MEDICAL ASEPSIS ( INFECTION CONTROL ) : MEDICAL ASEPSIS ( INFECTION CONTROL ) Slide 2: Infection control practices control or eliminate sources of infection ana help protect; patients and health care providers from disease. A patient entering £ health care setting is a[ risk for acquiring infections because of lowered resistance to infectious microorganisms, increased exposure to numbers and types of disease-causing organisms and invasive procedures. The nurse comes in contact with a variety of microorganisms and must practice infection control techniques to avoid spreading them to patients.
In the home a patient must recognize sources of infection and be able to institute protective measures. The nurse is responsible for teaching patients about infection, mode of transmission , reasons for susceptibility, and infection control.
The nurse's knowledge of infection process, application of infection control principles, and use of common sense help protect patients from infection. Infection control is an important part of every nursing action.
Patients in health care settings can easily acquire infection because they are at risk. Nosocomial infections are infections that result from delivery of health services in a health care facility. A hospital is one of the most likely places for acquiring an infection because it harbors a high population of microorganisms, some of which are resistant to certain antibiotics. The number of workers caring for patients, the type and number of invasive procedures and the length of hospitalization all influence the chance of infection. Slide 3: The presence of a pathogen does not mean that an infection will begin. Development of an infection occurs in a cyclical process that depends on the following six
1. An infectious agent or pathogen
2. A reservoir or source for pathogen growth
3. A portal of exit from the reservoir
4. A mode of transmission
5. A portal of entry to the host
6. A susceptible host
An infection develops if this chain remains intact Nurses use infection control practices to break an element of the chain so that infection will not develop.
The nurse's efforts to minimize the onset and spread of infection are based on the principles of aseptic technique Asepsis is the absence of germs or pathogens. Aseptic technique is the effort to keep a patient as free from hospital microorganisms as possible.
The two types of aseptic Technique the nurse practices are medical and surgical asepsis. Slide 4: Medical asepsis, or clean technique,
includes procedures used to reduce the number of microorganisms and prevent their spread. Changing a patient’s bed linen daily or when soiled, hand washing, and using clean medication cups are examples of medical asepsis. Principles of medical asepsis are commonly followed in the home as in the case of washing hands before preparing food. Disinfection, a technique used in medical asepsis, is a method of inhibiting the growth of pathogenic microorganisms.
Surgical asepsis, or sterile technique, includes procedures used to eliminate microorganisms from an area. Sterilization destroys all microorganisms and their spores. Sterile technique is practiced by nurses in the operating room and treatment areas, where sterile instruments and supplies are used. The techniques used in maintaining surgical asepsis are more rigid than those performed under medical asepsis. Guidelines for maintaining Medical Asepsis : Guidelines for maintaining Medical Asepsis 1. Remember that thorough hand washing is the most important and basic technique for infection control,
2. Always know a client's susceptibility to infection. Age, nutritional status, stress, disease processes, and forms of medical therapy can place clients at risk.
3. Recognize the elements of the infection chain and initiate measures tc prevent the onset and spread of infection.
4 Never practice aseptic techniques haphazardly. Rigid adherence to aseptic procedures is the only way to ensure that a client is at minimal risk for infection,
5 Protect fellow health care workers from exposure to infectious agents. Nosocomial infections occur with greater frequency when clients become exposed to health care workers who are carriers of infection.
6. Be aware of body sites where nosocomial infection is most likely to develop. This enables the nurse to direct preventive measures at infection control. UNIVERSAL PRECAUTIONS : UNIVERSAL PRECAUTIONS Universal precautions apply to blood, body fluids containing blood, tissues and pericardia!, peritoneal, amniotic, semen, synovia!, vaginal cerebrospinal, and pleural body fluids.
Gloves should be worn when contacting blood and the above-mentioned fluids.
Gloves should be worn for handling items or surfaces soiled with blood and the above
mentioned fluids, and for performing phlebotomy.
Gloves should be changed between contact with patients requiring universal precautions.
Hands and other skin surfaces should be washed immediately and thoroughly if contaminated with blood or other fluids.
Masks and protective eye-wear or face shields should be worn when the generation of droplets of blood (splashing) is anticipated. Slide 8: Protective apparel (gowns and aprons) should be worn during procedures likely to cause splattering or splashing of blood and body fluids.
The potential for transmission is greatest when needles, scalpels and other sharp instruments or devices are used .Used needles should not be recapped by hand, removed from disposable syringes by hand, or purposely bent, broken, or otherwise manipulated fry hand. Place in puncture-proof container for disposal.
Mouthpieces, resuscitation bags, or other ventilation devices should be available for use in areas in which the need for resuscitation is anticipated.
All patient specimens should be placed in sturdy leak-proof containers with a secure lid to prevent leaking during transport. Care is taken to avoid contaminating, outside of containers and laboratory slips.
All health care workers who have exudative lesions or weeping dermatitis should refrain from direct patient care activities and from handling patient care equipment.
Personnel should report to their supervisors all incidents of exposure to blood or body fluids, including needle or sharp sticks. Slide 9: Barrier Techniques and Isolation for Infection Prevention and Control Isolation is a protective procedure that limits the spread of infectious disease among hospitalized patients, hospital personnel and visitors The transfer of pathogens from person to person can be decreased by limiting dissemination of pathogens. The most practical way to accomplish this is transmitting the pathogens The latest CDC (Center for Disease Control and Prevention) guidelines include major features of universal & body substance precautions which includes the importance of body fluids, secretions & excretions in the transmission of nosocomial pathogens. Nurses must understand the various isolation or barrier techniques, if they are to use them correctly & minimize infection risks to patients as well as themselves. There are two tiers of Precautions:
Standard Precautions- used in the care of all hospitalized individuals regardless of their diagnosis or possible infection status e.g. all body fluids, secretions & excretions.
Transmission-Based Precautions- used in addition to standard precautions for patients in hospitals with suspected infection with pathogens that can be transmitted by airborne, droplet or contact routes. Below is the summary of CDC recommended practices for precautions. SUMMMARY of CDC Recommended Practices for Standard and TRANSMISSION BASED PRECAUTIONS : SUMMMARY of CDC Recommended Practices for Standard and TRANSMISSION BASED PRECAUTIONS Standard Precautions (Tier I)
1. Wash hands after touching blood, body fluids, secretions, excretions, and contaminated items, regardless of whether gloves are worn. Wash hands immediately after gloves are removed, between patient contacts, and whenever indicated to prevent transfer of microorganisms to other patients or environments. Use plain soap for routine handwashing and an antimicrobial or waterless antiseptic agent for specific circumstances.
2. Wear clean non sterile gloves when touching blood, body fluids, excretions of secretions, contaminated items, mucous membranes, and non intact skin. Change gloves between tasks on the same patient as necessary and remove gloves promptly after use.
3. Wear personal protective equipment such as mask, eye protection, face shield, or fluid-repellant gown during procedures and care activities that are likely to generate splashes or sprays of blood or body fluids. Use gown to protect skin and prevent soiling of clothing, Slide 11: 4. Avoid recapping used needles. If you must recap, never use two hands. Use a needle-recapping device or the one-handed scoop technique Place needles, sharps, and scalpels in appropriate puncture-resistant containers after use,
5. Handle used patient care equipment that is soiled with blood or identified body fluids, secretions, and excretions carefully to prevent transfer of microorganisms. Clean and reprocess items appropriately ie used for another patient.
6 Use adequate environmental controls to ensure that routine care, cleaning, and disinfection procedures are followed.
7. Review room assignments carefully. Place patients who may contaminate the environment in private rooms (such as an incontinent patient). Transmission-Based Precautions (Tier 5) : Transmission-Based Precautions (Tier 5) The following precautions are recommended in addition to standard precautions:
1. Use these for patient?, who have infections that spread Through the air, such as tuberculosis, varicella (chicken pox) and rubella (measles)
2. Place patient in private room that has monitored negative air pressure in relation to surrounding areas 6 to 12 air changes per hour, and appropriate discharge of air outside or monitored filtration if air is re circulated. Keep door closed and patient in the room.
3. Use respiratory protection when entering room of patient with known or suspected tuberculosis. If patient has known or suspected rubella (measles) or varicella (chicken pox), respiratory protection should be worn unless person entering room is immune to these diseases.
4. Transport patient out of room only when necessary and place a surgical mask on the patient if possible. Consult CDC Guidelines for additional prevention strategies for tuberculosis. Droplet Precautions : Droplet Precautions 1. Use these for patients with an infection that spread by large particle droplets, such as rubella, mumps, diphtheria, and the adenovirus infection in infants and young children.
2.Use a private room, if available. Door may remain open.
3.Wear a mask when working within 3 feet of patient
4.Transport patient out of room only when necessary and place a surgical mask on the patient if possible.
5.Keep visitors 3 feet from the infected person, Contact Precautions : Contact Precautions 1.Use these for patients who are infected or colonized by a microorganism that spreads by direct or indirect contact, such as MRSA, VRE. or VISA
2.Place the patient in a private room if available,
3.Wear gloves whenever you enter the room. Change gloves after having contact with infective material Remove gloves before leaving the environment, and wash hands with an anti-microbial or waterless antiseptic agent.
4.Wear a gown if contact with infectious agent is likely or patient has diarrhea, an ileostomy, colostomy, or wound drainage not contained by dressing.
5.Limit movement of the patient out of the room.
6.Avoid sharing patient care equipment.
Adapted from Garner, J. 1996. Guidelines for Isolation precautions in hospitals, Infection control and hospital Epidemiology. 17(1), 53-80