PRPD/CIN2/2007

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 The nurse’s efforts to minimize the onset & spread of infection are based on the principles of aseptic technique.
 Aseptic technique is an effort to keep the client as free from exposure to infectioncausing pathogens as possible.

 Aseptic technique is the effort taken to keep the patient as free from hospital micro-organisms as possible (Crow 1989).
 It is a method used to prevent contamination of wounds & other susceptible sites by organisms that could cause infection.
 This can be achieved by ensuring that only sterile equipment & fluids are used during invasive medical & nursing procedures.

 There are two types of asepsis:
Medical asepsis & Surgical asepsis.
 Medical or Clean Asepsis reduces the number of organisms & prevents their spread.

 includes procedures used to eliminate microorganisms from an area & is practiced by nurses in OTs, labour & delivery area, major diagnostic areas & Rx areas.

 During daily routine care, the nurse uses basic medical aseptic techniques to break the infection chain.
 Eg.of medical asepsis are changing client’s bed linen daily, handwashing, barrier techniques, & routine environmental cleaning.

Cont…
 Follow Isolation technique as appropriate.
 Clients with high susceptibility to infection require special precautions to prevent exposure to pathogens.

Cont…
 In medical asepsis, an area or object is considered contaminated only if it is suspected of containing pathogen (e.g., used bedpan, the floor & a wet piece of gauze).

 Sterilization destroys all microorganisms & their spores.
 Surgical asepsis demands the highest level of aseptic technique & requires that all areas be kept as free as possible of infectious micro-organisms.

Cont…
 These techniques can be practiced by nurses in the OR (surgical incision) or at the bedside
(e.g, inserting IV or urinary catheter & reapplying sterile dressings) where sterile instruments & supplies are used.

Cont…
 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 unsterile surface).

Cont…
 The nurse working with a sterile field or with sterile equipment must understand that the slightest break in technique results in contamination.

Cont…
 A nurse in an operating room follows a series of steps to maintain sterile techniques, including applying a mask, protective eyewear, and a cap; performing a surgical hand washing; & applying a sterile gown & gloves.

Cont…
 Effectiveness of aseptic practices depends on the nurse’s conscientiousness & consistency in using effective aseptic techniques.

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Cleansing
 Is the removal of all foreign materials such as soil & organic material from objects.
 Generally, cleansing involves use of water & mechanical action with or without detergents.
- Disposable object has to be discarded.
- Reusable objects must be cleansed thoroughly before disinfection
& sterilization.

 When cleaning equipment that is soiled by organic material such as blood, fecal matter, mucus or pus, the nurse applies a mask, protective eyewear, & waterproof gloves.
 These barriers provide protection from infectious organisms.
 A brush, detergent or soap are needed for cleaning.

 Disinfection – eliminates pathogenic organisms on inanimate objects with the exception of bacterial spore. Noninfectious microorganisms may or may not be killed.

 Sterilization – is the process of eliminating and destroying all microorganisms, including spores & viruses.

 The principle of disinfection is that of denaturation of the bacterial cell protein.
 This process can be carried out by two methods:
1. Physical
2. Chemical -
boiling disinfectants

A) Types of microorganisms
Certain strains of bacteria are more resistant to destruction than vegetative forms.
B) Number of microorganisms present on articles
The more heavily contaminated the articles are, the harder for destruction.

Essential factors for maximum effectiveness of disinfection are:-
- Cleanliness of items
- Unlocking all locked instruments
- Complete immersion of articles

Indications for use of Hospital Disinfectants:
1. Disinfection of skin & mucous membranes.
2. Disinfection of instruments & other items.
3. Decontamination of the inanimate environment.

1. Phenolics a) clear soluble fluids, e.g., 2% Printol. 1% Sudol b) Hexachlorophene e.g., Phisohex, Gamaphene
- for wide range of antibacterial activity.
2. 70% - 75% Ethyl or Isopropyl Alcohol - for wide range of antibacterial activity, most active against
TB.

Chemical Disinfectants cont….
3. Halogens - for inactivation of viruses and anti bacterial activity except TB. a) Chlorine (hypochlorites) e.g., Milton, Eusol.
b) Iodine.
4. Glutardehyde, e.g., Cidex - wide range of antibacterial activity, very effective against Hepatitis B virus. Best for heat sensitive instruments.

5. Quaternary ammonium compounds e.g., Cetrimide (Cetavlon) - good detergent
(more active against gram +ve organisms).
6. Diguanides, e.g., Chlorhexidine (Hibitane)
Chlorhexidine + detergent (Hibiscrub, Savlon) useful skin ‘disinfectant’. Very active against gram +ve organisms.

This process can be carried out by 4 methods :-
 HEAT
- moist heat (Autoclave)
- dry heat (Hot Air Oven)
 IRRADIATION
- ultra violet light
- gamma rays/cobalt 60
 CHEMICAL
- in solution, e.g., Ethicon
Fluid, Glutaraldehyde
- vapour, e.g.,
Formaldehyde
- gas, e.g., Ethylene
Oxide
 FILTRATION
- applicable to pharmaceutical laboratory where it is used in combination with ultra violet light.

 Medical Hand Washing – cleaning of trolley, opening the dressing pack, to cleaning the wound.
 Surgical Hand Washing – scrubbing in surgery.

 protective clothing is used to reduce bacterial spread by contact (nurse’s uniforms become heavily contaminated during clinical procedures.

 Gloves – The purpose of wearing gloves is both to protect the hands from contamination by micro-organisms and to prevent the transfer of micro-organisms already on the hands.

 irrigation devices should not be used for multi-use purposes as there is potential for cross-infection between pts.
e.g., IV lines & buckets.

SEXUALLY TRANSMITTED DISEASES (STDs)
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HIV Infection/AIDS
Hepatitis B (HBV)
 Hepatitis C (HCV)
 Syphilis
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Gonorrhoea
Chlamydia
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Herpes Simplex
Cytomegalovirus

 Hand washing / Hand Scrub
Wash hands before touching pts, before scrubbing & any time hands have been soiled.

 Gloves
- put on clean gloves just before contact with mucous membranes & non intact skin.
- wear appropriate gloves any time hands likely to have contact with moist body substances.
- remove gloves immediately after task is completed.

 Gowns or Plastic Aprons
Wear any time it is likely that clothing or skin will be soiled.
 Masks
- wear in OR / sterile area
-wear when working directly over large areas of open skin.
- wear when it is likely that nasal & oral mucous membranes will be spattered with moist body substances.

Needles & Sharps
Discard in rigid, puncture-resistant containers.
- Do not recap used needles by hand.
- Be particularly careful when manipulating small devices such as heparin locks.

 Room Selection
- Assign patient with infectious disease to an individual
OR or last on surgical list.

 Trash & Linen
- Bag all soiled trash & linen securely.
- Discard according to facility policy.
- Wear gloves & protective garments when handling soiled linen & trash.

 Housekeeping
- Clean all rooms on regular schedule.
- Clean articles, equipment & furniture soiled with moist body substances immediately. Wear gloves.

 Laboratory Specimens
- Handle all laboratory specimens with equal care. Special precautionary labels are required.

 Compliance of Care Providers
Develop programme to ensure that health care workers comply with the infection precautions system.

 The nurse is responsible for providing the client with a safe environment.
 The nurse’s first responsibility to the client is to first do no harm.
 It is easy to forget key procedural steps or, when hurried, to take shortcuts that break aseptic procedures. However, the nurse’s failure to be meticulous will place the client at risk for an infection that can seriously impair recovery.
(Florence Nightingale, 1859)
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