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Asepsis

One of the more important methods for breaking the chain of infection is asepsis. Asepsis is defined as a condition in which pathogens are absent or controlled. Aseptic practices break the chain of infection by preventing the transmission of pathogens. Strict adherence to aseptic practices is the only way to prevent the spread and transmission of infectious diseases. There are three levels of aseptic control: antisepsis or sanitation, disinfection, and sterilization.
Antisepsis or sanitation
This is a method of infection control that includes using soap and water to wash the hands and body as well as the use of antiseptics such as alcohol, iodine, and Betadine® to cleanse the skin for medical procedures.

The level of asepsis may kill or inhibit some bacteria but generally are not effective against viruses or bacterial spores.
Disinfection
This is the process of using chemicals or boiling water to destroy or kill microorganisms.
The process is not always effective against viruses or bacterial spores.
Disinfectants are used on surfaces, equipment, and instruments.
Disinfectants are harsh and cannot be used on the skin.
Sterilization
This is the only level of asepsis that kills all microorganisms.
Sterilization is achieved by the use of gas, chemicals, radiation, and steam under pressure.
It is primarily used on medical instruments and equipment, surgical dressings, and gowns.

MEDICAL ASEPSIS
Medical asepsis, sometimes called clean technique, is based on maintaining cleanliness to prevent the spread of infectious diseases and to assure that the environment is as free of microorganisms as possible. Medical asepsis involves confining microorganisms to specific areas and making objects either clean or dirty. The basic principles of medical asepsis include:
Cleanse hands frequently following CDC’s Hand Hygiene Guidelines.
Keep soiled items and equipment from touching clothing.
Do not place soiled bed linens or other items on the floor.
Avoid having the patient cough, sneeze, or breathe directly on others.
Move equipment away from you when sweeping, dusting, or scrubbing articles.
Clean the least soiled items first then the more soiled ones.
Dispose of soiled or used items directly into the appropriate containers.
Pour liquids that are to be discarded directly into the drain to avoid splattering in the sink and onto you.
Avoid leaning against sinks, supplies, and equipment.
Avoid touching your eyes, face, and mouth.
Use practices of personal grooming that help prevent spreading microorganisms.
Follow your facility’s guidelines for isolation and barrier techniques.

SURGICAL ASEPSIS
Surgical asepsis, also called sterile technique, is used in the operating room, delivery room, during surgical procedures, catheterization, and during dressing changes. Basic principles include:
Only a sterile object can touch another sterile object.
Open sterile packages so that the first edge of the wrapper is directed away from the worker to avoid the possibility of a sterile wrapper touching non-sterile clothing.
Avoid spilling any solution on a cloth or paper used as a field for sterile set up.
Hold sterile objects above the waist level.
Avoid talking, coughing, sneezing, and reaching over a sterile field or object.
Never walk away from or turn your back on a sterile field.
All items brought into contact with broken skin or used to penetrate the skin in order to inject substances into the body, or to enter normally sterile body cavities, should be sterile.
Use dry, sterile forceps when necessary.
Consider the edge (outer 1”) of a sterile field to be contaminated.
Consider an object contaminated if you have any doubt as to its sterility.
HANDWASHING
On October 25, 2002, the Centers for Disease Control and Prevention (CDC), released the Guideline for Hand Hygiene in Healthcare Settings. Among other items, the guideline describes washing hands with soap and water and cleansing hands with alcohol-based hand rubs. Washing hands with soap and water is always acceptable. However, use of alcohol-based hand rubs is not always acceptable.
Soap and Water Required
Alcohol-Based Hand Rub OK
After removing gloves that are visibly contaminated with blood/body fluids.
When bare hands are visibly contaminated with blood/body fluids.
Before eating.
After using a restroom.
After exposure to known or suspected Bacillus anthracis (anthrax).
After removing gloves that are not visibly contaminated.
After bare hands come in contact with blood/body fluids, mucous membranes, nonintact skin if hands are not visibly
contaminated.
Before direct patient contact.
After contact with a patient’s intact skin.
Proper hand hygiene is the single most important thing that
everyone can do to prevent and control the spread of infection!

Recommended Hand Hygiene Procedures
Soap and Water
Alcohol-Based Hand Rub
1. Wet hands with water.
2. Apply the recommended amount of soap to wash hands.
3. Rub hands vigorously for at least 15 seconds, covering all surfaces of the hands and fingers.
4. Rinse hands with water and dry thoroughly with a disposable paper towel.
5. Use another paper towel to turn off the faucet.
NOTE: Avoid using hot water, because repeated exposure to hot water may increase the risk of dermatitis.
1. Apply the recommended amount of product to the palm of one hand.
2. Rub hands together, covering all surfaces of the hands and fingers, until the hands are dry.
3. Make sure to rub hands together until your hands are DRY!
Surgical Hand Hygiene/Antisepsis
Remove rings, watches, and bracelets before beginning the surgical hand scrub.
Remove debris from underneath fingernails using a nail cleaner and running water.
Perform surgical hand antisepsis using an antimicrobial soap or an alcohol-based hand rub with persistent activity.
IF
THEN
Using antimicrobial soap
a. Scrub hands and forearms for the length of time recommended by the manufacturer, usually 2 – 6 minutes.
b. Dry hands and forearms thoroughly.
c. Don sterile gloves.
Using alcohol-based surgical hand scrub with persistent activity
a. Pre-wash hands and forearms with a non-antimicrobial soap and dry hands and forearms completely.
b. Apply the alcohol-based surgical hand scrub following manufacturer’s instructions.
c. Allow hands and forearms to dry thoroughly.
d. Don sterile gloves.
For more information on CDC’s Hand Hygiene Guidelines, refer to CE Course 1220206 Hand Hygiene Guideline.

STANDARD PRECAUTIONS
Standard Precautions were developed in 1996 when the CDC joined the major features of Universal Precautions and Body Substance Isolation. Standard Precautions should be used in the care of all patients and eliminates the need for Body Substance Isolation and category-specific blood/body fluids isolation.
Standard Precautions:
Assumes that ALL blood, body fluids (except sweat), non-intact skin, and mucous membranes are capable of transmitting bloodborne pathogens.
Personal Protective Equipment (PPE) such as gloves, gowns, mask, eye protection, etc., should be used to prevent the healthcare worker from direct contact with blood, body fluids, non-intact skin, and mucous membranes.

TRANSMISSION-BASED PRECAUTIONS
The Centers for Disease Control and Prevention (CDC) recommend the use of isolation-based categories to prevent the spread of infection in a hospital setting. These categories are initiated as soon as the patient is suspected to be infected. These precautions are used

IN ADDITION to Standard Precautions.
Contact Precautions
Used for infections that could be spread through direct or indirect contact.
Examples: herpes simplex, hepatitis A, sexually transmitted diseases
Gloves and gowns are worn when handling the patient, body fluids, or items from the patient room. A surgical mask and eyewear should be worn if there is a potential for exposure to body fluids.
Droplet Precautions
Used for a patient known or suspected to be infected with microorganisms transmitted by droplets formed when the patient coughs, sneezes, or talks.
Examples: influenza, whooping cough, rubella.
Droplets can travel approximately three feet.
Regular masks are worn to prevent inhalation of droplets. Gloves and gowns must be worn if being exposed to blood or body fluids.
Airborne Precautions
Used to prevent transmission of organisms that are carried on air currents on dust particles.
Examples: tuberculosis, chickenpox.
Special ventilation in a negative air pressure isolation room is required.
Individuals entering the patient room must wear a particulate respirator (HEPA) mask that has been properly fit. Gowns and gloves must be worn if coming into direct contact with the patient.
CONCLUSION
Infectious diseases are caused by microorganisms and can be spread by human to human contact, animal to human contact, human contact with an infected surface, airborne transmission through tiny droplets of infectious agents suspended in the air, and, finally, by such common vehicles as food or water. Approximately 5% of all hospital patients acquire an infection during a hospital stay. These infections result in increased cost, increased time spent in the hospital and, in some cases, death. Infectious diseases can be spread from patient to healthcare worker, healthcare worker to healthcare worker, and healthcare worker to patient. Knowledge of how microorganisms are transmitted is required before healthcare personnel can establish policies and procedures to minimize the risk or eliminate the spread of infections. To ensure the safety of patients and employees, all healthcare workers should strictly adhere to infection control polices and procedures.
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