ASEPSIS

AND
INFECTION
CONTROL
 Infection Surgical Asepsis

¡ An invasion of the body tissue • Practices that render and keep

by microorganisms and their objects and areas free from
proliferation there. microorganisms.
Asepsis • Sterile technique.
¡ The absence of disease- Sepsis
TERMINOLOGIES producing microorganisms.
• The presence of infection.
¡ Being free from infection

Medical Asepsis

• Practices designed to reduce

the number and transfer of
pathogens.
• Clean technique.
 TERMINOLOGIES
Septicemia. Contact.
¡ Transport of infection or the products of ¡ A person or animal known or believed to
infection throughout the body or by have been exposed to a disease.
blood. Reservoir.
Carrier. ¡ The natural habitat for the growth and
multiplication of microorganisms.
¡ A person or animal, who is without signs of
illness but who harbors pathogens
within his body that can be transferred to
another.
 TERMINOLOGIES
Transient flora or bacteria. Disinfectant.
¡ The microorganism picked up by the skin as ¡ A substance, usually intended for use on
a result of normal activities that inanimate objects, that destroys
can be removed readily. pathogens but generally not the spores.

Resident flora or bacteria.

¡ The microorganism that normally live on a
person’s skin.

Sterilization.
¡ The process by which all microorganisms
including their spores are destroyed.
 TERMINOLOGIES
Antiseptic.
¡ A substance, usually intended for use on
persons that inhibit the growth of
pathogens but not necessarily destroy them.

Bactericidal.
¡ A chemical that kills microorganisms.

Bacteriostatic.
¡ An agent that prevents bacterial
multiplication but does not kill all forms of
organisms.
 TERMINOLOGIES
Contamination. Infectious Disease.
¡ The process by which something is rendered ¡ Results from the invasion and multiplication
unclean or unsterile. of microorganisms in a host.

Disinfection. Pathogen.
¡ The process by which pathogens but not ¡ A disease-producing microorganism.
their spores are destroyed from
inanimate objects.

Communicable Disease.
¡ Results if the infectious agent can be
transmitted to an individual by direct or
indirect contact through a vector or vehicle,
or as an airborne infection.
 TERMINOLOGIES
Pathogenecity. Opportunistic Pathogen.
¡ The ability to produce a disease. ¡ Causes disease only in susceptible
individual.
Virulence.
¡ The vigor with which the organism can grow
and multiply.

Specificity.
¡ The organism’s attraction to a specific host,
which may include humans.
 TERMINOLOGIES
Nosocomial Infection. Etiology.
¡ Hospital-acquired infection. ¡ The study of causes.

Isolation.
¡ The separation of persons with
communicable diseases from other persons so
that their direct/indirect transmission to
susceptible persons is prevented.

Isolation Techniques.
¡ Practices designed to prevent the transfer of
specific microorganisms.
Stages of Infectious Process
¡ Incubation Period. Extends from the entry of microorganisms into the body to the
onset of signs and symptoms.

¡ Prodromal Period. Extends from the onset of non-specific signs and

symptoms to the appearance of specific signs and symptoms.

¡ Illness Period. Specific signs an symptoms develop and become

evident.

¡ Convalescent Period. Signs and symptoms start to abate until the

client returns to normal state of health.

TYPES OF MICROORGANISMS THAT CAUSES INFECTION

¡ Bacteria- are by far the most common infectious-causing

microorganism
¡ Viruses – consist primarily of Nucleic acid and therefore must center
the living cell in order to reproduce
¡ Fungi- includes yeast and molds
¡ Parasites- Live in other living organism such as protozoa
CHAIN OF INFECTION
 (1) Etiologic/Infectious Agent:
(microorganisms):
Bacteria, fungi, virus, parasites

(2) Reservoir
(6) Susceptible Host (source):
Immunosuppressed children/ Human beings, animals,
elderly, chronically ill, those with inanimate objects, plants, general
trauma or surgery environment such as air, water
and soil

(5) Portal of Entry

Mucous membrane, nonintact (3) Portal of Exit
skin, GI tract, GU tract, Sputum, emesis, stool, blood
Respiratory Tract

(4) Modes of Transmission

Contact, vehicle, airborne,
vectorborne
1. Etiologic Agent (microorganism)
These may be bacteria, virus, fungi or parasites. The ability of the infectious agent to cause a disease depends on its pathogenicity, virulence,
invasiveness and specificity.

2. Reservoir (source)
Humans (clients, visitors, health care personnel)
Animals (insects, rats)
Plants
General Environment (air, water, food, soil)

3. Portal of Exit from Reservoir

Respiratory Tract: droplets, sputum
Gastrointestinal Tract: vomitus, feces, saliva, drainage tubes.
Urinary Tract: urine, urethral catheters.
Reproductive Tract: semen, vaginal discharge
Blood: open wound, needle puncture site

4. Mode of Transmission
a. Contact Transmission. This may be direct or indirect contact:
¡ Direct contact involves immediate and direct transfer from person to
person (body surface – to – body surface).
¡ Indirect contact occurs when susceptible host is exposed to a
contaminated object such as dressing, needle, surgical instrument.
 b. Droplet Transmission. This may be considered a type of contact
transmission.
¡ It occurs when mucous membrane of the nose, mouth, or conjunctiva are exposed to secretion of an
infected person who is coughing, sneezing,
laughing, or talking, usually within a distance of 3 feet.
c. Vehicle Transmission. This involves the transfer of microorganisms by way of vehicles or contaminated
items that transmit pathogens.
d. Airborne Transmission. This occurs when fine particles are suspended in the air for a long time or when
dust particles contain pathogens. Air current disperses microorganisms, which can be inhaled or
deposited on the skin of a susceptible host.
e. Vector borne Transmission. Vectors can be biologic or mechanical.
¡ Biologic vectors are animals, like rats, snails, ,mosquitoes.
¡ Mechanical vectors are inanimate objects that are infected with infected
body fluids like contaminated needles and syringes.
5. Portal of Entry
¡ This permits the organism to gain entrance into the host.
¡ Pathogens can enter susceptible hosts through body crifices such as the
mouth, nose, ears, eyes, vagina, rectum or urethra. Breaks in the skin or
mucous membranes from wounds or abrasions increase chance for
organisms to enter hosts.
6. Susceptible Host
¡ A host is a person who is at risk for infection; whose own body defense
mechanisms, when exposed, are unable to withstand the invasion of
pathogens.

Factors Influencing the Host’s Susceptibility

¡ Intact skin and mucous membrane are the body’s first line of defense.
¡ The normal ph levels of secretions and of genito-urinary tract help ward off microbial invasion.
¡ The body’s WBC influence resistance to certain pathogens.
¡ The age sex and race have been shown to influence susceptibility.
¡ Immunization. (natural/acquired), acts to resists infection.
¡ Fatigue, climate, general health status, presence of pre-existing illness, previous/current treatments
and some kinds of medications may play a part in the susceptibility of a potential host.
 Types of Immunization

1. Active Immunization. Antibodies are produced by the body in response to

infection.
a. Natural. Antibodies are formed in the presence of active infection in the body.
It is lifelong.
b. Artificial. Antigens (vaccines or toxoids) are administered to stimulate
antibody production. Requires booster inoculation after many years.
2. Passive Immunization. Antibodies are produced by another source such as

animal or human.
a. Natural. Antibodies are transferred from the mother to her newborn
through the placenta or in the colostrums.
b. Artificial. Immune serum (antibody) from an animal or another human is
injected to a person.
PRINCIPLES UNDERLYING MEDICAL AND SURGICAL ASEPSIS
¡ The patient is a source of pathogenic microorganisms.
¡ The patient’s microorganisms leave through specific routes.
¡ There are always microorganisms in the environment which in some individuals and under certain
circumstances can cause illness.
¡ Microorganisms harmful to man can be transmitted by direct and indirect contact.
¡ Spread of infection from source to others can be prevented by various methods to stop the spread as
close to the source as possible.
¡ The effectiveness of medical/surgical asepsis is dependent on the conscientiousness of those
carrying them out.
¡ In observing medical asepsis, areas are considered contaminated if they bear or are suspected of
having pathogens.
¡ In observing surgical asepsis, areas are considered contaminated if touched by any object that is not
sterile.
 Breaking the Chain of Infection: Aseptic Practices

* Hand Washing
* Cleaning, Disinfection, Sterilization
* Use of Barriers
* Isolation Systems
* Surgical Asepsis
1. Handwashing.
¡ Handwashing is the single most important infection control
practice. All
caregivers, clients and family members should learn handwashing
techniques.
¡ Microorganisms are transient flora until the hands are washed.
¡ Soap and water and alcohol – based hand rubs are effective
preparations for removing transient microorganisms.
¡ Wash hands before and after every client care contact.
¡ Effectiveness of handwashing is greatly influenced by adequate
friction and
thoroughness of surfaces cleansed.
CONTINUATION

¡Handwashing for medical asepsis is done by holding hands lower than the

elbows. Hands are more contaminated that the lower arms.

¡ Wash hands using running water, soap and friction for 15 to 3o seconds on
each hand. This is mechanically loosen and remove dirt and microorganisms on
all hand surfaces.
¡ Clean under fingernails.
¡ Ideally, turn off faucet with clean paper towel.
¡ Keep fingernails short and avoid nail polish to prevent harboring
microorganisms.
¡ Always wear gloves during client care when the skin is abraded.
2. Cleaning, Disinfection and Sterilization.
¡ Cleaning. The physical removal of visible dirt and debris by washing, dusting or
mopping surfaces that are contaminated. Soap is used for mechanical cleaning.
¡ Disinfection. The chemical or physical process used to reduced the number of
potential pathogens on an object’s surface. But spores of the pathogens are not
necessarily destroyed.
¡ Sterilization. The complete destruction of all microorganisms, including
spores, leaving no viable forms of organisms.
FACTORS CAN BE CONSIDERED IN THE SELECTION OF
STERILIZATION OR DISINFECTION METHODS:

1. Nature of organisms present.

¡ some may be destroyed easily, others more difficult.

2. Number of organisms present.

¡ more organisms require longer time to destroy.

¡ organism protected by coagulated protein requires longer time to destroy.

¡ cleaned articles before disinfection or sterilization are rendered

clean/sterile more quickly.

3. Types of equipment.
¡ Equipment with small lumen, or points are difficult to clean an require

special care.
4. Intended use of equipment.
¡ for medical asepsis: clean technique.
¡ for surgical asepsis: sterile technique.

5. Available means of sterilization and disinfection.

METHODS OF STERILIZATION

1. Steam sterilization. Autoclaving is sterilization using supersaturated steam under pressure.

¡ This method is non – toxic, inexpensive, sporicidal, and able to penetrate

fabrics rapidly. It is used to sterilize surgical dressings, surgical linens,

parenteral solutions, metals and glass objects.
¡ Color indicator strips change color, indicating that sterilization has
occurred.
¡ Check packaging for integrity and always check the expiration date to

ensure sterility of the object.

2. Gas Sterilization. Ethylene oxide is a colorless gas that can penetrate
plastic, rubber, cotton and other substances. This is used to sterilize oxygen
or suction gauges, BP apparatus, stethoscopes, catheters.
¡ Articles must be left to release the gas through aeration before they are used.
¡ This type of sterilization is expensive and requires 2 to 5 hours to be accomplished.
¡ Ethylene oxide is toxic to humans.
3. Radiation. Ionizing radiation penetrates deeply into objects.
¡ This is used in sterilizing drugs, foods, and other heat – sensitive items.
4. Chemicals. These are effective disinfectants.
¡ They attack all types of microorganisms, act rapidly, work with water, are inexpensive, are stable in
light and heat, are not harmful to body tissues, do not destroy articles.
¡ These are used for instruments and equipment such as glass thermometer. Chlorine is used for
disinfecting water.
5. Boiling Water. This is least expensive for use in home.
¡ Items like glass baby bottles should be boiled for at least 15 minutes.
 Types of Disinfection
Concurrent Disinfection- In the care of the client, his supplies, his immediate environment, to limit/Ongoing practices that are
observed control the spread of microorganisms
Terminal Disinfection- Practices to remove pathogens from the client’s belongings and his immediate environment after his
illness is no longer communicable.

Medical Aseptic Practices to be Implemented During Client Care

¡ Wash hands frequently, especially:

1. before handling foods

2. before and after using the toilet

3. before and after performing nursing procedures

4. before and after each patient contact

¡ Keep soiled items/equipment from touching the clothing's.

¡ Instruct client to cover mouth and nose when coughing and sneezing.

¡ Avoid raising dust; do not shake linens

¡ Clean least contaminated areas first then move to more contaminated areas.
 ¡ Practice segregation of wastes.
¡ Sterilize objects suspected of containing pathogens.
¡ Use practices of good personal hygiene to help prevent spread of
microorganisms.

3. Use of Barriers
¡ Techniques that prevent the transfer of pathogens from one person to another are referred
to as “barriers”.
¡ The most commonly used barriers are as follows:
Masks
Caps and shoe coverings
Gloves
Private rooms
Waterproof disposable bags for linen and thrash
Labeling and bagging of contaminated equipment and specimens
Control of airflow into the sterile areas and out of contaminated
areas
Goggles or face shields
¡ Masks
ü Masks should fit tightly to the face, covering the nose and the mouth.
ü Mask lose their effectiveness if they are wet, worn for long periods, and
when they are not changed after caring for each client.
ü Disposable particulate respirators look like masks but fit the face more
tightly and are able to filter out particles or organisms as small as 1
micromillimeter.These are indicated whenever a caregiver is working with
a client who has, or is suspected of having contagious airborne diseases
such as tuberculosis.
¡ Gowns ü Gowns should be worn when
caregiver’s clothing is likely to be soiled by infected material.
ü Use gowns only once and discard them.
ü Change gowns when it becomes wet.
¡ Caps and Shoe Coverings
ü Caps are used to cover the hair, and special covers are available for
shoes.
ü These shield body parts from accidental exposure to contaminated body
secretions.
 HAND WASHING OR HAND HYGIENE
• Hand washing is the simplest and most cost effective way of preventing the transmission of
infection and thus reducing the incidence of health-care associated infections.
DEFINITION OF TERMS
• Asepsis – defined as the absence of pathogenic organisms.
• Medial Hand Washing
a brief but vigorous rubbing together of all hands surface lathered with soap or
antibacterial hand gel or hand washing agents followed by a thorough rinsing in a continuous
stream of water. It is proven method of asepsis, which effectively minimizes the onset of
infection.
Purpose:
• To remove dirt and any transient organism from the hands and the reduction of microorganism count.
• Factors influencing frequency of Hand Washing:
• Intensity of contacts with patients
• Patients/nurses susceptibility to infection
• Contamination degree that result from contact
• Procedure/activity to be performed

Situation Where Hand Washing/ Hand Hygiene in Necessary:

• At the beginning of every work shift
• When hands are visibly soiled
• Before and after contact with patient
• Before performing invasive procedures (e.g. Indwelling catheter insertion)
• After contact with a source of microorganism (e.g. Blood/blood fluids, mucous membrane or potentially contaminated objects)
• After removal of gloves
• Any time you are in doubt about the necessity for doing so
• At the end of every shift before leaving the healthcare facility
Five (5) Moments for Hand Hygiene
» Before patient contact
» Before aseptic task
» After body fluid exposure risk
» After patient contact
» After contact with patient
surroundings
Material Required
• Deep sink
• Hand towel /paper towel
• Antiseptic soap or antibacterial solution
• Running water
Procedure:
ACTION RATIONALE
1. Use easy-to-reach sink with warm running water, plain
soap or antimicrobial soap, paper towel or air dryer.

2. Inspect hand and fingers for break/cuts in skin. Open cuts or wound may be penetrated or may harbor
Report such lesions when caring for highly susceptible microorganisms.
clients.

3. Inspect hands for heavy dirt. Inspect nails for length. Heavy dirt requires longer time for hand washing. Most
microbes present in the hands come from under the
fingernails.

4. Pull uniform sleeves above wrist. Wristwatch and rings Jewelry can be a place for microorganism to lodge.
should be removed during hand washing. Note: Except
for wedding ring.

5. Stand in front of the sink, keeping hands and uniform To avoid contamination.
away from the sink surface.
6. Turn on water. Press pedal with foot to regulate flow or Regulating the flow of the water prevents splashing of
push knee pedals laterally to control flow and water into uniform that may result in contamination. Hot
temperature of the water. If using a hand faucet turn it on or warm water removes microorganism more effectively
with the use of dry paper towel hold with your hand. And than cold water.
adjust the temperature.
7. Wet hands and wrist thoroughly under running water. Hands are the most contaminated area; it should be
Hands and forearms should be lower than elbows during washed after elbow following the rule of washing from the
washing. least to the most contaminated area.
8. Dispense 1 tsp. of liquid soap and lather thoroughly. Antiseptic agents eliminate bacteria but may irritate the
Note: If bar soap is to be used, lather and rinse the bar skin so use depends on the procedure to be performed.
thoroughly before putting it back to the soap dish.
9. Washing hands using plenty of lather and friction for a Dirt and transient bacteria are removed by friction and
minimum of 10-15 seconds. By rubbing: rubbing. Interlacing fingers ensures total cleansing.
a. palm to palm
b. palm over dorsum
c. palm to palm, fingers interlaced
d. back of finger to opposing palms
e. rotate thumbs in palm
f. rotate fingers in palm
g. rotate wrists and forearms
Keep fingers down.
10. If fingernails are soiled use brush or orange Areas under the fingernails are highly contaminated
wood stick and additional soap may also be needed. which may result in infection.

11. Rinse hands and wrist thoroughly keeping Keeping hands lower than elbow prevents
hands below elbows. Inspect for remaining dirt and microorganism from being rinsed back to arms and
soap. hands.
12. Dry hands thoroughly from fingers to wrist and
forearms with the use of a paper towel, single use
towel or warm dryer. And discard used paper towel
properly.
13. Turn off water using foot or knee pedals, Use Prevents transfer of pathogens.
clean, dry paper towel to turn off hand faucet.
Avoiding touching with hands. Drop the paper towel
in the waste receptacle.

14. Use lotion if desired. To maintain your skin condition because frequent
hand washing can lead to dry, crack skin. Use lotion
help keep skin intact, thus preventing possible
invasion by microorganisms.