CHAPTER 6 Microbiology-Related Procedures

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Introduction

• Medical waste─Infectious─Non-infectious

• Requires special handling• Proper procedures necessary for obtaining

culture from appropriate body site without contamination

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• Solid or liquid wastes may cause disease if improperly handled, treated, transported, stored, or disposed

• Examples of waste: body fluid, items coming in contact with body fluids/blood

• Handle with gloves• Place in biohazard container for disposal

in sanitary landfill per local/state rules and regulations

Infectious Waste Disposal

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• Non-sharp– Biological liquid wastes– Pathological wastes– Patient care items

• Sharp– Needles or IV tubing with needle attached– Scalpel blades– Glassware

(Continues)

Types of Infectious Waste

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• Disposal of non-sharp items– Wearing gloves, place waste in red infectious

waste biohazard bags– If bag ¾ full, seal, place in disposal container– Discard liquids per local/state Department of

Health regulations– Place liquids in leakproof container in red

infectious biohazard bags– Remove gloves/wash hands

(Continues)

Types of Infectious Waste

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• Disposal of sharp items─Wearing gloves, place sharps in disposable sharps

container located at point of use─Never recap needles─Seal container when ¾ full─Never force instruments into sharps container─Never place sharps container in normal waste

disposal─Wash hands after completing task

Types of Infectious Waste

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• Gloves are not always needed; do not waste/misuse PPE

• Donning non-sterile gloves– Wash and dry hands– Remove one glove from box; slide glove onto

other hand; with gloved hand, remove another glove and slide onto bare hand

– Interlace fingers, push down between fingers to ensure proper fit

Applying Non-Sterile Disposable Gloves

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• Remove immediately after use• Grip one glove at base of palm; pull off

inside out, place in palm of other glove• Slip bare fingers under other glove at wrist • Push glove down and off holding first

glove inside• Place gloves in appropriate receptacle• Wash and dry hands

Removing Non-Sterile Disposable Gloves

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Applying Sterile Gloves

• Two methods– Open– Closed

• Open (see text for complete instructions)– Wash and dry hands before and after gloving– Dispose of gloves in appropriate container

(Continues)

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Applying Sterile Gloves

• Closed– Allows donning of gloves without possibility of

sterile outside of glove touching skin of health care worker

– Used by personnel who are scrubbed for operating room, or wearing sterile gown for performing of procedure

– See text for complete instructions of procedure

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• Absence of microorganisms• Two types

– Medical: reduces number, growth, and spread of microbes

– Surgical: eliminates microbes/spores from object/area

Asepsis

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Medical Asepsis

• Includes– Hand washing– Gloving– Changing bed linens daily– Cleaning furniture daily– Cleaning floor daily

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Surgical Asepsis

• Surgical hand scrub• Sterilization of instruments• Surgical attire• Proper handling of sterile equipment/

instruments• Establishing/maintaining sterile field• Used for: OR, delivery room,

diagnostic/therapeutic interventions

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Hand Hygiene for Surgical Asepsis

• Requires careful scrubbing of hands, nails, wrists, forearms before donning sterile gloves

• Requires 3- to 6-minute scrub• Since skin is not sterile, donning of sterile

gloves is required to obtain/maintain sterility of field

• Refer to text for specific instructions

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Sterile Principles

• Guidelines designed to determine areas and items of sterility and actions that might cause contamination

• Sterile field may be created by using sterile drapes, gloves, and gowns if procedure is performed in area where sterility is not possible (e.g., insertion of IV at jugular site at bedside)

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Maintenance of Sterile Field

• Sterile objects must be dry and should not touch non-sterile objects

• Maintain visual contact with sterile field• Items below waist level are considered

contaminated• See text/tables for specific instructions

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Specimen Collection

• Use aseptic technique• Note date, time, site, antibiotics

(if applicable), collection method, possibility of infectious organisms

• Transport immediately or refrigerate• Blood and CSF should be kept at room

temperature

(Continues)

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Specimen Collection

• Refer to text for specific information for each type of culture

• Blood culture– Use aseptic phlebotomy procedures– Transport to lab immediately or store at room

temperature or place in incubator at 35˚C; never refrigerate

(Continues)

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Specimen Collection

• CSF culture– Obtained by physician or specially trained

personnel only; 8–15 mL of fluid withdrawn; transport immediately

• Sputum culture– Obtain prior to antibiotic regimen; specimen

should be expelled after deep cough; transport immediately or refrigerate

(Continues)

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Specimen Collection

• Wound culture– Needle aspiration or deep tissue culture is

preferred over swab; transport immediately or refrigerate

• Urine specimen– Avoid bacterial contamination from distal

urethra; clean-catch specimen, catheterization or suprapubic aspiration; transport immediately or refrigerate

(Continues)

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Specimen Collection

• Stool specimen– Best performed on fresh specimen– May use transport medium– Transport immediately or refrigerate

• Throat culture– Use sterile swab– Do not touch tongue, sides of mouth, or uvula– Transport immediately

(Continues)

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Specimen Collection

• Nasal specimen– Use nasal swab– Insert at depth of 2–3 cm– Transport immediately

• Reminder– Refer to text for specific instructions for each

specimen collection– Proper specimen collection assists with

determination of diagnosis

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Summary

• Disposal of medical waste, sharps• Donning and removal of non-sterile gloves• Donning and removal of sterile gloves• Gloving does not replace hand washing• Obtaining culture specimens using aseptic

technique (blood, CSF, sputum, wound, urine, stool, throat, nasal)

(Continues)

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Summary

• Proper transportation/storage of specimens

• Asepsis (medical/surgical)• Maintaining sterile field• Specimen collection

– Refer to textbook for specific instructions concerning obtaining specimens for each type of culture

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