5asepsis & Infection Control

7/30/2019 5asepsis & Infection Control

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ASEPSIS & INFECTION CONTROL

TERMINOLOGIES

Sterilization all microorganisms including their spores are destroyed

Disinfection not including the spores (surg instruments, thermometers)

Antiseptic inhibit only the growth of the pathogens

Bactericidal chemical used to destroy microorganism

Bacteriostatic prevents only bacterial multiplication

STAGES OF INFECTIOUS PROCESS

1. Incubation Period entry of microorganism on the body up to the onset of the signs &symptoms

2. Prodromal Period onset of the appearance of specific or non-specific signs & symptoms

3. Illness Period positive evidence of sign & symptoms

4. Convalescent Period signs & symptoms subside until the client turn into the normal state

THE CHAIN OF INFECTION

MODE OF TRANSMISSION

2

Reservoir

(Source)

6

Susceptible Host

(Ill person)

1

Etiologic Agent

(microorganism)

3

Portal of Exit

(Sputum, blood,

stool)

4

Modes of

Transmission

5

Portal of Entry

(Skin GI tract)


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1) Contact Transmission Direct Contact body surface to body surface (bathing, dressing changes,

insertion of tubes & catheters)

Indirect Contact exposure in a contaminated objects (dressing, needles, surginstruments)

2) Droplet Transmission Exposure of mucous membrane with a distance of 3 feet (coughing, sneezing, talking)

3) Airborne Transmission Microorganism are suspended in air for a long time which can be inhaled or

deposited in the skin

TYPES OF IMMUNIZATION

1. Active Immunization antibodies produced by own body

a. Natural presence of active infection of the body Lifelong immunity

Recovery from mumps, chicken pox

b. Passive vaccines or toxoids which administer to stimulate antibody reaction

requires booster

TT, OPV

2. Passive Immunization produced by animals

a. Natural mother to her baby

breast feedingb. Passive immune serum from animals or human

TIGH

BREAKING THE CHAIN OF INFECTION

I. HandwashingII. Cleaning, disinfection, sterilizationIII. Used of barriersIV. Isolation techniqueV. Surgical asepsis

I. HANDWASHING Based handscrub are effective preparations for removing microorganism

Before & after client care should wash hands

Adequate friction and thoroughness of surfaced cleansed

Medical Asepsis - holdings hands lower the elbows

Clean under finger nails

Closed the faucet by paper towel

Wear gloves during client care especially the skin is abraded


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II. CLEANING, DISINFECTION, STERILIZATION

Any item introduced into sterile tissues or vascular tissues such assurgical instruments cardiac & urinary catheters, vaginal speculum,implants, IV fluids & needles must be STERILE

METHODS OF STERILIZATION

a. Steam Sterilization Autoclaving using steam under pressure

Non toxic, inexpensive, sporicidal, & able to penetrate fabrics rapidly

Color indicator strips change in color , indicates sterilization occured

b. Gas Sterilization Ethylene Oxide is colorless gas that penetrate plastic & rubber cotton

Expensive & requires 2-5 hrs

Ethylene Oxide is toxic to humans

c. Radiations deeply into the object

d. Chemicals effective disinfectant

Chlorine is used

e. Boiling Least expensivefor used in homes

15 mins

TYPES OF DISINFECTION

1) Concurrent Disinfection

Ongoing practices during the care of the client

2) Terminal Disinfection

After the illness is no longer communicable

USE OF BARRIERS (PERSONAL PROTECTION EQUIPMENT PPE)Masks

Caps & shoe coveringsGlovesPrivate roomsWaterproof disposable bags for linen & trashLabelling & bagging of contaminated equipment & specimenControl of airflow into the sterile areas & out of contaminated areasGoggles or face shield

MASKS

Should fit tightly to the face, covering nose and mouth

Wet mask considered contaminated

1 micromilimeter small of organism can passed

GOWNS


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Used it only once

When wet changed it

CAPS & SHOE COVERINGS

It shield body parts from accidental exposure to contaminated body secretion

GLOVES

Discard between clients & changed when torn & grossly soiled

Should not be washed & used

PRIVATE ROOMS Clients gowns & dressing should be changed before leaving the room & wear barriers

EQUIPMENT & REFUSE HANDLING

Linens soiled by any body fluid should be placed in impervious (waterproof) bag before it removes

at the client bedsides

DOUBLE BAGGING when outside of the bag becomes contaminated, placed another bag in other

bag

ISOLATION TECHNIQUE

Classified as Standard Precautions, Transmission Based Precautions & ProtectiveIsolation

STANDARD PRECAUATIONS Prevent transmission of bloodborne & moist body substance

Wear clean gloves when touching

Any secretions & excretions, any body fluids

Mucous membranes

Non-intact skin

Perform handwashing immediatelyWhen there is direct contact with any secretions & excretions, any body fluids

After removing gloves

Between patient contacts

Wear a mask, eye protection & face shield during procedure & patient care

Wear a cover gown during procedure & patient care

Clean & reprocess all equipment before reused by other clients

Discard all single used items immediately

Prevent injuries from sharp objects (needles, scalpels)

Never remove, recap, bend or break used needles

Never point needle toward body parts Used ONE- HANDED SCOOP METHOD on special syringes for enclosing a needle

TRANSMISSION BASED PRECAUTIONS

Airborne Precautions small particle droplets (TB varicella measles)

Client should in a private, negative airflow room

Caregivers should wear mask

Clients wear mask when transported out of the room

Droplet Precautions larger-particle droplet (influenza, diphtheria, rubella, pneumonia


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In private room

Wear mask

3 feet away from the client

Contact Precautions by hand or skin to skin contact (shigella, impetigo)

In private room

COHABITATION client who has a roommate with a same disease

Before entering the room, wear gloves

Remove gloves before leaving the room

PROTECTIVE ISOLATION

People whose resistance to infection/body defenses are lowered or compromise

In private room

Handwashing by client, family, & caregivers

Restrict visitors

Persons who suspected an infection are not allowed to visit the client

No fresh fruits, vegetables, raw foods, fresh flowers or potted plants

Cooked foods or canned fruits are allowed

SURGICAL ASEPSIS

surgical procedures

procedures that invade the blood stream

IM injections

Insertion of tubes, catheters

PRINCIPLES OF SURGICAL ASEPSIS

1. Moisture causes contamination Prevent splashing of liquids in sterile field

Wet objects are placed in sterile basin

Microorganisms more easily travel in moist environment2. Never assume that an object is sterile

Ensure that it is labelled as sterile

Check the integrity

Verify the expiration date

Whenever in doubt of the sterility of an object, consider it as unsterile3. Always face the sterile field

Objects that out of the line of vision are considered contaminated4. Sterile articles may touch only sterile articles or if surface they are to maintain

their sterility

Objects used in cleaning the skin (swab) must be used once5. Sterile equipment or areas must be kept above the waist & top of the sterile

fieldDrapes hanging over the edge of the table are contaminated

Waist level is the limit of good visual field

6. Prevent unnecessary traffic & air currents around the sterile areaClosed doors

Unfold drapes or wrappers slowly


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Do not reach across sterile fields

7. Open unused sterile articles are no longer sterile after the procedure

Once protective wrapping have been removed the articles are contaminated

Liquids open during the procedure that remain in their original container are

contaminated8. Person who is considered sterile who becomes contaminated must re-

established sterility9. Surgical technique is a team effort

STERILE CONSCIENCE best to achieved sterile technique

To enhance everyones sterile technique, review the procedures & infection controlsurveillance

Related Nursing Skills: PERFORMING STERILE PROCEDURES

SURGICAL HAND SCRUB

PURPOSE: Remove as many microorganism from the hands as possible before the sterileprocedure

EQUIPMENT:

Sink with knee or foot controls (ideally)

Antimicrobial soap

Surgical scrub brush

Plastic nail stick or sterile nail cleaner (ideally)

Sterile towel for drying

STEPS:

1) Be sure fingernails are short & healthy. Nail polish should be removed2) Remove rings. Apply surgical shoe covers, cap, face mask & protective eye wear3) Wash & rinse hands for initial wash4) Open disposable brush impregnated with antimicrobial soap, adjust water

temperature to warm using knee or foot control lever.

Warm water decreases drying of hands5) Wet hands & arms. Keep hands above the elbows.6) Use nail stick or cleaner to clean under nails of both hands7) Wet scrub brush or apply antimicrobial soap if not already impregnated in the brush8) Anatomic Timed Scrub. Starting with finger tips, scrub each anatomic area (nails,

fingers each side & web space, palmar surface, dorsal surface & forearm) for around5 mins. Scrub vigorously using vertical strokes. repeat with other hand.

9) Counted Brush Stroke Method. Starting with finger, scrub each anatomic area (sameas in step no. 8) for the designated number of strokes according to agency policy.Scrub vigorously using vertical strokes

10) Rinse hands thoroughly under warm running water, holding hands upward.These allow water to drain towards the flexed elbows.

11) Keep hands held upward to allow water to drip from the hands to the elbow.Dry hands with sterile towel


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APPLYING & REMOVING STERILE GLOVES

PURPOSE: Prevent transfer of microorganisms from hands to sterile objects or open wounds.

EQUIPMENT:

Packaged sterile gloves in correct size

Flat working surface

STEP:

APPLYING GLOVES

Wash hands.Peel of outside wrapper as directed by manufacturer (peel sides part)Lay inner package on clean, flat surface about waist level. Open wrapper from the outside,keeping gloves on inside surfaceGrasp first glove by inside edge of cuff with thumb & first 2 fingers of the dominant hand. Holdhands above waist; insert non-dominant hand into glove. Adjust fingers inside glove after bothgloves are on.Slip glove hand ($ fingers with thumb up) underneath second gloved cuff and pull over dominant

hand

Put gloves on the nondominant hand first, then on the nondominant handKeeping hands above waist, adjust above glove fit, touching only sterile areas

REMOVING GLOVES

Wash handsWith dominant hand, grasp outer surface of nondominant glove adjust below thumb. Peel off gloveinside out without touching exposed wristPlace ungloved hand under thumb side of second cuff & peel of toward the fingers holding first

gloved inside second glove. Discard into appropriate receptacleWash hands

DONNING A STERILE GOWN & CLOSED GLOVING

Purpose:to apply attire necessary to safely carry out sterile procedures usually in the OR & DREQUIPMENT:

Sterile gown

Sterile gloves

Mayo stand or flat surface area above waist level

STEPS:

1) Wear shoe covers, cap that covers all hair, face mask & protective wear (ideally) &perform the surgical scrub

DONNING A STERILE

2) Grasp folded sterile gown at the neckline & step away from the sterile field. Allowgown to gently unfold, being careful that it does not touch the floor. The inside of thegown is toward the user.

3) Holding the arms & shoulder level, grasp the sterile gown just below the neckbandnear the shoulders A slide arms until the fingers are & the end of the cuffs but notthrough the cuffs.

4) Have someone to tie back of the gown, taking caret the ties are touched & not thesides or front of the gown.


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The front of the gown from shoulder to the table level is sterile &the sleeves are considered sterile from 2 inches above the elbow to thewrist.

CLOSED GLOVING

With fingers still within the cuff of the gown, open the inner sterile glove package & pick up the firstglove by the cuff, using the nondominant hand.

Position the cuff over the cuff of the gown so the fingers are in alignment, & stretch the entireglove over the cuff of the gown, being carefully not to touch its edge. Fingers remain with the cuffof the gownWork finger into the glove & pull the glove up over the wrist with the nondominant hand that stillremains within the cuff of the gownUse the sterile gloved hand to pick up the second glove, placing it over the cuff of the gown of theother hand & repeat the glove applicationAdjust glove for comfort & fit, taking care to keep hands above waist level & all times.

DONNING & REMOVING GLOVES, MASK, GOWNS & EYE WEAR

For sterile procedures on a general nursing division, the nurse may wear surgical mask andgloves without the cap.Eye wear is ideally worn if there is risk of fluid or blood splashing into the nurses eye.First applies a clean cap, mask eye wear, & shoe coverIn removing: gloves, mask, gown, eye wear, cap & shoe cover

PREPARING & MAINTAINING A STERILE FIELD

PURPOSE: to create an environment that helps ensure the sterility of supplies & equipment &prevent of microorganisms during sterile procedure.

EQUIPMENT:

Flat work surface

Sterile drape

Sterile supplies (sterile gauze, sterile basin, solutions, scissors, forceps)

Packaged sterile gloves

STEPS:

SPECIAL CONSIDERATIONS

) Wash hands) Inspect all sterile packages for package integrity, contamination, or moisture.) Never turn back on the sterile field or lower hands below the level of the field during the entire

procedure.

OPENING A STERILE DRAPE

) Remove the sterile drape from the outer wrapper & place the inner drape in the surface of thework surface, at or above waist level with the outer flap facing away from you.

) Touching the outside of the flap, reach around (rather than over) the sterile field to open the flapaway from you.

) open the side flaps in the same manner, using the right hand for the right flap & left hand for theleft flap

) Open the innermost flap that faces you, being careful that it does not touch your clothing or anyobject.

ADDING STERILE SUPPLIES TO THE FIELD


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) open unsealed edge of prepackaged sterile supplies, taking care not to touch the supplies with thehands

) Hold supplies 10 to 12 inches above the field and allow them to fall to middle of the sterile field.0) Wrapped sterile supplies are added by holding the sterile objects with one hand and unwrapping

the flaps with the flaps with the other hand. Carefully drop the object onto the sterile field.

POURING SOLUTIONS TO A STERILE FIELD

1) Check the label and expiration date of the solution. Note any signs of contamination.2) Remove cap & place it with the inside facing up on a flat surface. do not touch inside of cap or rim

of bottle3) Hold bottle 6 inches above receptacle on the sterile field & pour it slowly to avoid spills4) Recap the solution bottle, place it outside the sterile field label it with date 7 time of opening if the

solution is to be reused5) Add any additional supplies & don sterile gloves just prior to beginning the procedure helps to

ensure sterility.

CARE OF THE STERILE PICK-UP FORCEPS

PURPOSE:To transfer sterile articles & maintain sterility of these articles & the sterile field.

EQUIPMENT:

Sterile forceps in sterile bottle with germicidal/disinfectant solution

STEPS:

1) The prongs of the sterile forceps should be fully immersed in disinfectant solution2) Sterile forceps are always held above & in front of the waist, within the vision of the

nurse3) The tips of the forceps are always considered sterile & need to be held down

4) The handles of the forceps are considered contaminated except when they areundergone in sterilization

5) Use the thumb & middle fingers when lifting the forceps from the container. From thetip should not touch the rim or any part of the container not directly in contact withthe disinfectant

6) Tap the handle of the forceps with index finger to remove excess from the tip, ousidethe sterile field.

7) When removing sterile items from a container, the tips of the forceps and/or the itemshould be kept away from the edges of the container or disposable wrapper

8) Return the forceps to the container, without touching the tips to the rim or part of the

container not immersed in disinfectant.

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5asepsis & Infection Control