INFECTION CONTROL

Banu TERZİ, Associate Professor, PhD, BSN

Akdeniz University, Faculty of Nursing
Fundamentals of Nursing Department

1
CONTENTS
 Asepsis
 Hand washing
 Antisepsis
 Disinfection
 Sterilization
 Waste Management
 Isolation
2
Semmelweis (1847)
noticed that the
mortality rate from
puerperal sepsis
decreased from 12%
to 3.4% after washing
hands with
hypochlorite solution.

3
Florence Nightingale (1854) argued that hospital location
and patient care strategies affect the risk of infection and
reduced the rate of infection with its regulations.

4
With the observation
of Lister (1860) in the
field of asepsis and
antisepsis,

Discovered the role of

bacteria in surgical wound
infections. He described
inflammation and
suggested the application
of antiseptics to the
wound to fight bacteria.

5
ASEPSIS

6
 BASIC CONCEPTS
Contamination

What is the CONTAMINATION?

 The concept of contamination has various meanings in many

different branches of science.

 It occurs as a result of the transfer of pollution from another

environment to a clean surface, environment or tissue.

 That is, a carrier is needed for the spread of pollution

 The most important source of contamination is HUMAN.

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 Disinfection
 It is the process of reducing the number of pathogenic microorganisms
on inanimate objects or completely destroying them.

 It is the purification of an object or substance from disease-causing

microorganisms.

 High-level disinfection with physical or chemical agents eliminates all

microorganisms except some bacterial endospores.

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Disinfectant
 The chemicals used in the disinfection process are called
disinfectants (sanitizers).

 Disinfectants are chemicals used to destroy pathogenic

microorganisms that may cause infection; however, they
are not expected to kill bacterial spores and all viruses.

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 Sterilization
 It is the purification of all microorganisms with any substance
or object from all kinds of living and active forms.

 In surgery, the instruments that will come into contact with the
tissues and the drugs to be injected into the body must be
sterile in order to prevent infections.

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Sterilant
 Sterilant substances are special chemical substances that
destroy all forms of microorganisms, including spores,
without glutaraldehyde, formaldehyde or aldehydes.

 The word sterilant refers to absolute sterility.

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 ASEPSIS
 Asepsis; It is the process of removing pathogenic
microorganisms from an environment or host.
 The general term that defines all the efforts made in health
institutions to prevent microorganisms from entering any part
of the body where they can cause infection is called ASEPSIS,
and all of the procedures performed for this purpose are called
ASEPTIC TECHNIQUE.
 The aim of asepsis is to reduce or destroy the number of
microorganisms on living surfaces (skin and tissue) and
objects (medical and surgical instruments).

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ASEPSIS
 1. Medical Asepsis,

 2. Surgical Asepsis

is divided into two.

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1. Medical Asepsis
 It is the process of preventing the spread of pathogenic
microorganisms from one person to another or to the environment.

 It also includes methods of destroying microorganisms after leaving

the source.

 Medical asepsis practices are very important in the prevention of

hospital infections.

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Medical Asepsis
(clean-dirty)
 Hand hygiene
 Glove use
 Isolation measures
 Disinfection-
sterilization
 Ground-surface
cleaning
 Waste management

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Points to consider in medical asepsis:
… Hands should be washed before and after the
operations to be performed
.… Dirty tools and bedding are transported without
touching the uniform
.… Dirty bedding and other utensils are not put on the
floor
.… Bedding is not shaken
.… Precautions are taken to avoid contact with the
cough, sneezing and breathing of the patients
.… Tools are kept away from the body while being
washed, brushed or dusted
.…The cleaning process is done from the less polluted
area to the more polluted area. Dirty or used tools are
put directly into suitable containers.
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… Dirty water, such as bath water and mouthwash,
is poured directly into the duct without splashing
onto the rim of the tub and the uniform
.… Wet utensils contaminated with body wastes and
streams are put into plastic bags and then thrown
into his dirty car
.… Equipment suspected of being contaminated
with pathogens is sterilized
.… Attention is paid to individual cleanliness in
order to prevent the spread of microorganisms.

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HAND WASHING

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The Importance and Types of Hand Washing
 Hand washing is the simplest method of
preventing nosocomial infections.

 In addition to hospital infections, hand washing is

extremely important in terms of protecting and
improving general public health.

 The hands of healthcare personnel play an

important role in the spread of microorganisms
from patient to patient.
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Situations where hands should be washed according to
the recommendation of the American Center for Disease
Control (CDC);
Before contacting the patient
 After contact with the patient (for example, after measurements
of fever, pulse, blood pressure, after transporting the patient,
etc.)
 Before wearing gloves
 After removing gloves
 Before urinary catheter, peripheral venous catheter or other
invasive procedures
 Body fluids before and after contact with mucous membranes
 Wound contact, before and after wound care
 Transition from contaminated area to clean area during patient
care
 After contact with materials near the patient

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General rules to be followed when washing
hands:
Jewelry on hands and arms are removed.
Nails are trimmed.

If there are nail polish and fake nails, they are

removed.

If there are cuts and scratches on the hands and

arms, they are covered with a waterproof, sterile tape.

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 Hand Washing Types:
 Normal (social) hand washing,

 Hygienic hand washing,

 Rubbing with antiseptic solution (Fast Hand

Antisepsis)

 Surgical hand washing

is separated.

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 Normal (Social) Hand Washing
 Normal hand washing is washing dirty hands with
soap and water.

 Here, the visible dirt on the hand and the temporary

flora on the skin (microorganisms that are transmitted
from the patient's secretions and contaminated
equipment, to the hands of healthcare personnel and
settled on the surface of the skin) are completely
removed from the environment.

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 Normal hand washing refers to washing dirty hands with
soap without antimicrobial activity. Here, visible dirt on the
hand and temporary flora elements on the skin are completely
removed from the environment.

- To ensure this effectiveness, hands should be washed for

at least 15-20 seconds.

- Jewelry on hands and arms are removed.

- Under running water, hands are wetted with water and

soap is taken into the palm.

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- - The entire surface of the hands, especially the
palms and between the fingers, is rubbed vigorously
for at least 15-20 seconds, including the fingers.

- - The hands are rinsed with water and dried with a

paper towel, starting from the wrist.

- - Turn off the tap with the same paper towel.

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 During intense daily activities, most of the time, the hand
washing process is not performed properly or there are areas
that are neglected during the washing process because it is
completed in less than 10 seconds.

 It should not be forgotten that the correct hand washing

process is of great importance in the prevention of nosocomial
infections.

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28
 HYGIENIC HAND WASHING
 Normal soaps and antiseptic soaps can be used.In this way,
temporary microorganisms are killed and removed.

 Hygienic hand washing should be done before interventions

on the patient's body, before contact with the patient prone to
infection, before and after contact with wound and urethral
catheters, before and after wearing gloves, and after
encountering situations where there may be contamination
with blood and exudates.

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Hygienic Hand Washing
- Tap is turned on and hands are thoroughly wetted under warm
water.

- - 3-5 ml after wet hands. Soap or antiseptic soap is taken into the
hands and foamed well.

- - The palms of the hands are rubbed together at least 5 times.

- - The back of the hand is rubbed at least 5 times with the palm of
the other hand.- One hand is placed on the back of the other hand,
fingers are intertwined and thoroughly washed.

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- The same movement is repeated in the other hand.
- - The fingertips and nails of both hands are
cleaned by rubbing against the palm of the other
hand at least 5 times.
- - This process is continued for at least 15-30
seconds.
- Both hands are rinsed under running water and
dried with a dryer or paper towel.
- - The faucet is turned off with a paper towel or
with the arm without touching it.
- - Used towels are thrown into the trash.

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33
FAST HAND DISINFECTION
 The purpose of hand disinfection; It is the effective and rapid
removal of bacteria from the hands.

 Here it is necessary to use disinfectant with antiseptic properties.

 For this, 3-5 ml of a fast-acting alcohol-based solution is taken, both

hands are rubbed and rubbed together for 30-60 seconds.

 During this process, the contact of the antiseptic solution with all
sides of the hands and between the fingers is ensured. Hand
disinfection should not completely replace hand washing. When
visibly soiled, hands should be washed with soap and water.
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35
X 36
FAST HAND ANTISEPTIC

It should be in
easily accessible
places.

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SURGICAL HAND WASHING
 Hygienic hand washing is the removal of temporary flora.

 Surgical hand washing is aimed at reducing the number of

persistent flora (found in the deep layers of the skin)
bacteria.

 Surgical hand washing is usually the preparation made

before the operation to be applied to the patient.

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 SURGICAL ASEPSIS
 It is the process of purifying the environment, environment and
necessary equipment from microorganisms.

 Surgical asepsis is applied when skin integrity is impaired, sterile

body cavities are entered (invasive procedures), and patients
with impaired skin integrity and sterile body cavities are cared
for (urinary catheterization, wound care, parenteral applications,
etc.).

 The term sterile within the concept of asepsis applies to surgical

asepsis and is the complete absence of microorganisms and
spores. 39
Basic Principles of Surgical Asepsis-I
- A sterile object can only touch a sterile object.

- When a non-sterile object touches a sterile object, it

contaminates it.

- No liquid should be splashed on a sterile cloth or paper.

- The sterile object should be kept above waist level. Thus,

it is ensured that the object remains in the field of view
and accidental contamination is prevented.

- Talking, coughing and sneezing on a sterile area or object

should be avoided. 40
Basic Principles of Surgical Asepsis-II
- Do not turn away from or turn your back on the sterile area.

- The area protruding from the field of view may be

contaminated.

- Everything that is inserted through cut skin, penetrates the skin,

or is placed in normally sterile body cavities must be sterile.

- Sterile objects when necessary; sterile material should be

handled with forceps or sterile gloves.

- If there is even the slightest doubt whether the object is sterile, it

should be considered contaminated.
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Surgical Asepsis-1
(Sterile-Nonsterile)

Something is either
sterile or not!!

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 Surgical Asepsis-2
(Sterile-Nonsterile)
If a sterile material is
touched with a non-
sterile device, that
material is no sterile.

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 Surgical Asepsis-3
(Sterile-Nonsterile )

The material that is

accepted as
“sterile”if
wet/moist it is not
sterile.

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Surgical Asepsis-4
(Sterile-Nonsterile )

Even if you have

0.1% doubt, you
can use that
material must be
considered non- %100 sterile
sterile.

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Considerations While Opening the Sterile Package
- Remember that the outside of a sterile package is not
sterile.

- Check if the sterile material package is torn.

- Check whether the sterile material package is wet.

- Check the expiry date of the sterile material package.

- Check that it has been subjected to sterilization on the

package.
a) unsterilized package b) Sterilized package (note the tapes)
- Never open the package by tearing it.
- If you are opening the sterile material to someone who is
dressed sterile, wait for the material in the opened
package to be received, do not touch it.
- If the sterile package or bundle is to be opened by
placing it somewhere, the floor must be dry, empty,
above waist level and flat.
- Hold the package by the outer edges with both hands.
- Open the package or bundle starting from the far side.

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- Carefully check the chemical indicator (chemical
indicator that changes color at high temperature)
in the sterile package and keep it until the end of
the process.

- Do not open the sterile materials until the time of

use, do not open and wait.

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 Figure. Unsterilized (left) and past (right) chemical indicators

- Dispose of the packaging materials in the

appropriate waste bag.

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 ANTISEPSIS
 The process of cleaning the pathogenic microorganisms on the
body surface (skin and mucous membrane) and wounds with
chemical substances to prevent infection is called
ANTISEPSIS.

 Chemical substances that provide antisepsis by cleaning

pathogenic microorganisms on living surfaces are called
ANTISEPTIC SOLUTIONS. Antiseptic solutions are made
usable in tissues by diluting the chemicals used in disinfection
sufficiently. For this reason, antisepsis can also be called tissue
disinfection. 52
 Antiseptic solutions do not only reduce dirt and bacteria
like water and soap; These agents kill bacteria with a
chemical effect (bactericidal effect) or stop their
reproduction (bacteriostatic effect).

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 Antiseptic solutions used for hand and skin
antisepsis are:
 Soap
 Hexachlorophene (Phisohex)
 Chlorhexidine Gluconate (hibiscrup,
chlorhex)
 Iodine and Iodoforms
 TriclosanAlcohols (70%) ethyl or isopropyl
alcohol

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55
What is the
Nosocomial
infection?

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 HOSPITAL INFECTION
(Nosocomial infection)
(Healthcare Associated Infection)
 They are infections caused by
microorganisms acquired in the hospital
and developed in the hospital.
 Sometimes the patient gives symptoms
after discharge.
 All healthcare professionals, other
patients and visitors who come into
contact with the patient may be
responsible. 57
 Edirne

Kayseri

Manisa
Ankara

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Why healthcare associated
infections are important?-1

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Why healthcare associated
infections are important?-2
Because;
 it is lethal
 It is expensive
 Preventable

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Causes of Healtcare Associated
Infections

A- Unchangeable causes
= patient reasons
B- Modifiable reasons
= hospital/employee reasons

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Unchangeable Causes
(patient's)

 Age
 Underlying diseases
 Long-term use of antibiotics

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 Modifiable reasons
 Uncontrolled use of antibiotics
 Invasive interventions
 Length of stay in hospital
 Non-compliance with surgical and medical asepsis
techniques

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How Can
Be
Prevent

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How Can Be Prevent?

Surgical asepsis
Medical asepsis

following the rules …

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Risk of contamination around
the patient
HEALTH CARE AREA

PATIENT UNIT
Critical area
with risk of
infection for the
patient

Critical area for

risk of exposure
to body fluids

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Contacts in the patient unit

2
3

1 4
5
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With Hands Contamination: Step 1

Microorganisms
are found on the
patient's skin and
surrounding
surfaces.

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With Hands Contamination: Step 2

These microorganisms in
and around the patient
contaminate the hands
of healthcare workers
through direct and
indirect contact.

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With Hands Contamination: Step 3
Microorganisms can survive and reproduce in
the hands of healthcare workers.

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With Hands Contamination: Step 4

Improper hand
cleaning causes
hands to remain
contaminated

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With Hands Contamination: Step 5
Microorganisms cross between patients A and
B with the hands of healthcare professionals

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With Hands Contamination: Step 6
Handling invasive
equipment with
contaminated
hands causes
microorganism to
be transmitted to
areas of the
patient at risk of
infection.

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How should a hospital worker's
hands be?

 Nails
 Jeweleries
 Nail polish
 Clothes
sleeves

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X 75
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WEARING GLOVES

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When to Wear Non-
Sterile Gloves?

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In case of contact with blood
and infected material

79
During procedures such as blood
drwaing, venipuncture

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In case of
contact
with non-
intact skin

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X 82
Personnel working with gloves on

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When to Change Non-
Sterile Gloves?

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Moving from one patient care to another

GLOVES MUST BE CHANGED

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When caring for different body parts of a
patient
GLOVES MUST BE CHANGED

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Risky Body Fluids
 blood
 genital secretions
 pleural fluid
 cerebrospinal
fluid
 synovial fluid
 amniotic fluid
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Contamination Routes of
Liquids

 Stinging of needles
 Injury with cutting
tools
 Splash into the mucous
membranes

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 Standard Precautions-1
 In contact with blood,
body fluids and
contaminated surfaces
 If there is a risk of
contact with mucous
membranes and unstable
skin
 During blood collection,
venipuncture procedures
 WEAR GLOVES

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Standard Precautions-2
After removing the glove
WASH YOUR HANDS

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 Standard Precautions-3
If blood and body fluids
are splashed
WEAR MASK, GLASSES
WEAR an Apron

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Standard Precautions-4

X
To avoid injuries
PUTTING THE NEEDLES IN THE COVER

93
First Aid for Injury with Sharp Tools
1-Let the wound bleed on its own.
2-Wash the injured area with soap and water.
3-After washing, apply povidone - iodine or
alcohol to the area.
4-Go to the Department of Infectious Diseases
and Clinical Microbiology as soon as possible.
5-If possible, find out which patient the cutting
device belongs to.

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ISOLATION MEASURES BASED ON
TRANSACTION

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 Airline Precautions-1

 Tuberculosis
 Varicella
from 5 microns small
particles contamination  Varicella
zoster virus
 Measles
 Coronavirus
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 Airline Precautions-2
 Negative pressure private room
 Doors must be kept closed
 Wear a mask at the entrance to the
patient's room (N95)
 Sensitive people should not enter the
room

97
 Droplet Precautions-1
 Meningitis
 Multiple resistant
 Pneumococcal
from 5 microns large infections
particles  Whooping cough
contamination
 Mumps
 Parvovirus B19
 Adenovirus

98
 Droplet Precautions-2
 Private room
 1 meter distance between beds
 Wear a mask when entering the
patient's room
 The room door may be open

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Contact Precautions
Aim:
To prevent transmission of the
microorganism from an infected or
colonized patient or infected object

100
Multi-resistant microorganisms
requiring contact isolation

 MRSA
 VRE
 K. Pneumoniae
 Rotavirüs
 RSV
 P.aeruginosa
 C.difficile

101
Contact Precautions -1

Take the patient to a single room

Patients with the same infection together
Isolation in patient’ bed

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Contact Precautions -2

Wear a clean, non-sterile gown

before entering the patient's room

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Contact Precautions -3

Wear clean non-

sterile gloves
before entering
the patient
room

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Contact Precautions -4

Remove gloves
and apron
before leaving
the roomThrow
it in the trash
can with the
red bag inside
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Contact Precautions -5

Wash your hands OR

Scrub with quick waterless hand sanitizer

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Contact Precautions-6

Do not touch any of

the surfaces in
the room with
clean hands

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Contact Precautions-6

Do not touch any of

the surfaces in
the room with
clean hands

108
Contact Precautions-7
Do not transfer
goods and medical
equipment from
patient to patient
between rooms.

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Contact Precautions-8
Provide disinfection
of surfaces twice
a day after
mechanical
cleaning

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DISINFECTION

111
DISINFECTION

 It is the process of destroying or

stopping the reproduction of
microorganisms (except bacterial
spores) on inanimate substances and
surfaces.
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Factors affecting disinfection
 Cleaning of equipment
 Concentration of disinfectant
 The contact time of the instrument
with the disinfectant
 Physical properties of the tool
 Media specifications

113
Disinfection Application

 Decontamination
 Mechanical cleaning
 Dilution
 Expiration date
contact time
 Right contact

114
 Medical instruments

Critical
instruments Non-critical
instruments
Semi-critical
instruments

115
Critical instruments

Instruments that enter sterile

body cavities, tissues, and the
vascular system (surgical
instruments, cardiac and urinary
catheters, implants, etc.)
It must be sterile.

116
Semi-critical instruments
Instruments (endoscopes, laryngoscope
blades, ventilator and anesthesia
circuits, etc.) that come into contact
with mucosa or non-intact skin

Sterilization/high-level disinfection

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Non-critical instruments and
surfaces
Instruments that come into contact with
intact skin (slides, floors, walls, furniture,
sphygmomanometers, etc.)
Low level disinfection / cleaning with water and
detergent

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*Disposable tools should not be
disinfected and reused.

* Disinfectants should never be used for

cleaning purposes.

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WASTE MANAGEMENT-1
Aim
It is to prevent
uncontrolled
environmental
pollution and the
spread of
microorganisms.

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WASTE MANAGEMENT-2
1- Red waste bag
• * Medical waste
• 2- Blue waste bag
• * Paper
• * Glass
• 3- Black waste bag
• * Domestic waste
• 4- Yellow waste bin
• * Radioactive waste

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