Download Medical and Surgical Asepsis - Faculty Sites

Metropolitan Community College
NURS 1510
Nancy Pares, RN, MSN
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Asepsis…
◦ .absence of germs or micro organisms
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Medical asepsis….
◦ technique or procedure which reduces the number
of micro organisms and thus prevents the spread of
disease
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Surgical asepsis….
◦ Protection against infection before, during and after
a surgical procedure.
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Infection
◦ Invasion of the body by pathogens
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Bacteria
◦ One celled, multiply rapidly, classified by shape and
how they cluster together
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Virus
◦ Smallest of all pathogens; replication within the
host
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Fungi
◦ Organisms that exist by feeding on organic matter
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Protozoa
◦ Single celled organism; spread by feces,
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Rickettsia
◦ Organisms multiply in animal hosts and transmit to
humans through bites
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Helminths
◦ Parasitic worms found in soil; transmitted via hand
to mouth
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Mycoplasmas
◦ No cell wall; multi shaped
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Chemical agents
◦ Pesticides, food additives, medications, industrial
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Physical agents
◦ Heat, noise, radiation, and machines
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Moisture
Organic matter
Warmth
Darkness
Oxygen
Alkaline ph
Infectious agents
 Pathogens
 Normal flora that become pathogenic
Reservoir
 Where pathogens live and multiply
 May be living
• Humans, animals, insects
• May be nonliving
 Food, floors, equipment, contaminated water
Portal of Exit:
Mode of Transmission:
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Via
• Bodily fluids
• Coughing, sneezing,
diarrhea
• Seeping wounds
• Tubes, IV lines
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Contact
• Direct – touching,
kissing, sexual contact
• Indirect – contact with a
fomite
Droplet: Cough, sneeze
Airborne: Via air
conditioning, sweeping
Portal of Entry:
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Eye, nares, mouth,
vagina, cuts, scrapes
Wounds, surgical sites,
IV or drainage tube
sites
Bite from a vector
Susceptible Host:
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Person with inadequate
defense
Three determining
factors:
• Virulence
• Number of organisms
• Host’s defenses
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Incubation: From time of infection until
manifestation of symptoms; can infect others
Prodromal: Appearance of vague symptoms;
not all diseases have this stage
Illness: Signs and symptoms present
Decline: Number of pathogens decline
Convalescence: Tissue repair, return to health
By Location:
 Local
• Occurs in a limited region in the body (e.g.,
urinary tract infection)
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Systemic
• Spread via blood or lymph
• Affects many regions (e.g., septicemia)
Acute - Rapid onset of short duration
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e.g., Common cold
Chronic - Slow development, long duration
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e.g., Hypertension, diabetes mellitus, osteomyelitis
Latent - Infection present with no discernible
symptoms
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e.g., HIV/AIDS
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Presence of pathogen
Reservoir (source)
◦ Pathogen survive and multiply
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Portal of exit from reservoir
◦ Direct, indirect, airborne
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Mode of transmission
Portal of entry to host
Susceptible host
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Local
◦ Limited to a defined area; resembles inflammation
◦ Ex: redness, warmth, tenderness, swelling
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Systemic
◦ Affects the entire body and may involve multiple
organs, goes through the stages of infection
◦ Ex: fever, anorexia, n/v, lymph node swelling
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Vascular
◦ Aterioles dilate, blood and WBC go to area
◦ s/s= redness and warmth
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Inflammation
◦ Tissue dies causing release of chemicals (histamine
and prostaglandins) which allow blood vessel
permeability. Cells, proteins, fluids enter the
tissue spaces blocking lymphatics to create a ‘wall’
against infection
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Phagocytosis
◦ WBC enter the tissues causing release of pyrogens
(fever); exudates form discharge; healing occurs
An infection acquired in a health-care facility
Cost to the health-care system = $4.5 billion/year
 Leading cause of death
 Preventable with use of aseptic principles/
techniques
Exogenous Nosocomial Infection: Pathogen
acquired from health-care environment
Endogenous Nosocomial Infection: Normal flora
multiply and cause infection as a result of
treatment
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•
Iatrogenic
▫ Infection from a procedure
ex: UTI from foley insertion
•
exogenous
▫ Infection from non-normal flora
ex: clostridium
•
Endogenous
▫ Infection when normal flora altered
ex: yeast infection
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UTI
◦ Insertion, contamination of drainage system,
improper cleansing
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Surgical site
◦ Improper technique for handwashing or dressing
change
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URI
◦ Improper handwashing or suctioning technique
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IV
◦ Improper handwashing or site care
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Extended LOS in hospital
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Multiple care givers
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Antibiotic choices and over use
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Improper medical or surgical asepsis
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Age
◦ Very young and very old
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Poor nutritional status
Smoker, ETOH use
Existing co-morbid conditions
Chronic illnesses, chemo,radiation
Clients with invasive procedures
Clients with prolonged stress
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Containing nosocomial infections
CLEAN, DISINFECT, STERILIZE
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Controlling/eliminating reservoirs
▫ Bathing, dressing changes, patent drainage
systems
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Controlling the portal of exit
▫ Cover mouth/nose, wear mask, client teaching
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Controlling transmission
▫ Do not share equipment, proper handling of linens,
HANDWASHING
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Controlling portal of entry
▫ Maintain skin integrity, position changes, proper
wiping techniques, maintain drainage integrity
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Protecting susceptible host
◦ Protect natural defenses-skin, mucous membranes,
fluid intake
◦ Encourage cough and deep breathing
◦ Change position
◦ Oral hygiene
◦ Promote rest and sleep
◦ Reduce client stress
Primary Defenses:
 Anatomical features, limit pathogen entry
• Intact skin
• Mucous membranes
• Tears
• Normal flora in GI tract
• Normal flora in urinary tract
Secondary Defenses:
 Biochemical processes activated by chemicals
released by pathogens
• Phagocytosis
• Complement cascade
• Inflammation
• Fever
Tertiary Defenses:
 Humoral immunity
• B-cell production of antibodies in response to an
antigen
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Cell-mediated immunity
• Direct destruction of infected cells by T cells
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Developmental stage
Breaks in the skin
Illness/injury, chronic disease
Smoking, substance abuse
Multiple sex partners
Medications that inhibit/decrease immune
response
Nursing/medical procedures
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Adequate nutrition
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Balanced hygiene
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• To manufacture cells of the immune system
• Sufficient to decrease skin bacterial count
• Not overzealous; causes skin cracking
Rest/exercise
Reducing stress
Immunization
Medical asepsis:
 “A state of cleanliness that decreases the
potential for the spread of infections”
 Promoted through:
• Maintaining a clean environment
• Maintaining clean hands
• Following Centers for Disease Control (CDC)
guidelines
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Clean spills and dirty surfaces promptly
Remove pathogens through chemical means
(disinfect)
Remove clutter
Consider supplies brought to the client room
as contaminated
Consider items from the client’s home as
contaminated
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When you arrive in the unit
When you leave the unit
Before and after restroom use
Before and after client contact
Before and after contact with client belongings
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Before gloving
After glove removal
Before and after touching your face
Before and after eating
After touching a contaminated article
When you see visible dirt on your hands
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Wash for at least 15 seconds in nonsurgical
setting; 2-6 minutes in surgical setting
Use warm water, not hot
Apply soap to wet hands
Use friction
Clean beneath fingernails and jewelry
Rinse soap
Towel or hand dry
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Standard precautions (universal precautions)
Protects health-care workers from exposure
Decreases transmission of pathogens
Protects clients from pathogens carried by
health-care workers
Contact Precautions:
Pathogen is spread by direct contact
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Sources of infection - draining wounds, secretions,
supplies
Precautions include:
• Possible private room
• Clean gown and glove use
• Disposal of contaminated items in room
• Double-bag linen and mark
Droplet Precautions:
Pathogen is spread via moist droplets:
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Coughing, sneezing, touching contaminated objects
Precautions include:
• Same as those for contact
• Addition of mask and eye protection within 3 ft of
client
Airborne Precautions:
Pathogen is spread via air currents
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Transmission via ventilation systems, shaking
sheets, sweeping
Precautions include:
• Same as those for contact, with addition of special
mask
“Reverse” isolation:
 Protects the client from organisms
 Used with immune-compromised client
population
 Precautions include:
• Private room likely
• Nurse not assigned to clients with active infection
• Mask, handwashing, clean/sterile gown, gloves
• No reuse of gowns, gloves
Includes:
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Creation of a sterile environment
Use of sterile equipment/supplies
Sterilization of reusable supplies
Surgical hand scrub
Surgical attire
Sterile gloves
Sterile field
Use of sterile technique
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Protective barriers
Change gloves
HANDWASHING
Discard sharps correctly
Double bag
Cover breaks in the skin
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Organs most vital to a functional immune
system
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Liver…produces immunoglobulins (antibodies)
Lymph nodes…produce and circulate lymphocytes
Bone marrow and thymus..form immune sys. Cells
Spleen…removes dead cells and foreign molecules
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Humoral
◦ Attack bacteria and virus’ at the extracellular level
◦ B cell lymphocytes cause synthesis of antibodies
leading to destruction of antigens and creation of
antibodies that subsequently protect from the same
antigen
◦ Five classes of antibodies
 IgG, IgM, IgA, IgE, and IgD. IgG is most abundant and
crosses the placenta provides passive immunity for
newborns.
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Cell mediated immunity
◦ Fights pathogens inside the cell
◦ T cells (a form of WBC) binds with the antigen,
becomes sensitized and releases lymphokines
which attract macrophages that destroy the antigen
◦ Three types of T cells
 Cytotoxic, helper T and suppressor T
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Natural
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Passive
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Active
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Acquired
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Artificial
▫ Present at birth, genetically determined
▫ Acquired through introduction of antibodies, ie
mother passes to infant
▫ Antibodies develop within the body to neutralize or
destroy an infective agent
▫ Exposure to an antigen or passive injection of
immunoglobulin
▫ Produced by vaccination
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Medical asepsis
◦ Practice which reduces the number, growth and
spread of micro organisms
◦ Referred to as ‘clean’ technique’
◦ Handwashing 2 min-15 sec
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Surgical asepsis
◦ Total elimination of all micro organisms, spores
◦ Sterile field (OR, L&D, etc), gown and glove
◦ Methods:
 Steam, radiation, chemicals, or gas
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Apply to :
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All body fluids, secretions (except perspiration)
Blood
Non intact skin
Mucous membranes
Gloves worn:
◦ To provide a protective barrier
◦ To reduce opportunities for ‘nurse’ organism
transfer to client
◦ WEARING GLOVES DOES NOT REPLACE
HANDWASHING!!!
 The
single most important
measure to reduce the risk of
transmission!
 Nurses do hands on work, so
always wash first!
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Cover your nose and mouth with your elbow.
Use tissues to contain respiratory secretions
and dispose into the nearest waste container
after use.
Perform hand hygiene after contact with any
contaminated materials/objects
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Turn on slow, steady stream of warm water
Moisten hands with water, then apply soap
Rub hands together vigorously for at least 15
seconds
Rinse under water
Use a clean paper towel or air dryer to dry
hands
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May use when hands are not visibly soiled
Apply adequate amount to palm of one hand
Rub hands together, covering all surfaces of
hands and fingers (including under the nails)
until hands are dry
Do not rinse with water
May be used 5-10 times before washing with
soap and water is required.
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Admitting calls to tell you that they have a
client who previously cultured positive for
MRSA in their urine. What precaution do you
place this client in?
What if the MRSA was positive in the sputum?
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You have a client that has very runny stools.
The doctor orders a stool culture.
What additional information can you supply
the lab?
What precautions would you place this patient
in?
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Client presents to ED with high fever,
headache, body aches and non-productive
cough. Client states the her husband just
returned from a business trip in China.
First thought?
Precautions?