ASEPSIS BY:

KIZZY ANN PENAVERDE, RN, LPT

NATUREOFINFECTION
Infection
▪ results when a pathogen invades tissues and
beginsgrowingwithinahost.
▪ Colonization- is the presence and growth of microorganismswithina host
but without tissue invasion or damage. ▪ Com m unicable disease- an
infectious disease that canbetransmitted directly from one person to
another. ▪ Infectious disease- a disease caused by an invasionof
pathogenswithin a host and alter normal tissue function. ▪ Two types of
infection:
▪ Sym ptom atic- results when the pathogens multiply
andcancauseclinicalsigns and symptoms
▪ Asym ptom atic- clinical signs and symptoms are not present
CHAIN OF INFECTION
Chain of Infection
▪ The chain of infection refers to those elements that must bepresent to
cause an infection from a microorganism.
 ▪ Basic to the principle of infection is to interrupt thischainsothat an
infection from a microorganismdoes not occur inclients.
Infectious agent:
microorganisms capable of causing infections
are referred to as an infectious agent or
pathogen

Infectious Agent ▪ Resident organisms (normal flora)

are permanent residentsoftheskin and within the body, where they survive
and multiplywithoutcausing illness.
▪ The potential for microorganisms or parasites to causediseasedepends
on the number of microorganisms present; their virulence,or ability to
produce disease; their ability to enter andsurviveinahost; and the
susceptibility of the host.
▪ Resident skin microorganisms are not virulent. However,
theseskinmicroorganisms can cause serious infection
whensurgeryorotherinvasive procedures allow them to enter deep
tissuesor whenapatient is severely immunocompromised (has an
impairedimmunesystem).
▪ Transient microorganisms attach to the skin whenapersonhascontact
with another person or object during normal activities. ▪ For example, when
you touch a contaminated gauze dressingor cleanse a patient following diarrheal
episode, transient bacteriaadhereto your skin. These organisms may be readily
transmittedunlessremoved using hand hygiene.
▪ Hand hygiene is the most effective way to break the chainof infection.
Factors Influencing
Microorganism’sCapabilitytoproduce Infection
⮚ Number of microorganisms present ⮚ Virulence
and potency of themicroorganisms(pathogenicity)
⮚ Ability to enter the body ⮚ Susceptibility of the
host ⮚ Ability to live in the host’s body
Reservoir: it can be a person, animal, arthropod,plant,oil or
a combination of these things; reservoirsthatsupport
organism that are pathogenic tohumansareinanimate
objects food and water, andother humans.

A reservoir is a place where

microorganismssurvive,multiply, and await transfer to a
susceptiblehost.

Frequent reservoirs for HAIs include

 healthcareworkers,especially their hands; patients;
equipment; andtheenvironment.

To thrive organisms require a proper

environment,including appropriate food, oxygen, water,
temperature,pH, and light.
Reservoir
▪ Food. Microorganisms require nourishment. Some such as Clostridiumperfringens,
the microbe that causes gas gangrene, thrive on organicmatter.Others such as
Escherichia coli consume undigested foodstuff inthebowel.Carbon dioxide and
inorganic material such as soil provide nourishment forotherorganisms.
▪ Oxygen. Aerobic bacteria require oxygen for survival and for multiplicationsufficient
to cause disease. Anaerobic bacteria thrive where littleor nofreeoxygen is
available.
▪ Water. Most organisms require water or moisture for survival. For
example,afrequent place for microorganisms is the moist drainage fromasurgical
wound.Some bacteria assume a form, called a spore, which is resistant
todrying,andcan live on inanimate surfaces for long periods of time.
▪ Temperature. Each species of bacteria has a specific temperatureat whichitgrows
 best. The ideal temperature for most human pathogens is20°to43°C(68° to 109° F).
▪ pH. The acidity of an environment determines the viability of
microorganisms.Most microorganisms prefer an environment within a pHrangeof
5.0to7.0.Bacteria in particular thrive in urine with an alkaline pH.
▪ Light. Microorganisms thrive in dark environments such as
thoseunderdressingsand within body cavities.
Portal of exit
❑ the means in which the pathogen escapes from the
reservoir and can cause diseases

❑ After microorganisms find a site

to grow and multiply, they
need to find a portal of exit if they
are to enter another host and
cause disease. Portals of exit
include sites such as blood, skin
and mucous membranes,
respiratory tract,
genitourinary (GU) tract,
 gastrointestinal (GI) tract, and transplacental (mother
to fetus).
Portal of Exit
▪ Skin and Mucous Membranes. The skin is consideredaportal
ofexitbecause any break in the integrity of the skin and
mucousmembranesallows pathogens to exit the body. This may be
exhibitedbythepresence of purulent drainage.
▪ Respiratory Tract. Pathogens that infect the respiratorytract
suchastheinfluenza virus are released from the body when an
infectedpersonsneezes or coughs.
▪ Urinary Tract. Normally urine is sterile. However, whenapatient hasaurinary
tract infection (UTI), microorganisms exit duringurination.▪ Gastrointestinal
Tract. For example, organisms exit whenapersonexpectorates saliva. In
addition, gastrointestinal portalsof exit includeemesis, bowel elimination,
drainage of bile via surgical wounds, ordrainage tubes.
▪ Reproductive Tract. Organisms such as Neisseria gonorrheaandHIVexit
through a man's urethral meatus or a woman's vaginal canal
duringsexual contact.
▪ Blood. The blood is normally a sterile body fluid; however,
inthecaseofcommunicable diseases such as HBV, HCV, or HIV, it
becomesareservoir for pathogens. Organisms exit fromwounds,
venipuncturesites, hematemesis, and bloody stool.
Mode Of
Transm ission
❑microorganism
must have a means
of transmission to get
from one location to
another,
called direct or
indirect
 Methods of Transmission
1. Contact Transm ission
between
❖Direct Contact• Person-to-person (fecal, oral) physical contact
source and susceptible host (e.g., touchingpatient fecesand
then touching
❖Indirect Contact•
your inner mouth or consuming contaminatedfood)
Personal contact of susceptible host with
contaminated inanimate object
(e.g., needles or sharpobjects, dressings, environment)
2. Droplet Transm ission• Large particles that travel upto3feet duringcoughing,
 sneezing, or talking and come in contact withsusceptible 3. Airborne
host
Transm ission• Droplet nuclei or residueor evaporateddroplets suspended in
air during coughing or sneezingor carriedon
dust particles 4. Vehicle Transm
ission• Contaminated items • Water • Drugs, solutions
• Blood • Food (improperly handled, stored, or cooked; freshorthawed
meats)
5. Vector transm ission• External mechanical transfer (flies) •
Internaltransmission such as parasitic conditions between vector
andhostsuch
as: • Mosquito • Louse • Flea • Tick
Portal of entry
❑ the means of a pathogen entering a host: the
means of entry can be same as one that is the
portal of exit
(gastrointestinal,
respiratory,
genitourinary tract)
❑ For example, during
venipuncture when a needle pierces a patient's
skin, organisms enter the body if proper skin
preparation is not
performed first. Factors such as a depressed
immune system that reduce body defenses
enhance the chances of pathogens entering the
body.
Susceptible host
❑ describes a host (human or animal) not possessing
enough resistanceagainst aparticular pathogen to
prevent diseaseorinfection from occurring
whenexposedtothepathogen;
❑ Susceptibility to an infectious agent dependson an
individual's degree of resistancetopathogens.
BREAKING OF CHAIN OF INFECTION
Etiologic Agent
❑ Correctly cleaning, disinfecting or sterilizing
 articles before use.
❑ Educating clients and support persons about
appropriate methods to clean, disinfect, and
sterilize articles
Reservoir (source)
❑ Changing dressing and bandages when soiled
or wet ❑ Appropriate skin and oral hygiene
❑ Disposing of damp,
soiledlinenappropriately
❑ Ensuring that all fluid containers acre covered
or capped
❑ Emptying suction and drainage bottles at end
of each shift or before full or according to
agency policy
Portal of exit
❑ Avoiding talking, coughing, or sneezing over
open wounds or sterile fields
❑ Covering the mouth andnose when coughing
or sneezing
Method of transm ission

❑ Proper hand hygiene ❑ Instructing clients and

support personstoperform hand hygiene
beforehandlingfood, eating, after
eliminatingandafter
touching infectious material ❑ Wearing
gloves when handlingsecretionsand excretions
❑ Wearing gowns if there is danger of soiling
clothing with body substances
 ❑Placing discarded soiled materialsin
moisture-proof refuse bags❑Holding used bedpans
steadilytoprevent spillage ❑Disposing of urine and
feces inappropriate receptacles ❑Initiating and
implementingaseptic
precautions for all clients
❑ Wearing masks and eyeprotection when in
closecontact with client who have
infectionstransmitted by droplets
fromtherespiratory tract.
❑ Wearing masks and eyeprotection when
sprays of bodyfluid are possible
Portal of entry

❑ Using sterile technique for invasive

 procedures, when
exposing open wounds or handling
dressings ❑ Placing used disposableneedles
and syringes inpuncture-resistant containers
for disposal
❑ Providing all clients withwonpersonal
care items.
Susceptible host

❑ Maintaining the integrity of the client’s skin

and mucous membranes
❑ Ensuring that the client receives a balanced
diet ❑ Educating the public about the
importance of immunizations
The Infectious Process
 Course of Infection 1.Incubation 2.Prodromal
stage 3.Full- stage 4.Convalescence
Course of Infection
▪ I. Incubation : the time between initial contact with an infectiousagentuntil the
first Signs or symptoms - - > the incubation periodvariesfromdifferent
Pathogens; microorganisms are growing and multiplyingduringthisstage
▪ II. Prodrom al Stage : the time period fromthe onset of nonspecificsymptoms to
the Appearance of specific symptoms relatedtothecausativepathogen - - >
symptoms range from being fatigued tohavingalow-gradefever with Malaise;
during this phase it is still possible totransmit thepathogen to Another host
▪ III. Full Stage : manifestations of specific signs & symptomsof infectiousagent;
referred to as the acute stage; during this stage, it maybepossibleto transmit
the infectious agent to another, depending onthevirulenceofthe infectious agent
▪ IV. Convalescence : time period that the host takes toreturntothepre illness stage;
also called the recovery period; - - >the host defensemechanisms have
responded to the infectious agent andthesignsandsymptoms of the disease
disappear; the host, however, is morevulnerableto other pathogens at this
time; an appropriate nursing diagnosticlabelrelated to this process would be
Risk for Infection
 Types of Infection
▪ Local- limited to the specific part of the
bodywherethemicroorganisms remain
▪Systemic- microorganisms spread and damagedifferentparts
of the body
▪Acute- duration of short period of time ▪Chronic- months and
years; e.g. Rabies, Tuberculosis,Leprosy, HIV
▪Nosocomial- infection associated with thedeliveryofhealthcare
services in a health care facility ▪ Endogenous- originates from the
clients themselves▪ Exogenous- from the hospital environment/ personnel
▪ Iatrogenic- results from diagnostic/ therapeuticprocedures
Signs of Localized Infection (5 Cardinal Signs)

▪ Localized swelling (tumor) ▪ Localized

redness (rubor) ▪ Pain or tenderness
 withpalpitationormovement (dolor)
▪ Palpable heat in the infectedarea(calor)
▪ Loss of function of the bodypart affected,
depending on thesiteandextent of
involvement. (functiolaesa)
Signs of Systemic Infection

▪ Fever
▪ Increased pulse and respiratoryrateifthe fever
high
▪ Malaise and loss of energy▪ Anorexia and in
some situations, nausea and vomiting ▪
Enlargement and tendernessof lymph nodes that
drain theareaof infection
Health care-
AssociatedInfections(HAIs)
▪ Health care–associated infections (HAIs) result fromthe deliveryof healthservices in a
health care facility. They occur as the result of invasiveprocedures, antibiotic
administration, the presence of multidrug-resistantorganisms (MDROs), and
breaks in infection prevention andcontrol activities.
▪ Nosocomial Infections : are those that are acquired as a result of
ahealthcaredelivery system
▪ Iatrogenic infection: these nosocomial infections are directly relatedtotheclient’s
treatment or diagnostic procedures; an example of aniatrogenicinfection would be
a bacterial infection that results froman intravascularlineorPseudomonas
aeruginosa pneumonia as a result of respiratorysuctioning
▪ Exogenous infection : are a result of the healthcare facility environment
orpersonnel; an example would be an upper respiratory
infectionresultingfromcontact with a caregiver who has an upper respiratory
infection
▪ Endogenous Infection : can occur from clients themselves or asareactivationof a
previous dormant organism such as tuberculosis; an exampleof endogenous
infection would be a yeast infection arising in awomanreceivingantibiotic therapy;
the yeast organisms are always present inthevagina,butwith the elimination of the
normal bacterial flora, the yeast flourish
Anatomic and Physiologic
BarriersDefendAgainst Infection

⮚ Intact skin and mucous membranes⮚ Moist

mucous membranes andciliaof thenasal passages
⮚ Alveolar macrophages ⮚ Tears
⮚ High acidity of the stomach⮚ Resident flora of the
large intestine⮚ Peristalsis
⮚ Low pH of the vagina
Factors Increasing Susceptibility toInfection
▪ Age : young infants & older adults areat greaterriskofinfection
because of reduced defense mechanismsa.Young infants
have reduced defenses relatedtoimmatureimmune systems
▪ In elderly people, physiological changes occur inthebodythat
make them more susceptible to infectiousdisease;some of
these changes are:
▪ i. Altered immune function (specifically,
decreasedphagocytosisbythe neutrophils and by the
macrophages)
▪ ii. Decreased bladder muscle tone resulting in urinaryretention▪ iii.
Diminished cough reflex, loss of elastic recoil bythelungsleadingto
inability to evacuate normal secretions ▪ iv. Gastrointestinal changes
resulting in decreasedswallowingabilityand delayed gastric emptying.
Factors Increasing Susceptibility
▪Heredity: some people have a genetic
toInfection
predispositionor
susceptibility to some infectious
▪Cultural practices: healthcare beliefs
diseases
andpractices,aswellas nutritional and hygiene
practices, caninfluencea
person’s susceptibility to
infectious diseases

▪Nutrition: inadequate nutrition can

makeapersonmoresusceptible to infectious diseases;

nutritional practicesthatdo not supply the body with

the basic componentsnecessary to synthesized

proteins affect thewaythe

body’s immune system can
▪Stress: stressors, both physical
respond topathogens
and emotional, affectthebody’s ability to protect

against invadingpathogens;stressors affect the body

 by elevating bloodcortisonelevels; if elevation of

serumcortisone is prolonged,itdecreasesthe

anti-inflammatory responseanddepletes
energy stores,
thus increasing the risk of infection
▪ Rest,
Factors Increasing Susceptibility toInfection
exercise and personal health habits: alteredrest andexercise

patterns decrease the body’s protective, mechanismsand may cause

physical stress to the body resultinginanincreased risk of infection;

personal health habitssuchaspoornutrition and unhealthy lifestyle

habits increasetheriskofinfectious over time by altering the body’s

responseto ▪ Inadequate defenses: any physiological

pathogens
abnormalityorlifestylehabit can influence normal defense

mechanismsinthebody,making the client more susceptible to

infection; theimmunesystem functions throughout the body and

dependsonthe
following:
▪ a. Intact skin and mucous membranes ▪ b. Adequate blood cell production
▪ d. An ability
and differentiation ▪ c. A functional lymphatic system and spleen
to differentiate foreign tissue and pathogensfromnormalbody tissue and flora;

in autoimmune disease, the bodyhasaproblemwith recognizing it’s own tissue

and cells; people withautoimmunedisease are at increased risk of infection

related to their immunesystem

deficiencies
Factors Increasing Susceptibility toInfection
▪Environmental: an environment that exposesindividualstoan
increased number of toxins or pathogensalsoincreasesthe
risk of infection; pathogens growwell inwarmmoistareas with
 oxygen (aerobic) or without oxygen(anaerobic)depending on
the microorganism, an environment thatincreases exposure
to toxic substances alsoincreasesrisk
▪ Immunization history: inadequately immunizedpeoplehavean
increased risk ofinfection specifically for thosediseasesfor
which vaccines have been developed.
▪ Medications and medical therapies: examplesof therapiesand
medications thatincrease clients risk for infectionincludes
radiation treatment, anti-neo-plasticdrugs,anti inflammatory
drugs and surgery
NANDA Diagnosis

∙ Risk for Infection - State in which an individual isat

increased risk for being invadedbypathologic
microorganisms ∙ Risk Factors
 - Inadequate primary defenses- Inadequate
secondary defenses
Related Diagnosis
∙ Potential complication of infection: Fever∙
Imbalanced nutrition: less thanbodyrequirement
∙ Acute pain
∙ Impaired Social Interaction or Social isolation∙
Anxiety
Intervention to Reduce Risk for Infection∙ Proper
Hand hygiene techniques∙ Environmental
control
∙ Sterile technique when warranted∙ Identification
and Management of clientsatrisk
 INFECTIONCONTROL
▪SEPSIS- state of infection ▪ASEPSIS-
freedomfromdisease- causingmicroorganisms
▪2 Types:
▪ Medical Asepsis- confine a specific microorganismsto a
specific area, limiting the number, growth,
andtransmission of microorganisms; CLEAN
TECHNIQUE
▪Surgical Asepsis- it includes destroyingall
microorganisms and spores; STERILETECHNIQUE
Methods of InfectionControl
▪Antisepsis- inhibits the growth of microorganisms; used on
akin and tissues; aka Medical Asepsis
▪Disinfecting- destroy pathogens other thanspores; used on
inanimate objects
▪Two types of Disinfecting Agents: ▪ Bactericidal- destroys/ kills
bacteria ▪ Bacteriostatic- prevents growth and reproduction

▪Two types of Disinfection:

▪ Concurrent disinfection- ongoing practices; done whenthepatient is still
the source of infection ▪ Terminal disinfection- done when patient is no
longer communicable; usually upon discharge

Methods of InfectionControl
▪ Sterlization- process that destroys
microorganismsincludingspores; aka Surgical Asepsis
▪ Methods of Sterilization:
▪ Moist heat (steam)
✔ uses steam under pressure (higher than the boiling point)
✔ e.g. autoclave
✔ Pressure: 15- 17 lbs.
 ✔ Temperature: 121- 123 ‘C
▪ Free steam
✔ used to sterilize objects that would be destroyed by autoclave ✔Temperature: 100 ‘C
▪ Gas
✔ uses ethylene oxide
✔ has good penetration and effective for heat- sensitive items
✔ Disadvantage: toxic to humans
▪ Boiling water
✔ most practical method and inexpensive
✔water temp: 100’C for a minimum of 15 minutes
▪ Radiation
✔ UV light/ rays do not penetrate deeply
✔ used to sterilize food, drugs, and other items that are sensitive to heat ✔ Disadvantage:
Expensive

Methods of InfectionControl ▪Disinfestation-

habitat destruction

▪Fumigation- gaseous agents to kill animal forms▪ e.g.

fogging for Dengue and Malaria
 ▪Delousing- as treatment for pediculosis
Methods of InfectionControl ▪ The following factors
influence the efficacy of thedisinfectingor ▪•
sterilizing method:
Concentration of solution and duration of contact.

Aweakenedconcentration or shortened exposure time

lessensits ▪ • Type and number of pathogens. The

effectiveness.
greater thenumberofpathogens on an object, the longer the

requireddisinfecting ▪ • Surface areas to treat. All dirty

time.
surfaces andareasneedtobefully exposed to disinfecting and

sterilizing agents. Thetypeofsurface is an important factor. Is the

surfaceporousor ▪ • Temperature of the environment.

nonporous?
Disinfectantstendtowork ▪ • Presence of
best at room temperature.
soap. Soap causes certain disinfectantstobeineffective. Thorough

rinsing of an object is necessarybefore ▪ • Presence of

disinfecting.
organic materials. Disinfectantsbecomeinactivated unless blood,

saliva, pus, or bodyexcretionsare

washed off.
ISOLATION PRECAUTIONS
▪ In 2007 the Hospital Infection Control
PracticesAdvisoryCommittee (HICPAC) of the
CDCpublishedrevisedguidelines for isolation
precautions.
▪ 2 TIERS:
▪TIER 1 (Standard Precautions)
▪TIER 2 (Transmission- based Precautions)
 Standard Precautions
▪ designed to be used for the care of all patients,
inallsettings, regardless of risk or
presumedinfectionstatus.▪Standard Precautions are the
primary strategies(includingbarrier precautions) for
prevention of infectiontransmission and apply to contact
withblood, bodyfluids,nonintact skin, mucous membranes,
andequipmentorsurfaces contaminated with potentially
infectiousmaterials.▪Universal Precaution + Body-
substanceIsolation▪ Universal Precaution- prevents the spread of
blood- bornepathogens
▪ Body- substance Isolation- all body fluids, secretions, feces,urine
except sweat
Standard Precautions
▪ Standard precautions apply to blood, blood products, all bodyfluids, secretions,
excretions (except sweat), nonintact skin, andmucousmembranes.
▪ • Perform hand hygiene before, after, and between direct contact
withpatients.▪ • Perform hand hygiene after contact with blood, body fluids,
mucousmembranes, nonintact skin, secretions, excretions, or
wounddressings;aftercontact with inanimate surfaces or articles in a patient
room; andimmediatelyafter gloves are removed.
▪ • When hands are visibly soiled or contaminated with bloodor bodyfluids,wash
them with either a nonantimicrobial or an antimicrobial soapandwater.▪ • When
hands are not visibly soiled or contaminated with bloodor bodyfluids,use an
alcohol-based, waterless antiseptic agent to performhandhygiene(WHO, 2009).
▪ • Wash hands with nonantimicrobial soap and water if contact withspores(e.g.,
Clostridium difficile) is likely to have occurred. ▪ • Do not wear artificial fingernails
or extenders if duties includedirect contactwith patients at high risk for infection
and associated adverseoutcomes.

Standard Precautions
▪ • Wear gloves when touching blood, body fluids, secretions,
excretions,nonintact skin, mucous membranes, or contaminated itemsor
surfacesislikely. Remove gloves and perform hand hygiene betweenpatient
careencounters and when going from a contaminated to a cleanbodysite.
▪ • Wear personal protective equipment (PPE) when the
anticipatedpatientinteraction indicates that contact with blood or body
 fluidsmayoccur.▪ • A private room is unnecessary unless the patient's
hygieneisunacceptable (e.g., uncontained secretions, excretions, or
wounddrainage).
▪ • Discard all contaminated sharp instruments and needlesinapuncture
resistant container. Health care facilities must make
availableneedlelessdevices. Any needles should be disposed of uncapped,
or amechanicalsafety device is activated for recapping.
▪ • Respiratory hygiene/cough etiquette: Have patients cover
thenose/mouthwhen coughing or sneezing; use tissues to contain
respiratorysecretionsand dispose in nearest waste container; performhand
hygieneaftercontacting respiratory secretions and contaminated
objects/materials;contain respiratory secretions with procedure or surgical
mask; spatialseparation of at least 3 feet away from others if coughing.

Transmission- basedPrecautions
▪Airborne precautions (droplet nuclei smaller
than5microns)
✔Measles, chickenpox (varicella),
disseminatedvaricellazoster,pulmonary or laryngeal tuberculosis
✔Private room (airborne infection isolation room),
 negative-pressure airflow of at least 6 to 12 exchanges per
hourviahigh-efficiency particulate air (HEPA) filtration ✔wear mask
or respiratory protection device, N95respirator(depending on
condition)
✔limit client movement outside the room✔if private room is
not available, place client withsamemicroorganisms
Transmission- basedPrecautions
▪Droplet precautions:
✔Focus on diseases that are transmitted by
largedroplets(greaterthan 5 microns) expelled into the air and by
beingwithin3feetofa patient.
✔Droplet precautions require the wearing of asurgical
maskwhenwithin 3 feet of the patient, proper hand hygiene,
andsomededicated-care equipment.
✔Diphtheria (pharyngeal), rubella, streptococcal
pharyngitis,pneumonia or scarlet fever in infants and
youngchildren,pertussis, mumps, Mycoplasma pneumonia,
meningococcalpneumonia or sepsis, pneumonic plague
Transmission- basedPrecautions
▪Contact precautions:
✔Used for direct and indirect contact with
patientsandtheirenvironment.
✔Direct contact refers to the care and handlingof
contaminatedbody fluids.
✔Contact precautions require a gown and gloves.
Anexampleincludes blood or other body fluids froman
infectedpatientthatenter the health care worker's body through
direct contactwithcompromised skin or mucous membranes
✔Indirect contact involves the transfer of an
infectiousagentthrough a contaminated intermediate object
suchascontaminated instruments or hands of healthcareworkers.
✔The health care worker may transmit
microorganismsfromonepatient site to another if hand hygiene
is not performedbetweenpatients
Personal Protective Equipment
 ▪Gowns.
⮚The primary reason for gowning is to prevent
soilingclothesduring contact with a patient.
⮚Gowns or cover-ups protect health care personnel
andvisitorsfrom coming in contact with infected material
andbloodorbodyfluids.
⮚Gowns used for barrier protection are made of
afluid-resistantmaterial.
⮚Change gowns immediately if damaged or
heavilycontaminated.Isolation gowns usually open at the back
andhavetiesorsnapsat the neck and waist to keep the gown
closedandsecure.
⮚Gowns need to be long enough to cover all outer
garments.Longsleeves with tight-fitting cuffs provide added
protection. ⮚Carefully remove gowns to minimize contaminationof
thehandsand uniform and discard them after removal.
Personal Protective Equipment ▪ Masks
⮚ Masks provide respiratory protection.
 ⮚ Wear full-face protection (with eyes, nose, and mouth covered) when youanticipatesplashing or
spraying of blood or body fluid into the face. Also wear masks whenworkingwith a patient
placed on airborne or droplet precautions.
⮚ The mask protects you from inhaling microorganisms and small-particledropletnuclei
that remain suspended in the air from a patient's respiratorytract. ⮚ The surgical
mask protects a wearer from inhaling large- particleaerosolsthattravel short distances
(3 feet).
⮚When caring for patients on droplet or airborne precautions,
applyamask(surgical or respirator) when entering the isolation room. ⮚A patient
who is susceptible to infection wears a mask to prevent inhalationofpathogens.
⮚Patients on droplet or airborne precautions who are transportedoutsideoftheirrooms
need to wear a surgical mask to protect other patients andpersonnel.⮚ A mask
discourages the wearer from touching the eyes, nose, or mouth⮚A properly applied
mask fits snugly over the mouth and nose sopathogensandbody fluids cannot enter or
escape through the sides. ⮚A mask that has become moist does not provide a barrier
to microorganismsandis ineffective. You need to discard it. Never reuse a
disposablemask.

Personal Protective Equipment

▪Eye Protection
⮚Use either special glasses or goggles when performingprocedures
that generate splash or splatter. ⮚Examples include irrigation of a
 large abdominal woundorinsertion of an arterial catheter when the
nurseassistsahealthcare provider.
⮚Eyewear is available in the formof plastic glassesor goggles.⮚The
eyewear needs to fit snugly around the facesofluidscannotenter
between the face and the glasses.
Personal Protective Equipment
▪Gloves.
⮚Gloves help to prevent the transmission of pathogensbydirect
and
⮚The CDC (2007) notes that you need to wear
indirect contact.
cleangloveswhentouching blood, body fluid, secretions,

excretions(exceptsweat),moist mucous membranes, nonintact skin,

andcontaminated ⮚Change gloves and perform

items or surfaces.
hand hygiene betweentasksandprocedures on the same patient after

contact withmaterial that

contains a high concentration of
 ⮚Remove gloves promptly after use, before
microorganisms.
touchingnoncontaminated items and environmental surfaces,

andbefore
going to another patient. ⮚Perform hand hygiene
immediately to avoid transfer of microorganisms to other patients or
environments.
Personal Protective Equipment

❑Applying PPE (GoMEG)

⮚Gown--> mask--> Eyewear (goggles) --> gloves

⮚Removing PPE (GloMaGoCaGo)

⮚Gloves--> mask-->gown-->cap--> goggles
Disposal of Soiled Equipment
 andSupplies▪Bagging
▪ Bagging contaminated items prevents accidental exposureof
personneland contamination of the surrounding environment.
▪ The use of a single, intact, standard-size linen bag that isnot
overfilledandtied securely is adequate to prevent infection transmission.
Checkthecolorcode of bag that your facility uses for bagging these items.
▪ articles contaminated with pus, blood, body fluids, feces or
respiratorysecretions need to be enclosed in sturdy bag before
theyareremovedfrom the client’s room.
SURGICAL ASEPSIS
▪ Surgical asepsis or sterile technique
preventscontaminationofan open wound, serves to isolate an
operativeareafromtheunsterile environment, and maintains a
sterilefieldforsurgery.
▪ It includes procedures used to eliminate all
microorganisms,including pathogens and spores, froman object
or area.▪ In surgical asepsis an area or object is
consideredcontaminated if touched by any object that isnot
sterile.Itdemands the highest level of aseptic
 techniqueandrequiresthat all areas be kept free of infectious
microorganisms.▪ Use surgical asepsis in the following situations:
▪ • During procedures that require intentional perforationof thepatient'sskin,
such as insertion of peripheral IV catheters or acentral intravenous line
▪ • When the integrity of the skin is broken as a result of
trauma,surgicalincision, or burns
▪ • During procedures that involve invasive proceduressuchasinsertionof
a urinary catheter or surgical instruments into sterilebodycavitiessuch
as insertion of a wound drain
Principles of Surgical Asepsis
▪A sterile object remains sterile only
whentouchedbyanother sterile object.
✔a. Sterile touching sterile remains sterile (e.g., usesterileglovesor
sterile forceps to handle objects on a sterilefield). ✔b. Sterile
touching clean becomes contaminated(e.g., ifthetipof a syringe or
other sterile object touches thesurfaceofacleandisposable glove,
the object is contaminated). ✔c. Sterile touching contaminated
becomes contaminated(e.g.,when a nurse touches a sterile object
with anunglovedhand,the object is contaminated).
 ✔d. Sterile state is questionable (e.g., when youfindatearorbreak in
the covering of a sterile object). Discardit regardlessofwhether the
object itself appears untouched.
Principles of Surgical Asepsis
▪Only sterile objects may be placed onasterilefield.Allitems
are properly sterilized before use. ✔Sterile objects are kept in
clean, dry storageareas. The
package or container holding a sterile object must
beintactanddry.
✔A package that is torn, punctured, wet, or
openisconsideredunsterile.
▪ A sterile object or field out of
Principles of Surgical Asepsis
the range of visionor anobject
held below a person's waist is
✔Nurses never turn their back on a sterile field or tray or
contaminated.
leaveit ✔Contamination can occur accidentally by a
unattended.
danglingpieceof clothingor
an unknowing patient touching a sterile object.
 ✔Any object held below waist level is considered contaminatedbecause
it
✔Keep sterile objects in front with the hands
cannot be viewed at all times.
as closetogetheras ▪ A sterile object or field becomes
possible.
contaminatedbyprolonged ✔Avoid activities that create
exposure to air.
air currents such as excessivemovements
or rearranging linen after a sterile
✔When you open sterile packages, it is
object or field becomesexposed.
important tominimizethe
number of people walking into an area.
✔Microorganisms also travel by droplet through the air. Donot talk,laugh,

sneeze, or cough over a sterile field or whengatheringand

using sterile
✔When opening sterile packages, hold the itemor pieceof
equipment.
equipmentas
close as possible to the sterile field without
touchingthesterilesurface.
Principles of Surgical Asepsis
 ▪When a sterile surface comes in contact
withawet,contaminated surface, the sterile object or
fieldbecomescontaminated by capillary action.
✔When stored sterile packages become wet,
discardtheobjectsimmediately or send the equipment for
resterilization. ✔When working with a sterile field or tray,
youmayhavetopoursterile solutions. Any spill is a source of
contaminationunlessona sterile surface that moisture cannot
penetrate. ✔Urinary catheterization trays contain
sterilesuppliesthatrestina sterile, plastic container.
✔In contrast, if you place a piece of sterile gauzeinitswrapperon a
patient's bedside table and the table surfaceiswet,thegauze is
considered contaminated.
Principles of Surgical Asepsis
▪ Fluid flows in the direction of gravity.
✔A sterile object becomes contaminated if gravity
causesacontaminated liquid to flow over the surface of theobject. ✔To
avoid contamination during a surgical hand scrub, holdyourhandsabove
 your elbows. This allows water to flowdownwardwithoutcontaminating
your hands and fingers.
✔The principle of water flow by gravity is also the reasonfor
dryingfromfingers to elbows, with hands held up, after the scrub. ▪ The
edges of a sterile field or container
areconsideredtobecontaminated.
✔Frequently you place sterile objects on a sterile towel, drape,
ortray.Because the edge of the drape touches an
unsterilesurfacesuchasatable or bed linen, a 2.5-cm (1-inch) border
aroundthedrapeisconsidered contaminated.
✔Objects placed on the sterile field need to be
insidethisborder.Theedges of sterile containers become exposed to air
after theyareopenand thus are contaminated.