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NUR152-Nursing Theory and

Science I

Asepsis and Prevention


of Infection
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Infection
When microorganisms capable
of producing disease invade the
body

Microorganisms
Small living plants or animals
seen only with a microscope
Multiple microbes
Normal flora
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Possible Reservoirs of
Microorganisms

Humans
Animals
Soil
Food, water, milk
Inanimate objects
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Requirements of
Microorganisms

Host
Water
Nourishment
Oxygen

Warmth

Chain of Infection

Source (Infectious Agent)


Reservoir
Portal of exit
Method of
transmission
Portal of entry
Susceptible host
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Common Portals of Exit

Respiratory
Gastrointestinal
Genitourinary tracts
Breaks in skin
Blood and tissue

Stages of Infection

Incubation
Prodromal
Illness
Decline
Convalescence

Classifications of Infection
By Location
Local
Systemic

By Duration
Acute
Chronic
Latent
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NOSOCOMIAL INFECTIONS

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Nosocomial Infections
An infection acquired in a
healthcare facility
Cost to the health-care system
= $4.5 billion/year
Leading cause of death
Preventable with use of aseptic
principles/ techniques
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Measures to Reduce Incidence


of Nosocomial Infections
Constant surveillance by infection-control
committees and nurse epidemiologists
Written infection-prevention practices for
all agency personnel
Hand hygiene recommendations
Infection control precaution techniques
Keeping patient in best possible physical
condition

LINES OF DEFENSE

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Primary Defenses
Anatomical features, limit
pathogen entry
Intact skin
Mucous membranes
Tears
Normal flora in GI tract
Normal flora in urinary tract
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Secondary Defenses
Biochemical processes
activated by chemicals
released by pathogens
Phagocytosis
Complement cascade
Inflammation
Fever
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Tertiary Defenses
Humoral immunity
B-cell production of antibodies
(IgM, IgG, IgE, IgA, IgD) in response
to an antigen

Cell-mediated immunity
Direct destruction of infected cells
by
T cells
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Factors That Increase Infection


Risk

Developmental stage
Breaks in the skin
Illness/injury, chronic disease
Smoking, substance abuse
Multiple sex partners
Medications that inhibit/decrease
immune response
Nursing/medical procedures
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Factors That Support Host


Defenses

Adequate nutrition
Balanced hygiene
Rest/exercise
Reducing stress
Immunization
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PREVENTING INFECTION

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Aseptic Technique
Includes all activities to prevent or
break the chain of infection
Two categories
Medical asepsisclean technique
Hand hygiene, PPE, barrier techniques

Surgical asepsissterile technique

BASIC MEDICAL ASEPSIS PRINCIPLES:


GOOD HAND HYGIENE
KEEP SOILED LINENS/EQUIPMENT AWAY FROM
CLOTHING
DO NOT PLACE SOILED LINEN/ITEMS ON FLOOR.
NOW YOU HAVE CONTAMINATED TWO SURFACES
AVOID RAISING DUST. DO NOT SHAKE LINENS
CLEAN LEAST SOILED THEN MOST SOILED
DISPOSE OF SOILED ITEMS IN APPROPRIATE
CONTAINERS
POUR LIQUIDS DIRECTLY INTO DRAIN TO AVOID
SPLASHING

Medical Asepsis
A state of cleanliness that
decreases the potential for the
spread of infections
Promoted through:
Maintaining a clean environment
Maintaining clean hands
Following Centers for Disease Control
(CDC) guidelines
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Maintaining Clean Hands


Hand-washing is one of the most
important means of preventing
the spread of infection, according
to the Centers for Disease Control
and Prevention (CDC).
1840s: infection and death rates
for women who delivered their
babies in hospitals was very high.
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Implementing CDC Guidelines


Standard precautions (universal
precautions)
Protects health-care workers from
exposure
Decreases transmission of
pathogens
Protects clients from pathogens
carried by health-care workers
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Implementing CDC Guidelines


Transmission-based precautions
used in addition to standard
precautions for patients with
suspected infection
Include airborne, droplet, or contact
precautions

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Wash Your Hands

When you arrive on the unit


When you leave the unit
Before and after restroom use
Before and after client
contact
Before and after contact with
client belongings
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Wash Your Hands

Before gloving
After glove removal
Before and after touching your face
Before and after eating
After touching a contaminated
article
When you see visible dirt on your
hands
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Handwashing Guidelines
Wash for at least 15-20 seconds in
nonsurgical setting; 2-6 minutes in
surgical setting
Use warm water, not hot
Apply soap to wet hands
Use friction
Clean beneath fingernails
Rinse soap
Towel or hand dry
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Antiseptic Hand Rubs


Alcohol based
Approved for use when hands
are not visibly soiled
Should not be used for patients
with C. Dif
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Other Principles of Medical


Asepsis

Keep soiled linens/equipment away


from clothing
Dont place soiled linen/items on
floor
Avoid raising dust
Clean least soiled first then most
soiled
Dispose of soiled items in
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PPE
PERSONAL PROTECTIVE EQUIPMENT

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Gloves
When to Wear
Contact (direct
or indirect) with
blood, body
fluids, secretions,
excretions,
mucous
membranes, and
non-intact skin
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Mask
When to Wear
Airborne and
droplet
precautions

Types
Simple
TB
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Gowns
When to Wear
Protect
yourself
Protect your
patient

Use only
ONCE
(if you cant wash

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Protective Eyewear

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Applying & Removing PPE


Applying
Hand
Hygiene
Gown
Mask
Eyewear
Gloves

Removing
Gloves
Eyewear
Gown
Mask
Hand Hygiene
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TRANSMISSION BASED
PRECAUTIONS
`

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Contact Precautions
Pathogen is spread by direct contact
Multiple sources of infection
Precautions include:
Private room if possible
Clean gown and glove use
Use of disposal items
Disposal of contaminated items in room
Double-bag linen and mark per facility
policy
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Droplet precautions
Pathogen is spread by contact
with moist droplets
Precautions include
Standard precautions
Contact precautions
Mask and eye protection
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Airborne Precautions
Pathogen is spread by air
currents
Spread through ventilation
system or any activity that stirs
the air

Tuberculosis Varicella
Examples:
SARS
Rubeola

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Protective isolation
Protects patients
Reverse isolation
Follow
Standard precautions
Selective patient assignment
Hand washing, masks, gowns

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Implementing Surgical Asepsis

Creation of a sterile environment


Use of sterile equipment/supplies
Sterilization of reusable supplies
Surgical hand scrub
Surgical attire
Sterile gloves
Sterile field
Use of sterile technique
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Use of Surgical Asepsis


Operating room, labor and delivery
areas
Certain diagnostic testing areas
Patient bedside
e.g., for procedures that involve
insertion of urinary catheter, sterile
dressing changes, or preparing and
injecting medicine

Principles of Surgical Asepsis

Sterile Objects Can Touch Only Sterile


Objects
Sterile Items Are Contaminated By
Contact With Anything Not Sterile.
When Opening Sterile Solutions Place
The Cap Up To Avoid Contamination.
Place Only Sterile Objects In A Sterile
Field

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Sterile Field Continued

Items introduced onto a sterile field must be opened


and transferred maintaining sterility.
Wrappers are opened by peeling back the edge.
Open packages away from self, then each side, then
toward self to avoid reaching across the field.
Never reach across a sterile field unless wearing
sterile attire.

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Opening A Sterile Package

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Applying Sterile Gloves


Select correct size
On a clean surface, opens outside
package
With cuff towards self unfolds inner
package
Applies sterile glove on dominant
hand and then non-dominant hand
careful not to contaminate
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Maintaining Sterility

Hands that drop below


waist level are
contaminated.
If you turn your back to
a sterile field it is
considered
contaminated.
Only the front of a
sterile gown is
considered sterile.

Sterile Objects

Become Contaminated by
Prolonged Exposure
Items open to air are considered
contaminated after 1 hour.
Cover with sterile drape.
Solutions are only considered sterile for
24
hours after opening.
Time and date when solutions are
opened.