CHAPTER 6

Medical and
Surgical Asepsis
 CHAPTER 6
Medical and
Surgical Asepsis
Learning Objectives:
1. Differentiate between sepsis and asepsis
2. Distinguish between medical asepsis and surgical
asepsis
3. Enumerate general aseptic procedures followed to
maintain a clean environment and prevent the spread
of infectious diseases
4. Explain the various isolation precaution measures
5. Identify aseptic measures utilized in the operating
room
6. Determine general measures that can be used to
prevent the development of infection in the
community
INFECTION CONTROL
- One of the major concerns that healthcare
workers in healthcare facilities and hospitals
constantly address.

Terminologies:
1. Chain of infection- HOW to acquire the
infectious agent, What is the infectious
agent, Where is the source, Transmission,
Portal of entry
2. MODE OF TRANSMISSION- The manner in
which the infectious organism is acquired by the
host
The Different Modes of Transmission
1. Direct Contact-
- takes place through skin-to-skin contact, as well as kissing
and sexual intercourse.
- Contact with soil or vegetation harboring infectious
organisms
- Ex. infectious mononucleosis (“kissing disease”) and
gonorrhea
Hookworm is spread by direct contact with contaminated
soil.
● Droplet spread

- refers to spray with relatively large, short-range

aerosols produced by sneezing, coughing, or even
talking.
- Ex. Pertussis and meningococcal infection are
examples of diseases transmitted from an infectious
patient to a susceptible host by droplet spread.
2. Indirect transmission
- refers to the transfer of an infectious agent from a
reservoir to a host
● Airborne transmission

- Occurs when infectious agents are carried by dust or

droplet nuclei suspended in air. Airborne dust
includes material that has settled on surfaces and
become resuspended by air currents as well as
infectious particles blown from the soil by the wind.
- Ex. Measles
● Vehicles

- That may indirectly transmit an infectious agent include food, water,

biologic products (blood), and fomites (inanimate objects such as
handkerchiefs, bedding, or surgical scalpels).
- Ex. improperly canned foods provide an environment that supports
production of botulinum toxin by Clostridium botulinum.
● Vectors

- such as mosquitoes, fleas, and ticks may carry an infectious agent

through purely mechanical means or may support growth or changes in
the agent.
- Examples of mechanical transmission are flies carrying Shigella on
their appendages
- biologic transmission, the causative agent of malaria or guinea worm
disease undergoes maturation in an intermediate host
3. Standard Precautions

- The specific measures used to prevent the spread

of infection among all patients and healthcare
workers, including measures of protection
Standard Precautions include:

● Hand hygiene.
● Use of personal protective equipment (e.g., gloves,
masks, eyewear).
● Respiratory hygiene / cough etiquette.
● Sharps safety (engineering and work practice
controls).
● Safe injection practices (i.e., aseptic technique for
parenteral medications).
● Sterile instruments and devices.
● Clean and disinfected environmental surfaces.
4. Contamination

- Denotes contact of a sterile or aseptic item with

microorganisms.

5. Decontamination

- The process where physical or chemical means are

used to remove, inactive, or destroy pathogens on a
surface or item making them safe for handling or use
and incapable of transmitting infectious agents
6. Disinfection

- The process of using physical or chemical means to destroy pathogens,

excluding the spores

7. Sterilization

- The process by which all pathogens are destroyed, including the spores.
The various methods of physical and chemical sterilization will be
discussed in the succeeding chapters

8. Antiseptic

- A chemical solution that inhibits the growth of some microorganisms.

Can be used directly on the skin (alcohol and iodine)
9. Healthcare-associated infection

- Any infection that is acquired during the time a patient is admitted in a healthcare
facility.
- Most common UTI

10. Iatrogenic infection

- Acquired in the course of undergoing diagnostic tests or therapeutic procedures

11. Occupational Exposure

- Acquisition of exposure to an infectious agent of a healthcare worker during the
course of his/her work

12. Personal Protective Equipment (PPE)

- Specialized equipment and attire used by healthcare workers to protect them from
infections.
- Gloves, masks, gowns and goggles.
ASEPSIS

- Refers to a condition in which the individual and his/her

surrounding environment are free of any
microorganisms.

SEPSIS

- Refers to the clinical condition where an individual

develops a systemic reaction to a bacterial infection
that starts from a localized infection in one part of the
body
FACTORS FOR INFECTION
- All patients in healthcare facilities are vulnerable to pathogenic
organisms

1. Suppression of the immune system

2. Prolonged duration of illness
3. Procedures that patient undergo (e.g.
in-dwelling catheter, IV line, ET tube
Most common pathogens that lead to nosocomial
infections

● Escherichia coli
● Staphylococcus aureus
● Pseudomonas aeruginosa
● Candida Albicans
● Enterococcus

Locations of infections:

● Surgical wound
● Urinary tract
● respiratory tract
● bloodstream
MEDICAL or Clean Asepsis
- refers to the absence of disease-producing microorganism.
- Infection control process that aims to reduce the spread of infection
- Ex. Preparation of patient’s skin before administration of
subcutaneous medication

SURGICAL or sterile asepsis

- Absence of all microorganisms.
- Involves procedures that aim to eliminate microorganisms from an
area in the body where surgical procedures will be performed.
- The principles of surgical asepsis are applied when the skin is not
intact and when internal areas of the body are involved in
procedures, whether for dx or tx purposes.
- Ex. Wound care, insertion of urinary catheter
GENERAL ASEPTIC PROCEDURES:

1. Frequent handwashing of hospital personnel

2. Prompt and safe disposal of contaminated
materials like bandages and needles
3. Regular checking and emptying of containers
for surgical drains
4. Prompt cleaning of soiled or moist areas
5. Proper labeling of containers regarding the date
and time of disposal
HANDWASHING

- Most basic means of preventing the spread of

pathogenic organisms
Reasons:

1. To reduce the flora on the healthcare worker’s skin

2. To protect the healthcare worker in the event that there is
a break in his or her skin
3. To reduce the risk of contact with infectious agents if
gloves worn are punctured
4. To reduce the chances of disease transmission
Examples of healthcare acquired infections

1. Methicillin-resistant Staphylococcus aureus

(MRSA)
2. Vancomycin-resistant Enterococcus (VRE)
3. Penicillin-resistant Streptococcus
pneumoniae
When should handwashing be done?

1. At the beginning and end of each shift

2. When the hands are visibly soiled
3. After contact with a possible source of
microorganisms such as blood, body fluids,
mucous membrane,non-intact skin, or
contaminated objects
4. Before and after performing invasive
procedures
5. Before removing gloves if they are visibly
soiled and each time after removing gloves
PERSONAL PROTECTIVE EQUIPMENT (PPE)

- Are specialized equipment and attire used in healthcare

facilities to protect healthcare workers, patients and
visitors against infections
GLOVES
- Most commonly used during medical procedures
and are disposable
- 2 types:
- Examination- sterile or non sterile
- Surgical- sterile
Guidelines for proper gloving (WHO)

1. Gloves are not meant to replace observance of proper

hygiene.
2. Gloves must be worn if contact with blood or body fluids,
mucous membrane, open wounds, or potentially infectious
materials
3. Gloves must be removed and disposed of after caring for a
patient
4. Gloves must be removed or changed if moving from a
contaminated body site to another body site in the course of
caring for a patient
5. Re-using of gloves after decontamination is not
recommended
Use of gloves in the following situations:

1. Before performing a sterile procedure.

2. When in contact with a patient and his or her
surroundings in conditions where contact
precautions are warranted
3. When contact with blood or body fluids,
non-intact skin, and mucous membrane is
anticipated
Removal of gloves is indicated in the following:

1. When hand hygiene is indicated

2. After contact with a single patient and his or
her surroundings is ended or when contact
with a contaminated body site is ended
3. As soon as the gloves are damaged or there
is loss of integrity of the gloves
4. After contact with blood or body-fluids,
non-intact skin, and mucous membrane
MASKS
- must cover the mouth and nose
- minimal gaps between the face and the mask
- Supposed to be single-used
- Hand hygiene after disposal

STERILE GOWNS
- Wear when there is probability of contact with blood, body
secretions excluding sweat, or other body substances.
- The type of apron or gown to wear depends on the degree
of risk with the infectious agents and the potential for body
substances and blood to penetrate through the clothes or
skin of the healthcare workers
TYPES:

1. Fluid-Resistant gown- If there is a risk for body

substances, blood, or body secretions to
contaminate the clothing or skin
2. Clean, non-sterile gowns or apron- generally
sufficient to protect the skin and prevent soiling of
clothing during procedures or other in-patients
activities that may lead to splashing or spraying of
blood and body substances
3. Fluid-resistant gowns- are always worn with gloves
and other PPE
Fluid-resistant, single-use, long-sleeved, full body gowns
are usually worn:

1. When there is a risk of contact of the healthcare

worker’s skin with a patient who has broken skin
2. If there is extensive skin to skin contact between
the healthcare worker and the patient
3. If the risk of contact with body substances or fluids
cannot be contained such as when the patient has
diarrhea or is vomiting incessantly
Sterility Parameters:

1. The front of a sterile gown is considered sterile from the

chest down to the level of sterile field.
2. The gown sleeves are sterile from two inches above the
elbow to the cuff, circumferentially
3. The back of the gown is not considered sterile because it
cannot be constantly monitored
4. The neck, sleeves cuffs, and underarms of the gloves are
not considered sterile and are not considered as effective
microbial barriers
ISOLATION PRECAUTIONS:(universal)
- The process of separating an individual with an
infectious disease from the rest of the healthy
population to prevent the spread of infection to other
individuals

TRANSMISSION-BASED PRECAUTIONS
- Based on the mode of transmission of the infectious
agents
Contact Precautions
- To prevent the spread of infections or infectious agents that
are transmitted through touching of patients or items in the
room where the infectious agents may be deposited (fomites)
- Wear gowns and gloves

Droplet Precautions
- Used for diseases or infectious agents that are spread in tiny
droplets caused by coughing and sneezing.
- Used to prevent contact with secretions from the respiratory
tract
- Travel distance of 3km (90cm), cough or sneeze
- surgical mask
Airborne Precautions

- Measures to prevent the spread of disease or

infectious agents that are spread through the air.
- Microorganisms that are too tiny such as: chicken
pox, measles, tuberculosis
- Reverse isolation, room with negative air pressure.
Door must remain closed at all times
- Surgical mask
Aseptic Measures in the Operating Room

● Thorough cleaning of the operating room with

detergent or detergent germicides, soap and
water must be done.
● All equipment must be properly sterilized
● Surgical instruments can be sterilized in the
autoclave or by using chemical agents
● Personnel must ensure sterility by making sure
that sterile packages are dry and intact
● Sterile surgical clothing and operating room gowns and other
protective devices must be used to maintain asepsis in the OR
● Gowns used by the surgical team are considered sterile in
front from the chest to the level of the sterile surgical field and
2 inches above the elbows to the cuffs of the sleeves.
● Sterile drapes are sterilized linens placed around the field to
delineate sterile areas. Only the top surface is considered
sterile
● Wrapped kits of instruments are opened in such a way that the
contents do not touch non-sterile items or surfaces. Opening
the farthest areas of package first.
● Surgical scrubs must be performed by all members of the
surgical team and all others who will perform the surgical team
 Preventing Infection in the Community

● Controlling the spread of communicable disease before

the occurrence
● Infection Control
● Educate the public on infectious disease, mode of
transmission, to know the steps of prevention
● Sanitation techniques: water purification, improvement of
health practices, proper sewage disposal
● Improvement of health practices: education on proper
food handling, storage and preparation
● Vaccination: information and schedule