U N I V E R S I T Y O F S A N T O T O M A S - L E GA Z P I
BACHELOR OF SCIENCE IN NURSING
FUNDAMENTALS IN NURSING SLE
Asepsis
COURSE OUTLINE
1. Asepsis
2. Safety
3. Hygiene
REFERENCE BOOK
Fundamentals of Nursing, concepts, process, and
practice; Kozier & Erb’s 11th edition
Integral Components
of Client Care
Introduction:
➢ Some microorganisms are normal resident flora
(the collective vegetation in a given area) in one
part of the body, yet produce infection in another.
➢ Infection is the growth of microorganisms in body
tissue where they are not usually found. Such a
microorganism is called an infectious agent. If the
microorganism produces no clinical evidence of
disease, the infection is called asymptomatic or
subclinical.
ASEPSIS
➔ the freedom from disease-causing microorganisms.
To decrease the possibility of transferring
microorganisms from one place to another, aseptic
technique is used.
Medical Asepsis
● Includes all practices intended to confine a specific
microorganism to a specific area, limiting the
number, growth, and transmission of
microorganisms.
● In medical asepsis, objects are referred to as clean,
which means the absence of almost all
microorganisms, or dirty (soiled, contaminated),
which means likely to have microorganisms, some
of which may be capable of causing infection.
Sirgical Asepsis / Sterile Technique
● refers to those practices that keep an area or
object free of all microorganisms; destroy all
microorganisms and spores (microscopic dormant
structures formed by some pathogens that are very
hardy and often survive common cleaning
techniques).
● Sepsis is the condition in which acute organ
dysfunction occurs secondary to infection.
TYPES OF MICROORGANISMS THAT CAUSE
INFECTIONS
Bacteria
● are by far the most common infection-causing
microorganisms.
● Several hundred species can cause disease in
humans and can live and be transported through
air, water, food, soil, body tissues and fluids, and
inanimate objects
Viruses
● consist primarily of nucleic acid and therefore
must enter living cells in order to reproduce.
● Common virus families include the rhinovirus
(causes the common cold), hepatitis, herpes, and
human immunodeficiency virus.
Fungi
● include yeasts and molds.
● Candida albicans is a yeast considered to be
normal flora in the human vagina.
Parasites
● live on other living organisms.
● Include protozoa such as the one that causes
malaria, helminths (worms), and arthropods (mites,
fleas, ticks).
TYPES OF INFECTIONS
Colonization
● process by which strains of microorganisms
become resident flora. In this state, the
microorganisms may grow and multiply but do not
cause disease.
Local infection
● is limited to the specific part of the body where the
microorganisms remain.
Systemic infection
● If the microorganisms spread and damage different
parts of the body.
Bacteremia
● When a culture of the person’s blood reveals
microorganisms
septicemia
● When bacteremia results in systemic infection.
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BACHELOR OF SCIENCE IN NURSING
FUNDAMENTALS IN NURSING SLE
Asepsis
Acute and Chronic infections
● .Acute infections generally appear suddenly or last
a short time.
● A chronic infection may occur slowly, over a very
long period, and may last months or years
NOSOCOMIAL AND HEALTH CARE–ASSOCIATED
INFECTIONS
Nosocomial infections
● .infections that originate in the hospital.
● can either develop during a client’s stay in a facility
or manifest after discharge.
● Nosocomial microorganisms may also be acquired
by personnel working in the facility.
● can originate from the clients themselves (an
endogenous source) or from the hospital
environment and hospital personnel (exogenous
sources)
● Nosocomial infections are a subgroup of health
care–associated infections (HAIs)—those that
originate in any health care setting.
A number of factors contribute to nosocomial
infections:
Iatrogenic infections
● are the direct result of diagnostic or therapeutic
procedures.
● One example of an iatrogenic infection is
bacteremia that results from an intravascular
infusion line.
● Not all nosocomial infections are iatrogenic, nor are
all nosocomial infections preventable.
compromised host, and Insufficient hand hygiene.
CHAIN OF INFECTION
Etiologic Agent
● The extent to which any microorganism is capable
of producing an infectious process depends on:
★ number of microorganisms present
★ the virulence and potency of the
microorganisms (pathogenicity)
★ the ability of the microorganisms to enter
the body
★ the susceptibility of the host
★ the ability of the microorganisms to live in
the host’s body
Reservoir
● sources of microorganisms.
● Common sources are other humans, the client’s
own microorganisms, plants, animals, or the
general environment.
● People are the most common source of infection for
others and for themselves.
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BACHELOR OF SCIENCE IN NURSING
FUNDAMENTALS IN NURSING SLE
Asepsis
● A carrier is a person or animal reservoir of a
specific infectious agent that usually does not
manifest any clinical signs of disease.
Portal of Exit from Reservoir
● Before an infection can establish itself in a host, the
microorganisms must leave the reservoir.
Method of Transmission
● means of transmission to reach another person or
host through a receptive portal of entry. There are
three mechanisms:
1. Direct transmission
● involves immediate and direct transfer of
microorganisms from person to person through
touching, biting, kissing, or sexual intercourse.
● Droplet spread is also a form of direct transmission
but can occur only if the source and the host are
within 1 m (3 ft) of each other.
(Sneezing, coughing, spitting, singing, or talking can
project droplet spray )
2. Indirect transmission
● may be either vehicle borne or vector borne:
a. Vehicle-borne transmission
- A vehicle is any substance that serves as
an intermediate means to transport and
introduce an infectious agent into a
susceptible host through a suitable portal
of entry.
- Fomites (inanimate materials or objects),
such as handkerchiefs, toys, soiled
clothes, cooking.
- Water, food, blood, serum, and plasma are
other vehicles.
b. Vector-borne transmission
- an animal or flying or crawling insect
that serves as an intermediate means of
transporting the infectious agent.
- injecting salivary fluid during biting or by
depositing feces or other materials on the
skin through the bite wound
3. Airborne transmission
● involve droplets or dust.
● Droplet nuclei, the residue of evaporated droplets
emitted by an infected host such as someone with
tuberculosis, can remain in the air for long periods;
transmitted by air.
Portal of Entry to the Susceptible Host
● Before a person can become infected,
microorganisms must enter the body.
● The skin is a barrier to infectious agents; however,
any break in the skin can readily serve as a portal of
entry.
● Often, microorganisms enter the body of the host by
the same route they used to leave the source.
Susceptible Host
● any person who is at risk for infection.
● compromised host is a person at increased risk,
an individual who for one or more reasons is more
likely than others to acquire an infection.
BODY DEFENSES AGAINST INFECTION
➔ Nonspecific defenses protect the person against
all microorganisms, regardless of prior exposure.
Specific (immune) defenses, by contrast, are
directed against identifiable bacteria, viruses, fungi,
or other infectious agents.
Nonspecific Defenses
Anatomic and physiological barriers and the inflammatory
response.
1. ANATOMIC AND PHYSIOLOGICAL BARRIERS
● Intact skin and mucous membranes are the body’s
first line of defense against microorganisms.
● The nasal passages have a defensive function. As
entering air follows the tortuous route of the
passage, it comes in contact with moist mucous
membranes and cilia. These trap microorganisms,
dust, and foreign materials.
● The lungs have alveolar macrophages (large
phagocytes). Phagocytes are cells that ingest
microorganisms, dead cells, and foreign particles.
● Each body orifice also has protective mechanisms.
The oral cavity regularly sheds mucosal epithelium
to rid the mouth of colonizers.
● The flow of saliva and its partial buffering action
help prevent infections.
● The eye is protected from infection by tears
● The vagina also has natural defenses against
infection. When a girl reaches puberty, lactobacilli
ferment sugars in the vaginal secretions, creating a
vaginal pH of 3.5 to 4.5. This low pH inhibits the
growth of many disease-producing microorganisms.
2. INFLAMMATORY RESPONSE
● a local and nonspecific defensive response of
the tissues to an injurious or infectious agent. It is
an adaptive mechanism that destroys or dilutes the
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BACHELOR OF SCIENCE IN NURSING
FUNDAMENTALS IN NURSING SLE
Asepsis
injurious agent, prevents further spread of the injury,
and promotes the repair of damaged tissue.
● with the suffix -itis
● It is characterized by five signs: (1) pain, (2)
swelling, (3) redness, (4) heat, and (5) impaired
function of the part, if the injury is severe.
● Injurious agents can be categorized as physical
agents, chemical agents, and microorganisms.
★ Physical agents include mechanical
objects causing trauma to tissues,
excessive heat or cold, and radiation.
★ Chemical agents include external irritants
(e.g., strong acids, alkalis, poisons, and
irritating gases) and internal irritants.
★ Microorganisms include the broad groups
of bacteria, viruses, fungi, and parasites.
● Stages of the inflammatory response:
First stage: vascular and cellular responses
Second stage: exudate production
Third stage: reparative phase.
a. VASCULAR AND CELLULAR RESPONSES
● blood vessels at the site of injury constrict.
● This is rapidly followed by dilation of small blood
vessels (occurring as a result of histamine released
by the injured tissues).
● Thus, more blood flows to the injured area.
● This marked increase in blood supply is referred to
as hyperemia and is responsible for the
characteristic signs of redness and heat.
● Fluid, proteins, and leukocytes (white blood cells)
leak into the interstitial spaces, and the signs of
inflammation—swelling (edema) and pain—appear.
● Pain is caused by the pressure of accumulating fluid
on nerve endings and the irritating chemical
mediators.
● Fluid pouring into areas such as the pleural or
pericardial cavity can seriously affect organ
function. In other areas, such as joints, mobility is
impaired.
● In response to the exit of leukocytes from the blood,
the bone marrow produces large numbers of
leukocytes and releases them into the bloodstream.
This is called leukocytosis. A normal leukocyte
count of 4,500 to 11,000 per cubic millimeter of
blood can rise to 20,000 or more when inflammation
occurs.
b. EXUDATE PRODUCTION
● the inflammatory exudate is produced, consisting of
fluid that escaped from the blood vessels, dead
phagocytic cells, and dead tissue cells and products
that they release.
● The plasma protein fibrinogen (which is
converted to fibrin when it is released into the
tissues), thromboplastin (released by injured
tissue cells), and platelets together form an
interlacing network to wall off the area, and prevent
spread of the injurious agent.
c. REPARATIVE PHASE
● involves the repair of injured tissues by
regeneration or replacement with fibrous tissue
(scar) formation.
● Regeneration is the replacement of destroyed
tissue cells by cells that are identical or similar in
structure and function.
● Damaged cells are replaced one by one, but the
cells are also organized so that the architectural
pattern and function of the tissue are restored
● The ability to regenerate cells varies considerably
from one type of tissue to another
● Tissues that have little regenerative capacity
include nervous, muscular, and elastic tissues.
● When regeneration is not possible, repair occurs by
fibrous (scar) tissue formation.
● Damaged tissues are replaced with the connective
tissue elements of collagen, blood capillaries,
lymphatics, and other tissuebound substances.
● In the early stages of this process, the tissue is
called granulation tissue. . Later in the process,
the tissue shrinks (the capillaries are constricted,
even obliterated) and the collagen fibers contract,
so that a firmer fibrous tissue remains. This is called
cicatrix, or scar.
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BACHELOR OF SCIENCE IN NURSING
FUNDAMENTALS IN NURSING SLE
Asepsis
Specific Defenses
● involve the immune system.
● An antigen is a substance that induces a state of
sensitivity or immune responsiveness (immunity). If
the proteins originate in a person’s own body, the
antigen is called an autoantigen.
● Two components: antibody-mediated defenses and
cell-mediated defenses. These two systems provide
distinct but overlapping protection.
ANTIBODY-MEDIATED DEFENSES
● humoral (or circulating) immunity because these
defenses reside ultimately in the B lymphocytes and
are mediated by antibodies produced by B cells.
● Antibodies, also called immunoglobulins, are part
of the body’s plasma proteins. The
antibody-mediated responses defend primarily
against the extracellular phases of bacterial and
viral infections.
● The two major types of immunity are active and
passive
1. ACTIVE IMMUNITY
- host produces antibodies in response to
natural antigens (e.g., infectious
microorganisms) or artificial antigens (e.g.,
vaccines).
2. PASSIVE IMMUNITY
- host receives natural (e.g., from a nursing
mother) or artificial (e.g., from an injection
of immune serum) antibodies produced by
another source.
CELL-MEDIATED DEFENSES
● or cellular immunity, occur through the T-cell
system.
● On exposure to an antigen, the lymphoid tissues
release large numbers of activated T cells into the
lymph system
● three main groups of T cells:
(1) helper T cells, which help in the functions of the
immune system;
(2) cytotoxic T cells, which attack and kill
microorganisms and sometimes the body’s own
cells;
(3) suppressor T cells, which can suppress the
functions of the helper T cells and the cytotoxic T
cells.
FACTORS INCREASING SUSCEPTIBILITY
TO INFECTION
➔ One of the most important factors is host
susceptibility, which is affected by age, heredity,
level of stress, nutritional status, current medical
therapy, and preexisting disease processes.
1. Newborns and older adults have reduced defenses
against infection
2. With advancing age, the immune responses again
become weak
3. Heredity influences the development of infection in
that some people have a genetic susceptibility to
certain infections.
4. The nature, number, and duration of physical and
emotional stressors can influence susceptibility to
infection.
5. Resistance to infection depends on adequate
nutritional status.
6. Some medical therapies predispose a person to
infection. For example, radiation treatments for
cancer.
7. Certain medications also increase susceptibility to
infection. Antineoplastic (anticancer) medications
may depress bone marrow function,
8. Certain antibiotics can also induce resistance in
some strains of organisms.
NURSING MANAGEMENT
Assessing
● During the assessing phase of the nursing process,
the nurse obtains the client’s history, conducts the
physical assessment, and gathers laboratory data.
Nursing History
● During the nursing history, the nurse assesses
(a) the degree to which a client is at risk of
developing an infection
(b) any client complaints suggesting the presence of
an infection.
Physical Assessment
● Commonly the skin and mucous membranes are
involved in a local infectious process, resulting in
the following:
★ Localized swelling
★ Localized redness
★ Pain or tenderness with palpation or
movement Palpable heat at the infected
area
★ Loss of function of the body part affected,
depending on the site and extent of
involvement.
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BACHELOR OF SCIENCE IN NURSING
FUNDAMENTALS IN NURSING SLE
Asepsis
● Signs of systemic infection include the following:
★ Fever
★ Increased pulse and respiratory rate if the
fever is high
★ Malaise and loss of energy
★ Anorexia and, in some situations, nausea
and vomiting
★ Enlargement and tenderness of lymph
nodes that drain the area of infection
Planning
● The major goals for clients suscpetible to infection
are to:
★ Maintain or restore defenses
★ Avoid the spread of infectous organisms
★ Reduce or alleviate problmes associated
with the infection.
HAND HYGIENE
➔ Hand hygiene is important in every setting,
including hospitals. It is considered one of the most
effective infection prevention measures.
➔ Because hand hygiene is performed so frequently, it
provides a good opportunity for the nurse to take a
moment to breathe and prepare for the next client
encounter.
➔ By allowing a full, quiet breath in and a slow,
complete exhalation, the nurse can focus his or her
attention and intention to remain mindful. This
mindful attitude enhances the nurse’s therapeutic
presence and increases the effectiveness and
safety of care.
➔ For routine client care, vigorous hand washing
under a stream of water for 15 to 20 seconds using
granular soap, soap-filled sheets, or liquid soap at
the beginning of the nurse’s shift, when hands are
visibly soiled, and after using the toilet is
recommended (WHO, 2009).
➔ Antimicrobial soaps are usually provided in high-risk
areas (e.g., the newborn nursery). In the following
situations, the CDC recommends antimicrobial hand
hygiene agents:
★ When there are known multiple resistant
bacteria
★ Before invasive procedures
★ In special care units, such as nurseries
and intensive care units (ICUs)
★ Before caring for severely
immunocompromised clients
● Proper use of alcohol-based products includes
following these steps:
★ Apply a palmful of product into cupped
hand—enough to cover all surfaces of both
hands.
★ Rub palms against palms
★ Interlace fingers palm to palm.
★ Rub palms to back of hands.
★ Rub all surfaces of each finger with
opposite hand.
★ Continue until product is dry—about 20 to
30 seconds.
Hand hygiene pages : 614-616.
Supporting Defenses of a Susceptible Host
● .Susceptibility is the degree to which an individual
can be affected, that is, the likelihood of an
organism causing an infection in that person. The
following measures can reduce a person’s
susceptibility:
★ Hygiene
★ Nutrition
★ Fluid
★ Sleep
★ Stress
★ Immunizations
Disinfecting and Sterilizing
● .The first links in the chain of infection, the etiologic
agent and the reservoir, are interrupted by the use
of antiseptics (agents that inhibit the growth of
some microorganisms) and disinfectants (agents
that destroy pathogens other than spores) and by
sterilization.
A. Disinfecting
● An antiseptic is a chemical preparation used on skin
or tissue. A disinfectant is a chemical preparation,
such as phenol or iodine compounds, used on
inanimate objects. Disinfectants are frequently
caustic and toxic to tissues
.
● Both antiseptics and disinfectants are said to have
bactericidal or bacteriostatic properties.
- bactericidal preparation destroys bacteria
- bacteriostatic preparation prevents the
growth and reproduction of some bacteria.
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BACHELOR OF SCIENCE IN NURSING
FUNDAMENTALS IN NURSING SLE
Asepsis
B. Sterilizing
● Sterilization is a process that destroys all
microorganisms, including spores and viruses.
1. Moist Heat
- with an autoclave
- steam under pressure is used
2. Gas
- Ethylene oxide gas destroys
microorganisms by interfering with their
metabolic processes.
3. Boiling Water
- most practical and inexpensive method for
sterilizing in the home
- Boiling a minimum of 15 minutes is
advised for disinfection of articles in the
home.
4. Radiation
- Both ionizing (such as alpha, beta, and
x-rays) and nonionizing (ultraviolet light)
radiation are used for disinfection and
sterilization.
- rays do not penetrate deeply
INFECTION PREVENTION AND CONTROL
➔ The isolation guidelines contain a two-tiered
approach. The first is standard precautions (SP).
Some agencies may use an earlier term—universal
precautions (UP)—reflecting their applicability in all
client care situations
Standard Precautions
● are used in the care of all hospitalized individuals
regardless of their diagnosis or possible infection
status.
● They are used in any situations involving blood, all
body fluids, excretions, and secretions except sweat
(whether or not blood is present or visible),
nonintact skin, and mucous membranes.
● SP include
(a) hand hygiene;
(b) use of personal protective equipment (PPE),
which includes gloves, gowns, eyewear, and masks;
(c) safe injection practices;
(d) safe handling of potentially contaminated
equipment or surfaces in the client environment;
(e) respiratory hygiene/cough etiquette.
Transmission-Based Precautions
● used in addition to standard precautions for clients
with known or suspected infections that are spread
in one of three ways: by airborne or droplet
transmission, or by contact.
a. Airborne precautions
● used for clients known to have or suspected of
having serious illnesses transmitted by airborne
droplet nuclei smaller than 5 microns.
b. Contact precautions
● are used for clients known to have or suspected of
having serious illnesses easily transmitted by direct
client contact or by contact with items in the client’s
environment.
Personal Protective Equipment
Gloves
● are worn for three reasons:
First, they protect the hands when the nurse is likely
to handle any body substances, for example, blood,
urine, feces, sputum, and nonintact skin.
Second, gloves reduce the likelihood of nurses
transmitting their own endogenous microorganisms
to individuals receiving care. Nurses who have open
sores or cuts on the hands must wear gloves for
protection.
Third, gloves reduce the chance that the nurse’s
hands will transmit microorganisms from one client
or an object to another client.
Applying and Removing Personal Protective Equipment
(Gloves, Gown, Mask, Eyewear): 650-652
Face Masks
● worn to reduce the risk for transmission of
organisms by the droplet contact and airborne
routes and by splatters of body substances
Eyewear
● Protective eyewear (goggles, glasses, or face
shields) and masks are indicated in situations
where body substances may splatter the face.
● If the nurse wears prescription eyeglasses, goggles
must still be worn over the glasses because the
protection must extend around the sides of the
glasses
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BACHELOR OF SCIENCE IN NURSING
FUNDAMENTALS IN NURSING SLE
Asepsis

Sterile Gloves
● Sterile gloves may be applied by the open method
or the closed method. The open method is most
frequently used outside the operating room because
the closed method requires that the nurse wear a
sterile gown. Gloves are worn during many
procedures to enable the nurse to handle sterile
items freely and to prevent clients at risk (e.g.,
those with open wounds) from becoming infected by

microorganisms on unsterile gloves or the nurse’s

hands.

Principles and Practices of Surgical Asepsis: 656

Establishing and Maintaining a Sterile Field: 657-660.

Applying and Removing Sterile Gloves (Open Method):

661-664

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