Asepsis and Infection Control PDF

AS E PS IS AND INFE CTION CONTROL Asepsis and infection control are fundamental principles in healthcare that prevent the spread of harmful microorganisms and protect both patients and healthcare workers. What is Asepsis? Why It Matters The state of being free...

AS E PS IS AND INFE CTION CONTROL Asepsis and infection control are fundamental principles in healthcare that prevent the spread of harmful microorganisms and protect both patients and healthcare workers. What is Asepsis? Why It Matters The state of being free from Prevents healthcare-associated disease-causing microorganisms infections, ensures patient safety, through sterilization and and maintains sterile medical antiseptic procedures environments Key Applications Essential in surgical procedures, wound care, medical device handling, and daily healthcare practices Components of the Infection Cycle 1 Infectious agent 2 Reservoir Disease-causing microorganisms such as bacteria (like Natural habitat where pathogens live and multiply, including human Staphylococcus aureus), viruses (like influenza), or fungi (like bodies (infected patients), animals (rats carrying plague), or Candida albicans) environmental sources (contaminated water) 3 Portal of exit 4 Means of transmission Point of escape for the organism through cut Ways pathogens spread: direct contact (touching infected person), indirect contact (contaminated instruments), airborne route (coughing, sneezing), or vector-borne (mosquitoes carrying malaria) 5 Portal of entry 6 Susceptible host Entry points for pathogens including respiratory tract (breathing in Person at risk of infection - protection includes proper PPE (masks, TB bacteria), broken skin (surgical wounds), or mucous membranes gloves), good hand hygiene practices, and maintaining strong (conjunctiva of eyes) immune system through vaccination and healthy lifestyle The Infection Cycle Infectious Agents Bacteria: most significant and most prevalent in hospital settings. For example, Staphylococcus aureus commonly causes hospital- acquired infections and can live on surfaces for weeks. These single-celled organisms multiply rapidly in warm, moist environments. Virus: smallest of all microorganisms, requiring host cells to reproduce. Common examples include influenza viruses, which cause seasonal flu, and rhinoviruses responsible for the common cold. They can spread through air, water, or direct contact. Fungi: plant-like organisms present in air, soil, and water Factors Affecting an Organism's Potential to Produce Disease Number of organisms Virulence The quantity of microorganisms present affects infection risk. Refers to the organism's ability to cause disease. For For example, it may take 10-100 Salmonella bacteria to instance, some E. coli strains are harmless gut inhabitants, cause food poisoning, while thousands of Staphylococcus while others like E. coli O157:H7 can cause severe illness bacteria are needed for infection. even in small numbers. Competence of person's immune system L ength and intimacy of contact Closer and longer exposure increases infection risk. For example, healthcare workers spending extended time with infected patients have higher transmission risks than brief casual contacts. Possible Reservoirs for Microorganisms Other People Animals S oil Humans can harbor various Both domestic and wild animals can Natural repository for many microorganisms, especially in carry disease-causing organisms. For microorganisms. respiratory tract and skin. For instance, rats can carry Leptospira example, people with strep throat can bacteria, and birds may harbor spread bacteria through coughing or Salmonella. sneezing. Food, Water, and Milk Inanimate Objects These essential resources can harbor bacteria and other Everyday items like doorknobs, phones, and medical pathogens if not properly treated. Examples include E. coli in equipment can harbor microbes. Studies show coronavirus undercooked meat or Giardia in contaminated water. can survive on surfaces for several days. Common Portals of Exit R espiratory Gastrointestinal Genitourinary tracts Includes nose and mouth - primary Through mouth and rectum - routes for spreading airborne common in foodborne illnesses and diseases through coughing, sneezing, viral infections (e.g., norovirus, and speaking (e.g., influenza, salmonella) tuberculosis) Breaks in skin Blood and tissue Including cuts, wounds, and needle punctures - important Through direct contact with infected blood or tissue fluids - route for bloodborne pathogens (e.g., hepatitis B, bacterial crucial in healthcare settings (e.g., during surgery, blood skin infections) transfusions) Stages of Infection 1 Incubation Period During this initial stage, organisms are growing and multiplying within the host. For example, the flu virus typically has an incubation period of 1-4 days before symptoms appear. 2 Prodromal Stage This is when the person is most infectious, showing vague and nonspecific signs of disease. Common examples include mild fever, fatigue, and general discomfort, similar to early cold symptoms. 3 Full Stage of Illness Presence of specific signs and symptoms of disease 4 Convalescent Period The recovery phase from the infection where symptoms gradually improve. For instance, energy levels slowly return to normal and fever subsides. This period can last from days to weeks depending on the infection severity. Note: Malaise (feeling tired/lethargic) can occur throughout multiple stages but is especially common during the prodromal and full stages of illness. Factors Affecting Host S usceptibility Intact skin and mucous membranes: These act as the body's first line of defense, creating physical barriers against pathogens and harmful substances Normal pH levels: Proper acid-base balance, especially in areas like the stomach (pH 2) and skin (pH 5.5), helps prevent harmful microorganism growth Body's white blood cells (high infection) Age, sex, race, hereditary factors: For example, elderly people and newborns are generally more susceptible to infections, while certain genetic traits can provide resistance to specific diseases Immunization, natural (breastfeeding) or acquired: Breast milk contains antibodies that protect infants, while vaccines provide long-term immunity against specific pathogens Fatigue, climate, nutritional and general health status: Poor nutrition, extreme weather conditions, and lack of sleep can weaken immune response and increase susceptibility Stress: Chronic stress releases cortisol which can reduce immune cell numbers and inflammatory signaling, making you more vulnerable to infections Use of invasive or indwelling medical devices: Devices like catheters or breathing tubes can create entry points for pathogens, bypassing natural defense barriers Outcome Identification and Planning/Infection Control Demonstrate effective hand hygiene and good personal hygiene practices: For example, washing hands for at least 20 seconds with soap and water, especially before and after patient contact, and using alcohol-based sanitizers when soap isn't available. Identify the signs of an infection: Learn to recognize key indicators such as redness, swelling, warmth, unusual discharge, fever, or increased pain in affected areas. Maintain adequate nutritional intake. Demonstrate proper disposal of soiled articles: This includes using designated containers for different types of waste, such as regular trash, biohazard bags for contaminated materials, and sharps containers for needles. Use appropriate cleansing and disinfecting techniques: For instance, using EPA-approved disinfectants, following correct contact time, and cleaning from clean to dirty areas. Demonstrate an awareness of the necessity of proper immunizations: Stay current with recommended vaccines like annual flu shots, tetanus boosters, and other required immunizations for healthcare workers. Demonstrate stress-reduction techniques: Practice methods such as deep breathing exercises, regular breaks, and time management to maintain optimal immune function. Cardinal S igns of Acute Infection Rednes s (Rubor): Occurs due to increased blood flow to the infected area. For example, the red streak around an infected cut or the redness around an infected tooth Heat (Calor): The infected area feels warmer than surrounding tissues due to increased blood flow. E xample: A warm sensation when touching an infected insect bite Swelling (Tumor): Occurs when fluid accumulates in infected tissues Pain (Dolor): Results from tissue damage and pressure on nerve endings. For instance, the tenderness experienced with an infected hangnail or throat infection L oss of function (F unctio laes a): Reduced mobility or function of the affected area. E xample: Difficulty moving an infected joint or swallowing with a throat infection Laboratory Data Indicating Infection Elevated white blood cell count—normal is 5,000 to 10,000/mm3 (When the body fights infection, this number often rises above 10,000, sometimes reaching 15,000 or higher) Increase in specific types of white blood cells (particularly neutrophils for bacterial infections and lymphocytes for viral infections) Elevated erythrocyte sedimentation rate Presence of pathogen in urine, blood, sputum, or draining cultures (For example: E. coli in urine cultures indicating UTI, or Streptococcus in throat cultures indicating strep throat) Five Moments for Hand Hygiene (WHO) Moment 1: Before touching a Moment 2: Before clean/aseptic Moment 3: After body fluid patient procedure exposure risk Protects your patient from harmful Protects patient from harmful germs After exposure to blood, secretions, germs carried on your hands. entering their body. Examples: oral excretions, or mucous membranes Examples: shaking hands, helping care, dressing wounds, inserting patient move, taking pulse catheters Moment 4: After touching a patient Moment 5: After touching patient surroundings Protects you and the healthcare environment from patient germs. Examples: after physical examination, after changing Prevents spread of patient-area germs to other areas. patient position Examples: changing bed linens, adjusting monitor alarms, touching bedrails B acterial Flora Transient Flora R esident Flora Bacteria that are temporarily attached loosely to the outer Permanently colonized bacteria found deeper in skin layers, layer of skin. These organisms are picked up during direct particularly in skin crevices and hair follicles. These are more contact with patients, equipment, or environmental surfaces. difficult to remove and form part of our natural skin defense. Examples: E. coli, Pseudomonas, Klebsiella Examples: Staphylococcus epidermidis, Corynebacterium Can be easily removed through basic hand hygiene species Requires mechanical scrubbing with antimicrobial soap for removal Four Categories Responsible for Majority of Hospital- Acquired Infections (HAIs) Catheter-associated urinary tract infection (CAUTI) - Occurs when bacteria enter the urinary tract through a urinary catheter. Example: E. coli infection developing 48 hours after catheter placement Surgical site infection (SSI) - Infection that occurs at or near the surgical incision site within 30-90 days after the procedure. Example: Post-appendectomy wound infection Central-line associated bloodstream infection (CLABSI) Ventilator-associated pneumonia (VAP) - Lung infection developing 48 hours or more after mechanical ventilation. Example: Hospital- acquired pneumonia in ICU patients on breathing support Risk Factors for Vancomycin-Resistant Enterococci (VRE ) Compromised immune systems Recent surgery Invasive devices Surgical procedures, especially Catheters, central lines, and other Patients with weakened immune systems abdominal or cardiac surgeries, create medical devices. due to conditions like HIV/AIDS, cancer opportunities for bacterial entry and treatments, or organ transplants have colonization. For example, patients who reduced ability to fight infections, making undergo heart valve replacement or them more susceptible to VRE. bowel surgery are at higher risk. Prolonged antibiotic use Prolonged hospitalization Extended use of antibiotics, particularly vancomycin, can eliminate Extended hospital stays, particularly in intensive care units (ICUs) beneficial bacteria and create conditions favorable for VRE or long-term care facilities, increase exposure to resistant bacteria. growth. This commonly occurs in patients receiving multiple Patients staying longer than 2 weeks are at significantly higher courses of antibiotics over several weeks. risk. CDC Recommendations to Prevent C. difficile infection (CDI) #1 Avoiding the use of electronic equipment that is difficult to clean (electronic thermometers) (E xample: Use single-use disposable thermometers instead, as electronic devices can harbor bacteria in small crevices) Disinfecting dedicated patient care items and equipment (stethoscopes) (These items frequently move between patients and can transfer C. difficile spores if not properly disinfected with appropriate agents) Using full-barrier contact precautions (gown and gloves) Placing patients in private rooms; cohort patients with the same strain of CDI (This reduces cross-contamination risk; when private rooms aren't available, grouping patients with the same strain prevents new infections) Performing meticulous hand hygiene (Note: C. difficile spores are resistant to alcohol-based hand sanitizers; use soap and water for thorough mechanical cleaning) CDC Recommendations to Prevent C. difficile infection (CDI) #2 Performing environmental contamination of rooms - This includes thorough cleaning with EPA-registered disinfectants specifically tested against C. difficile spores. For example, cleaning all surfaces including bed rails, call buttons, and door handles at least daily and upon patient discharge. Educating health care providers (and patients/families as appropriate) on clinical presentation, transmission, and epidemiology of CDI - This includes regular training sessions covering symptom recognition (like watery diarrhea), proper hand hygiene techniques, and isolation protocols. For instance, providing illustrated handouts showing proper gown and glove removal sequences. Using antimicrobials at an appropriate dose and only when indicated Body's Defense Against Infection Body's normal flora: Beneficial microorganisms that live on and in our body (e.g., gut bacteria that help digestion and prevent harmful bacteria growth) Inflammatory respons e: The body's immediate reaction to injury or infection, including redness, swelling, and increased blood flow (e.g., the warm, red area around a cut) Immune response Factors Determining Use of Sterilization and Disinfection Methods Nature of organisms present Number of organisms present Different microorganisms require different approaches. For example, Higher microbial loads require longer processing times or stronger bacterial spores need more intensive sterilization compared to methods. For instance, heavily soiled surgical instruments need vegetative bacteria. longer sterilization cycles. Type of equipment Intended use of equipment Critical items entering sterile tissue require sterilization, while non- critical items touching intact skin may only need low-level disinfection. Available means for sterilization and disinfection Time Options may include autoclave, chemical disinfectants, or UV light, Some methods work quickly (flash sterilization: 3-1 0 minutes) while depending on facility resources and capabilities. others require longer exposure (ethylene oxide: 1 0-48 hours). Personal Protective Equipment and Supplies Gloves: Provides barrier protection against direct contact with contaminated surfaces and bodily fluids. Available in nitrile, latex, and vinyl varieties for different clinical needs Gowns: Protects clothing and skin from contamination during procedures. Types include isolation gowns for general use and surgical gowns for sterile procedures Masks Protective eyewear: Shields eyes from splashes, sprays, and airborne particles. Includes safety glasses, goggles, and face shields for different levels of protection Type N95 Particulate R espirator Definition and Purpose A respiratory protective device designed to achieve a very close facial fit and highly efficient filtration of airborne particles, filtering out at least 95% of very small (0.3 micron) particles from the air. Key Features Creates an airtight seal around the nose and mouth, features adjustable nose piece, and includes two elastic straps for secure positioning. Marked with "N95" certification from NIOSH. When to Use Required during aerosol-generating procedures, when caring for patients with airborne diseases like tuberculosis, and in situations with high-risk of airborne pathogen exposure. Proper Usage Must perform seal check before each use, ensure proper fit with both straps, and avoid touching the front of respirator during use and removal. Cannot be used with facial hair that interferes with seal. Standard Precautions Used in the care of all hospitalized patients regardless of their diagnosis or possible infection status. For example, healthcare workers should wear gloves when drawing blood from any patient, whether they have a known infection or not. This universal approach ensures consistent safety and eliminates discrimination based on perceived risk. Apply to blood, all body fluids, secretions, and excretions except sweat (whether or not blood is present or visible), nonintact skin, and mucous membranes. This includes handling items such as soiled bedding, emptying urinary drainage bags, or managing wound dressings. For instance, wearing gloves and a gown when changing dressings on a pressure ulcer, regardless of whether infection is present. New additions are respiratory hygiene/cough etiquette, safe injection practices, and directions to use a mask when performing high-risk prolonged procedures involving spinal canal punctures Transmission-B ased Precautions Used in addition to standard precautions for patients in hospitals with suspected infection with pathogens that can be transmitted by airborne, droplet, or contact routes. For example, tuberculosis requires airborne precautions, influenza requires droplet precautions, and MRSA requires contact precautions. The 2007 guidelines include a directive to don personal protective equipment (PPE) when entering the room of a patient on contact or droplet precautions. This means wearing appropriate gear (like gowns, gloves, masks) immediately upon room entry, rather than waiting until direct patient contact. Previously, PPE was only required when the nurse was delivering care within 3 feet of the patient. These categories recognize that a disease may have multiple routes of transmission (airborne, droplet, contact). For instance, chickenpox can spread through both airborne and contact routes, requiring a combination of isolation precautions to effectively prevent transmission. Aseptic Technique Aseptic technique encompasses all practices and procedures that prevent the transmission of pathogens and maintain a clean or sterile environment in healthcare settings. Medical Asepsis (Clean Technique) Surgical Asepsis (Sterile Technique) Practices that reduce the number and transmission of Practices that eliminate all microorganisms from an area. microorganisms. Used in operating rooms Hand hygiene and handwashing Sterile wound dressing changes Using personal protective equipment Central line insertions Proper cleaning and disinfection of equipment Urinary catheterization Environmental cleaning Healthcare providers must choose the appropriate technique based on the procedure and risk level to ensure patient safety and prevent healthcare-associated infections. Use of S urgical Asepsis Operating room, labor and delivery areas - These sterile environments require the highest level of infection control to prevent surgical site infections and protect both mother and newborn during childbirth Certain diagnostic testing areas - Including cardiac catheterization labs and interventional radiology suites where invasive procedures require strict sterile technique to prevent healthcare-associated infections Patient bedside Medical procedures requiring sterile technique - Including urinary catheterization, sterile dressing changes, and medication preparation/injection to maintain sterility and prevent contamination Patient Teaching for Medical Asepsis at Home Wash hands before preparing or eating food - This removes bacteria that accumulate on hands throughout the day, especially after touching surfaces like doorknobs or phones. Prepare foods at high enough temperatures - Most harmful bacteria are killed when food is heated to at least 1 65°F (74°C), particularly important for meat and poultry. Use care with cutting boards and utensils. Keep food refrigerated - Bacteria multiply rapidly between 40°F and 1 40°F (4°C-60°C). Refrigeration slows or stops this growth. Wash raw fruits and vegetables - E ven organic produce can carry harmful bacteria from soil or handling. A thorough rinse removes these contaminants. Use pasteurized milk and fruit juices - Pasteurization eliminates harmful bacteria while preserving nutritional benefits. Wash hands after using bathroom - This prevents the spread of fecal-oral bacteria like E. coli and other harmful microorganisms. Use individual care items - Personal items like towels, washcloths, and toothbrushes can harbor bacteria. Keep them separate for each family member. E valuating Patient Goals Use techniques of medical asepsis Identify health habits and lifestyle patterns promoting health This includes proper hand washing, maintaining clean environments, and using sterile equipment when needed. For Observe daily routines like diet, exercise, and sleep patterns. example, washing hands for at least 20 seconds with soap Example: noting that a patient maintains regular 8-hour sleep and water before wound care. schedule and follows a balanced diet. S tate signs and symptoms of an infection Identify unsafe situations in the home environment Monitor for fever, redness, swelling, and unusual discharge. Look for potential hazards like loose rugs, poor lighting, or improperly stored medications. For instance, checking that medications are stored away from direct sunlight and heat sources.