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Medical and Surgical Asepsis. Metropolitan Community College NURS 1510 Nancy Pares, RN, MSN. Define Terms. Asepsis… .absence of germs or micro organisms Medical asepsis…. technique or procedure which reduces the number of micro organisms and thus prevents the spread of disease

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Medical and surgical asepsis

Medical and Surgical Asepsis

Metropolitan Community College

NURS 1510

Nancy Pares, RN, MSN

Define terms

Define Terms

  • Asepsis…

    • .absence of germs or micro organisms

  • Medical asepsis….

    • technique or procedure which reduces the number of micro organisms and thus prevents the spread of disease

  • Surgical asepsis….

    • Protection against infection before, during and after a surgical procedure.

  • Infection

    • Invasion of the body by pathogens

Classifications of pathogens

Classifications of pathogens

  • Bacteria

    • One celled, multiply rapidly, classified by shape and how they cluster together

  • Virus

    • Smallest of all pathogens; replication within the host

  • Fungi

    • Organisms that exist by feeding on organic matter

  • Protozoa

    • Single celled organism; spread by feces,

Pathogens cont

Pathogens cont

  • Rickettsia

    • Organisms multiply in animal hosts and transmit to humans through bites

  • Helminths

    • Parasitic worms found in soil; transmitted via hand to mouth

  • Mycoplasmas

    • No cell wall; multi shaped

Other causes of infection

Other causes of infection:

  • Chemical agents

    • Pesticides, food additives, medications, industrial

  • Physical agents

    • Heat, noise, radiation, and machines

Factors that promote pathogen growth

Factors that promote pathogen growth

  • Moisture

  • Organic matter

  • Warmth

  • Darkness

  • Oxygen

  • Alkaline ph

The spread of infection six links

The Spread of Infection: Six Links

Infectious agents

  • Pathogens

  • Normal flora that become pathogenic


  • Where pathogens live and multiply

  • May be living

    • Humans, animals, insects

    • May be nonliving

      • Food, floors, equipment, contaminated water

The spread of infection

The Spread of Infection

Mode of Transmission:

  • Contact

    • Direct – touching, kissing, sexual contact

    • Indirect – contact with a fomite

  • Droplet: Cough, sneeze

  • Airborne: Via air conditioning, sweeping

Portal of Exit:

  • Via

    • Bodily fluids

    • Coughing, sneezing, diarrhea

    • Seeping wounds

    • Tubes, IV lines

Spread of infection

Spread of Infection

Susceptible Host:

  • Person with inadequate defense

  • Three determining factors:

    • Virulence

    • Number of organisms

    • Host’s defenses

Portal of Entry:

  • Eye, nares, mouth, vagina, cuts, scrapes

  • Wounds, surgical sites, IV or drainage tube sites

  • Bite from a vector

Stages of infection

Stages of Infection

  • Incubation: From time of infection until manifestation of symptoms; can infect others

  • Prodromal: Appearance of vague symptoms; not all diseases have this stage

  • Illness: Signs and symptoms present

  • Decline: Number of pathogens decline

  • Convalescence: Tissue repair, return to health

Classification of infections

Classification of Infections

By Location:

  • Local

    • Occurs in a limited region in the body (e.g., urinary tract infection)

  • Systemic

    • Spread via blood or lymph

    • Affects many regions (e.g., septicemia)

Classification of infections by duration

Classification of Infections by Duration

Acute - Rapid onset of short duration

  • e.g., Common cold

    Chronic - Slow development, long duration

  • e.g., Hypertension, diabetes mellitus, osteomyelitis

    Latent - Infection present with no discernible symptoms

  • e.g., HIV/AIDS

Chain of infection

Chain of Infection

  • Presence of pathogen

  • Reservoir (source)

    • Pathogen survive and multiply

  • Portal of exit from reservoir

    • Direct, indirect, airborne

  • Mode of transmission

  • Portal of entry to host

  • Susceptible host

Signs and symptoms of infection

Signs and symptoms of infection

  • Local

    • Limited to a defined area; resembles inflammation

    • Ex: redness, warmth, tenderness, swelling

  • Systemic

    • Affects the entire body and may involve multiple organs, goes through the stages of infection

    • Ex: fever, anorexia, n/v, lymph node swelling

Inflammatory response stages

Inflammatory response stages

  • Vascular

    • Aterioles dilate, blood and WBC go to area

    • s/s= redness and warmth

  • Inflammation

    • Tissue dies causing release of chemicals (histamine and prostaglandins) which allow blood vessel permeability. Cells, proteins, fluids enter the tissue spaces blocking lymphatics to create a ‘wall’ against infection

  • Phagocytosis

    • WBC enter the tissues causing release of pyrogens (fever); exudates form discharge; healing occurs

Nosocomial infection

Nosocomial Infection

An infection acquired in a health-care facility

  • Cost to the health-care system = $4.5 billion/year

  • Leading cause of death

  • Preventable with use of aseptic principles/ techniques

    Exogenous Nosocomial Infection: Pathogen acquired from health-care environment

    Endogenous Nosocomial Infection: Normal flora multiply and cause infection as a result of treatment

Nosocomial subcatagories


  • Iatrogenic

    • Infection from a procedure

      ex: UTI from foley insertion

  • exogenous

    • Infection from non-normal flora

      ex: clostridium

  • Endogenous

    • Infection when normal flora altered

      ex: yeast infection

Causes of nosocomial infections

Causes of nosocomial infections

  • UTI

    • Insertion, contamination of drainage system, improper cleansing

  • Surgical site

    • Improper technique for handwashing or dressing change

  • URI

    • Improper handwashing or suctioning technique

  • IV

    • Improper handwashing or site care

Causes cont

Causes cont

  • Extended LOS in hospital

  • Multiple care givers

  • Antibiotic choices and over use

  • Improper medical or surgical asepsis

Who is at risk for nosocomial infection

Who is at risk for nosocomial infection?

  • Age

    • Very young and very old

  • Poor nutritional status

  • Smoker, ETOH use

  • Existing co-morbid conditions

  • Chronic illnesses, chemo,radiation

  • Clients with invasive procedures

  • Clients with prolonged stress

Nurse s role in

Nurse’s role in

  • Containing nosocomial infections


  • Controlling/eliminating reservoirs

    • Bathing, dressing changes, patent drainage systems

  • Controlling the portal of exit

    • Cover mouth/nose, wear mask, client teaching

  • Controlling transmission

    • Do not share equipment, proper handling of linens, HANDWASHING

  • Controlling portal of entry

    • Maintain skin integrity, position changes, proper wiping techniques, maintain drainage integrity

Nurses role in

Nurses role in

  • Protecting susceptible host

    • Protect natural defenses-skin, mucous membranes, fluid intake

    • Encourage cough and deep breathing

    • Change position

    • Oral hygiene

    • Promote rest and sleep

    • Reduce client stress

Lines of defense against infection

Lines of Defense Against Infection

Primary Defenses:

  • Anatomical features, limit pathogen entry

    • Intact skin

    • Mucous membranes

    • Tears

    • Normal flora in GI tract

    • Normal flora in urinary tract

Lines of defense against infection1

Lines of Defense Against Infection

Secondary Defenses:

  • Biochemical processes activated by chemicals released by pathogens

    • Phagocytosis

    • Complement cascade

    • Inflammation

    • Fever

Lines of defense against infection2

Lines of Defense Against Infection

Tertiary Defenses:

  • Humoral immunity

    • B-cell production of antibodies in response to an antigen

  • Cell-mediated immunity

    • Direct destruction of infected cells by T cells

Factors that increase infection risk

Factors that Increase Infection Risk

  • Developmental stage

  • Breaks in the skin

  • Illness/injury, chronic disease

  • Smoking, substance abuse

  • Multiple sex partners

  • Medications that inhibit/decrease immune response

  • Nursing/medical procedures

Factors that support host defenses

Factors that Support Host Defenses

  • Adequate nutrition

    • To manufacture cells of the immune system

  • Balanced hygiene

    • Sufficient to decrease skin bacterial count

    • Not overzealous; causes skin cracking

  • Rest/exercise

  • Reducing stress

  • Immunization

Preventing infection implementing medical asepsis

Preventing Infection: Implementing Medical Asepsis

Medical asepsis:

  • “A state of cleanliness that decreases the potential for the spread of infections”

  • Promoted through:

    • Maintaining a clean environment

    • Maintaining clean hands

    • Following Centers for Disease Control (CDC) guidelines

Maintaining a clean environment

Maintaining a Clean Environment

  • Clean spills and dirty surfaces promptly

  • Remove pathogens through chemical means (disinfect)

  • Remove clutter

  • Consider supplies brought to the client room as contaminated

  • Consider items from the client’s home as contaminated

Wash your hands

Wash Your Hands

  • When you arrive in the unit

  • When you leave the unit

  • Before and after restroom use

  • Before and after client contact

  • Before and after contact with client belongings

Wash your hands1

Wash Your Hands

  • Before gloving

  • After glove removal

  • Before and after touching your face

  • Before and after eating

  • After touching a contaminated article

  • When you see visible dirt on your hands

Hand washing guidelines

Hand Washing Guidelines

  • Wash for at least 15 seconds in nonsurgical setting; 2-6 minutes in surgical setting

  • Use warm water, not hot

  • Apply soap to wet hands

  • Use friction

  • Clean beneath fingernails and jewelry

  • Rinse soap

  • Towel or hand dry

Implementing cdc guidelines

Implementing CDC Guidelines

  • Standard precautions (universal precautions)

  • Protects health-care workers from exposure

  • Decreases transmission of pathogens

  • Protects clients from pathogens carried by health-care workers

Transmission based precautions

Transmission-Based Precautions

Contact Precautions:

Pathogen is spread by direct contact

  • Sources of infection - draining wounds, secretions, supplies

  • Precautions include:

    • Possible private room

    • Clean gown and glove use

    • Disposal of contaminated items in room

    • Double-bag linen and mark

Transmission based precautions1

Transmission-Based Precautions

Droplet Precautions:

Pathogen is spread via moist droplets:

  • Coughing, sneezing, touching contaminated objects

  • Precautions include:

    • Same as those for contact

    • Addition of mask and eye protection within 3 ft of client

Transmission based precautions2

Transmission-Based Precautions

Airborne Precautions:

Pathogen is spread via air currents

  • Transmission via ventilation systems, shaking sheets, sweeping

  • Precautions include:

    • Same as those for contact, with addition of special mask

Protective isolation

Protective Isolation

“Reverse” isolation:

  • Protects the client from organisms

  • Used with immune-compromised client population

  • Precautions include:

    • Private room likely

    • Nurse not assigned to clients with active infection

    • Mask, handwashing, clean/sterile gown, gloves

    • No reuse of gowns, gloves

Implementing surgical asepsis

Implementing Surgical Asepsis


  • Creation of a sterile environment

  • Use of sterile equipment/supplies

  • Sterilization of reusable supplies

  • Surgical hand scrub

  • Surgical attire

  • Sterile gloves

  • Sterile field

  • Use of sterile technique

Standard precautions

Standard Precautions

  • Protective barriers

  • Change gloves


  • Discard sharps correctly

  • Double bag

  • Cover breaks in the skin

Body specific immune defenses

Body specific immune defenses

  • Organs most vital to a functional immune system

    • Liver…produces immunoglobulins (antibodies)

    • Lymph nodes…produce and circulate lymphocytes

    • Bone marrow and thymus..form immune sys. Cells

    • Spleen…removes dead cells and foreign molecules



  • Humoral

    • Attack bacteria and virus’ at the extracellular level

    • B cell lymphocytes cause synthesis of antibodies leading to destruction of antigens and creation of antibodies that subsequently protect from the same antigen

    • Five classes of antibodies

      • IgG, IgM, IgA, IgE, and IgD. IgG is most abundant and crosses the placenta provides passive immunity for newborns.

Immunities cont

Immunities, cont

  • Cell mediated immunity

    • Fights pathogens inside the cell

    • T cells (a form of WBC) binds with the antigen, becomes sensitized and releases lymphokines which attract macrophages that destroy the antigen

    • Three types of T cells

      • Cytotoxic, helper T and suppressor T

Types of immune responses

Types of immune responses

  • Natural

    • Present at birth, genetically determined

  • Passive

    • Acquired through introduction of antibodies, ie mother passes to infant

  • Active

    • Antibodies develop within the body to neutralize or destroy an infective agent

  • Acquired

    • Exposure to an antigen or passive injection of immunoglobulin

  • Artificial

    • Produced by vaccination

Principles of medical and surgical asepsis

Principles of medical and surgical asepsis

  • Medical asepsis

    • Practice which reduces the number, growth and spread of micro organisms

    • Referred to as ‘clean’ technique’

    • Handwashing 2 min-15 sec

  • Surgical asepsis

    • Total elimination of all micro organisms, spores

    • Sterile field (OR, L&D, etc), gown and glove

    • Methods:

      • Steam, radiation, chemicals, or gas

Cdc guidelines standard

CDC Guidelines: Standard

  • Apply to :

    • All body fluids, secretions (except perspiration)

    • Blood

    • Non intact skin

    • Mucous membranes

  • Gloves worn:

    • To provide a protective barrier

    • To reduce opportunities for ‘nurse’ organism transfer to client




  • The single most important measure to reduce the risk of transmission!

  • Nurses do hands on work, so always wash first!

Respiratory hygiene cough etiquette

Respiratory hygiene/cough etiquette

  • Cover your nose and mouth with your elbow.

  • Use tissues to contain respiratory secretions and dispose into the nearest waste container after use.

  • Perform hand hygiene after contact with any contaminated materials/objects

Proper handwashing

Proper handwashing

  • Turn on slow, steady stream of warm water

  • Moisten hands with water, then apply soap

  • Rub hands together vigorously for at least 15 seconds

  • Rinse under water

  • Use a clean paper towel or air dryer to dry hands

Waterless hand rub

Waterless hand rub

  • May use when hands are not visibly soiled

  • Apply adequate amount to palm of one hand

  • Rub hands together, covering all surfaces of hands and fingers (including under the nails) until hands are dry

  • Do not rinse with water

  • May be used 5-10 times before washing with soap and water is required.

Case study

Case Study

  • Admitting calls to tell you that they have a client who previously cultured positive for MRSA in their urine. What precaution do you place this client in?

  • What if the MRSA was positive in the sputum?

Case study1

Case Study

  • You have a client that has very runny stools. The doctor orders a stool culture.

  • What additional information can you supply the lab?

  • What precautions would you place this patient in?

Case study2

Case study

  • Client presents to ED with high fever, headache, body aches and non-productive cough. Client states the her husband just returned from a business trip in China.

  • First thought?

  • Precautions?

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