Principles of Asepsis and Standard Precautions PDF

PRINCIPLES OF ASEPTIC TECHNIQUES & STANDARD PRECAUTIONS NURSING SKILL LECTURE BY OYELEYE, O.R RADIOLOGY AND PHYSIOTHERAPY STUDENTS UNIVERSITY OF LAGOS, NIGERIA NOVEMBER, 2024  LEARNING OBJECTIVES At the end of the lec...

PRINCIPLES OF ASEPTIC TECHNIQUES & STANDARD PRECAUTIONS NURSING SKILL LECTURE BY OYELEYE, O.R RADIOLOGY AND PHYSIOTHERAPY STUDENTS UNIVERSITY OF LAGOS, NIGERIA NOVEMBER, 2024  LEARNING OBJECTIVES At the end of the lecture, the students should be able to; explain the general principles of Asepsis explain standard precautions and infection control measures identify the elements of standard precautions mode of disease transmissions and chains of infections Highlight steps in hand washing State the guidelines relating to Asepsis and Standard precautions  GENERAL PRINCIPLES OF ASEPSIS The term "asepsis" refers to the practices and methods used to stop the introduction, growth, and transmission of microorganisms that could infect or harm people. It is essential to keep an environment clean and lower the risk of infection transmission in medical and healthcare settings. There are several levels of asepsis, including disinfection, clean, medical, and sterile methods. 1. Clean Technique: Also referred to as medical asepsis or medical cleanliness, clean technique uses strategies and procedures to reduce the number of bacteria and stop them from spreading from one person or object to another.  GENERAL PRINCIPLES OF ASEPSIS cont.. It concentrates on lowering the total microbial load rather than eliminating all the microorganisms. The following are examples of clean technique: Hand hygiene: frequent, thorough handwashing or the use of alcohol-based hand sanitizers. Regular cleaning and disinfection of surfaces: Using the right disinfectants, clean surfaces, furniture, and equipment as needed. Using personal protective equipment (PPE) to avoid direct contact with potentially infectious items by donning gloves, gowns, masks, and other protective gear as required. Respiratory hygiene: using tissues properly when you sneeze or cough, and covering your mouth and nose when you cough.  GENERAL PRINCIPLES OF ASEPSIS cont…. 2. Sterile Technique: The practice of keeping a sterile environment devoid of any microorganisms, such as bacteria, viruses, and fungi, is known as sterile technique. This is required in invasive treatments, operations, and the handling of sterile supplies or devices. Sterile technique's essential components are as follows: Sterilization of equipment: The process of purging germs from tools and equipment using autoclaving, chemical sterilization, or gas sterilization. The use of sterile drapes and gloves: Using sterile drapes and sterile gloves to separate sterile and non-sterile areas. GENERAL PRINCIPLES OF ASEPSIS cont…. Aseptic gowning and gloving: Putting on sterile clothing without contaminating it by following particular instructions. Maintaining a sterile field: Taking steps to prevent contamination of the operating room or other sterile environments while performing procedures. 3. Disinfection: Using chemical agents or procedures to eliminate or render inactive microorganisms on surfaces, devices, or objects is known as disinfection. Disinfection decreases the amount of germs to a level that is regarded as safe, while it does not always eradicate all of them. To stop the spread of germs, disinfection is necessary. Typical techniques for disinfection include:  GENERAL PRINCIPLES OF ASEPSIS cont… The application of cleaning agents: applying the recommended disinfection solutions or wipes to surfaces, tools, or equipment. Contact time: Enough time must pass between surfaces for the disinfectant to do its job. Appropriate concentration: Using the disinfectant at the right concentration required according to the manufacturer's recommendations. Implementing frequent cleaning and disinfection procedures will help to maintain a clean and secure environment.  STANDARD PRECAUTIONS AND INFECTION CONTROL MEASURES UNIVERSAL PRECAUTIONS refers to medical practice that avoids contact with patients' body fluids, while providing healthcare services by wearing nonporous article / materials such as medical gloves, goggles, and face shields. The practice was introduced in 1985–88. In 1987, the practice of universal precautions was adjusted by a set of rules known as body substance isolation. In 1996, both practices were replaced by the latest approach known as standard precautions. STANDARD PRECAUTIONS AND INFECTION CONTROL MEASURES cont… Under universal precautions all patients were considered to be possible carriers of blood-borne pathogens. STANDARD PRECAUTION is defined as, “a set of precautionary measures including good hand hygiene practices and use of protective barriers during routine patient care carried out by health care workers (HCW)”.  KEY ELEMENTS OF STANDARD PRECAUTIONS Hand hygiene PPE ( MASK, GLOOVES etc) Prevention of needle stick & injuries from sharp instruments Respiratory hygiene & cough etiquette Environmental cleaning Linens Waste disposal Patient care equipment  INFECTION PROCESS AND MODES OF DISEASE TRANSMISSION The invasion of bodily tissue by pathogenic micro-organisms that proliferate, resulting in tissue injury that can progress to disease. Infectious diseases kill more people worldwide than any other single cause. Infectious diseases are caused by germs. Germs are tiny living things that are found everywhere - in air, soil and water. Person can get infected by touching, eating, drinking or breathing something that contains a germ.  INFECTION PROCESS AND MODES OF DISEASE TRANSMISSION cont… INFECTION PROCESS: The presence of a pathogen does not mean that an infection will begin. In order for infectious disease to spread, several necessary steps must occur. These steps are known as “chain of infection”. An infection will develop only if chain remains intact. These links are; Causative Agent Reservoir Portal of Exit Mode of Transmission Portal of Entry Susceptible Host CHAIN OF INFECTION Causative Agent Susceptible Reservoir Host CHAIN OF INFECTION Portal of Portal of Entry Exit Mode of Transmi s sion CAUSATIVE AGENT: The microorganism (for example bacteria, virus or fungi). RESERVOIR (SOURCE): A host which allows the microorganism to live, and possibly grow, and multiply. Humans, animals and the environment can all be reservoirs for microorganisms. PORTAL OF EXIT: A path for the microorganism to escape from the host. The blood, respiratory tract, skin and mucous membranes, genitourinary tract, gastrointestinal tract, and transplacental route from mother to her unborn infant are some examples.  CHAIN OF INFECTION cont…. MODE OF DISEASE TRANSMISSION: Since micro-organisms cannot travel on their own; they require a vehicle to carry them to other people and places. Infectious diseases and even certain contagious diseases spread through the following agencies. Their ways of spreading is also given along with these agencies:  Air-borne transmission  Contact transmission-direct and indirect  Vehicle transmission (Water, milk, food etc.)  Vector-transmission  Transplacental transmission CHAIN OF INFECTION cont…. PORTAL OF ENTRY: A path for the microorganism to get into a new host, similar to the portal of exit. SUSCEPTIBLE HOST: A person susceptible to the microorganism  GUIDELINES RELATED TO ASEPSIS AND STANDARD PRECAUTIONS To encourage infection control procedures in healthcare settings, the Centers for Disease Control and Prevention (CDC) offers detailed guidelines and recommendations. CDC recommendations for respiratory hygiene, exposure occurrences, body substances and precautions based on transmission include: Standard Precautions: As the cornerstone of infection prevention and control, the CDC stresses the adoption of standard precautions. Hand hygiene, the use of personal protective equipment (PPE) when appropriate, safe injection techniques, careful handling of possibly contaminated equipment, and respiratory hygiene/cough etiquette are all considered standard precautions.  GUIDELINES RELATED TO ASEPSIS AND STANDARD PRECAUTIONS Hand Hygiene: The CDC stresses the need of good hand hygiene in the fight against infection. It advises healthcare professionals to wash their hands with soap and water or alcohol-based hand sanitizers before and after coming into contact with patients, after handling infected surfaces, and whenever their hands appear filthy. Use of Personal protective equipment (PPE) such as gloves, gowns, masks, and eye protection. The CDC offers instructions on how to use PPE properly. When and how to use it based on the level of anticipated exposure to body substances or infectious agents. GUIDELINES RELATED TO ASEPSIS AND STANDARD PRECAUTIONS cont…. Respiratory Hygiene: To stop the transmission of respiratory illnesses, the CDC promotes good respiratory hygiene and coughing manners. This entails using tissues and properly disposing of them, covering the mouth and nose while coughing or sneezing, and keeping a safe distance from others who exhibit respiratory symptoms. Exposure Incidents: For addressing exposure situations like needlestick injuries or contact with bodily fluids, the CDC outlines actions to take as soon as an exposure occurs, such as washing the afflicted area with soap and water, reporting the occurrence, and getting emergency medical attention and follow-up.  GUIDELINES RELATED TO ASEPSIS AND STANDARD PRECAUTIONS cont…. 3. Transmission-Based Precautions: The CDC divides precautions based on transmission into three categories: contact precautions, droplet precautions, and airborne precautions. Depending on the manner of transmission of particular infections, it offers precise instructions on when and how to put these measures into practice. Contact Precautions: Recommendations include using gloves and gowns, specialized medical equipment, and thorough surface disinfection. GUIDELINES RELATED TO ASEPSIS AND STANDARD PRECAUTIONS cont…. Droplet Precautions: Wearing a mask, keeping a safe distance from the patient, and putting the patient in a private room or with other people who have the same pathogen infection are all recommended as droplet precautions. Airborne Precautions: These include using a specific respirator mask, putting the patient in a room with low pressure, and restricting the patient's movement outside the room. It's important to note that the CDC guidelines are regularly updated based on emerging evidence and infectious disease trends.  GUIDELINES RELATED TO ASEPSIS AND STANDARD PRECAUTIONS cont…. The Occupational Safety and Health Administration (OSHA) is a regulatory body that establishes and upholds regulations to guarantee safe and healthy working conditions. OSHA has specific rules and recommendations for bodily fluids, common safety precautions, and ways for preventing infections, with particular focus on bloodborne pathogens. An analysis of OSHA recommendations in these areas is provided below: 1. Bloodborne Pathogens Standard: The Bloodborne Pathogens (BBP) Standard of OSHA is intended to safeguard healthcare workers from contact with bloodborne pathogens like HIV, HBV, and HCV.  GUIDELINES RELATED TO ASEPSIS AND STANDARD PRECAUTIONS cont…. Employers are required by the standard to create an exposure control strategy that outlines steps to prevent or reduce employee exposure to blood and other potentially infectious materials with the use of Universal precautions, the provision of suitable personal protective equipment (PPE), the provision of Hepatitis B vaccination, the safe handling and disposal of sharps, employee infection control training, and other elements that are crucial parts of the Blood Borne Pathogens Standard.  GUIDELINES RELATED TO ASEPSIS AND STANDARD PRECAUTIONS cont…. 2. Methods for Reducing Infection: Several strategies are highlighted by OSHA for lowering the risk of infection in the workplace, including: - Engineering controls: These include provision of sharps containers, safer medical devices (such as needleless systems), and other tools intended to stop accidents that cause injuries and exposure. - Work Practice Controls: According to OSHA regulations, employers should establish work practices that reduce exposure risk. This covers recommended hand washing techniques, the appropriate use of PPE, the careful handling and disposal of contaminated materials, and limitations on particular activities that may increase the risk of exposure.  GUIDELINES RELATED TO ASEPSIS AND STANDARD PRECAUTIONS cont…. - Personal Protective Equipment (PPE): OSHA requires that employers provide workers at risk of exposure with the proper PPE, such as gloves, masks, face shields, and protective clothes. Employers must ensure that employees receive training on proper use, limitations, maintenance, and disposal of PPE. - Hepatitis B Vaccination: OSHA requires employers to offer the Hepatitis B vaccine series to employees who have occupational exposure to blood or other potentially infectious materials. The vaccination must be provided at no cost to the employee. 3. Employee Training and Recordkeeping: OSHA requires employers to give thorough training to workers who may come into contact with bloodborne diseases. Topics including infection control practices, PPE use, exposure response methods, and emergency procedures must be covered in the training. - According to OSHA's recordkeeping rules, employers must also keep track of employee training, medical evaluations, and exposure events. Employers in healthcare environments should be aware of and adhere to OSHA regulations regarding bodily substance and standard safeguards. These recommendations are meant to safeguard workers and lower the possibility of workplace exposure to bloodborne infections. To provide a safe working environment, employers should constantly review OSHA guidelines and take the appropriate steps.  THE PRINCIPLE OF HAND HYGIENE Hand washing or hand hygiene is the act of cleaning one's hands with or without the use of water or another liquid, or with the use of soap for the purpose of removing soil, dirt, and/or microorganisms.  Hand-washing Washing hands with plain soap and water Antiseptic hand-wash Washing hands with water and soap or other detergents containing an antiseptic agent Alcohol-based hand-rub Rubbing hands with an alcohol-containing preparation Surgical hand hygiene/antisepsis Hand-washing or using an alcohol-based hand-rub before operations by surgical personnel STEPS OF HAND WASHING  ISOLATION PROCEDURES The isolation process, which is often referred to as isolation precautions or infection control precautions, is a collection of practices and guidelines used in healthcare facilities to stop the spread of infectious diseases and safeguard patients, staff members, and outside visitors. Based on how a particular infectious agent is transmitted, isolation precautions are taken. The general steps in the isolation process are as follows: 1. The first step is to identify the specific infectious agent that is responsible for the disease or condition. A bacteria, virus, fungus, or other microbes might be the cause of this.  ISOLATION PROCEDURES 2. Isolation precautions are classified as follows: Isolation precautions are divided into various forms according to how the infectious agent is transmitted: a. Standard Precautions: No matter the patient's diagnosis or suspected infection state, the standard precautions are always used when caring for them. They consist of behaviors including hand washing, using PPE when appropriate, safe injection techniques, handling potentially contaminated equipment safely, and respiratory hygiene/cough etiquette. b.Transmission-Based Precautions: When a patient is known to be infected or colonized with a particular pathogen, these precautions are utilized in addition to routine precautions. Three different transmission-based safety measures exist:  ISOLATION PROCEDURES Contact Precautions: Used to prevent the spread of infections through contaminated surfaces or via close contact with patients. Measures include using gloves and gowns, specialized patient-care tools, and effective surface disinfection. Droplet Precautions: Used to prevent the transmission of infections that are transmitted through respiratory droplets from talking, sneezing, or coughing. A mask should be used, you should keep a safe distance from the patient, and you should put the patient in a secluded room or with other people who have the same infection. ISOLATION PROCEDURES Airborne Precautions: Used for diseases that are spread by airborne particles that remain in the atmosphere for a long time. Among the precautions are donning a specialized respirator mask (such a N95 mask), putting the patient in a chamber with negative pressure, and restricting their movement outside the room. Implementation of Precautions: After the proper isolation precautions have been identified, healthcare professionals rigorously and consistently put them into practice. This entails using good hand hygiene, putting on and taking off personal protective equipment (PPE), maintaining respiratory hygiene, cleaning and disinfecting the surroundings appropriately, and placing patients in specific spaces.  ISOLATION PROCEDURES 3. 4. Communication and Education: It's crucial to inform patients, visitors, and healthcare workers about the unique isolation precautions in place. Regarding the safety measures and required actions, there should be clear communication regarding the precautions and ensure every person understands and follow precaution guidelines. 5. Monitoring and Compliance: To determine whether isolation precautions are being followed, regular monitoring, surveillance, and audits are carried out. This entails adhering to certain measures, using PPE appropriately, and following hand hygiene rules. The dynamics of the isolation procedure can change based on the particular infectious agent, the patient's health, and the rules and regulations of the healthcare facility. In order to stop the transmission of infections and keep the  THE USE OF PERSONAL PROTECTIVE EQUIPMENT(PPE) Personal Protective Equipment (PPE) is a general term for specialized clothing, gear, or other items created to shield users from potentially harmful substances, infectious diseases, or other risks in the workplace or other places. PPE serves as a protective shield between the wearer and any dangers, lowering the possibility of illness, infection, or injury. It is extensively employed across a variety of sectors, including healthcare, industry, construction, and emergency response. Here are a few examples of typical forms of PPE. PPE Working Condition GLOVES should be used when touching blood, body fluids, secretions, excretions, or contaminated items and for touching mucous membranes and nonintact skin. GOWNS should be used during procedures and patient care activities when contact of clothing and/or exposed skin with blood, body fluids, secretions, or excretions is anticipated. Aprons are sometimes used as PPE over scrubs, such as in hemodialysis centers when inserting a needle into a fistula. MASK AND should be used during patient care activities that are likely to generate GOGGLES OR A splashes and sprays of blood, body fluids, secretions, or excretions. FACE SHIELD Gloving: Gloves must be available and accessible in a range of sizes in all patient care areas. Wearing gloves reduces contamination of hands and minimizes the risk that a health care worker will become infected after contact with a patient’s blood or body substance. Wearing gloves reduces the likelihood that staff will transmit micro-organisms for their hands to patients. The type of glove used will depend on the task involved: Non sterile gloves: Non sterile nitrile gloves are suitable for most situations when contact with any blood or body substance, mucous membranes or non-intact skin is anticipated. Sterile gloves: Sterile latex gloves shall be worn for surgical procedures where asepsis must be maintained. Staff involved with surgical procedures should double-glove for added protection EYE/ FACE PROTECTION: Eye/face protection shall be worn in any situation when splash or splatter with blood or body substance to the mucous membrane of the mouth, nose and or eyes in likely. SURGICAL MASK: N95 Particulate Mask: Used when caring for patients with diagnosed or suspected airborne infectious diseases. TYPES OF PROTECTIVE GOWN: Plastic aprons: In general, disposable plastic aprons are suffi cient to provide protection from contamination Fluid Resistant Gown: Long sleeved, disposable fluid resistant gowns should be used for contact isolation or where there is an elevated risk of contamination  REFERENCES Occupational Safety and Health Administration (OSHA): https://www.osha.gov/respiratory-protection/general Health and Safety Executive (HSE): https://www.hse.gov.uk/ National Institute for Occupational Safety and Health (NIOSH): https://www.cdc.gov/niosh/ Centers for Disease Control and Prevention (CDC): https://www.cdc.gov/hai/prevent/prevention.html National Safety Council (NSC): https://www.nsc.org/ Centers for Disease Control and Prevention (CDC): https://www.cdc.gov/oralhealth/infectioncontrol/summary-infection-prevention- practices/standard-precautions.html American Academy of Pediatrics (AAP): https://www.aap.org/ World Health Organization (WHO): https://www.who.int/publications/i/item/WHO-UHL-IHS-IPC- 2022.1