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Medical / Surgical Asepsis

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Medical / Surgical Asepsis and Infection Control Sharon L. Kinley-Schwing BSN Pacific College 2006 Foundations of Nursing Christensen Kockrow Mosby – PowerPoint PPT presentation

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Title: Medical / Surgical Asepsis


1
Medical / Surgical Asepsis and
Infection Control
Sharon L. Kinley-Schwing BSN Pacific
College 2006
Foundations of Nursing Christensen Kockrow
Mosby Lois White / Thomas
2
Medical/Surgical Asepsis
and Infection Control
  • Joseph Lister (1827 1912) is known as the
    father of aseptic technique.
  • Josephs technique helped reduce morbidity and
    mortality.
  • It is now known that microorganisms cause
    infection.
  • The growth and reproduction of a microorganism
    must be stopped to prevent an infection.
  • Concern and education regarding transmissible
    infections have increased in both hospitals and
    homes.

3
Infection Control
  • Policies and procedures in infection control are
    included in all health care facilities.
  • The education of all staff personnel is to
    minimize the risk of nosocomial infections.
  • Any patient entering a health care facility, due
    to illness or need for invasive procedure is
    at risk for developing an infection.

4
  • The application of infection control principles,
    and use of common sense help protect the
    patients.
  • Nurses are very often exposed to pathogenic
    microorganisms and should use specialized and
    routine practices of cleanliness to prevent the
    spread of infection.

5
Asepsis
  • Microorganisms are tiny, microscopic, capable of
    carrying on living process.
  • Microorganism are naturally present in the
    environment, as well as on the human body.
  • Many microorganisms are harmless, unless an
    individual is ill, and then highly susceptible to
    infection.
  • There are some microorganisms that do cause
    specific diseases or infections.

6
Asepsis
  • Medical asepsis, know as clean technique,
    inhibits the growth and spread of pathogenic
    microorganisms
  • Hand washing.
  • Changing the patients linen daily.
  • Daily activities of cleanliness.
  • Principles of medical asepsis is common at home.

7
  • Surgical asepsis, known as sterile technique,
    destroys all microorganisms and their spores .
  • Sterile technique and use in special skills and
    procedures.
  • Care of surgical wounds.
  • Urinary catheters.
  • Invasive procedures and surgery.

8
FLORA
  • Microorganisms that occur or have adapted to live
    in a specific environment.
  • Resident floraalways present, usually without
    altering the clients health.
  • Transient floraepisodic, and do not continually
    live on the skin.

9
PATHOGENICITY AND VIRULENCE
  • Pathogensdisease-producing microorganisms.
  • Pathogenicityability of microorganism to produce
    disease.
  • Virulencefrequency with which a pathogen causes
    disease.

10
FACTORS AFFECTING VIRULENCE
  • The strength of the pathogen to adhere to healthy
    cells.
  • The ability of a pathogen to damage cells or
    interfere with the bodys normal regulating
    systems.
  • The ability of a pathogen to evade the attack of
    white blood cells.

11
Infection Process
  • Six elements must be present for infection to
    occur
  • Infectious agent
  • Reservoir
  • Exit
  • Method of transportation
  • Entrance
  • Host

12
The Chain of Infection
13
Infectious Agents
14
BACTERIA
  • Small, one-celled microorganisms that lack a true
    nucleus or mechanism to provide metabolism.
  • Not all bacteria harmful or cause disease.
  • Common bacterial infections diarrhea, pneumonia,
    sinusitis, cellulitis, urinary tract infections,
    meningitis, gonorrhea.

15
Bacteria
  • Many different characteristics.
  • Three basic shapes, they include ?
  • During cell division some bacterial stay together
    to form pairs.
  • These difference help identifying specific kinds
    of bacteria.
  • Aerobic bacteria
  • Anaerobic bacteria
  • What is a spore ?

16
Bacteria continued
  • Many diseases can be diagnosis and treated when
    the specific microorganism in identified.
  • Body fluids, secretion suspected of containing
    pathogenic organisms can be evaluated for
    diagnosis.
  • Cultures and sensitivity test are completed to
    determine the antibiotic that will inhibit
    growth.
  • Streptococcus is responsible for more diseases
    than any other organism. Some strains are fatal.

17
Viruses
  • Smallest known agents that cause disease.
  • Not complete cells, but consist of a protein coat
    around a nucleic acid core.
  • 1898 Beijernick name these small bodies viruses.
  • 1941 electron microscope made in possible to
    study these small agents.
  • Enter the body via the respiratory,
    gastrointestinal, broken skin (vector or
    injection).
  • Most viruses are self limiting illnesses, others
    are fatal.

18
VIRUSES
  • Organisms that can live only inside cells.
  • They cannot get nourishment or reproduce outside
    cells.
  • Common viral infections common cold, influenza,
    measles, chickenpox, hepatitis B, genital herpes,
    HIV.

19
Fungi
  • Fungal (mycotic ) infections are among the most
    common.
  • Fungi belong to the plant kingdom, many are
    harmless, some are responsible for infections.
  • The grey, black, green, white fuzzy growth on old
    bread is a type of fungi.
  • Most mycotic infections are caused by yeasts and
    molds.
  • Most commonly involve the skin and mucous
    membranes.
  • Fungi that invade deeper tissue may be come fatal.

20
FUNGI
  • Grow in single cells or in colonies.
  • Food from dead organic matter, living organisms.
  • Most are not pathogenic.
  • Fungi can cause infections of the hair, skin,
    nails, and mucous membranes.

21
Protozoa
  • Single celled animals existing every where in
    nature in some form.
  • Some of the parasitic forms are found in the
    intestinal, genitourinary, respiratory and
    circulatory systems.
  • Disease producing protozoa are responsible for
    malaria, amebic dysentery, and African sleeping
    sickness.
  • Pathogenic microorganisms are infectious agents.
  • These microorganisms require food, and a proper
    environment in which to grow and live.
  • The strength of the organism, depends on the
    number present and the patients immune system.

22
PROTOZOA
  • Single-celled parasitic organisms with ability to
    move.
  • Food from dead, decaying organic matter.
  • Infection is spread through contaminated food,
    water, or insect bites.
  • Common infections malaria, gastroenteritis,
    vaginal infections.

23
RICKETTSIA
  • Intracellular parasites that
  • need to be in living cells to reproduce.
  • Spread through fleas, ticks, mites, and lice.
  • Common rickettsia infections include typhus,
    Rocky Mountain spotted fever, and Lyme disease.

24
COLONIZATION AND INFECTION
  • Colonizationthe multiplication of microorganisms
    on or within a host without resulting in cellular
    injury.
  • Infectionthe invasion and multiplication of
    pathogenic microorganisms in body tissue that
    result in cellular injury.

25
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26
AGENT
  • Entity that can cause disease
  • Biological agents living organisms that invade
    the host, causing disease
  • Chemical agents substances that can interact
    with body, causing disease.
  • Physical agents factors in environment capable
    of causing disease.

27
RESERVOIR
  • Place where agent can survive
  • In humans, animals, environment.
  • Fomitesobjects contaminated with infectious
    agent.
  • Carriershave infectious agent but symptom free.

28
Reservoir continue
  • Any natural habitat of a microorganism that
    promotes growth and reproduction is a reservoir.
  • Many microorganisms are found in many areas of
    the body, but the presents doesnt always mean
    infection.
  • Examples of Reservoirs
  • Soiled dressings
  • Wet dressings
  • Bed linens/
    Gowns/Uniforms
  • Hospital equipment
  • Urinary drainage
    bags/ Urinals
  • Carrier or vector is a person or animal that
    harbors and spreads an organism causing disease,
    with out becoming ill them self.

29
Exit Route
  • Microorganism cannot spread without first finding
    a way out of the first host.
  • Human exit routes include
  • gastrointestinal
  • respiratory
  • genitourinary
  • blood
  • tissue
  • Handwashing prevent the spread of microorganisms
    or cross contamination.
  • Coving the nose and mouth when coughing also
    prevents the spread of dieses causing organisms.

30
PORTAL OF EXIT
  • How infectious agent leaves the reservoir
  • Sputum.
  • Semen, vaginal secretions, and urine.
  • Saliva and feces.
  • Blood.
  • Draining wounds.
  • Tears.

31
Method of Transmission
  • Once a microorganism has exited a reservoir there
    are many vehicles.
  • These vehicles are called contaminated, soiled or
    stained.
  • What is a fomite ?
  • What is a vector ?
  • Give examples of
    each..

32
MODES OF TRANSMISSION
  • Movement of infectious agent from reservoir or
    source through portal of exit to portal of entry
    of susceptible host
  • Contact transmission.
  • Airborne transmission.
  • Vehicle transmission.
  • Vector-borne transmission.

33
PORTAL OF ENTRY
  • How an infectious agent enters the host
  • Integumentary system.
  • Respiratory tract.
  • Genitourinary tract.
  • Gastrointestinal tract.
  • Circulatory system.
  • Transplacental.

34
Entrance of Microorganisms
  • Once an organism has exited one host and been
    transmitted, it must find a way to enter a
    susceptible host.
  • When a hosts defense mechanisms are reduced,
    there is a greater chance of the organism to
    enter.
  • What are some of the ways organism can enter a
    host?

35
Host
  • A host is an organism in which another ,
    usually parasitic, organism is nourished and
    harbored.
  • Susceptibilities are determined by the amount to
    resistance shown to the pathogen.
  • Microorganisms are constantly in contact with
    people, but infections do not develop unless a
    person is susceptible to the numbers of
    organisms.
  • Immunizations have proven effective in providing
    additional protection against infectious disease.

36
HOST
  • Organism that can be affected by agent.
  • Susceptible hostperson who has no resistance to
    an agent and thus is vulnerable to disease.
  • Compromised hostperson whose normal body
    defenses are impaired and is therefore
    susceptible to infection.

37
FACTORS AFFECTING SUSCEPTIBILITY TO INFECTION
  • Age
  • Concurrent diseases
  • Stress
  • Immunization/vaccination status
  • Lifestyle and occupation
  • Nutritional status
  • Heredity

38
  • Infectious process
  • incubation period
  • prodromal stage
  • illness stage
  • convalescence
  • Inflammatory response

39
STAGES OF INFECTION
  • Incubation stagethe time between entry of an
    infectious agent and the onset of symptoms.
  • Prodromal stagethe time from the onset of
    nonspecific symptoms until specific symptoms
    begin to manifest.
  • Illness stagethe time when client has specific
    signs and symptoms.
  • Convalescent stagefrom the beginning of the
    disappearance of acute symptoms until client
    returns to previous state of health.

40
Nosocomial Infections
  • Term taken from the Greek word, meaning health
    care facility.
  • An infection that is acquired while in a hospital
    or other health care agency.
  • This infection is usually acquired at least 12
    hour after admission.
  • The hospital harbors microorganisms that may be
    highly virulent.

41
NOSOCOMIAL INFECTIONS continued
  • Infection acquired in hospital or other health
    care facility that was not present at the time of
    the clients admission.
  • Include those infections that become symptomatic
    after the client is discharged.
  • Four categories urinary tract, surgical wounds,
    pneumonia, and septicemia.
  • These infections cause extended stays and
    treatment for patient, and increase cost of care
    for the hospital.

42
Infection Control Team
  • Valuable discipline in the health care arena.
  • These teams include who ?
  • OSHA and JAHO have pressured hospitals to better
    organize these teams, and document infections
    within the hospital.
  • What is the duty of infection control personnel ?
  • Employee health services.

43
BREAKING THE CHAIN OF INFECTION Page 359
44
Standard Precautions
  • Set of guidelines designed to reduce the link of
    transmission of blood born pathogens and
    pathogens from moist body secretions.
  • Guidelines apply to
  • Blood
  • All body fluids, secretions and excretions
  • Nonintact skin
  • Mucous membrane
  • Precautions promote
  • Handwashing
  • Use of gloves, masks, eye protection
  • Use of gowns when appropriate for patient contact

45
Hand Hygiene
  • The most important and basic preventive
    technique for interruption the infectious
    process.
  • 2 minute handwashing will provide protection
    before the nurse cares for a patient.
  • 30 second handwashing before caring for another
    patient should be sufficient to ensure minimal
    transmission of microorganism between patients.

46
MEDICAL ASEPSIS
  • Hand hygienethe most basic and effective
    infection-control measure to prevent and control
    the transmission of infectious agents.
  • Single most important procedure for preventing
    nosocomial infections.

47
  • Performing a 2 minute hand wash.
  • Using an Alcohol-Based Waterless Antiseptic for
    Routine Hand Hygiene.

48
Performing a 2-minute handwashing
(From Elkin, M.K., Perry, A.G., Potter, P.A.
2004. Nursing interventions and clinical
skills. 3rd ed.. St. Louis Mosby.)
49
Health Promotion Considerations
  • Adequate exercise, well balanced diet, current
    immunizations.
  • Discuss susceptibility of the patient to disease.
  • Teach correct and safe methods of storing and
    preparing foods.
  • Hygiene.
  • Know family and others susceptibilities to
    disease.
  • Home cleaning techniques for patients cared for
    at home.

50
Gloving
  • Gloves are use if there is nay possibility of
    contact with infectious material.
  • Advice from the CDC on wearing gloves include ?
  • Donning gloves / Removing gloves

51
  • Gowning
  • gowning for isolation
  • Mask / Protective eyewear
  • donning a mask
  • Disposing of Contaminated Equipment
  • Double bagging
  • Isolation technique

52
Donning a mask.
(From Potter, P.A., Perry, A.G. 2005.
Fundamentals of nursing. 6th ed.. St. Louis
Mosby.)
53
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54
Double bagging.
55
Types of Precautions Patients Requiring Precaution
  • Standard precautions
  • Airborne precautions
  • Droplet precautions
  • Tuberculosis isolation

56
Types of Precautions continued
  • Contact Precautions
  • Immunocompromised patients
  • Monitoring of isolation

57
ASEPSIS
  • Absence of microorganisms
  • Medical asepsispractices used to reduce the
    number, growth, and spread of microorganisms
  • Surgical asepsispractices that eliminate all
    microorganisms and spores from an object or area

58
Surgical Asepsis
  • Surgical or sterile technique, requires a nurse
    to use precautions different from those of
    medical asepsis.
  • Nurse working with a sterile field or equipment
    must understand sterile technique.
  • Any break in this technique results in
    contamination.
  • Surgical asepsis is practiced in the operating
    room, labor and delivery area, and major
    diagnostic areas.
  • Surgical asepsis may also be used during
    procedures at the bedside.

59
Surgical handwashing
60
Surgical Handwashing.
(From Elkin, M.K., Perry, A.G., Potter, P.A.
2004. Nursing interventions and clinical
skills. 3rd ed.. St. Louis Mosby.)
61
  • Cleaning
  • Disinfection
  • and Sterilization

62
  • Cleaning
  • Disinfection
  • Sterilization
  • Preparing for disinfection and sterilization

63
CLEANSING
  • Removal of soil or organic material from
    instruments and equipment used in providing
    client care.
  • Involves the use of water, mechanical action, and
    sometimes, a detergent.
  • Nurses should wear gloves, masks, and goggles
    during cleansing.

64
Sterilization or Disinfection
  • Physical Method
  • Steam under pressure/ moist heat
  • Boiling water
  • Radiation
  • Dry heat
  • Chemical Process
  • Gas
  • Chemical solutions

65
DISINFECTION
  • Elimination of pathogens, except spores, from
    inanimate objects.
  • Disinfectantschemical solutions used to clean
    inanimate objects.
  • Germicideschemicals that can be applied to both
    animate (living) or inanimate objects to
    eliminate pathogens.

66
STERILIZATION
  • Destroying all microorganisms including spores.
  • Equipment that enters normally sterile tissue or
    blood vessels must be sterilized.

67
STERILIZATION (continued)
  • Methods include
  • Moist heat (steam)
  • Dry heat
  • Ethylene oxide gas
  • Autoclaving (moist heat or steam) is the most
    common method.

68
B, Receptacle receiving fluids is placed near
edge of sterile table.
69
Patient Teaching for Infection Control
  • The nurse will need to educate patient about the
    nature of infection and the techniques to use in
    planning or controlling its spread
  • Infection control for home and hospice settings.
  • Prevention of infection
  • Hand washing
  • food preparation
  • lines
  • waste containers
  • body fluid spills

70
Infection Control
  • Older adult considerations
  • Cultural and Ethnic Considerations

71
Infection Control for Home and Hospice Settings
  • Nursing Process
  • Assessment
  • Prevention of Infection in the Home setting
  • Hand hygiene
  • Food preparation
  • Linens
  • Waste containers
  • Body fluid spills

72
BODY DEFENSES
  • A hosts immune system is a defense against
    infectious agents.
  • An immune response against an antigen protects
    the body from infection.
  • Immune defenses are identified as nonspecific and
    specific.

73
NONSPECIFIC IMMUNE DEFENSE
  • Protects host from all microorganisms
  • does not depend on prior
    exposure to antigen
  • Skin and normal flora.
  • Mucous membranes.
  • Coughing, sneezing, and tearing reflexes.
  • Elimination and acidic environment.
  • Inflammation.

74
INFLAMMATION
  • Nonspecific cellular response to tissue injury
  • Redness (erythema).
  • Heat.
  • Pain.
  • Swelling (edema).
  • Loss of function.
  • Purulent exudate (pus).

75
SPECIFIC IMMUNE DEFENSE
  • Response specific to an invading antigen.
  • Acquired immunityprotects individual against
    future invasions of already experienced antigens.
  • Vaccinationan inoculation with a vaccine to
    produce immunity against specific diseases.

76
TYPES OF INFECTION
  • Localized infectionslimited to defined area or
    single organ with symptoms that resemble
    inflammation (redness, tenderness, swelling),
    such as cold sore.
  • Systemic infectionsaffect entire body, involve
    multiple organs, such as AIDS.

77
NURSING DIAGNOSIS
  • Risk for infection.
  • Ineffective protection.
  • Impaired tissue integrity.
  • Impaired oral mucous membrane.
  • Impaired skin integrity.
  • Deficient knowledge (specify).

78
  • Nursing diagnosis
  • Expected outcomes
  • Planning
  • Implementation
  • Evaluation

79
  • Questions ?
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