INFECTION AND

INFECTION CONTROL
MEDICAL ASEPSIS

• Includes all practices intended to confine a specific microorganism to a specific area

• Limits the number, growth, and transmission of microorganisms
• Objects referred to as clean or dirty (soiled, contaminated)
SURGICAL ASEPSIS

• Sterile technique
• Practices that keep an area or object free of all microorganisms
• Practices that destroy all microorganisms and spores
• Used for all procedures involving sterile areas of the body
PRINCIPLES OF ASEPTIC TECHNIQUE

• Only sterile items are used within sterile field.

• Sterile objects become unsterile when touched by unsterile objects.
• Sterile items that are out of vision or below the waist level of the nurse are considered unsterile.
• Sterile objects can become unsterile by prolong exposure to airborne microorganisms.
• Fluids flow in the direction of gravity.
• Moisture that passes through a sterile object draws microorganism from unsterile surfaces above or below to
the surface by capillary reaction.
• The edges of a sterile field are considered unsterile.
• The skin cannot be sterilized and is unsterile.
• Conscientiousness, alertness and honesty are essential qualities in maintaining surgical asepsis
INFECTION
• Signs of Localized Infection
• Localized swelling
• Localized redness
• Pain or tenderness with palpation or movement
• Palpable heat in the infected area
• Loss of function of the body part affected, depending on the site and extent of involvement
• Signs of Systemic Infection
• 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
FACTORS INFLUENCING MICROORGANISM’S
CAPABILITY TO PRODUCE INFECTION

• Number of microorganisms present

• Virulence and potency of the microorganisms (pathogenicity)
• Ability to enter the body
• Susceptibility of the host
• Ability to live in the host’s body
ANATOMIC AND PHYSIOLOGIC BARRIERS DEFEND
AGAINST INFECTION
• Intact skin and mucous membranes
• Moist mucous membranes and cilia of the nasal passages
• Alveolar macrophages
• Tears
• High acidity of the stomach
• Resident flora of the large intestine
• Peristalsis
• Low pH of the vagina
• Urine flow through the urethra
INTERVENTIONS TO REDUCE RISK FOR INFECTION

• Proper hand hygiene techniques

• Environmental controls
• Sterile technique when warranted
• Identification and management of clients at risk
CHAIN OF INFECTION
• The chain of infection refers to those elements that must be present to cause an infection from a microorganism
• Basic to the principle of infection is to interrupt this chain so that an infection from a microorganism does not occur in client
• Infectious agent; microorganisms capable of causing infections are referred to as an infectious agent or pathogen
• Modes of transmission: the microorganism must have a means of transmission to get from one location to another, called
direct and indirect
• Susceptible host describes a host (human or animal) not possessing enough resistance against a particular pathogen to
prevent disease or infection from occurring when exposed to the pathogen; in humans this may occur if the person’s
resistance is low because of poor nutrition, lack of exercise of a coexisting illness that weakens the host.
• Portal of entry: the means of a pathogen entering a host: the means of entry can be the same as one that is the portal of exit
(gastrointestinal, respiratory, genitourinary tract).
• Reservoir: the environment in which the microorganism lives to ensure survival; it can be a person, animal, arthropod, plant,
oil or a combination of these things; reservoirs that support organism that are pathogenic to humans are inanimate objects
food and water, and other humans.
• Portal of exit: the means in which the pathogen escapes from the reservoir and can cause disease; there is usually a
common escape route for each type of microorganism; on humans, common escape routes are the gastrointestinal,
respiratory and the genitourinary tract.
HEALTH CARE ASSOCIATED INFECTION

• Two categories of infectious diseases:

1. Hospital acquired infection (HAI)
2. Community acquired infection
PATHOGENS MOST OFTEN INVOLVE IN HAI

• Staphylococcus aureus
• E.coli
• Pseudomonas aerugenosa
• Klebsiella Pneumoniae
• Mycobacterium tuberculosis
• Staphylococcus epidermidis
MODE OF TRANSMISSION INVOLVED IN HAI

• Contact transmission
a. Direct contact – person to person
b. Indirect contact – intermediate object to person
• Droplet transmission – from respiratory tract of infectious individuals to susceptible mucosal surfaces of
recipient
• Airborne transmission – dissemination of either airborne droplet nuclei or small particles containing
pathogens.
MOST COMMON TYPE OF HAI

• UTI
• Surgical sites of infections
• Lower respiratory tract infection
• Blood stream infection
• Gastrointestinal infection

• Who are most likely to develop HAI?

MAJOR FACTORS CONTRIBUTING TO HAI

• Drug resistant bacteria

• Failure of health care personnel to follow infection control
• Increased in number of immune compromised patients

WHAT CAN BE DONE TO REDUCE THE

NUMBER OF HAI?
WHAT CAN BE DONE TO REDUCE THE NUMBER OF
HAI?

• Primary way: strict compliance to infection control guidelines

Hand washing – single most important measure to reduce risk of transmitting pathogens.

Assignment: 5 moments of hand washing

INFECTION CONTROL

• Medical asepsis
• Surgical asepsis
• Use of PPE
Standard Precaution
• Combined features of universal precaution and transmission based precaution:
• Applied to all patients and health care personnel regardless of suspected or confirmed presence of an
infectious agent.
 STANDARD PRECAUTION
- ASSUME THAT EVERY PERSON IS POTENTIALLY INFECTED WITH AN ORGANISM THAT COULD BE
TRANSMITTED IN THE HEALTH CARE SETTING

• Hand hygiene
• Use of personal protective equipment ( gloves, gowns, mouth, nose, eye
protection )
• Respiratory hygiene/ cough etiquette
• Patient-care equipment and instruments
• Care of the environment
• Textiles and laundry
TRANSMISSION BASED PRECAUTION

1. Contact precaution
- Wear gloves
- Hand hygiene
- Gowns
- Patient transport
- Patient care equipment
DROPLET PRACAUTION

• Use for particles larger than 5 mu(micrometer)

• Transmission occurs when droplets containing microbes are propelled a
short distance through the air and become deposited on another person’s
conjunctiva, nasal mucosa or mouth.

Droplet precaution:
1. PPE – MASK
2. Hand hygiene
3. Patient placement – private room; 3 feet away from other patients
4. Patient transport – limit transport- who will wear a mask?
AIRBORNE PRECAUTION
• Involves airborne droplet nuclie or dust containing pathogen
• less than 5 um in size; suspended in the air
• Use airborne precaution as recommended for patients known or
suspected to have agents person to person by the airborne route ( TB,
Measles, chickenpox, herpes)

• Airborne precaution:
• Patient placement – airborne infection isolation room ( AIIR)
• Wear mask outside the isolation room
• patient transport
• Hand hygiene
• PPE
• Wear n95 mask when entering the isolation room ( nurses, visitors)
 AIRBORNE INFECTION ISOLATION ROOM ( AIIR)
• Single patient room equipped with special air handling and ventilation system
• Negative pressure room
• When the door is opened and air that is evacuated from such rooms passes through high efficiency
particulate air (HEPA) filters to remove pathogens.
•
PROTECTIVE ENVIRONMENT
• Rooms that are positive pressure, and vented air that enter these rooms passes through HEPA filters

Handling Food and Eating Utensils

Handling fomites
- Fomites – any non-living or inanimate objects other than food that may harbour microbes.
- Example: gowns, beddings, eating utensils, stethoscope
Medical Waste Disposal