Fundamental Fundamental NursingNursing

Chapter 10Chapter 10

AsepsisAsepsisInst.: Dr. Ashraf El - JediInst.: Dr. Ashraf El - Jedi

Preventing infections is one of the most Preventing infections is one of the most important priorities in nursingimportant priorities in nursing

MicroorganismsMicroorganisms, living animals or plants , living animals or plants visible only with a microscope, are commonly visible only with a microscope, are commonly called germs. What they lack in size, they called germs. What they lack in size, they make up for in numbers. Microorganisms are make up for in numbers. Microorganisms are everywhere: in the air, soil, and water, and on everywhere: in the air, soil, and water, and on and within virtually everything and everyone.and within virtually everything and everyone.

Types of MicroorganismsTypes of Microorganisms

Microorganisms are divided into two main Microorganisms are divided into two main groups: groups: nonpathogensnonpathogens or or normal floranormal flora and and pathogenspathogens

Non Pathogens Pathogens have high potential for causing

infectious communicable diseases also called also called contagious diseasescontagious diseases and and community-community-acquired infectionsacquired infections. .

Bacteria Bacteria Viruses Viruses FungiFungi RickettsiaeRickettsiae Protozoans Protozoans MycoplasmasMycoplasmas Helminths Helminths

Many pathogens have mutated to adapt to Many pathogens have mutated to adapt to hostile environments and unfavorable living hostile environments and unfavorable living conditions. Such adaptability has ensured that conditions. Such adaptability has ensured that they continue to pose a threat to humans.they continue to pose a threat to humans.

A A sporespore is a temporarily inactive microbial is a temporarily inactive microbial

life form that can resist heat and destructive life form that can resist heat and destructive chemicals and survive without moisture. chemicals and survive without moisture.

Chain of InfectionChain of Infection

By interfering with the conditions that By interfering with the conditions that perpetuate the transmission of microorganisms, perpetuate the transmission of microorganisms, humans can avoid acquiring infectious diseases. humans can avoid acquiring infectious diseases.

The six essential components of the The six essential components of the chain of chain of infectioninfection (sequence that enables the spread of (sequence that enables the spread of disease-producing microorganisms) must be in place disease-producing microorganisms) must be in place if pathogens are to be transmitted from one location if pathogens are to be transmitted from one location or person to another:or person to another:

An infectious agentAn infectious agent A reservoir for growth and reproductionA reservoir for growth and reproduction An exit route from the reservoirAn exit route from the reservoir A mode of transmissionA mode of transmission A port of entryA port of entry A susceptible host (A susceptible host (Fig. 10-2))

Infectious AgentsInfectious Agents

Some microorganisms are less dangerous than Some microorganisms are less dangerous than others. others.

For example, intestinal bacteria help produce For example, intestinal bacteria help produce vitamin K, which, in turn, helps control vitamin K, which, in turn, helps control bleeding. bleeding.

ReservoirReservoir A A reservoirreservoir is a place where microbes grow and is a place where microbes grow and

reproduce, providing a haven for their survival. reproduce, providing a haven for their survival. Examples: Examples:

skin, skin, shafts of hair shafts of hair open wounds open wounds blood blood lower digestive tract lower digestive tract nasal passages nasal passages

The The exit routeexit route is how microorganisms escape from is how microorganisms escape from their original reservoir and move about their original reservoir and move about

A A mode of transmissionmode of transmission is how infectious is how infectious microorganisms move to another location. microorganisms move to another location.

See table 10-1 See table 10-1

The The port of entryport of entry is where microorganisms find their is where microorganisms find their way onto or into a new host, facilitating their way onto or into a new host, facilitating their relocation. One of the most common ports of entry is relocation. One of the most common ports of entry is an opening in the skin or mucous membranes. an opening in the skin or mucous membranes.

Susceptible HostSusceptible Host

Humans become susceptible to infections Humans become susceptible to infections when their defense mechanisms are when their defense mechanisms are diminished or impaired. A diminished or impaired. A susceptible hostsusceptible host, , the last link in the chain of infection, is one the last link in the chain of infection, is one whose biologic defense mechanisms are whose biologic defense mechanisms are weakened in some way weakened in some way

Are burn victimsAre burn victims Have suffered major traumaHave suffered major trauma Require invasive procedures such as endoscopy Require invasive procedures such as endoscopy Need indwelling equipment such as a urinary catheterNeed indwelling equipment such as a urinary catheter Receive implantable devices such as intravenous Receive implantable devices such as intravenous

catheterscatheters Are given antibiotics inappropriately, which Are given antibiotics inappropriately, which

promotes microbial resistancepromotes microbial resistance Are receiving anticancer drugs and anti-inflammatory Are receiving anticancer drugs and anti-inflammatory

drugs such as corticosteroids that suppress the drugs such as corticosteroids that suppress the immune systemimmune system

Are infected with HIVAre infected with HIV

Nurses must understand and practice methods Nurses must understand and practice methods to prevent to prevent nosocomial infectionsnosocomial infections (infections (infections acquired while a person is receiving care in a acquired while a person is receiving care in a health care agency).health care agency).

AsepsisAsepsis means those practices that decrease or means those practices that decrease or eliminate infectious agents, their reservoirs, eliminate infectious agents, their reservoirs, and vehicles for transmission. It is the major and vehicles for transmission. It is the major method for controlling infection.method for controlling infection.

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AsepsisAsepsis

Medical AsepsisMedical Asepsis Medical asepsisMedical asepsis means those practices that confine means those practices that confine

or reduce the numbers of microorganisms. Also or reduce the numbers of microorganisms. Also called, called, clean techniqueclean technique, it involves measures that , it involves measures that interfere with the chain of infection in various ways. interfere with the chain of infection in various ways.

Principles of medical asepsis:Principles of medical asepsis: Microorganisms exist everywhere except on sterilized Microorganisms exist everywhere except on sterilized

equipment.equipment. Frequent handwashing and maintaining intact skin are the best Frequent handwashing and maintaining intact skin are the best

methods for reducing the transmission of microorganisms.methods for reducing the transmission of microorganisms.

Blood, body fluids, cells, and tissues are considered major Blood, body fluids, cells, and tissues are considered major reservoirs of microorganisms.reservoirs of microorganisms.

Personal protective equipment such as gloves, gowns, masks, Personal protective equipment such as gloves, gowns, masks, goggles, and hair and shoe covers serves as a barrier to goggles, and hair and shoe covers serves as a barrier to microbial transmission.microbial transmission.

A clean environment reduces microorganisms.A clean environment reduces microorganisms.

Certain areas—the floor, toilets, and insides of sinks—are Certain areas—the floor, toilets, and insides of sinks—are more contaminated than others. Cleaning should be done from more contaminated than others. Cleaning should be done from cleaner to dirtier areas.cleaner to dirtier areas.

Examples of medical aseptic practices include:Examples of medical aseptic practices include: using antimicrobial agents, using antimicrobial agents, performing hand hygiene, performing hand hygiene, wearing hospital garments, wearing hospital garments, confining and containing soiled materials confining and containing soiled materials

appropriately, appropriately, and keeping the environment as clean as and keeping the environment as clean as

possible. possible.

11 . .Using Antimicrobial Using Antimicrobial AgentsAgents

Antimicrobial agentsAntimicrobial agents are chemicals that are chemicals that destroy or suppress the growth of infectious destroy or suppress the growth of infectious microorganisms microorganisms

Examples are antiseptics, disinfectants, and Examples are antiseptics, disinfectants, and anti-infective drugs. anti-infective drugs.

AntisepticsAntiseptics

AntisepticsAntiseptics, also known as , inhibit the growth , also known as , inhibit the growth of, but do not kill, microorganisms. An of, but do not kill, microorganisms. An example is alcoholexample is alcohol

DisinfectantsDisinfectants

DisinfectantsDisinfectants, also called and , destroy active , also called and , destroy active microorganisms but not spores. Phenol, microorganisms but not spores. Phenol, household bleach, and formaldehyde are household bleach, and formaldehyde are examples. examples.

Disinfectants rarely are applied to the Disinfectants rarely are applied to the skin because they are so strong. Rather, they skin because they are so strong. Rather, they are used to kill and remove microorganisms are used to kill and remove microorganisms from equipment, walls, and floorsfrom equipment, walls, and floors

Anti-Infective DrugsAnti-Infective Drugs

antibiotics antibiotics

Antiviral Antiviral

22 . .Hand washingHand washing

Hand washingHand washing is an aseptic practice that is an aseptic practice that involves scrubbing the hands with soap, water, involves scrubbing the hands with soap, water, and friction. and friction.

Considering Considering how often health care personnel how often health care personnel use their hands with clients, it is no surprise use their hands with clients, it is no surprise that that handwashing is the single most effective handwashing is the single most effective way to prevent infectionsway to prevent infections. .

Performing a Surgical Performing a Surgical ScrubScrub

A A surgical scrubsurgical scrub, a type of skin and nail , a type of skin and nail antisepsis, is performed before donning sterile antisepsis, is performed before donning sterile gloves and garments when the nurse is actively gloves and garments when the nurse is actively involved in an operative or obstetric involved in an operative or obstetric procedure. The purpose is to more extensively procedure. The purpose is to more extensively remove transient microorganisms from the remove transient microorganisms from the nails, hands, and forearms. nails, hands, and forearms.

Wearing Personal Protective Wearing Personal Protective EquipmentEquipment

uniforms uniforms scrub suits or gownsscrub suits or gowns masks masks gloves gloves protective eyewearprotective eyewear Hair and Shoe Covers Hair and Shoe Covers

GlovesGlovesNurses wear clean gloves, sometimes called Nurses wear clean gloves, sometimes called

examination gloves, in the following examination gloves, in the following circumstances:circumstances:

As a barrier to prevent direct hand contact with As a barrier to prevent direct hand contact with blood, body fluids, secretions, excretions, mucous blood, body fluids, secretions, excretions, mucous membranes, and nonintact skinmembranes, and nonintact skin

As a barrier to protect clients from microorganisms As a barrier to protect clients from microorganisms transmitted from nursing personnel when transmitted from nursing personnel when performing procedures or care involving contact performing procedures or care involving contact with the client's mucous membranes or nonintact with the client's mucous membranes or nonintact skinskin

When there is a potential transfer of When there is a potential transfer of microorganisms from one client or object to microorganisms from one client or object to another client during subsequent nursing careanother client during subsequent nursing care

GlovesGloves……

Examination gloves are generally made of Examination gloves are generally made of latexlatex

Unfortunately some nurses and clients are Unfortunately some nurses and clients are allergic to latex. allergic to latex.

Confining Soiled Articles:Confining Soiled Articles:

Utility RoomsUtility Rooms Waste ReceptaclesWaste Receptacles

Keeping the Environment Keeping the Environment CleanClean

Health agencies employ laundry staff and Health agencies employ laundry staff and housekeeping personnel to assist with cleaning housekeeping personnel to assist with cleaning

Terminal disinfectionTerminal disinfection is more thorough than is more thorough than concurrent disinfection and consists of measures used concurrent disinfection and consists of measures used to clean the client environment after discharge.to clean the client environment after discharge.

Nurses who work in home health can teach the client Nurses who work in home health can teach the client and family simple aseptic practices for cleaning and family simple aseptic practices for cleaning contaminated articlescontaminated articles

Surgical AsepsisSurgical Asepsis

Surgical asepsisSurgical asepsis means those measures that means those measures that render supplies and equipment totally free of render supplies and equipment totally free of microorganisms. microorganisms. Sterile techniqueSterile technique is those is those practices that avoid contaminating microbe-practices that avoid contaminating microbe-free items.free items.

SterilizationSterilization

SterilizationSterilization consists of physical and chemical consists of physical and chemical techniques that destroy all microorganisms techniques that destroy all microorganisms including spores.including spores.

11 . .Physical SterilizationPhysical Sterilization

Microorganisms and spores are destroyed Microorganisms and spores are destroyed physically through radiation or heat (boiling physically through radiation or heat (boiling water, free-flowing steam, dry heat, and steam water, free-flowing steam, dry heat, and steam under pressure).under pressure).

RadiationRadiation

Ultraviolet radiation can kill bacteria, Ultraviolet radiation can kill bacteria, especially the organism that transmits TB. especially the organism that transmits TB.

Boiling WaterBoiling Water

Boiling water is a convenient way to sterilize Boiling water is a convenient way to sterilize items used in the home. To be effective, items used in the home. To be effective, contaminated equipment needs to be boiled for contaminated equipment needs to be boiled for 15 minutes at 212°F (100°C)15 minutes at 212°F (100°C)

Free-Flowing SteamFree-Flowing Steam

Free-flowing steam is a method in which items Free-flowing steam is a method in which items are exposed to the heated vapor that escapes are exposed to the heated vapor that escapes from boiling water. from boiling water.

Dry HeatDry Heat

Dry heat, or hot air sterilization, is similar to Dry heat, or hot air sterilization, is similar to baking items in an oven. To destroy baking items in an oven. To destroy microorganisms with dry heat, temperatures of microorganisms with dry heat, temperatures of 330°to 340°F (165° to 170°C) are maintained 330°to 340°F (165° to 170°C) are maintained for at least 3 hours.for at least 3 hours.

Steam Under PressureSteam Under Pressure

Steam under pressure is the most dependable Steam under pressure is the most dependable method for destroying all forms of organisms method for destroying all forms of organisms and spores.and spores.

The autoclave is an example figure 10-8The autoclave is an example figure 10-8

22 . .Chemical SterilizationChemical Sterilization

Both gas and liquid chemicals are used to Both gas and liquid chemicals are used to sterilize invasive equipment.sterilize invasive equipment.

Principles of Surgical Principles of Surgical AsepsisAsepsis

They preserve sterility by touching one sterile They preserve sterility by touching one sterile item with another that is sterile.item with another that is sterile.

Once a sterile item touches something that is Once a sterile item touches something that is not, it is considered contaminated.not, it is considered contaminated.

Any partially unwrapped sterile package is Any partially unwrapped sterile package is considered contaminated.considered contaminated.

If there is a question about the sterility of an If there is a question about the sterility of an item, it is considered unsterile.item, it is considered unsterile.

The longer the time since sterilization, the The longer the time since sterilization, the more likely it is that the item is no longer more likely it is that the item is no longer sterile.sterile.

A commercially packaged sterile item is not A commercially packaged sterile item is not considered sterile past its recommended considered sterile past its recommended expiration date.expiration date.

Once a sterile item is opened or uncovered, it Once a sterile item is opened or uncovered, it is only a matter of time before it becomes is only a matter of time before it becomes contaminated.contaminated.

The outer 1-inch margin of a sterile area is The outer 1-inch margin of a sterile area is considered a zone of contamination.considered a zone of contamination.

sterile wrapper, if it becomes wet, wicks sterile wrapper, if it becomes wet, wicks microorganisms from its supporting surface, microorganisms from its supporting surface, causing contamination.causing contamination.

Any opened sterile item or sterile area is Any opened sterile item or sterile area is considered contaminated if it is left considered contaminated if it is left unattended.unattended.

Coughing, sneezing, or excessive talking over Coughing, sneezing, or excessive talking over a sterile field causes contamination.a sterile field causes contamination.

Reaching across an area that contains sterile Reaching across an area that contains sterile equipment has a high potential for causing equipment has a high potential for causing contamination and is therefore avoided.contamination and is therefore avoided.

Sterile items that are located or lowered below Sterile items that are located or lowered below waist level are considered contaminated waist level are considered contaminated because they are not within critical view.because they are not within critical view.

Creating a Sterile FieldCreating a Sterile Field

A A sterile fieldsterile field means a work area free of means a work area free of microorganisms. (Skill 10-3)microorganisms. (Skill 10-3)

Nursing ImplicationsNursing Implications

Risk for InfectionRisk for Infection Risk for Infection TransmissionRisk for Infection Transmission Ineffective ProtectionIneffective Protection Delayed Surgical RecoveryDelayed Surgical Recovery Deficient KnowledgeDeficient Knowledge