1. Chapter 31
Asepsis

2. Asepsis Medical asepsis “Clean technique”
Includes all practices intended to confine a specific microorganism to a specific area
Limits the number, growth, and transmission of microorganisms
Objects referred to as clean or dirty (soiled, contaminated)

3. Asepsis (cont'd) Surgical asepsis Sterile technique
Practices that keep an area or object free of all microorganisms
Practices that destroy all microorganisms and spores
Used for all procedures involving sterile areas of the body

4. Type of Infections Local infection Systemic infection Bacteremia
Septicemia
Acute infections
Chronic infections

5. Nosocomial Infections
Originate in the health care facility
Health care associated infections (HAIs)
Common HAIs
Factors
What is the impact of HAIs on clients?

6. Figure 31-1 The chain of infection6

7. Etiologic Agent Microorganisms Number of microorganisms present
Virulence and potency of the microorganisms (pathogenicity)
Ability to enter the body
Susceptibility of the host

8. Reservoir
Where the microorganism lives
Common sources
Carrier

9. Portal of Exit Must leave reservoir Coughing Sneezing
Saliva & mucous membranes
Feces & urine
Drainage
Open wound

10. Method of Transmission
Direct Transmission
Indirect Transmission
Vehicle borne
Formite
Vector borne
Airborne Transmission

11. Portal of Entry & Host
Portal of entry (5th link of chain of infection)
Any opening in the body
Non-intact skin
Susceptible host (6th link of chain)
Person who is at risk for infection

12. First line of defenses against infection
Intact skin & mucous membranes
Mouth
Cilia of the nasal passages
Tears GI
Vagina
Urine flow

13. Second line of defense against infection
Inflammatory Response
Signs
Suffix –itis

14. Stages of Inflammatory Response
First Stage- vascular & cellular response
Vessel constriction quickly followed by dilation
Increase in vascular permeability
Production & release of leukocytes (type of WBC) into bloodstream

15. Stages of Inflammatory Response
Second Stage
Exudate production
Fibrinogen, thromboplastin & platelets clump together
Form a barrier to prevent additional harm/injury

16. Stages of Inflammatory Response
Third Stage
Reparative phase
Regeneration
Granulation tissue
Fibrous tissue formation (scar)

17. Third line of defense against infection- Specific Defenses
Active immunity
Host produces antibodies in response to natural antigens or artificial antigens
Natural
From active infection
Artificial
Administered

18. Passive Immunity Passive immunity
Host receives natural or artificial antibodies
Natural passive immunity
Ex. from mother to baby through breastmilk
Artificial passive immunity
injection of antibodies

19. Factors Influencing Susceptibility to Infection
Age
Heredity
Stress
Nutrition
Medications/procedures
Disease
Other

20. Consider your current lifestyle
Consider your current lifestyle. Identify the risk factors that increase your risk for infection. How would you evaluate your ability to support your body’s defenses?
Is there anything you can do to decrease your risk for infection?

21. Nursing Nursing history Physical assessment S/S localized infection
S/S systemic infection
Laboratory data
Elevated WBC count
Increase in specific WBC types
Elevated erythrocyte sedimentation rate (ESR)
Cultures of urine, blood, sputum, or other drainage

22. Nursing Nursing goals focus on: Maintaining/restoring defenses
Avoiding spread of infection
Reduce/alleviate complications

23. CDC Guidelines to Prevent Infection
Two tiered approach
Standard precautions (SP)
Transmission based precautions
Hand hygiene
Personal protective equipment
Environmental controls
Respiratory hygiene (cough etiquette)

24. Standard Precautions (Box 31-1 pg. 694)
Designed for all clients
Apply to:
Blood
All body fluids, excretions, secretions, except sweat
Nonintact skin
Mucous membranes

25. Transmission-Based Precautions
Used in addition to standard precautions
For known or suspected infections that are spread in one of three ways:
Contact
Airborne
Droplet
May be used alone or in combination but always in addition to standard precautions

26. General Guidelines for Isolation Precautions
Limit supplies taken into room
Limit client transport outside of room
Use disposable supplies if possible
Keep precaution supplies just outside the client’s room
Removal of items from room
Private room if possible (or place with client with same infection)

27. Contact Precautions Transmitted by direct or indirect contact
Includes drug resistant bacteria
Methicillin-resistant Staphylococcus Aureus (MRSA)
Vancomycin-resistant Enterococcus (VRE)
Extended spectrum beta-lactamase-producing (ESBL)
Clostridium difficile (C-diff)
Spore which requires soap and water, not alcohol based hand sanitizer

28. Contact Precautions (cont.)
Surfaces in room are contaminated
PPE

29. Airborne Precautions Transmitted by small droplets
TB, measles, varicella
Airborne infection isolation room
Negative air pressure room
PPE

30. Droplet Precautions Transmitted by larger droplets 3 ft. diameter PPE
Pertussis, mumps, influenza (flu), strep throat
3 ft. diameter
PPE

31. Personal Protective Equipment (pg. 695-700)
As discussed in learning lab:
Indications, donning and removal of:
Gloves
Gowns
Face masks
Eyewear

32. Psychosocial Needs of Isolation Clients
Sensory deprivation
Environment lacks normal stimuli
Lack of interaction
Feeling of Inferiority
Nursing interventions

33. Sterile Technique (pg. 700-710)
As discussed in learning lab:
Sterile field
Sterile gloves
Sterile gowns

34. Infection Control for Health Care Workers
Regulations
Common hazards
Contaminated needles/sharps injury
Skin contact
Mucous membrane contact
Medical asepsis, PPE, and avoiding carelessness behavior

35. Practice Guidelines Steps to follow After Exposure to Bloodborne Pathogen
Provide immediate care to exposed area
Report the incident immediately
Complete injury report
Seek appropriate evaluation and follow-up

36. Group Work
You are working as a nurse on a medical-surgical unit. How do nurses help break the chain of infection at each link?
What education is necessary to help control infection?