Medical and surgical asepsis

Medical and surgical asepsis

Asepsis is being free of disease-producing microbes. Microbes are everywhere. Measures are needed to achieve asepsis. Medical asepsis (clean technique) is the practices used to:

·    Remove or destroy pathogens. The number of pathogens is reduced.

·     Prevent pathogens from spreading from one person or place to another person or place.

Microbes cannot be present during surgery or when instruments are inserted into the body. Open wounds (cuts, burns, incisions) require the absence of mi­crobes. They are portals of entry for microbes. Surgical asepsis (sterile technique) is the practices that keep items free of all microbes. Sterile means the absence of all microbes—pathogens and non-pathogens. Sterilization is the process of destroying all microbes (pathogens and non-pathogens).

Contamination is the process of becoming un­clean. In medical asepsis, an item or area is clean when it is free of pathogens. The item or area is con­taminated if pathogens are present. A sterile item or area is contaminated when pathogens or non-pathogens are present.

COMMON ASEPTIC PRACTICES

Aseptic practices break the chain of infection. To prevent the spread of microbes, wash your hands:

·       After urinating or having a bowel movement.

·       After changing tampons or sanitary pads.

·       After contact with your own or another person's blood, body fluids, secretions, or excretions. This includes saliva, vomitus, urine, feces, vaginal discharge, mucus, semen, wound drainage, pus, and respiratory secretions.

·       After coughing, sneezing, or blowing your nose.

·       Before and after handling, preparing, or eating food. Also do the following:

·       Provide all persons with their own toothbrush, drinking glass, towels, washcloths, and other personal care items.

·       Cover your nose and mouth when coughing, sneezing, or blowing your nose.

·       Bathe, wash hair, and brush your teeth regularly

·       Wash fruits and raw vegetables before eating or serving them.

·       Wash cooking and eating utensils with soap and water after use.

HAND HYGIENE

Hand hygiene is the easiest and most important way to pre­vent the spread of infection. Your hands are used for al­most everything. They are easily contaminated. They can spread microbes to other persons or items. Practice hand hygiene before and after giving care.

Procedure Handwashing

1.     Make sure you have soap, paper towels, orange stick or nail file, and a wastebasket. Collect missing items.

2.     Push your watch up 4 to 5 inches. Also push up uniform sleeves.

3.     Stand away from the sink so your clothes do not touch the sink. Stand so the soap and faucet are easy to reach

4.     Turn on and adjust the water until it feels warm.

5.     Wet your wrists and hands. Keep your hands lower than your elbows.

6.     Apply about 1 teaspoon of soap to your hands.

7.     Rub your palms together and interlace your fingers to work up a good lather. This step should last at least 15 seconds.

8.     Wash each hand and wrist thoroughly. Clean well between the fingers.

9.     Clean under the fingernails Rub your fingertips against your palms.

10.  Clean under fingernails with a nail file or orange stick. This step is done for the first hand washing of the day and when your hands are highly soiled.

11.  Rinse your wrists and hands well. Water flows from the arms to the hands.

12.  Repeat steps 7 through 12, if needed.

13.  Dry your wrists and hands with paper towels. Pat dry starting at your fingertips.

14.  Discard the paper towels.

15.  Turn off faucets with clean paper towels. This prevents you from contaminating your hands. Use a clean paper towel for each faucet.

16.  Discard paper towels.

Fig.  Steps for Correct Hand Washing

SUPPLIES AND EQUIPMENT

Supply departments disinfect, sterilize, and distribute equipment. Many single-use and multi-use items are disposable. Single-use items are discarded after use. A person uses multi-use items many times. They include bedpans, urinals, wash basins, water pitchers, and drinking cups. Do not "borrow" them for another person. Disposable items help prevent the spread of infection.

Non-disposable items are cleaned and then disinfected. Then they are sterilized.

CLEANING. Cleaning reduces the number of microbes present. It also removes organic matter such as blood, body fluids, secretions, and excretions. When cleaning equipment:

·       Wear personal protective equipment—gloves, mask, gown, and eyewear—when cleaning items contaminated with blood, body fluids, secretions, or excretions.

·       Rinse the item in cold water first. Rinsing removes organic matter. Heat causes organic matter to become thick, sticky, and hard to remove.

·       Wash the item with soap and hot water.

·       Scrub thoroughly. Use a brush if necessary.

·       Rinse the item in warm water.

·       Dry the item.

·       Disinfect or sterilize the item.

·       Disinfect equipment and the sink used in the cleaning procedure.

·       Discard personal protective equipment.

·       Practice hand hygiene.

DISINFECTION. Disinfection is the process of destroying pathogens. Spores are not destroyed. Spores are bacteria protected by a hard shell. Spores are killed by extremely high temperatures. Germicides are disinfectants applied to skin, tissues, and nonliving objects. Alcohol is a common germicide.

Reusable items are cleaned with chemical disinfectants. Such items include:

·       Blood pressure cuffs

·       Commodes and metal bedpans

·       Counter tops

·       Wheelchairs and stretchers

·       Furniture

Chemical disinfectants can burn and irritate the skin. Wear utility gloves or rubber household gloves to prevent skin irritation. These gloves are waterproof Do not wear disposable gloves. Some chemical disinfectants have special measures for use or storage.

STERILIZATION. Sterilizing destroys all non-pathogens and pathogens, including spores. Very high temperatures are used. Microbes are destroyed by heat.

Boiling water, radiation, liquid or gas chemicals, dry heat, and steam under pressure are sterilization methods. An autoclave is a pressure steam sterilizer. Glass, surgical items, and metal objects are autoclaved. High temperatures destroy plastic and rubber items. They are not autoclaved. Steam under pressure usually sterilizes objects in 30 to 45 minutes.

 

Fig.  Autoclave (By Priorclave North America - Own work, CC BY-SA 4.0)

STANDARD PRECAUTIONS

Standard Precautions reduce the risk of spreading pathogens and known and unknown infections. Standard Precautions are used for all persons. They prevent the spread of infection from:

•                 Blood

•                 All body fluids, secretions, and excretions (except sweat) even if blood is not visible

•                 Non-intact skin (skin with open breaks)

•                 Mucous membranes

SURGICAL ASEPSIS

Surgical asepsis (sterile technique) is the practices that keep equipment and supplies free of all microbes. Sterile means the absence of all microbes, including spores. Surgical asepsis is required any time the skin or sterile tissues are entered.

Surgery and labor and delivery areas require surgical asepsis. So do many tests and nursing procedures. If a break occurs in sterile technique, microbes can enter the body. Infection is a risk.

You can assist nurses with sterile procedures. Some states let nursing assistants perform certain sterile procedures. Examples include sterile dressing changes and suctioning.

SAFETY ALERT: Sterile Procedures

Do not perform a sterile procedure unless:

•                 Your state allows you to perform the procedure

•                 The procedure is in your job description

•                 You received the necessary education and training

•                 You review the procedure with the nurse

•                 A nurse is available for questions and guidance

PRINCIPLES OF SURGICAL ASEPSIS

All items in contact with the person are kept sterile. If an item is contaminated, infection is a risk. A sterile field is needed. A sterile field is a work area free of all pathogens and non-pathogens (including spores).