Asepsis and Infection

Control

MARISSA S. FERNANDEZ, RN,MAN

CLINICAL INTRUCTOR
 Focusing on Blended Skills:
 Cognitive Skills:
 1. basic knowledge of the infection cycle and nursing interventions
to break the chain of infection.
 2. Ability to identify the principles of medical and surgical asepsis
applicable to the care of patients to prevent and control infection.
 3. Knowledge of factors that reduce the incidence of nosocomial
infection.
 4. Knowledge of Center for Disease Control and Prevention
Guidelines for standard and transmission-based precautions.
 Technical Skills:
 1. Demonstration of strong history and physical assessment
techniques to determine a patient’s risk of infection.
 2. Ability to implement techniques correctly applying the principles
of medical and surgical asepsis.
 3. Ability to use the equipment and protocols necessary to conform
to principles of medical and surgical asepsis.
 4. Ability to use appropriate infection-control precautions and
barrier techniques for infection prevention and control.
 5. Ability to demonstrate competence in technical nursing
assistance to meet the needs of the patients who are at risk or are
experiencing an infection.

 Interpersonal Skills:
 1. Ability to communicate and interact effectively with individuals
and families.
 2. Ability to communicate care and compassion to patients
requiring infection-control measures.
 3. Ability to establish trusting relationship with patients and families
as a basis for teaching, counselling, and securing compliance with
infection-control measures
 Ethical and Legal Skills:
 1. Demonstration of a commitment to safety and quality; strong
sense of responsibility, accountability; strong advocacy abilities.
 2. Ability to identify braches in infection-control measures that
violate ethical and legal standards.
 3. Knowledge of special regulations, legislation and policy
detailing nursing responsibilities related to asepsis and infection
control.

 A major concern for health practitioner is the danger of

spreading microorganism from person to person and from place to
place. Microorganisms are naturally present in almost all
environment. Some are beneficial, some are not. Some are harmless
to most people, and others are harmful to most people.
 Prevention of infection is a major focus for nurses. As primary
caregivers, nurses involved in identifying, preventing, controlling and
teaching the patient about infection.
 Terminologist:
 Infection – an invasion of body tissue by microorganism and their proliferation.
 Asepsis – the absence of disease-producing microorganism; being free from infection
 Medical asepsis – practices designed to reduce the number and transfer of
pathogens. Clean technique.
 Surgical asepsis – practices that render and keep objects and areas free from
microorganisms. Sterile technique.
 Sepsis – presence of infection.
 Septicemia – transport of an infection throughout the body or by blood.
 Carrier – a person or an animal, who is without sign of illness but who harbors
pathogens within his body that can be transferred to another.
 Contact – a person or an animal known or believed to have been exposed to a
disease.
 Reservoir – the natural habitat for the growth and multiplication of microorganisms.
 Transient flora or Bacteria – microorganisms picked up by the skin as a result of normal
activities that can be removed readily.
 Resident flora or Bacteria – microorganisms that normally live on the person’s skin.
 Sterilization – process by which all microorganisms including spores are destroyed.
 Disinfectant – a substance usually intended for use if inanimate objects that destroys
pathogens but generally not the spores.
 Antiseptic – a substance intended for use on persons that inhibit the growth of
pathogens but not necessary destroy them.
 Bactericidal – a chemicals that kills microorganism.
 Bactriostatic – an agent that prevent bacterial multiplication but does not kill all forms
of organism.
 Contamination – process by which something is rendered unclean or unsterile.
 Disinfection – process by which pathogens but not 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.
 Infectious disease – results from the invasion and multiplication of microorganism in a
host
 Pathogen – disease-producing microorganism.
 Nosocomial infection – hospital acquired infecrion.
 Stages of Infection Process:
 1. Incubation Period – extends from the entry of microorganisms into
the body to the onset of signs and symptoms.
 2. Prodromal Period – extends from the onset of non-specific signs
and symptoms to the appearance of specific signs and symptoms.
 3. Illness Period – specific signs and symptoms develop and become
evident.
 4. Convalescent Period – signs and symptoms start to abatr until
client returns to normal state of health
 Infection: is a disease state that results from the presence of
pathogens (disease-producing microorganisms) in or on the body.
 Components of infection occurs as a result of cyclic process:
 = Infectious agent
 = Reservoir
 = Portal of exit
 = Means of transmission
 = Portal of entry
 = Susceptible host
 The Infection Cycle:


 immunization Hand hygiene. Sterilization

Screen health care staff Infectious Antibiotics/ Antimicrobials

agent

Suscepti
ble host Reservoir

Hand hygiene, wear gloves/ mask Chain transmission based

And PPE, proper disposal
Of precautions, Sterilization
Of needles and
infection use of disposable supplies
Sharps Portal of
Portals of
exit from
entry
Means reservoir
of
hand hygiene and use of transmis dry intact dressing, hand hygiene
pesticides to eliminate vectors sion wear gloves if in contact with body fluids
adequate refrigeration cover nose and mouth when sneezing
 1. Infectious Agents: (Etiologic agent)
 Infectious agents (pathogens) include not only bacteria but also viruses,
fungi, and parasites.
 The virulence of these pathogens depends on their number, their potency,
their ability to enter and survive in the body, and the susceptibility of the
host.
 For example, the smallpox virus is particularly virulent, infecting almost all
people exposed.
 In contrast, the tuberculosis bacillus infects only a small number of people,
usually people with weakened immune function, or those who are
undernourished and living in crowded conditions.
 2. Reservoir
 A reservoir is any person, animal, arthropod, plant, soil or substance
(or combination of these) in which an infectious agent normally lives
and multiplies.
 The infectious agent depends on the reservoir for survival, where it
can reproduce itself in such manner that it can be transmitted to a
susceptible host.
 = Animate reservoirs include people, insects, birds, and other
animals.
 = Inanimate reservoirs include soil, water, food, feces,
intravenous fluid, and equipment.
 3. Portal of Exit
 Portals of exit is the means by which a pathogen exits from a reservoir.
For a human reservoir, the portal of exit can include blood, respiratory
secretions, and anything exiting from the gastrointestinal or urinary
tracts.
 Once a pathogen has exited the reservoir, it needs a mode of
transmission to transfer itself into a host. This is accomplished by
entering the host through a receptive portal of entry.
 Transmission can be by direct contact, indirect contact, or through the
air.
 Transmission of respiratory infections such as COVID-19 is primarily via
virus-laden fluid particles (i.e., droplets and aerosols) that are formed in
the respiratory tract of an infected person and expelled from the
mouth and nose during breathing, talking, singing, coughing, and
sneezing.
 4. Mode of transmission:
 a. Contact transmission:
 = direct contact – involves immediate and direct transfer fro person
to person ( body surface – to – body surface). E.g. health care personnel
to clients during dressing changes, insertion of tubes and catheters.
 = indirect contact – occurs when a susceptible host is exposed to a
contaminated object such as dressing, needle, surgical instrument.
 b. Droplet transmission:
 = occurs when mucous membrane of the nose, mouth or
conjunctiva are exposed to secretions of an infected persons who is
coughing , sneezing, laughing or talking usually within a distance of 3 feet.
 c. Vehicle transmission – involves the transfer of microorganisms by way
of vehicles or contaminated items that transmit pathogens. E.g. food,
water, blood, eating utensils, pillows and mattress.

 d. Airborne transmission:
 = this occurs when fine particles are suspended in the air for 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.
 = can occur when the residue of evaporated droplets from an
infected person remain in the air long enough to be transmitted to
the respiratory tract of a susceptible host.

 e. Vectorborne transmission: Vector 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.
 Human-to-human transmission of COVID-19 occurs primarily via three routes:
 (1) large particles that are expelled with sufficient momentum so as to
directly impact the recipients’ mouth, nose, or conjunctiva; (droplet and
contact)
 (2) physical contact with droplets deposited on a surface and subsequent
transfer to the recipient’s respiratory mucosa; (droplet and contact)
 (3) inhalation of aerosolized droplet nuclei delivered by ambient air currents.
(airborne).
 5. Portal of Entry:
 Infectious agents get into the body through various portals of entry, including the
mucous membranes, non-intact skin, and the respiratory, gastrointestinal, and
genitourinary tracts.
 Pathogens often enter the body of the host through the same route they exited the
reservoir, e.g., airborne pathogens from one person’s sneeze can enter through the
nose of another person.
 6. Susceptible Host:
 The final link in the chain of infection is a susceptible host, someone at risk of
infection. Infection does not occur automatically when the pathogen enters the
body of a person whose immune system is functioning normally. When a virulent
pathogen enters an immune-compromised person, however, infection generally
follows.
 Whether exposure to a pathogen results in infection depends on several factors
related to the person exposed (the host), the pathogen (the agent), and the
environment.
 Host factors that influence the outcome of an exposure include the presence or
absence of natural barriers, the functional state of the immune system, and the
presence or absence of an invasive device.
 Factors influencing the Host’s susceptibility:
 1. Intact skin and mucous membrane are the body’s first line of
defense.
 2. The normal ph level of secretions and of genito-urinary tract help
ward off microbial invasion.
 3. The body’s WBC influence resistance to certain pathogens.
 4. The age, sex and race have been shown to influence
susceptibility.
 5. Immunization. (natural or acquired), acts to resist infection.
 6. Fatigue, climate, general health status, presence of pre-existing
illness. Previous and 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. E.g. recovery from mumps, chicken pox
 b. Artificial – antigens (vaccines or toxoids) are administered to
stimulate antibody production. Requires booster inoculation after
many years. E.g. tetanus toxoid, oral polio vaccine.
 2. Passive immunization – antibodies produced by another source,
such as animals 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 human
is injected to a person. E.g. tetanus immunoglobulin human (TIGH).
 Principles Underlying Medical and Surgical Asepsis:
 1. the patient is a source of pathogenic microorganisms.
 2. the patient’s microorganisms leave through specific routes.
 3. there are always microorganisms in the environment which in
some individuals and under circumstances can cause illness.
 4. microorganisms harmful to man can be transmitted by direct and
indirect contact.
 5. spread of infection from source to others can be prevented by
various methods to stop the spread as close to the source as
possible.
 6. the effectiveness of medical and surgical asepsis is dependent on
the consciousness of those carrying them out.
 7. in observing medical asepsis, areas are considered contaminated
if they bear or are suspected of having pathogens.
 8. in observing surgical asepsis, areas are considered contaminated
if touched by any object that is not sterile.
 Breaking the Chain of Infection: Aseptic Practices.
 1. Handwashing. Medical asepsis is done by holding hands lower
than the elbow.
 2. Cleaning, Disenfection and Sterilization.
 3. use of barriers
 4. Isolation system
 5. Surgical asepsis
 Methods of Sterilization:
 1. Steam sterilization
 2. gas sterilization
 3. radiation
 4. chemicals
 5. boiling water
  Methods of Sterilization and Disinfection:
Method Discussion Caution
Physical
Steam Higher temperature caused by higher pressure most plastic and rubber devices are
destroys organisms (by autoclaving) damaged by autoclaving

Frequently used in the home – simple and Some boiling are not destroyed by
Boiling water inexpensive; boil item at least 10 minutes boiling.

Alternative sterilization method for home. Used for Insufficient to destroy all
Dry heat metal items. Heat oven to 350*F for 2 or more hours. microorganisms. Not use in health
care agencies.

Objects must be directly exposed to

Used for pharmaceuticals, foods, plastics and other ultraviolet radiation of all surfaces.
Radiation heat sensitive items Poses risk to personnel.

Chemical
Ethylene oxide gas Destroys microorganism and spores by interfering Precaution necessary because gas
metabolic processes in cells. Gas is released while is toxic to humans.
are contained in autoclave.

Chemical solutions Generally used for instrument and equipment Methods does not destroy all spores
disinfection and for housekeeping disinfection. and many cause corrosion on metal
A solution of sodium hypochlorite (household surfaces.
bleach) in a 1:1000 dilution effectively inactivates
 Organism Capable of Causing Disease:

Organism Reservoir Means of Disease transmitted

transmission
Staphylococcus Skin surface, Mouth, Nose. Contact ( direct) Wound infection
Throat, Abscess, carbuncle
Aureus Boil

Hepatitis B virus Blood, Feces Contact (Indirect) Hepatitis B

Body fluids and excretions

Human Blood , Semen, Contact (direct) Acquired

Vaginal secretions Immunodeficiency
Immunodeficiency Breast milk Ingestion syndrome
virus

Mycobactrium TB Sputum (respiratory tract) Airborne Tuberculosis

Ticks ( sheep, cattle, deer, Vectors Lyme disease
Borrelia burgdorferi mice)
Escherichia coli Feces Contact (direct) E. Coli infections
Undercooked meat (beef) Contact (ingestion)
Unpasteurized apple juice
 Medical Asepsis:
 Medical asepsis techniques are used continuously both within and
outside health agencies, based on the assumption that pathogens
are likely to be present.
 In a health care facility, if a specific pathogen is known to be
present, special methods of medical asepsis are used to prevent
further spread of the organism.
 Therefore the nurse assumes a major responsibility for breaking the
cycle of infection by providing safe patient care and protecting the
patient, as well as the nurse, from microorganisms that may cause
the disease.
 Practicing Basic Principles of Medical Asepsis in Patient Care:
 1. Practice good hand hygiene.
 2. keep soiled items and equipment from touching the clothing.
 3. Do not place soiled linen or any items on the floor, which is grossly contaminated.
It increases contamination on both surfaces.
 4. Avoid having patient cough, sneeze, or breath directly on others. Provide them
tissue, or instruct them as indicated.
 5. Move equipment away from you when brushing, dusting, or scrubbing articles.
 6. Avoid raising dust.
 7. Clean the least soiled areas first and then the more soiled ones.
 8. Dispose of soiled or used items directly into appropriate containers.
 9. Pour liquids that are to be discarded directly into the drain to avoid splattering in
the sink and unto you.
 10. Sterilize items that are suspected of containing pathogens.
 11. Use practices of personal grooming that help prevent spreading
microorganisms.
 Surgical Asepsis:
 Surgical asepsis technique, used regularly in the operating room,
labor and delivery areas, and certain diagnostic testing areas, and
also patient’s bedside.
 One of the most important aspects of medical and surgical asepsis
is that the effectiveness of both depends on faithfulness and
conscientious practice by those carrying them out.
 Being a patient advocate requires vigilant aseptic technique and a
willingness to speak up if the patient’s safety has been
compromised by improper procedures.
 Practicing Basic Principles of Surgical Asepsis:
 1. All objects used in a sterile field must be sterile.
 2. A sterile object becomes non-sterile when touched by a non-sterile object.
 3. Sterile items that are below the waist level, or items held below waist level, are
considered to be non-sterile.
 4. Sterile fields must always be kept in sight to be considered sterile.
 5. When opening sterile equipment and adding supplies to a sterile field, take
care to avoid contamination.
 6. Any puncture, moisture, or tear that passes through a sterile barrier must be
considered contaminated.
 7. Once a sterile field is set up, the border of one inch at the edge of the sterile
drape is considered non-sterile.
 8. If there is any doubt about the sterility of an object, it is considered non-sterile.
 9. Sterile persons or sterile objects may only contact sterile areas; non-sterile
persons or items contact only non-sterile areas
 10. Movement around and in the sterile field must not compromise or
contaminate the sterile field.