Timby Fundamental Nursing Skills and...

Fundamental Nursing Skills and Concepts

Collected By Mr. Bader A. El safadi

2019 - 2020

Islamic University of Gaza

Faculty of Nursing

Chapter 10

Asepsis

Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 2 First semester 19 - 20

Islamic University of Gaza Faculty of Nursing

Preventing infections is one of the most important

priorities in nursing

Microorganisms :

living animals or plants visible only with a microscope

( also commonly called germs )

Everywhere: in the air, soil, and water, and on and within

virtually everything and everyone

Once Microorganisms invade , one of three events occur

1. The body’s immune defense mechanisms eliminate them

2. They reside within the body without causing disease

3. They cause an infection or infectious disease Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 3 First semester 19 - 20

Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 4

Types of Microorganisms

Microorganisms are divided into two main

groups:

1. Non Pathogens or Normal flora

Harmless , beneficial microorganism .

2. Pathogens Microorganism that cause illness

Have high potential for causing infectious

(communicable) diseases.

also called contagious diseases. First semester 19 - 20


Types of Microorganisms

Bacteria

Viruses

Fungi

Rickettsia

Protozoans

Mycoplasmas

Helminthes

First semester 19 - 20


Many pathogens have mutated to adapt to

hostile environments and unfavorable living

conditions.

Such adaptability has ensured that they

continue to pose a threat to humans.

A spore is a temporarily inactive microbial life

form that can resist heat and destructive

chemicals and survive without moisture.



Chain of Infection By interfering with the conditions that continue the

transmission of microorganisms, humans can avoid acquiring

infectious diseases.

The six essential components of the chain of infection

(sequence that enables the spread of disease-producing

microorganisms) must be in place if pathogens are to be

transmitted from one location or person to another:

1. An infectious agent

2. A reservoir for growth and reproduction

3. An exit route from the reservoir

4. A mode of transmission

5. A port of entry

6. A susceptible host ( Fig.10-2)



Chain of Infection ……cont'd

1. Infectious Agents

Some microorganisms are less dangerous than others.

For example, intestinal bacteria help produce vitamin K, which, in turn,

helps control bleeding.

2. Reservoir

A reservoir is a place where microbes grow and reproduce,

providing a haven for their survival. Examples:

skin,

shafts of hair

open wounds

blood

lower digestive tract

nasal passages



Chain of Infection …….. cont'd

3. The exit route

is how microorganisms escape from their original

reservoir and move about

4. A mode of transmission

is how infectious microorganisms move to another

location. See table 10-1

5. The port of entry

is where microorganisms find their way onto or into a

new host, facilitating their relocation. One of the most

common ports of entry is an opening in the skin or

mucous membranes.



Chain of Infection…… cont'd

6. Susceptible Host

Humans become susceptible to infections when their defense

mechanisms are diminished or impaired. A susceptible host, is one

whose biologic defense mechanisms are weakened in some way,

a susceptible host include those who

1. Are burn victims

2. Have suffered major trauma

3. Require invasive procedures such as endoscopy

4. Need indwelling equipment such as a urinary catheter

5. Receive implantable devices such as intravenous catheters

6. Are given antibiotics inappropriately, which promotes microbial resistance

7. Are receiving anticancer drugs and anti-inflammatory drugs such as corticosteroids that suppress the immune system

8. Are infected with HIV


Secind semester 15- -16 Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 13


Factors affecting susceptibility to infection

1. Inadequate nutrition.

2. Poor hygiene practices.

3. Suppressed immune system.

4. Prematurity.

5. Advanced age.

6. Compromised skin integrity.

7. Diminished blood circulation



Asepsis

Nosocomial Infections

infections acquired while a person is receiving care in

a health care agency

Asepsis

“Practices that decrease or eliminate infectious agents,

their reservoirs, and vehicles for transmission”.

It is a major method for controlling infection.

Health care professionals use medical and surgical

asepsis to prevent spread of infections



Medical Asepsis

Practices that confines or reduces the numbers of

microorganisms

Also called clean technique

It involves measures that interfere with the chain

of infection in various ways



Principles of Medical Asepsis

Microorganisms exist everywhere except on

sterilized equipment.

Frequent hand washing and maintaining intact skin

are the best methods for reducing the transmission of

microorganisms.

Blood, body fluids, cells, and tissues are considered

major reservoirs of microorganisms.

Personal protective equipment such as gloves,

gowns, masks, goggles, and hair and shoe covers

serves as a barrier to microbial transmission.


Principles of Medical Asepsis…… cont'd

A clean environment reduces microorganisms.

Certain areas ( the floor, toilets, and insides of

sinks) are more contaminated than others.

Cleaning should be done from cleaner to dirtier

areas.



Examples of medical aseptic practices include:

1. Using antimicrobial agents,

2. Performing hand hygiene,

3. Wearing hospital garments,

4. Confining and containing soiled materials

appropriately, and

5. keeping the environment as clean as possible.



Using Antimicrobial Agents

Antimicrobial agents are chemicals that destroy or

suppress the growth of infectious microorganisms Examples are antiseptics, disinfectants, and anti-infective drugs.

1) Antiseptics: (called bacteriostatic agent)

inhibit the growth of, but do not kill, microorganisms

used on living tissues

an example: is alcohol

2) Disinfectants: (also called bactericides agent)

destroy active microorganisms but not spores.

used on non-living items

Examples: Phenol, household bleach, and formaldehyde

3) Anti-Infective Drugs ( Antibiotics ,Antiviral )



Hand washing

is an aseptic practice that involves scrubbing the hands

with soap, water, and friction.

removes resident microorganisms

is the single most effective way to prevent infections.


Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 24 Second semester 15 - 16

5 Moments for Hand Hygiene

Bader A. EL Safadi BSN , MSc Fundamental of Nursing - B Asepsis 25 Second semester 15 - 16


Performing surgical scrub

A surgical scrub, a type of skin and nail antisepsis, is

performed before donning sterile gloves and garments

when the nurse is actively involved in an operative or

obstetric procedure.

The purpose is to more extensively remove transient

microorganisms from the nails, hands, and forearms.



Wearing Personal Protective Equipment

Uniforms

Scrub suits or gowns

Masks

Gloves

Protective eyewear

Hair and Shoe Covers



Gloves Nurses wear clean gloves, sometimes called examination

gloves, in the following circumstances:

As a barrier to prevent direct hand contact with blood,

body fluids, secretions, excretions, mucous membranes,

and non intact skin.

As a barrier to protect clients from microorganisms

transmitted from nursing personnel when performing

procedures or care involving contact with the client's

mucous membranes or non intact skin

When there is a potential transfer of microorganisms

from one client or object to another client during

subsequent nursing care



Gloves

Examination gloves are generally made of latex

Unfortunately some nurses and clients are allergic to

latex.

Keeping the Environment Clean

agencies employ laundry staff and housekeeping

personnel to assist with cleaning

Terminal disinfection is more thorough than concurrent

disinfection and consists of measures used to clean the

client environment after discharge.

Nurses who work in home health can teach the client

and family simple aseptic practices for cleaning

contaminated articles



Surgical Asepsis

Surgical asepsis means those measures that

render (prepare) supplies and equipment totally free

of microorganisms.

Sterile technique include practices that avoid

contaminating microbe-free items.

Sterilization

Sterilization consists of physical and chemical

techniques that destroy all microorganisms

including spores.



Physical Sterilization

Microorganisms and spores are destroyed

physically through radiation or heat

Examples : boiling water, free-flowing steam, dry

heat, and steam under pressure .



Physical Sterilization….. cont'd

Radiation: Ultraviolet radiation can kill bacteria,

especially the organism that transmits TB.

Boiling water is a convenient way to sterilize

items used in the home. To be effective,

contaminated equipment needs to be boiled for 15

minutes at 212°F (100°C)

Free-flowing steam is a method in which items

are exposed to the heated vapor that escapes from

boiling water.



Physical Sterilization ……. cont'd

Dry Heat or hot air sterilization,

is similar to baking items in an oven.

to destroy microorganisms with dry heat,

temperatures of 330°to 340°F (165° to 170°C) are

maintained for at least 3 hours.

Steam under pressure

is the most dependable method for destroying all

forms of organisms and spores.

(The autoclave is an example) figure 10-8



Chemical Sterilization

Both gas and liquid chemicals are used to

sterilize invasive equipment.

(example :Ethylene oxide gas)



Principles of Surgical Asepsis

Surgical asepsis is based on the premise that once

equipment and areas are free of microorganisms, they

remain in that state if contamination is prevented

They preserved sterility by touching one sterile item with

another that is sterile

Once a sterile item touches something that is not sterile,

it is considered contaminated

Any partially unwrapped sterile package is considered

contaminated.

If there is a question about the sterility of an item, it is

considered unsterile



Principles of Surgical Asepsis ….cont’d

The longer the time since sterilization, the more likely

that the item is no longer sterile

A Commercially packaged sterile item is not considered

sterile past its recommended expiration date

Opened sterile item or area, left unattended, is considered

contaminated

Once a sterile item is opened or uncovered, it becomes

contaminated

The outer 1-inch margin of a sterile area is considered a

zone of contamination



Principles of Surgical Asepsis …..cont’d

A wet sterile wrapper wicks microorganisms from its

supporting surface, causing contamination

Coughing, sneezing, or excessive talking over a sterile

field causes contamination

Reaching across an area that contains sterile equipment

may cause contamination

Sterile items located or lowered below waist level are

considered contaminated



Creating a Sterile Field

A sterile field means a work area free of

microorganisms. (Skill 10-3)



Difference between Surgical and Medical Asepsis

Medical asepsis, or clean technique, includes

procedures used to reduce the number of

organisms present, and prevent the transfer of

organisms.

Surgical asepsis, or sterile technique, prevents

contamination of an open wound, serves to

isolate the operative area from the unsterile

environment, and maintains a sterile field for

surgery


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