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Asepsis and infection control. Shurouq Qadose 13/1/2008.
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Asepsis and infection control Shurouq Qadose 13/1/2008
Nurses are directly involved in providing a biologically safe environment. Microorganisms exist everywhere: in water, in soil, and on body surface such as the skin, intestinal tract, and other areas open to the outside (e.g., mouth, upper respiratory tract, vagina, and lower urinary tract). Most Microorganisms are harmless, and some are even beneficial in that they perform essential functions in the body. Some Microorganisms found in the intestines (e.g., enterobacteria) produce substance called bacteriocins, which are lethal to related strains of bacteria. Some Microorganisms are normal resident flora in one part of the body, yet produce infection in another.
For example. Escherichia coli is a normal inhabitant of the large intestine but a common cause of infection of the urinary tract. Nursing practice focuses on providing a safe and therapeutic environment to protect clients, family members, and health care providers from acquiring infections.
Role of Microorganisms in infection Microorganisms that are capable of harming people are called pathogens or pathogenic. Sepsis a term that means poisoning of tissues, often is used to describe the presence of infection. Transport of an infection or the products of infection throughout the body by the blood is known as septicemia. Infection an invasion of body tissue by microorganisms and their proliferation there. Such as a microorganism is called infectious agents. If the microorganism produces no clinical evidence of disease, the infection is called asymptomatic or subclinical.
Asepsis: is the freedom from disease –causing microorganisms. There are two basic types of asepsis: Medical asepsis refers to measures taken to control and reduce the number of pathogens present. It is also known as ‘’ clean technique’’. Measures used to prevent the spread of organisms from place to place include hand washing, gloving, gowning, and disinfecting solutions.
Surgical asepsis refers to ‘’ 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. Surgical asepsis is used for all procedures involving the sterile areas of the body.
Types of Microorganisms Four major categories of microorganisms cause infection in humans: bacteria, viruses, fungi, and parasites. Types of infections Infections can be localinfection is limited to the specific part of the body where the microorganisms remain. Systemicinfection when microorganisms spread and damage different parts of the body.
There are also acute or chronic infections. Acute infections generally appear suddenly or last a short time. A chronic infection may occur slowly, over a very long period, and may last months or years.
Six links make up the chain of infection:- 1- Infectious agent The first link in the chain of infections is the microbial agent, which may be bacterium, virus, fungus, or parasite. The ability of the infectious agent to cause disease depends on its:- Pathogenicity……. Is the organism’s ability to harm and to cause disease. Virulence ………. Relates to the vigor with which the organism’s can grow and multiply. Invasiveness ……….. Describes the organism’s ability to enter tissues. Specificity ………… Refers to the organism’s attraction to a specific host, which may include humans.
2- Reservoir or source The sources of organisms are elements in the environment. Inanimate objects, human beings, and animals are sources. Inanimate objects include medications, air, food, water. Human sources include other clients, health care personnel, family members, visitors, and clients themselves. Animals sources include insects and rats. A carrier is a person or animal reservoir of a specific infectious agent can usually does not manifest any clinical signs of disease.
3- Portal of exit from reservoir The portal of exit provides a means for the microorganism to leave the source. Sputum, emesis, stool, urine, blood, wound drainage, or secretions from genitals all permit microorganisms to exit the source. Animal discharge or blood organisms also can provide a means of escape.
4- Mode of Transmission Refers to the way in which the organism moves or is carried from the source’s portal of exit. The five main routes of transmission are:- - Contact Transmission Is the most frequent means of transmitting infections in health care facilities. Contact transmission is by:
Direct contact Involves body surface- to – body surface contact causing the physical transfer of organisms between an infected person and a susceptible host. Indirect contact Occurs when a susceptible host is exposed to a contaminated object, such as addressing, needle, or surgical instrument.
- Vehicle Transmission Involves the transfer of microorganisms by way of vehicles, or contaminated items that transmit pathogens. - Droplet Transmission Occurs when mucous membranes of the nose, mouth, or conjunctiva are exposed to secretions of an infected person who is coughing, sneezing, or talking.
- Airborne Transmission Occurs when fine particles are suspended in the air for a long time or when dust particles contain pathogens - Vectorborne Transmission Vectors can be biologic or mechanical. Biologic vectors such as rats or insects, that carry pathogens. Mechanical vectors are inanimate objects that are contaminated with infected body fluids such as contaminated needles and syringes.
5- Portal of entry Pathogens can enter susceptible hosts through body orifices, such as the mouth, nose, ears, eyes, vagina, rectum or urethra, breaks in the skin. 6- Susceptible Host Is any person who is at risk for infection. A compromised host is a person “at increased risk” an individual who for one or more reasons is more likely than others to acquire an infection. Impaired of the body’s natural defenses and a number of other factors can affect susceptibility to infection.
Factors increasing susceptibility to infection • Age • Heredity • Level of stress • Nutritional status • Current medical therapy • Preexisting disease processes Susceptibility is the degree to which an individual can be affected or the likelihood of an organism causing an infection in that person.
The following measures can reduce a person's susceptibility: • Hygiene Intact skin and mucous membranes are one barrier against microorganisms entering the body. Also good oral care, bathing, shampooing all these measure can reduce the presence of microorganisms • N utrition Adequate nutrition enables tissues to maintain and rebuild themselves and helps keep the immune functioning well.
Fluid Fluid intake permits fluid output that flushes out the bladder and urethra, removing microorganism that could cause an infection. • Rest and sleep Adequate rest and sleep are essential to health and to renewing energy.
Stress Excessive stress predispose people to infections. Nurses can assist clients to learn stress – reducing techniques • Immunizations The use of immunizations has dramatically decreased the incidence of infectious diseases.
Nosocomial Infections Refers to ‘’ hospital – acquired’’ infection but may be extended to include infections acquired in other health care delivery settings. Nosocomial infection can either develop during a client’s stay in a facility or manifest either discharge. The microorganisms that cause Nosocomial infections can originate from the client themselves (an endogenous source) or from the hospital environment and hospital personnel (exogenous source).Iatrogenic infection are the direct result of diagnostic or therapeutic procedures.
Risk factors that contribute to the development of nosocomial infections Can be grouped into three categories - Environment Hospitals, outpatient clinic, the home school are reservoirs of organisms. The sources of these organisms include the air, other clients, families and visitors, contaminated equipment, food, and personnel. Influenza can spread rapidly among clients and other people in all types of facilities.
- Therapeutic Regimen Drugs such as immunosuppressive agents, and cancer therapy, as well as prolonged use of antibiotics predispose clients to infection, Equipment such as IV catheters, urinary catheters, and feeding tubes that invade body orifices, also inadequate dressing techniques for wounds all these provide routes for bacterial invasion. - Client resistance Stress, fatigue, poor nutrition, and chronic illness these factors decrease the client’s ability to ward off infection.
Infection control Prevention and control of infections are important concerns for all types of healthcare agencies. The infection control practitioner is usually a nurse with advanced training in infection control practice and methods for tracking the source and spread of infections. Each department in the hospital must have written policies and procedures for the control of infection.
Needlesticks One of the most frequently occurring and potentially serious exposures for health care personnel is needlestick injury, which may transmit organisms that cause blood borne diseases, such as hepatitis or AIDS. Accidental Needlesticks account for almost one third of all health care accidents and billions of dollars for treatment costs. Approximately 600,000 to 800,000 needlestick injuries occur annually to U.S. A significant number of all needlestick injuries (30% to 40%) result from recapping needles after their contact with blood from a client(e.g., after an injection, drawing blood, or starting an IV line ).
Waste Disposal Disposal waste categorized into - Infectious waste such as blood and blood products, body parts from surgery, laboratory cultures, dialysis materials, suction bottles. - Injuries waste such as needles, lancet, broken glass, scalpel blades - Hazardous waste such as radioactive materials, chemotherapy solutions, caustic chemical Health care agencies use separate waste containers, clearly marked ''Biohazard'' for infectious waste, such as blood contaminated items.
Hand Hygiene Nothing is more effective than hand hygiene to prevent the spread of infection. It is also the least expensive method for decreasing the risk of infecting oneself or others. Contact transmission, from the hands of healthcare personnel or the clients themselves, is the most common form of contamination because microorganisms are transient flora until the hands are washed.
Factors that contribute to poor compliance with hand washing :- - Lack of awareness of client care activities that require handwashing, such as taking blood pressure or shaking hands with a client. - Common misperception that wearing gloves and gowns can substitute for handwashing - Understaffing and high workloads. - Inaccessibility of sinks - Skin irritation and dryness
Wash your hand in the following situations: • At the beginning and end of the shift • Before the contact with a client • Between contacts with different clients • Before and after contact with wounds, dressing, specimens • Before performing any invasive procedure • Before administering medications • After contact with client secretion • Before and after using the bathroom • After sneezing, coughing, or blowing your nose • After removing gloves • Before eating
The CDC” Center for Disease Control and Prevention” recommends antimicrobial handwashing agents in the following situations: • When there are known multiple resistant bacteria. • Before invasive procedures • In special care units, such as nurseries and ICUs • Before caring for severely immuno compromised clients.
Medical and surgical asepsis vary in the technique for proper handwashing. Handwashing for surgical asepsis usually takes longer. Most long – term flora on the hands reside in the nailbed and under the fingernails, so keep fingernails short and avoid nail polish. Remove all rings before handwashing to minimize the potential places for bacteria.
Cleaning, Disinfecting, and Sterilizing The etiologic agent and the reservoir, are interrupted by the use of antiseptics (agents that inhibit the growth of some microorganisms). Disinfectants(agents that destroy pathogens other than spores). And Sterilizing is a process that destroys all microorganisms, including spores and viruses.
Cleaning • Cleaning refers to the physical removal of visible dirt and debris by washing, dusting, or contaminated surface .The following steps should be followed when cleaning objects in a hospital: • Rinse the article with cold water to remove organic material. Hot water coagulates the protein of organic material and tends to make it adhere. • Wash an abrasive, such as a stiff-bristled brush, to clean equipment with grooves and corners. Friction helps dislodge foreign materials.
Wash the article in hot water and soap. The emulsifying action of soap reduces surface tension and facilitates the removal of substances. Washing dislodges the emulsified substances. • Rinse the article well with warm to hot water. • Dry the article; it is now considered clean • Clean the brushed and sink.
Disinfecting A disinfectant is a chemical preparation, such as phenol or iodine compounds, used as inanimate objects. A chemical used on lifeless objects is called Disinfectants, because they are frequently caustic and toxic to tissue. A chemical used on living objects is called antiseptic. Both antiseptic and disinfectants are said to have bactericidal preparation destroy bacteria, whereas bacteriostatic preparation prevents the growth and reproduction of some bacteria.
When disinfecting articles, nurses need to follow agency protocol and consider the following: • The type and number of infectious organisms. Some microorganisms are readily destroyed, whereas others require longer contact with the disinfectant. • The recommended concentration of the disinfectant and the duration of contact. • The temperature of the environment. Most disinfectants are intended for use at room temperature.
The presence of soap. Some disinfectants are ineffective in the presence of soap or detergents. • The presence of organic materials. The presence of saliva, blood, pus, or excretions can readily inactivate many disinfectants. • The surface areas to be treated. The disinfecting agents must come into contact with all surfaces and areas.
Sterilizing • Sterilization is a process that destroys all microorganisms, including spores and viruses. Four commonly used methods of sterilization are moist heat, gas, boiling water, and radiation.
Use of Barriers Techniques that prevent the transfer of pathogens from one person to another are referred to as '' barriers''. The most commonly used barriers are:- 1- Masks Masks prevent transmission of infectious agent through the air. They protect the wearer from inhaling both large- particle droplets, which are transmitted by close contact and usually travel only a short distance (up to 3 feet), and small – particle droplets. Masks lose their effectiveness if they are wet or are worn for long periods, also if they are not changed after caring for each client.
