WEST VISAYAS STATE UNIVERSITY
College of Nursing
ASEPSIS
THE CHAIN OF REACTION| Intro
✔ Describes the development of an infection process.
✔ An interactive process involving an agent, host, and
environment is required.
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
FUNDAMENTALS OF
NURSING
ASEPSIS
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
ASEPSIS| Intro
LEARNING OBJECTIVES
After completing this chapter, you will be able to:
1. Explain the concepts of medical and surgical asepsis.
2. Identify signs of localized and systemic infections and inflammation.
3. Identify risks for nosocomial and health care–associated infections.
4. Identify factors influencing a microorganism’s ability to produce an infectious process.
5. Identify anatomic and physiological barriers that defend the body against microorganisms.
6. Differentiate active from passive immunity.
7. Identify relevant nursing diagnoses and contributing factors for clients at risk for infection and who have an infection.
8. Identify interventions to reduce risks for infections.
9. Identify measures that break each link in the chain of infection
10. Compare and contrast category-specific, disease-specific, standard, and transmission-based isolation precaution systems.
11. Verbalize the steps used in:
• a. Performing hand hygiene.
• b. Applying and removing a gown, face mask, eyewear, and clean gloves.
• c. Establishing and maintaining a sterile field.
• d. Applying and removing sterile gloves by the open method.
• e. Applying a sterile gown and gloves by the closed method.
12. Recognize when it is appropriate to delegate infection prevention skills to unlicensed assistive personnel.
13. Describe the steps to take in the event of a blood borne pathogen exposure
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INFECTIONS| INTRO
INFECTION
The growth of microorganisms in body tissue where they are not
usually found.
Such a microorganism is called an infectious agent
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
INFECTIONS| Intro
ASYMPTOMATIC OR SUBCLINICAL
- Microorganism produces NO clinical evidence of disease.
DISEASE
- Detectable alteration in normal tissue function
COMMUNICABLE DISEASE
- If the infectious agent can be transmitted to an individual by direct
or indirect contact or as an airborne infection, the resulting condition.
PATHOGENICITY
- Ability to produce disease; thus, a pathogen is a microorganism that
causes disease
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
INFECTIONS| Intro
ASEPSIS
- Is the freedom from disease- causing microorganisms.
- To decrease the possibility of transferring microorganisms
from one place to another, aseptic technique is use
SEPSIS
- Condition in which acute organ dysfunction occurs
secondary to infection
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
INFECTIONS| Intro
ACUTE INFECTION
- Generally appear suddenly or last a short time
CHRONIC INFECTION
- Occur slowly, over a very long period, and may
last months or years.
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CHAIN OF INFECTION| Intro
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
THE CHAIN OF REACTION| Essential Elements
✔ AGENT
- An entity that is capable of causing disease
- Agents that cause disease may be as follows
o Biological Agents
o Chemical Agents
o Physical Agents
ETIOLOGIC AGENT
- The extent to which any microorganism is capable of producing an infectious process
depends on the:
*number of microorganisms present, the virulence and potency of the microorganisms
(pathogenicity)
*the ability of the microorganisms to enter the body,
*the susceptibility of the host,
*and the ability of the microorganisms to live in the host’s body.
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THE CHAIN OF REACTION| Essential Elements :
Agents
BIOLOGICAL AGENTS
Living organisms that invade the host, causing disease
o Bacteria
o Viruses
o Protozoa
o Rickettsia
o Spirochete
o Parasites
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THE CHAIN OF REACTION| Essential Elements :
Agents
✔ BACTERIA
- Simple, one-celled microbes with double- celled membranes that protect them from harm.
- Produce rapidly and are considered the most common cause of fatal infectious diseases
- Classified according to:
*Shape (cocci, bacilli, spirillae)
*Need of oxygen ( aerobic, anaerobic)
*Response to staining (gram+, gram-)
*Motility (motile, nonmotile)
*Tendency to capsulate
*Capacity to form spores
✔ VIRUSES
- Smallest known microbes
- Cannot replicate independently in the host’s cells; rather, they invade and stimulate the host’s
cells to participate in the formation of additional viruses.
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THE CHAIN OF REACTION| Essential Elements : Agents
✔ FUNGI
- Found almost everywhere on earth
- Live in organic matter, soil, water, animals and plants
- Can also live inside and outside the body
- Maybe harmful or beneficial
✔ PROTOZOA
- Larger than bacteria
- Absorb nutrients from the body of the host
✔ RICKETTSIA
- Small, Gram(-) , bacteria-like microbes that can induce life-threatening infections
- Like viruses, they require a host cell for replication
- Usually transmitted through a bite of arthropod carriers like lice, fleas, ticks, as well as
through waste products
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THE CHAIN OF REACTION| Essential Elements :
Agents
✔SPIROCHETE
- A bacteria with flexible, slender, undulating spiral rods that possess a cell wall
- 3 Forms that cause disease:
* Treponema
* Leptospira
* Borilia
✔PARASITES
- Live on or within the organisms
- Live at the expense of others
- Don’t usually kill their host but take the nutrients they need
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THE CHAIN OF REACTION| Essential Elements :
Agents
CHEMICAL AGENTS
Substances that can interact with the body, causing disease, such
as food additives, medications, pesticides, and industrial chemicals
PHYSICAL AGENTS
Factors in the environment that are capable of causing disease,
such as heat, light, noise and radiation
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THE CHAIN OF REACTION| Essential Elements :
Reservoir
✔RESERVIOR
- A place or environment where the agent can survive and
multiply
- The most common reservoir are:
o Humans
o Animal
o Physical environment
o Fomites
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THE CHAIN OF REACTION| Essential Elements : Portal of
Exit
PORTAL OF EXIT
- The agent leaves the reservoir through body
secretions including
* Sputum (from the respiratory tract)
* Semen, vaginal secretions, or urine
* Saliva and feces (from the gastrointestinal tract)
* Blood
* Draining
* Wounds
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
THE CHAIN OF REACTION| Essential Elements : Modes of
Transmission
MODES OF TRANSMISSION
The process of the infectious agent moving from the reservoir or source through
the portal of exit to the portal of entry of the susceptible “new” host
CONTACT TRANSMISSION
Transfer of an agent from an infected person
Indirect contact with the infected person through a fomites or close contact with
contaminated.
ex. Sexually Transmitted Disease (Direct) Common viral infections i.e cold,
measles, flu
(Close contact)
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
THE CHAIN OF REACTION| Essential Elements : Modes of
Transmission
INDRECT TRANSMISSION
- Indirect transmission may be either vehicle borne or vector borne:
*Vehicle-borne transmission
Agent is transferred to a susceptible host by contaminated inanimate objects i.e.
Water, food, milk, drugs
Ex: Cholera transmitted through drinking water Salmonellosis transmitted through
contaminated meat
*Vector-borne transmission
Agent is transferred to a susceptible host by animate means such as
mosquitoes, fleas, ticks, lice.
Ex: Lyme Disease, Malaria, West Nile virus
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
THE CHAIN OF REACTION| Essential Elements : Modes of
Transmission
AIRBORNE TRANSMISSION
A susceptible host contacts droplets nuclei or dust particles that are suspended in
the air.
Ex. Measles contaminated Virus sprayed in air because of sneezing.
Droplet - portal of entry - mucous membranes or conjunctiva
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
THE CHAIN OF REACTION| Essential Elements : Portal of
Entry
✔PORTAL OF ENTRY
- Route which an infectious agent
enters the host.
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THE CHAIN OF REACTION| Essential Elements : Host
✔ HOST
Organism that can be affected by the agent (Human being).
SUSEPTIBLE HOST
- A susceptible host is any person who is at risk for
infection.
- A compromised host is a person at increased risk, an
individual who for one or more reasons is more likely
than others to acquire an infection.
Ex. Person with common cold or skin burn is at greater risk
for infection (impaired state of the body’s mechanism)
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
THE CHAIN OF REACTION| Essential Elements : Host
NON SPECIFIC DEFENCES
- Nonspecific body defenses include anatomic and physiological barriers and
the inflammatory response
SPECIFIC DEFENCES
- Specific defenses of the body involve the immune system.
- An antigen is a substance that induces a state of sensitivity or immune
responsiveness (immunity). If the proteins originate in a person’s own body,
the antigen is called an autoantigen
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
THE CHAIN OF REACTION| Essential Elements : Host
BODY DEFENCES AGAINST INFECTION
NONSPECIFIC DEFENCES
- Nonspecific body defenses include anatomic and physiological barriers and
the inflammatory response
SPECIFIC DEFENCES
- Specific defenses of the body involve the immune system.
- An antigen is a substance that induces a state of sensitivity or immune
responsiveness (immunity). If the proteins originate in a person’s own body,
the antigen is called an autoantigen
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
THE CHAIN OF REACTION| Essential Elements : Host
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
THE CHAIN OF REACTION| Essential Elements : Host
✔ ANTIBODY-MEDIATED DEFENSES
- Another name for the antibody-mediated defenses is humoral (or circulating)
immunity because these defenses reside ultimately in the B lymphocytes and are
mediated by antibodies produced by B cells.
- Antibodies, also called immunoglobulins, are part of the body’s plasma
proteins. The antibody-mediated responses defend primarily against the
extracellular phases of bacterial and viral infections.
✔ CELL-MEDIATED DEFENSES
- The cell-mediated defenses, or cellular immunity, occur through the T-cell
system. On exposure to an antigen, the lymphoid tissues release large numbers of
activated T cells into the lymph system. These T cells pass into the general
circulation.
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
THE CHAIN OF REACTION| REVIEW
1 QUICK TEMPERATURE CHECK
2 CLEANING: Physical removal of dirt and debris (washing, dusting and mopping)
3 DISINFECTION: Physical or chemical process used to reduce the number of potential pathogens on a
surface
4 STERILIZATION: Complete destructions of all microorganism; including spores
Types of Chemicals for Disinfections
Disinfectant Chemical use on nonliving
Antiseptic Chemical used on living objects
Bactericidal Kills microorganisms
Bacteriostatic Prevent Bacterial multiplication but does not
kill
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
BREAKING THE CHAIN OF REACTION| INFECTION
CONTROL
FIRST LINE OF DEFENSE
HAND HYGIENE
First line of defense against
infection and is the single most
important practice in preventing
the spread of infection
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
BREAKING THE CHAIN OF REACTION| INFECTION
CONTROL
BETWEEN AGENT AND RESERVOIR
- First link in the chain of infection
BETWEEN THE RESERVOIR AND THE PORTAL OF EXIT
- The goal is to eliminate the reservoir for the microorganism
before a pathogen can escape to a susceptible host.
- The goal is to eliminate the reservoir for the microorganism
before a pathogen can escape to a susceptible host.
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
BREAKING THE CHAIN OF REACTION| INFECTION
CONTROL
BETWEEN PORTAL O EXIT AND MODE OF TRANSMISSION
- The goal is to prevent the exit of infectious agents
BETWEEN MODE OF TRANSMISSION AND PORTAL OF ENTRY
- Asepsis must be ensured and barrier protection should be
worn when the care of clients involves contact with body
secretions
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
BREAKING THE CHAIN OF REACTION| INFECTION
CONTROL
BETWEEN THE PORTAL OF ENTRY AND HOST
The goal at this point is to prevent the transmission of the
infection to a client or healthcare worker
BETWEEN THE HOST AND AGENT
Eliminating infection before it begins
Allow an individual or maintain an intact immune system
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
BREAKING THE CHAIN OF REACTION| INFECTION CONTROL
CLEANSING
- Cleansing is a potential hazard to the nurse because of possible splashing of
contaminated material onto the body.
- Wear gloves, masks, googles during cleansing
DISINFECTION
- Elimination of pathogens, except spores, from inanimate objects.
i.e. Alcohol, Sodium Hypochlorite, quaternary ammonium, phenolic solutions
and glutaraldehyde.
GERMICIDE
- Chemical that can be applied to both animate (living) and inanimate objects to
eliminate pathogens. i.e. Alcohol and silver sulfadiazine
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
BREAKING THE CHAIN OF REACTION| INFECTION
CONTROL
STERILIZATION
- Destroy all microorganism including
spores.
- The method of sterilization depends
on the object to be sterilized and the
kind and amount of contamination. i.e.
Moist heat (steam), dry heat and
ethylene oxide gas.
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
INFECTION| TYPES AND STAGES OF INFECTIONS
LOCALIZED
- Limited to a defined area or
single organ with symptoms that
resemble inflammation (redness,
tenderness & swelling) SYSTEMIC
-Infections affect the entire
body and involve multiple
organs such as AIDS.
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
INFECTION| TYPES AND STAGES OF INFECTIONS
INCUBATION STAGE
- Time between entry of infectious agent into
the host and the onset of symptoms
- Infectious agent invades the tissue and
multiplies to produce an infection
SAFETY:
-Always verify the incubation period of a
suspected infection.
-Remember that a client may be able to
transmit the infection to another person before
the onset of symptoms.
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
INFECTION| TYPES AND STAGES OF INFECTIONS
PRIMORDIAL STAGE
Time from the onset of non specific symptoms
until specific symptoms begin to manifest.
The infectious agent continues to invade and
multiply in the host. Client may also be
infectious to other persons during this time
period.
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
INFECTION| TYPES AND STAGES OF INFECTIONS
ILLNESS STAGE
Time when the client has
specific s/sx of an
infections process .
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
INFECTION| TYPES AND STAGES OF INFECTIONS
CONVALESCENT STAGE
From beginning of the
disappearance of acute
symptoms until the client
returns to his or her previous
state of health.
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
INFECTION| TYPES AND STAGES OF INFECTIONS
NOSOCOMIAL INFECTIONS
(Hospital Acquired Infections)
- Infection acquired in a hospital or other healthcare facility
Urinary Surgical
that was not present or incubating at the time of the client’s
admission.
tract Wounds
- Include those infections that become symptomatic after
the client is discharged and infections passed among medical
personnel.
- Transmitted by healthcare personnel’s who fail to practice Pneumoni Septicemi
proper hand hygiene, or those who fail to change gloves between a a
client contacts
Health care-associated Infection (HAIs)
- Those that originate in any health care setting
Iatrogenic infections
- are the direct result of diagnostic or therapeutic procedures.
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
INFECTION| STANDARD PRECAUTIONS
CDC PRECAUTIONS
HAND-WASHING
- Wash hands before contact with each client; during
care as needed (even if wearing gloves) to prevent cross
contamination of body sites; and after touching blood,
body fluids, secretions, excretions and contaminated items
(with or without gloves)
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
INFECTION| STANDARD PRECAUTIONS
CDC PRECAUTIONS
GLOVES
Wear gloves (clean, non-sterile, adequate) whenever
contact is expected with bloody, body fluids, secretions,
excretions, mucous membranes and non- intact skin and
contaminated items.
Always change gloves between clients and between tasks
and procedures on the same client after contact with
material that may contain a high concentration of
microorganisms.
Remove gloves promptly after use and before touching
non-contaminated items and environmental surfaces.
Wash hands before going to another
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
INFECTION| STANDARD PRECAUTIONS
CDC PRECAUTIONS
FACE PROTECTION (MASK, GOGGLES, FACE SHIELDS)
- Wear a face shield or wear goggles and a mask that covers
both the nose and the mouth during procedures and client care
activities that are likely to generate splashes or sprays of blood,
body fluids, secretions or excretions to provide protection of the
mucous membranes of the eyes, nose and mouth.
Wear a face shield or wear goggles and a mask that covers both the
nose and the mouth during procedures and client care activities
that are likely to generate splashes or sprays of blood, body fluids,
secretions or excretions to provide protection of the mucous
membranes of the eyes, nose and mouth.
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
INFECTION| STANDARD PRECAUTIONS
CDC PRECAUTIONS
OTHER PRECAUTIONS
- Clean and reprocess reusable equipment before using
it on another client.
Follow agency procedure for routine cleaning and
disinfection of surfaces and for handling spills of blood
and body fluid.
- Avoid contamination of self with soiled linen by
folding the body and placing directly into the laundry
receptacle.
- Avoid recapping needles. Use the scoop technique if
recapping is necessary. Discard used syringes and needles
immediately into a puncture-proof container while
holding the needle pointed away from self. Do not bend
or break needles.
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
INFECTION| TRANSMISSIONS BASED PRECAUTIONS
AIRBORNE DROPLET CONTACT
PRECAUTION PRECAUTION PRECAUTION
Use when small (<5um Use with large (>5um Use with known suspected
pathogen infected pathogen- infected microorganisms transmitted by
droplet nuclei may droplets that travel 3 ft direct hand-to-skin client contact
or indirect contact with surfaces
remain suspended in or less via coughing, or care items in the environment.
air over time and sneezing etc. or during Ex. Clostridium difficile,
travel distances procedures (suctioning) diphtheria (cutaneous) herpes
greater than 3ft. Ex. Hemophilis influenza, simplex (mucocutaneous or
Ex. Varicella, measles, Neisseria meningitidis, neonatal), impetigo, pediculosis,
scabies, zoster, others.
tuberculosis others
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
GENERAL NURSING CARE|PREVENTION
HEALTH EDUCATION
Educate the family and the client with respect to:
▪ Availability and importance of
prophylactic immunization
▪ Manner in which infectious illness is spread
and methods of avoiding the spread
▪ Importance of seeking medical advice for any
signs of health problem
▪ Importance of environmental cleanliness
and personal hygiene
▪ Means of preventing contamination of food and
water supply.
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
GENERAL NURSING CARE|PREVENTION
IMMUNIZATION
- Induction or introduction of specific
antibodies in a susceptible person for the
purpose of producing cellular immunity.
- Expanded Program of Immunization (EPI)/
Proclamation No. 6:
- Prevent the seven childhood diseases [TB,
DPT, Polio, Measles, Hepa B]UN goal:
Universal child immunizations
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GENERAL NURSING CARE|PREVENTION
Environmental
Sanitation
PD. 856
Anti-littering: PD 825
Proper supervision of food
handlers.
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
GENERAL NURSING CARE|
CONTROL/LIMIT THE SPREAD OF INFECTION BY MEANS OF
ISOLATION
Separation of infected person from others
during the period of communicability
in order to prevent the direct or indirect
transmission of the infectious agent from
infected person to those who are
susceptible or those who may spread the
disease to others.
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
GENERAL NURSING CARE|
CONTROL/LIMIT THE SPREAD OF INFECTION BY MEANS OF
QUARANTINE
- Limitation of freedom of
movement of persons or animals who
have been exposed to a communicable
disease for a period of time equal to
longest usual incubation period of
diseases so as to prevent effective
contact with those who are not
exposed: may either be complete or
modified
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
GENERAL NURSING CARE|
CONTROL/LIMIT THE SPREAD OF INFECTION BY MEANS OF
FUMIGATION
- any process by which the
killing of animal forms is
accomplished with the use of
gaseous agents.
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
GENERAL NURSING CARE| CONTROL/LIMIT THE SPREAD OF
INFECTION BY MEANS OF
Disinfection
- any physical or chemical process that destroys undesired animal forms present in
a person, clothing or the environment.
a. Concurrent:
application of disinfection as rapidly as possible after the discharge of infectious
material from the body of an infected person of after the soiling of articles with such
infectious discharges.
b. Terminal:
the process of rendering the personal clothing and immediate physical environment
of the infection to others at the time when the patient is no longer a source of infection
Asepsis
- the state or condition of being free from infection.
Operating Room Nurses Association of the Philippines, Inc – ILOILO CHAPTER
