MEDICAL AND
SURGICAL ASEPSIS
Jonald P. Regio, RN, RMT
LEARNING GOALS / OBJECTIVES
•After 3 hours of lecture / presentation students will be
able to:
• Differentiate asepsis vs sepsis
• Distinguish medical asepsis and surgical asepsis
• Enumerate general aseptic procedures followed to maintain a clean environment
and prevent the spread of infection diseases
• Explain the various isolation precaution measures
• Identify aseptic measures utilized in the operating rooms
• Determine general measures that can be used to prevent the development of
infection in the community
INFECTION CONTROL
• Infection control prevents or stops the spread of infections in healthcare
settings. This site includes an overview of how infections spread, ways to
prevent the spread of infections, and more detailed recommendations by type
of healthcare setting. (CDC)
• Often relates to : Chain of Infection, modes of transmission, asepsis, types
of infection and PPE’s
INFECTION CONTROL
• Chain of Infection - how an individual acquires the infectious agents and
includes the infectious agents, the source of infection or its reservoir, how the
organism is transmitted and the organism’s portal of entry into the susceptible
host.
• Chain of Infection
INFECTION CONTROL
• Mode of Transmission – The manner in which the infectious organism is
acquired by the host.
MODE OF TRANSMISSION
• Modes of Transmission
• The three principle routes by which pathogens involved in HAIs are
transmitted are contact, droplet, and airborne.
MODE OF TRANSMISSION
• Contact Transmission
• There are two types of contact transmission:
• Direct contact transmission, pathogens are transferred from one infected person to
another person without a contaminated intermediate object or person.
• Indirect contact transmission happens when pathogens are transferred via a
contaminated intermediate object or person.
• Droplet Transmission
• In droplet transmission, respiratory droplets carrying pathogens transmit infection
when they travel from the respiratory tract of an infectious individual (e.g., by
sneezing or coughing) to susceptible mucosal surfaces of a recipient. Droplets
traditionally have been defined as being larger than 5 m in size.
MODE OF TRANSMISSION
• Airborne Transmission
• Airborne transmission occurs with dissemination of either airborne droplet
nuclei or small particles containing pathogens. Traditionally, air- borne droplets
are defined as being less than or equal to 5 m in size.
STANDARD PRECAUTION
• Standard Precaution – the specific measures used to prevent spread of
infection among all patients and healthcare workers, including measures to
protect them from contaminated blood and other bloody fluids.
Handwashing is the single most important measure to reduce the risks of transmitting pathogens from one patient to
another or from one anatomic site to another on the same patient.
• Wash your hands before you:
•Prepare or eat food
• Treat a cut or wound or tend to someone who is sick
• Insert or remove contact lenses
• Wash your hands after you:
• Use the restroom
• Handle uncooked foods, particularly raw meat, poul-
• try, or fish
• Change a diaper
• Cough, sneeze, or blow your nose
• Touch a pet, particularly reptiles and exotic animals
• Handle garbage
• Tend to someone who is sick or injured
• Wash your hands in the following manner:
• Use warm or hot running water
• Use soap (preferably an antibacterial soap)
• Wash all surfaces thoroughly, including wrists, palms, back of hands, fingers, and under fingernails (preferably
with a nail brush)
• Rub hands together for at least 10 to 15 seconds
• When drying, begin with your forearms and work toward your hands and fingertips, and pat your skin rather
than rubbing to avoid chapping and cracking
TRANSMISSION-BASED PRECAUTIONS
• Within a healthcare setting, pathogens are transmitted by three major routes:
contact, droplet, and airborne. Transmission-Based Precautions are used for
patients who are known or suspected to be infected or colonized with highly
transmissible or epidemiologically important pathogens for which addi- tional
safety precautions beyond Standard Precautions are required to interrupt
transmission within hospitals. There are three types of Transmission-Based
Precautions, which may be used either singly or in combination: Contact
Precautions, Droplet Precautions, and Airborne Precautions.
CONTACT PRECAUTIONS
• Contact transmission is the most important and frequent mode
of transmission of HAIs.
Contact Precautions are used for patients known or sus pected
to be infected or colonized with epidemiologically important
pathogens that can be transmitted by direct or indirect contact.
Examples include multidrug-resistant bacteria, C.
difficile-associated diseases, respiratory syncy- tial virus (RSV)
infection in children, scabies, impetigo, chickenpox or shingles,
and viral hemorrhagic fevers.
DROPLET PRECAUTION
• Droplet Precautions
• Technically, droplet transmission is a form of contact transmission. However, in
droplet transmission, the mechanism of
transfer is quite different than either direct or indirect contact transmission.
Droplets are produced primarily as a result of coughing, sneezing, and talking,
as well as during hospital procedures such as suctioning and bronchoscopy.
Transmission occurs when droplets (larger than 5 m in diameter) containing
microbes are propelled a short distance through the air and become deposited
on another person’s conjunctiva, nasal mucosa, or mouth. Because of their size,
droplets do not remain suspended in the air.
AIRBORNE PRECAUTION
• Airborne Precautions
• Airborne transmission involves either airborne
droplet nuclei or dust particles containing a
pathogen. Airborne droplet nuclei are
small-particle residues (5 m or less in diameter)
of evaporated droplets containing microbes;
because of their small size, they remain suspended
in air for long periods
• Contamination denotes 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 becomes contaminated if they
get in contact with non sterile items.
• Decontamination is 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 is the process of using physical or chemical means to destroy pathogens, excluding spores.
• Sterilization is the process by which all pathogens are destroyed, including the spores.
• Antiseptic a chemical solution inhibits the growth of some microorganisms. Most antiseptics can be used
directly on the skin. (alcohol & iodine)
• HAI any infection that is acquired during the time a patient is admitted in a HA facility. The most common
HAI is UTI.
• Patients Most Likely To Develop Healthcare-Associated Infections
• (Next Slide)
• The highest infection rates are in intensive care unit (ICU) patients. HAI rates are three times higher in adult
and peiadiatric ICUs than elsewhere in the hospital. Listed here are the most vulnerable patients in a hospital
setting:
• Elderly patients
• Women in labor and delivery
• Premature infants and newborns
• Surgical and burn patients
• Patients with diabetes or cancer
• Patients with cystic fibrosis
• Patients having an organ transplant
• Patients receiving treatment with steroids, anticancer drugs, antilymphocyte serum, or radiation
• Immunosuppressed patients (i.e., patients whose immune systems are not functioning properly)
• Patients who are paralyzed or are undergoing renal dialysis or urinary catheterization
• Patients with indwelling devices such as endotracheal tubes, central venous and arterial cathers, and synthetic
implants
• The term “healthcare-associated infection” should not be confused with the term “iatrogenic infection”
(iatrogenic literally meaning “physician-induced”).
• An iatrogenic infection is an infection that results from medical or surgical treatment (i.e., an infection that
is caused by a surgeon, another physician, or some other healthcare worker). Examples of iatrogenic
infections are surgical site infections and urinary tract infections (UTIs) that result from urinary
catheterization of patients. Iatrogenic infections are a type of HAI, but not all HAIs are iatrogenic infections.
The CDC recommend use of the term “healthcare-associated infections” for
infections acquired within any type of healthcare facility. The term replaces the
older term “hospital-acquired infections,” and its synonym, “nosocomial
infections.”
• Occupational exposure is the acquisition or exposure to an infectious agent of a health worker during the
course of work.
• PPE are specialized equipment's and attire used by healthcare workers to protect them from infection.
These include GLOVES , MASKS, GOWNS, GOGGLES.
PPE’S
• Gloves. Gloves can protect both patients and healthcare personnel from exposure to infectious materials
that may be carried on hands. Healthcare personnel should wear gloves when:
• • Anticipating direct contact with blood or body fluids, mucous membranes, nonintact skin, and other poten-
tially infectious materials
• • Having direct contact with patients who are colonized or infected with pathogens transmitted by the
contact route
• • Handling or touching visibly or potentially con- taminated patient care equipment and environmental
surfaces
• Masks. Masks are used for three primary purposes in healthcare settings:
• 1. They are worn by healthcare personnel to protect them from contact with infectious material from
patients.
• 2. They are worn by healthcare personnel when engaged in procedures requiring sterile technique to protect
patients from exposure to pathogens that may be present in a healthcare worker’s mouth or nose.
• 3. They are placed on coughing patients to limit poten- tial dissemination of infectious respiratory secretions
from the patient to others.
•Eye Protection. Types of eye protection include
goggles and disposable or non disposable face shields.
Masks may be used in combination with goggles, or a
face shield may be used instead of a mask and goggles.
Even when Droplet Precautions are not indicated, eye,
nose, and mouth protection are necessary when it is
likely that there will be a splash or spray of any
respiratory secretions or other body fluids. Eye
protection and masks are removed after gloves are
removed.
•Respiratory Protection. Respiratory protection
re- quires the use of a respirator with N95 of higher
filtration to prevent inhalation of infectious particles
(Fig. 12-6).g Do not confuse masks with particulate
respirators. Respirators are recommended when
working with patients with tuberculosis, SARS, and
smallpox, and during the performance of
aerosol-generating procedures on patients with avian
or pandemic influenza.
•Sepsis refers to the presence of
pathogens in blood or tissues, whereas
asepsis means the absence of pathogens.
The two general categories of aseptic
technique— medical and surgical asepsis.
•
• Medical asepsis, or clean technique, involves procedures and practices that reduce the number and
transmission of pathogens. Medical asepsis includes all the precautionary measures necessary to prevent
direct transfer of pathogens from per- son to person and indirect transfer of pathogens through the air or on
instruments, bedding, equipment, and other inanimate objects (fomites).
• Techniques include frequent and thorough handwashing; personal grooming; wearing of clean masks, gloves,
and gowns when appropriate; proper cleaning of supplies and equipment; disinfection; proper disposal of
needles, contaminated materials, and infectious waste; and sterilization.
• Surgical Asepsis
• Surgical asepsis, or sterile technique, includes practices used to render and keep objects and areas sterile
(i.e., free of microbes). Note the differences between medical and surgical asepsis:
• Medical asepsis is a clean technique, whereas surgical asepsis is a sterile technique.
• The goal of medical asepsis is to exclude pathogens, whereas the goal of surgical asepsis is to exclude all
microbes.
• Surgical aseptic techniques are practiced in operating rooms, in labor and delivery areas, and during invasive
procedures.
• Airborne Infection Isolation Rooms
•The preferred placement for patients who are infected
with pathogens that are spread via airborne droplet
nuclei and, therefore, require Airborne Precautions, is in
an airborne infection isolation room (AIIR).
•An AIIR is a single-patient room that is equipped with
special air handling and ventilation systems. AIIRs are
under negative pressure to prevent room air from
entering the corridor when the door is opened, and air
that is evacuated from such rooms passes through
high-efficiency particulate air (HEPA) filters to remove
pathogens. Standard and Airborne Precautions are strictly
enforced.
REFERENCES
• CDC
• WHO
• BURTONS
• TORTORA
• SCOTLAND NATIONAL HEALTH SERVICES
• LAB MANUAL FOR HEALTH SCIENCES