Nosocomial Infection
----Prevention and control
Wang kefang（王克芳）
wangkf@sdu.edu.cn
4

Aseptic Technique
Contents


Concepts
Principals of
Aseptic Technique

教学目标

、无菌物品
Aseptic
Techniques
解释术语：无菌区、非无菌区

掌握无菌技术的原则

熟练掌握无菌技术的基本操作
Concepts

Aseptic technique

the practices which prevent microorganisms
invading human beings, sterile objects and
areas from being contaminated during medical
procedures and nursing interventions.
Aseptic Technique
Principals of Aseptic Technique

Environment requirement

Staff preparation

Distinguish different areas

Item management

Aseptic concept during
procedures
Aseptic Technique
Environment requirement

The environment should be clean, spacious, and
disinfected routinely.

The Operating table is clean, dry, and flat and the
layout is rational

stop cleaning the surroundings 30 minutes before
the procedures, and minimize moving to prevent
dust from floating.
Aseptic Technique
Staff

Wear mask and cap, trim fingernails and perform
hand hygiene before aseptic procedures.

Wear sterile gown and sterile gloves if
necessary.
Aseptic Technique
Distinguish different areas

Aseptic area


Non-aseptic area


refers to the sterile area which has not been
contaminated.
is a non-sterilized area or an area having been
sterilized but being contaminated again.
Aseptic supply

is an aseptic item physically or chemically
sterilized.
Aseptic Technique
Item management
Aseptic supply is an aseptic item physically or
chemically sterilized.

Place aseptic supplies and non-aseptic supplies
separately and have distinct label.

Keep aseptic supply in sterile package or container.

Label sterile packages with name, expiration date
accurately.
Valid time :7 days/14days/1month

A set of aseptic supply is only for a client to use
once.
Aseptic Technique
During Procedures




Keep the body away from the aseptic area during
procedures.
Face sterile area during procedures.
Use sterile transfer forceps to fetch sterile items
Keep hands and arms above the waist level.
Aseptic Technique
During Procedures




Keep the body away from the aseptic area during
procedures.
Face sterile area during procedures.
Use sterile transfer forceps to fetch sterile items
Keep hands and arms above the waist level.

Once taken out of the container, aseptic supplies
can not be put back even not be used.

Do NOT talk, laugh, cough or sneeze over a sterile
field.

When in doubt about the sterility of a package, or
consider it contaminated, re-sterilize the items.
Aseptic Technique
Aseptic Techniques

Apply Sterile Transfer Forceps

Apply Sterile Container

Use Sterile Package

Prepare Sterile Treatment Tray

Pour Sterile Solution

Don and Remove Sterile Gloves
Aseptic Technique
Isolation
Do you know how to protect
yourself and others from
infection?
Do you know what to do if
you come in contact with
blood?
Concepts

Isolation


Using a variety of methods, techniques,
and measures to prevent pathogens
transmission from patients and carriers.
采用各种方法、技术，防止病原体从患者及携
带者传播给他人的措施。
Isolation
卫生部医院隔离技术规范 2009
Concepts

Clean area



Potentially-contaminated area



the area not contaminated by pathogens
such as treatment room, Nutrition pantry and pharmacy.
the area that is potentially contaminated by pathogens
like office, laboratory and disinfection room.
Contaminated area


the area contaminated by pathogens which is in contact with
clients directly and indirectly
such as ward, clients’ restroom and bathroom.
Isolation
Isolation Principle

在标准预防(Standard Precautions)的基础上，结合
疾病的传播途径制定相应的隔离预防措施
(Transmission-based precautions) 。

隔离病室应有隔离标志，并限制人员的出入。
Airborne
Precautions
Droplet
Precautions
Contact
Precautions

传染病/可疑传染病患者应安置在单人隔离房间。

受条件限制的医院，同种病原体感染的患者可安置
于一室

建筑布局合理，符合有关规定。
卫生部医院隔离技术规范 2009
Infectious Agent
Contact
Droplet
Airborne
Direct
Indirect
Droplet
Nuclei
Hands
Injection
Insect/
Animal
Equipment/
Environment
Isolation measures
----标准预防（Standard
Precautions）
----基于传播途径的隔离
（ Transmission-based precautions）
A quick recap
how isolation precautions evolved
over time
HISTORY OF GUIDELINES FOR ISOLATION
PRECAUTIONS IN HOSPITALS
Isolation
1970 Techniques,
1st edtn.
-Introduced seven isolation precaution categories:
Strict, Respiratory, Protective, Enteric, Wound and Skin,
Discharge, and Blood
- No user decision-making required
- Simplicity a strength; over isolation prescribed for some
infections
1975 Isolation
Techniques,
2nd edtn.
Same conceptual framework as 1st edition
1983 CDC
Guideline for
Isolation
Precautions
in Hospitals
-Provided two systems for isolation:
category-specific and disease specific
- Protective Isolation eliminated; Blood Precautions expanded to
include Body Fluids
-Categories included
Strict, Contact, Respiratory, Enteric, Drainage/Secretion,
Blood and Body Fluids
- Emphasized decision-making by users
HISTORY OF GUIDELINES FOR
ISOLATION PRECAUTIONS IN HOSPITALS contd-19851988
Universal
precautions
Developed in response to HIV/AIDS epidemic
- Blood and Body Fluid precautions to all patients, regardless of infection status
- Did not apply to feaces, nasal secretions, sputum, sweat, tears, urine, or vomitus
unless contaminated by visible blood
- Added personal protective equipment to protect HCWs from mucous membrane
exposures
- Handwashing recommended immediately after glove removal
- Added specific recommendations for handling needles and other sharp devices;
1987
Body
substance
isolation
- Emphasized avoiding contact with all moist and potentially infectious body
substances except sweat even if blood not present
- Shared some features with Universal Precautions
- Weak on infections transmitted by large droplets or by contact with dry surfaces
- Did not emphasize need for special ventilation to contain airborne infections
- Handwashing after glove removal not specified in the absence of visible soiling
1996
Guideline
for Isolation
Precautions
in
Hospitals
- Melded major features of Universal Precautions and Body Substance Isolation
into Standard Precautions to be used with all patients at all times
-Included three transmission-based precaution categories:
contact, droplet & airborne
- Listed clinical syndromes that should dictate use of empiric isolation until an
etiological diagnosis
WHAT ARE STANDARD PRECAUTIONS?

Standard Precautions include a group of infection
prevention practices that apply to all patients,
regardless of suspected or confirmed infection
status, in any setting in which healthcare is
delivered
---- America CDC in 1996 and updated in 2007
(Siegal JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory
Committee, Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare
Settings, 2007)
All healthcare workers MUST.....

Assume that every person is potentially
infected or colonized with an organism that
could be transmitted in the healthcare
setting.

Apply a set of work practices to




Blood
all body fluids (except sweat)
mucous membranes
non intact skin.
Key Components of Standard
Precautions
Hand hygiene
Patient
placement
Respiratory hygiene
PPE
Standard
Precautions
C&D
Waste Management
Safe injection
Linen & laundry
Recommendation for all individuals with respiratory
symptoms
Respiratory hygiene and cough etiquette

•
Cover the nose/mouth
when coughing or
sneezing
Use tissue paper to
contain respiratory
secretions and
dispose in the waste
receptacle

Perform hand hygiene if
contact respiratory
secretions and
contaminated objects

Put on a surgical mask
Key Components of Standard
Precautions
Hand hygiene
PPE
Patient
placement
Respiratory hygiene
Standard
Precautions
C&D
Waste Management
Safe injection
Linen & laundry
Personal Protective Equipment(PPE)
specialized clothing or equipment worn by
an employee for protection against
infectious materials
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
 Gloves – protect hands
 Gowns/aprons – protect skin and/or
clothing
 Masks and respirators– protect
mouth/nose
 Goggles – protect eyes
 Face shields – protect face, mouth,
nose, and eyes
PPE for Standard Precautions:
Based on Risk Assessment


IF direct contact with blood & body fluids, secretions,
excretions, mucous membranes, non-intact skin
 Gloves
 Gown
IF there is the risk of spills onto the body and/or face
 Gloves
 Gown
 Face protection (mask plus eye protection goggle; face
shield)
What Type of PPE Would You Wear?
• Giving a bed bath?
• Generally none
• Suctioning oral secretions?
• Gloves and
mask/goggles or a face
shield – sometimes
gown
• Transporting a patient in a
wheel chair?
• Generally none
• Taking vital signs?
• Generally none
?
• Drawing blood from a vein?
• Gloves
• Responding to an emergency
where blood is spurting?
• Gloves, fluid-resistant
gown, mask/goggles or a
face shield
• Cleaning an incontinent
patient with diarrhea?
• Gloves / gown
• Irrigating a wound?
• Gloves, gown,
mask/goggles or a face
shield
Isolation measures
----Standard
Precautions
Should be applied for ALL patients
----Transmission-based precautions



Contact
Droplet
Airborne
*Transmission-based precautions are often used
empirically, according to the clinical syndrome and the
likely etiological agent
All healthcare workers MUST.....

Assume that every person is potentially
infected or colonized with an organism that
could be transmitted in the healthcare
setting.

Apply a set of work practices to




Blood
all body fluids (except sweat)
mucous membranes
non intact skin.
Contact Precautions
耐甲氧西林金黄色葡萄球菌-MRSA
耐万古霉素肠球菌-VRE
产超广谱β-内酰胺酶-ESBLs细菌
多重耐药铜绿假单胞菌-MDR-PA

经接触传播疾病如肠道感染、多重耐药菌感
染、皮肤感染等的患者

在标准预防的基础上，还应采用接触隔离措
施
Contact Precautions
----患者的隔离



Limit patient contact with non-infected
persons
Place patient in a single room or cohort
with similar patients
Limit transportation
患者接触过的物品


可重复使用的（被单、衣物） 灭菌-清洁-消毒-灭
菌
无保留价值的：焚烧处理
Contact Precautions
----医务人员的防护(2-1)

Use disposable, gown or apron
进入隔离病室，戴口罩、帽子，从事可能污染
工作服的操作时，应穿隔离衣；离开病室前，脱下
隔离衣，按要求悬挂，每天更换清洗与消毒;或使
用一次性隔离衣。
接触甲类传染病穿脱防护服。
鼠疫 霍乱 H1NI SARS
Contact Precautions
----医务人员的防护(2-2)

Use disposable gloves
接触隔离患者的血液、体液、分泌物、排泄物
等物质时，应戴手套；离开隔离病室前，接触污染
物品后应摘除手套，洗手/手消毒。手上有伤口时
应戴双层手套。
Airborne Precautions

病原微生物经悬浮在空气中的微粒-气溶胶
来传播的疾病如肺结核、水痘等

在标准预防的基础上，还应采用空气隔离
措施。
Airborne Precautions
----患者的隔离

Use surgical mask

Place patient in a single room or cohort with
similar patients

Limit patient movement

Room ventilation or disinfect
Airborne Precautions
----医务人员的防护

Use a particulate respirator(医用防护口
罩)when entering the patient isolation
room；
进行可能产生喷溅的诊疗操作时，应戴
防护目镜或防护面罩，穿防护服
当接触患者及其血液、体液、分泌物、
排泄物等物质时应戴手套。
Droplet Precautions

接触经飞沫传播的疾病，如百日咳、白喉
、流行性感冒、病毒性腮腺炎、流行性脑
脊髓膜炎等

在标准预防的基础上，还应采用飞沫隔离
措施。
Droplet Precautions
----患者的隔离

Use surgical mask；

Limit patient movement。

Maintain a distance ≥ 1 meter between
infectious patient and others

Place patient in a single room or cohort with
similar patients

Room ventilation or disinfect
Droplet Precautions
----医务人员的防护

Use a mask when < 1 m of patient
进行可能产生喷溅的诊疗操作时，应戴护
目镜或防护面罩，穿防护服；
当接触患者及其血液、体液、分泌物、排
泄物等物质时应戴手套。
保护性隔离----反向隔离
（protective isolation）

适用范围

抵抗力低下或极易感染的患者，如严重烧伤、
早产儿、白血病、脏器移植及免疫缺陷患者等。
保护性隔离措施
患者
单间隔离，有条件可放在正压病房
注意口腔卫生，采用洗必泰漱口，每天至少4次
尽量不与其他无关人员接触
工作
人员
严格执行手卫生规范
正确穿戴口罩、帽子、隔离衣（接触患者面为清洁面）
患感染性疾病期间，不得进入隔离室
无关人员不得进入隔离室
治疗、护理应有计划的集中进行，减少出入室的次数
家属
访客
不进入隔离室内探视。必要时应做好手卫生并戴口罩
疑患感染时，不得探视
不得携带鲜花、宠物入室
环境
管理
保证隔离室内压力高于走廊
定期对室内环境进行消毒。
Terminal Disinfection

Terminal disinfection of the client

Terminal disinfection of the ward
Isolation
Terminal disinfection of the client

Transferred to other wards or discharged



bathe the clients and wear clean clothes
take their personal items with them after
disinfection.
For the dead client

clean the body with disinfectant and plug the mouth,
nose, ears, anus with sterile cotton, change wound
dressing, envelop the body with disposable linen.
Isolation
Terminal disinfection of the ward

Close the doors and windows, open bedside table,
spread the quilt and place the mattress vertically on
the bed, fumigate them with disinfectant or disinfect
by ultraviolet light.

Then open the door and windows




furniture and floor: rubbing
Thermometer: immersion
Blood-pressure meter and stethoscope: fumigation
Mattress, quilt and pillows: ultraviolet light.
Isolation
Isolation techniques
 Hand
 Cap
hygiene
and mask
 Goggles/Face
 Gloves
 Gowns/aprons
shields
Cap
masks
口罩种类
棉布口罩
效果
机械过滤 pm10<30%
医用外科口罩
（一次性）
仅对飞沫等大颗粒
有一定的滤过作用
防尘口罩
（N95）
对病毒、细茵以及
PM2．5大小的空气
污染物颗粒都具有
滤过作用
滤过率取决
于纱布厚度
滤过率90%
滤过率95%---99%
Pm： Particulate matter
wash hands:
Before Wear a mask after taking off the mask
如何佩戴N95口罩
１拉松头带。金属
软条向上，将手
穿过头带
２戴上口罩，头带分
别置於头顶後及
３将双手的食指及中
颈後
指由中央顶部向两
旁同时按压金属软
条。
４检查妥当（密合
性检查）
DON’T
×
× ×
×
×
——Face shields
Goggles: 安全的玻璃来防护眼睛
Gowns
 – Use during procedures and patient care
activities when contact of clothing/ exposed skin
with blood/body fluids, secretions, or excretions
is anticipated
PPE Use in Healthcare Settings
Gloves

Indications for gloving and for glove removal
手套的种类
●
●
●
●
●
无菌乳胶手套
清洁一次性使用乳胶手套
双层手套
一次性使用薄膜手套
卫生胶手套
57
手套的使用
■ Glove use does not
replace any hand
hygiene action
≠
Prevention
Is Primary!
Protect patients…protect healthcare personnel…
promote quality healthcare!
5
医院隔离预防
教学内容




概述
隔离原则
隔离预防措施
常用隔离技术
教学目标

解释术语：隔离、清洁区、潜在
污染区、污染区、标准预防

掌握隔离的原则与措施

掌握隔离技术的基本操作方法
Words:

Hand Hygiene
Isolation

Handwashing
Clean area

Alcohol-based handrub
Contaminated area

Aseptic Technique

Aseptic area

Aseptic supply