pp_medical_asepsis by liuhongmei


 An infection is the result of an
  interaction between a susceptible hose
  and an infectious agent (bacteria,
  viruses, fungi, parasites) a clinical
  syndrome caused by the invasion and
  multiplication of a pathogen in the

 Thecourse of an infection can be
 divided into four major phases:

 1. Incubation

 2. Prodromal

 2. Period of Clinical illness

 3. Convalescence
 Health Care institutions can present a danger
 in infectious disease transmission

 ‣ Nosocomial infection -   a hospital-acquired

 ‣ Iatrogenic infection – a direct result of treatments
 Goal4 of the National Patient Safety Goals
 (NPSG’s) is directed toward infection related
 sentinel events: ―Preventing health-care
 associated infections‖.

 Healthcare-associated infections are a
 serious problem and health care workers
 need to strive toward preventing the
1. Skin and mucous membrane

2. Respiratory system

3. Gastrointestinal system

4. Circulatory system
1.   Inflammatory response
       Local reaction to an infectious agent
       Serves to localize, destroy, dilute,
        neutralize, remove a pathogen
       Signs – redness, heat, swelling and pain

2. Immune response
      Immunity is a measure of a person’ s ability to
       fight disease by forming immunoglobulins (
       antibodies formed against invading antigens),
       or producing interferon.
                 Source of infection
Susceptibility                         Portal of Entry to
                                       susceptible host

   Mode of
transmission                         Reservior

                    Portal of exit
                  from Reservior

 What is the type of organism – virus, bacteria,
 fungi, parasites, etc.

 Level   of virulence

 Number     of organisms
 Eyes

 Mucous     membranes

 Respiratory   tract

 Placenta

 Breaks   in the host barriers
 Humans

 Animals

 Environmental   surfaces
 Respiratory tract
 Genitourinary tract
 Gastrointestinal tract
 Skin / mucous membrane
 Placenta
 Blood and body fluids
 Direct   contact

 Droplets

 Vectors

 Airborne
 Lack   of effective resistance

 Changes    in host defense

 Tissue   destruction
Risk for Infection RT:
The patient will:



 Although  it is impossible to ensure
 that the patient’s environment is
 free of microorganisms, there are
 many steps that a nurse can take
 to reduce the spread of
 microorganisms and thus promote
 safety for both the patient and the
 healthcare personnel.
 Goal  4
  ‣ Reduce the risk of health care–associated
 According to the Centers for Disease Control and
  Prevention, each year, millions of people acquire an
  infection while receiving care, treatment, and
  services in a health care organization.

 Consequently, health care-associated infections
 (HAIs) are a patient safety issue affecting all types
 of health care organizations.
 Thegoal of QSEN is to address the challenge
 of preparing future nurses with the
 knowledge, skills and attitudes (KSA)
 necessary to continuously improve the quality
 and safety of the healthcare systems in which
 they work.

 They have 6 competencies and Safety is one
 of the main competencies.
Infection control measures used in the
 hospital include:

 ‣ Medical Asepsis
 ‣ Standard Precautions
 ‣ Isolation Precautions
     Practicesdesigned to reduce
      the numbers of pathogenic
      microorganisms and limit
      their growth and
      transmission in the patient’s
1.   Helps the patient fight a current infection
     and prevent its spread.

2.   Prevents the patient from being re-infected
     by the same pathogen.

3.   Prevents the patient from being infected
     with a new pathogen.

4. Prevents health care professionals and
   visitors who come in contact with the
   patient from being infected.
5.   Helps decrease the chance of the patient acquiring a
     nosocomial infection.
     ◦ The infections can be simple and uncomplicated,
        or major and life threatening. Patients are at
        risk for nosocomial infection because they often
        have weakened immune systems and because
        the health care facility contains patients and
        equipment that harbor infection.

    The desired result is:

     ◦   to reduce the transmission of the
         microorganisms from one person to another.

     ◦   Or from one person to an object
The first line of defense in
medical asepsis is hand-washing.

Proper hand-washing is considered
 the single most effective way to
 stop the spread of microorganisms
 and preventing infection.
Reduction   in the
 number of
 pathogens on the
 Assess    that the fingernails are short
   Highest concentration of organisms on the
   hands are found UNDER THE NAILS.

 Jewelryshould be removed, especially
 rings with stones. Wedding bands may be
 worn sometimes.

 Skin   is free of lesions
 ‣ If the skin should have a small lesion, bandage
   the area then double glove.
 At   the start of each shift

 After   sneezing or coughing

 After   using the bathroom

 After   handling contaminated items

 Beforeand after giving patient care and between

 After   handling body excretions- even with gloves
Beforeand after performing any

After   removing gloves

At the end of each shift before
 leaving the health facility
   HANDS !
1. Hand-washing is one of the most effective
   methods of preventing the spread of

2. Usually 15 seconds should be allowed to
   wash the hands

3. Clean from the cleanest
   area to the dirtiest area

1. Friction

                                       3. Cleansing

    2. Running Water
4. These 3 are necessary to remove
5. Do not touch the sink when washing hands –
   stand away
6. Keep clean items separate from dirty ones.
7. Turn off water with a dry paper
   towel – wet acts as a wick.
8. Jewelry makes it difficult to adequately
   cleanse the hands. It is best to not wear
   jewelry in the clinical setting. Wedding
   bands are acceptable sometimes.

9. If using hand lotion—allow hands to dry
   about 30 minutes before applying. Do NOT
   apply hand lotion immediately after washing
 Alcohol-based   hand rubs (foam or gel) kill
  more effectively and more quickly than
  handwashing with soap and water.
 They are less damaging to skin than soap and
  water, resulting in less dryness and irritation.
 They require less time than handwashing with
  soap and water.
 Bottles/dispensers can be placed at the point
  of care so they are more accessible.
 HAND   RUB (foam and gel)
 ‣ Apply to palm of one hand (the amount used
  depends on specific hand rub product).

 ‣ Rub hands together, covering all surfaces,
  focusing in particular on the fingertips and
  fingernails, until dry. Use enough rub to require
  at least 15 seconds to dry.
 Bringbacterial soap and paper
  towels with you to the patient’s

 Ifno running water is available in
  the home, use disposable wipes or
  alcohol-based rubs.
Standard   Precautions are:
 ‣ Those precautions designed
   for the care of all patients
   in hospitals regardless of
   their diagnosis or
   presumed infection status.
        Standard Precautions

    of guidelines developed by the
 Set
 Centers for Disease Control and
 Prevention (CDC) for preventing
 contact with potentially infectious
 blood or body fluids that may
 harbor diseases regardless of
 whether or not they contain visible
    body fluids, secretions and excretions
 All
 regardless of whether or not they contain visible
       Sputum, saliva
       Urine
       Feces
       Nasal secretions, tears
       Vomitus
       Spinal fluid/ cerebrospinal fluid
       Synovial, pleural, peritoneal , pericardial,
        amniotic fluid
 Allmoist body surfaces, mucus membranes
 Blood
Used  for all patient’s, not just those
 with known infections

These  precautions should be
 implemented whenever contact with
 potentially infectious material is

Used   to protect the caregiver.
1. Hand-Washing
2. Personal Protective Devices
        Gloves
        Mask, Eye Protection, Face Shield, Gown
3.   Patient-care equipment
4.   Environment
5.   Linen
6.   Sharp Objects
 Hands must be washed after
 patient contact regardless of the
 use of gloves. Even if you wear
 gloves, wash your hands

       hands cannot be effectively
 Gloved
 Gloves    can be used to avoid direct contact
    with infectious material

 Wear    gloves to handle:
    ‣ Blood
    ‣ Body fluids
    ‣ Secretions, Excretions
    ‣ Contaminated items
 Change     gloves before preceding to the next
    task, or touching non-contaminated items
    even on the same patient.

 Made    of vinyl or latex -- vinyl are used
                    if allergy to latex is present.
Masks provide barrier protection against
   splashes and sprays, and airborne
Masks come in various types depending on
   their permeability to airborne particles.
Eye goggles or glasses and face shields
   provide barrier protection against
   splashes and sprays.
Gown – should be water
 impermeable to provide barrier
 Handleequipment in a manner that
 prevents personal skin and mucous
 membrane exposure and cross
 contamination to other patient’s.

 Reusable  equipment must be cleaned/
 disinfected and reprocessed before using
 it in the care of another patient.
Each  hospital, clinic has procedures
 for care, cleaning, and disinfection of
 environmental surfaces.

      of blood or body fluids need to
 be handled with special procedures.
 Handledin a way to prevent contamination of
 skin, mucous membranes, and clothing.

 Foldsoiled linen with contaminated area to
 the inside. Do not shake.

 Holdaway from body and place in
 appropriate bag and dispose
 of properly.
      all sharp objects in a
 Place
  puncture-proof container.

 Do   not re-cap needles

 Immediatelydiscard after use. Do not
 attempt to bend or break a needle before
 discarding. Throw away the whole thing.
Isolation precautions are utilized when:
 ‣ patients have a greater susceptibility to
   infection than others

 ‣ A patient or patient’s body fluids are a carrier
   of microorganisms that can easily be
   transmitted to other patients, family
   members, or health care workers.
In addition to standard precautions, the
 CDC recommends three categories of
 transmission-based precautions. They
 ‣ 1.   Airborne precautions
 ‣ 2.   Droplet precautions
 ‣ 3.   Contact precautions

The fourth type of isolation is protective
Used when the organism is capable of
 remaining in the air for prolonged periods
 of time and can be transported in the air
 for distances greater than 3 feet.

Most common organisms are:
 ‣ Tuberculosis
 ‣ Chicken pox
 ‣ Measles

Must wear a special particulate filter mask
A private negative air pressure room is
 used for patients needing airborne
 ‣ Negative air pressure rooms are used for
     patients needing airborne precautions
 ‣   Bring air into the room from the hallway and
     have a separate exhaust system.
 ‣   Outside the room is isolation cart that contains
     supplies needed to care for the patient and
     protects persons entering the room.
 Caring   for the patient in isolation
 ‣ Personal Care - **Remember it is the disease
   that is being isolated, not the patient.
   Place linens in proper contaminated –waste
   container, and soiled paper towels in an
   isolation waste container.
 ‣ Food Service – disposable paper trays and
   disposable dishes that are discarded in proper
   isolation waste container. Do not put tray
   back on the food cart.
 ‣ Contaminated articles – according
  to agency policy, usually double
  bagged or color-coded waste
  bags to indicate contaminated waste.
    patients on airborne precautions should
 All
 wear surgical
 masks when leaving
 the negative air
 pressure room for
 x-rays, tests, or
 Organisms  that can be spread by large
  airborne droplets through the air but are
  unable to remain in the air further than 3
 Examples of organisms include:
 ‣ Influenza
 ‣ Cold
 ‣ Meningitis
 ‣ Mumps
 ‣ Pertussis
 Single rooms are preferable
 Patients with same disease can share
  the same room
 Standard surgical masks without a filter
  must be worn for anyone coming
  within 5 feet of the patient.
 Gowns should be worn if clothing or
  uniforms are likely to become
  contaminated with respiratory
 Gloves should be worn anytime
  handling tissues or items contaminated
  with the respiratory secretions
 Purposeis to prevent the transmission of
 disease by direct or indirect contact
 ‣ Direct contact involves:
   Touching
   Bathing
   Skin-to-skin contact
 ‣ Indirect contact involves:
   Contact with inanimate objects – doorknobs, light
    switches, tabletops, telephones
 Examples of diseases are: staph, herpes,
 diphtheria, and many others
 Contact precautions include use of barrier
  precautions such as gloves and
  impermeable gowns to prevent direct
  contact with infectious organism
 Used:
 ‣ For patient with diarrhea
 ‣ When coming into contact with draining wounds
 ‣ Patients with acquired antibiotic resistance
 Youhave gone in Mr. A.’s room to perform a
 dressing change.

 What   type of isolation is he in?

 Whatequipment would you use?
 ‣ A. Gloves only
 ‣ B. Gloves and gown
 ‣ C. Gloves, gown, and mask
     with patients who are
 Used
 immunocompromised such as:
 ‣ Chemotherapy
 ‣ Organ transplants
1.   __   Influenza             A. Airborne
2.   __   Diarrhea              B. Droplet
3.   __   Tuberculosis          C. Contact
                                D. Protective / Strict
4.   __   AIDS
5.   __    Chicken pox
6.   __    Draining wound
7.   __    Chemotherapy pt’s
 Mrs.   B. is on airborne isolation.

 What specific equipment is used in airborne
 isolation that is not used in other types of
 When   would the nurse apply goggles
          or a face mask?

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