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MEDICAL ASEPSIS
HAND HYGIENE
- hand hygiene is the most effective way to help prevent the spread of
organisms
- applies to either hand washing with plain soap and water, use of antiseptic
handrubs including alcohol-
based products, or surgical hand antisepsis
- important to clean hands promptly: when they are visibly soiled, after
each contact with contaminated
materials, after removing gloves
ii.Resident Bacteria
- normally found in creases in the skin (relatively stable in
number and type)
- cling tenaciously to the skin by adhesion and absorption,
requiring considerable friction
with a brush for removal
- less susceptible to antiseptics
2. CLEANSING AGENTS
a. Types
i. Nonantimicrobial Agents
- soaps and detergents (bar, liquid, leaflet, and powdered)
- considered adequate for routine mechanical cleansing of the
hands and removal of most
transient microorganisms
- lower surface tension and act as emulsifying agents
ACTION RATIONALE
1. Stand in front of sink – Don’t Clothing may carry contamination from
allow clothes place to place
to touch sink during washing
2. Remove jewelry Microorganisms may accumulate in settings
3. Use warm water and medium Water splashed will contaminate clothing.
force Warm water is more comfortable, has less
tendency to open pores and remove oils
from skin. Organisms can lodge in rough,
broken areas of chapped skin
4. Keep hands lower than Water should flow from the cleaner
elbows (forearms) toward contaminated (hands)
5. Apply washing agent (if using Rinsing bar soap removes lather than may
bar, rinse contain microorganisms
soap again and return to soap
dish)
6. With firm rubbing and circular Friction helps loosen dirt / organisms
motions, Length of washing is determined by degree
wash hands, up to at least 1” of contamination
above the
hands (Continue for at least
15 sec.)
7. Use fingernails of other hand Area under nails has a high microorganism
or clean count
orangewood stick to clean
under
fingernails
8. Rinse thoroughly & pat hands Drying and patting the skin well prevents
dry using chapping
paper towels and discarding
immediately
without touching other clean
hand
9. Use lotion, if desired Avoid oil-based lotions – they deteriorate
gloves
3. METHODS
Physical:
a. Steam – higher temperature caused by higher pressure destroys
organisms (ex. autoclaving)
- most plastic and rubber devices are damaged by autoclaving
b. Boiling Water – simple, inexpensive – frequently used in homes – boil
item for at least 10 minutes
- spores and some viruses are not destroyed by boiling
c. Dry Heat – alternative sterilization method for home – used for metal
items – 350º heated oven for 2
hrs. or more
- insufficient to destroy all microorganisms – not used in
healthcare agencies
d. Radiation – used for pharmaceuticals, foods, plastics, and other heat-
sensitive items
- items must be directly exposed to ultraviolet radiation on all
surfaces – poses risk to
personnel
Chemical:
a. Ethylene Oxide Gas – destroys microorganisms and spores (gases
released with items in autoclave)
- precautions necessary because gas is toxic to humans
b. Chemical Solutions – generally used for instruments and equipment
disinfection and housekeeping
disinfection
- chlorines, sodium hypochlorite (household bleach), betadine and
alcohol are used
- method does not destroy all spores and may cause corrosion on
metal
a. Latex Allergy – sensitivity reactions can range from local skin reactions
to urticaria (hives) to
systemic anaphylaxis (an exaggerated allergic reaction that can
result in death)
- cornstarch powder or talc used to make gloves easier to put on is
a major causative factor
-powder particles may be inhaled, be absorbed into skin or
mucous membranes or
enter the bloodstream
- nitrile gloves (synthetic material that resembles latex but has not
latex protein) tear easily
but provide an alternative to latex
- latex safe environment involves removal or covering of any
natural latex rubber items, such
as wall mounted blood pressure cuffs, sharps containers,
injection port caps on IV
tubing, and urinary catheters
- always ask whether patients have experienced any unusual signs
or symptoms when
blowing up balloons, using latex condoms, or wearing
rubbing gloves for
dishwashing or cleaning
2. GOWNS
- usually worn to prevent soiling of healthcare worker’s clothing by the
patient’s blood and body fluids
- provide barrier protection and are donned immediately before entering
a patient’s room
- worn only once and then discarded appropriately
- if gown becomes heavily soiled or moistened with blood or body fluids
when caring for a patient,
remove it, perform thorough hand hygiene and put on a clean
gown
- neck strings are considered clean
- gown that is not visibly soiled requires no particular technique for
removal
3. MASKS
- help prevent wearer from inhaling large-particle aerosols, which
usually travel short distances
(about 3 ft) and small-particle droplet nuclei, which can remain
suspended in air and travel
longer distances
- discourage wearer from touching the eyes, nose, and mouth, limiting
contact with mucous
membranes
- worn only once and never lowered around the neck and then brought
back over the mouth and
nose for reuse
- high-efficiency particulate air (HEPA) filter respirator or N95 respirator
certified by NIOSH must be
worn when entering room of patient with known or suspected
tuberculosis
- these respirators filter inspired air (surgical masks filter only
expired air)
- N95 respirator fits more comfortably against the face and costs
considerably less than the
HEPA filter respirators
- elastic straps provide more protection and a better fit than
the ties on regular
surgical masks
4. PROTECTIVE EYEWEAR
- goggles or face shield
- must be available whenever there is a risk of contaminating the
mucous membranes of the eyes
ex. while suctioning a tracheostomy or assisting in an invasive
procedure
CDC recommends that healthcare workers use gloves, gowns, masks, and protective
eyewear when exposure to
blood or body fluids is likely and that all patients should be considered
potentially infected
- blood, semen, vaginal secretions, breast milk, cerebrospinal, synovial,
pleural, peritoneal, pericardial, and
amniotic fluids are included
SPECIAL SITUATIONS
Methicillin Resistant Staphylococcus Aureus (MRSA)
Vancomycin Resistant Enterococcus (VRE)
- use standard and transmission-based (particularly contact) precautions
- avoid wearing rings, bracelets, or watches
Immunosuppressed Patients – more often than not become infected by
organisms harbored in their own
bodies rather than pathogens present in the environment or transmitted
from other people
- provide a healthy healthcare provider
- restrict visits from friends and family who have colds or contagious
illnesses
- avoid standing collection of water in the room
Home Practices: washing hands before preparing food and before eating
preparing foods at temps. high enough to ensure safe eating
using care with cutting boards and utensils – thorough
cleaning before and after
handling raw meat
keeping food refrigerated, especially those containing
mayonnaise
washing raw fruits and vegetables
using pasteurized milk and fruit juices
washing hands after using the restroom
using individual personal care items (washcloths, towels,
toothbrushes, etc.)
Community Practices: use sterilized combs and brushes in barber and beauty
shops
perform exam of food handlers for evidence of disease