ASEPSIS

Asepsis is divided into the following two categories:

1. Medical asepsis consists of techniques that inhibit the growth and spread of
pathogenic microorganisms. Medical asepsis is also known as clean technique
and is used in many daily activities, such as hand hygiene and changing
patients bed linen. You follow principles of medical asepsis in the home, for
instance, with the common practice of washing your hands before preparing
food.
2. Surgical asepsis destroys all microorganisms and their spores (the
reproductive cell of some microorganisms, such as fungi or protozoa). Surgical
asepsis is known as sterile technique and is used in specialized areas or skills,
such as care of surgical wounds, urinary catheter insertion, invasive procedures,
and surgery.
CHAIN OF INFECTION
INFECTION For a microorganism to be transported and be effective in continuing
contamination, it follows a definite cycle or chain of events. The following six
elements are necessary for infection to occur:
1. The infectious agenta pathogen
2. Reservoirwhere the pathogen can grow
3. Exit route from reservoir
4. Method or vehicle of transportation, such as exudate, feces, air droplets,
hands, and needles
5. Entrance through skin, mucous lining, or mouth
6. Hostanother person or animal
To prevent the spread of a microorganism, the cycle must be interrupted.
Through daily practices of medical asepsis, this is possible. These practices help
to inhibit (to stop or slow a process) the growth and reduce the number of
microorganisms.
MEASURES TO REDUCE RESERVOIRS OF INFECTION
BATHING
Use soap and water to remove drainage, dried secretions, excess perspiration,
or sediment from disinfectants.

DRESSING CHANGES
Change wet or soiled dressings.
CONTAMINATED ARTICLES
Place used tissues, soiled dressings, and soiled linen in moisture-resistant bags
for proper disposal. Place pourable, drippable, or squeezable dressings in
biohazard bags.
CONTAMINATED NEEDLES AND SHARPS
Place syringes, uncapped hypodermic needles, and sharps such as scalpels in
moisture-resistant, punctureproof containers. Keep these in patients rooms or
treatment areas so that it is not necessary to carry exposed, contaminated
equipment any distance.
Do not recap needles or attempt to break them.
BEDSIDE UNIT
Keep table surfaces clean and dry.
BOTTLED SOLUTIONS
Do not leave bottled solutions open for prolonged periods.
Keep solutions tightly capped.
Date bottles when opened.
Use only as directed by the manufacturer.
SURGICAL WOUNDS
Maintain the patency of drainage tubes and collection bags to prevent
accumulation of serous fluid under the skin surface.
DRAINAGE BOTTLES AND BAGS
Empty and dispose of drainage suction canisters according to agency policy.
Empty all drainage systems on each shift unless otherwise ordered by a
physician.
Never raise a drainage system (e.g., urinary drainage bag) above the level of
the site being drained unless it is clamped off.
STAGES OF AN INFECTIOUS PROCESS (LOCALIZED OR SYSTEMIC)

INCUBATION PERIOD: Interval between entrance of pathogen into body

and appearance of first symptoms (e.g., chickenpox, 1 to 3 weeks;
common cold, 1 to 2 days; infl uenza, 1 to 3 days; mumps, 12 to 26 days)

PRODROMAL STAGE: Interval from onset of nonspecific signs and

symptoms (malaise, low-grade fever, fatigue) to more specific symptoms
(during this time, microorganisms grow and multiply, and patient is more
capable of spreading disease to others). For example, herpes simplex
begins with itching and tingling at the site during the prodromal stage,
before the lesion appears.
ILLNESS STAGE: Interval when patient manifests signs and symptoms
specific to type of infection (e.g., common cold manifested by sore throat,
sinus congestion, rhinitis; mumps manifested by earache, high fever,
parotid and salivary gland swelling)
CONVALESCENCE: Interval when acute symptoms of infection disappear
(length of recovery depends on severity of infection and patients general
state of health; recovery takes from several days to month.
FACTORS AFFECTING IMMUNOLOGIC DEFENSE MECHANISMS

Increasing age and extreme youth

Stress
Nutritional status
Hereditary factors
Disease processes
Environmental factors
Medical therapy
Chemotherapy
Radiation
Lifestyle
Occupation
Diagnostic procedures
Travel history
Trauma
STANDARD PRECAUTIONS
universal blood and body fluid precautions, or universal precautions, and
body substance isolation when caring for all patients. These two sets of
precautions have now been incorporated into one standard set of guidelines,
called standard precautions.
CDC GUIDELINES FOR ISOLATION PRECAUTIONS IN HOSPITALS

The goal of these guidelines is to interrupt the chain of infection and reduce
transmission of bloodborne pathogens and other potentially infectious materials
from moist body substances.
They apply to
(1) blood
(2) all body fluids,secretions, and excretions except sweat, regardless of whether
or not they contain visible blood
(3) nonintact skin; and
(4) mucous membranes.
Standard precautions are designed to reduce the risk of transmission of
microorganisms from both recognized and unrecognized sources of infections
These precautions promote hand hygiene and use of gloves, masks, eye
protection, and gowns when appropriate for patient contact.
HAND HYGIENE
Hand hygiene is considered of utmost importance when practicing standard
precautions. Hands are to be washed before patient care and after touching
blood, body fluids, secretions, excretions, and contaminated items, regardless of
whether gloves are worn. Perform hand hygiene immediately after gloves are
removed, between patient contacts, and when otherwise indicated to prevent
transfer of microorganisms to other patients or environments. It may be
necessary to wash hands between tasks and procedures on the same patient to
prevent cross-contamination of different body sites.
Use approved soaps and alcohol-based hand sanitizers and lotions.
GLOVES
Wear clean, unsterile gloves when the potential for touching blood, body fluids,
secretions, excretions, and contaminated items exists.
Put on clean gloves just before touching mucous membranes and nonintact skin.
Change gloves between tasks and procedures on the same patient after contact
with material that possibly contains a high concentration of microorganisms.
Remove gloves promptly after use, before touching non contaminated items and
environmental surfaces.
Perform hand hygiene immediately after removing gloves to prevent transfer of
microorganisms to other patients or environment.
MASK, EYE PROTECTION, FACE SHIELD

 Wear a mask and eye protection or a face shield to protect mucous membranes
of the eyes, the nose, and the mouth during procedures and patient care
activities that are likely to generate splashes or sprays of blood, body fl uids,
secretions, and excretions.
GOWN
Wear a fluid-resistant gown (a clean, unsterile gown is adequate) to protect
skin and prevent soiling of clothing during procedures and patient care activities
that are likely to generate splashes or sprays of blood, body fluids, secretions, or
excretions or cause soiling of clothing. Select a gown that is appropriate for the
activity and amount of fluid likely to be encountered. Remove the soiled gown as
promptly as possible and perform hand hygiene to prevent transfer of
microorganisms to other patients or environments.
MISCELLANEOUS GUIDELINES
Place used sharps, such as needles or scalpels, in a designated sharps
disposal container.
Do not purposefully bend, break, or recap needles. Place disposable wastes
and articles contaminated with blood or large amounts of body fluids in a
biowaste container for a trash pickup.
Clean up spills of blood or body fl uids per hospital protocol (i.e., blood spill kit).
Place all soiled linen in a laundry bag. Do not overfill the bag, to prevent
contamination of the environment.
For patients with diarrhea: Strongly recommend soap and water for hand
hygiene.
For patients who are coughing: Wear a face mask if within 3 feet of patient and
teach patient about respiratory hygiene.
Use mouthpieces, resuscitator bags, or other ventilation devices if resuscitation
is needed.
Health care workers: If you have exudative (draining) lesions, refrain from all
direct patient care and from handling patient care equipment until wound is
healed.
Handle laboratory specimens from all patients as if they are infectious (refer to
agency manual).
Use private rooms for patients with communicable diseases subject to airborne
transmission or patients who soil their environment uncontrollably with body
substances. For certain diseases (e.g., meningococcal meningitis), personnel and
family entering the patients room are to wear masks. This is true for the first 24
hours until antibiotics have been started, then is no longer required per the CDC.

Roommates who are immune to the patients disease or who are currently
infected with the same disease are permitted to share rooms (institutional policy
may vary on this).

Hand Hygiene Is Essential

When hands are visibly soiled

Before and after caring for a patient
After contact with organic material, such as feces, wound drainage, and
mucus
In preparation for an invasive procedure, such as suctioning, catheterization,
or injections
Before changing a dressing or having contact with open wounds
Before preparing and administering medications
After removing disposable gloves or handling contaminated equipment
Before and after using the toilet
Before and after eating
At the beginning and end of the shift
CDC Hand Hygiene Guidelines
Hand hygiene is a term that applies to handwashing, use of an antiseptic
hand rub, or surgical hand antisepsis. Evidence suggests that hand
antisepsis, the cleansing of hands with an antiseptic hand rub, is more
effective in reducing health careassociated infections than plain
handwashing.
FOLLOW THESE GUIDELINES IN THE CARE OF ALL PATIENTS
Continue practice of washing hands with either a nonantimicrobial or an
antimicrobial soap and water whenever hands are visibly soiled.
Use an alcohol-based hand rub to routinely decontaminate the hands in the
following clinical situations: ( NOTE: If alcohol-based hand rubs are not
available, the alternative is handwashing.
Before and after patient contact
Before donning sterile gloves when inserting central intravascular
catheters
Before performing nonsurgical invasive procedures (e.g., urinary catheter
insertion, nasotracheal suctioning)
After contact with body fluids or excretions, mucous membranes,
nonintact skin, and wound dressings If moving from a contaminated body
site (rectal area or mouth) to a clean body site (surgical wound, urinary
meatus) during patient care
After contact with inanimate objects (including medical equipment) in the
immediate vicinity of the patient
After removing gloves
Before eating and after using a restroom, wash hands with soap (non
antimicrobial or antimicrobial) and water.
Antimicrobial-impregnated wipes (i.e., towelettes) are not a substitute for
using an alcohol-based hand rub or antimicrobial soap.
If exposure to Bacillus anthracis is suspected or proven, wash hands with
soap (non antimicrobial or antimicrobial) and water. The physical action of

washing and rinsing hands is recommended because alcohols, chlorhexidine,

iodophors, and other antiseptic agents have poor activity against spores.
FOLLOW THESE GUIDELINES FOR SURGICAL HAND ANTISEPSIS
Surgical hand antisepsis reduces the resident microbial count on the hands
to a minimum.
The CDC recommends using an antimicrobial soap to scrub hands and
forearms for the length of time recommended by the manufacturer. Refer to
agency policy for time required.
When using an alcohol-based surgical hand-scrub product with persistent
activity, follow the manufacturers instructions. Before applying the alcohol
solution, prewash hands and forearms with a nonantimicrobial soap, and dry
hands and forearms completely. After application of the alcohol-based
product as recommended, allow hands and forearms to dry thoroughly before
donning sterile gloves.
GENERAL RECOMMENDATIONS FOR HAND HYGIENE
Use hospital-approved hand lotions or creams to minimize the occurrence
of irritant contact dermatitis associated with hand antisepsis or handwashing.
Do not wear artificial fingernails or extenders when having direct contact
with clients at high risk (e.g., those in intensive care units or operating
rooms).
Keep natural nail tips less than 14 inch long.
Wear gloves when contact with blood or other potentially infectious
materials, mucous membranes, and nonintact skin could occur.
Remove gloves after caring for a patient. Do not wear the same pair of
gloves for the care of more than one patient, and do not wash gloves
between uses with different patients.
Change gloves during patient care if moving from a contaminated body
site to a clean body site.
GLOVING
The CDC (Boyce & Pittet, 2002) gives the following advice regarding gloves:
Wear gloves only once, and then place them into the appropriate waste
containers for safe disposal.
If you have not completed the patients care but have come into contact
with infectious material, change the gloves before continuing the patients
care.
There is the risk of perforating the gloves during use, so perform hand
hygiene after removing the gloves.
Nursing Action (Rationale)
Donning Gloves
1. Remove gloves from dispenser. (Keeps gloves handy and ready for
use.)
2. Inspect gloves for perforations. (Prevents pathogenic
microorganisms from entering through perforation in gloves.)
3. Don gloves when ready to begin patient care. Wearing gloves with a
gown does not necessitate any special technique for putting them on;

wear them pulled over cuffs of gown. (Ensures full coverage of your
wrists.)
4. Change gloves after direct handling of infectious material such as
wound drainage. (Prevents cross-contamination.)
5. Do not touch side rails, tables, or bed stands with contaminated
gloves. (Prevents spread of microorganisms throughout environment.)
Removing Gloves
6. Remove first glove by grasping outer surface at palm with other
gloved hand and pulling glove inside out and off (see illustration ).
Place this glove in the hand that is still gloved. (Prevents you from
touching own skin with contaminated glove.)
7. Remove second glove by placing finger under cuff and turning glove
inside out and over other glove (see illustration ). Drop gloves into
waste container. (Prevents you from touching contaminated glove.
Wraps contamination inside gloves to help protect others.)
8. Perform hand hygiene. (Helps prevent crosscontamination.)
9. Do patient teaching (see Patient Teaching box on gloving
technique).
10. If contamination continues, it is necessary to reassess technique
GOWNING
The use of a gown while administering care to a patient in isolation is
important primarily to protect your clothing from being soiled. The gown also
provides protection against infectious microorganisms possibly given off by
the patient.
It is recommended that you discard your gown when leaving the patients
room rather than reuse it. This aids in preventing the spread of pathogens to
other patients or personnel. This procedure also applies to visitors.
Another rationale for use of a gown is protection of a patient whose immune
system is inadequate. In this situation, health care personnel and visitors
wear a sterile gown to prevent the transfer of pathogens from themselves to
the patient.
Donning an isolation gown is indicated when caring for patients with
diseases characterized by heavy drainage or exudate, infectious and acute
diarrhea, other gastrointestinal disorders, respiratory disorders, skin
wounds or burns, and urinary disorders.
Nursing Action (Rationale)
Gowning
1. Remove your watch and push up long sleeves, if you have them.
(Ensures that uniform sleeve is under gown sleeve for protection.)
2. Place your watch on a paper towel or in a see through plastic bag
before taking vital signs. (Prevents cross-contamination.)
3. Perform hand hygiene. (Reduces spread of microorganisms.)
4. Don gown and tie it securely at neck and waist (Provides protective
covering of the entire uniform.)
5. Remove gown after providing necessary patient care(Has protected
the nurse.)
6. Discard soiled gown appropriately (Prevents contamination.)
7. Perform hand hygiene. (Prevents spread of microorganisms.)

8. Record use of gown in isolation procedure.

9. Do patient teaching.
10. If contamination continues, it is necessary to reassess technique.
MASK AND PROTECTIVE EYEWEAR
When a mask is correctly applied, it will t snugly below your chin and securely over your
nose and mouth,and the top edge will t below your eyeglasses, if youwear them. (This prevents
fogging of your glasses.)
Masks are available with eye shields like glasses to cover your eyes (or glasses). Goggles are
another possible way to protect your eyes.
Change your mask at least every 20 to 30 minutes or if it becomes moist.
Do not reuse a mask or allow it to dangle around your neck and then reuse it.
A mask is worn for the following reasons:
To protect the wearer from inhaling microorganisms that travel on airborne droplets for short
distances or that remain suspended in the air for longer periods, or if splashing should occur
To prevent inhaling pathogens if resistance is reduced or if being transported to another area
(patientwears mask)
To discourage the wearer from touching the mouth, nose, or eyes and from transmitting
infectious material
DISPOSING OF CONTAMINATED EQUIPMENT
The disposal of contaminated materials also comes under the review of the infection preventionist
and the infection prevention and control committee.
A major risk to personnel is in the disposal of sharps (needles, blades), which are often contaminated
by blood. When left in linens or in dressings, these have the potential to injure workers cleaning
patient or resident care areas and examination rooms.
DOUBLE BAGGING
The CDC recommends double bagging (an infection control practice that involves placing a
bag of contaminated items into another, clean bag that is held outside an isolation room by
other personnel) when it is impossible to keep the outer surface of a single bag free from
contamination.
Label or color code the second bag to alert nursing personnel and to prevent contamination of
housekeeping personnel who will handle the contaminated material.
The CDC recommends the following guidelines for handling isolation linen:
Place soiled linen in a laundry bag in the patients room.
Treat all linen as though it is infectious.
Linen requires less handling if it is placed in a bag that is soluble in hot water; however, it is
often necessary to double bag such a bag because it punctures or tears easily.
Note that double bagging is no longer recommended as a universal practice, unless a cloth bag is
being placed in a plastic bag.

DONING A MASK

Nursing Action (Rationale)

1 Remove mask from container. (Mask is readily available for use.)
2 Don mask when ready to begin patient care b ycovering your nose, mouth, and eyes (or
glasses)with the device. Wear a mask with a protective eyeshield when there is risk of splashing.

Secure mask in place with elastic band or by tying the strings behind your head (Provides protection
from microorganisms.)
3 Wear mask until it becomes moist, but no longerthan 20 to 30 minutes. (Moisture renders a
maskineffective.)
4 Make certain patient feels comfortable and accepted. (Contributes to patientswell-being.)
5 Remove mask by untying the strings or movingthe elastic. Make certain not to touch
contaminatedarea(Prevents your comingintocontact with contaminated mask.)
6 Dispose of soiled mask in appropriate container. (Protects other health care workers.)
7 Wash hands thoroughly. (Removes microorganisms.)
8 Record use of mask during patient care (some agencies require documentation of specic barriers
used). (Providesproofof wearing mask for protectionof patient and nurse.)
9 If contamination continues, it is necessary to reassess technique.
1 0 Do patient teaching.

ISOLATION TECHNIQUE
The CDC issued isolation guidelines, in addition to standard precautions, that contain two tiers of
approach:

The rst contains precautions designed to care for all patients in health care facilities
regardless of their diagnosis or presumed infectiousness. This rst tier is called standard
precautions.

The second tier condenses the disease-specic and categories approach to isolation into new
transmission categories: airborne, droplet, and contact precautions. These precautions are
designed for specic patients with highly transmissible pathogens.