Fundamental of Nursing

Chapter 4
Asepsis, Infection Prevention &
Control
Prepared By

Dr. Motasem S. Salah

BSN, MSN, PhD Nursing Management

Dr. Motasem S. Salah

 Infection

• An infection is the growth of microorganisms in body

tissue.
• Such a microorganism is called an infectious agent. If
the microorganism produces no clinical evidence of
disease, the infection is called asymptomatic or
subclinical.
• Some subclinical infections can cause considerable
damage.

Dr. Motasem S. Salah

 Infection
• A detectable alteration in normal tissue function is called
disease.
• The host can transmit pathogens and infectious diseases
to others.
• If the infectious agent can be transmitted to an individual
by direct or indirect contact or as an airborne infection,
the resulting condition is called a communicable disease.
• An opportunistic pathogen causes disease only in a
susceptible individual.

Dr. Motasem S. Salah

 Infection

• Infectious diseases (diseases spread from one person

to another) are also called contagious or
communicable diseases and community acquired
infections.
• Colonization: condition that results when microbes
are present but host is without signs or symptoms of
infection.

Dr. Motasem S. Salah

 Types Of Microorganisms that Cause
Infections
• Bacteria are the most common infection causing
microorganisms, may be aerobic or anaerobic. Several
hundred types can cause disease in humans and can live
and be transported through air, water, food, soil, body
tissues and fluids, and inanimate(nonliving) objects.
• Viruses consist primarily of nucleic acid and therefore
must enter living cells in order to reproduce (cause of
common cold, HBV, and HIV).
• Fungi: yeast considered to be normal flora in the human
vagina
• Parasites live on otherDr.living organisms (malaria, worms)
Motasem S. Salah
 Types of Infections

• Infections can be local or systemic.

• A local infection is limited to the specific part of the
body where the microorganisms remain.
• If the microorganisms spread and damage different
parts of the body, the infection is a systemic infection.
• When a culture of the person’s blood reveals(expose)
microorganisms, the condition is called bacteremia.
• When bacteremia results in systemic infection, it is
referred to as Septicemia.
Dr. Motasem S. Salah
 Types of Infections

• There are also acute and chronic infections.

• Acute infections generally appear suddenly or last a
short time.
• Chronic infection may occur slowly, over a very long
period, and may last months or years.

Dr. Motasem S. Salah

 Nosocomial and Health
Care–Associated Infections

• Nosocomial infections are classified as infections that

originate in the hospital.
• The microorganisms that cause nosocomial infections
can originate from the clients themselves (an
endogenous source) or from the hospital environment
and hospital personnel (exogenous sources)
• Iatrogenic infections are the direct result of diagnostic or
therapeutic procedures.
• Example for iatrogenic infection is bacteremia that
results from an intravascular infusion line.
Dr. Motasem S. Salah
 Asepsis

• Asepsis is the freedom from disease-causing

microorganisms.
• Two basic types of asepsis are medical and surgical.
• Medical asepsis includes all practices intended to
confine(limit) a specific microorganism to a specific
area, limiting the number, growth, and transmission
of microorganisms.

Dr. Motasem S. Salah

 Asepsis
• In medical asepsis, objects are referred to as clean,
which means the absence of almost all microorganisms,
or dirty (soiled, contaminated), which means likely to
have microorganisms, some of which may be capable of
causing infection.
• Surgical asepsis, or sterile technique, refers to those
practices that keep an area or object free of all
microorganisms; it includes practices that destroy all
microorganisms and spores
• Sepsis is the condition in which acute organ dysfunction
occurs secondary to infection.
Dr. Motasem S. Salah
Dr. Motasem S. Salah
 Chain of Infection
• Infectious agent : agents that cause infection are
bacteria, viruses, and fungi.
• Reservoir :The reservoir for growth and multiplication
of microorganisms is the natural habitat(home) of the
organism. include other people, animals, food, water,
milk, and inanimate(dead) objects.
• Portal of exit: The portal of exit is the point of escape
for the organism from the reservoir. common portals of
exit or escape routes include the respiratory,
gastrointestinal, and genitourinary tracts, Blood and
tissue can also be portals of exit for pathogens
Dr. Motasem S. Salah
 Chain of Infection
• Means of transmission: An organism may be
transmitted from its reservoir by various means or routes.
Direct contact between the susceptible host and an
infected person or a carrier, such as through
touching, kissing, or sexual intercourse.
Indirect contact route involves personal contact with
an inanimate object, such as touching a
contaminated instrument.

Dr. Motasem S. Salah

 Chain of Infection

• Contaminated blood, food, or inanimate objects are

vehicles of transmission. Vectors, such as mosquitoes, are
nonhuman carriers that transmit
• Organisms from one host to another.
• Microorganisms can also be spread through the
airborne route when an infected host coughs the
organism attached to dust particles. Another mean is
through droplets.

Dr. Motasem S. Salah

 Chain of Infection

• Portals of entry: the point at which organisms enter a

new host. The urinary, respiratory, and gastrointestinal
tracts and the skin are common portals of entry.
• Susceptible host: is any person who is at risk for
infection.
 A compromised host is a person at increased risk.

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Dr. Motasem S. Salah
Stages of Infection

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Factors Affecting the Risk for Infection

The susceptibility of the host depends on various factors:

• Integrity of skin and mucous membranes.
• Integrity and number of the body’s WBCs.
• Age, sex, race, and hereditary.
• Immunizations, natural or acquired.
• Level of fatigue, nutritional and general health status.
• Stress level.
• Use of invasive or indwelling medical devices.

Dr. Motasem S. Salah

 Infection Control Precautions

• Infection control precautions are physical measures

designed to limit the spread of infectious diseases.
• They are essential when caring for clients.
• Infection control precautions require knowledge of the
mechanisms by which an infectious disease is
transmitted and the methods that will interfere with
the chain of infection.

Dr. Motasem S. Salah

Dr. Motasem S. Salah
 Standard Precautions

• Standard precautions are measures for reducing the

risk for microorganism transmission from both
recognized and unrecognized sources of infection.
• Health care personnel follow standard precautions
when caring for all clients, regardless of diagnosis or
infection status.
• This precautionary system combines methods
previously known as universal precautions.

Dr. Motasem S. Salah

 Standard Precautions

• Health care personnel follow standard precautions

whenever there is the potential for contact with the
following:
– Blood
– All body fluids except sweat
– Nonintact skin
– Mucous membranes

Dr. Motasem S. Salah

 Standard Precautions

Handwashing
• Wash hands after touching blood, body fluids, secretions,
excretions, and contaminated items, whether or not gloves
are worn.
• Wash hands immediately after gloves are removed,
between patient contacts, and when otherwise indicated;
wash between tasks and procedures on the same patient
to prevent cross-contamination of different body sites.
• Use plain (natural) soap for routine handwashing.
• Use an antimicrobial agent or a waterless antiseptic agent
to control outbreaks or hyperendemic infections (highly
infectious in all age groups)
Dr. Motasem S. Salah
 Standard Precautions

Gloves
• Wear clean, nonsterile gloves when touching blood,
body fluids, secretions, excretions, and contaminated
items.
• Change gloves between tasks on the same patient after
contact with material that may contain a high
concentration of microorganisms.
• Remove gloves and wash hands immediately before
caring for another patient.

Dr. Motasem S. Salah

 Standard Precautions

Mask, Eye Protection, Face Shield

• Wear a mask and eye protection, or face shield to
protect the eyes, nose, and mouth when there is a
likelihood that splashes(sucks) or sprays of blood, body
fluids, secretions, or excretions will occur.
Gown
• Wear a clean, nonsterile gown when there is a
likelihood that splashes or sprays of blood, body fluids,
secretions, or excretions will occur.
• Remove a soiled gown promptly and wash hands.

Dr. Motasem S. Salah

 Standard Precautions

Patient-Care Equipment
• Handle equipment soiled with blood, body fluids,
secretions, and excretions so as to prevent the transfer
of microorganisms to oneself, others, or the
environment.
• Ensure that soiled reusable equipment is cleaned before
another subsequent use.
• Discard soiled single-use equipment properly.

Dr. Motasem S. Salah

 Standard Precautions

Environmental Control
• Ensure that procedures for routine cleaning and
disinfection of environmental surfaces, beds, bedrails,
bedside equipment, and other frequently touched
surfaces are carried out.
Linen
• Handle, transport, and process soiled linen in such a way
as to prevent exposure to oneself, others, and the
environment.

Dr. Motasem S. Salah

 Standard Precautions

Occupational Health and Blood-borne Pathogens

• Prevent injuries when using needles, scalpels (knife), and
other sharp devices
– Never recap used needles
– Use either a one-handed “scoop” method or
mechanical device for covering a needle.
– Place all disposable sharp items in a puncture-
resistant container as close to the location of use as
possible; transport reusable syringes and needles in a
puncture-resistant container for reprocessing.
Dr. Motasem S. Salah
 Standard Precautions

Use mouthpieces,
• resuscitation bags, or other ventilation devices as an
alternative to mouth-to-mouth resuscitation methods in
areas where the need for resuscitation is predictable.
Patient Placement
• Place a patient who contaminates the environment,
who does not—or cannot be expected to—assist in
maintaining appropriate hygiene or environmental
control in a private room.
• Consult with an infection control professional
concerning alternatives if a private room is not
available.
Dr. Motasem S. Salah
 Transmission-Based Precautions

• Transmission-based precautions are measures for

controlling the spread of infectious agents from
clients known to be or suspected of being infected
with highly transmissible or epidemiologically
important pathogens. They are also called The three
types of transmission-based precautions are:
• Airborne precautions.
• Droplet precautions.
• Contact precautions.
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 Airborne Precautions

• Airborne precautions are measures that reduce the risk

for transmitting airborne infectious agents. They block
pathogens 5 microns or smaller that are present in the
residue of evaporated droplets that remain suspended
in the air, as well as those attached to dust particles.
• Tuberculosis (TB) is an example of a disease transmitted
in the air.

Dr. Motasem S. Salah

Dr. Motasem S. Salah
Dr. Motasem S. Salah
 Droplet Precautions

• Droplet precautions are measures that block pathogens

within moist droplets larger than 5 microns. They are used to
reduce pathogen transmission from close contact (usually 3
feet or less) between an infected person or a person who is a
carrier of a droplet-spread microorganism and others.
• Microorganisms carried on droplets commonly exit the body
during coughing, sneezing, talking, and procedures such as
airway suctioning and bronchoscopy. Airborne precautions
are not used because droplets do not remain suspended in
the air.

Dr. Motasem S. Salah

Dr. Motasem S. Salah
 Contact Precautions

• Contact precautions are measures used to block the

transmission of pathogens by direct or indirect contact.
This is the final category of transmission-based
precautions. Direct contact involves skin-to-skin
contact with an infected or colonized person.
• Indirect contact occurs by touching a contaminated
intermediate object in the client's environment.
Additional precautions are necessary if the
microorganism is antibiotic resistant
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Dr. Motasem S. Salah
 Infection Control Measures

• Infection control measures involve the use of personal

protective equipment (garments that block the
transfer of pathogens from one person, place, or
object to oneself or others) and techniques that serve
as barriers to transmission.

Dr. Motasem S. Salah

Dr. Motasem S. Salah
 Infection Control Measures

• Disposing of contaminated linen, equipment, and

supplies in such a way that nurses do not transfer
pathogens to others
• Using infection control measures to prevent pathogens
from spreading when transporting laboratory
specimens or clients

Dr. Motasem S. Salah

 Client Environment .1

• The client environment includes the room designated

for the care of a client with an infectious disease and
the equipment and supplies essential to controlling
transmission of the pathogens

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 Infection Control Room

• Most health care agencies assign infectious or potentially

infectious clients to private rooms.
• They keep the door to the room closed to control air currents and
the circulation of dust particles.
• The room has a private bathroom so that personnel can flush
contaminated liquids and recyclable solids. A sink(basin) is also
located in the room for handwashing.
• Staff members post an instruction card stating that isolation
precautions are required on the door or nearby at eye level.
• Nurses are responsible for teaching visitors how to comply with
the infection control measures.

Dr. Motasem S. Salah

 Equipment and Supplies

• The infection control room contains the same equipment and

supplies as any other hospital room, with a few modifications.
• Equipment that personnel would ordinarily use for several non-
infected clients, such as a stethoscope and sphygmomanometer,
remains in the client's room whenever possible. This prevents the
need to clean and disinfect the items each time they are removed.
• For the same reason, disposable thermometers are preferred.
Personnel disinfect electronic or tympanic thermometers to make
them safe for the next client.
• Items such as a container for soiled laundry, lined waste containers,
and liquid soap dispensers are also placed in the room.
Dr. Motasem S. Salah
 .Personal Protective Equipment .2

• Infection control measures involve the use of one or

more items for personal protection. Personal protective
equipment, also called barrier garments, includes
gowns, masks, respirators, goggles or face shields, and
gloves.
• These items are located just outside the client's room
or in an anteroom.

Dr. Motasem S. Salah

 Removing Personal Protective
Equipment

• The procedure involves making contact between two

contaminated surfaces or two clean surfaces. Nurses
remove the garments that are most contaminated first,
preserving the clean uniform underneath.

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Disposing of Contaminated Linen,
Equipment, and Supplies

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Double-bagging is an infection control measure in
which one bag of contaminated items, such as trash or
laundry, is placed within another.

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 Removing Reusable Items
• They are cleaned with an antimicrobial
disinfectant, bagged, and sterilized using heat
or chemicals.

Dr. Motasem S. Salah

 Transporting Clients

• During transport, nurses use methods to prevent the

spread of pathogens either directly or indirectly from the
client.
• The client wears a mask or particulate air filter respirator
if the pathogen is transmitted by the airborne or droplet
route. Any hospital personnel having direct contact with
the client use personal protective equipment similar to
that used in client care.

Dr. Motasem S. Salah

 Psychological Implications

• Although infection control measures are necessary,

they often leave clients feeling shunned (ignored). Clients
with infectious diseases continue to need human
contact and interaction.

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 Promoting Social Interaction

• Nurses encourage visitors to come as often as the

agency's policies and the client's condition permit.
• They use every opportunity to emphasize that as long
as visitors follow the infection control precautions, they
are not likely to acquire the disease.

Dr. Motasem S. Salah

 Combating Sensory Deprivation
• Sensory deprivation results when a person
experiences insufficient sensory stimulation or is
exposed to sensory stimulation that is continuous
and monotonous (repetitive).

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 Nursing Implications

• Risk for Infection

• Ineffective Protection
• Risk for Infection Transmission
• Impaired Social Interaction
• Social Isolation
• Risk for Loneliness
• Deficient Diversional Activity
• Powerlessness
• Fear
Dr. Motasem S. Salah