Module 10. Aseptic Technique, Isolation Precaution and Standard Precaution

Republic of the Philippines
Cebu Normal University

Osmeña Blvd. Cebu City, 6000 Philippines
College of Nursing
Center of Excellence (COE) | Level IV Re-Accredited (AACCUP)
Telephone No.: (+63 32) 254 4837
Email: cn@cnu.edu.ph; secretary@cnunursing.org
Website: www.cnu.edu.ph
Infection Control Principles and Practices

Isolation Precaution and Standard Precaution
Course Code: MC 3
Course Name/Title: Microbiology and Parasitology
Course Credit: Lec 54 hours; Laboratory 51 hours Level Offering:
Level I
Academic Year: Summer 2023
Name/s of Faculty: Ma. Mayla Imelda M. Lapa
Call or
text
+63932-
Facebook.com/Ma. Mayla
Imelda Lapa
689-
7743
Ma. Mayla Imelda Lapa
Email me:
ma.maylaimeldalapa@gmail.com
Pre-Requisite Courses: Biochemistry, JHS Biology
This module is part of the 6 – module series in infection control and health maintenance. This
module contains basic concepts in asepsis, standard precaution and levels of isolation. This module is
basic to the study on prevention of disease transmission within and among the population as well as in
the healthcare setting i.e. nosocomial infection.
This module will contain lessons in

Lesson 1. Aseptic technique
Lesson 2. Standard precaution
Lesson 3. Levels of isolation in the clinical setting
The chain of infection is composed of 6 components; the infectious agent, reservoir, portal of exit
from the reservoir, mode of transmission, portal of entry into the susceptible host, and the susceptible
host. As healthcare practitioners, at any point in the chain of infection, we have the responsibility to find
the weakest link in the chain and break the chain. This module deals with breaking the chain of infection,
in particular addressing mode of transmission. The concepts of this module talk about preventing the
transfer of pathogen from one host to the other. This module considers the mode of transmission as the
(Document Code)
Page 1 of 20
number)
Registration No. 52Q18778 Disclaimer: Concepts in building this module is reflective of the author’s study of
Certification Date: 6 August 2018 different reference materials about the subject of discourse.
Recertification due date: 24 January 2021
For verification of the certificate please access
Warning: No part of this module will be reproduced for commercial distribution and
www.globalgroup.net (Certification check and type the registration otherwise, without explicit consent

College of Nursing
Telephone No.: (+63 32) 254 4837
weakest link in the chain. Further, the module talks about ways to prevent the transfer of pathogen either
through direct contact transmission or airborne transmission.
LESSON 1. ASEPTIC TECHNIQUE
Bacteria are everywhere, and some are good for us while others are harmful. Bacteria, viruses
and other microorganisms that cause diseases are called pathogens. In the healthcare setting, the
patients are considered as susceptible host and healthcare practitioners have the responsibility to
protect them from harmful bacteria and other pathogens during medical procedures (iatrogenic
infection) and during their hospital stay (nosocomial infection). As protection of the patients against
possible infection, health care providers use aseptic technique.
Asepsis is the state of being free from disease-causing microorganisms (such as pathogenic
bacteria, viruses, pathogenic fungi, and parasites). It covers all those procedures designed to reduce the
risk of bacterial, fungal or viral contamination, using sterile instruments, sterile draping and the gloved
‘no touch’ technique. They also include all of the prophylactic methods, working processes and
behavioral forms by which microorganisms can be kept away from the patient's body and the surgical
incision. The goal of asepsis is to prevent contamination, which can be ensured by the use of sterile
devices, materials and instruments and by creating an environment that is low in microbe volume.
Aseptic technique means using practices and procedures to prevent contamination from
pathogen therefore resulting in asepsis. It involves applying the strictest rules to minimize risk of
infection. Healthcare providers use aseptic technique in surgery rooms, clinics, outpatient care centers,
and other healthcare settings. The hospital is a place where patients, significant others, visitors,
doctors, nurses and other healthcare providers come and go. In this environment only the patient’s
health status is known while those of non-patient is unknown. Therefore, it is the nurse’s responsibility
to ensure that the environment where the patient is accommodated is prepared aseptically.
What is aspetic technique used for?
Following aseptic technique helps prevent the spread of pathogens that cause infection.
Healthcare professionals commonly use aseptic technique when they’re:
• handling surgery equipment in the operating room or in the delivery room
• helping with a baby’s birth during labor and delivery process in the delivery room •
handling dialysis catheters and performing dialysis in the renal unit
• inserting a chest tube in the ward to help the patient breath easy if the patient has water or blood
in the lungs. Tube insertion is considered a minor surgery because it does not require the
patient to be brought into the operating room, the procedure can be performed at the bedside
or in the emergency room as required by the patient’s condition
• inserting central intravenous (IV) or arterial lines, usually performed at the bedside to accurately
measure arterial pressure
• inserting other draining devices i.e. catheter insertion, NG tube insertion
• performing various surgical techniques such as major surgeries
(Document Code)
Page 2 of 20
number)

College of Nursing
Telephone No.: (+63 32) 254 4837
At this time in your journey to become a nurse practitioner, you will be assigned in the labor room,
delivery room and nursery room where the patients that you will be taking care of are susceptible. The
labor room is where the women in labor and are waiting for their time to give birth are temporarily
accommodated. These women are undergoing a lot of stress during the labor process, it is important
that aseptic principles and technique are observed in order to protect them against infection in the labor
room. In the delivery room and in preparation for the delivery of the baby, the mother is prepared
aseptically, so that the mother’s normal microflora will not infect the baby during its passage from the
birth canal. In the nursery, babies who would need close monitoring will be accommodated and these
babies are susceptible to infection because their body had not yet developed their normal microbiota for
protection. Therefore, in handling these babies it is very important that septic techniques are used.
What are the categories of aseptic technique?
There are two categories of asepsis: medical and surgical. To know better these 2 categories of
asepsis, let us refer to the table below
Table 1.Medical Asepsis and Surgical Asepsis

Medical Asepsis Surgical Asepsis
Definition Medical asepsis is maintaining a Surgical asepsis is maintaining a

clean environment in order to sterile field.
reduce the number of pathogens. A sterile field is an environment that is
free from all microorganisms and
spores.
Other It is also called clean technique. Surgical asepsis is also known

name as sterile technique.
Aim Medical or clean asepsis reduces the Surgical or sterile asepsis includes
number of organisms and prevents procedures to eliminate
their spread. microorganisms from an area and is
practiced by surgical technologists
and nurses.
Indication Procedures that are considered It is required for procedures that

• technically simple; are • involve extended procedure
• short in duration (usually less than time (more than 20 minutes) or a
20 minutes); large open site
• Involve small sites such as puncture • most invasive and surgical operations
sites or injection sites;
Technique Common medical aseptic practices The main aseptic field needs to be
include handwashing, routine cleaning, managed as a critical aseptic field (a
and using personal protective controlled working space that ensures
equipment, such as gloves and asepsis by providing protection from
masks. the procedure environment –
typically by using a sterilized drape),
using sterile gloves and often with
full barrier
precautions to include sterile gown,
mask and cap.
(Document Code)
Page 3 of 20
Registration No. 52Q18778
Certification Date: 6 August 2018
For verification of the certificate please access Warning: No part of this module will be reproduced for commercial distribution and
number)
Disclaimer: Concepts in building this module is reflective of the author’s study of

different reference materials about the subject of discourse.

College of Nursing
Telephone No.: (+63 32) 254 4837
In this module, we will talk mostly of medical asepsis or the clean technique because this is the
most common technique that is used in-patient care, in areas where patients are commonly
accommodated. The sterile technique will be taken up and discussed in level III during medical –
surgical nursing. However, early introductions of surgical asepsis will be met when you will discuss
labor and delivery process. For microbiology and parasitology, suffice it to say that the principles of
medical asepsis will be applied in the patient’s room or ward.
Table 2. Principles of Medical Asepsis

Action Rationale
Hand hygiene Remove transient microorganisms from the hand
Safe storage of Prevent damage to the sterile equipment, preserve sterility of the
equipment equipment and prevent microbial contamination
Cleaning of the Reduce microbial contamination

procedure trolley
or tray
Preparation of Prevent microbial contamination of sterile equipment

the equipment
Personal Apron provide protection from potential contamination from the

Protective healthcare worker’s (HCW) uniform and the procedure and also protect
Equipment the HCW from potential contamination from the procedure.
Nonsterile gloves provide protection for the HCW from contamination

from blood and body fluids that may contaminate the hands.
Sterile gloves protect sites rom potential microbial contamination from the
HCW’s hands
Preparation of Reduce microbial contamination during the procedure

the
environment
Preparation of Gain informed consent and reduce anxiety

the patient
Waste disposal Prevent contamination of the environment
Documentation Provide essential communication and standards of patient care
Stages of Medical Aseptic Technique
1. Hand hygiene
Hand hygiene, its importance cannot be overemphasized especially in the healthcare
setting. It is the single most important way of preventing the spread of infection. Hands can act
as a mode of transmission in the chain of infection by carrying pathogens from one patient to
another patient. Additionally, when pathogens are on a health care worker's hands, the health
care worker is in danger of contracting the disease or infection. Because of this danger, health
care workers must use appropriate hand cleansing hygiene.
(Document Code)
Page 4 of 20
Recertification due date: 24 January 2021 different reference materials about the subject of discourse.
www.globalgroup.net (Certification check and type the registration
otherwise, without explicit consent
number)
College of Nursing
Telephone No.: (+63 32) 254 4837
When to cleanse hands:

• Must be performed before any aseptic technique. Hands can be decontaminated by
washing with soap and water or by use of alcohol-based hand rub
• Hand hygiene must be performed before preparation of the sterile equipment to avoid
contamination of the equipment and may need to be repeated immediately before the
procedure if the hands have become contaminated.
• It must also be performed before and after performing a procedure.
• When arriving at the health care facility and immediately, before leaving the facility. •
Before and after every patient contact.
• Before and after handling a specimen.
• Before and after touching the mouth, eyes, or nose.
• Before donning gloves and immediately after removing gloves.
• After contacting soiled or contaminated items.
• After picking up any item from the floor.
• After using the bathroom.
• After coughing, sneezing, or using a tissue.
How to cleanse hands

• Hand washing
Hand washing involves using plain soap and water to cleanse the hands. Health care
workers should wash their hands when they are visibly dirty or soiled.
• Hand sanitizer or alcohol – based hand rub
An alcohol-based hand rub involves using an alcohol-based lotion or gel to cleanse the
hands. Alcohol-based hand rubs are more effective than hand washing at removing
microorganisms. Health care workers should use an alcohol-based on their hands when
they are not visibly soiled.
2. Storage of Equipment
• All sterile equipment should be stored in a clean and dry environment
• The sterile packages should not be allowed to become wet or damaged as this affects
the sterility of the equipment inside.
• Ideally the equipment should be kept out of direct sunlight as this could also affect the
packaging, as well as the quality of the sterile products of the equipment.
• It is also sensible to store the equipment in a manner that enables staff to locate it easily,
preventing wasted time.
• Environment where sterile equipment are stored must be kept clean and free of
contaminants
• Separate storage for clean and sterile equipment, preferably with label.
3. Preparing equipment
• Preparation of aseptic technique equipment before performing a procedure should be
done in a clean area.
(Document Code)
Page 5 of 20
number)

College of Nursing
Telephone No.: (+63 32) 254 4837
• A suitable surface should be prepared, such as a dressing trolley or a procedure tray, by

cleaning it with a detergent wipe or according to institutional policy
• Ideally, preparation should be undertaken far enough away from hand washbasins to
prevent droplets from the sink outlet contaminating the prepared equipment • Each sterile
package should be inspected to ensure the packaging is still intact with no visible damage;
the expiry date must be checked to ensure the equipment is still in date • All equipment
required should be gathered at this point and laid out in a manner to protecting it using
sterile packets, covers and caps
• Alternatively, a sterile field can be created using a sterile dressing pack
4. Consent
• It is important to inform the patient before undertaking any procedure and to obtain
consent, allowing time to explain the specific procedure and to help reduce any
anxieties the patient may have
• Where the patient has capacity, this can usually be done verbally and then documented
in the patient’s record
• A best-interest decision may need to be made for a patient who is unable to give consent
and this decision needs to be clearly documented in the patient’s record.
5. Environment
• The procedure should be carried out in a location that maintains the patient’s privacy and
dignity, such as a treatment room, at the bedside with the curtains drawn or in the
patient’s own home
• To reduce the risk from airborne dispersal of microorganisms, the procedure area should
be prepared by closing windows, turning off any fans that are in use and avoiding any
bed making being undertaken in close proximity.
6. Use of gloves and apron as barriers

Barriers protect the patient from the transfer of pathogens from a healthcare worker,
from the environment, or from both. Some barriers used in aseptic technique include: • A clean
disposable apron provides an ideal barrier between potentially contaminated uniforms and the
procedure, reducing any contamination that may arise from the procedure.
• The decision as to whether single-use sterile or single-use non-sterile examination gloves
should be worn, or whether gloves are required at all, should be based on a risk
assessment
• Single-use non-sterile gloves should be worn to protect the healthcare worker when there
is a risk of contact with blood or body fluids during any procedure
• Where there is a risk that sites cannot be protected, for example, during urinary catheter
insertion, sterile gloves should be worn
• Sterile gloves are worn to render the hand sterile since washing hands with antiseptic
alone will only reduce the number of bacteria on it.
(Document Code)
Page 6 of 20
number)

College of Nursing
Telephone No.: (+63 32) 254 4837
• It is important to remember that the single-use gloves, whether sterile or non-sterile,

should be applied immediately before beginning the procedure; applying them before
this point is likely to contaminate sterile gloves and/or prevent an opportunity for hand
hygiene
• Sterile barriers are those that have not touched a contaminated surface. They’re
specially packaged and cleaned items.
Gloving guidelines
➢ During the gloving process, touch only the inside of the glove with the non
gloved washed hand. The outside of the glove can be touched with the gloved
hand.
➢ Once gloved, do not touch non-sterile areas or articles with the gloved hand.
Remember that the patient’s skin is non-sterile. Surgeons should not poke their
finger into the lumen of intestines! If there is a need to do so, the glove should
be changed immediately.
➢ If the glove is punctured torn or contaminated, replace it.
7. Maintaining a sterile field

• During the procedure, the sterile field needs to be maintained; this can be achieved by
careful opening of the sterile packets to avoid contamination of the sterile equipment
and the sterile surfaces of the inside packaging.
• If a sterile dressing pack is being used, care should be taken to ensure that only the
corners are used when opening out the sterile field.
• Carefully open any other sterile equipment and gently place it onto the sterile field,
avoiding any contamination of the sterile surfaces of the equipment
• When opening packets/envelopes ensure that the inside of the packet is not touched.
Transfer the item or the inside package from the packet to the sterile field by either
dropping it in, grasping it with a gloved hand/sterile forceps without touching the exterior
of the packet.
• The entire sterile instruments/disposable items (such as lines and catheters) should lie
within a sterile field.
8. Equipment disposal
• At the end of the procedure, all waste must be disposed of in the appropriate waste
stream bin, such as a healthcare waste bin.
• Sharps, including needles, suture cutters, scissors and blades must be disposed of at the
point of use in an approved sharps container
• The remaining waste, including aprons and gloves, should be disposed of according to
institutional policy
• When all the waste has been disposed of safely and apron and gloves, if worn, have
been removed hands should be decontaminated
• Once hands are clean, the procedure should be clearly documented in the patient’s
records
(Document Code)
Page 7 of 20
number)

College of Nursing
Telephone No.: (+63 32) 254 4837
9. Contact guidelines or Non – touched technique

Work processes that are devised so that the sterile or disinfected item or instrument does
not come into contact with non-sterile items. This can be achieved by studying the possible
instances where contamination can occur in the context of various procedures and devising
methods of avoiding it, includes
• Once healthcare providers have on sterile barriers, the individual should only touch other
sterile items and avoid touching nonsterile items at all costs.
• Exposure of objects to air for the duration of clinical procedures is not considered as
contamination and does not cause these objects to lose their sterility
• Contact between sterile items with any other non-sterilized object renders the instrument
or item non-sterile
• If a non-sterile instrument is to be used during the procedure, then sterile sleeves or
sterile see through covers need to be used (ultrasound probes microscopes, button &
switches).
Personal Protective Devices/Equipment (PPE)

The use of personal protective equipment protects the health care staff, clients, and visitors
against infections. Personal protective equipment (PPE) is specialized equipment and attire that is used
by employees in health care to protect against infections. Examples of personal protective equipment
include gowns, gloves, masks, goggles, and respirators.
Some basic principles for donning and removing personal protective equipment include donning
sterile gowns and gloves using the surgical technique by touching only the sterile surfaces of these
items with sterile hands. For example, the first sterile glove is applied by touching the inside of the glove
with the bare hand after which the second sterile glove is donned by holding the glove with the sterile
gloved hand without touching any skin surfaces.
Another basic principle includes removing used personal protective equipment by folding the
item inside out and disposing of it in the proper receptacle.
(Document Code)
Page 8 of 20
number)

College of Nursing
Telephone No.: (+63 32) 254 4837
LESSON 2. STANDARD PRECAUTION
UNIVERSAL PRECAUTION
Universal precautions (introduced in 1985 by CDC) were developed to guide the practice of
hospital workers in caring for patients. Originally, precautions were put into place to be used when a
patient was known to be infected with a disease that could be transmitted by bloodborne pathogens. For
example, if a man with HIV came into the ER with bleeding, healthcare workers would use gloves and
face shields to protect themselves. Other precautions include handwashing and avoiding exposure to
used needles or sharps. But if a man came into the ER with the same injury but no known disease, it
would not be necessary to use PPE based on the original guidelines.
BODY SUBSTANCE ISOLATION

In 1987, the CDC introduced another set of guidelines termed Body Substance Isolation. These
guidelines advocated the avoidance of direct physical contact with “all moist and potentially infectious
body substances,” even if blood is not visible. A limitation of this guideline was that it emphasized
handwashing after removal of gloves only if the hands were visibly soiled.
STANDARD PRECAUTION
Introduced in 1996, combined the major features for Universal Precaution and Body Substance
Isolation. These guidelines also introduced three transmission-based precautions: airborne, droplet, and
contact. All transmission-based precautions are to be used in conjunction with standard precautions.
Standard precautions apply to the care of all patients, irrespective of their disease state. These
precautions apply when there is a risk of potential exposure to (1) blood; (2) all body fluids, secretions,
and excretions, except sweat, regardless of whether or not they contain visible blood; (3) non-intact
skin, and (4) mucous membranes. This includes the use of hand hygiene and personal protective
equipment (PPE), with hand hygiene being the single most important means to prevent transmission of
disease. It include guidelines for patient contact and environmental cleanliness.
In the healthcare setting, standard precaution is practiced as part of infection control practices.
Figures 1A and 1B, depicts the practice of this infection control practice in the hospital and other
healthcare settings. Standard precautions are infection control measures that are used to prevent the
spread of infection among ALL patients whether or not they have a known infection. Standard
precautions protect health care workers and patients from the spread of infection secondary to
contaminated blood and other bodily fluids.
New Elements of standard precautions
Three such areas of practice that have been added are: Respiratory Hygiene/Cough Etiquette,
safe injection practices, and use of masks for insertion of catheters or injection of material into spinal or
epidural spaces via lumbar puncture procedures (e.g., myelogram, spinal or epidural anesthesia). While
most elements of Standard Precautions evolved from Universal Precautions that were developed for
protection of healthcare personnel, these new elements of Standard Precautions focus on protection of
patients. (Continue on page 12)
(Document Code)
Page 9 of 20
Certification Date: 6 August 2018 Disclaimer: Concepts in building this module is reflective of the author’s study of
number) otherwise, without explicit consent

College of Nursing
Telephone No.: (+63 32) 254 4837
Fig. 1A Standard Precautions in Health care settings
(Document Code)
Page 10 of 20
College of Nursing
Telephone No.: (+63 32) 254 4837
Fig. 1B Health care facility recommendations for Standard Precautions
(Document Code)
Page 11 of 20
number)

College of Nursing
Telephone No.: (+63 32) 254 4837
Respiratory hygiene/cough etiquette.

The strategy proposed has been termed Respiratory Hygiene/Cough Etiquette and is intended
to be incorporated into infection control practices as a new component of Standard Precautions. The
strategy is targeted at patients and accompanying family members and friends with undiagnosed
transmissible respiratory infections, and applies to any person with signs of illness including cough,
congestion, rhinorrhea, or increased production of respiratory secretions when entering a healthcare
facility. The term cough etiquette is derived from recommended source control measures for M.
tuberculosis.
The elements of Respiratory Hygiene/Cough Etiquette include

• education of healthcare facility staff, patients, and visitors;
• posted signs, in language(s) appropriate to the population served, with instructions to patients
and accompanying family members or friends;
• source control measures (e.g., covering the mouth/nose with a tissue when coughing and prompt
disposal of used tissues, using surgical masks on the coughing person when tolerated and
appropriate);
• hand hygiene after contact with respiratory secretions; and
• spatial separation, ideally >3 feet, of persons with respiratory infections in common waiting areas
when possible.
Safe injection practices

The investigation of four large outbreaks of HBV and HCV among patients in ambulatory care
facilities in the United States identified a need to define and reinforce safe injection practices. The
primary breaches in infection control practice that contributed to these outbreaks were
• reinsertion of used needles into a multiple-dose vial or solution container (e.g., saline bag) and •
use of a single needle/syringe to administer intravenous medication to multiple patients.
In one of these outbreaks, preparation of medications in the same workspace where used
needle/syringes were dismantled also may have been a contributing factor. These and other outbreaks
of viral hepatitis could have been prevented by adherence to basic principles of aseptic technique for
the preparation and administration of parenteral medications. These include the
• use of a sterile, single-use, disposable needle and syringe for each injection given and •
prevention of contamination of injection equipment and medication.
• Whenever possible, use of single-dose vials is preferred over multiple-dose vials, especially when
medications will be administered to multiple patients.
(Document Code)
Page 12 of 20
number)

College of Nursing
Telephone No.: (+63 32) 254 4837
Fig. 2 Guidelines in the application of Standard Precaution
(Document Code)
Page 13 of 20
number)

College of Nursing
Telephone No.: (+63 32) 254 4837
When to use PPE in the context of Standard Precaution and other prevention
interventions Gloves
Must be worn when touching blood, body fluids, secretions, excretions, mucous membranes, or
non-intact skin. Change when there is contact with potentially infected material in the same patient to
avoid cross-contamination. Remove before touching surfaces and clean items. Wearing gloves does
not mitigate the need for proper hand hygiene.
Mask, Goggles/Eye Visor, and/or Face Shield

Wear a mask and eye protection or face shield during procedures that may spray or splash
blood, body fluids, secretions, or excretions.
Gown
Wear to protect skin or clothing during procedures that may spray or splash blood, body fluids,
secretions, or excretions.
Needles and Other Sharps

Do not break, bow, or directly manipulate used needles. Recapping is not recommended, but if
necessary, “use a one-handed scoop technique only.” Discard all used sharps in appropriate puncture
resistant containers.
PROPER DONNING AND REMOVAL OF PPE
Donning of PPE
The CDC recommends that PPE be donned in following sequence:

(1) gown,
(2) mask or respirator,
(3) goggles or face shield, and
(4) gloves.
Removal of PPE
The safe removal of PPE also follows a specific sequence that requires special attention to
areas that are now considered contaminated:
(1) gloves should be removed by first grasping the palm of the other hand and peeling off the first glove,
keep hold of the removed glove in the gloved hand, slide the fingers of the ungloved hand under
the remaining glove and peel it off over the first glove,
(2) goggles or face shield should be removed by lifting from behind the head,
(3) gowns should untied and removed by pulling away from the neck and shoulders, turning the gown
inside out and only touching the inside,
(4) mask or respirator should be removed by reaching behind the head and grasping the bottom ties
then the top ties and removing without touching the front.
Alternatively, the gloves and gown may be removed at the same time by grasping the gown from
the front and pulling away from the body, rolling the gown into a bundle, and removing the gloves at the
(Document Code)
Page 14 of 20
College of Nursing
Telephone No.: (+63 32) 254 4837
same time using the inside of the gown. Hand hygiene should be performed after removal of all PPE,
and anytime during removal if they become contaminated.
LESSON 3 LEVELS OF ISOLATION IN CLINICAL SETTING
In addition to the practice of asepsis and standard precaution in the healthcare setting, it is also
necessary that healthcare workers are able to protect patients from nosocomial infection. Nosocomial
infection also known as hospital-acquired infections, are newly acquired infections that are contracted
within a hospital environment. Transmission usually occurs via healthcare workers, patients, hospital
equipment, or interventional procedures. This type of infection results in additional burden to the patient
and the family physically and economically. Patients are susceptible to this type of infection because of
their compromised natural defenses which may be indirectly brought about by their condition. Thus, to
prevent this infection from occurring healthcare providers must know how to apply precaution
techniques.
The center for disease control and prevention, commonly known as CDC, introduced not just
standard precaution but also 2 other precautions; transmission – based precautions and contact
precautions. Transmission – based precautions include contact precautions to prevent direct and
indirect contact transmissions of infectious pathogens like those found in infected wounds, infectious
diarrhea, and infections such as herpes simplex; droplet precautions are used to prevent the
transmission of pathogens that are transmitted with a cough or sneeze, therefore, face masks are
indicated for these precautions; and airborne precautions are used for airborne transmission microbes
like tuberculosis which requires a negative pressure private room and a HEPA mask.
Contact Precaution
These precautions are used in patients with known or suspected infection or colonization with
pathogens that are spread by direct and indirect patient contact. Indirect patient contact occurs when
physical contact is made with items or surfaces in the patient’s environment.
• Patient placement
Private rooms are preferred; however, they may be placed in a semi-private room with another
patient having the same active infection, and no other infection (cohorting). “When a private
room is not available, and cohorting is not achievable, consider the epidemiology of the
microorganism and the patient population when determining patient placement. Consultation
with infection
control professionals is advised before patient placement.”
• PPE
Gloves and gowns should be donned prior to entering the patient's room and removed before
leaving. Donning PPE upon room entry and properly discarding before exiting the patient room
is done to contain pathogens. Hand hygiene should be performed immediately afterward. Care
should be taken not to touch any potentially contaminated surface upon leaving the room
• Transport
Limit transport and movement of patients outside of the room to medically-necessary purposes.
When transport or movement is necessary, cover or contain the infected or colonized areas of
the patient’s body. Remove and dispose of contaminated PPE and perform hand hygiene prior
to transporting patients on Contact Precautions. Don clean PPE to handle the patient at the
transport location. Maintain contact precautions at all times.
(Document Code)
Page 15 of 20
number)

College of Nursing
Telephone No.: (+63 32) 254 4837
• Patient Equipment
When possible, patients should have dedicated equipment that remains in the room with them,
e.g., single-patient-use blood pressure cuff. If single-patient-use items are not available, then
they should be cleaned and disinfected before use on another patient.
• Prioritize cleaning and disinfection of the rooms of patients on contact precautions ensuring
rooms are frequently cleaned and disinfected (e.g., at least daily or prior to use by another
patient if outpatient setting) focusing on frequently touched surfaces and equipment in the
immediate vicinity of the patient.
• Indications
Contact precautions should be used for the following infections and conditions for the duration
listed:
➢ Abscess, major draining (duration of illness, until cessation of drainage).
➢ Adenovirus: pneumonia (duration of illness).
➢ Burkholderia cepacia in Cystic Fibrosis patients.
➢ Bronchiolitis (duration of illness).
➢ Clostridium difficile (duration of illness).
➢ Congenital rubella (duration is until 1 year of age, or urine and nasopharyngeal
cultures consistently negative after 3 months of age).
➢ Conjunctivitis, viral (duration of illness).
➢ Diphtheria: cutaneous (duration is until completion and antibiotics and 2 negative
cultures 24 hours apart).
➢ Staphylococcal furunculosis (duration of illness).
➢ Rotavirus (duration of illness).
➢ Hepatitis A (duration is age specific in incontinent patients: children < 3 years old is
duration of hospitalization; 3-14 years old is 2 weeks after onset; > 14 years old is 1
week after onset).
➢ Herpes simplex: neonatal, disseminated, severe, or mucocutaneous (duration is until
lesions dry and crust).
➢ Herpes zoster: disseminated (duration of illness).
➢ Human metapneumovirus (duration of illness).
➢ Impetigo (duration is until 24 hours after initiating effective therapy).
➢ Lice: head (duration is until 24 hours after initiating effective therapy).
➢ Monkeypox (duration is until lesions crust).
➢ Multidrug-resistant organisms infection or colonization (duration is while evidence of
ongoing or increased risk of transmission, or while there are wounds that cannot be
covered).
➢ Parainfluenza virus (duration of illness).
➢ Poliomyelitis (duration of illness).
➢ Pressure ulcer, major infected (duration of illness).
➢ Respiratory syncytial virus: infants, young children, and immunocompromised adults
(duration of illness).
➢ Staphylococcal scalded skin syndrome, Ritter’s disease (duration of illness).
➢ Scabies.
(Document Code)
Page 16 of 20
number)

College of Nursing
Telephone No.: (+63 32) 254 4837
➢ Severe acute respiratory syndrome (duration of illness plus 10 days after fever and
respiratory symptoms have resolved or improved).
➢ Smallpox (duration of illness).
➢ Staphylococcus aureus skin infection, major (duration of illness).
➢ Group A streptococcus skin infection, major (duration is until 24 hours after initiating
effective therapy).
➢ Tuberculosis: extrapulmonary, draining lesions (duration is until clinically improving and
drainage has stopped or there are consecutively three negative cultures).
➢ Vaccinia (duration is until lesions crust and dry).
➢ Varicella zoster (duration is until lesions crust and dry).
➢ Ebola, Marburg, Crimean-Congo, and Lassa fever viruses: viral hemorrhagic fevers
➢ Wound infections, major (duration of illness).
Airborne Precautions
These precautions are used in patients with known or suspected infection with pathogens that
are spread by airborne transmission, i.e., “airborne droplet nuclei (small-particle residue {5 um or
smaller in size} of evaporated droplets that may remain suspended in the air for long periods of time) or
dust particles containing the infectious agent.”
• Source control
Put mask on patient.
• Patient Placement
Patients should be placed in a negative pressure isolation room that allows a minimum of 6 to
12 air changes per hour or an airborne infection isolation room (AIIR). Patients with the active
infection with the same pathogen, and no other infection, may be roomed together (cohorting).
Doors to the room must remain closed at all times. “When a private room is not available, and
cohorting is not desirable, consultation with infection control professionals is advised before
patient placement.”
• Restrict susceptible healthcare personnel from entering the room of patients known or
suspected to have measles, chickenpox, disseminated zoster, or smallpox if other immune
healthcare personnel are available.
• PPE
Respirators that filter at least 95% of airborne particles must be worn over the nose and mouth,
i.e., powered air-purifying respirator (PAPR) with a high-efficiency particular air (HEPA) filter,
including a fit-tested NIOSH-approved N95 or higher level respirator for healthcare personnel. •
Transport
Limit transport and movement of patients outside of the room to medically necessary purposes.
If transport or movement outside an AIIR is necessary, instruct patients to wear a surgical mask,
if possible, and observe Respiratory Hygiene/Cough Etiquette. Healthcare personnel
transporting patients who are on Airborne Precautions do not need to wear a mask or respirator
during transport if the patient is wearing a mask and infectious skin lesions are covered.
• Immunize susceptible persons as soon as possible following unprotected contact with vaccine
preventable infections (e.g., measles, varicella or smallpox).
(Document Code)
Page 17 of 20
number)

College of Nursing
Telephone No.: (+63 32) 254 4837
• Indications
Airborne precautions should be used for the following infections and conditions for the minimum
duration listed:
➢ Aspergillosis if “massive soft tissue infection with copious drainage and repeated
irrigations required.”
➢ Herpes Zoster that is disseminated or in immunocompromised patients (duration of
illness).
➢ Measles (duration of 4 days after onset of rash in immunocompotent host; duration of
illness in immunocompromised).
➢ Monkeypox (duration is until diagnosis is confirmed and smallpox has been excluded).
➢ Smallpox (duration of illness).
➢ Tuberculosis: pulmonary or laryngeal (duration until improving clinically on effective
therapy with three negative sputum smears on consecutive days).
➢ Tuberculosis: extrapulmonary, draining lesions (duration until clinically improving and
drainage has stopped or there are consecutively three negative cultures).
➢ Varicella Zoster (duration until the lesions crust and dry).
Droplet Precautions
These precautions are used in patients with known or suspected infection with pathogens that
are spread by droplet transmission. “Droplets are particles of respiratory secretions +/- 5 microns.
Droplets remain suspended in the air for limited periods. Transmission is associated with exposure
within three to six feet (one to two meters) of the source.”
• Source Control
Put a mask on the patient
• Patient Placement
Private rooms are preferred; however, they may be placed in a semi-private room with another
patient having the same active infection, and no other infection (cohorting). When a private
room or cohorting is not available, the infected patient should be placed at least 3 feet away
from other patients and visitors. The doors to the room may be left open, and no special air
handling is required
• PPE
Don surgical mask upon entry into the patient room or patient space. It should be worn while
within 6 feet of the patient.
• Transport
Limit transport and movement of patients outside of the room to medically necessary purposes.
If transport or movement outside of the room is necessary, instruct patient to wear a surgical
mask and follow Respiratory Hygiene/Cough Etiquette.
• Indications
Droplet precautions should be used for the following infections and conditions for the duration
listed:
➢ Adenovirus: pneumonia (duration of illness).
(Document Code)
Page 18 of 20
number)

College of Nursing
Telephone No.: (+63 32) 254 4837
➢ Diphtheria: pharyngeal (duration is until completion of antibiotics and 2 negative cultures

24 hours apart).
➢ Haemophilus influenzae type b: epiglottitis or meningitis (duration is until 24 hours after
initiating effective therapy).
➢ Influenza, pandemic
➢ Neisseria meningitidis: meningitis, sepsis, or pneumonia (duration is until 24 hours after
initiating effective therapy).
➢ Mumps (duration is 5 days after onset).
➢ Mycoplasma pneumonia (duration of illness).
➢ Parvovirus B19 (duration is 7 days in acute disease, duration of hospitalization in
chronic disease of immunocompromised host).
➢ Pertussis (duration is 5 days).
➢ Yersinia pestis: pneumonic plague (duration is 48 hours).
➢ Group A Streptococcus: pneumonia, pharyngitis, scarlet fever, serious invasive disease
(duration is until 24 hours after initiating effective therapy).
➢ Rhinovirus (duration of illness).
➢ Rubella (duration is until 7 days after rash onset).
➢ Ebola, Marburg, Crimean-Congo, and Lassa fever viruses: viral hemorrhagic fevers
You may want to know more……..
• Infection Prevention and Control Guidelines

https://www.health.state.mn.us/facilities/patientsafety/infectioncontrol/guidelines.html •
Infection prevention and control: injection safety https://www.who.int/infection-prevention/en/ •
Practical guidelines for infection control in health care facilities
https://www.who.int/water_sanitation_health/emergencies/infcontrol/en/
• Needlestick injury https://www.youtube.com/watch?v=53Wxyh6NUbc
• Nursing Needle Sticks | Preventing Sharp Injuries on the Job | Plus My Experience
https://www.youtube.com/watch?v=d8O3KT0L_Qo
• WHO: What are the core components for effective infection prevention and control?
https://www.youtube.com/watch?v=LZapz2L6J1Q
• Asepsis and Infection Control Unit 5 Nursing Fundamentals F18
https://www.youtube.com/watch?v=_i51N8jsUo0
(Document Code)
Page 19 of 20
number)

College of Nursing
Telephone No.: (+63 32) 254 4837
I. References
Broussard, I. a. (2020, July 26). Universal Precautions. Retrieved from NCBI Resources:
https://www.ncbi.nlm.nih.gov/books/NBK470223/
Denton, A., & Hallam, C. (2020). Principles of asepsis 1: the rationale for using aseptic technique.
Nursing Times [online], 116: 38-41.
Dockery, D. (2012). Aeptic Technique. Retrieved from sciencedirect:

https://www.sciencedirect.com/topics/immunology-and-microbiology/asepsis
Pranata, S. (2020). Aseptic Technique & Streaking for Isolation. Retrieved from Slideplayer.com:
https://slideplayer.com/slide/16303196/
Standard Precautions, Transmission - Based and Surgical Asepsis. (2020, September 5). Retrieved
from Registered Nursing.org: https://www.registerednursing.org/nclex/standard
precautions-transmission-based-surgical
asepsis/#:~:text=Medical%20asepsis%20also%20referred%20to,proliferation%20and%20gro
wth%20of%20microorganisms.
U.S. Department of Health & Human Services. (2019, July 22). Infection Control. Retrieved from
Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic
Infectious Diseases:
https://www.cdc.gov/infectioncontrol/guidelines/isolation/precautions.html
(Document Code)
Page 20 of 20
number)

otherwise, without explicit consent

Module 10. Aseptic Technique, Isolation Precaution and Standard Precaution

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Module 10. Aseptic Technique, Isolation Precaution and Standard Precaution

Uploaded by

Copyright:

Available Formats

Republic of the Philippines

Cebu Normal University

Infection Control Principles and Practices

Ma. Mayla Imelda Lapa

Pre-Requisite Courses: Biochemistry, JHS Biology

This module will contain lessons in

Republic of the Philippines

LESSON 1. ASEPTIC TECHNIQUE

What is aspetic technique used for?

Republic of the Philippines

What are the categories of aseptic technique?

Table 1.Medical Asepsis and Surgical Asepsis

Definition Medical asepsis is maintaining a Surgical asepsis is maintaining a

Other It is also called clean technique. Surgical asepsis is also known

Indication Procedures that are considered It is required for procedures that

Disclaimer: Concepts in building this module is reflective of the author’s study of

Republic of the Philippines

Table 2. Principles of Medical Asepsis

Hand hygiene Remove transient microorganisms from the hand

Cleaning of the Reduce microbial contamination

Preparation of Prevent microbial contamination of sterile equipment

Personal Apron provide protection from potential contamination from the

Nonsterile gloves provide protection for the HCW from contamination

Preparation of Reduce microbial contamination during the procedure

Preparation of Gain informed consent and reduce anxiety

Waste disposal Prevent contamination of the environment

Documentation Provide essential communication and standards of patient care

Stages of Medical Aseptic Technique

When to cleanse hands:

How to cleanse hands

Republic of the Philippines

• A suitable surface should be prepared, such as a dressing trolley or a procedure tray, by

6. Use of gloves and apron as barriers

Republic of the Philippines

• It is important to remember that the single-use gloves, whether sterile or non-sterile,

7. Maintaining a sterile field

Republic of the Philippines

9. Contact guidelines or Non – touched technique

Personal Protective Devices/Equipment (PPE)

Republic of the Philippines

LESSON 2. STANDARD PRECAUTION

BODY SUBSTANCE ISOLATION

New Elements of standard precautions

Republic of the Philippines

Disclaimer: Concepts in building this module is reflective of the author’s study of

Respiratory hygiene/cough etiquette.

The elements of Respiratory Hygiene/Cough Etiquette include

Safe injection practices

Republic of the Philippines

Republic of the Philippines

Mask, Goggles/Eye Visor, and/or Face Shield

Needles and Other Sharps

PROPER DONNING AND REMOVAL OF PPE

The CDC recommends that PPE be donned in following sequence:

LESSON 3 LEVELS OF ISOLATION IN CLINICAL SETTING

Disclaimer: Concepts in building this module is reflective of the author’s study of

Republic of the Philippines

Republic of the Philippines

Republic of the Philippines

Republic of the Philippines

➢ Diphtheria: pharyngeal (duration is until completion of antibiotics and 2 negative cultures

You may want to know more……..

• Infection Prevention and Control Guidelines