Medical / Surgical Asepsis and Infection Control

Foundations of NursingChristensen Kockrow Mosby Lois White / Thomas

Sharon L. Kinley-Schwing BSN Pacific College 2006

Medical/Surgical Asepsis and Infection Control

• Joseph Lister (1827 – 1912) is known as the father of aseptic technique.

• Josephs technique helped reduce morbidity and mortality.

• It is now known that microorganisms cause infection.

• The growth and reproduction of a microorganism must be stopped to prevent an infection.

• Concern and education regarding transmissible infections have increased in both hospitals and homes.

Infection Control

• Policies and procedures in infection control are included in all health care facilities.

• The education of all staff personnel is to minimize the risk of nosocomial infections.

• Any patient entering a health care facility, due to illness or need for invasive procedure is at risk for developing an infection.

• The application of infection control principles, and use of common sense help protect the patients.

• Nurses are very often exposed to pathogenic microorganisms and should use specialized and routine practices of cleanliness to prevent the spread of infection.

Asepsis

• Microorganisms are tiny, microscopic, capable of carrying on living process.

• Microorganism are naturally present in the environment, as well as on the human body.

• Many microorganisms are harmless, unless an individual is ill, and then highly susceptible to infection.

• There are some microorganisms that do cause specific diseases or infections.

Asepsis

• Medical asepsis, know as clean technique, inhibits the growth and spread of pathogenic microorganisms:

– Hand washing.

– Changing the patients linen daily.

– Daily activities of cleanliness.

– Principles of medical asepsis is common at home.

• Surgical asepsis, known as sterile technique, destroys all microorganisms and their spores .

– Sterile technique and use in special skills and procedures.

– Care of surgical wounds.

– Urinary catheters.

– Invasive procedures and surgery.

FLORA

• Microorganisms that occur or have adapted to live in a specific environment.

• Resident flora–always present, usually without altering the client’s health.

• Transient flora–episodic, and do not continually live on the skin.

PATHOGENICITY AND VIRULENCE

• Pathogens–disease-producing microorganisms.

• Pathogenicity–ability of microorganism to produce disease.

• Virulence–frequency with which a pathogen causes disease.

FACTORS AFFECTING VIRULENCE

• The strength of the pathogen to adhere to healthy cells.

• The ability of a pathogen to damage cells or interfere with the body’s normal regulating systems.

• The ability of a pathogen to evade the attack of white blood cells.

Infection Process

• Six elements must be present for infection to occur:

Infectious agent

Reservoir

Exit

Method of transportation

Entrance

Host

The Chain of Infection

Infectious Agents

BACTERIA

• Small, one-celled microorganisms that lack a true nucleus or mechanism to provide metabolism.

• Not all bacteria harmful or cause disease.

• Common bacterial infections: diarrhea, pneumonia, sinusitis, cellulitis, urinary tract infections, meningitis, gonorrhea.

Bacteria

• Many different characteristics.• Three basic shapes, they include ?• During cell division some bacterial stay together

to form pairs. • These difference help identifying specific kinds

of bacteria.• Aerobic bacteria• Anaerobic bacteria• What is a spore ?

Bacteria continued

• Many diseases can be diagnosis and treated when the specific microorganism in identified.

• Body fluids, secretion suspected of containing pathogenic organisms can be evaluated for diagnosis.

• Cultures and sensitivity test are completed to determine the antibiotic that will inhibit growth.

• Streptococcus is responsible for more diseases than any other organism. Some strains are fatal.

Viruses

• Smallest known agents that cause disease.

• Not complete cells, but consist of a protein coat around a nucleic acid core.

• 1898 Beijernick name these small bodies viruses.

• 1941 electron microscope made in possible to study these small agents.

• Enter the body via the respiratory, gastrointestinal, broken skin (vector or injection).

• Most viruses are self limiting illnesses, others are fatal.

VIRUSES

• Organisms that can live only inside cells.

• They cannot get nourishment or reproduce outside cells.

• Common viral infections: common cold, influenza, measles, chickenpox, hepatitis B, genital herpes, HIV.

Fungi

• Fungal (mycotic ) infections are among the most common.

• Fungi belong to the plant kingdom, many are harmless, some are responsible for infections.

• The grey, black, green, white fuzzy growth on old bread is a type of fungi.

• Most mycotic infections are caused by yeasts and molds.

• Most commonly involve the skin and mucous membranes.

• Fungi that invade deeper tissue may be come fatal.

FUNGI

• Grow in single cells or in colonies.

• Food from dead organic matter, living organisms.

• Most are not pathogenic.

• Fungi can cause infections of the hair, skin, nails, and mucous membranes.

Protozoa

• Single celled animals existing every where in nature in some form.

• Some of the parasitic forms are found in the intestinal, genitourinary, respiratory and circulatory systems.

• Disease producing protozoa are responsible for malaria, amebic dysentery, and African sleeping sickness.

• Pathogenic microorganisms are infectious agents.

• These microorganisms require food, and a proper environment in which to grow and live.

• The strength of the organism, depends on the number present and the patients immune system.

PROTOZOA

• Single-celled parasitic organisms with ability to move.

• Food from dead, decaying organic matter.

• Infection is spread through contaminated food, water, or insect bites.

• Common infections: malaria, gastroenteritis, vaginal infections.

RICKETTSIA

• Intracellular parasites that

need to be in living cells to reproduce.

• Spread through fleas, ticks, mites, and lice.

• Common rickettsia infections include typhus, Rocky Mountain spotted fever, and Lyme disease.

COLONIZATION AND INFECTION

• Colonization–the multiplication of microorganisms on or within a host without resulting in cellular injury.

• Infection–the invasion and multiplication of pathogenic microorganisms in body tissue that result in cellular injury.

AGENT

Entity that can cause disease:

• Biological agents: living organisms that invade the host, causing disease

• Chemical agents: substances that can interact with body, causing disease.

• Physical agents: factors in environment capable of causing disease.

RESERVOIR

Place where agent can survive:

• In humans, animals, environment.

• Fomites–objects contaminated with infectious agent.

• Carriers–have infectious agent but symptom free.

Reservoir continue

• Any natural habitat of a microorganism that promotes growth and reproduction is a reservoir.

• Many microorganisms are found in many areas of the body, but the presents doesn’t always mean infection.

• Examples of Reservoirs: Soiled dressings Wet dressings Bed linens/ Gowns/Uniforms Hospital equipment Urinary drainage bags/ Urinals Carrier or vector is a person or animal that harbors and

spreads an organism causing disease, with out becoming ill them self.

Exit Route

• Microorganism cannot spread without first finding a way out of the first host.

• Human exit routes include: gastrointestinal respiratory genitourinary blood tissue

• Handwashing prevent the spread of microorganisms or cross contamination.

• Coving the nose and mouth when coughing also prevents the spread of dieses causing organisms.

PORTAL OF EXIT

How infectious agent leaves the reservoir:

• Sputum.

• Semen, vaginal secretions, and urine.

• Saliva and feces.

• Blood.

• Draining wounds.

• Tears.

Method of Transmission

• Once a microorganism has exited a reservoir there are many vehicles.

• These vehicles are called contaminated, soiled or stained.

• What is a fomite ?

• What is a vector ?

Give examples of each..

MODES OF TRANSMISSION

Movement of infectious agent from reservoir or source through portal of exit to portal of entry of susceptible host:

• Contact transmission.

• Airborne transmission.

• Vehicle transmission.

• Vector-borne transmission.

PORTAL OF ENTRY

How an infectious agent enters the host:

• Integumentary system.

• Respiratory tract.

• Genitourinary tract.

• Gastrointestinal tract.

• Circulatory system.

• Transplacental.

Entrance of Microorganisms

• Once an organism has exited one host and been transmitted, it must find a way to enter a susceptible host.

• When a host’s defense mechanisms are reduced, there is a greater chance of the organism to enter.

• What are some of the ways organism can enter a host?

Host

• A host is an organism in which another , usually parasitic, organism is nourished and harbored.

• Susceptibilities are determined by the amount to resistance shown to the pathogen.

• Microorganisms are constantly in contact with people, but infections do not develop unless a person is susceptible to the numbers of organisms.

• Immunizations have proven effective in providing additional protection against infectious disease.

HOST

• Organism that can be affected by agent.

• Susceptible host–person who has no resistance to an agent and thus is vulnerable to disease.

• Compromised host–person whose normal body defenses are impaired and is therefore susceptible to infection.

FACTORS AFFECTING SUSCEPTIBILITY TO INFECTION

• Age

• Concurrent diseases

• Stress

• Immunization/vaccination status

• Lifestyle and occupation

• Nutritional status

• Heredity

• Infectious process:

incubation period

prodromal stage

illness stage

convalescence

• Inflammatory response:

STAGES OF INFECTION

• Incubation stage–the time between entry of an infectious agent and the onset of symptoms.

• Prodromal stage–the time from the onset of nonspecific symptoms until specific symptoms begin to manifest.

• Illness stage–the time when client has specific signs and symptoms.

• Convalescent stage–from the beginning of the disappearance of acute symptoms until client returns to previous state of health.

Nosocomial Infections

• Term taken from the Greek word, meaning health care facility.

• An infection that is acquired while in a hospital or other health care agency.

• This infection is usually acquired at least 12 hour after admission.

• The hospital harbors microorganisms that may be highly virulent.

NOSOCOMIAL INFECTIONS continued

• Infection acquired in hospital or other health care facility that was not present at the time of the client’s admission.

• Include those infections that become symptomatic after the client is discharged.

• Four categories: urinary tract, surgical wounds, pneumonia, and septicemia.

• These infections cause extended stays and treatment for patient, and increase cost of care for the hospital.

Infection Control Team

• Valuable discipline in the health care arena. • These teams include who ?

• OSHA and JAHO have pressured hospitals to better organize these teams, and document infections within the hospital.

• What is the duty of infection control personnel ?

• Employee health services.

BREAKING THE CHAIN OF INFECTION

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Standard Precautions • Set of guidelines designed to reduce the link of transmission of

blood born pathogens and pathogens from moist body secretions.

• Guidelines apply to:– Blood– All body fluids, secretions and excretions– Nonintact skin– Mucous membrane

– Precautions promote:– Handwashing– Use of gloves, masks, eye protection– Use of gowns when appropriate for patient contact

Hand Hygiene

• The most important and basic preventive technique for interruption the infectious process.

• 2 minute handwashing will provide protection before the nurse cares for a patient.

• 30 second handwashing before caring for another patient should be sufficient to ensure minimal transmission of microorganism between patients.

MEDICAL ASEPSIS

• Hand hygiene–the most basic and effective infection-control measure to prevent and control the transmission of infectious agents.

• Single most important procedure for preventing nosocomial infections.

• Performing a 2 minute hand wash.

• Using an Alcohol-Based Waterless Antiseptic for Routine Hand Hygiene.

Performing a 2-minute

handwashing

(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions

and clinical skills. [3rd ed.]. St. Louis: Mosby.)

Health Promotion Considerations

• Adequate exercise, well balanced diet, current immunizations.

• Discuss susceptibility of the patient to disease.

• Teach correct and safe methods of storing and preparing foods.

• Hygiene.

• Know family and others susceptibilities to disease.

• Home cleaning techniques for patients cared for at home.

Gloving

• Gloves are use if there is nay possibility of contact with infectious material.

• Advice from the CDC on wearing gloves include ?

• Donning gloves / Removing gloves

• Gowning gowning for isolation

• Mask / Protective eyewear donning a mask

• Disposing of Contaminated Equipment

• Double bagging

• Isolation technique

Donning a mask.

(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)

Double bagging.

Types of PrecautionsPatients Requiring Precaution

• Standard precautions

• Airborne precautions

• Droplet precautions

• Tuberculosis isolation

Types of Precautions continued

• Contact Precautions

• Immunocompromised patients

• Monitoring of isolation

ASEPSIS

• Absence of microorganisms

• Medical asepsis–practices used to reduce the number, growth, and spread of microorganisms

• Surgical asepsis–practices that eliminate all microorganisms and spores from an object or area

Surgical Asepsis

• Surgical or sterile technique, requires a nurse to use precautions different from those of medical asepsis.

• Nurse working with a sterile field or equipment must understand sterile technique.

• Any break in this technique results in contamination.

• Surgical asepsis is practiced in the operating room, labor and delivery area, and major diagnostic areas.

• Surgical asepsis may also be used during procedures at the bedside.

Surgical handwashing

Surgical Handwashing.

(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)

Cleaning Disinfection and Sterilization

• Cleaning

• Disinfection

• Sterilization

• Preparing for disinfection and sterilization

CLEANSING

• Removal of soil or organic material from instruments and equipment used in providing client care.

• Involves the use of water, mechanical action, and sometimes, a detergent.

• Nurses should wear gloves, masks, and goggles during cleansing.

Sterilization or Disinfection

• Physical Method Steam under pressure/ moist heat Boiling water Radiation Dry heat

• Chemical Process Gas Chemical solutions

DISINFECTION

• Elimination of pathogens, except spores, from inanimate objects.

• Disinfectants–chemical solutions used to clean inanimate objects.

• Germicides–chemicals that can be applied to both animate (living) or inanimate objects to eliminate pathogens.

STERILIZATION

• Destroying all microorganisms including spores.

• Equipment that enters normally sterile tissue or blood vessels must be sterilized.

STERILIZATION (continued)

• Methods include: – Moist heat (steam)– Dry heat– Ethylene oxide gas

• Autoclaving (moist heat or steam) is the most common method.

B, Receptacle receiving fluids is placed near edge of sterile table.

Patient Teaching for Infection Control

• The nurse will need to educate patient about the nature of infection and the techniques to use in planning or controlling its spread:

– Infection control for home and hospice settings.

– Prevention of infection:

• Hand washing

• food preparation

• lines

• waste containers

• body fluid spills

• Older adult considerations

• Cultural and Ethnic Considerations

Infection Control

Infection Control for Home and Hospice Settings

• Nursing Process

• Assessment

• Prevention of Infection in the Home setting:

Hand hygiene

Food preparation

Linens

Waste containers

Body fluid spills

BODY DEFENSES

• A host’s immune system is a defense against infectious agents.

• An immune response against an antigen protects the body from infection.

• Immune defenses are identified as nonspecific and specific.

NONSPECIFIC IMMUNE DEFENSE

Protects host from all microorganisms; does not depend on prior exposure to antigen:

• Skin and normal flora.

• Mucous membranes.

• Coughing, sneezing, and tearing reflexes.

• Elimination and acidic environment.

• Inflammation.

INFLAMMATION

Nonspecific cellular response to tissue injury:

• Redness (erythema).

• Heat.

• Pain.

• Swelling (edema).

• Loss of function.

• Purulent exudate (pus).

SPECIFIC IMMUNE DEFENSE

Response specific to an invading antigen.

• Acquired immunity–protects individual against future invasions of already experienced antigens.

• Vaccination–an inoculation with a vaccine to produce immunity against specific diseases.

TYPES OF INFECTION

• Localized infections–limited to defined area or single organ with symptoms that resemble inflammation (redness, tenderness, swelling), such as cold sore.

• Systemic infections–affect entire body, involve multiple organs, such as AIDS.

NURSING DIAGNOSIS

• Risk for infection.

• Ineffective protection.

• Impaired tissue integrity.

• Impaired oral mucous membrane.

• Impaired skin integrity.

• Deficient knowledge (specify).

• Nursing diagnosis

• Expected outcomes

• Planning

• Implementation

• Evaluation

Questions ?