1. Chapter 10 Asepsis Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 1 Second semester 15 - 16

2.  Preventing infections is one of the most important priorities in nursing Microorganisms : living animals or plants visible only with a microscope ( also commonly called germs ) Everywhere: in the air, soil, and water, and on and within virtually everything and everyone Once Microorganisms invade, one of three events occur 1. The body’s immune defense mechanisms eliminate them 2. They reside within the body without causing disease 3. They cause an infection or infectious disease Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 2 Second semester 15 - 16

3. Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 3 Types of Microorganisms Microorganisms are divided into two main groups: 1. Non Pathogens or Normal flora ( harmless, beneficial microorganism ) 2. Pathogens (microorganism that cause illness ) have high potential for causing infectious communicable diseases, also called contagious diseases. Second semester 15 - 16

4. Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 4 Types of Microorganisms Bacteria Viruses Fungi Rickettsia Protozoans Mycoplasmas Helminthes Second semester 15 - 16

5. Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 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. A spore is a temporarily inactive microbial life form that can resist heat and destructive chemicals and survive without moisture. Second semester 15 - 16

6. Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 6 Chain of Infection By interfering with the conditions that continue 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: 1. An infectious agent 2. A reservoir for growth and reproduction 3. An exit route from the reservoir 4. A mode of transmission 5. A port of entry 6. A susceptible host ( Fig.10-2) Second semester 15 - 16

7. Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 7 Second semester 15 - 16

8. Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 8 Chain of Infection cont'd 1. Infectious Agents Some microorganisms are less dangerous than others. For example, intestinal bacteria help produce vitamin K, which, in turn, helps control bleeding. 2. 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

9. Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 9 Chain of Infection cont'd 3. The exit route is how microorganisms escape from their original reservoir and move about 4. A mode of transmission is how infectious microorganisms move to another location. S ee table 10-1 5. 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. Second semester 15 - 16

10. Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 10 Second semester 15 - 16

11. Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 11 Biologic Defense Mechanisms It is an anatomic ( physiologic) methods that stop microorganisms from causing an infectious disorder Types : 1. Mechanical (physical) barriers :that prevent microorganisms from entering the body or expel them before they multiply ( example: skin, mucous membrane) 2. Chemical: destroy or incapacitate microorganisms through natural biologic substances (example Gastric acid) Second semester 15 - 16

12. Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 12 Chain of Infection cont'd 6. Susceptible Host Humans become susceptible to infections when their defense mechanisms are diminished or impaired. A susceptible host, is one whose biologic defense mechanisms are weakened in some way, A susceptible host include those who 1. Are burn victims 2. Have suffered major trauma 3. Require invasive procedures such as endoscopy 4. Need indwelling equipment such as a urinary catheter 5. Receive implantable devices such as intravenous catheters 6. Are given antibiotics inappropriately, which promotes microbial resistance 7. Are receiving anticancer drugs and anti-inflammatory drugs such as corticosteroids that suppress the immune system 8. Are infected with HIV Second semester 15 - 16

13. Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 13 Factors affecting susceptibility to infection 1. Inadequate nutrition. 2. Poor hygiene practices. 3. Suppressed immune system. 4. Prematurity. 5. Advanced age. 6. Compromised skin integrity. 7. Diminished blood circulation Nosocomial Infections are infections acquired while a person is receiving care in a health care agency Second semester 15 - 16

14. Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 14 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 Second semester 15 - 16

15. Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 15 Medical Asepsis Confines or reduces the numbers of microorganisms Also called clean technique It involves measures that interfere with the chain of infection in various ways Second semester 15 - 16

16. Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 16 Principles of Medical Asepsis A clean environment reduces microorganisms. Cleaning should be done from cleaner to dirtier areas Microorganisms exist everywhere except on sterilized equipment. Frequent hand washing 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 Second semester 15 - 16

17. Principles of Medical Asepsis cont'd Personal protective equipment such as gloves, gowns, masks, goggles, and hair and shoe covers serves as a barrier to microbial transmission. Certain areas—the floor, toilets, and insides of sinks—are more contaminated than others. Second semester 15 - 16Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 17

18. Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 18 Examples of medical aseptic practices include: 1. Using antimicrobial agents, 2. Performing hand hygiene, 3. Wearing hospital garments, 4. Confining and containing soiled materials appropriately, and 5. keeping the environment as clean as possible. Second semester 15 - 16

19. Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 19 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. A. Antiseptics: (also called bacteriostatic agent) inhibit the growth of, but do not kill, microorganisms. ( used on living tissues) An example: is alcohol B. Disinfectants: (also called bactericides agent) destroy active microorganisms but not spores. ( used on non-living items) Examples: Phenol, household bleach, and formaldehyde Note: 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 C. Anti-Infective Drugs ( Antibiotics,Antiviral ) Second semester 15 - 16

20. Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 20 Second semester 15 - 16

21. Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 21 Second semester 15 - 16 5 Moments for Hand Hygiene

22. Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 22 Second semester 15 - 16

23. Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 23 Performing surgical hand antisepsis 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. Second semester 15 - 16

24. Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 24 Second semester 15 - 16

25. Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 25 Second semester 15 - 16 Wearing Personal Protective Equipment Uniforms Scrub suits or gowns Masks Gloves Protective eyewear Hair and Shoe Covers

26. Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 26 Gloves Nurses wear clean gloves, sometimes called examination gloves, in the following circumstances: 1. As a barrier to prevent direct hand contact with blood, body fluids, secretions, excretions, mucous membranes, and non intact skin 2. 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 non intact skin 3. When there is a potential transfer of microorganisms from one client or object to another client during subsequent nursing care Second semester 15 - 16

27. Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 27 Second semester 15 - 16 Surgical Asepsis  Surgical asepsis means those measures that render (prepare) supplies and equipment totally free of microorganisms.  Sterile technique include practices that avoid contaminating microbe-free items.  Sterilization consists of physical and chemical techniques that destroy all microorganisms including spores.

28. Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 28 Second semester 15 - 16 Difference between surgical and medical asepsis?  Medical asepsis, or clean technique, includes procedures used to reduce the number of organisms present, and prevent the transfer of organisms. Surgical asepsis, or sterile technique, prevents contamination of an open wound, serves to isolate the operative area from the unsterile environment, and maintains a sterile field for surgery

29. Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 29 1.Physical Sterilization Microorganisms and spores are destroyed physically through radiation or heat (boiling water, free-flowing steam, dry heat, and steam under pressure). Second semester 15 - 16

30. Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 30 1.Physical Sterilization cont'd  Radiation: Ultraviolet radiation can kill bacteria, especially the organism that transmits TB.  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 is a method in which items are exposed to the heated vapor that escapes from boiling water. Second semester 15 - 16

31. Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 31 1.Physical Sterilization cont'd  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 is the most dependable method for destroying all forms of organisms and spores. (The autoclave is an example) Second semester 15 - 16

32. Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 32 2.Chemical Sterilization Both gas and liquid chemicals are used to sterilize invasive equipment. (example :Ethylene oxide gas) Second semester 15 - 16

33. Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 33 Second semester 15 - 16 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 If there is a question about the sterility of an item, it is considered unsterile

34. Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 34 Second semester 15 - 16 Principles of Surgical Asepsis (cont’d) 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 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

35. Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 35 Second semester 15 - 16 Principles of Surgical Asepsis (cont’d) A wet sterile wrapper wicks microorganisms from its supporting surface, causing contamination 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

36. Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 36 Second semester 15 - 16 Adding an Agency-Sterilized Item

37. Adding Sterile Solution Adding Sterile Gauze Second semester 15 - 16Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 37

38. Nursing Implications Risk for Infection Risk for Infection Transmission Ineffective Protection Delayed Surgical Recovery Deficient Knowledge Secind semester 15- -16 Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 38