ASEPSIS

1
ASEPSIS
By Purwaningsih
2
Learning Objectives

• Be able to state the requirements for clean,
  aseptic or sterile technique recommended for
  common procedures
• Demonstrate use of the SCRIPT method to prepare
  for and carry out procedures
• Be able to demonstrate aseptic and sterile
  technique for 4 procedures

3
Nosocomial Infections

• Worldwide Problem
• Acquired in health care facilities
• Cost is in the billions for extended
• care and treatment
• A Leading cause of death
• Spread by health care workers who fail to wash
  hands or change gloves

4
Airborne Transmission

• Agent Transferred by droplet nuclei (moisture) or
  dust particles
• coughing , talking, sneezing

5
Vehicle Transmission

• Agent transferred to host by contaminated
  inanimate objects
• Food, milk, water, drugs, blood, urine
• Cholera by water
• Salmonellosis by meat
• E-coli by spinach

6
Vectorborne

• Agent transferred to host by animate means
• Mosquitoes, fleas, ticks, lice, and other animals
• Lyme Disease, malaria, West Nile virus

7
Chain of Infection

• Agent, Host and Environmental Interaction
• The links symbolize essential elements needed by
  microorganisms to invade and cause cellular injury

8
Portal of Entry

• Agent enters the Host by
• Integumentary system (skin breaks, mucous
  membranes as in surgical wounds)
• Respiratory tract (inhale droplets as colds,
  measles, influenza)
• Genitourinary (infected vaginal secretions,
  semen, as in STDs)
• Gastrointestinal (ingestion food, water
  contaminates, as typhoid and Hepatitis A)
• Circulatory (insect bites as malaria from
  mosquito bite
• Transplacental (mother to fetus as HIV and
  Hepatitis B)

9
Host

• Human being is a susceptible host that can be
  affected by an agent.
• If you have not received measles vaccine more
  likely to get it because you lack immunity.

10
Host Characteristics

• Age (immunity declines as age increases)
• Illness and Injury
• Stress (decreases immune response)
• Immunization/Vaccination Status
• Lifestyle (sharing needles, multiple sex
  partners, smoking, alcohol and drug abuse)
• Occupation (chemical agents,needle sticks
• Skin breaks which is the first line of defense
  (surgical, pressure ulcer, IV)

11
Host Characteristics

• Nutritional Status (overweight, underweight)
• Heredity
• Medications (steroids, non-steroidal
  anti-inflammatory agents NSAIDs (ibuprofen,
  aspirin), chemotherapy, antibiotics lead to
  vaginal yeast infections
• Nursing and Medical Procedures (urinary
  catheters, IVs)

12
Breaking Chain of Infection

• Infection Control is the First Line of Defense
• HAND HYGIENE IS THE SINGLE MOST PRACTICE IN
  PREVENTING THE SPREAD OF INFECTION
• JCAHO June 2006 Hand washing is the top priority
• National Patient Safety Goal (USA Government)

13
Breaking the Chain of Infection

• Wear gloves, masks, gowns and goggles
• Client Hygiene
• Dressing Changes using aseptic technique
• Clean linens
• Clean Equipment
• Educate on covering mouth and nose when coughing
  and sneezing throwing tissues into garbage bag

14
Breaking Chain of Infection

• Nutrition (protein needed to maintain and repair
  tissues, production of antibodies, and acid-base
  balance
• Exercise
• Immunizations (measles, mumps, rubella, tetanus
  every 10 years and flu every year
• MUMPS reported by CDC (8/6/2006) as being beyond
  historical limits. Cummulative for 2006 in
  selected states 5,482

15
Body Defenses

• Immune system recognizes its self
• Antigen is non-self pathogen and the immune
  system will attack it
• Non-Specific Immune Responses are
• Skin and its normal flora
• Mucous membranes (as cilia in respiratory tract
  keep from entering lungs)

16
Non-Specific Immune Responses

• Coughing, sneezing, tearing reflexes
• Elimination and acid environment
• Flora in the large intestine prevent growth of
  pathogens and peristalsis removes them with feces
• Natural urine acidity prevents growth and
  urination rids bladder neck and urethra of
  microorganisms

17
Non-Specific Immune Responses

• Vaginal Flora is acidic puberty lactobacilli
  ferment and produce sugars lowering the pH
  preventing growth of microorganisms
• Inflammation is cellular response to tissue
  injury by bacteria, trauma, chemicals, heat etc.
• Erythema (redness) increased blood flow to area
• Heat (increased blood flow and metabolism)
• Pain (pressure on pain receptors)
• Edema (swelling) fluid and leukocytes
• Function Loss (pain, swelling)
• Purulent Exudate (WBCs, dead cells, bacteria,
  debris)

18
Specific Immune Response
Response to invading antigen Phagocytes do not
destroy antigen completely T-cells (T
lymphocytes) produce and release lymphokines thus
attracting phagocytes and lymphocytes to destroy
the antigens T-cells stimulate B-cell production
which leads to antibody production against antigen
19
ASEPSIS
The term asepsis means the absence of
disease-producing microorganisms
20
Concept of Asepsis

• The nurses 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.

21
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.

22
The Goal Reduce Health Care Associated
Infections

• The goal is to reduce health care-associated
  infections that occur when staff spread microbes
  to patients
• Germs move to patients from hands, and from
  objects used for patient care
• Use of clean, aseptic or sterile technique
  reduces the number of germs transferred and thus,
  reduces the risk of infection

23
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.

24
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.
25
Medical Asepsis

• During daily routine care, the nurse uses basic
  medical aseptic techniques to break the infection
  chain.
• Eg.of medical asepsis are changing clients bed
  linen daily, handwashing, barrier techniques,
  routine environmental cleaning.

26
Cont

• Follow Isolation technique as appropriate.
• Clients with high susceptibility to infection
  require special precautions to prevent exposure
  to pathogens.

27
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).

28
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.

29
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.

30
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).

31
Cont
The nurse working with a sterile field or with
sterile equipment must understand that the
slightest break in technique results in
contamination.
32
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.

33
Cont
Effectiveness of aseptic practices depends on the
nurses conscientiousness consistency in using
effective aseptic techniques.
34
INFECTION CAUSE BY MICROORGANISMS

• BACTERIA
• FUNGI
• PROTOZOA
• ALGAE
• VIRUSES

35

Clean Technique

• Use clean technique if staff or objects will
  touch intact skin, intact mucous membranes or
  dirty (contaminated) items

36
Examples of When Clean Technique is Used

• . Clean tech is appropriate for
• Taking blood pressures
• Examining patients
• Feeding patients

37
Definition Invasive Procedures

• Acts done to patients that come in contact with
  the wounds, blood stream, the inside of the body,
  or normally sterile parts of the body
• Remember invasive procedures invade the inside of
  the body

38
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.

39

• 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.

40
To Prevent Contamination

• Keep clean, dirty, and sterile items separate
• Only put sterile items in a sterile field
• Change gloves and wash hands if going from a
  contaminated act to a aseptic or sterile act
• Time skin antisepsis and surgical hand hand
  hygiene with a clock
• The sterile field is considered sterile except
  for the 2.5 cm border
• Wet items are considered contaminated

41
Planning Reduces Errors in Technique

• Use the S.C.R.I.P.T. reminder to plan
• Visualise every step in advance, to make sure
  supplies are available

42
S.C.R.I.P.T Procedures

• Space and work flow?
• Clean, aseptic, or sterile technique?
• Routine, aseptic or surgical hand hygiene?
• Instruments and supplies?
• Personal protective equipment?
• Trash sharps, infectious waste, radioactive
  waste, pathology or routine waste?

43
Space and Work Flow?

• Should the procedure be done in a dedicated room
  or space?
• Who will ensure that all visible dirt is removed
  form the space ahead of time, and surfaces
  disinfected if necessary?

44
Space and Work Flow?
Work flow can staff move from hand washing to
hand drying to separate clean and sterile areas
without passing or touching contaminated areas?
Where will used instruments and specimens be
placed?
45
Clean, Aseptic, or Sterile Technique?

• All team members should be clear on who should be
  using clean, aseptic or sterile technique and
  what elements are intended
• Example a physician places a thoracic drain with
  sterile technique,the nurse assisting uses clean
  technique, and the person who empties the drain
  in subsequent days uses aseptic technique

46
Instruments and Supplies

• Plan what medical devices and supplies are needed
  
• Plan where each item should be placed
• Plan where and how each item should be discarded
  or sterilised

47
Work Flow Chart Decontamination Cycle
48
Routine, Aseptic or Surgical Hand Hygiene?

• Prepare in advance for the type of hand hygiene
  that is necessary
• Arrange the supplies including hand drying
  towels, as appropriate

49
Personal Protective Equipment
. Discuss what other items are expected and
needed These may include aprons, shoe covers for
bloody procedures, masks, hair coverings, face
shields or goggles
50
Disinfection Sterilization
Disinfection eliminates pathogenic organisms on
inanimate objects with the exception of bacterial
spore. Noninfectious microorganisms may or may
not be killed.
51
Sterilization is the process of eliminating and
destroying all microorganisms, including spores
viruses.
52
DISINFECTION

• The principle of disinfection is that of
  denaturation of the bacterial cell protein.
• This process can be carried out by two methods
• Physical
• - boiling
• 2. Chemical
• - disinfectants

53
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.
54
Essential factors for maximum effectiveness of
disinfection are - Cleanliness of items -
Unlocking all locked
instruments - Complete immersion of
articles
55
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.
56
Chemical Disinfectants are such as

• Phenolics
• clear soluble fluids, e.g., 2 Printol. 1 Sudol
• b) Hexachlorophene e.g., Phisohex, Gamaphene
• - for wide range of antibacterial activity.
• 70 - 75 Ethyl or Isopropyl Alcohol
• - for wide range of antibacterial activity, most
  active against TB.

57
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
58
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.
59
STERILIZATIONThis process can be carried out by
4 methods-

• HEAT
• moist heat (Autoclave)
• - dry heat (Hot Air Oven)
• CHEMICAL
• in solution, e.g., Ethicon Fluid, Glutaraldehyde
• vapour, e.g., Formaldehyde
• - gas, e.g., Ethylene Oxide

• IRRADIATION
• ultra violet light
• - gamma rays/cobalt 60
• FILTRATION
• - applicable to pharmaceutical laboratory where
  it is used in combination with ultra violet light.

60
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.
61
Gowns Aprons

• protective clothing is used to reduce bacterial
  spread by contact (nurses uniforms become
  heavily contaminated during clinical procedures.

62
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.
63
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.

64
BLOOD TRANSMISSABLE DISEASES SEXUALLY
TRANSMITTED DISEASES (STDs)

• HIV Infection/AIDS
• Hepatitis B (HBV)
• Hepatitis C (HCV)
• Syphilis
• Gonorrhoea
• Chlamydia
• Herpes Simplex
• Cytomegalovirus

65
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.

66

• 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.

67
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.

68
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.

69
Infection Prevention Measures BSIS

• Room Selection
• - Assign patient with infectious disease to an
  individual OR or last on surgical list.

70
Trash Linen

• Bag all soiled trash linen securely.
• Discard according to facility policy.
• Wear gloves protective garments when handling
  soiled linen trash.

71
Infection Prevention Measures BSIS

• Housekeeping
• - Clean all rooms on regular
• schedule.
• - Clean articles, equipment
• furniture soiled with moist
• body substances
• immediately.
• - Wear gloves.

72
Laboratory Specimens

Handle all laboratory specimens with equal care.
Special precautionary labels are required.
73

Clean Aseptic Sterile
Procedure space On ward or at beside Dedicated area Dedicated room
Gloves Clean or none Sterile Sterile surgical
Hand hygiene before the procedures Routine Aseptic, e.g. alcohol Surgical scrub Iodophors, chlorheximide
Skin antisepsis No Alcohol Long acting agent
Sterile field No No Yes
Sterile gown, mask, head covering No No Yes
74
Remember !!!

• The nurse is responsible for providing the client
  with a safe environment.
• The nurses 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 nurses failure
  to be meticulous will place the client at risk
  for an infection that can seriously impair
  recovery.
• (Florence Nightingale, 1859)

75

• Govt. Hospital of Thoracic Medicine. 2013. Clean,
  Aseptic and Sterile Technique. No Publication