ASEPSIS, INFECTION

CONTROL, HYGIENE
By
Sherwin M. Amid, RN, RPT

ILLNESS
Is a personal state in which the person feels unhealthy.
Illness is a state in which a persons physical, emotional, intellectual, social,
developmental, or spiritual functioning is diminished or impaired compared
with previous experience.
Illness is not synonymous with disease.

STAGES OF ILLNESS
Symptoms Experience- experience some symptoms, person believes something is wrong 3
aspects physical, cognitive, emotional
Assumption of Sick Role acceptance of illness, seeks advice
Medical Care Contact- Seeks advice to professionals for validation of real illness,
explanation of symptoms, reassurance or predict of outcome
Dependent Patient Role
The person becomes a client dependent on the health professional for help.
Accepts/rejects health professionals suggestions.
Becomes more passive and accepting.

Recovery/Rehabilitation- Gives up the sick role and returns to former roles and functions.

DISEASE
An alteration in body function resulting in reduction of capacities or a
shortening of the normal life span.

COMMON CAUSES OF DISEASE

Biologic agent e.g. microorganism
Inherited genetic defects e.g. cleft palate
Developmental defects e.g. imperforate anus
Physical agents e.g. radiation, hot and cold substances, ultraviolet rays
Chemical agents e.g. lead, asbestos, carbon monoxide
Tissue response to irritations/injury e.g. inflammation, fever
Faulty chemical/metabolic process e.g. inadequate insulin in diabetes
Emotional/physical reaction to stress e.g. fear, anxiety

ASEPSIS
The absence of disease producing Microorganisms
Being free from infection

2 TYPES OF ASEPSIS
Medical Asepsis

Includes all practices intended to confine a specific microorganism to a

specific area

Surgical Asepsis

Sterile technique

Practices that keep an area or object free of all microorganisms

Limits the number, growth, and transmission of microorganisms

Practices that destroy all microorganisms and spores

Objects referred to as clean or dirty (soiled, contaminated)

Used for all procedures involving sterile areas of the body

TERMINOLOGIES
Sepsis - The presence of infection
Septicemia - Transport of an infection or the products of infection throughout
the body or by blood.
Carrier a person or animal who is without signs of illness but who harbors
pathogens within his body that can be transferred to another
Transient flora the microorganism picked up by the body as a result of
normal activities that can be removed readily
Resident flora the microorganism that normally live on a persons body

MICROORGANISMS
Tiny organisms that can be disease causing that can only be seen with
assistance of a microscope

COMMON INFECTIOUS AGENTS

Bacteria
Streptococcus strep throat,
pneumonia
E coli urinary tract infections
Tuberculosis lung disease

Virus
HIV acquired immune deficiency
syndrome
Hepatitis A, B, C liver disease ( Hep
B 3 shots)
Common cold respiratory infection
Influenza fever, chills, body aches
Herpes zoster - shingles

Fungi
Tinea pedis athlete's foot
Candida albicans yeast
infection

Insects
Lice body, head, pubic,
causes itching
Scabies skin rash

INFECTION
An invasion of the body tissue by microorganism and their proliferate there.

TYPES OF INFECTIONS
Colonization is the process by which strains of microorganisms become resident flora.
A local infection is limited to the specific part of the body where the microorganisms remain.
If the microorganisms spread and damage different parts of the body, the infection is a
systemic infection.
When a culture of the persons blood reveals microorganisms, the condition is called
bacteremia.
When bacteremia results in systemic infection, it is referred to as septicemia.
Acute infections generally appear suddenly or last a short time. A chronic infection may
occur slowly, over a very long period, and may last months or years.
Nosocomial infections are classified as infections that originate in the hospital.

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

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

CHAIN OF INFECTION
Thechain of infectionrefers to those elements that must be present to
cause an infection from a microorganism
Basic to the principle of infection is to interrupt this chain so that an infection
from a microorganism does not occur in client

ETIOLOGIC AGENT
Infectious agent; microorganisms capable of causing infections are referred
to as aninfectious agent or pathogen

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.

PORTAL OF EXIT FROM RESERVOIR

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.

METHOD OF TRANSMISSION
After a microorganism leaves its source or reservoir, it requires a means of
transmission to reach another person or host through a receptive portal of
entry.

DIRECT TRANSMISSION.
Direct transmission involves immediate and direct transfer of microorganisms
from person to person through touching, biting, kissing, or sexual
intercourse.
Droplet spread is also a form of direct transmission but can occur only if the
source and the host are within 1 m (3 ft) of each other. Sneezing, coughing,
spitting, singing, or talking can project droplet spray into the conjunctiva or
onto the mucous membranes of the eye, nose, or mouth of another person.

INDIRECT TRANSMISSION
. Vehicle-borne
transmission

A vehicle is any substance that serves as an intermediate means to

transport and introduce an infectious agent into a susceptible host
through a suitable portal of entry. Fomites (inanimate materials or
objects), such as handkerchiefs, toys, soiled clothes, cooking or eating
utensils, and surgical instruments or dressings, can act as vehicles.
Water, food, blood, serum, and plasma are other vehicles. For example,
food or water may become contaminated by a food handler who carries
the hepatitis A virus. The food is then ingested by a susceptible host.

Vector-borne transmission

A vector is an animal or flying or crawling insect that serves as an

intermediate means of transporting the infectious agent. Transmission
may occur by injecting salivary fluid during biting or by depositing feces
or other materials on the skin through the bite wound or a traumatized
skin area.

AIRBORNE TRANSMISSION
Airborne transmission may involve droplets or dust. Droplet nuclei, the
residue of evaporated droplets emitted by an infected host such as someone
with tuberculosis, can remain in the air for long periods. Dust particles
containing the infectious agent (e.g., Clostridiumdifficile, spores from the
soil) can also become airborne. The material is transmitted by air currents to
a suitable portal of entry, usually the respiratory tract, of another person.

PORTAL OF ENTRY TO THE SUSCEPTIBLE

HOST
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).

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.

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
Educating the public about the importance of immunizations

COURSE OF INFECTION
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
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
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
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
he 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
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
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
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.

IMMUNE RESPONSE
The immune response involves specific reactions in the body to antigens or
foreign material
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

CELL MEDIATED IMMUNITY: T-LYMPHOCYTES ARE

RESPONSIBLE FOR CELLULAR IMMUNITY

When fungi , protozoa, bacteria and some viruses activate T-lymphocytes, they
enter the circulation from lymph tissue and seek out the antigen
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
After the antigen is gone, the lymphokines disappear
Some T-lymphocytes remain and keep a memory of the antigen and are
reactivated if the antigen appears again.

HUMORAL RESPONSE: THE ABILITY OF THE BODY TO

DEVELOP A SPECIFIC ANTIBODY TO A SPECIFIC
ANTIGEN (ANTIGEN-ANTIBODY RESPONSE)
B-lymphocytes provide humoral immunity by producing antibodies that convey
specific resistance to many bacterial and viral infections
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
Antibodies are formed in presence of active infection in the body
Duration lifelong

Artificial active immunity

Antigens administered to stimulate antibody formation
Lasts for many years
Reinforced by booster

 Passive Immunity
Host receives natural or artificial antibodies produced from another source
Natural passive immunity
Antibodies transferred naturally from an immune mother to baby through the placenta
or in colostrums
Lasts 6 months to 1 year

Artificial passive immunity

Occurs when immune serum (antibody) from an animal or another human is injected
Lasts 2 to 3 weeks

NOSOCOMIAL INFECTION
Nosocomial Infections: are those that are acquired as a result of a healthcare delivery system
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
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
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.

4 CDC CATEGORIES
Standard
Contact
Airborne

Droplet

STANDARD PRECAUTIONS
Assume that every person is potentially infected or colonized
with an organism that could be transmitted in the healthcare
setting.
Wear PPE according to the level of anticipated contamination,
when handling patient-care equipment and instruments/devices
that are visibly soiled or may have been in contact with blood or
body fluids.

CONTACT ISOLATION
Protects from diseases spread by contact.
Including:
Clostridium difficile (C-Diff)
Scabies, lice, impetigo
Patients with multiple drug
resistant organisms
(MDRO) like MRSA, VRE,
and MDRO gram negative
organisms
(i.e.Pseudomonas,
Acinetobacter).

Private room
required
Gown required
Gloves required

Contact Isolation:
Patient transport:
Patient: Patient wears clean gown.
Cover any open wounds.
Cover patient with clean sheet prior to transport.
HCW:

Wear Personal protective equipment (PPE) when touching patient.

(Healthcare
Remove and dispose of PPE and perform hand hygiene prior to
Worker) transporting patient.
Don clean PPE to handle patient at transport destination.
Visitors: Visitors who are not providing direct care to patients in contact
precautions will not need to wear gown and gloves. This does not apply to
students, residents or other healthcare providers.
Equipment: Clean glucometers, thermometers or any other equipment
used for or on a patient. Dedicate stethoscope, B/P cuff to
patient.

each

For patients with spore-forming organisms, such as Clostridium

difficile
(C. diff), you must wash hands with soap and water. Alcohol-based
hand cleaners are less effective.

Memorial Medical
Center ONLY

AIRBORNE PRECAUTIONS

Protects from disease spread by air/respiratory tract.

Primarily used for suspected or

diagnosed TB.
A special ventilation room (negative
airflow) is required. Door is kept
closed.
A Powered Air-purifying Respirator
(PAPR) is required to enter the room.
Some areas (surgery, MRI) wear a N-95
mask. An annual fit-test is required for
N-95 users.

Airborne Isolation:
Patient transport:
Patient: Patient wears surgical mask when out of room.
Follow respiratory hygiene/cough etiquette.
If skin lesions are presentcover lesions with clean sheet
HCW:

Wear PAPR when entering room and handling patient

(Healthcare
May remove PAPR once out of the room and patient is wearing
worker)
mask
Hand hygiene prior to transport
HCW does not need to wear PAPR during transport
Equipment: Clean stretchers/wheelchairs after use
Clean glucometers, thermometers, or any other equipment
used for patient

AIRBORNE/CONTACT PRECAUTIONS
Used for other occasions when a special
ventilation room (negative airflow) is needed,
i.e. varicella (chickenpox), measles, shingles
(varicella) in an immunocompromised patient,
or disseminated shingles.
These conditions are also spread by contact
so Contact precautions are required also.
A PAPR, gown and gloves are required to
enter the room.

DROPLET PRECAUTIONS
Protects against diseases spread by respiratory droplets.

Including suspected or known:

Neisseria meningitidis
(meningococcemia),
Meningitis of unknown origin (bacterial
vs. viral)
Influenza
Pertussis (whooping cough).
A surgical type mask is required to
enter the room.

Droplet Isolation:
Patient Transport:
Patient: Patient wears surgical mask when out of room.
Follow respiratory hygiene/cough etiquette
HCW: Wear mask when entering room
(Healthcare
May remove mask once patient is wearing a mask
Worker)
HCW does not need to wear mask during transport
Equipment: Clean stretchers/wheelchairs after use
Clean glucometers, thermometers or any other
equipment used for patient