarity of understanding he avoids talking about by observing the body
- Stick to ideas appropriate for the occasion language and his facial expression
- Look at the person to whom you are speaking - Sift facts and avoid hasty judgment. Wait until
and avoid actions that may distract him the speaker has finished and you can evaluate what
- Use terms that are persuasive rather than he has said before you draw conclusions
argumentative
For good observation
- Remember that ridicule or derision as well as
argument stops the flow of communication Good observation requires that the observer
concentrates on the person, avoids distractions, and
- Recapitulate the conversation and confirm the avoids unsupported assumptions and hasty actions.
conclusion that has been reached The observer must appear passive though his mind
must be very active. If the observer reacts strongly or
Written communication hastily in any way, the subject may feel inhibited or
Factors important in oral communication are threatened and the communication may be distorted.
important in written communication as well. When The housekeeper must often use observation in
communicating through writing, it is important to the performance of duties. Observation is an important
choose words and phrases carefully, as the writer part of supervision; it is a major factor in inspection.
cannot gauge the response to the message as can a
Summing up the above discussion
speaker in a face-to-face situation; nor does the writer
usually have the opportunity to clarify what is said The sender and the receiver require certain basic skills,
by answering questions. to make the communication effective.

For effective written communication For sender

- Present one idea at a time - Send clear information
- Phrase the idea in simple words - Select the best means for communication
- Present ideas in a logical order - Ensure that the receiver has understood the message
- Avoid sentences that average more than 20 words For receiver
- Make paragraphs short - Listen to or read the message carefully, when
- Engage interest in the first paragraph receiving it
- Retain the reader’s interest by explaining how the - When the message is given directly, face to face,
idea will help him watch the body language
- Use repetition to reinforce the idea - Ensure that the complete message has been
- Give examples to clarify the idea received and understood
- Use action words, but spare long adjectives and Communication with senior officers of an
adverbs that may obscure the action words organisation plays a vital role in the efficiency of the

Housekeeping in Eye Care Services - A practical guide

8

organisation. This communication can take place in Housekeeping department and

the following ways: communication
Chief of The housekeeping department is not an isolated
Manager Staff
administration department. It is a responsible department which has
Senior level to junior le vel to function in co-ordination with the reception,
The message is sent from the Chief of Administration medical and other departments. Communication
to the Manager or from the Manager to the staff. with the staff of these departments, and the patients
coming to the hospital should be a two way
Chief of
Manager Staff communication. A one way communication will lead
administration
to waste of time, material and manpower.
Junior level to senior level Communication should not only be effective with
For example, in the housekeeping department, if the other departments, but also within the department.
sweepers wish to express problems related to their For example, if a manager simply asks for a room to
job, the message is sent through the housekeeping be arranged to conduct a meeting, the message is
staff to the manager and through him to the chief of incomplete and the result is confusion and delay in
administration. starting the meeting. In order to avoid this, the
manager should have indicated the place, time, date
Intermediate communication
and purpose of the meeting to be conducted. If
This deals with communication between the something is not clear, the staff should get it clarified
housekeeping department and other departments. it with the concerned manager. On the other hand,
Housekeeping Staff of other Housekeeping the manager should ensure that the staff has
staff departments Manager understood the message completely.
Reasons for ineffective communication Key points to remember
- Not planning the message to be sent - Ensure that the message is sent clearly
- No clear idea about the message
- Ensure that the message is received and understood
- Using difficult words
- Language problem - Listen attentively when the message is being given
- Speaking without facing one another - Observe the body language of the speaker
- Anxiety on account of nervousness with a senior - Do not fear to ask for clarification if the message is
staff member causes one to listen to and not understood
understand the message wrongly
- Lack of attention on the part of the receiver Student exercise
causes him to misunderstand the message
Answer the following
Effective measures for good communication 1. Why is effective and clear communication
- Speak clearly in order to be heard and understood. important for efficiency?
- Improve listening skills 2. What are the different means of communication?
- Do not interrupt when the message is being given 3. What are the factors contributing to effective oral
- Observe the body language of the speaker communication?
- If there is difficulty in understanding the message, 4. What do we need to keep in mind when using
ask for clarification written communication?

©A R A V I N D E Y E C A R E S Y S T E M
CHAPTER 3 CLEANLINESS AND HYGIENE

CONTENTS
A brief introduction to different microbes
Methods of infection control
Odour control
Waste disposal
Personal hygiene
GOAL
To emphasize the importance of cleanliness and basic hygiene
OBJECTIVES
To give the trainees a clear understanding of
- Sanitation
- Bacteriology
- Disinfection and disinfectants
 CHAPTER 3
Cleanliness and Hygiene
Many people visit a hospital. They are affected by Conditions favourable for the growth of bacteria are
o
various infections and come for treatment. These temperatures of about 37 C, humidity, food and
infections can spread to others through water, air and acidity in a human body. Some bacteria require
through direct and indirect physical contact. oxygen to multiply. These are called ‘Aerobes’. Others
Sanitation and institutional housekeeping can that do not need oxygen to multiply are called
both be defined as the practice of eliminating agencies ‘Anaerobes’ Some bacteria produce spores when
injurious to health. Microbiology, the study of conditions are unfavourable.
microscopic living beings, including bacteria, viruses,
Conditions that cause bacteria growth
yeasts and molds, is the biological science on which
sanitation is based. The housekeeper, therefore, should Humidity: Bacteria live by sucking moisture from
have some knowledge of microbiology to develop food. They absorb the moisture from food particles
routine cleaning procedures, such as odour control and produce an enzyme or toxin.
methods, waste disposal operations and pest control Oxygen: This applies only to certain bacteria.
methods. More importantly, the housekeeper should Darkness: Bacteria grow rapidly in dark areas.
be familiar with organisms which produce diseases Certain disease causing bacteria produce toxins that
in man. circulate through blood and cause toxemia.
A brief introduction to different Fungi
microbes Ordinarily fungi cause diseases in the hair, nails, skin
and mucous membranes. They can cause corneal
Microbiology
ulcers and also affect the mouth region. Fungi are
Organisms which can be seen only through a responsible for pus formation in the body. Fusarium
microscope are called micro-organisms. The study and Aspergillus Contida cause ulcers in the cornea.
of micro-organisms is called Microbiology. We are Stye, Madras eye, and preorbital pus formation
affected by many diseases such as cholera, malaria, around the eye is also caused by fungi. Diabetics and
pneumonia and fever which are all caused by micro- those who use excessive antibiotics are easily affected
organisms because microorganisms often grow by fungi.
rapidly in dark stagnant air. A hospital should let in
maximum sunlight and be well ventilated. Basic Virus
cleaning such as dusting, sweeping and mopping Viruses are smaller than bacteria and are visible only
should be carried out several times a day. through an electron microscope. They cause
Among the different kinds of microorganisms, diseases like cold, influenza, pox, herpes zoster,
only some are disease causing microorganisms. These jaundice, AIDS. A virus kills healthy cells by using
are classified as bacteria, fungi and virus. the cell to get multipled. To control viruses, anti-
viral medicines are used. Viruses spread in different
Bacteria ways - for example, the influenza virus spreads
Bacteria are unicellular living microorganisms. These through blood vessels to different parts of the
are reproduced by the process of bifurcation. body.
 11

Methods of infection control Methods of disinfection

Control of infection caused by these micro-organisms 1. Natural method of disinfection
depends upon breaking what is called the “chain of
Sunlight : Direct and continuous exposure to
infection”. This chain consists of the reservoir or the
sunlight kills many disease producing organisms. The
source of infection, such as bacteria laden dust, the
ultra violet rays of the sun kills the bacteria.
vector or the means of transmission such as air, and
the host or the patient who becomes infected while 2. Physical method of disinfection
in the health care unit. The object of infection control a. Moist heat
measures is to eliminate reservoirs and to block the
- Boiling
means of transmission.
- Passing vapour/steam
Disinfectants, when properly used, are very helpful
- Compressed steaming
in infection control. Their usefulness goes beyond
the normal cleaning process - for example, the use of - Pasteurization: In this method, certain articles
germicide in mop water. It must be emphasized are brought to a certain temperature, then
however, that there is no substitute for careful rapidly cooled and maintained at this cooled
cleaning. temperature
b. Dry heat
Bacterial, laden - Exposure to heat
dust (Reservoir/ Air Patient in - Burning the articles that contain germs
source of (Vector) hospital (Host) c. Boiling
infection Boiling articles for five minutes in water kills the
microbes. It takes 30 minutes for microbes with
Disinfection sperm to die. Before boiling, the articles should
be washed and cleaned; otherwise blood and
Disinfection destroys both the microbes that cause
tissue will clot and provide protection for the
diseases and those that do not. It is very important
microbes. Instruments should be put into the
to keep the disinfected materials sterilised under the
water only after reaching the boiling point. Glass
same conditions until they are ready to be used.
articles should be immersed when starting to heat
Anti-microbe disinfectant (Antiseptic) the water.
By this method, the microbes are destroyed
Chemicals that destroy the growth and prevent the
because their protoplasm is reduced or changed.
multiplication of microbes.
d. Compressed steam
Asepsis The principle behind using compressed steam:
o
A condition in which there are no disease causing When steam is pressurized it increases to 100 C
germs. There are three methods of disinfection - from its original temperature. There are two parts
natural method, physical method and chemical in the autoclave - the inner chamber and the outer
method. chamber. The autoclave is made up of heavy

Housekeeping in Eye Care Services - A practical guide

12

metal. The materials to be disinfected are put in - Spirit

Spirit: Pure spirit is not a disinfectant; hence
the inner chamber. The autoclave is then closed spirit as a disinfectant is used in concentrations
tightly and heated. of 50% or 70%. It takes one hour to destroy
When it is heated, the water from the outer ordinary germs, and is used as a hand scrub.
chamber enters the inner chamber as steam. Since - B leaching popowwder: This is used to clean places
there is no outlet, the pressure and the which are dirtied by faeces and urine.
temperature of steam increases to 15lb. and 120oC - Iodine
odine: This is used as 7% tincture iodine to kill
respectively. germs that are present in the skin.
Articles that are disinfected using an autoclave: - Dettol
Dettol: 10-20 drops of dettol are added to a glass
1. Blunt instruments used for surgery and other of water to wash and disinfect a room. It is also
purposes. used to wash hands.
2. Clothes that are used in the operation theatre, - Lysol
ysol: This is a germicide, which contains
such as the mask, cap, and the surgical gowns carbonic acid and soap.
worn by doctors and nurses.
Procedures that will help to control the
3. Chemical method spread of infection
This involves killing germs using chemicals such 1. Give top priority to the cleaning of horizontal
as: surfaces and also give proper attention to cleaning
- Carbolic acid of walls and other vertical surfaces. Harmful
- Lysol bacteria are air borne only for a short distance
before attaching to both horizontal and vertical
- Dettol
surfaces, especially the floor.
- Spirit
2. Use wet-cleaning methods such as damp-wiping,
- Bleaching powder damp-mopping, and wet-mopping. Dry-dusting
- Formalin may only redistribute the bacteria laden dust.
- Potassium permanganate However, the use of properly filtered vacuum
cleaners is acceptable for cleaning.
Properties of a good disinfectant
3. Add effective germicides or chemicals to the
- Has the potential to destroy microbes wet-cleaning solutions. The strength of the
- Must not harm human tissues or the articles that combination of detergent and chemicals should
have to be disinfected. be sufficiently concentrated to combat both dirt
The following are properties and uses of some accumulation and contamination. While
disinfectants used in hospitals: germicide has some value on the floor, its real
- Formalin
ormalin: Used to disinfect operation theatres value is in the reduction of bacteria levels in the
and patients’ rooms. Formalin is available in the mop bucket. Unless checked, the bacteria
form of tablets and as a liquid. In the vapour multiply rapidly in the warm and moist
form it is used to destroy air borne microbes. environment of the mop water and may actually
Formalin should be handled carefully as it contaminate the floor while it is being cleaned.
produces a burning sensation on the skin. 4. Issue sufficient mops and dust cloths to the
- Potassium permanganate
permanganate: This is used to cleanse employees so that they may use fresh cloths and
sores and as a mouth wash. mops as required.

©A R A V I N D E Y E C A R E S Y S T E M
 13

5. Launder the used wet mops and dust cloths every in disposal units in the kitchen, if such a facility is
day. Do not leave soiled and moist mops and available. Wet as well as dry waste can also be burned
cloths overnight in the work closet. in an incinerator or placed in special containers for
6. Clean the equipment and storage closet every day. removal by the commercial service. Waste chemicals
7. Provide plastic film or waxed paper bags for the can be disposed off in the sewer after being
disposal of infected materials. Contaminated neutralized. Burning waste on hospital premises has
linen should be handled with care. some advantages over other methods of waste
disposal. It eliminates the collection of refuse dumps,
Odour control thus preventing the breeding of rodents and insects,
as well as the cost of commercial services.
Odour problems arise as a result of poor sanitation
in toilet areas, utility rooms and work closets. Whatever methods are used, the housekeeper is
Deodorizer blocks or sprays which mask the odour responsible for developing waste disposal methods.
are a mark of poor housekeeping. The most effective In developing these procedures, various other
way to deodorize these areas is with fresh air, removal pertinent factors such as time schedules, equipment
of the causes, and frequent cleaning with a detergent- required, sanitation standards, problems of odour and
disinfectant solution. noise control, must be taken into consideration. The
safety of the housekeeping personnel should not be
Garbage collection areas and soiled linen storage
neglected. They should be furnished with safety
areas may be sites where bad odours arise. Frequent
gloves and goggles for use while working at the
removal of garbage, cleansing of garbage cans, use of
incinerator, caps for the protection of the hair and
tight lids, and the use of waxed papers or plastic liners
scalp, masks to keep them from inhaling noxious
in the garbage cans will help minimise the odours.
gases, and rubber aprons or overalls to protect their
Daily washing of walls and floors in both the garbage
uniforms. While emptying or sorting out any kind
and soiled linen rooms will be helpful. Frequent
of refuse the personnel should be cautioned against
cleaning of drains and weekly flushing with a
any kind of injurious material such as broken bottles
germicide solution will help reduce the problem.
or syringes.
Waste disposal The housekeeper should make regular tours of
Waste constitutes a problem; the size of the problem the waste disposal area to be sure that the procedures
varying with the size of the institution. The waste are being followed correctly and that safety measures
must be disposed of in an economical, efficient and are being taken.
sanitary way. Safety against fire, prevention of cross
Personal hygiene
contamination by infectious materials, odour control
and pest control are all included in waste disposal It is always necessary to keep yourself clean. A person
procedures. A carefully planned procedure of waste who is sloppy in dress, unclean, and emits body odour
disposal will safeguard not only the patients and is not only unhygienic but also aesthetically
personnel, but also the community. unpleasant.
Waste may be classified into non-combustible When you are working in hospitals where you
waste, combustible waste and chemical waste. In are surrounded with patients, you tend to become a
general, the methods of handling waste will depend carrier of disease causing germs which can harm others
on the facilities of the institution, the community as well as harmful to yourself. Thus it is very
and the regulations of the health board. Wet waste important to follow simple rules of hygiene. Wash
such as waste from the kitchen may be disposed off your hands thoroughly after your work is done, or

Housekeeping in Eye Care Services - A practical guide

14

before your tea and lunch break. It is advisable to 6. Rinse well

wear gloves when cleaning dirty areas or when 7. Dry thoroughly
disposing waste. Wear clean and washed clothes every 8. Make certain that the sink is clean before you
day. Preferably dry the clothes in sunlight, as the sun leave it (Fig. 3.1)
is a natural disinfectant.
Student exercise
Hand washing procedure
Eight step procedure for washing hands: Answer the following
1. Wet hands 1. Briefly mention the harm caused by bacteria, virus
2. Apply soap thoroughly; get under the nails and and fungi
between fingers 2. Why is disinfection necessary in a hospital? Name
3. If necessary, use a brush to remove any substance some of the disinfectants used in the hospital
offering resistance 3. What are the different methods of disinfection?
4. With a rotating frictional motion, rub hands Write briefly about each of them
together while you count 20. Wash at least 2-3 4. What are the points you need to remember in order
inches above the wrist. to control infection?
5. To wash fingers and the spaces between them, 5. What are the aspects to be borne in mind during
interlace the fingers and rub up and down. waste disposal, in order to avoid infection?

Procedure 1 Procedure 2 Procedure 3

Wet hand and wrists. Right palm over left, Palm to over, fingers interlaced
Apply soap left over right

Procedure 4 Procedure 5 Procedure 6

Back fingers to opposing Rotational rubbing of right thumb Rotational rubbing backwards and
fingers interlocked claspec in left palm and vice versa forwards with tops of fingers and thumb
of right hand in left and vice versa
Note: Repeat procedures 1-6 until the hands are clean. Rinse hands and pat dry
Fig. 3.1
©A R A V I N D E Y E C A R E S Y S T E M
CHAPTER 4 BODY MECHANICS

GOAL
To enable housekeepers and other staff do their work without fatigue
OBJECTIVES
To teach the trainees the harm caused to their body by wrong movements and the
fatigue caused by unplanned work
 CHAPTER 4
Body Mechanics
Housekeeping is, without doubt, a strenuous and of the housekeeping personnel. It is therefore
stressful work. The housekeeper is expected to be necessary for the housekeeping department to teach
alert at all times, looking after multiple functions. the staff work methods that will reduce fatigue. It
The housekeeper has to ensure cleanliness and is also helpful to introduce meditation or yoga as
hygiene, keep the hospital premises free of rodents part of their routine activity. This will help them to
and other pests, ensure safety and security, and keep always feel energetic, which, in turn will keep them
a constant eye on the cleaners to make sure they are
looking and feeling cheerful.
doing their work to perfection. The housekeeper
juggles multiple tasks while keeping a calm exterior, Student exercise
and regularly interacts with the patients to make sure
that patient comfort and needs are met. Answer the following
This kind of job is bound to cause strain and 1. What do you understand by Body Mechanics? Why
stress, affecting the mental and physical well-being is knowledge of this important to housekeeping?
CHAPTER 5 EQUIPMENT REQUIRED FOR HOUSEKEEPING

CONTENTS
Purchasing equipment
Maintaining equipment
Equipment and supplies commonly used in housekeeping
GOAL
To give the trainee knowledge about the equipment and supplies used in
housekeeping
OBJECTIVES
The trainee will know
- How equipment and supplies are selected
- How equipment is maintained to last long
- Where and how the different equipment and supplies are used
 CHAPTER 5
Equipment required for Housekeeping
Various equipment and supplies are used to keep the Purchasing equipment
hospital clean and hygienic. The housekeeper must
Poor economy is buying anything below high quality
make a careful selection of equipment based on its
and time consuming equipment. Buying good
suitability for a health care institution, appropriate equipment and letting it lay idle or buying a product
design and size, rugged construction and finish, easy
of better quality than is needed is also poor economy.
availability of materials for maintenance, initial and
Comparing the results of a trial use (in case of
operating costs, pre-tested on-the-job performance,
equipment), or sampling, (in case of supplies) to the
safety, and overall efficiency. The housekeeper should performance of similar items already in use is
also research supplies and develop basic procedures
beneficial before placing an order for a new one.
on how to effectively use them to maintain desired
standards of cleanliness. The housekeeper is responsible for selecting new
equipment. The housekeeper may obtain advice from
Housekeeping property is broadly classified as
any personnel involved with the equipment, be they
either equipment or supplies. Generally, equipment
the purchasing agent, maintenance superintendent,
such as brooms, mops, stools, vacuum machines, are
laundry manager, or microbiologist, but the final
reusable, and supplies such as dusters, detergents,
decision rests with the housekeeper. If the housekeeper
germicides, are consumables. (Fig. 5.1 & Fig. 5.2)
discovers that any equipment is inadequate, it must
be personally observed and research the market to
obtain knowledge about the different advancements
and technology that is available for that one
equipment. Only then can they understand the limits
of expectation from one such equipment. A general
checklist can be formulated to help the housekeeper
and other personnel involved in the purchase of the
equipment to remember every factor pertinent to the
purchase of the equipment.
Fig. 5.1 - Equipment needed for cleaning The housekeeper also needs to evaluate a product
before purchase. Very often the employees who use
the product are the best people to consult for this. In
the initial stages of introducing a new type of
equipment the general trend should be monitored.
Making a checklist can help in this process. For
example when monitoring a new type of mop, list
who the distributor is, the cost, how often it needs
to be replaced. If the mop is being used in different
areas, monitor whether the durability, usability varies
Fig. 5.2 - Supplies needed for cleaning
from one area to another and investigate why.
 19

For ensuring long life of a machine it is necessary housekeeper’s file. Copies should be given to the
to provide appropriate storage space and create maintenance department for making repairs and to
awareness among the users to put it back into its use the parts list for stockpiling small replacement
place as soon as they complete their work. parts. Each employee should be given individual
instruction in handling the equipment they use, and
Maintaining equipment should have a set of instructions framed and hung in
When an employee is provided with high quality the immediate work area. When training an employee
equipment, he must be trained in its proper care, use to use new equipment, observe the employee as he
and storage. All equipment should also be inspected uses the equipment to evaluate how closely he adheres
daily by the housekeeper or by a representative for to the instructions.
cleanliness, indications of wear and tear, neglect or If the maintenance department does not have
abuse. In case of heavy machinery, ask the distributor workers with the skills required to repair particular
to agree on a contract for periodic detailed inspections equipment, using the services of the manufacturer’s
to forestall breakdowns. local representative for systematic maintenance and
Some institutions hold workers responsible for overhauling is advisable. By contracting his services,
the equipment assigned to them. Other equipment the institution need not stock up any spare parts,
that is used by the department for general work, and and it can avoid loss of time, as he can provide
which is shared by all the staff, is cared for and substitute equipment while repairs are being made.
inspected regularly by the senior housekeeper, or a
person assigned for the purpose. One method to Equipment and supplies needed for
ensure regular inspection is to set aside a specific room housekeeping
where equipment is turned in at the end of the day Duster : To clean dust from tables, chairs, and other
and made ready for use the next day. Another method articles.
is the systematic tagging of machines that have been
(hard
B room (har bristle): To clean the surroundings,
d bristle)
inspected. This makes it easy for the housekeeper to
the toilets, and to remove water after washing the
make a quick check of machines that have not been
floor. It is also used to sweep rough flooring.
inspected.
oftbroom
S oftbr oom : To sweep dust and waste on a smooth
A card file with separate cards for each floor.
equipment’s service history should be kept in the
Waste B Basket
asket : Placed in the patients’ rooms, office
housekeeping department which will provide the
area and common areas of the hospital for dropping
department with important data whenever
waste materials.
replacement of equipment is being considered. In case
of failure, a tag stating “defective’ should be attached Dust bin : All the garbage collected from different
to the equipment, and the equipment should be areas of the hospital is put into the dust bin.
checked by the maintenance department. Space Dust pan : To pick up and remove dust and waste
should be provided on the tag for a brief description collected at a place.
of the defect, the department from which it was sent, Rugs : Placed at the entrances to absorb all the dust
the date on which it was sent, and the name of the particles from peoples footwear when they come in
person who discovered the defect. from outside.
The manufacturer’s instructions concerning the Door mat : Placed in front of the entrance, operation
operation, maintenance and adjustments of the theatre, laboratory, other rooms, toilets and
equipment should be permanently kept in the bathrooms, in order to absorb moisture and dust.

Housekeeping in Eye Care Services - A practical guide

20

Disinfectant : Different disinfectants for Hydrochloric acid : Used to remove stains on

disinfection are used for cleaning floors and toilets. washbasins and toilets and to remove any clogs in
Floor cleaning liquid : To clean and remove dirt the washbasins and sinks.
from the floor. H arpic / Toilet cleaner : To remove stains on tiles
Bucket : To carry water and while swabbing the floor and in toilets and make them sparkle .
and also to carry cleaning equipments from one place B rasso : To polish brass articles.
to other. Mansion polish : To polish floors.
Thread
Thr ead mop : To clean and mop the verandah and Stain rremo
emo
emovver : To remove stains and dirt from
rooms.
clothes.
Swabbing cloth : To wipe bathrooms and small areas
Varnish : To polish wooden furniture and protect
and keep them dry.
them from termites.
Washing liquid / po powwder : To clean bathrooms,
Floor stain rremo
emo ving stone : To remove salt stains
emoving
toilets and washbasins.
from mosaic flooring.
Liquid soap / SSoapoap solution : To clean walls and
tiles. Toilet paper : A roll of toilet paper is placed in the
toilets.
Bleaching po powwder : To clean moss-covered places,
sewage tanks and water tanks. Vaccum cleaner : Amachine used to remove
cobwebs and dust from places that are not easily
Scrubber
Scr ubber : To scrub washbasins, vessels and remove
reached, such as corners of walls, and ceilings, window
stains.
grills, and mosquito mesh
WC br ush : To clean the outlet for sewage water.
brush
Scrubbing machine : A machine used to scrub the
Wooden br ush : To clean the footrests and tiled
brush floors and keep them clean
flooring in the toilets and to clean water tanks.
Polishing machine : To polish floors and keep them
The wooden brushes that are used to clean toilets
shining
should not be used for any other purpose.
Cururvved br ush : To clean the inside of the commode
brush Multi-action mop : To clear water from the floor.
and toilet bowl, as well as corners and edges. It is used in the bathrooms to dry up the floor, as
well as to clean it thoroughly.
Nylon sponge : To clean walls and tiles.
For a demonstration on the equipment and supplies
Nuvon : An insecticide that is sprayed to prevent
used for cleaning, please watch the video of the CD.
cockroaches, mosquitoes, ants and flies, and placed
in septic tanks to prevent breeding of cockroaches Student exercise
Insecticide : Sprayed or used in powder form to
prevent cockroaches, flies, and other insects. Answer the following
Naphthalene balls : Placed in the drains of 1. What are the important factors to be kept in mind
washbasins to prevent insects from coming up when purchasing equipment?
through the drains, and to prevent bad odours. 2. What are the different ways that maintenance of
Air freshener : Placed in the toilet, stalls or in rooms equipment can be organised in the housekeeping
to drive away odour department?

©A R A V I N D E Y E C A R E S Y S T E M
CHAPTER 6 CLEANING PROCEDURES - PART I

CONTENTS
Basic cleaning
- Dusting
- Sweeping
- Mopping
- Scrubbing
- Washing
GOAL
To train the trainee in methods of keeping the interiors and surroundings clean
OBJECTIVES
To teach the trainees the correct procedures in
- Dusting
- Sweeping
- Mopping
- Scrubbing
- Washing
 CHAPTER 6
Cleaning Procedures - Part I

Basic cleaning methods - part I dust. To minimize the dust spread through the air,
the housekeeper should have one or two treated
Dust can be airborne; one must remember the
dusters in hand . To properly treat a duster, fill a tray
importance of removing dust rather than shifting dust
or pan with mineral oil and lightly place the duster
from one place to another.
in the tray to let it soak overnight. Care should be
Dust can be removed by taken when treating a duster that it does not become
- Dusting
Dusting: When a surface is dusted by rubbing, greasy. The duster should be folded in 4, 8 or 16
the electro-static charge caused by the friction folds, depending on the size of the duster, so that the
attracts dust faster than before. Hence, as soon as cloth can be unfolded and refolded to prevent the
the dusting is over, the dust rapidly settles on the same dusty side of the cloth from being re-used on
surface again. Though frequently used, this different surfaces (Fig. 6.1).
method is not satisfactory. This activity needs to
be carried out immediately after sweeping, and
should be done with a wet duster, followed by a
dry duster
- Sweeping
Sweeping: Sweeping merely circulates the fine
particles of dust into the air and is an
unsatisfactory method. For this reason sweeping
should be done just before dusting Fig. 6.1 - Folded duster cloth
- Mopping
opping: This is a fairly efficient method
provided the mop is clean and the water is Equipment and supplies
regularly changed during the cleaning process. - Duster - 2nos
However, most times the cleaner continues to - Dry cloth
use the same water, which is dirty, and does not - Cotton
care to wash the mop after the cleaning process.
- Spirit
Thus the mopping done with dirty water and a
- Water
greasy mop makes the whole exercise futile
- Suction
uction: This is probably the most efficient Method of dusting
method of dust removal, as the dust is collected - Collect all items required for dusting
in a bag placed inside the vacuum cleaner. Once - Fold the duster so as to be able to dust a number
the bag is full, it can be disposed off of surfaces
Dusting - Commence work from the entrance of the room
and proceed in a clockwise direction
In different areas of the hospital, especially in the
patients’ rooms, on doors, windows, tables, chairs, - Start with the highest point to be dusted and
cupboards, fans, lights and beds, dust settles down work down towards the floor
and this poses a health hazard as dust is a major cause - Prevent overlapping and skipping edges. Hold
for infection. Dusting is the process of removing this the cloth loosely so that it can absorb dust easily
 23

- Do not shake the dust off the cloth Key points to remember
- Inspect the work after it is done. A well dusted - Always knock and politely ask permission before
area will be bright and free of dust entering an occupied room
- After the work is complete, wash the duster and - Fold the cloth into 4, 8 or 16 folds
put it back in its place - The fold should be changed after dusting each
surface
Dusting a room
- First wipe with a wet cloth and then with a dry
All rooms should be dusted daily. When dusting a cloth. By doing this, the dust will not fly about
room, the following points need to be remembered:
Doors and windows: When cleaning the door of a
room, wipe the door with a wet duster from top to
bottom in a left to right direction. Then wipe it again
with a dry duster.
When wiping a window, the window frame, the
glass panes and the frame around the glass panes, with
all its corners should be wiped with a wet duster
breadth- wise, and then again with a dry duster. Fig. 6.2 - Correct method of sweeping
cupboards:
Tables, chairs, cupboar ds: The table top, its
underside, drawers, and legs should be wiped with a
dry duster. Similarly, a chair should also be wiped,
starting with the backrest, the seat, under the seat,
the legs, and the arms. All sides of a cupboard should
be wiped daily, starting from the top. Then the inside
of the cupboard should be cleaned thoroughly. The
cobwebs should be removed, and the shelves should
be cleaned. This should be done only in the absence
of the patient.
Cots: The mattress should be dusted thoroughly.
After folding the mattress, the cot should be wiped
with a wet duster, and then thoroughly with a dry
duster. If it is not wiped dry, the mattress will start Fig. 6.3 - Wrong method of sweeping
to smell. Care should be taken to wipe the edges, the
legs, and the underside of the cot. Sweeping
witchboards,
Switchboar ds, lights, fans: Fans and lights should Sweeping is a task that is carried out daily. People are
be dusted only after switching them off. This may always moving about in all the areas and rooms of
be cleaned periodically, once a week. First they should the hospital. Their footwear brings in mud and dust
be wiped with a wet duster and then with a dry duster. particles from the outside. Sweeping is the process
The switchboard should be wiped with spirit, and, if to remove this dust and dirt by using a brush or a
a wet cloth is used, there is a risk of an electric shock. broom. Sweeping is always done before mopping.
Other ar articles
ticles : The verandah balustrade, photos, The frequency of sweeping depends on the amount
and decorative articles in the room and other common of traffic and the type of service. The out-patient
places should be wiped daily. section, in-patient section, and registration are the

Housekeeping in Eye Care Services - A practical guide

24

areas with maximum movement of people. Hence - Every nook of the room, including under the
these areas should be cleaned several times a day cupboard, under the cot and area behind the doors
(Fig. 6.2 & Fig. 6.3). should be swept thoroughly
The wards should be swept twice a day. The office - The dust collected from the room should be
and administrative areas of the hospital should be swept outside and piled against the wall
dusted and swept after working hours. - After sweeping the room the dust should
immediately be collected into a dustpan and put
Equipment and supplies into the dustbin
- Soft broom - Switch the fan back on and thank the patient for
- Dust pan the co-operation
- Dust bin - All areas of the hospital should be swept in the
same manner.
Selecting the equipment - After sweeping, store the broom, pan and dustbin
- The brush of the broom should be long and in their allotted place
dense
Key points to remember
- Do not use a broken dust bin or a broken dust pan
- The articles removed from the patient’s room to
Method of sweeping a patient’s room facilitate cleaning, should be put back in their
- Before entering the room for cleaning, keep all respective places after the cleaning is complete.
the required materials ready - While sweeping, the person should bend and use
- Enter the room only after knocking and getting the broom, in order to sweep thoroughly.
the patient’s permission to clean
- Switch off the fan Mopping
- If the room is dark, switch on the light To disinfect all the areas of the hospital, we need to
- Look around the room mop with a mixture of clean water and an anti-
- Handpick the solid waste lying around on the microbe disinfectant. Mopping will also remove any
floor and put it in the dust bin before starting to dust that remains after sweeping, and any stains on
sweep the floor. This is a routine task.
- Keep the windows wide open Equipment and supplies
- Latch the doors and windows to avoid them - 2 Buckets
from banging - Water
- Do not shake the dust from the doormat in front - Disinfectant
of the patient. Take it to a corner of the room, - Mop
bend and dust it thoroughly
It is wrong to carry two full buckets of water in one
- Bend and sweep the room thoroughly, including
hand.
all the edges and corners
- After sweeping the room, put the doormat in its Two buckets filled with water should be carried
place separately in each hand.
- Do not drag the tables and chairs. The sound Method of mopping the patient’s room
will disturb the patient, and moreover, dragging - Mop only after the room has been thoroughly
furniture will create scratches that will collect swept
additional dust
©A R A V I N D E Y E C A R E S Y S T E M
 25

- The mop should always be clean or else it will Key points to remember
stain the floor - Before mopping check whether the mop is clean
- Before mopping, all the required materials should and dry
be at hand - Divide the room into small portions. Thoroughly
- Depending on how dirty the mopping area is, rinse the mop after each portion and dip the mop
divide the room into imaginary portions in detergent before beginning a new portion
- Fill two-thirds of one bucket with water mixed
with detergent, and two-thirds of the other - The dirty water should be poured directly into the
bucket with plain and clean water. bathroom outlet
- Place both the buckets on a mat to prevent Scrubbing
staining of the floor
Scrubbing is done on surfaces that are extremely dirty.
- Set aside light furniture to clean the floor well.
More water is needed for scrubbing than for mopping.
- Rinse the mop in clean water, dip it in the bucket This activity is carried out whenever necessary.
containing the detergent, squeeze it well, and then
mop Equipment and supplies
- Mop by drawing a figure “S” from left to right - 2 Buckets
- After mopping each small portion, rinse the mop - 2 Mops
in clean water, and repeat the process (Fig. 6.4) - Brush with a long handle
- Cleaning agent

Method of scrubbing a floor

- First, sweep the area to be scrubbed, and then
dampen it with water
- Sprinkle/spray the cleaning agent on the damp
area
- Start scrubbing, using the long handled brush. If
the whole room needs to be scrubbed, start from
the far corner and move towards the door. If a
small area, start scrubbing from the outer area
and end at the center, to avoid spreading dirt. If
the stain is stubborn use steel wool
- Remove the dirty solution using a mop
Fig. 6.4 - Mopping of the floor by cleaner
- Dip the second mop in clean water and mop the floor
- If the water becomes dirty, replace it with clean water - Repeat the scrubbing and mopping process until
- The dirty water should be poured directly into all the dirt is removed
the bathroom outlet, otherwise the dirty water - Inspect the area. A well-scrubbed area should look
may stagnate and cause floor stains clean and dry
- Inspect the work. A well-mopped floor should - Clean all the equipment and store them back in place
have a clean surface. The corners should be clean
Washing
and the floor should have no watermarks
- After completing the work, wash the mop Washing of floors is done to remove the soil and dirt
thoroughly and dry it in the sun. A wet mop brought in from the outside with the use of water.
breeds bacteria Sometimes scouring powder is used to remove tough
Housekeeping in Eye Care Services - A practical guide
26

stains. Walls are washed at least once a month to

ensure that they remain clean and stain free. Wash as
often as necessary to maintain cleanliness and hygiene.
Equipment and supplies
- 2 Containers
- Cleaning agent
- Sponge
- 2 Swabbing cloths Fig. 6.5 - Cleaning the sunshade
- A ladder to reach high places
should regularly check for waste lying at the entrance
Method for washing and remove it immediately. A dustbin with the
- Fill one container with a cleaning agent and the caption “please put waste in the dust bin” should be
second container with water. Place them on a placed at the entrance.
mat to prevent staining The area outside the hospital compound should
- Wipe away loose earth from the area to be cleaned. be swept daily and the waste should be removed
- Dip the sponge in the cleaning solution. Squeeze immediately. The night shift workers should then
out the excess solution to prevent dripping dispose this off.
- Apply the solution on a small area using a circular The parking area in front of the entrance should
motion be checked regularly for diesel and oil stains caused
- Dip a cloth in the clean water and wash the area by vehicles. These should be removed immediately,
using an up-down motion by scrubbing using a scouring powder, otherwise they
- Dry the area with a dry cloth form stubborn stains.
- Repeat the process until the entire area has been Waste thrown out of the windows by the patients
cleaned and visitors accumulates on the ground and
windowsills, creating an unseemly look clogging the
- Change the water and solution frequently
drains during the rainy season. The fringes and backyard
- Inspect the work. A well-washed area will have
of the hospital building should also look tidy. The dry
no scratches or patches
leaves and litter should be swept away and the
- Clean the equipment and store them back in place
windowsills, sunshades and outer walls of the hospital
Cleaning the surroundings should be swept daily and washed once a week.
Maintaining cleanliness and hygiene in the area
Cleaning the surroundings means maintaining the surrounding the hospital is as important as
cleanliness and hygiene at the hospital entrance, maintaining the interior.
around the hospital building and the area surrounding
the hospital compound. This is a daily activity. Student exercise
(Fig.6.5). Answer the following
The entrance is the face of the hospital and should 1. What are the different ways of keeping the hospital
be spotless to make a positive impression on the premises clean?
visitors. 2. Under what conditions are scrubbing and washing
Since the entrance has the most human traffic, it preferred to ordinary sweeping and mopping?
needs to be swept frequently. Visitors may throw 3. Write a detailed note on how you would dust a
away bus tickets; cigarette butts, paper scrap, plastic patient’s room
bags, and flowers on the path leading to the hospital. 4. How would you sweep a patient’s room?
Housekeepers assigned to the out-patient section 5. Why do we mop after sweeping? How is this done?
©A R A V I N D E Y E C A R E S Y S T E M
CHAPTER 7 CLEANING PROCEDURES - PART II

CONTENTS
Cleaning a room
- Cleaning the wash basin and sink
- Cleaning and removing stains from bath rooms and toilets, washing walls
- Cleaning the waste bucket, bed making and telephone cleaning
Cleaning a room vacated by an infected patient, or where a patient has died
Cleaning the operation theatre
GOAL
To teach the trainees to keep the hospital stain free and odour free
OBJECTIVES
To train the trainees in methods of
- Bed making
- Cleaning a room vacated by an infected patient, or in which a patient has died
- Cleaning the Operation theatre
 CHAPTER 7
Cleaning Procedures - Part II

Cleaning a room Method of cleaning a washbasin / sink

- Make a solution using the cleaning agent
Cleaning the wash basin or sink - Clean the washbasin/sink with a nylon brush
A washbasin is used to wash face and hands, and a while keeping the tap running to flush the drain.
sink is used to wash vessels (Fig. 7.1). Washbasins are - Turn off the tap
present in bathrooms, toilets, the catering section, - Soak the scrubber in the solution and scrub the
patients’ rooms, and doctors’ rooms. Due to frequent washbasin/sink thoroughly. Do not forget to scrub
use the washbasins become dirty leading to stain the outside and underside of the washbasin or sink
formation and disease causing bacteria growth in the
- The sieve area should be thoroughly scrubbed;
drains. Therefore a washbasin should be cleaned
otherwise moss will form causing it to appear
thoroughly twice a day - once in the morning and
dirty and stained
once after lunch. Remnants of food may clog the
catering section wash basin and emit a bad odour or - Rinse everything thoroughly with water
cause dirty water to fall on the floor. The blocks in - Wipe dry with a cloth
the drain should be removed immediately, the - If tiles are fixed on the wall above the wash basin/
washbasin should be cleaned, and the dirty water on sink, they should also be scrubbed and wiped
the floor should be mopped. - Water splashed on the floor should be wiped with
a cloth. Then the floor should be scrubbed and
again wiped dry with a clean cloth
- Inspect the work. A well-washed washbasin will
look as good as new

Hydrochloric acid
Hydrochloric acid is highly caustic and care should
be taken to ensure that it does not come into contact
with the skin. Housekeepers should ensure that the
cleaner is wearing gloves when using hydrochloric acid.
- Hydrochloric acid is used if tough stains such
as salt stains cannot be removed with soap and
Fig. 7.1 - Cleaning washbasin water
Equipment and supplies - A small piece of cotton attached to a stick should
- Cleaning agent be used to apply hydrochloric acid. Apply it
- Scrubber directly on the stain to be removed
- Swabbing cloth - Wash the area with water after the stain is removed
 29

A clogged / blocked sink - Remove the water from the floor using the multi-
Sometimes various solid particles or matter that goes action mop and wipe the floor with a dry
down the drain will clog the sink and the water will swabbing cloth
not drain quickly or will not drain at all. Remove - Inspect the work. A bathroom should look clean,
the waste matter and food particles by hand and clean and should always be kept dry
the small holes in the drain with fine wires. Check if
the blockage has been removed by running the water. Cleaning a bathroom / toilet
If the block has not been removed, remove the The number of bathrooms and toilets depend on
drain pipe and check for the cause of the blockage. the size of the hospital and the number of patients.
When removing the drain pipe, place a bucket under Separate toilets are provided for male and female
the sink to collect the dirty water that flows out. patients or visitors in the out-patient and in-patient
A caustic soda stone can be placed in the sink to sections. Since out-patient toilets are used by many
prevent clogging. Be careful when handling the stone, people, they should be cleaned several times a day.
for it causes a burning sensation on the skin. The frequency of cleaning will depend on the usage.
If none of the above methods work for removing The in-patient toilets should be cleaned twice a day.
the block, call a plumber. Toilets should always be dry because people who exit
a wet bathroom or toilet will leave footprints and
Cleaning the bathroom dirty the corridors. Puddles can be a health hazard
Equipment and supplies because germs breed in wet places and patients can
slip and injure themselves. Toilets that are dirty will
- Cleaning agent
smell and are unhygienic. Hence they should be
- Scrubber
cleaned several times a day. A notice requesting
- Sponge patients and visitors to flush the toilets may be posted
- Acid solution in the toilets, and housekeepers should maintain
- A multi-action mop toilets with frequent and thorough cleaning
Method of cleaning a bathroom Equipment and supplies
- Before cleaning the bathroom, shake the bathmat - Gloves
out and beat it against the floor
- Cleaning agent
- Place the bathmat outside the bathroom and
using a bucket and a mug pour water on the walls - Scrubber
of the bathroom - Wooden brush
- Wet the door, window and ventilator and wash - Round brush
it with water. Any dirt should be scrubbed using - Harpic or toilet cleaner
a scrubber and the cleaning agent, and washed
- Phenol or disinfectant
with water
- Clean the wash basin in the toilet - Odonil or air freshener
- Scrub the floor of the bathroom and wash it with - Stick broom
clean water - Multi-action mop

Housekeeping in Eye Care Services - A practical guide

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Method of cleaning an Indian toilet - Squeeze “Harpic” on the inside of the toilet bowl
- Gloves should be worn when cleaning the toilet and scrub it with the round brush to remove any
- Form a solution with the cleaning agent stains in the bowl
- Sprinkle this solution on the floor of the toilet - Wash all the scrubbed areas with water and wipe
and scrub thoroughly the flush tank, and the outside of the commode
- Rinse the floor with water (pedestal, seat, lid and the surrounding area) with
a dry swabbing cloth
- Remove any stains on the floor when scrubbing it
- Scrub the tiles on the walls and wipe the windows
- Wet the walls, and scrub using a scrubber and
and door
the cleaning agent
- Remove the water that has spilled on the floor
- Wash the walls and wipe dry
with the multi-action mop
- Scrub the footrest with the soap solution and a
- Wash the floor of the toilet, and wipe it dry with
wooden brush and wash it
a swabbing cloth
- Squeeze “Harpic” (or any liquid toilet cleaner)
- Inspect the work. The toilet should be stain-free
on the inside of the toilet and scrub it with the
and dry
round brush
- Place “odonil ” in the toilet to absorb bad odour
- Clean the outlet thoroughly, again using the
and leave a pleasant fragrance
round brushes
- After the toilet is completely cleaned and washed, Washing the walls
pour a disinfectant, inside the toilet and the outlet Although less dirt collects on the walls in comparison
- Finally wipe the door, window, ventilator and to the floors, it is just as important to keep the walls
mirror with a wet cloth spotlessly clean. When the patients and attendants
- Wipe again with a dry cloth to clean out any lean on the walls, oil from their hair and dirt from
dust and dirt their hands leave stains on the wall. Betel juice that is
- Remove any water from the floor of the toilet, spat in corners also forms stains on the wall. Walls
using a multi-action mop should be washed once a fortnight, when there are
- Inspect the work. There should be no stains, and no patients in a room,. The walls of the corridors
the floor should be dry and common areas should also be cleaned when the
- Place “odonil ” near the toilet to absorb bad odour patient flow is less (Fig. 7.2).
and leave a pleasant fragrance

Method of cleaning a western toilet

- Gloves should be worn when cleaning the toilet
- Form a solution using the cleaning agent
- Flush the commode using a bucket of water, so
that the stagnant water is emptied out
- Scrub the outer walls of the flush tank with the
soap solution using the scrubber
- Scrub the outside and the top of the commode
with the soap solution
Fig. 7.2 - Wiping the wall with a swabbing cloth

©A R A V I N D E Y E C A R E S Y S T E M
 31

Equipment and supplies Cleaning the waste bucket

- Cleaning agent Residue of water and dust leave stains in buckets,
- Sponge mugs and trash cans. These stains cannot be removed
- Duster with soap and water. We need to clean the waste
- Bucket buckets at least once a week.
- Cup Equipment and supplies
- Ladder - Hydrochloric acid
- A soft broom - Cleaning agent
- A stick broom - Water
Method of washing a wall - Scrubber
- Remove the curtains, bed, chair, photos and - Stick broom
miscellaneous items from the room and keep
Method of cleaning a waste bucket
them in a safe place outside the room
- The housekeeper must ensure that the cleaner is
- Using a soft broom, remove the dust and wearing gloves when performing this task
cobwebs from the walls
- Remove the garbage from the waste bucket. Pour
- Use the cleaning agent to form a soap solution water in the bucket and let it soak for at least 30
- Dip the sponge in this solution and start wiping minutes
the wall - Remove the water and use the stick broom to
- The wall should be wiped length wise, from top remove remnants of food and other waste from
to bottom the fringes of the bucket
- Divide the wall into imaginary sections - Using the cleaning agent and the scrubber, scrub
- After every section is cleaned with the soap the inside and outside of the bucket
solution wash it with water - Apply hydrochloric acid on stains and leave it
- Repeat this process until all sections of the wall for 30 minutes
are cleaned - Wipe the hydrochloric acid using a piece of cloth
- Finally when the bottom is reached, wipe breadth torn from a damaged bed sheet
wise - Wash the waste bucket with the cleaning agent
- After the wall is completely washed with water, and let it dry in direct sunlight to remove the
wipe the wall with a clean and dry swabbing cloth. bad odour and germs from the bucket
Any droplets of water will leave unsightly · Inspect the work. A bucket that has been washed
watermarks on the wall well will look clean and stainless
- Inspect the work. A clean wall will not have any
marks on it Bed making
- Remove the dirty water that has collected on the
floor, and wash the floor with clean water Equipment and materials needed
- Remove all the water from the floor and mop it - Cloth duster -2nos
dry - Pillow cover

Housekeeping in Eye Care Services - A practical guide

32

- Bed sheet - In a similar manner tuck the opposite end. Make

- Additional sheet sure that there are no creases in the bed sheet after
it is tucked
Making a bed - The four corners of the bed sheet which remain
A patient requires a comfortable bed to take rest and unfolded should be mitered. (To miter a corner,
recover and a well- made bed will not only provide tuck in along the foot or the head of the mattress,
comfort but also add to the pleasant ambience of lift a point along the sheet 30cm from the corner
their room. and tuck in the remaining portion. Next drop
the flap and tuck in) (Fig. 7.3).
Changing dirty linen
- Tuck in the sides along the length of the bed
Method (Fig. 7.4).
- Take clean bed sheets and clean pillow covers - Pat the bed sheet to remove any creases
- Knock on the patient’s door and politely ask - Inspect the work
permission to enter and make the bed
- Make polite enquiries about the patient’s health,
and say a few comforting words
- Help the patient get out of bed and sit on the
chair
- Remove the outer cover of the pillow by gently
untying the knots
- If the inner cover is not clean, remove it as well.
- Gently remove the used sheets from the bed by Fig. 7.3 - Mitering the bed sheet
carefully folding it into four, so that the dust does
not fly around. Place this along with the pillow
covers with the dirty linen outside the room

Spreading a clean bed sheet

Method
- Fold the mattress into two and wipe the dust
under the mattress with a wet cloth
Fig. 7.4 - Tucking the bed sheet in the corner
- Wipe the bed thoroughly with a dry cloth. A
damp bed will cause the mattress smell Putting on a pillow cover
- Clean and dust the legs and the underside of the Method
bed in a similar manner - Change the inner cover only if it is dirty
- Make sure that the bed sheet to be spread has no - Fold the pillow in half, slip it into the cover,
stains and is not torn then unfold to fill out the pillow cover
- Fold it uniformly and place it in the centre of - Slip the knotted side of the inner cover into the
the bed outer cover first
- Lift the mattress breadth wise above the bed, and - The opening of the pillow cover should not be
tuck one end of the bed sheet under the mattress visible

©A R A V I N D E Y E C A R E S Y S T E M
 33

Arranging the bed Key points to remember

- Place the pillow at the head of the bed - The washbasin should be cleaned twice a day
- After the bed sheet has been neatly spread and - A lot of caution needs to be exercised when using
the pillow cover has been put on, fold the hydrochloric acid, as it burns the skin and causes
additional sheet neatly and put it at the foot of sores
the bed
- Always wear gloves when cleaning the toilet
- Settle the patient comfortably on the bed again,
thank him, and then leave the room - Bathrooms and toilets should always be kept dry
- Clean the wall from top to bottom working length
Cleaning the telephone wise
Phones are used by a wide variety of people and are a - Divide the wall into small portions for the purpose
common source of indirect infection. Germs on
of cleaning
people’s hands transfer onto the receiver’s handle and
oral microbes spread onto the mouthpiece. Daily - When the bottom of the wall is reached, scrub and
thorough disinfection of the phone is necessary (Fig. 7.5) wipe the wall both length wise and breadth wise
- Torn or stained bed sheets and pillow covers should
Equipment and materials
be replaced immediately
- Cotton cloth
- The bed sheet should be spread so that there are
- Spirit
no creases, and the corners should be tucked in
Method of cleaning and disinfecting the firmly and neatly
phone - The receiver and the mouthpiece of the phone
- Wipe the mouthpiece and the receiver of the should be cleaned thoroughly
phone with a clean cloth
- While cleaning the phone ensure that the spirit on
- Wipe all the parts of the phone with cotton the cotton does not get into the holes on the
soaked in spirit mouthpiece and the receiver
- Wipe the numbers on the phone with spirit
- Stretch the wire and wipe with spirit Cleaning a room which is vacated by
- Re-wipe all these parts with a clean, dry lint-free cloth an infected patient, or in which a
- Inspect the work. There should be no marks on patient has died
the phone A room that has been occupied by a patient who
had an infection cannot be occupied without
thoroughly disinfecting it. The same rule applies
when a patient has died in the room. If proper
disinfecting is not done there is every chance that
the next person occupying the room will get the
infection. When disinfecting such a room, care
should be taken to see that the person disinfecting
and cleaning the room follows all the safety
Fig. 7.5 - Cleaning the telephone measures, and is well protected.

Housekeeping in Eye Care Services - A practical guide

34

Equipment and supplies the OT is kept not only clean but absolutely germ
- A strong disinfectant free. Unlike the other areas of the hospital, which are
- Gloves and face mask cleaned using a disinfectant, the OT is cleaned using
a stronger disinfectant.
- Cotton swabs
- Plastic sheets Cleaning the OT can be divided into daily
cleaning and weekly cleaning.
- Gum tape
Daily cleaning
Method
- Walls
Fumigation - Floors
- Ensure that the person who enters the room is - Doors
wearing gloves and a face mask - Overhead lamps & Fan
- Leave all items in the room undisturbed, - OT Tables
- Seal all outlets except the main door with gum - Tables
tape to prevent any noxious gases from escaping - Microscopes
the room
- Spread plastic sheets around the room Weekly cleaning
- Furniture and equipment
- Pour concentrated disinfectant on cotton swabs
and place on the plastic sheets - Air conditioner filter
- Seal the main door immediately from the outside The cleaning procedures are the same as that of
with gum tape and lock it. Put gum tape on the cleaning the rooms. However the cleaner and
lock to indicate that the room is sealed housekeeper should take extra care to protect
themselves with gloves and face mask when handling
- Keep the room sealed for 24 – 72 hours,
strong disinfectants.
depending on the severity of the infection
For a demonstration on cleaning a patient’s room and
Opening and cleaning the room operation theatre, please watch the video of the CD.
- Wear gloves and face mask
Student exercise
- Open the windows and let in as much sunlight
to naturally disinfect the room Answer the following
- Remove the plastic sheets by folding them and 1. How would you unclog a blocked washbasin?
placing them in an airtight dust bin 2. How would you wash a toilet?
- Clean the room by wiping every item in the room 3. Describe the procedure for washing walls
with a disinfectant 4. What do we need to do to keep the hospital odour
- Clean the room again as you would a vacant room free?
5. Why is it important to provide fresh linen to the
Cleaning the operation theatre patients daily?
Operation theatre (OT) deals with open wounds 6. Why is it necessary to wipe the portion of the bed
during surgery, and so it is a high risk area for under the mattress every time we make the bed?
infections in a hospital. It is extremely important that 7. Describe the method of spreading the bed-sheet

©A R A V I N D E Y E C A R E S Y S T E M
CHAPTER 8 MAINTAINING A FLOOR

CONTENTS
Removing stains
Cleaning different types of stains
Polishing the floors
GOAL
To enable the housekeeper to distinguish the different types of stains and keeping
the floors stain free
OBJECTIVES
To teach the trainees
- Different types of stains
- Different methods of removing stains
- Method of polishing the floor
- Methods of maintaining different kinds of flooring
 CHAPTER 8
Maintaining a Floor

Removing stains Equipment and supplies

- Small wooden brush
Stains
- Cleaning agent
Floor stain - Swabbing cloth
Floors that are used every day such as in rooms, - Multi - action mop
corridors, stairs, bathrooms and toilets tend to get - Buckets - 2nos
heavily stained. - Water
Simple stains Method of removing floor stains by hand
Examples of simple stains are dust, soil, foot prints, - Fill one bucket with a solution using the cleaning
betel juice and salt stains, which, if left unattended, agent and the other bucket with clean water. Place
can result in tough stains. Simple spills such as tea, both the buckets on mats to prevent soiling of
coffee or oil are also easy to remove, but if not cleaned the floor
quickly can accumulate dust and leave stubborn - Sweep the floor, sprinkle the soap solution and
stains. Seemingly harmless spills such as water can scrub with a small wooden brush
form moss and leave permanent damage on the floor - Brush out all the stains
as well. Avoid unnecessary work by removing stains
- Mop up the excess water with the multi-action
and spills at the earliest possible stage.
mop
Tough stains - Wipe dry with the swabbing cloth
Tough stains are often the result of neglected simple - Rinse the cloth in the bucket of clean water and
stains. However, a few stains are difficult to remove wipe again
even if attended to quickly and can become - Repeat this process until the stains are completely
impossible to remove if left for too long. Petrol, oil, removed
and diesel leaks from vehicles should be removed - Inspect the work. There should be no marks or
immediately by scrubbing. Thick stains, such as tar patches
and chewing gum, should be removed by scrubbing - Clean the equipment and put them back in their
toward the centre of the stain to prevent the stain place
from spreading.
Removing the stain with a machine
Methods to remove stains
Stains on the floor can be removed using an electric
There are two methods to remove floor stains. – By polishing machine, but this should be reserved for
hand, and by machine. stains that cannot be removed by any of the methods
Stains in smaller areas can be removed by hand, mentioned above, because it can be used only once
while very tough stains, or stains in large areas can be in six months. The machine has different brushes
removed using a machine. for removing the stains and for floor polishing. Stains
 37

should be removed before the floor is waxed and - Check if there is enough electric supply to
polished, so ensure that the right brush is attached function this machine
before beginning each task. - Use the cleaning agent prescribed for the machine
Equipment and supplies Don’t
- A stain removing machine - Use cleaning agents that cause excess lather or
- A bucket that have high acid content
- Cleaning agent - Use cable wire exceeding 20m in length
- Multi-action mop, - Use a brush that is worn out. Change it
- Swabbing cloth. immediately
- Water - Change the direction of the brushes more than
4-5 times in an hour. The motor may burn out
Method of removing floor stains using a due to excess heat
machine The following points should be remembered
- Form a solution using the cleaning agent in the before using the stain-removing machine:
bucket. Place the bucket on a mat to prevent 1. Switch on the machine
staining the floor
2. Check if the indicator light is on and whether it
- Clean the floor thoroughly goes off automatically after 5 seconds
- Divide the floor on which the stains have to be 3. If the indicator light does not come on immediately
removed into small portions when the machine is switched on, look into the
- Sprinkle a portion with the cleaning solution matter promptly by calling the electrician
- Attach the brush used for removing stains, to 4. If the indicator light does not go off after 5
the machine seconds, switch off the motor for one minute
- Use the machine to remove the stain and switch it on again. If the light still does not
- Remove excess water using the multi-action mop function properly, check the centrifugal switch
- Wipe the area dry with the swabbing cloth to see if there is a fault in the switch
- Repeat this process until all the stains are removed Method of changing the brushes
- Inspect the work. There should be no patches or - All three brushes should be changed at the same
marks time. If any one brush is damaged, change all the
- Clean the brushes and put the machine back in three brushes
its place - The machine should always be kept erect so that
In order to keep the machine in good the brushes that are fitted on the round wooden
condition frame do not touch the floor
- Slowly pull the brushes out one at a time, using
Dos both hands
- Keep the machine erect so that the brushes do - Fix new brushes to the spokes in the wooden
not touch the floor when the machine is not in frame
use - The brushes can be used until the nylon bristles
- Change the direction of the brushes every 15 are 10-12mm in length. If the bristles are smaller,
minutes when using the machine the brush may become worn out on one side

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38

- The direction in which the brushes rotate should - Rinse the cloth in the bucket of clean water and
be changed every 15 minutes wipe again
- Repeat this process until the edges are sparkling
Points to be remembered when changing the
clean
direction of rotation of the brushes
- Inspect the work. The edges should be spotlessly
- The switch that is used to turn on the machine is
clean
the same switch used to change the direction of
rotation of the brushes Stains on the stairway
- Turn off the switch and wait for the brushes to The stairway is used frequently by patients, visitors
stop rotating and staff. It therefore gets stained with the dust and
- Switch on the machine again and the brushes soil brought in from outside. There are also stains
will rotate in the opposite direction made by tea and coffee spills. All these stains need to
be attended to immediately, and regularly. Stains
Cleaning different types of stains from the stairways need to be removed weekly.
The different types of stains are - floor stains, fringe
stains, salt stains, stains on the stairway, stains on tiles. Equipment and supplies
- Scrubber
Fringe stains
- Cleaning agent
When swabbing a room or a corridor, the dirt gets - Swabbing cloth
deposited at the fringes and the sides of the walls
- Buckets - 2nos
appear dirty. Fringe stains are formed in places between
the walls and the floor by the accumulation of dirt. - Water
The work of removing fringe stains should be done
Method of cleaning stains on the stairway
weekly.
- Form a solution with the cleaning agent in the
Equipment and supplies bucket. Place the bucket on a mat to avoid soiling
- Cleaning agent the floor
- Scrubber - Put up a sign both at the top and at the bottom
- Swabbing cloth of the stairs saying
- Water “Caution: the stairs are being washed.
Inconvenience is regretted”
- Buckets- 2nos.
- The stairs are used frequently, so it would be best
Method of cleaning fringe stains to first work on the left of the steps and then on
- Form a solution with the cleaning agent in the the right, so that people may continue to use the
bucket. Place the bucket on a mat to avoid soiling stairs even when the work is in progress
the floor - Sweep the stairs clean, and start the stain removing
- Using a spray bottle, spray the solution in the from the top of the stairs
edges that are to be cleaned - Wipe the scrubbed portion with a swabbing cloth
- Thoroughly scrub the narrow line between the rinsed in clean water
wall and the floor with the scrubber - Repeat this process until all the stains are removed.
- The dirty water that results from this scrubbing - Inspect the work. The stairs should appear bright
should be wiped carefully with a swabbing cloth and clean

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Salt stains - Wipe again with a clean dry cloth

Salt stains are white salt deposits from hard water - Inspect the work. Tiles that are washed well will
that are difficult to remove. They are common in be shining clean
places like the bathroom or on items like buckets
and cups, which hold water for long periods. Polishing the floor
Scrubbing with an ordinary cleaning agent can There are two types of floors - rough and smooth.
remove the stains to some extent. However, stain Rough materials such as cement do not need
removing stones or polish stones is used to remove polishing. Smooth materials such as cuddapah,
these stains completely. mosaic, marble and tiles need to be polished at least
Special measures should be taken when dealing once a year. Although floors are cleaned and swabbed
with marble, since marble is a relatively soft material. several times a day, waxing and polishing provides a
Cleaning with a smooth stone or a non-acidic liquid protective covering and added shine that cannot be
will avoid marble damage. achieved through regular cleaning. In fact, polishing
reduces the necessity for frequent cleaning because
In toilet bowls, use “Harpic” (or any stain
the wax protects the surface from dirt penetration.
removing liquid) to remove salt stains. Before using
The material of the floor being polished should be
this liquid, the bowl should be cleaned thoroughly
considered carefully before choosing a polishing
as already discussed in chapter 7. Then scrub the bowl
method because the selection of a faulty method will
with “Harpic”, and leave it for 30 minutes. Flush
result in permanent damage.
the toilet and the stains will disappear.
Equipment and supplies
Stains on tiles
- White mansion polish
Salt water, soap water or dirty water form stains on
- Wax
tiles. In order to prevent stains, the tiles should be
regularly washed with soap. - Petrol
- Cotton cloth – 2nos.
Equipment and supplies - Small bucket
- Cleaning agent - Small mug
- A sponge - Polishing machine
- A bucket
- Water Method of waxing a floor
- Swabbing cloth - 2 nos. - Put up a notice, requesting people not to use the
area and apologize for the inconvenience
Method of removing stains from tiles - Divide the area to be polished into smaller
- Make a solution with the cleaning agent in the portions
bucket - Sweep and clean one such portion thoroughly
- Dip the sponge in the solution and squeeze out - Remove the stains
the excess liquid - Check the condition of the polishing machine.
- Wipe the tile with the sponge, starting from the If the brushes are not in a usable condition,
top and working towards the bottom. A sponge replace them with new ones (Fig 8.1)
is used to wipe the tile, to prevent scratches - To make a wax mixture, mix the required
- Wash the tiles with clean water quantity of white wax and petrol in a bucket to
- Wipe the tiles with a clean wet cloth form a smooth paste. The petrol allows for an

Housekeeping in Eye Care Services - A practical guide

40

easy application of wax on the floor, and gives not touching the floor. If this is not done, the
the floor a good shine bristles will bend and fall off (Fig. 8.2).
- Pour a little wax mixture into the small cup. - Clean the bristles thoroughly with a cloth dipped
Apply the wax in small circular motions with a in kerosene. If this is not done, leftover wax and
cloth polish will clump the bristles together and the
- Leave this polish for 30 minutes brush will have to be changed, and it will become
- Operate the machine on this area difficult to use a brush whose bristles are stuck
together

Fig. 8.2 - Polishing machine in the upright position

- The wax and polish on the bristles can be cleaned

Fig. 8.1 - Using a polishing machine
using kerosene. Wipe the bristles with a cloth
dipped in kerosene
- The direction of the brushes should be changed
every 5 minutes - Store the equipment and materials in a safe place
- Every 30 minutes, turn off the machine for 15 Key points to remember
minutes and allow the motor to cool down
- Confirm the availability of a plug point to run the
- Inspect the area that has been polished. A properly machine before using it
waxed floor should not have heavy buff marks
- Wax should be applied in circular motion
- Do not allow anyone to walk over this area for
at least 6 hrs - Let the wax soak in for 30 minutes
- Repeat this process until the entire area has been - Do not allow anyone to walk over the polished
waxed area for at least 6 hours
- Clean and wipe the machine after use - On completion of the work, keep the machine in
- Store the machine in a vertical position so that an upright position so that the brushes are not
the brushes are not touching the floor touching the floor
- If waxing is done properly the floor will always
appear like new Methods of maintaining different types of
flooring
Machine maintenance Floors made of non-porous material are termed as
- After the work is completed, the machine should “sealed floor”, and those made of porous material are
be in an upright position so that the brushes are “unsealed floors”

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 41

Kind of floor Harmful substances Sweeping Cleaning

Cement: Used where Flammable solvents: For unsealed floor: For unsealed floor:
need for appearance Drive soil further into Use fibre brush Use neutral synthetic
and infection control cement For sealed floor use detergent in warm
are secondary. Soaps: react with lime in treated or damp mop water
Highly porous cement and form a scum For sealed floor:
which speeds soiling use neutral synthetic
Alkaline salts: damage detergent in hot
cement water
Wet mopping: To remove
stains use poultice
treatment of powder
cleanser and water.(ie.
Prepare a poultice of a
mixture of the powder
cleanser and water to treat
the floor. For oil stains,
use whiting and
trisodium phosphate
(only as a last resort).
Rinse after use.

Marble: Can be Acids: React with marble Treated mop - use wax Flush with water
maintained with and dissolve it base only before cleaning
very little effort Soaps: Leave a gummy Damp mop Use neutral detergent
deposit solution
Ammonia water: Causes Vacuum or mop up
yellowing the solution
Compounds containing Rinse thoroughly with
oil, sand or abrasives clean water and wipe
Metal: Scratch the surface dry.

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42

Kind of floor Harmful substances Sweeping Cleaning

To remove cleanser build-

up use mildly abrasive
cleaners periodically.For
stubborn stains use the
poultice method
Scrubbing machines
should be used very
carefully to avoid
scratches.
Terrazz o: Composed
errazzo: Acids Treated mop - use wax Use only neutral detergent
of 70% marble, 30% Alkaline Salts base only solutions only
cement. It is smooth Soaps Damp mop Mild abrasives: use with
beautiful and easy to Oils care; marble component
maintain. Steel wool - leaves rust is easily scratched
stains To remove stains use
Paints - epoxies, poultice treatment of
lacquers etc. powder cleanser and
water. For oil stains, use
whiting and trisodium
phosphate, only as a last
resort. Rinse after use.

Ceramic Tile: A very Alkaline salts Treated mop:: use wax Use only neutral
durable surface. The Soaps base only synthetic detergents
cement between the tiles Oils Damp mop Pre-wet tile before
and under the tiles is Steel wool: leaves rust cleaning
most susceptible to stains Wet mop as required
wear and tear. Paints: epoxy, Machine scrub with
lacquers, etc. abrading nylon pads
weekly, if necessary
Fine abrasive cleaners:
use occasionally to
remove firm or stubborn
soil. Grit from between
tiles is hard to remove.
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Kind of floor Harmful substances Sweeping Cleaning

Slate and quarry tile: Tile is impervious Treated dust mop Use synthetic detergent
Resists staining by Avoid agents that might for heavy soils
grease, soap, food, water damage the cement Remove light soil with
Best to use for grout mop moistened with
kitchen areas water.

Magnesite: Extremely Excessive amounts of Treated mop: use wax Damp mop when this
durable surface. water and salts cause the base only method is sufficient.
Especially serviceable in floor to become porous. Damp mop Use neutral synthetic
kitchens and similar detergents. Rinse and
areas-excellent resistance Strong alkaline salts dry after cleaning.
to grease and oils. Acids Pre-wet floor to keep
solution out of pores.
Use a liquid cleaner for
stubborn soil or grease
only on sealed floor.
Linoleum: A thermostat Heavy furniture Treated mop - use wax Use clear water in as
material more resistant Moisture
Moisture-avoid frequent base only small an amount as
to temperature changes cleaning. Allow the floor Damp mop possible.
and indentation than to dry completely before Use neutral synthetic
other floorings. opening to traffic detergents.
Somewhat porous. Alkaline solutions - they Use dry cleaning
attack the binder methods with steel wool
Scouring powders - pads in non-patient areas.
damage the surface when
the floor is wet

Vinyl: Good wear Solvent floor polishes Treated mop - use wax Use clear water.
resistance, smooth,glossy Abrasives, grit, sand - base only Use neutral detergent
surface, free of damage keep the floor well swept Damp mop Buff with fine steel
by oil and grease wool to restore gloss
Excellent resistance to or to remove stains and
acids, alkalies and heel marks
moisture. Use alkaline cleaners
only if needed

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44

Kind of floor Harmful substances Sweeping Cleaning

Hardwood:
Hardwood:Not suitable Water – use only treated Treated dust mops Use dry cleaning
for patient areas, unless or damp mops, vacuum methods such as
plastic coated. If so, it cleaners or solvent sweeping
should be treated as cleaners Spot clean with damp
vinyl. mop- use synthetic
detergent solution
Rebuff cleaned areas and
if necessary, refinish
lightly

For a demonstration on stain removing and polishing floors, please watch the video of CD

Student exercise

Answer the following

1. What are the different types of stains? How will you deal with each of these types?
2. Why is a floor polished? Describe the procedure of polishing the floor

©A R A V I N D E Y E C A R E S Y S T E M
CHAPTER 9 CLEANING SPECIAL AREAS

CONTENTS
Cleaning classrooms and conference hall, stores, library using vacuum cleaner
Cleaning the elevator
Cleaning glass
GOAL
To impart knowledge about maintaining other utilities in the hospital
OBJECTIVES
To train the trainees to clean
- Classrooms and conference halls
- Stores and library
- The elevator
- Glass items
- Brass and other items
 CHAPTER 9
Cleaning Special Areas

Cleaning classrooms, conference stains on it. Wipe the metal strip used for placing
halls, stores and library using a the marker pens thoroughly
vacuum cleaner - Clean the overhead projector carefully by wiping
it with a dry cloth
Classrooms are heavily used; lectures for trainees are
- Clean the LCD screen and ensure that there are
held everyday, officers and managers conduct
no marks on it by wiping it with a clean dry
meetings or discussions with their staff, and multiple
cloth
workshops and training courses are held during
various training programmes. Sometimes, classrooms - Now sweep and mop the room thoroughly
are used even for non-hospital related discussions and - The lights and fans should be kept clean. Ensure
training. The much used classrooms and conference that they are in good working condition
halls need to be neat and well arranged so that sessions - Check if the doors close properly and smoothly
can run comfortably and smoothly. Make sure that the hinges do not squeak. If there
is a problem, call the carpenter and have it
Equipment and supplies rectified immediately
- Cloth - Make sure the door-stoppers are in good
- Cleaning liquid condition, otherwise have them replaced
- Soft broom - Make sure the air conditioner is functioning. If
- Mop not, inform the electrician
- Waste basket - Ensure that the doors and windows are closed
- Maintenance handbook tight when the AC is in operation
- An attractive flower arrangement should be kept
Method of cleaning a classroom or in an appropriate place
conference hall - Ensure that drinking water and glasses are made
- As with ordinary rooms, dust, sweep and mop available in the classroom / conference hall
the room - The waste-baskets should be emptied everyday
- Tables, chairs and other items in the room should and placed in the class / conference hall
be dusted and cleaned every day. The table and - When the class / meeting is over, ensure that the
chairs should be arranged neatly in rows unless lights, fans and other electrical equipment are
instructed otherwise switched off
Pay attention to the following details Using a vacuum cleaner
- All parts of the room should be dusted
The vacuum cleaner is an expensive electrical machine
- Tables and chairs should be wiped thoroughly that must be handled with care. However, if used
- Window grills and frames should be wiped first properly, the vacuum cleaner is an efficient cleaning
- The white board, used for writing should be tool that is well worth the investment. Housekeepers
wiped clean, and it should be ensured that the can clean rooms such as the library, the medical records
wet duster used for wiping does not leave any department, rooms with carpets, and store rooms.
 47

These rooms need to be cleaned by vacuum cleaner

as it is time consuming to manually clean the rooms.
Manually cleaning requires all the books, records, and
items stored on the shelves to be removed, cleaned
and put back. Though manual cleaning can make a
room clean, a vacuum cleaner can remove particles
that are not visible to the naked eye, such as dust and
cobwebs. They are especially useful in cleaning
appliances such as AC units, AC grills, computers,
and keyboards. Accessories suited to these different
tasks are provided with the vacuum cleaner (Fig. 9.1).
Fig. 9.3 - Attaching an additional pipe to increase the
length

Fig. 9.1 - Vaccum cleaner and its parts

Equipment and materials

- Vacuum cleaner
- Paper bag to collect the waste

Assembling the different parts before using

the vacuum cleaner
Fig. 9.4 - Keeping the disposable bag inside the canvas
Insert the tube into the equipment and tighten like a
bag
screw (Fig. 9.2 & Fig. 9.3).

Fig. 9.5 - Closing the machine after placing the bag

Fig. 9.2 - Inserting the tube into the equipment inside

Housekeeping in Eye Care Services - A practical guide

48

Method of cleaning with a vacuum cleaner sweeping, cleaning the carpet, cleaning the sofa
- A vacuum cleaner can be used in two ways - as a and mattress, spraying, spray painting, and
vacuum device and as a blower. When used as a cleaning the ACs
vacuum device, dust and waste is sucked into the - Accessories should be chosen carefully and
waste paper bag. When used as a blower, the pipe appropriately. These should be attached properly
blows pressured air into forcefully to reach places because loose attachments can break during
to blow dust or waste out. Unlike the blower, cleaning
the vacuum can remove dust, cobwebs, and litter
rather than spreading them around. Therefore, Method of attaching the waste collection bag
the vacuum is often preferred over the blower. When the waste bag is full, it should be discarded
However, there are a few situations when a blower and replaced by a fresh bag. Open the vacuum cleaner
is more useful such as the grooves in a sliding lid and a waste collection pocket should be visible.
window or door, and shelves stacked with books The waste collection bag is fitted here. Follow the
and files (Fig. 9.6). directions below to exchange the bag. (Fig 9.4 & Fig
9.5).

The method of attaching the bag is given

below
- Stop the device and open the lid by pressing the
button
- Remove the plastic ring
- Insert a new paper bag inside the canvas bag
- Grasp the top of the paper bag and fold the upper
portion of the paper bag and keep it inside the
machine
- Close the lid

Maintenance of the vacuum cleaner

- After use, the different parts should be removed,
wiped thoroughly and stored safely
- The machine should always be kept in a vertical
position and the pipe should be hung in the shape
Fig. 9.6 - Cleaning the grill with vaccum cleaner of the number 8
- Place a cover over the machine to prevent the
- The pipe can be elongated or shortened as required accumulation of dust
- The strength of suction or blowing can be
adjusted according to need. There are three Key points to remember
settings: high, low, and medium - The appropriate accessory should be used to do an
- The vacuum cleaner should be switched off for appropriate job
five minutes every half an hour to prevent the - Stop the machine for 5 minutes every half an hour
motor from overheating
- Fix the pipe tightly onto the machine. The air
- The vacuum cleaner comes with accessories that
pressure can blow the pipe off
can be used for different jobs like dusting,
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 49

- Discard the waste paper bag when it is full and Method of cleaning an elevator
replace it with a new one - Place a notice outside the elevator on each floor
stating “The elevator is under cleaning. You are
Cleaning the elevator requested to use the stairway. Inconvenience is
In a hospital, several people use the elevator (lift) regretted.”
everyday. It is used to carry patients and their - The elevator should be switched off during
attendants to different floors of the hospital building. cleaning
The lift is also used to carry operated patients, elderly - Have all the necessary materials and equipment
people who have difficulty in walking, wheelchairs, at hand
heavy or bulky loads, and garbage disposal carts. The - Dust the ceiling and the walls and remove all
heavily used multi-purpose elevator quickly becomes cobwebs from the corners
dusty and dirty; hence it needs to be thoroughly
- Sweep the floor and remove the dust
cleaned every day (Fig. 9.7).
· Rinse a swabbing cloth in cleaning liquid and
wipe the lift
- If any pictures adorn the walls of the elevator,
remove them, wipe them clean and put back neatly
- Wipe away any oil or grease on the door
- Remove the dust and loose soil from the door
groove with a brush
- Any stains on the floor of the lift should be
removed using the cleaning solution and a
scrubber. If any glue-like substance is stuck to
the floor, remove it with the blunt knife carefully
to avoid damaging the floor
- The fan and light should be wiped thoroughly
- The switchboard should be wiped with spirit
- Check if the light and fan are working. If not,
inform the electrician
Fig. 9.7 - Cleaning the elevator - Inspect the work. Ensure that there are no stains
or marks on the walls and floor of the lift
Equipment and supplies - When cleaning is completed, switch the elevator
- Soft broom back on
- Dust pan - Remove the notice placed on each floor
- Coir brush - All the articles used for the cleaning should be
returned to the store-room
- Vim
- A blunt knife Key points to remember
- Swabbing cloth - Place a notice outside the elevator before starting
- Cleaning liquid to clean
- Scrubber - Switch off the elevator before cleaning

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50

Cleaning glass
Glass is present all over the hospital. Windows, doors,
photo frames, mirrors, aquarium tanks, cupboards,
tabletops and notice boards all have glass material
that look beautiful only if they are kept spotlessly
clean. Thus glass needs to be cleaned every day.

Equipment and materials

- Glass-cleaning liquid
- Lint-free cloth
- Sponge (Fig. 9.8)

Fig. 9.9 - Cleaning the glass

Key points to remember
- The glass-cleaning liquid should be used in the
required quantity. If it is used in excess, it will
stain the glass
- Tinted glass should be wiped with a sponge to
remove the dirt
- The dust in corners of the window frames including
glass frames on doors should be wiped with a wet
Fig. 9.8 - Materials needed for cleaning glass cloth and the dust should be removed
- Both sides of the glass should be wiped in a uniform
Method of cleaning glass manner
- Wipe the glass with a wet sponge to remove the
dust Cleaning and polishing brass
- Spray the glass-cleaning liquid on the glass
Equipment and supplies
- Wipe the glass horizontally from left to right,
using a lint-free cloth - Cloth
- Wipe again, vertically, from the top to the bottom - Brasso- brass polish
- Clean the other side of the glass in the same way. - Cup
- Marks will appear if the glass is not wiped - Toothbrush
uniformly in one direction, and the glass will - Cleaning liquid
appear dirty - Scrubber
- Inspect the work. Stand at a distance and see if - Polythene paper
both sides look clear and clean Brass articles are used to decorate the rooms. These
- Wipe away any remaining marks on the glass articles become dull and tarnished due to chemical
(Fig. 9.9) changes over time. They need to be polished once a

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 51

week. Each brass article should be cleaned with the - Wipe the lamp dry using a clean cloth
utmost care using brasso, a brass cleaning liquid. When - Pour the required quantity of Brasso into a cup
cleaned, the article should shine like new. (Fig. 9.10) - Dipping a clean cloth into the Brasso liquid, wipe
the lamp starting at the bottom and working your
way to the top
- Let the liquid soak into the lamp for 5-10
minutes
- Wipe the lamp by rubbing it vigorously. Repeat
the wiping process three times, each time using a
clean cloth
- Assemble the polished and shining lamp
- Holding the lamp at the top, very carefully
remove any finger marks on the polished surface
Fig. 9.10 - Brass cleaning with a dry cloth
- Inspect the work. Ensure that there are no marks
Brass articles in the hospital left on it
- The kuthuvizhakku (brass lamp) and its stand - Holding it with a clean duster or paper so as to
are used as decorative pieces in the reception area avoid finger marks, lift and put it back in its place
and as puja lamps in the meditation room in some
hospitals 2. Immovable and heavy brass articles
- Large and small brass articles are used as decorative Brass items that are heavy and cannot be moved
pieces in the reception area of hospitals should be polished in its place. Follow the same
- Flowerpots are placed inside large brass vessels procedure as above, but polish the article from the
top to the bottom. Move the cloth in one direction;
- Brass flower vases, plates, “kumkum” container,
otherwise, it will leave marks.
and small idols also adorn the meditation room
- Brass flower vases are in rooms such as the dining 3. Brass plates/Name plates/idols
hall The brasso and dirt runs into the crevices and grooves
- Some nameplates are also made of brass of brass articles with designs on them. Follow the
same polish procedure as above and take care to
Method of polishing brass articles
remove the dirt and excess brasso with a toothbrush.
1. The kuthuvizhakku
4. Brass flower vase
- Remove the oil in the kuthuvizhakku
After the brasso is applied to a vase, wipe vertically
- Dismantle the lamp and place the different parts from top to bottom. When wiping it the second
of the lamp in a line time, wipe horizontally, starting at the bottom. The
- Scrub all parts of the lamp using the cleaning liquid third wipe is for removing any remaining fingerprints.
- Use the toothbrush to scrub corners and any
engraved figures on the lamp 5. Brass vessel
- Fold the cloth into 4 or 8 folds, depending on A few more steps are required to clean a brass vessel
the size of the cloth. Wipe all parts of the lamp - Wash the inside and outside of the vessel with
to remove the dirt the cleaning liquid

Housekeeping in Eye Care Services - A practical guide

52

- Wipe the vessel dry (particularly on the outside) - If a brass article has not been cleaned for a long
with a clean cloth time, scrub it with a lemon, wash it with the
- Apply brasso on the outside and let it soak in for cleaning liquid and polish it with Brasso
5-10minutes - If marks are still present after polishing and wiping,
- Polish it uniformly, using the same procedure the article should be wiped again
given above
- Brasso will not polish alloys such as copper and
- Remove any finger marks in the final polish bronze
- If a potted plant has to be placed inside the vessel,
For a demonstration on the using of vacuum cleaner,
spread a polythene paper inside. Then place some
cleaning the elevator, glass and brass items, please watch
bricks on the polythene paper, and place the pot
the video of the CD.
carefully on the bricks
- If water is used in a vessel, scrub the inside Student exercise
everyday with the cleaning liquid and a nylon
brush. Wipe the outside with a dry cloth to Answer the following
prevent moss formation 1. What are the advantages of using a vacuum cleaner
- Avoid spilling water on the polished surface for cleaning?
2. What are the points to bear in mind when cleaning
Key points to remember the elevator?
- Must to have at least 3 dusters for polishing. If a 3. When cleaning glass, why is it important to move
cloth duster is used for one coat of polish do not use the cloth only in one direction?
it again 4. Describe the procedure of polishing brass.
- Brasso is expensive. Do not waste it. Take only the 5. Explain the important points to keep in mind when
required amount in the cup preparing a conference hall for a meeting.

©A R A V I N D E Y E C A R E S Y S T E M
CHAPTER 10 CLEANING THE HOSPITAL KITCHEN AND DINING AREA

GOAL
To ensure clean and hygienic cooking and dining areas
OBJECTIVES
To teach the trainees
- How to clean up a kitchen after the work is done
- Setting up the dining hall for a meal
- Cleaning up the dining area after a meal
 CHAPTER 10
Cleaning the Hospital Kitchen and Dining Area
Food should not only be good, but it should also be - Clean all the other parts of the stove except
clean, safe, and healthy. Therefore, one must pay extra for the burners, and remove any oil or food
attention to maintaining cleanliness and hygiene in stains
the kitchen (Fig. 10.1). This task should not be taken - Wipe the top of the stove with a sponge dipped
lightly because cooking large volumes for a hospital in the cleaning agent
can easily make the kitchen one of the messiest rooms, - Wipe it with a clean cloth
if not well maintained. Daily cleaning of the kitchen,
- Wipe the stove dry using a clean dry cloth
stove, utensils, washbasin and dirty water outlet is
necessary. Keeping a clean kitchen is an art. Arranging the dining hall
Since the food is consumed in the dining hall, - Clean the dining hall thoroughly. Remove any
the dining hall should also be scrupulously cleaned. dust or cobwebs from the walls. Sweep and mop
the floor well, and remove any stains that may
Equipment and materials be there on the floor
- Cleaning agent - The dining room should be spacious and well
- Trays ventilated. Arrange the hall neatly to create a
- Plates spacious atmosphere
- Glasses - The windows should be opened and the curtains
- Sponge should be clean and neatly draped
- The dining table should be neat and clean. Place
Cleaning a stove a simple flower arrangement on the table, but
- Disconnect the stove from the gas cylinder make sure it does not inconvenience those who
- If the stove is movable, set it aside, apply the sit at the table
cleaning agent under and around the stove and - A neatly written and artistically designed menu
scrub it well card can be printed and placed at the table

Fig. 10.1 - Hospital kitchen

 55

- The walls can be adorned with beautiful pictures. Cleaning up after a meal
(Fig. 10.2) - Remove the food from the table
- A jug of clean drinking water and well washed - Take the serving bowls, plates, glasses, spoons,
glasses should be placed at every table (Fig. 10.3) forks, and trays to the sink
- The wash basin in the dining hall should always - If the table cloth is stained, remove the stain
be kept clean and stain free before sending it to the laundry
- If the table is stained, remove the stain with
Arranging food at the table
cleaning liquid
- Serving bowls and dishes should be adequate for
- The food on the floor should be swept up and
the food being served
the floor should be wiped clean. Stains should
- Only ¾ of the bowl should be filled with food be removed immediately
- Cover every dish with a lid - The windows should be left open to allow
- Serving spoons should also be chosen depending sunlight into the room. Open windows and let
on the food to be served in fresh air, and let out any odour from the room
- Place the serving spoons on the right side of the - Switch off the lights and fans
bowl so that it is convenient to handle
- Leftovers from the serving bowls and dishes can
- Napkins, plates, table spoons, forks and glasses
be served to the cleaners and other kitchen staff.
should be placed at the corner of the table
- Leftovers on the plates should be thrown into
Serving at the table the dustbin immediately
- Those serving at the table must wash their hands - Wash all the dirty vessels and dry them out
before serving. Their nails should be clean, and
- Wash and clean the sink with the cleaning agent.
they should be dressed in neat and clean clothes
Remove any drainage clogs. Dry the sink
- If two persons are serving at the same table, clearly
assign their duties to avoid any confusion thoroughly to prevent any water marks.
- Preplan the order in which the dishes are served - Empty the dustbin, wash it and put it in the
to avoid confusion sunlight to dry

Fig. 10.2 - Table arrangement for special occasions Fig. 10.3 - Arrangement in the patient dining hall

Housekeeping in Eye Care Services - A practical guide

CHAPTER 11 SAFETY AND SECURITY

GOAL
To ensure a safe and accident free atmosphere to the patients and staff of the
hospital
OBJECTIVES
To teach the trainees
- The various hazards in the hospital
- Prevention of accidents
- Methods of ensuring safety from thefts
 CHAPTER 11
Safety and Security

Housekeeping and security - While climbing the stairs, climb one step at a
time, and keep to your left. Do not leap and
The housekeeping department is responsible for
jump on the stairs
maintaining a peaceful atmosphere in the hospital. If
the patients and staff always fear for their safety and - Leave place for people on the opposite side to
the safety of their belongings, the atmosphere will come through at the same time when passing
be very tense. Hence every housekeeper should be through spring doors
aware of ways to protect herself and others, especially - Be brisk, not hasty
the patients around her and the property of the
hospital from accidents and theft. Protecting patients and materials of the
hospital
Several accidents could occur at the place of work.
- Do not discuss hospital matters in public places
These include fire accidents, falls, sprains, muscle
cramps, wounds, injuries, negligence in handling - Spreading rumours and careless talk in public
electrical equipment, inhaling certain chemicals, places is dangerous
handling chemicals and articles falling off the top shelf. - Outsiders should not handle hospital documents
Even simple injuries should not be neglected. and case sheets
Immediate treatment should be given / taken. - The belongings of the hospital should not be
taken out or mishandled
How to avoid accidents
- If a suspicious person is spotted in the premises
- To avoid a fall, take care while walking on a wet of the hospital, the matter should be reported to
floor, oily surfaces or mossy areas the security personnel at once
- When one part of the stairway is being cleaned, - Patients should not be allowed to accept tea,
the other half should be used coffee or any eatables from strangers
- Do not place furniture or buckets, mops, and - If the patients leave their room even for a short
brooms in the way time, they should be asked to lock their room
- If there is any breakage, the debris should be
-· Smoking and use of intoxicants are prohibited
removed immediately. Any electric wires or nails
in the hospital premises
in the way should be removed
A major accident hazard in the hospital is fire. Fire
- Broken glass pieces should be removed using
accidents cause loss of life and property on a large scale.
thickly folded wet paper
They occur because of negligence on the part of a few
- While handling electric devices, ensure that your people. The staff should have knowledge about the
dress and hands are dry different types of fire accidents and first aid.
- Some chemicals cause injuries to bare hands.
Hence always wear gloves when handling them What causes a fire accident?
- When arranging things on the shelves, heavier - Negligence in throwing burning cigarette butts
objects should be placed at a lower level, and the or match sticks into a dustbin containing paper
lighter articles on the top waste, or throwing them carelessly where they
 59

may be fanned by air to spread into a full-fledged - Cooking: Fire caused by gas, acetylene, hydrogen
fire methane, the valve of the source of supply should
- Chemicals placed close to each other may react be switched off. Open up all the doors and
to cause a fire windows. Dry sand should be used to extinguish
- A short circuit in an electric connection may erupt this fire
into a fire - Chemical fire: Phosphorous, and sulphur require
- Carelessness in the kitchen, such as overheating a heat at a high temperature for burning. But
oil may cause a fire, or a gas leak in the kitchen metals like sodium, magnesium, and uranium
may be the cause of a fire are easily combustible. Sand and dry powder
(Sodium bicarbonate (baking soda)) can be used
Methods of extinguishing a fire
to extinguish the fire
- Starvation
Starvation: isolating the burning object and thus
- Electrical fire: When fire is caused due to defects
starving the fire
in electrical equipment or electrical fittings, first
- Blanketing
Blanketing: preventing oxygen supply to the
cut off the electric supply. Non-conductors
fire
should be used. Dry powder and sand should be
- Cooling
Cooling: cooling the heat of the fire by splashing used to extinguish this fire. Water should never
water forcefully on it.
be used here
Important points to be kept in mind Apart from the above methods, any kind of fire
- Fire will spread from one place to another in no can be extinguished by the starvation method. If an
time oil container burns, the oil drums nearby should be
- Fire tends to spread in the direction of the wind. removed immediately. If a vessel on the stove catches
It will spread through wooden articles and electric fire due to overheating, do not pour water. Instead
wires to other parts of the room cover the vessel with a lid to put out the fire.
- Leaving cotton cloth near a pooja lamp should
Steps to be taken by a housekeeper on seeing
be avoided
fire
- It is dangerous to leave petrol or kerosene near a - Caution others by shouting “fire! fire!” Easily
lighted gas stove combustible material should be removed
- Chemicals should be kept away from one another. immediately. The remaining areas should be
For example, turpentine and chlorine gas cooled with water
- Machines should not be operated continuously - The administrator and fire service should be
without a break informed immediately
Types of fire accidents and methods of - The work should be divided among the staff
extinguishing the fire - It is important to be alert but calm
- Fire caused on trees, clothes and thatch can be
extinguished by pouring water or throwing sand General safety rules for the housekeeping
over it. This is called the cooling method 1. Report every injury to the supervisor
- Liquid fire: Fire caused on account of petrol, 2. Understand the job thoroughly so that it can be
diesel, kerosene, rubber, can be extinguished by carried out safely. When there is a doubt ask the
using a fire extinguisher. Splashing foam is like supervisor
covering with a blanket and is called the blanket 3. Help and guide new employees to do their jobs
method. Water should not be used here safely and correctly
Housekeeping in Eye Care Services - A practical guide
60

4. Report any defective or broken equipment or 15. Ensure that all areas are kept dry. People may
machine to the supervisors at once slip if there is water on the floor and injure
5. Always use a ladder for high reaching jobs. Never themselves
use a chair or a table 16. Never run on the stairs - always walk
6. Wear safe, comfortable and sensible clothing at 17. Fire escapes must be kept free and open at all
work times
7. Arrange the stores in a safe manner so that no 18. Always observe the ‘No Smoking signs’
one is injured when taking things from the 19. Store oily rags in tightly covered metal tins to
shelves. Do not overload shelves prevent them from catching fire
8. Lift heavy loads carefully. Never try and lift heavy 20. Inflammable liquids should be stored in small
loads alone quantities in metal containers away from heat
9. Turn on the light before entering a dark room and flames
10. Do not touch switches with wet hands
Student exercise
11. Never pick up broken glass, blades and other
sharp objects with bare hands. Always use a broom Answer the following
and dust pan 1. What are the various accidents that can occur
12. Never put your hand in the bin when emptying it within the hospital?
13. Always wear a mask and use gloves when cleaning 2. How can you prevent these accidents?
bathrooms or when dealing with waste 3. What are the causes of fire?
14. Store brooms, mops, baskets, cleaning equipment 4. What are the different methods of putting out the
in a safe place. Do not leave them in places where fire?
people trip over them and fall 5. List any 5 important safety points.

©A R A V I N D E Y E C A R E S Y S T E M
56

Key points to remember Student Exercise

- It is very important to maintain cleanliness in the
Answer the following
kitchen, dining hall and the surrounding areas to
1. Why is it important to maintain cleanliness in the
keep them free of rats and cockroaches kitchen and dining area?
2. What are the points to keep in mind when
For a demonstration on cleaning the kitchen and arranging the table?
dinning hall, please watch the video of the CD 3. How do you clean up after a meal?

©A R A V I N D E Y E C A R E S Y S T E M
CHAPTER 12 MAINTENANCE OF DRINKING WATER SUPPLY SYSTEM

CONTENTS
Cleaning the drinking water tank
Cleaning the water filter and cooler
Chlorination
GOAL
To ensure a safe and accident free atmosphere to the patients and staff of the
hospital
OBJECTIVES
To train the housekeepers in the method of
- Cleaning the water tank
- Cleaning water filters and water coolers
- Chlorination
 CHAPTER 12
Maintenance of Drinking Water Supply System

Maintenance of drinking water - Leave the tank open to dry in the sun
- Close it tight after it is dry and fill it with
Equipment and supplies
water
- Wooden brush
- Clean the water tank in this manner at least once
- Bleaching powder a month
- Cleaning liquid - This method of thorough cleaning will prevent
- Scrubber moss formation
Clean and safe drinking water - If the tank is kept free of dust and other particles,
the pipes can be prevented from getting clogged
Water is a basic necessity for man. It is therefore
important to provide safe and hygienic drinking Cleaning of the water filter attached
water, as 80% of all diseases are spread through water. to a water cooler
Normally, only boiled and filtered water is given to
the patients. It is equally important to supply safe A water filter is used to filter invisible germs and
and clean drinking water to the visitors and staff of dust particles. A water cooler is used to provide cold
the hospital. water during summer. Hence, to provide cold and
pure drinking water, the water cooler is connected to
Cleaning the drinking water tank a water filter. Both these are electrical appliances, and
It is very important to protect and cover the water should be handled with care. Both should be cleaned
tank properly to prevent dust, other impurities and together once a month.
living creatures from falling into it. Closing the water It is important to note that the materials used to
tank properly prevents breeding of mosquitoes, and clean the water filter and water cooler should not be
formation of algae. used for any other purpose.
It is important to note that the articles and Cleaning of this equipment should be done with
materials used for cleaning a water tank should be the help of a plumber. You can be present to help
kept exclusively for this purpose and should not be him and ensure that the job is done hygienically.
used for any other purpose. The process of cleaning the water system starts
Method with checking the pipes that supply the water.
- Empty the tank Method of cleaning drinking water pipes
- Sprinkle bleaching powder in the tank and scrub Drinking water pipes should be clean and free of any
thoroughly with the wooden brush blockages. Water pipes may get clogged due to moss,
- Leave the bleaching powder on the surface of the dust and salt formation in the pipes. If there is a block,
walls and bottom of the tank for 30 minutes it is absolutely necessary that the cause is found and
- Wash the tank thoroughly with clean water the block is removed immediately.
 63

Equipment and materials - Pour out any water that is in the filter, and clean
- Water the filter using the cleaning solution and a
- A wire or a stick scrubber
- Hydrochloric acid. - Ensure that the dirt and salt deposits are
completely removed, and the tank is sparkling
Cleaning a pipe which is blocked with clean
collection of dust / waste / moss - After washing it with clean water, wipe it with a
Method clean dry cloth
Pour a small quantity of water into the pipe and thrust - Now wash the candle very carefully. Hold it in
a stick or iron rod and scrub. This may remove the the palm while washing, and scrub it using the
block and clean the pipe. cleaning liquid and the scrubber till it is absolutely
clean
Cleaning a pipe which is blocked on account - Wash the candle thoroughly with clean water and
of salt deposits wipe with a clean dry cloth
Method - Fix the candle carefully in the lower part of the
filter
Mix hydrochloric acid and water in the ratio 1:3.
Pour this solution into the pipe till it is full and close - After all the parts are wiped, let the filter dry for
it. Leave it in this condition for about 30 minutes. about 30 minutes
The acid solution will dissolve the salt in the pipe - Fix the filter with the help of the plumber. Ensure
and clean it. If necessary, the process may be repeated. that the lid is properly fixed
After the pipe is absolutely clear, it should be washed
Cleaning the water cooler
twice with clean water.
Procedure
Cleaning the water filter - Disconnect the water cooler from the electric
Equipment and supplies power supply
- Cleaning liquid - Open the lid of the upper portion of the water
cooler
- Scrubber
- The two black belts at the rim of the upper
- Clean cloth
portion of the water cooler should be removed
Sometimes, if the drinking water is hard water, and cleaned with a scrubber
salt deposits will block the filter. These deposits need - Wipe them with a clean dry cloth
to be removed before washing the filter
- Scrub the inside of the water cooler with the
Method cleaning liquid
- Close the valve to stop the flow of water from - Remove the salt deposits and dirt thoroughly
the tank to the filter - Wash it with clean water. Wipe thoroughly with
- Remove the lid of the filter by unscrewing it a clean dry cloth to remove any droplets of water
- Remove the lower tank of the filter in the same that may be present
manner - Wipe the outside of the water cooler and its lid
- Remove the candles from the tank and place with the cleaning liquid
them safely in a plate along with their respective - Wipe these surfaces again with a wet cloth and
screws then with a clean dry cloth

Housekeeping in Eye Care Services - A practical guide

64

- The remaining water at the bottom of the pipe - Pour chlorine uniformly in all the four corners
and outer areas of the water cooler should be of the tank
wiped dry
- Clean the attachment plate, wash it with the Key points to remember
cleaning liquid and wipe dry with a clean dry - Materials used to clean the water filter and water
cloth cooler should not be used for any other purpose
- After all the parts are washed and wiped, allow - Inform the plumber a day before the cleaning and
them to dry for 30 minutes keep all the required materials ready at hand
- Assemble the water cooler - The different parts of the water cooler such as the
- Press the ball like part at the top of the cooler to candles and the screws should be kept safely in a
allow the water to fill the tank of the cooler plate
- Fix the black belts in place, and shut the lid tight. - Cleaning of the water filter, water cooler and water
- Fix the wire to the water cooler tank should be undertaken on holidays when the
- If there is any leak in the filter or the water cooler, number of patients is less
inform the plumber immediately - To prevent living creatures such as the rat, squirrel,
crow, from falling into the tank, as well as to prevent
Chlorination
the breeding of mosquitoes, the tank should remain
Microbes causing diseases spread from one person to closed at all times
another through water, air, hard particles and food. 80%
of diseases such as diahorrhea and cholera are spread For a demonstration on cleaning the drinking water
through water. Therefore water has to be purified using tank, the water filter, cooler and chlorination, please
a chemical called chlorine which is a germicide. This watch the video of the CD.
method of purification is called chlorination. Student exercise
Method of mixing chlorine in the water tank Answer the following
- Find out the capacity of the water tank 1. Why is it important to get safe drinking water?
- Mix chlorine in appropriate proportion – 1litre 2. What are the steps we can take to ensure safe
chlorine to 10,000 litres of water drinking water to all in the hospital?
- It is dangerous if chlorine is in excess as the water 3. Describe the method of cleaning a water filter
becomes poisonous 4. How would you clean a water cooler?
- Also, if the quantity of chlorine is less, it is 5. What is chlorination? How would you chlorinate
ineffective, and the process becomes futile water in the hospital?

©A R A V I N D E Y E C A R E S Y S T E M
CHAPTER 13 CLEANING THE SEPTIC TANK

GOAL
To clean and maintain the septic tank
OBJECTIVES
To teach the housekeepers the method of
- Cleaning the septic tank
 CHAPTER 13
Cleaning the Septic Tank
There are two types of septic tanks – septic tanks
connected to a public drain and septic tanks without any
drain. Septic tanks connected to a drain should be cleaned
every week and septic tanks without drains should be
manually drained and cleaned as per the procedure given
below. The size of the septic tank depends on the number
of toilets in the hospital. Depending on the size, a septic
tank can store a large quantity of sewage and sewage water.
Thus cleaning is necessary to prevent bad odour and Fig. 13.1 - Cleaning the septic tank connected to a
breeding of cockroaches. public drain
Method of placing nuvon in the tank
Equipment and supplies - Nuvon is an insecticide, which kills cockroaches
- Stick broom and other insects
- Bleaching powder - Mix 100ml of Nuvon in a cupful of water.
- Nuvon or any other insecticide - Take an iron rod about 1 foot in length
- Iron rod, cotton - Attach a one-inch piece of cotton firmly to one
- Mug, bucket end of the rod
- Hosepipe - Dip the cotton in the Nuvon solution
- Water - Bend the rod into a hook and place it in a corner
of the tank
Method of cleaning a septic tank connected
to a public drain Method of cleaning a septic tank not
- The cleaner must wear gloves and galoshes when connected to a public drain
cleaning the septic tank - Water collected in the upper portion of the tank should
- Attach a hosepipe to a tap and make a path for be manually removed once a month using buckets
the water to flow into the tank - Waste and excreta should be removed once a year.
- Remove the lid of the tank and spray water to The Sanitary department of the Municipal
rinse the lid Corporation comes and does this using a suction
- Splash water into the tank with the help of the pump
hosepipe - Clean the tank using the procedure given above
- Sprinkle bleaching powder into the tank - Place Nuvon in the tank using the above procedure
- Using the stick broom, scrub vigorously to clean For a demonstration on cleaning the sceptic tank, please
all the edges and corners of the tank and remove watch the video of the CD.
any moss that has formed
Student exercise
- Wash the tank with water
- Place nuvon into the tank Answer the following
- Close the tank (Fig. 13.1) 1. Why do we need to clean a septic tank? How is it done?
CHAPTER 14 LINEN MANAGEMENT

CONTENTS
Setting up of a linen department
Selecting cleaning agents and detergents
Stain removing
Sample format for systematic running of the linen department
GOAL
To provide clean and fresh linen in the hospital at all times, and to ensure a maximum
life for linen
OBJECTIVES
To teach the trainees how to
- Set up a linen department
- Select linen at the time of purchase
- Setting up a system for linen management
- Selecting the right detergents and cleaning agents
- Washing the clothes
 CHAPTER 14
Linen Management

Setting up a linen department - Ensuring that infected and stained linen is

sterilized and washed separately
Linen forms an integral part of any hospital. Providing
clean and fresh linen is an important task of - Ensuring that the linen is washed under hygienic
housekeeping. Maintaining linen is a full-time job, conditions and returns stain-free from the
and hence the linen department may be looked upon washing area
as a department in itself. - Maintaining the stock register
The linen department needs a large area, where - Repairing damaged linen immediately
the entire linen of the hospital is stored. This should - Checking linen every month and separating the
be situated near the laundry so as to make it easy to linen which needs to be condemned
control the movement of linen from different areas - Regularly checking on the detergents and cleaning
of the hospital to the laundry and back. agents available in the market to ensure that the
The cupboards storing the linen should be neatly detergents used are good and cost-effective
labeled, both on the inside and outside, indicating - Stocking all the linen systematically in cupboards
the linen and the area to which the linen belongs. To provided for the purpose
ensure the smooth functioning of the linen
department, par stock should be maintained. (Par Selecting linen for the hospital
stock means three to four times the quantity of linen When setting up a linen department, the first thing
required for the hospital.) Regular stocks have to be to look into is the requirement of linen for the
maintained in a register specially designed for this hospital. In the wards, for a multi-speciality hospital,
purpose. the ratio is 1:4 (4sets per bed) while in a single
The linen that comes for washing should be speciality hospital 1:3 (3 sets per bed).Then comes
scrutinized daily for damage. The regular life of linen the requirement for the OT, OP and other areas.
is about 250 washes, or 2-3 years, after which the Colour coding and quality of the linen is next in
linen should be condemned, and new linen bought the decision making process. Colour coding may be
to replace the condemned linen. This condemnation done department-wise, or room-wise, as the
should be carried out monthly, and a record management deems fit. Choose colours that will not
maintained in the stock register. The condemned linen bleed. Choose colours that are soothing to the eye. The
can be recycled as cloth dusters. quality of linen should be good, so that it is easy to
The housekeeper assigned to this department has maintain. By cutting costs and opting for cheap linen
the following role to play: we may be the losers in the long run. The cloth will give
- Maintaining a daily account of soiled linen way soon, or may become rough and difficult to use.
received from the different areas of the hospital, When purchasing linen it is always best to first obtain
and the fresh linen issued to the different areas. samples that may be tested for quality and strength.
 69

Setting up a system for linen management clear record of clothes given and received should be
One of the important jobs of the housekeeping maintained. This helps in tracking the missing clothes.
department is clothes and linen management. In a
hospital different types of clothes are used. The outer Selecting the right cleaning agents
gowns worn by doctors and patients, the bed sheets, and detergents
blankets, pillow covers and pillows are to be washed, As with materials and equipment, care should be
cleaned and maintained properly. This is one of the taken to select detergents that are not harsh on the
most important jobs of a housekeeper. Other than clothes, yet clean well. Avoid the use of bleaching
this, napkins, curtains and seat covers have to be agents as they tend to corrode the cloth and the clothes
laundered. Maintaining the cleanliness of clothes and wear out faster than they should. While selecting
linen will prevent the spread of disease detergents, the cost factor should also be kept in
Dirty bed sheets should be folded to prevent dust mind, although it is wiser to go for a costlier detergent
from flying about. The clothes that need to be washed if it is giving you better results and helps in making
from different rooms should be put into their the clothes last longer.
respective laundry bags and brought to the laundry.
Washing the clothes
In the laundry they should be sorted out
according to their condition and type. Torn clothes, The washing machine in the hospital is an electrical
good clothes, clothes with blood stains, clothes with device. At a time, 30 bed sheets, 70 pillow covers, or
rust stains, should be sorted out and kept separately. 25 curtains can be washed in the machine (Fig.14.1).
Torn sheets and clothes should be mended. In case
they are very badly torn and cannot be mended, they
should be condemned. These condemned clothes
should be recycled and used as dusters.
Clothes should also be separated type-wise, that
is, bed sheets, pillow covers, towels, curtains, doctors’
gowns and coats, and then sent to the washing
machine.
Clothes stained with blood or body fluids should
be washed separately by hand and the stains should
be removed. Deal with this kind of stain as soon as Fig. 14.1 - Washing machine
possible, the longer you wait the more time the stain
has to soak in /or dry, making it more difficult to Equipment and materials
remove. After that the linen should be soaked and Detergent as recommended for washing a load of 30
rinsed in dettol or disinfectant mixed water and then bed sheets.
dried in direct sunlight. Only then they should be
sent to the laundry for the regular wash. Procedure
After the clothes are washed and returned to the - Remove all stains on the clothes before loading
linen room, they have to be sorted out according to them into the washing machine. The chart below
area, and type, and sent to the different user gives different methods adopted to remove
departments. The extra clothes have to be put back different kinds of stains
into the cupboard in the allotted places. Both when - Take the required amount of detergent and
receiving the clothes and while distributing them a dissolve it in water

Housekeeping in Eye Care Services - A practical guide

70

- Pour this solution into the machine pillows and wash them with clean water every time a
- The clothes that have been sorted out should be patient is discharged. Then rinse them in this dettol
put into the machine type-wise solution. Dettol helps to kill the germs present and
- The first round of washing should not exceed makes the mats and pillows hygienically clean. After
25 minutes rinsing the mats and pillows in the dettol solution,
dry them thoroughly in direct sunlight. The dried
- In the second round the clothes should be rinsed
mats and pillows should be piled together and tied
with an adequate amount of water. This round
until required.
should not exceed 10 minutes
- In the third round rinse the clothes again with Dry cleaning
clean water for 10 minutes Silk clothes, clothes with glass work, and other costly
- Now put the clothes into the extractor and clothes should be dry cleaned.
remove them
- Put the washed clothes out to dry in direct sunlight Time allotted for washing
- When the clothes are absolutely dry, they should - Each type of cloth should be washed according
be ironed, folded and neatly stored in the to its usage
cupboard (Fig. 14.2 & Fig. 14.3) - The bed sheet, pillow covers, bed spread in the
- Clothes such as napkins, doctors’ coats and gowns in patient’s room should be changed every
should not be put into the machine. They should alternate day. Used linen should be removed and
be hand washed replaced with fresh linen
- A stock register of the clothes in the cupboard must - Linen should be changed immediately if it is
be maintained. Entries should be regularly made stained with blood or body fluid
- For patients with ulcers and oozing sores, the
Cleaning mats and pillows linen should be changed every day
In the free section of some eye hospitals , mats and - Table cloths and doctor’s coats should be washed
pillows are provided to the patients to rest. These once a week
mats and pillows can get stained on account of vomit, - Hand towels should be washed daily
loose motions, or blood. This provides an excellent - Curtains should be washed once a month
breeding ground for germs. To avoid this and to keep
- The mattress cover should be washed once in six
these mats and pillows clean and hygienic, mix 100ml
months or whenever stained
of dettol in 5litres of water. Rinse the mats and

Fig. 14.2 - Pressing and folding machine Fig. 14.3 - Linen storage
©A R A V I N D E Y E C A R E S Y S T E M
 71

Removal of stains on clothes

Sr. no Condition Colour of the Method of removal
cloth

1. Tea, coffee, and

cocoa stains
a. Wet stains White Wash with boiling water and immediately rinse
with warm water
b. Dried stains White Soak over night. Then apply borax on the stain and rinse
in hot water
2. Fruit stains
a. Wet stains White Soak the stain in hot saline solution and then wash
Other colours Soak in warm hydrogen peroxide solution and wash.
b. Dry stains White Sprinkle borax on the stain and pour boiling water on it
Other colours Soak in warm sodium peroxide solution and wash.
3. Blood stains White colour Soak in enzyme stain remover. Then dry for a short
time in sunlight.
Other colours Soak in enzyme stain remover, then soak in cold saline
solution and wash.
4. Stains due to iron White Apply a mixture of lime juice and salt on the stain
instruments(rust) and wash it with hot water. Rust removers can also
be used.
Other colours Soak in a mixture of warm lime juice and salt. Now use
rust removers that are available in the market.

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72

Format for recording the number of clothes washed daily

Date Bed Pillow Towel Curtain Bed Inner cover Table Total
sheet cover cover of pillow cloth

Total number
of Clothes
Cost of washing
each piece
Total Cost

Format of the clothes/linen stock register

Types of linen colour-wise Old Torn In hand

Green bed sheet

Green pillow cover
Blue bed sheet
Blue pillow cover
Yellow bed sheet
Yellow pillow cover
Grey bed sheet
Grey pillow cover
Pink bed sheet (suite room)
White bed sheet
White usable pillow cover
Meditation room carpet
Black bed sheet
Special pillow cover
New inner cover of pillow
Old inner cover of pillow

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 73

Format of stock register of new linen

Linen classified by type of room War
ardd In hand Total

Bed sheet –‘A’ class room

Pillow cover – ‘A’ class room
Bed sheet – ‘A’ special room
Pillow cover – ‘A’ special room
Bed sheet – suite room
Pillow cover – suite room
Inner bed cover – suite room

A sample format for recording daily use of detergent and water

Laundry Detergents Daily Usage

Month: ______________

Date Load LOC SA -8 No. of items / day Water/ltrs ALA

Housekeeping in Eye Care Services - A practical guide

 74

©A
Linen - D aily Transaction - OP
Daily

R A V I N D
Date: Unit Clinical OP

E Y E
Item I II III Retina Glaucoma Uvea Paediatric Cornea Orbit

Given Recd Given Recd Given Recd Given Recd Given Recd Given Recd Given Recd Given Recd Given Recd

C A R E
Bedsheet
Grey

S Y S T E M
Camp
Pillow
Cover
Grey
Camp
Curtains
C, Cover
M.Cover
In.Cover
Table Cloth
Coat
Tow el
Napkin
Sign:
 75

A sample format for daily transaction of linen in the ward and OP

Linen-Daily Transaction - War
Linen-Daily d
ard

Date: Floor Lasik Eye Bank

Bank
Item I II III IV Room
Given Recd Given Recd Given Recd Given Recd Given Recd Given Recd

Bedsheet
White
Blue
Yellow
Addtl
Suite Room
White
Suite Room
Colour
White
Cover
Colour
Cover

Pillow Cover
White
Blue
Yellow
Addtl
Suite Room
White
Suite Room
Colour

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76

Linen-Daily Transaction - War

Linen-Daily d
ard

Date: Floor Lasik Eye Bank

Bank
Item I II III IV Room
Given Recd Given Recd Given Recd Given Recd Given Recd Given Recd
Curtains
C, Cover
M.Cover
In.Cover
Divan set
Tow el
Gown
Cap
Mask
Pant
Shirt
Sign:

Student exercise

Answer the following

1. What is the role of the linen department? 3. What are the factors to be kept in mind when
2. Why do we need bedsheets in the ratio 1:4 in a selecting detergents?
multispeciality hospital, but 1:3 in an eye 4. What is the system to be followed from bed making
hospital? to sending the soiled linen to the laundry?,

©A R A V I N D E Y E C A R E S Y S T E M
CHAPTER 15 WASTE MANAGEMENT

CONTENTS
What is waste management?
Impact of poor waste management system
Segregation
Collection
Transportation
Disposal
GOAL
To manage the waste generated in the hospital in a hygienic manner and prevent the
spread of disease
OBJECTIVES
To teach the trainees
- Proper handling of bio-medical waste
- The importance of segregation of waste
- Proper methods of waste disposal
 CHAPTER 15
Waste Management
A lot of things are used everyday in the hospital and Bio medical waste
then discarded. Care should be taken to see that the This is waste that is generated during diagnosis,
items are not strewn about everywhere, but are thrown treatment, and immunisation of humans or animals
into the dustbins. Dustbins should be provided in or during research activity. By implication, solid waste
all areas of the hospital, and should be emptied daily, other than cotton, dressing, linen etc. which are
and in some areas where the waste generation is more contaminated with blood are considered as municipal
the dustbins should be cleared twice a day. If decaying waste, unless they come in contact with other bio
matter is not disposed of immediately, it emits a bad medical waste. Bio medical waste includes:
odour, and generates disease causing germs. This will - Cotton
affect the environment and our health. Hence it is
- Swabs
very important to ensure that waste in a hospital is
cleared and disposed daily. It is also important to - Infectious plastics
ensure that the waste bins are washed daily and - Plastics
disinfected with dettol ( any disinfectant) and then - Glass
put out to dry in direct sunlight. - Syringes
In this lesson we shall study the importance of a - Needles
good waste management system. - Blades
Of the above, the last 4 come into the category
What is waste management?
of “sharps”, as they can easily cut or get into the skin
The process of collecting, transporting, processing of the person handling the waste, causing immediate
and disposing of waste is known as waste infection.
management. Nowadays waste management has gone
The general waste can be further classified into 2
one step ahead. It not only deals with planning of
groups:
disposal but also attempts to see how we can reuse or
recycle certain materials from the waste. Recyclable waste
The waste from health care facilities is categorised This is waste that can be re-used, such as
into 2 main categories - Cardboard
General solid waste - Paper
This is the majority of all waste found in health care - Plastic bottles, covers and cups
facilities and is similar to waste generated in other - Ropes and strings
places. This includes: - Rubber items
- Paper - Shoes & slippers
- Polythene - Thermocol
- Food waste - Wood
- Kitchen Waste - Coconut shells
- Garden Waste - Cloth pieces
 79

- Dry batteries to cause physical injury, especially when

- Glass bottles intermixed with other waste
- Leather items 3. Chemical injur y: This results from hazardous,
injury:
- Metal toxic, corrosive, flammable, reactive and
genotoxic wastes which can produce burns on
Bio - degradable items accidental exposure, or cause toxicity to cells
These are items that easily decompose and mix into 4. Radiation injur y: This occurs due to exposure
injury:
the soil. to various forms of radioactive waste such as that
- Dust from the chemotherapy and X-ray rooms
- Food waste On environment
- Kitchen waste 1. Water pollution: Measures should be taken to
- Garden waste reduce the quantity and strength of incompatible
- Coal and ash pollutants in wastewater flow. If not connected
- Hair to municipal wastewater treatment plant, an on-
site treatment should be started. Sludge from such
- Insects and rodents
a plant should be managed with the same
- Tea and coffee powder precautions as for municipal waste sludge ie. it
- Egg should not be put on food crops unless treated
properly. For chemicals, which are a potential
Impact of poor waste management systems
source of pollution, an on-site chemical waste
On people survey is a pre-requisite to the development of
1. Infections: This is the most common health an effective waste management system. Waste
hazard associated with poor hospital waste chemicals, as far as possible should be recycled,
management. Those exposed to this hazard are- and more hazardous chemicals should be
substituted wherever possible with less hazardous
a) Patients attending the health care institution
chemicals. Use of disinfectants should be limited
b) People visiting the patients in the health care and alternatives used wherever possible
institution
2. Air pollution
pollution: Most of the air pollution results
c) Medical and paramedical persons who are from incineration. It should be ensured that
providers of medical care incinerators for health care institutions be
d) Sanitation staff involved in collection, designed specifically for that purpose and must
segregation, transportation and final disposal comply with the accepted norms of emission.
of waste Fume hoods, which are another outlet for air
e) Staff working in support services of the pollution should be fitted with filters
hospital 3. Soil pollution: General waste along with properly
2. Physical injur y: This occurs due to the improper
injury: treated infectious waste can safely be disposed of
handling of various biomedical wastes at various in a specialised landfill. Properly operated
stages of waste management. Out of various incinerators produce sterile ash, which can safely
categories of waste, the sharps are the most prone be put in a specialised landfill

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Generation and segregation of waste

S.No. Category of waste Recommended
Generation of Waste refers to activities and colour code
procedures, which result in the production of waste.
In a hospital scenario generation of bio-medical waste 1. General Non- hazardous
is done at all levels and in all areas, starting from the waste Black
highly trained specialists to the class IV sanitation 2. Sharps (infected or not) Yellow
staff. It is the first step in hospital waste management. 3. Infected waste (not
Source of waste refers to those areas or sites where containing sharps) Yellow
wastes are generated. 4. Chemical and Red
Segregation of waste is defined as separation of Pharmaceutical waste
different types of wastes by sorting. (other than cytotoxic
It is the most important prerequisite in the entire drugs, radioactive
process of waste management as it allows special wastes, high pressure
attention to be given to the relatively small quantities containers
of infectious and hazardous waste thereby reducing 5. Clinical wastes that Blue
the risk and the cost of handling and disposal. need autoclaving
Segregation of waste is the key to the entire process
of scientific waste management, as proper sorting into Storage is the duration of time the wastes are
different categories will entail right treatment and kept in the areas of generation and transit, till the
disposal. Segregation of waste should be done at point of disposal. One should be very careful about
source, and hence becomes the responsibility of the storage, as unless the waste is securely stored,
generators of waste, viz. doctors, nurses and unscrupulous elements and rag pickers may gain
paramedics. Sensitising the generators of waste to access to the waste and cause problems. Under the
properly segregate the waste at source is the key to provisions of Biomedical Wastes (Management and
successful implementation of scientific waste Handling) Rules, 1998, the following section pertains
management.It is important to put the waste in to the storage of waste:
respective colour bin which is accepted by the Authorised persons handling biomedical wastes
management. shall ensure that:
1. No untreated biomedical waste shall be stored
Collection, storage and beyond a period of 48 hours
transportation of waste 2. If, for any reason it becomes necessary to store
Collection of hospital waste is the process, which is waste beyond such period, the authorized
done after segregation, and in a way, both can be person must take permission of the prescribed
considered as being complementary to each other. authority and take measures to ensure that the
Several guidelines have been suggested for waste does not affect human health and the
categorisation of hospital wastes enunciated by environment
various authorities. One of these is the colour coded No waste shall be stored where it is generated
classification for developing countries by WHO: beyond a period of 48 hrs.

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 81

Characteristics of waste storage containers 3. There should be a proper facility for locking of
Containers for interim waste storage must have the the area to prevent tampering by rag pickers. The
following characteristics: key should be kept with a responsible person at
1. Made up of hard plastics / metal which should all times
be sturdy and leak proof 4. There should be a clear warning sign with
2. The size of the containers will depend upon the symbols
quantity of waste generated 5. Location should be away from public places and
3. Should have a secure lid which can be shut after food preparation areas
the waste is collected. It should not allow insects 6. Construction should be robust with drainage
and animals to go inside system, lights and ventilation
4. Should be puncture proof, reusable, colour
coded, labeled and not easily destroyed by rodents Transportation
and other animals Waste disposal is a multiphase activity, in which the
5. The inner surface should be smooth and rounded different stages (ie. generation, segregation, collection,
without any sharp edges which can tear the plastic interim storage, transportation, treatment and final
bags kept inside disposal) are highly interdependent, both technically
It is preferable to have three sizes – for collection, and organisationally. In this entire spectrum of
storage and transportation activities, collection and transportation form a vital
link between the point of generation and final
Plastic bags used for waste collection, storage disposal.
and transportation
1. Should be large enough to accommodate all the Types of transportation
waste of that particular category. It should
Internal
completely line the container and a portion of it
should be outside This refers to the transportation of waste from the
2. Should be sturdy enough to withstand the weight point of generation and storage in the wards to a
of the load of waste without tearing or giving point outside the building premises, where it is kept,
way pending the transport to the actual site of disposal.
3. Should be leak proof and water proof, without External
any weak areas or tears This refers to the transportation of waste from the
4. Should be colour coded. Labeled and marked central collection point outside the building to the
clearly with labels site of final disposal.
In case the bags are to be incinerated they should
be made up of non-chlorinated plastics Vehicles for transportation

Waste collection area / centre should have the Internal transportation

following characteristics 1. Push cart - An open push cart designed so that
1. Should be an area specifically marked for one or two bins/containers of waste can be moved
collection and storage of waste, pending from rooms to the garbage trolley parked outside
treatment and final disposal the ward
2. Should be covered and protected from all sides 2. Waste trolley - A large trolley made of iron/
against humans and animals stainless steel with 4 revolving castors and of

Housekeeping in Eye Care Services - A practical guide

82

sturdy construction. It should be covered so that - The site should be securely fenced and should
insects, flies, etc. do not have access inside to it have a gate away from public view with
3. Wheel barrow - Can be used for small amount signboard stating “Landfill site”
of general/non-hazardous waste - Covered with at least 0.5m of suitable cover
material
External transportation
Landfill is done by any of the following methods:
1. Cycle rickshaw - can be used if the site of final
- Trench Method – A long trench 2-3m deep
disposal is close to the hospital. It should be
and 3-10 m wide depending upon local
covered on all sides and can be divided into 2
conditions is made. The treated waste is ideally
compartments, for infectious and non-infectious
compacted, filled up to 2m and covered with
waste
excavated earth
2. Van / lorry - It should be earmarked for waste
- Ramp Method - This is well suited where the
transportation with the label ‘Bio medical Waste”
terrain is moderately sloping, and excavation
on both sides and at the back. It should be fully
is done to secure the covering material
covered and lined internally with aluminum or
metal to give it a smooth impervious finish. It - Area Method - This method is used for terrain
should have rounded corners without edges or land depressions, disused quarries and clay
angles for effective cleaning and disinfection. The pits. The treated waste is deposited, packed
driver’s cabin should be fully separated from the and consolidated in uniform layers up to 2-
bulk head, and the load compartment should be 2.5 m deep. Each layer is sealed on its exposed
securely locked during transit. If the journey to surface with a mud cover at least 12” thick
the site of final disposal is long, roof vents need to prevent infestation of flies, rodents etc
to be provided for ventilation After the waste has been buried, chemical,
bacteriological and physical changes occur and the
Final disposal temperature goes up to 600 C within 7 days
Disposal means burial, discharge, deposit, dumping, hastening the decomposition process. Within 4-6
land-filling or placing on land, of any biomedical months complete decomposition of matter occurs
waste. into an innocuous mass. The potential use of filled
land includes improvement of eroded areas, marshes
Disposal of general/non-hazardous solid and other marginal land.
waste 2. P it B urial: This is suitable for small camps or
Burial:
Depending upon the quantity of general non- institutions, where in a small pit of size 2m by
hazardous wastes generated in the hospital the 2m waste is put with 10cm soil between each
following are the options available for disposal. layer of waste. When the level is full, it is closed
with a thick layer of soil. It is also fenced with
For small quantities of wastes secure gate for entry and exit. Contents get
1. Landfill: This is the most satisfactory method decomposed within 4-6months
of garbage disposal where suitable land is 3. Composting: This is a method of combined
available. However, the site of landfill has to be disposal of refuse and night soil. It is a process
chosen with utmost care and the following factors whereby organic matter breaks down under
regarding construction should be kept in mind: bacterial action resulting in the formation of
- It should be avoided near sources of water relatively stable humus like material called

©A R A V I N D E Y E C A R E S Y S T E M
 83

compost which has considerable manorial value for 4. Gasification technology (biogas from organic
soil as it contains nitrates and phosphates. The waste): Energy derived from anaerobic digestion
temperature achieved over a period of days destroys of organic waste involves the production of biogas
the eggs and larvae of flies and other insects. from organic waste. The technology involves the
Vermiculture: In this process, the biodegradable separation of wastes at source or mechanically
wastes from the kitchen, houses and the cafeteria prior to digestion and comprises the following
are converted into manure with the help of steps: (i) pre-treatment (ii) digestion (iii) post
earthworms. Organic waste is kept in wooden treatment of waste. This process is eco friendly
boxes or earthen ditches with small amount of and recovers 100% methane, reduces odour,
waste at the bottom. A small bunch of produces electricity and displaces carbon dioxide.
earthworms are placed in each part and covered It is a traditional source of energy and forms a
with organic matter. This is sprinkled with water, suitable by-product, viz. compost which is an
and in due course gets converted into manure excellent manure

For large quantities of waste Disposal of human anatomical, blood and

1. NADEP Composting: General refuse/waste can body fluids
be converted into rich, soft, good smelling The preferred treatment for this is incineration. After
compost by using this simple, economical and incineration, the ash can be sent for specialized
non-polluting technology landfills, as it is sterile.
2. Pelletisation Technology: This process converts
Disposal of sharps
biodegradable wastes into “fuel pellets” by
treatment with heat, humidity, and pressure by Although sharps comprise of a relatively small
machine designed for this purpose. The fuel thus proportion of the total hazardous waste generated in
developed is cheaper, has less smoke emission but any hospital, they have the maximum propensity and
lasts longer potential for causing needle “stick” injuries and hence
can cause infection. It has been proved beyond doubt
3. Biopress Methods: This turns garbage into
that the category of waste that needs maximum
incinerable matter and produces methane gas.
precaution and care is sharps. Sharps are stored in
Methane is produced naturally in any landfill
areas or points of generation in puncture-proof
through decomposition of organic matter, over
containers. Before storing them, the needles, which
a period of 20-30years.It contains roughly 50%
comprise the majority of sharps, can be destroyed by
methane and 50% carbon dioxide. The
needle destroyers or by using syringe melting and
recoverable gas is about 50-80% of the total gas
disposal systems.
which can be used for:
- Generation of electricity in an internal Disposal of microbiological and
combustion engine or gas turbine technological waste
- Directly as a boiler fuel This is disposed using any of the technological
- Compressed for vehicle fuel or upgraded to options such as autoclaving, microwaving,
pipeline gas hydroclaving, or incineration.

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84

Disposal of pharmaceutical and infectious and gases, which are generally low-level radioactive
solid waste wastes, should be diluted properly and disposed of
This can be incinerated and the ash can be disposed in the sewers or released in the open atmosphere.
of in landfills.
Disposal of pressurised container
Disposal of chemical waste These should be disposed of with general waste, in
Non-hazardous chemical waste can be disposed of specialised landfills.
using the same method as general wastes. The waste For a demonstration on waste management, please
that can be recycled should be packed, labeled properly watch the video of the CD.
and stored for recycling. Hazardous chemical waste
should be recycled if possible or treated and disposed Student exercise
of in sewers after dilution (liquids) or incineration
Answer the following
(solids). The ash is disposed of in landfills.
1. What is waste management?
Disposal of radio active wastes 2. Why is it important to have a good waste
This should be done as per the guidelines laid down management system?
by BARC, India. These wastes can be disposed of in 3. What are the different types of waste generated in
the normal channels under strict supervision, after an eye hospital?
their radioactivity is neutralised. 4. What are the wastes generated in a multi speciality
Solids should be stored in appropriate containers hospital?
like plastic bags or large cans under strict security and 5. What are the measures the Housekeeping
thereafter disposed of as ordinary waste after removal Department can take to reduce the generation of
of all radioactive labels and warning signs. Liquid waste?

©A R A V I N D E Y E C A R E S Y S T E M
CHAPTER 16 PEST CONTROL

CONTENTS
Cockroach
Fly
Silverfish
Lizard
Bees, wasps and spiders
Bed bug
Mosquitoes
Rats
Termites
GOAL
To keep all areas of the hospital free from all types of pests
OBJECTIVES
To familiarize the trainees with
- Habits of common pests
- Different techniques of pest control methods
 CHAPTER 16
Pest Control
No matter how clean one keeps one’s surroundings, under coverings, in bathrooms, toilets, and sinks,
you cannot avoid the “uninvited guests” - the pests. where large numbers congregate around sources of
It is not only embarrassing but also speaks badly of a water. The American cockroach infests all houses in
hospital where one sees rats, cockroaches, and lizards store-rooms, kitchens, cupboards, and libraries, while
running around. Pest control is another major job of the brown banded cockroach which can fly prefers
the housekeeping department (Fig. 16.1). locations high up in the rooms.

Inspection
Inspection and treatment should go together whether
a complaint has been received or not. All the possible
hiding places of cockroaches must be thoroughly
investigated. These places would probably be dark
corners. Your inspection should begin where the
patient or staff thinks he or she has seen one. You
must be equipped with a flash light and a hypodermic
syringe with a flushing agent to flush crevices and
areas behind in-built furniture where the flash light
cannot reach. Remove the drawers and shelves of the
furniture wherever possible and inspect the inside of
the furniture thoroughly. Check calendars and pictures
on the walls, electrical appliances such as the
Fig 16.1 Sprayer and pesticides refrigerators, wall clocks, ovens, food mixers, and
We shall discuss below a few common pests and coffee blenders.
methods of controlling them. Other places that need attention and which we
tend to overlook are:
Cockroach - Rubber and gasket lining in the refrigerator and
Cockroaches are eminently tropical but certain species other appliances
have become widely disseminated through commerce - Splash plate - in walls behind ovens and stoves
and are now cosmopolitan. They are nocturnal in
- Baseboard - forming a base around the room up
habit and attack food, paper, clothing, shoes, and
to 8” above floor level
dead insects. The German cockroach prefers a warm
and moist environment. Consequently it has become - Linoleum - corners and around the walls
a pest of kitchens, and restaurants, where food, - Carpets - underneath; to be rolled up
warmth and moisture provide the necessary ecological - Panels - on the walls - to be injected wherever
requirements. The oriental cockroach on the other there are cracks
hand prefers cooler areas. These are therefore found - Fuse box, behind sinks, light fixtures etc
 87

Measures to be taken The common housefly

Sprinkle Baygon bait in places where cockroaches This species is probably the most familiar and
congregate, rest or hide, such as dark corners of closets, certainly the most widely distributed of all insects. It
base of walls in basements, under sinks, around drain has accompanied man everywhere and has adapted
pipes, upon shelves, etc. However, Baygon is toxic, itself to breeding in a variety of rejected food and
and can harm children and pets if accidentally excrement of man and his domestic animals.
ingested. Bay leaves, cucumber slices and garlic are It would be difficult to exaggerate the importance
natural deterrents for roaches, and are far safer to use. of the Common Housefly as a pest in homes. This is
Also, spraying cockroaches directly with soapy water on account of its importance as a carrier of disease
kills them instantly. Hence keeping a spray of soapy brought about by its habit of flying between human
water handy near cockroach infested areas is faeces and human food. The disease organisms of
useful.Sealing of small cracks and crevices in walls, typhoid, dysentery, summer diarrhea, and probably
around window frames and in the floor are also infantile paralysis are transferred from faecal matter
proofing measures that would help to prevent nesting to food by vomit drops in fly excrement or by
of cockroaches. organisms adhering to the fly’s feet. The eggs of
parasitic worms are also transferred in this way. In
Fly tropical and sub-tropical areas, in addition to these
As a rule flies are of small or moderate size; some diseases the housefly is also responsible for the spread
species are even minute, measuring one millimeter of cholera, and opthalmia.
long, while some Australian robber flies exceed three
inches in wing-expanse with a body length of one Fly control
and three-quarter inches. The majority of flies are Exclusion has been an effective method of fly control
diurnal and frequently fly around for nectar or haunt for many years. Putting up mesh screens made of
decaying organic matter of diverse kinds. Many flies any metal are helpful. Screens if properly maintained
do not visit flowers but are found on foliage, tree provide excellent control of flies.
trunks, fallen logs, in grass, on the ground, or on the Mint is a natural repellent for flies. Small sachets
mud where they seek food. The primitive blood of crushed mint left around the ward will keep flies
sucking species, such as the mosquito and the sand away. Bay leaves, cloves and eucalyptus oil hung on
fly are mostly crepuscular (active at dawn or dusk) or windows in small sachets will also keep the flies away.
nocturnal. Many species are predacious on smaller
insects, mites, and small worms. A relatively small Chemical control
number have acquired the habit of blood sucking, Fly sprays and household sprays are synonymous since
confined mostly to the female of the species. A small a spray that controls flies will also control other
number of the blood sucking species are of great insects. There are three kinds of sprays in the market
importance to us on account of their ability to - the space spray which includes aerosols, the surface
transmit various diseases to man and other animals. or residual spray which may be pressurised and the
The pathogenic organism of malaria, yellow fever, combination space and residual spray. Space sprays
elephantiasis, and other diseases are transmitted from are applied as a mist into the air and must be in contact
animal to man and from man to man through the with the insect at the time of spraying. They provide
medium of biting flies, and cannot be contracted in quick knockdown and fast results but temporary
any other way. control. An aerosol spray sprays the insecticidal

Housekeeping in Eye Care Services - A practical guide

88

ingredients which are dispersed by means of the 2. The application can be limited to areas of heavy
vapour pressure of liquefied gas rather than the infestation which are easily located. This avoids
pressure of compressed air. Surface or residual sprays waste of material and labour.
may have a petroleum or water base. They are applied 3. Baygon also controls flies which have developed
on surfaces as a wet spray rather than a mist and they resistance to the action of chlorinated hydro-
leave a toxic layer of either crystals or film on the carbon and organo-phosphorous insecticides.
evaporation of the carrier. Surface sprays provide 4. The 2% formulation of Baygon bait has a relatively
relatively slow knockdowns but long lasting control low order of toxicity to human beings, yet is
against non-resistant flies and do not have to come powerful enough to achieve extremely good results
in contact with the insect at the time of spraying in in a few minutes of application. The undisturbed
order to be effective. Residual sprays are applied to bait remains effective for a very long time.
surfaces frequented by houseflies such as light fixtures,
Application
window screens and walls. When a residual spray is
used as a space spray, the large amount of toxicant Sprinkle Baygon bait wherever flies congregate.
becomes hazardous to the user, and may contaminate Particular care should be taken to apply the bait
food as well. around refuse dumps, garbage heaps, market and
slaughter house refuse, around cess pools and other
Toxicants used for space sprays similar areas.
Pyr ethr
yrethr um : This is the most common ingredient in
ethrum Baygon bait can also be used by dissolving the
a fly spray. At recommended dosage it is the safest bait in water and sprinkling or brushing the solution
toxicants and has exceptionally fast knockdown effect. along the walls and on the floor avoiding direct
It has the disadvantage of not killing all the insects contact with food stuff.
knocked down.
Other methods of fly control
Allenthrin : This chemical is often referred to as
synthetic pyrethrins. It has knockdown and mortality The presence of houseflies is an indication of our
characteristics similar to natural pyrethrins when used failure to properly dispose off manure, garbage,
against flying insects in space sprays. sewage, food wastes, human excrement dead animals
or other organic waste. Therefore proper
Residual sprays : DDT was considered to be very environmental sanitation is fundamental to successful
effective until 1950, but by then the flies had become
fly control and fly breeding can be prevented by simple
resistant to this toxicant. Today the most common
practice of burying such organic matter or by drying
toxicant used is Malathion and diazinon, but the it so that its moisture content is below that of larvae
housefly is becoming resistant to these toxicants too.
development. More importantly, flies cannot breed
Baygon bait: there are many fly killing insecticides in thinly scattered material because it dries out and
in the market, however many of them do not solve there is no fermentation. Open outdoor toilets are
the real problem of doing their work – that of bringing the biggest menace from the stand-point of fly-borne
into contact the fly and the insecticide. The ideal diseases. Where privies cannot be avoided, they should
answer to this is the ready-to-use Baygon Bait. It first be made as fly-proof as possible and the refuse kept
attracts, and then kills the fly. covered by daily applications of waste crankcase oil
The baygon bait has the following advantages: or liberal amounts of lime.
1. The dry granular form makes application very Electric flycatcher units that have UV- light
convenient for even unskilled labour to sprinkle. emitting fluorescent tubes can do flying insect
No material for dilution or equipment is needed monitoring.

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Silverfish These shelves should therefore receive the crack and

crevice injections. Caution must be exercised when
This primitive wingless insect is so called on account
applying liquids, as the liquid may stain the books
of its shining grey colouration, its sinuous
especially when water based sprays are used. When it
movements, and its quick darts to cover when it is
is not possible to use either sprays or dust, then it is
disturbed. The silverfish is nocturnal, shuns light and
advisable to sprinkle bait on the shelves. A small
is most often seen when uncovered in dampish places
amount of bait, bait dispenser, or bait pellets can be
like the kitchen and the scullery. It is able to walk up
put in the corner of the bookshelves.
rough vertical surfaces such as wall paper and plaster,
but unable to do the same on smooth surfaces like Silverfish can be easily trapped in small glass
glass and porcelain. Hence it gets trapped in wash containers. Wrap the outside with tape. Silverfish can
basins and bathrooms. easily climb on rough surfaces, so they can climb up
and fall in. They will be trapped inside because they
The silverfish is responsible for little actual
cannot climb smooth surfaces. Drown them in soapy
damage. It feeds on carbohydrate substances such as
water. However the best preventive control is to
starch used for wall paper paste and is recorded as remedy the damp conditions.
biting small irregular shaped holes in linen, cotton
and artificial silk. Its carbohydrate diet is Lizards
supplemented by protein from dead insects and glues
Lizards are typically dry land animals loving the sun
used in book binding. Silverfish is not of great
and its heat. They are four-legged animals and are
economic importance, but is an unpleasant inhabitant
capable of very active movements. Usually they are
in the hospital and in hospital library and needs to
very small and slender creatures. The common garden
be attended to.
lizards have a very long tail. The “flying dragon” of
Control of silverfish India, Draco, is able to hop from branch to branch
of the trees that it inhabits. The ordinary wall lizard
Insecticides such as DDT, chlordane, dieldrin, and
or gecko, is equipped with vacuum - cupped toes
lindane formerly used for the control of silverfish are
which help them to chase insects along the walls and
no longer registered for use. Although liquids, dust
ceilings of the rooms. A very interesting protective
or baits can be used for the control of silverfish, liquids
feature of these lizards is the power to break off their
are preferred in visible or exposed areas of the home tails automatically. This power of automatically
where dusts or baits may present an undue hazard to breaking off parts of the body is called autotomy.
children or pets. Dusts can be used in attics,
basements, and places where their use is not Control
potentially hazardous. Lizard control is usually carried out in the warmer
In controlling silverfish, the insecticide will be periods of the year. Lizards are cold blooded animals
most effective when applied where the insect is most and hence in the cold season they tend to hibernate
commonly seen. The silverfish commonly occurs in in the warm corners of the house to restore their body
damp areas such as behind or beneath kitchen sinks, temperature. During the warmer periods they come
beneath or behind cabinet shelves, and inside out and can be seen crawling up and down the walls.
cupboards and linen closets. Particular attention They usually come out after dusk as they feed on
should be paid to inject small amounts of liquid into smaller insects that fly around the light sources.
or dusts into crevices and cracks formed by shelves, Lizards are also found in places infested with
loose moulding or floor tiles, and loose drawer glides. cockroaches, as they feed them. Usually, places where
Silverfish are commonly found around book shelves. lizards abound one will rarely see cockroaches.

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Mechanical control Most individuals who fear bees do so because of

Lizards are found mostly behind picture frames, their potent sting. When the bee stings the sting,
curtains, shelves and window frames. They enter the poison sac, and several other parts of the bee’s anatomy
house through the ventilators and windows. Hence are torn from the bee’s body and the bee soon dies.
the windows and ventilators should be properly The action of the sting takes place instantly. The sting
meshed. The house should be kept clean and the has barbs on it and if it is not immediately removed
suspected hiding places should be regularly inspected. the reflex action of the muscle attached to the sting
As the lizards thrive on insects, the most effective drives it deeper into the sting permitting more time
way of controlling lizards is to control the insects in for the poison to be discharged. The pain due to the
the hospital. sting gets more acute as the toxin is discharged.

Chemical control Control

Lizards are carnivorous and prey on other insects. While bees are almost always mild in the swarming
Hence they cannot be controlled using bait. Chemical stage, it is still advisable to wear a bee veil and to tie
control of lizards involves spraying of pesticides the cuffs of trousers tightly to the ankle when trying
directly on the reptiles. Chemicals such as to trap them. Where the swarm has settled on a limb,
dichlorophos, malathion etc. sprayed on the body the limb may be jerked and the swarm collected in a
kills the lizard instantly. However this process is cardboard box. One should be sure that the queen
difficult and tiresome in godowns and libraries where bee does not remain on the limb. The box is then
there are several lizards and lots of goods or books closed and sealed to prevent the bees from escaping.
behind which they can hide. In such places After taking the box to a distance away from the
fumigation is recommended. Fumigation is carried swarming place it may be opened and the bees set
out using Aluminum Phosphide or any other free. If the bees have to be returned to the hive the
approved fumigant. box is completely sealed and moved at night to where
the hive is located. The bees are then transferred the
Bees, wasps and spiders next morning.
As a rule bees and wasps are beneficial insects A variety of insecticides are effective including
unmindful of the activities of man, as long as man bendiocard, carbaryl, diazinon, malathion and
makes it a point to disregard them. However, at times porpoxur. The dust formulation of these products is
the nests of these insects are made in close proximity preferable to spray formulations when bee and wasp
of the hospital. Although the sting of wasps and bees nests are in enclosed places. Dust has the advantage
is painful, for some persons it may prove to be serious. of being widely distributed by the insects themselves
It may result in severe reaction and even death.
as they move around in the nest. Sprays kill only
The honey bee is man’s oldest insect friend and those insects which come in contact with the sprayed
to this insect that we owe honey, beeswax and the area. Usually one application is sufficient with activity
fertilization of many of our crop bearing plants. The ceasing in one or two days. Nests should be treated
honey bee is a social insect living in colonies of 20,000 at night to avoid getting stung.
to 80,000.
As with man, the honey bee too has its periods Wasps
of depression. On cloudy days when they are unable The wasp flies above lawns which are infested with
to forage for nectar, they get “frustrated” and need to beetle grubs, as these grubs are food for the wasp.
“take out their frustration” on others. On these days Wasps appear in the morning and fly all day, retiring
we need to be cautious. early in the evening. These wasps generally do not
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attack people. You can walk safely through them as Traps

they fly around. In order to control them the lawn
can be sprayed with carbaryl or the grubs controlled Make a simple water trap
with chloropyrifos or diazinon. Use a razor knife to cut the top from a 2-liter
plastic pop bottle. Cut just above the shoulder of
Yellow jackets and hornets the bottle. Discard the screw top. Fill with water about
These are the real problems of the wasp world as far halfway. Coat the neck with jam, invert it and set
as humans are concerned. These social wasps live in back on the bottle. Use two small pieces of tape to
colonies which number in thousands. These beneficial hold it in place.
insects would not anger man except they like to live Wasps will go down the funnel to get the jam,
in close proximity with us. they nest in attics and but will find it difficult to get out. Most will drop
voids in the walls where they can go unnoticed for a into the water and drown.
long time. They usually go outdoors in search of food, A few drops of dish soap in the water will make
but when they are not able to get food, they come it hard for the wasps to tread water, and will hasten
into the living area and become a threat to the their demise. (You can also add a 1/4 cup of vinegar
inhabitants of the place. They feed in trash cans, and to the water to discourage honeybees from entering
enjoy our food they resent our efforts to keep them the trap in search of water.)
away from our food. When this happens they need
Note: In the spring and early summer, wasps are
to be controlled.
attracted to protein-based baits; use jam or other
Prevention
sweet baits in later summer and into fall.
Seal entry points. Searching for and sealing off their Empty the trap daily! As more wasps are caught,
they create a raft on which other wasps can survive
point of entry is the best line of defense. Check your
for a considerable time. Some of these wasps then
house for unsealed vents, torn screens, cracks around
find purchase on the plastic of the bottle and
windows and door frames and open dampers.
eventually crawl out. The longer the trap is untended,
Observe the flight path of a wasp, especially in the
the more wasps will manage to escape, which may
morning, which may reveal the entry/exit point.
result in swarming.
Any food left outdoors, such as pet food, picnic
The trap will be most effective if set about 4'
scraps, open garbage containers or uncovered
above ground.
compost piles should be removed or covered. Wasps
imprint food sources, and will continue to search an Control
area for some time after the food has been removed. If the nest can be found, control is simple. Simply
Be sure to cover drinks and open food containers, spray bendiocarb, carbaryl, chloropyrifos, diazinon,
keep a lid on the compost and avoid walking barefoot or resmethrin into the nest opening of the aerial
near fruit trees. Remove any fallen fruit rotting on nesters. Then wet the nest envelope. The nest may
the ground. be removed in a day or two. For ground nests dust
Avoid swatting. Swatting and squashing wasps is formulation of any of the above insecticides is
counterproductive. When a wasp is squashed, a preferable. Workers entering the nest will track the
chemical (pheromone) is released which attracts and dust into the nest and contaminate it. The problem
incites other nearby wasps. It's best to walk away is that it is most difficult if not impossible to track
from a hovering wasp. the nest.

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Spiders can be quite effective. Dust formulations are best

There are 35,000 species of spiders in the world. Most directed against web building spiders and to entry
spiders that are a cause of concern to the public and cracks and crevices for spiders entering from outside
which pest control experts are called upon to control of the structure. Space sprays are useful for spider
are either large or have striking marking. The large problems in confined areas when there is no hazard
spider is often thought to be a tarantula, and the to people using the structures. Residual sprays are
coloured one the black widow. Only a few species of usually applied to infested windows, corners,
spiders reside in dwellings and a larger number stray doorframes, roofs, and storage areas.
or are carried into the houses. Dust formulations for spiders include products
containing bendiocarb, diazinon, malathion and
The house spider
pyrethrum. Space sprays are DDVP, pyrethrum, and
The house spider is so cosmopolitan and so widely resmethrin. Residual formulations include those based
distributed that it is difficult to trace its original on bendiocarb, bromine, chloropyrifos, DDVP
homeland. The house spider selects its web sites at diazinon, malathion, propetamphos, propoxur,
random. If the web does not yield prey, it is abandoned pyrethrum, resmethrin, and runnel. Since all the
and another site is selected. Eventually the spider end materials are effective, control depends on using a
up constructing webs where food is most available. formulation that is effective against a spider species,
Control or group that gives the best result based on the habits
of the spider group.
It should be recognised that spiders are predators and
require prey to survive. However spiders stray into Bed bug
dwellings and other indoor habitats. In windows and
outdoor dwellings, spiders frequently construct webs This pest has plagued man since the dawn of
as insect prey may be attracted by the light or brought civilization. It is believed that the bed bug originally
in by the air flow. The removal of debris, lumber was associated with bats living in caves in the Middle
piles, and materials may reduce the presence of some East. It was in the caves that these parasites became
species. Care needs to be taken when using clothing, associated with man.
tents, sleeping bags, and other items left unused for Although this creature draws no line between the
long periods in areas where spiders are common. rich and the poor, its presence is more evident in the
Improved storage, use of air tight boxes and bags, quarters of the impoverished, owing to conditions
elevation of materials off the ground, discarding more favourable for its growth. Escaping through
unwanted items, and periodically sweeping or windows, they pass along walls water pipes, or gutters
vacuuming under furniture and behind mirrors and and thus gain entrance into adjoining houses. The
pictures are all helpful control measures. Thick leather bed bug is distributed readily in a laundry and on
gloves should be worn when cleaning areas infested clothes and baggage of individuals who have visited
with spiders. infested areas. This pest is disseminated primarily from
Spiders are easily susceptible to most modern one house to another by stowing away in furniture
insecticides. One consideration which is important and bedding that is being moved.
when web building spiders are being treated is their These creatures are very wary and cautious, and
habit of recycling silk. They chew up the old web their hiding place taxes the patience and ingenuity of
and consume the silk. They also have powerful man. Infestations can be detected by the bloodstains
digestive juices which dissolve the silk. This means on the walls or linen, and by the characteristic spots
that a dust formulation lightly applied to the web of excrement. In addition to their disgusting

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appearance, the bugs make a mess and they stink. it has been found that there are 1,700 species of these
The mess is due to their frequent excretion which insects in the world. While the mosquito is found
causes brownish yellowish or black spots on the walls abundantly in the tropical region, there are traces of
near the crevices where they hide. The dark marks them even in the Arctic region. Not all mosquitoes
are due to the presence of partly digested blood in are blood suckers, and most of them are attracted to
their faeces to make way for a fresh meal. light. Hence light traps are used in order to obtain
The bed bug plays an insignificant role in carrying information about them. Only the females suck
disease to man. However they do cause nervous and blood. The male feeds on pollen and nectar.
digestive disorders in sensitive persons. The house in The vast majority of them prefer water but some
which bugs are tolerated will be a home of live in salt marshes and brackish water. Still others
malnutrition, dirt and other causes of physical are happiest in water contaminated with sewage.
inferiority. Species that breed near houses and consistently enter
houses are called domestic mosquitoes. There are two
Control main types of mosquitoes - culicine and anopheline .
DDT which was once considered the best control The culicine type are painful biters and capable of
measure for bugs is today not effective. The bugs have transmitting certain diseases found in tropical areas
become totally immune to this insecticide. No matter such as yellow fever, filariasis and dengue fever. The
what insecticide is used, the pest control specialist must anopheline group are capable of transmitting malaria.
try and find their place of hiding. He must look for By and large, the mosquito constitutes a
any place that offers darkness, isolation and protection. hazardous pest in the house. Many species inflict
Spray of 1% malathion, 1% fenchlophos, 0.5% painful bites and some species do so at night.
DDVP, and 0.5% synegised pyrethrins have given Scratching the itching bite often sets up secondary
good results. Mattresses should be treated only at complications.
the seams and should not be soaked in spray.
Mattresses should be allowed to dry and should be Control
covered when used. Several residual sprays used as Various methods for the control of mosquitoes have
water emulsions and or oil-based solutions may be been developed. The ideal plan calls for a complete
used away from beds: 0.5% diazinon 2%malathion, survey of the district, the mapping of all breeding
and 1% fenchlophos. Hand spray is usually adequate places, and the identification of the species. This is
and spraying should be done early in the day so that necessary in order to determine the kind of
the insecticide can dry before the room is used for mosquitoes and their breeding habits. Control
sleeping. Lindane, malathion, pyrethrin or consists essentially of destroying the larvae and their
fenchlophos can be used to spray mattresses. breeding places. Tin cans and all objects that hold
Pyrethrum treatments need to be repeatedly given water are eliminated and the rain barrels and cisterns
on account of its limited residual action. Care should are treated periodically. Draining provides permanent
be taken not to sleep on a freshly sprayed mattress. control and is used to eliminate small pools, swamps
Treatment of infant crib and bedding should be and marshy areas; ditches, and creeks are cleaned up
avoided. so that water flows evenly and does not back up.
Areas of water that cannot be eliminated by draining
Mosquitoes or leveling are sprayed or dusted.
Mosquitoes received very little attention until it was Prevention of bites is an essential feature in the
found that they were the cause for malaria and other prevention of mosquito borne diseases. All buildings
disease. It was then that a study was conducted, and should be screened to prevent entry of these insects.

Housekeeping in Eye Care Services - A practical guide

94

Where there are no screens sleeping nets should be - Keep a section of yard open to sun and breeze
used. A mixture of indalone, Rutgers 612 and - Make a fire to create a dense, cool, low-hanging
dimethylphthalate is a good general repellent. Aerosol smoke. When smoke hangs around, the
bombs containing pyrethrum, rotenone or DDT are mosquitoes don't. This should not disturb the
patients
- Brush them off. Our most common mosquitoes
take several seconds after landing to bite

Rats
Rats, mice and squirrels are from the same family -the
Rodents. This group of animals is distinguished by
their teeth – large and chisel-like front teeth. They use
these teeth to gnaw through any kind of hard matter -
wood and cement walls. There are many kinds of rats
in the world, but only two kinds of rats the pest
control man deals with-the Norway rat and the roof
rat. The Norway rat is so called because it is believed
that they originated in Norway. They are larger, and
Fig 16.2 - Spraying to control mosquitoes
have larger droppings than the roof rat.
used to kill mosquitoes in small areas. DDT is used Roof rats also known as black or ship rat prefer
to spray wells and screens, and is effective for long warmer climate and upper floors of buildings. The
periods, but kills slowly, and should be used carefully. Norway rat prefers basements and often burrows
The aedes and culex remain in dark portions of the around water sewers, docks or wharfs. Rodents
building and bite during the day. Spraying will urinate and leave droppings on the food they eat.
destroy them and prevent the spread of dengue and Their hair also drops in these foodstuffs. Hence
filariasis (Fig. 16.2). Several types of small fish like humans should not consume food contaminated by
Fundulus and Gambusia are useful in controlling these creatures.
mosquitoes and are often introduced into ponds and In order to control rats the service man must be
other breeding places. able to predict:
1. Where the rat will be
Mosquito bite prevention
2. When the rat will be there
- Stay in the breeze.The mosquito can fly only
eight m.p.h., so it doesn't take much to waft her 3. What the rats will eat
away 4. How the rats react to strange items of food.
- Wear long, loose-fitting garb to keep the Rats are designed for darkness, and hence are
mosquito from biting through to skin. Earth hues active only at night. If rats are visible during the day,
disguise us in the woods; green is best, brown it means that the place is infested with rats. The rats
rates second. White masks your silhouette in depend largely on their sense of smell and touch. They
the open. Blue is worst; Mosquito mistakes it are suspicious by nature and do not touch or go near
for a flowering plant from which she draws anything unfamiliar to them. During inspection if a
sustaining juices. Red flags her in also, as well as rat trail is found, then it is very possible that the rat
other insects will come back again to the same area.

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Rats eat the same kind of food that we do and Making buildings rodent-proof
prefer fresh clean food. They eat large amounts of 1. Place a curtain wall or barrier of metal, or
the food that they like. Any new food is carefully concrete around and below the foundation of
examined by them and nibbled. If they do not like it buildings
they will not touch it again. If they do, they will 2. Wooden floors should be replaced with concrete
come back only after a period of time. Thus rats are
3. Close all vents around pipes with brick stone or
very clever to ignore poisoned food, however
cement
attractive the food may be. In the case of poisoned
food, if a few rats die after eating the food, other rats 4. Protect ventilator grills and low windows with
in the colony will not come anywhere near to it. galvanised steel mesh
5. Ensure that the clearance between the door and
The house mouse sill is not more than 3/8 “
Like the rat the house mouse is most active during 6. Flash cellar doors with 24 gauge galvanised sheet iron
the night, but unlike rats the house mouse is not 7. A metal cover with small perforations should be
suspicious; rather, it is curious. cemented over the drain pipes in the floors and
The control technique for the house mouse is openings around the drain
very different from rats. Hence the service person 8. Circular rat guards should be placed around
must know which of the two he is treating. vertical pipes and wires to prevent rats from
One common technique is baiting – combination climbing up
of food with toxic material. In order that this is effective,
Control
the serviceman must know what the rodents are eating
and where they are getting their food and water. Mechanical control
Another is traps. These will be effective only if Snap traps: trapping is done when the use of poisons
they are placed in the rodents’ route or trail. is dangerous. Traps can be used again and again. The
Elimination of rodent nesting place or hide-outs is bait should be tied securely to the trigger. This
another method of control. The rodents may be prevents the rodent from nibbling the bait without
nesting outside the building, but enter the building setting off the trigger. The bait may be food or cotton.
in search of food. We must find out the point of The rat uses the cotton for nesting.
entry. Rodents leave clues or signs in their path. Electromagnetic or ultra sound devices:
Correct reading of these signs will enable these electromagnetic devices work on the principle that a
servicemen to determine the kind of rodents, sources magnetic field produces a barrier which has a stunning
of food and water, where the trails are located where effect on the rodents. The ultrasonic device works
they are entering the building and where they are on the principle that certain high frequencies and
nesting. In order to keep their teeth in good amplitudes of sound are irritating. Ultrasonic sounds
condition, the rodents gnaw on hard surfaces. This is are directional and rodents seek shelter behind solid
a big tell tale mark to know that rodents are around. objects. In such cases there should be alternate use of
Rodents also like to touch or be in contact with walls baits and traps in these shadow zones.
and other surfaces as they travel. This habit of theirs
leaves rub marks on the walls. Chemical control
Once a rat is killed it should be picked up with a ANTU: this kills rats by causing acute lung dropsy
pair of tongs gloved hands or a stick. If the fleas should and an accumulation of fluid in the chest cavity. Death
bite the serviceman, it will transmit the disease to usually occurs within 12 – 48 hours. ANTU should
him. All dead rats should be buried. be thoroughly mixed into the bait
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96

Arsenic: this chemical is odourless and tasteless, and should be such that it prevents future re-infestation
is therefore easily taken by the rat when mixed with through the foundation. This is achieved by four
food. However, on account of the very same technical operations.
properties, care should be taken that it is not tructural
Str uctural alterations: This includes any structural
accidentally consumed by humans. operation which renders a structure less susceptible
B arium carbonate: This too is tasteless and to termite attack or which renders the immediate
odourless, and inexpensive. The toxicity of this poison surroundings of a structure less favourable to
is not very consistent. Some rats die after consuming termites.
very little of it, while others are no affected. treatment: chemicals are applied to the soil
Soil treatment
hosphorous
Phosphor ous paste: This material is spread between immediately adjacent to or under a structure for the
two slices of bread in the form of a sandwich. Since purpose of eliminating existing infestations and
phosphorous glows in the dark, one need to be creating an insecticidal barrier.
careful. It dissolves easily in fats, and should therefore Foundation tr treatment:
eatment: this involves application of
be used with greasy baits. chemicals to any type of foundation for preventing
luoroacetamide:
Fluor oacetamide: This is used for the control of access to termites.
sewer rats, as it can be used in water baits. Wood tr treatment
eatment: chemicals are applied to wooden
eatment
S t rryy chnine: This is extremely poisonous and members of the structures to render them resistant
characterized with very rapid action. However it has to termites.
a bitter taste and is not generally taken by rats.
Pre construction termite treatment
Z inc phosphide: This too is a quick killing
rodenticide. However it has a strong garlic – like - Treatment to the bottom of trenches upto 30cm
odour, which alerts rats when mixed in food. height
- Treatment to the sides of the foundation after
Termites the backfilling is done
Termites are insects that cause serious damage to wood - Treatment to the wall and floor joints, and under
and paper. They actually eat wood as food, and like the floors
ants, live in colonies. - Treatment to the external perimeter of the
There are three types of termites – the subterranean, building upto a depth of 30cm.
the damp wood and the dry wood termites. The For a demonstration on pest control, please watch the
subterranean termite lives in the ground which provides video of the CD.
the dampness required for it to stay alive. The damp
wood termite needs a lot of moisture to survive, but Student exercise
does not need to return to the ground. It can stay in
the wood which is close to the ground or near a leaking Answer the following
roof. The dry roof termite is often found living in 1. What are the common pests in a hospital?
desert areas. They do not need water or moisture to 2. Why is it necessary to have regular pest control?
survive and can nest in dry seasoned wood. 3. What measures will you take to rid the hospital of
cockroaches?
Post construction termite treatment 4. What measures will you take to reduce flies and
White ants attack a building from their colonies under mosquitoes?
its floor or from outside or both. Any treatment given 5. How will you deal with a problem of rats?

©A R A V I N D E Y E C A R E S Y S T E M
CHAPTER 17 INFECTION CONTROL

CONTENTS
Infections and precautions in a hospital
Housekeeping and infection control
Infection control in the linen department
Housekeeping in the isolation ward
Housekeeping in the operation theatre
GOAL
To maintain an infection-free hospital
OBJECTIVES
To familiarise the trainees with
- Infection control, sterilisation and disinfection
- The role of housekeeping in infection control
 CHAPTER 17
Infection Control
In order to provide better and safer hospital facilities Several surveys of infections in developed countries
for its patients and personnel, the Health Care have shown that occupationally acquired infections are
Institution has to adopt a programme of infection greatest among some categories of health care workers
control involving all sections of the Health Care (HCW) such as medical and technical staff, attenders
Centre. and cleaners, while such risk is low among secretarial
A satisfactory infection control programme staff. This is essentially because of their coming into
requires the co-operation of all personnel involved contact with pathogens or infected specimens.
with patients. Any break in technique or lapse in The most effective method of preventing
discipline on the part of one person can render the occupationally acquired infections is adopting safe
efforts of a number of conscientious individuals working practices. Based on the risk assessment of
ineffective. It is only through co-operative efforts of the staff, specific protection may be recommended.
every member of the staff that nonsocomial The assessment takes into account the pathogens they
infections can be prevented. may be exposed to, the local epidemiology of the
Nonsocomial infections are defined as infections disease, the nature of specimens/infective material
acquired during or as a result of hospitalisation. The handled the frequency of exposure/contact with
patients neither have these infections nor are potentially infected material or patient. Staff
incubating these infections on admission. Generally considered to be at risk should be offered specific
a patient who develops an infection after 48 hours of protection, including immunisation.
hospitalisation is considered to have nosocomial Safety education must be given at the time of
infection. However, nonsocomial infection may not employment. A video on universal precautions should
manifest as disease immediately and may manifest as be screened and the employee should secure a certain
disease only after discharge. score on a questionnaire that follows. All staff should
be informed of the need to report exposure to blood
Infections and precautions in a hospital or potentially infectious body fluids to the duty doctor
without any delay. Other health and safety education
Objectives of an infection control should also be carried out as appropriate.
programme
1. To develop written policies and procedures for Rules of universal precautions
standards of cleanliness, sanitation and asepsis in - Consider all patients potentially infectious
the hospital - Assume all blood and body fluids and tissue
2. To interpret, uphold and implement the hospital contaminated with blood borne pathogens
infection control policies and procedures in - Assume all unsterile needles and other sharps are
specific situations similarly contaminated
3. To provide surveillance for nonsocomial infections
4. To review and analyse data on infections that What does one need to do?
occur, in order to take corrective steps 1. Hand washing: Hands should be washed if
5. To develop a mechanism to supervise infection contaminated with blood or body fluids and after
control measures in all phases of hospital activities removing the gloves
6. To provide for continuing education of 2. All HCWs should routinely use appropriate
employees on infection control aspects barrier precautions when exposure to blood or
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potentially infected body fluids is anticipated. Surfaces of large equipment should be disinfected
These include: with 1:100 dilution of sodium hypochlorite or
- Use of gloves for contact with blood, an approved disinfectant. Heavily soiled
potentially infectious body fluids, mucous equipment may require additional cleaning with
membranes or non-intact skin in ALL detergent and water. Gloves must be worn while
patients. Gloves should also be used for cleaning the equipment
handling items or surfaces soiled with blood 5. Waste Disposal : Non plastic items soiled with
or body fluids and for performing blood, bloody drainage, or potentially infected
venipuncture or other vascular access material must be placed in the yellow biohazard
procedures. Gloves should be removed before plastic bags. Items that may tear the bag must
leaving the patient’s bedside not be put into the bag. Excreta, blood or body
- Masks and protective eyewear should be used fluids must be emptied down the drain with
for procedures likely to generate droplets of adequate amount of water
body fluids or blood that could lead to 6. Linen: Linen soiled with blood or potentially
contamination of eyes, nose, or mouth infectious body fluid must be soaked in Lysol
- Appropriate protective clothing such as for 60 minutes, placed in a leak proof bag and
gowns, aprons, surgical caps, and impervious sent to the laundry
shoes should be worn if there is a risk of 7. Spill clean up: Cover spills of blood or body
exposure. The type and characteristics of the fluids with Dakins solution or 1:10 to 1:100
attire worn will depend on the task and degree dilution of freshly prepared sodium hypochlorite
of exposure anticipated. All protective or household bleach for 10 minutes. Then mop
clothing and equipment must be properly dry. A second decontamination may be done if
discarded or decontaminated before leaving required. Wash the area with detergent and water.
the work area Gloves must be worn during cleanup and
3. Proper disposal of needles and sharps: Needles decontamination procedures
and sharps are the commonest mode of
Disinfection and sterilisation
transmission of blood borne pathogens to
HCWs. Precautions should be taken to prevent Sterilisation is defined as a process where all microbes
injuries by sharp instruments, especially hollow are removed from a defined object, inclusive of
bore needles that have been used for bacterial endospores. Disinfection is a process where
venipuncture or other vascular access procedures most microbes are removed from a defined object or
- Needles should not be recapped, bent or surface, except bacterial endispores. Certain chemicals
broken by hand. Disposal needles and other are capable of sterilising an object if exposed for long
sharps should be disposed of immediately after periods of time, and serve as disinfectants at shorter
use into puncture resistant containers which exposure time. However, a common practice is to
should be located at the site of the procedure call all chemical agents as disinfectants - a misnomer.
- If a needle has to be removed from a syringe, Disinfectants can be classified according to their
use forceps or do it with utmost care ability to destroy these categories of microorganisms.
- Do not overfill a sharps container The agent which destroys only vegetative bacteria is
termed a low level disinfectant. If the agent is capable
4. Disinfection of instruments: Re-use instruments,
of rendering myco-bacteria non-viable it is termed as
tubings, etc. only after decontamination and
intermediate level disinfectant. It is a safe assumption
sterilization. Do not touch the equipment with
that all the other categories of microbes which are
soiled gloves or gloves used for patient care.
Housekeeping in Eye Care Services - A practical guide
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classified more susceptible are also destroyed if efficacy 11. Toilets are cleaned with a brush using a detergent
against myco- bacteria can be demonstrated. High twice a day. Disinfection may be done using 7%
level disinfection is in other words sterilisation Lysol. A stain removing liquid can be used once
wherein all microbial life is destroyed inclusive of a month to remove stains
endospores. 12. Wash basins are to be cleaned with vim powder
every morning and with the stain removing liquid
Housekeeping and infection control once a month
The following procedures need to be followed by 13. Regular AC maintenance is a must. The AC
the housekeeping department in order to maintain a section should draw up a protocol for this
zero percent infection rate in the hospital:
1. The floor should be cleaned at least 4 times in Infection control in the linen
24 hours. Detergents and copious amount of department
water should be used during one cleaning. Lysol - Bed linen is to be changed once in 2 days and
or any other equivalent disinfectant may be used whenever soiled with blood and body fluids
to mop the floor for the remaining times
- Patient’s gown is to be changed every day and
2. The walls are to be washed with a brush, using whenever soiled with blood and body fluids
detergent and water once a week
- Dry dirty linen is to be sent to the laundry for
3. High dusting should be done once a week with a
regular wash
wet mop
- Linen soiled with blood or body fluids and all
4. Fans and lights should be cleaned with soap and
water once a month. This should be handled by linen used by patients diagnosed to have HIV,
the electrical department HBV, and MRSA is to be decontaminated in
the ward by soaking in 7% Lysol for at least 1
5. All work surfaces are to be disinfected by wiping
hour and then sent to the laundry
with 7% Lysol and then cleaned with detergent
and water twice a day Rubber goods
6. Cupboards, shelves, beds, lockers, IV stands,
Rubber goods are to be cleaned with soap and water,
stools and other fixtures are to be cleaned with
disinfected with 7% Lysol, dried in the sun, sprinkled
detergent and water once a week
with powder, rolled and stored.
7. Curtains should be changed once a month or
whenever soiled. These curtains are to be sent for Thermometer solution
regular laundering. In certain high risk areas such Separate thermometers are recommended in intensive
as the ICU and transplant units more frequent care units, nurseries and transplant units. In areas
changes are required where a common thermometer is used, it is
8. Patient’s cot is to be cleaned every week with disinfected between patients by immersing it in
detergent and water. 7% Lysol is to be used when thermometer solution (containing alcohol) for 5
soiled with blood or body fluids. In the isolation minutes. After disinfection, the thermometer is
ward, cleaning is to be done daily washed and kept dry or immersed in alcohol. Empty
9. Store rooms should be mopped once a day and the water from the container when not in use, and
high dusted once a week keep it dry. The thermometer solution should be
10. The floor of bathrooms is to be cleaned with a changed once in three days. The date of change of
broom and detergents once a day. For disinfection the thermometer solution should be written on an
7% Lysol can be used adhesive tape which is stuck to the tray.

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Miscellaneous items d. The bathrooms should be cleaned with detergent

K basins, bed pans, urinals, etc. are to be cleaned and disinfected with 7% Lysol
with vim powder and water and disinfected with
At discharge (terminal disinfection)
7% Lysol.
- Keep an ultra-violet light in the room facing each
Metal buckets are to be cleaned with vim powder direction for half an hour in a 2 bedded room
every week. Dustbins are to be cleaned with detergent and 1 hour in a 4 bedded room
and water every morning and then with dettol
- The pillows and mattress are to be cleaned with
solution.
detergent, disinfected with 7% Lysol and dried
Housekeeping in the isolation ward in sunlight for 24 hours
- Bed sheets, curtains, gowns and dusters must be
Before admission removed, soaked in 7% Lysol for one hour and
The admitting physician should inform the sister in then sent to the laundry
charge of Isolation Ward at least one hour prior to - After disinfection, wash the room, walls,
admission, mentioning the diagnosis, sex and the windows, doors, bathrooms, sink and furniture
general state of the patient. with soap solution after doing thorough high
dusting in that cubicle
Pre-requisites for Isolation - Soaked bed pan, urinal, kidney basin in Lysol
- A source of running water should be available at solution for one hour, wash with detergent and
the entrance of each room to facilitate hand washing dry it under sunlight
- The mattress and pillow should have an - Bath basins, multi-bin, bucket, jugs, mugs are
impervious cover such as mackintosh so that it washed with solution and dried in sunlight
can easily be damp dusted - Rubber sheets are to be cleaned with Lysol, dried,
- Clean gowns should always be available powdered and replaced
- Separate urinals, bed pans and thermometers are - Soak the thermometer tray and its contents in
to be used for each patient 7% Lysol after cleaning. Utensils used by the
- A bin lined with appropriate colour coded plastic patient are washed, boiled and replaced
cover should be available in each room for
disposal of medical waste Housekeeping in the operation theatre
- Rooms should be isolated according to disease Theatre complex should be absolutely clean at all
conditions and should be well lit times. Dust should not accumulate at any region in
the theatre.
Cleaning procedure for isolation ward
Soap solution is recommended for cleaning floors
a. Linen should be stripped from the bed taking and other surfaces. Operating rooms (ORs) are
care not to shake the linen during this action. cleaned daily and the entire theatre complex is cleaned
The linen should then be soaked in 7% lysol thoroughly once a week.
solution before sending to the laundry
b. All other articles like IV stands, and furniture Before the start of the first case
should be cleaned with detergent and disinfected Wipe all furniture, equipment, room lights, suction
with 7% Lysol solution points, OR table, surgical light reflectors, other light
c. Walls should be cleaned with detergent and fittings, slabs with soap solution. This should be
disinfected with 7% lysol completed at least one hour before the surgery.

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After each case - Clean doors, hinges, facings, glass inserts, and
rinse with a cloth moistened with detergent
Linen and gloves
- Wipe down walls with clean cloth mop with
Gather all soiled linen and towels in the receptacles detergent
provided. Take them to the service corridor (behind - Scrub floor using detergent and water
the theatre) and place them in trolleys to be taken
- Stainless steel surfaces - clean with detergent, rinse
for sorting. The dirty linen is then sent to the laundry.
and clean with warm water
Use gloves while handling soiled linen.
- Replace portable equipment: clean wheel castors
Instruments by rolling across toweling saturated with detergent
Used instruments are cleaned immediately by the - Wash (clean) and dry all furniture and equipment.
scrub nurse and the attender. Reusable sharps are (OR table, suction holders, foot and sitting
decontaminated in Lysol / hypochlorite and then stools, Mayo stands, IV poles, basin stands, X-
washed in the room adjacent to the respective OR ray view boxes, hamper stands, all tables in the
by scrubbing with a brush, liquid soap and vim. They room, hoses to oxygen tank, kick buckets and
are then sent for sterilization in the TSSU. In the holder, and wall cupboards)
septic theatre alone the instruments are sent in the - After washing floors, allow disinfectant solution
instrument tray for autoclaving. Once disinfected, to remain on the floor for 5 minutes to ensure
they are taken back to the same instrument cleaning destruction of bacteria
area for a manual wash described earlier. They are - Do not remove or disturb delicate equipment
then packed and re-autoclaved before use. - While wiping cabinets, see to it that the solution
Environment does not get inside and contaminate sterile supplies
Wipe used equipment, furniture, OR table, etc. with - Operating rooms and scrub rooms should never
detergent and water. If there is a blood spill, disinfect be dry dusted
with sodium hypochlorite before wiping. Maintenance and repairs
Empty and clean suction bottles and tubing with - Machinery and equipment should be checked,
disinfectant. cleaned and repaired routinely on Sundays
After the last case - Urgent repairs should be carried out at the end
of the days list
The same procedure as mentioned above is followed
- Air conditioners and suction points should be
and in addition, the following are carried out.
checked, cleaned and repaired on a weekly basis.
- Wipe overhead lights, cabinets, waste receptacles,
- Preventive maintenance on all theatre equipment
equipment, furniture with a detergent
is to be carried out every Saturday, and major
- Wash floor and wet mop with liquid soap and work to be done at least once a year.
then remove water and wet mop with a
disinfectant solution Student exercise
- Clean the storage shelves, scrub and clean sluice Answer the following
room 1. What are the steps needed to be taken to keep the
hospital infection free?
Weekly cleaning procedure 2· What measures does housekeeping take in the OT?
- Remove all portable equipment 3· What is the role of housekeeping in keeping the
- Damp wipe lights and other fixture with detergent hospital free of any infection?
©A R A V I N D E Y E C A R E S Y S T E M
CHAPTER 18 GENERAL MAINTENANCE DEPARTMENT

GOAL
Maintenance of electrical equipment
Maintenance of taps, pipes and drains
Maintenance of wooden fixtures / furniture
GOAL
To ensure smooth running of the hospital by carrying out regular maintenance and
repair
OBJECTIVES
To teach the trainees
- How the maintenance of electrical equipment is carried out
- Maintenance of plumbing works
- Maintenance of wooden furniture and fixtures
 CHAPTER 18
General Maintenance Department
For the hospital to function smoothly it is necessary should function well. Any problem with electrical
to prevent breakdown of infrastructure or try to keep fittings causes a lot of discomfort to the patients and
breakdown at a minimum. This includes civil work, the staff. Hence it is absolutely essential for the
plumbing, carpentry and electrical. The housekeeping housekeeper to visit the patients’ rooms and the office
department therefore has to work closely with the sections every day to check if the electrical fittings are
General maintenance department functioning properly. If the light is flickering, or not
functioning in any room, if the fan or AC is not
Maintenance of electrical equipment working, or is making a sound when switched on, it
The maintenance of the electrical equipment is the should be noted down immediately in the handbook,
most important job of the housekeeper. Electrical mentioning the room no, area of the hospital and the
fittings and equipment such as the fans, lights, defect. These details should be given to the Electrical
refrigerators, and others are used daily in all the areas maintenance department and the housekeeper should
of the hospital. It is therefore essential that they ensure that immediate action is taken.

Format of the maintenance of electrical equipment/fittings

Sr.no
.no.. Date Room Defect Date of Date of Signature of Signature of
no registration completion housekeeper electrician

Fittings and equipment the housekeeper - It is important to ensure that the fan is working.
should check and record in the maintenance If there is an unusual sound while functioning,
register make a note and get it repaired. Also check the
regulator and get it repaired if needed
In the patients’ rooms
- If the room is air conditioned, ensure that the
- Operate the switches on the switch board and
AC is working soundlessly. Any disturbance
ensure that they are working. Note down any
should be noted down and rectified
fault in the register
immediately
If the tube light is not functioning properly, the
housekeeper should try and adjust the starter. If Other equipment
it still does not function, then have the tube - If water filled and kept in the refrigerator does
replaced. If the light still doesn’t function, have not chill in the stipulated time, the refrigerator
the choke replaced should be checked and the fault should be
- Check the night lamp. Replace it if it is not corrected. This can be done with the help of the
functioning general maintenance department
 105

- The water heater or geyser is a dangerous appliance. not hold the pipes when going up and down the
It is very important to handle this with care. It is stairs. Do not shake them or use them as supports
essential to find out if this appliance gives a shock when standing near them. This will make them
when it is functioning. Wearing footwear is a must loose and weak. If pipes have come off the wall
when checking this out. Do not touch it with wet due to the clamps being broken, have them fixed
hands. Check if it heats the water in the stipulated again with the help of a plumber. Pipelines
time. If there is any defect, it should be noted down connected at ground level should not be trampled
in the register and immediate action should be upon
taken to rectify the fault - Pipelines are usually straight. If they have to be
- Similarly, the vacuum cleaner and the stain taken around the curves of the buildings, they
removing/polishing machine should be checked are connected with the help of elbow fittings.
out, and any faults should be noted down and Sometimes these fittings become loose, and water
rectified with the help of an electrician starts to leak. This should be rectified
immediately
Maintenance of taps, pipes and - If the taps are connected very close to the wall on
drains account of short pipes, water will be wasted. Due
Water required for the bathroom and the toilets is to leakage of water and the closeness of the tap
supplied through the pipes. Taps may leak since they to the wall, there will be stains on the walls. Hence
are opened and closed several times during the day, taps should always be fitted leaving enough room
and this damages the washers. If this is not rectified between the tap and the wall
immediately, not only is water wasted, but the salt
Problems that develop in a wash basin
deposits from water will leave stains on the floors
and in the wash basins. Saving water is an important Waste coupling
task of the housekeeper. The method of using water - If the waste coupling is broken or the groove is
without wastage is explained in this lesson. worn out, the coupling should be changed
Maintenance of taps - If the sieve is worn out, the waste water will
- Close the taps tight to prevent water from leaking remain at the bottom and water cannot flow into
the inner pipe. It therefore starts to flow out. To
- If the water continues to leak even after closing
avoid this, a new coupling needs to be fitted
the tap tight, open the tap and check the washer.
If required, change the washer Waste pipe
- If the tap still continues to leak, check the grooves The wash basin should be checked for any leak in
in the tap, and if they are worn out, have the tap the pipe through which the waste water goes down.
replaced If a leak is found, try and tighten the pipe fitting. If
the leak still persists, check if there is a crack in the
Maintenance of pipelines
groove. If so, replace the pipe.
The pipeline is most important for water supply. We
use either iron pipes or PVC pipes. Problems that arise in a western closet
- Pipelines are connected along the wall to the toilets - If there is a leak in the flush tank, it means the
and bathrooms. Elbow clamps, unions and washer inside the tank is not functioning. The
threads are used to make these connections. Do washer therefore needs to be replaced

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- There is a nylon rope present on the flush tank If any of these is broken, have it replaced
between the handle and the valve. If this rope is immediately to prevent any damage to the glass
worn thin it has to be replaced windows and the door hinges
- Since the handle of the flush is being used several - Check the furniture such as tables and chairs in a
times a day, and by so many different people, it room. If any repair needs to be carried out, attend
may break and stop functioning due to rough to it immediately. If they are irreparable remove
use. It needs to be replaced them from the room and replace them. The
- A block in the plastic bend due to salt accumulation condemned furniture should be put into the store
can be removed using hydrochloric acid room till the hospital decides what to do with it.
- In course of time, due to wear and tear, the cup - Check the window frame, the glass pane, and
in the bend may break and will have to be replaced the windows for damage. If the glass is broken,
- The bend in the flush tank should be replaced have it replaced
when it has become old - The lower portion of the bathroom doors gets
- If the flush tank overflows the valve needs to be wet, and hence the wood decays. Check these
checked, and replaced if required regularly and have them repaired. It is advisable
to nail an aluminum sheet to the lower half of
Maintenance of wooden fixtures/ the door and have it painted. This will prevent it
furniture from decaying
- Check the latches and the handles of the doors
The proper maintenance of wooden fixtures/
for any repair that may be needed
furniture in a hospital is very important, and is second
only to maintaining electrical equipment. Similar to - It is not enough to check and note down the
noting down the defects in the functioning of the damage. It should be repaired immediately by
electrical equipments in all the areas of the hospital calling the carpenter. This is the responsibility of
and in the patients’ rooms, it is important to note the housekeeper
down the defects, if any, in the doors, windows, tables Student exercise
and chairs. This should be done regularly.
Answer the following
Maintaining wooden fixtures in a room 1. Why is maintenance important for a hospital?
- When opening and closing doors pay attention 2. What are the things we need to look into to ensure
to the hinges. If the hinges are squeaking, get it smooth functioning of electrical items?
rectified immediately. The squeaking noise 3. What are the things needed to be done to ensure
irritates the patient and aggravates his pain no problem in plumbing?
- Check the hooks, latches and door stoppers that 4. How will you ensure that the wooden furniture
prevent the doors and windows from banging. and fixtures are well maintained?

©A R A V I N D E Y E C A R E S Y S T E M
CHAPTER 19 CREATING A GOOD AMBIENCE IN THE HOSPITAL
AREA

CONTENTS
Factors that decide the interiors
Components that make up interiors
Colours
Making beautiful articles for interiors
GOAL
To create a pleasant ambience
OBJECTIVES
To help the trainees
- To be creative by training them to make articles for interior decoration at affordable
price
- To cultivate an aesthetic sense in the trainees
 CHAPTER 19
Creating a Good Ambience in the Hospital Area
Creating a pleasant and classy ambience is also one of Geographic and climatic factors
the several jobs of the housekeeping department. This The colours, curtains, tapestry, etc. will depend on
is not easy and requires a good eye for detail. A person the place and the climate. eg. we will not use a wall
who is artistically inclined can turn an ordinary room carpet in a place that has a hot climate.
into a beautiful one at very little cost. Some people
are naturally aesthetic; others have to cultivate the Tradition
art. While it may be said that this work is an art, it is This plays a vital role in planning the layout.
not difficult to learn what goes into creating a pleasant
atmosphere. Following certain rules, and being Availability of materials
imaginative, one can make a room aesthetically It is easier and more economical to use materials
pleasing to the eye. Pictures, colours, show pieces locally available. Hence plans should be made
and curtains can beautify a room. Carpets, lamps, accordingly
tables and chairs should be collected in order to
Socioeconomic conditions in the area
arrange a room. The skill of the housekeeper lies in
positioning these things appropriately to lend grace The building should fit in with the general economic
and beauty to a room. conditions of the area. A very ornate building in an
area that is economically backward will look out of
Why do we need to decorate the interiors? place.
- Adds beauty and colour to the room : A room that
is tastefully done is certainly pleasing to the eye
Components that make up interiors
- Gives the room a personal touch: When care has Furniture
been taken to decorate a room, it adds warmth
Selection of furniture should be based on
to the room. A pleasantly decorated room helps
the patient to recover faster - Size of the room
- Colours and lighting affect the mood and A large room with very little furniture looks bare
behaviour: Colours have a definite effect on the and unseemly. Similarly a small room with large
mood of the person in the room. Hence this pieces of furniture or too much furniture looks
aspect of interior decoration has to be very cluttered
carefully looked into - Comfort
Furniture should be comfortable rather than
Factors that decide the interiors ornate or fashionable. When buying furniture,
Purpose of the building thought should be given to the fact that people
The interiors differ from building to building. The of different heights and girths, and different
interiors of a hotel will differ from that of an office backgrounds will be using the room
building or a hospital. - Affordability
 109

Draperies - Can be used as fillers on shelves

Draperies, which become a part of the background In order that the photo/picture fulfills its purpose,
contribute to the appearance in the following ways: care should be taken when framing it. The mount
- Blend various colours used on the walls, floor and frame should be carefully chosen, not only
and furniture to make the picture attractive, but to go with
- Soften or accentuate the lines of a room the walls or shelves
- Can be used to offset architectural problems Colours
Carpets Colours play a vital role in interiors, as colours have
Carpets lend elegance and class to a room. A large healing as well as disturbing effects. They can be
carpet or a number of small rugs tend to break up introduced into a room by the use of pictures,
the floor area and reduce the room space. However, cushions, lamp shades, flower arrangements, and
in the end they can bring colour, pattern and texture other accessories like waste paper baskets, and ash
to an otherwise plain floor. A patterned carpet is trays.
usually chosen for larger rooms with plain walls. - Red, peach and yellow give an illusion of warmth.
They also make the room seem smaller
When selecting a carpet the following points need
to be kept in mind: - Blue and green appear cool, and make the room
seem larger
- The colour of the carpet should match the walls
and the table in the room - Red and gold are associated with formal occasions
- A carpet with a lot of design is not suitable for a - Purple is associated with status
hospital room. The carpet should be simple with - Black is looked upon as a colour of death and
very little or no design depression
Hence colours have an effect on emotional health,
Maintaining a carpet and affect both mood and behaviour
- When the carpet is new, small bits of thread will
fall from it when brushing or cleaning. Hence Colour wheel
the cleaning should be done carefully and gently
- If any thread is protruding, it should be carefully Yellow
cut with scissors, and not pulled out by hand Red Orange
- The furniture on the carpet should be gently lifted Orange
Orange
when moved, and not dragged. Dragging will
spoil the carpet
Yellow
Pictures/Photos Red Yellow Green
Pictures and photos can be used to add colour to a Red
room. The colours in a picture can be used to Purple
Purple Blue
complement another colour. The size of the picture Green
depends on the wall space available and the general
décor of the room. Blue
Blue Green
Pictures and photos usually are used to
Purple
- Enhance the walls

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Colour combinations Flower arrangement

Of all the various skills that go into making a room
Monochromatic colour harmony
look beautiful, flower arrangement is the most
This makes use of values and intensities of a single important. Flowers and indoor plants add colour and
colour eg. light blue, medium blue and dark blue. beauty to a room. Flower arrangement is an art, but
Sometimes an accent colour (contrast) is added in the can be learnt. The arrangements may be circular, semi-
form of pictures, pillows, or drapes. Eg. with blue circular, or triangular.
(cool colour), the accent may be red or yellow (warm).
- The vase should be positioned in a prominent
Complementary colour schemes place
This a combination of any two complementary - The table cloth should be selected to blend well
colours (colours opp. to each other on the colour with the colour of the vase and of the flowers
wheel). Complementary colours are best used in - The flowers should be 1.5” above the neck of
unequal amounts - one colour is dominant and the the vase
other is used as accent. eg. bright red and bright green - Adding a pinch of salt and sugar to the water
cannot be used in equal amounts. They must keeps the flowers fresh
complement each other. - A wooden stick helps climbers (money plant) to
grow in the direction we want
Analogous colour harmony
- Before placing the flowers in the vase, cut the
This is achieved by using colours adjacent to each stem in a slant and immediately put it in water.
other on the colour wheel. This is pleasing to the eye This helps the plant take in water and remain
as they are related by a common colour.eg. blue, blue- fresh. Never break the stem or bend it
green and green.
- Wash the flowers and check for worms and insects
Lighting before arranging them
Artificial lighting is an important factor of designing. - Do not keep the flower vase directly under the
fan or directly in the sunlight. The flowers will
- The type of lighting and the intensity of lighting
wither and die
in an area depends on the specific function of the
area Making beautiful articles for interior
- The type of fixtures used should be such that
decoration
they are easy to clean
Decorative articles play an important role in the
Decorative pieces interior decoration of a room. They may be wooden,
- These are used to enhance the look of shelves, clay or metal articles with minute artistic work done
corners and table tops on them. Simple clay articles can be decorated and
- They must have a theme eg. one should not mix used to beautify a room by
terracotta items with marble statues, or cut glass - Pasting figures
- They should not clutter a shelf or the room. They - Egyptian artifacts
should be well spaced out, and blend in with the - Printing
rest of the room - Glass and “chamki” work

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Pasting figures gold and bronze fabric paint, varnish, kerosene, paint
Using our imagination we can make figures and paste brush (no.0 or no.1)
them on the vases and pots. This enhances the beauty
Method
of these objects.
- Make the large mud pot smooth by using sand
Materials paper
Mud pot, white cement, fevicol(glue), enamel paint, - Mix white cement, water and fevicol to form a
varnish, kerosene, artist’s paint brush (no. 0 or no.1) batter of the consistency of idli(pancake) batter
- Pour this batter into a plastic bag
Method
- Twist and fold the plastic bag to form a cone
- Rub the outside of the pot with sand paper to and close it with the help of a rubber band.
make it smooth
- Cut a small hole at the apex of the cone
- Prepare dough with white cement, water and a
- Using the cone like in applying mehendi or icing
little fevicol
on a cake, use your imagination and draw images
- Prepare figures using this dough. This should be on the pot
done before the dough becomes dry and hardens.
- After these images are dry, paint the pot using
You can prepare flowers, dolls, animals or birds
the black enamel paint
with the dough
- Then brush the pot with metallic bronze or gold
- Paste these figures on the pot using fevicol
paint
- After these images dry, paint them using the artist’s
- After the paint dries, varnish it
paint brush with vibrant colours
- The plain mud pot has been transformed into a
- Paint the pot with black enamel
beautiful and seemingly expensive bronze one
- Varnish the pot after the paint has completely
dried up. This helps to make the pot look more Printing
attractive
Materials
- The pot is now ready for use as a decorative piece
or a flower pot in any room Mud pot, sand paper, lady’s finger, enamel paint,
varnish, blade, paint brush (no.1)
- Ensure that the flowers put into the pot do not
clash with the colour of the figures painted on Method
the pot - Make the outer part smooth with the help of
- These would look very good in the reception sand paper, and then paint it with black enamel
area, classrooms or the dining hall paint
- Cut the lady’s finger with a blade, into two parts.
Egyptian artifacts
- Take one part and push the seeds inside using a
This type of hand work helps to convert a simple
stick
and inexpensive mud pot into a beautiful and
expensive looking pot. - Now dip this in metallic gold paint and stamp it
on the pot
Materials - Do this several times till the pot is printed all
White cement, fevicol (glue), plastic cover, rubber over
band, big flower pot, enamel paint, metallic copper, - Now varnish the pot

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Glass and “chamki” work For a demonstration on painting and decorating flower
vases, please watch the video of the CD.
Method
- Smooth the pot with the help of sand paper Student exercise
- Paint the pot neatly with black enamel paint
Answer the following
- Using our imagination and paste the mirrored 1. Why is interior decoration important in a hospital?
glass or “chamki” to form patterns on the pot
2. What are the factors on which interior decorations
Key points to remember depend?
3. What are the components that play an important
- The pot should be evenly painted. Move the brush role in decorating the interiors?
either length wise or breadth wise. If the direction
4. Explain the effect colours have on the mood and
is not maintained, it will show in broad lines and behaviour of people
will look ugly 5. What are the points to be kept in mind when
- It is important to wash the brush in kerosene after arranging flowers?
use. Otherwise the bristles will stick together and 6. Explain any one method of decorating a simple
the brush will become useless clay pot.

©A R A V I N D E Y E C A R E S Y S T E M
CHAPTER 20 HORTICULTURE AND GARDENING

CONTENTS
Cultivating a garden
Maintenance of a garden
Expanding the garden
Plants in interior decoration
GOAL
To create pleasant hospital grounds by gardening
OBJECTIVES
To teach the trainees how to
- Plan a garden
- Mix manure
- Expand an existing garden
- Maintain a good garden
- Watering
- Pruning and shaping trees and plants
- Weeding
- Cleaning
- Maintain indoor plants
 CHAPTER 20
Horticulture and Gardening

Horticulture and garden beauty and the second on the backside to supply the
maintenance necessary vegetables to the kitchen. The plan and
position of the garden should be settled before the
Cultivating and maintaining a garden is an art. A building is constructed.
garden is not only aesthetically pleasing to the eye,
but plays an important role in providing a clean and Selection of trees, plants and creepers
fresh environment. With the rising pollution a
Selection of plants needs to be given a lot of thought.
peaceful garden can visually dissociate the hospital
The type of trees, plants and creepers should be
from the urban grime. The trees and plants create a
appropriate and should suit the surroundings.
green landscape, which is the most soothing colour
to the eye and can help the patients relax. Maintaining Trees
a fertile and beautiful garden requires hard work,
Trees that will provide more shade and trees that bear
meticulous care and attention. However, gardens can
flowers throughout the year should be planted
also be beneficial to the gardeners since the act of
outside the hospital and near the compound wall.
gardening has been known to relieve stress.
Plants
Equipment and materials
- Flower pots Plants can be reared in two ways - in the soil, and in
pots. Crotons and flowering plants can be planted
- Red mud
on both sides of the pathway leading into the hospital,
- River sand either in the ground or in flower pots.
- Hose pipe
- Watering can Creepers
- Manure Flower bearing creepers should be selected and planted
- Sticks and poles required to support creepers near the compound wall to give them the required
support. The newly planted creepers need to have
- Pesticides
their tender stems supported by a stilt so that they
- Stick broom grow vertically. This is required until they get firmly
- Scissors fixed in the soil, after which they can be supported
by the wall.
Cultivating a garden
A garden is a place where there are flowers, trees, Lawn
plants, creepers and grass. There are two types of A beautiful green lawn can be planted at the entrance
gardens - a flower garden that lends beauty and a or on both sides of the pathway. The garden will be
kitchen garden where vegetables are grown. A hospital more captivating and attractive if colourful flowers
can have both the gardens - one in the front to add are planted along the edges or in the centre of the lawn.
 115

Maintenance of a garden For pot plants, a hole needs to be made at the

bottom of the pot to allow the excess water to drain
Fertility of the soil out.
After selecting the trees, plants, and creepers, for the
garden, check if the soil is fertile. Spread the soil Adding manure
evenly. When doing so, remove any hard rock or While adding manure, the liquid manure should
plastic bags that may be embedded in the soil. If the not come in direct contact with the stem and the
soil is not fertile, replace it with a mixture of red soil root. It can be sprinkled or poured at a distance of
and sand. one foot. Natural manure is preferred to chemical
manure.
Method of arranging the plants
Dig a pit one foot deep and one foot wide, and let it Preparing natural manure
dry for a day. On the next day put a layer of sand at Dig a small pit. Put the dry leaves and stems which
the bottom of the pit. Now mix red soil, sand and are swept from the garden into this pit and leave them
natural manure in the ratio 1:2:2 and put this mixture there for a few days. This will form into natural
into the pit that has been dug. Plant the saplings manure.
firmly into it and pour some water. Do not pour
excess water. After 40 days the sand at the bottom of Weeding
the pit should be turned properly. Do not use manure Weeds are the parasite plants that grow on and around
for 2 months. After the plant has taken root, and the plants. If they are not removed immediately, the
started to grow, manure mixed with water should be manure and water meant for the plant is used by the
poured once a month. Care should be taken not to weeds, and the plant gradually grows weak and dies
pour manure on the roots. If the plant has to grow
well, the weeds around the plant should be pulled Pruning and shaping the trees, plants and
out. Cow dung is not good manure. Worms grow creepers
out of it, and destroy the plant. When the trees plants and creepers have grown, they
need to be pruned and shaped to look neat. In the
Watering the garden process, the plants can be shaped to resemble peacocks,
During the summer, plants need to be watered twice elephants, deer, or birds. This adds to the beauty of
a day, in the morning and in the evening but not in the garden
the afternoon. When watering the plants, care should
be taken not to pour water on the roots. Dig a shallow Cleaning a garden
canal around the plant, a little distance away, and The garden should be kept neat and clean, if the
pour water into this canal. Care should be taken not garden is to look beautiful, and remain healthy. The
to pour excess water. Do not forget to sprinkle water dried leaves and fallen twigs should be swept and put
on the leaves. The leaves need to be regularly cleaned, in an appropriate place to form natural manure which
as dust blocks the pores. can be used later.
During winter, plants need far less water. Care
Expanding the garden
should be taken to see that water does not stagnate
near the plant. This will cause the stem and the roots New plants and creepers can be grown to expand the
to rot and the plant will wilt and die. garden by means of seeding, grafting and cutting.

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Seeding
The seed bearing plants should be nurtured carefully
and seeds should be collected. These can be sown to
bring up new plants.

Grafting
The mature stem of a rose, or jasmine plant should
be bent and diverted towards another pot or a
polythene bag filled with fertile soil. It should be
inserted and covered with soil so that it is not seen.
After some days the new plant will take root. When
this happens, the stem should be cut off from the
mother plant without disturbing the new plant.

Cutting Fig 20.1 - Potted plant inside a hall

A matured stem of a plant can be cut and planted in
another pot or another place in the soil to raise a new Key points to remember
plant of its type. - Do not put manure directly on the stem or the
roots of the plant
Plants in interior decoration - While watering a plant do not forget to sprinkle
Pot plants and creepers play an important role in water on the leaves to keep them free of dust
interior decoration. Plants lend beauty and a natural - It is important to arrange the plants, creepers and
atmosphere to a room. It requires skill and effort to
the lawn so that they are not trampled upon or
maintain these plants and keep them looking fresh.
brushed against by the patients when walking into
Method to maintain indoor plants the hospital
- Place a square stone or a plate under each flower
pot. This will prevent stains on the floor caused For a demonstration on gardening, please watch the
by excess water flowing out video of the CD.
- The plants should be kept in moderate sunlight
at least once a week Student exercise
- Remove the dry leaves that fall into the pot Answer the following
- Sprinkle water on the leaves regularly to remove 1. How does the garden enhance the ambience in a
the dust collected there hospital?
- The plants should be provided with the required 2. What are the things you need to keep in mind
manure from time to time when starting a garden?
- To keep the pots looking clean and new, paint 3. How is natural manure prepared?
them from time to time 4. How will you maintain indoor plants?

©A R A V I N D E Y E C A R E S Y S T E M
CHAPTER 21 HOSPITALITY AND EVENT MANAGEMENT

CONTENTS
Administration
Publicity and promotion
Financial management
Accommodation and meals
Post-conference wrap-up
GOAL
To ensure that all conferences and workshops are well-planned.
OBJECTIVES
To teach the trainees
- How to plan for any event in the organisation
 CHAPTER 21
Hospitality and Event Management
As described in the earlier chapters, the housekeeping - Staffing the conference registration desk
department has so many multiple functions to - Preparing conference registration packets that
perform. Another major role the department plays is contain the conference programme, infor -
playing host to the various guests and volunteer mation about the organisation, appropriate
workers who visit the Hospital and in making maps, information about restaurants, and
appropriate arrangements for conferences, meetings sightseeing ideas
and workshops that are a regular feature in the
Hospital. The word “appropriate” is to be noted. Each - Preparing and distributing conference name
event is different, and we need to create a service badges
tailored to the needs of the particular event. - Prepare appropriate signs for the event
Given below is the complete exercise that an - Prepare and distribute a roster of attendees
organisation needs to go through in order to conduct
an event successfully. The housekeeping department may
be required to help the various departments in
coordinating the work. Depending on the size and
complexity of the event, the housekeeping department
may need to work in all of the areas listed or in just a
few. Hence it is important that a housekeeper is familiar
with what goes into organizing an event.

Administration
There are hundreds of details that must be worked
out to properly plan, schedule, and administer an
event. No job is too big, no detail too small, to merit
attention. We need to:
- Develop a plan that will help to coordinate all
programme details by assigning specific
responsibilities to individuals.
- Schedule appropriate meeting and event space in
the Conference Hall, the Auditorium or other
rooms in campus, or at off-campus locations. Fig. 21.1 - Welcome board for the participants
Keep a welcome board in the entrance (Fig. 21.1).
- Manage the entire conference registration process, - Arrange for appropriate entertainment
including: - Provide comprehensive on-site management
- Collecting and processing registration fees for the entire conference
- Sending pre registration receipts and - Provide up-to-the-minute enrollment
confirmation letters tracking
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Publicity and promotion Arrange for on-campus accommodation, when

available, or off-campus accommodation in local
An important factor in guaranteeing success for the
event is to reach the proper target audience with hotels or motels which can meet the financial needs
appropriate publicity and promotional materials. As of all participants.
part of the total publicity and promotion plan for Help select menus, schedule banquet facilities, and
the conference, we need to: coordinate with the catering department or food service
- Produce effective brochure copy that will reflect providers. The housekeeping department assists with
the uniqueness of the programme and provide refreshment breaks, and service during meals.
the necessary information to potential participants Instructional media assistance
- Design the appropriate graphics to complement
We need to coordinate the services of a variety of
the brochure copy
instructional media professionals who can assist in
- Print conference brochures and fliers creating audiovisual and other learning aids for the
- Create a mailing list to reach the potential conference. In this regard, we need to:
registrants and maintain this list for future use - Arrange for audiovisual equipment such as
- Mail printed brochures projectors, screens, sound equipment, video
- Develop a Web page for the programme projectors, and recording equipment
- Arrange for news releases about the - Produce appropriate overhead transparencies,
programme slides, posters, and charts to enhance the content
of presentations
Financial management - Arrange for audio or video cassettes of major
It is important to draft a comprehensive programme conference presentations for historical purposes
budget. This budget will reflect the unique needs of or for distribution to participants
the event and help make the programme self-
supporting. To ensure sound financial management, Exhibit planning
we need to: Exhibitor kits need to be prepared, and a plan needs
- Establish realistic registration fees to be chalked out for exhibits and displays.
- Collect and administer programme tuition Evaluation
- Carefully monitor all conference income and
The success or effectiveness of the programme needs
expenses so that conference finances are managed
to be evaluated. For this we need to:
in accordance with legal and institutional
requirements - Design a programme-specific evaluation
form
- Maintain accurate accounting records of all
conference income and expenses - Produce a summary report based on evaluation
data
- Pay all conference bills
- Recommend what should be included in future
- Prepare a final financial report for the Organisation
programmes
Accommodation and meals Post-conference wrap-up
The Event Manager should coordinate in arranging for
After the programme is over, we need to wrap up all
accommodation, meals and special refreshments for
the dozens of details that occur in connection with
the participants.

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the event. The programme is not considered to be - Update the roster of attendees
over until all the following are completed - Create a computerised mailing list of attendees
- Account for all income and expenses for use in announcing future programmes
- Pay all conference bills
Student exercise
- Write appropriate thank-you letters to speakers
and others who contributed to the success of the Answer the following
event 1. What are the factors that play a major role in
- Handle all administrative paperwork planning and execution of an event?
- Process all appropriate documents related to 2. What is the role of the housekeeping department
travel, speakers’ honoraria and other expenses in event management?

©A R A V I N D E Y E C A R E S Y S T E M
CHAPTER 22 HOUSE KEEPING MANAGEMENT

CONTENTS
Organising a housekeeping department
Job descriptions
- Manager
- Housekeeping supervisor
- Housekeeper
- Sweeper
- Gardener
Responsibilities of the housekeeping department
Qualities required for housekeeper
Recruitment, selection and training of manpower
Supervision and evaluation of staff
Organisation of work
Inter departmental communication
Housekeeping and other departments
GOAL
To have a well trained and well managed team
OBJECTIVES
To teach the trainees
- How to set up a housekeeping department
- How to plan and organise work
- Evaluation of staff
 CHAPTER 22
House Keeping Management

Organising a housekeeping - Other general information and important

department announcements
The housekeeping department serves all areas and Key board
departments of a hospital. Hence the housekeeping - Patients’ room keys
department needs to be centrally located and close to
- Office room keys
the vertical transport system to facilitate easy
movement of housekeeping materials and equipment. - Entrance key
- Others
Facilities and space requirement
Registers, files, forms
- Office for the housekeeping manager
- Housekeeping equipment and supplies list
- Clerical work area
- Attendance register for sweepers
- Chief housekeeper’s desk and bulletin board to
put up daily duty charts and other housekeeping - Request form for supplies and equipment from
information stores
- Request form for repairs to be carried out in other
- Store room for the housekeeping equipment and
departments
materials
- Inventories of supplies and equipment
- housekeeping closets on all floors of the hospital
with space and shelves for housekeeping - Checklist for patients’ rooms
equipment and materials, and trolleys. As a matter - Year planning calendar
of routine, supplies for daily use should be - Inventories of furniture and furnishings
delivered to their respective closets directly. - Inventory of linen
Housekeeping control desk Housekeeping stores
The housekeeping control desk is the nerve centre of For the housekeeping department to function in a
the entire department and its efficiency determines systematic manner, it is essential to maintain a
the smooth operation and effectiveness of housekeeping Stores. All items necessary for the day
housekeeping. It is the focal point for the to day functioning of the department are stored here.
dissemination of information and communication It is from here that the housekeepers issue the
to various points in the housekeeping department as necessary cleaning equipment, agents and supplies to
well as to other departments for co-ordination. The the floor and out-patient areas. It is the duty of the
area of the control desk must have: housekeepers to request the equipment and supplies
needed to clean the areas they are overseeing.
Information board
The housekeeping supervisor should inform the
- Duty chart for housekeepers and sweepers purchase department of the required items. These
- Cleaning schedules items are purchased and kept in the housekeeping
- Hospital staff room accommodation details stores. They are then distributed to the various areas
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daily, weekly, fortnightly or monthly. Maintaining a The housekeeping department has multiple functions
regular disbursing system helps to keep track of the to perform. Housekeeping services may be requested
materials and supplies used, and minimizes waste and any time of the day or night, hence the staff structure
misuse. The rules to be followed when requesting must be so arranged as to provide the necessary
supplies and materials: services. Personalised services remain very much an
- New for old important part of “quality” health care and this too is
- Full for empty largely provided by the housekeeping department.
The Out-patient area housekeepers should be The housekeeping manager, as Head of the
given charge of the stores. They are responsible for department, must coordinate the performance of
all issues made from the stores and for the replacement these functions for the most efficient operation
of the items. Their duty is to take weekly inventory possible. Since the housekeeper cannot single-
to ensure that the stocks are maintained and there is handedly discharge all the functions of supervision,
no shortage or pilferage. It is also their responsibility requisition, scheduling, budgeting and so forth, the
to keep the stores neat and clean at all times. Cleaning department must be organized in such a way that
the stores should be a regular part of the housekeeping each of these jobs is capably done. Delegation of
work. Access to the stores should be limited only to authority through a clear chain of command will
persons dealing with maintenance and issuing. accomplish this objective. It must however be
Unauthorised entry should be forbidden and this rule remembered that although authority is delegated, the
should be strictly enforced. A part of the stores may Manager retains full responsibility for the department.
be used for storing and stocking furniture such as
extra chairs, tables and camp cots. These should be
Job descriptions
protected by covering them with dust sheets. Housekeeping manager
Organisation chart Reports to: Administrator
This is an important position in a hospital as it carries
the responsibilities for the cleanliness, maintenance
Manager - Housekeeping
and aesthetic appeal of the hospital. An efficient
housekeeping manager must possess a high degree of
tact as well as good organizing ability, because of the
Housekeeping supervisor need to work with other departments and with so
many different people.

Work to be performed
Housekeeping Housekeeping - Collaborate with other departments to ensure
Assistant Trainee delivery of quality services
- Interview, select, train, evaluate and counsel staff
in the hospital housekeeping department
- Instruct and advise staff on changes in policies,
procedures or working standards
Gardener Cleaner Washer man - Listen to the problems if any, of the housekeepers
and sweepers and try to resolve them

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- Attend to the complaints and queries, if any, from - Arrange rotation of cleaners and housekeepers in
other departments, or patients regarding the case of leave, absence or day off
housekeeping functions and take necessary - Assign shifts to the cleaners and housekeepers-
remedical action day shift and night shift
- Conduct meetings with the housekeepers and - Calculate the salaries of all staff every month and
sweepers separately to exchange ideas and solve maintain a record of the same
problems - Ensure that correct procedures are followed in
- Prepare a report as required by the management Linen Management and that clean and hygienic
- Work closely with the administrator on day to conditions are maintained in the washing area
day housekeeping requirements - Maintain a monthly stock of all items in the hospital
- Monitor departmental activities to ensure that - Ensure that damaged furniture and fixtures are
maximum efficiency is maintained in the services attended to immediately, and condemn those that
being provided cannot be repaired once in a month
- Assist in developing, delegating and monitoring - Ensure that damaged linen is repaired
departmental goals, objectives and programmes immediately, and condemned linen is recycled
to ensure timely completion - Ensure that regular repair and maintenance work
- Build a good rapport with all departments and is carried out
staff to enable smooth functioning of the - Ensure a clean and safe environment to the staff
housekeeping department and patients
Housekeeping supervisor - Report to the housekeeping Manager on
housekeepers’ and sweepers’ performance
Reports to: Manager - Housekeeping
This is a senior position within the department. The Housekeeper
Supervisor takes the responsibility to ensure that all Reports to: Housekeeping Supervisor
procedures and policies brought into the department
Work performed
by the Manager are being followed.
- Keep all areas of the hospital dust free and stain
Work to be performed free
- Go on rounds every morning to inspect the floors - Follow the systems and procedures as laid down
of the hospital and to correct any mistakes on by the department
the part of the housekeepers - Ensure clean and dry bathrooms at all times
- Deployment, supervision and control of staff - Co-operate with the staff of other departments
- Train all staff to efficiently perform the standard - Supervise and instruct the sweepers on the day
procedures as applicable to their job positions to day activities
- Monitor the use of supplies and equipment and - Enhance the décor of different areas of the
prepare a monthly request list including purchase hospital with floral arrangements
of cleaning supplies - Train new recruits
- Keep inventories and records of equipment and - Check all the safety items on allotted floors
supplies - Record all “lost and found” items on as per laid
- Maintain a record of attendance of the down norms
housekeepers, cleaners, gardeners and laundry staff - Ensure total patient satisfaction

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Sweeper - Trash and garbage removal including proper

Reports to: Housekeeper hospital waste disposal
- Exterminating bugs and pests
Work to be performed - Preventing spread of infection
- Receive the allocation of floor and area of cleaning - Ensuring clean linen
- Clean the rooms twice a day - Safety and security of the hospital
- Clean the common toilets and bathrooms twice - Creating an aesthetically pleasing environment
a day
- Gardening
- Follow instructions and cleaning procedures given
- Making the necessary arrangements for meetings,
by housekeepers
workshops and conferences
- Take care of cleaning materials and ensure
economical use of supplies given from the Indirect responsibilities
department - Saving electricity by switching off lights and fans
- Remove and dispose off refuse and rubbish at when not in use
the assigned area - Ensuring an economical use of supplies
- Report missing or broken hospital property to - Developing goodwill by a courteous, helpful and
the housekeeper caring attitude towards patients and visitors
- Maintain a polite, dignified and helpful attitude - Promoting safety rules and measures by observing
toward the patients them and reporting dangerous conditions
- Hand over the unclaimed articles found in the - Maintaining a harmonious working relationship
premises to the supervisor with the staff of other departments
- Attend over daily briefings and give attendance - Arranging accommodation facilities for visitors
and providing food during their stay at the
Gardener
hospital
Reports to: Housekeeper

Work to be performed
Qualities required for a housekeeper
- Clean and maintain the garden - Basic knowledge of health care and sanitation,
including principles of bacteriology, chemistry and
- Take good care of newly cultivated plants
related sciences, applicable to the prevention and
- Take an interest in adopting new technology in control of infections and communicable diseases
the development of the garden The housekeeper should also have the ability to
- Water and prune the plants convey this knowledge in a non-technical way to
- Be creative in arranging the plants in a garden subordinate supervisors and workers so that they
- Attend work regularly can apply it in their daily work
- Ability to plan, administer and develop all phases
Responsibilities of the housekeeping of a comprehensive housekeeping programmeme
department that will provide a suitable environment for the
hospital’s medical and administrative activities
Direct responsibilities - General working knowledge of sanitation,
- Daily cleaning laundry operations, linen service and interior
- Periodic cleaning decoration

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- Ability to assign, supervise and evaluate the work - Conduct written exam and interview
of subordinate supervisors and their personnel - Shortlist the selected candidates
- An interest in people and tact in handling them - Send employment letters
- A pleasant personality and the ability to converse - Conduct an orientation programme for the
with all types of people selected candidates
- An ability to hide personal likes and dislikes and - Conduct a basic training programme
to be conscientious, fair and just - Give an on-the-job training
- Be strict with respect to punctuality and
observance of rules and regulations of the hospital Selection criteria for housekeeper
- Loyalty to the hospital and to the staff Educational 12th(Higher secondary class)
- A sense of humour Qualifications passed with 500-700marks
- A cool head to deal with emergencies Age 18-20 years
- Adaptability and willingness to experiment with Experience Fresh candidate with no prior
new ideas experience in hospitals.
- Powers of critical observation Skills Ability to talk clearly and
politely. Ability to listen well.
Recruitment, selection and training Ability to influence others.
of manpower Knowledge of knitting,
Having decided on the layout and facilities in the drawing, stitching.
housekeeping department, the next task is to decide Understand and speak the local
how many people are needed for the department. language
The number of people would depend on the structure Personality Independent, responsible, open,
of the hospital (block construction or cluster of bold, bright and pleasant
rooms), number of floors and rooms per floor, disposition
number of public areas, size of landscape, the flow Background A low /middle income family
of patients and the time required for each task.
Health and Smart, clean, tidy, simple in
Recruitment and selection appearance dress.Good health - should pass
the medical test criteria
The Administrator of the hospital and housekeeping
Manager make the final decision regarding the Basic training programmeme for
selection of housekeepers. The process involved in housekeepers
recruitment and selection is:
The basic training schedule for the recruited
Planning the selection schedule housekeepers should be planned for a specific period
- Print application form and should cover all aspects of housekeeping. The
housekeeping Manager should appoint appropriate
- Inform public and staff through bulletin boards,
well-trained staff from the housekeeping department
advertisements and by word of mouth
and other resource persons to conduct the training in
- Issue application forms the related field. The trainees can then be put on an
- Collect application forms on-the-job training.
- Shortlist and file applications The training schedule can cover the following
- Arrange interviews areas:

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- Introduction to housekeeping - Sweeper’s job description

- General rules and regulations - Effective communication
- Hospital work culture and values
- Housekeeping and patient relationship –
Orientation schedule for cleaners
interaction with patients to ensure patient Day Particulars
satisfaction 1 General orientation about the hospitalVisit to
- Housekeeping and other departments all departments and wards of the hospital
- Microbiology Dress code
- Ward management General cleaning - demonstration and
sweeping under the guidance of a housekeeper
- Bed making
- General cleaning procedures 2 Sweeper’s role in the organisationIntroduction
to cleaning materials, equipment and supplies
- Dusting
Demonstration on the use of these equipment
- Cleaning of picture-frames and windows and materials
- Sweeping General cleaning - demonstration and
- Mopping mopping under the guidance of a housekeeper
- Cleaning the surroundings 3 Teaching the significance of cleanliness and
- Cleaning the room personal hygiene
- Cleaning toilets and bathrooms Orientation on the different types of rooms
- Stain removal and polishing Demonstration on gardening, and cleaning the
surroundings
- Cleaning walls
General cleaning-sweeping and mopping
- Cleaning brass items under the supervision of a housekeeper
- Cleaning the lift
4 Carrying out sweeping, mopping, cleaning the
- Cleaning the water filter and cooler surroundings and gardening
- Maintenance and cleaning of drinking water tank. Discussions with senior housekeeper regarding
Chlorination days off, leave, shifts, night duty, Sunday duty,
- Importance of checklists welfare schemes, discipline and attitude
- Indenting expected of the cleaner
- Maintenance and use of various equipment Demonstration of cleaning wash basins, walls,
- Other housekeeping activities like making articles doors, windows, and stain removal
for interior decoration 5 -10 Cleaning wash basin, walls, doors, windows,
- Linen management and supply and removing stains under the supervision of
a housekeeper
- Waste Management
- Furniture care and maintenance 11 Observation and cleaning of bathroom under
the guidance of a housekeeper
- Arrangement for meeting and conference in the
concerned rooms or hall Refresher training
- Flower arrangement This should be conducted periodically to upgrade
- Problem solving the standards of cleanliness, or whenever the standards
- .Manpower planning and management are not being met adequately. This can also be

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conducted whenever there is a change in policy, Guidelines for effective supervision

procedure or equipment. - Workers should understand clearly what is
expected of them
Welfare of the staff
- Workers should get guidance in performing work
To keep up the morale of the staff and to motivate
- Good work should always be recognized
them, it is important to provide a good working
- Poor work should be corrected by adopting
atmosphere at the hospital. This can be done by
remedial methods
providing:
- Good working conditions - Unwanted action and behaviour towards workers
should be avoided
- Good working relationship and accessibility
- Incentive bonus Routine inspection work is required to
- Best employee award - Ensure that correct procedures and methods are
- Statutory wages (provident fund, gratuity etc) being followed, and to make any improvements
- Medical facilities - Ensure that standards are met and maintained
- Sick leave and maternity leave - Allow action to be taken to correct defective work
- Meals when on duty - Identify responsibility for defective work
- Proper work methods - Enable complaints to be dealt with effectively
Good employees are hard to come by and once The supervisor should check each employee’s
they are found, it is important to consider their work in each area at least twice during a work period.
welfare. Discipline should be maintained. Rules that The first check should be at the beginning of the
are made should always be followed. Managerial work to ensure that it has been started on time, and
policies should be consistent and every member of that it is being carried out satisfactorily. The second
the staff should participate in the efficient and check should be made before the work in each area is
economic running of the department. completed to ensure that the work is satisfactory and
to inform the worker to correct any faults, if necessary.
Supervision and evaluation of staff It is also important to check that the work is being
Supervising the workers and getting quality work achieved in the stipulated time.
done is an important role of the housekeeping Checks should not be carried out at the same
supervisor. time each day, as the staff would be alert and
The functions of the supervisors are: responsive. Spot checks in the course of the work
- Organize the work assigned to them period are useful. More frequent checks are necessary
for new recruits who are under training.
- Plan the task to be performed
- Direct the work of those responsible to them Handling the difficult worker
- Co-ordinate the resources under their direction - Find out the reasons for the problem - health,
- Control workers and resources personal problem, or problem with the work
- Evaluate the total job performance and the procedures
individual - Arrange refresher training if required

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- Frequently monitor and supervise the work Work specification

- Ask them to repeat the work if found This is a detailed description of the work to be carried
unsatisfactory out in a specific area. There should be work
- Motivate him to adopt new procedures and specifications for every area covered by the
techniques adopted by the department (inculcate housekeeping department.
positive thinking) Eg. Work specification for cleaning corridors:
- Encourage the worker through incentives, and a. C o l l e c t t h e r e q u i r e d e q u i p m e n t a n d
bonus for festivals materials
Evaluation of workers b. Store the equipment and materials neatly in the
corridor to be cleaned
In order to ensure continuing efficiency, it is
c. Empty the waste bins and collect any other waste
important that the staff is evaluated from time to
that may be on the ground
time. This exercise will be effective, if the following
points are kept in mind d. Remove the dust from the walls, windows,
curtains and picture frames
- Pay individual attention to each worker and
supervise his work e. Spot clean areas such as door handles, window
sills and shaft
- Observe if he completes his work in the stipulated
time f. Frequency of corridor cleaning - to be decided
based on the patient flow
- Help him if he has a problem related to his work
- Plan additional training for the worker, if you Work schedule
think he requires it This is a list of actual work to be carried out by an
- Observe his attitude to other workers in the individual staff member during a particular period
department of the day. It would also include meal breaks and
allow time for cleaning and tidying up of
Organisation of work equipments. The number of schedules necessary
A well managed housekeeping department relies on indicates the number of staff required to clean an
the ability of its housekeepers to organize work area once a day.
efficiently and manage the use of equipment, space
and human labour with minimum effort. It is also Job procedure
important that she concerns herself with the staff This specifies the way a job is done and is to be
requirements and modern cleaning equipments, prepared for each job individually.
agents, and methods. She should study their Eg. Procedure for cleaning a telephone
advantages and disadvantages and bring into use those
that make cleaning easier for her staff, spare time and Materials
ultimately cut down costs. Damp cloth, dusters, disinfectant
Work organisation involves the preparation of:
Method
1. Work specification
Dust the telephone completely with the damp cloth.
2. Work schedule
Wipe down with a disinfectant solution paying
3. Job procedure attention to the dial, mouthpiece, and phone. Wash,
4. Work study rinse and dry the dusters, and put them back in their
5. Work simplification place.

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Work study A few methods of work are listed below:

A work study involves work measurements that are - Movement of the worker should be limited to
required to determine the work involved in a the minimum necessary
particular job, the time taken to carry out a job under - The work should be in a pattern of curved line
normal; circumstances by an average worker. This motion
helps in determining the number of staff required - Both hands should begin and complete a motion
and in standardising labour costs. at the same time
Example: A work study on bed making showed - Arms should move in opposite and symmetrical
that the distance covered by the staff during bed- directions to give the worker proper balance
making can be reduced if she were to strip the bed - Daily activity should be restricted to normal reach
more systematically and did not tuck in the sheets level. Objects out of reach can be cleaned
and the covers till the end of bed-making. periodically
A work study must be carried out whenever there - Use of different parts of the body should be
is a waste of time, labour or material. When there is restricted to a minimum
a delay in carrying out the work, or when the
- Before starting work the equipment and materials
complaints made by patients increase, it is a sure
should be arranged
indication that one worker is overburdened with
work, and another is not fully occupied. This is an conveniently to avoid unnecessary movement
indication that a work study needs to be carried out. - Wherever possible, adjust work heights to make
the work easier
A work study involves the following procedure:
a. Select the job procedure and identify the problem Planning the cleaning procedure in a hospital
b. Observe and record the present work method Cleaning requires a systematic and planned approach,
c. Develop an improved method both, towards the individual tasks involved and
d. Conduct periodic checks to ensure that the towards the hospital’s cleaning operations as a whole.
improved method is working satisfactorily This involves two areas:
A work study cannot be carried out unless it gets - The cleaning process
the full co-operation of the staff involved throughout - The work schedule
the investigation. It is possible to get a clear picture
of the old working method, and implement the new The cleaning process
method only with the full support of the staff. The objective of the process of cleaning is to remove
as much dirt as possible without damaging the
Work simplification surface, and to prevent dirt from resettling. To do
While a worker is busy and on the job, the muscles this effectively and safely, we need to identify the
of his body need moments of rest between motions. different types of dust and stains involved, along with
Tensed muscles produce neither high quality nor great ways in which they are introduced into the building.
quantity of work. The worker finds the work easy or This information helps to decide which cleaning
difficult depending on the way he uses his body. New method, equipment and materials are most
methods need to be developed to make the work appropriate. The housekeeping department should
easier and to reduce the stress factor for the worker. establish methods of cleaning and work schedules.

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The work schedule low risk areas. The standard of housekeeping

Before any cleaning programme can be carried out, a services depends on the level of risk
suitable work plan must be drawn up. The work Housekeeping cleaning standard has been defined as:
schedule gives the actual work to be undertaken by a Housekeeping cleaning standard = method x frequency
particular staff member during a particular period of When cleaning methods are correctly selected,
the day. This should take into account several factors, correct equipment and agents are used for each
which affect the way in which the work is carried surface and cleaning tasks are carried out
out. These factors include: methodically, the housekeeping standards are said
- Standard of cleanliness: Cleaning standards vary to be efficiently met. The following table shows
in different parts of the hospital. In every hospital, the standard of cleanliness required in different
the area of work can be classified as high risk and areas of the hospital:

Area Standard Requirement

High risk areas(operation theatres, Prestige standard Highest possible standard of

special units) cleaning, dust and infection control
Medium risk areasKitchen, toilets Special standard High standard of cleaning, and infection
control
Low risk areasCorridors, offices, Normal standard Good standard of cleaning, absence of
waiting areas, patient rooms soil, dust and stains

- The activity in the area and the time of day: - Periodic schedule: This includes tasks, those
Consideration should be given to the level of additional to, but in combination with
activity and amount of traffic in the areas to be routine tasks, which have a frequency of once
cleaned. Where possible, cleaning will be in every 15 days or once in every month.
undertaken when these levels are at their lowest. (Changing curtains, removing stains,
Each part of the hospital has a primary function polishing, cleaning water tanks, cleaning
which should be disrupted as little as possible. septic tanks) records should be maintained
Cleaning should fit in as modestly as possible to show when and where a particular task is
with the main activity of that area. started and completed
Administration areas and most departments have Frequency of cleaning: Frequencies are to be
a standard working day. Hence cleaning in these based on sound quality cleaning, especially
areas can be programmed to take place either as they relate to “routine” cleaning. A set time
before or after working hours schedule is not considered appropriate for
- The planning schedule: The housekeeping routine cleaning. If an area requires cleaning,
department should plan and apply a systematic it should be cleaned, if it does not require
cleaning procedure. This includes: cleaning, it should not be cleaned. Cleaning
- Daily and weekly schedule: This includes all on the basis of “it has to be cleaned everyday
tasks that are to be carried out regularly in a even when it does not need it” is not
specific functional area on a predetermined applicable
basis set by management according to area Even though waiting area, patient examination
usage and the need for cleanliness. (Dusting, area, refraction area and pathways are considered low
sweeping, mopping) risk areas in the hospital, frequency of routine
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cleaning is to be followed to keep the area clean all then and instruct the sweepers to go for special
the time. The area supervisor should check now and cleaning.
The following table may be used to plan the frequency of cleaning:

Area Frequency of Special attention Special care

cleaning

OPD
Registration Continual Patient flow is high; Provide doormats at the
Waiting area rainy season entrances and clean them
Corridors frequently
Common toilets 4-6 times a day Patient flow is high

Wards
ards
Patient room Twice a day Emergency, spillage, Take immediate action to
vomiting clean
Corridors 4 times a day Emergency; spillage Take action immediately
Room toilets Twice a day More usage
Common toilets Four times a day More usage

Office area
Camp office Once a day
Finance department
Personnel department

Laboratory
Biochemistry lab Twice a day
Lab. toilet 4 - 6 times a day Patient flow is high Use odonil, and a good
disinfectant

Outside area Twice a day Sprinkle water to settle dust

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Usage area Cleaning agent Dilution Time for cleaning Frequency of use
agent to act

Floor, tiles, wash LOC, Vim or any 20ml: 5litre, Direct Twice a day
basin, outside of w/c other good detergent 8gm/washbasin/
closet, flush tank toilet
Floor, glass mirror LOC, seespray/colin 20ml:5Llitre Direct Weekly
8ml/litre
Toilet closet and all Harpic No dilution Direct Once a day
stain removal
Mopping the floor. Pursue 18ml/litre Direct Twice a day
Cleaning the toilet
Septic tank- 1kg/wash Bleaching powder No dilution 2 mins. Septic tank-weekly
Water tank-500gms/ Water tank-
wash monthly
Brass items Brasso Direct Special cleaning
Drawers, wardrobes, Naphthalene balls Direct Weekly
sinks
Toilet odour control Odonil Direct Weekly
Disinfections Dettol 100ml/5litres Direct Daily

Inter departmental communication - Proper job specification

Effective communication between housekeepers and - Two-way communication is essential to avoid
workers is very important. Generally the cleaners are misunderstanding the work procedure
illiterate and recruited from the rural areas. Hence - Guidelines given to the workers should neither be over
they understand only very simple language. Thus, it commanding, nor easy. They should be moderate
is necessary for the housekeeper to use very simple - New policies and procedures should immediately
language when explaining the work procedures, so be communicated to the workers and their
that the workers are not mislead into using incorrect queries clarified
procedures. This will lead to poor quality work. Poor communication results in
Factors to be considered - Following incorrect cleaning methods
- Workers should understand clearly what is - Improper use of cleaning materials and
expected of them equipment, which results in increased costs
- Unwanted actions should be avoided - Taking more time to finish the given task
- Use simple and clear language - Arguments with the housekeeper
- Adopt demonstration methods to explain the - Frequent absence from work
work procedures - Discontinue from service

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Inter departmental relationships clean and quality linen to the operation theatres and
other departments. Whether in-house or out-sourced,
Personnel Maintenance Laundry coordination between hospital and laundry is very
important. The housekeepers should check the need
and use of materials with the ward staff. The senior
Security Housekeeping Catering
housekeeper should maintain registers for checking
stock and transaction of materials, planning the
Other Stores Nursing laundry process, and salary of in-house dhobi.
departments
Nursing
Maintenance The nursing department works closely with the
One of the most important functions of housekeeping department. It is this department that
housekeeping is the maintenance of keeping is involved in bed-making in the patients’ rooms,
furniture, fixtures and facilities in working order. and informs the housekeeping department about
Housekeepers need to constantly check on various any requirements by the patients. The nursing
things throughout the hospital on a daily or a weekly department also contacts the housekeeping
basis and inform the maintenance department department if there is any need for emergency
through a requisition form about any repairs that cleaning in a specific area, in case of spillage, breakage,
need to be done. The maintenance work could cover or if the patient has vomited. The nurses maintain
a number of aspects such as plumbing, carpentry, the admission and discharge details of the patients.
electricity and civil works. Hence a close coordination When the patient is discharged, it is the nurses who
with the maintenance department is absolutely check the room, lock the door and handover the
necessary. key to the housekeeper. The housekeeper then sends
a sweeper to clean the room thoroughly and get it
Stores ready for the next patient.
Hospitals stock all housekeeping equipment,
materials and supplies, except linen, in the general Catering
stores. Coordination with the stores ensures If a hospital has catering facilities, then the kitchen
availability of day-today requirements of and dining room needs to be cleaned at least twice a
housekeeping. Housekeepers can indent materials day. This comes under the purview of the
from the stores on a daily or a weekly basis. These housekeeping department. The housekeeping
indented materials can be issued directly to the staff department also needs to co-ordinate with the
or can be stored inside the department or under the Catering department when making arrangements for
staircase with proper safety measures. The stores guests and special occasions.
consult with the housekeeping department regarding
purchase of materials. Personnel
The housekeeping department deals with the
Laundry Personnel department for the recruitment of the
Most small hospitals prefer to outsource laundry on housekeeping staff, salary administration, indiscipline
account of limited space and manpower. Larger and grievance, identity cards for the staff, promotions
hospitals usually handle the laundry in-house to issue and exit facilities.

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Other departments 2. What is the importance of housekeeping stores?

Since every department in the hospital needs to be
3. What is a job description? Why is it necessary to
kept clean, the housekeeping department interacts
with every department. When electrical equipment have a clear job description for the employees?
is not working or a door does not close properly, it is 4. What are the direct responsibilities of the
the housekeeping department that takes down the
housekeeping department?
complaint and makes sure that the problem is
rectified. Thus, the housekeeping department is an 5. What is refresher training? Why is it necessary?
important and indispensable department in the
smooth functioning of a hospital. 6. Why is supervision and evaluation important?

Student exercise 7. What do you understand by work specification,

work schedule and work study?
Answer the following
1. Why is the housekeeping control desk important? 8. What areas in a hospital are considered high risk?
What are the requirements at the control desk? Why?

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