Chapter 9: Medical Asepsis Flashcards
What is medical asepsis?
Clean technique that includes procedures used for reducing the number of organisms and preventing their transfer
Includes proper hand hygiene, barrier techniques, and routine environmental cleaning
What places a PT at risk for infection?
Age, nutritional status, stress, disease processes, and forms of medical therapy
Health care-associated infections (HAIs)
Infections that result from staff, PTs, and environmental factors that support a high population of pathogens that are resistant to antibiotics
The chain of infection 6 elements
- An infectious agent or pathogen
- A reservoir or source for pathogen growth
- A portal of exit from the reservoir
- A mode of transmission
- A portal of entry to the host
- A susceptible host
In patient care, it is important to use infection control practices to break an element of the chain so as not to transmit infection
Medical asepsis practices for infectious agent (pathogenic organism capable of causing disease; element 1)
Clean contaminated objects
Clean, disinfect, and sterilize
Medical asepsis practices for reservoir (site or source of microorganism growth; element 2)
Perform hand hygiene before and after PT contact w/ appropriate antiseptic (e.g., chlorhexidine), or soap and water
Control sources of body fluids and drainage
Bathe PT with soap and water, chlorhexidine, or disposable bath
Change soiled dressings
Dispose soiled tissues, dressings, or linen in moisture-resistant bags
Place syringes, uncapped hypodermic needles, and intravenous needles in designated puncture-proof containers
Keep table surfaces clean and dry
Do not leave bottled solutions open for prolonged periods
Keep solutions tightly capped
Keep surgical wound drainage tubes and collection bags patent
Empty and dispose of drainage suction bottles according to agency policy
Medical asepsis practices for portal of exit (means by which microorganisms leave a site; element 3) Respiratory practices:
Avoid talking, sneezing, or coughing directly over wound or sterile dressing field
Cover nose and mouth when sneezing or coughing
Wear mask if suffering respiratory tract infection
Medical asepsis practices for portal of exit (means by which microorganisms leave a site; element 3) Urine, feces, emesis, and blood practices:
Wear clean gloves when handling blood and body fluids
Wear gowns and eyewear if there is a chance of splashing fluids
Handle all laboratory specimens as if infectious
Medical asepsis practices for transmission (means of spread; element 4)
Reduce microorganisms spread:
- ) perform hand hygiene
- ) use personal set of care items for each PT
- ) avoid shaking bed linen or clothes; dust with damp cloth
- ) avoid contact of soiled item with uniform
- ) discard any item that touches the floor
- ) follow standard precautions or select transmission-based isolation precautions
Medical asepsis practices for portal of entry (site through which microorganisms enter a host; element 5) Skin & mucosa:
Maintain skin and mucous membranes integrity, lubricate skin, offer frequent hygiene, turn and position
Cover wounds as needed
Clean wound sites thoroughly
Dispose of used needles in puncture-proof container
Medical asepsis practices for portal of entry (site through which microorganisms enter a host; element 5) Urinary:
Keep all drainage systems closed and intact, maintaining downward flow
Medical asepsis practices for host (PT; element 6)
Reduce susceptibility to infection
Provide adequate nutrition
Ensure adequate rest
Promote body defenses against infection
Provide immunizations
Cultural view and practices
Some may choose to rely on alternative health care practices
Provide proper teaching to ensure understanding of the therapeutic purpose of isolation
EX: isolation of a loved one may be considered disrespectful and uncaring behavior in collectivistic cultures
Use of alcohol based products vs. soap
Alcohol-based products are more effective for standard hand washing or hand antisepsis than soap or antiseptic soap
Brisk alcohol based rinses or gels containing emollients cause substantially less skin irritation and dryness than plain antimicrobial soaps
Soap and water is still necessary for hand hygiene if hands are visibly soiled or when caring for PTs infected with C. Diff
Safety guidelines
Do not wear artificial nails/extenders due to bacterial buildup
Nails should be no longer than 1/4 an inch, nail polish should not be chipped
Cover mouth and nose when coughing or sneezing, use tissues- dispose of- then wash hands
Use barrier protection when there is risk for splashing
Surgical hand antisepsis
Use of antiseptic hand wash or antiseptic hand rub before surgery by surgical personal to eliminate transient and reduce resident hand flora
Factors involved in the decision to perform hand hygiene:
- The intensity or degree of contact with PTs or contaminated objects
- The amount of contamination that may occur with the contact
- The PT or healthcare workers susceptibility to infection
- The procedure or activity to be performed
Standard precautions for TB
Suspect TB in respiratory infections lasting longer than 3 weeks accompanied by suspicious S/S (e.g., unexplained wt. loss, night sweats, fever, and a productive cough often steamed with blood
Consider the potential for infectious pulmonary or laryngeal TB from documented positive acid-fast bacilli (AFB) smear or culture, cavitation on chest x-ray film, or history of recent TB exposure
PT is put on airborne precautions in an isolation room with negative-pressure
Caregivers must wear special respirators
QFT-GIT (gold test) is recommended to test because it is not subject to reader bias
Airborne precautions (droplet nuclei smaller than 5 microns)
EX: measles, chickenpox (varicella), disseminated varicella zoster, pulmonary or laryngeal TB
Barrier protection: private room, negative-pressure airflow of at least 6-12 exchanges per hour via HEPA filtration; mask or respiratory protection device, N95 respirator (depending on condition)
Droplet precautions (droplets larger than 5 microns; being within 3 feet of PT)
EX: diphtheria (pharyngeal), rubella, streptococcal pharyngitis, pneumonia or scarlet fever in infants and young children, pertussis, mumps, mycoplasma pneumonia, meningococcal pneumonia or sepsis, pneumonic plaque
Barrier protection: private room or cohort PTs, mask or respirator (refer to policy)
Contact precautions (direct PT or environmental contact)
EX: colonization or infection with multidrug-resistant organisms such are VRE and MRSA, C. Diff, shigella, and other enteric pathogens, major wound infections, herpes simplex, scabies, varicella zoster (disseminated), resp. syncytial virus in infants, young children or immunocompromised adults
Barrier protection: private room or cohort PTs, gloves, gowns. PTs may leave their room for procedures or therapy if infectious material is contained or covered and placed in a clean gown and hands cleaned
Protective environment
EX: allogeneic hematopoietic stem cell transplants
Barrier protection: private room, positive airflow with >= 12 air exchanges per hour. HEPA filtration for incoming air, mask to be worn by PT when out of room during times of construction in area
Pediatric considerations
Use simple explanations
Allow PT to see your face before applying PPE
Gerontological considerations
Allow PT to see your face before applying PPE to decrease confusion
Assess need to close door (negative airflow room)
