Medical and Surgical Asepsis
Metropolitan Community CollegeNURS 1510Nancy Pares, RN, MSN
Asepsis….absence of germs or micro organismsMedical asepsis….technique or procedure which reduces the number of micro organisms and thus prevents the spread of diseaseSurgical asepsis….Protection against infection before, during and after a surgical procedure.InfectionInvasion of the body by pathogens
Define Terms
BacteriaOne celled, multiply rapidly, classified by shape and how they cluster togetherVirusSmallest of all pathogens; replication within the hostFungiOrganisms that exist by feeding on organic matterProtozoaSingle celled organism; spread by feces,
Classifications of pathogens
RickettsiaOrganisms multiply in animal hosts and transmit to humans through bitesHelminthsParasitic worms found in soil; transmitted via hand to mouthMycoplasmasNo cell wall; multi shaped
Pathogens cont
Chemical agentsPesticides, food additives, medications, industrialPhysical agentsHeat, noise, radiation, and machines
Other causes of infection:
MoistureOrganic matterWarmthDarknessOxygenAlkaline ph
Factors that promote pathogen growth
Infectious agentsPathogensNormal flora that become pathogenicReservoirWhere pathogens live and multiplyMay be livingHumans, animals, insectsMay be nonlivingFood, floors, equipment, contaminated water
The Spread of Infection: Six Links
Portal of Exit:ViaBodily fluidsCoughing, sneezing, diarrheaSeeping woundsTubes, IV lines
Mode of Transmission:ContactDirect– touching, kissing, sexual contactIndirect– contact with a fomiteDroplet: Cough, sneezeAirborne: Via air conditioning, sweeping
The Spread of Infection
Portal of Entry:Eye, nares, mouth, vagina, cuts, scrapesWounds, surgical sites, IV or drainage tube sitesBite from a vector
Susceptible Host:Person with inadequate defenseThree determining factors:VirulenceNumber of organismsHost’s defenses
Spread of Infection
Incubation:From time of infection until manifestation of symptoms; can infect othersProdromal:Appearance of vague symptoms; not all diseases have this stageIllness:Signs and symptoms presentDecline:Number of pathogens declineConvalescence:Tissue repair, return to health
Stages of Infection
By Location:LocalOccurs in a limited region in the body (e.g., urinary tract infection)SystemicSpread via blood or lymphAffects many regions (e.g., septicemia)
Classification of Infections
Acute- Rapid onset of short duratione.g., Common coldChronic- Slow development, long duratione.g., Hypertension, diabetes mellitus, osteomyelitisLatent- Infection present with no discernible symptomse.g., HIV/AIDS
Classification of Infections by Duration
Presence of pathogenReservoir (source)Pathogen survive and multiplyPortal of exit from reservoirDirect, indirect, airborneMode of transmissionPortal of entry to hostSusceptible host
Chain of Infection
LocalLimited to a defined area; resembles inflammationEx: redness, warmth, tenderness, swellingSystemicAffects the entire body and may involve multiple organs, goes through the stages of infectionEx: fever, anorexia, n/v, lymph node swelling
Signs and symptoms of infection
VascularAterioles dilate, blood and WBC go to areas/s= redness and warmthInflammationTissue dies causing release of chemicals (histamine and prostaglandins) which allow blood vessel permeability. Cells, proteins, fluids enter the tissue spaces blocking lymphatics to create a ‘wall’ against infectionPhagocytosisWBC enter the tissues causing release of pyrogens (fever); exudates form discharge; healing occurs
Inflammatory response stages
An infection acquired in a health-care facilityCost to the health-care system = $4.5 billion/yearLeading cause of deathPreventable with use of aseptic principles/ techniquesExogenous Nosocomial Infection:Pathogen acquired from health-care environmentEndogenous Nosocomial Infection:Normal flora multiply and cause infection as a result of treatment
Nosocomial Infection
IatrogenicInfection from a procedureex: UTI fromfoleyinsertionexogenousInfection from non-normal floraex: clostridiumEndogenousInfection when normal flora alteredex: yeast infection
Nosocomialsubcatagories
UTIInsertion, contamination of drainage system, improper cleansingSurgical siteImproper technique for handwashing or dressing changeURIImproper handwashing or suctioning techniqueIVImproper handwashing or site care
Causes ofnosocomialinfections
Extended LOS in hospitalMultiple care giversAntibiotic choices and over useImproper medical or surgical asepsis
Causes cont
AgeVery young and very oldPoor nutritional statusSmoker, ETOH useExisting co-morbid conditionsChronic illnesses, chemo,radiationClients with invasive proceduresClients with prolonged stress
Who is at risk fornosocomialinfection?
ContainingnosocomialinfectionsCLEAN, DISINFECT, STERILIZEControlling/eliminating reservoirsBathing, dressing changes, patent drainage systemsControlling the portal of exitCover mouth/nose, wear mask, client teachingControlling transmissionDo not share equipment, proper handling of linens, HANDWASHINGControlling portal of entryMaintain skin integrity, position changes, proper wiping techniques, maintain drainage integrity
Nurse’s role in
Protecting susceptible hostProtect natural defenses-skin, mucous membranes, fluid intakeEncourage cough and deep breathingChange positionOral hygienePromote rest and sleepReduce client stress
Nurses role in
Primary Defenses:Anatomical features, limit pathogen entryIntact skinMucous membranesTearsNormal flora in GI tractNormal flora in urinary tract
Lines of Defense Against Infection
Secondary Defenses:Biochemical processes activated by chemicals released by pathogensPhagocytosisComplement cascadeInflammationFever
Lines of Defense Against Infection
Tertiary Defenses:Humoral immunityB-cell production of antibodies in response to an antigenCell-mediated immunityDirect destruction of infected cells by T cells
Lines of Defense Against Infection
Developmental stageBreaks in the skinIllness/injury, chronic diseaseSmoking, substance abuseMultiple sex partnersMedications that inhibit/decrease immune responseNursing/medical procedures
Factors that Increase Infection Risk
Adequate nutritionTo manufacture cells of the immune systemBalanced hygieneSufficient to decrease skin bacterial countNot overzealous; causes skin crackingRest/exerciseReducing stressImmunization
Factors that Support Host Defenses
Medical asepsis:“A state of cleanliness that decreases the potential for the spread of infections”Promoted through:Maintaining a clean environmentMaintaining clean handsFollowing Centers for Disease Control (CDC) guidelines
Preventing Infection: Implementing Medical Asepsis
Clean spills and dirty surfaces promptlyRemove pathogens through chemical means (disinfect)Remove clutterConsider supplies brought to the client room as contaminatedConsider items from the client’s home as contaminated
Maintaining a Clean Environment
When you arrive in the unitWhen you leave the unitBefore and after restroom useBefore and after client contactBefore and after contact with client belongings
Wash Your Hands
Before glovingAfter glove removalBefore and after touching your faceBefore and after eatingAfter touching a contaminated articleWhen you see visible dirt on your hands
Wash Your Hands
Wash for at least 15 seconds in nonsurgical setting; 2-6 minutes in surgical settingUse warm water, not hotApply soap to wet handsUse frictionClean beneath fingernails and jewelryRinse soapTowel or hand dry
Hand Washing Guidelines
Standard precautions (universal precautions)Protects health-care workers from exposureDecreases transmission of pathogensProtects clients from pathogens carried by health-care workers
Implementing CDC Guidelines
Contact Precautions:Pathogen is spread by direct contactSources of infection-draining wounds, secretions, suppliesPrecautions include:Possible private roomClean gown and glove useDisposal of contaminated items in roomDouble-bag linen and mark
Transmission-Based Precautions
Droplet Precautions:Pathogen is spread via moist droplets:Coughing, sneezing, touching contaminated objectsPrecautions include:Same as those for contactAddition of mask and eye protection within 3 ft of client
Transmission-Based Precautions
Airborne Precautions:Pathogen is spread via air currentsTransmission via ventilation systems, shaking sheets, sweepingPrecautions include:Same as those for contact, with addition of special mask
Transmission-Based Precautions
“Reverse” isolation:Protects the client from organismsUsed with immune-compromised client populationPrecautions include:Private room likelyNurse not assigned to clients with active infectionMask, handwashing, clean/sterile gown, glovesNo reuse of gowns, gloves
Protective Isolation
Includes:Creation of a sterile environmentUse of sterile equipment/suppliesSterilization of reusable suppliesSurgical hand scrubSurgical attireSterile glovesSterile fieldUse of sterile technique
Implementing Surgical Asepsis
Protective barriersChange glovesHANDWASHINGDiscard sharps correctlyDouble bagCover breaks in the skin
Standard Precautions
Organs most vital to a functional immune systemLiver…produces immunoglobulins (antibodies)Lymph nodes…produce and circulate lymphocytesBone marrow and thymus..form immune sys. CellsSpleen…removes dead cells and foreign molecules
Body specific immune defenses
HumoralAttack bacteria and virus’ at the extracellular levelB cell lymphocytes cause synthesis of antibodies leading to destruction of antigens and creation of antibodies that subsequently protect from the same antigenFive classes of antibodiesIgG, IgM, IgA, IgE, and IgD. IgG is most abundant and crosses the placenta provides passive immunity for newborns.
Immunities
Cell mediated immunityFights pathogens inside the cellT cells (a form of WBC) binds with the antigen, becomes sensitized and releases lymphokines which attract macrophages that destroy the antigenThree types of T cellsCytotoxic, helper T and suppressor T
Immunities, cont
NaturalPresent at birth, genetically determinedPassiveAcquired through introduction of antibodies,iemother passes to infantActiveAntibodies develop within the body to neutralize or destroy an infective agentAcquiredExposure to an antigen or passive injection of immunoglobulinArtificialProduced by vaccination
Types of immune responses
Medical asepsisPractice which reduces the number, growth and spread of micro organismsReferred to as ‘clean’ technique’Handwashing 2 min-15 secSurgical asepsisTotal elimination of all micro organisms, sporesSterile field (OR, L&D, etc), gown and gloveMethods:Steam, radiation, chemicals, or gas
Principles of medical and surgical asepsis
Apply to :All body fluids, secretions (except perspiration)BloodNon intact skinMucous membranesGloves worn:To provide a protective barrierTo reduce opportunities for ‘nurse’ organism transfer to clientWEARING GLOVES DOES NOT REPLACE HANDWASHING!!!
CDC Guidelines: Standard
The single most important measure to reduce the risk of transmission!Nurses do hands on work, so always wash first!
Handwashing
Cover your nose and mouth with your elbow.Use tissues to contain respiratory secretions and dispose into the nearest waste container after use.Perform hand hygiene after contact with any contaminated materials/objects
Respiratory hygiene/cough etiquette
Turn on slow, steady stream of warm waterMoisten hands with water, then apply soapRub hands together vigorously for at least 15 secondsRinse under waterUse a clean paper towel or air dryer to dry hands
Proper handwashing
May use when hands are not visibly soiledApply adequate amount to palm of one handRub hands together, covering all surfaces of hands and fingers (including under the nails) until hands are dryDo not rinse with waterMay be used 5-10 times before washing with soap and water is required.
Waterless hand rub
Admitting calls to tell you that they have a client who previously cultured positive for MRSA in their urine. What precaution do you place this client in?What if the MRSA was positive in the sputum?
Case Study
You have a client that has very runny stools. The doctor orders a stool culture.What additional information can you supply the lab?What precautions would you place this patient in?
Case Study
Client presents to ED with high fever, headache, body aches and non-productive cough. Client states the her husband just returned from a business trip in China.First thought?Precautions?
Case study
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