MEDICAL AND SURGICAL ASEPSIS

• Medical and surgical asepsis


  Infection control, one of the major concerns that healthcare workers in healthcare facilities and hospitals constantly address
• Chain of infection

  How an individual acquires the infectious agents, including the infectious agent, the source of infection or its reservoir, how the organism is transmitted, and the organism's portal of entry into the susceptible host
• Mode of transmission


  The manner in which the infectious organism is acquired by the host
• Standard precautions


  The specific measures used to prevent the spread of infection among all patients and healthcare workers, including measures to protect them from contaminated blood and other body fluids
• Contamination


  Contact of a sterile or aseptic item with microorganisms. Medically aseptic items become contaminated if they get in contact with disease-producing organisms. Sterile items become contaminated if they get in contact with items that are not sterile.
• Decontamination


  The process where physical or chemical means are used to remove, inactivate, or destroy pathogens on a surface or item making them safe for handling or use and incapable of transmitting infectious agents
• Disinfection


  The process of using physical or chemical means to destroy pathogens, excluding the spores
• Sterilization


  The process by which all pathogens are destroyed, including the spores
• Antiseptic


  A chemical solution that inhibits the growth of some microorganisms. Most antiseptics can be used directly on the skin (e.g., alcohol and iodine).
• Healthcare-associated infection


  Any infection that is acquired during the time a patient is admitted in a healthcare facility. The most common healthcare-associated infection is the urinary tract infection (UTI).
• Iatrogenic infection


  Infection that is acquired in the course of undergoing diagnostic tests or therapeutic procedures
• Occupational exposure

  The acquisition or exposure to an infectious agent of a healthcare worker during the course of his/her work
• Personal protective equipment (PPE)


  Specialized equipment and attire used by healthcare workers to protect them from infections, including gloves, masks, gowns, and goggles

  
• Sepsis


  Refers to the clinical condition where an individual develops a systemic reaction to a bacterial infection that starts from a localized infection one part of the body
• Asepsis


  Refers to a condition in which the individual and his/her surrounding environment are free of any microorganisms
• Goals of asepsis

  • To protect the patient from hospital-acquired nosocomial infections
  • To prevent the spread of pathogenic microorganisms
• Factors that play a role in the occurrence of infection among patients

  • Suppression of the immune system
  • Prolonged duration of illness
  • Procedures that patients undergo in the healthcare facility such as insertion of indwelling catheters, use of antibiotics, insertion of intravenous lines or endotracheal tubes
• Most commonly occurring pathogenic microorganisms that lead to nosocomial infections

  • Escherichia coli
  • Staphylococcus aureus
  • Pseudomonas aeruginosa
  • Candida albicans
  • Enterococcus
• Medical asepsis (or Clean asepsis)


  Refers to the absence of disease-producing microorganisms. It is the infection control process that aims to reduce the spread of infection and involves certain procedures aimed to decrease the number of organisms and prevent their spread in the general clinical setting.
• Instances when medical asepsis is applied

  • Proper hand hygiene
  • Administration of all medications except those that are given intravenously
  • Preparation of the patient's skin before administration of subcutaneous medication
• Surgical asepsis (or Sterile asepsis)


  The absence of all microorganisms. Involves procedures that aim to eliminate microorganisms from an area in the body where surgical procedures will be performed as well as the location where the surgical procedure will be carried out.
• Applications of surgical asepsis

  • Wound care
  • During invasive procedures (e.g., endoscopy)
  • Administration of intravenous drugs
  • During insertion of urinary catheter and other internally placed tubes
• Handwashing


  The most frequent source of microorganisms leading to outbreaks of infection in health institutions is the hands of the healthcare workers. Proper handwashing is one of the most basic means of preventing the spread of pathogenic organisms.
• Essential reasons for handwashing in the healthcare environment

  • To reduce the flora on the healthcare worker's skin
  • To protect the healthcare worker in the event that there is a break in his or her skin
  • To reduce the risk of contact with infectious agents if gloves worn are punctured
  • To reduce the chances of disease transmission

  
• When to handwash

  • At the beginning and end of each shift
  • When the hands are visibly soiled
  • After contact with a possible source of microorganisms such as blood or body fluids, mucous membrane, non-intact skin, or contaminated objects
  • Before and after performing invasive procedures
  • Before removing gloves if they are visibly soiled and each time after removing gloves

  
• Personal protective equipment (PPE)


  Specialized equipment and attire used in healthcare facilities to protect not only the healthcare workers but also the patients and visitors against infections, including masks, gowns, and goggles
• Gloves (PPE)


  Among the various PPEs in use, this is the most commonly used. Gloves used during medical procedures are disposable. There are two types: examination gloves (may be sterile or non-sterile) and surgical gloves (sterile).

  
• Masks (PPE)


  Must cover the mouth and nose, be tied in a way that there should be minimal gaps between the face and the mask, and be replaced when damp. Masks are supposed to be single-use items.
• Sterile gowns (PPE)


  Healthcare workers are recommended to wear gowns or aprons when there is probability of contact with blood, body secretions excluding sweat, or other body substances. The type of apron or gown to wear depends on the degree of risk with the infectious agents and the potential for body substances and blood to penetrate through the clothes or skin of the healthcare worker.
• When to wear fluid-resistant, single-use, long-sleeves, full body gowns

  • When there is a risk of contact of the healthcare worker's skin with a patient who has broken skin
  • If there is extensive skin to skin contact between the healthcare worker and the patient
  • If the risk of contact with body substances or fluids cannot be contained such as when the patient has diarrhea or is vomiting incessantly

  
• Sterility parameters for gowns

  The front of a sterile gown is considered sterile from the chest down to the level of the sterile field. The gown sleeves are sterile from 2 inches above the elbow to the cuff, circumferentially. The back of the gown is not considered sterile. The neck, sleeve cuffs, and underarms of the gloves are not considered sterile and are not considered as effective microbial barriers.
• Isolation


  The process of separating an individual with an infectious disease from the rest of the healthy population to prevent the spread of the infection to other individuals
• Universal precautions


  Geared towards handling of patients with an infection from an unknown pathogen to decrease the risk of transmission. Apply to all body fluids including blood, skin, and mucous membrane.
• Components of universal precautions

  • Proper handwashing
  • Use of personal protective equipment (gloves, aprons, gowns, masks or face shields)
  • Proper handling and disposal of secretions and excretions excluding sweat
  • Proper handling and disposal of soiled linen and equipment
  • Environmental control
  • Prevention of injury from sharp devices such as needles
  • Patient placement
• Transmission-based precautions


  Have been developed to further prevent the spread of infectious agents. These precautions are based on the mode of transmission of the infectious agents.
• Contact precautions


  Used to prevent the spread of infections or infectious agents that are transmitted through touching of patients or items in the room where the infectious agents may be deposited (called fomites). Examples include MRSA, viruses such as RSV, and agents that cause diarrhea and open wound.
• Droplet precautions


  Used for diseases or infectious agents that are spread in tiny droplets caused by coughing and sneezing, to prevent contact with secretions from the respiratory tract. Examples include influenza, mumps, and pertussis (whooping cough).
• Airborne precautions


  Measures geared towards preventing the spread of diseases or infectious agents that are spread through the air from one person to another, such as chickenpox, measles, and tuberculosis. Patients must be placed in a room with negative air pressure where the air is gently sucked out and not allowed to flow into the hallway.