Prepared by: Mr. Val L.

Ramilo RN
 MEDICAL ASEPSIS
Is the freedom from
disease-causing
microorganisms.
To decrease the possibility
of transferring
microorganisms from
one place to another,
asepsis is used.
 SURGICAL ASEPSIS OR STERILE
TECHNIQUE
Refers to those practices
that keep an area or
object free of all
microorganisms; it
includes practices that
destroy all
microorganisms and
spores.
TYPES OF MICROORGANISMS
CAUSING INFECTIONS
Bacteria – the most
common infection-
causing microorganisms.
Viruses – Consist
primarily of nucleic acid
and therefore must enter
living cells in order to
reproduce.
Fungi – Include yeasts
and molds
Parasites – Live on other
living organisms. They
include protozoa such as
the one that causes,
malaria, helminths
(worms), and
anthropods (mites, fleas,
ticks)
TYPES OF INFECTION
Colonization – Is the
process by which strains
of microorganisms
become resident flora. In
this state, the
microorganisms may
grow and multiply but
do not cause a disease.
1. Local Infection- Is
limted to specific part
of the body where the
microorganisms
remain.
2. Systemic Infection –
Microorganisms
spread and damage
different parts of the
body.
Bacteremia – When a
culture of the person’s
blood reveals a
microorganisms.
Septicemia – When
bacteremia results in
systemic infection.
Acute Infection –
Generally appear and
suddenly or last a short
time.
Chronic Infection- may
occur slowly, over a long
period, and may last
months or years.
NOSOCOMIAL INFECTION
Are classified as
infections that are
associated with the
delivery of health care
services in a health care
facility.
Endogenous source –
microorganism causing
disease originates from
the client
Exogenous source –
Coming from the
hospital environment or
hospital personnel.
 Iatrogenic Infections
Are the direct result of
diagnostic or therapeutic
prcoedures.
The hands of personnel are
a common vehicle for the
spread of microorganisms.
Insufficient hand washing
is thus an important factors
contributing to the spread
of nosocomial
microorganism.
 CHAIN OF INFECTION

INFECTIOUS AGENT
A microbial organism with the
ability to cause disease. The
greater the organism's
virulence (ability to grow and
multiply), invasiveness (ability
to enter tissue) and
pathogenicity (ability to cause
disease), the greater the
possibility that the organism
will cause an infection.
Infectious agents are bacteria,
virus, fungi, and parasites.
RESERVOIR
A place within which
microorganisms can
thrive and reproduce.
For example,
microorganisms thrive in
human beings, animals,
and inanimate objects
such as water, table tops,
and doorknobs.
PORTAL OF EXIT
A place of exit providing a
way for a microorganism
to leave the reservoir. For
example, the
microorganism may leave
the reservoir through the
nose or mouth when
someone sneezes or
coughs. Microorganisms,
carried away from the
body by feces, may also
leave the reservoir of an
infected bowel.
MODE OF
TRANSMISSION
Method of transfer by
which the organism
moves or is carried from
one place to another.
The hands of the health
care worker may carry
bacteria from one
person to another.
PORTAL OF ENTRY
An opening allowing the
microorganism to enter
the host. Portals include
body orifices, mucus
membranes, or breaks in
the skin. Portals also result
from tubes placed in body
cavities, such as urinary
catheters, or from
punctures produced by
invasive procedures such
as intravenous fluid
replacement.
SUSCEPTIBLE HOST
A person who cannot resist
a microorganism invading
the body, multiplying, and
resulting in infection. The
host is susceptible to the
disease, lacking immunity
or physical resistance to
overcome the invasion by
the pathogenic
microorganism.
 PREVENTION AND CONTROL OF INFECTION:
Breaking the Chain
Nurses maintain the immediate health  The practice of medical asepsis
care environment. Because they helps to contain infectious
provide care for a variety of organisms and to maintain an
patients, the risk of contamination environment free from
from pathogenic microorganisms contamination. The techniques
is increased. The practice of used to maintain medical asepsis
medical asepsis and standard include hand washing, gowning and
precautions provides the nurse with wearing facial masks when
techniques for destroying or appropriate, as well as separating
containing pathogens and for clean from contaminated or
preventing contamination to other potentially contaminated materials
people or to bedside materials and and providing information to
equipment. patients about basic hygienic
practices. Appropriate hand washing
by the nurse and the patient remains
the most important factor in
preventing the spread of
microorganisms.
 Standard precautions  Universal precautions help
combine the major features of control contamination from
universal precautions and bloodborne viruses such as
body substance isolation. human immunodeficiency virus
These standard precautions (HIV) and hepatitis viruses.
alert the health care worker to When in contact with a
patient situations that require patient's blood or any body
special barrier techniques. secretion that may be
These barrier techniques are contaminated with blood,
used when working with any protective measures such as
patient where potential or wearing gloves, gown, facial
actualized contact with blood or mask, and/or goggles must be
body fluid exists. followed.
 Body substance isolation  Strict adherence to basic
protects against bacterial techniques such as hand
organisms that may exist in washing, wearing barrier gloves
body substances. Body and protective isolation
substance isolation applies in provides the foundation for life
all patient encounters regardless saving measures. However, the
of the diagnosis. The application physical protection gained from
of gloves for contact with moist barrier isolation may have a
body surfaces and areas of negative psychological impact on
nonintact skin, gowns when in the patient.
contact with body secretions,
and facial mask when in danger
of contact with respiratory
droplet secretions, prevents the
contamination of both health
care worker and patient.
 An elderly patient, hospitalized with a gastrointestinal disorder, was on bed rest and required assistance for activities of daily living. The
patient had frequent uncontrolled diarrhea stools and the nurse provided excellent care to maintain cleanliness and comfort. Following
one episode of cleaning the patient and changing the bed linen, the nurse immediately went to a second patient to provide care. The
nurse's hands were not washed before assisting the second patient.

Let's examine the chain of infection as it applies to this situation.

Escherichia coli

Large intestine
E. coli, bacteria in the large intestine of humans forms the greater part of the normal intestinal flora.

E. coli exited the body in feces.

The nurse removed the contaminated linen from the bed. The E. coli organism contaminated the hands of the nurse who then provided
morning care to another patient.

The second patient receiving care had a Foley catheter. The nurse manipulated the tubing attached to the catheter. The E. coli organism
on the nurse's hands contaminated the catheter tubing and ascended to the patient's meatus and then into the urinary bladder.

The second patient with a Foley catheter. This patient was elderly and had a chronic illness necessitating complete bed rest. The Foley
 
catheter contaminated by the E. coli organism provided a direct route into the urinary bladder.
 NOSOCOMIAL INFECTIONS
Most Common Microorganisms Causes
Urinary Tract ( E. Coli, Enterococcus Improper catheterization technique
species Contamination of closed drainage
system
Inadequate handwashing
Surgical Sites ( Staphylococcus Aureus, Inadequate Handwashing
Psedomonas Aeruginosa) Improper dressing change technique
Bloodstream ( Staphylococcus aureus) Inadequate handwashing
Improper intravenous fluid, tubing,
and site care technique
Pneumonia (Staphylococcus aureus, Inadequate hand washing
Pseudomonas aeruginosa) Improper suctioning technique
 HUMAN BODY RESERVOIRS, COMMON
INFECTIOUS MICROORGANISM AND PORTALS OF
EXIT
BODY AREA COMMON PORTALS OF EXIT
INFECTIOUS
ORGANISMS
Respiratory Tract Parainfluenza virus Nose or mouth through
sneezing, coughing,
breathing or talking.
GIT Hepatitis A virus Mouth, saliva, vomitus,
Salmonella species anus, feces, ostomies
Eschirechia Coli
enterococci
Urinary Tract E. Coli enterococci Urethral meatus and
urinary diversion
Reproductive Tract Neisseria gonorrhea Vagina; vaginal discharge
Blood Hepatitis B virus Open wound, needle
puncture site
 BODY DEFENSE AGAINST INFECTION
Non-specific Defenses – Specific – (Immune)
protect the person defenses by contrast, are
against all directed against
microorganisms, identifiable bacteria,
regardless of prior viruses, fungi or other
exposure. infectious agents.
NON SPECIFIC DEFENSESES
Anatomic an physiologic Inflammatory response
barriers
1. Intact skin Inflammation- Is a local and
2. Nasal passages no specific defensive
3. Oral cavity response of the tissues to
4. Eye
an injurious or infection
agent.
5. Vagina An adaptive mechanism that
destroys or dilutes the
injurious agents, prevents
further spread of injury
and promotes and repair
of damaged tissue.
 FIVE SIGNS OF INFLAMMATION
1. Pain (Dolor) Commonly, words with
2. Swelling (tumor) the suffix –it is describe
an inflammatory
3. Redness (rubor)
process. For example,
4. Heat (calor or color) appendicitis means an
5. Impaired function of inflammation of the
the part appendix; gastritis
means inflammation of
the stomach.
 Vascular and Cellular Response
During inflammation

Constrict blood vessels

Dilation of blood vessels

(because of the release of
histamine)

Hyperemia – marked
increase in blood supply,
responsible for the
characteristic signs of
redness and heat.
 EXUDATE PRODUCTION
The second stage of
inflammation, the
inflammatory exudate is
produced, consisting of
fluid that escaped form
the blood vessels.
 REPARATIVE PHASE
The third stage of
inflammatory response
involves the repair of
injured tissues by
regeneration or
replacement with
fibrous tissue (scar)
formation.
 SPECIFIC DEFENSES
Antigen – Is a substance Humoral Immunity –
that induces a state of resides ultimately in the b
sensitivity or immune lymphocytes and are
responsiveness (immunity) mediated by antibodies
If the proteins originate in produced by B cells.
a person’s own body, the Antibodies, also called
antigen is called Immunoglobulins, are part
autoantigen. of the body’s plasma
proteins. The antibody-
mediated responses
defend primarily against
the extracellular phases of
bacterial and viral
infections.
 TYPES OF IMMUNITY
TYPE ANTIGEN OR ANTIBODY DURATION
SOURCE

1. Active Antibodies are produced by the Long

body in response to an antigen

a. Natural Antibodies are formed in the Lifelong

presence of active infection in
the body

b. Artificial Antigens (vaccines or toxoids) Many years; the immunity must

are administered to stimulate be reinforced by booster
antibody production

2. Passive Antibodies are produced by

another source, animal or human

a. Natural Antibodies are transferred 6 months to 1 yr

naturally from an immune
mother to her baby through the
placenta or in colostrum

b. Artificial Immune serum (antibody) from 2 to 3 weeks

an animal or another human is
injected
Cell-Mediated Defenses  These T cells pass into the
The cell mediated defenses or general circulation.
cellular immunity, occur There are three main groups
through the T-cell system. of T cells:
On exposure to an antigen, 1. Helper T cells – helps in the
the lymphoid tissues release function of immune system
large numbers of activated T 2. Cytotoxic T cells – Which
cells into the lymph system.
attack and kill
microorganisms and
sometimes the body’s own
cell.
3. Suppressor T cells – Which
can suppress the function of
the helper T cells and the
cytotoxic T cells.
FACTORS INCREASING SUSCEPTIBILITY
TO INFECTION
Age
Heredity
Nature, number and
duration of physical and
emotional stressor
Resistance to infection
Some medical therapies
Any disease that lessens
the body’s defense
against infection
 NURSING MANAGEMENT
ASSESSING Nursing History – the
- The nurse obtains the nurse assess: degree to
client’s history, conducts which a client is at risk
the physical assessment of dev. infection. And
and gathers laboratory any client complaints
data. suggesting the presence
of infection.
Physical Assessment Laboratory data
Sings and symptoms of 1. Elevated Leukocytes (white
infection vary according to blood cell or EBC)
the body area involved. 2. Elevated erythrocyte
sedimentation rate – red
blood cells normally settle
slowly, but the rate increases
in the presence of an
inflammatory process.
3. Urine, blood, sputum or
other drainage cultures that
indicate the presence of
pathogenic microorganisms.
 DIAGNOSING
The nurse should identify Potential complication of
risk factors: Infection: Fever
1. Inadequate primary
defenses such as broken Impaired Physical mobility
skin, traumatized tissue, if the client is fatigued,
decreased ciliary action. connected to infusion
2. Inadequate secondary devices or in discomfort
defenses such as Imbalanced Nutrition:
leukopenia, Less Than Body
immunosuppression, Requirements if the client
decreased hemoglobin, or is too ill to eat adequately
suppressed inflammatory
response.
 PLANNING
The major goals for
clients susceptible to
infection are to:
1. Maintain or restore
defenses
2. Avoid the spread of
infectious organisms
3. Reduce or alleviate
problems associated
with the infection
 Planning for Home Care
 Clients being discharged following  Discuss injury proofing the home to
hospital care for an infection often prevent the possibility of further
require continued care to tissue injury
completely eliminate the infection  Teach proper handwashing and
or to adapt to a chronic state. related hygienic measures to all
 The nurse tailors teaching plan for family members
the client and family.  Teach the client and family
members the signs and symptoms
of infection, and when to contact a
health care provider.
 Teach the client and family the
signs of wound healing and of
wound infection
 Referrals- Provide appropriate
information regarding how to
access community resources, home
care agencies, sources of supplies.
 IMPLEMENTING
Whenever possible, the Preventing Nosocomial
nurse implements Infection – Meticulous
strategies to prevent use of medical and
infection. If infection surgical asepsis is
cannot be prevented, the necessary to prevent and
nurse’s goal is to prevent transport of potentially
the spread of infection infectious
within and between microorganisms.
persons, and to treat
existing infection.
HANDWASHING
Is important in every setting, Before eating, after using the
including hospitals. bedpan or toilet and after the
Considered one of the most hands have come in contact
effective infection control with any body substances,
measures. such as sputum, or drainage
It is important that both forma wound.
nurse’s and the clients’ hands The CDC recommends
be washed at the following antimicrobial foam, hand gel,
times to prevent the spread or vigorous hand washing
of microorganisms: under a stream of water for
at least 10 seconds using
granule soaps, soap filled
sheets or antimicrobial liquid
soap.
The CDC recommends
antimicrobial hand
washing agents in the ff
situations:
When there are known
multiple resistant bacteria
Before invasive procedures
In special care units, such
as nurseries and ICU’s
Before caring for severely
immunocompromised
clients.
HANDWASHING
Purposes:
1. To reduce the number of
microorganisms on the
hands
2. To reduce the risk of
transmission of
microorganisms to clients.
3. To reduce the risk of cross-
contamination among clients
4. To reduce the risk of
transmission of infectious
organisms to oneself.
 CLEANING, DISINFECTING AND
STERILIZING
The first link in the Cleaning – inhibits the
chain of infection, the growth of
etiologic agent and the microorganisms; when
reservoir, are cleaning visibly soiled
interrupted by the use of objects, nurse must
antiseptics ( agents that always wear gloves to
inhibit the growth of avoid direct contact with
some microorganisms) infectious
and disinfectants (agents microorganisms.
that destroy pathogens
other than spores) and
by sterilization.
 Cleaning
1. Rinse the article with 2. Wash the article in hot
cold water to remove water or soap. The
organic material. Hot emulsifying action of
water coagulates the soap reduces surface
protein of organic tension and facilitates
material and tends to the removal of
make it adhere. substance. Washing
Examples of organic dislodges the emulsified
materials are blood and substance.
pus.
3. Use an abrasive, such as 4. Rinse the article well
a stiff-bristled brush, to with warm to hot water
clean equipment with 5. Dry the article; it is now
grooves and corner. considered clean
Friction helps dislodge
6. Clean the brush and
foreign material. sink. These are
considered soiled until
they are cleaned
appropriately, usually
with a disinfectant.
 Disinfecting
Disinfectant – chemical
preparation, such as
phenol or iodine
compounds, used on
inanimate objects.
Are frequently caustic
and toxic to tissues.
Antiseptic – Is a
chemical preparation
used on skin or tissue.
Both antiseptic and
disinfectants are said to
have bactericidal or
bacteriostatic properties.

Bactericidal – destroys
bacteria
Bacteriostatic – prevents
the growth and
reproduction of some
bacteria.
The type and number of
infectious organisms
The recommended
concentration of the
disinfectant and the
duration of contact
The temperature of the
environment
The presence of soap
The presence of organic
materials
The surface area to be
treated.
 STERILIZING
Sterilization – Is a process
that destroys all
microorganisms,
including spores and
viruses. Four commonly
methods of sterilization:
1. Moist Heat – For
sterilizing, moist heat
(steam) can be
employed in two ways.
2. Gas – Ethylene oxide gas
destroys microorganism
interfering with their
metabolic processes. It is
also effective against
spores.
3. Boling water – Most
practical and
inexpensive method of
sterilizing in the home.
5. Radiation – Both
ionizing ( such as alpha,
beta, and x-rays) and
non-ionizing (ultraviolet
light) radiations are used
for disinfection and
sterilization.
 ISOLATION PRECAUTIONS
Isolation – refers to
measures designed to
prevent the spread of
infections or potentially
infectious
microorganisms to
health personnel, clients
and visitors.
 1. Category-specific isolation
precaution – use seven
categories:
a. Strict isolation
b. Contact isolation
c. Respiratory isolation
d. Tuberculosis isolation
e. Enteric precautions
f. Drainage/secretions
precautions
g. blood./body fluid precautions
2. Disease-specific isolation
precautions – provide
precautions for specific
disease. These precautions
delineate use of private rooms
with special ventilation,
having the client share a
room with other clients
infected with the same
organism and gowning to
prevent gross soilage of
clothes for specific infectious
disease.
 UNIVERSAL PRECAUTIONS
Are techniques to be
used with all clients to
decrease the risk of
transmitting
unidentified pathogens.
Obstruct the spread of
bloodborne pathogens,
 RECOMMENDED ISOLATION
PRECAUTIONS IN HOSPITALS
Standard precautions
Transmission-based
precautions
Droplet Precautions
Contact precautions
 Transmission-Based Precautions
Airborne precautions –
Used for clients known
to have or suspected of
having serious illnesses
transmitted by airborne
droplet nuclei smaller
than 5 microns.
Examples, measles,
varicella, tuberculosis.
Droplet Precautions –
Used for clients known
or suspected to have
serious illnesses
transmitted by particle
droplets larger than 5
microns. Examples,
diphtheria, pertussis,
mumps, rubella.
Pneumonia.
 ISOLATION PRACTICES
Use aseptic technique
when performing any
invasive procedures( eg.
Inserting an intravenous
needle or catheter)
Change intravenous tubing
and solution containers
according to hospital.
Check all sterile supplies
for expiration date and
intact packaging.
Prevent urinary infections by
maintaining a closed urinary
drainage system with a
downhill flow of urine.
Implement measure to
prevent impaired skin
integrity and to prevent
accumulation of secretions
in the lungs (encourage the
client to move. Cough, and
breathe deeply at least every
2 hours)
THANK YOU FOR LISTENING!
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