PROMOTING

ASEPSIS AND
PREVENTING
INFECTION
NCM 1237: NURSING MANUAL OF CLINICAL PROCEDURES

PROMOTING ASEPSIS AND PREVENTING INFECTION

Guidelines
A. Standard Precautions
B. Transmission-based Precautions
 Airborne
 Droplet
 Contact
C. Principles of Infection Control
D. Basic Guidelines to Maintain Surgical Asepsis
E. The Chain of Infection

A. STANDARD PRECAUTIONS

Standard Precautions are a set of precautions that the Centers for Disease Control and Prevention
(CDC) has called for in order to minimize the risk in acquiring an infection from a patient or spread
infection among patients.

Standard precautions are formerly known as the Universal Precautions. As these Universal precautions
are specific to prevent transmission of blood borne pathogens, the Standard Precautions basically
expands upon Universal Precautions by covering more body fluids and sites, as follows:

✓ Blood Secretions
✓ Non-intact skin
✓ Body Fluids Excretions (except sweat)
✓ Mucous membranes

(CDC, 2007)

Standard precautions are meant to reduce the risk of transmission of bloodborne and other pathogens
from both recognized and unrecognized sources. They are the basic level of infection control
precautions which are to be used, as a minimum, in the care of all patients.

KEY CONCEPT:
➢ To assume that all body fluids and substances are potentially infectious

Components of Standard Precaution

1. Hand Hygiene

Key Elements:

➢ Hand washing (40–60 sec): wet hands and apply soap; rub all surfaces; rinse hands and
dry thoroughly with a single use towel; use towel to turn off faucet.
➢ Hand rubbing (20–30 sec): apply enough antiseptic/disinfectant product to cover all
areas of the hands; rub hands until dry.

Indications:
▪ Before and after any direct patient contact and between patients, whether or not gloves
are worn.
▪ Immediately after gloves are removed.
▪ Before handling an invasive device.
▪ After touching blood, body fluids, secretions, excretions, non-intact skin, and
contaminated items, even if gloves are worn.
▪ During patient care, when moving from a contaminated to a clean body site of the
patient.
▪ After contact with inanimate objects in the immediate vicinity of the patient.

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2. Use of Personal Protective Equipment (PPE)

Key Elements:
➢ Gloves
▪ Wear when touching blood, body fluids, secretions, excretions, mucous
membranes, non-intact skin.
▪ Change between tasks and procedures on the same patient after contact with
potentially infectious material.
▪ Remove after use, before touching non-contaminated items and surfaces, and
before going to another patient. Perform hand hygiene immediately after
removal.
➢ Facial protection (eyes, nose, and mouth)
▪ Wear (1) a surgical or procedure mask and eye protection (eye visor, goggles) or
(2) a face shield to protect mucous membranes of the eyes, nose, and mouth
during activities that are likely to generate splashes or sprays of blood, body
fluids, secretions, and excretions.
➢ Gown
▪ Wear to protect skin and prevent soiling of clothing during activities that are
likely to generate splashes or sprays of blood, body fluids, secretions, or
excretions.
▪ Remove soiled gown as soon as possible, and perform hand hygiene.
➢ Prevention of needle stick and injuries from other sharp instruments
Use care when:
▪ Handling needles, scalpels, and other sharp instruments or devices.
▪ Cleaning used instruments.
▪ Disposing of used needles and other sharp instruments.

3. Respiratory Hygiene and Cough Etiquette

➢ Persons with respiratory symptoms should apply source control measures:

▪ Cover their nose and mouth when coughing/sneezing with tissue or mask,
dispose of used tissues and masks, and perform hand hygiene after contact with
respiratory secretions.

➢ Health-care facilities should:

▪ Place acute febrile respiratory symptomatic patients at least 1 meter (3 feet)
away from others in common waiting areas, if possible.
▪ Post visual alerts at the entrance to health-care facilities instructing persons with
respiratory symptoms to practice respiratory hygiene/cough etiquette.
▪ Consider making hand hygiene resources, tissues and masks available in
common areas and areas used for the evaluation of patients with respiratory
illnesses.

B. TRANSMISSION-BASED PRECAUTIONS

Airborne Precautions
Use standard precautions as well as the following:
1. Place client in a private room that has negative air pressure, 6-12 air changes per hour, and
either discharge of air to the outside or a filtration system for the room air.
2. If a private room is not available, place client with another client who is infected with the
same microorganism.
3. Wear a respiratory device (N95 respirator) when entering the room of a client who is known
or suspected of having primary tuberculosis.
4. Susceptible people should not enter the room of a client who has rubeola (measles) or
varicella (chickenpox). If they must enter, they should wear a respirator.
5. Limit movement of client outside the room to essential purposes. Place a surgical mask on
the client during transport.

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Droplet Precautions
Use standard precautions as well as the following:
1. Place client in a private room.
2. If a private room is not available, place client with another client who is infected with the
same microorganism.
3. Wear a mask if working within 3 feet of the client.
4. Limit movement of client outside the room to essential purposes. Place a surgical mask on
the client during transport.

Contact Precautions
Use standard precautions as well as the following:
1. Place client in private room.
2. If a private room is not available, place client with another client who is infected with the
same microorganism.
3. Wear gloves as described in standard precautions.
a. Change gloves after contact with infectious material.
b. Remove gloves before leaving clients room.
c. Cleanse hand immediately after removing gloves. Use an antimicrobial agent. Note:
If the client is infected with C. difficile, do not use an alcohol-based hand rub as it
may not be effective on these spores. Use soap and water.
d. After hand cleansing, do not touch possibly contaminated surfaces or items in the
room.
4. Wear a gown when entering a room if there is a possibly of contact with infected surfaces or
items, or if the client is incontinent, or has a diarrhea, a colostomy, or wound drainage not
contained by a dressing.
a. Remove gown in the client’s room.
b. Make sure uniform does not contact possible contaminated surfaces.
5. Limit movement of client outside the room.
6. Dedicate the use of noncritical client care equipment to a single client or to clients with same
infecting microorganisms.

C. PRINCIPLES OF BASIC INFECTION CONTROL

1. Microorganisms move on air currents.
2. Microorganisms are transferred from one when one surface to another whenever objects
touch.
3. Microorganisms are transferred by gravity when one item is held above another.
4. Microorganisms are released into the air on droplet nuclei whenever a person breathes or
speaks.
5. Microorganisms move slowly on dry surfaces but quickly through moisture.
6. Proper handwashing removes many of the microorganisms that can be transferred by the
hands from one item to another.
7. Blood-borne infections may be spread to another person through contact between blood
and body substances contain blood-borne organism and open wounds, sores or mucous
membranes and through penetrating injuries with contaminated items.
8. Some body substances, such as feces, urine, nasal secretions, vomitus, and sputum, do not
contain blood-borne organisms, but they may contain such large quantities of bacteria
that their removal through handwashing alone is difficult.

D. PRINCIPLES OF ASEPTIC TECHNIQUE

1. The patient is the center of the sterile field.

2. Only sterile items are used within the sterile field.

a. Examples of items used.
b. How do we know they are sterile? (Wrapping, label, storage)

3. Sterile persons are gowned and gloved.

a. Keep hands at waist level and in sight at all times.
b. Keep hands away from the face.
c. Never fold hands under arms.

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d. Gowns are considered sterile in front from chest to level of sterile field, and the sleeves from
above the elbow to cuffs. Gloves are sterile.
e. Sit only if sitting for entire procedure.

4. Tables are sterile only at table level.

a. Anything over the edge is considered unsterile, such as a suture or the table drape.
b. Use non-perforating device to secure tubing and cords to prevent them from sliding to the
floor.
5. Sterile persons touch only sterile items or areas; unsterile persons touch only unsterile
items or areas.
a. Sterile team members maintain contact with sterile field by wearing gloves and gowns.
b. Supplies are brought to sterile team members by the circulator, who opens wrappers on sterile
packages. The circulator ensures a sterile transfer to the sterile field. Only sterile items touch
sterile surfaces.

6. Unsterile persons avoid reaching over sterile field; sterile persons avoid leaning over
unsterile area.
a. Scrub person sets basins to be filled at edge of table to fill them.
b. Circulator pours with lip only over basin edge.
c. Scrub person drapes an unsterile table toward self first to avoid leaning over an unsterile
area. Cuff drapes over gloved hands.
d. Scrub person stands back from the unsterile table when draping it to avoid leaning over an
unsterile area.
7. Edges of anything that encloses
sterile contents are considered
unsterile.
a. When

opening sterile packages, open away from you first. Secure

flaps so they do not dangle.
b. The wrapper is considered sterile to within one inch of the
wrapper.
c. In peel-open packages, the edges where glued, are not
considered sterile.

8. Sterile field is created as close as possible to time of use.

a. Covering sterile tables is not recommended.

9. Sterile areas are continuously kept in view.

a. Sterility cannot be ensured without direct observation. An unguarded sterile field should be
considered contaminated.

10. Sterile persons keep well within sterile area.

a. Sterile persons pass each other back to back or front to front.
b. Sterile person faces a sterile area to pass it.
c. Sterile persons stay within the sterile field. They do not walk around or go outside the room.
d. Movement is kept to a minimum to avoid contamination of sterile items or persons.

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11. Unsterile persons avoid sterile areas.

a. Unsterile persons maintain a distance
of at least 1 foot from the sterile field.
b. Unsterile persons face and observe a
sterile area when passing it to be sure
they do not touch it.
c. Unsterile persons never walk between
two sterile fields.
d. Circulator restricts to a minimum all
activity near the sterile field.

12. Destruction of integrity of microbial

barriers results in contamination.
a. Strike through is the soaking through
of barrier from sterile to non-sterile or
vice versa.
b. Sterility is event related.

13. Microorganisms must be kept to irreducible minimum.

a. Perfect asepsis is an idea. All microorganisms cannot be eliminated. Skin cannot be sterilized.
Air is contaminated by droplets.

E. BASIC GUIDELINES TO MAINTAIN SURGICAL ASEPSIS

Only a sterile object can touch another sterile object. Unsterile touching sterile is contamination.
1. Open sterile packages so that the first edge of the wrapper is directed away from the worker
to avoid the possibility of a sterile surface touching unsterile clothing. The outside of the
sterile package is considered contaminated.
2. Avoid spilling any solution on a cloth or paper used as a field for a sterile set up. The
moisture penetrates through the sterile cloth or paper and carries organisms by capillary
action to contaminate the field. A wet field is contaminated if the surface immediately below
it is not sterile.
3. Hold sterile objects above the level of the waist. This will help ensure keeping the object
within sight and prevent accidental contamination.
4. Avoid talking, coughing, sneezing or reaching over a sterile field or object. This will help to
prevent contamination by droplets from the nose and the mouth or by particles dropping
from the worker’s arm.
5. Never walk away from or turn your back on a sterile field. This will prevent possible
contamination while the field is out of the worker’s view.
6. All items brought into contact with broken skin, or used to penetrate the skin or in order to
inject substances into the body, or to enter normally sterile body cavities, should be sterile.
These items include dressings used to cover wounds and incisions, needles for injection, and
tubes used to drain urine from the bladder.
7. Use dry, sterile forceps when necessary. Forceps soaked in disinfectant are not considered
sterile.
8. Consider the outer 1 inch of a sterile field to be contaminated.
9. Consider an object contaminated if you have any doubt as to its sterility.

F. THE CHAIN OF INFECTION

Chain of Infection – describes the development of an infectious process. An interactive process

involving an agent, host and environment is required.

SIX ESSENTIAL LINKS (elements) IN THE CHAIN OF INFECTION

I. AGENT – entity that is capable of causing disease. Agents that causes diseases are as follows.
▪ Humans Biologic agents: living organisms that invade the host, causing
disease, such as bacteria, virus, fungi, protozoa and rickettsia.
▪ Chemical agents: substances that can interact with the body, causing disease,
such as food additives, medications , pesticides and industrial chemicals

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▪ Physical agents: factors in the environment that are capable of causing

disease, such as heat, light ,noise and radiation

II. RESERVOIR – is a place where the agent can survive. The most common reservoir are
▪ Humans
▪ Animals
▪ Environment
▪ Fomites

Carriers – have the infectious disease but are symptom free

III. PORTAL OF EXIT – is the route by which an infectious agent leaves the reservoir to be
transferred to a susceptible host. The agent leaves the reservoir through body secretions
including
▪ Sputum, from the respiratory tract
▪ Semen, vaginal secretions, or urine, from the genitourinary tract
▪ Saliva and feces, from gastrointestinal tract
▪ Blood
▪ Draining wounds
▪ Tears

IV. MODES OF TRANSMISSION – is the process of the infectious agent moving from the
reservoir or source through the portal of exit to the portal of entry of the susceptible new host
▪ Contact transmission – involves the transfer of an agent from an infected,
indirect contact with the infected person through fomite, or close contact with
contaminated secretions.
▪ Airborne transmission – occurs when a susceptible host contacts droplet
nuclei or dust particles that are suspended in the air.
▪ Vehicle transmission – occurs when an agent is transferred to a susceptible
host by contaminated inanimate objects such as water, food , milk ,drugs, and
blood.
▪ Vector-borne transmission – occurs when the agent is transferred to a
susceptible host by animate means such as mosquito, fleas, ticks, lice and other
animals.

V. PORTAL OF ENTRY – is the route by which an infectious agent enters the host. Portals of
entry include the following
▪ Integumentary system – through break in the integrity of the skin or mucus
membranes (surgical wounds)
▪ Respiratory tract – by inhaling contaminated droplets ( such as colds,
influenza, measles
▪ Genitourinary tract – through the contact with infected vaginal secretions or
semen (as in STI)
▪ Gastrointestinal tract – by ingesting contaminated food or water (typhoid
hepatitis A)
▪ Circulatory system – through the bite of insects (such as mosquito bite
resulting in malaria)
▪ Transplacental – through transfer of microorganisms from mother to fetus via
the placenta and umbilical cord (including HIV, hepatitis B.

VI. HOST – is an organism that can be affected by an agent. A human being is usually
considered a host.
▪ Susceptible host – person who has no resistance to an agent and thus is
vulnerable to disease (ex. No vaccine)
▪ Compromised host – person whose normal body defense are impaired and is
therefore susceptible to infection (ex. Cold, or superficial burns)

Breaking the Chain of Infection

 Hand hygiene is the first line of defense against infection and is the single most
important practice in preventing the spread of infection

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TERMS
a. Disinfection – is the elimination of pathogens, excepts spores , from inanimate objects
b. Concurrent – after the discharge of infectious material from the body of an infected person or
after soiling the articles
c. Terminal – at the time the person is no longer source of infection
d. Disinfectants are chemical solutions used to clean inanimate objects
e. Germicide is a chemical that can be applied to both animate (living ) or inanimate objects to
eliminate pathogen
f. Sterilization is destroying all microorganisms including spores (autoclaving) but not boiling
water (clean)
g. Isolation is the separation of infected person from other persons during period of
communicability
h. Quarantine is the limitation of freedom of movement of persons or animals equal to the longest
usual incubation period of the disease
i. Fumigation is any process which the killing of animal forms in accomplished with the use of
gaseous agents

Types of infection

1. Localized infections – are limited to a defined area or single organ with symptoms that
resemble inflammation (redness , tenderness, and swelling,)
2. Systemic infections – affect the entire body and involve multiple organs, such as AIDS

CHAIN OF INFECTION

(image source: http://www.iahcsmm.org/Recertification/LessonPlans/images/Lesson_403_figure_1.gif

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HOSPITAL HOUSEKEEPING

A. BASIC CLEANSING OPERATION

1. Sweeping
2. Dusting
3. Washing
4. Mopping
5. Scrubbing
6. Waxing

SWEEPING

Definition: Sweeping is basic cleansing operation which removes dirt from the floor area.

Equipment:
 Floor brush or broom
 Sweep
 Dust pan
 Dust box

PROCEDURE RATIONALE
1. Gather all equipment to the area to be
To save time and energy.
swept.
2. Place the dustpan and dust box where the
To keep dust box out of traffic.
swept articles or dirt will be accumulated.
3. Start sweeping using lone strokes from the Dirt is accumulated and collected at the center of
corners to the center of the room. the room where the dustpan and box awaits.
4. Tap broom or brush on the floor at the end
To free the brush or broom from dirt.
of every stroke.
5. Inspect area swept for any signs of
unremoved dirt.

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6. Proceed to other cleaning operation. If no

other cleaning operation is done, return
equipment to proper places.

DUSTING

Definition: Dusting is a basic cleaning operation used in removing dirt from furniture.

Types of Dusting:
1. Low Dusting: Done daily to remove dirt form places easily reached while standing on the
floor.
2. High Dusting: done periodically to remove dirt from high areas like ceilings, windows, etc.

Equipment:
 Basin or Pail with water
 Laundry Soap
 Newspaper
 Dusting Clothes
 Brush or duster or Chicken Feathers.

PROCEDURE RATIONALE
1. Gather all equipment to the area to be
To save time and energy.
dusted.
2. Bring the dusting tray to the room and place Newspaper prevents the furniture from getting
it on the table over a newspaper lining. wet.
3. Start dusting from the entrance and around Long straight strokes prevents skipping of corners
the room using long straight strokes. and edges.
4. Dusting should be done in sequence from
highest to lowest area to the floor.
5. Choose furniture that are not injured by This would avoid flicking dust over other
moisture and wipe this furniture with damped furniture.
cloth.
6. Dust in the small crevices of the furniture
should be removed by dusters with a stick
end wrapped in cloth.
7. Inspect area swept for any signs of It should appear bright and free from streaks.
unremoved dirt.
8. Proceed to other cleaning operation. If no
other cleaning operation is done, return
equipment to proper places.

WASHING

Definition: It is a basic cleaning operation to remove dirt using water and soap. It includes removing
loose dirt, washing, rinsing and drying.

Equipment:
 Basin or Pail
 Cleaning solution
 Paper lining
 Dust clothes

PROCEDURE RATIONALE

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1. Gather all equipment to the washing area. To save time and energy.
2. Line floor with newspaper. To protect floor from dripping.
3. Dust or wipe any loose dirt on the furniture.
4. Dip cloth in the cleansing solution and
To prevent dripping on the floor.
squeeze out.
5. Wash area in small circular motion. Rinse the
furniture using another cloth.
6. Dry the area washed.
7. Continue washing, rinsing, and drying over Overlapping strokes would prevent streaks over
entire area overlapping strokes. furniture.
8. Change water as often as possible. Dirty water causes over area washed.
9. Inspect area swept for any signs of
Dirty water causes streaks over area washed.
unremoved dirt.
10. Proceed to other cleaning operation. If no
other cleaning operation is done, return
equipment to proper places.

Other Basic Cleansing Operations:

 MOPPING – Mopping is a basic cleansing operation o rub or wipe the floor.
 SCRUBBING – Scrubbing is the removal of dirt through application of friction.
 WAXING – Waxing is the application of protective coating over surfaces usually floor which is
usually polished by scrubbing.
CARE OF HOSPITAL EQUIPMENT

CARE OF BEDPANS AND URINALS

Equipment
 Disinfectant Solution
 Dutch Cleanser of Detergent
 Bedpan Brush

PROCEDURE RATIONALE
1. Gather all equipment to the washing area. To save time and energy.
2. Empty the contents into the toilet bowl and
rinse with water.
3. Soak bedpan in disinfectant solution for two
Soaking is one way of killing microorganisms.
hours
4. Brush the insides of the bedpan. To remove the dirt and odor which had adhered
in the bedpan & urinals.
5. Wash the outside of the bedpan using
To remove stains.
washcloth and cleanser.
6. Rinse, wipe and dry in the rack.

7. Inspect for any signs of unremoved dirt.

CARE OF THE RUBBER GOODS

CATHETER & TUBES

PROCEDURE RATIONALE
1. Place under the faucet and let cold water run
through it.
2. Use syringe bulb to flush the lumen. Syringe bulb is used to flush small lumen.

3. Rinse using warm water.

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4. Wipe with cloth by pressing between thumbs

and fingers.
5. Allow to boil for at least 5 minutes. Boiling is a method of killing microorganisms.

6. Apply powder, coil and wrap using a gauze

RUBBER RINGS & KELLY PADS

PROCEDURE
1. Clean with soap, rinse and dry.

2. Disinfectant is used if the Kelly pad had been used in infectious cases.

3. Hand to dry.

RUBBER GLOVES
PROCEDURE
1. Wash with soap inside out.
2. Rinse with water.
3. Hang inverted for at least one hour.
4. Apply powder
5. Pack for sterilization.

RUBBER SHEET
PROCEDURE
1. Wash with soap

2. Rinse with clean water

3. Dry the rubber sheet

4. Roll and store in the proper place.

5. If used in infectious cases, apply disinfectant.

ICE CAPS
PROCEDURE RATIONALE
1. Empty the contents
Moisture is a favorable medium for growth of
2. Wipe outside to dry
microorganism
To prevent the two surfaces from coming in
3. Inflate before closing
contact with each other

HOT WATER BAG

PROCEDURE RATIONALE
1. Empty the content after use

2. Wipe outside to dry. Moisture is a favorable growth for microorganism

3. Hang with opening downward. To drain all water content.

4. If used in infectious cases, soaked in
To kill microorganisms
formalin solution for an hour then rinse.

CARE OF THE UNIT/ROOM UPON DISCHARGE OF THE PATIENT

Purposes:

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1. To free the room from microorganisms.

2. To prevent cross infections.
3. To maintain order in the ward.
4. To prepare the room for the new patient.

STRIPPING AND AIRING THE BED

PROCEDURE RATIONALE
1. Open the window of the room to allow entry Proper ventilation prevents growth of
of air into the unit. microorganisms
2. Place a chair with the back at the foot of the
Allows room for the nurse to work.
bed.
3. Strip the pillow case from the pillow and use
this pillow case as a laundry bag.
4. Loosen the beddings all starting at the
center of the part raising the mattress with
Dust carries microorganisms.
one hand and drawing out the linen with the
other hand without raising the dusts.
Microorganisms can be transmitted by air currents
5. Roll the linen away from the uniform.
or by direct contact.
6. Place soiled linen into the laundry bag
7. Turn mattress from top to bottom and arch
its upper and lower side for 30 minutes

CARE OF THE BED

Equipment:
 Basin with water
 Dust cloth
 Soap or any detergent
 Paper lining / old newspaper
 Mattress brush

PROCEDURE RATIONALE
1. Place cleansing equipment on bedside table
To prevent from wetting the floor
with paper lining.
2. Spread paper lining under the bed.
3. Move mattress crosswise and towards the
Allows for cleaning half of the bed.
lower half of the bed.
4. Clean upper side of mattress with
dampened brush
5. Use long strokes away from you.
6. Raise headset. With long rinsed in soapy
solution. Wash springs and bed frame.
7. Rinse and dry thoroughly.

8. Lower headrest.
9. Turn mattress with clean side down to the
upper part of the bed.
10. Clean the other side of the mattress.

11. Place rubber sheet on springs

12. Dry well.

13. Turn the mattress and wash the other side.

14. Hang mattress over the head of the bed. Allow space to clean pillows & rubber sheet

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15. Place pillows on the spring and clean with

damp cloth.
16. Rinse knee rest of the bed. Wash the lower
half of the bed frame and springs.
17. Take cleaning equipment to utility room and
do after care.

MEDICAL HANDWASHING

Definition: Hand washing refers to washing hands with soap and water

Purpose:
➢ To reduce the number of microorganism on the hands.
➢ To reduce the risk of transmission of microorganism to clients.
➢ To reduce the risk of cross-contamination among clients
➢ To reduce the risk of transmission of infectious organisms to oneself.

Equipment:
 Soap
 Warm running water
 Disposable or sanitized towels

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PROCEDURE RATIONALE
Short, natural nails are less likely to harbor
1. Nails should be kept short microorganisms, scratch a client, or puncture
gloves.
Microorganisms can lodge in the settings of
2. Remove all jewelry jewelry under rings. Removal facilitates proper
cleaning of the hands and arms.

A nurse who has open sores may be at risk for

3. Check hands for breaks in the skin, such as
transmission of infectious organisms due to the
hangnails or cuts.
chance of acquiring or passing an infection.

4. If you are washing your hands where the

client can observe you, introduce yourself Keeping the patient informed alleviates anxiety.
and explain to the client what you are going
to do and why it is necessary.
5. Turn on the water and adjust the flow.

There are five common types of faucet

controls.
a. Hand-operated handles
b. Knee levers. Move these with the knee to
regulate flow and temperature.
c. Foot pedals. Press these with the foot to
regulate flow and temperature.
d. Elbow controls. Move these with the
elbow instead of hands.
e. Infrared control. Motion in front of the
sensor causes water to start and stop
flowing automatically.

6. Adjust the flow so that the water is warm Warm water with soap reduces surface tension
and this, aided by friction, loosens surface
microorganisms, which wash away in the lather.

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7. Wet the hands thoroughly by holding them

The water should flow from the least
under running water and apply soap to
contaminated to the contaminated area; the
hands. Hold the hands lower than the elbows
hands are generally considered more
so that the water flows from the arms to the
contaminated than the lower arms.
fingertips.
8. Thoroughly wash and rinse the hands. Use
firm, rubbing, and circular movements to
The circular action creates friction that helps
wash the palm, back, interdigital spaces,
remove microorganism mechanically. Interlacing
fingers, fingertips knuckles and wrist of each
the fingers and thumbs cleans interdigital spaces.
hand. Be sure to include the heel of the
hand. Continue this motion for at least 15
seconds. Rinse hands.
9. Thoroughly pat dry hands and arms. Dry
hands and arms thoroughly with a paper Moist skin chaps readily as does dry skin that is
towel without scrubbing. Discard paper towel rubbed vigorously; chapping produces lesions.
in the appropriate container.
10. Turn off water. Use new paper towel to This prevents the nurse from picking up
grasp a hand-operated control faucet. microorganism from the faucet handles.
.

MEDICAL HANDWASHING
(image source: http://www.icleangreen.ca/H1N1_flu.html)

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DONNING STERILE GLOVES (OPEN METHOD)

(image source: http://www.utmb.edu/surgery/clerks/ormanual.html)
DONNING AND REMOVING STERILE GLOVES (OPEN METHOD)
Purposes:
➢ To enable the nurse to handle or touch sterile objects freely without contaminating them.

➢ To prevent transmission of potentially infective organisms from the nurse's hands to clients at
high risk infection.

Equipment:
Packages of sterile gloves

PROCEDURE RATIONALE
1. Prior to performing the procedure, introduce Use non-latex gloves whenever possible.
self and verify the client's identity using
agency protocol. Explain to the client what
you are going to do and why it is necessary.
Check client record and ask about latex
allergies.
2. Observe appropriate infection control Refer to handwashing procedures
procedures.
3. Provide for client privacy.
4. Open the package of the sterile gloves.
a. Place the package of the gloves on a Any moisture on the surface could contaminate
clean, dry surface the gloves
b. Some gloves are packed in an inner as
well as an outer package. Open the outer
package without contaminating the gloves
or the inner package
c. Remove the inner package from the outer
package
5. Put the first glove on the dominant hand
a. If the gloves are packaged so that they lie The hands are not sterile. By touching only the
side by side, grasp the glove for the inside of the glove, the nurse avoids
dominant hand by its folded cuff edge (on contaminating the outside
the palmar side) with the thumb and first
finger of non-dominant hand. Touch only
the inside of the cuff.
b. Move one step back away from the table
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c. Insert the dominant hand into the glove If the thumb is kept against the palm, it is less
and pull the glove on. Keep the thumb of likely contaminates the outside of the glove
the inserted hand against the palm of the
hand during insertion
d. Leave the cuff in place once the unsterile Attempting to further unfold the cuff likely to
hand releases the glove contaminate the glove.
2. Put the second glove on the non-dominant
hand.
a. Pick up the other glove with sterile gloved This helps prevent accidental contamination of
hand, inserting the gloved fingers (thumb the glove by the bare hand
should be abducted) under the cuff and
holding the gloved thumb close to the
gloved palm
b. Pull on the second glove carefully. Hold In this position, the thumb is less likely to touch
the thumb of the gloved first hand the arm and become contaminated
as far as possible from the palm
c. Adjust each glove so that it fits smoothly,
and carefully pull the cuffs up by sliding
the fingers under the cuff

ENVIRONMENT AND PATIENT SAFETY

A. SAFE STAFF BEHAVIOR

1. Use Good Body Mechanics. As you carry out your duties, which require much standing and
walking, an erect posture in good body alignment protects you from stain. Stretching and
reaching, as well as carrying or moving heavy objects, can take their toll on poorly aligned
muscles.

2. Walk; Avoid Running. Running is risky and leads to falls. For safe movement, well-fitting shoe are
essential. Clogs and other ill-fitting shoes can prove hazardous, particularly if running becomes
necessary, because they may slip off and tip the wearer.

3. Keep to the Right in Hallways. It is easy to run into someone else whose attention diverted.
Therefore, as a general practice, always walk to the right. This provides for a smoother flow of
traffic.

4. Turn Corners Carefully. Most collisions take place when two people are rounding a corner. Always
keep to the right, slow your pace, and turn corners carefully. This is of particular importance
when you are pushing a stretcher or cart. I some hallways, mirrors are placed high on the
intersecting walls to allow you to see around the corner and avoid such collisions.

5. Open Doors Slowly. An opening door may easily strike someone on the other side. If it is opened
slowly, it is less likely to cause injury.

6. Use Stretchers Properly. When pushing on a stretcher, keep the patient’s head toward your body
and the feet in front. This is done so that the head, which highly vulnerable to impact injury, is
protected and the feet, which are less vulnerable, are outward.

7. Use Brakes on Beds, Wheelchairs and Stretchers. When beds, wheelchairs, and stretchers are
stationary, apply the brake or brakes. When a patient is being transferred to one of these pieces
of equipment or when it is standing still, the braking action prevents accidental movement that
may lead to injury.

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8. Place Elevators on “Hold” when Loading or Unloading. When you are pushing a patient in a
wheelchair or stretcher, place elevator operating buttons on “hold”. This will keep the doors open
until you and the patient are safely in or out of the elevator. Back into the elevator with an
occupied wheelchair so that if the door does not hold with the hold request button and suddenly
closes you, rather than the patient, will receive the impact.

B. SAFETY IN WORKING SPACES, HALLS AND CORRIDORS

1. Lighting. These spaces should always be lighted well enough to allow objects and people to be
seen clearly.

2. Floor Surfaces. Cracked tiles, raised linoleum, or torn carpeting can easily lead to falls. Highly
polished floors can also cause skidding, falls, and injury. Dropped materials such as tissues or
food substances should be retrieved immediately, because they also can cause a staff member, a
visitor, or a patient to skid. It is very important to wipe up spills of liquids immediately. Calling a
custodian or maintenance person could a delay long enough to expose someone to the danger of
a fall. If mopping is in progress, “Danger, Wet Floor” signs should always be posted.

3. Electrical Appliances. It is essential that all appliances being used be in good working order and
have a cord weight that is adequate for the appliance. A frayed or damaged cord or plug should
never be used because it may cause sparks or fire, injuring the operator or endangering the
surrounding area. All plugs should be of the three-pronged ground type so that the third prong
carries any unexpected, potentially dangerous bursts of electricity to the ground. When an
appliance, such as an electric floor polishing machine is being used in a hallway or work area, the
cord should not lie in such a way that people can trip over it. Cords that have to remain in place
should be taped to the floor away from the walking areas. Unused electrical outlets should have a
safety cover in place to protect children and others from electrical shocks.

4. Needles and Other Sharp Objects. Hospital personnel should not manually recap contaminated
needles. Thus is done to reduce the chance of needle sticks and the risk of exposure to diseases
transmitted by blood and body fluids. Carrying an uncapped needle down a hallway is a violation.
Razor blades, scalpels, and other small sharp instruments may also be placed in these receptacles.

5. Dangerous or Caustic Substances or Materials. All products, regardless of where they are used,
should be clearly labeled to warn of any risks or dangers. They should never be left within easy
reach of others in hallways or work spaces, including nurse's stations. They should be ingested by
children or by persons who are confused or incompetent. A liquid substance could be spilled,
causing burns or injury.

6. Uncluttered Hallways. In a fire or emergency, such equipment could block access of emergency
personnel and equipment and the evacuation of patients and staff.

C. SAFETY IN PATIENTS' ROOM

1. Lighting. Patient rooms need enough light to allow the patient who is ambulatory to easily see
objects that maybe in the way and to allow staff to work without difficulty. At night, most patients
who have slept in complete darkness at home are not disturbed by the use of the nightlight. This
light helps to orient both the bedridden patient and the patient who is able to get out of bed to
use the bathroom.

2. Floor surface. Again, floor surfaces should be smooth, whether they are of tile, linoleum or
carpeting. Liquids should be mopped or wiped up immediately and foreign items picked-up and
disposed of. The unsteady patient can slip even more easily than an abled-bodied visitor or staff
member. Provide non-slip mats for use on the floor of a shower or on the bottom of a bathtub to
prevent slipping. Hand rails and a call cord within reach can ensure the safety of the patient.

3. Oxygen. If oxygen is in use, special precautions have to be taken to ensure that sparks and flames
never occur in the vicinity. While oxygen, as a gas, does not itself explode, it supports very
combustion, and materials will burn at an explosive rate in its presence. A “No Smoking” sign is
posted on the door of the room to remind the patient and visitors o tot smoke. Electrical

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appliances, including electric razors, are mot to be used when oxygen therapy is being done for
the patient. These precautions are utmost importance for safety.

4. Electrical Appliances. All cords and plugs used on equipment in the patient’s room should be
examined. All should be grounded with a three-pronged plug. It is essential that all electrical
equipment be in proper working order, particularly when a patient is receiving oxygen. A spark in
this environment could cause a fire and endanger the patient.

5. Furniture. All furniture in the patient’s room should be arranged to allow easy access to the wash
basin, bathroom, closet area, and door. This protects both ambulatory patients and staff members
from bumps or falls.

6. Medication and Dangerous Substances. Medications and dangerous substances should be removed
from the patient’s bedside. If a liquid used in treatment, such as saline or hydrogen peroxide
solution, is to be kept at the bedside, the container to prevent a visitor or someone for whom they
were not intended from ingesting them.

7. Doors. Entrance doors and bathroom, closet, and cabinet doors should be either fully open or fully
closed at all times to eliminate the possibility of people running into them. If latches are not pair,
have them fixed or replaced.

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