Medical & Surgical AsepsisMedical & Surgical Asepsis

Dr. Abdul-Monim BatihaDr. Abdul-Monim BatihaAssistant ProfessorAssistant ProfessorCritical Care NursingCritical Care Nursing

Philadelphia university Philadelphia university

Learning objectivesLearning objectives

Explain the concepts of medical and Explain the concepts of medical and surgical asepsis.surgical asepsis.

Identify types of microorganisms Identify types of microorganisms causing infections.causing infections.

Identify types & signs of localized Identify types & signs of localized and systematic infections.and systematic infections.

Identify risks for nosocomial Identify risks for nosocomial infections.infections.

Explain chain of infection.Explain chain of infection. Identify factors influencing a Identify factors influencing a

microorganism's capability to microorganism's capability to produce an infectious process.produce an infectious process.

Identify measures that break each Identify measures that break each link in the chin of infection.link in the chin of infection.

AsepsisAsepsis Asepsis Asepsis is the freedom from is the freedom from

disease-causing microorganisms. disease-causing microorganisms. To decrease the possibility of To decrease the possibility of transferring microorganisms transferring microorganisms from one place to another, from one place to another, asepsis is used. asepsis is used.

There are two basic types There are two basic types of asepsisof asepsis

Medical & Surgical Medical & Surgical asepsis.asepsis.

11 . .Medical asepsisMedical asepsis Includes Includes all practicesall practices

intended to confine a intended to confine a specific microorganism to a specific microorganism to a specific area,specific area, limiting the limiting the number, growth, and number, growth, and transmission of transmission of microorganismsmicroorganisms..

In medical asepsisIn medical asepsis, objects are , objects are referred to as referred to as cleanclean, which , which means the absence of almost all means the absence of almost all microorganisms, or dirty microorganisms, or dirty (soiled, contaminated, which (soiled, contaminated, which means likely to have means likely to have microorganisms, some of which microorganisms, some of which may be capable of causing may be capable of causing infectioninfection. .

22 . .Surgical asepsis or sterileSurgical asepsis or sterile Technique, refers to keep an area Technique, refers to keep an area

or object or object free of all free of all microorganismmicroorganism, it includes , it includes practices that practices that destroydestroy all all microorganisms and spores. microorganisms and spores. Surgical asepsis is used for all Surgical asepsis is used for all procedures involving the sterile procedures involving the sterile areas of the body.areas of the body.

SepsisSepsis is the state of is the state of infection and can take infection and can take many forms, including many forms, including septic shock.septic shock.

Types of Types of microorganisms microorganisms

causing infectionscausing infections

1. 1. BacteriaBacteria can live and be transported can live and be transported through air, water, food, soil, body tissues through air, water, food, soil, body tissues and fluids, and inanimate objects.and fluids, and inanimate objects.

2. 2. VirusesViruses (causes the common cold) (causes the common cold) hepatitis, herpes, and human hepatitis, herpes, and human immunodeficiency virus.immunodeficiency virus.

3. 3. FungiFungi include yeasts and molds. Candida include yeasts and molds. Candida albicans albicans

4. 4. ParasitesParasites They include protozoa such as They include protozoa such as the that causes malaria. the that causes malaria.

Types of infectionTypes of infection

A local infectionA local infection is limited to the is limited to the specific part of the body where specific part of the body where the microorganisms remain.the microorganisms remain.

If the microorganisms spread and If the microorganisms spread and

damage different parts of the damage different parts of the body, it is a body, it is a systemic infectionsystemic infection. .

When a culture of the person's When a culture of the person's blood reveals microorganisms, blood reveals microorganisms, the condition is the condition is called called bacteremia.bacteremia.

When bacteremia results in When bacteremia results in systemic infection, it is systemic infection, it is referred to as referred to as septicemia. septicemia.

Acute infectionsAcute infections generally generally appear suddenly or last a appear suddenly or last a short time. short time. A chronic A chronic infectioninfection may occur slowly, may occur slowly, over a very long period, and over a very long period, and may last months or years. may last months or years.

Nosocomial infectionsNosocomial infections classified as infections that are classified as infections that are

associated with the delivery of health associated with the delivery of health care services in a health care facility. care services in a health care facility. NosocomialNosocomial infections can either infections can either develop during a client's stay in a develop during a client's stay in a facility or manifest after discharge.facility or manifest after discharge.

The incidence of The incidence of nosocomial infections is nosocomial infections is significant. Major sites for significant. Major sites for these infections are the these infections are the respiratory and urinary respiratory and urinary tracts, the bloodstream, tracts, the bloodstream, and wounds.and wounds.

Factors that contribute to Factors that contribute to nosocomial infection risksnosocomial infection risks are are invasive procedures, medical invasive procedures, medical therapies, the existence of a large therapies, the existence of a large number of susceptible persons, number of susceptible persons, inappropriate use of antibiotics, and inappropriate use of antibiotics, and insufficient hand washing after client insufficient hand washing after client contact and after contact with body contact and after contact with body substances.substances.

Chain of Chain of infectioninfection

6Susceptible

host

5Portal of entry

to the susceptible host

4Method of

transmission

3Portal of exit

from reservoir

2Reservoir

(source)

1Etiologic agent

(microorgnanisms)

1.1. Etiologic agentEtiologic agentThe any microorganism The any microorganism is capable of producing is capable of producing an infectious process an infectious process depends on the number depends on the number of microorganisms of microorganisms presentpresent..

22 . .ReservoirReservoirThere are many There are many reservoirs, or sources of reservoirs, or sources of microorganisms, microorganisms, common sources are common sources are other humans, the other humans, the client's, plants, animals, client's, plants, animals, or general environment.or general environment.

3. Portal of exit from 3. Portal of exit from reservoirreservoir

Before an infection can Before an infection can establish itself in a host, establish itself in a host, the microorganisms must the microorganisms must leave the reservoir. leave the reservoir.

4. Method of 4. Method of transmissiontransmission

TThere are three here are three mechanismsmechanisms

11 . .Direct transmissionDirect transmission Involves immediate and direct Involves immediate and direct

transfer of microorganisms transfer of microorganisms from person to person through from person to person through touching, biting, kissing, or touching, biting, kissing, or sexual intercourse. Droplet sexual intercourse. Droplet spread is also a form of direct spread is also a form of direct transmission.transmission.

22 . .Indirect transmissionIndirect transmission Material objects, such as toys, Material objects, such as toys,

soiled clothes, cooking or soiled clothes, cooking or eating and surgical eating and surgical instruments, or dressing, instruments, or dressing, water, food, blood, serum, and water, food, blood, serum, and plasma. Animal or flying.plasma. Animal or flying.

3. Airborn transmission3. Airborn transmission

may involve may involve droplets or dust. droplets or dust.

55 . .Portal of entryPortal of entry Before a person can become Before a person can become

infected, microorganisms must infected, microorganisms must enter the body. The skin is a enter the body. The skin is a barrier to infectious agents; barrier to infectious agents; however, any break in the skin however, any break in the skin can readily serve as a portal of can readily serve as a portal of entry.entry.

66 . .Susceptible HostSusceptible Host

A susceptible host is any A susceptible host is any person who is at risk for person who is at risk for infection. A compromised infection. A compromised host is a person at host is a person at "increased risk" "increased risk"

Factors Increasing Factors Increasing Susceptibility to InfectionSusceptibility to Infection

1. Age influence the risk of 1. Age influence the risk of infection. infection.

2. Heredity influences the 2. Heredity influences the development of infection.development of infection.

3. The nature, number, 3. The nature, number, and duration of physical and duration of physical and emotional stressors and emotional stressors can influence can influence susceptibility to infection. susceptibility to infection.

Stressors elevate blood Stressors elevate blood cortisone. Prolonged cortisone. Prolonged elevation of blood cortisone elevation of blood cortisone decrease anti-inflammatory decrease anti-inflammatory responses depletes energy responses depletes energy stores, lead to a state of stores, lead to a state of exhaustion, and decrease exhaustion, and decrease resistance to infection. resistance to infection.

4. Resistance to infection depends on 4. Resistance to infection depends on adequate nutritional status. adequate nutritional status.

5. Some medical therapies predispose 5. Some medical therapies predispose a person to infection. a person to infection. For example,For example, radiation treatments for cancer, some radiation treatments for cancer, some diagnostic procedures may also diagnostic procedures may also predispose the client to an infection. predispose the client to an infection.

6. Certain medication also 6. Certain medication also increase susceptibility to increase susceptibility to infection. Anticancer infection. Anticancer medications may depress bone medications may depress bone marrow function, resulting marrow function, resulting inadequate production of white inadequate production of white blood cells, anti-inflammatory blood cells, anti-inflammatory and antibiotics medications.and antibiotics medications.

Cleaning, Disinfecting, and Cleaning, Disinfecting, and SterilizingSterilizing

The first links in the chain of infection, The first links in the chain of infection, the etiologic agent and the reservoir, are the etiologic agent and the reservoir, are interrupted by the use of interrupted by the use of antiseptics antiseptics (agents that inhibit the growth of (agents that inhibit the growth of some microorganisms) and some microorganisms) and disinfectants (agents that destroy disinfectants (agents that destroy pathogens other than spores) and by pathogens other than spores) and by sterilization.sterilization.

CleaningCleaningCleanliness inhibits the growth Cleanliness inhibits the growth of microorganisms. When of microorganisms. When cleaning visibly soiled objects, cleaning visibly soiled objects, nurses must always wear gloves nurses must always wear gloves to avoid direct contact with to avoid direct contact with infections microorganisms. infections microorganisms.

DisinfectingDisinfecting A disinfectantA disinfectant is a chemical is a chemical

preparation, such aspreparation, such as phenol or iodinephenol or iodine compounds, used on inanimate objectscompounds, used on inanimate objects. .

DisinfectantsDisinfectants are frequently caustic and are frequently caustic and toxic to tissues. Antoxic to tissues. An antisepticantiseptic is a is a chemical preparation used on skin or chemical preparation used on skin or tissuetissue. .

Disinfectants and Disinfectants and antisepticsantiseptics often have often have similar chemical similar chemical components, but the components, but the disinfectant is a more disinfectant is a more concentrated solutionconcentrated solution. .

When disinfecting articles, When disinfecting articles, nurses need to follow nurses need to follow agency protocol and agency protocol and

consider the following:consider the following:

1. The type and number of 1. The type and number of infectious organisms. infectious organisms.

2.2. The recommended The recommended concentration of the concentration of the disinfectant and the duration disinfectant and the duration of contact.of contact.

3. 3. The temperature of the The temperature of the environment. environment.

4. The presence of soap. Some disinfectants 4. The presence of soap. Some disinfectants are ineffective in the presence of soap or are ineffective in the presence of soap or detergent.detergent.

5. The presence of organic materials, the 5. The presence of organic materials, the presence of saliva, blood, pus can readily presence of saliva, blood, pus can readily inactive many disinfectants.inactive many disinfectants.

6. The surface areas to be treated. The 6. The surface areas to be treated. The disinfecting agent must come into contact disinfecting agent must come into contact with all surfaces and areas. with all surfaces and areas.

SterilizingSterilizing Sterilization is a Sterilization is a

process that destroys all process that destroys all microorganisms, microorganisms, including spores and including spores and viruses. viruses.

Four commonly used Four commonly used methods of sterilization aremethods of sterilization are

1. Moist heat1. Moist heat2. Gas 2. Gas 3. Boiling water 3. Boiling water 4. Radiation4. Radiation

Sterile TechniqueSterile Technique

The basic principles The basic principles of surgical asepsisof surgical asepsis

1.1. All objects used in a sterile field All objects used in a sterile field must be strile.must be strile.

2.2. Sterile objects become un-sterile Sterile objects become un-sterile when touched by un-sterile when touched by un-sterile objects.objects.

3.3. Sterile items that are out of Sterile items that are out of vision or below the waist level of vision or below the waist level of the nurse are considered unsterile.the nurse are considered unsterile.

4. Sterile objects can become 4. Sterile objects can become unsterile by prolonged unsterile by prolonged exposure to airborne exposure to airborne microorganisms.microorganisms.

5. Fluids flow in the direction 5. Fluids flow in the direction of gravity. of gravity.

6. Moisture that passes through 6. Moisture that passes through a sterile object draws a sterile object draws microorganisms from un-microorganisms from un-sterile surfaces above or sterile surfaces above or below to the sterile surface by below to the sterile surface by capillary action.capillary action.

7.7. The edges of a sterile The edges of a sterile field are considered un-field are considered un-sterile.sterile.

8.8. The skin cannot be The skin cannot be sterilized and is un-sterile.sterilized and is un-sterile.