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Medical & Surgical Asepsis

Miss. M.N Priyadarshanie

B.Sc .Nursing (Hons)
20th July 2013
Learning objectives
 Explain the concepts of medical and surgical
 Identify types of microorganisms causing
 Identify types & signs of localized and
systematic infections.
 Identify risks for nosocomial infections.

 Explain chain of infection.

 Identify factors influencing a
microorganism's capability to produce an
infectious process.
 Identify measures that break each link in the
chin of infection.
Asepsis is the freedom from
disease-causing microorganisms. To
decrease the possibility of
transferring microorganisms from
one place to another, asepsis is
There are two basic types
of asepsis
Medical & Surgical
1. Medical asepsis
Includes all practices intended
to confine a specific
microorganism to a specific
area, limiting the number,
growth, and transmission of
In medical asepsis,
objects are referred to as
clean, which means the absence of
almost all microorganisms, or dirty
(soiled, contaminated, which
means likely to have
microorganisms, some of which
may be capable of causing
2. Surgical asepsis or sterile
Technique, refers to keep an area
or object free of all
microorganism, it includes
practices that destroy all
microorganisms and spores.
Surgical asepsis is used for all
procedures involving the sterile
areas of the body.
Sepsis is the state of

infection and can take

many forms, including
septic shock.
Types of
causing infections
1. Bacteria can live and be transported through
air, water, food, soil, body tissues and fluids,
and inanimate objects.

2. Viruses (causes the common cold) hepatitis,

herpes, and human immunodeficiency virus.

3. Fungi include yeasts and molds. Candida

4. Parasites They include protozoa such as the
that causes malaria.
Types of infection
 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, it is a systemic infection.
 When a culture of the person's
blood reveals microorganisms,
the condition is called
 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

classified as infections that are
associated with the delivery of health
care services in a health care facility.
Nosocomial infections can either
develop during a client's stay in a
facility or manifest after discharge.
 The incidence of
nosocomial infections is
significant. Major sites for
these infections are the
respiratory and urinary
tracts, the bloodstream,
and wounds.
 Factors that contribute to
nosocomial infection risks are
invasive procedures, medical
therapies, the existence of a large
number of susceptible persons,
inappropriate use of antibiotics, and
insufficient hand washing after client
contact and after contact with body
Chain of
Etiologic agent

Susceptible host

5 3
Portal of entry to Portal of exit
the susceptible from reservoir

Method of
1. Etiologic agent

The any microorganism is capable

of producing an infectious process
depends on the number of
microorganisms present.
2. Reservoir
There are many reservoirs, or
sources of microorganisms,
common sources are other
humans, the client's, plants,
animals, or general
3. Portal of exit from reservoir

Before an infection can

establish itself in a host,
the microorganisms
must leave the reservoir.
4. Method of transmission

There are three

1. 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
2. Indirect transmission
 Material objects, such as toys,
soiled clothes, cooking or eating
and surgical instruments, or
dressing, water, food, blood,
serum, and plasma. Animal or
3. Airborn transmission

may involve
droplets or dust.
5. Portal of entry

 Before a person can become

infected, microorganisms must
enter the body. The skin is a barrier
to infectious agents; however, any
break in the skin can readily serve
as a portal of entry.
6. Susceptible Host

A susceptible host is any

person who is at risk for
infection. A compromised host is
a person at "increased risk"
Factors Increasing
Susceptibility to Infection
1. Age influence the risk of

2. Heredity influences the

development of infection.
3. The nature, number, and
duration of physical and emotional
stressors can influence
susceptibility to infection.
 Stressors elevate blood cortisone.
Prolonged elevation of blood
cortisone decrease anti-
inflammatory responses depletes
energy stores, lead to a state of
exhaustion, and decrease
resistance to infection.
4. Resistance to infection depends on
adequate nutritional status.

5. Some medical therapies predispose

a person to infection. For example,
radiation treatments for cancer, some
diagnostic procedures may also
predispose the client to an infection.
6. Certain medication also increase
susceptibility to infection.
Anticancer medications may
depress bone marrow function,
resulting inadequate production of
white blood cells, anti-inflammatory
and antibiotics medications.
Cleaning, Disinfecting, and
The first links in the chain of infection,
the etiologic agent and the reservoir, are
interrupted by the use of antiseptics
(agents that inhibit the growth of
some microorganisms) and
disinfectants (agents that destroy
pathogens other than spores) and by
Cleanliness inhibits the growth
of microorganisms. When
cleaning visibly soiled objects,
nurses must always wear gloves
to avoid direct contact with
infections microorganisms.
 A disinfectant is a chemical
preparation, such as phenol or iodine
compounds, used on inanimate objects.
 Disinfectants are frequently caustic and

toxic to tissues. An antiseptic is a

chemical preparation used on skin or
 Disinfectants and
antiseptics often have
similar chemical
components, but the
disinfectant is a more
concentrated solution.
When disinfecting articles,
nurses need to follow
agency protocol and
consider the following:
1.The type and number of infectious

2.The recommended concentration of

the disinfectant and the duration
of contact.

3.The temperature of the

4. The presence of soap. Some disinfectants are
ineffective in the presence of soap or

5. The presence of organic materials, the

presence of saliva, blood, pus can readily
inactive many disinfectants.

6. The surface areas to be treated. The

disinfecting agent must come into contact
with all surfaces and areas.

Sterilization is a process
that destroys all
microorganisms, including
spores and viruses.
Four commonly used
methods of sterilization are

 Heat sterilization
 Chemical sterilization
 Radiation sterilization
Sterile Technique
The basic principles
of surgical asepsis
1. All objects used in a sterile field
must be strile.
2. Sterile objects become un-sterile
when touched by un-sterile
3. Sterile items that are out of
vision or below the waist level of
the nurse are considered unsterile.
4.Sterile objects can become unsterile
by prolonged exposure to airborne
5.Fluids flow in the direction of gravity.
6.Moisture that passes through a sterile
object draws microorganisms from
un-sterile surfaces above or below to
the sterile surface by capillary action.
7. The edges of a sterile field are
considered un-sterile.

8. The skin cannot be sterilized and is