Medical and Surgical Asepsis - PowerPoint Presentation

Medical and Surgical Asepsis Metropolitan Community College NURS 1510 Nancy Pares, RN, MSN

Asepsis… .absence of germs or micro organisms Medical asepsis….technique or procedure which reduces the number of micro organisms and thus prevents the spread of diseaseSurgical asepsis….Protection against infection before, during and after a surgical procedure.InfectionInvasion of the body by pathogens Define Terms

Bacteria One celled, multiply rapidly, classified by shape and how they cluster together VirusSmallest of all pathogens; replication within the hostFungiOrganisms that exist by feeding on organic matterProtozoaSingle celled organism; spread by feces, Classifications of pathogens

Rickettsia Organisms multiply in animal hosts and transmit to humans through bites HelminthsParasitic worms found in soil; transmitted via hand to mouthMycoplasmasNo cell wall; multi shaped Pathogens cont

Chemical agents Pesticides, food additives, medications, industrial Physical agentsHeat, noise, radiation, and machinesOther causes of infection:

Moisture Organic matter WarmthDarknessOxygenAlkaline ph Factors that promote pathogen growth

Infectious agents Pathogens Normal flora that become pathogenic Reservoir Where pathogens live and multiply May be living Humans, animals, insects May be nonliving Food, floors, equipment, contaminated water The Spread of Infection: Six Links

Portal of Exit: Via Bodily fluidsCoughing, sneezing, diarrheaSeeping wounds Tubes, IV lines Mode of Transmission: Contact Direct – touching, kissing, sexual contact Indirect – contact with a fomite Droplet: Cough, sneeze Airborne: Via air conditioning, sweeping The Spread of Infection

Portal of Entry: Eye, nares, mouth, vagina, cuts, scrapes Wounds, surgical sites, IV or drainage tube sitesBite from a vectorSusceptible Host: Person with inadequate defense Three determining factors: Virulence Number of organisms Host’s defenses Spread of Infection

Incubation: From time of infection until manifestation of symptoms; can infect others Prodromal: Appearance of vague symptoms; not all diseases have this stageIllness: Signs and symptoms presentDecline: Number of pathogens declineConvalescence: Tissue repair, return to health Stages of Infection

By Location: Local Occurs in a limited region in the body (e.g., urinary tract infection)SystemicSpread via blood or lymphAffects many regions (e.g., septicemia) Classification of Infections

Acute - Rapid onset of short duration e.g., Common coldChronic - Slow development, long duratione.g., Hypertension, diabetes mellitus, osteomyelitisLatent - Infection present with no discernible symptoms e.g., HIV/AIDS Classification of Infections by Duration

Presence of pathogen Reservoir (source) Pathogen survive and multiplyPortal of exit from reservoirDirect, indirect, airborneMode of transmissionPortal of entry to hostSusceptible host Chain of Infection

Local Limited to a defined area; resembles inflammation Ex: redness, warmth, tenderness, swellingSystemicAffects the entire body and may involve multiple organs, goes through the stages of infectionEx: fever, anorexia, n/v, lymph node swelling Signs and symptoms of infection

Vascular Aterioles dilate, blood and WBC go to area s/s= redness and warmthInflammationTissue dies causing release of chemicals (histamine and prostaglandins) which allow blood vessel permeability. Cells, proteins, fluids enter the tissue spaces blocking lymphatics to create a ‘wall’ against infectionPhagocytosisWBC enter the tissues causing release of pyrogens (fever); exudates form discharge; healing occurs Inflammatory response stages

An infection acquired in a health-care facility Cost to the health-care system = $4.5 billion/year Leading cause of deathPreventable with use of aseptic principles/ techniquesExogenous Nosocomial Infection: Pathogen acquired from health-care environmentEndogenous Nosocomial Infection: Normal flora multiply and cause infection as a result of treatment Nosocomial Infection

Iatrogenic Infection from a procedure ex: UTI from foley insertion exogenous Infection from non-normal flora ex: clostridium Endogenous Infection when normal flora altered ex: yeast infection Nosocomial subcatagories

UTI Insertion, contamination of drainage system, improper cleansing Surgical siteImproper technique for handwashing or dressing changeURIImproper handwashing or suctioning techniqueIVImproper handwashing or site care Causes of nosocomial infections

Extended LOS in hospital Multiple care givers Antibiotic choices and over useImproper medical or surgical asepsis Causes cont

Age Very young and very old Poor nutritional statusSmoker, ETOH useExisting co-morbid conditionsChronic illnesses, chemo,radiationClients with invasive proceduresClients with prolonged stress Who is at risk for nosocomial infection?

Containing nosocomial infectionsCLEAN, DISINFECT, STERILIZE Controlling/eliminating reservoirs Bathing, dressing changes, patent drainage systems Controlling the portal of exit Cover mouth/nose, wear mask, client teaching Controlling transmission Do not share equipment, proper handling of linens, HANDWASHING Controlling portal of entry Maintain skin integrity, position changes, proper wiping techniques, maintain drainage integrity Nurse’s role in

Protecting susceptible host Protect natural defenses-skin, mucous membranes, fluid intake Encourage cough and deep breathingChange positionOral hygienePromote rest and sleepReduce client stress Nurses role in

Primary Defenses: Anatomical features, limit pathogen entry Intact skinMucous membranesTearsNormal flora in GI tractNormal flora in urinary tract Lines of Defense Against Infection

Secondary Defenses: Biochemical processes activated by chemicals released by pathogens PhagocytosisComplement cascadeInflammationFever Lines of Defense Against Infection

Tertiary Defenses: Humoral immunity B-cell production of antibodies in response to an antigenCell-mediated immunityDirect destruction of infected cells by T cells Lines of Defense Against Infection

Developmental stage Breaks in the skin Illness/injury, chronic diseaseSmoking, substance abuseMultiple sex partnersMedications that inhibit/decrease immune responseNursing/medical procedures Factors that Increase Infection Risk

Adequate nutrition To manufacture cells of the immune system Balanced hygieneSufficient to decrease skin bacterial countNot overzealous; causes skin crackingRest/exercise Reducing stress Immunization Factors that Support Host Defenses

Medical asepsis: “A state of cleanliness that decreases the potential for the spread of infections” Promoted through:Maintaining a clean environmentMaintaining clean handsFollowing Centers for Disease Control (CDC) guidelines Preventing Infection: Implementing Medical Asepsis

Clean spills and dirty surfaces promptly Remove pathogens through chemical means (disinfect) Remove clutterConsider supplies brought to the client room as contaminatedConsider items from the client’s home as contaminated Maintaining a Clean Environment

When you arrive in the unit When you leave the unit Before and after restroom useBefore and after client contactBefore and after contact with client belongings Wash Your Hands

Before gloving After glove removal Before and after touching your faceBefore and after eatingAfter touching a contaminated articleWhen you see visible dirt on your handsWash Your Hands

Wash for at least 15 seconds in nonsurgical setting; 2-6 minutes in surgical setting Use warm water, not hot Apply soap to wet handsUse frictionClean beneath fingernails and jewelryRinse soapTowel or hand dry Hand Washing Guidelines

Standard precautions (universal precautions) Protects health-care workers from exposure Decreases transmission of pathogensProtects clients from pathogens carried by health-care workersImplementing CDC Guidelines

Contact Precautions: Pathogen is spread by direct contactSources of infection - draining wounds, secretions, supplies Precautions include: Possible private room Clean gown and glove use Disposal of contaminated items in room Double-bag linen and mark Transmission-Based Precautions

Droplet Precautions: Pathogen is spread via moist droplets:Coughing, sneezing, touching contaminated objectsPrecautions include:Same as those for contact Addition of mask and eye protection within 3 ft of client Transmission-Based Precautions

Airborne Precautions: Pathogen is spread via air currents Transmission via ventilation systems, shaking sheets, sweepingPrecautions include:Same as those for contact, with addition of special mask Transmission-Based Precautions

“Reverse” isolation: Protects the client from organisms Used with immune-compromised client populationPrecautions include:Private room likelyNurse not assigned to clients with active infection Mask, handwashing, clean/sterile gown, gloves No reuse of gowns, gloves Protective Isolation

Includes: Creation of a sterile environment Use of sterile equipment/suppliesSterilization of reusable suppliesSurgical hand scrub Surgical attire Sterile gloves Sterile field Use of sterile technique Implementing Surgical Asepsis

Protective barriers Change gloves HANDWASHINGDiscard sharps correctlyDouble bagCover breaks in the skinStandard Precautions

Organs most vital to a functional immune system Liver…produces immunoglobulins (antibodies) Lymph nodes…produce and circulate lymphocytesBone marrow and thymus..form immune sys. CellsSpleen…removes dead cells and foreign moleculesBody specific immune defenses

Humoral Attack bacteria and virus’ at the extracellular level B cell lymphocytes cause synthesis of antibodies leading to destruction of antigens and creation of antibodies that subsequently protect from the same antigenFive classes of antibodiesIgG, IgM, IgA, IgE, and IgD. IgG is most abundant and crosses the placenta provides passive immunity for newborns. Immunities

Cell mediated immunity Fights pathogens inside the cell T cells (a form of WBC) binds with the antigen, becomes sensitized and releases lymphokines which attract macrophages that destroy the antigenThree types of T cellsCytotoxic, helper T and suppressor TImmunities, cont

Natural Present at birth, genetically determined Passive Acquired through introduction of antibodies, ie mother passes to infant Active Antibodies develop within the body to neutralize or destroy an infective agent Acquired Exposure to an antigen or passive injection of immunoglobulin Artificial Produced by vaccination Types of immune responses

Medical asepsis Practice which reduces the number, growth and spread of micro organisms Referred to as ‘clean’ technique’Handwashing 2 min-15 secSurgical asepsisTotal elimination of all micro organisms, sporesSterile field (OR, L&D, etc), gown and gloveMethods: Steam, radiation, chemicals, or gas Principles of medical and surgical asepsis

Apply to : All body fluids, secretions (except perspiration) BloodNon intact skinMucous membranesGloves worn:To provide a protective barrierTo reduce opportunities for ‘nurse’ organism transfer to clientWEARING GLOVES DOES NOT REPLACE HANDWASHING !!! CDC Guidelines: Standard

The single most important measure to reduce the risk of transmission! Nurses do hands on work, so always wash first! Handwashing

Cover your nose and mouth with your elbow. Use tissues to contain respiratory secretions and dispose into the nearest waste container after use. Perform hand hygiene after contact with any contaminated materials/objectsRespiratory hygiene/cough etiquette

Turn on slow, steady stream of warm water Moisten hands with water, then apply soap Rub hands together vigorously for at least 15 secondsRinse under waterUse a clean paper towel or air dryer to dry handsProper handwashing

May use when hands are not visibly soiled Apply adequate amount to palm of one hand Rub hands together, covering all surfaces of hands and fingers (including under the nails) until hands are dryDo not rinse with waterMay be used 5-10 times before washing with soap and water is required.Waterless hand rub

Admitting calls to tell you that they have a client who previously cultured positive for MRSA in their urine. What precaution do you place this client in? What if the MRSA was positive in the sputum? Case Study

You have a client that has very runny stools. The doctor orders a stool culture. What additional information can you supply the lab? What precautions would you place this patient in?Case Study

Client presents to ED with high fever, headache, body aches and non-productive cough. Client states the her husband just returned from a business trip in China. First thought? Precautions?Case study