Jump to: navigation, search Asepsis is the practice to reduce or eliminate contaminants (such as bacteria, viruses, fungi, and parasites) from entering the operative field in surgery or medicine to prevent infection. Ideally, a field is sterile ! free of contaminants ! a situation that is difficult to attain. "o#ever, the goal is elimination of infection, not sterility. Contents $hide% & 'elated terms ( "istory ) *ethods + ,-ternal links [edit] Related terms Antiseptis is a term used sometimes as a synonym, but also applies to the uses of antiseptics. .ntiseptics are agents that reduce or kill germs chemically and are applied to skin and #ound surfaces. In contrast, disinfectants are chemicals applied to inert surfaces and are usually too harsh to be used on biological surfaces. .ntibiotics kill specifically bacteria and #ork biochemically/ they can be used e-ternally or internally. [edit] History 0he first step in asepsis is cleanliness, a concept already espoused by "ippocrates. 0he modern concept of asepsis evolved in the &1th century. 2emmel#eis sho#ed that #ashing the hands prior to delivery reduced puerperal fever. .fter the suggestion by 3ouis 4asteur, 3ister introduced the use of carbolic acid as an antiseptic and reduced surgical infections rates. 3a#son 0ait #ent from antisepsis to asepsis, introducing principles and practices that have remained valid to this day. ,rnst von 5ergmann introduced the autoclave, a device used for the sterilisation of surgical instruments. [edit] Methods 0oday6s techni7ues include a series of steps that complement each other. Foremost remains good hygienic practice. 0he procedure room is laid out according to specific guidelines, sub8ect to regulations concerning filtering and airflo#, and kept clean bet#een surgical cases. . patient #ho is brought for the procedure is #ashed and #ears a clean go#n. 0he surgical site is #ashed, possibly shaved, and skin is e-posed to a germicide (i.e., an iodine solution such as betadine). In turn, members of the surgical team #ash hands and arms #ith germicidal solution. 9perating surgeons and nurses #ear sterile go#ns and gloves. "air is covered and a surgical mask is #orn. Instruments are sterili:ed through autoclaving, or, if disposable, are used once. Irrigation is used in the surgical site. 2uture material or -enografts have been sterili:ed beforehand. ;ressing material is sterile. .ntibiotics are often not necessary in a clean case, that is, a surgical procedure #here no infection is apparent/ ho#ever, #hen a case is considered contaminated, they are usually indicated. ;irty and biologically contaminated material is sub8ect to regulated disposal. [edit] External links This template is misplaced. It belongs on the talk page: Talk:Sepsis. Sepsis (in <reek , putrefaction) is a serious medical condition, resulting from the immune response to a severe infection. Septicaemia is sepsis of the bloodstream caused by bacteremia, #hich is the presence of bacteria in the bloodstream. 0he term septicaemia is also used to refer to sepsis in general. Contents $hide% & ,pidemiology ( 2igns and symptoms ) ;efinition of sepsis + 0reatment = 'elated conditions>complications ? 'eferences @ 2ee also A ,-ternal links [edit] Epidemiology In the Bnited 2tates, sepsis is the leading cause of death in nonCcoronary IDB patients, and the tenth most common cause of death overall according to (EEE data from the Denters for ;isease Dontrol and 4revention. $&% 2epsis is common and also more dangerous in elderly, immunocompromised, and critically ill patients. It occurs in &FC(F of all hospitali:ations and accounts for as much as (=F of intensive care unit (IDB) bed utili:ation. It is a ma8or cause of death in intensive care units #orld#ide, #ith mortality rates that range from (EF for sepsis to +EF for severe sepsis to G?EF for septic shock. [edit] Signs and symptoms 2ymptoms of sepsis are often related to the underlying infectious process. When the infection crosses into sepsis, the resulting symptoms are tachycardia, tachypnea, pyre-ia and>or decreased urination. 0he immunological response that causes sepsis is a systemic inflammatory response causing #idespread activation of inflammation and coagulation path#ays. 0his may progress to dysfunction of the circulatory system and, even under optimal treatment, may result in the multiple organ dysfunction syndrome and eventually death. [edit] e!inition o! sepsis 2epsis is considered present if infection is highly suspected or proven and t#o or more of the follo#ing systemic inflammatory response syndrome (2I'2) criteria are met: $(% "eart rate G 1E beats per minute 5ody temperature H )? (1?.A IF) or G )A ID (&EE.+ IF) "yperventilation (high respiratory rate) G (E breaths per minute or, on blood gas, a 4aD9( less than )( mm "g White blood cell count H +EEE cells>mmJ or G &(EEE cells>mmJ (H + - &E 1 or G &( - &E 1 cells>3), or greater than &EF band forms (immature #hite blood cells). Donsensus definitions ho#ever continue to evolve #ith the latest e-panding the list of signs and symptoms of sepsis to reflect clinical bedside e-perience. $)% 0he more critical subsets of sepsis are severe sepsis (sepsis #ith acute organ dysfunction) and septic shock (sepsis #ith refractory arterial hypotension). .lternatively, #hen t#o or more of the systemic inflammatory response syndrome criteria are met #ithout evidence of infection, patients may be diagnosed simply #ith 2I'2. 4atients #ith 2I'2 and acute organ dysfunction may be termed severe 2I'2. 4atients are defined as having severe sepsis if they have sepsis plus signs of systemic hypoperfusion/ either end organ dysfunction or a serum lactate greater then + mmol>d3. 4atient are defined as having septic shock if they have sepsis plus hypotension after an appropriate fluid bolus (typically (E ml>kg of crystaloid). 0he criteria for diagnosing an adult #ith sepsis do not apply to infants under one month of age. In infants, only the presence of infection plus a constellation of signs and symptoms consistent #ith the systemic response to infection are re7uired for diagnosis (9ski6s 4ediatrics, (EE?). [edit] Treatment 0he therapy of sepsis rests on antibiotics, surgical drainage of infected fluid collections, fluid replacement and appropriate support for organ dysfunction. 0his may include hemodialysis in kidney failure, mechanical ventilation in pulmonary dysfunction, transfusion of blood products, and drug and fluid therapy for circulatory failure. ,nsuring ade7uate nutrition, if necessary by parenteral nutrition, is important during prolonged illness. . problem in the ade7uate management of septic patients has been the delay in administering therapy after sepsis has been recogni:ed. 4ublished studies have demonstrated that for every hour delay in the administration of appropriate antibiotic therapy there is an associated @F rise in mortality. . large international collaboration #as established to educate people about sepsis and to improve patient outcomes #ith sepsis, entitled the 2urviving 2epsis Dampaign. 0he Dampaign has published an evidenceC based revie# of management strategies for severe sepsis, $+% #ith the aim to publish a complete set of guidelines in subse7uent years. ,arly <oal ;irected 0herapy (,<;0), developed at "enry Ford "ospital by ,. 'ivers, *;, is a systematic approach to resuscitation that has been validated in the treatment of severe sepsis and septic shock. It is meant to be started in the ,mergency ;epartment. 0he theory is that one should use a stepC#ise approach, having the patient meet physiologic goals, to optim:e cardiac preload, afterload, and contractility, thus optimi:ing o-ygen delivery to the tissues. $=% In ,<;0, fluids are administered until the central venous pressure (DK4), as measured by a central venous catheter reachs AC&( cm of #ater (or &EC&= cm of #ater in mechanically ventilated patients). If the mean arterial pressure is less than ?= mm"g or greater than 1E mm"g, vasopressors or vasodilators are given as needed to reach the goal. 9nce these goals are met the central venous saturation (2cv9(), i.e. the o-gyen saturation of venous blood as it returns to the heart as measured at the superior vena cava, is optimi:ed. If the 2cv9( is less than @EF, blood is given to reach a hemoglobin of &E g>dl and then inotropes are added until the 2cv9( is optimi:ed. ,lective intubation may be performed to reduce o-ygen demand if the 2cv9( remains lo# despite optimi:ation of hemodynamics. Brine output is also monitored, #ith a goal of E.= ml>kg>h. In the original trial, mortality #as cut from +?.=F in the control group to )E.=F in the intervention group. $=% 0he 2urviving 2epsis Dampaign guidelines recommends ,<;0 for the initial resuscitation of the septic patient #ith a level 5 strength of evidence (single randomi:ed control trial). $+% *ost therapies aimed at the inflammatory process itself have failed to improve outcome, ho#ever drotrecogin alfa (activated protein D, one of the coagulation factors) has been sho#n to decrease mortality from about )&F to about (=F in severe sepsis. 0o 7ualify for drotrecogin alfa, a patient must have severe sepsis or septic shock #ith an .4.D", II score of (= or greater and a lo# risk of bleeding. $?% 3o# dose hydrocortisone treatment has sho#n promise for septic shock patients #ith relative adrenal insufficiency as defined by .D0" stimulation testing. $@% 2tandard treatment of infants #ith suspected sepsis consists of supportive care, maintaining fluid status #ith intravenous fluids, and the combination of a betaClactam antibiotic (such as ampicillin) #ith an aminoglycoside such as gentamicin. [edit] Related conditions"complications Infection is the invasion of normally sterile host tissues by a microbial pathogen. 5acteremia is the presence of bacteria in the blood. 5acteremia can occur in sepsis and other serious diseases such as infective endocarditis, bacteremic pyelonephritis or pneumonia and meningitis but it may also be a harmless and transient condition. 2eptic 8oint is an infection of a 8oint/ it is associated #ith bacteremia and trauma. ;isseminated intravascular coagulation (;ID) can be the result of sepsis .cute tubular necrosis (.0L) leading to acute renal failure, can be the result of hypoperfusion of the kidneys in sepsis (i.e. not enough blood gets to the kidney and they stop #orking properly) .rrhythmia is an abnormal heart rhythm/ it can be the result of sepsis. Ileus or ischemic colitis can be the result (hypoperfusion) or cause of sepsis *ultiple organ dysfunction syndrome can be the result of sepsis *eningitis, infection of the tissue that covers the brain and spinal cord, can be a complication or cause of sepsis 9steomyelitis is an infection of the bone/ it can be the cause or result of sepsis ,ndocarditis, infection of the inner surface of heart #hich is in contact #ith blood, can also be a complication or cause of sepsis 4yaemia ! causes abscesses [edit] Re!erences &. # *artin <2, *annino ;*, ,aton 2, *oss *. 0he epidemiology of sepsis in the Bnited 2tates from &1@1 through (EEE. L ,ngl J *ed. (EE) .pr &@/)+A(&?):&=+?C=+. 4*I; &(@EE)@+ Full 0e-t. (. # 5one 'D, 5alk '., Derra F5, ;ellinger '4, Fein .*, Mnaus W., 2chein '*, 2ibbald WJ. ;efinitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. 0he .DD4>2DD* Donsensus Donference Dommittee. .merican Dollege of Dhest 4hysicians>2ociety of Dritical Dare *edicine. Dhest. &11( Jun/&E&(?):&?++C==. 4*I; &)E)?((. ). # 3evy **, Fink *4, *arshall JD, .braham ,, .ngus ;, Dook ;, Dohen J, 9pal 2*, Kincent J3, 'amsay </ 2DD*>,2ID*>.DD4>.02>2I2. (EE& 2DD*>,2ID*>.DD4>.02>2I2 International 2epsis ;efinitions Donference. Drit Dare *ed. (EE) .pr/)&(+):&(=EC?. +. N a
b ;ellinger '4, Darlet J*, *asur ", <erlach ", Dalandra 0, Dohen J, <eaC 5anacloche J, Meh ;, *arshall JD, 4arker **, 'amsay <, Oimmerman J3, Kincent J3, 3evy **/ 2urviving 2epsis Dampaign *anagement <uidelines Dommittee. 2urviving 2epsis Dampaign guidelines for management of severe sepsis and septic shock. Drit Dare *ed. (EE+ *ar/)(()):A=AC@). ,rratum in: Drit Dare *ed. (EE+ Jun/)((?):&++A. Dorrection of dosage error in te-t. Drit Dare *ed. (EE+ 9ct/)((&E):(&?1C@E. 4*I; &=E1E1@+. =. N a
b 'ivers ,, Lguyen 5, "avstad 2, 'essler J, *u::in ., Mnoblich 5, 4eterson ,, 0omlanovich */ ,arly <oalC;irected 0herapy Dollaborative <roup. ,arly goalCdirected therapy in the treatment of severe sepsis and septic shock. L ,ngl J *ed. (EE& Lov A/)+=(&1):&)?AC@@. ?. # 5ernard <', Kincent J3, 3aterre 4F, 3a'osa 24, ;hainaut JF, 3ope:C'odrigue: ., 2teingrub J2, <arber <,, "elterbrand J;, ,ly ,W, Fisher DJ Jr/ 'ecombinant human protein D World#ide ,valuation in 2evere 2epsis (4'9W,22) study group. ,fficacy and safety of recombinant human activated protein D for severe sepsis. L ,ngl J *ed. (EE& *ar A/)++(&E):?11C@E1. 4*I; &&()?@@) Full 0e-t. @. # .nnane ;, 2ebille K, Dharpentier D, 5ollaert 4,, Francois 5, Morach J*, Dapellier <, Dohen P, .:oulay ,, 0roche <, DhaumetC'iffaut 4, 5ellissant ,. ,ffect of treatment #ith lo# doses of hydrocortisone and fludrocortisone on mortality in patients #ith septic shock. J.*.. (EE( .ug (&/(AA(@):A?(C@&. 4*I; &(&A??E+. [edit] See also *eningococcemia 2eptic shock 2ystemic inflammatory response syndrome [edit] External links 2urviving 2epsis Dampaign International 2epsis Forum Advances in Sepsis 8ournal sepsis.com: $&% *edscape 2epsis 'esource Denter 'etrieved from http:>>en.#ikipedia.org>#iki>2epsis Dategories: Dleanup from June (EE@ Q .ll pages needing cleanup Q Wikipedia articles needing conte-t Q Wikipedia introduction cleanup Q Wikipedia articles that are too technical Q *ain pages #ith misplaced talk page templates Q Infectious diseases Q *edical emergencies Q Intensive care medicine Asepsis a$s %ikipedia& der !reien En'yklop(die Wechseln :u: Lavigation, 2uche Bnter Asepsis (griech. RMeimfreiheitS, #Trtlich Rohne FulnisS) versteht man in der *edi:in alle *aUnahmen :ur 5eseitigung von Mrankheitserregern. 2ie soll das ,indringen von Kiren, 5akterien und 4il:en in den 9rganismus bei chirurgischen ,ingriffen verhindern. *aUnahmen :ur .sepsis (Raseptische KautelenS) sind unter anderem: 'aumdesinfektion, #obei hier nur <ren:#erte erreicht #erden kTnnen. ,inen 'aum, in dem *enschen arbeiten, kann man nicht vTllig sterilisieren. 2terilisation (Meimfreimachung) aller medi:inischen Instrumente und der Mleidung (9perationskittel, "andschuhe), Ker#endung steril verpackter ,inmalinstrumente und Ckleidung. *an muss auch hier bedenken, dass es einige 2porenbildner und Kiren gibt, die sich von den Vblichen 2terilisationsverfahren nicht inaktivieren lassen. 'aumluftsterilisation, auch R3aminar Flo#S genannt, bedeutet, dass der .rbeitsbereich mit einer laminaren, von oben nach unten gerichteten 2trTmung steril filtrierter 3uft durchstrTmt #ird. ;ies soll verhindern, dass Meime aufge#irbelt #erden, b:#. #erden diese am 5oden gehalten. ;ie in dem 5ereich arbeitenden 4ersonen tragen partikelarme Mleidung so#ie einen *undschut:. In besonderen FWllen kann die ausgeatmete 3uft laufend abgesaugt #erden. ;iese 0echnik stellt der:eit ((EE=) das "TchstmaU an Meimarmut dar, das erreichbar ist. Kerhalten im 9perationsaal: "ier gibt es einige Kerhaltensregeln, die ebenfalls einer Kerkeimung entgegen#irken sollen .b:ugren:en von dem 5egriff der .sepsis ist die .ntisepsis, die keine vollstWndige Meimfreiheit, sondern nur eine Meimreduktion bedeutet. Siehe a$ch [)ear*eiten] Hospitalismus Alternati+e names Return to top Systemic inflammatory response syndrome (SIRS) e!inition Return to top 2epsis is a severe illness caused by over#helming infection of the bloodstream by to-inCproducing bacteria. Ca$ses& incidence& and risk !actors Return to top 2epsis is caused by bacterial infection that can originate any#here in the body. Dommon sites include the follo#ing: The kidneys (upper urinary tract infection) The liver or the gall bladder The bowel (usually seen with peritonitis) The skin (cellulitis) The lungs (bacterial pneumonia) *eningitis may also be accompanied by sepsis. In children, sepsis may accompany infection of the bone (osteomyelitis). In hospitali:ed patients, common sites of infection include intravenous lines, surgical #ounds, surgical drains, and sites of skin breakdo#n kno#n as decubitus ulcers or bedsores. 0he infection is often confirmed by a positive blood culture, though blood cultures may be negative in individuals #ho have been receiving antibiotics. In sepsis, blood pressure drops, resulting in shock. *a8or organs and systems, including the kidneys, liver, lungs, and central nervous system, stop functioning normally. . change in mental status and hyperventilation may be the earliest signs of impending sepsis. 2epsis is often lifeCthreatening, especially in people #ith a #eakened immune system or other medical illnesses. Symptoms Return to top Fever or hypothermia (low body temperature) Hyperventilation hills Shaking !arm skin Skin rash Rapid heart beat onfusion or delirium "ecreased urine output Signs and tests Return to top !hite blood cell count that is low or high #latelet count that is low $lood culture that is positive for bacteria $lood gases that reveal acidosis %idney function tests that are abnormal (early in the course of disease) This disease may also alter the results of the following tests& #eripheral smear may demonstrate a low platelet count and destruction of red blood cells' Fibrin degradation products are often elevated( a condition that may be associated with a tendency to bleed' $lood differential )) with immature white blood cells seen Treatment Return to top 2eptic patients usually re7uire monitoring in an intensive care unit (IDB). 5road spectrum intravenous antibiotic therapy should be initiated as soon as sepsis is suspected. 0he number of antibiotics administered may be decreased #hen the results of blood cultures become available and the causative organism is identified. 0he source of the infection should be discovered, if possible, #hich may mean further diagnostic testing. 2ources such as infected intravenous lines or surgical drains should be removed, and sources such as abscesses should be surgically drained. 2upportive therapy #ith o-ygen, intravenous fluids, and medications that increase blood pressure may be re7uired for a good outcome. ;ialysis may be necessary in the event of kidney failure, and mechanical ventilation is often re7uired if respiratory failure occurs. Expectations ,prognosis- Return to top 0he death rate can be as high as ?EF for people #ith underlying medical problems. *ortality is less (but still significant) in individuals #ithout other medical problems. Complications Return to top Septic shock Impaired blood flow to vital organs (brain( heart( kidneys) "isseminated intravascular coagulation Update Date: 8/8/2006 Sepsis is a serious but rare infection that is usually caused by bacteria. It occurs when bacteria, which can originate in a child's lungs, intestines, urinary tract, or gallbladder, make toxins that cause the body's immune system to attack the body's own organs and tissues. Sepsis can be frightening because if it is untreated, it can lead to serious complications that affect a child's kidneys, lungs, brain, and hearing. But by learning to recognize the symptoms, you can help your child get treatment and fully recover. Sepsis can affect a person of any age, but it is more prevalent in young infants whose immune systems have not developed enough to fight off overwhelming infections and people whose immune systems are compromised from conditions such as I!. If your infant has a rectal temperature of "##.$ degrees %ahrenheit &'( degrees )elsius*, seems lethargic, uninterested in eating, or seems to be having difficulty breathing, it's a good idea to call your child's doctor. In an older child, the symptoms of sepsis may include a fever &an oral temperature at or above ++., degrees %ahrenheit -'.., degrees )elsius/*0 your child may also seem lethargic, irritable, and may complain that his or her heart feels like it's racing. If your child's temperature is normal, but you're still concerned, it's a good idea to call the doctor. What Is Sepsis? Sepsis occurs when the body's normal reaction to inflammation or a bacterial infection goes into overdrive. 1ith sepsis, the bacteria create a toxin that causes a widespread inflammation of the body's organs and causes rapid changes in a person's body temperature, blood pressure, and dysfunction in the lung and other organs. Babies under the age of 2 months are more susceptible to sepsis because their immune systems have not yet developed enough to fight off some serious infections. It is also more prevalent in people of all ages whose immune systems are compromised by chronic illnesses and conditions like I!. Signs and Symptoms of Sepsis Sepsis in newborns produces few concrete symptoms, though symptoms can vary widely between from child to child. %re3uently, these babies suddenly aren't feeling well or 45ust don't look right4 to their caretakers. Some of the more common signs or symptoms of sepsis in newborns and young infants include6 disinterest or difficulty in feeding fever &above "##.$ degrees %ahrenheit -'( degrees )elsius/ rectally* or sometimes low, unstable temperatures irritability or increased crankiness lethargy ¬ interacting and listless* decreased tone &floppiness* changes in heart rate 7 either faster than normal &early sepsis* or significantly slower than usual &late sepsis, usually associated with shock* breathing very 3uickly or difficulty breathing periods where the baby seems to stop breathing for more than "# seconds &apnea* 5aundice 8lder children who have sepsis might have a fever &an oral temperature above ++., degrees %ahrenheit -'.., degrees )elsius/*, vomit, and complain of feeling like their hearts are racing. 9 child with sepsis may have started with an infection such as cellulitis that seems to be spreading and getting worse, not better. What Causes Sepsis? Bacteria are almost always the cause of sepsis in newborns and infants. Bacteria such as E. coli, Listeria monocytogenes, Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae type b, Salmonella, and :roup B streptococcus &:BS* are the more common culprits in sepsis in newborns and infants younger than ' months. ;remature babies receiving neonatal intensive care are particularly susceptible to sepsis because their immune systems are even more underdeveloped than other babies, and they typically undergo invasive procedures involving long7term intravenous &I!* lines, multiple catheters, and need to breathe through a tube attached to a ventilator. <he incisions a young infant gets for catheters or other tubes can provide a path for bacteria, which normally live on the skin's surface, to get inside the baby's body and cause the infection. In many cases of sepsis in new babies, bacteria enter the baby's body from the mother during pregnancy, labor, or delivery. Some pregnancy complications that can increase the risk of sepsis for a newborn include6 bleeding maternal fever an infection in the uterus or placenta premature rupture of the amniotic sac &before '. weeks of gestation* rupture of the amniotic sac very early in labor &"( hours or more before delivery* a long, difficult delivery Some bacteria 7 :BS in particular 7 can be ac3uired by the newborn as the child is being delivered. 9t least one out of every five pregnant women carries the bacterium for :roup B streptococcus in her vagina or rectum, where it can be passed from mother to child during delivery. Diagnosing and Treating Sepsis Because symptoms of sepsis can be vague in infants, laboratory tests play a crucial role in confirming or ruling out sepsis. <hese lab tests may include6 Blood tests &including red and white blood cell counts* and blood cultures may be taken to determine whether bacteria are present in the blood. =rine is usually collected by inserting a sterile catheter into the baby's bladder through the urethra for a few seconds to remove urine0 this will be examined under a microscope and cultured to check for the presence of bacteria. 9 lumbar puncture &spinal tap* may be performed, depending on the baby's age and overall appearance. 9 sample of cerebrospinal fluid will be tested and cultured to determine if the baby has possible meningitis. >7rays, especially of the chest &to make sure there isn't pneumonia*, are sometimes taken. If the baby has any kind of medical tubes running into his or her body &such as I! tubes, catheters, or shunts*, the fluids inside those tubes may be tested for signs of infection as well. Sepsis, or even suspected cases of sepsis in infants, is treated in the hospital, where doctors can closely watch the infection and administer strong antibiotics intravenously to fight the infection. <ypically, doctors start infants with sepsis on antibiotics right away 7 even before the diagnosis is confirmed. If more symptoms of sepsis begin to appear, they usually start them on I! fluids to keep them hydrated, blood pressure medication to keep their hearts working properly, and respirators to help them breathe. Can Sepsis Be Prevented? 9lthough there's no way to prevent all types of sepsis, some cases can be avoided, namely the transmission of :roup B streptococcus bacteria from mother to child during childbirth. ;regnant women can have a simple swab test during the ',th and '.th weeks of pregnancy and again 5ust before the birth to determine if they carry the :BS bacteria. If a woman tests positive for :BS, she can receive intravenous antibiotics during labor. 1omen are at higher risk of carrying :BS if they have a fever during labor, if the amniotic sac ruptures prematurely, if they have prolonged labor, or if they had other children with sepsis or other diseases triggered by :BS, such as pneumonia or meningitis. 9 woman with one of these risk factors can receive intravenous antibiotics to lower her risk of transmitting the bacteria to her child. Immunizations routinely given to infants today include vaccinations against certain strains of pneumococcus and Haemophilus influenzae type b that can cause sepsis or occult bacteremia, an infection of the blood. When to Call Your Childs Doctor Because the symptoms of sepsis can be very difficult to identify in newborns and young infants, it's a good idea to call your child's doctor or seek emergency medical care if your baby shows any of the following symptoms6 difficulty or continued disinterest in feeding fever &"##.$ degrees %ahrenheit -'( degrees )elsius/ and above rectal temperature* in newborns and young infants labored or unusual breathing change in skin color &paler than usual or mildly bluish* listlessness or lethargy change in the sound of the baby's cry or excessive crying change in baby's muscle tone 7 either seeming too stiff or especially floppy a slower or faster heart rate than usual bulging or fullness of the 4soft spot4 on the baby's head any type of behavior or appearance that concerns you <hese signs and symptoms don't necessarily mean your baby has sepsis, but infants who are younger than ' months should be checked out immediately to ensure that nothing else is wrong. ?eviewed by6 Barbara ;. omeier, @A Aate reviewed6 Bune 2##, Asepsis Training 2tradis "ealthcare can provide your kit in any format #ith any content that you re7uire for your procedures. 5ecause our kits are customi:able, many of our customers have the packages divided according to ho# the content #ill be used. For e-ample, your package may have t#o sections that can be cut apart. 0he first #ould contain the nonCsterile shoe covers, masks, hair covers and scrub items. 0he second section #ould contain all the sterile materials such as go#ns, gloves, drapes, to#els, gau:e, etc. 9ur customers fre7uently include items they once purchased in bulk packaging to help them control inventory and reduce the chances they may run out of a needed item. 0his is particularly true of items that are only used for procedures re7uiring asepsis. 'emember, the more you place in the pack, the less you have to #orry about running short. 2ome items that our customers find useful to include in their packs are e-tra gau:e, to#els and tubing. *any also use the light handle covers for controls on certain types of instruments should they need ad8usting during the procedure. Pou may find that you6ll need to ad8ust your kits several times to find the optimal combination for your needs. 0hat6s the beauty of our system X our trained sales professionals are al#ays available to make changes and suggestions to make your life easier. 0his overvie# of asepsis techni7ue is like#ise designed to make your life a little easier. It is divided into five sections: <eneral 'ules of .sepsis 5efore Pou 5egin 0he 2crub 9peratory 4reparation 4atient 4reparation