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Asepsis

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Objectives:
▸ At the end of discussion, students will be able to:
1. Explain the concepts of medical and surgical asepsis.
2. Identify signs of localized and systemic infections and
inflammation.

2
Objectives:
3. Identify risks for nosocomial and health care–associated
infections.
4. Identify factors influencing a microorganism’s ability to
produce an infectious process.
5. Identify anatomic and physiological barriers that defend the
body against microorganisms.

3
Objectives:
6. Differentiate active from passive immunity.
7. Identify relevant nursing diagnoses and contributing factors
for clients at risk for infection and who have an infection.
8. Identify interventions to reduce risks for infections.
9. Identify measures that break each link in the chain of
infection.

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Concepts
1. Infection: growth of microorganisms in body
tissue where they are not usually found.
2. Disease: detectable alteration in normal tissue
function.

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Concepts
3. Asepsis: freedom from disease-causing microorganisms.
TWO BASIC TYPES:
a. Medical asepsis: to confine a specific microorganism to a
specific area, limiting the number, growth, and transmission of
microorganisms.

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Concepts
3. Asepsis is the freedom from disease-causing
microorganisms.
TWO BASIC TYPES:
b. Surgical asepsis, or sterile technique: keep an area or object free of all
microorganisms; it includes practices that destroy all microorganisms and
spores (microscopic dormant structures formed by some pathogens that
are very hardy and often survive common cleaning techniques).

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Concepts
4. Virulence: ability to produce disease
5. Communicable disease: infectious agent can be transmitted
to an individual by direct or indirect contact or as an airborne
infection
6. Pathogen: a microorganism that causes disease

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Concepts
7. Pathogenicity: ability to produce disease
8. Colonization: process by which strains of microorganisms
become resident flora.
9. Carrier: person or animal reservoir of a specific infectious
agent that usually does not manifest any clinical signs of
disease

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Concepts
10. Antiseptics: agents that inhibit the growth of some
microorganisms
11. Disinfectants: agents that destroy pathogens other than
spores

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TYPES OF MICROORGANISMS THAT
CAUSE INFECTIONS
1. Bacteria
2. Viruses
3. Fungi
4. Parasites

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TYPES OF INFECTIONS
▸ A local infection is limited to the specific part of
the body where the microorganisms remain.
▸ Systemic infection is an infection when the
microorganisms spread and damage different
parts of the body.

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TYPES OF INFECTIONS
▸ Acute infections generally appear suddenly or
last a short time.
▸ A chronic infection may occur slowly, over a
very long period, and may last months or
years.

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NOSOCOMIAL AND HEALTH CARE–
ASSOCIATED INFECTIONS
▸ Nosocomial infections are classified as
infections that originate in the hospital.
▸ are a subgroup of health care–associated
infections (HAIs)—those that originate in any
health care setting.

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factor contributing to the development of
nosocomial infections
▸ endogenous source= originate from the clients themselves.
▸ exogenous sources= originate from the hospital
environment and hospital personnel.
▸ Iatrogenic infections= direct result of diagnostic or
therapeutic procedures.

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 “
The cost of nosocomial infections to the client, the
facility, and funding sources (e.g., insurance
companies and federal, state, or local governments)
is great. Nosocomial infections extend
hospitalization time, increase clients’ time away
from work, cause disability and discomfort, and
even result in loss of life.

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 CHAIN OF INFECTION

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source.
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Method of Transmission
▸ There are three mechanisms:
1. Direct transmission

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Method of Transmission
2. Indirect transmission
a. Vehicle-borne: any
substance that serves as an
intermediate means to
transport and introduce an
infectious agent into a
susceptible host through a
suitable portal of entry
b. Vector-borne: an animal
or flying or crawling insect
that serves as an
intermediate means of
transporting the infectious
agent.
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Identify the types of indirect transmission

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Method of Transmission
3. Airborne transmission: involve droplets or dust.
-The material is transmitted by air currents to a
suitable portal of entry, usually the respiratory
tract, of another person.

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BODY DEFENSES AGAINST
INFECTION
▸ Nonspecific defenses ▸ Specific (immune)
protect the person defenses, are directed
against all against identifiable
microorganisms, bacteria, viruses, fungi,
regardless of prior or other infectious
exposure. agents.

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BODY DEFENSES AGAINST INFECTION:
Nonspecific defenses
1. Intact skin and mucous membranes
2. Nasal passages
3. Eye
4. Vagina

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INFLAMMATORY RESPONSE
▸ Inflammation is a local ▸ 5 signs:
and nonspecific (1) pain,
defensive response of
(2) swelling,
the tissues to an
injurious or infectious (3) redness,
agent. (4) heat, and
(5) impaired function of
the part, if the injury is
severe
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INFLAMMATORY RESPONSE
3 stages of the inflammatory response:
▸ First stage: vascular and cellular responses
▸ Second stage: exudate production
▸ Third stage: reparative phase.

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BODY DEFENSES AGAINST INFECTION:
Specific defenses
1. involve the immune system
Antigen: substance that induces a state of
sensitivity or immune responsiveness (immunity).
Autoantigen: when the proteins originate in a
person’s own body.

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BODY DEFENSES AGAINST INFECTION:
Specific defenses
The immune response has two components:
1. antibody-mediated defenses 2. cell-mediated defenses
-defenses reside ultimately in the B -occur through the T-cell
lymphocytes and are mediated by system
antibodies produced by B cells

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TWO MAJOR TYPES OF IMMUNITY

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FACTORS INCREASING
SUSCEPTIBILITY TO INFECTION
1. Age: Newborns, older adults and advancing
age
2. Heredity
3. Level of stress
4. Nutritional status
5. Current medical therapy
6. Preexisting disease processes 30
NURSING MANAGEMENT
1. Assessing
2. Nursing History
3. Physical Assessment

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NURSING MANAGEMENT
3. Physical Assessment • Palpable heat at the
skin and mucous infected area
membranes: • Loss of function of the
• Localized swelling body part affected,
depending on the site and
• Localized redness
extent of involvement.
• Pain or tenderness with
In addition, open wounds
palpation or movement
may exude drainage of
various colors. 32
NURSING MANAGEMENT
4. Laboratory Data
a. WBC
b. ESR
c. Urine, blood, sputum, or other drainage cultures

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NURSING MANAGEMENT
5. Diagnosing
Risk for Infection
• Inadequate primary defenses such as broken skin, traumatized tissue,
decreased ciliary action, stasis of body fluids, change in pH of secretions, or
altered peristalsis
• Inadequate secondary defenses such as leukopenia, immunosuppression,
decreased hemoglobin, or suppressed inflammatory response
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NURSING MANAGEMENT
6. Planning
• Maintain or restore defenses.
• Avoid the spread of infectious organisms.
• Reduce or alleviate problems associated with the
infection.

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NURSING MANAGEMENT
7. Planning for Home Care
-eliminate the infection or to adapt to a chronic
state.
-In preparation for discharge, the nurse needs to
know the client’s and family’s risks, needs,
strengths, and resources.

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NURSING MANAGEMENT
8. Implementing
a. Break the Chain of Infection
➢ Etiologic agent (microorganism)
-articles are correctly cleaned and disinfected or sterilized
before use
-Educate clients and support people about appropriate
methods for cleaning, disinfecting, and sterilizing articles 37
NURSING MANAGEMENT: Implementing
▸ Reservoir (source)
-Change dressings and bandages when they are soiled or
wet.
-skin and oral hygiene.
-Dispose of damp, soiled linens appropriately
-Dispose of feces and urine in appropriate receptacles.
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NURSING MANAGEMENT: Implementing
▸ Reservoir (source)
-all fluid containers are covered or capped.
- Empty suction and drainage bottles at the end of
each shift or before they become full, or according
to agency policy.

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NURSING MANAGEMENT: Implementing
▸ Portal of exit from the reservoir
-Avoid talking, coughing, or sneezing over open
wounds or sterile fields, and cover the mouth and
nose when coughing and sneezing.

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NURSING MANAGEMENT: Implementing
▸ Method of transmission
-Cleanse hands between client contacts, after
touching body substances, and before performing
invasive procedures or touching open wounds.
-Instruct clients and support people to cleanse
hands before handling food or eating, after
eliminating, and after touching infectious material.
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NURSING MANAGEMENT: Implementing
▸ Method of transmission
-Wear gloves when handling secretions and excretions.
-Wear gowns if there is danger of soiling clothing with
body substances.
-Place discarded soiled materials in moisture-proof refuse
bags.

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NURSING MANAGEMENT: Implementing
▸ Method of transmission
-Hold used bedpans steadily to prevent spillage, and dispose
of urine and feces in appropriate receptacles.
-Wear mask and eye protection when in close contact with
clients who have infections transmitted by droplets from the
respiratory tract.
-Wear mask and eye protection when sprays of body fluid are
possible (e.g., during irrigation procedures). 43
NURSING MANAGEMENT: Implementing
▸ Portal of entry to the susceptible host
-Use aseptic technique for invasive procedures (e.g., injections,
catheterizations).
-Use sterile technique when exposing open wounds or handling
dressings.
-Place used disposable needles and syringes in puncture-resistant
containers for disposal.
-Provide all clients with their own personal care items. 44
NURSING MANAGEMENT: Implementing
▸ Susceptible host
-Maintain the integrity of the client’s skin and
mucous membranes.
-Ensure that the client receives a balanced diet.
-Educate the public about the importance of
immunizations.

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NURSING MANAGEMENT: Implementing
▸ Susceptible host
-Encourage deep, slow, full breathing, ambulation, and
movement.
-Offer stress management strategies and encourage healthy
relationships.
-Fluid intake and adequate sleep

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NURSING MANAGEMENT: Implementing
b. Preventing Nosocomial Infections
-use of medical and surgical asepsis
c. Hand Hygiene (discussed on RLE)
d. Disinfecting and Sterilizing

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Disinfecting
▸ Antiseptic ▸ Disinfectant ▸ BOTH
-used on skin or -used on inanimate -similar chemical
tissue. objects components, but the
-ex: phenol or iodine disinfectant is a more
compounds concentrated solution
-frequently caustic - bactericidal or
and toxic to tissues bacteriostatic
properties
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Sterilizing
▸ Sterilization is a process that destroys all
microorganisms, including spores and viruses

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Sterilizing
▸ Four commonly used methods of sterilization:
1. Moist heat: steam under pressure is used because it attains
temperatures higher than the boiling point
2. Gas: Ethylene oxide gas destroys microorganisms by interfering with
their metabolic processes
3. Boiling water: Boiling a minimum of 15 minutes is advised for
disinfection of articles in the home
4. Radiation: Both ionizing and nonionizing radiation 50
NURSING MANAGEMENT: Implementing
a. Break the chain of infections
b. Preventing Nosocomial Infections
-use of medical and surgical asepsis
c. Hand Hygiene (discussed on RLE)
d. Disinfecting and Sterilizing
e. Infection Prevention and Control
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Infection Prevention and Control
▸ Isolation refers to measures designed to
prevent the spread of infections or potentially
infectious microorganisms to health personnel,
clients, and visitors.

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Infection Prevention and Control
▸ Sets of guidelines:
▸ Category-specific isolation precautions use seven
categories: strict isolation, contact isolation, respiratory
isolation, tuberculosis isolation, enteric precautions,
drainage/secretions precautions, and blood/ body fluid
precautions.
▸ Disease-specific isolation precautions provide precautions
for specific diseases. 53
Infection Prevention and Control
▸ Standard Precautions: a. hand hygiene
used in the care of all b. use of personal protective equipment (PPE),
hospitalized individuals which includes gloves, gowns, eyewear, and
regardless of their masks
diagnosis or possible
c. safe injection practices
infection status.
d. safe handling of potentially contaminated
equipment or surfaces in the client
environment
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e. respiratory hygiene/cough etiquette
Infection Prevention and Control
▸ Transmission-based precautions are used in
addition to standard precautions for clients with
known or suspected infections that are spread in
one of three ways: by airborne or droplet
transmission, or by contact.

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Infection Prevention and Control
▸ Transmission-based precautions
1. Airborne precautions: transmitted by airborne droplet nuclei
smaller than 5 microns.
a. Place client in an airborne infection isolation room (AIIR).
b. If a private room is not available, place client with another
client who is infected with the same microorganism.
c. Wear an N95 respirator mask 56
Infection Prevention and Control
▸ Transmission-based precautions
1. Airborne precautions: transmitted by airborne droplet nuclei
smaller than 5 microns.
d. Susceptible people should not enter the room of a client who
has rubeola (measles) or varicella (chickenpox).
e. Limit movement of client outside the room to essential
purposes. Place a surgical mask on the client during
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Infection Prevention and Control
▸ Transmission-based precautions
2. Droplet precautions: transmitted by particle droplets larger than 5 microns
a. Place client in private room.
b. If a private room is not available, place client with another client who is
infected with the same microorganism.
c. Wear a mask if working within 1 m (3 ft) of the client.
d. Limit movement of client outside the room to essential purposes. Place a
surgical mask on the client while outside the room.

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Infection Prevention and Control
▸ Transmission-based precautions
3. Contact precautions: easily transmitted by direct client contact or by contact
with items in the client’s environment.
a. Place client in private room.
b. If a private room is not available, place client with another client who is
infected with the same microorganism.

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Infection Prevention and Control
▸ Transmission-based precautions; Contact precautions
c. Wear gloves as described in standard precautions
d. Wear a when entering a room if there is a possibility of contact with
infected surfaces or items, or if the client is incontinent, or has diarrhea, a
colostomy, or wound drainage not contained by a dressing.
e. Limit movement of client outside the room.
f. Dedicate the use of noncritical client care equipment to a single client or to
clients with the same infecting microorganisms.
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NURSING MANAGEMENT: Implementing
a. Break the chain of infections
b. Preventing Nosocomial Infections
-use of medical and surgical asepsis
c. Hand Hygiene (discussed on RLE)
d. Disinfecting and Sterilizing
e. Infection Prevention and Control
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NURSING MANAGEMENT: Implementing
f. Isolation Practices
g. Sterile Technique
h. Infection Prevention for Health Care Workers

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NURSING MANAGEMENT: Implementing
f. Isolation Practices
1. Personal Protective Equipment
clean or sterile gloves, gowns, masks, and protective eyewear
2. Disposal of Soiled Equipment and Supplies
Bagging, Linens, Laboratory Specimens, Dishes, Blood Pressure
Equipment, Thermometers, Disposable Needles, Syringes, and
Sharps 63
NURSING MANAGEMENT: Implementing
f. Isolation Practices
3. Transporting Clients with Infections
4. Psychosocial Needs of Isolation Clients

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NURSING MANAGEMENT: Implementing
f. Isolation Practices
g. Sterile Technique: free of all microorganism
Read Table 31-7: Principles and Practices of Surgical
Asepsis (page 627)

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NURSING MANAGEMENT: Implementing
f. Isolation Practices
g. Sterile Technique
h. Infection Prevention for Health Care Workers

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NURSING MANAGEMENT: Implementing
h. Infection Prevention for Health Care Workers
Occupational exposure: defined as skin, eye, mucous
membrane, or parenteral contact with blood or other
potentially infectious materials that may result from the
performance of an employee’s duties.
-Use PPE
- vaccinations
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NURSING MANAGEMENT:
9. Evaluating
Using data collected during care—vital signs, lung
sounds, skin status, characteristics of urine or
other drainage, laboratory blood values, and so
on—the nurse judges whether client outcomes
have been achieved.

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Test Your Knowledge
Which is the most effective nursing action for preventing
and controlling the spread of infection?
1. Thorough hand hygiene
2. Wearing gloves and masks when providing direct client
care
3. Implementing appropriate isolation precautions
4. Administering broad-spectrum prophylactic antibiotics
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Wrap-up
1. Concepts
2. Types Of Microorganisms That Cause Infections
3. Types of Infections
4. Chain of Infections
5. Nursing Management

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Reference
▸ Kozier & Erb’s (2018). Fundamentals of
Nursing, tenth edition. Pearson.