Chapter 9: Medical Asepsis

Question 1

What is medical asepsis?

Answer 1

Clean technique that includes procedures used for reducing the number of organisms and preventing their transfer

Includes proper hand hygiene, barrier techniques, and routine environmental cleaning

Question 2

What places a PT at risk for infection?

Answer 2

Age, nutritional status, stress, disease processes, and forms of medical therapy

Question 3

Health care-associated infections (HAIs)

Answer 3

Infections that result from staff, PTs, and environmental factors that support a high population of pathogens that are resistant to antibiotics

Question 4

The chain of infection 6 elements

Answer 4

1. An infectious agent or pathogen
2. A reservoir or source for pathogen growth
3. A portal of exit from the reservoir
4. A mode of transmission
5. A portal of entry to the host
6. A susceptible host

In patient care, it is important to use infection control practices to break an element of the chain so as not to transmit infection

Question 5

Medical asepsis practices for infectious agent (pathogenic organism capable of causing disease; element 1)

Answer 5

Clean contaminated objects

Clean, disinfect, and sterilize

Question 6

Medical asepsis practices for reservoir (site or source of microorganism growth; element 2)

Answer 6

Perform hand hygiene before and after PT contact w/ appropriate antiseptic (e.g., chlorhexidine), or soap and water

Control sources of body fluids and drainage

Bathe PT with soap and water, chlorhexidine, or disposable bath

Change soiled dressings

Dispose soiled tissues, dressings, or linen in moisture-resistant bags

Place syringes, uncapped hypodermic needles, and intravenous needles in designated puncture-proof containers

Keep table surfaces clean and dry

Do not leave bottled solutions open for prolonged periods

Keep solutions tightly capped

Keep surgical wound drainage tubes and collection bags patent

Empty and dispose of drainage suction bottles according to agency policy

Question 7

Medical asepsis practices for portal of exit (means by which microorganisms leave a site; element 3) Respiratory practices:

Answer 7

Avoid talking, sneezing, or coughing directly over wound or sterile dressing field

Cover nose and mouth when sneezing or coughing

Wear mask if suffering respiratory tract infection

Question 8

Medical asepsis practices for portal of exit (means by which microorganisms leave a site; element 3) Urine, feces, emesis, and blood practices:

Answer 8

Wear clean gloves when handling blood and body fluids

Wear gowns and eyewear if there is a chance of splashing fluids

Handle all laboratory specimens as if infectious

Question 9

Medical asepsis practices for transmission (means of spread; element 4)

Answer 9

Reduce microorganisms spread:

1. ) perform hand hygiene
2. ) use personal set of care items for each PT
3. ) avoid shaking bed linen or clothes; dust with damp cloth
4. ) avoid contact of soiled item with uniform
5. ) discard any item that touches the floor
6. ) follow standard precautions or select transmission-based isolation precautions

Question 10

Medical asepsis practices for portal of entry (site through which microorganisms enter a host; element 5) Skin & mucosa:

Answer 10

Maintain skin and mucous membranes integrity, lubricate skin, offer frequent hygiene, turn and position

Cover wounds as needed

Clean wound sites thoroughly

Dispose of used needles in puncture-proof container

Question 11

Medical asepsis practices for portal of entry (site through which microorganisms enter a host; element 5) Urinary:

Answer 11

Keep all drainage systems closed and intact, maintaining downward flow

Question 12

Medical asepsis practices for host (PT; element 6)

Answer 12

Reduce susceptibility to infection

Provide adequate nutrition

Ensure adequate rest

Promote body defenses against infection

Provide immunizations

Question 13

Cultural view and practices

Answer 13

Some may choose to rely on alternative health care practices

Provide proper teaching to ensure understanding of the therapeutic purpose of isolation

EX: isolation of a loved one may be considered disrespectful and uncaring behavior in collectivistic cultures

Question 14

Use of alcohol based products vs. soap

Answer 14

Alcohol-based products are more effective for standard hand washing or hand antisepsis than soap or antiseptic soap

Brisk alcohol based rinses or gels containing emollients cause substantially less skin irritation and dryness than plain antimicrobial soaps

Soap and water is still necessary for hand hygiene if hands are visibly soiled or when caring for PTs infected with C. Diff

Question 15

Safety guidelines

Answer 15

Do not wear artificial nails/extenders due to bacterial buildup

Nails should be no longer than 1/4 an inch, nail polish should not be chipped

Cover mouth and nose when coughing or sneezing, use tissues- dispose of- then wash hands

Use barrier protection when there is risk for splashing

Question 16

Surgical hand antisepsis

Answer 16

Use of antiseptic hand wash or antiseptic hand rub before surgery by surgical personal to eliminate transient and reduce resident hand flora

Question 17

Factors involved in the decision to perform hand hygiene:

Answer 17

1. The intensity or degree of contact with PTs or contaminated objects
2. The amount of contamination that may occur with the contact
3. The PT or healthcare workers susceptibility to infection
4. The procedure or activity to be performed

Question 18

Standard precautions for TB

Answer 18

Suspect TB in respiratory infections lasting longer than 3 weeks accompanied by suspicious S/S (e.g., unexplained wt. loss, night sweats, fever, and a productive cough often steamed with blood

Consider the potential for infectious pulmonary or laryngeal TB from documented positive acid-fast bacilli (AFB) smear or culture, cavitation on chest x-ray film, or history of recent TB exposure

PT is put on airborne precautions in an isolation room with negative-pressure

Caregivers must wear special respirators

QFT-GIT (gold test) is recommended to test because it is not subject to reader bias

Question 19

Airborne precautions (droplet nuclei smaller than 5 microns)

Answer 19

EX: measles, chickenpox (varicella), disseminated varicella zoster, pulmonary or laryngeal TB

Barrier protection: private room, negative-pressure airflow of at least 6-12 exchanges per hour via HEPA filtration; mask or respiratory protection device, N95 respirator (depending on condition)

Question 20

Droplet precautions (droplets larger than 5 microns; being within 3 feet of PT)

Answer 20

EX: diphtheria (pharyngeal), rubella, streptococcal pharyngitis, pneumonia or scarlet fever in infants and young children, pertussis, mumps, mycoplasma pneumonia, meningococcal pneumonia or sepsis, pneumonic plaque

Barrier protection: private room or cohort PTs, mask or respirator (refer to policy)

Question 21

Contact precautions (direct PT or environmental contact)

Answer 21

EX: colonization or infection with multidrug-resistant organisms such are VRE and MRSA, C. Diff, shigella, and other enteric pathogens, major wound infections, herpes simplex, scabies, varicella zoster (disseminated), resp. syncytial virus in infants, young children or immunocompromised adults

Barrier protection: private room or cohort PTs, gloves, gowns. PTs may leave their room for procedures or therapy if infectious material is contained or covered and placed in a clean gown and hands cleaned

Question 22

Protective environment

Answer 22

EX: allogeneic hematopoietic stem cell transplants

Barrier protection: private room, positive airflow with >= 12 air exchanges per hour. HEPA filtration for incoming air, mask to be worn by PT when out of room during times of construction in area

Question 23

Pediatric considerations

Answer 23

Use simple explanations

Allow PT to see your face before applying PPE

Question 24

Gerontological considerations

Answer 24

Allow PT to see your face before applying PPE to decrease confusion

Assess need to close door (negative airflow room)