Infection control

and Asepsis
UNIVERSITY OF GEORGIA
RESEARCH AND CLINICAL
SKILLS III
MARINA JIMUKHADZE MD
Objectives:
To learn infection control methods
To describe nature of Infection, chain of infection, common
microorganisms and their characteristics, routes of transmission
To learn infection control methods and types of personal protective
equipment(PPE)
To Describe how and when to use additional precautions and personal
protective equipment
Client’s and Healthcare Workers’
Risks of Acquiring an Infection

Client teaching should include information concerning infections,

modes of transmission, and methods of prevention
Health care workers can protect themselves from exposure to a
communicable disease by having knowledge of the infectious process
and appropriate barrier protection
Nature of Infection
An infection is the growth of microorganisms in body tissue where they
are not usually found
Asymptomatic Infection
Symptomatic Infection
Communicable disease
Aseptic technique
Medical asepsis -“Clean technique”
Includes all practices intended to confine a specific microorganism to a
specific area
Limits the number, growth, and transmission of microorganisms
Objects referred to as clean or dirty (soiled, contaminated)

Surgical asepsis - ANTT

Sterile technique
Practices that keep an area or object free of all microorganisms
Practices that destroy all microorganisms and spores
Used for all procedures involving sterile areas of the body
Aseptic technique
ANTT (Aseptic Non-Touch Technique)
 Insertion, repositioning, or dressing, invasive devices, such as
catheters, drains, or intravenous lines
 Dressing wounds healing by primary intensions
 Suturing
 When sterile body areas are to be entered
 If there is tracking to deeper areas or the patient is
immunocompromised
Aseptic technique
Clean technique
 Removing sutures, drains, urethral catheters
 Endotracheal suction, management of tracheostomy site
 Management of enteral feeding lines
 Care of stomas
 Instillation of eye drops
Type of Infections
 Local infection
 Systemic infection
 Bacteremia
 Septicemia
 Acute infections
 Chronic infections
Nosocomial Infections
Nosocomial infection results from delivery of health services in a health
care facility
 Health care associated infections (HAIs)
 Common HAIs
 Risk factors

What is the impact of HAIs on clients?

 Chain of Infection
Figure 31-1 The chain of infection
Chain of Infection
Development of an infection occurs in a cycle with following elements:
An infectious agent or pathogen
A reservoir or source for pathogen growth
A portal of exit from reservoir
A mode of transmission
A portal of entry to a host
A susceptible host

HCW break the chain so infection will not develop

Etiologic Agent
Microorganisms include
Bacteria- most common
Viruses- must enter a living cell in order to reproduce (rhinovirus)
Fungi- yeast and molds
Parasites- live on other organisms

Resident organisms of the skin- normal microorganisms that are found

on the skin
Transient organisms of the skin
Infectious Agent
The potential of infectious agent to cause disease depends on
Number of organisms
Virulence, or ability to cause disease
Susceptibility of the host
Reservoir

Where the microorganism lives

Common sources

Carrier
Portal of Exit
Must leave reservoir
Coughing
Sneezing
Saliva & mucous membranes
Feces & urine
Drainage
Open wound
Method of Transmission
Direct Transmission
Indirect Transmission
Airborne Transmission
Method of Transmission
Direct Transmission
Droplet spread is form of Direct Transmission
Method of Transmission
Indirect Transmission
◦ Vehicle borne
◦ Utilizes an intermediate means of transport and introduce
an infectious hose
◦ Contaminated surfaces (fomites)

◦ Vector borne
◦ Animal or flying/crawling insect that serves an intermediate
means of transporting the infectious agent
◦ Feces
Portal of Entry
Skin
Respiratory Tract
Urinary Tract
GI Tract
Reproductive Tract
Blood
Factors Affecting the
Risk for Infection
Level of integrity of skin and mucous membranes
pH levels in GI and GU tracts and Skin
Integrity and number of the body’s white blood cells
Age, race, gender, and hereditary factors which influence susceptibility
Immunizations, natural or acquired
Level of fatigue, nutritional and general health status, presence of
preexisting illness, previous or current treatments and certain medications
Stress level
Use of indwelling medical devices
Unsafe sex practices and sharing IV needles
First line of defenses
against infection
Intact skin & mucous membranes
Mouth
Cilia of the nasal passages
Tears
GI
Vagina
Urine flow
Second line of defense
against infection
•Inflammatory Response
Third line of defense against
infection- Specific Defenses
Active immunity
◦ Host produces antibodies in response to natural antigens or artificial
antigens
◦ Natural
◦ From active infection
◦ Artificial
◦ Administered
Passive Immunity
Passive immunity
Host receives natural or artificial antibodies
◦ Natural passive immunity
◦ Ex. from mother to baby through breastmilk
◦ Artificial passive immunity
◦ injection of antibodies
Factors Influencing
Susceptibility to Infection
Age
Heredity
Stress
Nutrition
Medications/procedures
Disease
Other
Assessment
• Medical history
• Physical assessment
– S/S localized infection
– S/S systemic infection
– Laboratory data
 Elevated WBC count
 Increase in specific WBC types
 Elevated erythrocyte sedimentation rate (ESR)
 Cultures of urine, blood, sputum, or other drainage
Infection control
•HCW’s goals focus on:
◦ Maintaining/restoring defenses

◦ Avoiding spread of infection

◦ Reduce/alleviate complications
CDC Guidelines to
Prevent Infection
Two tiered approach
◦ Standard precautions (SP)
◦ Transmission based precautions

Hand hygiene
Personal protective equipment
Environmental controls
Respiratory hygiene (cough etiquette)
Isolation
Standard Precautions
Designed for all clients
Apply to:
Blood
All body fluids, excretions, secretions, except sweat
Nonintact skin
Mucous membranes
 Preventing Nosocomial
Infections
Transfer of pathogens from person to person can be decreased by using a personal protective
equipment, hand hygiene

 Hand washing
 Gloves
 Face masks
 Protective eye wear
 protective clothing
 instrument sterilization and disinfection

Hand Hygiene is the most effective way to help prevent the spread of organisms!!!!
Protecting Your Patients
 When Should Hands be
Cleaned?
Before initial contact with patient or environment contact
 Before any clean (routine) or aseptic (sterile) procedure
After blood or body fluid risk/exposure

 After contact/touching the patient

After contact with the patient’s/client’s/resident’s environment
Hand Washing
METHOD

Wet hands with clean (not

hot) water
Apply soap
Rub hands together for at
least 30 seconds
Rinse with clean water
Dry with disposable towel
or air dry
Use towel to turn off faucet
 Waterless
Alcohol Gel
Hand Hygiene
with
emollients

Hand disinfection is the single most important

intervention for the prevention of nosocomial
infections in hospitalized patients.
Alcohol-based Hand
Rubs
Effective if hands not visibly soiled
More costly than soap & water
Method
Apply appropriate (3ml) amount to palms
Rub hands together, covering all surfaces until dry
PPE
Personal protective equipment, or PPE, as defined by the Occupational
Safety and Health Administration (OSHA) is “specialized clothing or
equipment, worn by an employee for protection against infectious
materials.”
Types of PPE
Gloves

Gowns

Masks

Eye protection
Gloves Different kinds of gloves
 Housekeeper gloves
 Clean gloves
 Sterile glove
 gloves
- Work from “clean to dirty”
- Limit opportunities for “touch contamination”
1) protect yourself, others, and the environment
2) Change gloves
3) Discard in appropriate receptacle
Hand dermatitis that developed from wearing latex gloves.
Types of PPE
Gowns

Fully cover torso

Have long sleeves

Fit snuggly at the wrist

 Types of PPE
Surgical masks
Cotton, paper
Protect against body fluids and large particles

Particulate respirators (N95)

Fit testing essential
Protect against small droplets and other airborne particles

Alternative materials (barrier)

 Tissues, cloth
Types of PPE
Eye Protection
Face shields
Goggles
Applying and
removing PPE
Hand hygiene Remove the gloves
Apply a clean gown Perform hand hygiene
Apply the face mask Remove protective eyewear
Apply protective eyewear Remove the gown
Apply clean gloves
PPE Supplies
Maintain adequate, accessible supplies

Creative alternatives (studies not done to asses

effectiveness)
◦ Mask: tissue, scarf
◦ Gown: laboratory coat, scrubs
Working with Limited
Resources
Avoid reuse of disposable PPE items
◦ Consider reuse of some disposable items only as an urgent, temporary
solution
◦ Reuse only if no obvious soiling or damage

When prioritizing PPE purchase

◦ Masks
◦ Gloves
◦ Eye protection
Handling and Disposing
of Supplies
All spills of body fluids or substances must be immediately cleaned
with appropriate chemical germicide or disinfectant
A contaminated item can NEVER be used for another person
All items that are disposable and have body fluids on them must be
thrown away in a BIOHAZARD bag or container
Specialized Infection-
Control Precautions
Transmission- based Precautions
Precautions used in addition to standard precautions for patients will
suspected infections that can be transmitted by airborne, droplet or contact
routes
Puncture resistant containers for disposal of all needles and sharps
 Most needle sticks occur while recapping – NEVER RECAP!!!
 Possible exposure blood borne pathogens
 Transmission-Based
Precautions
Airborne precautions
◦ For patients who have infections that spread through the air (chicken
pox, Tb, rubella, measles)
◦ Place pt in a private room with negative pressure (air flows one way).
Keep door closed and patient in room
◦ Use respiratory protection when entering room
◦ Transport patient out of room only when necessary and place a
surgical mask on pt if possible
Transmission-Based
Precautions
Droplet Precautions
◦ Used for when patient has an infection that is
spread by large-particle droplets (rubella, mumps,
diphtheria and adenovirus)
◦ Use a private room but door can be open
◦ Wear mask when working within 3 feet (1 meter)
of patient
◦ Transport pt only when necessary and place a
surgical mask on pt if possible
◦ Keep visitors 3 feet (about 1 meter) away from
person
Transmission-Based
Precautions
Contact Precautions
◦ For patients who are infected or colonized by a microorganism
that spreads by direct or indirect contact
◦ Place pt in private room if possible
◦ Wear gloves whenever you enter the room, change gloves
after having contact with infective material, remove gloves
before leaving patient environment and wash hands with
antimicrobial or waterless antiseptic agent
◦ Wear a gown if contact with infectious agent is likely or pt has
diarrhea, ileostomy, colostomy or wound drainage not
contained by a dressing
◦ Limit movement of patient out of the room
◦ Avoid sharing patient equipment
Immunosuppressed
patients
Patients who have had a transplant or are receiving chemotherapy
(patients with neutropenia)
◦ Greater risk at being infected by organisms in their own body

Standard precautions always PLUS the following

◦ Healthy caregiver
◦ Restrict visitors who have cold or contagious illnesses
◦ Avoid standing collection of water in the room
Surgical Asepsis
Always err on the side of caution
Opening a sterile pack and preparing a sterile field
◦ Can be opened on a flat surface or while held in hands
◦ Should be covered if it is not used immediately
◦ Only allow a sterile object to touch another sterile object
◦ Hold sterile object above the level of the waist
◦ Avoid talking, coughing and sneezing or reaching over sterile field
◦ Never walk away or turn your back on sterile field
Surgical Asepsis
Pouring sterile solutions
◦ Outside of bottle and cap are considered unsterile
◦ Should be labeled with date and time once opened
◦ Considered sterile for 24 hours after it is opened
◦ Avoid spilling any solution on a cloth or paper used as a field for sterile setup

Adding sterile supplies to a sterile field

◦ Keep all items sterile that are brought into contact with broken skin or used
to penetrate the skin to inject substances into the body or to enter normally
sterile body cavities
◦ Use dry sterile forceps when necessary
◦ Consider the edge (outer 2.5 cm) to be contaminated
Preventing Healthcare
Associated Infections
Most common
◦ Urinary Tract Infections
◦ Pneumonia
◦ Blood stream infections

Almost all of these infections can be traced back to an invasive device

Usually hands of HCWs using the instruments or equipment are the
most significant means of transmission
Infection Control
Precautions
Research has shown that pts in isolation may suffer unintentional
consequences

Tell patient
◦ Precautions are temporary
◦ Precautions are used to protect patient, staff and other patients
◦ Proper hand hygiene is most effective in prevention
◦ Continued explanation about procedures and continued updates on progress
help to minimize anxiety
 Reporting Accidental
Exposures
Any needle stick injury or accidental exposure to blood or body fluids must be
reported immediately
◦ Washing the exposed area immediately with warm water and soap
◦ Reporting the incident to the appropriate person and completing an incident or injury
report
◦ Inform the agency the source (pt’s name) and nature of the exposure
◦ Consenting to initial baseline blood tests
◦ Consenting to post exposure prophylaxis
◦ Awaiting blood test results of the involved patient
◦ Attending counseling sessions regarding safe practices to protect self and others
 Review
Wash your hands
If it is sterile Keep it sterile
Report accidental or even
intentional exposures
Disinfection and
Sterilization
Disinfection
◦ Destroys all pathogenic organisms except spores
◦ Used when preparing skin for procedure or cleaning a piece of equipment
that does not enter the body

Sterilization
◦ Destroys all microbes including spore
◦ Done on equipment that is entering a sterile portion of the body
How to Clean
Equipment
Wear waterproof gloves at all times
Rinse the articles first with cold running water to remove organic
material
Wash the articles, after rinsing them, in warm water that contains
detergent or soap
Use a brush with stiff bristles to clean articles thoroughly
Rinse and dry the article thoroughly
Prepare for sterilization or disinfecting
Consider the brush, gloves, and sink or basin in which the articles were
cleaned as highly contaminated and treat or discard accordingly
The holding solution
Precleaning instruments
Precleaning is done in three ways:
- Hand scrubbing
- Ultrasonic cleaning
- Instrument washing machine
Sterilization
 Sterilization methods:
 Moist heat (Autoclave)
 Gas
 Boiling water
 Radiation
Sterilization monitoring
Safe management of wastes
Medical waste Definition: potentially
infectious waste materials generated at
health care facilities, such as hospitals,
clinics, physician’s offices, dental practices,
blood banks, and veterinary
hospitals/clinics, as well as medical research
facilities and laboratories.
Categories of health-
care waste
Non-hazardous or general health-care waste
Hazardous health-care waste
Non-hazardous or
general waste
Waste that has not been in contact with infectious agents, hazardous
chemicals or radioactive substances and does not pose a sharps hazard.
(Corrugated cardboard boxes Newspapers and magazines, plastic water
bottles, soft-drink bottles, Paper, containers for food, plastic bottles for
saline solutions or sterile irrigation fluids and etc.)
Hazardous health-care
waste
Sharps waste - needles, hypodermic needles, scalpels and other blades,
knives, infusion sets, saws, broken glass and pipettes
Infectious waste - waste contaminated with blood or other body fluids,
cultures and stocks of infectious agents from laboratory work, waste
from infected patients in isolation wards
Pathological waste - tissues, organs, body parts, blood, body fluids and
other waste from surgery and autopsies on patients with infectious
diseases.
Hazardous health-care
waste
Pharmaceutical waste - expired, unused, spilt and contaminated
pharmaceutical products, prescribed and proprietary drugs, vaccines
and sera
Cytotoxic waste - alkylating agents, antimetabolites, mitotic inhibitors,
contaminated materials from drug preparation and administration, such
as syringes, needles, gauzes, vials, packaging, outdated drugs, excess
(leftover) solutions, drugs returned from the wards.
Hazardous health-care
waste
Chemical waste - discarded solid, liquid and gaseous chemicals
Radioactive waste - materials contaminated with radionuclides
Biohazard symbol
 References
Clinical Procedures for Safer Patient Care -Doyle, G.R., McCutcheon, J.A.
(2015)
Fundamentals of nursing : concepts, proses and practice-10th ed. Berman, A.,
Snyder, Sh. 2016
US Centers for Disease Control and Prevention. “Cover Your Cough’
http://www.cdc.gov/flu/protect/covercough.htw.
https://apps.who.int/phint/pdf/b/7.5.9.5.8-Methods-of-sterilization.pdf