ASEPSIS Scrub nurse

					ASEPSIS


   PRPD/CIN2/2007
         ASEPSIS


 The term asepsis means the
 absence of disease-producing
 microorganisms
          Concept of Asepsis
 The nurse’s efforts to minimize the onset &

  spread of infection are based on the
  principles of aseptic technique.



 Aseptic technique is an effort to keep the
  client as free from exposure to infection-
  causing pathogens as possible.
                   Definition
 Aseptic technique is the effort taken to keep the
  patient as free from hospital micro-organisms as
  possible (Crow 1989).

 It is a method used to prevent contamination of
  wounds & other susceptible sites by organisms
  that could cause infection.

 This can be achieved by ensuring that only
  sterile equipment & fluids are used during
  invasive medical & nursing procedures.
     Types of Asepsis Technique
 There are two types of asepsis:

  Medical asepsis & Surgical asepsis.



 Medical or Clean Asepsis reduces the number of
  organisms & prevents their spread.
   Surgical or Sterile Asepsis or
        Sterile Technique

 includes procedures used to eliminate micro-

  organisms from an area & is practiced by
  nurses in OTs, labour & delivery area, major
  diagnostic areas & Rx areas.
              Medical Asepsis

 During daily routine care, the nurse uses basic
  medical aseptic techniques to break the
  infection chain.

 Eg.of medical asepsis are changing client’s bed

  linen daily, handwashing, barrier techniques, &
  routine environmental cleaning.
Cont…

 Follow Isolation technique as appropriate.


 Clients with high susceptibility to infection
  require special precautions to prevent
  exposure to pathogens.
Cont…

 In medical asepsis, an area or object is
  considered contaminated only if it is
  suspected of containing pathogen (e.g., used
  bedpan, the floor & a wet piece of gauze).
               Surgical Asepsis

 Sterilization destroys all microorganisms & their spores.

 Surgical asepsis demands the highest level of aseptic
  technique & requires that all areas be kept as free as
  possible of infectious micro-organisms.
Cont…

 These techniques can be practiced by nurses
  in the OR (surgical incision) or at the bedside
  (e.g, inserting IV or urinary catheter &
  reapplying sterile dressings) where sterile
  instruments & supplies are used.
Cont…

 In surgical asepsis, an area or object may be
  considered contaminated if touched by an
  object that is not sterile (e.g., a tear in a
  surgical glove during a procedure, a sterile
  instrument placed on an unsterile surface).
Cont…

 The nurse working with a sterile field or with
  sterile equipment must understand that the
  slightest break in technique results in
  contamination.
  Cont…

 A nurse in an operating room follows a series of steps to
  maintain sterile techniques, including applying a mask,
  protective eyewear, and a cap; performing a surgical
  hand washing; & applying a sterile gown & gloves.
Cont…

 Effectiveness of aseptic practices depends on
  the nurse’s conscientiousness & consistency
  in using effective aseptic techniques.
Aseptic Practices
Aseptic Practices
Aseptic Practices
INFECTION CAUSE BY MICROORGANISMS


            BACTERIA
              FUNGI
            PROTOZOA
             ALGAE
             VIRUSES
      CONTROL OR ELIMINATION
       OF INFECTIOUS AGENTS
Cleansing

 Is the removal of all foreign materials such as soil & organic material

   from objects.

 Generally, cleansing involves use of water & mechanical action with

   or without detergents.

   - Disposable object has to be discarded.

   - Reusable objects must be cleansed thoroughly before disinfection

   & sterilization.
 When cleaning equipment that is soiled by
  organic material such as blood, fecal matter,
  mucus or pus, the nurse applies a mask,
  protective eyewear, & waterproof gloves.

 These barriers provide protection from
  infectious organisms.

 A brush, detergent or soap are

needed for cleaning.
Disinfection & Sterilization


 Disinfection – eliminates pathogenic
  organisms on inanimate objects with the
  exception of bacterial spore. Noninfectious
  microorganisms may or may not be killed.
 Sterilization – is the process of eliminating
  and destroying all microorganisms, including
  spores & viruses.
             DISINFECTION

 The principle of disinfection is that of

  denaturation of the bacterial cell protein.



 This process can be carried out by two
  methods:

      1. Physical        -     boiling

      2. Chemical        -     disinfectants
 Choice of method depends on:

A) Types of microorganisms

      Certain strains of bacteria are more resistant to
      destruction than vegetative forms.



B) Number of microorganisms present on articles

      The more heavily contaminated the articles are,
      the harder for destruction.
Essential factors for maximum
  effectiveness of disinfection are:-

     - Cleanliness of items

     - Unlocking all locked instruments

     - Complete immersion of articles
            Use of Disinfectants

Indications for use of Hospital Disinfectants:



  1. Disinfection of skin & mucous membranes.

  2. Disinfection of instruments & other items.

  3. Decontamination of the inanimate environment.
   Chemical Disinfectants are such as:

1. Phenolics -
    a) clear soluble fluids, e.g., 2% Printol. 1% Sudol
    b) Hexachlorophene e.g., Phisohex, Gamaphene
          - for wide range of antibacterial activity.

2. 70% - 75% Ethyl or Isopropyl Alcohol - for wide
range of antibacterial activity, most active against
TB.
  Chemical Disinfectants cont….

3. Halogens - for inactivation of viruses and anti bacterial activity
   except TB.
        a) Chlorine (hypochlorites) e.g., Milton, Eusol.
        b) Iodine.

4. Glutardehyde, e.g., Cidex - wide range of antibacterial activity, very
   effective against Hepatitis B virus. Best for heat sensitive
   instruments.
5. Quaternary ammonium compounds
     e.g., Cetrimide (Cetavlon) - good detergent
   (more active against gram +ve organisms).

6. Diguanides,
    e.g., Chlorhexidine (Hibitane)
Chlorhexidine + detergent (Hibiscrub, Savlon) -
 useful skin ‘disinfectant’. Very active against
 gram +ve organisms.
                 STERILIZATION
    This process can be carried out by 4 methods:-

 HEAT                           IRRADIATION
 - moist heat (Autoclave)        - ultra violet light
 - dry heat (Hot Air Oven)       - gamma rays/cobalt 60

 CHEMICAL                       FILTRATION
 - in solution, e.g., Ethicon    - applicable to
      Fluid, Glutaraldehyde      pharmaceutical
 - vapour, e.g.,                 laboratory where it is
      Formaldehyde               used in combination
 - gas, e.g., Ethylene           with ultra violet light.
      Oxide
     THE PRINCIPLES OF ASEPTIC
     TECHNIQUE IN WOUND CARE

 Medical Hand Washing – cleaning of trolley, opening the

  dressing pack, to cleaning the wound.

 Surgical Hand Washing – scrubbing in surgery.
Gowns & Aprons

 protective clothing is used to reduce bacterial
  spread by contact (nurse’s uniforms become
  heavily contaminated during clinical
  procedures.
 Gloves – The purpose of wearing gloves is
  both to protect the hands from contamination
  by micro-organisms and to prevent the
  transfer of micro-organisms already on the
  hands.
Single-use

 irrigation devices should not be used for
  multi-use purposes as there is potential for
  cross-infection between pts.

     e.g., IV lines & buckets.
BLOOD TRANSMISSABLE DISEASES
             &
SEXUALLY TRANSMITTED DISEASES (STDs)
            HIV Infection/AIDS
            Hepatitis B (HBV)
            Hepatitis C (HCV)
                 Syphilis
               Gonorrhoea
               Chlamydia
             Herpes Simplex
            Cytomegalovirus
 INFECTION PREVENTION MEASURES:
 Body Substance Isolation System (BSIS)
 Hand washing / Hand Scrub
     Wash hands before touching pts, before scrubbing &
 any time hands have been soiled.
 Gloves
      - put on clean gloves just before contact
 with mucous membranes & non intact skin.
      - wear appropriate gloves any time hands
 likely to have contact with moist body
 substances.
      - remove gloves immediately after task is
 completed.
Infection Prevention Measures: BSIS
 Gowns or Plastic Aprons

      Wear any time it is likely that clothing or skin will be soiled.



 Masks

      - wear in OR / sterile area

      -wear when working directly over large areas of open skin.
      - wear when it is likely that nasal & oral mucous membranes
       will be spattered with moist body substances.
Needles & Sharps

- Discard in rigid, puncture-resistant containers.

- Do not recap used needles by hand.

- Be particularly careful when manipulating
  small devices such as heparin locks.
Infection Prevention Measures: BSIS
 Room Selection

 - Assign patient with infectious disease to an individual
 OR or last on surgical list.
 Trash & Linen


 - Bag all soiled trash & linen securely.
 - Discard according to facility policy.
 - Wear gloves & protective garments when
 handling soiled linen & trash.
Infection Prevention Measures: BSIS

 Housekeeping



 - Clean all rooms on regular
 schedule.

 - Clean articles, equipment &
 furniture soiled with moist body
 substances immediately. Wear
 gloves.
 Laboratory Specimens

 - Handle all laboratory specimens with equal
 care. Special precautionary labels are
 required.
Infection Prevention Measures: BSIS


 Compliance of Care Providers
  - Develop programme to ensure that health care

      workers comply with the infection precautions
      system.
                    Remember !!!

 The nurse is responsible for providing the client with a
  safe environment.
 The nurse’s first responsibility to the client is to first do no
  harm.
 It is easy to forget key procedural steps or, when hurried,
  to take shortcuts that break aseptic procedures. However,
  the nurse’s failure to be meticulous will place the client at
  risk for an infection that can seriously impair recovery.
                                   (Florence Nightingale, 1859)


                                                      THE END

				
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