Module 6: Medical/Surgical Asepsis Notes

Module Learning Outcome

  • After studying this module, you should be able to:
    • Discuss concepts related to the chain of infection.
    • Differentiate medical and surgical asepsis.
    • Identify common practices of medical asepsis in everyday living.
    • Cite common practices of medical asepsis in personal grooming.
    • Explain specific medical asepsis practices in hospitals.
    • Specify types of isolation practices.
    • List common practices during the isolation process.
    • Define blood-borne diseases.
    • Illustrate modes of transmission of blood-borne diseases in healthcare settings.
    • Demonstrate universal precautions to prevent blood-borne infections.

Beginning of Modern Asepsis

  • Before the discovery of asepsis:
    • Many people died from infections post-operation.
  • Dr. Ignaz Semmelweis recommended handwashing for doctors to prevent infection.
  • Joseph Lister, inspired by Louis Pasteur's germ theory, used carbolic acid in operating rooms, leading to a drastic reduction in infections.

Pathogenic vs. Non-Pathogenic Agents

  • Pathogenic: Disease-causing agents that affect healthy individuals.
    • Opportunistic Pathogen: Causes disease in susceptible individuals.
  • Virulence: The severity of disease caused by an infectious agent.
  • Non-Pathogenic: Resident flora that are typically harmless but can cause disease if moved to inappropriate locations.

Infection Types

  • Local Infection: Affects a specific area of the body.
  • Systemic Infection: Microorganisms spread and damage multiple areas.
    • Bacteremia: Microbes in the bloodstream.
    • Septicemia: When bacteremia spreads throughout the body.
  • Nosocomial Infections: Acquired from healthcare delivery, can be:
    • Endogenous: Originating from the patient’s flora.
    • Exogenous: From external sources, including healthcare personnel and equipment.
    • Iatrogenic: Infection caused by medical procedures or treatments.

Drug-Resistant Pathogens

  • MRSA: Methicillin-resistant Staphylococcus aureus.
    • Resistant to many antibiotics that treat staph infections.
  • VRE: Vancomycin-resistant enterococci, resistant to antibiotics including vancomycin.
  • MDR TB: Multidrug-resistant tuberculosis, resistant to potent TB drugs.

Medical vs. Surgical Asepsis

  • Medical Asepsis (Clean Technique):
    • Aims for the reduction of pathogenic organisms.
    • Used in all clinical patient care activities.
    • Key components include:
    • Understanding dirty, clean, and sterile items.
    • Keeping these categories separate.
    • Taking immediate action for contamination.
  • Surgical Asepsis (Sterile Technique):
    • Aims to completely remove microorganisms for surgical procedures.
    • Components include:
    • Understanding sterile vs. non-sterile.
    • Maintaining separation of conditions.
    • Immediate action upon contamination recognition.

Principles of Medical Asepsis

  • Perform hand hygiene correctly.
  • Use personal protective equipment (PPE) when contacted with body fluids.
  • Clean and disinfect shared equipment and environments.
  • Ensure healthcare providers are disease-free and vaccinated.

Principles of Surgical Asepsis

  • Ensure the patient and OR team do not contaminate sterile areas.
  • Adhere to meticulous surgical scrub practices.
  • Recognize and manage potential environmental contamination.

Hand Hygiene

  • Importance:
    • Primary mode of pathogen transmission.
    • Reduces antimicrobial resistance spread and healthcare-associated infections.
  • Types:
    • Handwashing with soap and water.
    • Antiseptic hand wash.
    • Alcohol-based hand rub.
    • Surgical antisepsis.

Five Elements of Pathogen Transmission on Hands

  1. Germs are present on patients and nearby surfaces.
  2. Germs contaminate healthcare provider hands through contact.
  3. Germs multiply on healthcare provider hands.
  4. Defective hand hygiene leads to contamination.
  5. Contaminated hands infect the next patient or surface.

Hand Hygiene Compliance

  • Noted compliance rates in various studies ranged from 16% to 81%, showing low adherence.
  • Barriers to compliance include:
    • Inaccessible hygiene supplies.
    • Skin irritation.
    • Glove use and rushing.

When to Perform Hand Hygiene

  • The 5 Moments of Hand Hygiene:
    1. Before touching a patient.
    2. Before clean or aseptic procedures.
    3. After body fluid exposure risk.
    4. After touching a patient.
    5. After touching patient surroundings.

How to Wash Hands Effectively

  • Total duration: 40-60 seconds.
  • Steps include:
    • Wet hands and apply soap.
    • Rub palms together and interlace fingers.
    • Clean backs of hands and between fingers.
    • Rinse and dry hands, using a single use towel.

How to Use Hand Rub

  • Total duration: 20-30 seconds.
  • Steps include:
    • Apply product and cover all hand surfaces.
    • Rub hands palm to palm and between interlaced fingers until dry.

Cleaning, Disinfection, and Sterilization

  • Cleaning: Physical removal of contaminants.
  • Disinfection: Reducing pathogen levels on surfaces.
    • Spaulding Classification:
    • Critical: Sterilization required.
    • Semi-Critical: High-level disinfection necessary.
    • Non-Critical: Low-level disinfection acceptable.
  • Sterilization Methods:
    • Steam under pressure (autoclave).
    • Gas.
    • Radiation.
    • Chemicals.

Sterile Technique Guidelines

  • Must keep objects sterile and maintain a sterile field.
  • Avoid contamination by not reaching across or turning your back on the sterile field.
  • No contamination at edges of sterile areas and maintain dryness.

Knowledge Check

  • Assess understanding of asepsis components and practices.

Summary

  • Hand hygiene is crucial; prefer hand rubbing when possible for quick disinfection. Wash hands only when visibly soiled. Perform at least 20 seconds for rubs and 40-60 seconds for washing, adhering to recommended techniques for effective results.