ASEPSIS & INFECTION PREVENTION

Nature of Infection
Infection – is the invasion of a susceptible host by pathogens or microorganisms
Colonization – is the presence and growth of microorganisms within a host but without tissue invasion or damage
Communicable Disease
- infectious disease that can be transmitted directly from one person to another
- results if the infectious agent can be transmitted to an individual by direct or indirect contact through a vector or vehicle, or
as an airborne infection
Symptomatic – when pathogens multiply and cause clinical signs and symptoms
Asymptomatic – when clinical signs and symptoms are not present
Infectious disease – results from the invasion and multiplication of microorganisms in a host
Pathogen – a disease-producing microorganism
Pathogenicity – the ability to produce a disease
Virulence – the vigor with which the organism can grow and multiply / ability to produce disease
Nosocomial infection – hospital-acquired infection
Isolation – the separation of persons with CDS from other persons so that either direct/indirect transmission to susceptible persons
is prevented
Etiology – the study of causes

TYPES OF MICROORGANISMS THAT CAUSE INFECTION

1. Bacteria – most common
2. Viruses – primarily consist of nucleic acid
3. Fungi – yeasts and molds
4. Parasites – live on other living organisms

Chain of Infection
Infectious Agent (Bacteria, Virus, Fungi, Protozoa)
Reservoir – place where the microbe lives and replicates, such as people, equipment, water, food and animals
Portal of Exit – place where the microbe leaves reservoir such as coughing, sneezing, bleeding, faeces
Modes of Transmission – contact (hands, sharps injury), airbourne, vehicle (DUWL), insect vector
Portal of Entry – entry point such as wound/opening in the skin or mucosa of the mouth via sutures, catheters, IV lines
Susceptible Host – non immune person, immune deficiency, babies, elderly, immunosuppressed by drugs
----- Susceptibility to an infectious agent depends on an individual’s degree of resistance to pathogens

MODES OF TRANSMISSION (Contact)

Direct Person to person (fecal-oral) physical contact between source and

susceptible host

Indirect Personal contact of susceptible host with contaminated inanimate object

(ex. Needles, Dressings, Environment)

Droplet Large particles that travel up to 3 feet during coughing, sneezing, talking
and come in contact with susceptible host

Airborne Droplet nuclei or evaporated droplets suspended in air during coughing,

sneezing or carried on dust particles

Vehicles Contaminated items, water, drugs, solutions, blood, food (improperly

handled, stored or cooked, fresh or thawed meats)

Vector External mechanical transfer (flies)

Internal transmission (parasitic conditions between vector and host like
mosquito, mouse, flea, tick)

THE INFECTIOUS PROCESS

COURSE OF INFECTION BY
STAGE

Incubation Period Interval between entry of pathogen into body and apperance of first
 symptoms

Prodromal Stage Interval from onset of nonspecific signs and symptoms to more specific
symptoms (The time when microorganisms grow and multiply and the
patient may be capable of spreading the disease to others

Illness Stage Interval when a patient manifests specific to type of infection

Convalescence Interval when acute symptoms of infection disappear (length of recovery

depends on severity of infection and patient’s host resistance; recovery may
take several days to months)

TYPES OF INFECTION
 Colonization of resident flora not infection
 Invasion to unprotected area is infection
 Local Infection: localized symptoms like pain, tenderness, warmth and redness on wound site (wound infection) limited to
specific part
 Systemic: an infection that affects the entire body instead of just a single organ or part (if undetected or untreated, it
becomes fatal)
 Bacteremia – microorganisms in the blood
 Septicemia – systemic infection resulting for bacteremia
 Acute infections – appear suddenly or last short period of time
 Chronic infections – occurs slowly over a long period, last months/years

DEFENSES AGAINST INFECTION

 Natural defenses is present in the body which protect against infection
 Nonspecific Defenses:
a) Normal Floras: do not usually cause disease when residing in their usual area of the body but instead participate
in maintaining health
b) Body System Defenses
c) Inflammation: the cellular response of the body to injury, infection or irritation

Signs of Localized Inflammation

- Swelling, redness, heat, pain, or tenderness and loss of function of affected body part
Systemic Inflammation
- Fever, elevated wbcs, malaise, anorexia, nausea, vomiting, lymph node enlargement or organ failure
Inflammatory Response Includes: vascular and cellular responses, formation of inflammatory exudates and tissue repair.

Health Care – Associated Infections (HAIS)

 Result from the delivery of health services in a health care facility
 Occur as the result of invasive procedures, antibiotic administration, the presence of multi-drug resistant organisms
(MDROS) and breaks in infection prevention and control activities.

Exogenous Infection
 Comes from microorganisms found outside the individual (ex: clostridium tetani, salmonella)
Endogenous Infection
 Occurs when part of the patient’s flora becomes altered and an overgrowth results (ex: staphylococci, streptococci,
yeasts) patients receives broad-spectrum antibiotics
Iatrogenic Infection
 Caused by an invasive diagnostic or therapeutic procedure
Exudates: fluid and cells that are discharged from cells or blood vessels (like pus or serum)
 Serous: clear like plasma
 Sanguineous: containing RBCS
 Purulent: containing WBCS and bacteria

FACTORS INFLUENCING INFECTION PREVENTION AND CONTROL

 Age
  Nutritional Status
 Stress
 Disease Process

Laboratory Value Normal Values (Adult)

WBC Normal: 5,000 – 10,000/mm3
ESR Up to 15 mm/hr (Male); 22mm/hr (Female)
Iron 80-180 mcg/mL (Male); 60-160 mcg/mL (Female)
Cultures for urine and blood Normally sterile, without microorganism growth
Cultures and Gram stain of wound sputum and throat No WBC’s on Gram stain, possible normal flora
Differential count (WBCs)
Neutrophils 55-70%
Lymphocytes 20-40%
Monocytes 2-8%
Eosinophils 1-4%
Basophils 0.5-1.5%

NURSING DIAGNOSIS
 Risk for infection
 Imbalanced nutrition: less than body requirement
 Impaired oral mucous membrane
 Risk for impaired skin integrity
 Social isolation
 Impaired tissue integrity

Asepsis – the absence of pathogenic (disease-producing) microorganisms

Aseptic Technique – the practices/procedures that help reduce the risk for infection
Medical Asepsis – practices designed to reduce the number and transfer of pathogens (clean technique)
Surgical Asepsis (sterile technique)
- Prevents contamination of an open wound, serves to isolate an operative area from the unsterile environment, and
maintains a sterile field
- Includes procedures used to eliminate all microorganisms, including pathogens and spores, from an object or an area
Sterile field: is an area free of micorganisms and prepared to receive sterile items

TYPES OF IMMUNIZATION
1. Active Immunization: antibodies are produced by the body in response to infection
a. Natural: antibodies are formed in the presence of active infection in the body. It is lifelong
b. Artificial: antigens (vaccines or toxoids) are administered to stimulate antibody production. Require booster
inoculation after many years.

2. Passive Immunization: antibodies are produced by another source such as animal or human
a. Natural: antibodies are transferred from the mother to her newborn through the placenta or in the colostrum
b. Artificial: immune serum (antibody) from animal or another human is injected to a person

SPECIFIC DEFENSES
1) Antigen – substance that induces a state of sensitivity or immune responsiveness (immunity)
2) Autoantigen – when proteins originate in person’s own body
3) Antibody-Mediated Defenses
a. Humoral (Circulating) Immunity – defenses in B lymphocytes
b. Antibodies (Immunoglobulins) – part of body’s plasma proteins
4) Cell-Mediated Defenses
- Also known as cellular immunity
- Three groups of activated T cells
i. Helper T Cells
ii. Cytotoxix T Cells
iii. Supressor T Cells

BREAKING THE CHAIN OF INFECTION: ASEPTIC PROCESS

 Handwashing
 Cleaning disinfection, sterilization
 Use of barriers
 Isolation systems
 Surgical asepsis
CONTROL OR ELIMINATION OF INFECTIOUS AGENTS
 Hand Hygiene
Four Techniques of Hand Hygiene
a. Handwashing
b. Antiseptic Hand Wash
c. Antiseptic Hand Rub
d. Surgical Hand Antisepsis

Handwashing
- The vigorous, brief rubbing together of all surfaces of lathered hands, followed by rinsing under a stream of warm water for
15 seconds (CDC, 2008)
Handwashing is the single most important infection control practice
Soap, water and alcohol-based handrubs are effective preparations for removing transient microorganisms
Wash hands before and after every client care contact
Adequate friction and thoroughness of surfaces cleansed results to effectiveness of handwashing
Handwashing (Medical Asepsis)
- Holding hands lower than the elbows (hands are more contaminated than lower arms)
Wash hands using running water, soap, and friction 15-30 seconds on each hand in order to loosen and remove dirt and
microorganisms on all hand surfaces
Clean under fingernails
Ideally, turn off faucet with clean paper towel

 Use of Barriers – techniques that prevent the transfer of pathogens from one person to another
Commonly Used:
 Masks
 Caps and shoe coverings
 Gloves
 Private rooms
 Waterproof disposable bags for linen and trash
 Labeling and bagging of contaminated equipment and specimens
 Control of airflow into the sterile areas and out of contaminated area
 Goggles and face shields

CATEGORIES OF INSTITUTIONAL WASTES

A. Infectious Wastes
- Blood and blood products
- Pathology laboratory specimen
- Laboratory culture
- Body parts from surgery
- Contaminated equipment (NGT, Urinary catheters, suction catheters)
- Food
- Unrinsed infant and adult diapers

B. Injurious Wastes
- Needles
- Scalpel blades
- Lancets
- Broken glass
- Pipettes

C. Hazardous Wastes
- Radioactive materials
- Chemotherapy solutions and their containers

RECOMMENDATION FOR WASTE DISPOSAL

 Incinerations or autoclaving of infectious wastes before disposal to sanitary landfill
 Liquid body fluids can be flushed down a drain connected to a sewer system
 Infectious waste use separate containers clearly marked “biohazard” (E.G blood)

Color Code for Segregation (Segregation Guidelines)

Colour Waste Description
Human tissues, organs, body parts, items contaminated by
Yellow blood/body fluids, soiled cotton & dressing, soiled plaster casts,
 discarded medicines, discarded cytotoxix drugs
Catheters, tubings, cannulae, syringes, plastic IV bottles & sets,
Red used gloves, infected plastics, specimen containers, lab waste,
microbiology cultures, used of discarded bags of blood/blood
products, vaccines
Blue Glass items, needles, syringes, scalpels, blades, used and
unused sharps
Black Radioactive and chemotherapy wastage
General waste, non-infected plastic materials & papers,
Green disposables, cardboards, metal containers, office waste, food
waste

Black – non infectious dry waste

Green – non infectious wet waste
Yellow – infectious and pathological
Orange – radioactive wastes
Red – sharps and pressurized can
Yellow with Black Band – chemical waste including heavy metals (pharmaceutial)

 Cleaning
- The removal of organic material or inorganic material from objects and surfaces; before disinfection and sterilization
procedures
- The physical removal of visible dirt and debris by washing, dusting, mopping surfaces that are contaminated
- Use of water, detergent/disinfectant, proper mechanical scrubbing

 Disinfection
- A process that eliminates many or all microorganisms which the exception of bacterial spores, from inanimate objects
Types: Disinfection of Surfaces and High Level Disinfection

 Sterilization
- Eliminates or destroys all forms of microbial life including spres
Methods: steam, dry heat, hydrogen peroxide plasma, ethylene oxide (ETO)

FACTORS TO BE CONSIDERED IN THE SELECTION OF STERILIZATION OR DISINFECTION METHODS

1. Nature of Organisms Present
2. Number of Organisms Present
3. Types of Equipment
4. Intended Use of Equipment (Medical Asepsis, Surgical Asepsis)
5. Available Mean of Sterilization and Disinfection

Methods of Sterilization
1. Steam Sterilization
Autoclaving is sterilizating using supersaturated steam under pressure, non-toxic, inexpensive, sporicidal and
able to penetrate fabrics rapidly (surgical dressings, surgical linens, parenteral solution, metals, glass objects)
2. Gas Sterilization
Enthylene oxide is a colorless gas that can penetrate plastic, rubber, cotton and other substances used to
sterilize oxygen or suction gauges, bp apparatus, stethoscopes, catheters
3. Radiation
Ionization radiation penetrates deeply into objects (sterilize drugs, foods and other heat-sensitive items)
4. Chemicals
Attacks all types of microorganisms, work with water, inexpensive, stable to light and heat, not harmful to body
tissues, do not destroy articles (instruments and equipment like glass thermometer, chlorine is for disinfecting
water)
5. Boiling Water
Least expensive for use in home (EX: glass baby bottles)
  Specimen Collection
- In obtaining culture specimens, use clean gloves and sterile equipment, seal all specimen containers to prevent spillage
and contamination of the outside of the container

 Bagging Rash or Linen

- Prevents accidental exposure of personnel and contamination of the surrounding environment
- Use single, intact, standard size linen bag that is not overfilled and dtied securely. Check the color code of the bag (facility
policies)
- Not recommended

 Transporting Patients
- Provide clean gowns to serve as robes
- Notify personnel in diagnostic or procedural areas or the type of isolation precautions

SURGICAL ASEPSIS
- Use of sterile technique to prevent introduction of microorganisms
- Required when:
 Surgical procedures
 All procedures that invade the bloodstream
 Procedures that cause a break in the skin or mucous membranes
 Complex dressing changes and wound care
 Insertion of tubes, catheters or devices into the sterile body cavities
 Care for highrisk groups

PRINCIPLES OF SURGICAL ASEPSIS

1. Moisture causes contamination
2. Never assume that an object is sterile
3. Always face the sterile field
4. Sterile articles may touch only sterile articles or surfaces if they are to maintain sterility
5. Sterile equipment or areas must be kept above the waist and on the top of the sterile field
6. Prevent unnecessary traffic and air currents around the sterile area
7. Open, unused sterile articles are no longer sterile after procedure
8. A person who is considered sterile who becomes contaminated must reestablished sterility
9. Surgical technique is a team effort