Transcript Asepsis Fundamental Nursing Chapter 10 Inst.: Dr. Ashraf El - Jedi

Fundamental Nursing
Chapter 10
Asepsis
Inst.: Dr. Ashraf El - Jedi
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Preventing infections is one of the most
important priorities in nursing
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Microorganisms, living animals or plants
visible only with a microscope, are commonly
called germs. What they lack in size, they
make up for in numbers. Microorganisms are
everywhere: in the air, soil, and water, and on
and within virtually everything and everyone.
Types of Microorganisms
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Microorganisms are divided into two main
groups: nonpathogens or normal flora and
pathogens
Non Pathogens
Pathogens have high potential for causing
infectious communicable diseases also called
contagious diseases and communityacquired infections.
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Bacteria
Viruses
Fungi
Rickettsiae
Protozoans
Mycoplasmas
Helminths
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Many pathogens have mutated to adapt to
hostile environments and unfavorable living
conditions. Such adaptability has ensured that
they continue to pose a threat to humans.
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A spore is a temporarily inactive microbial life
form that can resist heat and destructive
chemicals and survive without moisture.
Chain of Infection
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By interfering with the conditions that
perpetuate the transmission of microorganisms,
humans can avoid acquiring infectious diseases.
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The six essential components of the chain of
infection (sequence that enables the spread of
disease-producing microorganisms) must be in place
if pathogens are to be transmitted from one location
or person to another:
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An infectious agent
A reservoir for growth and reproduction
An exit route from the reservoir
A mode of transmission
A port of entry
A susceptible host (Fig. 10-2)
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Infectious Agents
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Some microorganisms are less dangerous than
others.
For example, intestinal bacteria help produce
vitamin K, which, in turn, helps control
bleeding.
Reservoir
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A reservoir is a place where microbes grow and
reproduce, providing a haven for their survival.
Examples:
skin,
shafts of hair
open wounds
blood
lower digestive tract
nasal passages
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The exit route is how microorganisms escape from
their original reservoir and move about
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A mode of transmission is how infectious
microorganisms move to another location.
See table 10-1
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The port of entry is where microorganisms find their
way onto or into a new host, facilitating their
relocation. One of the most common ports of entry is
an opening in the skin or mucous membranes.
Susceptible Host
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Humans become susceptible to infections
when their defense mechanisms are diminished
or impaired. A susceptible host, the last link
in the chain of infection, is one whose biologic
defense mechanisms are weakened in some
way
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Are burn victims
Have suffered major trauma
Require invasive procedures such as endoscopy
Need indwelling equipment such as a urinary catheter
Receive implantable devices such as intravenous
catheters
Are given antibiotics inappropriately, which promotes
microbial resistance
Are receiving anticancer drugs and anti-inflammatory
drugs such as corticosteroids that suppress the
immune system
Are infected with HIV
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e and practice methods
 Nurses must understand
to prevent nosocomialdiinfections (infections
acquired while a person
@ is receiving care in a
health care agency). h
o
 Asepsis means those practices
that decrease or
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eliminate infectious agents,
their reservoirs,
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and vehicles for transmission.
It is the major
i
method for controllinglinfection.
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Asepsis
Medical Asepsis
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Medical asepsis means those practices that confine or
reduce the numbers of microorganisms. Also called,
clean technique, it involves measures that interfere
with the chain of infection in various ways.
Principles of medical asepsis:
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Microorganisms exist everywhere except on sterilized
equipment.
Frequent handwashing and maintaining intact skin are the best
methods for reducing the transmission of microorganisms.
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Blood, body fluids, cells, and tissues are considered major
reservoirs of microorganisms.
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Personal protective equipment such as gloves, gowns, masks,
goggles, and hair and shoe covers serves as a barrier to
microbial transmission.
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A clean environment reduces microorganisms.
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Certain areas—the floor, toilets, and insides of sinks—are
more contaminated than others. Cleaning should be done from
cleaner to dirtier areas.
Examples of medical aseptic practices include:
 using antimicrobial agents,
 performing hand hygiene,
 wearing hospital garments,
 confining and containing soiled materials
appropriately,
 and keeping the environment as clean as
possible.
1. Using Antimicrobial Agents
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Antimicrobial agents are chemicals that
destroy or suppress the growth of infectious
microorganisms
Examples are antiseptics, disinfectants, and
anti-infective drugs.
Antiseptics
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Antiseptics, also known as , inhibit the growth
of, but do not kill, microorganisms. An
example is alcohol
Disinfectants
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Disinfectants, also called and , destroy active
microorganisms but not spores. Phenol,
household bleach, and formaldehyde are
examples.
Disinfectants rarely are applied to the skin
because they are so strong. Rather, they are
used to kill and remove microorganisms from
equipment, walls, and floors
Anti-Infective Drugs
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antibiotics
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Antiviral
2. Hand washing
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Hand washing is an aseptic practice that
involves scrubbing the hands with soap, water,
and friction.
Considering how often health care personnel
use their hands with clients, it is no surprise
that handwashing is the single most effective
way to prevent infections.
Performing a Surgical Scrub
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A surgical scrub, a type of skin and nail
antisepsis, is performed before donning sterile
gloves and garments when the nurse is actively
involved in an operative or obstetric
procedure. The purpose is to more extensively
remove transient microorganisms from the
nails, hands, and forearms.
Wearing Personal Protective Equipment
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uniforms
scrub suits or gowns
masks
gloves
protective eyewear
Hair and Shoe Covers
Gloves
Nurses wear clean gloves, sometimes called
examination gloves, in the following
circumstances:
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As a barrier to prevent direct hand contact with
blood, body fluids, secretions, excretions, mucous
membranes, and nonintact skin
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As a barrier to protect clients from microorganisms
transmitted from nursing personnel when
performing procedures or care involving contact
with the client's mucous membranes or nonintact
skin
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When there is a potential transfer of
microorganisms from one client or object to
another client during subsequent nursing care
Gloves…
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Examination gloves are generally made of
latex
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Unfortunately some nurses and clients are
allergic to latex.
Confining Soiled Articles:
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Utility Rooms
Waste Receptacles
Keeping the Environment Clean
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Health agencies employ laundry staff and
housekeeping personnel to assist with cleaning
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Terminal disinfection is more thorough than
concurrent disinfection and consists of measures used
to clean the client environment after discharge.
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Nurses who work in home health can teach the client
and family simple aseptic practices for cleaning
contaminated articles
Surgical Asepsis
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Surgical asepsis means those measures that
render supplies and equipment totally free of
microorganisms. Sterile technique is those
practices that avoid contaminating microbefree items.
Sterilization
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Sterilization consists of physical and chemical
techniques that destroy all microorganisms
including spores.
1. Physical Sterilization
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Microorganisms and spores are destroyed
physically through radiation or heat (boiling
water, free-flowing steam, dry heat, and steam
under pressure).
Radiation
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Ultraviolet radiation can kill bacteria,
especially the organism that transmits TB.
Boiling Water
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Boiling water is a convenient way to sterilize
items used in the home. To be effective,
contaminated equipment needs to be boiled for
15 minutes at 212°F (100°C)
Free-Flowing Steam
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Free-flowing steam is a method in which items
are exposed to the heated vapor that escapes
from boiling water.
Dry Heat
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Dry heat, or hot air sterilization, is similar to
baking items in an oven. To destroy
microorganisms with dry heat, temperatures of
330°to 340°F (165° to 170°C) are maintained
for at least 3 hours.
Steam Under Pressure
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Steam under pressure is the most dependable
method for destroying all forms of organisms
and spores.
The autoclave is an example figure 10-8
2. Chemical Sterilization
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Both gas and liquid chemicals are used to
sterilize invasive equipment.
Principles of Surgical Asepsis
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They preserve sterility by touching one sterile
item with another that is sterile.
Once a sterile item touches something that is
not, it is considered contaminated.
Any partially unwrapped sterile package is
considered contaminated.
If there is a question about the sterility of an
item, it is considered unsterile.
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The longer the time since sterilization, the
more likely it is that the item is no longer
sterile.
A commercially packaged sterile item is not
considered sterile past its recommended
expiration date.
Once a sterile item is opened or uncovered, it
is only a matter of time before it becomes
contaminated.
The outer 1-inch margin of a sterile area is
considered a zone of contamination.
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sterile wrapper, if it becomes wet, wicks
microorganisms from its supporting surface,
causing contamination.
Any opened sterile item or sterile area is
considered contaminated if it is left
unattended.
Coughing, sneezing, or excessive talking over
a sterile field causes contamination.
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Reaching across an area that contains sterile
equipment has a high potential for causing
contamination and is therefore avoided.
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Sterile items that are located or lowered below
waist level are considered contaminated
because they are not within critical view.
Creating a Sterile Field
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A sterile field means a work area free of
microorganisms. (Skill 10-3)
Nursing Implications
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Risk for Infection
Risk for Infection Transmission
Ineffective Protection
Delayed Surgical Recovery
Deficient Knowledge