Asepsis and Microorganisms

Asepsis

• Focuses on preventing infections through techniques that reduce or eliminate microorganisms
• Emphasizes hand hygiene as a fundamental practice
• Includes hand hygiene and other aseptic techniques to reduce or eliminate microorganisms

Microorganisms

• Microscopic living entities are present virtually everywhere
• Impact depends on body defenses, characteristics, and the host's health
• They are found in air, soil, water, and on/within living things
• Three outcomes after invasion include: Elimination by immune defenses, Harmless residence within the body, and Infection or infectious disease
• Factors influencing infection include: Type and number of microorganisms, Microorganism characteristics (e.g., virulence), and Host's health status

Types of Microorganisms: Pathogens vs. Nonpathogens

• Microorganisms are classified into nonpathogens (normal flora) and pathogens
• Nonpathogens (Normal Flora): Harmless, beneficial microorganisms that live on/within the human body (host)
• Nonpathogens are found in areas exposed to the external environment and internal areas (skin, nose, mouth, throat, lower urethra, intestines)
• They adapt to human defense mechanisms (e.g., acidic sweat) and have mutually beneficial or neutral relationships
• Nonpathogens inhibit pathogenic growth by competing for nutrients and space
• Pathogens: Cause infectious communicable diseases (contagious diseases, community-acquired infections)
• Examples: Measles, streptococcal sore throat, sexually transmitted infections, TB
• Pathogens may cause temporary illness or death
• They proliferate when nonpathogens are reduced (e.g., after broad-spectrum antibiotics)
• Virulence factors include fimbriae (attachment), flagella (motility), toxins, and intracellular invasion

Specific Types of Microorganisms

• Microorganisms include bacteria, viruses, fungi, rickettsiae, protozoans, mycoplasmas, helminths, and prions
• Bacteria: Single-celled microorganisms with round (cocci), rod-shaped (bacilli), or spiral (spirochetes) shapes that are aerobic (require oxygen) or anaerobic (exist without oxygen)
• Viruses: Submicroscopic infectious agents that replicate only inside the living cells of an organism
• Fungi: Eukaryotic organisms that include yeasts, molds, and mushrooms
• Rickettsiae: A group of bacteria that include many human pathogens
• Protozoans: Single-celled eukaryotic organisms
• Mycoplasmas: Bacteria that lack a cell wall
• Helminths: Parasitic worms
• Prions: Infectious proteins

Chain of Infection

• The chain of infection outlines the sequence required for disease transmission
• Breaking one link can prevent infection
• Components: Infectious Agent, Reservoir, Exit Route, Means of Transmission, Portal of Entry, and Susceptible Host

Biologic Defense Mechanisms

• It has natural defense mechanisms to combat microorganisms
• Examples include intact skin and mucous membranes, cilia in the respiratory tract, gastric acid in the stomach, antibodies, inflammatory response, and immune response

Health Care-Associated Infections (HAIs)

• Infections acquired in a health care setting
• Definition: Infections acquired during medical care and risk factors include invasive procedures, prolonged hospital stays, antibiotic use, and immunocompromised status

Asepsis: Medical vs. Surgical

• Asepsis is divided into medical and surgical approaches, each with specific techniques and goals
• Medical Asepsis (Clean Technique): Practices to confine or reduce the number of microorganisms; examples are hand hygiene and using antimicrobial agents
• Surgical Asepsis (Sterile Technique): Measures to render supplies and equipment free of all microorganisms and practices to avoid contaminating microbe-free items; includes sterilization

Principles of Medical Asepsis

• Medical asepsis involves practices to reduce the number and spread of microorganisms
• Includes frequent and thorough hand hygiene and using antimicrobial agents (disinfectants and antiseptics)
• Requires confining soiled articles with proper disposal of contaminated materials and keeping environments clean through regular cleaning and disinfection

Medical Aseptic Practices

• Specific actions that implement the principles of medical asepsis
• Such as hand washing with soap and water, hand antisepsis with alcohol-based rubs, wearing clean gloves when contact with body fluids is possible
• Wearing masks when there is a risk of droplet or airborne transmission, wearing gowns when there is a risk of soiling clothing with body fluids
• Wearing protective eyewear when there is a risk of splashes to the eyes, confining soiled articles with designated containers
• Cleaning and disinfecting equipment following agency protocols

Techniques for Sterilizing Equipment

• Sterilization techniques eliminate all microorganisms, including spores
• Physical Sterilization: Radiation and heat (boiling water, free-flowing steam, dry heat, and steam under pressure)
• Chemical Sterilization: Gas (ethylene oxide) and liquid chemicals

Principles of Surgical Asepsis

• Maintains a sterile environment to prevent infection during invasive procedures
• Sterile to Sterile: Only sterile items can touch other sterile items
• Contamination: A sterile item touching a non-sterile item is contaminated; partially unwrapped sterile packages are contaminated; questionable sterility means the item is unsterile; expired sterile items are unsterile
• Time: The longer since sterilization, the higher the risk of contamination
• Open Sterile Items: Are eventually contaminated
• 1-Inch Margin: Outer 1-inch of a sterile area is considered contaminated
• Wet Wrappers: Wicking causes contamination
• Unattended Sterile Items: Are considered contaminated
• Coughing/Sneezing: Over a sterile field causes contamination
• Reaching Over: A sterile field causes contamination
• Below Waist Level: Sterile items below waist level are contaminated

Nursing Activities Requiring Surgical Asepsis

• Specific nursing activities demand the application of surgical asepsis principles
• Including surgery by maintaining a sterile field during surgical procedures
• Invasive procedures by inserting urinary catheters and IV lines
• Wound care to care for open wounds

Creating a Sterile Field

• Provides a microorganism-free work area
• Using Sterile Wrappers: Use the inner surface of a sterile cloth or paper wrapper
• Opening Sterile Packages: Carefully avoid contamination

Adding Items to a Sterile Field

• Adding sterile items or solutions to a sterile field requires specific techniques to maintain sterility
• Sterile Items: Agency-sterilized items wrapped in cloth and commercially prepared supplies in paper wrappers
• Sterile Solutions: opening without contaminating and pouring without splashing

Personal Protective Equipment (PPE)

• Includes garments worn to protect health care providers from infection
• Worn based on risk of exposure to infectious agents and includes uniforms, scrub suits, gowns, masks, gloves, hair and shoe covers, and protective eyewear

Hand Hygiene: Hand Washing vs. Hand Antisepsis

• Critical component of infection control, encompassing both hand washing and hand antisepsis
• Hand Washing: Use soap and water, required when hands are visibly soiled, minimum 20 seconds of scrubbing
• Hand Antisepsis: Use alcohol-based hand rub (at least 60% alcohol), preferred when hands are not visibly soiled, apply to all surfaces of hands and fingers, rub until dry

Gloves

• Serve as a barrier to prevent direct contact with infectious materials
• Include latex, vinyl, and other materials
• Prevent direct hand contact with blood, body fluids, secretions, excretions, mucous membranes, and nonintact skin
• Protect clients from microorganisms transmitted from nursing personnel and prevent transfer of microorganisms from one client or object to another
• Be aware of potential latex allergy

Masks and Respirators

• Masks and respirators protect against droplet and airborne transmission
• Wear masks if there is a risk of coughing or sneezing within 3 feet, position to cover nose and mouth, change every 20-30 minutes or when damp
• Particulate Filter Respirators (e.g., N95): Use when there is a potential for airborne transmission; can be worn multiple times if rechecked for leakage and fit

Hair and Shoe Covers

• Reduce the transmission of pathogens
• Generally worn during surgical or obstetric procedures; shoe covers should cover the open ends of pant legs; hair covers should envelop the entire head
• For general nursing care, keep hair short or contained

Protective Eyewear

• Prevents body fluids from splashing into the eyes
• Essential when there is a possibility of splashes; goggles worn with a mask or a multipurpose face shield

Confining Soiled Articles

• Proper containment of soiled articles prevents the spread of microorganisms
• Use designated clean and dirty utility rooms; the dirty utility room should have covered waste receptacles, a laundry hamper, and a flushable hopper
• Use waste receptacles with paper bags for tissues, plastic-lined wastebaskets, covered suction and drainage containers, and puncture-resistant containers for sharps

Keeping the Environment Clean

• Maintaining a clean environment reduces the risk of infection
• Laundry staff and housekeeping personnel should assist with cleaning
• Concurrent Disinfection: Daily measures to keep the client environment clean; cleaning less soiled areas before grossly dirty ones; wet-mopping floors and damp-dusting furniture; frequently discarding mopping solutions; never placing clean items on the floor
• Scrubbing mattress surface and insides of drawers and bedside stands

Cleaning Potentially Infectious Equipment

• Proper cleaning of contaminated equipment is essential to prevent infection
• Client and Family Teaching: Wear waterproof gloves; designate one container for cleaning; disassemble and rinse reusable equipment after use; rinse grossly contaminated items under cool, running water; soak reusable items in detergent or disinfectant solution

Surgical Hand Antisepsis

• Rigorous hand-cleaning process performed before surgical procedures
• Procedure: Use a deep sink with knee or foot controls; use a liquid cleanser dispensed with a foot pump; clean under fingernails with a nail cleaner; scrub hands and forearms for a specified time (e.g., 2-6 minutes); rinse from fingertips to elbows; dry with a sterile towel; don a sterile gown and gloves

Gerontologic Considerations

• Older adults are more vulnerable to infections due to various age-related factors
• Common Infections: Pneumonia, influenza, urinary tract infections, skin infections, tuberculosis (TB)
• Risk Factors: Devices such as urinary catheters, humidifiers, oxygen administration devices; compromised tissues from IV fluids, parenteral nutrition, tube feedings, and reprocessed endoscopy equipment; colonization with antibiotic-resistant bacteria; thinning, drying, and decreased vascular supply to skin and mucous membranes due to declining estrogen; enlarged prostate in males, leading to urinary retention; comorbidities such as diabetes
• Prevention: Visitors with respiratory infections should wear masks or avoid contact; frequent and thorough hand washing; annual immunizations against influenza and pneumococcal vaccine

Pharmacologic Considerations

• Antibiotics are used to treat bacterial infections, but their use must be carefully managed to prevent antibiotic resistance
• Broad-Spectrum Antibiotics: Active against a wide range of bacteria and preferred when antiinfective therapy needs to start before the pathogen is identified, multiple pathogenic organisms are involved, or resistance to narrow-spectrum drugs is identified
• Narrow-Spectrum Antibiotics: Target specific bacteria and are less likely to kill nonpathogenic bacteria or result in resistance when the bacterial pathogen is identified

Causes of Antibiotic Drug Resistance

• Prescribing antibiotics for minor or self-limiting bacterial infections
• Administering antibiotics prophylactically without infection
• Failing to take the full course of antibiotic therapy
• Taking someone else's prescribed antibiotic
• Prescribing antibiotics for viral infections
• Dispersing antibiotic solutions into the environment
• Depositing partially empty IV bags containing antibiotics

Summary

• Pathogens: High potential for causing infectious diseases
• Nonpathogens: Live on and in the body but do not cause disease
• Microorganisms: Include bacteria, viruses, fungi, rickettsiae, protozoans, mycoplasmas, helminths, and prions
• Chain of Infection: Sequence enabling the spread of disease-producing microorganisms
• Asepsis: Practices that decrease or eliminate infectious agents for transmission
• Medical Asepsis: Clean technique to confine or reduce microorganisms
• Surgical Asepsis: Sterile technique to render supplies and equipment totally free of microorganisms
• PPE: Garments worn to protect health care providers

Key Points Hand Rub and Masks

• Alcohol-Based Hand Rub Time: Minimum 15 seconds
• Appropriate Mask Actions: Position to cover nose and mouth

Assessment/Skills

• Secure ties at the back of the head and neck and discard within a waterproof receptacle
• Hand Washing Actions Requiring More Teaching: Wearing an engagement ring and turning the faucet off with bare hands

Skills: Hand Washing

• Before review precautions, check supplies and explain the purpose
• Implementation: Use appropriate controls, wet hands from wrists to fingers, dispense soap, lather, and rub vigorously for at least 20 seconds, rinse from wrists to fingers, dry thoroughly with paper towels, turn off faucet with a paper towel, apply hand lotion
• Evaluation: Hand washing meets time requirements and hands are clean and is not documented, but expected as standard of care

Hand Antisepsis

• Ensure hands are not visibly dirty and prepare to perform routine hand antisepsis when hands are not visibly soiled
• Use dispensation of approximately 3 mL of the alcohol-based product into a cupped palm
• Distribute and rub the alcohol-based product over all surfaces of the hands and fingers

Surgical Hand Antisepsis.

• Locate the area, verify has water control; liquid dispenser and nail cleaner supplies available
• Change clothes, remove jewelry, hair cover and masks donned,
• Wet hands and forearms with warm water
• Clean subungual with nail cleaner, antimic soap to plam, wash hands for manf time recommendation and rinse to elbow
• Use hand operatable waste and sterile towels for elbows kept elevated

Sterile Field

• Inspect the work area, get package read and confirm all is good
• Plan what you will say, what clients need and remove objects
• Do hand hygeine, put wrap on waist area, perform with the outermost triangular edge of the wrapper, make the other side not touch the stand but 1 in, then perform
• Add all and remember

Sterile Gloves/Garments

• Assessment: Determine if it is needed, read and communicate
• Planning: Explain place to clients and put items on bedsides (no need)
• Implementation:
• Perform aseptic washing
• open outer, then inner with each side folding away for use
• pull non dom glove, then slip under dom and cover forearms
• Do not touch the exterior gloves and ensure your forearm area is closed
• If not working correctly repeat and do everything again with the same principle of the sterile areas

Medical Asepsis:

• Also known as clean technique. confine or reduce the number of microorganisms.
• Principles: Microorganisms are ubiquitous, except on sterilized equipment. Hand hygiene and intact skin are crucial for reducing transmission, Blood, body fluids, cells, and tissues are major reservoirs, Personal Protective Equipment (PPE) acts as a barrier, A clean environment reduces microorganisms: Clean should proceed from cleaner to dirtier areas Examples: Hand hygiene, PPE, proper disposal of soiled materials, environmental cleaning.

Antimicrobial Agents

• Antimicrobial agents are chemicals that either destroy or suppress the growth of infectious microorganisms and are administered internally
• Types are antiseptics also known as bacteriostatic agents) and disinfectants (germicides, bactericides)
• Also include antiinfective drugs (antibacterials, antivirals)

Antiseptics/Disinfectants

• Antiseptics, also known as bacteriostatic agents, inhibit the growth of microorganisms without necessarily killing them and are applied to the skin
• Disinfectants, also called germicides or bactericides, destroy active microorganisms but not spores and are used on surfaces and equipment and also too strong

Antiinfective Drugs

Drugs include antibacterials (antibiotics and sulfonamides) and antivirals Types:

• Alter bacterial metabolic processes, damage cell walls, or disrupt reproduction.and antivirals limit or stimulate.
• Overuse can lead to antibiotic resistance so you can always reactivate and know them