Fundamental Nursing Chapter 10 Asepsis

Preventing infections is one of the most important priorities in nursing Microorganisms, living animals or plants visible only with a microscope, are commonly called germs. What they lack in size, they make up for in numbers. Microorganisms are everywhere: in the air, soil, and water, and on and within virtually everything and everyone.

Types of Microorganisms Microorganisms are divided into two main groups: nonpathogens or normal flora and pathogens Non Pathogens Pathogens have high potential for causing infectious communicable diseases also called contagious diseases and community-acquired infections.

Bacteria Viruses Fungi Rickettsiae Protozoans Mycoplasmas Helminths

Many pathogens have mutated to adapt to hostile environments and unfavorable living conditions. Such adaptability has ensured that they continue to pose a threat to humans. A spore is a temporarily inactive microbial life form that can resist heat and destructive chemicals and survive without moisture.

Chain of Infection By interfering with the conditions that perpetuate the transmission of microorganisms, humans can avoid acquiring infectious diseases.

The six essential components of the chain of infection (sequence that enables the spread of disease-producing microorganisms) must be in place if pathogens are to be transmitted from one location or person to another: An infectious agent A reservoir for growth and reproduction An exit route from the reservoir A mode of transmission A port of entry A susceptible host (Fig. 10-2)

Infectious Agents Some microorganisms are less dangerous than others. For example, intestinal bacteria help produce vitamin K, which, in turn, helps control bleeding.

Reservoir A reservoir is a place where microbes grow and reproduce, providing a haven for their survival. Examples: skin, shafts of hair open wounds blood lower digestive tract nasal passages

The exit route is how microorganisms escape from their original reservoir and move about A mode of transmission is how infectious microorganisms move to another location. See table 10-1 The port of entry is where microorganisms find their way onto or into a new host, facilitating their relocation. One of the most common ports of entry is an opening in the skin or mucous membranes.

Susceptible Host Humans become susceptible to infections when their defense mechanisms are diminished or impaired. A susceptible host, the last link in the chain of infection, is one whose biologic defense mechanisms are weakened in some way

Are burn victims Have suffered major trauma Require invasive procedures such as endoscopy Need indwelling equipment such as a urinary catheter Receive implantable devices such as intravenous catheters Are given antibiotics inappropriately, which promotes microbial resistance Are receiving anticancer drugs and anti-inflammatory drugs such as corticosteroids that suppress the immune system Are infected with HIV

aajedi@hotmail.com Asepsis Nurses must understand and practice methods to prevent nosocomial infections (infections acquired while a person is receiving care in a health care agency). Asepsis means those practices that decrease or eliminate infectious agents, their reservoirs, and vehicles for transmission. It is the major method for controlling infection.

Medical Asepsis Medical asepsis means those practices that confine or reduce the numbers of microorganisms. Also called, clean technique, it involves measures that interfere with the chain of infection in various ways. Principles of medical asepsis: Microorganisms exist everywhere except on sterilized equipment. Frequent handwashing and maintaining intact skin are the best methods for reducing the transmission of microorganisms.

Blood, body fluids, cells, and tissues are considered major reservoirs of microorganisms. Personal protective equipment such as gloves, gowns, masks, goggles, and hair and shoe covers serves as a barrier to microbial transmission. A clean environment reduces microorganisms. Certain areas—the floor, toilets, and insides of sinks—are more contaminated than others. Cleaning should be done from cleaner to dirtier areas.

Examples of medical aseptic practices include: using antimicrobial agents, performing hand hygiene, wearing hospital garments, confining and containing soiled materials appropriately, and keeping the environment as clean as possible.

1. Using Antimicrobial Agents Antimicrobial agents are chemicals that destroy or suppress the growth of infectious microorganisms Examples are antiseptics, disinfectants, and anti-infective drugs.

Antiseptics Antiseptics, also known as , inhibit the growth of, but do not kill, microorganisms. An example is alcohol

Disinfectants Disinfectants, also called and , destroy active microorganisms but not spores. Phenol, household bleach, and formaldehyde are examples. Disinfectants rarely are applied to the skin because they are so strong. Rather, they are used to kill and remove microorganisms from equipment, walls, and floors

Anti-Infective Drugs antibiotics Antiviral

2. Hand washing Hand washing is an aseptic practice that involves scrubbing the hands with soap, water, and friction. Considering how often health care personnel use their hands with clients, it is no surprise that handwashing is the single most effective way to prevent infections.

Performing a Surgical Scrub A surgical scrub, a type of skin and nail antisepsis, is performed before donning sterile gloves and garments when the nurse is actively involved in an operative or obstetric procedure. The purpose is to more extensively remove transient microorganisms from the nails, hands, and forearms.

Wearing Personal Protective Equipment uniforms scrub suits or gowns masks gloves protective eyewear Hair and Shoe Covers

Gloves Nurses wear clean gloves, sometimes called examination gloves, in the following circumstances: As a barrier to prevent direct hand contact with blood, body fluids, secretions, excretions, mucous membranes, and nonintact skin

As a barrier to protect clients from microorganisms transmitted from nursing personnel when performing procedures or care involving contact with the client's mucous membranes or nonintact skin When there is a potential transfer of microorganisms from one client or object to another client during subsequent nursing care

Gloves… Examination gloves are generally made of latex Unfortunately some nurses and clients are allergic to latex.

Confining Soiled Articles: Utility Rooms Waste Receptacles

Keeping the Environment Clean Health agencies employ laundry staff and housekeeping personnel to assist with cleaning Terminal disinfection is more thorough than concurrent disinfection and consists of measures used to clean the client environment after discharge. Nurses who work in home health can teach the client and family simple aseptic practices for cleaning contaminated articles

Surgical Asepsis Surgical asepsis means those measures that render supplies and equipment totally free of microorganisms. Sterile technique is those practices that avoid contaminating microbe-free items.

Sterilization Sterilization consists of physical and chemical techniques that destroy all microorganisms including spores.

1. Physical Sterilization Microorganisms and spores are destroyed physically through radiation or heat (boiling water, free-flowing steam, dry heat, and steam under pressure).

Radiation Ultraviolet radiation can kill bacteria, especially the organism that transmits TB.

Boiling Water Boiling water is a convenient way to sterilize items used in the home. To be effective, contaminated equipment needs to be boiled for 15 minutes at 212°F (100°C)

Free-Flowing Steam Free-flowing steam is a method in which items are exposed to the heated vapor that escapes from boiling water.

Dry Heat Dry heat, or hot air sterilization, is similar to baking items in an oven. To destroy microorganisms with dry heat, temperatures of 330°to 340°F (165° to 170°C) are maintained for at least 3 hours.

Steam Under Pressure Steam under pressure is the most dependable method for destroying all forms of organisms and spores. The autoclave is an example figure 10-8

2. Chemical Sterilization Both gas and liquid chemicals are used to sterilize invasive equipment.

Principles of Surgical Asepsis They preserve sterility by touching one sterile item with another that is sterile. Once a sterile item touches something that is not, it is considered contaminated. Any partially unwrapped sterile package is considered contaminated. If there is a question about the sterility of an item, it is considered unsterile.

The longer the time since sterilization, the more likely it is that the item is no longer sterile. A commercially packaged sterile item is not considered sterile past its recommended expiration date. Once a sterile item is opened or uncovered, it is only a matter of time before it becomes contaminated. The outer 1-inch margin of a sterile area is considered a zone of contamination.

sterile wrapper, if it becomes wet, wicks microorganisms from its supporting surface, causing contamination. Any opened sterile item or sterile area is considered contaminated if it is left unattended. Coughing, sneezing, or excessive talking over a sterile field causes contamination.

Reaching across an area that contains sterile equipment has a high potential for causing contamination and is therefore avoided. Sterile items that are located or lowered below waist level are considered contaminated because they are not within critical view.

Creating a Sterile Field A sterile field means a work area free of microorganisms. (Skill 10-3)

Nursing Implications Risk for Infection Risk for Infection Transmission Ineffective Protection Delayed Surgical Recovery Deficient Knowledge