Documente Academic
Documente Profesional
Documente Cultură
Terms
Infection
An invasion of the body tissue by
microorganisms and their
proliferation there
Asepsis
The absence of disease-producing
microorganisms Being free from
infection
Medical Asepsis
Practices designed to reduce the
number and transfer of pathogens
Clean technique
Surgical Asepsis
Practices that render and keep
objects and areas free from
microorganisms Sterile technique
Sepsis
The presence of infection
Septicemia
Transport of 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
Contact
A person or animal known or
believed to have been exposed to a
disease
Reservoir
The natural habitat for the growth
and multiplication of
microorganisms
Transient flora or bacteria
The microorganism picked up by the
skin as a result of normal activities
that can be removed readily
Resident flora or bacteria
The microorganism that normally
live on a persons skin
Sterilization
The process by which all
microorganisms including their
spores are destroyed
Disinfectant
A substance, usually intended for use
on inanimate objects, that destroys
pathogens but generally not the
spores
Antiseptic
A substance, usually intended for use
on persons that inhibit the growth of
pathogens but not necessarily destroy
them
Bactericidal
A chemical that kills microorganisms
Bacteriostatic
An agent that prevents bacterial
multiplication but does not kill all
forms of organisms
Contamination
The process by which something is
rendered unclean or unsterile
Disinfection
The process by which pathogens but
not their spores are destroyed from
inanimate objects
Communicable Disease
Results if the infectious agent can be
transmitted to an individual by direct
or indirect contact through a vector
or vehicle, or as an airborne infection
Infectious Disease
Results from the invasion and
multiplication of microorganisms in
a host
Pathogen
A disease-producing microorganism
Pathogenecity
The ability to produce a disease
1
ASEPSIS AND INFECTION CONTROL
Virulence
The vigor with which the organism
can grow and multiply
Specificity
The organisms attraction to a
specific host, which may include
humans
Opportunistic Pathogen
Causes disease only in susceptible
individual
Nosocomial Infection
Hospital-acquired infection
Isolation
The separation of persons with
communicable diseases from other
persons so that their direct/indirect
transmission to susceptible persons is
prevented
Isolation Techniques
Practices designed to prevent the
transfer of specific microorganisms
Etiology
The study of causes
In this state, the microorganisms may grow and multiply but do not cause disease
Infection occurs when newly introduced or resident microorganisms succeed in
invading a part of the body where the hosts defense mechanisms are ineffective
and the pathogen causes tissue damage.
The infection becomes a disease when the signs and symptoms of the infection are
unique and can be differentiated from other conditions.
INFECTION
is a disease state that results from the presence of pathogen (disease producing
microorganisms) in or on the body
- Occurs as a result of cyclic process, consisting of six components (chain of infection)
TYPES OF INFECTION:
1. LOCAL INFECTION is limited to the specific part of the body where the
microorganisms remain
2. SYSTEMIC INFECTION the microorganisms spread and damage different parts of the
body.
ACUTE INFECTION generally appears suddenly or last a short time
CHRONIC INFECTION may occur slowly, over a long period of time, and may last
months or years
2
ASEPSIS AND INFECTION CONTROL
THE
CHAIN
OF
INFECTI
ON
(2) Reservoir
(source):
Human beings,
animals,
inanimate objects, plants,
general environment such as air,
CHAIN OF INFECTION
3.
4.
a.
Direct contact
- involves immediate and direct transfer from person to person (body surface to
body surface) through touching, biting, kissing, or sexual intercourse
Indirect
contact
- occurs when susceptible host is exposed to a
a. A host is a person who is at risk for infection; whose own body defense
mechanisms, when exposed, are unable to withstand the invasion of
pathogens
Blood
Tissue
Salmonella Species
Clostridium difficile
Escherichia coli
enterococci
Pseudomonas
aeroginosa
Neisseria gonorrhoeae
Treponema pallidum
Herpes simplex virus
type 2 Hepatitis B virus
(HBV)
Hepatitis B virus
Human Immunodeficiency
virus (HIV)
Staphylococcus
aureus
Staphylococcus
epidermis
The vagina also has natural defenses against infection. When a girl reaches puberty,
lactobacilli ferment sugars in the vaginal secretions, creating a vaginal pH of 3.5 to 4.5.
This low pH inhibits the growth of many disease producing microorganisms. These
include Staphylococcus epidermis coagulase (from the skin) and Escherichia coli (from
feces). It is believed that the urine flow has a flushing and bacteriostatic action that keeps
the bacteria from ascending the urethra. The intact mucosal surface also acts as a barrier.
b. Inflammation
- is a local and nonspecific defensive response of the tissues to an injurious or infectious
agent. It is an adaptive mechanism that destroys or dilutes the injurious agent, prevents
further spread of the injury, and promotes the repair of damaged tissue.
It is characterized by five signs: 1. Pain, 2. Swelling, 3. Redness, 4. Heat, 5.
Impaired function of the part.
1
1
1
2
The nature and amount of exudates vary according to the tissue involved and the
intensity and duration of the inflammation. The major types of exudates are serous,
purulent, and hemorrhagic (sanguineous).
c. REPARATIVE PHASE
The third stage of the inflammatory response involves the repair of injured tissues
by regeneration or replacement with fibrous tissues (scar) formation.
Regeneration is the replacement of destroyed tissue cells by cells that are identical or
similar in structure and function.
Damaged cells are replaced one by one but also cells are organized so that the
architectural pattern and function of the tissue are restored. The ability to regenerate
cells varies considerably from one type of tissue to another. For example epithelial
tissues of the skin and of the digestive and respiratory tracts have a good regenerative
capacity, if their underlying support structures are intact.
When regeneration is not possible, repair occurs by fibrous (scar) tissue formation.
The inflammatory exudate with its interlacing network of fibrin provides the
framework for this tissue to develop. Damaged tissues are replaced with the
connective tissue elements of collagen, blood capillaries, lymphatics, and other
tissue bound substances.
In the early stages of this process, the tissue is called granulation tissue. It is a
fragile, gelatinous tissue, appearing pink or red because of the many newly formed
capillaries. Later in the process, the tissue shrinks ( the capillaries are constricted,
or even obliterated) and the collagen fibers contract, so that a firmer fibrous tissue
remains. This is called cicatrix, or scar.
1
3
1
4
a. Natural
- Antibodies are transferred from the mother to her newborn through the placenta or in the
colostrums
b. Artificial
- Immune serum (antibody) from an animal or another human is injected to a
person. (e.g. tetanus immunoglobulin human (TGIH)).
TYPES OF IMMUNIZATION
TYPE
DURATION
1. ACTIVE
a. Natural
b. Artificial
Long
Lifelong
2. PASSIVE
a. Natural
Antibodies are produced by another source, animal or human.
Antibodies are transferred naturally from an immune mother to
babythe placenta or in colostrums
b. Artificial her
through
Immune serum (antibody) from an animal or another human is
injected.
Short
6months to 1
year
2 to 3 weeks
1
5
1
6
Sterilization
The complete destruction of all microorganisms, including spores, leaving no viable
forms of organisms.
These are used for instruments and equipment such as glass thermometer.
Chlorine is used for disinfecting water.
5. Boiling Water
This is least expensive for use in home.
Items like glass baby bottles should be boiled for at least 15 minutes.
TYPES OF DISINFECTION
1. Concurrent Disinfection
in the care of the client, his supplies, his immediate environment, to limit/Ongoing
practices that are observed control the spread of microorganism
2. Terminal Disinfection
Practices to remove pathogens from the clients belongings and his immediate
environment after his illness is no longer communicable
MEDICAL ASEPTIC PRACTICES TO BE IMPLEMENTED DURING CLIENT
CARE
Wash hands frequently, especially:
before handling foods
before and after using the toilet
before and after performing nursing procedures
before and after each patient contact
Keep soiled items/equipment from touching the clothing's.
Instruct client to cover mouth and nose when coughing and sneezing.
Avoid raising dust; do not shake linens
Clean least contaminated areas first then move to more contaminated areas.
Practice segregation of wastes.
Sterilize objects suspected of containing pathogens.
Use practices of good personal hygiene to help prevent spread of microorganisms.
3. USE OF BARRIERS
Techniques that prevent the transfer of pathogens from one person to another are
referred to as barriers.
The most commonly used barriers are as follows:
Masks
Caps and shoe coverings
Gloves
Private rooms
Waterproof disposable bags for linen and thrash
Labeling and bagging of contaminated equipment and specimens
Control of airflow into the sterile areas and out of contaminated areas
Goggles or face shield.
Masks
Masks should fit tightly to the face, covering the nose and the mouth.
Masks lose their effectiveness if they are wet, worn for long periods, and when they
are not changed after caring for each client.
Disposable particulate respirators look like masks but fit the face more tightly and are
able to filter out particles or organisms as small as 1 micro millimeter. These are
indicated whenever a caregiver is working with a client who has, or is suspected of
having contagious airborne diseases such as tuberculosis.
Gowns
Gowns should be worn when caregivers clothing is likely to be soiled by infected
material.
Use gowns only once and discard them.
Change gowns when it becomes wet.
Caps and Shoe Coverings
Caps are used to cover the hair, and special covers are available for shoes.
These shield body parts from accidental exposure to contaminated body secretions.
Gloves
Gloves protect the hands for acquiring infective organisms.
These reduce likelihood of transmission of microbial flora from personnel to clients or
from client to other clients.
Gloves should be changed and discarded between clients or when they become torn or
grossly soiled.
Hands are washed and dried before and after removing gloves.
Gloves should not be washed and reused.
*Note: Never touch with bare hands anything that is wet coming from a body surface.
Private Rooms
Separation of clients into private rooms decreases the chance of transmission of infection
by all routes.
If this is impossible, a client with an infection may be placed in the same room as
another client who is infected with the same microorganisms, as long as they are not
infected with other potentially transmissible microorganisms and the likelihood of
reinfection with the same microorganisms is minimal.
If transport to another department is necessary, clients gowns and dressings should be
changed before leaving the room and the client should wear necessary barriers such as
mask or gown.
c. Hazardous Waste
- Radioactive materials
-chemotherapy solutions and their containers and other caustic chemicals
Recommendations for waste disposal are as follows: incineration or autoclaving of
infectious wastes before disposal in sanitary landfill; liquid body fluids (blood, urine,
aspirated body fluids) can be flushed down a drain connected to a sewer system; use
separate containers, clearly marked Biohazard, for infectious waste, such as blood
contaminated items.
Most healthcare agencies use color code for segregation of waste:
BLACK trashcan - for wet; biodegradable items
YELLOW trashcan for dry, non biodegradable/ recyclable items.
4. ISOLATION SYSTEMS
ISOLATION refers to techniques used to prevent or to limit the spread of infection.
Isolation precautions are classified as: Standard precautions, Transmission
based precautions, and Protective isolation.
1. STANDARD PRECAUTIONS
Synthesize the major features of Universal Precautions and Body substance
Isolation.
These precautions are intended to prevent transmission of blood borne and
moist body substance pathogens.
A. Wear clean gloves when touching
Blood, body fluids, secretions and excretions, and items containing these body
substances.
Mucous membrane
Nonintact skin
B. Perform hand washing immediately
When there is direct contact with blood, body fluids, secretions and excretions, or
contaminated items.
After removing gloves.
Between patient contacts.
C. Wear a mask, eye protection and face shield during procedures and patient care activities
that are likely to generate splashes or sprays of blood, body fluids, secretions, and
excretions.
D. Wear a cover gown during procedures and patient care activities that are likely to generate
splashes or sprays of blood, body fluids, secretions or excretions, or cause soiling of clothing.
E. Remove soiled protective items promptly when the potential for contact with reservoir of
pathogens is no longer present.
F.Clean and reprocess all equipment before reuse by another patient.
G. Discard all single use items promptly in appropriate containers that prevent contact with
blood, body fluids, secretions and excretions, contamination of clothing, or transfer to other
patients and the environment.
H. Prevent injuries with used needles, scalpels, and other sharp devices by:
Never removing, recapping, bending or
breaking used needles. Note: never recap
needles. Use your needle disposal container.
Never pointing needle toward a body part.
Using a one handed scoop method, special syringes with a retractable protective
guard or shield for enclosing a needle, or blunt point needles.
Depositing disposable and reusable syringes and needles in puncture resistant
containers.
I. Use a private room or consult with an infection control professional for the care of the
patients who contaminate the environment or who cannot or do not assist with
appropriate hygiene or environmental cleanliness measures.
2. TRANSMISSION BASED PRECAUTIONS
A. Airborne Precautions these are used for microorganisms transmitted by small particle
droplets that can remain suspended and become widely dispersed by air currents.
Examples: TB, Varicella, measles(rubeola)
The client should be cared for in a private, negative airflow room, to contain the air
within the clients unit.
Caregivers are to wear masks; the client should wear mask when transported out of
the room.
B. Droplet Precautions these are used for microorganisms transmitted by large particle
droplets, (through coughing, sneezing or talking) which disperse into air currents.
Examples: Haemophilus, influenza, diphtheria, rubella, mumps, mycoplasma pneumonia,
pertussis, streptococcal pharyngitis, or scarlet fever in infants and young children.
The client should be in private room.
The caregivers are to wear masks when working within 3 feet of the client.
The client should wear mask when outside the room.
Limit movement of client outside the room to essential purposes. Place surgical
mask on the client during transport.
C. Contact Precautions these are used with organisms that can be transmitted by hand or
skin to skin contact, such as during client care activities or when touching the clients
environmental surfaces or care items. Examples: clostridium difficile, shigella, impetigo,
wound infections.
The client is cared for in a private room or has a roommate who is infected with
the same organism (cohabitation).
Personnel use gloves before entering the room and change gloves when exposed to
potentially infected material during care delivery.
Remove gloves before leaving the clients room.
3. PROTECTIVE ISOLATION
An object is considered sterile only for a specified period. Items that have
passed the expiration date are considered unsterile.
3. Always face the sterile field.
Rationale: Objects are out of the line of vision may be inadvertently contaminated.
4. Sterile articles may touch only sterile articles or surfaces if they are to maintain their
sterility.
Rationale: Anything considered unsterile may transfer microorganisms to the sterile
object it touches. An object used in cleaning the skin (e.g. swabs) must be used once and
then discarded because the skin cannot be sterilized.
5. Sterile equipment or areas must be kept above the waist and on top of the sterile field.
Drapes hanging over the edge of the table are not considered sterile.
Rationale: Waist level is the limit of good visual field. Maximum visibility of all
sterile objects prevents inadvertent contamination.
6. Prevent unnecessary traffic and air currents around the sterile area.
Close doors.
Unfold drapes or wrappers slowly.
Do not sneeze, cough, or talk excessively over the sterile field.
Do not reach across sterile fields.
Move around a sterile field to reach for an
object, if necessary. Rationale:
Microorganisms cannot be completely excluded from the air.
Overreaching across sterile fields will render sterile objects unsterile.
7. Open, unused sterile articles are no longer
sterile after the procedure. Rationale:
Once protective wrapping have been removed, the article is being contaminated
by air so, it must be discarded or desterilized before it is used.
Liquids opened during the procedure that remain in their original container
are also considered contaminated.
8. A person who is considered sterile who becomes contaminated
must reestablish sterility. Rationale:
If a scrubbed person punctures the gloves or is contaminated by touching
an unsterile object, he or she must change the contaminated article.
If a scrubbed person leaves the area of the sterile field, he or she
must go through the procedure of rescrubbing, gowning and gloving.
9. Surgical technique is a team effort.
A collective and individual sterile conscience is the best method of enhancing
sterile technique. Rationale:
Staff members must rely on one another to maintain sterile technique.
Periodic review of procedures and infection control surveillance reports
enhance everyones sterile technique.
26
ASEPSIS AND INFECTION CONTROL
Steps:
a. Applying Gloves
1. Wash hands.
Rationale: Clean hands reduce the number of microorganisms that could be transmitted if
gloves accidentally puncture or tear.
2. Peel off outside wrapper as directed by manufacturer (peel sides apart).
Rationale: This protects inner package from inadvertently opening and contaminating the
gloves.
3. Lay inner package on clean, flat surface about waist level. Open wrapper from the outside,
keeping gloves on inside surface.
27
ASEPSIS AND INFECTION CONTROL
Rationale: Objects below waist level are considered contaminated. Inner surface of
wrapper is considered sterile.
4. Grasp first glove by inside edge of cuff with thumb and first two fingers of the dominant
hand. Hold hands above waist; insert non dominant hand into glove. Adjust fingers inside
glove after both gloves are on. Rationale: Objects below waist level are considered
contaminated. Inner surface of wrapper is considered sterile.
5. Grasp first glove by inside edge of cuff with thumb and first two fingers of the dominant hand.
Hold hands above waist; insert non dominant hand into glove. Adjust fingers inside glove
after both gloves are on. Rationale: Inner folds of cuff unfold against skin of hand and are not
sterile once applied. Contamination occurs if ungloved hand contacts gloved hand.
6. Slip gloved hand (four fingers with thumb up) underneath second gloved cuff and pull over
dominant hand. Rationale: Sterile cuff protects fingers of gloved hand from being
contaminated.
Note: Put on gloves on the nondominant hand first, then on the dominant hand.
7. Keeping hands above waist, adjust glove fit, touching only sterile areas.
Rationale: This prevents potential contamination while ensuring a smooth fit over fingers.
B. Removing Gloves
8. Wash gloved hands first.
Rationale: To reduce the number of microorganisms that could contaminate the hands.
9. With dominant hand, grasp outer surface of non dominant glove just below thumb. Peel off
glove inside out, without touching exposed wrist. Rationale: After use, outer surface of
gloves is contaminated and could transfer microorganisms to the nurses wrist.
10. Place ungloved hand under thumb side of second cuff and peel off toward the fingers
holding first glove inside second glove. Discard into appropriate receptacle.
Rationale: folding contaminated glove surfaces toward the inside minimize the
chance of transfer of microorganisms.
Note: Use glove to glove, skin to skin technique when removing gloves.
11. Wash hands.
Safety Alert: Wash hands before and after removing gloves to prevent contamination of
hands.
DONNING A STERILE GOWN AND CLOSED GLOVING
Purpose: To apply attire necessary to safely carry out sterile procedures usually in the
operating room and delivery room.
Equipment:
Sterile gown
Sterile Gloves
Mayo stand or flat surface area above waist level
Steps:
28
ASEPSIS AND INFECTION CONTROL
1. Wear shoe covers, cap that covers all hair, face mask and protective eye wear (ideally) and
perform surgical scrub.
Rationale: The gown and gloves should be donned last, because it is the most important for
them to be sterile.
a. DONNING A STERILE GOWN
2. Grasp folded sterile gown at the neckline and step away from the sterile field. Allow gown
to gently unfold, being careful that it does not touch the floor. The inside of the gown is
toward the user.
Rationale: Maintains sterility of the gown and positions it for donning.
3. Holding the arms at shoulder level, grasp the sterile gown just below the neckband near
the shoulders and slide arms in the sleeves until the fingers are at the end of the cuffs but
not through the cuffs.
Rationale: the fingers remain in the cuffs to protect the sterility of the gown and prepare for
closed gloving.
4. Have someone tie the back of the gown, taking care that only the ties are touched and not the
sides or front of the gown.
Rationale: Maintains sterility of the gown. Gowns are considered sterile in the front from
the shoulder to the table level, and sleeves are considered sterile from 2 inches above the
elbow to the wrist.
b. CLOSED GLOVING
5. With fingers still within the cuff of the gown, open the inner sterile glove package and pick
up the first glove by the cuff, using the nondominant hand.
Rationale: Maintains sterility of the glove.
6. Position the glove over the cuff of the gown so the fingers are in alignment, and stretch the
entire glove glove over the cuff of the gown, being careful not to touch its edge. Fingers
remain within the cuff of the gown. Rationale: Maintains sterility of the glove.
7. Work the fingers into the glove and pull the glove up over wrist with the non dominant hand
that still remains within the cuff of the gown.
Rationale: Maintains sterility of the glove. Use the sterile gloved hand to pick up the second
glove, placing it over the cuff of the gown of the other hand and repeat the glove application
process.
Rationale: Maintains sterility of the glove.
8. Adjust gloves for comfort and fit, taking care to keep gloved hands above waist
level at all times. Rationale: If gloved hands fall below waist level, they are no
longer sterile.
DONNING AND REMOVING GLOVES, MASKS, GOWNS, AND EYEWEAR
29
ASEPSIS AND INFECTION CONTROL
For sterile procedures on a general nursing division, the nurse may wear surgical
mask and gloves without a cap. Eyewear is ideally worn if there is risk of fluid or
blood splashing into the nurses eyes.
For sterile surgical procedures, the nurse first applies a clean cap that covers all of
the hair and then surgical mask, eye wear, and shoe cover.
A mask must fit snugly around the face and nose to prevent contamination by droplet
nuclei.
To remove protective devices: remove gloves first, then the mask,
The gown, the eye wear or goggles, cap and shoe cover. Removing the
gloves first prevents contamination of the hair, neck, and facial area.
30
ASEPSIS AND INFECTION CONTROL
5. Touching the outside of the flap, reach around (rather than over) the sterile field to open the
flap away from you. Rationale: Maintains sterility of the field.
6. Open the side flaps in the same manner, using the right hand for the right flap and the left
hand for the left flap.
Rationale: This maintains sterility by avoiding crossing over the field.
7. Open the innermost flap that faces you, being careful that it does not touch your clothing
or any object. Rationale: Maintains sterility of the field.
c. ADDING STERILE SUPPLIES TO THE FIELD
8. Open unsealed edge of prepackaged supplies, taking care not to touch the supplies
with the hands. Rationale: Maintains sterility of the supplies.
9. Hold supplies 10 12 inches above the field and allow them to fall to the middle of
the sterile field. Rationale: Ensures that sterile supplies are placed within the sterile
field.
10. Wrapped sterile supplies are added by holding the sterile object with one hand and
unwrapping the flaps with the other hand. Carefully drop the object onto the sterile field.
Rationale: Maintains sterility of the object and the field.
d. POURING SOLUTIONS TO A STERILE FIELD
11. Check the label and expiration date of the solution. Note any signs
of contamination. Rationale: Ensures that the correct solution is used
and that it is sterile.
12. Remove cap and place it with the inside facing up on a flat surface. Do not touch
inside of cap or rim of bottle.
Rationale: Maintains sterility of the solution and the field.
13. Pour a small amount of solution into a sink or waste container to rinse the rim of the
container (this is done when pouring weak solutions like sterile normal saline solution,
distilled water).
Rationale: This ensures sterility of the solution.
14. Hold bottle 6 inches above receptacle on the sterile field and pour slowly to
avoid spills. Rationale: Spilling fluid on the sterile field results in
contamination because a wet surface allows microorganisms to transfer from
the flat surface which is not sterile.
15. Recap the solution bottle, place it outside the sterile field and label it with date and
time of opening if the solution is to be reused.
Rationale: Keeps solution in the bottle sterile and avoids use of solution that has passed
expiration date.
31
ASEPSIS AND INFECTION CONTROL
16. Add any additional supplies and don sterile gloves before starting the procedure.
Rationale: Donning sterile gloves just prior to beginning the procedure helps to ensure
sterility.
32
ASEPSIS AND INFECTION CONTROL
33
ASEPSIS AND INFECTION CONTROL
8. Return forceps to the container, without touching the tips to the rim or part of the container
not immersed in disinfectant.
Rationale: This maintains sterility of the forceps.
34
ASEPSIS AND INFECTION CONTROL