ASEPSIS

By
Purwaningsih
Learning Objectives

Be able to state the

requirements for clean,
aseptic or sterile technique
recommended for common
procedures

Demonstrate use of the

SCRIPT method to prepare
for and carry out procedures

Be able to demonstrate
aseptic and sterile technique
for 4 procedures
Nosocomial Worldwide Problem
Infections
Acquired in health care
facilities
Cost is in the billions for
extended
care and treatment
A Leading cause of death
Spread by health care
workers who fail to wash
hands or change gloves
 Airborne Transmission

Agent Transferred by
droplet nuclei (moisture) or
dust particles
coughing , talking, sneezing
Vehicle Transmission

Agent transferred to
host by contaminated
inanimate objects
Food, milk, water,
drugs, blood, urine
Cholera by water
Salmonellosis by
meat
E-coli by spinach
 Vectorborne

Agent transferred
to host by
animate means
Mosquitoes,
fleas, ticks, lice,
and other
animals
Lyme Disease,
malaria, West
Nile virus
 Chain of
Infection

Agent, Host
and
Environmental
Interaction

The links
symbolize
essential
elements
needed by
microorganism
s to invade and
 Portal of
Entry

Agent enters the

Host by:
Integumentary system (skin breaks,
mucous membranes as in surgical
wounds)

Respiratory tract (inhale droplets as

colds, measles, influenza)

Genitourinary (infected vaginal

secretions, semen, as in STDs)

Gastrointestinal (ingestion food,

water contaminates, as typhoid and
Hepatitis A)

Circulatory (insect bites as malaria

 Host

Human being is a
susceptible host that
can be affected by an
agent.

If you have not

received measles
vaccine more likely to
get it because you lack
immunity.
 Host
Characteristic
s
Age (immunity declines
as age increases)
Illness and Injury
Stress (decreases
immune response)
Immunization/Vaccinati
on Status
Lifestyle (sharing
needles, multiple sex
partners, smoking,
alcohol and drug
abuse)
Occupation (chemical
agents,needle sticks
Skin breaks which is
the first line of defense
 Host
Characteris
tics

Nutritional Status (overweight, underweight)

Heredity
Medications (steroids, non-steroidal anti-inflammatory
agents NSAIDs (ibuprofen, aspirin), chemotherapy,
antibiotics lead to vaginal yeast infections
Nursing and Medical Procedures (urinary catheters, IVs)
 Breaking Chain
of Infection

Infection Control is the

First Line of Defense
HAND HYGIENE IS THE
SINGLE MOST PRACTICE IN
PREVENTING THE SPREAD
OF INFECTION
JCAHO June 2006: Hand
washing is the top priority
National Patient Safety
Goal (USA Government)
Breaking the Chain of
Infection

Wear gloves, masks,

gowns and goggles
Client Hygiene
Dressing Changes using
aseptic technique
Clean linens
Clean Equipment
Educate on covering
mouth and nose when
coughing and sneezing;
throwing tissues into
Breaking Chain of
Infection

Nutrition (protein needed to

maintain and repair tissues,
production of antibodies, and
acid-base balance
Exercise
Immunizations (measles,
mumps, rubella, tetanus every
10 years and flu every year
MUMPS reported by CDC
(8/6/2006) as being beyond
historical limits. Cummulative
for 2006 in selected states
5,482
 Body Defenses

Immune system
recognizes its self
Antigen is non-self
pathogen and the
immune system will
attack it

Non-Specific Immune
Responses are
Skin and its normal
flora
Mucous membranes
(as cilia in respiratory
tract keep from
 Non-Specific
Immune
Responses
Coughing, sneezing, tearing
reflexes
Elimination and acid
environment
Flora in the large intestine
prevent growth of
pathogens and peristalsis
removes them with feces
Natural urine acidity
prevents growth and
urination rids bladder neck
and urethra of
microorganisms
Non-Specific Immune
Responses

Vaginal Flora is acidic; puberty

lactobacilli ferment and produce
sugars lowering the pH preventing
growth of microorganisms

Inflammation is cellular response to

tissue injury by bacteria, trauma,
chemicals, heat etc.
Erythema (redness) increased
blood flow to area
Heat (increased blood flow and
metabolism)
Pain (pressure on pain receptors)
Edema (swelling) fluid and
leukocytes
Function Loss (pain, swelling)
 Specific Immune
Response

Response to invading antigen

Phagocytes do not destroy
antigen completely
T-cells (T lymphocytes) produce
and release lymphokines thus
attracting phagocytes and
lymphocytes to destroy the
antigens;
T-cells stimulate B-cell
production which leads to
antibody production against
antigen
 ASEPSIS

The term asepsis means

the absence of disease-
producing microorganisms
 Concept of
Asepsis

The nurses efforts to

minimize the onset &
spread of infection are
based on the principles of
aseptic technique.

Aseptic technique is an
effort to keep the client
as free from exposure to
infection-causing
pathogens as possible.
 Definition

Aseptic technique is the effort

taken to keep the patient as free
from hospital micro-organisms as
possible (Crow 1989).

It is a method used to prevent

contamination of wounds & other
susceptible sites by organisms
that could cause infection.

This can be achieved by ensuring

that only sterile equipment &
fluids are used during invasive
medical & nursing procedures.
 The Goal: Reduce
Health Care
Associated Infections

The goal is to reduce health

care-associated infections that
occur when staff spread
microbes to patients
Germs move to patients from
hands, and from objects used
for patient care
Use of clean, aseptic or sterile
technique reduces the number
of germs transferred and thus,
reduces the risk of infection
Slide 22
 Types of Asepsis
Technique

There are two types of

asepsis:
Medical asepsis & Surgical
asepsis.

Medical or Clean Asepsis

reduces the number of
organisms & prevents their
spread.
 Surgical or Sterile
Asepsis or Sterile
Technique

includes procedures used to

eliminate micro-organisms
from an area & is practiced by
nurses in OTs, labour &
delivery area, major
diagnostic areas & Rx areas.
 Medical Asepsis

During daily routine care, the

nurse uses basic medical aseptic
techniques to break the infection
chain.

Eg.of medical asepsis are

changing clients bed linen daily,
handwashing, barrier techniques,
& routine environmental cleaning.
 Cont

Follow Isolation
technique as
appropriate.

Clients with high

susceptibility to infection
require special
precautions to prevent
exposure to pathogens.
 Cont

In medical asepsis, an area

or object is considered
contaminated only if it is
suspected of containing
pathogen (e.g., used
bedpan, the floor & a wet
piece of gauze).
 Surgical
Asepsis

Sterilization destroys all microorganisms

& their spores.
Surgical asepsis demands the highest
level of aseptic technique & requires that
all areas be kept as free as possible of
infectious micro-organisms.
 Cont

These techniques can be

practiced by nurses in the
OR (surgical incision) or at
the bedside (e.g, inserting
IV or urinary catheter &
reapplying sterile
dressings) where sterile
instruments & supplies are
used.
 Cont

In surgical asepsis, an
area or object may be
considered
contaminated if
touched by an object
that is not sterile (e.g.,
a tear in a surgical
glove during a
procedure, a sterile
instrument placed on
 Cont

The nurse working with a sterile

field or with sterile equipment
must understand that the
slightest break in technique
results in contamination.
 Cont

A nurse in an operating
room follows a series of
steps to maintain
sterile techniques,
including applying a
mask, protective
eyewear, and a cap;
performing a surgical
hand washing; &
 Cont

Effectiveness of
aseptic practices
depends on the
nurses
conscientiousness &
consistency in using
effective aseptic
techniques.
INFECTION CAUSE BY
MICROORGANISMS

BACTERIA
FUNGI
PROTOZO
A
ALGAE
VIRUSES
 Clean Technique

Use clean technique if staff or

objects will touch intact skin,
intact mucous membranes or
dirty (contaminated) items
 Examples of When Clean
Technique is Used

. Clean tech is
appropriate for:
Taking blood
pressures
Examining
patients
Feeding
patients

4: Clean, Aseptic, Sterile Slide 36

 Definition: Invasive
Procedures

Acts done to patients that

come in contact with the
wounds, blood stream,
the inside of the body, or
normally sterile parts of
the body
Remember invasive
procedures invade the
inside of the body
4: Clean, Aseptic, Sterile Slide 37
 CONTROL OR
ELIMINATION OF
INFECTIOUS AGENTS

Cleansing

Is the removal of all foreign materials such as

soil & organic material from objects.

Generally, cleansing involves use of water &

mechanical action with or without detergents.
- Disposable object has to be
discarded.
- Reusable objects must be cleansed
thoroughly before disinfection
& sterilization.
When cleaning equipment that is soiled by
organic material such as blood, fecal matter,
mucus or pus, the nurse applies a mask,
protective eyewear, & waterproof gloves.
These barriers provide protection from infectious
organisms.

A brush, detergent or soap are

needed for cleaning.
 To Prevent
Contamination

Keep clean, dirty, and sterile items

separate:
Only put sterile items in a sterile
field
Change gloves and wash hands if
going from a contaminated act to a
aseptic or sterile act
Time skin antisepsis and surgical
hand hand hygiene with a clock
The sterile field is considered sterile
except for the 2.5 cm border
Wet items are considered
contaminated
4: Clean, Aseptic, Sterile Slide 40
 Planning Reduces Errors in
Technique

Use the S.C.R.I.P.T.

reminder to plan

Visualise every step in

advance, to make sure
supplies are available
4: Clean, Aseptic, Sterile Slide 41
 S.C.R.I.P.T Procedures

Space and work flow?

Clean, aseptic, or sterile
technique?
Routine, aseptic or
surgical hand hygiene?
Instruments and
supplies?
Personal protective
equipment?
Trash: sharps,
infectious waste,
radioactive waste,
4: Clean, Aseptic, Sterile Slide 42
 Space and Work Flow?

Should the
procedure be done
in a dedicated room
or space?
Who will ensure
that all visible dirt
is removed form
the space ahead of
time, and surfaces
disinfected if
4: Clean, Aseptic, Sterile necessary?
Slide 43
 Space and Work Flow?

Work flow: can staff move from

hand washing to hand drying to
separate clean and sterile areas
without passing or touching
contaminated areas?
Where will used instruments
and specimens be placed?
4: Clean, Aseptic, Sterile Slide 44
 Clean, Aseptic, or
Sterile Technique?

All team members should be

clear on who should be using
clean, aseptic or sterile
technique and what elements are
intended
Example: a physician places a
thoracic drain with sterile
technique,the nurse assisting
uses clean technique, and the
person who empties the drain in
subsequent days uses aseptic
technique
4: Clean, Aseptic, Sterile Slide 45
 Instruments
and Supplies

Plan what
medical devices
and supplies are
needed
Plan where each
item should be
placed
Plan where and
how each item
should be
4: Clean, Aseptic, Sterile discarded
Slide 46 or
 Work Flow Chart:
Decontamination
Cycle

4: Clean, Aseptic, Sterile Slide 47

 Routine, Aseptic or Surgical
Hand Hygiene?

Prepare in advance for the type

of hand hygiene that is
necessary

Arrange the supplies including

hand drying towels, as
appropriate
4: Clean, Aseptic, Sterile Slide 48
 Personal Protective
Equipment

. Discuss what other items are

expected and needed
These may include aprons,
shoe covers for bloody
procedures, masks, hair
coverings, face shields or
goggles
4: Clean, Aseptic, Sterile Slide 49
 Disinfection &
Sterilization

Disinfection eliminates pathogenic

organisms on inanimate objects with
the exception of bacterial spore.
Noninfectious microorganisms may or
may not be killed.
Sterilization is the
process of eliminating
and destroying all
microorganisms,
including spores &
viruses.
 DISINFECTION

The principle of disinfection

is that of denaturation of the
bacterial cell protein.

This process can be carried

out by two methods:
1.Physical
- boiling
2. Chemical
- disinfectants
 Choice of method
depends on:

A) Types of microorganisms
Certain strains of bacteria are more
resistant to
destruction than vegetative forms.

B) Number of microorganisms present on

articles
The more heavily contaminated the
articles are,
Essential factors for maximum
effectiveness of disinfection
are:
- Cleanliness of
items
- Unlocking all
locked
instruments
- Complete
 Use of Disinfectants

Indications for use of Hospital

Disinfectants:

1. Disinfection of skin & mucous

membranes.
2. Disinfection of instruments & other
items.
3. Decontamination of the inanimate
environment.
 Chemical Disinfectants
are such as:

1. Phenolics

a) clear soluble fluids, e.g., 2% Printol. 1%

Sudol

b) Hexachlorophene e.g., Phisohex,

Gamaphene

- for wide range of antibacterial activity.

2. 70% - 75% Ethyl or Isopropyl Alcohol

- for wide range of antibacterial activity,

most active against TB.
 Chemical
Disinfectants
cont..

3. Halogens - for inactivation of viruses

and anti bacterial activity except TB.
a) Chlorine (hypochlorites) e.g.,
Milton,
Eusol.
b) Iodine.

4. Glutardehyde, e.g., Cidex - wide range

of antibacterial activity, very effective
against Hepatitis B virus. Best for heat
5. Quaternary ammonium compounds

e.g., Cetrimide (Cetavlon)

- good detergent (more active

against gram +ve organisms).

6. Diguanides,
e.g., Chlorhexidine (Hibitane)
Chlorhexidine + detergent
(Hibiscrub, Savlon)

- useful skin disinfectant. Very

active against gram +ve organisms.
 STERILIZATION
This process can be carried
out by 4 methods:-

HEAT
IRRADIATION
-moist heat
(Autoclave) -ultra violet light

- dry heat (Hot - gamma

Air Oven)
rays/cobalt 60
CHEMICAL
FILTRATION
-in solution, e.g.,
Ethicon Fluid, - applicable to
Glutaraldehyde pharmaceutical
laboratory where it
-vapour, e.g.,
is used in
Formaldehyde
combination with
- gas, e.g., ultra violet light.
Ethylene Oxide
 THE PRINCIPLES OF ASEPTIC
TECHNIQUE IN WOUND CARE

Medical Hand Washing cleaning of

trolley, opening the dressing pack, to
cleaning the wound.
Surgical Hand Washing scrubbing in
surgery.
 Gowns & Aprons

protective clothing is used to reduce

bacterial spread by contact (nurses
uniforms become heavily
contaminated during clinical
procedures.
Gloves The purpose of wearing gloves
is both to protect the hands from
contamination by micro-organisms and
to prevent the transfer of micro-
organisms already on the hands.
 Single-use

irrigation devices should not be

used for multi-use purposes as
there is potential for cross-
infection between pts.
e.g., IV lines & buckets.
BLOOD TRANSMISSABLE
DISEASES &
SEXUALLY TRANSMITTED
DISEASES (STDs)

HIV Infection/AIDS
Hepatitis B (HBV)
Hepatitis C (HCV)
Syphilis
Gonorrhoea
Chlamydia
Herpes Simplex
Cytomegalovirus
 INFECTION PREVENTION
MEASURES: Body
Substance Isolation System
(BSIS)

Hand washing / Hand Scrub

Wash hands before touching pts,
before scrubbing & any time hands
have been soiled.
Gloves
put on clean gloves
just before contact
with mucous
membranes & non
intact skin.

wear appropriate
gloves any time
hands likely to have
contact with moist
body substances.

remove gloves
immediately after
task is completed.
 Infection Prevention
Measures: BSIS

Gowns or Plastic Aprons

Wear any time it is likely that

clothing or skin will be soiled.

Masks
wear in OR / sterile area
wear when working directly over
large areas of open skin.
wear when it is likely that nasal
& oral mucous membranes will
be spattered with moist body
 Needles & Sharps

Discard in rigid,
puncture-resistant
containers.
Do not recap used
needles by hand.
Be particularly
careful when
manipulating small
devices such as
heparin locks.
 Infection Prevention
Measures: BSIS

Room Selection
- Assign patient with infectious disease
to an individual OR or last on surgical
list.
 Trash & Linen

Bag all soiled trash & linen

securely.
Discard according to facility
policy.

Wear gloves & protective

garments when handling soiled
linen & trash.
 Infection Prevention
Measures: BSIS

Housekeeping
- Clean all rooms on regular

schedule.
- Clean articles, equipment &
furniture soiled with moist
body substances
immediately.
- Wear gloves.
 Laboratory
Specimens

Handle all laboratory

specimens with equal care.
Special precautionary labels
are required.
 Clean Aseptic Sterile

Procedure space On ward or at Dedicated Dedicated

beside area room
Gloves Clean or Sterile Sterile
none surgical
Hand hygiene before Routine Aseptic, Surgical
the procedures e.g. alcohol scrub
Iodophors,
chlorheximide
Skin antisepsis No Alcohol Long acting
agent

Sterile field No No* Yes

Sterile gown, mask, No No Yes

head covering
 Remember
!!!
The nurse is responsible for
providing the client with a safe
environment.

The nurses first responsibility to

the client is to first do no harm.

It is easy to forget key procedural

steps or, when hurried, to take
shortcuts that break aseptic
procedures. However, the nurses
failure to be meticulous will place
the client at risk for an infection
that can seriously impair recovery.
(Florence Nightingale, 1859)
 Govt. Hospital of Thoracic Medicine. 2013. Clean, Aseptic and Sterile Techn