Asepsis and Infection Control

Function of nurses: Provide a biologically safe environment

Microorganisms always present in the environment exists in water,
soil, and body surfaces such as skin, intestinal tract, & areas open to the
outside (mouth, upper and lower urinary tract, and vagina)

Resident Flora or Bacteria microorganisms that are a common resident
in one body part yet produce infection in other part (ex. E.Coli, a resident
flora in intestine that causes UTI); microorganisms that normally live in
the skin.

Transient Flora or Bacteria microorganism picked up by the skin as a
result of normal activities and can be removed readily.

Infection invasion of body tissue by microorganism and their growth
there

Infectious agent microorganisms that invade body tissue and grow
there

Asymptomatic or Subclinical Infection microorganisms that produce no
clinical evidence of disease but some cause damage (ex. CMV in pregnant
woman can lead disease in unborn child)

Disease
Detectable alteration of normal tissue function
Alteration in body functions resulting in reduction of capacities and
shortening of normal life span.
Disturbance of the structure and function of the body or its
constituent parts.

Communicable Disease results if an infectious agent can be transmitted
to another by direct or indirect contact (thru vector or vehicle) or as an
airborne infection

Virulence- vigor with which the organism can grow and multiply;
microorganisms vary their ability to produce disease.

Pathogen Disease producing microorganism
Pathogenicity ability to produce a disease
Opportunistic Pathogen causes disease only in susceptible individuals
True Pathogen causes disease in a healthy individual

World Health Organization (WHO) Major regulatory agency at the
International Level for disease prevention and control

Centers for Disease Control and Prevention (CDC) Principle public
health agency at the National Level for disease prevention and control

Asepsis Freedom from or absence of disease causing microorganisms ;
free from infection. Has 2 Types:
a. Medical Asepsis
Clean Technique
Practices that confine a specific microorganism in a specific
area, limiting or reducing the no., growth, and transmission

b. Surgical Asepsis
Sterile Technique
Practices that keep area or object free from microorganisms
Destroy ALL microorganisms and SPORES (microscopic
dormant structures formed by pathogens that can survive in
common cleaning technique)
Used for procedures that involves sterile areas of the body
Used for invasive procedures
Sepsis Presence or State of Infection
Septicimia transport of infection throughout the body or blood

Types of Microorganism Causing Infections
1. Bacteria most common infection causing microorganism; can live
and transported thru air, water, food, soil, body tissues and fluids,
and inanimate objects
2. Viruses consists of nucleic acid and therefore must enter cells to
reproduce (ex. Rhinovirus most common; cause of common cold;
hepatitis, herpes, HIV)
3. Fungi yeasts & molds (ex. Candida Albicans - normal flora in vagina)
4. Parasites live in other organisms (ex. Protozoa that causes Malaria;
worms; anthorpods such as mites, ticks, and fleas)

Colonization - Process which microorganisms become resident flora
they grow and multiply but dont cause disease.

TYPES OF INFECTION
1. Local Infection limited to specific body part where microorganisms
remain.
2. Systemic Infection microorganisms spread and damage different
body parts
3. Acute Infection appears sudden/abrupt and last a short time <6
months
4. Chronic Infection occurs slowly or gradually, over a long period of
time and last months or years ( >6 months)
5. Bacterimia presence of bacteria in blood; bacterimia results to
septicemia
6. Septicemia transport of infection throughout body or blood.




Nosocomial Infection
Hospital acquired infection
Hospital associated (associated with the delivery of health care
services in a health care facility)
Infection acquired 48 hours after admission to hospital.
Develops during client stay and manifest after discharged
Can originate from client themselves (endogenous source most
common) or from hospital and hospital personnel (exogenous
source)

Common sites
Urinary (ex. unsterile indwelling urinary catheter)
Respiratory
GIT
Bloodstream
Skin, Wound, Burn
Surgical Site Infection
Others

Factors that can contribute to Nosocomial Infections:
Iatrogenic Infection unintended infection result of diagnostic or
therapeutic procedures (ex. Bacterimia from intravascular line)
Compromised Host normal defenses lowered by surgery or illness
Hands of Personnel common vehicle for spread of microorganisms
Age
Duration of Hospitalization
Immune Status (decreased resistance)
* Chemotherapy
* Radiation Therapy
* Malignancy
Diagnostic Technique and procedures
Environment
Patient
4 STAGES OF INFECTIOUS PROCESS
1. Incubation Period entry of microorganism to body onset of non
specific s/s
2. Prodromal Period onset of non specific s/s appearance of
specific s/s
3. Illness Period specific s/s develop and become evident
4. Convalescent Period s/s start to abate (decrease) client returns
to normal state of health.

CHAIN OF INFECTION
1
ST
- ETIOLOGIC / INFECTIOUS AGENT
Microorganism (bacteria, virus, fungi, or parasite) capability to
produce infection depends on no. of microbes, pathogenicity,
ability to enter body, susceptibility of host, and ability to live on
the hosts body.
Ability of agent to cause disease depends on the microorganisms
pathogenicity, virulence, invasiveness, and specificity (organisms
attraction to a specific host)

2
ND
- RESERVOIR (SOURCE OF MICROORGANISM)
humans (most common; clients, visitors, health care personnel)
clients own microorganism
animals (insects, rat)
plants
inanimate objects
general environment (air, water, soil, food, feces)


3
RD
- PORTAL OF EXIT FROM RESERVOIR
Respiratory nose or mouth thru sneezing, coughing, breathing,
talking; droplets, sputum
GIT mouth (vomitus, saliva), anus (feces), ostomies, drainage
tubes
Urinary urethral meatus (urine, urethral catheters); anus (feces
and colostomies)
Reproductive vaginal discharge, semen
Blood open wound, needle puncture site
Tissue drainage from cut or wound

4
th
MODES OF TRANSMISSION

1. Contact Transmission - direct / indirect
a. Direct Transmission immediate and direct transfer from
person to person (body surface->body surface); hands of
caregivers - most frequent mode of transmission (ex. Nurses to
clients during bathing, dressing changes, insertion of tubes and
catheter)

b. Indirect Transmission - susceptible host exposed to
contaminated objects such as dressing, needle, surgical
instrument

Vehicle Borne Transmission
transfer of microorganisms by vehicles or contaminated
objects (ex. food, water, milk, blood, utensils, pillows,
mattress)
Fomites or Inanimate Objects (surgical instruments or
dressings, handkerchief, soiled clothes, toys, utensils,
surgical instruments / dressings)

Vector Borne Transmission
Biologic vectors animals such as rats, snails, mosquitoes;
Flying or crawling insects that serves as intermediate means
to transport infectious agent. Transmission by injecting the
saliva during biting or depositing feces on skin thru wound
bite
3. Airborne Transmission
Involves DROPLET NUCLEI OR DUST
Occurs when fine particles are suspended in the air for a long
time or when dust particles contain pathogens. Air current
disperses microbes which can be inhaled or deposited on the
skin of susceptible host.
Droplet Nuclei residue of evaporated droplets emitted by
infected host (ex. TB Patient)

5
th
PORTAL OF ENTRY TO THE SUSCEPTIBLE HOST
Microorganism enters the body of susceptible host by the same route
they used to leave the source.
Pathogens can enter through body orifices such as mouth, nose, ears,
eyes, vagina, rectum, or urethra. Breaks in skin / mucous membranes
from wounds or abrasions increases chance for organisms to enter
host.

6
th
SUSCEPTIBLE HOST - Person at risk for infection whose own body
defense mechanisms, when exposed are unable to withstand the invasion
of pathogens

Susceptibility degree in which individual can be affected

Compromised Host person at increased risk, more likely than others to
acquire infection; normal defenses have been lowered.
Malnourished children
client w/ leukemia
Impaired natural defenses
Age (very young and very old)
Clients receiving immunosuppressive treatment for CANCER
Clients with immune deficiency conditions
Following a successful organ transplant

Factors influencing the Hosts Susceptibility
Intact skin and mucous membrane are bodys 1
st
line of defense
Normal PH LEVELS of secretions and of genito-urinary tract help ward
off microbial invasion
Bodys WBC influence resistance to certain pathogens
Immunization (natural/acquired), acts to resist infection
Fatigue, climate, general health status, presence of pre-existing
illness, previous or current treatments and some medications may
play part in the susceptibility of a potential host.

BODY DEFENSES AGAINST INFECTION (NONSPECIFIC / SPECIFIC)
1. NON SPECIFIC
Protect the person against all microorganisms, regardless of
prior exposure
Includes anatomic and physiologic barriers
Intact Skin 1
st
line of defense unless cracked or broken;
dryness is also deterrent to bacteria. Bacteria are plenty in
moist areas such as perineum and axillae. Resident bacteria
of skin also prevent other bacteria from multiplying. normal
secretions make skin slightly acidic that inhibits bacteria.
Nasal Passages (has cilia that trap microbes, dust, and
foreign material)
Oral Cavity (saliva contains microbial inhibitors such as
lactoferin, lysozome,etc)
Eye (protected by tears which wash microbes away and
contain lysozome)
Lungs (has alveolar macrophages II large phagocytes)
GIT (high acidity prevents microbial growth; peristalsis
moves microbes out)
Vagina (has natural defenses; when a girl reach puberty,
lactobacilli ferment sugars in vaginal secretions creating PH
3.5-4.5- this low PH inhibits growth of pathogens
Urethra (urine flushes bacteria)
INFLAMMATORY RESPONSE
Local and non specific response of tissues to infectious agent
An adaptive mechanism that destroys injurious agents and prevents
further spread of injury and promotes repair.
ENDING IN ITIS describes INFLAMMATORY PROCESS
Characterized by:
a. Pain or Dolor
b. Swelling or Tumor
c. Redness or Rubor
d. Heat or Color/Calor
e. Impaired function of the part if severe injury

INJURIOUS AGENTS
1. Physical Agents mechanical objects causing trauma to tissues,
excessive heat or cold, radiation, UV Rays
2. Chemical Agents strong acids and bases, alkalis, poisons, gases
3. Microorganisms

3 STAGES OF INFLAMMATORY RESPONSE
1. Vascular and Cellular Response
2. Exudates Production
3. Reparative Phase (Regeneration and Fibrosis)
* Fibrosis - formation of excess fibrous connective tissue in an organ
or tissue in a reparative or reactive process; SCARRING

2. SPECIFIC IMMUNE DEFENSES
a. Anti-body Mediated Defenses (Antibodies or Immunoglobins)
b. Cell Mediated Defenses or Cellular Immunity (TCeLLS)

SUPPORTING DEFENSE OF A SUSCEPTIBLE HOST
proper hygiene
balanced diet
adequate fluid intake
adequate sleep
immunizations
stress (nurses can assist to learn stress reducing techniques)

TYPES OF IMMUNIZATION
1. ACTIVE IMMUNIZATION - Antibodies produced by the body in
response to infection
a. Natural - Antibodies formed in the presence of active infection
in the body; IT IS LIFELONG ex. recovery from mumps, chicken
pox
b. Artificial Antigens (VACCINES OR TOXOIDS) administered to
stimulate antibody production; Requires booster inoculation
after many years.ex. Tetanus Toxoid, OPV

2. PASSIVE IMMUNIZATION antibodies produced by another source
such as animal or human
a. Natural antibodies from mother to newborn thru placenta or
in colostrums
b. Artificial Immune Serum (antibody) from animal or another
human is injected (ex. Tetanus Immunoglobin Human TIGH)

BREAKING THE CHAIN OF INFECTION / ASEPTIC PRACTICES
1. HANDWASHING
The single most important infection control practice
microorganisms are transient floras until hands are washed
soap, water, and alcohol based hand rubs are effective
preparations for removing transient microorganisms
wash hands before and after client contact
Medical asepsis - hands LOWER than elbows. Hands are more
contaminated than elbows.
Use running water, soap & friction for 15 30 secs each hand
turn off faucet with clean paper towel.
Always wear gloves during client care when skin is abraded.
2. CLEANING, DISINFECTION, STERILIZATION
a. Cleaning physical removal of dirt and debris by washing,
dusting, or mopping contaminated surfaces

b. Disinfection Chemical or physical process to reduce no. of
potential pathogens on surface but not necessarily the spores.

Disinfectant chemical preparation used on INANIMATE
OBJECTS (ex. Phenol); have bactericidal and bacteriostatic
properties

Antiseptic chemical preparation used on SKIN OR TISSUE;
have bactericidal and bacteriostatic properties

Bactericidal destroys/kills bacteria; chemical that kills
microorganisms

Bacteriostatic prevents growth and reproduction of some bacteria;
prevents bacterial multiplication

Commonly used anti-septics and disinfectants
Isopropyl alcohol hands and vials
Chlorine (bleach) blood spills
Hydrogen Peroxide and Phenols surfaces
Iodophors equipment; intact skin and tissues if diluted
Triclosan (Bacti-stat) hands, intact skin

Types of Disinfection
1. Concurrent Disinfection ongoing practices observed in the care of
the client, his supplies, immediate environment, to limit / control
spread of microbes.
2. Terminal Disinfection practices to remove pathogens from clients
belongings and his immediate environment after his/her illness is no
longer communicable

c. Sterilization - Process that destroys all microorganisms, including
spores, and viruses Has 4 Common Methods:
1. Steam Sterilization auto-claving using supersaturated steam
under pressure
o non toxic, inexpensive, sporicidal, penetrates fabric
rapidly.
o for surgical dressings, surgical linens, parenteral solutions,
metals, and glass objects
o color indicator strips change color to indicate sterilization
o check packaging for integrity and check expiration date to
ensure sterility of object

2. Gas Sterilization ETHYLENE OXIDE is a colorless gas that can
penetrate plastic, rubber, cotton and other subs. used for oxygen
and suction gauges, BP apparatus, stethoscopes, catheters
o expensive and requires 2 5 hrs
o Ethylene oxide is TOXIC TO HUMANS.

3. Radiation ionizing radiation penetrates deeply to objects; used
for drugs, food, and other heat-sensitive items.

4. Chemicals effective disinfectants
o all kinds of microbes, act rapidly, work with water,
inexpensive, stable in light and heat, not harmful to body
tissues, do not destroy articles
o Chlorine is used.

5. Boiling Water least expensive for use @ home; for baby
bottles boiled for at least 15mins