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Preventing Infection 525

Health Care Skills

Preventing Infection ................................................525 Washing your hands........................................526 How to disinfect...............................................526
How to Take Temperature, Pulse, Respiration and Blood Pressure..........................530
Temper ature....................................................... 530 Pulse.......................................................................531 Respiration (breathing rate)........................531 Blood pressure...................................................532 How to Examine the Abdomen..........................534 How to Examine a Woman’s Genitals (the Pelvic Exam).......................................................535

Caring for Burns .......................................................538 How to Give Fluids to Treat Shock .................. 540
How to give rectal fluids...............................541 How to Give an Injection......................................542
Where to give an injection...........................542 How to prepare a syringe ..........................543 How to inject into the muscle....................544 How to give an injection under the skin (subcutaneous injection)......................544 Be prepared to treat allergic reaction and allergic shock...........................545 Acupressure Massage..............................................546

In many parts of this book we refer to certain skills that can help a person give the best care to someone who is ill. These skills include preventing infection, giving an exam and getting information about a person’s body, giving life-saving fluids, and giving injections.
This section gives more complete information about these skills. You may think of these as ‘doctor’s’ or ‘nurse’s’ skills, but they are all skills that anyone can learn with time and practice. Some skills, like giving an exam or an injection, are best learned by having a skilled person show you how. Once learned, all of these skills can make a careful person better able to help others safely.
Preventing Infection
Infections cause many kinds of sickness. People who are already sick or hurt are often more at risk for getting an infection, and getting one can make them much sicker. So it is important to do everything you can to keep infections from developing. It is also important to protect yourself from getting an infection from those you care for.
Infections are caused by germs, such as bacteria and viruses, that are too small to see. Every person carries bacteria on her skin, and in her mouth, intestines, and genitals all the time. These germs do not usually cause problems, but they can cause infections if passed to sick people. Germs also live on the equipment and tools used when caring for a sick person and can easily be passed to others you help.
You can prevent infection by following the guidelines in this chapter. For other ways to prevent infection, see page 149.
IMPORTANT You must follow these guidelines every time you help someone, whether you use your hands, tools, or special equipment. If you do not, you may get a dangerous infection, or pass an infection to the people you are helping.

Where Women Have No Doctor  2019

526 Health Care Skills

Washing your hands
Wash your hands before and after caring for another person. It the most important way to kill germs living on your skin. You need to wash your hands even more thoroughly and for a longer time:

Let your hands dry in the air instead of using a towel. Do not touch anything until your hands are dry.

• before and after helping someone give birth.

• before and after touching a wound or broken skin.

• before and after giving an injection, or cutting or piercing a body part.

• after touching blood, urine, stool, mucus, or fluid from the vagina.

• after removing gloves.

Use water that flows.

Use soap to remove dirt and germs. Count to 30 as you scrub your hands all over with the soapy lather. Use a brush or soft stick to clean under your nails. Then rinse. Use water that flows. Do not reuse water if your hands must be very clean.

Tr y making a Tippy Tap. It will save water and will make it easy to keep a supply of clean water for washing hands.

Use a large, clean plastic bottle with a handle.

1. Pinch the handle together here with a pair of hot pliers or a hot knife.

2. Make a small hole in the handle, just above where you sealed it.

3.To hang the tippy tap, make 2 more holes in the other side of the bottle and pass a string through them. Now you can hang it on a peg or tree branch.

4. Fill the bottle with clean water and replace the lid.

5.When you tip the bottle forward, the water will flow out, so you can wash your hands. Do not make the hole too large or it will waste water.

You can also hang a bar of soap from the string.

How to disinfect equipment and tools
Cleaning tools and equipment to get rid of nearly all the germs is called high-level disinfection. Tools must first be washed and then disinfected if they are used to:
• cut, pierce, or tattoo skin. • give an injection. • cut the cord during childbirth. • examine the vagina, especially during or after
childbirth, a miscarriage, or an abortion. • when giving fluids in the rectum.
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Preventing Infection 527

High-level disinfection: 3 steps
Steps 1 and 2 should be done right after using your tools. Try not to let blood and mucus dry on them. Step 3 should be done right before you use the tools again. All the steps can be done together if you can store your tools so they will stay disinfected (see the next page).
1. Soaking: Soak your tools for 10 minutes. If possible, use a 0.5% solution of bleach (chlorine). Soaking your tools in bleach solution first will help protect you from infection when cleaning the tools. If you do not have bleach, soak your tools in water.

How to make a disinfecting solution of 0.5% bleach:

If your bleach says:


2% available chlorine. . . . . . . . . . . . . . 1 part bleach to 3 parts water 5% available chlorine. . . . . . . . . . . . . . 1 part bleach to 9 parts water 10% available chlorine. . . . . . . . . . . . . 1 part bleach to 19 parts water 15% available chlorine. . . . . . . . . . . . . 1 part bleach to 29 parts water

For example:
If your bleach says 5% available chlorine, use this much bleach:

and this much water:

Mix just enough solution for one day. Do not use it again the next day. It will not be strong enough to kill germs anymore.

2. Washing: Wash all tools with soapy water and a brush until each one looks very clean, and rinse them with clean water. Be careful not to cut yourself on sharp edges or points. If possible, use heavy gloves, or any gloves you may have.
3. Disinfecting: Steam or boil the tools for 20 minutes (as long as it takes to cook rice)
To steam them, you need a pot with a lid. The water does not need to cover the tools, but use enough water to keep steam coming out the sides of the lid for 20 minutes.
To boil them, you do not need to fill the whole pot with water. But you should make sure water covers everything in the pot the entire time. If possible, put a lid on the pot.
For both steaming and boiling, start to count the 20 minutes after the water is fully boiling. Do not add anything new to the pot once you begin to count.
IMPORTANT Never use a tool on more than one person without washing and disinfecting all the parts between each use.

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528 Health Care Skills

Storing your tools
If you store your tools properly you can do Steps 1, 2, and 3 at one time, and the tools will be ready to use whenever you need them. To store tools:

• After boiling, pour off the water and let the tools dry by themselves. Do not dry them with a cloth. Put a lid or a thin, clean cloth over the pot to prevent flies and dust from getting in. Be sure to let the tools dry completely. Metal objects will rust if they are not dry.

• Do not let the tools touch your hands or anything else.

• Store the tools in a covered pot that has been

disinfected. You can use the pot that was used for boiling

with a lid, or the steamer that was used for steaming, or

a glass jar and lid that have been boiled.

If possible, put everything in a clean plastic bag to protect from dust.

Make sure the pot and lid where you store the tools

have also been disinfected.

Disinfecting needles and syringes, gloves, and bandages
Needles and syringes. If a needle and syringe can be used more than once (reusable), squirt bleach or soapy water through the syringe 3 times right after using it. Then take everything apart and follow Step 2 and then Step 3 on page 527. Carefully store the syringe until the next use. Be sure not to touch the needle or the plunger.
If you are not able to store things in a clean and dry place, boil or steam them again before use.
If a needle and syringe can be used one time only (disposable), carefully put them in a covered container that cannot be pierced by the needle, and bury the container deeply. If you cannot dispose of the needle safely, squirt bleach solution through it 3 times.

Used needles are dangerous!

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Preventing Infection 529

Gloves protect both you and the people you help against the spread of infection. If you do not have gloves, use clean plastic bags to cover your hands.
Sometimes it is OK to use gloves that are clean but not disinfected—as long as you are not reusing them. But you should always use high-level disinfected gloves when:
• putting your hand inside the vagina during an emergency exam before or after childbirth or abortion.
• touching broken skin.

If you do not have gloves, you can use clean plastic bags to cover your hands.

Using high-level disinfected gloves:
Be careful not to touch other gloves as you remove a pair from the jar or container where they have been stored.

When putting the gloves on, be careful not to let anything touch the part of the gloves that is going to touch the person.

touch here
touch here

do not touch the fingers

➤ If you have a pair of ‘sterile’ gloves in a package, save them for a time when you must be especially careful not to spread infection.

If you use gloves more than one time, they should be cleaned, disinfected, and stored following the instructions on pages 527 and 528. Always check washed gloves for holes, and throw away any that are torn.
If possible, it is best to steam gloves rather than boil them because they can stay in the pot they were steamed in until they are dry. If you are unable to steam gloves and must boil them, try to dry them in the sun. You will probably have to touch them to do this, so they will no longer be disinfected, but they will be clean. Keep them in a clean, dry place.
Cloth dressings If you do not have sterile gauze, use cloth dressings. Follow the instructions for
disinfection and storage on pages 527 and 528. Dry the dressings in the sun, but be sure to keep them off the ground, and to protect them from dust, flies, and other insects.
Any items that have touched blood or body fluids (urine, stool, semen, fluid from the bag of waters, pus) should be burned, or disposed of carefully so that children or animals will not find them. This includes supplies that are no longer useful but are contaminated, such as syringes, torn gloves or gloves that can only be used once, gauze, or cotton.

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530 Health Care Skills

How to Take Temperature, Pulse, Respiration, and Blood Pressure
When a person is sick or has a health problem, her basic physical signs may change. The next few pages tell how to measure these signs to know if a person has a problem.

If you need to know a person’s temperature and do not have a thermometer, touch the back of your hand to the person’s skin, and compare it with your own skin. If her skin feels much warmer, she probably has a fever. To learn what to do for a fever, see page 297.

If you have a thermometer, you can take a person’s temperature in the mouth, armpit, or rectum. A person’s temperature is normally cooler in the armpit, warmer in the mouth, and warmest in the rectum. There are 2 kinds of thermometer scales. Here is how they compare. Either can be used to measure a person’s temperature.

Celsius (C)

normal Sfeovmere

High fever

Fahrenheit (F)
The levels listed here for normal and fever temperatures are for the mouth.

How to take the temperature
(using a thermometer marked in degrees Celsius—°C)

1. Clean the thermometer well with soap and cold water, or alcohol. Hold it at the end without the silver (or red) and shake it hard, with a snap of the wrist, until it reads less than 36 degrees.

2. Put the thermometer . . .

under the tongue (keep the mouth closed around it)

in the armpit if there is OR danger that
the person might bite the thermometer

3. Leave it there for 3 or 4 minutes. 4. Read it (see above). 5. Wash the thermometer well with soap and cold water. Then, if you can, soak it for
20 minutes in a bleach solution (see page 527) and rinse with clean water.

Glass thermometers are filled with mercury, a very poisonous metal. Be careful with

glass thermometers, and if they break, do not pick up the mercury with

your bare hands. Sweep the mercury into a jar and bury it.

Do not let children play with thermometers or


mercury. Get a digital thermometer if you can.


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How to Take Temperature, Pulse, Respiration, and Blood Pressure 531

Pulse (heartbeat)
The pulse tells how fast the heart is beating and how hard it is working. After hard work or exercise, the heart of a healthy person beats fast, but slows back to normal in a few minutes. The heart usually increases 20 beats a minute for each degree (C) rise in fever.
A normal pulse in an adult is between 60 and 90 beats per minute. A fast pulse can be a sign of:
• blood loss or fluid loss, or shock (see page 254). • fever and infection. • problems with the lungs and breathing system, or with the heart. • thyroid problems.

To take the pulse, put your fingers on the wrist as shown (do not use your thumb).

If you cannot find the pulse in the wrist, feel for it in the neck beside the voicebox,

or put your ear directly on the chest and listen for the heartbeat.

Respiration (breathing rate)
The breathing rate tells you about health of the lungs and breathing system. It can also give information about a person’s general health.To take the breathing rate, watch the chest rise and fall when a person is at rest. Normal breathing in an adult is 12 to 20 total breaths per minute (a complete breath equals one breath in and one breath out).
Breathing usually speeds up (along with the pulse) when there is infection, fever, blood loss or dehydration, shock, lung problems, or other emergencies.
Very slow pulse and breathing in a very sick person can mean she is near death.
Fast, shallow breathing can be a sign of infection of the breathing system. A breathing rate of more than 30 breaths per minute may be a sign of pneumonia (see page 304).
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532 Health Care Skills

Blood pressure
Blood pressure is a measure of how hard the blood presses on the inside of the blood vessels.
It is useful to know a woman’s blood pressure at these times:
• during pregnancy, childbirth, miscarriage, or abortion.
• if she is using or planning to use birth control pills.
• in emergencies, such as shock, severe abdominal pain, or a difficult childbirth.

What the numbers mean A blood pressure measurement (BP) has two numbers:
120 is the top (systolic) reading or
80 is the bottom (diastolic) reading

Normal blood pressure for an adult is from 90/60 to 120/80.

If a person has a blood pressure in this range, there is no need to worry. If the blood pressure is between 120/80 and 140/90, a person should exercise, lose weight, and eat less salt. If the blood pressure is over 140/90, the person also needs to take medicines. A person who has diabetes or heart disease should take medicine if the blood pressure is over 130/80.

A pregnant woman who has a blood pressure over 140/90 should see a health worker for medicines that are safe for her to take.

A sudden drop in blood pressure is a danger sign, especially if it falls below 90/60. Watch for any sudden drop in the blood pressure of persons who are losing blood or at risk of shock. If you get an abnormal blood pressure reading and you do not think the person is in shock, wait a few minutes and take the blood pressure again.

You will often need to watch a person’s blood pressure over time (for example, during a woman’s pregnancy) to see how it changes. It will help to keep a record:

This woman’s blood pressure goes up and down a little from month to month. This is

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How to Take Temperature, Pulse, Respiration, and Blood Pressure 533

How to take blood pressure There are several types of blood pressure equipment.
Some have a tall gauge that looks like a thermometer.
Others have a round dial.
Blood pressure equipment usually comes with a stethoscope.

blood pressure

To take a person’s blood pressure, first tell her what you are going to do. Then

follow these steps:

1. Fasten the cuff around

2. Close the valve on the rubber bulb by turning the screw to the right.The valve will get shorter.

the bare



3. Feel for a pulse just below the elbow, on the inside of the arm, and put the stethoscope over the pulse. Sometimes you may not feel the pulse. If you cannot, put the stethoscope over the center of the skin crease inside the elbow.

5. As you pump, the needle will move.
When it reaches 200, stop pumping.

6. Then release the valve a little so that the air leaks out slowly.

4. Pump the cuff up by squeezing the bulb.
7. The needle will begin to go back down. (If the valve is closed, it will stay at 200.)

As the air leaks out, you will start to hear the person’s pulse through your stethoscope. Notice where the needle or the silver bar is when you start to hear the pulse (this will be the top number) and when the pulse disappears or gets very soft (this will be the bottom number).

If you... do not hear anything when the needle is here...
...or here
but start to hear a pulse about here and then lose it again when the needle is about here
then the blood pressure is: 100/70.

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534 Health Care Skills
How to Examine the Abdomen
If a woman has pain in the lower abdomen, first read the chapter on “Pain in the Lower Abdomen” and ask the woman the questions on page 357. Then examine her abdomen: 1. Ask her to undress so that you can see her abdomen from just below her breasts
down to the hair between her legs. 2. Ask her to lie flat on her back on a firm bed, a table, or a clean floor, with her knees
bent and her feet close to her buttocks. Ask her to relax her abdominal muscles as much as she can. This may be difficult for someone who is in pain. 3. Listen for bubbling and gurgling noises by putting your ear on her abdomen. If you do not hear anything for 2 minutes, this is a danger sign (see page 354).
4. Ask her to point to where it hurts most. Then begin pressing gently on the other side. Keep pressing gently as you move around her abdomen to see where it hurts most.
5. As you press her abdomen, feel for lumps. Also, see if her abdomen is soft or hard, and if she can relax it under your hand.
6. To make sure she does not have another problem like appendicitis, an infection in her gut, or a pelvic infection (PID), slowly but firmly press on her abdomen on the left side, just above where the leg joins the body (the groin). Press until it hurts a little. Then quickly remove the hand. If a very sharp pain (rebound pain) happens when the hand is removed, she may have a serious infection. Take her immediately to a health center or hospital to see if she needs surgery. If she does not have rebound pain, continue to examine her by looking at the outside of her genitals for sores, discharge, bleeding, or other signs of sexually transmitted infections (STIs). For signs and treatment of STIs, see page 261. If you know how, do a pelvic exam (see the next page).
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Health care skills