Chapter 10

Asepsis

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 Microorganisms
• Living animals or plants visible only with a
microscope; also commonly called germs
– The body’s immune defense mechanisms
eliminate them
– They reside within the body without
causing disease
– They cause an infection or infectious
disease

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 Types of Microorganisms

• Bacteria • Fungi
• Protozoans • Helminths
• Viruses • Rickettsiae
• Mycoplasmas • Prions

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Categorization of Microorganisms
Nonpathogens: Pathogens: cause
harmless, beneficial illness
Resident Transient pathogens
nonpathogens picked up during
constantly present contamination
on the skin
Aerobic: require Anaerobic: exist
oxygen to live without oxygen

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 Survival of Microorganisms
• Spores
– Temporarily inactive microbial life form;
can resist heat and destructive chemicals
and survive without moisture; reactivate
and reproduce when conditions are
favorable
• Antibiotic-resistant bacterial strains
– No longer respond to drugs that once
were effective against them
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 Question

• Is the following statement true or false?

Transient pathogens are present constantly

on the skin.

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 Answer

False.

Transient pathogens are picked up during

contamination.

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 Chain of Infection
• An infectious agent
• A reservoir for growth and reproduction
• An exit route from the reservoir
• A means of transmission
• A portal of entry
• A susceptible host

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Chain of Infection (cont’d)

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 Biologic Defense Mechanisms
• Anatomic or physiologic methods that stop
microorganisms from causing an infectious
disorder
– Mechanical: physical barriers that prevent
microorganisms from entering the body
or expel them before they multiply
– Chemical: destroy or incapacitate
microorganisms through natural biologic
substances
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 Nosocomial Infections

• Nosocomial infections are infections acquired

while a person is receiving care in a health
care agency

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 Question

• Is the following statement true or false?

Mechanical defense mechanisms destroy

or incapacitate microorganisms through
natural biologic substances.

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 Answer
False.

Chemical defense mechanisms destroy or

incapacitate microorganisms through natural
biologic substances.

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 Asepsis
• Practices that decrease or eliminate
infectious agents, their reservoirs, and
vehicles for transmission
• A major method for controlling infection
• Health care professionals use medical and
surgical asepsis to prevent spread of
infections

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 Medical Asepsis

• Confines or reduces the numbers of

microorganisms
• Involves measures that interfere with the
chain of infection in various ways
• Examples:
– Performing hand hygiene
– Wearing hospital garments

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 Surgical Asepsis

• Measures that render supplies and

equipment totally free of microorganisms
• Practices that avoid contaminating microbe-
free items
• Examples:
– Physical sterilization
– Chemical sterilization
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 Principles of Medical Asepsis
• Microorganisms exist everywhere except on
sterilized equipment
• Frequent handwashing and maintaining
intact skin reduces transmission of
microorganisms
• Blood, body fluids, cells, and tissues are
major reservoirs of microorganisms
• Personal protective equipments serve as
barriers to microbial transmission
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Principles of Medical Asepsis (cont’d)

• A clean environment reduces

microorganisms

• Cleaning should be done from cleaner

to dirtier areas

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 Question

• Is the following statement true or false?

Surgical asepsis involves measures that

interfere with the chain of infection in
various ways.

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 Answer

False.

Medical asepsis involves measures that

interfere with the chain of infection in
various ways.

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 Practicing Hand Antisepsis
• Apply about a nickel- to quarter-sized
volume of the product to the palm of one
hand or the amount recommended by the
manufacturer
• Distribute the product to cover all surfaces
of the hands and fingers
• Rub the product between the hands for 15
to 25 seconds until they are dry
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 Hand Antisepsis

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 Question
• Which of the following is a method of
surgical asepsis?
a. Donning a sterile gown
b. Using antimicrobial agents
c. Performing hand antisepsis
d. Performing handwashing

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 Answer

a. Donning a sterile gown

Donning a sterile gown is a method of surgical

asepsis. Using antimicrobial agents,
performing hand antisepsis, and handwashing
are methods of medical asepsis.

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Types of Hospital Garments
• Gloves
• Scrub suits and gowns
• Masks; Respirators
• Uniforms
• Hair and shoe covers
• Protective eyewear

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Hospital Garments

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 Utility Rooms
• Health care agencies: at least 2 utility rooms
(clean and dirty); personnel must not place
soiled articles in the clean utility room
• The utility room contains:
– Covered waste receptacles and laundry
hampers
– Flushable hopper and a sink
– Equipment for testing stool or urine
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 Concurrent Disinfection
• Clean less-soiled areas before grossly dirty
ones
• Wet-mop floors and damp-dust furniture to
avoid distributing microorganisms on dust
and air currents
• Frequently discard solutions used for
mopping in a flushable hopper
• Never place clean items on the floor
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 Terminal Disinfection

• More thorough than concurrent disinfection

and consists of measures used to clean the
client environment after discharge

• Includes scrubbing the mattress and the

insides of drawers and bedside stands

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 Sterilization
• Consists of physical and chemical techniques
that destroy all microorganisms including
spores
– Physical sterilization: radiation, boiling
water, free-flowing steam, dry heat,
steam under pressure
– Chemical sterilization: peracetic acid,
ethylene oxide gas
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 Principles of Surgical Asepsis
• Once equipment and areas are free of
microorganisms, they remain in that state if
contamination is prevented
• Sterility preserved: touching one sterile item
with another that is sterile
• Once a sterile item touches something that
is not sterile, it is considered contaminated
• Any partially unwrapped sterile package is
considered contaminated
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Principles of Surgical Asepsis (cont’d)
• Question the sterility of an item considered
unsterile
• Longer the time since sterilization, the more
likely that the item is no longer sterile
• Commercially packaged sterile item is not
considered sterile past its recommended
expiration date
• Opened sterile item or area, left unattended,
is considered contaminated
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Principles of Surgical Asepsis (cont’d)
• Once a sterile item is opened or uncovered,
it becomes contaminated
• The outer 1-inch margin of a sterile area is
considered a zone of contamination
• A wet sterile wrapper wicks microorganisms
from its supporting surface, causing
contamination

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Principles of Surgical Asepsis (cont’d)

• Coughing, sneezing, or excessive talking

over a sterile field causes contamination
• Reaching across an area that contains sterile
equipment may cause contamination
• Sterile items located or lowered below waist
level are considered contaminated

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Adding an Agency-Sterilized Item

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Adding Sterile Gauze

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Adding Sterile Solution

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General Gerontologic Considerations
• Older clients more susceptible to infections
• Maintain intact skin, proper aseptic
techniques, perineal hygiene, thorough
handwashing; indwelling catheters should be
avoided
• Bladder training, annual immunizations
• Ill health care workers should take sick leave
rather than expose susceptible clients to
infectious organisms
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