Medical Surgical Asepsis Dr AbdulMonim Batiha Assistant Professor

Medical & Surgical Asepsis Dr. Abdul-Monim Batiha Assistant Professor Critical Care Nursing Philadelphia university

Learning objectives Explain the concepts of medical and surgical asepsis. n Identify types of microorganisms causing infections. n Identify types & signs of localized and systematic infections. n

Identify risks for nosocomial infections. n Explain chain of infection. n Identify factors influencing a microorganism's capability to produce an infectious process. n Identify measures that break each link in the chin of infection. n

Asepsis is the freedom from disease-causing microorganisms. To decrease the possibility of transferring microorganisms from one place to another, asepsis is used.

There are two basic types of asepsis Medical & Surgical asepsis.

1. Medical asepsis Includes all practices intended to confine a specific microorganism to a specific area, limiting the number, growth, and transmission of microorganisms.

In medical asepsis, objects are referred to as clean, which means the absence of almost all microorganisms, or dirty (soiled, contaminated, which means likely to have microorganisms, some of which may be capable of causing infection.

2. Surgical asepsis or sterile Technique, refers to keep an area or object free of all microorganism, it includes practices that destroy all microorganisms and spores. Surgical asepsis is used for all procedures involving the sterile areas of the body.

Sepsis is the state of infection and can take many forms, including septic shock. n

Types of microorganisms causing infections

1. Bacteria can live and be transported through air, water, food, soil, body tissues and fluids, and inanimate objects. 2. Viruses (causes the common cold) hepatitis, herpes, and human immunodeficiency virus. 3. Fungi include yeasts and molds. Candida albicans 4. Parasites They include protozoa such as the that causes malaria.

Types of infection

n n A local infection is limited to the specific part of the body where the microorganisms remain. If the microorganisms spread and damage different parts of the body, it is a systemic infection.

When a culture of the person's blood reveals microorganisms, the condition is called bacteremia. n When bacteremia results in systemic infection, it is referred to as septicemia. n

n Acute infections generally appear suddenly or last a short time. A chronic infection may occur slowly, over a very long period, and may last months or years.

Nosocomial infections n classified as infections that are associated with the delivery of health care services in a health care facility. Nosocomial infections can either develop during a client's stay in a facility or manifest after discharge.

n The incidence of nosocomial infections is significant. Major sites for these infections are the respiratory and urinary tracts, the bloodstream, and wounds.

n Factors that contribute to nosocomial infection risks are invasive procedures, medical therapies, the existence of a large number of susceptible persons, inappropriate use of antibiotics, and insufficient hand washing after client contact and after contact with body substances.

Chain of infection

1 Etiologic agent (microorgnanisms ) 6 Susceptible host 2 Reservoir (source) 5 Portal of entry to the susceptible host 3 Portal of exit from reservoir 4 Method of transmission

1. Etiologic agent The any microorganism is capable of producing an infectious process depends on the number of microorganisms present.

2. Reservoir There are many reservoirs, or sources of microorganisms, common sources are other humans, the client's, plants, animals, or general environment.

3. Portal of exit from reservoir n Before an infection can establish itself in a host, the microorganisms must leave the reservoir.

4. Method of transmission There are three mechanisms

1. Direct transmission Involves immediate and direct transfer of microorganisms from person to person through touching, biting, kissing, or sexual intercourse. Droplet spread is also a form of direct transmission.

2. Indirect transmission n Material objects, such as toys, soiled clothes, cooking or eating and surgical instruments, or dressing, water, food, blood, serum, and plasma. Animal or flying.

3. Airborn transmission may involve droplets or dust.

5. Portal of entry n Before a person can become infected, microorganisms must enter the body. The skin is a barrier to infectious agents; however, any break in the skin can readily serve as a portal of entry.

6. Susceptible Host A susceptible host is any person who is at risk for infection. A compromised host is a person at "increased risk"

Factors Increasing Susceptibility to Infection 1. Age influence the risk of infection. 2. Heredity influences the development of infection.

3. The nature, number, and duration of physical and emotional stressors can influence susceptibility to infection.

n Stressors elevate blood cortisone. Prolonged elevation of blood cortisone decrease anti-inflammatory responses depletes energy stores, lead to a state of exhaustion, and decrease resistance to infection.

4. Resistance to infection depends on adequate nutritional status. 5. Some medical therapies predispose a person to infection. For example, radiation treatments for cancer, some diagnostic procedures may also predispose the client to an infection.

6. Certain medication also increase susceptibility to infection. Anticancer medications may depress bone marrow function, resulting inadequate production of white blood cells, anti-inflammatory and antibiotics medications.

Cleaning, Disinfecting, and Sterilizing The first links in the chain of infection, the etiologic agent and the reservoir, are interrupted by the use of antiseptics (agents that inhibit the growth of some microorganisms) and disinfectants (agents that destroy pathogens other than spores) and by sterilization.

Cleaning Cleanliness inhibits the growth of microorganisms. When cleaning visibly soiled objects, nurses must always wear gloves to avoid direct contact with infections microorganisms.

Disinfecting A disinfectant is a chemical preparation, such as phenol or iodine compounds, used on inanimate objects. n Disinfectants are frequently caustic and toxic to tissues. An antiseptic is a chemical preparation used on skin or tissue. n

Disinfectants and antiseptics often have similar chemical components, but the disinfectant is a more concentrated solution. n

When disinfecting articles, nurses need to follow agency protocol and consider the following:

1. The type and number of infectious organisms. 2. The recommended concentration of the disinfectant and the duration of contact. 3. The temperature of the environment.

4. The presence of soap. Some disinfectants are ineffective in the presence of soap or detergent. 5. The presence of organic materials, the presence of saliva, blood, pus can readily inactive many disinfectants. 6. The surface areas to be treated. The disinfecting agent must come into contact with all surfaces and areas.

Sterilizing n Sterilization is a process that destroys all microorganisms, including spores and viruses.

Four commonly used methods of sterilization are 1. Moist heat 2. Gas 3. Boiling water 4. Radiation

Sterile Technique The basic principles of surgical asepsis

1. All objects used in a sterile field must be strile. 2. Sterile objects become un-sterile when touched by un-sterile objects. 3. Sterile items that are out of vision or below the waist level of the nurse are considered unsterile.

4. Sterile objects can become unsterile by prolonged exposure to airborne microorganisms. 5. Fluids flow in the direction of gravity.

6. Moisture that passes through a sterile object draws microorganisms from unsterile surfaces above or below to the sterile surface by capillary action.

7. The edges of a sterile field are considered unsterile. 8. The skin cannot be sterilized and is un-sterile.