Chapter 10 Asepsis Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 1 Second semester 15 - 16.

Chapter 10

Asepsis

Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 1Second semester 15 - 16

Preventing infections is one of the most important priorities in nursing

Microorganisms :

living animals or plants visible only with a microscope ( also commonly called germs )

Everywhere: in the air, soil, and water, and on and within virtually everything and everyone

Once Microorganisms invade , one of three events occur

1. The body’s immune defense mechanisms eliminate them

2. They reside within the body without causing disease

3. They cause an infection or infectious diseaseBader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 2Second semester 15 - 16

Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 3

Types of Microorganisms

Microorganisms are divided into two main groups: 1. Non Pathogens or Normal flora ( harmless ,

beneficial microorganism )

2. Pathogens (microorganism that cause illness ) have high potential for causing infectious communicable diseases, also called contagious diseases.

Second semester 15 - 16


Types of Microorganisms

Bacteria Viruses FungiRickettsiaProtozoans MycoplasmasHelminthes



Many pathogens have mutated to adapt to hostile environments and unfavorable living conditions. Such adaptability has ensured that they continue to pose a threat to humans.

A spore is a temporarily inactive microbial life form that can resist heat and destructive chemicals and survive without moisture.



Chain of Infection By interfering with the conditions that continue the

transmission of microorganisms, humans can avoid acquiring infectious diseases.

The six essential components of the chain of infection (sequence that enables the spread of disease-producing microorganisms) must be in place if pathogens are to be transmitted from one location or person to another:1. An infectious agent

2. A reservoir for growth and reproduction

3. An exit route from the reservoir

4. A mode of transmission

5. A port of entry

6. A susceptible host ( Fig.10-2)Second semester 15 - 16


Second semester 15 - 16Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 8

Chain of Infection cont'd

1. Infectious Agents Some microorganisms are less dangerous than others.

For example, intestinal bacteria help produce vitamin K, which, in turn, helps control bleeding.

2. ReservoirA reservoir is a place where microbes grow and reproduce,

providing a haven for their survival. Examples: skin, shafts of hair open wounds blood lower digestive tract nasal passages



3. The exit route is how microorganisms escape from their original reservoir

and move about

4. A mode of transmission is how infectious microorganisms move to another

location. See table 10-1

5. The port of entry is where microorganisms find their way onto or into a new

host, facilitating their relocation. One of the most common ports of entry is an opening in the skin or mucous membranes.



10

10



Biologic Defense Mechanisms

It is an anatomic ( physiologic) methods that stop microorganisms from causing an infectious disorder

Types :1. Mechanical (physical) barriers :that prevent

microorganisms from entering the body or expel them before they multiply ( example: skin , mucous membrane)

2. Chemical: destroy or incapacitate microorganisms through natural biologic substances (example Gastric acid)




6. Susceptible Host Humans become susceptible to infections when their defense

mechanisms are diminished or impaired. A susceptible host, is one whose biologic defense mechanisms are weakened in some way , A susceptible host include those who

1. Are burn victims2. Have suffered major trauma3. Require invasive procedures such as endoscopy 4. Need indwelling equipment such as a urinary catheter5. Receive implantable devices such as intravenous catheters6. Are given antibiotics inappropriately, which promotes microbial

resistance7. Are receiving anticancer drugs and anti-inflammatory drugs such as

corticosteroids that suppress the immune system8. Are infected with HIV



Factors affecting susceptibility to infection1. Inadequate nutrition.

2. Poor hygiene practices.

3. Suppressed immune system.

4. Prematurity.

5. Advanced age.

6. Compromised skin integrity.

7. Diminished blood circulation

Nosocomial Infectionsare infections acquired while a person is receiving care in

a health care agency



AsepsisPractices 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



Medical Asepsis

Confines or reduces the numbers of microorganisms Also called clean technique

It involves measures that interfere with the chain of infection in various ways



Principles of Medical Asepsis

A clean environment reduces microorganisms.Cleaning should be done from cleaner to dirtier

areasMicroorganisms exist everywhere except on

sterilized equipment.Frequent hand washing and maintaining intact skin

are the best methods for reducing the transmission of microorganisms.

Blood, body fluids, cells, and tissues are considered major reservoirs of microorganisms


Principles of Medical Asepsis cont'd

Personal protective equipment such as gloves, gowns, masks, goggles, and hair and shoe covers serves as a barrier to microbial transmission.

Certain areas—the floor, toilets, and insides of sinks—are more contaminated than others.

Second semester 15 - 16 Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 17


Examples of medical aseptic practices include:

1. Using antimicrobial agents,

2. Performing hand hygiene,

3. Wearing hospital garments,

4. Confining and containing soiled materials appropriately, and

5. keeping the environment as clean as possible.



1. Using Antimicrobial Agents Antimicrobial agents are chemicals that destroy or

suppress the growth of infectious microorganisms Examples are antiseptics, disinfectants, and anti-infective drugs.

A.Antiseptics: (also called bacteriostatic agent) inhibit the growth of, but do not kill, microorganisms. (used on living tissues)

An example: is alcohol

1. Disinfectants: (also called bactericides agent) destroy active microorganisms but not spores. (used on non-living items)Examples: Phenol, household bleach, and formaldehyde

Note: Disinfectants rarely are applied to the skin because they are so strong. Rather, they are used to kill and remove microorganisms from equipment, walls, and floors

A.Anti-Infective Drugs ( Antibiotics ,Antiviral ) Second semester 15 - 16



5 Moments for Hand Hygiene



Performing surgical hand antisepsisA surgical scrub, a type of skin and nail antisepsis, is

performed before donning sterile gloves and garments when the nurse is actively involved in an operative or obstetric procedure. The purpose is to more extensively remove transient microorganisms from the nails, hands, and forearms.




Wearing Personal Protective EquipmentUniforms Scrub suits or gownsMasks Gloves Protective eyewearHair and Shoe Covers


GlovesNurses wear clean gloves, sometimes called examination gloves,

in the following circumstances:

1. As a barrier to prevent direct hand contact with blood, body fluids, secretions, excretions, mucous membranes, and non intact skin

2. As a barrier to protect clients from microorganisms transmitted from nursing personnel when performing procedures or care involving contact with the client's mucous membranes or non intact skin

3. When there is a potential transfer of microorganisms from one client or object to another client during subsequent nursing care



Surgical Asepsis Surgical asepsis means those measures that

render (prepare) supplies and equipment totally free of microorganisms.

Sterile technique include practices that avoid contaminating microbe-free items.

Sterilization consists of physical and chemical techniques that destroy all microorganisms including spores.


Difference between surgical and medical asepsis?Medical asepsis, or clean technique,

includes procedures used to reduce the number of organisms present, and prevent the transfer of organisms. Surgical asepsis, or sterile technique, prevents contamination of an open wound, serves to isolate the operative area from the unsterile environment, and maintains a sterile field for surgery


1. Physical Sterilization

Microorganisms and spores are destroyed physically through radiation or heat (boiling water, free-flowing steam, dry heat, and steam under pressure).



1. Physical Sterilization cont'd

Radiation: Ultraviolet radiation can kill bacteria, especially the organism that transmits TB.

Boiling water is a convenient way to sterilize items used in the home. To be effective, contaminated equipment needs to be boiled for 15 minutes at 212°F (100°C)

Free-flowing steam is a method in which items are exposed to the heated vapor that escapes from boiling water.



1. Physical Sterilization cont'd

Dry Heat or hot air sterilization, is similar to baking items in an oven. To destroy microorganisms with dry heat, temperatures of 330°to 340°F (165° to 170°C) are maintained for at least 3 hours.

Steam under pressure is the most dependable method for destroying all forms of organisms and spores. (The autoclave is an example)



2. Chemical Sterilization

Both gas and liquid chemicals are used to sterilize invasive equipment. (example :Ethylene oxide gas)



Principles of Surgical AsepsisOnce 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 sterileOnce a sterile item touches something that is not

sterile, it is considered contaminatedAny partially unwrapped sterile package is considered

contaminatedIf there is a question about the sterility of an item, it is

considered unsterile


Principles of Surgical Asepsis (cont’d)

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

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


Principles of Surgical Asepsis (cont’d)

A wet sterile wrapper wicks microorganisms from its supporting surface, causing contamination

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


Adding an Agency-Sterilized Item

Adding Sterile Solution Adding Sterile Gauze

Second semester 15 - 16 Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 37

Nursing ImplicationsRisk for InfectionRisk for Infection TransmissionIneffective ProtectionDelayed Surgical RecoveryDeficient Knowledge

Secind semester 15- -16Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 38

Chapter 10 Asepsis Bader A. EL Safadi BSN, MSc Fundamental of Nursing - B Asepsis 1 Second semester 15 - 16.

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