Chapter 41 Medical Asepsis

Medical Asepsis

Medical Asepsis

Clean technique, prevents infection; practice of REDUCING the number of microorganisms to PREVENT or REDUCE the transmission from one person to another;
handwashing is number 1; used in administrations of meds, enemas, tube feedings, and daily hygiene

Standard Precautions

set of guidelines to be used in the delivery of all healthcare; established by the CDC; are to be followed at all times by nurses and other healthcare providers when delivering any care or performing any procedures; treat all patients as though they are infectious

wear gloves

when handling blood, body fluids, non-intact skin or soiled items
or when performing any invasive procedure, including giving injections
change gloves between patients, double gloves may be used if needed

wear mask

and eye protection or face shield to protect mucuous membranes of the eyes, nose, and mouth when likely to be splashed

wear gown

to protect skin and prevent soiling of clothing when likely to be splashed or sprayed.

sharps disposal

dispose of syringes and other sharps into designated closed container. do not break or bend needles
do not re-cap needles

What do Standard Precautions include?

--maintenance of personal immunizations
--thorough handwashing
wearing gloves and other PPE (personal protective equipment)
handling sharps safely
proper disposal/cleanup of linens, used equipment, medication packages, biohazardous materials
Surface disinfection PRN (as needed)
maintenance of sterility of needles and catheters
use of mouthpieces for resuscitation

Asepsis

PRACTICES that minimize or eliminate pathogenic organisms
a= without or loss of
sepsis = bacteria

Surgical Asepsis

aims to DESTROY all organisms and the SPORES and is used only in certain situations; referred to as STERILE technique; used in dressing changes, catheterization, surgical procedure

Nosocomial Infections

infections acquired while in the hospital, can lengthen the persons stay in the healthcare facility and increase the cost of treatment, and even cause death
failing to use appropriate preventive techniques
presenting the possibility of cross-contamination
not following standard precautions

How may a healthcare worker contribute to the development of a nosocomial infection?

failing to use appropriate prevention techniques, increasing the clients possibility to pathogens, presenting the possibility of cross contamination, not following standard precautions; patients are more susceptible to infection in a HCF b/c resistance to disease is decreased and the HCF is a pathogen rich environment

Common Nosocomial Infections according to the CDC

genitourinary 40%, (UTIs- pt's with bed sores)
bacteremias 14%,
surgical site infections 17%
respiratory infections 13%,
gastrointestinal infections

Endogenous Organisms

microorganisms present WITHIN the person's body that cause infection such as
staphylococcus aureus & staphlyococcus epidermis

Exogenous Organisms

microorganisms from OUTSIDE the body that cause infection such as
salmonella, clostridium tetani, & aspergillus species

What type of organisms cause most nosocomial infections?

Gram Negative

What factors contribute to a person's lowered resistance to nosocomial infections?

-Trauma-stress or emotional shock, fatigue
-Pre-existing disease- generally poor health or frequent illness
-Age, inactivity, poor nutrition, inadequate hydration
Stress or emotional shock, fatigue
-Invasive therapy, immunosuppresants
-Frequent or inappropriate use of broad spectrum antibiotics, inadequate primary and secondary defenses

Breaking the chain of infection at the CAUSING AGENT

nurse helps reduce the number or virulence of the pathogen by administering antibiotics, following agency protocols for delivery of care, careful handwashing and sanitization

Breaking the chain of infection at the RESERVOIR

nurse helps to eliminate areas for pathogens to grow and multiply by proper disposal of contaminated dressings or body fluids, disposing outdated IV solutions or meds, proper cleanup of spills, keeping personal immunizations up to date, using disposable equipment and materials, discarding broken sterile packages, no jewelry or artificial nails, proper handwashing and sanitization

Breaking the Chain at Portal of EXIT

nurse gives special attention to respiratory and gastrointestinal tracts and body fluids, keeps wounds covered, encourages safe sex, follows isolation techniques, uses proper hand washing and sanitization

Breaking the chain VEHICLE of TRANSMISSION

nurse eliminates transmission of pathogens between people by correctly using masks and gloves, properly disposing of wound drainage, urine, feces, soiled dressings, diapers or tubing, proper catheterization and infection techniques, keeping urinary drainage equipment sterile, correct handling of body fluids, water proof bags for soiled or wet linens, proper hand washing and sanitization

Breaking the chain of infection at the PORTAL of ENTRY

nurses use proper nursing procedures to help prevent the pathogen from entering a patient's system by using protective isolation protocol, cleansing from clean to dirty such as in the perineal area, correct sterile technique, proper handwashing and sanitization

Breaking the chain Susceptible Host

nursing actions are aimed at increasing patient resistance to disease by promoting adequate nutrition, hydration, and rest, careful monitoring and maintenance of skin integrity, follow protocol for administration of antibiotics, administer prescribed medications, pat attention to the immuno compromised, assist and encourage patient to exercise

What should nurses obtain during a client history?

should be careful and thorough, recent surgeries, recent major illnesses, new conditions, undiagnosed conditions, knowledge of current infection, past related infections, immunization status

Why is the maintenance of skin important?

the skin is the first and best barrier to pathogens

Preventing Infection for Nursing Staff

--risks for infection in nurses after exposure to diseases such as tuberculosis or hepatitis
--appropriate immunizations
--careful hand washing and
--the use of standard precautions are vital in protecting the nurse

Infection Control Committee

monitors nosocomial infections; its functions are:
--watchfulness to locate instances of infection,
--investigation of any infections that occur
--compiling statistics regarding nosocomial events, --teaching staff, clients and families infection prevention,
--serves as a liason between the facility and the community

What is the single most effective measure to reduce the risk of transmitting disease?

Handwashing

Long Hand wash

at the beginning and the end of shifts
when hands visibly soiled or exposed to blood or body fluids without gloves
thorough washing of hands, lather at least twice, careful cleaning of nails

Short Hand wash

lasts 10-15 seconds
CDC recommends a 15 second wash approx the length of yankee doodle with a 10 second rinse

What are the reasons for handwashing?

reduce the flora on the skin
protect the nurse in case the skin is not intact
reduce risk if gloves break or punctured
reduce chances of disease transmission

When does the CDC reccomend handwashing?

when hands are visibly soiled
before and after contacts with all clients
after contact with a source of microorganisms
BEFORE REMOVING gloves if they are visibly soiled and each time after removing gloves

When is hand sanitation used instead of hand washing?

when there is no visible soil on the hands and if there is no contact with client's body fluids

What are considered barrier techniques?

All PPE
gloves, eye protection, gowns, and masks

what are the benefits of gloves?

reduce hand contamination by 70%
provide a protective barrier when touching blood or body fluids. The use of gloves does not eliminate the need for frequent, careful handwashing
Gloves help provide protection from microorganisms and help prevent the spread of pathogens from person to person

When can latex allergies occur?

from direct contact or from the powder on the gloves being dispersed in the air

what are the 3 levels of latex sesitivity

Skin Irritation
Contact Dermatitis
Generalized anaphylaxis

If a healthcare provider has a latex allergy, what is recommended?

carry a self injectable epinepherine syringe to be used in case of emergency, this should also be available on the unit for the sensitive client

What are the benefits of Masks?

protect from upper respiratory infections and certain communicable diseases

What are the types of masks?

Simple Masks
Particulate Masks

What do simple masks do?

filter larger particles

what do particulate masks do?

also call respirator
designed to filter out very small particle

What are the benefits of goggles?

eye protection w/ side and forehead shields

What is the sequence to remove PPE?

remove the most soiled item first
gloves, mask, eye, wash hands, gown, wash hands

What should be done if a needle stick occurs?

immediately wash area with germicidal soap
encourage bleeding from puncture site
report to employee health
incident report
blood tests
possible post exposure prophylaxis protocol

What is a disinfectant?

kills bacteria

what is an antiseptic?

inhibits or prevents the growth of bacteria

What is done when a biohazardous spill occurs?

follow facility protocols
sanitize area as specified
dispose of contaminated material and supplies immediately
specialists (janitors/evs) clean up spill on carpeting or upholstery

Disposal of biohazard waste

nurse is responsible for proper disposal of contaminated materials
follow written protocol of facility and nursing care guidelines
i.e. needles, lancets, razor blades or disiposable razors , suture removal scissors, scalpel blades
put in designated "sharps" container

Terminal Disinfection

care of clients unit after illness is over
usually done by housekeeping
terminal disinfection considers all links in the chain of infection
it is vital to the prevention of nosocomial infections

what should be included when TEACHING THE CLIENT about infection control?

handwashing technique
hygenic practices, aseptic techniques
proper methods for handling and disposing of contaminated material
proper handling of food
adequate fluid and good intake
exercise
take all antibiotics as prescribed
any special procedures or individual precautions

Soap

lowers surface tension of oil on skin which holds microorganisms
facilitates removal during rinsing
examples are dial and safeguard

Detergent

Same as soap except detergents do not form PRECIPITATE with water
examples are dreft and tide
used sanitizing eating utensils or doing laundry

Alcohol wipes

70% concentration injures protein and lipid structures in inner cellular membrane of some microorganisms
examples isopropanol and ethanol
use when cleansing skin and instruments

Alcohol based hand sanitizers

penetrates bacteria cell membrane
strips out layer of oil off hands
uses cleans skin if no visible soil does not kill viruses

Iodine

damages inner cell membrane of microorganisms
example betadine
cleanses skin

Chlorine

interferes with microbial enzyme systems and INHIBITS VIRUSES
examples are bleach and chlorine
uses are disinfection of surfaces, utensils, blood spills some effectiveness against HIV virus

Chlorexidine

damages inner cell membrane
ineffective against spores and viruses
example HIBICLENS

mercury

alters microbial cellular proteins
examples merthiolate, mercurochrome
disinfects skin

Glutaraldehyde

inactivates cellular proteins of bacteria, viruses, and microbes that form spores
examples cidex
used when sterilizing equipment

what to wear when irrigating a draining wound because of splashing?

faceshield
gloves
mask