1. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 10 Asepsis

2. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Living animals or plants visible only with a microscope; also commonly called germs –The body’s immune defense mechanisms eliminate them –They reside within the body without causing disease –They cause an infection or infectious disease Microorganisms

3. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Microorganisms Bacteria Protozoans Viruses Mycoplasmas Fungi Helminths Rickettsiae Prions

4. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Categorization of Microorganisms Nonpathogens: harmless, beneficial Pathogens: cause illness Resident nonpathogens constantly present on the skin Transient pathogens picked up during contamination Aerobic: require oxygen to live Anaerobic: exist without oxygen

5. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Survival of Microorganisms Spores –Temporarily inactive microbial life form; can resist heat and destructive chemicals and survive without moisture; reactivate and reproduce when conditions are favorable Antibiotic-resistant bacterial strains –No longer respond to drugs that once were effective against them

6. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Transient pathogens are present constantly on the skin.

7. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. Transient pathogens are picked up during contamination.

8. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chain of Infection 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

9. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chain of Infection (cont’d)

10. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Biologic Defense Mechanisms Anatomic or physiologic methods that stop microorganisms from causing an infectious disorder –Mechanical: physical barriers that prevent microorganisms from entering the body or expel them before they multiply –Chemical: destroy or incapacitate microorganisms through natural biologic substances

11. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Nosocomial Infections Nosocomial infections are infections acquired while a person is receiving care in a health care agency

12. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Mechanical defense mechanisms destroy or incapacitate microorganisms through natural biologic substances.

13. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. Chemical defense mechanisms destroy or incapacitate microorganisms through natural biologic substances.

14. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Asepsis Practices that decrease or eliminate infectious agents, their reservoirs, and vehicles for transmission A major method for controlling infection Health care professionals use medical and surgical asepsis to prevent spread of infections

15. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Medical Asepsis Confines or reduces the numbers of microorganisms Involves measures that interfere with the chain of infection in various ways Examples: –Performing hand hygiene –Wearing hospital garments

16. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Surgical Asepsis Measures that render supplies and equipment totally free of microorganisms Practices that avoid contaminating microbe- free items Examples: –Physical sterilization –Chemical sterilization

17. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Principles of Medical Asepsis Microorganisms exist everywhere except on sterilized equipment Frequent handwashing and maintaining intact skin reduces transmission of microorganisms Blood, body fluids, cells, and tissues are major reservoirs of microorganisms Personal protective equipments serve as barriers to microbial transmission

18. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Principles of Medical Asepsis (cont’d) A clean environment reduces microorganisms Cleaning should be done from cleaner to dirtier areas

19. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Surgical asepsis involves measures that interfere with the chain of infection in various ways.

20. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. Medical asepsis involves measures that interfere with the chain of infection in various ways.

21. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Practicing Hand Antisepsis Apply about a nickel- to quarter-sized volume of the product to the palm of one hand or the amount recommended by the manufacturer Distribute the product to cover all surfaces of the hands and fingers Rub the product between the hands for 15 to 25 seconds until they are dry

22. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Hand Antisepsis

23. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following is a method of surgical asepsis? a. Donning a sterile gown b. Using antimicrobial agents c. Performing hand antisepsis d. Performing handwashing

24. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer a. Donning a sterile gown Donning a sterile gown is a method of surgical asepsis. Using antimicrobial agents, performing hand antisepsis, and handwashing are methods of medical asepsis.

25. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Hospital Garments Gloves Scrub suits and gowns Masks Uniforms Hair and shoe covers Protective eyewear

26. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Hospital Garments

27. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Utility Rooms Health care agencies: at least 2 utility rooms (clean and dirty); personnel must not place soiled articles in the clean utility room The utility room contains: –Covered waste receptacles and laundry hampers –Flushable hopper and a sink –Equipment for testing stool or urine

28. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Concurrent Disinfection Clean less-soiled areas before grossly dirty ones Wet-mop floors and damp-dust furniture to avoid distributing microorganisms on dust and air currents Frequently discard solutions used for mopping in a flushable hopper Never place clean items on the floor

29. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Terminal Disinfection More thorough than concurrent disinfection and consists of measures used to clean the client environment after discharge Includes scrubbing the mattress and the insides of drawers and bedside stands

30. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Sterilization Consists of physical and chemical techniques that destroy all microorganisms including spores –Physical sterilization: radiation, boiling water, free-flowing steam, dry heat, steam under pressure –Chemical sterilization: peracetic acid, ethylene oxide gas

31. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Principles of Surgical Asepsis Once equipment and areas are free of microorganisms, they remain in that state if contamination is prevented Sterility preserved: touching one sterile item with another that is sterile Once a sterile item touches something that is not sterile, it is considered contaminated Any partially unwrapped sterile package is considered contaminated

32. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Principles of Surgical Asepsis (cont’d) Question the sterility of an item considered unsterile Longer the time since sterilization, the more likely that the item is no longer sterile Commercially packaged sterile item is not considered sterile past its recommended expiration date Opened sterile item or area, left unattended, is considered contaminated

33. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Principles of Surgical Asepsis (cont’d) Once a sterile item is opened or uncovered, it becomes contaminated The outer 1-inch margin of a sterile area is considered a zone of contamination A wet sterile wrapper wicks microorganisms from its supporting surface, causing contamination

34. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Principles of Surgical Asepsis (cont’d) Coughing, sneezing, or excessive talking over a sterile field causes contamination Reaching across an area that contains sterile equipment may cause contamination Sterile items located or lowered below waist level are considered contaminated

35. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Adding an Agency-Sterilized Item

36. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Adding Sterile Gauze

37. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Adding Sterile Solution

38. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins General Gerontologic Considerations Older clients more susceptible to infections Maintain intact skin, proper aseptic techniques, perineal hygiene, thorough handwashing; indwelling catheters should be avoided Bladder training, annual immunizations Ill health care workers should take sick leave rather than expose susceptible clients to infectious organisms