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Basic procedures in healthcare 1
(SOL / VCA81)
Topics:
1a) Asepsis and its principles in healthcare facilities
1b) Nosocomial infections
1c) Barrier care
1d) Hand washing and disinfection
1e) Using of gloves
1f) Handling with sterile material
1g) Preparation of sterile space for asepsis procedures
1a) Asepsis and its principles
in healthcare facilities

definition

related terms (antisepsis, disinfection, sterilization)

basic aseptic procedures
1a) Asepsis and its principles
in healthcare facilities
Definition
 complete absence of microorganisms and germs,
 antisepsis is achieved by means of sterilization (aseptic = sterile).
Related terms
Antisepsis
 a set of measures and procedures,
 the aim is to destroy infections on the surface of the body, mucous
membrane and in tissues of the human body,
 antisepsis is ensured by the application of antiseptic
on the surface of the body or into body cavities, into the wound.
1a) Asepsis and its principles
in healthcare facilities
Related terms
Disinfection
 destruction of most microorganisms on inanimate objects,
materials, surfaces, in the air or water,
 the aim is to interrupt the path of infection from the source
to susceptible individual,
 unlike antisense during disinfection, we can use relatively toxic
agents, since disinfection is not performed on living tissues
of the organism.
Sterilization
 a set of measures leading to the removal or destruction of all
microorganisms and higher organisms and / or its possible
forms.
1a) Asepsis and its principles
in healthcare facilities
Asepsis technique
 working method to prevent the spread
of infection and to achieve antisepsis.
Basic asepsis procedures
 hygienic hand washing and disinfection of hands before
and after direct contact with the patient,
 use of protective equipment,
 contaminated material stored in containers designed for this
purpose,
 careful handling of tools as the prevention of injuries,
 provide a sterile environment during invasive procedures.
*
1a) Asepsis and its principles
in healthcare facilities
Basic asepsis procedures
 observing of the skin surface of the patient and his vital signs,
 pressure ulcer prevention and treatment,
 isolation of patients with infectious diseases,
 providing of optimal food and fluid intake,
 education of the patient and family,
 compliance of barrier care.
1b) Nosocomial infections
• definition
• division
• transmission routes
• etiology
• risk factors
• prevention
1b) Nosocomial infections
 these infections are directly connected with the stay in a hospital
environment,
 they are an important indicator of quality of care,
 nosocomial infections can affect not only patients' but also
medical staff.
Division
 by occurrence - specific X nonspecific,
 by origin - exogenous X endogenous,
 according to the clinical display.
1b) Nosocomial infections
Division by occurrence
Nonspecific nosocomial infections
 infections that occur commonly outside the medical facilities,
and the are also present in healthcare facilities due to the
epidemiological situation in the region (e. g. flu),
 infectious agents are usually well sensitive to antibiotics.
Specific nosocomial infections
 they arise in a hospital environment in connection with diagnostic
or therapeutic procedures,
 they are characterized by the proliferation of specific, often highly
resistant originator, different approaches to prevent and treat
compared to hospital infections.
1b) Nosocomial infections
Division by origin
Exogenous nosocomial infections
 the infectious agent is outside the body of the patient (staff,
polluted air, material ...).
Endogenous nosocomial infections
 they are caused by the patient's own microbial flora,
 infectious agent is brought from the colonized organ or mucosal
surface into the surrounding tissue or to another organ
(e. g. intestinal microorganisms into the abdominal cavity).
1b) Nosocomial infections
Division according to clinical display
 urinary tract infection (approximately 40 %),
 infection spread to surgical wounds (approx. 25 %),
 respiratory infection – pneumonia (approx. 20 %),
 bloodstream infections – bacteremia (approx. 10 %),
 others – e. g. gastroenteritis, sinusitis (to 10 %).
1b) Nosocomial infections
Transmission routes
Direct – source of infection is present:
 direct contact – most hands of personnel,
 droplet infection.
Indirect – source of infection is not present:
 nonspecific carrier – air, water, food, clothes…,
 specific carrier– surgical wounds, parenteral administration
of medication, catheterization, mechanical ventilation, etc.
*
1b) Nosocomial infections
Etiology:
 bacteria,
bacteria
 virus,
 fungus,
 parasite.
Source: http://cs.medixa.org/nemoci/escherichia-coli, downloaded 26. 4. 2015
1b) Nosocomial infections
Etiology – bacterial agents
Gram positive:
 Staphylococcus aureus, including strains MRSA,
 Streptococcus pyogenes, agalactiae, pneumoniae,
 Clostridium perfringens, tetani.
Gram negative:
 Escherichia coli,
 Haemophilus influenzae,
 Pseudomonas aeruginosa,
 Enterococcus feacalis,
 Klebsiella pneumoniae.
1b) Nosocomial infections
Etiology – virus agents:
 adenoviruses,
 RS viruses,
 herpes viruses, EB viruses,
 Coxsackie virus,
 HAV, HBV, HCV,
 HIV, AIDS.
*
1b) Nosocomial infections
Etiology – fungus
 Candida albicans
 Aspergillus species
Etiology – parasite
 Pneumocystis carinii
 Giardia lamblia
1b) Nosocomial infections
Risk factors
 age (newborns, the elderly),
 basic disease (DM, liver and kidney disease, oncological
disease… ),
 nutritional status (malnutrition, obesity, alcohol, smoking, drugs..),
 diagnostic and therapeutic procedures (iv inputs, urine
catheterization. bladder, surgical drains, tracheotomy... ),
 trauma (injuries, burns, pressure ulcers... ),
 specific treatment (cytostatic, antibiotics, steroids... ),
 length of hospitalization.
1b) Nosocomial infections
Prevention
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
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washing and hand disinfection,
use of protective equipment,
adherence to the principles for handling laundry,
decontamination of biological material,
sanitary handling of food,
individualization of equipment/tools,
isolation of infectious patients, or those who are at risk of infection,
prevention of infectious aerosols with appropriate cleaning
procedures,
 cleaning and disinfection of the environment.
1c) Barrier care
• definition
• basic rules
1c) Barrier care
 regime measures and procedures that will defend the
transmission of pathogens between patients or staff.
Basic rules of barrier care:
 hygienic hand washing and hand disinfection,
 use of protective equipment,
 purity (personal, environmental, patient),
 a small number of patients in the room,
 use of individual devices for patients.
1c) Barrier care
Basic rules of barrier care:
 decontamination of biological material, used equipment,
instruments, medical supplies…,
 adherence to aseptic procedures during dressing changes,
 adherence to the principles for handling linen (clean and used),
 sanitary handling of food,
 isolation of infectious patients or vice versa patient who is
significantly threatened by infection,
 education of patient and family.
1d) Hand washing
and hand disinfection
• definition
• steps
• surgical hand disinfection
• hygienic hand disinfection
1d) Hand washing
and hand disinfection
Hand washing
 mechanical removal of impurities and partially transient microflora
from the skin of hands.
When to do it:
 while visible fouling,
 after using a toilet,
 before and after meal.
*
We may use hygienic hand disinfection in all other clinical situations.
1d) Hand washing
and hand disinfection
Hand washing
Steps:
 moisten your hands with water,
 apply a detergent and spread on the hands well,
 foam with a small amount of water,
 wash for 30 seconds,
 rinse thoroughly with running drinking water,
 dry wipe with disposable towel.
1d) Hand washing
and hand disinfection
Hand washing technique
Source: http://www.howdonkey.com/56252-wash-yourself-the-proper-way/#.VSF65uHIqZg,
downloaded 5. 4. 2015
1d) Hand washing
and hand disinfection
Hand washing before surgical hand disinfection
 mechanical removal of impurities and temporary microflora
of the skin, hands and forearms before surgical disinfection.
When to do it
 before the beginning of the surgical program.
Steps
 it is identical to the procedure of hand washing for 1 minute,
extended of mechanical washing of forearm,
 in the case of visible dirt with using a brush at around nails, nail
scratches and fingertips.
1d) Hand washing
and hand disinfection
Surgical hand disinfection (SHD)
 reducing the amount of transient or permanent microflora
on the skin of hands and forearms.
When to do it
 before the beginning of the surgical program,
 between each operation,
 while damage of integrity or replacement of gloves during
surgery.
1d) Hand washing
and hand disinfection
Surgical hand disinfection (SHD)
Steps
 rubbing an alcoholic disinfectant in about 10 ml for a period
of 3-5 minutes until the skin of hands and forearm is dry:
 from fingertips to elbows,
 from fingertips to mid-forearm,
 from fingertips to wrist.
 rub until dry,
 hands must be moist throughout the exposure,
 hands are not rinsed or dried.
*
1d) Hand washing
and hand disinfection
Hygienic hand disinfection (HHD)
 removing impurities and reducing the amount of transient
microflora on the skin of hands using washing detergent
with a disinfectant.
When to do it
 before and after contact with the patient,
 as part of the barrier nursing techniques,
 after taking off gloves,
 after contact with surfaces and objects in the immediate vicinity
of the patient,
 in the treatment of the contaminated parts of the body
and transferring to another body part,
 after accidental contamination of the hands with biological material.
1d) Hand washing
and hand disinfection
Hygienic hand disinfection (HHD)
Steps
 rubbing an alcoholic disinfectant in about 3 ml for a period
of 30-60 seconds until the skin of hands and forearm is dry,
 hands are not rinsed or dried,
 technique is the same as washing hands.
1d) Hand washing
and hand disinfection
Source: http://blogyourdissertation.com/hand-hygiene/wash-hands-way-surewash-train/ downloaded: 5. 4. 2015
1d) Hand washing
and hand disinfection
Most often neglected space when washing hands
Source:http://blog.gymlion.com/are-you-washing-your-hands-correctly/
downloaded 5.4.2015
1e) The use of gloves
• rules of using disposable gloves
• the use of sterile gloves
• threading technique
1e) The use of gloves
The use of disposable gloves
- gloves are protective equipment that:
 provides mechanical barrier,
 ↓ the risk of transmission of infection
from medical staff to patients and from
patients to medical staff,
 ↓ the risk of contamination of the hands of medical staff
with biological material.
Rules of the use of disposable gloves:
 perform hygienic hand disinfection before sliding it onto
the glove,
 put gloves after the disinfectant is dry.
*
1e) The use of gloves
Rules of the use of disposable gloves:
 always use gloves, if there is a potential risk of contamination
by biological material,
 gloves do not replace hand hygiene,
 clean pair of gloves for each patient,
 changing gloves when contamination even when taking care of one
patient (e. g. hygienic care before performing dressing... ),
 gloves undress immediately after the activity for which they were
used,
 do not use damaged gloves,
 used gloves dispose of as infectious material,
 gloves do not provide complete protection against contamination,
it is required to do sanitary disinfection and hand washing after using
gloves.
1e) The use of gloves
The use of sterile gloves
Indication:
 surgery,
 invasive radiological procedures,
 the provision of central vascular access,
*
 performances regarding cavities (with the exception of naturally
non-sterile body cavities), e. g. bladder catheterization,
 preparation of parenteral nutrition and chemotherapeutic agents,
 sterile bandages,
 preparation of a sterile field.
1e) The use of gloves
Putting on sterile gloves technique
Source: http://e-safe-anaesthesia.org/sessions/13_02/d/ELFH_Session/370/tab_542.html, downloaded 5.4.2015
1f) Handling with sterile material
• ways of handling sterile material
• principles of handling sterile material
1f) Handling with sterile material
We distinguish between two ways of handling sterile material:
1.
Administered way– surgical instruments are placed in sterile
packs, they are pulled out with sponge holding forceps.
2.
Non-administered way– surgical instruments or materials are
individually packaged.
1f) Handling with sterile material
Rules:
 the manipulation of sterile material is treated after hygienic hand
washing or disinfecting hands and in clean work clothes,
 sterile material is removed from a drum or container right before its
using,
 we pull out sponge holding forceps from quivers in the middle of the
quiver, we can not touch the quiver,
 we administer the tools with grasping part,
 we hold a tampon in sponge holding forceps on the edge,
 we must never put hands into the cassette,
 we hold the sterile sponge holding forceps above the waist,
 sterile material is added into the sterile field from a height of 10-15 cm.
1f) Handling with sterile material
Rules:
 a cap of cassette is put down the outer pad and it is closed
as quickly as possible,
 swabs are soaked into a sterile solution only once,
 sterile material, that is removed from the drum or container,
we can not get back even if it was not used.
1g) Preparation of sterile space
for asepsis procedures
• indications for preparing sterile field
• basic tools
• the procedure for preparing sterile field
1g) Preparation of sterile space
for asepsis procedures
Indications for preparing sterile field:
 the introduction of vascular inputs (central venous catheter,
arterial catheter),
stainless steel containers for surgical instruments
 tracheostomy,
 thoracic drainage,
 minor surgical interventions,
 more extensive wound dressing,
 surgeries etc.
1g) Preparation of sterile space
for asepsis procedures
Basic tools:
 surgical mask + hat,
 sterile gloves,
 sterile gown,
 basic surgical instruments (tweezers,
hemostats, scissors),
 sterile swabs and squares,
 2 syringes (10 ml),
 needle and suture,
 bowl for saline.
Other tools depending on the type of performance.
1g) Preparation of sterile space
for asepsis procedures
1g) Preparation of sterile space
for asepsis procedures
Steps:
 check the integrity of the table and if it is possible to adjust
the height of the desktop,
 mechanically clean the table and disinfect it,
 Put surgical mask back to front on the table,
 Put needed tools on the set table from a height of 10 - 15 cm,
 2.5 cm from the edge masks are considered non-sterile,
 if you need to move a cart, touch only the lower part,
 if needed (a surgery is not performed immediately), cover
the prepared table with a sterile drape, which is put front to back.
Revision:
 What is a barrier care?
 Describe / demonstrate the technique of hand washing.
 What is the basic equipment of a sterile table?
 What is the difference between direct and indirect transmission
of nosocomial infections?
 When do we perform hygienic hand disinfection?
 What is asepsis? What are nosocomial infections?
 Please list at least five principles for the use of disposable gloves.
 Please, name the principles of barrier care.
 What methods of disinfection and sterilization do you use at home?
 How much water and how much concentrate do you use to prepare 5 liters
of 2 % solution if the concentrate is 100%?
References:

KAPOUNOVÁ, Gabriela. Ošetřovatelství v intenzivní péči. Vyd. 1. Praha: Grada, 2007, 350 s., [16] s. barev. obr.
příl. Sestra (Grada). ISBN 978-80-247-1830-9.

KELNAROVÁ, Jarmila. Ošetřovatelství pro střední zdravotnické školy - 2. ročník. 1. vyd. Praha: Grada Publishing,
2009, 228 s. ISBN 9788024731063.

ROŠKOVÁ, Phdr. Silvia. Význam dezinfekce a sterilizace. Sestra [online]. 2012 [cit. 2015-04-07]. Dostupné z:
http://zdravi.e15.cz/clanek/sestra/vyznam-dezinfekce-a-sterilizace-464371.

ROZSYPALOVÁ, Marie, Alena ŠAFRÁNKOVÁ a Renata VYTEJČKOVÁ. Ošetřovatelství I: pro 1. ročník středních
zdravotnických škol. 2., aktualiz. vyd. Praha: Informatorium, 2009, 273 s. ISBN 978-80-7333-074-3

VÍT, Mudr. Michael. Metodický návod na mytí rukou MZ. [online]. 2005. vyd. [cit. 2015-04-07]. Dostupné z:
http://www.mzcr.cz/kvalitaabezpeci/obsah/metodicky-navod-na-myti-rukou-mz_2377_20.html

VOKURKA, Martin a Jan HUGO. Velký lékařský slovník: Martin Vokurka, Jan Hugo a kolektiv. 9., aktualiz. vyd.
Praha: Maxdorf, 2009, 1147, [12] s. ISBN 9788073452025

VYTEJČKOVÁ, Renata. Ošetřovatelské postupy v péči o nemocné II: speciální část. 1. vyd. Praha: Grada, 2013,
272 s., xvi s. obr. příl. Sestra (Grada). ISBN 978-80-247-3420-0.

ZOUHAROVÁ, Klára. Bariérová péče, zásady aseptického chování a postupů. [online]. 2011. [cit. 2015-04-07].
Dostupné z:http://www.szsmb.cz/admin/upload/sekce_materialy/Barierova_pece.pdf

ZOUHAROVÁ, Klára. Nozokomiální nákazy. [online]. 2011 [cit. 2015-04-07]. Dostupné z:
http://www.szsmb.cz/admin/upload/sekce_materialy/Nozokomialni_nakazy.pdf
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PICTURES * (if not specified differently): pinterest.com, google.com + using keywords („glowes“, „wash hands“…)