Medical and Surgical Asepsis

Click to edit Master subtitle style Metropolitan Community College

NURS 1510 Nancy Pares, RN, MSN

7/30/12

Define Terms

Asepsis

.absence of germs or micro organisms

Medical

asepsis.

technique or procedure which reduces the number of micro organisms and thus prevents the spread of disease

Surgical

asepsis.

Protection against infection before, during and after a surgical procedure. Invasion of the body by pathogens
7/30/12

Infection

Classifications of pathogens
Bacteria

One celled, multiply rapidly, classified by shape and how they cluster together Smallest of all pathogens; replication within the host Organisms that exist by feeding on organic matter Single celled organism; spread by feces,

Virus

Fungi

Protozoa

7/30/12

Pathogens cont
Rickettsia

Organisms multiply in animal hosts and transmit to humans through bites Parasitic worms found in soil; transmitted via hand to mouth No cell wall; multi shaped

Helminths

Mycoplasmas

7/30/12

Other causes of infection:

Chemical

agents

Pesticides, food additives, medications, industrial

Physical

agents

Heat, noise, radiation, and machines

7/30/12

Factors that promote pathogen growth

Moisture Organic Warmth Darkness Oxygen Alkaline

matter

ph

7/30/12

The Spread of Infection: Six Links Infectious agents

Pathogens Normal flora that become pathogenic

Reservoir Where pathogens live and multiply May be living

Humans, animals, insects May be nonliving

Food, floors, equipment, contaminated water
7/30/12

The Spread of Infection

Portal of Exit:

Via

Mode of Transmission:
Contact

Bodily fluids Coughing, sneezing, diarrhea Seeping wounds Tubes, IV lines

Direct touching, kissing, sexual contact Indirect contact with a fomite

Droplet:

Cough, sneeze Airborne: Via air conditioning, sweeping

7/30/12

Spread of Infection
Susceptible Host: Portal of Entry:
Eye, nares, mouth, vagina, cuts, Person with inadequate defense

scrapes Wounds, surgical sites, IV or drainage tube sites Three determining factors: Virulence Bite from a vector

Number of organisms Hosts defenses

7/30/12

Stages of Infection
Incubation:

From time of infection until manifestation of symptoms; can infect others Prodromal: Appearance of vague symptoms; not all diseases have this stage Illness: Signs and symptoms present Decline: Number of pathogens decline Convalescence: Tissue repair, return to health

7/30/12

Classification of Infections
By Location: Local

Occurs in a limited region in the body (e.g., urinary tract infection)

Systemic

Spread via blood or lymph Affects many regions (e.g., septicemia)

7/30/12

Classification of Infections by Duration

Acute - Rapid onset of short duration

e.g., e.g.,

Common cold Hypertension, diabetes mellitus, osteomyelitis

Chronic - Slow development, long duration Latent - Infection present with no discernible symptoms
e.g.,

HIV/AIDS
7/30/12

Chain of Infection
Presence

of pathogen Reservoir (source)

Pathogen survive and multiply
Portal

of exit from reservoir

Direct, indirect, airborne

Mode

of transmission Portal of entry to host Susceptible host

7/30/12

Signs and symptoms of infection

Local

Limited to a defined area; resembles inflammation Ex: redness, warmth, tenderness, swelling

Systemic

Affects the entire body and may involve multiple organs, goes through the stages of infection Ex: fever, anorexia, n/v, lymph node swelling

7/30/12

Inflammatory response stages

Vascular

Aterioles dilate, blood and WBC go to area s/s= redness and warmth Tissue dies causing release of chemicals (histamine and prostaglandins) which allow blood vessel permeability. Cells, proteins, fluids enter the tissue spaces blocking lymphatics to create a wall against infection WBC enter the tissues causing release of pyrogens (fever); exudates form discharge; healing occurs
7/30/12

Inflammation

Phagocytosis

Nosocomial Infection
An infection acquired in a health-care facility
to the health-care system = $4.5 billion/year Leading cause of death Preventable with use of aseptic principles/ techniques Exogenous Nosocomial Infection: Pathogen acquired from health-care environment Endogenous Nosocomial Infection: Normal flora multiply and cause infection as a result of treatment
Cost

7/30/12

Nosocomial subcatagories

Iatrogenic

Infection from a procedure ex: UTI from foley insertion

exogenous
Infection from non-normal flora ex: clostridium Infection when normal flora altered ex: yeast infection

Endogenous

7/30/12

Causes of nosocomial infections

UTI

Insertion, contamination of drainage system, improper cleansing

Surgical

site

Improper technique for handwashing or dressing change Improper handwashing or suctioning technique Improper handwashing or site care
7/30/12

URI

IV

Causes cont
Extended Multiple

LOS in hospital

care givers choices and over use medical or surgical asepsis

Antibiotic Improper

7/30/12

Who is at risk for nosocomial infection?

Age

Very young and very old

Poor

nutritional status Smoker, ETOH use Existing co-morbid conditions Chronic illnesses, chemo,radiation Clients with invasive procedures Clients with prolonged stress

7/30/12

Nurses role in

Containing nosocomial infections

CLEAN, DISINFECT, STERILIZE

Controlling/eliminating reservoirs

Bathing, dressing changes, patent drainage systems Cover mouth/nose, wear mask, client teaching Do not share equipment, proper handling of linens, HANDWASHING Maintain skin integrity, position changes, proper wiping techniques, maintain drainage integrity
7/30/12

Controlling the portal of exit

Controlling transmission

Controlling portal of entry

Nurses role in
Protecting

susceptible host

Protect natural defenses-skin, mucous membranes, fluid intake Encourage cough and deep breathing Change position Oral hygiene Promote rest and sleep Reduce client stress

7/30/12

Lines of Defense Against Infection

Primary Defenses: Anatomical features, limit pathogen entry

Intact skin Mucous membranes Tears Normal flora in GI tract Normal flora in urinary tract

7/30/12

Lines of Defense Against Infection

Secondary Defenses: Biochemical processes activated by chemicals released by pathogens

Phagocytosis Complement cascade Inflammation Fever

7/30/12

Lines of Defense Against Infection

Tertiary Defenses: Humoral immunity

B-cell production of antibodies in response to an antigen

Cell-mediated

immunity

Direct destruction of infected cells by T cells

7/30/12

Factors that Increase Infection Risk

Developmental

stage Breaks in the skin Illness/injury, chronic disease Smoking, substance abuse Multiple sex partners Medications that inhibit/decrease immune response Nursing/medical procedures

7/30/12

Factors that Support Host Defenses

Adequate

nutrition hygiene

To manufacture cells of the immune system Sufficient to decrease skin bacterial count Not overzealous; causes skin cracking

Balanced

Rest/exercise Reducing

stress Immunization

7/30/12

Preventing Infection: Implementing Medical Asepsis

Medical asepsis: A state of cleanliness that decreases the potential for the spread of infections Promoted through:

Maintaining a clean environment Maintaining clean hands Following Centers for Disease Control (CDC) guidelines
7/30/12

Maintaining a Clean Environment

Clean

spills and dirty surfaces promptly Remove pathogens through chemical means (disinfect) Remove clutter Consider supplies brought to the client room as contaminated Consider items from the clients home as contaminated

7/30/12

Wash Your Hands

When

you arrive in the unit When you leave the unit Before and after restroom use Before and after client contact Before and after contact with client belongings

7/30/12

Wash Your Hands

Before

gloving After glove removal Before and after touching your face Before and after eating After touching a contaminated article When you see visible dirt on your hands

7/30/12

Hand Washing Guidelines

Wash

for at least 15 seconds in nonsurgical setting; 2-6 minutes in surgical setting Use warm water, not hot Apply soap to wet hands Use friction Clean beneath fingernails and jewelry Rinse soap Towel or hand dry

7/30/12

Implementing CDC Guidelines

Standard

precautions (universal precautions) Protects health-care workers from exposure Decreases transmission of pathogens Protects clients from pathogens carried by health-care workers

7/30/12

Transmission-Based Precautions
Contact Precautions:
Pathogen is spread by direct contact
Sources

supplies Precautions include:

of infection - draining wounds, secretions,

Possible private room Clean gown and glove use Disposal of contaminated items in room Double-bag linen and mark

7/30/12

Transmission-Based Precautions

Droplet Precautions:
Pathogen is spread via moist droplets:
Coughing,

objects Precautions include:

sneezing, touching contaminated

Same as those for contact Addition of mask and eye protection within 3 ft of client
7/30/12

Transmission-Based Precautions

Airborne Precautions:
Pathogen is spread via air currents
Transmission

via ventilation systems, shaking sheets, sweeping Precautions include:

Same as those for contact, with addition of special mask

7/30/12

Protective Isolation
Reverse isolation: Protects the client from organisms Used with immune-compromised client population Precautions include:

Private room likely Nurse not assigned to clients with active infection Mask, handwashing, clean/sterile gown, gloves No reuse of gowns, gloves

7/30/12

Implementing Surgical Asepsis

Includes:
Creation

of a sterile environment Use of sterile equipment/supplies Sterilization of reusable supplies Surgical hand scrub Surgical attire Sterile gloves Sterile field Use of sterile technique

7/30/12

Standard Precautions
Protective

barriers Change gloves HANDWASHING Discard sharps correctly Double bag Cover breaks in the skin

7/30/12

Body specific immune defenses

Organs

system

most vital to a functional immune

Liverproduces immunoglobulins (antibodies) Lymph nodesproduce and circulate lymphocytes Bone marrow and thymus..form immune sys. Cells Spleenremoves dead cells and foreign molecules

7/30/12

Immunities
Humoral

Attack bacteria and virus at the extracellular level B cell lymphocytes cause synthesis of antibodies leading to destruction of antigens and creation of antibodies that subsequently protect from the same antigen Five classes of antibodies
IgG, IgM, IgA, IgE, and IgD. IgG is most abundant and crosses the placenta provides passive immunity for newborns.

7/30/12

Immunities, cont
Cell

mediated immunity

Fights pathogens inside the cell T cells (a form of WBC) binds with the antigen, becomes sensitized and releases lymphokines which attract macrophages that destroy the antigen Three types of T cells
Cytotoxic, helper T and suppressor T

7/30/12

Types of immune responses

Natural

Present at birth, genetically determined Acquired through introduction of antibodies, ie mother passes to infant Antibodies develop within the body to neutralize or destroy an infective agent Exposure to an antigen or passive injection of immunoglobulin Produced by vaccination

Passive

Active

Acquired

Artificial

7/30/12

Principles of medical and surgical asepsis

Medical

asepsis

Practice which reduces the number, growth and spread of micro organisms Referred to as clean technique Handwashing 2 min-15 sec

Surgical

asepsis

Total elimination of all micro organisms, spores Sterile field (OR, L&D, etc), gown and glove Methods:
Steam, radiation, chemicals, or gas

7/30/12

CDC Guidelines: Standard

Apply

to :

All body fluids, secretions (except perspiration) Blood Non intact skin Mucous membranes

Gloves

worn:

To provide a protective barrier To reduce opportunities for nurse organism transfer to client WEARING GLOVES DOES NOT REPLACE HANDWASHING!!!
7/30/12

Handwashing
The

single most important measure to reduce the risk of transmission! Nurses do hands on work, so always wash first!

7/30/12

Respiratory hygiene/cough etiquette

Cover Use

your nose and mouth with your elbow.

tissues to contain respiratory secretions and dispose into the nearest waste container after use. hand hygiene after contact with any contaminated materials/objects

Perform

7/30/12

Proper handwashing
Turn

on slow, steady stream of warm water Moisten hands with water, then apply soap Rub hands together vigorously for at least 15 seconds Rinse under water Use a clean paper towel or air dryer to dry hands

7/30/12

Waterless hand rub

May

use when hands are not visibly soiled Apply adequate amount to palm of one hand Rub hands together, covering all surfaces of hands and fingers (including under the nails) until hands are dry Do not rinse with water May be used 5-10 times before washing with soap and water is required.

7/30/12

Case Study
Admitting

calls to tell you that they have a client who previously cultured positive for MRSA in their urine. What precaution do you place this client in? if the MRSA was positive in the sputum?

What

7/30/12

Case Study
You

have a client that has very runny stools. The doctor orders a stool culture. What additional information can you supply the lab?
What

precautions would you place this patient in?

7/30/12

Case study
Client

presents to ED with high fever, headache, body aches and non-productive cough. Client states the her husband just returned from a business trip in China.

First

thought? Precautions?

7/30/12