Medical Asepsis

Ella Yu

Asepsis
 Freedom

from disease- causing microorganism  Medical and surgical  Sepsis = state of infection ( can take many forms ,including septic shock)

Medical asepsis
 The

practices intended to confine a specific microorganism to a specific area, limiting the number, growth and transmission of microorganism.  Clean- absence of almost all microorganism  Dirty- likely to have microorganism, some of which may be capable of causing infection

Surgical asepsis
 Sterile

technique  Practices keep an area or object free of all microorganism  Practices destroy all microorganism and spores

Infection
 An

invasion of body tissue by microorganism (infectious agent)  Asymptomatic or subclinical ( no clinical evidence of disease)  Disease (a detectable alteration in normal tissue function)

Microorganism

Harmful Vs Beneficial

Enterobacteria- bacteriocins (lethal to related strain of bacteria, other produce antibiotic- like substances and toxic metabolites that repress the growth of the other microorganism) Normal residential flora- e.g. Escherichia coli (the collective vegetative in a given area, yet produce infection to other) Their ability to produce disease Vary in the severity of disease Vary in their degree of communicability (common cold virus Vs Mycobacterium leprae) Communicable disease- the infectious agent can be transmitted to an individual by direct or indirect contact (vector/ vehicle/ airborne infection) True pathogen Opportunistic pathogen – causes disease only in susceptible individual

Virulence
   

Pathogenicity
 

Examples of Common Resident Microorganisms
Skin and nasal passages Oropharynx Mouth Intestine Urethral orifice, urethra, Vagina Staphylococcus epidermidis  Staphylococcus aureus

Lactobacillus  Streptococcus pneumoniae

Enterobacteriacea Escherichia coli

Proteus Clotridium Candida albicans

Microorganism

Bacteria

Common infection- causing microorganisms Enter living cells to reproduce Yeasts and mold Candida albicans- normal flora in vagina Live on other organism Protozoa- malaria, helminths (worm), anthropods (mites, fleas, ticks)

Viruses (consist nucleic acid)

Fungi
 

Parasites
 

Types of infection
 Colonization  Local

infection infection

(Specific part of the body) (Spread and damage different part)

 Systemic

 Acute

/ chronic infection infection

Appear suddenly/ occur slowly, last for long time

 Nosocomial

Nosocomial infection
  

Associate with the delivery of health care services in a health care facility (acquired by health care professionals) Endogenous( microorganism originate from the client)  E. Coli Exogenous( from hospital environment MRSA)  Methicillin resistance staphylococcus aureus Iatrogenic infections  Direct result of diagnostic or therapeutic procedure  Insertion of intravascular line, urinary catheter National Nosocomial Infection Surveillance (NNIS)  http://www.cdc.gov/ncidod/hip/survrill/nnis.htm

Chain of infection
 Etiology
  

agent

Virulence and potency of the microorganism Susceptibility of the host Ability to enter, ability to live in host A carrier- a person or animal reservoir of a specific infectious agent that usually does not manifest any clinical signs of disease

 Reservoir

 Portal

of exit

p. 631

Chain of infection
 Method
 

of transmission

Direct transmission (through touching, bitting, kissing, sexual intercourse, droplet- sneezing, coughing) Indirect transmission
 

Vehicle- borne (inanimate- toys, food, blood) Vector- borne (animal/ insects) Droplets/ dust is transmitted by air current Droplet nuclei- the residue of evaporated droplet

Airborne transmission
 

Chain of infection
 Portal

of entry of susceptible host host

Skin as a barrier Compromised host- a person “at increased risk” E.g. aging adult, immune suppression treatment for cancer

 Susceptible
 

Body defenses against infection
 Nonspecific
 

defenses

Anatomic and physiologic barrier Inflammatory responses

 Specific
 

defenses

Antibody- mediated defenses Cell-mediated defenses

Factors increasing susceptibility to infection
 Age  Heredity  Physical

and emotional stressors  Nutritional status  Medical therapies and diagnostic treatment  Medication e.g. immunosuppressant and corticosteroid, antibiotic  Disease e.g. diabetes mellitus, COAD

Nursing interventions that break the chain of infection

Assess signs and symptoms of an infection:
  

? Any sneezing, watery/ mucoid discharge from the nose ? Urinary frequency, cloudy or discolored urine Skin and mucous membranes  Localized swelling  Localized redness  Pain or tenderness with palpation or movement  Palpable heat at the infected area  Loss of function  ? exudate

Nursing interventions that break the chain of infection

Systemic infection
    

Fever Increased pulse and respiratory rate if fever is high Malaise and loss of energy Anorexia, nausea and vomitting Enlargement and tenderness of the lymph nodes

Nursing interventions that break the chain of infection

Laboratory data
 

Elevated leukocytes count Elevated ESR (erythrocyte sedimentation rate)

Red blood cells normally settles slowly, but the rate increases in the presence of an inflammatory process Laboratory cultivations of microorganisms in a special growth medium

Urine, blood, sputum or other drainage cultures

Nursing interventions that break the chain of infection
 Hand  PPE  Isolation

hygiene

precaution  Infection control measures

Nursing interventions that break the chain of infection
 World

Health Organization (2005)

Hand washing under a stream of water for at least 20 seconds using plain granule soap, soap-filled sheets, or liquid soap when hands are visibly soiled, after using the restroom before handling invasive device and after contact of the medical equipment. Alcohol-based antiseptic hand rubs (rinses, gels or foams) for use before and after direct client contact – enhance the adherence to hand cleansing

Nursing interventions that break the chain of infection

Nursing interventions that break the chain of infection

Nursing interventions that break the chain of infection

Nursing interventions that break the chain of infection

Nursing interventions that break the chain of infection

Nursing interventions that break the chain of infection
 Proper
    

application of alcohol- based products:

Apply a palmful of the product to a cupped hand. Rub palms against palms Interlace fingers palm rub palms to the back of hands Rub each finger individually on all sides with the other hand Continue until product is dry- about 20- 30 seconds

Supporting defenses of a susceptible host
 Hygiene  Nutrition  Fluid  Rest

and sleep  immunization

Compromised clients
Highly susceptible to infection  Have disease e.g. leukaemia, bone-marrow depression  Have extensive skin impairment e.g. major burns and dermatitis

Cleaning, disinfecting and sterilizing
 1.

2. 3. 4. 5. 6.

Cleaning Rinse the article with cold water to remove organic material (adhesion) Wash in hot water and soap Use a brush Rinse the article with warm and hot water Dry the article Clean the brush and sink

Cleaning, disinfecting and sterilizing
 Disinfecting  Disinfectant(

used on inanimated objects, toxic to tissue, more concentrated, phenol / iodine base)  Antiseptic (used on skin or tissue)  Bacteriocidal (destroy bacteria)  Bacteriostatic (prevent growth and reproduction)

P.647

Cleaning, disinfecting and sterilizing
Disinfectant  The type and number of infectious organisms  The recommended concentration  The temperature of the environment  The presence of soap  The presence of organic materials  The surface areas to be treated

Cleaning, disinfecting and sterilizing
Sterilizing  A process that destroy all microorganisms, including all spores and viruses  Moist heat  Steam under pressure or free steam  Autoclaves pressure 15-17 pound and 121 to 123 C  Gas  Ethylene oxide (interfere metabolic process, toxicity to human)  Boiling water( inexpensive)  100C for at least 15 minutes  Radiation  Ultrviolet light

Isolation precaution
 

Standard Precautions Transmission- Based Precautions
  

Airborne Droplets Contact

Standard Precautions
 Unidentified

pathogens  Interfere with the spread of bloodbourne pathogens  Body substance isolation (BSI)  Blood, body secretion abd excretions except sweat, nonintact skin and mucous membranes

Infection Control Practices
 General

guideline protective equipment

E.g. I. V. line, catheter care, needle handling Gloves Gowns

 Personal
 

Water resistant N95 (95% efficiency in prevent inhaling tuberculin organisms testing by NIOSH)

Face masks

Eyewear

Infection Control Practices

Infection Control Practices

Infection Control Practices

Infection Control Practices

Infection Control Practices

Infection Control Practices

Infection Control Practices

Infection Control Practices

Infection Control Practices

Infection Control Practices

Infection Control
 Centres

for Disease Control and Prevention (CDC) in United states  Infection Control Teams in hospitals