1. Implementation
 Health promotion
 Preventing an infection from developing or
spreading
 Acute care
 Treating an infectious process includes eliminating
the infectious organisms and supporting the
patient’s defenses.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. 1

2. Implementation (cont’d)
 When implementing care, consider:
 Medical and surgical asepsis
 Control or elimination of infectious agents
 Control or elimination of reservoirs
 Control of portals of entry
 Control of transmission
 Hand hygiene
 Isolation precautions
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. 2

3. Implementation: Asepsis
 Asepsis = Absence of pathogenic (disease-
producing) microorganisms.
 Aseptic technique = Practices/ procedures
that assist in reducing the risk for infection.
 Medical asepsis, or clean technique, includes
procedures for reducing the number of organisms
present and preventing 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.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. 3

4. Standard Precautions
 Standard precautions prevent and control
infection and its spread.
 Apply to contact with blood, body fluid, nonintact
skin, and mucous membranes from all patients.
 Hand hygiene includes using an instant alcohol
hand antiseptic before and after providing patient
care, washing hands with soap and water when
they are visibly soiled, and performing a surgical
scrub.
 Handwashing is the act of washing hands with
soap and water, followed by rinsing under a
stream of water for 15 seconds.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. 4

5. Disinfection versus Sterilization
 Disinfection: a process that eliminates many
or all microorganisms, with the exception of
bacterial spores, from inanimate objects
 Disinfection of surfaces
 High-level disinfection, which is required for some
items such as endoscopes
 Sterilization: the complete elimination or
destruction of all microorganisms, including
spores
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. 5

6. Infection Prevention and Control
 Patient safety
 Separate personal care items
 Handling solid and fluid waste
 Wound cleaning
 Patient education
 Cough etiquette
 Isolation and isolation precautions
 Surgical asepsis
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. 6

7. Cough Etiquette
 Cover your nose/mouth with a tissue when you
cough, and promptly dispose of the contaminated
tissue.
 Place a surgical mask on a patient if it does not
compromise respiratory function or is applicable; this
may not be feasible in pediatric populations.
 Perform hand hygiene after contact with
contaminated respiratory secretions
 Maintain spatial separation greater than 3 feet from
persons with respiratory infection
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. 7

8. Isolation and Isolation
Precautions
 Isolation is the separation and restriction of
movement of ill persons with contagious
diseases.
 Standard precautions
 Isolation precautions: airborne, droplet, contact,
and protective environment
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. 8

9. Isolation
 Psychological
implications
 Isolation environment
 Personal protective
equipment
 Specimen collection
 Bagging of trash or
linen
 Patient transport
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. 9

10. Surgical Asepsis
 Patient preparation
 Sterile field: an area free of
microorganisms and
prepared to receive sterile
items
 Principles
 Performing sterile
procedures
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. 10

11. Principles of Surgical Asepsis
1. A sterile object remains sterile only when
touched by another sterile object.
2. Only sterile objects may be placed on a
sterile field.
3. A sterile object or field out of the range of
vision or an object held below a person’s waist
is contaminated.
4. A sterile object or field becomes
contaminated by prolonged exposure to air.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. 11

12. Principles of Surgical Asepsis
(cont’d)
5. When a sterile surface comes in contact with
a wet, contaminated surface, the sterile object
or field becomes contaminated by capillary
action.
6. Fluid flows in the direction of gravity.
7. The edges of a sterile field or container are
considered to be contaminated.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. 12

13. Performing Sterile Procedures
 Donning and removing caps, masks, and eyewear
 Opening sterile packages
 Opening a sterile item on a flat surface
 Opening a sterile item while holding it
 Preparing a sterile field
 Pouring sterile solutions
 Surgical scrub
 Applying sterile gloves
 Donning a sterile gown
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. 13

14. Evaluation
 See through the patient’s eyes:
 Have the patient’s expectations been met?
 Patient outcomes
 Measure the success of the infection control
techniques.
 Compare the patient’s actual response with
expected outcomes.
 If goals are not achieved, determine what steps
must be taken.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. 14

15. Evaluation (cont’d)
 Exposure issues
 Patients and health care personnel are at risk for
acquiring infection from accidental needlesticks.
• Report any contaminated needlestick immediately.
 Follow-up for risk of acquiring infection begins with
source patient testing.
• Access to testing the source patient is stated in the
testing law for each state.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. 15