Chapter 10 Asepsis Copyright 2009 Wolters Kluwer Health

Microorganisms • Living animals or plants visible only with a microscope; also commonly called

Types of Microorganisms • Bacteria • Fungi • Protozoans • Helminths • Viruses •

Categorization of Microorganisms Nonpathogens: harmless, beneficial Pathogens: cause illness Resident nonpathogens constantly present on

Survival of Microorganisms • Spores – Temporarily inactive microbial life form; can resist heat

Question • Is the following statement true or false? Transient pathogens are present constantly

Answer False. Transient pathogens are picked up during contamination. Copyright © 2009 Wolters Kluwer

Chain of Infection • An infectious agent • A reservoir for growth and reproduction

Chain of Infection (cont’d) Copyright © 2009 Wolters Kluwer Health | Lippincott Williams &

Biologic Defense Mechanisms • Anatomic or physiologic methods that stop microorganisms from causing an

Nosocomial Infections • Nosocomial infections are infections acquired while a person is receiving care

Question • Is the following statement true or false? Mechanical defense mechanisms destroy or

Answer False. Chemical defense mechanisms destroy or incapacitate microorganisms through natural biologic substances. Copyright

Asepsis • Practices that decrease or eliminate infectious agents, their reservoirs, and vehicles for

Medical Asepsis • Confines or reduces the numbers of microorganisms • Involves measures that

Surgical Asepsis • Measures that render supplies and equipment totally free of microorganisms •

Principles of Medical Asepsis • Microorganisms exist everywhere except on sterilized equipment • Frequent

Principles of Medical Asepsis (cont’d) • A clean environment reduces microorganisms • Cleaning should

Question • Is the following statement true or false? Surgical asepsis involves measures that

Answer False. Medical asepsis involves measures that interfere with the chain of infection in

Practicing Hand Antisepsis • Apply about a nickel- to quarter-sized volume of the product

Hand Antisepsis Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question • Which of the following is a method of surgical asepsis? a. Donning

Answer a. Donning a sterile gown is a method of surgical asepsis. Using antimicrobial

Types of Hospital Garments • Gloves • Scrub suits and gowns • Masks •

Hospital Garments Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Utility Rooms • Health care agencies: at least 2 utility rooms (clean and dirty);

Concurrent Disinfection • Clean less-soiled areas before grossly dirty ones • Wet-mop floors and

Terminal Disinfection • More thorough than concurrent disinfection and consists of measures used to

Sterilization • Consists of physical and chemical techniques that destroy all microorganisms including spores

Principles of Surgical Asepsis • Once equipment and areas are free of microorganisms, they

Principles of Surgical Asepsis (cont’d) • Question the sterility of an item considered unsterile

Principles of Surgical Asepsis (cont’d) • Once a sterile item is opened or uncovered,

Principles of Surgical Asepsis (cont’d) • Coughing, sneezing, or excessive talking over a sterile

Adding an Agency-Sterilized Item Copyright © 2009 Wolters Kluwer Health | Lippincott Williams &

Adding Sterile Gauze Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Adding Sterile Solution Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

General Gerontologic Considerations • Older clients more susceptible to infections • Maintain intact skin,

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Microorganisms • Living animals or plants visible only with a microscope; also commonly called germs – The body’s immune defense mechanisms eliminate them – They reside within the body without causing disease – They cause an infection or infectious disease Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Categorization of Microorganisms Nonpathogens: harmless, beneficial Pathogens: cause illness Resident nonpathogens constantly present on the skin Aerobic: require oxygen to live Transient pathogens picked up during contamination Anaerobic: exist without oxygen Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Survival of Microorganisms • Spores – Temporarily inactive microbial life form; can resist heat and destructive chemicals and survive without moisture; reactivate and reproduce when conditions are favorable • Antibiotic-resistant bacterial strains – No longer respond to drugs that once were effective against them Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chain of Infection • An infectious agent • A reservoir for growth and reproduction • An exit route from the reservoir • A mode of transmission • A port of entry • A susceptible host Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Biologic Defense Mechanisms • Anatomic or physiologic methods that stop microorganisms from causing an infectious disorder – Mechanical: physical barriers that prevent microorganisms from entering the body or expel them before they multiply – Chemical: destroy or incapacitate microorganisms through natural biologic substances Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question • Is the following statement true or false? Mechanical defense mechanisms destroy or incapacitate microorganisms through natural biologic substances. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Asepsis • Practices that decrease or eliminate infectious agents, their reservoirs, and vehicles for transmission • A major method for controlling infection • Health care professionals use medical and surgical asepsis to prevent spread of infections Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Medical Asepsis • Confines or reduces the numbers of microorganisms • Involves measures that interfere with the chain of infection in various ways • Examples: – Performing hand hygiene – Wearing hospital garments Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Surgical Asepsis • Measures that render supplies and equipment totally free of microorganisms • Practices that avoid contaminating microbefree items • Examples: – Physical sterilization – Chemical sterilization Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Principles of Medical Asepsis • Microorganisms exist everywhere except on sterilized equipment • Frequent handwashing and maintaining intact skin reduces transmission of microorganisms • Blood, body fluids, cells, and tissues are major reservoirs of microorganisms • Personal protective equipments serve as barriers to microbial transmission Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Principles of Medical Asepsis (cont’d) • A clean environment reduces microorganisms • Cleaning should be done from cleaner to dirtier areas Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question • Is the following statement true or false? Surgical asepsis involves measures that interfere with the chain of infection in various ways. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Practicing Hand Antisepsis • Apply about a nickel- to quarter-sized volume of the product to the palm of one hand or the amount recommended by the manufacturer • Distribute the product to cover all surfaces of the hands and fingers • Rub the product between the hands for 15 to 25 seconds until they are dry Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question • Which of the following is a method of surgical asepsis? a. Donning a sterile gown b. Using antimicrobial agents c. Performing hand antisepsis d. Performing handwashing Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer a. Donning a sterile gown is a method of surgical asepsis. Using antimicrobial agents, performing hand antisepsis, and handwashing are methods of medical asepsis. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Utility Rooms • Health care agencies: at least 2 utility rooms (clean and dirty); personnel must not place soiled articles in the clean utility room • The utility room contains: – Covered waste receptacles and laundry hampers – Flushable hopper and a sink – Equipment for testing stool or urine Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Concurrent Disinfection • Clean less-soiled areas before grossly dirty ones • Wet-mop floors and damp-dust furniture to avoid distributing microorganisms on dust and air currents • Frequently discard solutions used for mopping in a flushable hopper • Never place clean items on the floor Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Terminal Disinfection • More thorough than concurrent disinfection and consists of measures used to clean the client environment after discharge • Includes scrubbing the mattress and the insides of drawers and bedside stands Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Sterilization • Consists of physical and chemical techniques that destroy all microorganisms including spores – Physical sterilization: radiation, boiling water, free-flowing steam, dry heat, steam under pressure – Chemical sterilization: peracetic acid, ethylene oxide gas Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Principles of Surgical Asepsis • Once equipment and areas are free of microorganisms, they remain in that state if contamination is prevented • Sterility preserved: touching one sterile item with another that is sterile • Once a sterile item touches something that is not sterile, it is considered contaminated • Any partially unwrapped sterile package is considered contaminated Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Principles of Surgical Asepsis (cont’d) • Question the sterility of an item considered unsterile • Longer the time since sterilization, the more likely that the item is no longer sterile • Commercially packaged sterile item is not considered sterile past its recommended expiration date • Opened sterile item or area, left unattended, is considered contaminated Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Principles of Surgical Asepsis (cont’d) • Once a sterile item is opened or uncovered, it becomes contaminated • The outer 1 -inch margin of a sterile area is considered a zone of contamination • A wet sterile wrapper wicks microorganisms from its supporting surface, causing contamination Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Principles of Surgical Asepsis (cont’d) • Coughing, sneezing, or excessive talking over a sterile field causes contamination • Reaching across an area that contains sterile equipment may cause contamination • Sterile items located or lowered below waist level are considered contaminated Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

General Gerontologic Considerations • Older clients more susceptible to infections • Maintain intact skin, proper aseptic techniques, perineal hygiene, thorough handwashing; indwelling catheters should be avoided • Bladder training, annual immunizations • Ill health care workers should take sick leave rather than expose susceptible clients to infectious organisms Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins