Asepsis and Infection Control (IHC) PDF

**Program:** Bachelor of Science in Midwifery **Subject:** MDW 101- Introduction to Health Care (IHC) **Title: ASEPIS AND INFECTION CONTROL** **Topic 5** **[ASEPSIS and INFECTION CONTROL ]** Infection - Infection Agent: Pathogenic organism in: - Bacteria - Viruses - Fungi - Pro...

**Program:** Bachelor of Science in Midwifery **Subject:** MDW 101- Introduction to Health Care (IHC) **Title: ASEPIS AND INFECTION CONTROL** **Topic 5** **[ASEPSIS and INFECTION CONTROL ]** Infection - Infection Agent: Pathogenic organism in: - Bacteria - Viruses - Fungi - Protozoa **Concept of Asepsis** Asepsis - The absence of disease-producing microorganism. **Types of Asepsis** 1\. Medical Asepsis or Clean technique - 2\. Surgical Asepsis or Sterile Technique - - - Avoid talking, coughing, sneezing - Avoid reaching over a sterile field of objects - Never walk away from or turn your back on a sterile field. **INDICATIONS for Using [Sterile Technique]** 1\. During procedure that require intentional perforation of the client's skin 2\. When the skin's integrity is broken due to trauma, surgical incision, or burns 3\. During procedures that involve insertion of catheters or surgical instruments into sterile body cavities. **PRINCIPLES OF SURGICAL ASEPSIS** 1\. Sterile object remains sterile only when touched by another sterile object. \- This principle guides the nurse in placement of sterile objects & how to handle them. a. Sterile touching sterile remains sterile b\. Sterile touching clean becomes contaminated c\. Sterile touching contaminated becomes contaminated. 2\. Only sterile objects maybe placed on a sterile field. \- All items are properly sterilized before use. A package is UNSTERILE if it is: - Torn - Punctured - Wet - Open 3\. A sterile object or field out of the range of vision or an object held below a person's waist is contaminated (kept infront) *Contamination can occur accidentally by:* a\. dangling piece of clothing b\. falling hair, c\. or an unknowing client touching a sterile object. 4\. A sterile object or field becomes contaminated by prolonged exposure to air. \- The midwife avoids activities that may create air currents: - rearranging linen (DR/OR) after a sterile object or field becomes exposed - Minimize the number of people walking into the area. - M.O. also travels by droplet through the air. - No one should talk, laugh, sneeze, or coughs over a sterile field - When opening sterile packages, the midwife holds the item or piece of equipment as close as possible to the sterile field w/o touching the sterile surface. - Minimal movement or rearranging of sterile items also reduces contamination by air transmission. 5\. When a sterile surface comes in contact w/ a wet considered contaminated surface. Rationale: by capillary action (moisture sweeps thru sterile surface) Pouring a sterile solution: - - 6\. Fluid flow in the direction of gravity. - A sterile object becomes contaminated if gravity causes a contaminated liquid to flow over the object's surface. 7\. The edges of a sterile field or container are considered to be contaminated. Boarder line: 2.5 or 1 inch border around a drape is considered contaminated. An opened solution in bottle: - Best steps to do: - 1^st^ step: When pouring a sterile liquid, the midwife first pours a small amount of solution & discards it. Rationale: The solution washes away m.o. on the bottle lip. - 2^nd^ step: Then the midwife pours, a second time on the same side to fill a container w/ the desired amount of solutions. **[TERMINOLOGIES]** **Sepsis** - The presence of infection **Septicemia** - **Carrier** - **Contact** - **[TYPES OF PATHOGENS]** 1\. Resident Pathogens - The microorganism that normally live on a person's skin. \- Not easily removed by handwashing w/ plain soaps & detergents unless considerate friction is used. 2\. Transient Pathogens /Flora or Bacteria **Reservior** - **Sterilization** - **Disinfection** \- The process by which pathogens but not their spores are destroyed from inanimate objects. **Disinfectant** - **Antiseptic** - **Bactericidal** - **Bacteriostatic** - **Contamination** \- The process by w/c something is rendered unclean or unsterile. **Communicable Disease** - **Infectious Disease** \- Results from the invasion & multiplication of microorganism in a host. **Pathogenecity** - **Virulence** \- The vigor with which the organism can grow & multiply. **Nosocomial Infections** - **Iatrogenic Infection** - **Types of Nosocomial Infections** 1. Exogenous Infection - 2\. Endogenous Infection - **[Isolation]** \- The separation of persons w/ communicable diseases from other person so that either direct/indirect transmission to susceptible persons is prevented. **Isolation Technique** - Etiology - **STAGES OF INFECTIOUS PROCESS (Course of Infection by Stage)** 1. Incubation Period 2. Prodromal Period 3. Illness Period 4. Convalescent Period **1. Incubation Period** - - Interval between entrance of pathogen into body & appearance of first symptoms **2. Prodromal Stage** \- Interval from the onset of nonspecific s/s to specific symptoms - - **3. Illness Period** \- Specific signs & symptoms of infection develop & become evident. **4. Convalescent Period** \- Interval when accurate symptoms of infection disappear \- Length of recovery depends on severity of infection & client's general state of health \- Recovery: may take several days to months **THE CHAIN OF INFECTION PROCESS** **1. Causative (Etiologic Agent/M.O.)** - It is the infectious agent or its toxic product that is *transmitted from the source of infection to the susceptible body.* **2. Reservoirs (Source)** - These are the living bodies that harbor, sustain & maintain the growth & multiplication of the infectious agent. Carrier - These are the infected persons who do not manifest any recognizable s/s. - They are strictly speaking not disease, they are NOT AWARE of their condition. - Circulate freely in the community & therefore constitute the most dangerous sources of infection. Animal Reservoir - Direct- thru contact between animals & man Indirect -- thru insect bite/vectors **3. Portal of Exit from Reservoir** - a. Respiratory Tract, b. b\. Intestinal tract c. c\. Genito-urinary tract d. d\. Open-Lesions e. e\. Mechanical Escape - External force (for exit): - - C. Aspiration by needle & syringe **4. Mode of Transmission** A. Contact Transmission a\. Direct b\. Indirect Contact B. Droplet Transmission C. Vehicle Transmission D. Airborne Transmission E. Vectoborne Transmission **Vectors can be:** biologic & mechanical **Biologic Vectors** - Animals - Insects **Mechanical Vectors** - Inanimate objects that are infected w/ infected body fluids (contaminated needles, syringes) **5. PORTAL OF ENTRY** - - **6. SUSCEPTIBLE HOST** a. A host is a person who is at risk for infection; b. Whose own body defence mechanisms, when exposed are unable to fight the invasion of pathogens **Susceptibility** \- Is the degree of resistance an individual has to pathogens. Remember: "For organisms to spread disease, they must grow, reproduce and move from one source to another." **Factors Influencing the Host's Susceptibility** 1. Intact skin & mucous membrane are the body's 1^st^ line or defence. 2. The normal ph levels of secretions & genito-urinary tract help ward off microbial invasion. 3. The body's WBC influence resistance to certain pathogens. 4. The age, sex & race have been shown to influence susceptibility. 5\. Immunization (natural/acquired) acts to resist infection. 6\. Fatigue, climate, general health status, presence of pre-existing illness, previous/current treatment. **TYPES OF IMMUNIZATION** **1. ACTIVE IMMUNIZATION** a\. Natural -- Antibodies are formed in the presence of active infection in the body. \- It is lifelong. b\. Artificial **2. PASSIVE IMMUNIZATION *(transfer)*** - a. Natural - b\. Artificial - **Principles Underlying MEDICAL and SURGICAL ASEPSIS** 1.The pt. is a source of pathogenic m.o. 2\. The patient's m.o. leaves through specific routes. 3\. There is always m.o. in the environment w/c in some individuals & under certain circumstances can cause illness. 4.M.O. harmful to man can be transmitted by direct & indirect contact. 5\. Spread of infection from source to others can be prevented by various methods to stop the spread as close to the source as possible. Ex: asepsis technique 6\. The effectiveness of medical/surgical asepsis is dependent on the conscientiousness of those carrying them out. 7\. In observing MEDICAL asepsis, areas are contaminated if they bear or are suspected of having pathogens. 8\. In observing SURGICAL asepsis, areas are considered contaminated if touched by any object that is NOT sterile. **BREAKING THE CHAIN OF INFECTION: ANTISEPTIC PRACTICES** 1. HANDWASHING 2. CLEANING, DISINFECTION, STERILIZATION 3. USE OF BARRIERS 4. ISOLATION SYSTEM 5. SURGICAL ASEPSIS **I. Handwashing** Every individual washes his hands: **Principles Guiding Action in Handwashing** 1\. Principles of Asepsis Observe the Basic. - - - - 2\. Law of Gravity \- Start cleaning from an area w/ few organisms or dirt to an area of greater organisms or dirty. 3\. Use a thoroughly motion & friction -- to loosen dirt that adheres to the skin especially the creases & crevices of the hands. 4\. Running water mechanically washes away dirt. 5\. The soap has an emulsifying effect/power & it also lowers the tension of water. **Breaking the Chain of Infection \# 2: Cleaning, Disinfection, Sterilization** **Cleaning** - The physical removal of visible dirt & debris by washing, dusting or mopping surfaces that are contaminated. - Soap is used for mechanical cleaning **Disinfection** - The chemical or physical processes used to reduce the number of potential pathogens on an object's surface. - But spores of the pathogens are not necessarily destroyed. **Sterilization** - The complete destruction of all m.o. including spores, leaving no viable forms of organisms. ***Remember:*** "Any items introduced into sterile tissues or the vascular system, such as: - Surgical instruments - Cardiac & urinary catheters - Vaginal speculum - Implants - IV Fluids - Needles....must be sterile **FACTORS TO BE CONSIDERED IN THE SELECTION OF STERILIZATION OR DISINFECTION METHOD:** 1\. Nature of Organisms Present 2\. Number of Organisms Present 3\. Types of EQUIPMENT - 4\. INTENDED USE OF EQUIPMENT \>for MEDICAL ASEPSIS -- Clean Technique \>for SURGICAL ASEPSIS-Sterile Technique 5\. AVAILABLE MEANS OF Sterilization & Disinfection **METHODS of STERILIZATION** **1. Steam Sterilization (Steam under Pressure)** **Moist Heat** \- Most dependable & practical means for the destruction of all forms of microbial life. \- Autoclaving is sterilization using supersaturated steam under pressure. -This procedure is non-toxic, inexpensive, sporicidal & able to penetrate fabris rapidly. Check: Color Indicator: Check: Packaging for Integrity **2. Boiling Water** - Advantage: Inexpensive, Simple Disadvantages: **3. Gas Sterilization** - Ethylene oxide is a colorless gas that can penetrate plastic, rubber, cotton & other substances. - Expensive & requires 2 to 5 hours to be accomplished. - Ethyl oxide is toxic to humans. - Articles must be left to release the gas through aeration before they are used. **4. Dry heat** Adv: harmless to objects that are damaged by moisture, such as: - - Dis: The penetration ability of dry heat is not believed sufficient to destroy all microorganisms **5. Radiation** Types: - \- Used for pharmaceuticals, foods, plastics & other heat-sensitive items. **6. Chemicals** - These are effective disinfectants. - They attact all types of m.o. act rapidly, work w/ water - Inexpensive - Stable in light & heat - Not harmful to body tissues - Do not destroy articles ***Chlorine*** \- Is used for disinfecting water. **TYPES OF DISINFECTION** 1. **Concurrent Disinfection** - Ongoing practices that are observed in the care of the client. - His supplies. His immediate environment - To limit/control the spread of microorganism **2. TERMINAL Disinfection** **Breaking the Chain of Infection\ \#3. "Use of Barriers"** - Techniques that prevent the transfer of pathogens from 1 person to another are referred to as "barriers". - The most commonly used Barriers? - Mask - Gloves - Caps & shoe covering - Private rooms - Water Proof Disposable bags for: - Linen - Trash Mask -pieces of gauze used to cover the nose & mouth Cap - It is the covering of the entire scalp & hair w/ a cap Gloves - Protect hands for acquiring infective organisms. **MASK** 1\. A mask protects the nurse/midwife from inhaling m.o. from a client's respiratory tract & prevents transmission of pathogens from the nurse's respiratory tract to the client. 2\. A properly applied mask fits snugly over the mouth & nose so that pathogens & body fluids cannot enter or escape through the sides. 3\. If a person wears glasses, the top edge of the masks fits below the glasses so that they will not cloud over as the person exhales. Talking should be kept to a minimum while wearing a a mask to reduce respiratory air flow. 4\. A mask that has become moist does not provide a barrier to m.o. & thus is ineffective. It should be discarded. 5\. A mask should never be reused. 6\. A safe rule is to change a mask every hour. 7\. Before removing a mask, individuals remove gloves (if worn) or wash hands if they have been in contact with infectious material. 8\. The mask is dispose by holding it at the tie, avoiding contact with the soiled surface. It is placed in a waste receptacle. **GLOVES** - Sterile gloves function as additional barrier to the transfer of m.o. Two method of applying gloves: a. Open Gloving Method - b\. Closed Gloving Method - - Selection of proper glove size is important. - Care should be taken so that the glove is not too tightly stretched to avoid tearing, but it should also be tight enough so that picking up of objects maybe done with ease **GOWN** **What is the primary reason of wearing gown?** - The primary reason of gowning is to prevent soiling clothes during contact with the client. - When assisting at a sterile field in the O.R., nurses/midwives are required to wear sterile gowns. - This is to allow for the handling of objects with lower risk of contamination. - The sterile gown functions as a barrier aimed at decreasing the shedding of m.o. from the skin to the air. In many cases, it prevents wound contamination. - Applying a sterile gown is usually done after performing handwashing & the application of a mask & surgical cap. \* The midwife in the absence of an assistant picks up the gown from a sterile pack. But if the assistant is present, he/she may hand the nurse gown. - Only certain areas of the gown are considered sterile -- the area from the anterior waist (excluding collar) & the anterior surface of the sleeves. - All other areas are considered not sterile because of the nurses' lack of view to ensure their sterility. **Private Room** \- Separation of clients into private rooms decreases the chance of transmission of infection by all routes. **CATEGORIES OF INSTITUTIONAL WASTE ARE AS FOLLOWS:** a. INFECTIOUS WASTE: b\. INJURIOUS Waste c\. HAZARDOUS Waste **RECOMMENDATION FOR WASTE DISPOSAL is as follows:** 1\. Incineration or autoclaving 2\. Liquid body fluids \- Can be flushed down a drain connected to a sewer system: Blood, urine, aspirated body fluids 3\. Use separate containers - Blood, contaminated items **COLOR CODE of Segration:** BLACK -- trashcan for wet -*Biodegradable* items YELLOW -trashcan for Non-biodegradable/recyclable items **\# 4. Breaking the Chain of Infection ISOLATION SYSTEM** - Technique used to prevent or to limit the spread of infection. **STANDARD precaution, transmission -- based precaution & protective isolation:** A. WEAR clean gloves when touching: B. Perform HW immediately - When there is direct contact w/ blood, body fluids, secretions & excretions or contaminated items. - After removing gloves - Between pt. contacts C. Wear a mask, eye protection & face shield during procedures & pt. care activities that are likely to generate splashes or sprays of: - Blood - Body Fluids - Secretion/Excretion D. Wear a cover during procedures & pt. care activities. E. Removed soiled protective items promptly when the potential for contact w/ reservoirs of pathogens is no longer present. F. Clean & reprocess all equipment before reuse by another pt. G. Discard all single-use items promptly in appropriate containers that prevent contact w/ blood H. Prevent injuries w/ used needles, scalpels & other sharp devices by: 1\. Never removing, recapping, bending or breaking used needles. ***"NEVER RECAP NEEDLES"*** ***"USE YOUR NEEDLE DISPOSABLE CONTAINER"*** 2\. Never pointing the needle toward a body part. 3\. Using a one-handed "scoop" method. 4\. Depositing disposable & reusable syringes & needles in puncture -- resistant container. **Learning Task** 1. Self-directed learning. 2. Analyze the following concept mapping quiz. 3. Write the answers legibly. 4. Queries relevant to the topic will be entertained thru face-to-face classes. **CONCEPT MAP** **Task 1: What is the difference between medical asepsis and surgical asepsis?** **Task 2: What are the four stages of infectious disease and describe each.** **Task 3: Complete the chain of infection process and discuss each process.** **Task 4: What are the different types of immunization and discuss its protection.** Immunization Protection -------------- ------------ **Task 5: How breaking the chain of infection minimizes the spread?** Submit your answer using the following portal: 1. Submit your answer in printed, hard copy on face-to-face schedule of classes. **References:** 1. Mastering Fundamentals of Nursing: Concepts and Clinical Application, Educational Publishing House 2. Kozier, Barbara, et al.,8^th^ edition 3. Fundamentals of Nursing , Potter Perry 3^rd^ Edition Volume 1 **Prepared by:** **Ms. Claire I. Cruz** **Instructor**