Medical / Surgical Asepsis

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Medical / Surgical Asepsis and
Infection Control
Sharon L. Kinley-Schwing BSN Pacific
College 2006
Foundations of Nursing Christensen Kockrow
Mosby Lois White / Thomas
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Medical/Surgical Asepsis
and Infection Control

• Joseph Lister (1827 1912) is known as the
  father of aseptic technique.
• Josephs technique helped reduce morbidity and
  mortality.
• It is now known that microorganisms cause
  infection.
• The growth and reproduction of a microorganism
  must be stopped to prevent an infection.
• Concern and education regarding transmissible
  infections have increased in both hospitals and
  homes.

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Infection Control

• Policies and procedures in infection control are
  included in all health care facilities.
• The education of all staff personnel is to
  minimize the risk of nosocomial infections.
• Any patient entering a health care facility, due
  to illness or need for invasive procedure is
  at risk for developing an infection.

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• The application of infection control principles,
  and use of common sense help protect the
  patients.
• Nurses are very often exposed to pathogenic
  microorganisms and should use specialized and
  routine practices of cleanliness to prevent the
  spread of infection.

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Asepsis

• Microorganisms are tiny, microscopic, capable of
  carrying on living process.
• Microorganism are naturally present in the
  environment, as well as on the human body.
• Many microorganisms are harmless, unless an
  individual is ill, and then highly susceptible to
  infection.
• There are some microorganisms that do cause
  specific diseases or infections.

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Asepsis

• Medical asepsis, know as clean technique,
  inhibits the growth and spread of pathogenic
  microorganisms
• Hand washing.
• Changing the patients linen daily.
• Daily activities of cleanliness.
• Principles of medical asepsis is common at home.

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• Surgical asepsis, known as sterile technique,
  destroys all microorganisms and their spores .
• Sterile technique and use in special skills and
  procedures.
• Care of surgical wounds.
• Urinary catheters.
• Invasive procedures and surgery.

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FLORA

• Microorganisms that occur or have adapted to live
  in a specific environment.
• Resident floraalways present, usually without
  altering the clients health.
• Transient floraepisodic, and do not continually
  live on the skin.

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PATHOGENICITY AND VIRULENCE

• Pathogensdisease-producing microorganisms.
• Pathogenicityability of microorganism to produce
  disease.
• Virulencefrequency with which a pathogen causes
  disease.

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FACTORS AFFECTING VIRULENCE

• The strength of the pathogen to adhere to healthy
  cells.
• The ability of a pathogen to damage cells or
  interfere with the bodys normal regulating
  systems.
• The ability of a pathogen to evade the attack of
  white blood cells.

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Infection Process

• Six elements must be present for infection to
  occur
• Infectious agent
• Reservoir
• Exit
• Method of transportation
• Entrance
• Host

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The Chain of Infection
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Infectious Agents
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BACTERIA

• Small, one-celled microorganisms that lack a true
  nucleus or mechanism to provide metabolism.
• Not all bacteria harmful or cause disease.
• Common bacterial infections diarrhea, pneumonia,
  sinusitis, cellulitis, urinary tract infections,
  meningitis, gonorrhea.

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Bacteria

• Many different characteristics.
• Three basic shapes, they include ?
• During cell division some bacterial stay together
  to form pairs.
• These difference help identifying specific kinds
  of bacteria.
• Aerobic bacteria
• Anaerobic bacteria
• What is a spore ?

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Bacteria continued

• Many diseases can be diagnosis and treated when
  the specific microorganism in identified.
• Body fluids, secretion suspected of containing
  pathogenic organisms can be evaluated for
  diagnosis.
• Cultures and sensitivity test are completed to
  determine the antibiotic that will inhibit
  growth.
• Streptococcus is responsible for more diseases
  than any other organism. Some strains are fatal.

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Viruses

• Smallest known agents that cause disease.
• Not complete cells, but consist of a protein coat
  around a nucleic acid core.
• 1898 Beijernick name these small bodies viruses.
• 1941 electron microscope made in possible to
  study these small agents.
• Enter the body via the respiratory,
  gastrointestinal, broken skin (vector or
  injection).
• Most viruses are self limiting illnesses, others
  are fatal.

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VIRUSES

• Organisms that can live only inside cells.
• They cannot get nourishment or reproduce outside
  cells.
• Common viral infections common cold, influenza,
  measles, chickenpox, hepatitis B, genital herpes,
  HIV.

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Fungi

• Fungal (mycotic ) infections are among the most
  common.
• Fungi belong to the plant kingdom, many are
  harmless, some are responsible for infections.
• The grey, black, green, white fuzzy growth on old
  bread is a type of fungi.
• Most mycotic infections are caused by yeasts and
  molds.
• Most commonly involve the skin and mucous
  membranes.
• Fungi that invade deeper tissue may be come fatal.

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FUNGI

• Grow in single cells or in colonies.
• Food from dead organic matter, living organisms.
• Most are not pathogenic.
• Fungi can cause infections of the hair, skin,
  nails, and mucous membranes.

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Protozoa

• Single celled animals existing every where in
  nature in some form.
• Some of the parasitic forms are found in the
  intestinal, genitourinary, respiratory and
  circulatory systems.
• Disease producing protozoa are responsible for
  malaria, amebic dysentery, and African sleeping
  sickness.
• Pathogenic microorganisms are infectious agents.
• These microorganisms require food, and a proper
  environment in which to grow and live.
• The strength of the organism, depends on the
  number present and the patients immune system.

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PROTOZOA

• Single-celled parasitic organisms with ability to
  move.
• Food from dead, decaying organic matter.
• Infection is spread through contaminated food,
  water, or insect bites.
• Common infections malaria, gastroenteritis,
  vaginal infections.

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RICKETTSIA

• Intracellular parasites that
• need to be in living cells to reproduce.
• Spread through fleas, ticks, mites, and lice.
• Common rickettsia infections include typhus,
  Rocky Mountain spotted fever, and Lyme disease.

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COLONIZATION AND INFECTION

• Colonizationthe multiplication of microorganisms
  on or within a host without resulting in cellular
  injury.
• Infectionthe invasion and multiplication of
  pathogenic microorganisms in body tissue that
  result in cellular injury.

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AGENT

• Entity that can cause disease
• Biological agents living organisms that invade
  the host, causing disease
• Chemical agents substances that can interact
  with body, causing disease.
• Physical agents factors in environment capable
  of causing disease.

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RESERVOIR

• Place where agent can survive
• In humans, animals, environment.
• Fomitesobjects contaminated with infectious
  agent.
• Carriershave infectious agent but symptom free.

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Reservoir continue

• Any natural habitat of a microorganism that
  promotes growth and reproduction is a reservoir.
• Many microorganisms are found in many areas of
  the body, but the presents doesnt always mean
  infection.
• Examples of Reservoirs
• Soiled dressings
• Wet dressings
• Bed linens/
  Gowns/Uniforms
• Hospital equipment
• Urinary drainage
  bags/ Urinals
• Carrier or vector is a person or animal that
  harbors and spreads an organism causing disease,
  with out becoming ill them self.

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Exit Route

• Microorganism cannot spread without first finding
  a way out of the first host.
• Human exit routes include
• gastrointestinal
• respiratory
• genitourinary
• blood
• tissue
• Handwashing prevent the spread of microorganisms
  or cross contamination.
• Coving the nose and mouth when coughing also
  prevents the spread of dieses causing organisms.

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PORTAL OF EXIT

• How infectious agent leaves the reservoir
• Sputum.
• Semen, vaginal secretions, and urine.
• Saliva and feces.
• Blood.
• Draining wounds.
• Tears.

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Method of Transmission

• Once a microorganism has exited a reservoir there
  are many vehicles.
• These vehicles are called contaminated, soiled or
  stained.
• What is a fomite ?
• What is a vector ?
• Give examples of
  each..

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MODES OF TRANSMISSION

• Movement of infectious agent from reservoir or
  source through portal of exit to portal of entry
  of susceptible host
• Contact transmission.
• Airborne transmission.
• Vehicle transmission.
• Vector-borne transmission.

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PORTAL OF ENTRY

• How an infectious agent enters the host
• Integumentary system.
• Respiratory tract.
• Genitourinary tract.
• Gastrointestinal tract.
• Circulatory system.
• Transplacental.

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Entrance of Microorganisms

• Once an organism has exited one host and been
  transmitted, it must find a way to enter a
  susceptible host.
• When a hosts defense mechanisms are reduced,
  there is a greater chance of the organism to
  enter.
• What are some of the ways organism can enter a
  host?

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Host

• A host is an organism in which another ,
  usually parasitic, organism is nourished and
  harbored.
• Susceptibilities are determined by the amount to
  resistance shown to the pathogen.
• Microorganisms are constantly in contact with
  people, but infections do not develop unless a
  person is susceptible to the numbers of
  organisms.
• Immunizations have proven effective in providing
  additional protection against infectious disease.

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HOST

• Organism that can be affected by agent.
• Susceptible hostperson who has no resistance to
  an agent and thus is vulnerable to disease.
• Compromised hostperson whose normal body
  defenses are impaired and is therefore
  susceptible to infection.

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FACTORS AFFECTING SUSCEPTIBILITY TO INFECTION

• Age
• Concurrent diseases
• Stress
• Immunization/vaccination status
• Lifestyle and occupation
• Nutritional status
• Heredity

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• Infectious process
• incubation period
• prodromal stage
• illness stage
• convalescence
• Inflammatory response

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STAGES OF INFECTION

• Incubation stagethe time between entry of an
  infectious agent and the onset of symptoms.
• Prodromal stagethe time from the onset of
  nonspecific symptoms until specific symptoms
  begin to manifest.
• Illness stagethe time when client has specific
  signs and symptoms.
• Convalescent stagefrom the beginning of the
  disappearance of acute symptoms until client
  returns to previous state of health.

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Nosocomial Infections

• Term taken from the Greek word, meaning health
  care facility.
• An infection that is acquired while in a hospital
  or other health care agency.
• This infection is usually acquired at least 12
  hour after admission.
• The hospital harbors microorganisms that may be
  highly virulent.

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NOSOCOMIAL INFECTIONS continued

• Infection acquired in hospital or other health
  care facility that was not present at the time of
  the clients admission.
• Include those infections that become symptomatic
  after the client is discharged.
• Four categories urinary tract, surgical wounds,
  pneumonia, and septicemia.
• These infections cause extended stays and
  treatment for patient, and increase cost of care
  for the hospital.

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Infection Control Team

• Valuable discipline in the health care arena.
• These teams include who ?
• OSHA and JAHO have pressured hospitals to better
  organize these teams, and document infections
  within the hospital.
• What is the duty of infection control personnel ?
• Employee health services.

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BREAKING THE CHAIN OF INFECTIONPage 359
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Standard Precautions

• Set of guidelines designed to reduce the link of
  transmission of blood born pathogens and
  pathogens from moist body secretions.
• Guidelines apply to
• Blood
• All body fluids, secretions and excretions
• Nonintact skin
• Mucous membrane
• Precautions promote
• Handwashing
• Use of gloves, masks, eye protection
• Use of gowns when appropriate for patient contact

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Hand Hygiene

• The most important and basic preventive
  technique for interruption the infectious
  process.
• 2 minute handwashing will provide protection
  before the nurse cares for a patient.
• 30 second handwashing before caring for another
  patient should be sufficient to ensure minimal
  transmission of microorganism between patients.

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MEDICAL ASEPSIS

• Hand hygienethe most basic and effective
  infection-control measure to prevent and control
  the transmission of infectious agents.
• Single most important procedure for preventing
  nosocomial infections.

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• Performing a 2 minute hand wash.
• Using an Alcohol-Based Waterless Antiseptic for
  Routine Hand Hygiene.

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Performing a 2-minute handwashing
(From Elkin, M.K., Perry, A.G., Potter, P.A.
2004. Nursing interventions and clinical
skills. 3rd ed.. St. Louis Mosby.)
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Health Promotion Considerations

• Adequate exercise, well balanced diet, current
  immunizations.
• Discuss susceptibility of the patient to disease.
• Teach correct and safe methods of storing and
  preparing foods.
• Hygiene.
• Know family and others susceptibilities to
  disease.
• Home cleaning techniques for patients cared for
  at home.

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Gloving

• Gloves are use if there is nay possibility of
  contact with infectious material.
• Advice from the CDC on wearing gloves include ?
• Donning gloves / Removing gloves

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• Gowning
• gowning for isolation
• Mask / Protective eyewear
• donning a mask
• Disposing of Contaminated Equipment
• Double bagging
• Isolation technique

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Donning a mask.
(From Potter, P.A., Perry, A.G. 2005.
Fundamentals of nursing. 6th ed.. St. Louis
Mosby.)
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Double bagging.
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Types of PrecautionsPatients Requiring Precaution

• Standard precautions
• Airborne precautions
• Droplet precautions
• Tuberculosis isolation

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Types of Precautions continued

• Contact Precautions
• Immunocompromised patients
• Monitoring of isolation

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ASEPSIS

• Absence of microorganisms
• Medical asepsispractices used to reduce the
  number, growth, and spread of microorganisms
• Surgical asepsispractices that eliminate all
  microorganisms and spores from an object or area

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Surgical Asepsis

• Surgical or sterile technique, requires a nurse
  to use precautions different from those of
  medical asepsis.
• Nurse working with a sterile field or equipment
  must understand sterile technique.
• Any break in this technique results in
  contamination.
• Surgical asepsis is practiced in the operating
  room, labor and delivery area, and major
  diagnostic areas.
• Surgical asepsis may also be used during
  procedures at the bedside.

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Surgical handwashing
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Surgical Handwashing.
(From Elkin, M.K., Perry, A.G., Potter, P.A.
2004. Nursing interventions and clinical
skills. 3rd ed.. St. Louis Mosby.)
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• Cleaning
• Disinfection
• and Sterilization

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• Cleaning
• Disinfection
• Sterilization
• Preparing for disinfection and sterilization

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CLEANSING

• Removal of soil or organic material from
  instruments and equipment used in providing
  client care.
• Involves the use of water, mechanical action, and
  sometimes, a detergent.
• Nurses should wear gloves, masks, and goggles
  during cleansing.

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Sterilization or Disinfection

• Physical Method
• Steam under pressure/ moist heat
• Boiling water
• Radiation
• Dry heat
• Chemical Process
• Gas
• Chemical solutions

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DISINFECTION

• Elimination of pathogens, except spores, from
  inanimate objects.
• Disinfectantschemical solutions used to clean
  inanimate objects.
• Germicideschemicals that can be applied to both
  animate (living) or inanimate objects to
  eliminate pathogens.

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STERILIZATION

• Destroying all microorganisms including spores.
• Equipment that enters normally sterile tissue or
  blood vessels must be sterilized.

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STERILIZATION (continued)

• Methods include
• Moist heat (steam)
• Dry heat
• Ethylene oxide gas
• Autoclaving (moist heat or steam) is the most
  common method.

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B, Receptacle receiving fluids is placed near
edge of sterile table.
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Patient Teaching for Infection Control

• The nurse will need to educate patient about the
  nature of infection and the techniques to use in
  planning or controlling its spread
• Infection control for home and hospice settings.
• Prevention of infection
• Hand washing
• food preparation
• lines
• waste containers
• body fluid spills

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Infection Control

• Older adult considerations
• Cultural and Ethnic Considerations

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Infection Control for Home and Hospice Settings

• Nursing Process
• Assessment
• Prevention of Infection in the Home setting
• Hand hygiene
• Food preparation
• Linens
• Waste containers
• Body fluid spills

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BODY DEFENSES

• A hosts immune system is a defense against
  infectious agents.
• An immune response against an antigen protects
  the body from infection.
• Immune defenses are identified as nonspecific and
  specific.

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NONSPECIFIC IMMUNE DEFENSE

• Protects host from all microorganisms
• does not depend on prior
  exposure to antigen
• Skin and normal flora.
• Mucous membranes.
• Coughing, sneezing, and tearing reflexes.
• Elimination and acidic environment.
• Inflammation.

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INFLAMMATION

• Nonspecific cellular response to tissue injury
• Redness (erythema).
• Heat.
• Pain.
• Swelling (edema).
• Loss of function.
• Purulent exudate (pus).

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SPECIFIC IMMUNE DEFENSE

• Response specific to an invading antigen.
• Acquired immunityprotects individual against
  future invasions of already experienced antigens.
• Vaccinationan inoculation with a vaccine to
  produce immunity against specific diseases.

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TYPES OF INFECTION

• Localized infectionslimited to defined area or
  single organ with symptoms that resemble
  inflammation (redness, tenderness, swelling),
  such as cold sore.
• Systemic infectionsaffect entire body, involve
  multiple organs, such as AIDS.

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NURSING DIAGNOSIS

• Risk for infection.
• Ineffective protection.
• Impaired tissue integrity.
• Impaired oral mucous membrane.
• Impaired skin integrity.
• Deficient knowledge (specify).

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• Nursing diagnosis
• Expected outcomes
• Planning
• Implementation
• Evaluation

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• Questions ?