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Unit fourUnit four

Mr. Ahmad AtaMr. Ahmad AtaRN,CNS,MSNRN,CNS,MSN

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Lecture ObjectivesLecture Objectives

At the end this lecture the students will At the end this lecture the students will able to:able to:

Define concept related to asepsis.Define concept related to asepsis. Identify the types of infection.Identify the types of infection. Describe the chain of infection and nursing Describe the chain of infection and nursing

interventions to break the chain.interventions to break the chain. Know CDC and prevention guideline.Know CDC and prevention guideline. Ability to implement technique correctly.Ability to implement technique correctly. Ability to use isolation and precaution system.Ability to use isolation and precaution system.

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Introduction:Introduction:

Micro organisms exist every where in Micro organisms exist every where in the environment: in water, soil, on the environment: in water, soil, on body surface such as skin, intestinal body surface such as skin, intestinal tract, mouth.tract, mouth.

The bacteria which found in The bacteria which found in intestine produce substance called intestine produce substance called bacterocin which are lethal to other bacterocin which are lethal to other bacteria, these bacteria called bacteria, these bacteria called normal floranormal flora..

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INTRDUCTION:INTRDUCTION:

Example of resident bacteria: Example of resident bacteria: staphylococcus epidermidis and staphylococcus epidermidis and cornybacterium xerosis founds in skin.cornybacterium xerosis founds in skin.

Some infections are asymptomatic or Some infections are asymptomatic or sub clinical for example sub clinical for example cytomegalovirus (CMV) which cytomegalovirus (CMV) which transmitted from animal specifically transmitted from animal specifically cats to pregnant woman can lead to cats to pregnant woman can lead to unborn child diseaseunborn child disease

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Definitions terms:Definitions terms:

InfectionInfection: is an invasion of bacteria : is an invasion of bacteria in the body tissue by microorganism in the body tissue by microorganism and their proliferation there.and their proliferation there.

Virulence:Virulence: their ability to produce their ability to produce disease.disease.

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CONTCONT

Communicable disease: Communicable disease: is is condition which transmitted condition which transmitted microorganism to individual by microorganism to individual by direct or indirect contact through air direct or indirect contact through air borne infection, vector or vehicle borne infection, vector or vehicle borne disease. borne disease.

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CONTCONT

Nosocomial infections:Nosocomial infections: Infection Infection associated with the delivery health associated with the delivery health care services in health care facilitiescare services in health care facilities

Example: urinary tract infection due Example: urinary tract infection due to catheterization technique.to catheterization technique.

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CONT:CONT:

Asepsis: IsAsepsis: Is freedom from disease - freedom from disease - causing micro organism order to causing micro organism order to decrease the possibility of decrease the possibility of transferring microorganism.transferring microorganism.

SepsisSepsis: is the opposite of asepsis : is the opposite of asepsis state.state.

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There are two basic types of There are two basic types of asepsis:asepsis:

Medical asepsis:Medical asepsis: includes all type of includes all type of practice intended to confine specific practice intended to confine specific microorganism to specific area in microorganism to specific area in order to limiting number or decrease order to limiting number or decrease transmission of microorganisms.transmission of microorganisms.

Medical asepsis is referred to:Medical asepsis is referred to: Clean: the absence of almost all Clean: the absence of almost all

microorganism.microorganism. Dirty: contaminated the likely Dirty: contaminated the likely

presence microorganism.presence microorganism.

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Examples of medical asepsis: Examples of medical asepsis:

Hand washing: practice that involve Hand washing: practice that involve scrubbing with antimicrobial soup and scrubbing with antimicrobial soup and water.water.

Personal protective equipment: Personal protective equipment: uniform, gown, gloves.uniform, gown, gloves.

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CONTCONT Using anti microbial agent.Using anti microbial agent.

Anti microbial agent: are chemical to Anti microbial agent: are chemical to hat limit the number of infection hat limit the number of infection microorganism by destroying them or microorganism by destroying them or suppressing their growth. suppressing their growth.

antiseptic: inhibit growth but don’t kill antiseptic: inhibit growth but don’t kill micro organism.micro organism.

Disinfectant: chemical destroy active Disinfectant: chemical destroy active micro organism in dead space.micro organism in dead space.

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CONT:CONT:

Surgical asepsis (sterile Surgical asepsis (sterile technique):technique): refer those practice refer those practice that keep an area free of all micro that keep an area free of all micro organism.organism.

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Sterilization techniqueSterilization techniquePurpose: elimination of microorganismsPurpose: elimination of microorganisms

Steam (Autoclaving)Steam (Autoclaving) instruments, dressingsinstruments, dressings

Dry heatDry heat instruments that could be corrodedinstruments that could be corroded

GasGas ethylene oxideethylene oxide if heat sensitivity (rubber, plastic materials,if heat sensitivity (rubber, plastic materials, endoscopic instruments)endoscopic instruments) RadiationRadiation gamma raysgamma rays solutions, catheters, sealed plastic materialssolutions, catheters, sealed plastic materials

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Type of organism causing Type of organism causing infection:infection:

Bacteria: the most common infection Bacteria: the most common infection causing microorganism can live in causing microorganism can live in water, soil, air.water, soil, air.

Viruses: consist primarily of nucleic Viruses: consist primarily of nucleic acid ( rhino virus cause common acid ( rhino virus cause common called).called).

Fungi.Fungi. Parasite.Parasite.

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Classification of bacteria:Classification of bacteria:

1) Shape: spherical (cocci), rod 1) Shape: spherical (cocci), rod shaped (bacilli), corkscrew shaped (bacilli), corkscrew (spirochetes).(spirochetes).

2) Reaction to gram stain: gram 2) Reaction to gram stain: gram negative and gram positive.negative and gram positive.

3) Need of oxygen: aerobic and 3) Need of oxygen: aerobic and anaerobic. anaerobic.

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Types of infection:Types of infection:

1) Local infection: is limited to the 1) Local infection: is limited to the specific part of the body where specific part of the body where microorganisms remain. microorganisms remain.

2) Systematic infection: when 2) Systematic infection: when microorganisms spread and damage microorganisms spread and damage different part of body.different part of body.

Bacteremia: when culture of persons Bacteremia: when culture of persons blood reveals microorganisms. blood reveals microorganisms.

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CONTCONT

Septicimia: when Bacteremia Septicimia: when Bacteremia results in systematic infection.results in systematic infection.

3) Acute infection: infection appears 3) Acute infection: infection appears suddenly or in short time.suddenly or in short time.

4) Chronic infection: infection may 4) Chronic infection: infection may occur slowly and takes long time.occur slowly and takes long time.

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Chain of infection:Chain of infection:

1. Etiologic agent: bacteria, virus.1. Etiologic agent: bacteria, virus. Factors effect on the infection Factors effect on the infection

agentagent:: Number of organism.Number of organism. Virulence.Virulence. Pathogenicity: ability to produce Pathogenicity: ability to produce

disease.disease. Invasiveness: the ability of Invasiveness: the ability of

microorganism to enter the body.microorganism to enter the body.

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CONT CONT

2. Reservoir2. Reservoir:: Human, animal, plants and general Human, animal, plants and general

environment.environment. Example: the person who have influenza Example: the person who have influenza

virus is frequently spread to other virus is frequently spread to other people.people.

Insects, birds and other animals are Insects, birds and other animals are common reservoir of infection.common reservoir of infection.

Food, water and milk also can be Food, water and milk also can be reservoirs.reservoirs.

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CONT CONT

3. portal exist:3. portal exist:

After microorganism leave its After microorganism leave its reservoir, its need to method to reach reservoir, its need to method to reach to another person these methods are:to another person these methods are:

Direct transmissionDirect transmission: involves direct : involves direct transfer of microorganism from transfer of microorganism from person to another through, touching, person to another through, touching, biting, kissing or sexual intercourse biting, kissing or sexual intercourse sneezing and coughing.sneezing and coughing.

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CONT CONT

3. portal exist:3. portal exist:

After microorganism leave its After microorganism leave its reservoir, its need to method to reach reservoir, its need to method to reach to another person these methods are:to another person these methods are:

Direct transmissionDirect transmission: involves direct : involves direct transfer of microorganism from transfer of microorganism from person to another through, touching, person to another through, touching, biting, kissing or sexual intercourse biting, kissing or sexual intercourse sneezing and coughing.sneezing and coughing.

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Indirect transmission may be:Indirect transmission may be: vehicle born transmission: is any vehicle born transmission: is any

substance that serves as substance that serves as intermediate means to transport intermediate means to transport infectious agent such as surgical infectious agent such as surgical instrument, cooking, water and milk.instrument, cooking, water and milk.

Vector borne transmission: is animal Vector borne transmission: is animal or flying or insect that serve or flying or insect that serve intermediate mean of transportation.intermediate mean of transportation.

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Common portal exist:Common portal exist: RespiratoryRespiratory GastrointestinalGastrointestinal Genitourinary tract.Genitourinary tract. Blood Blood Breaks skin.Breaks skin.

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CONT CONT

4) Portal entry:4) Portal entry: microorganism microorganism must enter the body through same must enter the body through same route that exist.route that exist.

5) Susceptible host5) Susceptible host: is any person : is any person who is at risk for infection who is at risk for infection

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Stages of infection:Stages of infection:

1.1. Incubation period: organism growing Incubation period: organism growing and multiplying.and multiplying.

2.2. Prodromal stage: person is most Prodromal stage: person is most infectious and non specific sign and infectious and non specific sign and symptom.symptom.

3.3. Full stage of illness: Full stage of illness: presence of specific sign and presence of specific sign and symptom.symptom.

4.4. ConvalescentConvalescent period :recovery from period :recovery from infection.infection.

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Body defense against Body defense against infection are:infection are:

1) Non specific defense such as:1) Non specific defense such as: Anatomic barrier.Anatomic barrier. Inflammatory response.Inflammatory response.

2) Specific defense:2) Specific defense: Anti bodyAnti body Cell mediated defense.Cell mediated defense.

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Factors increase Factors increase susceptibility to infection:susceptibility to infection:

Age.Age. Intact skin.Intact skin. Normal ph level.Normal ph level. Decreased WBC.Decreased WBC. StressStress

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Assessment:Assessment:

Lapratory data indicating infection:Lapratory data indicating infection: Increased leukocyte ( 4.500 – 11,000).Increased leukocyte ( 4.500 – 11,000). Increased specific type of leukocyte.Increased specific type of leukocyte. Erythrocyte sedimentation rate. Erythrocyte sedimentation rate. Positive culture in blood, urine and Positive culture in blood, urine and

sputum.sputum.

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Sign of local infection includes:Sign of local infection includes:

Swelling Swelling PainPain TendernessTenderness Palpable heat at infected area.Palpable heat at infected area. Loss of function body part in affected area.Loss of function body part in affected area.

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Sign of systematic infectionSign of systematic infection:: FeverFever Increased pulse and respiratory rate Increased pulse and respiratory rate Malaise and loss of energyMalaise and loss of energy Enlargement and tenderness of Enlargement and tenderness of

lymph node.lymph node.

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Nursing diagnosis:Nursing diagnosis: Risk for infection related to broken Risk for infection related to broken

skin.skin. Risk for infection related to Risk for infection related to

immunosuppression immunosuppression Fever related to physiological effect Fever related to physiological effect

of infection.of infection.

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Planning:Planning: Demonstrate effective hand washing.Demonstrate effective hand washing. Identify sign of infection.Identify sign of infection. Maintain adequate nutritional intake.Maintain adequate nutritional intake. Demonstrate proper disposals of soiled articlesDemonstrate proper disposals of soiled articles Use appropriate disinfecting technique.Use appropriate disinfecting technique. Demonstrate awareness of immunization.Demonstrate awareness of immunization.

Implementation Implementation Preventing Nosocomial infection Preventing Nosocomial infection Hand washing.Hand washing.

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Implementation:Implementation:

Teaching about infection control:Teaching about infection control: Wash hand.Wash hand. Preventing Nasocomial infection.Preventing Nasocomial infection. Invasive medical device.Invasive medical device. Antibiotic Resistant OrganismAntibiotic Resistant Organism Strategies to protect patients Strategies to protect patients

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Wearing personal protective Wearing personal protective equipment equipment ((PPE)PPE) such as: such as:

Uniforms.Uniforms. GownGown Mask and gloves.Mask and gloves. Head capsHead caps

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Isolation Precautions

Patient Transport

Linen & laundry Waste Management

Decontamination

PPE

Hand hygiene

Patient placement

Isolation Precautions

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Perform hand hygiene:Perform hand hygiene: Before and after patient contactBefore and after patient contact After removing gloves or any other PPE itemAfter removing gloves or any other PPE item After touching blood, body fluids, secretions, After touching blood, body fluids, secretions,

excretions, and contaminated items, whether or excretions, and contaminated items, whether or not gloves are wornnot gloves are worn

After contact with patient surroundingsAfter contact with patient surroundings Routine hand hygiene by alcohol hand rub Routine hand hygiene by alcohol hand rub

(preferably) or by washing hands with soap (preferably) or by washing hands with soap and waterand water

Perform hand hygiene after touching Perform hand hygiene after touching surgical mask/ N 95 respirator or before surgical mask/ N 95 respirator or before touching the facetouching the face

Hand hygiene

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PPE - PPE - GlovesGloves

1.1. When expose to blood, body When expose to blood, body fluids, secretions, excretions, fluids, secretions, excretions, mucous membranes and mucous membranes and non-intact skin, and non-intact skin, and contaminated itemscontaminated items

3.3. Perform hand Perform hand hygiene immediately hygiene immediately after glove removalafter glove removal

2. Change gloves when heavily contaminated

4. Disposable glove should not be reused

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PPE - GownPPE - Gown

1.1. When splashes or When splashes or sprays of blood and sprays of blood and body fluids, secretions body fluids, secretions and excretions to skin and excretions to skin and working clothes and working clothes are likelyare likely

2.2. When working When working clothes has clothes has substantial contact substantial contact with patient, with patient, environmental environmental surfaces or patient surfaces or patient itemsitems

3. Select an appropriate gown for the procedure

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Surgical masks and eye protection: Surgical masks and eye protection: When splashes or sprays of blood When splashes or sprays of blood

and body fluid, secretions and excretions and body fluid, secretions and excretions

are likelyare likely

Droplet precautionsDroplet precautions Airborne isolation precautionsAirborne isolation precautions

Change PPE promptly if heavily Change PPE promptly if heavily

contaminated during the procedurecontaminated during the procedure

PPE – Respiratory PPE – Respiratory & eye protection& eye protection

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Strategy of Strategy of Patient Patient

PlacementPlacement Isolate suspected or Isolate suspected or confirmed cases in a confirmed cases in a negative pressure isolation negative pressure isolation roomroom

When single rooms are fully When single rooms are fully occupiedoccupied

Cohort patients with same confirmed Cohort patients with same confirmed diagnosis in same cubicles, maintaining a diagnosis in same cubicles, maintaining a minimum of 1 metre distance from each minimum of 1 metre distance from each otherother

Confirmed and suspected cases should be Confirmed and suspected cases should be nursed in separatenursed in separate

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Transport of Suspected or Transport of Suspected or confirmed patientconfirmed patient

3. Inform the receiving service/department of concern beforehand

4. Clean / disinfect transport vehicles after use

LimitLimit patient transport unless patient transport unless clinically indicatedclinically indicated

Encourage patients to wear Encourage patients to wear surgical surgical maskmask if no contraindication if no contraindication

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DecontaminatioDecontamination - n -

Environmental Environmental ControlControl

Disinfect isolation and procedure rooms Disinfect isolation and procedure rooms after use by a high risk patientafter use by a high risk patient

Clean and disinfect the environment regularly Clean and disinfect the environment regularly and additional session for frequently touched and additional session for frequently touched surfacessurfaces

Contaminated area should be disinfected by one Contaminated area should be disinfected by one part of hypochlorite solution add in 49 parts of part of hypochlorite solution add in 49 parts of waterwater

If blood spills occur:If blood spills occur: Use one part of hypochlorite solution add in 49 Use one part of hypochlorite solution add in 49

parts of water for non-metallic and 70% alcohol for parts of water for non-metallic and 70% alcohol for metallic items.metallic items.

If spills involve large amount of blood, the blood If spills involve large amount of blood, the blood should be removed by disposable material soaked should be removed by disposable material soaked with one part of hypochlorite solution add in 4 with one part of hypochlorite solution add in 4 parts of water before further cleaning and parts of water before further cleaning and disinfectiondisinfection

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Linen and laundry managementLinen and laundry management

Proper handling of soiled linen: Proper handling of soiled linen: Avoid sortingAvoid sorting Minimum agitation and shakingMinimum agitation and shaking Well pack soiled linen to prevent leakageWell pack soiled linen to prevent leakage Wear appropriate PPE when handling soiled linenWear appropriate PPE when handling soiled linen Clean linen should be transported and stored Clean linen should be transported and stored

separately to prevent recontamination separately to prevent recontamination

Follow hospital policy Follow hospital policy

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Patient teaching for medical asepsis at Patient teaching for medical asepsis at home.home.

For further information please visit:For further information please visit:

www.cdc.orgwww.cdc.org

Center of disease control and prevention Center of disease control and prevention

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PLEASE REVIEW CHAPTER 27 PLEASE REVIEW CHAPTER 27 FROM REFFRENCES BOOKFROM REFFRENCES BOOK

THE ENDTHE END