Basilan State College

Isabela City College of Health Sciences Nursing Department

ASEPSIS Medical Handwashing

Nurses are responsible for providing the client with a safe environment, which includes preventing the transmission of nosocomial infections. Asepsis is the absence of microorganisms. Providing nursing care using aseptic technique decreases the risk and spread of nosocomial infections. Aseptic technique is the infection control practice used to prevent the transmission of pathogens. Two types of asepsis are medical and surgical.

Medical asepsis Medical asepsis uses practices to reduce the number, growth, and spread of microorganisms. Medical asepsis is also referred to as clean technique objects are generally referred to as clean or dirty in medical asepsis. Clean objects are considered to have the presence of some microorganisms that are usually not pathogenic. Dirty (soiled) objects are considered to have a high number of microorganisms, with some that are potentially pathogenic. Common medical aseptic measures used for clean or dirty objects are handwashing, gloves, changing linens daily, and cleaning floors and hospital furniture daily.

Handwashing Handwashing is the rubbing together of all surfaces and crevices of the hands using a soap or chemical and water. Handwashing is a component of all types of isolation precautions and is the most basic and effective infection control measure that prevents and controls the transmission of infectious agents. The CDC (2000) recommends vigorous scrubbing with warm, soapy water for at least 15 seconds to prevent the transfer of germs. The three essential elements of handwashing are soap or chemical, water, and friction. Soaps that contain antimicrobial agents are frequently used in high-risk areas such as emergency departments and nurseries. Friction is the most important element of the three because it physically removes soil and transient flora. Handwashing should be performed after arriving at work, before leaving work, between client contacts, after removing gloves, when hands are visibly soiled, before eating, after excretion of body waste (urination and defecation), after contact with body fluids, before and after performing invasive procedures, and after handling contaminated equipment. The exact

duration of time required for handwashing is not known. A washing time of 10 to 15 seconds is recommended to remove transient flora from the hands. High-risk areas, such as nurseries, usually require about a 2-minute handwash. Soiled hands usually require more time (CDC, 2000). Preparation: Action 1. Determine: Presence of factors increasing susceptibility to infection and possibility of undiagnosed infection. Whether the client uses immunosuppressive medications. Recent diagnostic procedures or treatments that penetrated the skin or a body cavity. Current nutritional status. Signs and symptoms indicating the presence of an infection: Localized infection swelling; redness; pain or tenderness with palpation or movement; palpable heat at site; loss of function of affected body part; or presence of exudate. Systemic infection fever; increased pulse and respiratory rates; lack of energy, anorexia; or enlarged lymph nodes. 2. Assemble equipment: Soap or liquid soap Warm, running water Disposable or sanitized towels Paper towels Assembling equipment at easy reach saves the nurses time and effort. Rationale

3. Assess the hands. Nails should be kept short. Remove all jewelry. Check the hands for breaks in the skin, such as hangnails or cuts. Long nails and jewelry harbor microorganisms which can lead to the spread of infection to the clients.

Procedure: 1. Remove jewelry. Wristwatch may be pushed Provides access to skin surfaces for up above the wrist (midforearm). Push cleaning. Facilitates cleaning of fingers, sleeves of uniform or shirt up above the hands, and forearms.

wrist at midforearm level. 2. Assess hands for hangnails, cuts or breaks Intact skin acts as barrier to in the skin, and areas that are heavily soiled. microorganisms. Breaks in skin integrity facilitate development of infection and should receive extra attention during cleaning. 3. Turn on the water. Adjust the flow and Running water removes microorganisms. temperature. Temperature of the water Warm water removes less of the natural should be warm. skin oils. 4. Wet hands and lower forearms thoroughly by holding under running water. Keep hands and forearms in the down position with elbows straight. Avoid splashing water and touching the sides of the sink. Water should flow from the least contaminated to the most contaminated areas of the skin. Hands are considered more contaminated than arms. Splashing of water facilitates transfer of microorganisms. Touching of any surface during cleaning contaminates the skin.

5. Apply about 5 ml (1 teaspoon) of liquid Lather facilitates removal of soap. Lather thoroughly. microorganisms. Liquid soap harbors fewer bacteria than bar soap. 6. Thoroughly rub hands together for about Friction mechanically removes 10 to 15 seconds. Interlace fingers and microorganisms from the skin surface. thumbs and move back and forth to wash Friction loosens dirt from soiled areas. between digits. Rub palms and back of hands with circular motion. Special attention should be provided to areas such as the knuckles and fingernails, which are known to harbor organisms. 7. Rinse with hands in the down position, Flow of water rinses away dirt and elbows straight. Rinse in the direction of microorganisms. forearm to wrist to fingers. 8. Blot hands and forearms to dry thoroughly. Dry in the direction of fingers to wrist and forearms. Discard the paper towels in the proper receptacle. Blotting reduces chapping of skin. Drying from cleanest (hand) to least clean area (forearms) prevents transfer of microorganisms to cleanest area.

9. Turn off the water faucet with a clean, dry Prevents contamination of clean hands by paper towel. a less clean faucet.

Basilan State College

Isabela City College of Health Sciences Nursing Department

Evaluation Criteria for Medical Handwashing

Name: ______________________________________ Year & Section: _______________________________ Procedure 1. Remove all jewelry. Secured the watch from the area to be washed. 2. Position self so as not to touch the sink. Flex knee slightly if the sink is low. 3. Regulate the water to wet hands and wrists thoroughly. 4. Apply appropriate amount of soap to hands. 5. Rinse off bar soap before returning it to the soap case. 6. Held hands always lower than the elbow during the wash. 7. Use firm rubbing circular movements to wash the palms, back of hands and wrists of each hand. 8. Interlace the fingers and the thumbs and move hands back and forth. 9. Wash hands for the recommended time. 10. Rinse hands thoroughly holding them lower than the elbow. 11. Dry the hands from the arms to the fingers thoroughly. 12. Use paper towels to turn off the hand operated control. 13. Discard used paper towels in appropriate containers. 14. Kept uniform dry throughout the technique. 61 64 = 1.0 57 60 = 1.25 53 56 = 1.5 49 52 = 1.75 45 48 = 2.0 41 44 = 2.25 37 40 = 2.5 33 36 = 2.75 32 = 3.0 1 2 3 4 Date: ________________

Equivalent Grade: ____________ Students Signature: __________ Instructors Signature: ________

Basilan State College

College of Health Sciences Nursing Department
Personal Protective Equipment DONNING AND REMOVING STERILE GLOVES

Gloves are worn for three reasons: First, they protect the nurse when the nurse is likely to handle any body substances, for example, blood, urine, feces, sputum, mucous membranes, and nonintact skin. Second, gloves reduce the likelihood of nurses transmitting their own endogenous microorganisms to individuals receiving care. Nurses who have open sores or cuts on the hand must wear gloves for protection. Third, gloves reduce the chance that the nurses hands will transmit microorganism from one client or fomite to another client. In all situations, gloves are changed between client contacts. The hands are washed each time gloves are removed for two primary reasons: (a) the gloves may have imperfections or be damaged during wearing so that they could allow microorganism entry and (b) the hands may become contaminated during the glove removal. Many of the gloves used in infection control are made of latex rubber, as are various items used in healthcare (catheters, blood pressure cuffs, rubber sheets, intravenous tubing, stockings and binders, adhesive bandages, and dental dams). Because of the frequent use of gloves, clients with chronic illnesses and healthcare workers have increasingly reported allergic reactions to latex. Latex gloves lubricated by powder or cornstarch are particularly allergenic because the latex allergen adhere to the powder, which is aerosolized during glove use and inhaled by the user. Latex gloves that are labeled hypoallergenic still contain measurable latex and should not be used by or on persons with known latex sensitivity. Recent studies show some level of latex allergy in 6 to 17% of health care personnel (Corbin, 2002). The people at the greatest risk for developing latex allergies are those with other allergic conditions and those who have had frequent or long-term exposure to latex. Latex allergies can be either local or systemic and may take the form of dermatitis, uticaria (hives), asthma, or anaphylaxis. Clients and healthcare workers should be assessed for possible allergies through a thorough history taking. Ask clients if they have had any reactions to items such as balloons, condoms, or dishwashing or utility gloves. Strategies to avoid sensitization or exposure or latex include use of nonlatex products, nonlatex barriers between latex products and the skin, and gloves that are unpowdered or washed before used. People with significant allergies should have no contact with latex products.

Basilan State College

College of Health Sciences Nursing Department
Name: __________________________________________________ Year and Course: _______________ Date: _________________

EVALUATION CRITERIA FOR DONNING STERILE GLOVES (OPEN METHOD)

Purpose: 1. To render Nurses hands sterile. 2. To complete sterile dress. 3. To allow the wearer to handle sterile equipment. Preparation: 1. Clean table or surface to hold open gloves package. 2. A package of sterile gloves in correct size.

Procedure 1. Place package of gloves on a clean dry surface. Rationale: Any moisture on the surface can contaminate the gloves. 2. Some gloves are packed in an inner as well as outer package. Open the outer package without contaminating the gloves or the inner package. Rationale: The inner surface which is next to the sterile gloves will remain sterile. 3. Open the inner package, making sure that the fingers do not touch the inner surface. (Some manufacturers specify a number of sequences for opening the flaps and provide tabs to grasp when opening the flaps. If no tabs are provided, pluck the flap so that the finger does not touch the inner surface.) Rationale: The inner surfaces, which are next to the sterile gloves, will remain sterile. 4. If the gloves are packaged so that it will lie side by side, grasp the gloves for your dominant hand by its cuff (on the palmar side) with the thumb and first finger of the non-dominant hand. Touch only the inside of the cuff to the top glove using the opposite hand. Rationale: The hands are not sterile. By touching only the inside of the glove, the nurse avoids contaminating the outside. 5. Insert the dominant hand into the glove and pull the glove on. Keep the thumb of the inserted hand against the palm of the hand during the insertion, leave the cuff turn down. Rationale: If the thumb is kept against the palm, it is less likely to contaminate the outside of the glove.

6. Pick up the other glove with the gloved hand and inserting the finger under the cuff and holding the gloved thumb outermost to the gloved hand. Rationale: This helps prevent accidental contamination of the glove by bare hands. 7. Pull on the second glove carefully. Hold thumb of the glove first hand outermost. Rationale: In this position, the thumb is less likely to touch the arm and become contaminated. 8. Adjust each glove so that it fits smoothly and carefully pull the cuff by sliding the finger under cuff. 9. Removing used gloves: Pluck either glove near cuff and pull glove over the hand so that the glove inverts itself with the contaminated surface. Rationale: Sterile gloves are considered contaminated once they have been used. 10. Slide two fingers of the bare hands against wrist under the cuff of the other glove and slide the second glove off, inverting it over itself and the first glove. Discard the gloves in the designed container.

40 = 1.0 39 37 = 1.25 36 34 = 1.5 33 31 = 1.75 30 28 = 2.0 27 25 = 2.25 24 22 = 2.5 21 20 = 2.75 19 = 3.0

Equivalent Grade: ______________ Students Signature: ____________ Instructors Signature: __________