ASEPSIS

PRPD/CIN2/2007

ASEPSIS

The term asepsis means the absence of disease-producing microorganisms

Concept of Asepsis

The nurse’s 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.

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.

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.

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.

Medical Asepsis

During daily routine care, the nurse uses basic

medical aseptic techniques to break the

infection chain.

Eg.of medical asepsis are changing client’s bed

linen daily, handwashing, barrier techniques, &

routine environmental cleaning.

Cont…

Follow Isolation technique as appropriate.

Clients with high susceptibility to infection

require special precautions to prevent

exposure to pathogens.

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).

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.

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.

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).

Cont…

The nurse working with a sterile field or with

sterile equipment must understand that the

slightest break in technique results in

contamination.

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.

Cont…

Effectiveness of aseptic practices depends on

the nurse’s conscientiousness & consistency

in using effective aseptic techniques.

Aseptic Practices

Aseptic Practices

Aseptic Practices

INFECTION CAUSE BY MICROORGANISMS

BACTERIA FUNGI

PROTOZOA ALGAE

VIRUSES

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.

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.

Disinfection – eliminates pathogenic

organisms on inanimate objects with the

exception of bacterial spore. Noninfectious

microorganisms may or may not be killed.

Disinfection & Sterilization

Sterilization – is the process of eliminating

and destroying all microorganisms, including

spores & viruses.

DISINFECTION

The principle of disinfection is that of

denaturation of the bacterial cell protein.

This process can be carried out by two methods:

1. Physical - boiling

2. Chemical - disinfectants

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.

Essential factors for maximum

effectiveness of disinfection are:-

- Cleanliness of items

- Unlocking all locked

instruments

- Complete immersion of articles

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.

Chemical Disinfectants are such as:

1. Phenolics - a) clear soluble fluids, e.g., 2% Printol. 1% Sudolb) Hexachlorophene e.g., Phisohex, Gamaphene

- for wide range of antibacterial activity.

2. 70% - 75% Ethyl or Isopropyl Alcohol - for wide range of antibacterial activity, most active against TB.

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.

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.

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.

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.

Gowns & Aprons

protective clothing is used to reduce bacterial

spread by contact (nurse’s uniforms become

heavily contaminated during clinical

procedures.

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.

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.

BLOOD TRANSMISSABLE DISEASES &

SEXUALLY TRANSMITTED DISEASES (STDs)

HIV Infection/AIDS Hepatitis B (HBV) Hepatitis C (HCV)

Syphilis Gonorrhoea Chlamydia

Herpes Simplex Cytomegalovirus

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.

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.

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.

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.

Infection Prevention Measures: BSIS

Room Selection

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

Trash & Linen

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

Infection Prevention Measures: BSIS

Housekeeping

- Clean all rooms on regular

schedule.

- Clean articles, equipment &

furniture soiled with moist body

substances immediately. Wear

gloves.

Laboratory Specimens

- Handle all laboratory specimens with equal

care. Special precautionary labels are

required.

Infection Prevention Measures: BSIS

Compliance of Care Providers

- Develop programme to ensure that health care

workers comply with the infection precautions system.

Remember !!!

The nurse is responsible for providing the client with a safe environment.

The nurse’s 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 nurse’s failure to be meticulous will place the client at risk for an infection that can seriously impair recovery.

(Florence Nightingale, 1859)

THE END