NURSING SERVICES

• By the end of the session, participants will be

able to:
• Define Asepsis and its critical concepts.
• Explain six links in the chain of infection and the
ways to break the chain.

• Discuss standard precautions.

• Discuss isolation.

• Discuss nursing care of patients with Contact,

Droplet, Air Borne Precaution, VHF, H1N1
influenza and EBOLA.
• PATHOGENS:
• Disease producing micro organisms are called pathogens.

• NON PATHOGENS:
• Micro organisms that do not produce disease are called
non pathogens

• INFECTION:
• Infection is a process by which organism establish a
parasitic relationship with its host.
•
• INFECTIOUS DISEASE:
• Any disease caused by the invasion and multiplication of
pathogenic microorganisms in the body.
•
• MICRO ORGANISM:
• Forms of life that can’t be seen without a
microscope.
• STERILE TECHNIQUE:
• A technique used to prevent entry of all micro
organisms.
• ANTIGEN:
• A foreign substance e.g. micro organism that
stimulates the production of antibodies.
• ANTIBODY:
• A glycoprotein produced by the body in response to
antigens. They are formed by lymphocytes. (WBC)
• “Asepsis is the state of being free from disease causing
contaminants.”
• (Donna & Linda, 2009)

• Medical Asepsis:
“It’s a clean technique, which is used to prevent the spread
of Microorganism against Pathogenic & Non-Pathogenic
organisms.”
• (Smeltzer, Bare, Hinkle, & Cheever, 2008)

• Surgical Asepsis:
Absence of microorganism in the surgical environment to
reduce the risk of infection.
• (Smeltzer, Bare, Hinkle, & Cheever, 2008)
S. MEDICAL SURGICAL
#

1 Clean technique Sterile technique

2 Simple procedure Complex procedure
3 It is used to prevent the It eliminates all microorganisms
spread of Microorganisms including viruses & spores.
against Pathogenic & Non-
Pathogenic organisms

4 Protects environment from Protects patient from

patients environment

5 Example: maintaining IV line, Example: Any procedure in OR

blood transfusion etc. under sterile field, Foley
catheter insertion etc.
• Micro-organism can be spread in a number of
way:
Contact
• Direct contact
• Indirect contact
• Non human carrier (Malaria, Typhus)
• Air borne (Chicken pox, Measles, TB)
• Blood borne (HIV, Hep B, Hep C)
• Oro-Fecal route (Hep A)
• There are six links in the chain of infection.
We need to understand each of these steps
in order to break the chain and prevent
infection.
• The first link is the microorganism such as
bacteria or viruses that can be spread
directly or indirectly from person to person.
• Break the chain:
• • Cleanse contaminated objects
• • Perform cleaning
• • Disinfection and Sterilization
• The second link is the source where the
microorganism is found. The source is a place
where the microorganism has all of the things it
needs to grow and multiply including warmth and
moisture. Humans make ideal source for
organism.
• Break the chain:
• •Control sources of body fluids and drainage
• •Perform hand hygiene
• •Change soiled dressings (inner to outer in close
wound, outer to inner in open wound)
• •Keep table surfaces clean and dry, bottled
solutions tightly capped
• For infection to spread, the microorganism has to
leave the source. The exit point is the third link in
the chain. The exit point is where microorganism
leave the source.
• Break the chain:
• •If respiratory – avoid talking, coughing, sneezing
directly over wound or sterile dressing field, cover
nose and mouth, wear masks if suffering respiratory
tract infections
• •If urine, faeces, emesis, blood – wear disposable
gloves when handling body fluids and substances
• •Wear gown and eyewear if there is a risk of
splashing fluids
• •Handle all specimens as infectious
• The micro-organism needs a method of spread or
a way to get from one person to another. This is
the fourth link in the chain. It can include direct
or indirect contact such as hands or shared
equipment. Other methods of spread include air,
blood or the Oro-fecal route.
• Break the chain:
• •Perform hand hygiene
• •Discard any item that has touched the floor
• •Avoid contact of soiled item with the uniform
• •Clean equipment like stethoscope before using
at another patient.
• The micro-organism needs a method of spread or
a way to get from one person to another. This is
the fourth link in the chain. It can include direct
or indirect contact such as hands or shared
equipment. Other methods of spread include air,
blood or the Oro-fecal route.
• Break the chain:
• •Perform hand hygiene
• •Discard any item that has touched the floor
• •Avoid contact of soiled item with the uniform
• •Clean equipment like stethoscope before using
at another patient.
• The final link in the chain is the person at
risk. All patients at risk of infection but some
patient are at greatest risk then others.
Patients with severe or chronic illness,
patients requiring the use of medical
devices; and people who are very old or very
young are most at risk.
• Break the chain:
• Reduce susceptibility to infection:
• •Provide adequate nutrition
• •Ensure adequate rest
• •Provide immunization
• Health care associated infection (HCAI) occurs as
direct result of any contact in a setting where health
care is provided. They can occur in hospital and in
the community and affect both patient and staff.
These infections can complicate patient’s illness,
causes distress and in some cases can even lead to
death.
• The most common types are bloodstream infection
(BSI), pneumonia (e.g, ventilator-associated
pneumonia [VAP]), urinary tract infection (UTI), and
surgical site infection (SSI).
• (Mirza & Steele, 2010)
• The most common site of nosocomial infection in
clients are the urinary tract , lower respiratory ,
surgical wound and blood stream.
• (Black & Hawks, 2009)
 Risk factors that contribute to the
development of nosocomial infection can be
grouped into 3 categories:
 Environment
 Therapeutic Regimen
 Client Resistance
• Hand washing before and after when come in contact
with patient.
• Sterile procedures must be carried out before ward
cleaning and bed making or one hour later.
• Avoid draught from open windows, fan, door etc.
• All equipments must be sterile for sterile procedures.
• Make triangle of sterile field between patient, care
giver and dustbin.
• Check the packages of sterile materials (intactness,
expiration date, chemical indicators)
• Sterile objects become unsterile when touched by
unsterile objects
• Never give back to sterile field.
• Ensure sterility by using transfer forceps or gloves.

• Hold sterile objects above waist level and within sight.

• Avoid spilling of solution over sterile field.

• Apply principle of “clean to dirty” when doing any procedure.

• Use clean / sterile swab once only. Don’t reuse it.

• Keep all unsterile equipments away from the wounds.

• The edges of sterile field are considered unsterile (2.5 cm (1
inch) margin at each edge of an opened drape is considered
unsterile).
 Hand Hygiene is the single most effective
infection control measure
 PPEs are clothing, items used to prevent
cross transmission from patients to staff or
from staff to patients.
 Note: Remove and discard PPE before
leaving the patient’s room or cubicle.
• COVER YOUR COUGH:
• Cover your nose and mouth and cough in to
your sleeves or upper arm
• Cover your nose and mouth with a tissue
and throw it away (DON’T REUSE)

• CLEAN YOUR HAND:

•  Wash hand with soap and water
•  Use alcohol base rub (purell)
• 1. Cleaning: It is a process that removes
contaminants including dust, soil,
microorganisms and organic matter (e.g.
faeces / blood). Cleaning is an essential pre-
requisite to disinfection and sterilization.
• 2.Sterilization: Sterilization achieves the
complete killing or removal of all types of
microorganisms, including bacterial
endospores, which are resistant to most
disinfectants.
• 3.Disinfection: It is a process used to reduce
the number of potentially pathogenic micro-
organisms but may not inactivate some
microbial agents, such as and bacterial spores.
• 3.1. High level Disinfection: a process that will
completely eliminate all microorganisms
except for small numbers of bacterial spores
• 3.2. Low-Level Disinfection: a process that will
inactivate most vegetative bacteria, some
fungi, and some viruses but cannot be relied
on to inactivate resistant microorganisms
 Do not throw dirty linen on floor and don’t
leave over filled hamper bags in patient care
areas.

• Linen soiled with blood or other body fluids

should be disposed (sent to laundry) in
impermeable YELOW bag, securely closed
and transported in a manner that will
prevent leakage regardless of infected
status.
• Place linen in appropriate bags at point of
generation.

• Keep hamper bag within reach during related

procedure. Do not throw dirty linen on floor and
don’t leave over filled hamper bags in patient care
areas.

• Linen soiled with blood or other body fluids should

be disposed (sent to laundry) in impermeable RED
bag, securely closed and transported in a manner
that will prevent leakage regardless of infected
status.
• Protective wear such as gown and gloves should
be worn when handling linen visibly
contaminated with blood and body fluid.

• Ensure that items such as needles, instruments,

incontinence pads, dressing’s accessories etc are
removed from linen so that safety of personnel
collecting ,transporting and handling used linen
is not compromised.

• Do not rinse or sort linen in patient care areas.

Segregate in appropriate area.
 Wash and dry hands after handling
soiled/used linen and before handling
laundered linen.

 Soiled linen should be handled as little as

possible to prevent contamination of person
as well as environment
• Discard sharp in designated puncture-
resistant containers. All needle stick
injuries/exposure to BBF should be reported
immediately to infection control
• •Never recap or bend needles as it can cause
needle stick injury.
• •Replace the sharps disposal container when
two-third (2/3) filled.
• .
• Clinical waste: Any waste that contains body
fluids, tissue or blood is considered as
clinical waste. Example: swabs, soiled
dressing, sharps etc. Clinical waste should be
placed in YELLOW bag dustbin.
• •General waste: Waste that dose not include
body fluids. Example: office paper, cups etc.
Non Clinical waste should be placed in White
bag dustbin
• It refers to technique used to prevent or to
limit the
• spread of infection whether to protect a high
risk
• person from exposure to pathogens or
prevent the
• transmission of pathogens from an infected
person
• to others.
• (Black & Hawks, 2009)
• 6
Air Born Isolation:
• Air born precautions are designed to reduce the
transmission of pathogen on air born droplet.
• (Black & Hawks, 2009)
• Airborne transmission occurs when droplet nuclei
(evaporated droplets) <5 micron in size are
disseminated in the air. These droplet nuclei can
remain suspended in the air for some time.
• *Negative isolation room accommodation
required*
• For example: Pulmonary tuberculosis, Measles
and Chicken Pox.
 Respiratory personal protective Equipment
(N95 mask) should be worn by:
 •All persons including HCWs and visitors,
prior to entering the patient’s room.
 •Person involved in transfer of patients
placed in airborne precautions.
 •The patient does not need N95 mask while
in the room
• Droplet Isolation:
• Droplet Precautions are for infections
transmitted by large particle droplets such as
those generated during coughing, sneezing,
speaking or suctioning.
• (Black & Hawks, 2009)
• Droplets transmission occurs through mucous
membrane (nose and mouth or conjunctivae)
of a susceptible person and large particle
droplet (>5 microns) released from patient.
• For example: Mumps, whooping cough, and
diphtheria, Meningitis etc.
• Contact precaution are designed to reduce
direct an indirect contact transmission of
microorganism.
• (Black & Hawks, 2009)
• For Example: MRSA, VRE, ESBL (Klebsiella,
Enterobacter, Ecoli), Multi-Drug Resistant
(Acinetobactor, Klebsiella, Ecoli,
Pseudomonas) organisms, which can
transmitted to others by direct contact with
the patient or indirect contact with
environmental surfaces or patient
equipment.
• YELLOW Plastic Bags

• Hamper Bags

• Clean gowns for care givers

• Disposable plastic apron

• Patient's LINEN if required

 Hand washing
 Standard precautions
 Linen Management
 Infectious disease notification
• Isolation:
• Patient must be kept in a single room.

• Hand Washing:
• Thorough and effective hand washing and using
an antiseptic agent is considered to be the most
important activity in prevention of transmission.

• Protective Clothing:
• Non-sterile latex or clean plastic gloves must be
worn prior to any activity that may lead to close
contact with the patient or their
• Plastic apron are usually adequate but in
case when extensive body contact is required
e.g. during certain lifting procedure, gowns
are preferable to protect the shoulder and
back from contamination.
• Face mask should be worn only for
procedures i.e. suctioning, chest
physiotherapy ( if its in trachea).
• Use disposable equipment to minimize the
sharing
• LABELING:
• Yellow Infection Control sticker should be pasted
prominently on patient's red folder

• TRANSFERRING PATIENT:
• Transfer of patient to other wards/departments
should be minimal

• TERMINAL CLEANING:
• Rooms that have been used to isolate patient will
require terminal cleaning and disinfection after
discharge including curtains and cushion cleaning
• ISOLATION:
• Placement of patients in single room,
cohorted or separated from others by at
least 1 meter.
• Limitation of patient outside their room.
• Limit HCWs & visitors in patient room. HAND
WASHING:
• Thorough and effective hand washing and
using an antiseptic agent is considered to be
the most important activity in prevention of
transmission
PROTECTIVE CLOTHING:
• Use of a N95 mask when within 1 meter / 3
feet of the patient.
• All those who are immune (e.g. had disease
or vaccination) do not require mask during
contact.

LINEN:
• All soiled linen must be discarded in red bag
along with hamper bag and dry linen must be
discarded in hamper bag.
• Alyiffe, G. (2006) Control of Hospital Infection: A Practical Hand book. (4th edition)
London: Arnold.
• Black, J. M., & Hawks, J. H. (2009). Medical Surgical Nursing;Clinical Management
for Positive Outcomes. (8TH Edition).New York: Saunders Elsevier.
• Didier, P. (2008). Hand Hygiene: It's All About When and How. Infection Control
and Hospital Epidemiology (29), 957-958.
• http intranet/Control. Ht
• ANTISEPSIS, ASEPSIS, AND UNDERSTANDING THE NATURE OF
•  INFECTION From: Townsend: Sabiston Textbook of Surgery, 18th ed.; CHAPTER 1
• Falagas, M. E., & Karageorgopoulos, D. E. (2008). Pandrug resistance (PDR),
extensive drug resistance (XDR), and multidrug resistance (MDR) among Gram-
negative bacilli: need for international harmonization in terminology.Clinical
infectious diseases, 46(7), 1121-1122.
• May, D. (2006).Infection control. Nursing Standard ,14 (28), 51 – 57.
• Mirza, A., & Steele, R. W. (2010). Hospital-Acquired Infections.
• Potter, P. A., & Perry, A. G. (2007). Basic Nursing: Essentials for practice. (6th
ed.). Mosby, Elsevier.
• Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H.(2008). Text Book of
Medical Surgical Nursing. (13th Edition).New York: Brunner & Suddarth's.

• Tavolacci, M. P., Lander, J., Bailly, L., Merle, V., Pitrou, I., Czernichow, P. (2008).
Presentation of Nosocomial Infection and Standard Precautions: Knowledge and
Source of Information Among Healthcare Students.
•  Infection Control and Hospital Epidemiology (29) 642-646.

• May, D. (2006).Infection control. Nursing Standard ,14 (28), 51 – 57.

• Potter, P. A., & Perry, A. G. (2007). Basic Nursing: Essentials for practice. (6th
ed.). Mosby, Elsevier.

•  Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H.(2008). Text Book of
Medical Surgical Nursing. (13th Edition).New York: Brunner & Suddarth's.
• Tavolacci, M. P., Lander, J., Bailly, L., Merle, V., Pitrou, I., Czernichow, P. (2008).
Presentation of Nosocomial Infection and Standard Precautions: Knowledge and
Source of Information Among Healthcare Students.
•  Infection Control and Hospital Epidemiology (29) 642-646.