NCM 213 CARE OF MOTHER, CHILD, ADOLESCENT
VANNESS GALLARDO
PRINCIPLES AND PRACTICES OF ASEPSIS
DEFINING ASEPSIS
MEDICAL
ASEPSIS
SURGICAL
ASEPSIS
DEFINITION
CLEAN
TECHNIQUE
STERILE
TECHNIQUE
EMPHASIS
FREEDOM
FROM MOST
PATHOGENI
C
ORGANISMS
FREEDOM
FROM ALL
PATHOGENI
C
ORGANISMS
PURPOSE
REDUCE
TRANSMISSI
ON OF
PATHOGENI
C
ORGANISMS
FROM
PATIENT TO
ANOTHER
PREVENT
INTRODUCTI
ON OF ANY
ORGANISMS
INTO AN
OPEN
WOUND OR
STERILE
BODY
CAVITY
MEDICAL ASEPSIS
● Measures aimed at controlling the
number of microorganisms and/or
preventing or reducing the
transmission of microbes from one
person-to-another
CLEAN TECHNIQUE
● Know what is :
○ Dirty
○ Clean
○ Sterile
● Keep first three conditions separate
● Remedy contamination immediately
NOTE!
GROSS CONTAMINATION
● unsuitable by contact with
something unclean
● Stain, dirt, etc.
DUSTING
● Cleaning
● To ensure that gross contamination
is eradicated
PRINCIPLES OF MEDICAL ASEPSIS
1. When the body is penetrated, natural
barriers such as skin and mucous
membranes are bypassed, making the
patient susceptible to microbes that
might enter.
a. Perform hand hygiene and put
on gloves
b. When invading sterile areas of
the body, maintain the sterility
of the body system
c. When placing an item into a
sterile area of the body, make
sure the item is sterile
2. Even though skin is an effective
barrier against microbial invasion, a
patient can become colonized with
other microbes if precautions are not
taken.
a. Perform hand hygiene
between patient contacts
b. When handling items that only
touch patient's intact skin, or
do not ordinarily touch the
patient, make sure item is
clean and disinfected (between
patients).
3. All body fluids from any patient
should be considered contaminated
a. Body fluids can be the source
of infection for the patient and
you.
b. Utilize appropriate personal
protective equipment (PPE)
c. When performing patient care,
work from cleanest to dirtiest
patient area.
4. The healthcare team and the
environment can be a source of
contamination for the patient.
a. Health care providers (HCP)
should be free from disease
b. Single use items can be a
source of contamination
c. Patients environment should
be as clean as possible
“SURGERY INCREASES RISK FOR INFECTION”
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NOTE!
IATROGENIC
● a disease induced by a drug
prescribed by a physician; or after a
medical or surgical procedure,
● Example:
○ Disease/infection acquired
from contaminated
instrument used from any
procedure
NOTE!
NOSOCOMIAL
● a hospital-acquired infection or a
health-care associated infection
(HAI)
REMEDY CONTAMINATION
● Every case is considered dirty and the
same infection control precautions
are taken for all patients
● When contamination occurs, address
it immediately
● Breaks in technique are pointed out
and action is taken to eliminate them.
○ Know chain of infection to
break the chain
(Please refer to table 1 on the next page)
TABLE 1. Chain of infection.
SURGICAL ASEPSIS
● Practices designed to render and
maintain objects and areas maximally
free from microorganisms:
STERILE TECHNIQUE
● Know what is :
○ Sterile
○ Not Sterile
● Keep sterile and nonsterile items apart
● Remedy contamination immediately
PRINCIPLES OF SURGICAL ASEPSIS
1. The patient should not be the source
of contamination
2. The operating room (OR) team should
not be the source of contamination
3. The surgical scrub should be done
meticulously
4. The OR technique of the surgeon is
very important
5. Recognize potential environmental
contamination.
NOTE!
LESS SKIN CONTACT = LESS INFECTION
STERILITY
● At waist level
STERILIZATION
● destroys all microorganisms and their
spores
● common means of sterilizing objects
used in the operating room (OR)
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HAND HYGIENE
WHAT IS HAND HYGIENE?
● Handwashing
● Antiseptic Handwash
● Alcohol-based Hand Rub
● Surgical Antisepsis
WHY IS HAND HYGIENE SO IMPORTANT?
● Hands are the most common mode of
pathogen transmission
● Reduces the spread of antimicrobial
resistance
● Prevents healthcare-associated
infections
HAND-BORNE MICROORGANISMS
● Healthcare providers (HCP)
contaminate their hands with 100-1000
Colony-Forming Units (CFU) of
bacteria during "clean" activities
(lifting patients, taking vital signs)
TRANSMISSION OF PATHOGENS ON HANDS
FIVE ELEMENTS
1. Germs are present on patients and
surfaces near patients
2. By direct and indirect contact, patient
germs contaminate healthcare
provider hands
3. Germs survive and multiply on
healthcare provider hands
4. Defective hand hygiene results in
hands remaining contaminated
5. Healthcare providers
touch/contaminate another patient
or surface that will have contact with
the patient.
REASONS FOR NONCOMPLIANCE
(OF HAND HYGIENE)
● Inaccessible hand hygiene supplies
● Skin irritation
● Too busy]
● Glove use
● Didn't think about it
● Lacked knowledge
WHEN TO PERFORM HAND HYGIENE
FIVE MOMENTS
1. Before touching a patient
a. Before and after touching a
patient
2. Before clean/aseptic procedure
a. Before donning sterile gloves
for central venous catheter
insertion; also insertion of
other invasive devices that do
3.
4.
5.
not require a surgical
procedure using sterile gloves
b. If moving from a contaminated
body site to another body site
during care of the same
patient
After body fluid exposure risk
a. After contact with body fluids
or excretions, mucous
membrane, non-intact skin or
wound dressing
b. If moving from a contaminated
body site to another body site
during care of the same
patient
c. After removing gloves
After touching a patient
a. Before and after touching the
patient
b. After removing gloves
After touching patient surrounding
a. After contact with inanimate
surfaces and objects
(including medical equipment)
in the immediate vicinity of the
patient
b. After removing gloves
SUMMARY OF HAND HYGIENE
● Hand hygiene must be performed
exactly where you are delivering
healthcare to patients (at the
point-of-care).
● During healthcare delivery, there are 5
moments (indications) when it is
essential that you perform hand
hygiene.
● To clean your hands, you should
prefer hand rubbing with an
alcohol-based formulation, if
available. Why? Because it makes
hand hygiene possible right at the
point-of-care, it is faster, more
effective, and better tolerated.
● You should wash your hands with
soap and water when visibly soiled.
● You must perform hand hygiene using
the appropriate technique and time
duration.
SPAULDING CLASSIFICATION OF SURFACES
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1.
2.
3.
CRITICAL
● Objects which enter normally
sterile tissue or the vascular
system and require
sterilization
● Any procedure that involves or
is in contact with inner layer of
the body
SEMI-CRITICAL
● Objects that contact mucous
membranes or non-intact skin
and require high level
disinfection
● Example: wound, scratch,
sliced flesh
NON-CRITICAL
● Objects that contact intact
skin but not mucous
membranes, and require low or
intermediate-level disinfection
● Example: Intact skin (placing a
thermometer on a patients
axilla then to the next patient
without cleaning the
thermometer)
DISINFECTION LEVELS
1. HIGH
● Inactivates vegetative
bacteria, mycobacteria, fungi,
and viruses but not
necessarily high numbers of
bacterial spores
2. INTERMEDIATE
● Destroys vegetative bacteria,
most fungi, and most viruses;
● Inactivates Mycobacterium
tuberculosis
3. LOW
● Destroys most vegetative
bacteria, some fungi, and
some viruses.
● Does not inactivate
Mycobacterium
● tuberculosis
CATEGORIES OF ENVIRONMENTAL
SURFACES
1. CLINICAL CONTACT SURFACES
● Exam tables, counter tops, BP
cuffs, thermometers
● Frequent contact with
healthcare providers' hands
● More likely contaminated
2. HOUSEKEEPING SURFACES
●
●
●
Floors, walls, windows, side
rails, over-bed table
No direct contact with
patients or devices
Risk of disease transmission
SURVIVAL OF PATHOGEN ON SURFACES
PATHOGEN
DURATION OF
PERSISTENCE
(RANGE)
MRSA
7 days - 4 months
VRE
5 days - 4 months
ACINETOBACTER
3 days - 5 months
C. difficile (spores)
5 months
NOROVIRUS
12 - 28 days
HIV
Minutes - Hours
HBV
7 days
HCV
16 hours - 4 days
SELECT, MIX, AND USE DISINFECTANTS
CORRECTLY
● Right product
● Right dilution
● Right preparation—not before low level
disinfection
● Right application method
● Right contact time
● Wear appropriate PPE (gloves, gown,
mask, eye protection
CLEANING RECOMMENDATIONS
● Clean disinfected surface using
correct technique:
1. From cleanest to dirtiest
2. Prevent contamination of
solution
● Don’t use dried out
wipes
3. Physical removal of soil
4. Contact time
5. Correct type of Cleaning
Materials
OTHER ENVIRONMENTAL ISSUES
● Blood and Body Fluid Spills
○ Promptly clean and
decontaminate
○ Use appropriate PPE
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○
Clean spills with dilute bleach
solution (1:10 or 1:100) or an
EPA-registered hospital
disinfectant with a TB or
HIV/HBV kill claim.
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1.
13 PRINCIPLES OF STERILE TECHNIQUE
4. Sterile Personnel Touch Only Sterile Items
Only Sterile Items are used within the
or Areas; Unsterile Personnel Touch Only
Sterile Field Damaged packages are
Unsterile Items or Areas.
not sterile
a. Sterile members maintain contact with
a. Damaged packages are not
sterile fields by means of gowns and
sterile:
gloves.
It is dirty
5. Unsterile Personnel Avoid Reaching over
Expired (expiration
the Sterile Field; Sterile Personnel Avoid
date)
Leaning over an Unsterile Area
Looks like it has been
a. Scrub nurse sets basins or glasses to
wet
be filled at the edge of the field.
Has it been properly
stored
NOTE!
Clearly labeled as
SCRUB NURSE = STERILE NURSE
sterile
CIRCULATING NURSE = UNSTERILE NURSE
NOTE!
If you are in doubt about the sterility of
anything, consider it is not sterile.
Storage of packs, wrapping materials and
time they remain sterile:
6. Edges of Anything that Encloses Sterile
Contents Are Considered Unsterile
a. Boundaries between sterile and
unsterile areas are not always rigidly
defined
7. Sterile Field Is created as Close as Possible
to Time of Use.
a. Sterile tables are set up just before the
surgical procedure.
b. There is not an established time
period or duration wherein the table is
considered sterile or unsterile.
8. Sterile Areas are Continuously Kept in View
Anything you cannot keep in your line of
vision (therefore, cannot control) is not sterile
a. Below the waist
b. Your back
c. Below the edge of the table
d. Sterile person face sterile areas
2. Sterile Personnel Are Gowned and Gloved
a. Gowns are considered sterile only from
the waist to shoulder level in front and
the sleeves.
3. Tables Are Sterile Only at Table Level
a. Only the top of a sterile, draped table
is considered sterile.
b. The edges and sides of the drape
extending below table level; are
considered contaminated.
9. Sterile personnel Keep Well Within the
Sterile Area
a. The scrub person should cautiously
maintain a wide margin of safety when
passing through unsterile areas.
10. Sterile Personnel Keep Contact with Sterile
Areas to a Minimum 12 inches.
11. Unsterile Personnel avoid Sterile Area.
a. Persons maintain at least one foot (30
cm) distance from any area of the
sterile field.
b. Unsterile persons never walk between
two sterile areas.
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12. Destruction of Integrity of Microbial
Barriers Results in Contamination.
a. A wet object is not a sterile object
b. Strike through from a wet surface
13. Microorganisms must Be Kept to an
Irreducible Minimum
a. All objects used in a sterile field are
sterile
b. The skin is not sterile
c. Sterile objects can become unsterile
by prolonged exposure to airborne
microorganisms.
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