Medical / Surgical Asepsis
and
Infection Control
Foundations of Nursing
Christensen Kockrow
Mosby
Lois White / Thomas
Sharon L. Kinley-Schwing BSN
Pacific College 2006
Medical/Surgical Asepsis
and Infection Control
• Joseph Lister (1827 – 1912) is known as the father of aseptic
technique.
• Josephs technique helped reduce morbidity and mortality.
• It is now known that microorganisms cause infection.
• The growth and reproduction of a microorganism must be
stopped to prevent an infection.
• Concern and education regarding transmissible infections
have increased in both hospitals and homes.
Infection Control
• Policies and procedures in infection
control are included in all health care
facilities.
• The education of all staff personnel is to
minimize the risk of nosocomial
infections.
• Any patient entering a health care facility,
due to illness or need for invasive
procedure is at risk for developing an
infection.
• The application of infection control
principles, and use of common sense help
protect the patients.
• Nurses are very often exposed to
pathogenic microorganisms and should
use specialized and routine practices of
cleanliness to prevent the spread of
infection.
Asepsis
• Microorganisms are tiny, microscopic, capable of
carrying on living process.
• Microorganism are naturally present in the
environment, as well as on the human body.
• Many microorganisms are harmless, unless an
individual is ill, and then highly susceptible to
infection.
• There are some microorganisms that do cause
specific diseases or infections.
Asepsis
• Medical asepsis, know as clean technique,
inhibits the growth and spread of pathogenic
microorganisms:
– Hand washing.
– Changing the patients linen daily.
– Daily activities of cleanliness.
– Principles of medical asepsis is common at
home.
• Surgical asepsis, known as sterile technique,
destroys all microorganisms and their spores .
– Sterile technique and use in special skills and
procedures.
– Care of surgical wounds.
– Urinary catheters.
– Invasive procedures and surgery.
FLORA
• Microorganisms that occur or have adapted
to live in a specific environment.
• Resident flora–always present, usually
without altering the client’s health.
• Transient flora–episodic, and do not
continually live on the skin.
PATHOGENICITY AND VIRULENCE
• Pathogens–disease-producing
microorganisms.
• Pathogenicity–ability of microorganism to
produce disease.
• Virulence–frequency with which a
pathogen causes disease.
FACTORS AFFECTING VIRULENCE
• The strength of the pathogen to adhere to
healthy cells.
• The ability of a pathogen to damage cells or
interfere with the body’s normal regulating
systems.
• The ability of a pathogen to evade the attack of
white blood cells.
Infection Process
• Six elements must be present for infection to occur:
Infectious agent
Reservoir
Exit
Method of transportation
Entrance
Host
The Chain
of Infection
Infectious Agents
BACTERIA
• Small, one-celled microorganisms that lack a true
nucleus or mechanism to provide metabolism.
• Not all bacteria harmful or cause disease.
• Common bacterial infections: diarrhea, pneumonia,
sinusitis, cellulitis, urinary tract infections, meningitis,
gonorrhea.
Bacteria
• Many different characteristics.
• Three basic shapes, they include ?
• During cell division some bacterial stay together
to form pairs.
• These difference help identifying specific kinds
of bacteria.
• Aerobic bacteria
• Anaerobic bacteria
• What is a spore ?
Bacteria continued
• Many diseases can be diagnosis and treated
when the specific microorganism in identified.
• Body fluids, secretion suspected of containing
pathogenic organisms can be evaluated for
diagnosis.
• Cultures and sensitivity test are completed to
determine the antibiotic that will inhibit growth.
• Streptococcus is responsible for more diseases
than any other organism. Some strains are fatal.
Viruses
• Smallest known agents that cause disease.
• Not complete cells, but consist of a protein coat
around a nucleic acid core.
• 1898 Beijernick name these small bodies viruses.
• 1941 electron microscope made in possible to study
these small agents.
• Enter the body via the respiratory, gastrointestinal,
broken skin (vector or injection).
• Most viruses are self limiting illnesses, others are
fatal.
VIRUSES
• Organisms that can live only inside cells.
• They cannot get nourishment or reproduce
outside cells.
• Common viral infections: common cold,
influenza, measles, chickenpox, hepatitis B,
genital herpes, HIV.
Fungi
• Fungal (mycotic ) infections are among the most common.
• Fungi belong to the plant kingdom, many are harmless, some
are responsible for infections.
• The grey, black, green, white fuzzy growth on old bread is a
type of fungi.
• Most mycotic infections are caused by yeasts and molds.
• Most commonly involve the skin and mucous membranes.
• Fungi that invade deeper tissue may be come fatal.
FUNGI
• Grow in single cells or in colonies.
• Food from dead organic matter, living
organisms.
• Most are not pathogenic.
• Fungi can cause infections of the hair, skin,
nails, and mucous membranes.
Protozoa
• Single celled animals existing every where in nature in
some form.
• Some of the parasitic forms are found in the intestinal,
genitourinary, respiratory and circulatory systems.
• Disease producing protozoa are responsible for malaria,
amebic dysentery, and African sleeping sickness.
• Pathogenic microorganisms are infectious agents.
• These microorganisms require food, and a proper
environment in which to grow and live.
• The strength of the organism, depends on the number
present and the patients immune system.
PROTOZOA
• Single-celled parasitic organisms with ability to
move.
• Food from dead, decaying organic matter.
• Infection is spread through contaminated food,
water, or insect bites.
• Common infections: malaria, gastroenteritis,
vaginal infections.
RICKETTSIA
• Intracellular parasites that
need to be in living cells to reproduce.
• Spread through fleas, ticks, mites, and lice.
• Common rickettsia infections include typhus,
Rocky Mountain spotted fever, and Lyme
disease.
COLONIZATION AND INFECTION
• Colonization–the multiplication of
microorganisms on or within a host without
resulting in cellular injury.
• Infection–the invasion and multiplication of
pathogenic microorganisms in body tissue
that result in cellular injury.
AGENT
Entity that can cause disease:
• Biological agents: living organisms that invade the
host, causing disease
• Chemical agents: substances that can interact
with body, causing disease.
• Physical agents: factors in environment capable of
causing disease.
RESERVOIR
Place where agent can survive:
• In humans, animals, environment.
• Fomites–objects contaminated with infectious
agent.
• Carriers–have infectious agent but symptom
free.
Reservoir continue
• Any natural habitat of a microorganism that promotes
growth and reproduction is a reservoir.
• Many microorganisms are found in many areas of the
body, but the presents doesn’t always mean infection.
• Examples of Reservoirs:
Soiled dressings
Wet dressings
Bed linens/ Gowns/Uniforms
Hospital equipment
Urinary drainage bags/ Urinals
Carrier or vector is a person or animal that harbors and
spreads an organism causing disease, with out becoming
ill them self.
Exit Route
• Microorganism cannot spread without first finding a way out of
the first host.
• Human exit routes include:
gastrointestinal
respiratory
genitourinary
blood
tissue
• Handwashing prevent the spread of microorganisms or cross
contamination.
• Coving the nose and mouth when coughing also prevents the
spread of dieses causing organisms.
PORTAL OF EXIT
How infectious agent leaves the reservoir:
• Sputum.
• Semen, vaginal secretions, and urine.
• Saliva and feces.
• Blood.
• Draining wounds.
• Tears.
Method of Transmission
• Once a microorganism has exited a reservoir there
are many vehicles.
• These vehicles are called contaminated, soiled or
stained.
• What is a fomite ?
• What is a vector ?
Give examples of each..
MODES OF TRANSMISSION
Movement of infectious agent from reservoir or
source through portal of exit to portal of entry of
susceptible host:
• Contact transmission.
• Airborne transmission.
• Vehicle transmission.
• Vector-borne transmission.
PORTAL OF ENTRY
How an infectious agent enters the host:
• Integumentary system.
• Respiratory tract.
• Genitourinary tract.
• Gastrointestinal tract.
• Circulatory system.
• Transplacental.
Entrance of Microorganisms
• Once an organism has exited one host and been
transmitted, it must find a way to enter a susceptible
host.
• When a host’s defense mechanisms are reduced,
there is a greater chance of the organism to enter.
• What are some of the ways organism can enter a
host?
Host
• A host is an organism in which another , usually
parasitic, organism is nourished and harbored.
• Susceptibilities are determined by the amount to
resistance shown to the pathogen.
• Microorganisms are constantly in contact with
people, but infections do not develop unless a
person is susceptible to the numbers of organisms.
• Immunizations have proven effective in providing
additional protection against infectious disease.
HOST
• Organism that can be affected by agent.
• Susceptible host–person who has no resistance
to an agent and thus is vulnerable to disease.
• Compromised host–person whose normal body
defenses are impaired and is therefore
susceptible to infection.
FACTORS AFFECTING
SUSCEPTIBILITY TO INFECTION
•
•
•
•
•
•
•
Age
Concurrent diseases
Stress
Immunization/vaccination status
Lifestyle and occupation
Nutritional status
Heredity
• Infectious process:
incubation period
prodromal stage
illness stage
convalescence
• Inflammatory response:
STAGES OF INFECTION
• Incubation stage–the time between entry of an
infectious agent and the onset of symptoms.
• Prodromal stage–the time from the onset of
nonspecific symptoms until specific symptoms begin
to manifest.
• Illness stage–the time when client has specific signs
and symptoms.
• Convalescent stage–from the beginning of the
disappearance of acute symptoms until client returns
to previous state of health.
Nosocomial Infections
• Term taken from the Greek word,
meaning health care facility.
• An infection that is acquired while in a
hospital or other health care agency.
• This infection is usually acquired at least
12 hour after admission.
• The hospital harbors microorganisms
that may be highly virulent.
NOSOCOMIAL INFECTIONS continued
• Infection acquired in hospital or other health care
facility that was not present at the time of the client’s
admission.
• Include those infections that become symptomatic
after the client is discharged.
• Four categories: urinary tract, surgical wounds,
pneumonia, and septicemia.
•
These infections cause extended stays and
treatment for patient, and increase cost of care for
the hospital.
Infection Control Team
• Valuable discipline in the health care arena.
• These teams include who ?
• OSHA and JAHO have pressured hospitals to better
organize these teams, and document infections
within the hospital.
• What is the duty of infection control personnel ?
• Employee health services.
BREAKING THE CHAIN
OF INFECTION
Page 359
Standard Precautions
• Set of guidelines designed to reduce the link of transmission of
blood born pathogens and pathogens from moist body
secretions.
•
Guidelines apply to:
– Blood
– All body fluids, secretions and excretions
– Nonintact skin
– Mucous membrane
–
–
–
–
Precautions promote:
Handwashing
Use of gloves, masks, eye protection
Use of gowns when appropriate for patient contact
Hand Hygiene
• The most important and basic preventive technique
for interruption the infectious process.
• 2 minute handwashing will provide protection
before the nurse cares for a patient.
• 30 second handwashing before caring for another
patient should be sufficient to ensure minimal
transmission of microorganism between patients.
MEDICAL ASEPSIS
• Hand hygiene–the most basic and effective
infection-control measure to prevent and control
the transmission of infectious agents.
• Single most important procedure for preventing
nosocomial infections.
• Performing a 2 minute
hand wash.
• Using an AlcoholBased Waterless
Antiseptic for Routine
Hand Hygiene.
Performing a
2-minute
handwashing
(From Elkin, M.K., Perry, A.G., Potter,
P.A. [2004]. Nursing interventions and
clinical skills. [3rd ed.]. St. Louis:
Mosby.)
Health Promotion Considerations
• Adequate exercise, well balanced diet, current
immunizations.
• Discuss susceptibility of the patient to disease.
• Teach correct and safe methods of storing and preparing
foods.
• Hygiene.
• Know family and others susceptibilities to disease.
• Home cleaning techniques for patients cared for at home.
Gloving
• Gloves are use if there is
nay possibility of contact
with infectious material.
• Advice from the CDC on
wearing gloves include ?
• Donning gloves /
Removing gloves
• Gowning
gowning for isolation
• Mask / Protective eyewear
donning a mask
• Disposing of Contaminated Equipment
• Double bagging
• Isolation technique
Donning a mask.
(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)
Double
bagging.
Types of Precautions
Patients Requiring Precaution
• Standard precautions
• Airborne precautions
• Droplet precautions
• Tuberculosis isolation
Types of Precautions continued
• Contact Precautions
• Immunocompromised patients
• Monitoring of isolation
ASEPSIS
• Absence of microorganisms
• Medical asepsis–practices used to
reduce the number, growth, and spread
of microorganisms
• Surgical asepsis–practices that eliminate
all microorganisms and spores from an
object or area
Surgical Asepsis
• Surgical or sterile technique, requires a nurse to use
precautions different from those of medical asepsis.
• Nurse working with a sterile field or equipment must
understand sterile technique.
• Any break in this technique results in contamination.
• Surgical asepsis is practiced in the operating room, labor
and delivery area, and major diagnostic areas.
• Surgical asepsis may also be used during procedures at
the bedside.
Surgical handwashing
Surgical Handwashing.
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St.
Louis: Mosby.)
Cleaning
Disinfection
and Sterilization
• Cleaning
• Disinfection
• Sterilization
• Preparing for disinfection and sterilization
CLEANSING
• Removal of soil or organic material from
instruments and equipment used in providing
client care.
• Involves the use of water, mechanical action,
and sometimes, a detergent.
• Nurses should wear gloves, masks, and
goggles during cleansing.
Sterilization or Disinfection
• Physical Method
Steam under pressure/ moist heat
Boiling water
Radiation
Dry heat
• Chemical Process
Gas
Chemical solutions
DISINFECTION
• Elimination of pathogens, except spores, from
inanimate objects.
• Disinfectants–chemical solutions used
to clean inanimate objects.
• Germicides–chemicals that can be applied to
both animate (living) or inanimate objects to
eliminate pathogens.
STERILIZATION
• Destroying all microorganisms including spores.
• Equipment that enters normally sterile tissue or
blood vessels must be sterilized.
STERILIZATION (continued)
• Methods include:
– Moist heat (steam)
– Dry heat
– Ethylene oxide gas
• Autoclaving (moist heat or steam) is the
most common method.
B, Receptacle receiving fluids is placed near edge of sterile table.
Patient Teaching for Infection Control
• The nurse will need to educate patient about the nature of
infection and the techniques to use in planning or
controlling its spread:
– Infection control for home and hospice settings.
– Prevention of infection:
• Hand washing
• food preparation
• lines
• waste containers
• body fluid spills
Infection Control
• Older adult considerations
• Cultural and Ethnic Considerations
Infection Control for Home and
Hospice Settings
• Nursing Process
• Assessment
• Prevention of Infection in the Home setting:
Hand hygiene
Food preparation
Linens
Waste containers
Body fluid spills
BODY DEFENSES
• A host’s immune system is a defense against
infectious agents.
• An immune response against an antigen protects
the body from infection.
• Immune defenses are identified as nonspecific
and specific.
NONSPECIFIC IMMUNE DEFENSE
Protects host from all microorganisms;
does not depend on prior exposure to antigen:
• Skin and normal flora.
• Mucous membranes.
• Coughing, sneezing, and tearing reflexes.
• Elimination and acidic environment.
• Inflammation.
INFLAMMATION
Nonspecific cellular response to tissue injury:
• Redness (erythema).
• Heat.
• Pain.
• Swelling (edema).
• Loss of function.
• Purulent exudate (pus).
SPECIFIC IMMUNE DEFENSE
Response specific to an invading antigen.
• Acquired immunity–protects individual against
future invasions of already experienced
antigens.
• Vaccination–an inoculation with a vaccine to
produce immunity against specific diseases.
TYPES OF INFECTION
• Localized infections–limited to defined area or
single organ with symptoms that resemble
inflammation (redness, tenderness, swelling),
such as cold sore.
• Systemic infections–affect entire body,
involve multiple organs, such as AIDS.
NURSING DIAGNOSIS
• Risk for infection.
• Ineffective protection.
• Impaired tissue integrity.
• Impaired oral mucous membrane.
• Impaired skin integrity.
• Deficient knowledge (specify).
• Nursing diagnosis
• Expected outcomes
• Planning
• Implementation
• Evaluation
Questions ?