Asepsis:

Learning Outcomes:
Explain the concepts of medical and surgical
asespsis
Identify signs of localized and systemic infections.
Identify the risks for nosocomial infections
Identify factors influencing a microorganisms capability to produce an infectious process
Identify anatomic and physiologic barriers that
defend the body against microorganisms
differentiate active from passive immunity

Infection results when the

body is invaded by pathogens.
The cost of infections that
are associated with the
delivery of health care
services (nosocomial infections), to the client, the facility and the funding sources
is great.
Nosocomial infections
extend hospitalization time,
increase clients time away
from work, cause disability
and discomfort, and even
result in loss of life.
Client safety in the health
care environment requires
the reduction of microorganism transmission so
infection control practices
are directed at controlling
or eliminating
sources of infection. Health
care workers are responsible for protecting clients
and themselves using the
aseptic technique.

A preventive nursing measure

Identify interventions to reduce risks for infections

identify measures that break each link in the
chain of infection
compare and cotrast different isolation precaution systems.
correctly implementing aseptic processes
describing the steps to take in the event of a
bloodborne pathogen exposure

Microorganisms are defined as tiny, microscopic entities naturally present in the environment capable of carrying on living processes.
Two Types of Microorganisms
1. the non-pathogens that do not cause diseases
2. the pathogens that cause diseases.
Resident Flora: the collective vegetation of microorganism in a given part of the body,
yet can produce infection in another part.
Infection: an invasion of the body tissue by microorganisms and their growth there.

Infectious agent: A microorganism that produces an infection

Asymptomatic Infection: an infection that produces no clinical evidence of a
disease.
Disease: A detectable alteration in normal tissue function.
Virulence: a microorganisms ability to produce disease.
Opportunistic Pathogen: A pathogen that only produces disease on immunosuppressed
or suscelptible individuals.
Asepsis: the freedom from disease-causing microorganisms.
Aseptic Technique: strategies to decrease the possibility of transferring microorganisms
from one place to another.

Two Types of Asepsis

1. Medical Asepsis: includes all practices intended to confine a specific microorganism
to a specific area, llimiting the number, growth and transmission of microorganisms.
2. Surgical Asepsis: Also known as Sterile Technique, refers to those practices that keep
an area or object free of all microorganisms; It includes practices that destroy all microorganisms and spores.

In medical asepsis, objects are

refered to as clean, which means
the absence of almost all microorganisms, or dirty which means
likely to have microorganisms,
some of which may be capable
of causing infections.
Sterile technique is used for all
procedures involving the sterile
areas of the body.

Types of Microorganisms Causing Infections

A PARASITE live in other microorganisms. they nclude protozoa.

Bacteria: the most common infection- causing microorganisms.

There are several hundreds of species that can cause disease in humans and can
live and be transported through air, food, water, soil, body tissues and fluids and inanimate objects.
Viruses: consists primarily of nucleic acid and therefore must enter living cells in order to
reproduce.
Fungi: a member of a large group of eukaryotic organisms that includes microorganisms
such as yeasts and molds, as well as the more familiar mushrooms

Types of Infections
Colonization: the process by which strains of microorganisms become resident flora.
Local Infection: an infection that islimmited to the specific part of the body where the microorganisms remain.
Systemic Infection: if the microorganisms spread ad damage different parts of the body.
Bacteremia: When a culure of a persons blood reveals microorganisms.
Septicemia: When bacteremia results in systemic infection.
Acute Infections: infections that generally appear suddenly or last a short time.
Chronic Infections: occurs slowly, over a very long period and may last for months or years.

Prepared by: Warren Jae M. Sandoval

The Chain of Infection

An infection, which is a disease state resulting from the presence of pathogens in or on
the body, occurs as a result of a cyclical process that involves the following elements:

1 ) An infectious I etiologic agent or pathogen

2 ) A reservoir or source for the growth of a pathogen

3 ) A portal of exit or method of escape of the pathogen from the reservoir

4 ) A mode of transmission

5 ) A portal of entry to the host

6 ) A susceptible host
Infectious Agent (Etiologic Agent or Pathogen )
Pathogenic organisms include bacteria, viruses, fungi
and parasites. The extent to which any microorganism is
capable of producing an infectious process depends on
the following:

a ) number of organisms

b ) virulence or ability to produce disease

c ) ability to enter and survive in the host

d) susceptibility ofhost
Reservoir
Pathogens have many sources or reservoirs for growth.
Common sources are other humans, the clients own
microorganisms, plants, animals, or the general environment (air, water, food, soil).
A carrier 1s a person or animal reservoir of specific infectious agent that does not usually manifest any clinical
signs of disease.
Portal of Exit
Before an infection can establish itself in a host, the pathogens must leave the reservoir. If
the reservoir is a human being, the pathogens can have the following exits:

Respiratory tract : droplets, sputum

Gastrointestinal tract : saliva, vomitus, feces, drainage tubes

Urinary tract : urine, urethral catheters

Reproductive tract : semen, vaginal discharges

Blood : open wound, needle puncture site
Mode of Transmission
Pathogens are carried or transmitted from the reservoir to the host through the following
mechanisms:

1. Direct Transmission. Involves immediate and direct transfer of pathogens from
person to person through touching, biting, kissing, or sexual intercourse.

2. Indirect Transmission. It may be either vehicle-borne or vector-borne.

a ) Vehicle-borne transmission. A vehicle is any substance that serves as an

immediate means to transport and introduce an infectious agent into a

susceptible host through a suitable portal of entry.
Examples include

fomites, (inanimate materials and objects), like handkerchiefs, toys, soiled

clothes, surgical instruments or dressings); water, food, blood, serum and

plasma.

b ) Vector-borne transmission. A vector is an animal or a flying or crawling

insect that serves as an immediate means of transporting the infectious
agent. Examples : rats, snails, mosquitoes.

3. Airborne Transmission. It may involve droplets or dusts. Droplet nuclei, the residue
of evaporated droplets emitted by an infected host can remain in the air for long periods.
Likewise, dust particles containing the infectious agent can be transmitted by air currents
to a suitable portal of entry, usually the respiratory tract, of another person
Portal of Entry
Pathogens can enter the body through the same routes they use for exiting. The portals of entry includes body
orifices like the mouth, nose, ears, eyes, vagina, rectum or urethra. Breaks in the skin or mucous membranes from
wounds or abrasions increase chances for pathogens to enter the host.
Susceptible Host
A susceptible host is any person who is at risk for infection. A compromised host is a person at increased risk ,
an individual who for one or more reasons is more likely than others to acquire an infection. Impairment of the
bodys natural defenses and a number of other factors can affect susceptibility to infection.
Examples include age, (the very young and the very old), clients receiving immune suppression treatment for
cancer, chronic illness, or following a successful organ transplant; and those with immune deficiency conditions.

Stages of the Infectious Process

Incubation Period. Interval between entrance of pathogen into body and appearance
offirst symptoms. (e.g., chickenpox, 2-3 weeks; common colds, 1-2 days; influenza, 1-3
days; mumps, 18 days)
Prodromal Period. Interval from onset of nonspecific signs and symptoms( malaise, lowgrade fever, fatigue) to more specific symptoms. It is during this stage that the pathogens
grow and multiply so the person is more capable of spreading the disease to others.
Illness Period. Interval when the client manifests signs and symptoms specific to type of
infection (e.g., common cold manifested by sore throat, sinus congestion, rhinitis; mumps
manifested by earache, high fever, parotid and salivary gland swelling)
Convalescence Period. Interval when acute symptoms of infection disappear. The length
of recovery depends on the severity of infection and the clients general state of health.
Asepsis is the absence
of all disease-producing
microorg isms. Aseptic
technique is the effort to
keep a client free from
hospital
microorganisms.
The two types of asepsis are
medical and surgical
asepsis.

Breaking The Chain of Infection

Medical Asepsis: or clean technique includes practices or procedures that reduee the
number and transmission of pathogens. Medical asepsis destroys organisms after they
leave the body. Medical asepsis protects the health care giver.
Surgical asepsis or sterile technique includes practices or procedures that destroy all
microorganisms and their spores.

Sterile technique is practiced in the operating room and treatment areas. In surgical asepsis, an area or object is considered contaminated if touched by any object that
is not sterile.

Surgical asepsis destroys organisms before they enter the body. Surgical asepsis
protects the client.

Medical Aseptic Practices

1. Hand washing - the single most important infection control practice.

2. Cleaning - the physical removal of visible dirt by washing using soap and water.
3. Disinfection -the use of chemical preparations to reduce the number of pathogens on
inanimate objects but not necessarily destroying the spores.
4. Use of barriers or techniques that prevent the transfer of pathogens from one person to
another. The most commonly used barriers are gloves, masks, caps, gowns, shoe coverings, goggles or face shields, waterproof disposable bags for linens and trash, labeling and
bagging of contaminated equipment and specimen, private rooms and the control of
airflow into the sterile areas and out of contaminated areas.
5. Proper waste segregation and disposal
6. Isolation systems

Surgical Aseptic Practice

1. Sterilization
The process that destroys all microorganisms including spores and viruses using moist heat,
gas, radiation, chemicals and boiling water.
2. Donning and removing cap and mask.
For sterile surgical procedures in the operating room or delivery room, a cloth or paper cap
is worn over the head covering all the hair. A mask is also worn fitted snugly over the nose
and mouth to prevent droplet nuclei.
After a surgical procedure, remove gloves before removing mask and cap to prevent
contaminating the hair, neck and face. Untie the mask, hold it by the ties and discard it
with the cap.
3. Donning sterile gloves
There are two methods of donning sterile gloves : open and closed. Open gloving is usually
used when changing dressings and inserting urinary catheters. The closed method is
practiced in the operating room and special treatment areas.

Standard Precautions for Infection Control

Standard Precautions are to be used for all clients receiving care in hospitals without regard to their diagnosis
or presumed infection status. Standard Precautions apply to blood; all body fluids, secretions and excretions
except sweat, regardless of the presence of visible blood; nonintact skin; and mucous membranes.
Wash Hands (use plain soap)
Wash after touching blood, body fluids, secretions, excretions and contaminated items.
Wash immediately after gloves are removed and between patient contacts.
Avoid transfer of microorganisms to other patients or environments.
Wear Gloves
Wear when touching blood, body fluids, secretions, excretions and contaminated
items.
Put on clean gloves just before touching mucous membranes and non-intact skin.
Change gloves between tasks and procedures on the same patient after contact with
material that may contain high concentrations of microorganisms. Remove gloves
promptly after use, before touching non-contaminated items and environmental surfaces, and before going to another patient, and wash hands immediately to avoid
transfer of microorganisms to other patients or environments.

Wear Mask and Eye Protection or Face Shield

Protect mucous membranes of the eyes, nose and mouth during procedures and
patient-care activities that are likely to generate splashes or sprays of blood, body fluids,
secretions or excretions.
Wear Gown
Protect skin and prevent soiling of clothing during procedures that are likely to generate splashes or sprays of blood, body fluids, secretions or excretions. Remove a soiled
gown as promptly as possible and wash hands to avoid transfer of microorganisms to
other patients or environments.
Patient-Care Equipment
Handle used patient-care equipment soiled with blood, body fluids, secretions or excretions in a manner that prevents skin and mucous membrane exposure, contamination of clothing, and transfer of microorganisms to other patients and environments.
Ensure that reusable equipment is not used for the care of another patient until it has
been appropriately cleaned and reprocessed and single use items are properly discarded.
Environmental Control
Follow hospital procedures for routine care, cleaning and disinfection of environmental
surfaces, beds, bedrails, bedside equipment and other frequently touched surfaces.
Linen
Handle, transport, and process used linen soiled with blood, body fluids, secretions
or excretions in a manner that prevents exposures and contamination of clothing and
avoids transfer of microorganisms to other patients and environments.
Occupational Health and Blood-borne Pathogens
Prevent injuries when using needles, scalpels and other sharp instruments or devices;
when handling sharp instruments after procedures; when cleaning used instruments;
and when disposing ofused needles.
Do not remove used needles from disposable syringes by hand; and do not bend,
break or otherwise manipulate used needles by hand.
Place used disposable syringes and needles, scalpel blades, and other sharp items in
puncture- resistant sharps containers located as close as practical to the area in which
the items were used, and place reusable syringes and needles in a puncture resistantcontainer for transfer to the reprocessing area.
Use resuscitation devices as an alternative to mouth-to-mouth resuscitation.

Never recap used

needles using both hands
or any other technique
that involves directing
the point of a needle
toward any part of the
body; rather, use either
a one-handed scoop
technique or a
mechanical device
designed for holding the
needle sheath

Patient Placement
Use a private room for a patient who contaminates the environment or who does not
(or can not be expected to) assist in maintaining appropriate hygiene or environmental control.
Consult Infection Control if a private room is not available.

Principles of Basic Infection Control

In all aspects of patient care, the following principles should be observed to minimize the spread of microorganisms.

1. Microorganisms move through space on air currents.

Because of this movement, avoid shaking or tossing linens.
2. Microorganisms are transferred from one surface to another whenever objects touch.
When a clean item touches a less clean item, it becomes dirty, because microorganisms are transferred to it.

Therefore, keep your hands away from your own hair and face, keep linens away from your uniform,
and always keep clean items separate from dirty ones. If you drop
anything on the floor, consider it dirty.
3. Microorganisms are transferred by gravity when one item is held above another.

Avoid passing dirty items over clean items or areas because it is possible for microorganisms to drop off onto a clean item or
area.

4. Microorganisms are released into the air on droplet nuclei whenever a person breathes
or speaks. Coughing or sneezing dramatically increases the number of microorganisms
released from the mouth and nose.

Avoid having a patient breathe directly into your face, and avoid breathing directly into a clients face.
5. Microorganisms move slowly on dry surfaces but very quickly through moisture.

For this reason, use a dry paper towel when you turn off faucets, and dry a bath basin before you
return it to a bedside stand for storage.
6. Proper hand washing removes many of the microorganisms that would be transferred
by the hands from one item to another.

Wash your hands not only when they are obviously soiled, but whenever you move from one client to
another or from patient contact to contact with the general environment or vice versa.
7. Blood-borne infections may be spread to another person by contact with items contaminated with blood and body substances that contain the blood-borne organism
through open wounds and vsores, nonintact mucous membranes, and penetrating
injuries.

Health care workers can protect themselves from these blood-borne infections by using precautions that
prevent contact with blood and body fluids that transmit
blood-borne pathogens.

Procedure Checklist: Handwashing

Purposes :
To reduce the number of microorganisms on the
hands.
To reduce the risk of transmission of microorganisms
to clients.
To reduce the risk of cross-contamination among
clients.
To reduce the risk of transmission of infectious
organisms to oneself.

Equipment:
Liquid I bar soap
Cloth or paper towels
Water

Action and Rationale

1. Assess condition of hands for hangnails, cuts or
breaks in the skin, as well as extent and areas of
contamination.
2. Remove jewelry. Roll sleeves of uniform.

3. Stand in front of the sink. Keep hands and uniform

away from the sink surface.

Intact skin acts as a barrier to microorganisms.

Breaks in skin integrity facilitate development of
infection and should receive extra
attention during cleaning.
Microorganisms can lodge in the settings
of jewelry and under rings.
Provides access to skin surfaces.
Facilitates cleaning of hands and forearms.
The sink is a contaminated area.
Reaching over the sink increases risk
of touching the edge which is contaminated.

4. Consider type of faucet. Turn on the water.

Adjust the flow and temperature.
Water temperature should be preferably warm.

Running water removes microorganisms.

Warm water is more comfortable and is less likely to open
pores and remove oils from the skin.

5. Wet hands and wrists thoroughly

under running water.
Keep hands and forearms lower than elbows.
Avoid splashing water and touching
the sides of the sink.

Water should flow from the least

to the most contaminated area.
The hands are generally considered more
contaminated than the lower arms.
Splashing of water facilitates transfer of microorganisms.
Touching of any surface during cleaning contaminates the skin.

6. Apply about 5 ml. (1 teaspoon) ofliquid soap.

Lather thoroughly.
If bar soap is used,
rub it firmly between the hands.
Rinse soap and drop it into the soap dish.

Liquid soap harbors less bacteria than bar soap.

Lather facilitates removal of microorganisms.
Rinsing the bar of soap prevents the spread
of microorganism to the next user.

7. Wash hands using plenty of lather and friction for

about 10-15 seconds.
Use firm, rubbing and circular movements to wash the
palm, back, wrist and fingers of each hand.
Interlace the fingers and thumbs, and
move the hands back and forth.
Rub the fingertips against the palm
of the opposite hand.
If nails are dirty, clean these using a flat toothpick or
use the fingernails of the opposite hand.

Friction and circular action mechanically loosen and remove dirt

and microorganisms.
Interlacing the fingers and thumbs cleans
the interdigital spaces.
The nails and fingertips are commonly missed during hand
washing.

8. Rinse hands and wrists thoroughly keeping hands

lower than the elbows.

Rinsing washes away dirt and microorganisms.

Gravity allows water to drain from an area
of lesser contamination to an area of greater contaminated.

9. With a towel, blot hands and forearms

to dry thoroughly.
Dry in the direction of fingers to wrist and forearm.
Discard paper towels in the proper receptacle.
10. Turn off the faucet with a clean dry paper towel.

Blotting reduces chapping of skin.

Drying from cleanest (hand) to least clean area (forearm)
prevents transfer of microorganisms to cleanest area.

Prevents contamination of clean hands by a less clean faucet.

Three elements of hand wasfiing: water, soap ana friction.

Soaps and detergents help remove dirt because these lower surface tension
and act as emulsifying agents.
Wash hands for 10 - 30 seconds for minimal contamination 1 - 2 minutes for
moderate contamination and 3 - 4 minutes for heavy contamination.
Repeat washing procedure as necessary. When hands are heavily
contaminated; a second and even a third washing is necessary to remove all
dirt and organisms.
Wash at least 1 inch above area of contamination.
Clean under the nails using a flat toothpick

Principles of Surgical Asepsis

1. A sterile object remains sterile only when touched by another sterile object.

a. Sterile touching sterile remains sterile.

b. Sterile touching clean becomes contaminated.

c. Sterile touching contaminated becomes contaminated.

d. Sterile touching questionable is contaminated.
2. Only sterile objects may be placed on a sterile field. All items are properly
sterilized before use.
3. A sterile object or field that is out of vision and an object held below the waist
level are considered unsterile. Do not turn your back on a sterile tray or leave it
unattended.
4. A sterile object or field can become unsterile by prolonged exposure to airborne
microorganisms.
5. Moisture that passes through a sterile object draws microorganisms from unsterile
surfaces above or below to the sterile surface by capillary action.
6. Fluids flow in the direction of gravity. A sterile object becomes contaminated if
gravity causes a contaminated liquid to flow over the objects surface.
7. The edges of a sterile field are considered unsterile. Place all sterile objects more
than 2.5 em. inside the edges of the sterile field.
8. The skin cannot be sterilized and so is unsterile.
9. All items brought in contact with broken skin, used to penetrate the skin to inject
substances into the body, or used to enter normally sterile body cavities should
be sterile (e.g.; dressings to cover wounds and incisions, needles for injection and
urinary catheters).
10. Avoid talking, coughing, sneezing, or reaching over a sterile field or object to
prevent contamination by droplets from the nose and mouth or by particles dropping from the workers arms.
11. Conscientiousness, alertness and honesty are essential qualities in maintaining
surgical asepsis.

Surgical Aseptic Practices

1. Donning and removing cap and mask.
For sterile surgical procedures in the operating room or delivery room, a cloth or
paper cap is worn over the head covering all the hair.
A mask is also worn fitted snugly over the nose and mouth to prevent droplet
nuclei.
After a surgical procedure, remove gloves before removing mask and cap to
prevent contaminating the hair, neck and face.
Untie the mask, hold it by the ties and discard it with the cap.

2. Donning sterile gloves

There are two methods of donning sterile gloves:

open and closed.
Open gloving is usually used when changing dressings and inserting urinary
catheters.
The closed method is practiced in the operating room and special
treatment areas.

Procedure Checklist: Donning and Removing Gloves

Purposes:
To protect the hands when the nurse is likely to handle
any body substances like, blood, urine, feces, sputum,
mucous membranes, and nonintact skin.
To reduce the likelihood of nurses transmitting their
own endogenous microorganisms to clients receiving
care.
To reduce the chance that the nurses hands will
transmit microorganisms from one client or a fomite to
another client.

Equipment:
Package of proper-sized sterile
gloves.

Action and Rationale

1. Wash your hands.

2. Place sterile glove package on clean, dry surface
at or above you waist.
3.Open the outside wrapper by carefully peeling
the top layer back.
Remove inner package handling only the outside of it.
4. Place the inner package on the work surface
with the cuff end closest to the body.
5. Carefully open the inner package.
Fold open the top flap,
then the bottom and sides.
Take care not to touch the inner surface
of the package or the gloves.

6. With the thumb and first two fingers

of the nondominant hand, grasp the
folded cuff of the glove for dominant hand,
touching only the exposed inside of the glove.
7. Keeping the hands above the waistline, lift
and hold the glove up and off
the inner package with fingers down.
Be careful it does not touch any unsterile object.

Deters the spread of microorganisms.

Moisture could contaminate the sterile gloves.
Any sterile object held below the waist
is considered contaminated.
This maintains sterility of gloves in inner packet.

Allows for ease of glove application.

The inner surface of the package is considered sterile.
The 1 inch border of the inner package is considered contaminated.
Liquid soap harbors less bacteria than bar soap.
Lather facilitates removal of microorganisms.
Rinsing the bar of soap prevents the spread of microorganism
to the next user.
Unsterile hand touches only inside of glove. Outside remains
sterile.

Glove is contaminated if it touches unsterile object.

8.Carefully insert dominant hand palm up

into glove and pull glove on.
Leave the cuff folded until the other hand is gloved.

Attempting to turn upward with unsterile hand may result in

contamination of sterile glove.

9. Hold the thumb of the gloved hand outward.

Place the fingers of the gloved hand inside
the cuff of the remaining glove.
Lift it up from the wrapper,
taking care not to touch anything
with the gloves or hands.

Thumb is less likely to become contaminated if held outward.

Sterile surface touching sterile surface prevents contamination.
Prevents contamination of clean hands by a less clean faucet.

10. Carefully insert nondominant hand into glove.

Pull the glove on, taking
care that the skin does not touch any
of the outer surfaces of the gloves.

Contact of gloved hand with exposed hand results in

contamination.

11. Adjust each glove so that it fits smoothly, interlock

fingers, and carefully pull the cuffs up by sliding
the fingers under the cuffs.

Glove is removed and held without contact with soiled surfaces.

12. Place the first two fingers of the bare hands inside
the cuff of the opposite glove.
Pull the second glove off the fingers and the first glove
by turning it inside out.

Exposes only the clean surface of the glove.

Reduces the chance of transferring any
microorganism by direct contact.

13. Dispose soiled gloves properly.

14. Wash your hands.

Prevents transmission of microorganisms.

Deters the spread of microorganisms.

Wash hands each time gloves are changed between client contact
Wash hands each time gloves are removed because

a) the gloves may have imperfections or be
damaged during wearing allowing entry of microorganisms.

b) the hands may become contaminated
during removal of glove.