MEDICAL ASEPSIS and INFECTION CONTROL

ASEPSIS the absence of microorganisms. It refers to the absence of septic matter,

the freedom from infection or infectious matter, and also includes general cleanliness.
Aseptic technique is the infection control practice used to prevent the
transmission of pathogens.

Medical Asepsis (Clean Technique) - practices to reduce the number, growth, and
spread of microorganisms
The most common cause of nosocomial infections is contaminated hands
of health care providers.
Wash hands before and after every client contact.

Surgical Asepsis (Sterile Technique) - practices that eliminate all microorganisms and
spores from an object or area
Surgical scrub
Surgical attire
Sterile fields
Sterile instruments and equipment

Medical Asepsis vs. Surgical Asepsis

a. Chief difference: destroys organism a. Destroys organism before they

after they leave the body enter the body.

b. It protects the giver of care b. It protects the patient

c. It is used caring for patients with c. It is used in caring for open wounds
Infectious diseases. It aims to prevent in surgical procedures
the patient from becoming re-infected
and the infection from Spreading to
other persons.
d. It prevents the spread of infection by d. It includes the complete sterilization
means of all instruments, linen or other object
Of: that may come in contact with the
- Isolating the object in the surgical wound.
patients Environment from
contamination.
- Disinfecting objects as
possible after contamination
Definition of Terms

1. Asepsis - Freedom from disease-causing microorganisms.

To decrease the possibility of transferring microorganisms from one place to
another, asepsis is used.
2. Infection is a state caused by the entry and multiplication of pathogenic
microorganism within the body.
Types of Microorganism causing Infections (It can cause various diseases
in humans and can be transported through air, water, food, soil, body tissues,
fluids and inanimate objects)
a. Bacteria are microscopic organism, maybe rod shape, round or spiral. It is the
most common cause of infections. Ex. Escherichia coli, Candida albicans
b. Viruses are microorganisms consisting primarily of nucleic acid (protein) and
therefore must enter living cells in order to reproduce. Ex. Rhinovirus common
colds, CORONA virus SARS, hepatitis virus, HIV virus
c. FUNGI/FUNGUS are sacrophytic (obtain food by absorbing dissolved organic
matter/decaying organic matter) and parasite organisms that has no chlorophyll.
Ex. Yeast and molds, candida albicans
d. PARASITES are organisms that live in / on other organism. It includes
protozoa like plasmodium which causes malaria, helminthes (worms) and
arthropods (mites, ticks and fleas)

INFECTION maybe TRANSIMITTED DIRECTLY or INDIRECTLY

Direct transmission refers to transmission by direct contact with body

discharges such as urine, feces, mucus or with drainage from an open sore,
ulcer or wound, or by droplet spread (sneezing, coughing, spitting, talking),
placental transmission or via blood transfusion.

Indirect transmission refers to vector, vehicle or airborne transmission such

as inanimate objects (bed linens, bed pans, drinking glasses, cooking utensils,
etc.)
Vectors are rats, mosquitoes, flies or other insects capable of harboring and
spreading the infectious agents.
Vehicle any substance that serves as an intermediate means to transport
and introduce an infectious agent into a susceptible host through a suitable
portal of entry.
Airborne (droplet or dust) transmission of disease by droplets of saliva or
mucus is called DROPLET INFECTION

Infection According to Area Affected

Local Infection is limited to a specific part of the body where
microorganisms remain.
 Systemic Infection when microorganisms spread and damage different
parts of the body

Infections according to onset or duration

Acute infection generally appear suddenly or last for short time
Chronic Infection may occur slowly over and very long period and may last
for months or years
Nosocomial infection classified as infections that are associated with the
delivery and health services in a health care facility
Iatrogenic infections are the direct result of diagnostic or therapeutic
procedures.

3. Disease a condition wherein there is a detectable alteration in normal tissue

function
4. Infectious agent are agents like microorganisms which cause infection/disease
5. Resident flora are microorganisms normally found in certain parts of the
body. Ex. Staphylococcus epidermidis skin ; Escherichia Coli intestines;
Streptococcus mutants mouth
6. Asymptomatic or Subclinical are infections that produces no clinical evidence of
disease
7. Virulence - the ability of the microorganism to produce dieases (maybe rapid,
severe, malignant, strong)
8. Pathogenicity is the ability to produce disease (related to virulence)
9. Communicable Disease is a condition when an infectious agent can be
transmitted to an individual by direct or indirect contact through a vector or
vehicle, or as an airborne infection
10. Pathogen is a microorganism that causes disease.
11. Opportunistic Pathogen are infectious agents/ microorganisms that cause
diseases only in susceptible (at risk) individual. Ex. Transplant patients on
immunosuppressive drugs; AIDS patients.
12. Sepsis is a state of infection. A toxic condition resulting from the spread of
bacteria or their products from a focus of infection.
13. Bacterimia when microorganism is present in the blood. When it becomes
systematic leads to septicemia.
14. Colonization the process by which strains microorganisms becomes resident
flora. Microorganism may grow and multiply but will not cause disease.
 CHAIN OF INFECTION
Microorganism (infectious agent)
Infectious Agents (Microorganisms)
Agents that produce infections can consist of bacteria, viruses, fungi,
protozoa, and rickettsia
The ability of a microorganism to infect a client is related to:
- Virulence of the agent
- Number of microorganisms present
- Ability of the agent to enter and live in the client
- Susceptibility of the client
Resident Infectious Agents
- Microorganisms which are always present on skin.
- Can be reduced through hand washing, but not totally removed.
Transient Infectious Agents
- Agents that are picked up by the skin from another person or object.
- Attach itself to the skin and then may be transmitted to a susceptible
host.
Source or Reservoir
Required for microorganism to survive while waiting for a host.
May allow the organism to multiply, making it more dangerous.
- The human body is the most common reservoir.
- Food, plants, animals, and feces are other common reservoirs.
Portal of Exit
Pathway by which pathogens leaves the body of the host. It can be
accessed by:
- Direct Contact
Transmission of disease from the host through touching, kissing,
and sexual intercourse
Sources: Skin, mucus membranes, urine, feces, reproductive tract,
blood
- Indirect Contact
Occurs with the use of vehicles and vectors
Vehicles (fomites): Toys, hospital supplies, instruments, dishes,
cups, or surgical dressings, food, fluids, blood
- Airborne Transmission
Transmission of infectious agents through coughing, sneezing,
dust particles
Usual entry via the persons respiratory tract
Portal of Entry
Pathway by which infectious agents gain access to the body
Susceptible Host
A person with a reduced immune response has increased susceptibility.
 The immune response is the bodys natural defense against infection.

Factors Increasing Susceptibility to Infection

Age
Heredity
Level of stress
Nutritional status
Current medical therapy
Preexisting disease processes

HOW MICROORGANISMS SPREAD:

1. Microorganisms move on air currents.
2. Microorganisms are transferred from one surface to another where objects
touched.
3. Microorganisms are transferred by gravity when one item is held above another
4. Microorganisms are released into the air on droplet nuclei whenever a person
breathe or speaks. Coughing or sneezing dramatically increases the number of
microorganisms released from the mouth and nose
5. Microorganisms move slowly on dry surfaces but quickly through moisture
6. Proper handwashing removes many of the microorganisms that can be
transferred by the hands from one item to another
7. Blood-borne infections may be spread to another person through contact
between blood and body surfaces that contain the blood-borne organism and
open wounds, sores or mucus membranes and through penetrating injuries with
contaminated items
8. Several body substances such as feces, urine, nasal secretions, vomitus, and
sputum do not contain blood-borne organisms but they may contain such large
quantities of bacteria that their removal through handwashing is difficult.

BASIC PRINCIPLES of MEDICAL ASEPSIS in PATIENT CARE

1. Practice good hygiene techniques.
2. Carry solid items, including linens, equipment, and other used articles away from
the body to prevent them from touching the clothing.
3. Do not place soiled linen or nay other items on the floor, which is grossly
contaminated. It increases contamination on both surfaces.
4. Avoid having patients cough, sneeze or breathe directly on others. Provide
patients with disposable tissues, and instruct them as indicated, to cover their
mouth and nose to prevent spread by airborne droplets.
5. Move equipment away from you when brushing, dusting or scrubbing articles.
This helps prevent contaminated particles from setting on your hair, face and
uniform.
6. Avoid raising dust. Use a specially treated or damped cloth. Do not shake linens.
Dust and lint particles constitute a vehicle by which organisms may be
transported from one area to another
 7. Clean the least soiled areas first then move on to the more soiled ones. This
helps prevent having the cleaner areas soiled by the dirtier areas.
8. Dispose soiled or used items directly into appropriate containers, Wrap items that
are moist from the body discharge or drainage in waterproof containers, such as
plastic bags, before discarding into the refuse holder so that the handlers will not
come in contact with others.
9. Pour liquids that are not discarded, such as bath water, mouth rinse, and the like
directly into the toilet bowl, or drain to avoid splattering into the sink and onto
you.
10. Sterilize items that are suspected of containing pathogens. After sterilization, they
can be managed as clean items if appropriate.
11. Use personal grooming habits that help prevent spreading microorganisms
a. Shampoo your hair regularly
b. Keep your fingernails short and free of broken cuticles and ragged edges
c. Do not wear false nails
d. Do not wear rings with grooves and stones that may harbor
microorganisms
12. Follow guidelines conscientiously for infection control or barrier techniques as
prescribed by the agency.

SOURCES of CONTAMINATION
1. Members of the medical team
2. Patient
3. All articles used in the care of a patient, especially highly contagious cases.
4. Dust in the air
5. Other personnel, visitors coming in and out of the hospital

PROPER ISOLATION TECHNIQUE

ISOLATION - refers to measures designed to prevent the spread of infections or
potentially infectious microorganisms to health personnel, clients and visitors.

Essential Components of Isolation:

1. adequate spacing or distance
2. personal precautionary measures
3. good body resistance of the health giver
4. observance of medical aseptic practices
5. healthy attitude towards the sick

7 Types of Isolation Technique (Classified by the Center for Disease Control, U.S.
Public Health Service)

1. Strict Isolation
Aims at preventing the transmission of highly communicable diseases
spread by contact and airborne routes
It necessitates the use of a private room with closed door.
 All those who enter this room must wear a gown, cap, mask, gloves and a
special set of shoes or slippers
The disposal of waste and discarding of the soiled linen utilize the double
bag technique
Hands must be washed thoroughly
Diseases that require this type of isolation: rabies, small pox, diphtheria,
staphylococcal or streptococcal pneumonia
2. Respiratory Isolation
Prevents transmission of microorganisms released into the environment
by coughing, sneezing or breathing or those harbored in freshly
contaminated articles (such as paper napkin)
A private room is necessary. The door of the room must be kept closed to
prevent the spread of microorganism through the air
Gloves and gowns are not necessary but the nurse should wear mask at
all times
The health worker should have strong resistance, otherwise she will get
infected
Use double bag technique to dispose the secretions
Examples of diseases requiring this isolation: chicken pox, mumps,
meningococcal meningitis, pertussis, pulmonary tuberculosis, rubella,
rubeola.
3. Protective or Reverse Isolation
Aims at preventing contact between potentially pathogenic organisms and
uninfected person who has seriously impaired body resistance.
Private room is necessary and door must be kept closed.
A gown, a mask, gloves. Headgear and changes of shoes or slippers are
musts because the objective here is to protect the patient from the
contamination
All equipment, supplies or other needed articles to be used by the patient
must be disinfected or sterile.
Example: Immunosuppressed patients i,e. blood dyscrasias like leukemia,
agranulocytosis.
4. Enteric Precaution
Help prevents the transmission of organisms through direct or indirect
contact with infected excreta or feces
An adult patient does not need to be placed in private room because he
knows how to manage the excretions of the body properly. Child needs
a private room
The nurse must wear gloves, a gown and a special set of shoes as a
precautionary measure. Mask are not necessary because the pathogens
are found mostly in fecal matter and the portal of entry into a host is oral
The diseases that require this as isolation are cholera, hepatitis and
typhoid fever
5. Wound and Skin Precautions
 Prevents the transmission of organisms by contact with wounds and
heavily contaminated articles
A gown, mask and head gear and gloves must be worn during the
cleansing of the skin and dressing of the wound
Examples of diseases: impetigo, staphylococcal skin and wound infection,
streptococcal skin infections, extensive wound infection
6. Discharge precautions
Are employed to prevent transmission of organisms by contact with
wounds, secretions, excretions and heavily contaminated articles when
there is possibility of cross infection
Gloves must be worn, especially if there is direct contact with wound or
soiled dressings.
Double bag technique is recommended for discarding soiled dressings
and linen
Examples: infected burns and wounds, conjunctivitis, gonnorhea,
syphyllis, staphylococcal food poisoning
7. Blood Precautions
Prevents the transmission of organisms by contact with blood or items that
are contaminated with blood
The specific measures to be taken are focused on the care of personnel
not to prick or break their own skin with needles contaminated with blood
from a patient.
Examples: serum hepatitis and malaria

PERSONAL PROTECTIVE EQUIPMENTS

1. Head Cap
- Prevents any hair from falling on anything the nurse is handling and also
protects the nurses hair from contamination
- This shall be worn to fully cover the hair at all times while inside the isolation
room
2. Mask
- Are worn to filter any organisms from inspired and expired air.
- Use to cover mouth and nose
3. Goggles
- Worn to protect the eyes from possible splash of blood or secretions during
nursing procedures
4. Gown
- Worn to protect uniform from being contaminated
5. Gloves
- Worn to protect the hands while handling and taking care of patients
6. Shoe cover
- Should be worn to protect your shoes while inside the isolation room.
Microorganisms settle on the floor
7. Shoes or Slippers
- Shoes carry microorganisms from one place to another
 Reduce or Eliminate Infectious Agents
Infection control practices to break the chain of infection
Cleansing
 Removal of soil or organic material from instruments and equipment used in
providing care
Water, mechanical action, detergent
Disinfection
Elimination of pathogens, except spores, from inanimate objects
Use of germicides and antiseptics.
Sterilization
Methods used for total elimination of all microorganisms including spores are:
Moist heat or steam (autoclave, boiling water)
Radiation
Chemicals
Ethylene oxide gas

Guidelines for Standards Precautions

Body Substances
Blood
All body fluids
Secretions
Contaminated items regardless of whether or not they contain visible blood
Non-ntact skin
Mucous membranes
Barrier Precautions
Use of masks, gowns, and gloves to minimize the risk of exposure to blood
and body fluids

Role of Health Care Personnel and Health Agencies in Infection Control

1. Mask and eye protection or face shield
2. Non-sterile gown
3. Tuberculosis masks
4. Isolation precautions initiated when positive cultures from a draining wound are
reported
5. Reinforce adherence to isolation.
6. Post signs indicating type of isolation.
7. Provide necessary supplies.
8. Place clients in a private room with adequate ventilation.
9. Use disposable supplies and equipment.
10. Labeling of all articles leaving the room
11. Use of impermeable bags or double bagging
12. Client and family instruction
13. Alert to psychological discomfort
14. Blood Borne Pathogen Exposure
OSHA requires that all health agencies make available the hepatitis B vaccine
and vaccination series to all employees.
15. Exposure Control Plan
 Begins with standard precautions and moves to postexposure prophylaxis
Specific follow-up for blood-borne pathogens
Postexposure prophylaxis only in cases of highest risk

Medical Handwashing and Medical Aseptic Practices read/study your manual of

nursing procedures