Medical and Surgical Asepsis

Medical and Surgical Asepsis

• Infection involves the growth of microorganisms in body tissues where they aren't typically found.
• An infectious agent is a microorganism that causes infection.
• Asymptomatic or subclinical infection produces no clinical evidence of disease.
• Asepsis is the freedom from disease-causing microorganisms aimed at preventing microorganism transfer.
• Aseptic technique is employed to decrease the risk of microorganisms spreading.
• Medical asepsis aims to limit the number, growth, and transmission of microorganisms to a specific area.
• In medical asepsis, clean refers to the absence of almost all microorganisms.
• Dirty in medical asepsis indicates the likely presence of microorganisms.
• Surgical asepsis or sterile technique keeps an area/object free of all microorganisms.
• Surgical asepsis includes practices that destroy all microorganisms and spores and is used for sterile body areas.
• Sepsis is the acute organ dysfunction secondary to infection.

Types of Microorganisms

• Bacteria are the most common infection-causing microorganisms, living in various environments.
• Viruses consist of nucleic acid and must enter living cells to reproduce.
• Fungi include yeasts and molds, with candida albicans considered normal flora in the vagina.
• Parasites live on other organisms, including protozoans, helminths, and arthropods.

Healthcare-Associated Infections (HAIs)

• HAIs are infections acquired in a healthcare setting.
• Endogenous antigens are generated within the cells.
• Exogenous antigens enter the body from the outside.
• Colonization is the presence of microorganisms on a host with growth but no interaction/clinical expression.
• Resident flora are microorganisms that usually occupy a particular body site.
• Transient flora colonize for hours/weeks but don't establish permanently.
• A strong immune system prevents infection from colonization.
• A weak immune system leads to frequent infections, such as acute or chronic.
• Acute infections appear suddenly and last a short time.
• Chronic infections occur slowly, over a long period, and possibly last months/years.
• Local infection is limited to a specific body part.
• Systemic infection spreads and damages different body parts.
• Bacteremia is microorganisms in the blood.
• Septicemia is systemic infection from bacteremia.
• Infections can result in either symptomatic or asymptomatic disease.

Chain of Infection

• The Chain of Infection model explains the spread of communicable diseases from one host to another.
• Breaking the chain at any link reduces the risk and stops disease spread.
• The infectious agent is microorganisms capable of causing disease/illness.
• Examples of infectious agents include bacteria, fungi, viruses, and parasites.
• Capacity of an infectious agent depends on the number of microorganisms present.
• Pathogenicity is the ability of microorganisms to enter the body.
• Host susceptibility is a factor, along with the ability of microorganisms to live in the host.
• Smallpox infects almost all susceptible people after exposure.
• Tuberculosis infects fewer individuals, typically those with compromised immunity.
• Interventions against the infectious agent include cleaning, disinfecting/sterilizing articles, and educating.
• The reservoir is a place where infectious agents live, grow, and reproduce.
• Examples of the reservoir include people, water, and food.
• The reservoir of infection can be any person, animal, plant, soil, or substance.
• Interventions to reduce the reservoir include changing dressings, and appropriate skin and oral hygiene.
• Other interventions involve disposing of soiled linens and ensuring fluid containers are covered/capped.

Portals of Exit

• Examples include blood, secretions, excretions, and skin.
• Portal of exit is the site from where microorganisms leave the host.
• Microorganisms may leave via the respiratory tract through sneezing, coughing, breathing, or talking.
• Microorganisms can leave via the gastrointestinal tract with saliva, vomitus, feces, or ostomies.
• The urinary tract is a portal of exit via the urethral meatus or urinary diversion.
• The reproductive tract is another portal via vaginal discharge, semen, or urine.
• Blood can be a portal of exit from wounds or disrupted skin/mucous membranes.
• Tissue drainage from cuts or wounds is a portal of exit.
• Interventions include avoiding talking, coughing, or sneezing over wounds/sterile fields.

Modes of Transmission

• Modes of transmission are ways infectious agents spread from the reservoir to a susceptible host.
• In direct transmission, infectious agents transfer by direct contact or droplets within 3 feet.
• Direct contact includes skin-to-skin contact, kissing, and sexual intercourse.
• Droplet spread is by large aerosols produced by sneezing, coughing, or talking.
• Indirect transmission transfers via inanimate objects (vehicle-borne) or vectors (vector-borne).
• Vehicle-borne transmission involves substances that transport infectious agents.
• Fomites like handkerchiefs and utensils, can act as vehicles.
• Water, food, blood serum, and plasma are other vehicles.
• Vector-borne transmission uses animals or insects to transport infectious agents.
• Mechanical transmission is when vectors carry infectious agents without growth.
• Biological transmission involves agent maturation in the vector before transmission.
• Airborne transmission occurs when agents are carried by dust or droplet nuclei suspended in air.
• Airborne dust includes settled material resuspended by air currents.
• Droplet nuclei are dried residue of less than 5 microns, remaining suspended longer distances.
• Interventions include hand cleansing, instructing clients, wearing gloves/gowns, and aseptic precautions.

Portals of Entry

• These are the ways infectious agents enter the susceptible host.
• Microorganisms must enter the body to cause infection.
• The skin is a barrier, but breaks in the skin serve as portals of entry.
• Microorganisms enter the body by the same route they used to leave the source.

Body Defenses

• Non-specific defenses protect against all microorganisms, regardless of prior exposure.
• Anatomic and physiological barriers are non-specific body defenses.
• The inflammatory response provides local and non-specific defense and response.
• Intact skin and mucous membranes are the first line of defense.
• Dryness of skin deters bacteria.
• Nasal passages trap microorganisms with mucous membranes and cilia.
• Macrophages and phagocytes exist in the lungs.
• The oral cavity sheds mucosal epithelium.
• The flow of saliva prevents infections.
• Tears in the eye wash microorganisms away.
• Lactobacilli ferment sugars in the vagina, which creates acidity, inhibiting the growth of harmful microorganisms.
• The flow of urine keeps bacteria from ascending the urethra.
• Inflammation is a local, non-specific response to injury/infectious agent, marked by 5 signs.

Inflammation

• Pain, swelling, redness, heat, and impaired function are key signs.
• Hyperemia is an increase in blood supply, causing redness and heat.
• Inflammatory exudate is produced, consisting of fluid from blood vessels, dead cells and tissue cells.
• Fibrinogen and platelets form a wall to prevent spread.
• Exudate is cleared by lymphatic drainage.
• Exudate types are serous, purulent, and hemorrhagic varying by tissue and inflammation intensity.
• Regeneration is the replacement of destroyed cells with identical/similar cells.

Immune System

• Antigens induce a state of sensitivity/immune responsiveness; proteins from own body are auto antigens.
• Antibody-mediated defenses (humoral/circulating immunity) are mediated by B cells.
• Antibodies (immunoglobulins) are part of plasma proteins.
• Antibody responses defend against extracellular bacterial/viral infections, also known as humoral immunity.
• Cell-mediated defenses (cellular immunity) occur through the T cell system.
• Lymphoid tissues release activated T cells into the lymph system upon antigen exposure.
• Helper T cells assist in immune system functions.
• Cytotoxic T cells attack and kill microorganisms/body cells.
• Suppressor T cells suppress the functions of helper/cytotoxic T cells.
• Loss of cell-mediated immunity (HIV) leads to defenselessness against infections.

Active and Passive Immunity

• Active immunity is when the host produces antibodies in response to antigens.
• Duration of active immunity tends to be long.
• Natural active immunity is when antibodies are formed from an active infection; this may be lifelong.
• Artificial active immunity is when antigens are administered to stimulate antibody formation; lasts years, needing boosters.
• Passive immunity is when the host receives antibodies from another source.
• Duration of passive immunity tends to be short.
• Natural passive immunity is when antibodies transfer from mother to baby via placenta/colostrum; lasts 6 months to 1 year maximum.
• Artificial passive immunity is when serum/antibodies from animal/human are injected; lasts 2–3 weeks.

Susceptible Host

• Individuals may have traits affecting disease susceptibility/severity.
• Host susceptibility is affected by age, hereditary, stress, nutritional status, medical therapy and preexisting disease.
• Newborns/older adults have reduced defenses; infections are a major cause of death in newborns.
• Hereditary influences infection development; some have genetic susceptibility to certain infections.
• Stress elevates blood cortisol, decreasing anti-inflammatory responses and resistance to infection.
• Malnutrition impairs the ability to synthesize antibodies and inadequate immune system function.
• Medical therapies like radiation destroy normal cells, predisposing to infection.
• Pre-existing diseases lessen body defenses; examples include pulmonary/vascular diseases, burns, and diabetes.

Nursing Management and Assessment

• Assessing, diagnosing, planning, implementing, and evaluating is essential.
• Assessing involves collecting, organizing, validating, and documenting client data.
• Identify the factors that predispose a client to risks by considering a person's history, current medications, stress factors, and nutrition.
• Physical assessment involves the signs and symptoms of infection, which will vary according to area involved and the state of the patient.
• Skin and mucous membranes will have localized swelling, redness, pain with palpation, loss of function, as well as drainage as signs of infection.
• Systemic infection signs include weight loss, anorexia, nausea, and vomiting.
• Lab data includes elevated leukocytes, and other infections include higher ESR for further signs of systemic infection.

Nursing Diagnosis

• Nursing diagnosis involves analyzing and synthesizing data to determine diagnostic labels.
• Potential complications of infection are fever, as well as an imbalance in nutrition as a result of being too ill to eat.
• Social isolation that includes anxiety is another issue.
• Another potential problem to note is an increased risk for further infection.

Planning and Implementation

• Determine how to prevent and/or reduce identified priority problems from occurring through meticulous medical and surgical techniques.
• Implement measures to strengthen a susceptible host and teach the importance of immunizations.
• Maintaining a clean, well-balanced state is an essential key factor.
• Nursing also includes using sterile techniques when and where necessary, such as catheter insertions or central line dressing changes.

Evaluation and Diagnosis

• Measure the goals and outcomes by collected data, such as subjective data, physical assessments, as well as lab values.
• Determine the factors or situations that affect the outcome and goals you are helping to achieve.

Nursing Interventions: Preventing Nosocomial Infections

• Meticulous use of medical surgical asepsis prevents microorganisms.
• Proper hand hygiene techniques help to prevent spreading.
• Hand hygiene prevents the spread of infection and is recommended to be a vigorous stream of water for at least 15 or 20 seconds with soap or alcohol-based hand rub, which is sufficient to get an adequate clean.

Alcohol-Based Hand Agents and Supporting Defenses

• Healthcare workers should cleanse their hands before and after giving care of any kind for routine client care.
• When there are multiple resistant hosts, antimicrobial-based cleaners are more effective for deep cleans.
• The CDC recommends alcohol-based antiseptic for quick and efficient cleaning.
• Hand washing when visibly soiled is more important to handwash to properly cleanse, even though alcohol-based agents are more efficient.
• Intact skin helps create a good barrier, the same as thorough washing on a consistent and regular basis.
• Balanced nutrition and constant intake flushes out the fluids causing susceptibility, as well as enough sleep and rest, is important.
• To enhance a balanced, well-rounded lifestyle, limiting stress is important to support the process.
• Immunizations are also essential to keeping the body clean and defended.

Disinfecting and Sterilization

• It is interrupted with antiseptic disinfectants to destroy more than can not be saved
• Sterilization and disinfection are key aspects in health practice.
• Some equipment might be readily destroyed or require longer contacts for the disinfectants to work.

Infection Prevention and Control: Standard Precautions

• Standard precautions apply in the care of ALL patients.
• Transmission-based isolation, droplet, smaller than 5 microns should have airborne protocols, with appropriate protective medical wear.
• Gloves, gowns, and face shields assist more that may splatter on the face.
• Must be aware and cautious of airborne transmission in close proximity, so must is important.
• PPE such as gowns should be clean to protect the skin properly.

Isolation Practices and Sterile Aseptic Technique

• Initiation on prevention of transmission is a nursing responsibility.
• The nurse needs to know that there is a risk of infection and act accordingly and cleanse her hands after doing it.
• All staff from the team nurses to the equipment and patients should be sterile to protect patients during an incident.
• Sterile in all cases is kept for long-lasting results, checking regularly for expirations.
• An item that comes in contact with an unclean item is considered unclean again and should be tossed.
• Once the nurse is aware of her surroundings, she is honest to herself and her co-workers about the sterility of her equipment.

Asepsis is the absence of disease-causing microorganisms to prevent transfer. Medical asepsis reduces microorganisms; surgical asepsis eliminates them. Sepsis is acute organ dysfunction due to infection. Aseptic techniques are employed to decrease the risk of microorganisms spreading.