ASEPSIS
By
Purwaningsih
Learning Objectives
• Be able to state the requirements for
clean, aseptic or sterile technique
recommended for common procedures
• Demonstrate use of the “SCRIPT”
method to prepare for and carry out
procedures
• Be able to demonstrate aseptic and
sterile technique for 4 procedures
Nosocomial
Infections
• Worldwide Problem
• Acquired in health care
facilities
• Cost is in the billions for
extended
care and treatment
• A Leading cause of death
• Spread by health care workers
who fail to wash hands or
change gloves
Airborne Transmission
Agent Transferred by droplet
nuclei (moisture) or dust particles
•
coughing , talking, sneezing
Vehicle Transmission
• Agent transferred to host
by contaminated inanimate
objects
• Food, milk, water, drugs,
blood, urine
• Cholera by water
• Salmonellosis by meat
• E-coli by spinach
Vectorborne
• Agent transferred
to host by animate
means
• Mosquitoes, fleas,
ticks, lice, and
other animals
• Lyme Disease,
malaria, West Nile
virus
Chain of Infection
• Agent, Host and
Environmental
Interaction
• The links symbolize
essential elements
needed by
microorganisms to
invade and cause
cellular injury
Portal of Entry
Agent enters the Host by:
• Integumentary system (skin breaks, mucous
membranes as in surgical wounds)
• Respiratory tract (inhale droplets as colds,
measles, influenza)
• Genitourinary (infected vaginal secretions,
semen, as in STDs)
• Gastrointestinal (ingestion food, water
contaminates, as typhoid and Hepatitis A)
• Circulatory (insect bites as malaria from
mosquito bite
• Transplacental (mother to fetus as HIV and
Hepatitis B)
Host
Human being is a
susceptible host that can be
affected by an agent.
If you have not received
measles vaccine more likely
to get it because you lack
immunity.
Host Characteristics
• Age (immunity declines as
age increases)
• Illness and Injury
• Stress (decreases immune
response)
• Immunization/Vaccination
Status
• Lifestyle (sharing needles,
multiple sex partners,
smoking, alcohol and drug
abuse)
• Occupation (chemical
agents,needle sticks
• Skin breaks which is the
first line of defense
(surgical, pressure ulcer, IV)
Host
Characteristics
• Nutritional Status (overweight,
underweight)
• Heredity
• Medications (steroids, non-steroidal
anti-inflammatory agents NSAIDs
(ibuprofen, aspirin), chemotherapy,
antibiotics lead to vaginal yeast
infections
• Nursing and Medical Procedures
(urinary catheters, IV’s)
Breaking Chain of
Infection
• Infection Control is the First Line of
Defense
• HAND HYGIENE IS THE SINGLE
MOST PRACTICE IN PREVENTING
THE SPREAD OF INFECTION
• JCAHO June 2006: Hand washing is
the top priority
• National Patient Safety Goal (USA
Government)
Breaking the Chain of Infection
• Wear gloves, masks, gowns and
goggles
• Client Hygiene
• Dressing Changes using aseptic
technique
• Clean linens
• Clean Equipment
• Educate on covering mouth and
nose when coughing and
sneezing; throwing tissues into
garbage bag
Breaking Chain of Infection
• Nutrition (protein needed to maintain
and repair tissues, production of
antibodies, and acid-base balance
• Exercise
• Immunizations (measles, mumps,
rubella, tetanus every 10 years and flu
every year
• MUMPS reported by CDC (8/6/2006)
as being beyond historical limits.
Cummulative for 2006 in selected
states 5,482
Body Defenses
• Immune system recognizes its
self
• Antigen is non-self “pathogen”
and the immune system will
attack it
• Non-Specific Immune
Responses are
• Skin and its normal flora
• Mucous membranes (as
cilia in respiratory tract
keep from entering lungs)
Non-Specific Immune
Responses
• Coughing, sneezing, tearing
reflexes
• Elimination and acid environment
• Flora in the large intestine
prevent growth of pathogens
and peristalsis removes them
with feces
• Natural urine acidity prevents
growth and urination rids
bladder neck and urethra of
microorganisms
Non-Specific Immune
Responses
• Vaginal Flora is acidic; puberty lactobacilli
ferment and produce sugars lowering the pH
preventing growth of microorganisms
• Inflammation is cellular response to tissue
injury by bacteria, trauma, chemicals, heat
etc….
• Erythema (redness) increased blood
flow to area
• Heat (increased blood flow and
metabolism)
• Pain (pressure on pain receptors)
• Edema (swelling) fluid and leukocytes
• Function Loss (pain, swelling)
• Purulent Exudate (WBCs, dead cells,
bacteria, debris)
Specific Immune Response
Response to invading antigen
Phagocytes do not destroy antigen
completely
T-cells (T lymphocytes) produce and
release lymphokines thus attracting
phagocytes and lymphocytes to destroy
the antigens;
T-cells stimulate B-cell production
which leads to antibody production
against antigen
ASEPSIS
The term asepsis means the
absence of disease-producing
microorganisms
Concept of Asepsis
• 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 infection-causing
pathogens as possible.
Definition
•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.
The Goal: Reduce Health Care
Associated Infections
• The goal is to reduce health
care-associated infections that
occur when staff spread
microbes to patients
• Germs move to patients from
hands, and from objects used
for patient care
• Use of clean, aseptic or sterile
technique reduces the number
of germs transferred and thus,
reduces the risk of infection
Slide 22
Types of Asepsis
Technique
There are two types of asepsis:
Medical asepsis & Surgical
asepsis.
Medical or Clean Asepsis
reduces the number of
organisms & prevents their
spread.
Surgical or Sterile Asepsis or Sterile
Technique
includes procedures used to eliminate
micro-organisms from an area & is
practiced by nurses in OTs, labour &
delivery area, major diagnostic areas
& Rx areas.
Medical Asepsis
• 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).
Surgical Asepsis
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.
INFECTION CAUSE BY
MICROORGANISMS
• BACTERIA
• FUNGI
• PROTOZOA
• ALGAE
• VIRUSES
Clean Technique
• Use clean technique if staff or objects
will touch intact skin, intact mucous
membranes or dirty (contaminated)
items
Examples of When Clean Technique is
Used
. Clean tech is
appropriate for:
• Taking blood
pressures
• Examining
patients
• Feeding
patients
4: Clean, Aseptic, Sterile
Slide 36
Definition: Invasive
Procedures
• Acts done to patients that come
in contact with the wounds,
blood stream, the inside of the
body, or normally sterile parts of
the body
• Remember invasive procedures
invade the inside of the body
4: Clean, Aseptic, Sterile
Slide 37
CONTROL OR ELIMINATION OF
INFECTIOUS AGENTS
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.
To Prevent Contamination
• Keep clean, dirty, and sterile items separate:
• Only put sterile items in a sterile field
• Change gloves and wash hands if going from a
contaminated act to a aseptic or sterile act
• Time skin antisepsis and surgical hand hand
hygiene with a clock
• The sterile field is considered sterile except
for the 2.5 cm border
• Wet items are considered contaminated
4: Clean, Aseptic, Sterile
Slide 40
Planning Reduces Errors in Technique
• Use the S.C.R.I.P.T. reminder to
plan
• Visualise every step in advance,
to make sure supplies are
available
4: Clean, Aseptic, Sterile
Slide 41
S.C.R.I.P.T Procedures
• Space and work flow?
• Clean, aseptic, or sterile
technique?
• Routine, aseptic or surgical
hand hygiene?
• Instruments and supplies?
• Personal protective
equipment?
• Trash: sharps, infectious
waste, radioactive waste,
pathology or routine waste?
4: Clean, Aseptic, Sterile
Slide 42
Space and Work Flow?
• Should the procedure be
done in a dedicated
room or space?
• Who will ensure that all
visible dirt is removed
form the space ahead of
time, and surfaces
disinfected if necessary?
4: Clean, Aseptic, Sterile
Slide 43
Space and Work Flow?
Work flow: can staff move from
hand washing to hand drying to
separate clean and sterile areas
without passing or touching
contaminated areas?
Where will used instruments and
specimens be placed?
4: Clean, Aseptic, Sterile
Slide 44
Clean, Aseptic, or Sterile
Technique?
• All team members should be clear
on who should be using clean,
aseptic or sterile technique and
what elements are intended
• Example: a physician places a
thoracic drain with sterile
technique,the nurse assisting uses
clean technique, and the person
who empties the drain in
subsequent days uses aseptic
technique
4: Clean, Aseptic, Sterile
Slide 45
Instruments and
Supplies
• Plan what medical
devices and supplies
are needed
• Plan where each item
should be placed
• Plan where and how
each item should be
discarded or sterilised
4: Clean, Aseptic, Sterile
Slide 46
Work Flow Chart:
Decontamination Cycle
4: Clean, Aseptic, Sterile
Slide 47
Routine, Aseptic or Surgical
Hand Hygiene?
• Prepare in advance for the type of
hand hygiene that is necessary
• Arrange the supplies including hand
drying towels, as appropriate
4: Clean, Aseptic, Sterile
Slide 48
Personal Protective
Equipment
. Discuss what other items are
expected and needed
These may include aprons, shoe
covers for bloody procedures, masks,
hair coverings, face shields or goggles
4: Clean, Aseptic, Sterile
Slide 49
Disinfection & Sterilization
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.
DISINFECTION
•The principle of disinfection is that of
denaturation of the bacterial cell
protein.
•This process can be carried out by
two methods:
1. Physical
-
boiling
2. Chemical
- disinfectants
Choice of method
depends on:
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
Use of Disinfectants
Indications for use of Hospital Disinfectants:
1. Disinfection of skin & mucous membranes.
2. Disinfection of instruments & other items.
3. Decontamination of the inanimate
environment.
Chemical Disinfectants are such as:
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.
STERILIZATION
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.
THE PRINCIPLES OF ASEPTIC TECHNIQUE
IN WOUND CARE
Medical Hand Washing – cleaning of trolley,
opening the dressing pack, to cleaning the wound.
Surgical Hand Washing – scrubbing in surgery.
Gowns & Aprons
• 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 microorganisms and to prevent the transfer of microorganisms already on the hands.
Single-use
• irrigation devices should not be
used for multi-use purposes as
there is potential for crossinfection between pts.
• e.g., IV lines & buckets.
BLOOD TRANSMISSABLE DISEASES &
SEXUALLY TRANSMITTED DISEASES (STDs)
• HIV Infection/AIDS
• Hepatitis B (HBV)
• Hepatitis C (HCV)
• Syphilis
• Gonorrhoea
• Chlamydia
• Herpes Simplex
• Cytomegalovirus
INFECTION PREVENTION MEASURES:
Body Substance Isolation System
(BSIS)
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.
Infection Prevention Measures: BSIS
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, punctureresistant containers.
• Do not recap used
needles by hand.
• Be particularly careful
when manipulating small
devices such as heparin
locks.
Infection Prevention Measures: BSIS
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.
Infection Prevention Measures: BSIS
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.
Clean
Aseptic
Sterile
On ward or at
beside
Dedicated
area
Dedicated
room
Gloves
Clean or
none
Sterile
Sterile
surgical
Hand hygiene before
the procedures
Routine
Aseptic,
e.g. alcohol
Surgical
scrub
Iodophors,
chlorheximide
Skin antisepsis
No
Alcohol
Long acting
agent
Sterile field
No
No*
Yes
Sterile gown, mask,
head covering
No
No
Yes
Procedure space
Remember !!!
• 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)
• Govt. Hospital of Thoracic Medicine. 2013. Clean, Aseptic and Sterile Technique. No Publicat
•