Week 4: Part 1 Notes MBP 108 Lecture Medical and Surgical Asepsis Learning Objectives

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WEEK 4: PART 1 NOTES 2. CONTAMINATION


MBP 108 LECTURE
- denotes contact of a sterile or aseptic item with
microorganisms. Medically aseptic items become
3. MEDICAL AND SURGICAL ASEPSIS contaminated if they get in contact with disease-
producing organisms. Sterile items become
Learning Objectives :
contaminated if they get in contact with items that
 Differentiate between sepsis and are not sterile.
asepsis
3. DECONTAMINATION
 Distinguish between medical asepsis
- the process where physical or chemical means are
and surgical asepsis;
used to remove, inactivate, or destroy pathogens on
 Enumerate general aseptic procedures
a surface or item making them safe for handling use
followed to maintain a clean
and incapable of transmitting infectious agents.
environment and prevent the spread of
infectious diseases; 4. DISINFECTION
 Explain the various isolation precaution -the process by using physical or chemical means to
measures; destory pathogens eluding the spores
 Identify aseptic measures utilized in the
operating room ; and 5. STERILIZATION
 Determine general measures that can - the process by which all pathogens are destroyed,
be used to prevent the development of including the spores.
infection in the community.
6. ANTISEPTIC
- a chemical solution that inhibits the growth of
3.1. Infection Control some microorganisms. Most antiseptics can be used
directly on the skin. (e.g. alcohol and iodine)
Is one of the major concerns that healthcare
7. HEALTH-ASSOCIATED INFECTION
workers in healthcare facilities and hospitals
- any infection that is acquired during the time a
constantly address.
patient is admitted in a healthcare facility. The most
There are certain terminologies associated with common healthcare-associated infection is the
urinary tract infection (UTI).
infection control that a healthcare worker must
be familiar with. 8. IATROGENIC INFECTION
- infection that is acquired in the course of
1. Chain of Infection undergoing diagnostic tests or therapeutic
2. Mode of Transmission procedures
3. Standard Precautions
4. Contamination 9. OCCUPATIONAL EXPOSURE
5. Decontamination - the acquisition or exposure to an infectious agent
6. Disinfection of a healthcare worker during the course of his/her
7.Sterilization work.
8. Antiseptic
10. PERSONAL PROTECTIVE EQUIPMENT (PPE)
9. Health-associated infection
- specialized equipment and attire used by
10. Iatrogenic Infection
healthcare workers to protect them from infections.
11. Occupational Exposure
These include gloves, masks, gowns, and googles.
12. Personal Protective Equipment

3.2 ASEPSIS
1. CHAIN OF INFECTION

3.2.1 Refers to a condition in which the individual


- how an individual acquires the infection agents and
and his/her surrounding environment are free of any
includes the infectious agent, the source of infection,
microorganisms.
or its reservoir, how the organism is transmitted, and
the organism’s portal of entry into the susceptible - SEPSIS, the opposite of asepsis, refers to
host. the clinical condition where an individual
develops a systemic reaction to a bacterial
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infection that starts from a localized - It involves certain procedures to decrease the
infection in one part of the body. number of organisms and prevent their spread in the
general clinical setting.
- The goal of asepsis are to protect the
patient from a hospital-acquired or Ex. Proper hand Hygiene, administration of all meds
nosocomial infections and to prevent the except that are given Intravenously, preparation of
spread of pathogenic microorganisms. patient’s skin before administration of subcutaneous
medication
- All patients in healthcare facilities are
vulnerable to pathogenic organisms. 2. Surgical or sterile asepsis

3.2.2 Some Factors that play role in the - Is defined as the absence of all microorganisms.
occurrence of infection among patients include :
- It involves procedures that aim to eliminate
1. Suppression of the immune system microorganisms from an area in the body where
surgical procedures will be performed as well as the
2. Prolonged duration of illness
location where the surgical procedure will be carried
out.
3. Procedures that patients undergo in the
healthcare facility such as insertion of in- The principles of surgical asepsis are applied when
dwelling catheters, use of antibiotics, and the skin is not intact and when internal areas of the
insertion of IV lines and ET tubes. body are involved in procedures, whether for
diagnostic or treatment purposes.

Examples : wound care, during invasive procedures


(e.g. endoscopy), administration of IV drugs, and
during insertion of urinary catheter and other
internally placed tubes.
3.2.3. The most commonly occurring pathogenic
microorganisms that lead to nosocomial infections : 3.2.5 GENERAL ASEPTIC PROCESURES THAT HELP
PRESERVE AND MAINTAIN A CLEAN MEDICAL
1. Escherichia coli ENVIRONMENT
2. Staphyloccocus aureus
3. Pseudomonas aeruginosa 1. Frequent handwashing of hospital
4. Candida albicans personnel (doctors, nurses, medical tech,
5. Enterococcus and orderlies);

The primary locations of infections from these 2. Prompt and safe disposal of contaminated
organisms are surgical wounds, urinary tract, materials like bandages and needles;
respiratory tract, and the bloodstream.
3. Regular checking and emptying of
Pathogens may be introduced to the patient through containers for surgical drains;
contact with hospital personnel, hospital
4. Prompt cleaning of soiled or moist areas ;
environment, or hospital equipment such as
respiratory machines, catheters, and intravenous 5. Proper labeling of containers regarding the
lines or needles. date and time of disposal.

Situations that require aseptic measures are surgery 3.2.6. General aseptic procedures:
and the insertion of intravenous lines, urinary
catheters, and drains. 3.2.6.1 HANDWASHING

3.2.4. ASEPSIS may be categorized : - The most frequent source of


microorganisms leading to outbreaks of
1. Medical or clean asepsis infection in health institutions is the hands
of the healthcare workers.
- refers to the absence of disease-producing
microorganisms. It is the infection control process - Most basic means of preventing the spread
that aims to reduce the spread of infection. of pathogenic organisms.
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Reasons for handwashing: 3.2.6.2 PERSONAL PROTECTIVE


EQUIPMENT (PPE)
1. Reduce the flora on the healthcare worker’s skin
2. Protect the healthcare worker in the event that - are specialized equipment and attire used in
there is a break in his or her skin ; healthcare facilities to protect not only the
3. Reduce risk of contact with infectious agents if healthcare workers but also the patients and
gloves worn are punctured ; visitors against infections. These include masks,
4. Reduce the chances of disease transmission. gowns and googles.

Healthcare acquired infections : 1. Gloves

1. Methicillin-resistant Staphylococcus aureus - Among the various PPEs in use, gloves are
(MRSA) the most commonly used.
2. Vancomycin-resistant Enterococcus (VRE)
- Used during medical procedures – two most
3. Penicillin-resistant Streptococcus pneumoniae
commonly used :
When should handwashing be done : a. Examination gloves (sterile or non-
The United States Center for Disease Control sterile)
recommend routing handwashing for at least 15 b. Surgical gloves (sterile)
seconds with a 10-second rinse.
- Serve as a protective barrier when handling
For healthcare workers, a longer period for our touching open wounds, blood or body
handwashing that entails thorough washing of the fluids.
hands, lathering at least twice, and careful cleaning
- Protection from microorganisms and help
of the fingernails is recommended in the following
prevent the spread of infectious agents
situations :
from one person to another.
1. At the beginning and end of each shift ;
- Sterile, disposable gloves must be provided
2. When the hands are visibly soiled ; to all personnel in healthcare facilities,
particularly those who have direct contact
3. After contact with a possible source of with patients.
microorganisms such as blood or body
fluids, mucous membranes, non-intact skin, - The gloves must be disposed of immediately
or contaminated objects ; after use.

4. Before and after performing invasive - Hands must be washed thoroughly after
procedures; using gloves. Why?

5. Before removing gloves if they are visibly


soiled and each time after removing gloves;

Proper handwashing can be done with :


WORLD HEALTH ORGANIZATION (WHO) :
GUIDELINES FOR PROPER USE OF GLOVES IN
> friction and regular soap and water ;
HEALTH CARE FACILITIES.
> hands thoroughly washed with vigorous scrubbing,
special attention to the areas around the nailbeds 1. Gloves are not meant to replace observance
and between the fingers; of proper hand hygiene. The practice of
(high in bacterial load) hand hygiene must still be observed before
and after wearing of gloves.
> fingernails should be kept short and clean.
2. Gloves must be worn if contact with blood
or body fluids, mucous membranes, open
wounds, or potentially infectious material is
anticipated.
3. Gloves must be removed and disposed of
after caring for a patient. Healthcare workers
 Alcohol-based sanitizing antimicrobial must not wear the same gloves if caring for
solutions or hand cleansers must not be more than one patient.
used as substitute for proper handwashing. 4. Gloves must be removed or changed if
However, if no water and soap, one may moving from a contaminated body site to
use it.
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another body site in the course of caring for  Likewise wearing gowns is recommended if
a patient. the healthcare worker has close contact
5. Re-using of gloves after decontamination is
with patients, equipment, or materials that
not recommended.
can introduce infectious agents to the
Furthermore, WHO recommends the use of gloves in healthcare worker’s skin, uniform and or
the following situations : other clothing.

 Fluid-resistant apron or gown :


1. Before performing a sterile procedure.
- Is recommended if there is a risk for body
2. When in contact with a patient and his or her
substances, blood or body secretions to
surroundings in conditions where contact
contaminate the clothing or skin of the
precautions are warranted.
healthcare worker.
3. When contact with blood or body fluids, non-
intact skin, and mucous membrane is anticipated.  Clean, non-sterile gowns or aprons
- generally sufficient to protect the skin and
The removal of gloves is indicated in the following :
prevent soiling of clothing during
1. When hand hygiene is indicated ; procedures or other in-patient activities
that may lead to splashing or spraying of
2. After contact with a single patient and his or blood and body substances.
her surroundings is ended or when contact
with a contaminated body site is ended.

3. As soon as the gloves are damaged or there  Fluid-resistant gowns or aprons are always
is loss of integrity of the gloves. worn with gloves and other personal
protective equipment.
4. After contact with blood or body fluids,
non-intact skin, and mucous membranes.  Healthcare workers must make sure that
they change gowns or aprons in between
treating different patients.

Sterility parameters to maintain the sterile field


: Surgical site
2. MASKS
The front of a sterile gown is considered sterile
 The mask must cover the mouth and nose.
from the chest down to the level of the sterile
 It must be tied in a way that there should be field. The reason for this is because most
minimal gaps between the face and the scrubbed personnel work next to a sterile table
mask. and / or bed.

 The moment it becomes damp, it should be 1. The gown sleeves are sterile from two
replaced with a clean, and dry one. inches above the elbow to the cuff,
circumferentially.
 Remember that mask are supposed to be
single-use items – disposed and discarded 2. The back of the gown is not considered
of as clinical waste. sterile because it cannot be constantly
monitored
 Recommended that hands are
decontaminated with soap and water after 3. The neck, sleeve cuffs, and underarms of
mask is disposed. the gloves are not considered sterile and
are not considered as effective microbial
3. STERILE GOWNS barriers.

 Healthcare workers are recommended to If contamination of the surgical gown occurs at any
wear gowns or aprons when there is point during the procedure :
probability of contact with blood, body
secretions excluding sweat, or other body Gown as well as the gloves must be changed.
substances. What is the function of the circulating nurse ?
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- Ex. MRSA, viruses such as respiratory


syncytial virus, agents that cause diarrhea
whether viral or bacterial, and open
wounds.

All individuals whether healthcare


personnel or non-healthcare personnel,
must wear gowns and gloves.

2. DROPLET PRECAUTIONS

- are used for diseases or infectious agents that


3.2.7. ISOLATION PRECAUTIONS are spread in tiny droplets caused by coughing
and sneezing. These are used to prevent contact
 Isolation is the process of separating an with secretions from the respiratory tract.
individual with an infectious disease from - these droplets can travel a distance of approx 3
the rest of the healthy population to feet (90 centimeters)
prevent the spread of the infection to other
individuals. Ex : influenza, mumps or pertussis (whooping
cough).
 Universal Precautions – are geared towards
handling of patients with an infection from - All persons entering the rooms of these
an unknown pathogen to decrease the risk patients are required to wear a surgical
of transmission. mask.

These precautions apply to all body fluids 3. AIRBORNE-PRECAUTIONS


including blood, skin, and mucous membranes.
- Spread through the air from one person to
1. Proper handwashing another.
2. Use of PPE - These microorganisms can float in the air
3. Proper handling and disposal of secretions and travel long distances.
and excretions excluding sweat.
4. Proper handling and disposal of soiled linen Ex. Chicken pox, measles, and tuberculosis
and equipment
- Patients who are admitted to the hospital
5. Environmental control
with the said infections must be placed in a
6. Prevention of injury from sharp devices such
room with negative air pressure where the
as needles
air is gently sucked out and not allowed to
7. Patient Placement
flow into the hallway thereby preventing
contact with the outside environment.
3.2.8. TRANSMISSION-BASED PRECAUTIONS
- The door must remain closed at all times
and all individuals entering the room must
Transmission-based precautions have been
wear a protective mask. This is called
developed to further prevent the spread of
reverse isolation.
infectious agents. These precautions are based on
the mode of transmission of the infectious agents
and are classified into :

1. Contact Precautions 3.2.9 ASEPTIC MEASURES IN THE OPERATING


2. Droplet Precautions ROOM
3. Airborne Precautions

1. Contact Precautions
- Are used to prevent the spread of infections  TO prevent post-operative infection,
or infectious agents that are transmitted asepsis must be strictly observed in the
through touching of patients or items in the
operating room. Thorough cleaning of
room where the infectious agents may be
the operating room with detergent or
deposited (called fomites).
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detergent germicides, soap and water


must be done.

 IN addition, all equipment that would


directly in contact with the patient must
be properly sterilized.

 Surgical instruments can be sterilized in


the autoclave or by using chemical
agents.

 Radiation is seldom used because of its


toxic effects to body cells.

 Personnel must ensure sterility by


making sure that sterile package are dry
and intact.

3.2.10 Preventing infection in the Community

Infection control in the community includes


sanitation techniques, improvement of health
practices, and vaccination.

 Sanitation techniques : water


purification, proper sewage disposal

 Improvement of health practices :


educating members of the community
on the proper handling, storage and
preparation of food

 VACCINATION : immunizations
awareness

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