Nursing 1ANursing 1AWeeks 1-3Weeks 1-3

Mt. San Antonio College Mt. San Antonio College Associate Degree Nursing ProgramAssociate Degree Nursing Program

AsepsisAsepsis

AsepsisAsepsis

Absence of microorganismAbsence of microorganism Microorganisms are everywhere!Microorganisms are everywhere! Healthy people have effective resistance Healthy people have effective resistance

to most organismsto most organisms Patients are more susceptible to Patients are more susceptible to

infections due to decreased resistance infections due to decreased resistance (elderly, infants and the chronically ill)(elderly, infants and the chronically ill)

Microorganisms Microorganisms (Bacteria Viruses, Fungi)(Bacteria Viruses, Fungi)

Spread by: Spread by: Direct contactDirect contact DropletDroplet Contact with infected articleContact with infected article Air currentsAir currents Moist or wet surfacesMoist or wet surfaces

Contact is the most common route of Contact is the most common route of transmissiontransmission

Medical AsepsisMedical Asepsis

Includes all practice intended to Includes all practice intended to confine a specific organism to a confine a specific organism to a specific areaspecific area

Limits the number, growth and Limits the number, growth and transmission of microorganismtransmission of microorganism

Objects are “clean” or “dirty”Objects are “clean” or “dirty”

Sterile AsepsisSterile Asepsis

Sterile technique (no microbes!)Sterile technique (no microbes!) Practice that keeps and area or Practice that keeps and area or

objects free of all microorganismobjects free of all microorganism Practice that destroys Practice that destroys

microorganisms and sporesmicroorganisms and spores Used for all procedures Used for all procedures

involving a sterile area of bodyinvolving a sterile area of body

Types of InfectionTypes of Infection

ColonizationColonization LocalLocal SystemicSystemic BacteremiaBacteremia SepticemiaSepticemia Acute vs. Chronic InfectionAcute vs. Chronic Infection Nosocomial InfectionNosocomial Infection

Chain of InfectionChain of Infection

Breaking the Chain of InfectionBreaking the Chain of Infection

Etiologic Agent (microorganism)Etiologic Agent (microorganism) Correct cleansing, disinfecting or Correct cleansing, disinfecting or

sterilizing of article before usesterilizing of article before use Educating pt and support person Educating pt and support person

about appropriate methods to clean about appropriate methods to clean and disinfectand disinfect

Reservoir (source)Reservoir (source) Changing dressing when wet/soiledChanging dressing when wet/soiled Appropriate skin and oral hygieneAppropriate skin and oral hygiene Disposing of damp/soiled linen Disposing of damp/soiled linen Emptying suction and drain bottles at Emptying suction and drain bottles at

end of shiftend of shift

Portal of exit (from reservoir)Portal of exit (from reservoir) Avoid talking, coughing. Or Avoid talking, coughing. Or

sneezing over open wounds or sneezing over open wounds or sterile field (cover your mouth)sterile field (cover your mouth)

Method of transmissionMethod of transmission Proper hand hygieneProper hand hygiene Educate pt and support person to Educate pt and support person to

perform hand hygiene prior to perform hand hygiene prior to eating, after elimination and after eating, after elimination and after touching infectious materialtouching infectious material

Initiating standard precaution on all Initiating standard precaution on all pt, wearing protective equipment pt, wearing protective equipment when warrantedwhen warranted

Portal of entry to susceptible hostPortal of entry to susceptible host Using sterile technique for invasive Using sterile technique for invasive

procedures, when exposed to open procedures, when exposed to open wounds or when handling dressingswounds or when handling dressings

Placing needles and syringes in puncture-Placing needles and syringes in puncture-resistant container resistant container

Susceptible hostSusceptible host Maintaining the integrity of the pt skin and Maintaining the integrity of the pt skin and

mucous membranemucous membrane Ensuring that the pt receives a balance dietEnsuring that the pt receives a balance diet Educating the public about importance of Educating the public about importance of

immunizationimmunization

Signs of Localized Signs of Localized InfectionInfection Localized swellingLocalized swelling Localized rednessLocalized redness Pain or tenderness with Pain or tenderness with

palpation or movementpalpation or movement Palpable heat in the infected Palpable heat in the infected

areaarea Loss of function of the body part Loss of function of the body part

affected, depending on the site affected, depending on the site and extent of involvement and extent of involvement

Signs of Systemic Signs of Systemic InfectionInfection

FeverFever Increased pulse and respiratory Increased pulse and respiratory

rate if the fever highrate if the fever high Malaise and loss of energyMalaise and loss of energy Anorexia and, in some Anorexia and, in some

situations, nausea and vomitingsituations, nausea and vomiting

Defense against infectionDefense against infection

Proper hand hygiene (washing/gel)Proper hand hygiene (washing/gel) Environmental controlEnvironmental control Sterile technique when warrantedSterile technique when warranted Identifying and managing patients Identifying and managing patients

at riskat risk

Hand washing is the single most Hand washing is the single most effective way to prevent the spread of effective way to prevent the spread of organisms.organisms.

Hand washing recommendationHand washing recommendation

When starting shift and leaving When starting shift and leaving for the dayfor the day

Before and after pt contactBefore and after pt contact Before and after proceduresBefore and after procedures Before and after going to the Before and after going to the

bathroombathroom

Hand Hygiene ProcedureHand Hygiene Procedure

See Procedure in Kozier-pg. See Procedure in Kozier-pg. 688-690, Skill 31-1688-690, Skill 31-1

CDC Guidelines for CDC Guidelines for Infection ControlInfection Control

AirborneAirborne (small droplet): can (small droplet): can disseminate by air widely. TB, disseminate by air widely. TB, VaricellaVaricella

DropletsDroplets (large droplet): propelled (large droplet): propelled short distance in air by coughing, short distance in air by coughing, sneezing and talking. H Influenza sneezing and talking. H Influenza Meningitis, pneumoniaMeningitis, pneumonia

ContactContact (touching): MRSA, (touching): MRSA, VRE, RSV, C DIFFVRE, RSV, C DIFF

StandardStandard (all pt’s all the time) (all pt’s all the time)

Standard precautionsStandard precautions

All blood, body fluids, secretions and All blood, body fluids, secretions and excretions are considered potentially excretions are considered potentially infectious (except sweat)infectious (except sweat)

GlovesGloves: should be worn for contact w/ : should be worn for contact w/ blood, body substance non-intact skin, blood, body substance non-intact skin, mucous membranes, surfaces soiled w/ mucous membranes, surfaces soiled w/ blood and body fluid blood and body fluid

Protective gogglesProtective goggles: should be worn : should be worn during procedures that are likely to cause during procedures that are likely to cause splashes of blood or body substancesplashes of blood or body substance

MasksMasks: are to be worn to reduce risk of : are to be worn to reduce risk of transmission organism via droplet and transmission organism via droplet and airborne routes and splatter of body airborne routes and splatter of body substancesubstance

GownsGowns: should be worn during : should be worn during procedures that are likely to result in procedures that are likely to result in splashes of blood or body substancesplashes of blood or body substance

Hand washingHand washing: should be done : should be done immediatelyimmediately

NeedlesNeedles: should never be recapped, must : should never be recapped, must be place in puncture resistance containerbe place in puncture resistance container

CPRCPR: should always be performed using a : should always be performed using a barrier device instead of mouth to mouthbarrier device instead of mouth to mouth

Correct Order for Donning and Correct Order for Donning and Removing Protective EquipmentRemoving Protective Equipment

DonningDonning GownGown MaskMask Protective Protective

EyewearEyewear GlovesGloves

RemovingRemoving GlovesGloves Protective Protective

EyewearEyewear GownGown MaskMask

Biohazard AlertBiohazard Alert