Asepsis and Infection Control - College of Nursing PDF

ASEPSIS / INFECTION CONTROL ASEPSIS Is the freedom from disease-causing microorganisms in order to decrease the possibility of transferring microorganism from one place to another, ASEPTIC TECHNIQUE Nurses are directly involved in maintaining safe environment to the client. Two...

ASEPSIS / INFECTION CONTROL ASEPSIS Is the freedom from disease-causing microorganisms in order to decrease the possibility of transferring microorganism from one place to another, ASEPTIC TECHNIQUE Nurses are directly involved in maintaining safe environment to the client. Two Basic Types of Asepsis MEDICAL ASEPSIS Includes all practices intended to confine a specific microorganism to a specific area, limiting the number, growth, and transmission of microorganism. Clean Technique Objects are referred to as clean means absence of most all microorganisms or Dirty (contaminated, soiled) if objects have microorganism, which may cause infection SURGICAL ASEPSIS Sterile technique, refers to those practice that keep an area or object free of all microorganism and it includes practices that destroy all microorganism and spores (microscopic dormant structures formed by some pathogens that are very hard and often survive common cleaning techniques. SURGICAL ASEPSIS  Is used for all procedures involving the sterile areas of the body. Urinary catheterization Surgical operation Birth and delivery  Sepsis, a state of infection INFECTION An invasion of the body tissue by microorganisms and their proliferation there. Such microorganism is called the infectious agent. A detectable alteration in normal tissue function, is called disease. Communicable disease, if the infectious agent can be transmitted to an individual COLONIZATION is the process by which strains of microorganism become resident flora. Microorganisms may grow and multiply but do not cause disease May cause tissue damage if the host defense mechanism if ineffective. The Four Major Categories of Microorganism Causing Infection in Humans Microorganisms Causing Infection 1. Bacteria Are by far the most common infection- causing microorganisms and several hundred species can cause disease in humans and can live and be transported through air, water, food, soil, body tissues, and fluids and inanimate objects Staphylococcus Aureus, Streptococcus E-Coli (Escherichia coli) Microorganisms Causing Infection 2. Viruses Consist primarily of nucleic acid and therefore must enter living cells in order to reproduce. Common viruses includes the corona virus, rhinovirus (causes the common cold), hepatitis, herpes, and human immunodeficiency virus families  MICROORGANISMS CAUSING INFECTION 3. Fungi Include yeast and molds. Candida albicans is a yeast considered to be normal flora in the human vagina  MICROORGANISMS CAUSING INFECTION 4. Parasites Live on other living organism. They include protozoa such as the one that causes malaria, helminthes (worms), and arthropods (mites, fleas, ticks). Types of Infections TYPES OF INFECTION 1. Local Infection Is limited to the specific part of the body where the microorganism remain. 2. Systemic The microorganism spread and damage different parts of the body. when the blood culture reveals microorganisms, this is called bacteremia. Types of Infection 3. Acute Infection Generally appear suddenly or last a short time Less than six months 4. Chronic Infection May occur slowly, over a very long period, and may last months or years More than six months NOSOCOMIAL INFECTIONS Are classified as infections that are associated with the delivery of health care services in a health care facility. Can develop during client’s stay in a facility or manifest after discharge. Can be acquired by health personnel working in the facility Most common settings – hospital surgical or medical intensive care units. NOSOCOMIAL INFECTIONS Most common nosocomial infection sites: Urinary tract, respiratory tract, bloodstream, and wounds. Causative microorganisms: Endogenous – originating from the client’s themselves e.g. Escherichia coli, Staphylococcus aureus, and enterococci Exogenous – from hospital environment and hospital personnel. NOSOCOMIAL INFECTIONS  Iatrogenic infections – are the direct result of diagnostic or therapeutic procedures. E.g. bacteremia that results from an intravascular line.  Factors contributing to development of nosocomial infection: Compromised host Hands of the health personnel Effects of Nosocomial Infection Added cost the client, facility and funding source Extend hospitalization time Discomfort Loss of life Stages of Infection Process 1. Incubation period –extends from the entry of microorganisms into the body to the onset of signs and symptoms 2. Prodromal Period – extends from the onset of non- specific signs and symptoms to the appearance of specific s/sx begin to manifest. 3. Illness period – specific signs and symptoms develop and become evident 4. Convalescent period – S/Sx start to abate until the client returns to normal state of health CHAIN OF INFECTION CHAIN OF INFECTION Describes the development of an infectious process Composed of 6 essential links (elements) in the chain of infection: 1. Agent 2. Reservoir 3. Portal of exit 4. Modes of transmission 5. Portal of entry 6. Host The Chain of Infection Etiologic /Infectious Agent (Microorganisms): Bacteria, fungi, virus, parasites Susceptible Host Reservior Immunosuppressed children/ (Source): Elderly, chronically ill, those Human beings, animals, inanimate w/ trauma or surgery Objects, plants, general environment, Such as air, water, and soil Portal of entry Portal of Exit Mucous Membrane, non-intact skin Sputum, emesis, stool, blood GIT, GUT, Respiratory tract Modes of Transmission Contact, vehicle, airborne, vectorborne 1. Etiologic Agent  Any microorganism that is capable of causing disease  Agents that cause disease: Living organisms that invade the host, causing disease a) Bacteria b) Viruses c) Protozoa d) Rickettsia e) Spirochete f) Parasites 2. Reservoir A place or environment where the agent can survive and multiply The most common reservoirs are: 1. Humans 2. Animals 3. Plants 4. Fomites (objects that are capable of transmitting microorganism e.g. clothes, dish, bed sheets ❖ Carrier: a person or animal reservoir of specific infectious agents that does not manifest any clinical signs of disease. 3. Portal of Exit  Route, path, or way by which an infectious agent leaves the reservoir to be transferred to a susceptible host.  The agent leaves the reservoir through body secretions: 1. Sputum (from the Respiratory tract) 2. Semen, vaginal secretions, urine (from the GUT) 3. feces (from the GIT) 4. Blood 5. Drainage from cut or wound 3. Portal of Exit 4. Modes of Transmission The process of the infectious agent moving from the reservoir or source through the portal of exit to the portal of entry of the susceptible “new” host. 1. CONTACT TRANSMISSION – may be direct or indirect contact 4. Modes of Transmission a. Direct contact involves immediate and direct transfer from person to person (body surface to body surface) though touching, kissing, or sexual intercourse.  Droplet spread can also a form of direct contact if the source and the host is within 3 feet of each other( sneezing, talking singing, spitting, or talking can project droplet spray to mucous membranes of eyes, nose, mouth. 4. Modes of Transmission b. Indirect contact occurs when a susceptible host is exposed to a contaminated object such as dressing, needle, or surgical instrument. Can be vehicle-born or vector- borne 4. Modes of Transmission Vehicle-borne transmission Vehicle is any substance that serves a means to transport or introduce infectious agents through portal of entry Occurs when an agent is transferred to a susceptible host by contaminated inanimate objects such as toys, handkerchiefs, soiled clothes, kitchen utensils water, food, milk, drugs, and blood E.g.: food or drinks may become contaminated by a food handler who carries hepatitis A virus 4. Modes of Transmission Vehicle-borne transmission 4. Modes of Transmission  Vector-borne transmission Vector is an animal, flying, crawling insects that serves as means of transporting infectious agents Injecting salivary fluid during biting, mosquito bites causing Dengue fever, malaria, leptospirosis 4. Modes of Transmission 4. AIRBORNE TRANSMISSION Occurs when a susceptible host contacts droplet nuclei or dust particles that are suspended in the air. A droplet can find a portal of entry through the mucous membranes or conjunctiva. Droplet nuclei, the residue of evaporated droplets emitted by infected host such as someone with tuberculosis, can remain the air for long period. 5. Portal of Entry The route by which an infectious agent enters the host Through body orifices such as the mouth, nose, ears, eyes, vagina, rectum, or urethra, and breaks in the skin or mucous membranes from wounds or abrasions. 6. Susceptible Host An organism that can be affected by an agent A human being is usually considered a host. A susceptible host is a person who has no resistance to an agent and thus is vulnerable to disease. A compromised host is a person whose normal body defences as impaired and is therefore susceptible to infection, more likely to be infected compared to others. Example of high risk: very young, very old, with HIV, receiving chemotherapy. 6. Susceptible Host Principles Underlying Medical and Surgical Asepsis The patient is a source of pathogenic microorganisms The patient’s microorganisms leave through specific routes There are always microorganisms in the environment which in some individuals and under certain circumstances can cause illness Microorganisms harmful to man can be transmitted by direct and indirect contact. Principles Underlying Medical and Surgical Asepsis Spread of infection from source to others can be prevented by various methods to stop the spread as close as to the source as possible. The effectiveness of medical/surgical asepsis is dependent on the conscientiousness of those carrying them out In observing, medical asepsis, areas are considered contaminated if touched by any object that is not sterile. Breaking the Chain of Infection 1. Hand washing 2. Cleaning, disinfection 3. Sterilization 4. Use off barriers 5. Isolation systems 6. Surgical asepsis Hand washing Hand washing Is the single most important infection control practice. All caregivers, clients and family members should learn hand washing techniques Microorganism are transient flora until the hands are washed Soap and water and alcohol – based hand rubs are effective preparations for removing transient microorganism Wash hands before and after every client are contact. Hand washing Effectiveness of hand washing is greatly influenced by adequate friction and thoroughness and surfaced cleansed. Hand washing for medical asepsis is done by holding hands lower than the elbows. Hands are more contaminated than lower arms. Hand washing Clean under fingernails. Ideally, turn off faucet with clean paper towel. Keep fingernails short and avoid nail polish to prevent harboring microorganism. Always wear gloves during client care when the skin is abraded.  CLEANING, DISINFECTIONS AND STERILIZATION CLEANING The physical removal of visible dirt and debris by washing, dusting or mopping surface that are contaminated. Soap is used for mechanical cleaning. DISINFECTIONS The chemical or physical processes used to reduced the number of potential pathogens on an object’s surface. But spores of the pathogens are not necessarily destroyed. Common disinfectants are alcohol, sodium hypochlorite, glutaraldehyde DISINFECTIONS STERILIZATION The complete destruction of all microorganism, including spores, leaving no viable forms of organism. STEAM STERILIZATION Autoclaving is sterilization using supersaturated steam under pressure. This method is non – toxic, inexpensive, sporicidal, and able to penetrate fabrics rapidly. It is used to sterilize surgical dressings, surgical linens, parenteral solution, metal and glass objects. STEAM STERILIZATION Color indicator strips change color, indicating the sterilization has occurred. Check packaging for integrity and always check the expiration date to ensure sterility of the object GAS STERILIZATION Ethylene oxide is a colorless gas that can penetrate plastic, rubber, cotton and other substances. This is used to sterilize oxygen or suction gauges, BP apparatus, stethoscope, catheters. ▪ Articles must be left to release the gas through aeration before they are used. ▪ This type of sterilization is expensive requires 2 to 5 hours to be accomplished ▪ Ethylene oxide is toxic to humans. RADIATION Ionizing radiation penetrates deeply into objects. ▪This is used in sterilizing drugs, foods, and other heat – sensitive items. CHEMICALS These are effective disinfectants. ▪They attack all types of microorganism, act rapidly, work with water, are inexpensive, are stable in light and heat, are not harmful to body tissues, do not destroy articles ▪These are used for instruments and equipment such as glass thermometer. Chlorine is used for disinfecting water BOILING WATER This is least expensive ▪should be boiled for at least 15 minutes. MEDICAL ASEPSIS: PRACTICES TO BE IMPLEMENTED DURING CLIENT CARE Medical Hand Washing ▪ Wash hands frequently, especially: 1. Before handling foods 2. Before and after using the toilet 3. Before and after performing nursing procedures 4. Before and after each patient contact ▪ Keep soiled item/equipment from touching the clothing. E.g. soiled linens. ▪ Instruct client to cover mouth and nose when coughing and sneezing Medical Hand Washing Avoid raising dust; do not shake linens. Clean least contaminated areas first then move to more contaminated areas. Practice segregation of wastes. Sterilize objects suspected of containing pathogens. Use practice of good personal hygiene to help prevent spread of microorganism The Most Commonly Used Barriers are as Follows: Surgical Masks Masks should fit tightly to the face, covering the nose and the mouth. Mask lose their effectiveness if they are wet, worn for long period, and when they are not changed after caring to each client. Surgical Mask Disposable particulate respirators look like masks but fit the face more tightly and are able to filter out particles or organism as small as 1 micro millimeter. >These are indicated whenever a caregiver is working with a client who has, or is suspected of having contagious, airborne disease such as tuberculosis. GOWNS Gowns should be worn when caregiver’s clothing is likely to be soiled by infected material. Use gowns only once and discard them. Change gown when it becomes wet. CAPS AND SHOE COVERINGS  Caps are used to cover the hair, and special covers are available for shoes.  These shield body parts from accidental exposure to contaminated body secretions. GLOVES Gloves protects the hand acquiring infective organisms. These reduce likelihood of transmission of microbial flora from personnel to clients or from client to other clients. GLOVES Gloves should be change and discarded between clients or when they become torn or grossly soiled. Gloves should not be washed and reused. PRIVATE ROOMS Separation of clients into private rooms decrease the chance of transmission of infection by all routes. If this is impossible, a client with an infection may be placed in the same room as another client who is infected with the same microorganisms, as long as they are not infected with other potentially transmissible microorganism and the likelihood of re-infection with the same microorganism is minimal. STANDARD PRECAUTIONS STANDARD PRECAUTIONS Synthesize the major features of Universal Precautions and Body substance Isolation. These precautions are intended to prevent transmission of blood borne and moist body substance pathogens. STANDARD PRECAUTIONS ▪ Wear clean gloves when touching. 1. Blood, body fluids, secretions and excretions, and items containing these body substances. 2. Mucous membrane 3. Non intact skin ▪ Performing hand washing immediately 1. When there is direct contact with blood, body fluids, secretions and excretions, or contaminated items. 2. After removing gloves 3. Between patient contacts STANDARD PRECAUTIONS  Wear a masks, eye protection and face shield during procedures and patient care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, and excretions.  Wear a cover gown during procedures and patient care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, or excretions, or cause soiling of clothing. STANDARD PRECAUTIONS Remove soiled protective items promptly when the potential for contact with reservoirs of pathogens is no longer present. Clean and reprocess all equipment before reuse by another patient. Discard all single – use item promptly in appropriate containers that prevent contact with blood, body fluids, secretions, excretions, contamination of clothing, or transfer to other patients and the environment. HAND WASHING Is the single most important infection control practice. All caregivers, clients and family members should learn hand washing techniques Microorganism are transient flora until the hands are washed Soap and water and alcohol – based hand rubs are effective preparations for removing transient microorganism Wash hands before and after every client are contact. HAND WASHING Effectiveness of hand washing is greatly influenced by adequate friction and thoroughness and surfaced cleansed. Hand washing for medical asepsis is done by holding hands lower than the elbows. Hands are more contaminated than lower arms. PURPOSES OF HAND WASHING To reduce the number of microorganisms on the hands. To reduce the risk of transmission of microorganisms to clients. To reduce the risk of cross-contamination among clients. To reduce the risk of transmission of infectious organisms to oneself. ESSENTIAL ELEMENTS IN HAND WASHING Water Soap Towel Friction is important element because it physically removes dirt and microorganisms PROCEDURE Preparation Rationale 1. Assess the hands.  Nails should be kept ❑ Short, natural nails are less short. likely to harbor microorganism, scratch a patient or puncture gloves.  Remove all jewelry. ❑ Microorganism can lodge it the setting of the jewellery and Push/roll sleeves of uniform under rings. Removal can up above mid forearm level. facilitate proper cleaning Remove/Secure ID so as not to touch the sink. ❑ Break in the skin increases the risk of acquiring or passing on  Check hands for breaks in infection the skin, such as hangnails or cuts. PROCEDURE 2. Roll sleeves above the elbow. Stand well away from the sink. Do not touch the inside or outside of the sink. Do not allow clothing/I.D. cord to touch sink during washing. PROCEDURE: There are five common types 3. Turn on the water of faucet controls: and adjust the flow. hand-operated handles knee levers foot pedals elbow controls infrared controls: motion sensor Procedure Rationale 4. Wet the hands thoroughly by holding them under the running water Hold the hands lower that the  Water should flow from elbow so that the water flows least contaminated area from the arms to fingertips to the most contaminated  Avoid splashing water and area, the hands are touching the sides of the sink generally considered more contaminated than 5. If the soap is liquid, apply 2 to 5 ml. the lower arm If it is bar soap, rub firmly between the hands. Rinse soap bar again and return to soap dish. 6. Thoroughly wash and rinse the hands for about 10-15 seconds.  Use firm rubbing circular movement to wash the  palm to palm  back of the hands with fingers interlaced  Palm to palm with fingers interlace,  Knuckles, palm to interlocked fingers. 7. Thoroughly wash and rinse the hands for about 10-15 seconds.  Use firm rubbing circular movement to wash the Thumbs, move the hands back and forth. Rub the fingertips against the palm of the opposite hand Rub the wrist towards the elbow.  Rub firmly, using rotary motion. Do the same with the other hand RATIONALE Rationale: Circular action creates friction that helps remove microorganism manually, interlacing the fingers and thumbs cleans the inter digital space.  8. Dry hands thoroughly from fingers to wrists and forearms with paper towel. Then discard paper towel in proper receptacle.  9. Turn off water faucet with a clean, dry paper towel if faucet is hand operated. Avoid touching handles with hands. Rationale: Prevents picking up microorganisms from the faucet Donning and Removing Sterile Gloves (Open Method) Purposes  To enable the nurse handle or touch sterile objects freely without contaminating them.  To prevent transmission of potentially infective organisms from the nurse’s hands to clients at high risk for infection Donning and Removing Sterile Gloves (Open Method) Preparation: Prepare the needed materials Packages of sterile gloves. Always have an extra pair of sterile gloves available. Ensure the sterility of the package of gloves. Wear PPE (facemask, surgical cap) Perform hand hygiene Donning and Removing Sterile Gloves (Open Method) Procedure:  Open the package of sterile gloves. Place the package of gloves on a clean, dry surface. Rationale: Any moisture on the surface could contaminate the gloves. Open the outer package without contaminating the gloves in the inner package. Remove the inner package from the outer package DONNING AND REMOVING STERILE GLOVES (OPEN METHOD) Rationale Procedure:  Touching only the Open the inner outside of the wrapper package maintains the sterility Pinch the flap on the of the inside of the outer side of the wrapper wrapper between thumb and index  If the inner surface finger. Use right hand touches any unsterile for the right flap article , it is Use the left hand for contaminated the left flap  By using both hands, Pull the flap open, reaching over the sterile laying it flat on the far area/contents is surface. avoided DONNING AND REMOVING STERILE GLOVES (OPEN METHOD) DONNING AND REMOVING STERILE GLOVES (OPEN METHOD) Procedure: Rationale  Put the first glove on  The hands are not the dominant hand sterile. By touching With the thumb and only the inside of the first finger of the non gloves, the outside dominant hand grasp remains sterile the gloves for the dominant hand. Touch only the inside of the cuff Donning and Removing Sterile Gloves (Open Method) Rationale Procedure:  Put the first glove on the dominant hand Insert the dominant hand into the glove and pull the glove on using the non dominant hand. Attempting the further unfold Leave the cuff in place the cuff is likely to once the unsterile hand contaminate the glove releases the gloves  DONNING AND REMOVING STERILE GLOVES (OPEN METHOD) Rationale: Procedure: This helps prevent accidental contamination of the glove by  Put the second glove on the bare hand. the non dominant hand Pick up the outer glove with the sterile gloved hand by inserting the gloved fingers under the cuff and holding the gloved thumb close to the gloved palm. DONNING AND REMOVING STERILE GLOVES (OPEN METHOD) Procedure: Rationale  Put the second glove on the  In this position, the thumb is non dominant hand less likely to touch the arm Pull the second glove and become contaminated. carefully. Hold the thumb of the gloved first hand as far as possible from the palm. Adjust each glove so that it fits smoothly, and carefully pull the cuffs up by sliding the fingers under the cuffs Donning and Removing Sterile Gloves (Open Method) Rationale Procedure:  This keeps the soiled parts  Remove and dispose the of the used gloves from used gloves touching the skin of the Remove the first glove by wrist or hand. grasping it on its palmar surface, taking care to touch only the gloved hand Pull the first glove completely off by inverting or rolling the gloves inside out. DONNING AND REMOVING STERILE GLOVES (OPEN METHOD) Procedure: Rationale  Remove and dispose the used  Touching the outside of the gloves second soiled glove with Continue to hold the bare hand is avoided. inverted removed glove by the fingers of the remaining  The soiled part of the glove gloved hand. is folded to the inside to Place the two fingers of the reduce the chance of bare hand inside the cuff of transferring any the second glove. microorganisms by direct Pull the second glove off to contact, the fingers by turning it inside out. This puts the first glove inside the second glove. Dispose to proper waste disposal DONNING AND REMOVING STERILE GLOVES (OPEN METHOD) Procedure:  Perform proper hand hygiene  Remove other PPE Cap Protective eyewear Mask  Discard to proper waste bin  Perform hand hygiene again  Thank you for listening Initial Demonstration Supervised Practice Quiz Return Demonstration