Chapter 9

Medical Asepsis

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 Infection Control

• Provides measures that reduce or eliminate

sources and transmission of infection
• Protects patients and health care providers
from disease
• Hand hygiene
• All patients in any setting are at risk
• Health care–associated infections (HAIs)
are acquired in health care settings

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Chain of Infection

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 Medical Asepsis
 Medical asepsis (clean technique)
 Reduces organisms
 Prevents transfer

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 Quick Quiz!
A nursing assistive personnel (NAP) arrives to
assist the nurse with a dressing change by
opening sterile packages. The NAP states that she
does not need to perform hand hygiene before
assisting the nurse because she is not going to
touch the patient. Is the NAP correct?
A.Yes.
B.No.

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 Patient-Centered Care
 Teach patients about infection control
 Patients in isolation
 Watch patient for signs of loneliness, changes in self-
concept or body image
 Practice cultural awareness

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 Evidence-Based Practice
 Bundled intervention improves hand hygiene
 Wall-mounted dispenser, pocket bottles, education
 Alcohol-based hygiene products more effective
than soap; reduce infections
 With emollients, cause less skin irritation and dryness
than soap
 Soap and water still necessary
 For visibly soiled hands
 When caring for patients with Clostridium difficile or
multidrug-resistant organisms (MDROs)

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 Quick Quiz!
Health care workers with chipped nail polish or
long or artificial nails have high numbers of
bacteria on their fingertips; therefore the CDC
recommends:
Using only neutral colored, nonchip polish.
Wearing gloves over artificial nails.

Keeping natural nails less than ¼ inch long.

Allowing extra time for handwashing to scrub nails.

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 Safety Guidelines

1. Hand hygiene with an appropriate

alcohol-based hand antiseptic or soap
and water is an essential part of patient
care and infection prevention and
fundamental to patient safety.
2. Always know a patient’s susceptibility to
infection.
3. Recognize the elements of the chain of
infection and initiate measures to prevent
its onset and spread.

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 Safety Guidelines (Cont.)

4. Recognize the elements of the chain of

infection, initiate prevention measures.
5. Practice fingernail hygiene.
5. Ensure that patients cover the mouth and nose
when coughing or sneezing; and use and
dispose of tissues properly.
6. Use clean gloves when you anticipate contact
with body fluids, nonintact skin, or mucous
membranes when there is a risk of drainage.

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 Safety Guidelines (Cont.)

7. Use gown, mask, and eye protection when there

is a splash risk.
8. Protect fellow health care workers from
exposure to infectious agents through proper
use and disposal of equipment.
9. Be aware of body sites where HAIs are most
likely to develop (e.g., urinary or respiratory
tract). This enables you to direct preventive
measures.

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 Hand Hygiene
Skill 9-1
 Most important technique for infection control
and prevention
 Hand hygiene
 Handwashing
 Antiseptic hand wash
 Antiseptic hand rub
 Surgical hand asepsis

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 Hand Hygiene
Skill 9-1 (Cont.)
 Decision to perform hand hygiene based on:
 Degree of contact
 Amount of contamination
 Susceptibility to infection
 Procedure/activity to be performed
 Hand hygiene is not optional

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 Hand Hygiene
Skill 7-1 (Cont.)
 Wash hands with plain soap and water or with
antibacterial soap and water when hands are
visibly dirty or soiled with blood or other body
fluids, before eating, and after using the toilet
 Wash hands if exposed to spore-forming
organisms
 If hands are not visibly soiled, use an alcohol-
based hand rub for routinely decontaminating
hands in clinical situations

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 Quick Quiz!
When hands are not visibly soiled or contaminated
with blood or body fluids, the nurse may use an
alcohol-based hand rub to perform hand hygiene.
True or False?
A.True.
B.False.

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 Delegation and Collaboration
 The task of hand hygiene is performed by all
caregivers
 Hand hygiene is not optional

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 Special Considerations
 Teaching
 Hand hygiene instruction
 Risks for infection
 Gerontological
 Impact of infection is greater in older adults

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 Special Considerations (Cont.)
 Home care
 Evaluate patient/primary caregiver on understanding
of infection control/hand hygiene
 Evaluate hand hygiene facilities in the home for
possibility of contamination, proximity to patient, and
maintenance of supplies

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Caring for Patients Under Isolation
Precautions
Skill 9-2
 Use procedures to reduce cross-contamination
to other patients
 Use standard precautions
 Assess need for PPE for each task and for all
patients
 Use CDC guidelines for isolation precautions

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 Standard Precautions
(Tier 1)
 Used for all patients, regardless of risk or
presumed infection status
 Apply to blood, blood products, all body fluids,
secretions, excretions (except sweat), nonintact
skin, and mucous membranes
 How does the nurse teach cough etiquette?

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 Transmission-Based Precautions
(Tier 2)
 Use for care of patients who are known or
suspected to be infected, or colonized, with
microorganisms transmitted by the contact,
droplet, or airborne route
 What type of barrier protection will the nurse use
for each of these patients?

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 Delegation and Collaboration
 Caring for patients on isolation precautions can
be delegated to NAP
 The nurse instructs NAP to:
 Explain reason patient is on isolation precautions
 Take precautions about bringing equipment into the
patient’s room
 Take special precautions regarding individual patient
needs

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 Recording and Reporting

• Document procedures performed and

patient’s response to social isolation. Also
document any patient education performed
and reinforced

• Document type of isolation in use and the

microorganisms (if known)

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 Special Considerations
 Teaching
 Teach visitors how to follow isolation precautions
when visiting the patient
 Pediatric
 Isolation causes a sense of separation from family
and loss of control
 Give children simple explanations
 Let the child see your face before you apply the mask

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 Special Considerations (Cont.)
 Gerontological
 Watch for signs of confusion or depression
 Home care
 Be aware of potential sources of contamination

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Caring for Patients with Multidrug-
Resistant Organisms and
Clostridium difficile
Procedural Guideline 9-1
 Multidrug-resistant organisms increasingly
common as causes of HAIs
 MRSA: increased mortality
 VRE: greater risk to immune-compromised and
debilitated patients
 C. difficile: spore-forming and difficult to eliminate; can
stay dormant for a long time

MRSA, methicillin-resistant Staphylococcus aureus; VRE, vancomycin-resistant Enterococcus.

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 Delegation and Collaboration
 Basic care procedures performed using contact
precautions can be delegated to NAP
 The nurse instructs NAP to:
 Clarify personal precautions used under contact
precautions
 Explain the types of clinical changes that should be
reported

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