ASEPSIS

Free of Pathogenic Microorganism

Two types of asepsis
1. Medical Asepsis (Clean Technique)
Is based on maintaining cleanliness to prevent the spread of pathogenic microorganisms and to
ensure that the environment is as free of microbes as possible.
Medical asepsis involves confining microbes to specific areas and rendering objects as either
clean or dirty.
2.Surgical Asepsis
Also known as Sterile Technique requires strict adherence to ordered and specific procedures
which render an area free from all microorganisms including spores. An object or area is
described as being sterile or not sterile
Surgical Asepsis is used in the operating room, delivery room, during surgical procedures,
catheterization, and during dressing changes.


COMPARISON BETWEEN MEDICAL AND SURGICAL ASEPSIS
FACTOR MEDICAL ASEPSIS SURGICAL ASEPSIS
Patient Has infection, lowered
resistance to other infection
Potential host, lowered
resistance makes more
susceptible
Reservoir of infection The patient Other people and the
environment
Objective of barriers Confine organisms to the
room, unit or locale
Prevent organism from
reaching the patient or area
Equipment and supplies Disinfect, sterilize, or dispose
of after contact with patient;
use clean materials
Disinfect or sterilize before
contact with patient; use
sterile materials
Nurses protection garb:
gown, mask ,gloves
Use clean garb to protect
worker from organisms;
discard after contact with
patient
Sterile garb to protect
patient; remedy if
contaminated

Goal of nursing action Confine organisms and
prevent spread of organisms
to other. (medical asepsis
reduces the number of
organisms or contains them to
reduce risk of transmission)
Reduce the number of
organisms and prevent
spread of infection to
patient. (surgical asepsis
keeps an area or objects free
of all microorganism.)


WHEN TO USE SURGICAL ASEPSIS VERSUS MEDICAL ASEPSIS
Use Surgical when:
Anything that requires intentional perforation of patient's skin: (CRITICAL)
- IV insertion
- Catheters

Use Medical when:
Anything that comes in contact with mucous membranes (SC) or skin (NC): (SEMICRITICAL AND
NONCRITICAL)
- Bedpans (NC)
- Food utensils (NC)
- Blood pressure cuffs (NC)
- Thermometer (SC)
- Linens (NC)
- Stethoscopes (NC)
- Respiratory equipment (SC)
- Endotracheal tubes (SC)
-
BASIC PRINCIPLES OF MEDICAL ASEPSIS
A. wash hands frequently, but especially before handling foods, before eating, after using a
handkerchief, after going to the toilet, before and after each client contact and after removing gloves.
B. Keep soiled items and equipment from touching the clothing
C. Do not place soiled bed linen or any other items onto the floor.
D. Avoid having clients cough, sneeze or breath directly on others
E. Move equipment away from you when brushing, dusting or scrubbing articles
F. Avoid raising dust.
G. Clean the least soiled areas first then more soiled ones.
H. Dispose of soiled or used items directly into appropriate containers
I. Pour liquids that are to be discarded directly into the drain so as to avoid splattering in the sink and
onto you
J. Avoid leaning against sinks supplies or equipments.
K. Avoid touching your eyes, face, nose or mouth
L. Use practices of personal grooming that help prevent spreading microorganisms
M. Follow guidelines conscientiously for isolation or barrier techniques as prescribed by your agency.

BASIC PRINCIPLES OF SURGICAL ASEPSIS
A. Only a sterile object can touch another sterile object.
B. Open sterile packages so that the first edge of the wrapper is directed away from the worker to avoid
the possibility of a sterile wrapper touching unsterile clothing.
C. Avoiding spilling any solution on a cloth or paper used as a field for a sterile set-up
D. Hold sterile objects above the level of the waist
E. Avoid talking, coughing, sneezing, or reaching over a sterile field or object
F. Never walk away from or turn your back on a sterile field
G. All items brought into contact with broken skin or used to penetrate the skin in order to inject
substances into the body, or to enter normally sterile body cavities, should be sterile
H. Use dry, sterile forceps when necessary
I. Consider the edge (outer 1 inch) of a sterile field to be contaminated
J. Consider an object contaminated if you have any doubt as to its sterility.

A.HAND WASHING
- Hand washing is the single most effective precaution for prevention of infection transmission
between patients and staff.
- Hand washing with plain soap is mechanical removal of soil and transient bacteria (for 10- 15
sec.)
- Hand antisepsis is removal & destroy of transient flora using anti-microbial soap or alcohol
based hand rub (for 60 sec.)
- Surgical hand scrub: removal or destruction of transient flora and reduction of resident flora
using anti-microbial soap or alcohol based detergent with effective rubbing (for least 2-3 min)
- Our hands and fingers are our best friends but still could be our enemies if they carry infective
organisms and transmit them to our bodies and to those whom we care for.
- Sinks & soap must be found in every patient care room. Doctors, nurses must comply to hand
washing policy.
-
When to Wash our Hands
1. Before & after an aseptic technique or invasive procedure.
2. Before & after contact with a patient or caring of a wound or IV line.
3. After contact with body fluids & excreta removal.
4. After handling of contaminated equipment or laundry.
5. Before the administration of medicines
6. After cleaning of spillage.
7. After using the toilet.
8. Before having meals.
9. At the beginning and end of duty.
10. Gloves cannot substitute hand washing which must be done before putting on gloves and after their
removal.

How to Wash our Hands
1. Jewelry must be removed. If unable to remove rings, wash and dry thoroughly around them.
2. Wet your hands with running warm water, dispense about 5 ml of liquid soap or disinfectant
into the palm of the hand.
3. Rub hands together vigorously to lather all surfaces and wrist paying particular attention to
thumbs, finger tips and webs.
4. Rinse hands thoroughly.
5. Turn off water using elbow-on elbow taps, dry hands thoroughly on a paper towel OR where
elbow taps are not present, first dry hands, thoroughly, then turns off the taps using fresh paper
towel.
6. Hand cream can be used on persona basis.
7. If a staff member develops a skin problem, he or she must consult dermatologist.

B. Barrier Precautions
1. Gloves:
Disposable gloves must be worn when:
a) Direct contact with B/BF is expected.
b) Examining a lacerated or non-intact skin e.g wound dressing.
c) Examination of Oropharynx, GIT, UIT and dental procedures.

d) Working directly with contaminated instruments or equipment.
e) HCW has skin cuts, lesions and dermatitis

NOTE: Sterile gloves are used for invasive procedures.
GLOVES MUST BE of good quality, suitable size and material. Never reuse.

2) Masks & Protective eye wear:
- MUST BE USED WHEN: engaged in procedures likely to generate droplets of B/BF or bone chips.
- During surgical operations to protect wound from staff breathings

- Masks must be of good quality, properly fixed on mouth and nasal openings.

3) Gowns/ Aprons:
Are required when:
- Spraying or spattering of blood or body fluids is anticipated e.g surgical procedures.
- Gowns must not permit blood or body fluids to pass through.
- Sterile linen or disposable ones are used for sterile procedures.

C.Sharp precautions
- Needle stick and sharp injuries carry the risk of blood born infection e.g AIDS, HCV,HBV and
others.
- Sharp injuries must be reported and notified
- NEVER TO RECAP NEEDLES
- Dispose of used needles and small sharps immediately in puncture resistant boxes (sharp
boxes).
- Sharp boxes: must be easily accessible, must not be overfilled, labeled or color coded.
- Needle incinerators can be another safe way of disposal.
- Reusable sharps must be handled with care avoiding direct handling during processing.

D. Handling of Contaminated Material
1. Cleaning of B/BF spills:
a- wear gloves.
b- wipe-up the spill with paper or towel.
c- apply disinfectant.

2. Cleaning & decontamination of equipment:
protective barriers must be worn.

3. Handling & processing lab specimens:
must be in strong plastic bags with biohazard label

4. Handling and processing linen:
Soiled linen must be handled with barrier precautions, sent to laundry in coded bags.

5. Handling and processing infectious waste:
a. must be placed in color coded, leakage proof bags, collected with barrier precautions
b. contaminated waste incinerated or better autoclaved prior to disposal in a landfill.
Environmental control:
1. Including physical facility plans must meet quality and infection control measures. Patient
equipment positioning and installation, traffic flow.
2. Cleaning of hospital environment and dis-infection according to policies.
3. Proper air ventilation.
4. Water pipes examination, check its quality.
5. Proper waste collection and disposal.
6. Cleaning and dis-infection of equipment.
7. Proper linen collection, cleaning, distribution
8. Food : ensure quality and safety.
9. Sterilization: Central sterilization department serving all hospital departments compiling with
infection control precautions.

.
Staff health promotion and education:
1. HCW is at risk of acquiring infection, they can also transmit infection to patients and other employee.
2. Employee health history must be reviewed, immunizations recommendations to be considered.
3. Release from work if sick, occupation injury must be notified.
4. Continuous education to improve practice, better performance of new techniques.