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ASEPSIS AND INFECTION CONTROL

Asepsis

Asepsis is the state of being free from disease-causing contaminants (such as bacteria, viruses, fungi, and
parasites) or, preventing contact with microorganisms. The term asepsis often refers to those practices
used to promote or induce asepsis in an operative field in surgery or medicine to prevent infection.

Medical asepsis

1. Includes all practices intended to confine a specific microorganism to a specific area

2. Limits the number, growth, and transmission of microorganisms
3. Objects referred to as clean or dirty (soiled, contaminated)

Surgical asepsis

1. Sterile technique
2. Practices that keep an area or object free of all microorganisms
3. Practices that destroy all microorganisms and spores
4. Used for all procedures involving sterile areas of the body

Principles of Aseptic Technique Only sterile items are used within sterile field.

1. Sterile objects become unsterile when touched by unsterile objects.

2. Sterile items that are out of vision or below the waist level of the nurse are considered unsterile.
3. Sterile objects can become unsterile by prolong exposure to airborne microorganisms.
4. Fluids flow in the direction of gravity.
5. Moisture that passes through a sterile object draws microorganism from unsterile surfaces above
or below to the surface by capillary reaction.
6. The edges of a sterile field are considered unsterile.
7. The skin cannot be sterilized and is unsterile.
8. Conscientiousness, alertness and honesty are essential qualities in maintaining surgical asepsis

Infection

Signs of Localized Infection

Localized swelling
Localized redness
Pain or tenderness with palpation or movement
Palpable heat in the infected area
Loss of function of the body part affected, depending on the site and extent of involvement
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Signs of Systemic Infection

Fever
Increased pulse and respiratory rate if the fever high
Malaise and loss of energy
Anorexia and, in some situations, nausea and vomiting
Enlargement and tenderness of lymph nodes that drain the area of infection

Factors Influencing Microorganisms Capability to Produce Infection

Number of microorganisms present

Virulence and potency of the microorganisms (pathogenicity)
Ability to enter the body
Susceptibility of the host
Ability to live in the hosts body

Anatomic and Physiologic Barriers Defend Against Infection

Intact skin and mucous membranes

Moist mucous membranes and cilia of the nasal passages
Alveolar macrophages
Tears
High acidity of the stomach
Resident flora of the large intestine
Peristalsis
Low pH of the vagina
Urine flow through the urethra

Interventions to Reduce Risk for Infection

Proper hand hygiene techniques

Environmental controls
Sterile technique when warranted
Identification and management of clients at risk

Chain of Infection

1. The chain of infection refers to those elements that must be present to cause an infection from a
microorganism
2. Basic to the principle of infection is to interrupt this chain so that an infection from a
microorganism does not occur in client
3. Infectious agent; microorganisms capable of causing infections are referred to as an infectious
agent or pathogen
4. Modes of transmission: the microorganism must have a means of transmission to get from one
location to another, called direct and indirect
5. Susceptible host describes a host (human or animal) not possessing enough resistance against a
particular pathogen to prevent disease or infection from occurring when exposed to the pathogen;
in humans this may occur if the persons resistance is low because of poor nutrition, lack of
exercise of a coexisting illness that weakens the host.
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6. Portal of entry: the means of a pathogen entering a host: the means of entry can be the same as
one that is the portal of exit (gastrointestinal, respiratory, genitourinary tract).
7. Reservoir: the environment in which the microorganism lives to ensure survival; it can be a
person, animal, arthropod, plant, oil or a combination of these things; reservoirs that support
organism that are pathogenic to humans are inanimate objects food and water, and other humans.
8. Portal of exit: the means in which the pathogen escapes from the reservoir and can cause disease;
there is usually a common escape route for each type of microorganism; on humans, common
escape routes are the gastrointestinal, respiratory and the genitourinary tract.
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Breaking the Chain of Infection

Etiologic agent

Correctly cleaning, disinfecting or sterilizing articles before use

Educating clients and support persons about appropriate methods to clean, disinfect, and sterilize
article

Reservoir (source)

Changing dressings and bandages when soiled or wet

Appropriate skin and oral hygiene
Disposing of damp, soiled linens appropriately
Disposing of feces and urine in appropriate receptacles
Ensuring that all fluid containers are covered or capped
Emptying suction and drainage bottles at end of each shift or before full or according to agency
policy

Portal of exit

Avoiding talking, coughing, or sneezing over open wounds or sterile fields

Covering the mouth and nose when coughing or sneezing

Method of transmission

Proper hand hygiene

Instructing clients and support persons to perform hand hygiene before handling food, eating, after
eliminating and after touching infectious material
Wearing gloves when handling secretions and excretions
Wearing gowns if there is danger of soiling clothing with body substances
Placing discarded soiled materials in moisture-proof refuse bags
Holding used bedpans steadily to prevent spillage
Disposing of urine and feces in appropriate receptacles
Initiating and implementing aseptic precautions for all clients
Wearing masks and eye protection when in close contact with clients who have infections
transmitted by droplets from the respiratory tract
Wearing masks and eye protection when sprays of body fluid are possible

Portal of entry

Using sterile technique for invasive procedures, when exposing open wounds or handling
dressings
Placing used disposable needles and syringes in puncture-resistant containers for disposal
Providing all clients with own personal care items

Susceptible host

Maintaining the integrity of the clients skin and mucous membranes

Ensuring that the client receives a balanced diet
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Educating the public about the importance of immunizations

Modes of Transmission

1. Direct contact: describes the way in which microorganisms are transferred from person to person
through biting, touching, kissing, or sexual intercourse; droplet spread is also a form of direct
contact but can occur only if the source and the host are within 3 feet from each other;
transmission by droplet can occur when a person coughs, sneezes, spits, or talks.
2. Indirect contact: can occur through fomites (inanimate objects or materials) or through vectors
(animal or insect, flying or crawling); the fomites or vectors act as vehicle for transmission
3. Air: airborne transmission involves droplets or dust; droplet nuclei can remain in the air for long
periods and dust particles containing infectious agents can become airborne infecting a susceptible
host generally through the respiratory tract

Course of Infection

1. Incubation: the time between initial contact with an infectious agent until the first signs of
symptoms the incubation period varies from different pathogens; microorganisms are growing and
multiplying during this stage
2. Prodromal Stage: the time period from the onset of nonspecific symptoms to the appearance of
specific symptoms related to the causative pathogen symptoms range from being fatigued to
having a low-grade fever with malaise; during this phase it is still possible to transmit the
pathogen to another host
3. Full Stage: manifestations of specific signs & symptoms of infectious agent; referred to as the
acute stage; during this stage, it may be possible to transmit the infectious agent to another,
depending on the virulence of the infectious agent
4. Convalescence: time period that the host takes to return to the pre-illness stage; also called the
recovery period; the host defense mechanisms have responded to the infectious agent and the signs
and symptoms of the disease disappear; the host, however, is more vulnerable to other pathogens
at this time; an appropriate nursing diagnostic label related to this process would be Risk for
Infection

Inflammation

The protective response of the tissues of the body to injury or infection; the physiological reaction
to injury or infection is the inflammatory response; it may be acute or chronic

Bodys response

1. The inflammatory response begins with vasoconstriction that is followed by a brief increase in
vascular permeability; the blood vessels dilate allowing plasma to escape into the injured tissue
2. WBCs (neutrophils, monocytes, and macrophages) migrate to the area of injury and attack and
ingest the invaders (phagocytosis); this process is responsible for the signs of inflammation
3. Redness occurs when blood accumulates in the dilated capillaries; warmth occurs as a result of the
heat from the increased blood in the area, swelling occurs from fluid accumulation; the pain occurs
from pressure or injury to the local nerves.
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Immune Response

1. The immune response involves specific reactions in the body to antigens or foreign material
2. This specific response is the bodys attempt to protect itself, the body protects itself by activating
2 types of lymphocytes, the T-lymphocytes and B-lymphocytes
3. Cell mediated immunity: T-lymphocytes are responsible for cellular immunity
o When fungi , protozoa, bacteria and some viruses activate T-lymphocytes, they enter the
circulation from lymph tissue and seek out the antigen
o Once the antigen is found they produce proteins (lymphokines) that increase the migration
of phagocytes to the area and keep them there to kill the antigen
o After the antigen is gone, the lymphokines disappear
o Some T-lymphocytes remain and keep a memory of the antigen and are reactivated if the
antigen appears again.
4. Humoral response: the ability of the body to develop a specific antibody to a specific antigen
(antigen-antibody response)
o B-lymphocytes provide humoral immunity by producing antibodies that convey specific
resistance to many bacterial and viral infections
o Active immunity is produced when the immune system is activated either naturally or
artificially.
Natural immunity involves acquisition of immunity through developing the disease
Active immunity can also be produced through vaccination by introducing into the
body a weakened or killed antigen (artificially acquired immunity)
Passive immunity does not require a host to develop antibodies, rather it is
transferred to the individual, passive immunity occurs when a mother passes
antibodies to a newborn or when a person is given antibodies from an animal or
person who has had the disease in the form of immune globulins; this type of
immunity only offers temporary protection from the antigen.

Types of Immunity

Active Immunity

Host produces antibodies in response to natural antigens or artificial antigens

Natural active immunity
o Antibodies are formed in presence of active infection in the body
o Duration lifelong
Artificial active immunity
o Antigens administered to stimulate antibody formation
o Lasts for many years
o Reinforced by booster

Passive Immunity

Host receives natural or artificial antibodies produced from another source

Natural passive immunity
o Antibodies transferred naturally from an immune mother to baby through the placenta or in
colostrums
o Lasts 6 months to 1 year
Artificial passive immunity
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o Occurs when immune serum (antibody) from an animal or another human is injected
o Lasts 2 to 3 weeks

Nosocomial Infection

1. Nosocomial Infections: are those that are acquired as a result of a healthcare delivery system
2. Iatrogenic infection: these nosocomial infections are directly related to the clients treatment or
diagnostic procedures; an example of an iatrogenic infection would be a bacterial infection that
results from an intravascular line or Pseudomonas aeruginosa pneumonia as a result of respiratory
suctioning
3. Exogenous Infection: are a result of the healthcare facility environment or personnel; an example
would be an upper respiratory infection resulting from contact with a caregiver who has an upper
respiratory infection
4. Endogenous Infection: can occur from clients themselves or as a reactivation of a previous
dormant organism such as tuberculosis; an example of endogenous infection would be a yeast
infection arising in a woman receiving antibiotic therapy; the yeast organisms are always present
in the vagina, but with the elimination of the normal bacterial flora, the yeast flourish.

Risks for Nosocomial Infections

Diagnostic or therapeutic procedures

o Iatrogenic infections
Compromised host
Insufficient hand hygiene

Factors Increasing Susceptibility to Infection

1. Age: young infants & older adults are at greater risk of infection because of reduced defense
mechanisms
o Young infants have reduced defenses related to immature immune systems
o In elderly people, physiological changes occur in the body that make them more
susceptible to infectious disease; some of these changes are:
Altered immune function (specifically, decreased phagocytosis by the neutrophils
and by the macrophages)
Decreased bladder muscle tone resulting in urinary retention
Diminished cough reflex, loss of elastic recoil by the lungs leading to inability to
evacuate normal secretions
Gastrointestinal changes resulting in decreased swallowing ability and delayed
gastric emptying.
Heredity: some people have a genetic predisposition or susceptibility to some infectious diseases
Cultural practices: healthcare beliefs and practices, as well as nutritional and hygiene practices, can
influence a persons susceptibility to infectious diseases
Nutrition: inadequate nutrition can make a person more susceptible to infectious diseases; nutritional
practices that do not supply the body with the basic components necessary to synthesized proteins affect
the way the bodys immune system can respond to pathogens
Stress: stressors, both physical and emotional, affect the bodys ability to protect against invading
pathogens; stressors affect the body by elevating blood cortisone levels; if elevation of serum cortisone is
prolonged, it decreases the anti-inflammatory response and depletes energy stores, thus increasing the risk
of infection
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Rest, exercise and personal health habits: altered rest and exercise patterns decrease the bodys
protective, mechanisms and may cause physical stress to the body resulting in an increased risk of
infection; personal health habits such as poor nutrition and unhealthy lifestyle habits increase the risk of
infectious over time by altering the bodys response to pathogens
Inadequate defenses: any physiological abnormality or lifestyle habit can influence normal defense
mechanisms in the body, making the client more susceptible to infection; the immune system functions
throughout the body and depends on the following:
o Intact skin and mucous membranes
o Adequate blood cell production and differentiation
o A functional lymphatic system and spleen
o An ability to differentiate foreign tissue and pathogens from normal body tissue and flora;
in autoimmune disease, the body has a problem with recognizing its own tissue and cells;
people with autoimmune disease are at increased risk of infection related to their immune
system deficiencies.
Environmental: an environment that exposes individuals to an increased number of toxins or pathogens
also increases the risk of infection; pathogens grow well in warm moist areas with oxygen (aerobic) or
without oxygen (anaerobic) depending on the microorganism, an environment that increases exposure to
toxic substances also increases risk
Immunization history: inadequately immunized people have an increased risk of infection specifically
for those diseases for which vaccines have been developed.
Medications and medical therapies: examples of therapies and medications that increase clients risk for
infection includes radiation treatment, anti-neo-plastic drugs, anti inflammatory drugs and surgery

Diagnostic Tests Used to Screen for Infection

1. Signs and symptoms related to infections are associated with the area infected; for
instance, symptoms of a local infection on the skin or mucous membranes are localized swelling,
redness, pain and warmth
2. Symptoms related to systemic infections include fever, increased pulse & respirations, lethargy,
anorexia, and enlarged lymph nodes
3. Certain diagnostic tests are ordered to confirm the presence of an infection.

Category-specific Isolation Precautions

Strict isolation
Contact isolation
Respiratory isolation
Tuberculosis isolation
Enteric precautions
Drainage/secretions precautions
Blood/body fluid precautions

Disease-specific Isolation Precautions

Delineate practices for control of specific diseases

o Use of private rooms with special ventilation
o Cohorting clients infected with the same organism
o Gowning to prevent gross soilage of clothes
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Universal Precautions (UP)

Used with all clients

Decrease the risk of transmitting unidentified pathogens
Obstruct the spread of bloodborne pathogens (hepatitis B and C viruses and HIV)
Used in conjunction with disease-specific or category-specific precautions

Body Substance Isolation (BSI)

Employs generic infection control precautions for all clients

Body substances include:
o Blood
o Urine
o Feces
o Wound drainage
o Oral secretions
o Any other body product or tissue

Standard Precautions

Used in the care of all hospitalized persons regardless of their diagnosis or possible infection
status
Apply to:
o Blood
o All body fluids, secretions, and excretions except sweat (whether or not blood is present or
visible)
o Nonintact skin and mucous membranes
Combine the major features of UP and BSI

Transmission-based Precautions

Used in addition to standard precautions

For known or suspected infections that are spread in one of three ways:
o Airborne
o Droplet
o Contact
May be used alone or in combination but always in addition to standard precautions

Managing Equipment Used for Isolation Clients

Many supplied for single use only

Disposed of after use
Agencies have specific policies and procedures for handling soiled reusable equipment
Nurses need to become familiar with these practices

Bloodborne Pathogen Exposure

Report the incident immediately

Complete injury report
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Seek appropriate evaluation and follow-up

Identification and documentation of the source individual when feasible and legal
Testing of the source for hepatitis B, C and HIV when feasible and consent is given
Making results of the test available to the source individuals health care provider
Testing of blood exposed nurse (with consent) for hepatitis B, C, and HIV please check these to
match style used in book fairly certain it should be caped antibodies
Postexposure prophylaxis if medically indicated
Medical and psychologic counseling

Puncture/Laceration

Encourage bleeding
Wash/clean the area with soap and water
Initiate first aid and seek treatment if indicated
Mucous membrane exposure (eyes, nose, mouth)
Flush with saline or water flush for 5 to 10 minutes