KOZIER & ERB’S

Fundamentals of NURSING
NINTH EDITION Concepts, Process, and Practice

CHAPTER

Asepsis

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Asepsis

• Resident flora
• Infection
• Disease
• Virulence
• Communicable disease
• Pathogenicity, opportunistic pathogen

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Asepsis (cont’d)

• Asepsis – freedom from disease-causing

organisms
• Medical asepsis - all practices intended to
confine a specific microorganism to a
specific area
– Limits number, growth, and transmission of
microorganisms

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Asepsis (cont'd)

• Surgical asepsis
– Sterile technique
– Practices that keep area or object free of all
microorganisms
– Practices that destroy all microorganisms and
spores
– Used for all procedures involving sterile areas
of the body
• Sepsis
Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Types of Microorganisms

• Bacteria
• Viruses
• Fungi
• Parasites

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
• Colonization of resident flora not infection
• Invasion to unprotected area = infection
• Local infection
– Limited to a specific body part
• Systemic infection
– Spreads and damages different body parts
• Bacteremia
– Microorganisms in the blood
Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Type of Infections (cont'd)

• Septicemia
– Systemic infection resulting from bacteremia
• Acute infections
– Appear suddenly or last a short period of time
• Chronic infections
– May occur slowly over a long period
– May lasts months or years

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
Health Care-associated Infections

• Nosocomial - infections that originate in

the hospital
• Diagnostic or therapeutic procedures
– Iatrogenic infections
• Poor hand hygiene major contributor

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
Figure 31-1 The chain of infection.

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Etiologic Agent

• Number of microorganisms present

• Virulence and potency (pathogenicity)
• Ability to enter the body
• Susceptibility of the host
• Ability to live in the host’s body

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Reservoir

• Common sources
– Other humans
– Client’s own microorganisms
– Plants
– Animals
– General environment (food, water, feces)
• Carrier
• Must have portal of exit from reservoir

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Method of Transmission

• Direct transmission
• Indirect transmission
– Vehicle-borne
– Vector-borne
• Airborne transmission
– Droplet nuclei

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Body Defenses

• Nonspecific defenses
• Specific immune defenses

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Nonspecific Barriers
• Intact skin and mucous • High acidity of the
membranes stomach
• Moist mucous • Resident flora of the large
membranes and cilia of intestine
the nasal passages • Peristalsis
• Alveolar macrophages • Low pH of the vagina
• Saliva • Urine flow through the
• Tears urethra

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
Nonspecific Barriers: Inflammatory
Response
• Inflammation
• Pain
• Swelling
• Redness
• Heat
• Impaired function
• Suffix –itis

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Specific Defenses

• Antigen
• Immunity
• Autoantigen
• Antibody-mediated defenses (active,
passive)

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Active Immunity

• Host produces antibodies in response to

natural antigens or artificial antigens
• Natural active immunity
– Antibodies are formed in presence of active
infection in the body
– Duration lifelong

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Active Immunity (cont'd)

• Artificial active immunity

– Antigens administered to stimulate antibody
formation
– Lasts many years

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Passive (Acquired) Immunity

• Host receives natural or artificial

antibodies produced from another source
• Natural passive immunity
– Antibodies transferred naturally from an
immune mother to baby through the placenta
or in colostrum
– Lasts 6 months to 1 year

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Passive (Acquired) Immunity
(cont'd)
• Artificial passive immunity
– Occurs when immune serum (antibody) from
an animal or another human is injected
– Lasts 2 to 3 weeks

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
Factors Increasing Susceptibility to
Infection
• Age
• Heredity
• Nature, number, and duration of stressor
• Nutrition
• Medical treatments or procedures (e.g.,
radiation)
• Some medications
• Diseases that lessen resistance (e.g., COPD)

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Assessing

• History
– Degree of risk for infection
– Complaints suggesting presence of infection

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Physical Assessment

• Localized swelling
• Localized redness
• Pain or tenderness with palpation or
movement
• Palpable heat in infected area
• Loss of function of affected body part,
depending on site and extent of
involvement
Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Physical Assessment (cont’d)

• Fever
• Increased pulse and respiratory rate if the
fever high
• Malaise and loss of energy
• Anorexia and, in some situations, nausea
and vomiting
• Enlargement and tenderness of lymph
nodes that drain the area of infection
Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Implementing: Reducing
Risk for Infection
• Prevent nosocomial infection
• Proper hand hygiene techniques
• Environmental controls
• Sterile technique when warranted
• Identification and management of clients
at risk

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
Implementing: Donning and Removing
Personal Protective Equipment (PPE)
• Gowns
• Masks
• Gloves

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Implementing:
Breaking the Chain of Infection
• Etiologic agent
– Correctly cleaning, disinfecting or sterilizing
articles before use
– Educating clients and support persons about
appropriate methods to clean, disinfect, and
sterilize article

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Breaking the Chain of
Infection (cont’d)
• Reservoir (source)
– Changing dressings and bandages when
soiled or wet
– Appropriate skin and oral hygiene
– Disposing of damp, soiled linens appropriately
– Disposing of feces and urine in appropriate
receptacles
– Ensuring that all fluid containers are covered
or capped
Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Breaking the Chain of
Infection (cont'd)
• Reservoir (source)
– Emptying suction and drainage bottles at end
of each shift or before full or according to
agency policy

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Breaking the Chain of
Infection (cont'd)
• Portal of exit
– Avoiding talking, coughing, or sneezing over
open wounds or sterile fields
– Covering the mouth and nose when coughing
or sneezing

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Breaking the Chain of
Infection (cont'd)
• Method of transmission
– Proper hand hygiene
– Teaching clients and support persons to
perform hand hygiene before handling food,
eating, after eliminating, and after touching
infectious material
– Wearing gloves when handling secretions and
excretions

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Breaking the Chain of
Infection (cont'd)
• Method of transmission
– Wearing gowns if danger of soiling clothing
with body substances
– Placing discarded soiled materials in
moisture-proof refuse bags
– Holding used bedpans steady to prevent
spillage
– Disposing of urine and feces in appropriate
receptacles

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Breaking the Chain of
Infection (cont’d)
• Method of transmission
– Initiating and implementing aseptic
precautions for all clients
– Wearing masks and goggles when close to
clients with infections transmitted by
respiratory droplets
– Wearing masks and eye protection when
sprays of body fluid are possible

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Breaking the Chain of
Infection (cont’d)
• Portal of entry
– Using sterile technique for invasive
procedures, exposing open wounds, or
handling dressings
– Placing used disposable needles and
syringes in puncture-resistant containers for
disposal
– Providing clients with separate personal care
items

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Breaking the Chain of
Infection (cont’d)
• Susceptible host
– Maintaining integrity of client’s skin and
mucous membranes
– Ensuring a balanced diet and adequate fluids
– Educating the public about immunizations
– Encourage deep, slow breathing and
movement, plus adequate rest and sleep
– Offer stress management strategies

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Category-Specific Isolation
Precautions
• Strict isolation
• Contact isolation
• Respiratory isolation; tuberculosis isolation
• Enteric precautions
• Drainage/secretions precautions
• Blood/body fluid precautions

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Standard Precautions

• Designed for all clients; decrease risk of

transmitting recognized and unrecognized
sources of infection
• Apply to:
– Blood; all body fluids, excretions, secretions,
except sweat
– Nonintact skin
– Mucous membranes

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Implementing:
Personal Protective Equipment
• Gloves
• Gowns
• Face masks
• Eyewear

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.