Medical Asepsis

Ella Yu
Asepsis
 Freedom from disease- causing
microorganism
 Medical and surgical

 Sepsis = state of infection ( can take many

forms ,including septic shock)
Medical asepsis
 The practices intended to confine a specific
microorganism to a specific area, limiting the
number, growth and transmission of
microorganism.
 Clean- absence of almost all microorganism

 Dirty- likely to have microorganism, some of

which may be capable of causing infection
Surgical asepsis
 Steriletechnique
 Practices keep an area or object free of all
microorganism
 Practices destroy all microorganism and
spores
Infection
 An invasion of body tissue by microorganism
(infectious agent)
 Asymptomatic or subclinical ( no clinical
evidence of disease)
 Disease (a detectable alteration in normal
tissue function)
Microorganism
 Harmful Vs Beneficial
 Enterobacteria- bacteriocins (lethal to related strain of bacteria, other produce
antibiotic- like substances and toxic metabolites that repress the growth of the other
microorganism)
 Normal residential flora- e.g. Escherichia coli (the collective vegetative in a given
area, yet produce infection to other)
 Virulence
 Their ability to produce disease
 Vary in the severity of disease
 Vary in their degree of communicability (common cold virus Vs Mycobacterium
leprae)
 Communicable disease- the infectious agent can be transmitted to an individual by
direct or indirect contact (vector/ vehicle/ airborne infection)
 Pathogenicity
 True pathogen
 Opportunistic pathogen – causes disease only in susceptible individual
 Examples of Common Resident
Microorganisms
Skin and nasal  Staphylococcus epidermidis
passages  Staphylococcus aureus

Oropharynx  Lactobacillus
Mouth  Streptococcus pneumoniae

Intestine Enterobacteriacea
Escherichia coli

Urethral orifice, Proteus

urethra, Vagina Clotridium
Candida albicans
Microorganism
 Bacteria
 Common infection- causing microorganisms
 Viruses (consist nucleic acid)
 Enter living cells to reproduce
 Fungi
 Yeasts and mold
 Candida albicans- normal flora in vagina
 Parasites
 Live on other organism
 Protozoa- malaria, helminths (worm), anthropods (mites,
fleas, ticks)
Types of infection
 Colonization

 Local infection
 (Specific part of the body)
 Systemic infection
 (Spread and damage different part)
 Acute / chronic infection
 Appear suddenly/ occur slowly, last for long time
 Nosocomial infection
Nosocomial infection
 Associate with the delivery of health care services in a health
care facility
 (acquired by health care professionals)
 Endogenous( microorganism originate from the client)
 E. Coli
 Exogenous( from hospital environment MRSA)
 Methicillin resistance staphylococcus aureus
 Iatrogenic infections
 Direct result of diagnostic or therapeutic procedure
 Insertion of intravascular line, urinary catheter
 National Nosocomial Infection Surveillance (NNIS)
 http://www.cdc.gov/ncidod/hip/survrill/nnis.htm
Chain of infection
 Etiology agent
 Virulence and potency of the microorganism
 Susceptibility of the host
 Ability to enter, ability to live in host
 Reservoir
 A carrier- a person or animal reservoir of a
specific infectious agent that usually does not
manifest any clinical signs of disease
 Portal of exit
p. 631
Chain of infection
 Method of transmission
 Direct transmission (through touching, bitting, kissing, sexual
intercourse, droplet- sneezing, coughing)
 Indirect transmission
 Vehicle- borne (inanimate- toys, food, blood)
 Vector- borne (animal/ insects)
 Airborne transmission
 Droplets/ dust is transmitted by air current
 Droplet nuclei- the residue of evaporated droplet
Chain of infection
 Portal of entry of susceptible host
 Skin as a barrier
 Susceptible host
 Compromised host- a person “at increased risk”
 E.g. aging adult, immune suppression treatment
for cancer
Body defenses against
infection
 Nonspecific defenses
 Anatomic and physiologic barrier
 Inflammatory responses
 Specific defenses
 Antibody- mediated defenses
 Cell-mediated defenses
Factors increasing
susceptibility to infection
 Age

 Heredity

 Physical and emotional stressors

 Nutritional status

 Medical therapies and diagnostic treatment

 Medication e.g. immunosuppressant and

corticosteroid, antibiotic
 Disease e.g. diabetes mellitus, COAD
Nursing interventions that
break the chain of infection
 Assess signs and symptoms of an infection:
 ? Any sneezing, watery/ mucoid discharge from the nose
 ? Urinary frequency, cloudy or discolored urine
 Skin and mucous membranes
 Localized swelling

 Localized redness

 Pain or tenderness with palpation or movement

 Palpable heat at the infected area

 Loss of function

 ? exudate
Nursing interventions that
break the chain of infection
 Systemic infection
 Fever
 Increased pulse and respiratory rate if fever is high
 Malaise and loss of energy
 Anorexia, nausea and vomitting
 Enlargement and tenderness of the lymph nodes
Nursing interventions that
break the chain of infection
 Laboratory data
 Elevated leukocytes count
 Elevated ESR (erythrocyte sedimentation rate)
 Red blood cells normally settles slowly, but the rate
increases in the presence of an inflammatory process
 Urine, blood, sputum or other drainage cultures
 Laboratory cultivations of microorganisms in a special
growth medium
Nursing interventions that
break the chain of infection
 Hand hygiene
 PPE

 Isolation precaution
 Infection control measures
Nursing interventions that
break the chain of infection
 World Health Organization (2005)
 Hand washing under a stream of water for at least
20 seconds using plain granule soap, soap-filled
sheets, or liquid soap when hands are visibly
soiled, after using the restroom before handling
invasive device and after contact of the medical
equipment.
 Alcohol-based antiseptic hand rubs (rinses, gels
or foams) for use before and after direct client
contact – enhance the adherence to hand
cleansing
Nursing interventions that
break the chain of infection
Nursing interventions that
break the chain of infection
Nursing interventions that
break the chain of infection
Nursing interventions that
break the chain of infection
Nursing interventions that
break the chain of infection
Nursing interventions that
break the chain of infection
 Proper application of alcohol- based products:
 Apply a palmful of the product to a cupped hand.
 Rub palms against palms
 Interlace fingers palm
 rub palms to the back of hands
 Rub each finger individually on all sides with the other
hand
 Continue until product is dry- about 20- 30 seconds
Supporting defenses of a
susceptible host
 Hygiene

 Nutrition

 Fluid

 Restand sleep
 immunization
Compromised clients
Highly susceptible to infection
 Have disease e.g. leukaemia, bone-marrow
depression
 Have extensive skin impairment e.g. major
burns and dermatitis
Cleaning, disinfecting and
sterilizing
 Cleaning
1. Rinse the article with cold water to remove
organic material (adhesion)
2. Wash in hot water and soap
3. Use a brush
4. Rinse the article with warm and hot water
5. Dry the article
6. Clean the brush and sink
Cleaning, disinfecting and
sterilizing
 Disinfecting

 Disinfectant( used on inanimated objects,

toxic to tissue, more concentrated, phenol /
iodine base)
 Antiseptic (used on skin or tissue)

 Bacteriocidal (destroy bacteria)

 Bacteriostatic (prevent growth and

reproduction)
 P.647
Cleaning, disinfecting and
sterilizing
Disinfectant
 The type and number of infectious organisms

 The recommended concentration

 The temperature of the environment

 The presence of soap

 The presence of organic materials

 The surface areas to be treated

Cleaning, disinfecting and
sterilizing
Sterilizing
 A process that destroy all microorganisms, including all spores
and viruses
 Moist heat
 Steam under pressure or free steam
 Autoclaves pressure 15-17 pound and 121 to 123 C
 Gas
 Ethylene oxide (interfere metabolic process, toxicity to human)
 Boiling water( inexpensive)
 100C for at least 15 minutes
 Radiation
 Ultrviolet light
Isolation precaution
 Standard Precautions
 Transmission- Based
Precautions
 Airborne
 Droplets
 Contact
Standard Precautions
 Unidentified pathogens
 Interfere with the spread of bloodbourne
pathogens
 Body substance isolation (BSI)

 Blood, body secretion abd excretions except

sweat, nonintact skin and mucous
membranes
Infection Control Practices
 General guideline
 E.g. I. V. line, catheter care, needle handling
 Personal protective equipment
 Gloves
 Gowns
 Water resistant
 Face masks
 N95 (95% efficiency in prevent inhaling tuberculin organisms
testing by NIOSH)
 Eyewear
Infection Control Practices
Infection Control Practices
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Infection Control
 Centres for Disease Control and Prevention
(CDC) in United states
 Infection Control Teams in hospitals