MEDICAL AND SURGICAL ASEPSIS Asepsis

Asepsis is any therapy, protocol or medical procedure used to defeat or prevent sepsis. Sepsis is a life-threatening illness. Your body's response to a bacterial infection usually causes it. Your immune system goes into overdrive, overwhelming normal processes in your blood. The result is that small blood clots form, blocking blood flow to vital organs. This can lead to organ failure. Babies, old people and those with weakened immune systems are most likely to get sepsis. But even healthy people can become deathly ill from it. A quick diagnosis can be crucial, because one third of people who get sepsis die from it. MEDICAL ASEPSIS Medical asepsis is the state of being free from disease cause microorganisms. Medical asepsis is concerned with eliminate the spread of microorganisms through facility practices. Medical asepsis protects both residents and caregivers from becoming ill. Medical asepsis as another means of fighting pathogens by breaking the disease chain. Referred to as the clean technique. Practices that reduce possibility of disease by reducing the number of pathogens or interrupting their transmission 1. Practices that reduce pathogens.

y Interrupts chain level at of causative agents and reservoir. y Hand washing the single most effective and important way to prevent spread of microorganisms. Occurs through friction loosening the microorganisms so they can be removed. Use of antiseptic soap killing numbers of microorganisms. y Use of disinfectants and antiseptics on people and objects . Disinfectant - substance that reduces the number of microorganisms, but does not eliminate them. Antiseptic substance that can be applied to skin to reduce the number of microorganisms When disinfecting articles, nurses need to follow agency protocol and consider the following: The type and number of infectious organisms. Some microorganisms are readily destroyed, whereas others require longer contact with the disinfectant.

The recommended concentration of the disinfectant and the duration of contact. The presence of soap. Some disinfectant are ineffective in the presence of soap or detergent. The presence of organic materials. The presence of saliva, blood, pus, or excretions van readily inactivate many disinfectants. The surface areas to be treated. The disinfecting agent must come into contact with all surfaces and areas. 2. Practices that interrupt transmission y Interrupts chain level at level of portal of exit, transmission, and portal of entry y Use of personal protective equipment Latex gloves Gowns Mask, goggles Equipment i.e. one way valves y Use of isolation procedure. 3. Antibiotics can also interrupt the infection cycle. These are medications that kill many types of bacteria.

 Appropriate hand washing by the nurse and the patient remains the most important factor in preventing the spread of microorganisms. PROCEDURE FOR APPLYING MEDICAL ASEPSIS Hospital-acquired infections and cross infections (infections that are transmitted between individuals with different pathogens) show the need of applying basic principles of medical asepsis. The following steps outline the basic procedures used in applying medical asepsis. 1. Perform Patient Care Hand wash. The patient care hand wash is the most important step in preventing and controlling infection. There may be times when you do not have the materials or the time to do a thorough hand wash; however, always wash your hands and clean your fingernails if time permits. 2. Disinfect Materials as Required. Disinfecting means cleaning objects to remove most organisms. Follow directions explicitly where chemical agents are used. 3. Maintain Clean Patient Care Environment. 4. Concurrent cleaning. Disinfect and dispose of infectious matter immediately during the course of a disease. This is a constant task. 5. Terminal cleaning. Disinfect contaminated materials after a patient dies, transfers, or is discharged. Use freshly prepared germicidal detergent solution to wash furniture,

mattress covers, grossly soiled areas of walls, and equipment not handled by central supply. Wet-vacuum or mop floors. If an isolation room, read isolation technique sign for special instruction. 6. Use Clean and Dirty Utility Rooms. Clean and dirty articles are not stored in the same place in order to prevent contamination. Clean rooms are used to store clean, unused equipment. Dirty rooms are rooms used to store contaminated items such as used linen, trash, contaminated equipment, dirty dietary trays, and basic laboratory tests. 7. HANDWASHING Hand washing is the single most important procedure for preventing the spread of biological contamination. Despite this fact many laboratory personnel don't wash their hands properly. Here are some hand washing tips and procedures for your use. 1. Consider the sink, including the faucet controls, contaminated. 2. Avoid touching the sink. 3. Turn water on using a paper towel and then wet your hands and wrists. 4. Work soap into a lather.

5. Vigorously rub together all surfaces of the lathered hands for 15 seconds. Friction helps remove dirt and microorganisms. Wash around and under rings, around cuticles, and under fingernails 6. Rinse hands thoroughly under a stream of water. Running water carries away dirt and debris. Point fingers down so water and contamination won't drip toward elbows. 7. Dry hands completely with a clean dry paper towel. 8. Use a dry paper towel to turn faucet off. 9. To keep soap from becoming a breeding place for microorganisms, thoroughly clean soap dispensers before refilling with fresh soap. 10. When hand washing facilities are not available at a remote work site, use appropriate antiseptic hand cleaner or antiseptic towelettes. As soon as possible, rewash hands with soap and running water. SURGICAL ASEPSIS Surgical asepsis is a sterile technique that requires nurses to use different precautions than they do for medical asepsis. It includes procedures used to eliminate all microorganisms, including pathogens and spores, from an object or area. Surgical asepsis procedures are followed when performing an invasive procedure into a body cavity normally free of microorganisms. GLOVING Gloves are worn for three reasons: First, they protect the hands of the nurse. Second, to reduce the like

hood of nurses transmitting their own endogenous microorganisms to individuals receiving care. Third, gloves reduce the chance that the nurses hands will transmit microorganism from one client or a for mite to another client. GLOVING Preparation for putting on surgical gloves Gloves are cuffed to make it easier to put them on without contaminating them. When putting on sterile gloves, remember that the first glove should be picked up by the cuff only. The second glove should then be touched only by the other sterile glove. Step 1 Prepare a large, clean, dry area for opening the package of gloves. Either open the outer glove package and then perform a surgical scrub or perform a surgical scrub and ask someone else to open the package of gloves for you. Step 2 Open the inner glove wrapper, exposing the cuffed gloves with the palms up. Step 3 Pick up the first glove by the cuff, touching only the inside portion of the cuff (the inside is the side that will be touching your skin when the glove is on).

will keep the fingers open.) Be careful not to touch anything, and hold the gloves above your waist level. NOTE: If the first glove is not fitted correctly, wait to make any adjustment until the second glove is on. Then use the sterile fingers of one glove to adjust the sterile portion of the other glove. Step 5 Pick up the second glove by sliding the fingers of the gloved hand under the cuff of the second glove. Be careful not to contaminate the gloved hand with the ungloved hand as the second glove is being put on. Step 6 Put the second glove on the ungloved hand by maintaining a steady pull through the cuff. Step 7 Adjust the glove fingers until the gloves fit comfortably. Donning and Removing Personal Protective Equipment. GOWN Pick up a clean gown, and allow it to unfold in front of you without allowing it to touch any are soiled with body substances. Slide the arms and the hands through the sleeves. Fasten the ties at the neck to keep the gown in place

Locate the top edge of the mask. Hold the mask by the top two strings or loops. Place the upper edge of the mask over the bridge of the nose, and ties at the back of the head or secure the loops around the ears. Secure the lower edge of the mask under the chin, and tie the lower ties at the nape of the neck. If the mask has metal strip, adjust this firmly over the bridge of the nose. Removing soiled PPE. Remove glove first. Wash your hands. Remove the mask y First untie the lower strings of the mask. y Then untie the top strings and, while holding the ties securely. Remove the mask from face. y If side loops are present, lift the side loops up and away from the ears and face. y Discard in the waste container. y Wash hands again if they have become contaminated by accidentally touching the soiled part.

Step 4 While holding the cuff in one hand, slip your other hand into the glove. (Pointing the fingers of the glove toward the floor

Overlap the gown at the back as much as possible and fasten the waist ties or belt. FACE MASK

 Remove the gown when preparing to leave the room. Unless a gown is grossly soiled with body substances.

TUB BATH y Tub baths are often preferred to bed baths because it is easier to wash and rinse in the tub. Tubs are also used for therapeutic baths. The amount of assistance the nurse offers depends on the abilities of the client. There are specially designed tubs for dependent clients. These tubs greatly reduce the work of the nurse in lifting client in and out of the tub and offer greater benefits than a sponge bath in bed. SELF HELP BED BATH

If a gown is grossly soiled: Avoid touching soiled parts on the outside of the gown if possible. Grasp the gown along the inside of the neck and pull down over the shoulders. Roll up the gown with the soiled part inside, and discard it in the appropriate container. BATHING BATHING PARTIAL BED BATH y Only the parts of the clients body that might cause discomfort or odor, if neglected, are washed: the face, hands, axillae, perineal area, and back. Omitted are the arms, chest, abdomen, legs and feet. The nurse provides this care for dependent clients and assists self-sufficient clients confined to bed by washing their backs. Some ambulatory clients prefer to take a partial bath at the sink. The nurse assists them by washing their backs.

a designated time, often 20-30 minutes. If the clients back, chest, and arms are to be treated, these areas need to be immersed in the solution. The bath temperature is generally included in the order: 37.7 to 46C (100-150F) may be ordered for adults and 40.5CV(105F) is usually ordered for infants. COMPLETE BED BATH y Giving someone a complete bed bath requires time, patience and respect for the patient's privacy and dignity. It can be a great time to converse with your patient and give them the personal attention they may not otherwise receive. A bed bath refreshes the bedridden patient and makes him feel more comfortable. As the caregiver, ensure that you provide them with this level of comfort throughout the entire process. Equipment y Basin of warm water y Soap and soap dish y Towels and washcloths (two or three of each, if possible) y Laundry bag or hamper y Clean gown y Clean gloves Procedure

y Client confined to bed are able to bathe themselves with the help from the nurse for washing the back and perhaps the feet. TOWEL BATH y The towel bath is an in-bed bath that uses a quick drying solution containing a disinfectant, a cleaning agent, and a softening agent mixed with water. The solution dries in a few second, avoiding the need to dry the client and thereby speeding the bathing process. THERAPEUTIC BATH y are given for physical effects, such as to soothe irritated skin or to treat an area. Medications may be placed in water. A therapeutic bath is generally taken in a tub 1/3 or full. The client remains in the bath for

 Discuss procedure with patient and ensure privacy. Promotes cooperation and decreases anxiety. Place all supplies within reach. Organizes task and prevents unnecessary steps. Wash hands. Reduces transmission of microorganisms. Position bed at comfortable height. Reduces nurses back strain. Fill basin with warm water, and test temperature on wrist. Testing temperature helps prevent accidental scalding. Help patient to side of bed closest to you, and lower side rail. Provides access to patient, and reduces back strain of nurse. Remove patients clothes while providing warmth and privacy with a covering such as a bed blanket. Provides access to body parts; provides modesty and warmth. Take washcloth and wrap the cloth around your hand tightly, forming a mitt. Prevents splashing water on patient and bedclothes. Wash the eyes. Be careful of the patients eyes. Use clear water to clean them, starting from the inner canthus to the outer canthus. If patient is not sensitive to soap, lather washcloth and gently wash the patients face, starting from the forehead down. Some patients are sensitive to soap or have very dry skin, and soap could increase dryness and lead to irritation and skin breakdown. Bathe from cleanest

area and work downward toward feet, going from areas of cleanest to dirtiest. Attention to the eyes prevents eye irritation and infection. Bathe ears and front and back of neck. Perspiration accumulates on the back of the neck when patients lie in bed for long periods. Bathe upper body and extremities, stroking arms from wrist to shoulder. Include auxiliary area. Stimulates circulation. Soak hands in basin if indicated. Dirt accumulates under fingernails, especially in incontinent patients. Keep chest covered with towel and wash under breasts on female patients. Apply powder if patient desires. This area stays moist on many females and can lead to skin excoriation. Bathe abdomen using side-to-side strokes on skin folds. Moisture and debris can accumulate in skin folds leading to irritation Bathe legs and feet, being sure perineal area is draped. Prevents unnecessary exposure. Soak feet in basin if indicated, and if patient is able to hold leg in position. Soaking will soften rough skin and facilitate cleaning toenails. Change bath water if necessary. Bath water may be cool or dirty. Assist patient to side-lying position and wash back. Give backrub. Side-lying position gives access to patients back for backrub.

Put on clean gloves and bathe perineal area. Dry thoroughly. Prevents cross contamination of organisms. Excess moisture contributes to skin breakdown. Remove gloves and assist patient to put on clean gown. Promotes dignity and reduces exposure. Conduct other personal hygiene activities as needed. Promotes patients body image. Lower bed, raise side rails, put call bell in reach, and dispose of used equipment and linen. Provides safety. Wash your hands. Reduces transmission of microorganisms.