Medical and Surgical Asepsis

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

2. Define Terms • 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 disease • Surgical asepsis…. • Protection against infection before, during and after a surgical procedure. • Infection • Invasion of the body by pathogens

3. Classifications of pathogens • Bacteria • One celled, multiply rapidly, classified by shape and how they cluster together • Virus • Smallest of all pathogens; replication within the host • Fungi • Organisms that exist by feeding on organic matter • Protozoa • Single celled organism; spread by feces,

4. Pathogens cont • Rickettsia • Organisms multiply in animal hosts and transmit to humans through bites • Helminths • Parasitic worms found in soil; transmitted via hand to mouth • Mycoplasmas • No cell wall; multi shaped

5. Other causes of infection: • Chemical agents • Pesticides, food additives, medications, industrial • Physical agents • Heat, noise, radiation, and machines

6. Factors that promote pathogen growth • Moisture • Organic matter • Warmth • Darkness • Oxygen • Alkaline ph

7. The Spread of Infection: Six Links 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

8. The Spread of Infection Mode of Transmission: • Contact • Direct – touching, kissing, sexual contact • Indirect – contact with a fomite • Droplet: Cough, sneeze • Airborne: Via air conditioning, sweeping Portal of Exit: • Via • Bodily fluids • Coughing, sneezing, diarrhea • Seeping wounds • Tubes, IV lines

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

10. Stages of Infection • Incubation: From time of infection until manifestation of symptoms; can infect others • Prodromal: Appearance of vague symptoms; not all diseases have this stage • Illness: Signs and symptoms present • Decline: Number of pathogens decline • Convalescence: Tissue repair, return to health

11. Classification of Infections By Location: • Local • Occurs in a limited region in the body (e.g., urinary tract infection) • Systemic • Spread via blood or lymph • Affects many regions (e.g., septicemia)

12. Classification of Infections by Duration Acute - Rapid onset of short duration • e.g., Common cold Chronic - Slow development, long duration • e.g., Hypertension, diabetes mellitus, osteomyelitis Latent - Infection present with no discernible symptoms • e.g., HIV/AIDS

13. Chain of Infection • Presence of pathogen • Reservoir (source) • Pathogen survive and multiply • Portal of exit from reservoir • Direct, indirect, airborne • Mode of transmission • Portal of entry to host • Susceptible host

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

15. Inflammatory response stages • Vascular • Aterioles dilate, blood and WBC go to area • s/s= redness and warmth • Inflammation • Tissue 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 infection • Phagocytosis • WBC enter the tissues causing release of pyrogens (fever); exudates form discharge; healing occurs

16. Nosocomial Infection An infection acquired in a health-care facility • Cost to the health-care system = $4.5 billion/year • Leading cause of death • Preventable with use of aseptic principles/ techniques Exogenous Nosocomial Infection: Pathogen acquired from health-care environment Endogenous Nosocomial Infection: Normal flora multiply and cause infection as a result of treatment

17. Nosocomialsubcatagories • 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

18. Causes of nosocomial infections • UTI • Insertion, contamination of drainage system, improper cleansing • Surgical site • Improper technique for handwashing or dressing change • URI • Improper handwashing or suctioning technique • IV • Improper handwashing or site care

19. Causes cont • Extended LOS in hospital • Multiple care givers • Antibiotic choices and over use • Improper medical or surgical asepsis

20. Who is at risk for nosocomial infection? • Age • Very young and very old • Poor nutritional status • Smoker, ETOH use • Existing co-morbid conditions • Chronic illnesses, chemo,radiation • Clients with invasive procedures • Clients with prolonged stress

21. Nurse’s role in • Containing nosocomial infections CLEAN, 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

22. Nurses role in • Protecting susceptible host • Protect natural defenses-skin, mucous membranes, fluid intake • Encourage cough and deep breathing • Change position • Oral hygiene • Promote rest and sleep • Reduce client stress

23. Lines of Defense Against Infection Primary Defenses: • Anatomical features, limit pathogen entry • Intact skin • Mucous membranes • Tears • Normal flora in GI tract • Normal flora in urinary tract

24. Lines of Defense Against Infection Secondary Defenses: • Biochemical processes activated by chemicals released by pathogens • Phagocytosis • Complement cascade • Inflammation • Fever

25. Lines of Defense Against Infection Tertiary Defenses: • Humoral immunity • B-cell production of antibodies in response to an antigen • Cell-mediated immunity • Direct destruction of infected cells by T cells

26. Factors that Increase Infection Risk • Developmental stage • Breaks in the skin • Illness/injury, chronic disease • Smoking, substance abuse • Multiple sex partners • Medications that inhibit/decrease immune response • Nursing/medical procedures

27. Factors that Support Host Defenses • Adequate nutrition • To manufacture cells of the immune system • Balanced hygiene • Sufficient to decrease skin bacterial count • Not overzealous; causes skin cracking • Rest/exercise • Reducing stress • Immunization

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

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

30. Wash Your Hands • When you arrive in the unit • When you leave the unit • Before and after restroom use • Before and after client contact • Before and after contact with client belongings

31. Wash Your Hands • Before gloving • After glove removal • Before and after touching your face • Before and after eating • After touching a contaminated article • When you see visible dirt on your hands

32. Hand Washing Guidelines • Wash for at least 15 seconds in nonsurgical setting; 2-6 minutes in surgical setting • Use warm water, not hot • Apply soap to wet hands • Use friction • Clean beneath fingernails and jewelry • Rinse soap • Towel or hand dry

33. Implementing CDC Guidelines • Standard precautions (universal precautions) • Protects health-care workers from exposure • Decreases transmission of pathogens • Protects clients from pathogens carried by health-care workers

34. Transmission-Based Precautions Contact Precautions: Pathogen is spread by direct contact • Sources 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

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

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

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

38. Implementing Surgical Asepsis Includes: • Creation of a sterile environment • Use of sterile equipment/supplies • Sterilization of reusable supplies • Surgical hand scrub • Surgical attire • Sterile gloves • Sterile field • Use of sterile technique

39. Standard Precautions • Protective barriers • Change gloves • HANDWASHING • Discard sharps correctly • Double bag • Cover breaks in the skin

40. Body specific immune defenses • Organs most vital to a functional immune system • Liver…produces immunoglobulins (antibodies) • Lymph nodes…produce and circulate lymphocytes • Bone marrow and thymus..form immune sys. Cells • Spleen…removes dead cells and foreign molecules

41. Immunities • 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 antigen • Five classes of antibodies • IgG, IgM, IgA, IgE, and IgD. IgG is most abundant and crosses the placenta provides passive immunity for newborns.

42. Immunities, cont • 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 antigen • Three types of T cells • Cytotoxic, helper T and suppressor T

43. Types of immune responses • 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

44. Principles of medical and surgical asepsis • Medical asepsis • Practice which reduces the number, growth and spread of micro organisms • Referred to as ‘clean’ technique’ • Handwashing 2 min-15 sec • Surgical asepsis • Total elimination of all micro organisms, spores • Sterile field (OR, L&D, etc), gown and glove • Methods: • Steam, radiation, chemicals, or gas

45. CDC Guidelines: Standard • Apply to : • All body fluids, secretions (except perspiration) • Blood • Non intact skin • Mucous membranes • Gloves worn: • To provide a protective barrier • To reduce opportunities for ‘nurse’ organism transfer to client • WEARING GLOVES DOES NOT REPLACE HANDWASHING!!!

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

47. Respiratory hygiene/cough etiquette • 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/objects

48. Proper handwashing • Turn on slow, steady stream of warm water • Moisten hands with water, then apply soap • Rub hands together vigorously for at least 15 seconds • Rinse under water • Use a clean paper towel or air dryer to dry hands

49. Waterless hand rub • 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 dry • Do not rinse with water • May be used 5-10 times before washing with soap and water is required.

50. Case Study • 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?