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Fundamental Nursing Skills and Concepts
Collected By Mr. Bader A. El safadi
2019 - 2020
Islamic University of Gaza
Faculty of Nursing
Chapter 10
Asepsis
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 2 First semester 19 - 20
Islamic University of Gaza Faculty of Nursing
Preventing infections is one of the most important
priorities in nursing
Microorganisms :
living animals or plants visible only with a microscope
( also commonly called germs )
Everywhere: in the air, soil, and water, and on and within
virtually everything and everyone
Once Microorganisms invade , one of three events occur
1. The body’s immune defense mechanisms eliminate them
2. They reside within the body without causing disease
3. They cause an infection or infectious disease Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 3 First semester 19 - 20
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 4
Types of Microorganisms
Microorganisms are divided into two main
groups:
1. Non Pathogens or Normal flora
Harmless , beneficial microorganism .
2. Pathogens Microorganism that cause illness
Have high potential for causing infectious
(communicable) diseases.
also called contagious diseases. First semester 19 - 20
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 5
Types of Microorganisms
Bacteria
Viruses
Fungi
Rickettsia
Protozoans
Mycoplasmas
Helminthes
First semester 19 - 20
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 6
Many pathogens have mutated to adapt to
hostile environments and unfavorable living
conditions.
Such adaptability has ensured that they
continue to pose a threat to humans.
A spore is a temporarily inactive microbial life
form that can resist heat and destructive
chemicals and survive without moisture.
First semester 19 - 20
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 7
Chain of Infection By interfering with the conditions that continue the
transmission of microorganisms, humans can avoid acquiring
infectious diseases.
The six essential components of the chain of infection
(sequence that enables the spread of disease-producing
microorganisms) must be in place if pathogens are to be
transmitted from one location or person to another:
1. An infectious agent
2. A reservoir for growth and reproduction
3. An exit route from the reservoir
4. A mode of transmission
5. A port of entry
6. A susceptible host ( Fig.10-2)
First semester 19 - 20
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 9
Chain of Infection ……cont'd
1. Infectious Agents
Some microorganisms are less dangerous than others.
For example, intestinal bacteria help produce vitamin K, which, in turn,
helps control bleeding.
2. Reservoir
A reservoir is a place where microbes grow and reproduce,
providing a haven for their survival. Examples:
skin,
shafts of hair
open wounds
blood
lower digestive tract
nasal passages
First semester 19 - 20
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 10
Chain of Infection …….. cont'd
3. The exit route
is how microorganisms escape from their original
reservoir and move about
4. A mode of transmission
is how infectious microorganisms move to another
location. See table 10-1
5. The port of entry
is where microorganisms find their way onto or into a
new host, facilitating their relocation. One of the most
common ports of entry is an opening in the skin or
mucous membranes.
First semester 19 - 20
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 12
Chain of Infection…… cont'd
6. Susceptible Host
Humans become susceptible to infections when their defense
mechanisms are diminished or impaired. A susceptible host, is one
whose biologic defense mechanisms are weakened in some way,
a susceptible host include those who
1. Are burn victims
2. Have suffered major trauma
3. Require invasive procedures such as endoscopy
4. Need indwelling equipment such as a urinary catheter
5. Receive implantable devices such as intravenous catheters
6. Are given antibiotics inappropriately, which promotes microbial resistance
7. Are receiving anticancer drugs and anti-inflammatory drugs such as corticosteroids that suppress the immune system
8. Are infected with HIV
First semester 19 - 20
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 14
Factors affecting susceptibility to infection
1. Inadequate nutrition.
2. Poor hygiene practices.
3. Suppressed immune system.
4. Prematurity.
5. Advanced age.
6. Compromised skin integrity.
7. Diminished blood circulation
First semester 19 - 20
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 15
Asepsis
Nosocomial Infections
infections acquired while a person is receiving care in
a health care agency
Asepsis
“Practices that decrease or eliminate infectious agents,
their reservoirs, and vehicles for transmission”.
It is a major method for controlling infection.
Health care professionals use medical and surgical
asepsis to prevent spread of infections
First semester 19 - 20
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 16
Medical Asepsis
Practices that confines or reduces the numbers of
microorganisms
Also called clean technique
It involves measures that interfere with the chain
of infection in various ways
First semester 19 - 20
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 17
Principles of Medical Asepsis
Microorganisms exist everywhere except on
sterilized equipment.
Frequent hand washing and maintaining intact skin
are the best methods for reducing the transmission of
microorganisms.
Blood, body fluids, cells, and tissues are considered
major reservoirs of microorganisms.
Personal protective equipment such as gloves,
gowns, masks, goggles, and hair and shoe covers
serves as a barrier to microbial transmission.
First semester 19 - 20
Principles of Medical Asepsis…… cont'd
A clean environment reduces microorganisms.
Certain areas ( the floor, toilets, and insides of
sinks) are more contaminated than others.
Cleaning should be done from cleaner to dirtier
areas.
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 18 First semester 19 - 20
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 19
Examples of medical aseptic practices include:
1. Using antimicrobial agents,
2. Performing hand hygiene,
3. Wearing hospital garments,
4. Confining and containing soiled materials
appropriately, and
5. keeping the environment as clean as possible.
First semester 19 - 20
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 20
Using Antimicrobial Agents
Antimicrobial agents are chemicals that destroy or
suppress the growth of infectious microorganisms Examples are antiseptics, disinfectants, and anti-infective drugs.
1) Antiseptics: (called bacteriostatic agent)
inhibit the growth of, but do not kill, microorganisms
used on living tissues
an example: is alcohol
2) Disinfectants: (also called bactericides agent)
destroy active microorganisms but not spores.
used on non-living items
Examples: Phenol, household bleach, and formaldehyde
3) Anti-Infective Drugs ( Antibiotics ,Antiviral )
First semester 19 - 20
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 21
Hand washing
is an aseptic practice that involves scrubbing the hands
with soap, water, and friction.
removes resident microorganisms
is the single most effective way to prevent infections.
First semester 19 - 20
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 24 Second semester 15 - 16
5 Moments for Hand Hygiene
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 26
Performing surgical scrub
A surgical scrub, a type of skin and nail antisepsis, is
performed before donning sterile gloves and garments
when the nurse is actively involved in an operative or
obstetric procedure.
The purpose is to more extensively remove transient
microorganisms from the nails, hands, and forearms.
First semester 19 - 20
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 27
Wearing Personal Protective Equipment
Uniforms
Scrub suits or gowns
Masks
Gloves
Protective eyewear
Hair and Shoe Covers
First semester 19 - 20
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 29
Gloves Nurses wear clean gloves, sometimes called examination
gloves, in the following circumstances:
As a barrier to prevent direct hand contact with blood,
body fluids, secretions, excretions, mucous membranes,
and non intact skin.
As a barrier to protect clients from microorganisms
transmitted from nursing personnel when performing
procedures or care involving contact with the client's
mucous membranes or non intact skin
When there is a potential transfer of microorganisms
from one client or object to another client during
subsequent nursing care
First semester 19 - 20
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 30
Gloves
Examination gloves are generally made of latex
Unfortunately some nurses and clients are allergic to
latex.
Keeping the Environment Clean
agencies employ laundry staff and housekeeping
personnel to assist with cleaning
Terminal disinfection is more thorough than concurrent
disinfection and consists of measures used to clean the
client environment after discharge.
Nurses who work in home health can teach the client
and family simple aseptic practices for cleaning
contaminated articles
First semester 19 - 20
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 31
Surgical Asepsis
Surgical asepsis means those measures that
render (prepare) supplies and equipment totally free
of microorganisms.
Sterile technique include practices that avoid
contaminating microbe-free items.
Sterilization
Sterilization consists of physical and chemical
techniques that destroy all microorganisms
including spores.
First semester 19 - 20
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 32
Physical Sterilization
Microorganisms and spores are destroyed
physically through radiation or heat
Examples : boiling water, free-flowing steam, dry
heat, and steam under pressure .
First semester 19 - 20
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 33
Physical Sterilization….. cont'd
Radiation: Ultraviolet radiation can kill bacteria,
especially the organism that transmits TB.
Boiling water is a convenient way to sterilize
items used in the home. To be effective,
contaminated equipment needs to be boiled for 15
minutes at 212°F (100°C)
Free-flowing steam is a method in which items
are exposed to the heated vapor that escapes from
boiling water.
First semester 19 - 20
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 34
Physical Sterilization ……. cont'd
Dry Heat or hot air sterilization,
is similar to baking items in an oven.
to destroy microorganisms with dry heat,
temperatures of 330°to 340°F (165° to 170°C) are
maintained for at least 3 hours.
Steam under pressure
is the most dependable method for destroying all
forms of organisms and spores.
(The autoclave is an example) figure 10-8
First semester 19 - 20
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 35
Chemical Sterilization
Both gas and liquid chemicals are used to
sterilize invasive equipment.
(example :Ethylene oxide gas)
First semester 19 - 20
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 36
Principles of Surgical Asepsis
Surgical asepsis is based on the premise that once
equipment and areas are free of microorganisms, they
remain in that state if contamination is prevented
They preserved sterility by touching one sterile item with
another that is sterile
Once a sterile item touches something that is not sterile,
it is considered contaminated
Any partially unwrapped sterile package is considered
contaminated.
If there is a question about the sterility of an item, it is
considered unsterile
First semester 19 - 20
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 37
Principles of Surgical Asepsis ….cont’d
The longer the time since sterilization, the more likely
that the item is no longer sterile
A Commercially packaged sterile item is not considered
sterile past its recommended expiration date
Opened sterile item or area, left unattended, is considered
contaminated
Once a sterile item is opened or uncovered, it becomes
contaminated
The outer 1-inch margin of a sterile area is considered a
zone of contamination
First semester 19 - 20
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 38
Principles of Surgical Asepsis …..cont’d
A wet sterile wrapper wicks microorganisms from its
supporting surface, causing contamination
Coughing, sneezing, or excessive talking over a sterile
field causes contamination
Reaching across an area that contains sterile equipment
may cause contamination
Sterile items located or lowered below waist level are
considered contaminated
First semester 19 - 20
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 39
Principles of Surgical Asepsis …..cont’d
A wet sterile wrapper wicks microorganisms from its
supporting surface, causing contamination
Coughing, sneezing, or excessive talking over a sterile
field causes contamination
Reaching across an area that contains sterile equipment
may cause contamination
Sterile items located or lowered below waist level are
considered contaminated
First semester 19 - 20
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 40
Creating a Sterile Field
A sterile field means a work area free of
microorganisms. (Skill 10-3)
First semester 19 - 20
Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 41
Difference between Surgical and Medical Asepsis
Medical asepsis, or clean technique, includes
procedures used to reduce the number of
organisms present, and prevent the transfer of
organisms.
Surgical asepsis, or sterile technique, prevents
contamination of an open wound, serves to
isolate the operative area from the unsterile
environment, and maintains a sterile field for
surgery
First semester 19 - 20