1. Fundamental Nursing Chapter 10 Asepsis Inst.: Dr. Ashraf El - Jedi

2. Preventing infections is one of the most important priorities in nursing 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. 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.

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

4. Bacteria Bacteria Viruses Viruses Fungi Fungi Rickettsiae Rickettsiae Protozoans Protozoans Mycoplasmas Mycoplasmas Helminths Helminths

5. 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. 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. A spore is a temporarily inactive microbial life form that can resist heat and destructive chemicals and survive without moisture.

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

7. 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: 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 An infectious agent A reservoir for growth and reproduction A reservoir for growth and reproduction An exit route from the reservoir An exit route from the reservoir A mode of transmission A mode of transmission A port of entry A port of entry A susceptible host (Fig. 10-2) A susceptible host (Fig. 10-2)Fig. 10-2Fig. 10-2

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

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

11. The exit route is how microorganisms escape from their original reservoir and move about 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. 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. 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.

13. 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 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

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

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

16. 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. 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. Microorganisms exist everywhere except on sterilized equipment. Frequent handwashing and maintaining intact skin are the best methods for reducing the transmission of microorganisms. Frequent handwashing and maintaining intact skin are the best methods for reducing the transmission of microorganisms.

17. Blood, body fluids, cells, and tissues are considered major reservoirs 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. 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. 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. Certain areas—the floor, toilets, and insides of sinks—are more contaminated than others. Cleaning should be done from cleaner to dirtier areas.

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

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

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

21. Disinfectants Disinfectants, also called and, destroy active microorganisms but not spores. Phenol, household bleach, and formaldehyde are examples. 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

22. Anti-Infective Drugs antibiotics antibiotics Antiviral Antiviral

23. 2. Hand washing Hand washing is an aseptic practice that involves scrubbing the hands with soap, water, and friction. 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. 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.

24. 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. 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.

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

27. 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 prevent direct hand contact with blood, body fluids, secretions, excretions, mucous membranes, and nonintact skin

28. 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 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 When there is a potential transfer of microorganisms from one client or object to another client during subsequent nursing care

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

30. Confining Soiled Articles: Utility Rooms Utility Rooms Waste Receptacles Waste Receptacles

31. Keeping the Environment Clean Health agencies employ laundry staff and housekeeping personnel to assist with cleaning 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. 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 Nurses who work in home health can teach the client and family simple aseptic practices for cleaning contaminated articles

32. 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. 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.

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

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

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

36. 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) 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)

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

38. 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. 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.

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

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

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

42. The longer the time since sterilization, the more likely it is that the item is no longer sterile. 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. 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. 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. The outer 1-inch margin of a sterile area is considered a zone of contamination.

43. sterile wrapper, if it becomes wet, wicks microorganisms from its supporting surface, causing 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. 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. Coughing, sneezing, or excessive talking over a sterile field causes contamination.

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

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

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