Asepsis

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Asepsis
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Learning Outcomes

• Explain the concepts of medical and surgical
  asepsis.
• Identify signs of localized and systemic
  infections.
• Identify risks for nosocomial infections.
• Identify factors influencing a microorganisms
  capability to produce an infectious process.
• Identify anatomic and physiologic barriers that
  defend the body against microorganisms.
• Differentiate active from passive immunity.

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• Identify relevant nursing diagnoses and
  contributing factors for clients at risk for
  infection and who have an infection.
• Identify interventions to reduce risks for
  infections.
• Identify measures that break each link in the
  chain of infection.
• Compare and contrast category-specific,
  disease-specific, universal, body substance,
  standard, and transmission-based isolation
  precaution systems.
• Correctly implement aseptic practices, including
  hand hygiene donning and removing a facemask,
  gown, and disposable gloves managing equipment
  used for isolation clients and maintaining a
  sterile field.
• Describe the steps to take in the event of a
  bloodborne pathogen exposure.

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Definitions

• Asepsis is the freedom from disease-causing
  microorganisms. To decrease the possibility of
  transferring microorganisms from one place to
  another, aseptic technique is used.

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Definitions

• Medical asepsis
• Includes all practices intended to confine a
  specific microorganism to a specific area
• Limits the number, growth, and transmission of
  microorganisms
• Objects referred to as clean or dirty (soiled,
  contaminated)

• Surgical asepsis
• Sterile technique
• Practices that keep an area or object free of all
  microorganisms
• Practices that destroy all microorganisms and
  spores
• Used for all procedures involving sterile areas
  of the body

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Types of microorganisms causing infections

• 1. Bacteria can live and be transported through
  air, water, food, soil, body tissues and fluids,
  and inanimate objects.
• 2. Viruses (causes the common cold) hepatitis,
  herpes, and human immunodeficiency virus.
• 3. Fungi include yeasts and molds. Candida
  albicans
• 4. Parasites They include protozoa such as the
  that causes malaria.

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Types of infection

• A local infection is limited to the specific part
  of the body where the microorganisms remain.
• If the microorganisms spread and damage different
  parts of the body, it is a systemic infection.

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• When a culture of the person's blood reveals
  microorganisms, the condition is called
  bacteremia.
• When bacteremia results in systemic infection, it
  is referred to as septicemia.
• Acute infections generally appear suddenly or
  last a short time. A chronic infection may occur
  slowly, over a very long period, and may last
  months or years.

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• Nosocomial infection classified as infections
  that are associated with the delivery of health
  care services in a health care facility.
  Nosocomial infections can either develop during a
  client's stay in a facility or manifest after
  discharge.

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Signs of Localized Infection

• Localized swelling
• Localized redness
• Pain or tenderness with palpation or movement
• Palpable heat in the infected area
• Loss of function of the body part affected,
  depending on the site and extent of involvement

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Signs of Systemic Infection

• Fever
• Increased pulse and respiratory rate if the fever
  high
• Malaise and loss of energy
• Anorexia and, in some situations, nausea and
  vomiting
• Enlargement and tenderness of lymph nodes that
  drain the area of infection

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Signs of Infection

• Laboratory data
• Elevated WBC count
• Increase in specific WBC types
• Elevated ESR
• Cultures of urine, blood, sputum, or other
  drainage

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Risks for Nosocomial Infections

• Nosocomial infections are associated with the
  delivery of health care services in a health care
  facility.
• A number of factors contribute to nosocomial
  infections.
• Diagnostic or therapeutic procedures
• Iatrogenic infections
• Compromised host
• Insufficient hand hygiene

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Factors Influencing Microorganisms Capability to
Produce Infection

• Number of microorganisms present
• Virulence and potency of the microorganisms
  (pathogenicity)
• Ability to enter the body
• Susceptibility of the host
• Ability to live in the hosts body

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Anatomic and Physiologic Barriers Defend Against
Infection

• Intact skin and mucous membranes
• Moist mucous membranes and cilia of the nasal
  passages
• Alveolar macrophages
• Tears
• High acidity of the stomach
• Resident flora of the large intestine
• Peristalsis
• Low pH of the vagina
• Urine flow through the urethra

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Active Immunity

• Host produces antibodies in response to natural
  antigens or artificial antigens
• Natural active immunity
• Antibodies are formed in presence of active
  infection in the body
• Duration lifelong
• Artificial active immunity
• Antigens administered to stimulate antibody
  formation
• Lasts for many years
• Reinforced by booster

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Passive Immunity

• Host receives natural or artificial antibodies
  produced from another source
• Natural passive immunity
• Antibodies transferred naturally from an immune
  mother to baby through the placenta or in
  colostrums
• Lasts 6 months to 1 year
• Artificial passive immunity
• Occurs when immune serum (antibody) from an
  animal or another human is injected
• Lasts 2 to 3 weeks

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Interventions to ReduceRisk for Infection

• Proper hand hygiene techniques
• Environmental controls
• Sterile technique when warranted
• Identification and management of clients at risk

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The Chain of Infection
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Breaking the Chain of Infection

• Etiologic agent
• Correctly cleaning, disinfecting or sterilizing
  articles before use
• Educating clients and support persons about
  appropriate methods to clean, disinfect, and
  sterilize article

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• Reservoir (source)
• Changing dressings and bandages when soiled or
  wet
• Appropriate skin and oral hygiene
• Disposing of damp, soiled linens appropriately
• Disposing of feces and urine in appropriate
  receptacles
• Ensuring that all fluid containers are covered or
  capped
• Emptying suction and drainage bottles at end of
  each shift or before full or according to agency
  policy

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Cleaning, Disinfecting, and Sterilizing

• The first links in the chain of infection, the
  etiologic agent and the reservoir, are
  interrupted by the use of antiseptics (agents
  that inhibit the growth of some microorganisms)
  and disinfectants (agents that destroy pathogens
  other than spores) and by sterilization.

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Cleaning

• Cleanliness inhibits the growth of
  microorganisms. When cleaning visibly soiled
  objects, nurses must always wear gloves to avoid
  direct contact with infections microorganisms

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Disinfecting

• A disinfectant is a chemical preparation, such as
  phenol or iodine compounds, used on inanimate
  objects.
• Disinfectants are frequently caustic and toxic to
  tissues. An antiseptic is a chemical preparation
  used on skin or tissue.
• Disinfectants and antiseptics often have similar
  chemical components, but the disinfectant is a
  more concentrated solution.

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Sterilizing

• Sterilization is a process that destroys all
  microorganisms, including spores and viruses.
• Four commonly used methods of sterilization are
• 1. Moist heat
• 2. Gas
• 3. Boiling water
• 4. Radiation

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• Portal of exit
• Avoiding talking, coughing, or sneezing over open
  wounds or sterile fields
• Covering the mouth and nose when coughing or
  sneezing

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Method of transmission

• Direct transmission Involves immediate and
  direct transfer of microorganisms from person to
  person through touching, biting, kissing, or
  sexual intercourse. Droplet spread is also a form
  of direct transmission.
• Indirect transmission Material objects, such as
  toys, soiled clothes, cooking or eating and
  surgical instruments, or dressing, water, food,
  blood, serum, and plasma. Animal or flying.
• Airborn transmission may involve droplets or
  dust

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• Method of transmission
• Proper hand hygiene
• Instructing clients and support persons to
  perform hand hygiene before handling food,
  eating, after eliminating and after touching
  infectious material
• Wearing gloves when handling secretions and
  excretions
• Wearing gowns if there is danger of soiling
  clothing with body substances

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• Placing discarded soiled materials in
  moisture-proof refuse bags
• Holding used bedpans steadily to prevent spillage
  
• Disposing of urine and feces in appropriate
  receptacles
• Initiating and implementing aseptic precautions
  for all clients
• Wearing masks and eye protection when in close
  contact with clients who have infections
  transmitted by droplets from the respiratory
  tract
• Wearing masks and eye protection when sprays of
  body fluid are possible

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• Portal of entry
• Using sterile technique for invasive procedures,
  when exposing open wounds or handling dressings
• Placing used disposable needles and syringes in
  puncture-resistant containers for disposal
• Providing all clients with own personal care
  items

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• Susceptible host
• Maintaining the integrity of the clients skin
  and mucous membranes
• Ensuring that the client receives a balanced diet
• Educating the public about the importance of
  immunizations

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Category-specific Isolation Precautions

• Strict isolation
• Contact isolation
• Respiratory isolation
• Tuberculosis isolation
• Enteric precautions
• Drainage/secretions precautions
• Blood/body fluid precautions

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Disease-specific Isolation Precautions

• Delineate practices for control of specific
  diseases
• Use of private rooms with special ventilation
• Cohorting clients infected with the same organism
• Gowning to prevent gross soilage of clothes

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Universal Precautions (UP)

• Used with all clients
• Decrease the risk of transmitting unidentified
  pathogens
• Obstruct the spread of bloodborne pathogens
  (hepatitis B and C viruses and HIV)
• Used in conjunction with disease-specific or
  category-specific precautions

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Body Substance Isolation (BSI)

• Employs generic infection control precautions for
  all clients
• Body substances include
• Blood
• Urine
• Feces
• Wound drainage
• Oral secretions
• Any other body product or tissue

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Standard Precautions

• Used in the care of all hospitalized persons
  regardless of their diagnosis or possible
  infection status
• Apply to
• Blood
• All body fluids, secretions, and excretions
  except sweat (whether or not blood is present or
  visible)
• Nonintact skin and mucous membranes
• Combine the major features of UP and BSI

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Transmission-based Precautions

• Used in addition to standard precautions
• For known or suspected infections that are spread
  in one of three ways
• Airborne
• Droplet
• Contact
• May be used alone or in combination but always in
  addition to standard precautions

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Bloodborne Pathogen Exposure

• Report the incident immediately
• Complete injury report
• Seek appropriate evaluation and follow-up
• Identification and documentation of the source
  individual when feasible and legal
• Testing of the source for hepatitis B, C and HIV
  when feasible and consent is given
• Making results of the test available to the
  source individuals health care provider
• Testing of blood exposed nurse (with consent) for
  hepatitis B, C, and HIV please check these to
  match style used in book fairly certain it
  should be caped antibodies
• Postexposure prophylaxis if medically indicated
• Medical and psychologic counseling

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Puncture/Laceration

• Encourage bleeding
• Wash/clean the area with soap and water
• Initiate first aid and seek treatment if
  indicated
• Mucous membrane exposure (eyes, nose, mouth)
• Flush with saline or water flush for 5 to 10
  minutes

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WHO IS AT RISK FOR INFECTION?

• THE HOSPITAL STAFF/SERVICE PROVIDERS
• They are exposed to potentially infectious blood
  and body fluids on a daily basis
• CLIENTS IN THE HOSPITAL
• Service providers who do not wash hands in
  between clients and procedures.
• NOSOCOMIAL INFECTION Hospital-acquired infection
• IATROGENIC INFECTION Direct result of procedures
  or therapeutic treatments or diagnostic
  examinations
• THE COMMUNITY
• Unsanitary waste disposal, improper disposal of
  medical wastes such as contaminated sharps,
  dressings

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STOPPING TRANSFER OF INFECTION

• HANDWASHING THE SINGLEMOST EFFECTIVE CONTROL
  MEASURE TO CONTROL INFECTIONS
• ASEPSIS MEDICAL ASEPSIS VERSUS SURGICAL ASEPSIS
• WEARING OF GLOVES
• PROPER HANDLING AND DISPOSAL OF SHARPS
• PROPER INSTRUMENT PROCESSING
• PROPER WASTE DISPOSAL

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Sterile Technique

• 1. All objects used in a sterile field must be
  sterile.
• 2. Sterile objects become un-sterile when touched
  by un-sterile objects.
• 3. Sterile items that are out of vision or below
  the waist level of the nurse are considered
  unsterile
• 4. Sterile objects can become unsterile by
  prolonged exposure to airborne microorganisms.

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• 5. Fluids flow in the direction of gravity.
• 6. Moisture that passes through a sterile object
  draws microorganisms from un-sterile surfaces
  above or below to the sterile surface by
  capillary action.
• 7. The edges of a sterile field are considered
  un-sterile.
• 8. The skin cannot be sterilized and is
  un-sterile.