2. REFERS TO THE PROCEDURES USED TO KEEP THE OBJECT
OR AREAS STERILE OR COMPLETELY FREE FROM
MICROORGANISM.
IN SURGICALASEPSIS ALL PRACTICES ARE DIRECTED TO
THE ELIMINATION OF BOTH PATHOGENIC AND
NONPATHOGENIC MICROORGANISMS.
4. Standard precautions
Standard precautions are a set of infection control
practices that healthcare personnel use to reduce
transmission of microorganisms in healthcare settings.
Standard precautions protect both healthcare personnel
and patients from contact with infectious agents.
5. Standard precautions include:
hand hygiene- this is the most important and basic preventive technique
for interrupting the infectious process. Wash hands before patient
care after touching blood, body fluids, secretions, excretions and
contaminated items, immediately after gloves are removed; between
patient contacts, and which otherwise indicated.
6. Personal protective equipment
Mask , eye protection and face shields
Wear a mask and eye protection, or face shield, during procedures that
are likely to generate splashes or sprays of blood, bodily fluids,
secretions, and excretions.
7. Personal protective equipment
Gloves
you should use new gloves when hands may become contaminated with
blood, body fluids, excretions, or secretions or when touching mucous
membranes or non-intact skin, or contaminated surfaces or objects.
Remove gloves after caring for a patient do not wear the same gloves
for more than one patient
Do not reuse or wash gloves
Don’t forget hand hygiene after removing gloves. Gloves are not
replacement for hand hygiene
8. Personal protective equipment
Gowns
wear a gown during procedures that are likely to generate splashes or
sprays of blood, bodily fluids, secretions, or excretions.
Secure gown appropriately.
Remove a soiled gown as soon as possible, and practice hand hygiene
after removing the gown.
9. Personal protective equipment
Shoe cover
protective coverings for shoes worn by surgical personnel working in a
sterile environment in order to minimize contamination.
10. Personal protective equipment
Surgical cap
surgical caps are used to protect both the medical professional and the
patient. The surgical cap is in place to prevent hazardous bodily fluids
from splashing onto the doctor or nurse’s hair and head. They are
also used to prevent hair from affecting the vision of the medical
professionals.
11. A STERILE OBJECT REMAINS STERILE WHEN TOUCHED
ONLY BY ANOTHER STERILE OBJECT
ONLY STERILE OBJECT MAY BE PLACED ON STERILE FIELD
AN OBJECT HELD BELOW A PERSON’S WAIST IS
CONTAMINATED
A STERILE OBJECT BECOMES CONTAMINATED BY
PROLONGED EXPOSURE TO AIR
WHEN STERILE COMES IN CONTACT WITH A WET
CONTAMINATED SURFACE THE STERILE OBJECTOR FIELD
BECOME CONTAMINTED
FLUID FLOWS IN DIRECTION OF GRAVITY
EDGES OF STERILE FIELD OR CONTAINER ARE CINSIDERED
TO BE CONTAMINATED
13. PRINCIPLES RATIONALE
Always face the sterile field. Do not turn back
or side on a sterile field
Sterile objects which are out of vision are
considered questionable and their sterility
cannot be guaranteed
Keep sterile equipment above your waist level
or above table level
Waist level and table level are considered
margins of safely and will promote maximum
visibility of the sterile field
Do not speak, sneeze and cough over a sterile
field.
To prevent or droplet infections
Never reach across sterile field When non sterile object is held above a sterile
object, gravity causes micro organisms to fall
into the sterile field
Keep the unsterile objects away from the
sterile field
Micro organisms may be transferred
whenever a non sterile object touches a sterile
field
Keep the sterile field dry Micro organisms do not pass easily through a
dry surfaces
The edge of the sterile field is considered
unsterile
Proximity to contaminated area makes
sterility doubtful
14. PRINCIPLES RATIONALE
Handle liquids caustiously near the sterile
field or prevent drapes or wrappers from
becoming wet
When a liquid wets it connects a non sterile
field with a sterile field
Each sterile supply should be clearly labeled
as to its contents, time and date of
sterilization
To ensure sterility
Never assume that a object is sterile. Always
check the sterility expiration date
Sterility of an object wrapped in paper or
cloth becomes doubtful after 4 weeks
Avoid sweeping and dusting when the sterile
objects are opened
Micro organisms travel in the dust particles
Put on mask, wash hands, put on gowns and
gloves before handling sterile supplies
To prevent contamination
17. Contact precautions
Apply to patients with any of the following conditions and/or disease
Presence of stool incontinence (may include patients with norovirus,
rotavirus, or clostridium difficile)
Draining wounds
Uncontrolled secretions
Pressure ulcers or presence of ostomy tubes and/or bags draining body fluids
methicillin-resistant staphylococcus aureus(MRSA)
Presence of generalized rash or exanthems
Perform hand hygiene before touching patient and prior to wearing gloves
Personal protective equipment (PPE) use:
Wear a gown if substantial contact with the patient or their environment is
anticipated
Perform hand hygiene after removal of PPE; note: use soap and water when
hands are visibly soiled (e.g. blood, body fluids), or after caring for patients
with known or suspected infectious diarrhea (clostridium difficile, norovirus)
Clean/disinfect the room and surroundings
Donning e upon room entry and discarding before exiting the patient room is
done to contain pathogens, especially those that have been implicated in
transmission through environmental contamination (e.g. vancomycin
resistant enterococci Clostridium difficile, noroviruses, and other intestinal
tract pathogens; Respiratory synctial virus)
18. Provide a private room- if possible otherwise in multi-patient rooms, 3 feet
spatial separation between beds is advised to reduced the opportunities for
inadvertent sharing items between the infected/colonized patient and other
patients
19. Droplet precautions
Apply to patients known or suspected to be infected with a pathogen (more than 5
microns) that can be transmitted by droplet route; these include, but are not
limited to:
Respiratory viruses (e.g. influenza, parainfluenza virus, adenovirus,
respiratory synctial virus, human metapneumovirus)
For first 24 hours of therapy;: neisseria meningitides, group A streptococcus
A single patient room is preferred
When a single-patient room is not available, do cohorting (keeping the patient
with an existing roommate with a spatial separation of more than 3 feet)
Healthcare personnel wear a mask (a respirator is not necessary) for close
contact with infectious patient; the mask is generally donned upon room
entry
Patients on droplet precautions who must be transported outside of the room
should wear a mask if tolerated and follow respiratory hygiene/cough
etiquette*. Minimize the patient transfer/transportation
If substantial spraying of respiratory fluid is anticipated, gloves and gown as
well as goggles (or face shield in the place of goggles) should be worn
Perform hand hygiene before and after touching the patient and after contact
with respiratory secretions and contaminated objects/materials; note: use
soap and water when hands are visibly soiled (e.g. blood, body fluids)
Clean and disinfect the room
20. RESPIRATORY / COUGH ETIQUETTE
Cover your mouth and nose with a tissue when coughing or sneezing
Use the nearest waste receptacle to dispose of the tissue after use
Perform hand hygiene (e.g. hand washing with non-antimicrobial soap and
water, alcohol-based hand rub, or antiseptic hand wash) after having contact
with respiratory secretions and contaminated objects/materials.
21. Airborne precautions
Apply to patients known or suspected to be infected with pathogen than can be
transmitted by airborne route; these include, but are not limited to:
Tuberculosis
Measles
Chickenpox (until lesions are crusted over)
Localized (in immunocompromised patient) or disseminated herpes zoster
(until lesions are crusted over)
Place the patient immediately in an airborne infection isolation room (AIIR)
PPE use:
Wear a fit-tested n-95 or higher level disposable respirator, if available, when
caring for the patient; the respirator should be donned prior to room entry
and removed exiting room*
If substantial spraying of respiratory fluids is anticipated, gloves and gown as
well as goggles face shield should be worn
Perform hand hygiene before and after touching the patient and after contact
with respiratory secretions and/or body fluids and contaminated
objects/materials; note: use soap and water when hands are visibly soiled (e.g.
blood, body fluids)
Instruct patient to wear a facemask when exiting the exam room, avoid
coming into close contact with other patients, and practice respiratory
hygiene and cough etiquette
22. once the patient leaves, the room should remain vacant for generally one hour
before anyone enters; however, adequate wait time may vary depending on the
ventilation rate of the room
If staff must enter room during the wait time, they are required to use respiratory
protection
Minimized the patient transfer/transport
Clean and disinfect the room accordingly
Whenever possible, non-immune healthcare workers should no care for patients
with vaccine-preventable airborne diseases (e.g. measles, chickenpox, and
smallpox)
23.
24. Chain of infection
Chain of infection is a process of infection that begins when
an agent leave its reservoir through portal of exit and is
conveyed by mode of transmission then enters through an
appropriate portal of entry to infect a susceptible host.
25.
26. INFECTIOUS AGENT OR CAUSATIVE AGENT
These are any microorganism than can cause a disease such as a bacteria,
virus, parasites, fungus. Reasons that the organism will cause an infection are
virulence (ability to multiply and grow), invasiveness (ability toenter tissue),
and pathogenicity (ability to cause disease).
Any organism is capable of causing infection if all the links/components are
present.
27. Bacteria -are present inside us, on us and around us in our environment.
Resident flora- bacteria present inside us, helps in digestion of food.
(Unharmful)
Transient flora-bacteria which we get from environment
Air, drinking water, food, dust, clothes etc.
Harmful
Get activated when meet favorable environment
Viruses
Respiratory infections influenza, cold etc.
GI infections- norovirus
Others- HIV, hepatatis etc.
Parasites
Present in environment.
Affects people with weak immune system.
Example – malaria, tape worm infection etc.
28. Reservoir
It is the place where the microorganism resides, thrives, and reproduces, i.e,.
Food, water, toilet seat, elevator buttons, human feces, respiratory secretions
etc.
29. Portal of exit
It is the place where the microorganism leaves the reservoir, such as the
respiratory tract (nose, mouth),intestinal tract (rectum via stool),
urinary tract, or blood and other body fluids.
30. Mode of transmission
Mode of transmission is the means by which an organism transfer from one
carrier o another by either direct transmission or indirect transmission.
31. Contact transmission- direct and indirect
Contact transmission is the most common route of transmission of organisms in
healthcare settings.
32. Droplet transmission
Droplet should come in contact with mucus membrane directly or indirectly
through sneezing, coughing, taking etc. examples of droplet transmission
include influenza, meningitis etc.
33. Airborne transmission
There are three common disease that are transmitted through the airborne route;
chickenpox (varicella), tuberculosis, and measles.
35. Portal of entry
The opening when an infectious disease enters the host’s body such as
mucus membranes, open wounds, or tubes inserted in body cavities
like urinary catheters or feeding tubes.
36. Susceptible host
It is a person who is at risk for developing an infection from the disease.
Factors include young people and elderly people, chronic disease such
as diabetes or asthma, conditions that weaken the immune system like
HIV, certain types of medications, invasive devices like feeding tubes,
and malnutrition.
39. 1. Control or elimination of infectious agent
Cleaning, disinfection and sterilization of contaminated objects significantly
reduce and often eliminate microorganism. It includes 4 steps
1. Cleaning-it is removal of all soil from objects and surface.
2. Asepsis – it is absence of pathogenic microorganism. It is of 2 types medical
and surgical asepsis
3. Disinfection-it is process of killing microorganisms, spores are not involved.
4. Sterilization- it is process of killing microorganisms and their spores.
Clean contaminated objects (reduces the number of organisms)
Perform disinfection and sterilization (kills or inactivates organisms).
Use antiseptics to inhibit growth.
Uses antiseptic agents/antimicrobial agents.
40. 2. Control or elimination of reservoir
Eliminate source of body fluids and drainage
Bathe with soap and water
Change soiled dressings
Remove standing water on bedside tables.
Cover bottles of used solutions
Maintain patency of surgical wound drains
Empty and rinse suction bottles
Empty drainage bags every shift
Place syringe and uncapped needles in moisture-resistant, puncture-
proof containers
Limit contact with persons with infection or exposed to infection
41. 3. Control of portal of exit
Cover your mouth and nose with tissue, when coughing or sneezing
Dispose the used tissue in the garbage can, immediately after use.
42. 4. Control of transmission
Reduce microorganisms spread
Wash hands
Use personal set of care items for each client
Avoid shaking bed linens or clothes
Discard any item that touches the floor
43. Hand hygiene moments
Before touching the patient
Before clean/aseptic procedure
After body fluid exposure risk
After touching a patient
After touching patient surroundings
44. 7 steps to hand washing
1. Rub palms together
2. Run the back of both hands
3. Interlace fingers and rub hands together
4. Interlock fingers and rub the back of fingers of both hands
5. Rub thumb in a rotating manner followed by the area between index
finger and thumb for both hands
6. Rub fingertips on palm for both hands
7. Rub both wrist rotating manner
45. Control of portal entry
Skin mucous membrane- maintain skin and mucous membrane
integrity, use proper hygiene measures.
Clean wound sites thoroughly. Disposed of used needles in proper
receptacles.
Urinary- keep all drainage systems closed and intact.
Discard facial tissues, wound dressings, and other body excreta
without touching
46. Protection of susceptible host
Provide adequate nutrition
Ensure adequate rest
Promote body defenses against infection
Provide immunization
Maintenance of hygiene
Use of personal protective equipments like gloves, gowns, shoe cover,
mask and cap
