University of Northern Philippines

COLLEGE OF NURSING
MARC ZEAGAL C. AGAM, MAN
Instructor

NOTES:

Nursing Care Management 109 (Skills)

ASEPSIS

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– a freedom from disease causing microorganism.

Isolation – measures designed to prevent the spread of infectious or potentially

infectious microorganisms to health care workers, clients and visitors

A. Category-specific isolation precautions – uses seven categories: strict

isolation, contact isolation, respiratory isolation, tuberculosis isolation, enteric
precaution, drainage/ secretion precautions, and blood or body fluid
M.Z.C.A.- R.N. - M.A.N.

precautions.
o Differentiate the seven categories of isolation.
(you can use the back of this paper or other paper)

M.Z.C.A.- R.N. - M.A.N.

Strict isolation: used for diseases spread through the air and in
some cases by contact. 
Contact isolation: used to prevent the spread of diseases that
can be spread through contact with open wounds.
Respiratory isolation: used for diseases that are spread through
particles that are exhaled.
Tuberculosis isolation: Home isolation is when a person is
required to stay at home because they have a contagious
disease such as TB.
Enteric precaution: Some germs are easily spread to other
patients by direct or indirect touch. Enteric precautions are a
way of preventing this spread.

M.Z.C.A.- R.N. - M.A.N.

Drainage/secretion precautions: designed to prevent infections
that are transmitted by direct or indirect contact with purulent
material or drainage from an infected body site.
Blood or body fluid precautions: designed to prevent the
M.Z.C.A.- R.N. - M.A.N.

transmission of HIV, hepatitis B virus (HBV), hepatitis C virus

(HCV), and other diseases while giving first aid or other health
care that includes contact with body fluids or blood.

B. Disease-specific isolation precaution – provides precautions for specific

diseases.
- It delineates the use of private rooms with special ventilation, and
room sharing with client with same disease.

Universal Precautions (UP)

- Decrease risk of transmitting unidentified pathogens
- It obstructs the spread of blood borne pathogens
- What are the microorganisms carried in the blood and body fluids that are
capable of infecting other persons with serious and difficult to treat?
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 University of Northern Philippines
COLLEGE OF NURSING
MARC ZEAGAL C. AGAM, MAN
Instructor

NOTES:

Bacteria, virus, parasites

Body Substance Isolation
- It employs generic infection control precautions for all clients except those
with dew diseases transmitted thru air.
- The BSI is based on 3 premises:
1. Contact

2. Droplet

3. Airborne

CDC (HICPAC) ISOLATION PRECAUTIONS

- The Hospital Infection Control Practices Advisory Committee of the CDC
presented new guidelines for isolation precautions on hospital in 1996.
- 2 tiers of precautions:
A. Standard Precaution
➢ Use in the care of all hospitalized person regardless of their diagnosis
or possible infection status
➢ Applies to blood, all body fluids, secretions, and excretions except
sweat, non-intact skin, and mucous membranes

B. Transmission-based precautions
➢ Used in addition to standard precautions for clients with known or
suspected infections that are spread in one of 3 ways
a. Airborne Precaution – used for clients known to have or
suspected of having serious illnesses transmitted by airborne
droplet nuclei smaller than 5 microns o Give 3 examples of
diseases that needs airborne precaution
- Measles, Severe Acute Respiratory Syndrome (SARS),
Varicella (chickenpox)

b. Droplet Precaution – for client with or suspected to have serious

ill transmitted by particle droplets larger than 5 microns o Give
7 examples of illnesses that needs droplet precaution
Strep throat. Whooping cough (pertussis), Flu (Influenza) and
other viral respiratory illnesses. German Measles (rubella) Certain types of meningitis.
Mumps, Mycoplasma pneumonia.

c. Contact Precaution – used for client with known or suspected to

have serious illnesses easily transmitted by direct client contact
or by contact with items in the client’s environment.

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 University of Northern Philippines
COLLEGE OF NURSING
MARC ZEAGAL C. AGAM, MAN
Instructor

NOTES:

o Give 4 highly contagious skin infections that can be

transmitted thru contact – scabies, ringworm, impetigo, yeast
infection

M.Z.C.A.- R.N. - M.A.N.

ISOLATION PRACTICES
- Initiation of practices to prevent the transmission of microorganisms.
- Nurses must clean their hands before and after giving care.
- The nurse decides whether to use gloves, gown, masks, and protective
eyewear

Personal Protective Equipment o All healthcare providers must apply clean

M.Z.C.A.- R.N. - M.A.N.

or sterile gloves, gown, mask, and protective eyewear according to the risk
exposure to potentially infective materials.

M.Z.C.A.- R.N. - M.A.N.

GLOVES – worn for three reasons:
1. to prevent cross contamination
2. for hand protection
3. to enhance grip and touch sensitivity

Hands are cleansed each time gloves are taken off for 2 primary reasons:
a. To reduce the risk of contamination of health-care workers hands with blood
and other body fluids
b. Hand hygiene by rubbing or washing remains the basic to
guarantee hand decontamination after glove removal. 

M.Z.C.A.- R.N. - M.A.N.

M.Z.C.A.- R.N. - M.A.N.

STERILE GLOVES
- Donned by the open and closed method.
- Open method is used outside the operating room
- Closed method requires the use of sterile gown to don a sterile glove - Used
when:
o Performing tasks that demands flexibility
o Places stress on material such as turning stopcocks, handling sharp
objects and tapes.
o And perform tasks that involve a high risk of pathogen exposure

STERILE GOWN
- Closed method of gloving can be used only when a sterile gown is worn
because the gloves are handled through the sleeves of the gown.
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 University of Northern Philippines
COLLEGE OF NURSING
MARC ZEAGAL C. AGAM, MAN
Instructor

NOTES:

- Hair cover and mask should be worn first before proceeding

DONNING A STERILE GOWN AND GLOVES

M.Z.C.A.- R.N. - M.A.N.

(CLOSED METHOD)
Purposes:
1. To enable the nurse to work close to a sterile field and handle sterile objects
only * To prevent contamination to the surgical wound and help control infection via
aseptic principles.
2. To protect clients from becoming contaminated with microorganisms on the
nurse’s hands and arms, clothing * help ensure the control of infection and
microbial contamination
M.Z.C.A.- R.N. - M.A.N.

Assessment:

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Review the clients record and orders to determine exactly what procedure will be
performed that requires sterile gloves. Check the client record and ask about latex
allergies. Use non latex gloves whenever possible.

Planning:
Think through the procedure, planning which steps should be completed before the
gloves and gown can be applied. Determine what additional supplies are needed to
perform the procedure for this client. Always have an extra pair of gloves.

Equipment:
➢ Sterile pack containing sterile gown
➢ Sterile gloves

M.Z.C.A.- R.N. - M.A.N.

Preparation:
Ensure the sterility of the package of gloves * to ensure the integrity of
the packaging materials. Any torn, previously opened, or wet packaging, or packaging
M.Z.C.A.- R.N. - M.A.N.

that has been dropped on the floor, is considered non-sterile and may not be used in
the sterile field.

Performance: {Provide a rationale for each procedure with asterisk (*)}

1. Prior to performing the procedure, introduce self and verify the client’s
identity using agency protocol. * essential in improving the reliability of the
patient’s identification process. 
➢ Explain to the client what you are going to do, why it is necessary, and
how he and she can cooperate.
2. Observe appropriate infection control procedures * to ensure the safety of our
patients/clients/residents
3. Provide for client privacy * it helps to build and develop trust.

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 University of Northern Philippines
COLLEGE OF NURSING
MARC ZEAGAL C. AGAM, MAN
Instructor

NOTES:

Donn Sterile Gown

4. Open the sterile package of sterile gloves.
➢ Remove the outer wrap from sterile gloves and leave the gloves
in their inner wrap on the sterile field. * Sterile objects must only be
touched by sterile equipment or sterile gloves.
5. Unwrap the sterile gown pack
6. Perform hand hygiene * To protect the patient from infection due to pathogens
carried on your hands 
7. Put on sterile gown
➢ Grasp the sterile gown at the crease near the neck, hold it away
from you, and permit it to unfold freely without touching
M.Z.C.A.- R.N. - M.A.N.

anything, including the uniform.

➢ Put the hands inside the shoulders of the gown without touching
the outside of the gown.
➢
➢ If donning sterile gloves by closed method, work the hands down
the sleeves only to the beginning of the cuff
➢ If donning sterile gloves by using open method, work the hands
down the sleeves and through the cuff
➢ Have a co-worker grasp the neck ties without touching the
outside of the gown and pull the gown upward to cover the
neckline of your uniform in front and back. The co-worker ties
the neck ties. * it will keep the tie sterile

Donning Sterile Gloves

8. Open the sterile glove wrapper while the hands are still covered by the sleeves
9. Put the glove in the non-dominant hand
➢ With the dominant hand, pick up the opposite glove with the thumb
and the index finger, handling it through the sleeve
➢ Position the dominant hand palm upward inside the sleeve. Lay the
glove on the opposite gown, thumb side down, with the glove opening
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➢ pointed toward the fingers

➢ Use the non-dominant hand to grasp the cuff of the glove through the
gown cuff, and firmly anchor it.
➢ With the dominant hand working through its sleeve, grasp the upper
side of the gloves cuff, and stretch it over the cuff of the gown.
➢
➢ Pull the sleeves up to draw the cuff over
the wrist as you extend the fingers of the
non-dominant hand into the glove’s
fingers
10. Put the glove on the dominant hand.
➢ Place the fingers of the gloved hand under
the cuff of the remaining glove.

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 University of Northern Philippines
COLLEGE OF NURSING
MARC ZEAGAL C. AGAM, MAN
Instructor

NOTES:

➢ Place the glove over the cuff of the second sleeve

➢ Extend your fingers to the glove as you pull the glove up over the
cuff.

M.Z.C.A.- R.N. - M.A.N.

Completion of Gowning
11. Complete gowning as follows:
➢ Have a co-worker holt the waist ties of your gown,
using sterile gloves or a sterile forceps or drape. *
Sterile objects must only be touched by sterile equipment or
sterile gloves.
➢ Make a three quarter turn, then take the tie, and secure
M.Z.C.A.- R.N. - M.A.N.

it in front of the gown. Or

➢
➢ Have a co-worker take the two ties of each side of the
gown and tie them at the back of the gown, making

M.Z.C.A.- R.N. - M.A.N.

sure that your uniform is completely covered.
➢ When worn, sterile gown should be considered sterile
in front from the waist tot the shoulder. Once the
nurse approaches a table, the gown is considered
contaminated from the waist or table down, whichever
is higher. The sleeves should be considered sterile
from the cuff to 2 inches above the elbow, since the
arms of the scrubbed person must move across a
sterile field. Moisture collection and friction areas
such as the neckline, shoulders, underarms, back, and
sleeve cuffs should be considered unsterile.
12. Remove and dispose used gown and gloves

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➢ If soiled remove the entire attire by turning it inside
out
13. If appropriate, document that sterile technique was used in the
performance of the procedure.
M.Z.C.A.- R.N. - M.A.N.

Evaluation:

What should be evaluated after doing the procedure?

 Check physician orders and hospital policy regarding procedure.

 Instruct patient how to assist throughout the procedure (e.g., lying still,
not talking over the sterile field or touching sterile objects).
 If required, check dressing on wound to assess for required supplies
needed for the procedure.

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 University of Northern Philippines
COLLEGE OF NURSING
MARC ZEAGAL C. AGAM, MAN
Instructor

NOTES:

 Offer analgesic and/or bathroom to ensure patient comfort throughout

the procedure.
 Explain procedure to the patient and give an approximate time frame

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for completing the procedure.

Questions:
1. What are the guidelines that a healthcare personnel should follow after
M.Z.C.A.- R.N. - M.A.N.

exposing him or herself to blood borne pathogens? What are the post
exposure protocol for HIV?
 Wash wounds and skin with soap and water. Flush mucous
membranes with water. Irrigate eyes with clean water, saline or sterile

M.Z.C.A.- R.N. - M.A.N.

irrigants. No scientific evidence shows that using antiseptics or
squeezing the wound will reduce the risk of transmission of a
bloodborne pathogen. Using a caustic agent such as bleach is not
recommended. Report the exposure to the government agency
responsible for managing exposures. Reporting is necessary because
PEP treatment may becarded needles or syringes for virus
contamination. Determine risk associated with exposure by: type of
fluid (e.g., blood, visibly bloody fluid, other potentially infectious
fluid or tissue, and concentrated virus) type of exposure (i.e.,
percutaneous injury, mucous membrane or non-intact skin exposure,
and bites resulting in blood exposure) body location of exposure

M.Z.C.A.- R.N. - M.A.N.

estimated volume of fluid, and estimated contact time. Evaluate
exposure source. Assess the risk of infection using available
information. Test known sources for HBsAg, anti-HCV, and HIV
antibody (consider using rapid testing). For unknown sources, assess
M.Z.C.A.- R.N. - M.A.N.

risk of exposure to HBV, HCV, or HIV infection. Do not test

discarded needles or syringes for virus contamination. Evaluate the
exposed person. Assess immune status for HBV infection (i.e., by
history of hepatitis B vaccination and vaccine response). Check for
previous testing for the presence of hepatitis B, hepatitis C, and HIV.
Check tetanus immunization status. Perform baseline testing for the
presence of hepatitis B, hepatitis C, and HIV. What current medical
problems does the exposed person have? What medications is the
exposed person currently taking? Is the exposed person pregnant or
breast feeding? HIV: During the follow-up period, especially the first
6-12 weeks when most infected persons are expected to show signs of
infection, the exposed person should follow recommendations for
preventing transmission of HIV. These include not donating blood,
semen, or organs and not having sexual intercourse. If the healthcare
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 University of Northern Philippines
COLLEGE OF NURSING
MARC ZEAGAL C. AGAM, MAN
Instructor

NOTES:

professional chooses to have sexual intercourse, using a condom

consistently and correctly may reduce the risk of HIV transmission. In
addition, women should consider not breastfeeding infants during the
follow-up period to prevent exposing their infants to HIV in breast
milk.

2. What are the post exposure protocol for Hepatitis B?

 HBV
• Baseline evaluation and testing of exposed person with unknown HBV
immune status
• Consideration of treatment
–when to give
–what to give
• Follow-up testing and counseling Post Exposure Management: Baseline
HBV Testing of Exposed* Person
• Test for anti-HBs if person has been vaccinated, but vaccine response is
unknown
• Baseline testing not necessary if vaccine response is known
• If exposed person has been vaccinated and is a known responder to the
vaccine, no PEP is necessary
Recommended Post Exposure Management: PEP for Exposure to HBV
Unvaccinated
Previously vaccinated Antibody response unknown HBIG x
1 and initiate hepatitis B vaccine series Test exposed person for anti-HBs
1. If adequate, no treatment
2. If inadequate, HBIG x 1 and vaccine booster
• No need for:
– modification of sexual practices or refraining from becoming pregnant or
breastfeeding
– modification to patient care responsibilities for exposed person
• If acute HBV infection, evaluate according to published recommendations
Occupational HCV Exposures Occupational Transmission of HCV
• Inefficiently transmitted by occupational exposures
• Average incidence 1.8% (range 0-7%) following percutaneous exposure
from HCV-positive source
• Case reports of transmission from blood splash to mucous membrane
• Prevalence 1-2% among healthcare personnel
– Lower than among adults in the general population
– 10 times lower than for HBV infection Elements of Post Exposure
Management

3. What is the post exposure protocols for Hepatitis C?

 HCV
• Baseline evaluation and testing
• Follow-up testing and counseling
• PEP Not recommended after exposure
– immunoglobulin not effective

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 University of Northern Philippines
COLLEGE OF NURSING
MARC ZEAGAL C. AGAM, MAN
Instructor

NOTES:

– no data on use of antivirals (e.g., interferon), and may be effective only with
established infection
– antivirals not FDA approved for this setting
Post exposure Management:
Baseline HCV Testing of Exposed Person
• If HCV-positive source, test exposed person for anti-HCV and ALT
• If source not infected, baseline testing not necessary
Post exposure Management:
HCV Post Exposure Counseling
• Refrain from donating blood, plasma, organs, tissue, or semen.
• No need for:
– modification of sexual practices or refraining from becoming pregnant
– special precautions to prevent secondary transmission.
– modification to patient care responsibilities for exposed person, even if HCV
infected

4. Give the principles of surgical asepsis and the practices for each principle.

Safety considerations:

Hand hygiene is a priority before any aseptic procedure.

When performing a procedure, ensure the patient
understands how to prevent contamination of equipment and
knows to refrain from sudden movements or touching,
laughing, sneezing, or talking over the sterile field.
Choose appropriate PPE to decrease the transmission of
microorganisms from patients to health care worker.
Review hospital procedures and requirements for sterile
technique prior to initiating any invasive procedure.
Health care providers who are ill should avoid invasive
procedures or, if they can’t avoid them, should double mask.

 Additional
Steps
Information

1. All objects used in a sterile Commercially packaged sterile

field must be sterile. supplies are marked as sterile;
other packaging will be
identified as sterile according
to agency policy.

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 University of Northern Philippines
COLLEGE OF NURSING
MARC ZEAGAL C. AGAM, MAN
Instructor

NOTES:

Check packages for sterility by

assessing intactness, dryness,
and expiry date prior to use.

Any torn, previously opened,

or wet packaging, or packaging
that has been dropped on the
floor, is considered non-sterile
and may not be used in the
sterile field.

Sterile objects must only be

touched by sterile equipment
or sterile gloves.

Whenever the sterility of an

2. A sterile object becomes
non-sterile when touched by a
non-sterile object.
object is questionable, consider
it non-sterile.
Fluid flows in the direction of
gravity. Keep the tips of
forceps down during a sterile
procedure to prevent fluid
travelling over entire forceps
and potentially contaminating
the sterile field.

Keep all sterile equipment and

3. Sterile items that are below sterile gloves above waist
the waist level, or items held level.
below waist level, are
considered to be non-sterile. Table drapes are only sterile at
waist level.

Sterile fields must always be

kept in sight throughout entire
4. Sterile fields must always sterile procedure.
be kept in sight to be
considered sterile. Never turn your back on the
sterile field as sterility cannot
be guaranteed.

5. When opening sterile Set up sterile trays as close to

equipment and adding the time of use as possible.
supplies to a sterile field, take
care to avoid contamination. Stay organized and complete
procedures as soon as possible.
 

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 University of Northern Philippines
COLLEGE OF NURSING
MARC ZEAGAL C. AGAM, MAN
Instructor

NOTES:

Place large items on the sterile

field using sterile gloves or
sterile transfer forceps.
 
Sterile objects can become
non-sterile by prolonged
exposure to airborne
microorganisms.

6. Any puncture, moisture, or

tear that passes through a Keep sterile surface dry and
sterile barrier must be replace if wet or torn.
considered contaminated.

7. Once a sterile field is set

Place all objects inside the
up, the border of one inch at
sterile field and away from the
the edge of the sterile drape is
one-inch border.
considered non-sterile.

8. If there is any doubt about Known sterility must be

the sterility of an object, it is maintained throughout any
considered non-sterile. procedure.

The front of the sterile gown is

sterile between the shoulders
and the waist, and from the
sleeves to two inches below
the elbow.

Non-sterile items should not

9. Sterile persons or sterile
objects may only contact
sterile areas; non-sterile
persons or items contact only
non-sterile areas.
cross over the sterile field. For
example, a non-sterile person
should not reach over a sterile
field.
When opening sterile
equipment, follow best practice
for adding supplies to a sterile
field to avoid contamination.

Do not place non-sterile items

in the sterile field.

10. Movement around and in Do not sneeze, cough,

the sterile field must not laugh, or talk over the sterile
compromise or contaminate field.
the sterile field.
Maintain a safe space or

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University of Northern Philippines
COLLEGE OF NURSING
MARC ZEAGAL C. AGAM, MAN
Instructor

NOTES:

margin of safety between

sterile and non-sterile objects
and areas.

Refrain from reaching over the

sterile field.

Keep operating room (OR)

traffic to a minimum, and keep
doors closed.

Keep hair tied back.

When pouring sterile solutions,

only the lip and inner cap of
the pouring container is
considered sterile. The pouring
container must not touch any
part of the sterile field. Avoid
splashes.

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