Medical and Surgical

Asepsis

Ashfaq Ahmad Sahil

Lecturer INS-MKU
Objectives

 By the end of presentation students will be able to:

 Define the terms Infection, Pathogenicity, Asepsis
and Sepsis.

 Differentiate medical and surgical hand washing.

 Define Nosocomial infection.

 Define isolation.
Cont……..

 Identify types of isolation.

 Identify the components of chain of infection.

 Relate Isolation to the chain of infection cycle.

 Identify nursing responsibilities in each type of

isolation.
Infection
 An infection is the invasion of
body tissues by disease-
causing microorganisms, their multiplication
and the reaction of body tissues to these
microorganisms and the toxins that they
produce.
 Infections are caused by microorganisms
such as viruses, bacteria, though larger
organisms like macro parasites and fungi
can also infect.
Pathogenicity

 A pathogen is a microorganism that is able

to cause disease in a plant, animal or insect.

 Pathogenicity is the ability of a pathogen to

produce an infectious disease in an
organism.
Sepsis
 Sepsis is a condition in which the body is
fighting a severe infection that has spread via
the bloodstream.
 If a patient becomes "septic," they will likely
have low blood pressure leading to poor
circulation and lack of perfusion of vital
tissues and organs.
 This condition is termed "shock" and is
sometimes referred to as septic shock.
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.
 Ideally, a surgical field is "sterile," meaning it is
free of all biological contaminants, not just those
that can cause disease.
Medical Asepsis
 The practice of medical asepsis helps to prevent
infectious organisms and to maintain an
environment free from contamination.

 The techniques used to maintain medical

asepsis include hand washing, gowning and
wearing facial masks when appropriate.

 Appropriate hand washing by the nurse and the

patient remains the most important factor in
preventing the spread of micro organisms.
Surgical Asepsis

 Refers to those practices that keep an area

or object free of all microorganisms, it include
practices that destroy all microorganisms and
the spores.
 It is used for all procedures involving the
sterile areas of the body.
Chain of Infection

 Etiologic agent
 Reservoir (source)
 Portal of Exit from reservoir
 Method of transmission
 Portal of entry to the susceptible host
 Susceptible host
 Patient Situation 1
The Spread of Infection
 An elderly patient, hospitalized with a gastrointestinal
disorder caused by (E,coli), was on bed rest and
required assistance for activities of daily living. The
patient had frequent uncontrolled diarrhoea stools and
the nurse provided excellent care to maintain cleanliness
and comfort. Following one episode of cleaning the
patient and changing the bed linen, the nurse
immediately went to a second patient to provide care
with Foleys catheter. The nurse’s hands were not
washed before assisting the second patient.
Cont......
 Infection Agent
(Escherichia coli)

 Reservoir
(Large intestine: E.coli, bacteria in the large intestine of
human forms the greater part of the normal intestinal
flora)

 Portal of Exit
(E.coli exited the body in feces)
 Cont........
 Mode of Transmission
The nurse removed the contaminated linen from the bed.
The E.coli organism contaminated the hands of the
nurse who then provided morning care to another
patient.

 Portal of Entry
The second patient receiving care had a Foley catheter.
The nurse manipulated the tubing attached to the
catheter. The E.coli organism on the nurse’s hands
contaminated the catheter tubing and ascended to the
patient’s meatus and then into the urinary bladder.
 Cont.....

 Susceptible Host
The second patient with a Foley catheter. This patient was
elderly and had a chronic illness necessitating complete
bed rest. The Foley catheter contaminated by the E.coli
organism provided a direct route into the urinary bladder.
 Patient Situation 2
The Nurse Breaks the Chain
 A patient assigned for morning care has an
open wound on her left lower leg. The wound
is draining and when last cultured, the micro
organism MRSA was identified.
 In preparation of bed making, hands of the
nurse were washed, clean linen and a bag for
soiled linen were gathered from the linen
room and placed on the patient’s clean bed
side stand.
To remove the soiled linen from the
bed, following procedure was followed:
 Hands washed
 Gloves worn
 Each side of the soiled linen ends folded
towards the middle of the bed
 Soiled linen held away from the nurse’s clean
uniform
 Soiled linen placed in the linen bag for later
discard
 Protective gloves removed.
Cont....

 Infection Agent
MRSA

 Reservoir
(Patient’s infected wound)

 Portal of Exit
(Draining from the open wound)
Cont.......

BREAK IN THE CHAIN

Nurse used proper hand washing techniques,
worn protective gloves and properly handled
the linen.
Mode of transmission

 MRSA commonly transferred on hands of the

nurse by indirect contact.

 BREAK IN THE CHAIN

Proper hand washing, gloving and handling of
linen
Portal of Entry

BREAK IN THE CHAIN

Organisms isolated with use of medical asepsis
and body substance isolation.
Isolation

 Isolation refers to the precautions that are

taken in the hospital to prevent the spread of
an infectious agent from an infected or
colonized patient to susceptible person.
Purpose

 Isolation practices are designed to minimize

the transmission of infection in the hospital,
using current understanding of the way
infections can transmit.
 Isolation should be done in a user friendly,
well accepted, inexpensive way that interferes
as little as possible with patient care,
minimizes patient discomfort, and avoids
unnecessary use.
 Standard Precautions
 Standard precautions define all the steps that should be
taken to prevent spread of infection from person to
person when there is an anticipated contact with:
 Blood
 Body fluids
 Secretions, such as phlegm
 Excretions, such as urine and feces whether or not
contain visible blood.
 Non- intact skin, such as an open wound
 Mucous membranes, such as the mouth cavity.
Standard precautions includes the use of one
or combinations of the following practices:
 Hand washing, the most important infection
control method
 Use of latex or other protective gloves.
 Masks, eye protection and/ or face shield.
 Gowns
 Proper handling of soiled patient care
equipment
 Proper environmental cleaning
Cont..........

 Minimal handling of soiled linen

 Proper disposal of needles and other sharp
equipment.
 Placement in a private room for patients who
cannot maintain appropriate cleanliness or
contain body fluids.
Transmission Based Precautions

 Transmission based precautions may be

needed in addition to standard precautions
for selected patients who are known or
suspected to certain infections.
 These precautions are divided into three
categories that reflect the differences in the
way infections are transmitted.
 Some diseases may require more than one
isolation category.
Airborne Precautions
 Airborne precautions prevent diseases that
are transmitted by minute particles called
droplet nuclei or contaminated dust particles.
 These particles because of their size, can
remain suspended in the air for long periods
of time; even after the infected person has
left the room.
 Examples of diseases requiring these
precautions are tuberculosis, measles and
chickenpox.
Cont........
 A patient needing airborne precautions should be
assigned to a private room with special ventilation
requirements.
 The door to this room must be closed at all
possible times. If a patient must move from the
isolation room to another area of the hospital, the
patient should be wearing a mask during the
transport.
 Any one entering the isolation room to provide
care to the patient must wear a special mask
called respirator.
Droplet Precautions

 Droplet precautions prevent the spread of organisms that

travel on particles much larger than the droplet nuclei.

 These particles do not spend much time suspended in

the air, and usually do not travel beyond a several foot
range from the patient. These particles are produced
when a patient coughs, talks or sneezes.

 Examples of diseases requiring droplet precautions are

meningococcal meningitis (a serious bacterial infection
of the lining of the brain), influenza, and mumps.
Cont.......
 Patients who require droplet precautions
should be placed in a private room or with a
roommate who is infected with the same
organism.
 The door to the room may remain open.
Health care workers will need to wear masks
within 3 ft of the patient.
 Patients moving about the hospital away from
the isolation room should wear a mask.
Contact Precautions

 Contact precautions prevent spread of organisms from

an infected patient through direct (touching the patient)
or indirect (touching surfaces or objects that have been
in contact with the patient) contact.
 Examples of patients who might be placed in contact
precautions are those infected with:
 Hepatitis A
 Scabies
 Lice
Cont.........

 This type of precautions requires the patient

to be placed in a private room or with a
roommate who has the same infection.
 Health care workers should wear gloves
when entering the room. They should change
their gloves if they touch material that
contains large volumes of organisms such as
soiled dressings.
Psychological Effect

 Strict adherence to basic techniques such as

hand washing, wearing barrier gloves and
protective isolation provides the foundation
for life saving measures.
 However, the physical protection gained from
barrier isolation may have a negative
psychological impact on the patient.
Cont........

 Many principles of infection control limit contact

between the nurse and patient. Wearing barrier
gloves for example, prevents direct physical
contact through touch and may cause an
individual to feel dirty or contaminated.
 Protective isolation, one form of isolation, limits
contact with health care workers and visits from
family and friends. Protective isolation often
results in feeling of loneliness and interferes in
needed emotional support.
Nursing interventions

 The knowledgeable nurse balances the

principles of asepsis, standard precautions
and psychological support.
 Knowledge of the infectious agent allows the
nurse to use protective measures without
isolating the patient beyond what is
necessary.
Cont....
 The nurse recognizes the importance of
interaction in maintaining psychological
health and therefore provides appropriate
contact within safe limits.
 For example, nurses wear barrier gloves
when handling moist body secretions.
However, holding a hand without the barrier
glove to provide psychological comfort is, in
most situations , an acceptable and important
intervention as well.
Cont.......

 Psychological support for the patient in

isolation comes in many forms , such as
allowing an individual to express feelings
about the constraints of isolation and
providing information about the purpose of
barrier techniques.
 The nurse provides psychological support
through the development and maintenance of
an effective nurse-patient relationship.
Cont......

 Prior to leaving the room, health care workers

should remove the gloves and wash their
hands with medicated soap. In addition, they
may need to wear protective gowns if there is
a chance of contact with potentially infective
materials such as diarrhea or wound
drainage that cannot be contained or if there
is likely to be extensive contact with the
patient or environment.
Cont.........

 Patient care limits, such as stethoscope, that

are used for a patient in contact precautions
should not be shared with other patients
unless they are properly cleaned and
disinfected before reuse. Patients should
leave the isolation room infrequently.
Sterile field

 “An area in which no visible microbes exist.”

Sterile Technique
 “Use only sterile materials in a sterile field.”
Principles of Sterile Technique
 Sterile items only used within a sterile field.
 Ensure that the item being opened is sterile
by :
 Checking the integrity of the package
 Checking the expiration date
 Checking the colour of the sterilization
indicator tape
 If a sterile package falls to the floor, it must
be discarded
Cont......

 Only the top of a sterile, draped table is

considered sterile; the edges and sides of the
drape extending below the table level are
considered unsterile.
 Anything that drops below the level of the
table surface is considered unsterile and
must be discarded.
Persons who are Sterile touch only sterile items; Persons
who are not sterile touch only unsterile items or areas.

 The sterile team members maintain contact with the

sterile field by means of sterile gowns and gloves.
 The circulating nurse does not directly contact the sterile
field.
 Supplies for sterile team members reach them by means
of the circulating nurse opening the wrappers on sterile
packages.
 Circulating nurse should face the sterile field when
passing with a safety margin of at least six inches
Cont.....

 Unsterile persons avoid over a sterile fied;

sterile person avoid leaning over an unsterile
area.
 Unsterile persons face and observe a sterile
area when passing it to ensure they do not
touch it.
 The edges of any thing that encloses sterile
contents are considered unsterile.
References

 Erb, G & kozier, B (1995). Fundamental of

nursing Concepts, Process and practice(5th
ed) :addison- Wesly.