Medical Asepsis and Infection Control Notes

Medical Asepsis & Infection Control

Medical Asepsis

• Medical asepsis is the state of being free from disease-causing microorganisms like viruses, bacteria, and fungi.

• Practicing medical asepsis helps contain infectious organisms and maintains an environment free from contamination.

Common Disease-Causing Bacteria

• Staphylococcus aureus (Staph)

  • Commonly found on our skin.

  • Can cause infections anywhere in the body if it enters.

• MRSA (Methicillin-Resistant Staph Aureus)

  • Discovered in 1961 in the UK and now found worldwide.

  • A "SUPERBUG" - a variation of Staphylococcus aureus that has evolved the ability to survive treatment from specific antibiotics like penicillin and methicillin.

  • Manifests as swollen, red bumps resembling pimples, full of pus, and can cause cellulitis near the affected area.

• Other Common Pathogens

  • Escherichia coli

  • Enterococci

  • Candida

• Nosocomial Infections

  • Originating in a hospital setting.

  • MRSA is the most common nosocomial infection.

• Causes of Infections

  • Urinary catheters leading to urinary tract infections.

  • Surgical procedures leading to surgical site infections.

  • Central venous catheters leading to bloodstream infections.

  • Mechanical ventilation leading to pneumonia.

• Prevention

  • Frequent and proper hand hygiene.

  • Use of PPE (Personal Protective Equipment).

  • Remove indwelling devices ASAP.

  • Appropriate antimicrobial use and routine disinfection.

Enterococcus

• Often occur in pairs (diplococci).

• Difficult to distinguish from Streptococci.

• Found in the intestines of humans.

• Prefer oxygen but can survive without it.

• Infections: Urinary tract, diverticulitis, meningitis.

• Treatment: Ampicillin and vancomycin.

• VRE (Vancomycin Resistant Enterococci)

  • A "SUPERBUG”.

Clostridioides difficile (C. diff)

• Gram-positive, anaerobic, spore-forming bacillus.

• Responsible for antibiotic-associated diarrhea and colitis.

• Manifests as mild-to-moderate diarrhea, occasionally with abdominal cramping.

• Hand sanitizer is ineffective against C. diff; hand washing is essential.

The Hidden Truth About C. Diff Infection

• C. diff infections (CDIs) cause more American deaths than HIV/AIDS and drunk driving combined.

  • CDIs: 29,000 deaths

  • HIV/AIDS: 17,000 deaths

  • Drunk Driving: 10,000 deaths

• CDI increases hospital stays by 3.3 days on average.

• 500,000 C. diff infections annually.

• 17,000 children get C. diff.

• C. diff is the 17th leading cause of death in people 65 and over.

• 9,000 nursing home deaths per year are attributed to C. diff.

• Recurs in 1 in 5 patients.

• One of the most common nosocomial infections, affecting 20% of all hospitalized patients.

• C. diff stays are three times more costly than many other stays.

  • Average cost per hospital stay:

    • C. diff: 24,400

    • Congestive Heart Failure: 18,200

    • Pneumonia: 9,300

    • Acute Myocardial Infarction: 10,500

• Annual hospital costs for C. diff patients total 8.2 billion.

Acid Fast Bacilli (AFB)

• Difficult to characterize using standard microbiological techniques.

• Stained using concentrated dyes combined with heat.

• Resist dilute acid once stained, hence the name “acid-fast”.

• Example: Mycobacterium tuberculosis.

Mycobacterium tuberculosis

• Causes Tuberculosis (TB), which primarily attacks the lungs but can damage other parts of the body.

• Spreads through the air when a person with TB of the lungs or throat coughs or sneezes.

• Individuals with weak immune systems are most susceptible to tuberculosis.

• Most Common AFB.

The Novel Coronavirus (SARS COV-2)

• Causes COVID-19.

• Spreads between people in close contact (within about 6 feet).

• Respiratory droplets produced when an infected person coughs, sneezes, or talks can land in the mouths or noses of people nearby or be inhaled into the lungs.

• Can be spread by people who are not showing symptoms.

COVID-19: Prevention

• Get vaccinated and boosted.

• Wash hands often.

• Avoid close contact.

• Cover your mouth and nose with a mask when around others.

• Cover coughs and sneezes.

• Clean and disinfect.

• Monitor your health daily.

Why Practice Medical Asepsis in Healthcare?

• Prevent organisms from spreading from infected patients to other patients (cross-contamination).

• Protect susceptible patients from becoming infected.

• Protect healthcare workers.

• Examples of communicable (infectious or transmissible) diseases:

  • H1N1 (Swine) Flu

  • HIV/AIDS

  • MRSA

  • Measles

  • Pertussis

  • Rabies

  • Flu (seasonal)

  • Sexually Transmitted Diseases

  • Tuberculosis

  • West Nile Virus

  • COVID-19

  • Hepatitis

  • Meningitis

Isolation Precautions

• Patients with infectious diseases are placed in isolation, and special practices are instituted.

• Types of Isolation:

  • Standard Precautions

  • Airborne Precautions

  • Droplet Precautions

  • Contact Precautions

  • Reverse Isolation

• The #1 most effective precaution against transmitting micro-organisms is hand washing.

Standard (Universal) Precautions

• Basic level of infection control used in the care of all patients, all the time.

• Includes:

  • Hand washing

  • Gown

  • Glove

  • Mask

  • Face Shield/Eye Protection (if splashes of blood/body fluid are likely)

• It is recommended to assume you should wear everything, but it is dependent on each patient situation. Protect yourself!

Airborne Precautions

• Used with patients with diseases spread by droplet nuclei particles.

• Commonly spread through coughing and sneezing.

• Examples: Tuberculosis, Measles, Varicella.

• Indicated: Gown, Glove, Eye Protection (if body fluid/blood splashes).

• A particulate mask (N95 fitted Respirator).

• Paper masks are not a snug fit, air leaks, effective 20 min.

• Private, negative pressure room.

Droplet Precautions

• Used with diseases spread by droplets from larger bacteria and viruses.

• Commonly spread through coughing and sneezing.

• Can spread 3 feet and deposit around patient!

• Additional exposure: CPR, suctioning

• Examples: Influenza, Meningitis, Mycoplasma pneumonia.

• Indicated: Gown, Glove, Eye Protection (if body/blood splashes).

• Paper mask: if within 3 feet of patient.

• Private Room.

Contact Precautions

• Used with diseases spread by contact with intact skin or surfaces.

• Examples: MRSA, VRE, Hepatitis A, Rotovirus, Lice and Scabies.

• Indicated: Gown, Glove.

• Mask may be required per hospital policy.

Reverse Isolation

• Protects the patient from the health care worker.

• Used for patients with severe burns, neutropenia, or those receiving treatments that lower natural resistance to infection.

• Aims to avoid nosocomial infection.

• Indicated:

  • Private room

  • All objects in contact with the patient must be sterile or free from micro-organisms as much as possible.

  • Strict hand washing, gowns, gloves, masks, bouffant/caps.

• The room is cleaned and disinfected daily, and cultures are taken to discover any infection.

PPE: Personal Protective Equipment

Hand Washing

• The single most effective technique for preventing the transmission of micro-organisms.

• Your hands are the most common spreader of communicable disease in the hospital!

• Wash hands before patient care, after patient care, and between patients (Even if gloves are worn).

• If you plan on wearing gloves (Ex: performing procedures, contact with patient body fluids), you must still wash your hands before & after using gloves.

• Hand that look clean can still have germs!

• Steps:

  1. Wet

  2. Get Soap

  3. Scrub

  4. Rinse

  5. Dry

Hand Sanitizer

• How to Use Hand Sanitizer the Right Way:

  1. Apply sanitizer to hands.

  2. Cover all surfaces of hands.

  3. Rub hands together until dry.

PPE: Gloves

• Wear gloves when touching blood, body fluids, secretions, excretions, mucous membranes, contaminated items, or non-intact skin.

• Protect ourselves and other patients.

• Different sizes and types available. Choose the right ones for you and what you are performing!

• Latex and Latex free options.

• Sterile gloves: sealed, sterile package

PPE: Mask / Eye Protection

• Protect us from droplets entering or contacting mucous membranes when performing procedures or working around patients.

• Eyes, Nose, Mouth

• Mask Options: Paper, Paper with eye protection, N95

• Eye Protection

PPE: Gowns

• Protect skin and clothing during procedures and activities likely to generate splashes of blood or body fluids.

• Protects other patients from nosocomial infections.

• Remove gown just prior to leaving patient room.

• May be sterile OR, Radiology suites, Cardiac Catheterization lab

Infection Control Procedures

• Containment

• Processes for Sterilization

Infection Control: Sharps

• Needles, Razors, Scissors, Scalpel Blades, Broken Ampoules, Broken Glass

• Disposal: Special RED containers designed specifically for sharps disposal.

• If you “Stick” Yourself - IMMediately Report!! Clean the site! Follow Hospital Procedure!

Sharps: DO NOT

• Throw lose sharps in trash

• put sharps in recycling

• Flush sharps down toilet

• of reach of children

• Force sharps into container

• put ur fingers inside container

• remove needle

• bend or break needle

• recap needle

  Infection Control: Double Bagging

• The process used to remove materials from an isolation room

Infection Control Sterilization:

The purpose of sterilization is to kill ALL
pathogens that may be present on
equipment.
 Processes of sterilization:
 Physical
 Chemical
 Gas

Physical Sterilization
 Autoclave:
 The most dependable and extensively used
method of Physical Sterilization
 Steam under pressure
 Effective for most equipment: cloth, glass, and metal
 Not for use:
Heat sensitive equipment
& instruments
Sharp instruments
(dulls sharp edges)

Chemical Sterilization
 Liquid Chemical:
 Soak the items in strong disinfectant or sterilizing
agent for a specified time
Buffered Glutaraldehyde
Acid Glutaraldehyde
 Heat and time must be added to
achieve sterilization
 Use on equipment that
can’t withstand heat

Gas Sterilization
 Ethylene Oxide:
 Highly toxic; can form toxic byproducts
 Highly effective
 Can be used on all equipment:
Rubber, plastic equipment
Electronic monitors
 Expensive
 Long time requirement
Aeration

Infection Control: Sterile Field
For an invasive procedure:
 Sterile instruments are placed on a tray or stainless-
steel table.
 Instruments are placed on top of a sterile towel.
 This area off limits unless directly involved with the
procedure!
 Reaching over
the sterile field is
considered
contamination!

Safety Data Sheets: SDS
 Each department in hospital MUST have SDS:
 For any hazardous material/chemical used
 Responsibility of the manager of department
to inform staff of the location of the SDS
 It is the responsibility of the employee:
Familiarize yourself with the specific SDS of
area
Know the procedures for safely handling /
working with a substance

Safety Data Sheets
Information contained / found:
 Product name
 Chemical name
 Formula
 Trade name
 Appearance/Odor
 Hazardous ingredients
 Physical and Chemical characteristics
 Health hazards
 Exposure limits
 Emergency and First aid procedures
 Spill/Leak procedures