Medical and Surgical

Asepsis
Metropolitan Community College
NURS 1510
Nancy Pares, RN, MSN
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.
 Infection
◦ Invasion of the body by pathogens
Classifications of pathogens
 Bacteria
◦ One celled, multiply rapidly, classified by shape and
how they cluster together
 Virus
◦ Smallest of all pathogens; replication within the
host
 Fungi
◦ Organisms that exist by feeding on organic matter
 Protozoa
◦ Single celled organism; spread by feces,
Pathogens cont
 Rickettsia
◦ Organisms multiply in animal hosts and transmit to
humans through bites
 Helminths
◦ Parasitic worms found in soil; transmitted via hand
to mouth
 Mycoplasmas
◦ No cell wall; multi shaped
Other causes of infection:
 Chemical agents
◦ Pesticides, food additives, medications, industrial

 Physical agents
◦ Heat, noise, radiation, and machines
Factors that promote pathogen growth

 Moisture
 Organic matter
 Warmth
 Darkness
 Oxygen
 Alkaline ph
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
The Spread of Infection

Portal of Exit: Mode of Transmission:

 Via  Contact
• Bodily fluids • Direct – touching,
• Coughing, sneezing, kissing, sexual contact
diarrhea • Indirect – contact with a
• Seeping wounds fomite
• Tubes, IV lines  Droplet: Cough, sneeze
 Airborne: Via air
conditioning, sweeping
Spread of Infection
Portal of Entry:
 Eye, nares, mouth,
vagina, cuts, scrapes
 Wounds, surgical sites,
IV or drainage tube
sites
 Bite from a vector
Susceptible Host:
 Person with inadequate
defense
 Three determining
factors:
• Virulence
• Number of organisms
• Host’s defenses
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
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)
Classification of Infections by
Duration

Acute - Rapid onset of short duration

 e.g., Common cold
Chronic - Slow development, long duration
 e.g., Hypertension, diabetes mellitus, osteomyelitis
Latent - Infection present with no discernible
symptoms
 e.g., HIV/AIDS
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
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
Inflammatory response stages
 Vascular
◦ Aterioles dilate, blood and WBC go to area
◦ s/s= redness and warmth
 Inflammation
◦ 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
 Phagocytosis
◦ WBC enter the tissues causing release of pyrogens
(fever); exudates form discharge; healing occurs
Nosocomial Infection
An infection acquired in a health-care facility
 Cost 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
Nosocomial subcatagories

• Iatrogenic
▫ Infection from a procedure
ex: UTI from foley insertion
• exogenous
▫ Infection from non-normal flora
ex: clostridium
• Endogenous
▫ Infection when normal flora altered
ex: yeast infection
Causes of nosocomial infections

 UTI
◦ Insertion, contamination of drainage system,
improper cleansing
 Surgical site
◦ Improper technique for handwashing or dressing
change
 URI
◦ Improper handwashing or suctioning technique
 IV
◦ Improper handwashing or site care
Causes cont
 Extended LOS in hospital

 Multiple care givers

 Antibiotic choices and over use

 Improper medical or surgical asepsis

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
Nurse’s role in
• Containing nosocomial infections
CLEAN, DISINFECT, STERILIZE
• Controlling/eliminating reservoirs
▫ Bathing, dressing changes, patent drainage
systems
• Controlling the portal of exit
▫ Cover mouth/nose, wear mask, client teaching
• Controlling transmission
▫ Do not share equipment, proper handling of linens,
HANDWASHING
• Controlling portal of entry
▫ Maintain skin integrity, position changes, proper
wiping techniques, maintain drainage integrity
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
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
Lines of Defense Against Infection

Secondary Defenses:
 Biochemical processes activated by chemicals

released by pathogens
• Phagocytosis
• Complement cascade
• Inflammation
• Fever
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
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
Factors that Support Host Defenses
 Adequate nutrition
• To manufacture cells of the immune system
 Balanced hygiene
• Sufficient to decrease skin bacterial count
• Not overzealous; causes skin cracking
 Rest/exercise
 Reducing stress
 Immunization
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
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 client’s home as
contaminated
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
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
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
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
Transmission-Based Precautions
Contact Precautions:
Pathogen is spread by direct contact
 Sources of infection - draining wounds, secretions,
supplies
 Precautions include:
• Possible private room
• Clean gown and glove use
• Disposal of contaminated items in room
• Double-bag linen and mark
Transmission-Based Precautions

Droplet Precautions:
Pathogen is spread via moist droplets:
 Coughing, sneezing, touching contaminated objects
 Precautions include:
• Same as those for contact
• Addition of mask and eye protection within 3 ft of
client
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
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
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
Standard Precautions

 Protective barriers
 Change gloves
 HANDWASHING
 Discard sharps correctly
 Double bag
 Cover breaks in the skin
Body specific immune defenses
 Organs most vital to a functional immune
system
◦ Liver…produces immunoglobulins (antibodies)
◦ Lymph nodes…produce and circulate lymphocytes
◦ Bone marrow and thymus..form immune sys. Cells
◦ Spleen…removes dead cells and foreign molecules
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.
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
Types of immune responses
• Natural
▫ Present at birth, genetically determined
• Passive
▫ Acquired through introduction of antibodies, ie
mother passes to infant
• Active
▫ Antibodies develop within the body to neutralize or
destroy an infective agent
• Acquired
▫ Exposure to an antigen or passive injection of
immunoglobulin
• Artificial
▫ Produced by vaccination
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
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!!!
Handwashing
 The single most important
measure to reduce the risk of
transmission!
 Nurses do hands on work, so

always wash first!

Respiratory hygiene/cough etiquette
 Cover your nose and mouth with your elbow.

 Use tissues to contain respiratory secretions

and dispose into the nearest waste container
after use.

 Perform hand hygiene after contact with any

contaminated materials/objects
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
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.

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?

 What if the MRSA was positive in the sputum?

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?
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?