Medical Asepsis PDF

# Medical Asepsis ## Introduction The nurse's efforts are directed toward minimizing the onset and spread of infection, keeping clients as free from exposure to infection-causing pathogens as possible based on the principles of aseptic technique. Aseptic technique implies all those procedures that...

# Medical Asepsis ## Introduction The nurse's efforts are directed toward minimizing the onset and spread of infection, keeping clients as free from exposure to infection-causing pathogens as possible based on the principles of aseptic technique. Aseptic technique implies all those procedures that eliminate pathogens or minimize their areas of existence. ## Definition of Terms - **Pathogens:** Microorganisms that can cause infectious diseases. - **Infection:** The pathological condition resulting from the invasion of the body by pathogenic microorganisms. - **Carriers:** People or animals that show no symptoms of illness but that have pathogens on or in their bodies that can be transferred to others. - **Nosocomial Infection (Hospital Acquired Infection):** An infection acquired from healthcare settings. - **Contamination:** The process by which something is unclean or unsterile - **Disinfection:** The process of eliminating pathogenic organisms on an inanimate object with the exception of spores. - **Disinfectant:** A chemical substance that is used for disinfecting only an inanimate object (e.g. phenol, chlorine) it reduces the number of microorganisms, but does not eliminate them. - **Antiseptic Solutions:** A substance that can be applied to a person's skin to reduce the number of microorganisms, inhibit its growth and activity, e.g. (alcohol, betadine). - **Infection Control** - **Sterilization:** The destruction of all microorganisms and their spores. - **Asepsis:** Practices that minimize or eliminate organisms that can cause infection and disease. There are two types of asepsis: - **Medical Asepsis (Clean Technique):** All procedures/practices that reduce the possibility of disease by reducing the number, growth, transfer and spread of pathogenic microorganisms. - **Surgical Asepsis (Sterile Technique):** Practices that keep an area or objects free from all microorganisms (non-pathogenic and pathogenic) including spores and viruses ## Differences Between Medical and Surgical Asepsis | Items | Medical Asepsis (Clean technique) | Surgical Asepsis (Sterile technique) | |:---|:---|:---| | Definition | All procedures/ practices that reduce the possibility of disease by reducing the number, growth, transfer and spread of pathogenic microorganisms. | Practices that keep an area or objects free from all microorganisms (non-pathogenic and pathogenic) including spores and viruses. | | Emphasis (focus) | Based on maintaining cleanliness to prevent spread of microorganisms (freedom from most pathogenic organisms). | Based on maintaining sterilization (free from all microorganisms). | | Purpose | To reduce the number of pathogenic organisms & prevents their spread. | To prevent introduction of any organism into the body. | ## Applications - **Medical Asepsis:** During daily routine care, the nurse uses medical aseptic techniques to break the infection chain. Examples include changing a client's bed linen daily, handwashing, a protective barrier, a clean mask, gown, gloves, over head and shoes, routine environmental cleaning, disinfecting articles and using antiseptics. Clean technique is appropriate for: - Taking BP - Examining patients - Feeding patients - **Surgical Asepsis:** Surgical asepsis implies the highest level of aseptic technique and requires that all areas be kept as free as possible of infectious microorganisms. These techniques can be practiced by nurses in the OR (surgical incision, delivery room, diagnostic areas), invasive procedure as inserting IV cannula, IV therapies, urinary catheter, & sterile wound dressings where sterile instruments & supplies are used. ## Principle - **Medical Asepsis:** In medical asepsis, an area or object is considered contaminated only it is suspected of containing a pathogen (e.g., used bedpan, the floor & a wet piece of gauze). - **Surgical Asepsis:** In surgical asepsis, an area or object may be considered contaminated if touched by an object that is not sterile (e.g., a tear in a surgical glove during a procedure, a sterile instrument placed on an un-sterile surface). ## Hand Washing - **Medical Asepsis:** Hands and forearms are washed for 1 to 2 minutes to remove surface contaminants and soil. Hands and arms are dried with paper towels. - **Surgical Asepsis:** Hands and forearms are scrubbed for 5 minutes to reduce the bacterial count on the skin surface. Hands and arms are dried with a sterile towel. ## The Goal of Medical Asepsis 1. To prevent or reduce the transmission of microorganisms from one person (or source) to another. 2. To prevent re-infection of the patient. 3. To ensure patient's comfort, safety and psychological well-being. ## Practices That Reduce Pathogens Include: - **Interrupts chain at the level of causative agent and reservoir through:** - Handwashing - Use of disinfectants and antiseptics as appropriate. ## Practices That Interrupt Transmission: - **Interrupts chain at the level of portal of exit, transmission, and portal of entry** - Use of personal protective equipment latex gloves, gowns, mask, eye goggles. - Proper Equipment i.e. one-way valves - Use of isolation procedures ## Chain of Infection It is a cyclic process that explains how a pathogen or infectious disease is transmitted from one person to another. Six elements must be present for the development of infection to take place. 1. Causative agent 2. Reservoir 3. Portal of exit 4. Means of transmission 5. Portal of entry 6. Susceptible host **1. Infectious Agent** Infectious agents are microorganisms that can be grouped into five classifications (viruses, bacteria, fungi, protozoa, and rickettsia). In order for an infection to occur, an infectious agent must be present. **2. Reservoir** The second ring in the chain of infection is the reservoir or the location of the infectious agent. Reservoirs (source) in which microorganisms live, possibly grow, and multiply. **3. Portal of exit:** The infectious agent must leave the reservoir to infect another person (host). The portal of exit is the method by which an infectious agent leaves the reservoir. The blood, respiratory tract, skin and mucous membranes, genitourinary tract, gastrointestinal tract, and trans-placental route from mother to her unborn infant are some examples. **4. Mode of Transmission:** Are specific ways by which microorganisms travel from a reservoir to a susceptible host. Routes of transmission include: - **Direct contact:** touching an infected person - **Airborne transmission:** inhaling the microorganism into the susceptible host's respiratory system - **Blood born transmission:** infected blood enters the susceptible host - **Ingestion:** eating or drinking contaminated items - **Indirect contact:** microorganisms are on a non-living object such as a table or piece of equipment that can absorb and transmit infection **5. Portal of entry** The portal of entry allows the agent access to the next person. Common entrance sites to the human body include broken skin, mucous membranes and systems' respiratory, GIT and genitourinary. **6. Susceptible host:** a person who is susceptible to the microorganism. **Causes of susceptibility:** - Presence of other diseases - Immunosuppressive disorders - Surgical procedures or trauma **Susceptibility of the person depends on several factors:** 1. Age (children and elders are more susceptible), and 2. socioeconomic status 3. General physical condition 4. Occupation, life style, and living environment 5. Presence of underlying disease or health problems ## Body defenses against infection The body has natural physical, chemical, and cellular defenses against invasion by pathogens such as viruses, bacteria, or other agents of disease. ### **1st Line of Defense** Body parts and mechanisms that prevent the pathogen from entering the body include: - **Skin** (acts as a physical barrier against the entry of pathogens) - **Mucus membranes** (inhibit the growth of most pathogenic microbes) - **Mucus and Cilia** (Microorganisms are trapped in sticky mucus and expelled by cilia) - **Tears and saliva** (wash bacteria away). - **Coughing or sneezing** - **PH of body areas** ### **2nd Line of Defense (non-specific response)** If a pathogen gets entrance into the body, the second line of defense takes place involving a range of defense mechanisms that occur inside the body (Phagocytic white blood cells, inflammation and fever, antimicrobial substances) as a response to the presence of any pathogen to inhibit or destroy it. This is called active immunity. The white blood cells have key functions. ### **3rd Line of Defense (specific immune response)** It takes place when nonspecific methods are not enough defenses. It is directed against identifiable bacteria, viruses, fungi, or other infectious agents e.g., Macrophages, T lymphocytes. ## How we can break the chain of infection Breaking the chain of infection at any point stops infection from spreading, however healthcare providers work directly toward breaking the chain of infection as early as possible. Preventing infection means looking at habits, lifestyles, and surroundings and assessing for those things that may promote infection to identifying risk factors. **There are some steps to break the chain of infection:** * **Hand washing:** The single most effective and important way to prevent spread of microorganisms. Wash hands before and after giving nursing care and after (handling equipment and supplies used for care, cleaning cuts, changing soiled linens, handling, coughing, sneezing or blowing nose.....etc.) * **Use of disinfectants for objects and antiseptics for people.** * **Treat all bodily fluids as potentially infectious.** * **Use protective barriers such as gloves, gown (aprons), masks.** * **Proper disposal of wastes, garbage, and used medical supplies.** * **Regular checkup and follow up, and protective vaccines.** ## Common Practices of Medical Asepsis at healthcare settings: - Wash hands. - Maintain aseptic technique during providing nursing care - Keep the patient's room as clean, bright, dry and airy as possible because organisms do not grow well in such an environment. - Cover breaks in the skin with sterile dressing. Breaks in the skin are a good portal of entry for many organisms. - Use equipment and supplies for one patient only. If they are to be reused by another patient, clean them thoroughly and then disinfect or sterilize them to prevent spreading organisms among patients. - Discard disposable equipment according to agency policy. All equipment used for patient care is considered contaminated after use. - Keep soiled equipment and supplies, especially linens, away from your uniform so that you do not carry organisms from patient to patient and yourself. - Consider the floor heavily contaminated. Discard any item if it falls to the floor, or clean it before using it. Also, disinfect or sterilize it as necessary. - Clean the least soiled areas first and the most soiled area last. This prevents having cleaner areas soiled even more by material from dirtier areas. - Pour liquids to be discarded, such as bath water and mouth wash rinsing, directly into a drain or toilet. Avoid spilling and splashing these liquids on yourself, the floor or other equipment because they are very likely to contain pathogens. - Use of isolation practices. ## Isolation Technique ### Definition Isolation refers to the precautions that are taken in the hospital to prevent the spread of an infectious agent from an infected or colonized patient to susceptible persons (patients, staff, and visitors). ### Purposes * Isolation is a medical asepsis technique that inhibits the spread and transfer of pathogenic organisms by limiting the contacts of the patient and creating some kind of physical barrier between the patient and others. * There are several common practices to help control the transmission organism by personal contact (hand washing, wearing gloves, gown, mask, hair & shoe covers). ### Types of Isolation Practices The Centers for Disease Control (CDC) have categorized isolation techniques into groups to help healthcare personnel to prevent transmission of communicable illness. **1) Strict isolation:** - Strict isolation is used to prevent transmission of highly communicable diseases that can be spread by both the contact and airborne routes (eg. Diphtheria & chickenpox). - Those who are kept in strict isolation are often kept in a special room at the facility designed for that purpose. Such rooms are supplied with an ante-chamber, and a negative-airflow setup should be used and are equipped with a special lavatory and care-giving equipment, and a sink and waste disposal. They are provided for workers upon leaving the area. The door of the room must be kept closed at all times. - Visitation to patients on strict isolation should be limited to only family/caregivers. Visitors should follow the strict isolation policy, report to the station nurse before entering the room. - Gloves, face masks, and gowns must be worn by all persons entering the room. - Hands must be washed on entering and after leaving the room. - Contaminated articles must be discarded or bagged and labeled before being sent for disinfection or sterilization. **2) Contact isolation** - Contact isolation is used to prevent the spread of diseases that can be spread through contact skin to skin (pathogens can be spread by touching) for examples rabies, scabies, wound infection. **3) Respiratory Isolation.** - Used to prevent transmission of microorganisms spread by droplets such as measles, pneumonia, TB, meningitis **4) Body Substance Isolation (BSI)** - Avoidance of any contact with bodily fluids of a patient due to pathogens that can be transmitted via these fluids. Body substances include (blood, urine, feces, oral secretions, wound drainage, seminal fluid, and vaginal secretions). **Blood isolation:** Precautious used to prevent transmission of blood-borne disease, examples of diseases that transmitted by blood (Malaria, Viral Hepatitis c and B, AIDS) **Blood-borne disease can be transmitted through**: - Injury with a needle or other sharp instrument, which has contaminated with blood or body fluids. - Exposure of open wounds to blood or body fluids from infected patients with an HIV & Viral Hepatitis B, C. - Splashes of infected blood or body fluids into mucous membranes & the eyes. - Use of contaminated instruments (needles - syringes, tooth brush, shaving). - Transfusion with infected blood by (HIV & Viral Hepatitis B, C, & D) - Skin graft, organism transplants & sexual intercourse from an HIV & Viral Hepatitis B, C, & D infected donor ## Guidelines for preventing blood-borne diseases in healthcare settings - Avoid contact with blood and other body fluids with barehanded. Use of personal protective barriers when you suspect contact with blood or body fluids. Also wear protective coverings, such as a mask, eyewear and a gown, if blood or other body fluids can splash. - Cover any cuts, scrapes, or sores and remove jewelry, including rings, before wearing gloves. - Change gloves before providing care to a different victim. Remove disposable gloves without contacting the soiled part of the gloves and dispose of them in a proper container. - Thoroughly wash your hands immediately after providing care. Wash hands upon arrival at hospital or returning to quarters. - Antiseptic hand cleaners should be available for special situations - Ensure that articles are correctly cleaned and disinfected or sterilized before use. If possible, use as much disposable equipment as possible. - Consider patient's clothing/belongings contaminated if soiled. - Needles should not be recapped or manipulated by hand. - Disposable sharps should be placed in a puncture-resistant container. Puncture-resistant containers should be readily available at all times. ## Common Practices of Medical Asepsis in Everyday Living The following practices are examples of good medical asepsis that should be maintained in everyday living 1. Cover the nose and mouth when coughing and sneezing. Coughing and sneezing carry large numbers of organisms from the mouth that may be inhaled by others. 2. Wash hands before handling food to prevent transferring organisms from your hands to the food, and after using the bathroom to prevent spreading organisms found in excretions. 3. Use personal care items, such as towels, tooth brushes, combs, hair brushes, shaving gear, and so on (change them frequently). This helps prevent spreading organisms from one person to another. 4. Use water fountains instead of public drinking cups to protect yourself and others from organisms logged on cups 5. Use pasteurized milk that has had many organisms removed. 6. License food handlers and inspect public eating places for protection from people carrying diseases and from poor practices of hygiene. 7. Control pests that may spread diseases, such as rats and mosquitoes. 8. Have regulations for immigrants and visitors who may enter the country with infectious diseases that can spread to others. 9. Teaching about maintaining good personal hygiene 10. Wash fruits and vegetables under running water. Store food properly. 11. Use liquid hand soap instead of bar soap 12. Use of T.V., radio, newspaper in health teaching regarding sources of disease and ways of prevention. 13. Proper safe water supply 14. Proper safe sewage disposal. 15. Maintain a clean home and environment. Improve home's air quality by increasing air circulation, and maintain good ventilation by opening windows. Control of air pollution. 16. Use of a system of health insurance for every individual. 17. Pre-employment medical examination to detect early any source of disease.