ASEPSIS

Sherwin Morales Amid Rn RPT

LEARNING OUTCOMES
After completing this chapter, you will be able
to:
Explain the concepts of medical and surgical
asepsis.
Identify signs of localized and systemic
infections and inflammation.
Identify risks for nosocomial and health care
associated infections.
Identify factors influencing a microorganisms
capability to produce an infectious process.
Identify anatomic and physiological barriers
that defend the body against
microorganisms.
Differentiate active from passive immunity.

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, standard, and

transmission-based isolation precaution systems.

Verbalize the steps used in Performing hand hygiene.

Recognize when it is appropriate to delegate infection control skills to

unlicensed assistive personnel.

Describe the steps to take in the event of a bloodborne pathogen

exposure.

HISTORY OF INFECTIOUS
DISEASE PREVENTION
first attempt to
prevent infection. He
believed:

Hippocrates

Environment and natural forces

play an important part in role of
disease and health
Simple treatments, using strong
drugs and surgery only as a last
resort.

JOSEPH LISTER
Discovered how to
use chemical
antiseptics to
control surgery
related infections
Used antiseptics to
disinfect surgical
equipment and
supplies
Microorganisms are simple forms of life
commonly made up of a single cell only seen
with a microscope.

RESIDENT FLORA
microorganisms are normal in one part of the body, yet produce infection
in another. For example, Escherichia coli, commonly referred to as E. coli,
is a normal inhabitant of the large intestine but a common cause of
infection of the urinary tract.

INFECTION
is an invasion of body tissue by microorganisms and their growth there.
Such a microorganism is called an infectious agent. If the microorganism
produces no clinical evidence of disease, the infection is called
asymptomatic or subclinical.

DISEASE.
A detectable alteration in normal tissue function,

VIRULENCE
Microorganisms ability to produce disease

COMMUNICABLE DISEASE.
If the infectious agent can be transmitted to an individual by direct or
indirect contact or as an airborne infection, the resulting condition is
called a communicable disease.

PATHOGENICITY
is the ability to produce disease; thus, a pathogen is a microorganism that
causes disease. Many microorganisms that are normally harmless can
cause disease under certain circumstances. A true pathogen causes
disease or infection in a healthy individual.

OPPORTUNISTIC PATHOGEN
causes disease only in a susceptible individual.

ASEPSIS
The term asepsis means
the absence of diseaseproducing microorganisms

CONCEPT OF ASEPSIS

The nurses efforts to minimize the onset & spread

of infection are based on the principles of aseptic
technique.

Aseptic technique is an effort to keep the client as

free from exposure to infection-causing pathogens
as possible.

DEFINITION

Aseptic technique is the effort taken to keep the patient

as free from hospital micro-organisms as possible (Crow
1989).
It is a method used to prevent contamination of wounds
& other susceptible sites by organisms that could cause
infection.
This can be achieved by ensuring that only sterile
equipment & fluids are used during invasive medical &
nursing procedures.

TYPES OF ASEPSIS
There are two types ofTECHNIQUE
asepsis:
Medical asepsis & Surgical asepsis.

Medical or Clean Asepsis reduces the number of

organisms & prevents their spread.

SURGICAL OR STERILE ASEPSIS

OR STERILE TECHNIQUE
includes procedures used to eliminate microorganisms from an area & is practiced by nurses in
OTs, labour & delivery area, major diagnostic areas
& Rx areas.

MEDICAL ASEPSIS

During daily routine care, the nurse uses basic medical

aseptic techniques to break the infection chain.
Eg.of medical asepsis are changing clients bed linen
daily, handwashing, barrier techniques, & routine
environmental cleaning.

 Follow Isolation technique as appropriate.

CONT

Clients with high susceptibility to infection require

special precautions to prevent exposure to
pathogens.

CONT
In medical asepsis, an area or object is considered
contaminated only if it is suspected of containing
pathogen (e.g., used bedpan, the floor & a wet
piece of gauze).

SURGICAL ASEPSIS
Sterilization destroys all microorganisms & their
spores.
Surgical asepsis demands the highest level of
aseptic technique & requires that all areas be kept
as free as possible of infectious micro-organisms.

CONT

These techniques can be practiced by nurses in the

OR (surgical incision) or at the bedside (e.g,
inserting IV or urinary catheter & reapplying sterile
dressings) where sterile instruments & supplies are
used.

CONT
In surgical asepsis, an area or object may be
considered contaminated if touched by an object
that is not sterile (e.g., a tear in a surgical glove
during a procedure, a sterile instrument placed on
an unsterile surface).

CONT

The nurse working with a sterile field or with sterile

equipment must understand that the slightest break

in technique results in contamination.

CONT
A nurse in an operating room follows a series of
steps to maintain sterile techniques, including
applying a mask, protective eyewear, and a cap;
performing a surgical hand washing; & applying a
sterile gown & gloves.

CONT

Effectiveness of aseptic practices depends on the

nurses conscientiousness & consistency in using
effective aseptic techniques.

ASEPTIC PRACTICES

ASEPTIC PRACTICES

ASEPTIC PRACTICES

CONTROL OR ELIMINATION OF
Cleansing
INFECTIOUS AGENTS
Is the removal of all foreign materials such as soil & organic

material from objects.

Generally, cleansing involves use of water & mechanical action

with or without detergents.

- Disposable object has to be discarded.
- Reusable objects must be cleansed thoroughly before
disinfection
& sterilization.

 When cleaning equipment that is soiled by organic

material such as blood, fecal matter, mucus or pus,
the nurse applies a mask, protective eyewear, &
waterproof gloves.
These barriers provide protection from infectious
organisms.
A brush, detergent or soap are
needed for cleaning.

DISINFECTION & STERILIZATION

Disinfection eliminates pathogenic organisms on
inanimate objects with the exception of bacterial
spore. Noninfectious microorganisms may or may
not be killed.

 Sterilization is the process of eliminating and

destroying all microorganisms, including spores &
viruses.

DISINFECTION
The principle of disinfection is that of denaturation
of the bacterial cell protein.

This process can be carried out by two methods:

1. Physical

- boiling

2. Chemical - disinfectants

CHOICE OF METHOD
DEPENDS ON:
A) Types of microorganisms
Certain strains of bacteria are more resistant to
destruction than vegetative forms.

B) Number of microorganisms present on articles

The more heavily contaminated the articles are,
harder for destruction.

the

Essential factors for maximum effectiveness

of disinfection are:- Cleanliness of items
- Unlocking all locked instruments
- Complete immersion of articles

USE OF DISINFECTANTS
Indications for use of Hospital Disinfectants:

1. Disinfection of skin & mucous membranes.

2. Disinfection of instruments & other items.
3. Decontamination of the inanimate environment.

CHEMICAL DISINFECTANTS ARE SUCH AS:

1. Phenolics a) clear soluble fluids, e.g., 2% Printol. 1% Sudol
b) Hexachlorophene e.g., Phisohex, Gamaphene
- for wide range of antibacterial activity.
2. 70% - 75% Ethyl or Isopropyl Alcohol - for wide range of
antibacterial activity, most active against TB.

CHEMICAL DISINFECTANTS
CONT.
3. Halogens - for inactivation of viruses and anti bacterial
activity

except TB.

a) Chlorine (hypochlorites) e.g., Milton, Eusol.

b) Iodine.
4. Glutardehyde, e.g., Cidex - wide range of antibacterial
activity, very effective against Hepatitis B virus. Best
for heat sensitive instruments.

5. Quaternary ammonium compounds

e.g., Cetrimide (Cetavlon) - good detergent (more
active against gram +ve organisms).
6. Diguanides,
e.g., Chlorhexidine (Hibitane)
Chlorhexidine + detergent (Hibiscrub, Savlon) - useful
skin disinfectant. Very active against gram +ve
organisms.

STERILIZATION
HEAT

THIS PROCESS CAN BE CARRIED OUT BY 4

METHODS: IRRADIATION

- moist heat (Autoclave)

- ultra violet light

- dry heat (Hot Air Oven)

- gamma rays/cobalt
60

CHEMICAL
- in solution, e.g., Ethicon
Fluid, Glutaraldehyde
- vapour, e.g.,
Formaldehyde
- gas, e.g., Ethylene Oxide

FILTRATION

- applicable to
pharmaceutical
laboratory where it is
used in combination
with ultra violet light.

THE PRINCIPLES OF ASEPTIC TECHNIQUE

IN WOUND CARE
Medical Hand Washing cleaning of trolley, opening
the dressing pack, to cleaning the wound.
Surgical Hand Washing scrubbing in surgery.

GOWNS & APRONS

protective clothing is used to reduce bacterial

spread by contact (nurses uniforms become heavily

contaminated during clinical procedures.

 Gloves The purpose of wearing gloves is both to

protect the hands from contamination by microorganisms and to prevent the transfer of microorganisms already on the hands.

SINGLE-USE

irrigation devices should not be used for multi-use

purposes as there is potential for cross-infection
between pts.
e.g., IV lines & buckets.

BLOOD TRANSMISSABLE DISEASES

&
SEXUALLY TRANSMITTED DISEASES
(STDs)
HIV Infection/AIDS
Hepatitis B (HBV)
Hepatitis C (HCV)

Syphilis

Gonorrhoea
Chlamydia
Herpes Simplex
Cytomegalovirus

INFECTION PREVENTION MEASURES: BODY

SUBSTANCE ISOLATION SYSTEM (BSIS)

Hand washing / Hand Scrub

Wash hands before touching pts, before

scrubbing & any time hands have been soiled.

 Gloves
- put on clean gloves just before contact with
mucous membranes & non intact skin.
- wear appropriate gloves any time hands likely
to have contact with moist body substances.
- remove gloves immediately after task is
completed.

INFECTION PREVENTION
MEASURES: BSIS
Gowns or Plastic Aprons
Wear any time it is likely that clothing or skin will be soiled.

Masks
- wear in OR / sterile area
-wear when working directly over large areas of open skin.
- wear when it is likely that nasal & oral mucous membranes
will be spattered with moist body substances.

NEEDLES & SHARPS

- Discard in rigid, puncture-resistant containers.
- Do not recap used needles by hand.
- Be particularly careful when manipulating small
devices such as heparin locks.

INFECTION PREVENTION
MEASURES: BSIS
Room Selection

- Assign patient with infectious disease to an

individual OR or last on surgical list.

 Trash & Linen

- Bag all soiled trash & linen securely.

- Discard according to facility policy.
- Wear gloves & protective garments when handling
soiled linen & trash.

INFECTION PREVENTION MEASURES: BSIS

Housekeeping

- Clean all rooms on regular

schedule.
- Clean articles, equipment &
furniture soiled with moist
body substances immediately.
Wear gloves.

 Laboratory Specimens
- Handle all laboratory specimens with equal care.
Special precautionary labels are required.

INFECTION PREVENTION
MEASURES: BSIS
Compliance of Care Providers
- Develop programme to ensure that health care

workers comply with the infection precautions

system.

REMEMBER !!!
The nurse is responsible for providing the client with a safe
environment.
The nurses first responsibility to the client is to first do no
harm.
It is easy to forget key procedural steps or, when hurried, to
take shortcuts that break aseptic procedures. However, the
nurses failure to be meticulous will place the client at risk
for an infection that can seriously impair recovery.

(Florence Nightingale, 1859)

THE END

COMMON INFECTIOUS AGENTS

Microorganisms tiny organisms that can be
disease causing that can only be seen with
assistance of a microscope
Bacteria
Streptococcus strep throat, pneumonia
E coli urinary tract infections
Tuberculosis lung disease

Virus

HIV acquired immune deficiency syndrome

Hepatitis A, B, C liver disease ( Hep B 3 shots)
Common cold respiratory infection
Influenza fever, chills, body aches
Herpes zoster - shingles

MICROORGANISMS
Fungi
Tinea pedis athlete's foot
Candida albicans yeast infection

Insects
Lice body, head, pubic, causes itching
Scabies skin rash

Antibiotic resistant bacterial infections

Methicillin resistant staphylococcus aureus (MRSA)
Vancomycin resistant enterococcus (VRE)

TYPES OF INFECTIONS
Colonization is the process by which strains of microorganisms become resident
flora.
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, the infection is
a systemic infection.
When a culture of the persons 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.
Nosocomial infections are classified as infections that originate in the hospital.

ETIOLOGIC AGENT
The extent to which any microorganism is capable of producing an
infectious process depends on the number of microorganisms present,
the virulence and potency of the microorganisms (pathogenicity), the
ability of the microorganisms to enter the body, the susceptibility of the
host, and the ability of the microorganisms to live in the hosts body.
Some microorganisms, such as the smallpox virus, have the ability to
infect almost all susceptible people after exposure. By contrast,
microorganisms such as the tuberculosis bacillus infect a relatively small
number of the population who are susceptible and exposed, usually
people who are poorly nourished, who are living in crowded conditions, or
whose immune systems are less competent (such as older adults or those
with HIV or cancer).

RESERVOIR
There are many reservoirs, or sources of microorganisms. Common sources
are other humans, the clients own microorganisms, plants, animals, or the
general environment. People are the most common source of infection for
others and for themselves.
For example, the person with an influenza virus frequently spreads it to
others. A carrier is a person or animal reservoir of a specific infectious
agent that usually does not manifest any clinical signs of disease. The
Anopheles mosquito reservoir carries the malaria parasite but is unaffected
by it. The carrier state may also exist in individuals with a clinically
recognizable disease such as the dog with rabies. Under either
circumstance, the carrier state may be of short duration (temporary or
transient carrier) or long duration (chronic carrier). Food, water, and feces
also can be reservoirs.

PORTAL OF EXIT FROM

RESERVOIR
Before an infection can establish
itself in a host, the microorganisms
must leave the reservoir.

METHOD OF TRANSMISSION
After a microorganism leaves its source or reservoir, it requires a means
of transmission to reach another person or host through a receptive portal
of entry. There are three mechanisms:
Direct 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 but can occur only if the source and the host are
within 1 m (3 ft) of each other. Sneezing, coughing, spitting, singing, or
talking can project droplet spray into the conjunctiva or onto the mucous
membranes of the eye, nose, or mouth of another person.

 Indirect transmission. Indirect transmission

may be either vehicle-borne or vector-borne.
a. Vehicle-borne transmission. A vehicle is
any substance that serves as an intermediate
means to transport and introduce an infectious
agent into a susceptible host through a
suitable portal of entry. Fomites (inanimate
materials or objects), such as handkerchiefs,
toys, soiled clothes, cooking or eating utensils,
and surgical instruments or dressings, can act
as vehicles. Water, food, blood, serum, and
plasma are other vehicles. For example, food
or water may become contaminated by a food
handler who carries the hepatitis A virus. The
food is then ingested by a susceptible host.

b. Vector-borne transmission. A vector is an animal or flying or

crawling insect that serves as an intermediate means of transporting the
infectious agent. Transmission may occur by injecting salivary fluid during
biting or by depositing feces or other materials on the skin through the
bite wound or a traumatized skin area.

Airborne transmission. Airborne transmission may involve droplets or

dust. Droplet nuclei, the residue of evaporated droplets emitted by an
infected host such as someone with tuberculosis, can remain in the air
for long periods. Dust particles containing the infectious agent (e.g.,
Clostridiumdifficile, spores from the soil) can also become airborne. The
material is transmitted by air currents to a suitable portal of entry,
usually the respiratory tract, of another person.

PORTAL OF ENTRY TO THE

SUSCEPTIBLE HOST
Before a person can become infected, microorganisms must enter the
body. The skin is a barrier to infectious agents; however, any break in the
skin can readily serve as a portal of entry. Often, microorganisms enter
the body of the host by the same route they used to leave the source.

SUSCEPTIBLE HOST
A susceptible host is any person who is at risk for infection. A
compromised host is a person at increased risk, an individual who for
one or more reasons is more likely than others to acquire an infection.
Impairment of the bodys natural defenses and a number of other factors
can affect susceptibility to infection. Examples include age (the very
young or the very old); clients receiving immune suppression treatment
for cancer, for chronic illness, or following a successful organ transplant;
and those with immune deficiency conditions.

BODY DEFENSES AGAINST

INFECTION
Individuals have defenses that protect the body from infection. These
defenses can be categorized as nonspecific and specific. Nonspecific
defenses protect the person against all microorganisms, regardless of
prior exposure. Specific (immune) defenses, by contrast, are directed
against identifiable bacteria, viruses, fungi, or other infectious agents.

NONSPECIFIC DEFENSES
Anatomic and Physiological Barriers
Inflammatory Response

SPECIFIC DEFENSES
Specific defenses of the body involve the immune system. An antigen is
a substance that induces a state of sensitivity or immune responsiveness
(immunity). If the proteins originate in a persons own body, the antigen
is called an autoantigen.

SUPPORTING DEFENSES OF A
SUSCEPTIBLE HOST
Hygiene. Intact skin and mucous membranes are one barrier against
microorganisms entering the body. In addition, good oral care, including
flossing the teeth, reduces the likelihood of an oral infection. Regular and
thorough bathing and shampooing remove microorganisms and dirt that
can result in an infection.
Nutrition. A balanced diet enhances the health of all body tissues, helps
keep the skin intact, and promotes the skins ability to repel
microorganisms. Adequate nutrition enables tissues to maintain and rebuild
themselves and helps keep the immune system functioning well.
Fluid. Fluid intake permits fluid output that flushes out the bladder and
urethra, removing microorganisms that could cause an infection.
Sleep. Adequate sleep is essential to health and to renewing energy.

 Stress. Excessive stress predisposes people to infections. Nurses can

assist clients to learn stress-reducing techniques.
Immunizations. The use of immunizations has dramatically decreased
the incidence of infectious diseases. It is recommended that
immunizations begin shortly after birth and be completed in early
childhood except for boosters.

INFECTION CONTROL
PRECAUTIONS
Standard Precautions. Standard precautions are used in the care of all
hospitalized persons regardless of their diagnosis or possible infection
status. They apply to blood, all body fluids, secretions, and excretions
except sweat (whether or not blood is present or visible), non intact skin,
and mucous membranes.
Transmission-Based Precautions. Transmission-based precautions are
used in addition to standard precautions for clients with known or
suspected infections that are spread in one of three ways: by airborne or
droplet transmission, or by contact. The three types of transmissionbased precautions may be used alone or in combination but always in
addition to standard precautions.

 Airborne precautions are used for clients known to have or suspected of having
serious illnesses transmitted by airborne droplet nuclei smaller than 5 microns.
Examples of such illnesses include measles (rubeola), varicella (including
disseminated zoster), and tuberculosis. The CDC has prepared special guidelines for
preventing the transmission of tuberculosis. The most current information may be
found on the CDC Division of Tuberculosis Elimination website.
Droplet precautions are used for clients known or suspected to have serious
illnesses transmitted by particle droplets larger than 5 microns. Examples of such
illnesses are diphtheria (pharyngeal); mycoplasma pneumonia; pertussis; mumps;
rubella; streptococcal pharyngitis, pneumonia, or scarlet fever in infants and young
children; and pneumonic plague.
Contact precautions are used for clients known or suspected to have serious
illnesses easily transmitted by direct client contact or by contact with items in the
clients environment.

COMPROMISED CLIENTS
Compromised clients (those highly susceptible to infection) are often
infected by their own microorganisms, by microorganisms on the
inadequately cleansed hands of health care personnel, and by nonsterile
items (food, water, air, and client-care equipment). Clients who are
severely compromised include those who:
Have diseases, such as leukemia, or treatments such as chemotherapy,
that depress the clients resistance to infectious organisms.
Have extensive skin impairments, such as severe dermatitis or major
burns, which cannot be effectively covered with dressings.