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Medical & Surgical Asepsis

Dr. Abdul-Monim Batiha


Assistant Professor
Critical Care Nursing
Philadelphia university

Learning objectives
Explain the concepts of medical and
surgical asepsis.
Identify
types of microorganisms
causing infections.
Identify types & signs of localized
and systematic infections.

Identify risks for nosocomial


infections.
Explain chain of infection.
Identify
factors influencing a
microorganism's capability to
produce an infectious process.
Identify measures that break each
link in the chin of infection.

Asepsis
Asepsis is the freedom from
disease-causing microorganisms.
To decrease the possibility of
transferring
microorganisms
from one place to another,
asepsis is used.

There are two basic types


of asepsis
Medical & Surgical
asepsis.

Medical asepsis. 1
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.

Surgical asepsis or sterile. 2


Technique, refers to keep an area
or
object
free
of
all
microorganism,
it
includes
practices
that
destroy
all
microorganisms
and
spores.
Surgical asepsis is used for all
procedures involving the sterile
areas of the body.

Sepsis is the state of


infection and can take
many forms, including
septic shock.

Types of
microorganisms
causing infections

1. Bacteria can live and be transported


through air, water, food, soil, body tissues
and fluids, and inanimate objects.
2. Viruses (causes the common cold)
hepatitis, herpes, and human
immunodeficiency virus.
3. Fungi include yeasts and molds. Candida
albicans
4. Parasites They include protozoa such as
the that causes malaria.

Types of infection

A local infection is limited to the


specific part of the body where
the microorganisms remain.

If the microorganisms spread and


damage different parts of the
body, it is a systemic infection.

When a culture of the person's


blood reveals microorganisms,
the
condition
is
called
bacteremia.
When bacteremia results in
systemic infection, it is
referred to as septicemia.

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 infections

classified as infections that are


associated with the delivery of health
care services in a health care facility.
Nosocomial infections can either
develop during a client's stay in a
facility or manifest after discharge.

The
incidence
of
nosocomial infections is
significant. Major sites for
these infections are the
respiratory and urinary
tracts, the bloodstream,
and wounds.

Factors
that
contribute
to
nosocomial infection risks are
invasive
procedures,
medical
therapies, the existence of a large
number of susceptible persons,
inappropriate use of antibiotics, and
insufficient hand washing after client
contact and after contact with body
substances.

Chain of
infection

Etiologic agent
microorgnanisms)
(
6
Susceptible
host

2
Reservoir
(source)

5
Portal of entry
to the
susceptible host

3
Portal of exit
from reservoir

4
Method of
transmission

1. Etiologic agent

The any microorganism


is capable of producing
an infectious process
depends on the number
of
microorganisms
present.

Reservoir. 2
There
are
many
reservoirs, or sources of
microorganisms,
common sources are
other
humans,
the
client's, plants, animals,
or general environment.

3. Portal of exit from


reservoir

Before an infection can


establish itself in a host,
the
microorganisms
must leave the reservoir.

4. Method of
transmission

There are three


mechanisms

Direct transmission. 1
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.

Indirect transmission. 2

Material objects, such as toys,


soiled clothes, cooking or
eating
and
surgical
instruments,
or
dressing,
water, food, blood, serum, and
plasma. Animal or flying.

3. Airborn transmission

may involve
droplets or dust.

Portal of entry. 5

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.

Susceptible Host. 6
A susceptible host is any
person who is at risk for
infection. A compromised
host is a person at
"increased risk"

Factors Increasing
Susceptibility to Infection
1. Age influence the risk of
infection.
2. Heredity influences the
development of infection.

3. The nature, number,


and duration of physical
and emotional stressors
can
influence
susceptibility to infection.

Stressors
elevate
blood
cortisone.
Prolonged
elevation of blood cortisone
decrease anti-inflammatory
responses depletes energy
stores, lead to a state of
exhaustion, and decrease
resistance to infection.

4. Resistance to infection depends on


adequate nutritional status.
5. Some medical therapies predispose
a person to infection. For example,
radiation treatments for cancer, some
diagnostic procedures may also
predispose the client to an infection.

6. Certain medication also


increase
susceptibility
to
infection.
Anticancer
medications may depress bone
marrow function, resulting
inadequate production of white
blood cells, anti-inflammatory
and antibiotics medications.

Cleaning, 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.

Cleaning
Cleanliness inhibits the growth
of
microorganisms.
When
cleaning visibly soiled objects,
nurses must always wear gloves
to avoid direct contact with
infections microorganisms.

Disinfecting
A disinfectant is a chemical
preparation, such as phenol or iodine
compounds, used on inanimate objects.
Disinfectants are frequently caustic
and toxic to tissues. An antiseptic is a
chemical preparation used on skin or
tissue.

Disinfectants
and
antiseptics often have
similar
chemical
components,
but
the
disinfectant is a more
concentrated solution.

When disinfecting articles,


nurses need to follow
agency protocol and
consider the following:

1. The type and number of


infectious organisms.
2.
The
recommended
concentration
of
the
disinfectant and the duration
of contact.
3. The temperature of the
environment.

4. The presence of soap. Some disinfectants


are ineffective in the presence of soap or
detergent.
5. The presence of organic materials, the
presence of saliva, blood, pus can readily
inactive many disinfectants.
6. The surface areas to be treated. The
disinfecting agent must come into contact
with all surfaces and areas.

Sterilizing

Sterilization is a process
that
destroys
all
microorganisms,
including spores and
viruses.

Four commonly used


methods of sterilization are
1. Moist heat
2. Gas
3. Boiling water
4. Radiation

Sterile Technique
The basic principles
of surgical asepsis

1. All objects used in a sterile field


must be strile.
2. Sterile objects become un-sterile
when touched by un-sterile
objects.
3. Sterile items that are out of
vision or below the waist level of
the nurse are considered unsterile.

4. Sterile objects can become


unsterile
by
prolonged
exposure
to
airborne
microorganisms.
5. Fluids flow in the direction
of gravity.

6. Moisture that passes through


a
sterile
object
draws
microorganisms from unsterile surfaces above or
below to the sterile surface by
capillary action.

7. The edges of a sterile


field are considered unsterile.
8. The skin cannot be
sterilized and is un-sterile.