Chapter 10: Safety and Infection Control

Safe, Effective Care Environment: Safety and Infection Control

• All healthcare personnel must perform hand hygiene before and after every client contact, and after removing gloves.
• Hand hygiene should be performed with an alcohol-based product or soap and water, especially when hands are visibly soiled, after contact with body fluids, before eating, and after using the restroom.

Medical Asepsis

• Asepsis is the absence of illness-producing micro-organisms.
• Medical asepsis refers to the use of precise practices to reduce the number, growth, and spread of micro-organisms ("clean technique").
• It applies to administering oral medication, managing nasogastric tubes, providing personal hygiene, and performing many other common nursing tasks.

Surgical Asepsis

• Surgical asepsis refers to the use of precise practices to eliminate all micro-organisms from an object or area and prevent contamination ("sterile technique").
• It applies to parenteral medication administration, insertion of urinary catheters, surgical procedures, sterile dressing changes, and many other common nursing procedures.

Hand Hygiene

• Wash hands with soap and warm water, rubbing hands together vigorously, and rinsing under running water.
• Hands should be washed for at least 15 seconds to remove transient flora.
• When using alcohol-based products, dispense the recommended amount (usually 3-5 mL) and rub hands together until dry.

Personal Hygiene Measures

• Emphasize the importance of covering the mouth and nose when coughing or sneezing, using and disposing of facial tissues, and performing hand hygiene to prevent spreading droplet infections.
• Encourage clients and visitors to practice respiratory hygiene/cough etiquette.

Protective Clothing

• Use masks, gloves, gowns, and protective eyewear to help control the contact and spread of micro-organisms.
• Remove jewelry from hands and wrists to facilitate hand disinfection.

Sterile Field Setup

• Ensure all sterile packages are dry and intact, with a future expiration date.
• Open packages per the manufacturer's directions, slipping the package onto the center of the workspace with the top flap opening away from the body.
• Grasp the tip of the top flap of the package, unfolding it away from the body, and then unfolding the side flaps.

Sterile Gloving

• Open the wrapper and handle only the outside of the wrapper.
• Don gloves by grasping the folded bottom edge of the cuff and lifting it up and away from the wrapper.
• Remove gloves by grasping the outer part of one glove at the cuff area, avoiding touching the wrist, and pulling the glove down over the fingers and into the hand.

Sterile Technique and Asepsis

• When preparing a sterile field, the nurse should keep the field at least 6 ft away from the client's bedside to prevent contamination.

• When entering a client's room to change a surgical dressing, the nurse should keep a box of facial tissues nearby for the client to use during the dressing change.

• When removing a sterile pack from its outside cover, the nurse should unfold the flap closest to their body first.

• When wearing sterile gloves, the nurse can touch:

  • A bottle containing a sterile solution
  • The edge of the sterile drape at the base of the field
  • The inner wrapping of an item on the sterile field
  • An irrigation syringe on the sterile field
  • One gloved hand with the other gloved hand

• To maintain sterile technique, the nurse should avoid touching the following:

  • The outer edge of the sterile field
  • The client's hand

• When handling soiled items, the nurse should:

  • Clean the least soiled areas first to prevent moving more contaminants into the cleaner areas
  • Use plastic bags for moist, soiled items
  • Put all soiled items directly into the appropriate receptacle to avoid handling soiled items more than once
  • Avoid shaking linens to prevent spreading micro-organisms in the air

• When setting up a sterile field, the nurse should:

  • Select a clean area above waist level in the client's environment
  • Check that all sterile packages are dry and intact and have a future expiration date
  • Ensure an appropriate waste receptacle is nearby
  • Pour any liquids used for client care directly into the drain to prevent splashing

• When handling laboratory specimens, the nurse should place them in biohazard containers or bags for transport or disposal.

• When removing sterile gloves, the nurse should use the ATI Active ungloved hand inside the soiled glove and pull the glove off so that it is inside out and only the clean inside part is exposed.