critical thinking activities medical and surgical asepsis

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Chapter 1. Infection Control

1.5 Principles of Asepsis

Asepsis refers to the absence of infectious material or infection. Surgical asepsis is the absence of all microorganisms within any type of invasive procedure. Sterile technique  is a set of specific practices and procedures performed to make equipment and areas free from all microorganisms and to maintain that sterility (Centre for Disease Control, 2007). In the literature, surgical asepsis and sterile technique are commonly used interchangeably, but they mean different things (Kennedy, 2013). Principles of sterile technique help control and prevent infection, prevent the transmission of all microorganisms in a given area, and include all techniques that are practised to maintain sterility.

Sterile technique is most commonly practised in operating rooms, labour and delivery rooms, and special procedures or diagnostic areas. It is also used when performing a sterile procedure at the bedside, such as inserting devices into sterile areas of the body or cavities (e.g., insertion of chest tube, central venous line, or indwelling urinary catheter). In healthcare, sterile technique is always used when the integrity of the skin is accessed, impaired, or broken (e.g., burns or surgical incisions). Sterile technique may include the use of sterile equipment, sterile gowns, and gloves (Perry et al., 2014).

Sterile technique is essential to help prevent surgical site infections (SSI) , an unintended and oftentimes preventable complication arising from surgery. It is simply post op infection that occurs at the surgical site (CDC, 2014). Preventing and reducing SSI are the most important reasons for using sterile technique during invasive procedures and surgeries.

Principles of Surgical Asepsis

All personnel involved in an aseptic procedure are required to follow the principles and practice set forth by the Association of periOperative Registered Nurses (AORN). These principles must be strictly applied when performing any aseptic procedures, when assisting with aseptic procedures, and when intervening when the principles of surgical asepsis are breached. It is the responsibility of all healthcare workers to speak up and protect all patients from infection.

Critical Thinking Exercises

• When should a sterile field be opened (under normal circumstances)?
• What part of the sterile field is considered non-sterile?

Clinical Procedures for Safer Patient Care Copyright © 2018 by Thompson Rivers University is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

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4.3 Aseptic Technique

In addition to using standard precautions and transmission-based precautions, aseptic technique (also called medical asepsis) is the purposeful reduction of pathogens to prevent the transfer of microorganisms from one person or object to another during a medical procedure. For example, a nurse administering parenteral medication or performing urinary catheterization uses aseptic technique. When performed properly, aseptic technique prevents contamination and transfer of pathogens to the patient from caregiver hands, surfaces, and equipment during routine care or procedures. The word “aseptic” literally means an absence of disease-causing microbes and pathogens. In the clinical setting, aseptic technique refers to the purposeful prevention of microbe contamination from one person or object to another. These potentially infectious, microscopic organisms can be present in the environment, on an instrument, in liquids, on skin surfaces, or within a wound.

There is often misunderstanding between the terms aseptic technique and sterile technique in the health care setting. Both asepsis and sterility are closely related, and the shared concept between the two terms is removal of harmful microorganisms that can cause infection. In the most simplistic terms, asepsis is creating a protective barrier from pathogens, whereas sterile technique is a purposeful attack on microorganisms. Sterile technique (also called surgical asepsis) seeks to eliminate every potential microorganism in and around a sterile field while also maintaining objects as free from microorganisms as possible. It is the standard of care for surgical procedures, invasive wound management, and central line care. Sterile technique requires a combination of meticulous hand washing, creation of a sterile field, using long-lasting antimicrobial cleansing agents such as betadine, donning sterile gloves, and using sterile devices and instruments.

Principles of Aseptic Non-Touch Technique

Aseptic non-touch technique (ANTT) is the most commonly used aseptic technique framework in the health care setting and is considered a global standard. There are two types of ANTT: surgical-ANTT (sterile technique) and standard-ANTT.

Aseptic non-touch technique starts with a few concepts that must be understood before it can be applied. For all invasive procedures, the “ANTT-approach” identifies key parts and key sites throughout the preparation and implementation of the procedure. A key part is any sterile part of equipment used during an aseptic procedure, such as needle hubs, syringe tips, needles, and dressings. A key site is any nonintact skin, potential insertion site, or access site used for medical devices connected to the patients. Examples of key sites include open wounds and insertion sites for intravenous (IV) devices and urinary catheters.

ANTT includes four underlying principles to keep in mind while performing invasive procedures:

• A lways wash hands effectively.
• N ever contaminate key parts.
• T ouch non-key parts with confidence.
• T ake appropriate infective precautions.

Preparing and Preventing Infections Using Aseptic Technique

When planning for any procedure, careful thought and preparation of many infection control factors must be considered beforehand. While keeping standard precautions in mind, identify anticipated key sites and key parts to the procedure. Consider the degree to which the environment must be managed to reduce the risk of infection, including the expected degree of contamination and hazardous exposure to the clinician. Finally, review the expected equipment needed to perform the procedure and the level of key part or key site handling. See Table 4.3 for an outline of infection control measures when performing a procedure.

Table 4.3 Infection Control Measures When Performing Procedures

Use of Gloves and Sterile Gloves

There are two different levels of medical-grade gloves available to health care providers: clean (exam) gloves and sterile (surgical) gloves. Generally speaking, clean gloves are used whenever there is a risk of contact with body fluids or contaminated surfaces or objects. Examples include starting an intravenous access device or emptying a urinary catheter collection bag. Alternatively, sterile gloves meet FDA requirements for sterilization and are used for invasive procedures or when contact with a sterile site, tissue, or body cavity is anticipated. Sterile gloves are used in these instances to prevent transient flora and reduce resident flora contamination during a procedure, thus preventing the introduction of pathogens. For example, sterile gloves are required when performing central line dressing changes, insertion of urinary catheters, and during invasive surgical procedures. See Figure 4.15 [1] for images of a nurse opening and removing sterile gloves from packaging.

See the “ Checklist for Applying and Removing Sterile Gloves ” for details on how to apply sterile gloves.

Applying Sterile Gloves on YouTube [2]

• “Book-pictures-2015-199-001-300x241.jpg,” “Book-pictures-2015-215.jpg,” and “Book-pictures-2015-219.jpg” by British Columbia Institute of Technology  are licensed under CC BY 4.0 . Access for free at https://opentextbc.ca/clinicalskills/chapter/sterile-gloving/ ↵
• RegisteredNurseRN. (2017, April 28). Sterile gloving nursing technique | Don/donning sterile gloves tips. [Video]. YouTube. All rights reserved. Video used with permission. https://youtu.be/lumZOF-METc ↵

The purposeful reduction of pathogen numbers while preventing microorganism transfer from one person or object to another.

A state of being free of disease-causing microorganisms.

Techniques used to eliminate every potential microorganism in and around a sterile field while maintaining objects and areas as free from microorganisms as possible.

A standardized technique, supported by evidence, to maintain asepsis and standardize practice.

A key part is any sterile part of equipment used during an aseptic procedure, such as needle hubs, syringe tips, dressings, etc.

A key site is the site contacted during an aseptic procedure, such as non-intact skin, a potential insertion site, or an access site used for medical devices connected to the patients.

Nursing Skills - 2e Copyright © 2023 by Chippewa Valley Technical College is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

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Open Resources for Nursing (Open RN); Ernstmeyer K, Christman E, editors. Nursing Skills [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2023.

Nursing Skills [Internet]. 2nd edition.

• About Open RN

Chapter 4 Aseptic Technique

4.1. aseptic technique introduction, learning objectives.

• Perform appropriate hand hygiene

• Use standard precautions

• Use category-specific, transmission-based precautions

• Maintain a sterile field and equipment

• Apply and safely remove sterile gloves and personal protective equipment

• Dispose of contaminated wastes appropriately

According to the Centers for Disease Control and Prevention (CDC), over 2 million patients in America contract a healthcare-associated infection, and 99,000 patients die from a healthcare-associated infection every year.[1]  Healthcare-associated infections  (HAIs) are unintended and often preventable infections caused by care received in a health care setting.  Healthcare-associated infections can be prevented by consistently following standard precautions and transmission-based precautions outlined by the CDC (2020). Standard precautions are used when caring for all patients and include performing appropriate  hand hygiene ; wearing  personal protective equipment  when indicated; implementing category-specific transmission precautions; encouraging respiratory hygiene; and following environmental infection control measures, including handling of sharps, laundry, and hazardous waste. Additional infection control measures include the appropriate use of aseptic technique and sterile technique when performing nursing procedures to protect the patient from transmission of microorganisms.[2] Each of these strategies to keep patients and health care workers free of infection is discussed in further detail in this chapter.

4.2. ASEPTIC TECHNIQUE BASIC CONCEPTS

Standard versus transmission-based precautions, standard precautions.

Standard precautions are used when caring for all patients to prevent health care associated infections. According to the Centers for Disease Control and Prevention (CDC),  standard precautions  are “the minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where health care is delivered.”[1] They are based on the principle that all blood, body fluids (except sweat), nonintact skin, and mucous membranes may contain transmissible infectious agents. These standards reduce the risk of exposure for the health care worker and protect the patient from potential transmission of infectious organisms.

Current standard precautions according to the CDC (2019) include the following:

Appropriate hand hygiene

Use of personal protective equipment (e.g., gloves, gowns, masks, eyewear) whenever infectious material exposure may occur

Appropriate patient placement and care using transmission-based precautions when indicated

Respiratory hygiene/cough etiquette

Proper handling and cleaning of environment, equipment, and devices

Safe handling of laundry

Sharps safety (i.e., engineering and work practice controls)

Aseptic technique for invasive nursing procedures such as parenteral medication administration[2]

Each of these standard precautions is described in more detail in the following subsections.

Transmission-Based Precautions

In addition to standard precautions, transmission-based precautions are used for patients with documented or suspected infection, or colonization, of highly-transmissible or epidemiologically-important pathogens. Epidemiologically-important pathogens include, but are not limited to, Coronavirus disease (COVID-19),  Clostridium difficile  (C-diff),  Methicillin-resistant Staphylococcus aureus  (MRSA),  Vancomycin-resistant enterococci  (VRE),  Respiratory Syncytial Virus  (RSV), measles, and tuberculosis (TB). For patients with these types of pathogens, standard precautions are used along with specific transmission-based precautions.

There are four categories of transmission-based precautions:  contact precautions , enhanced barrier precautions ,  droplet precautions , and  airborne precautions . Transmission-based precautions are used when the route(s) of transmission is (are) not completely interrupted using standard precautions alone. Some diseases, such as tuberculosis, have multiple routes of transmission so more than one transmission-based precautions category must be implemented. See Table 4.2 outlining the categories of transmission precautions with associated PPE and other precautions. When possible, patients with transmission-based precautions should be placed in a single occupancy room with dedicated patient care equipment (e.g., blood pressure cuffs, stethoscope, thermometer). Transport of the patient and unnecessary movement outside the patient room should be limited. However, when transmission-based precautions are implemented, it is also important for the nurse to make efforts to counteract possible adverse effects of these precautions on patients, such as anxiety, depression, perceptions of stigma, and reduced contact with clinical staff.

Table 4.2 

Transmission-Based Precautions[3]

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View a list of transmission-based precautions used for specific medical conditions at the  CDC Guideline for Isolation Precautions.

Patient transport.

Several principles are used to guide transport of patients requiring transmission-based precautions. In the inpatient and residential settings, these principles include the following:

• Limiting transport for essential purposes only, such as diagnostic and therapeutic procedures that cannot be performed in the patient’s room
• Using appropriate barriers on the patient consistent with the route and risk of transmission (e.g., mask, gown, covering the affected areas when infectious skin lesions or drainage is present)
• Notify other health care personnel involved in the care of the patient of the transmission-based precautions. For example, when transporting the patient to radiology, inform the radiology technician of the precautions.[4] 

Appropriate Hand Hygiene

Hand hygiene is the single most important practice to reduce the transmission of infectious agents in health care settings and is an essential element of standard precautions.[5] Routine handwashing during appropriate moments is a simple and effective way to prevent infection. However, it is estimated that health care professionals, on average, properly clean their hands less than 50% of the time it is indicated.[6] The Joint Commission, the organization that sets evidence-based standards of care for hospitals, recently updated its hand hygiene standards in 2018 to promote enforcement. If a Joint Commission surveyor witnesses an individual failing to properly clean their hands when it is indicated, a deficiency will be cited requiring improvement by the agency. This deficiency could potentially jeopardize a hospital’s accreditation status and their ability to receive payment for patient services. Therefore, it is essential for all health care workers to ensure they are using proper hand hygiene at the appropriate times.[7]

There are several evidence-based guidelines for performing appropriate hand hygiene. These guidelines include frequency of performing hand hygiene according to the care circumstances, solutions used, and technique performed. The Healthcare Infection Control Practices Advisory Committee (HICPAC) recommends health care personnel perform hand hygiene at specific times when providing care to  patients. These moments are often referred to as the “ Five Moments for Hand Hygiene .”[8] See Figure 4.1 [9] and Figure 4.2 [10] for an illustration and application of the five moments of hand hygiene. The five moments of hand hygiene are as follows:

Five Moments of Hand Hygiene

Five Moments of Hand Hygiene Expanded

• Immediately before touching a patient
• Before performing an aseptic task or handling invasive devices
• Before moving from a soiled body site to a clean body site on a patient
• After touching a patient or their immediate environment
• After contact with blood, body fluids, or contaminated surfaces (with or without glove use)

When performing hand hygiene, washing with soap and water, or an approved alcohol-based hand rub solution that contains at least 60% alcohol, may be used. Unless hands are visibly soiled, an alcohol-based hand rub is preferred over soap and water in most clinical situations due to evidence of improved compliance. Hand rubs are also preferred because they are generally less irritating to health care worker’s hands. However, it is important to recognize that alcohol-based rubs do not eliminate some types of germs, such as  Clostridium difficile  (C-diff).

When using the alcohol-based handrub method, the CDC recommends the following steps. See Figure 4.3 [11] for a handrub poster created by the World Health Organization.

WHO Handrub Poster

• Apply  product to the palm of one hand in an amount that will cover all surfaces.
• Rub  hands together, covering all the surfaces of the hands, fingers, and wrists until the hands are dry. Surfaces include the palms and fingers, between the fingers, the backs of the hands and fingers, the fingertips, and the thumbs.
• The process should take about 20 seconds, and the solution should be dry.[12]

When washing with soap and water, the CDC recommends using the following steps. See Figure 4.4 [13] for an image of a handwashing poster created by the World Health Organization.

WHO Handwashing Poster

• Wet  hands with warm or cold running water and apply facility-approved soap.
• Lather  hands by rubbing them together with the soap. Use the same technique as the handrub process to clean the palms and fingers, between the fingers, the backs of the hands and fingers, the fingertips, and the thumbs.
• Scrub  thoroughly for at least 20 seconds.
• Rinse  hands well under clean, running water.
• Dry  the hands using a clean towel or disposable toweling.
• Use  a clean paper towel to shut off the faucet.[14]

By performing hand hygiene at the proper moments and using appropriate techniques, you will ensure your hands are safe and you are not transmitting infectious organisms to yourself or others.

Video Reviews of Handwashing

Hand hygiene for healthcare workers[15].

CDC Handwashing for Children in School[16]

https://www.youtube.com/watch?v=LWmok9avzr4

For more information about hand hygiene recommendations, use the following links:

WHO Guidelines on Hand Hygiene

WHO Hand Hygiene Brochure

CDC Hand Hygiene in Healthcare Settings

Joint Commission on Hand Hygiene

Personal Protective Equipment (PPE)

Personal Protective Equipment (PPE) includes gloves, gowns, face shields, goggles, and masks used to prevent the spread of infection to and from patients and health care providers. Depending on the anticipated exposure, PPE may include the use of gloves, a fluid-resistant gown, goggles or a face shield, and a mask or respirator. When used for a patient with transmission-based precautions, PPE supplies are typically stored in an isolation cart next to the patient’s room, and a card is posted on the door alerting staff and visitors to precautions needed before entering the room.

Gloves protect both patients and health care personnel from exposure to infectious material that may be carried on the hands. Gloves are used to prevent contamination of health care personnel hands during activities such as the following:

• anticipating direct contact with blood or body fluids, mucous membranes, nonintact skin, and other potentially infectious material
• having direct contact with patients who are colonized or infected with pathogens transmitted by the contact route, such as  Vancomycin-resistant enterococci  (VRE),  Methicillin-resistant Staphylococcus aureus  (MRSA), and  Respiratory Syncytial Virus  (RSV)
• handling or touching visibly or potentially contaminated patient care equipment and environmental surfaces[17]

Nonsterile disposable medical gloves for routine patient care are made of a variety of materials, such as latex, vinyl, and nitrile. Many people are allergic to latex, so be sure to check for latex allergies for the patient and other health care professionals. See Figure 4.5 [18] for an image of nonsterile medical gloves in various sizes in a health care setting. At times, gloves may need to be changed when providing care to a single patient to prevent cross-contamination of body sites. It is also necessary to change gloves if the patient interaction requires touching portable computer keyboards or other mobile equipment that is transported from room to room. Discarding gloves between patients is necessary to prevent transmission of infectious material. Gloves must not be washed for subsequent reuse because microorganisms cannot be reliably removed from glove surfaces and continued glove integrity cannot be ensured.[19]

Non-Sterile Medical Gloves

Figure 4.5 Nonsterile Medical GlovesWhen gloves are worn in combination with other PPE, they are put on last. Gloves that fit snugly around the wrist should be used in combination with isolation gowns because they will cover the gown cuff and provide a more reliable continuous barrier for the arms, wrists, and hands.

Gloves should be removed properly to prevent contamination. See Figure 4.6 [20] for an illustration of properly removing gloves. Hand hygiene should be performed following glove removal to ensure the hands will not carry potentially infectious material that might have penetrated through unrecognized tears or contaminated the hands during glove removal. One method for properly removing gloves includes the following steps:

Proper Removal of Gloves to Prevent Contamination

• Grasp the outside of one glove near the wrist. Do not touch your skin.
• Peel the glove away from your body, pulling it inside out.
• Hold the removed glove in your gloved hand.
• Put your fingers inside the glove at the top of your wrist and peel off the second glove.
• Turn the second glove inside out while pulling it away from your body, leaving the first glove inside the second.
• Dispose of the gloves safely. Do not reuse.
• Perform hand hygiene immediately after removing the gloves.[21]

Isolation gowns are used to protect the health care worker’s arms and exposed body areas and to prevent contamination of their clothing with blood, body fluids, and other potentially infectious material. Isolation gowns may be disposable or washable/reusable. See Figure 4.7 [22] for an image of a nurse wearing an isolation gown along with goggles and a respirator. When using standard precautions, an isolation gown is worn only if contact with blood or body fluid is anticipated. However, when contact transmission-based precautions are in place, donning of both gown and gloves upon room entry is indicated to prevent unintentional contact of clothing with contaminated environmental surfaces.

Isolation Gown

Gowns are usually the first piece of PPE to be donned. Isolation gowns should be removed before leaving the patient room to prevent possible contamination of the environment outside the patient’s room. Isolation gowns should be removed in a manner that prevents contamination of clothing or skin. The outer, “contaminated,” side of the gown is turned inward and rolled into a bundle, and then it is discarded into a designated container to contain contamination. See more information about putting on and removing PPE in the subsection below.[23]

The mucous membranes of the mouth, nose, and eyes are susceptible portals of entry for infectious agents. Masks are used to protect these sites from entry of large infectious droplets. See Figure 4.8 [24] for an image of nurse wearing a surgical mask. Masks have three primary purposes in health care settings:

Surgical Mask

• Used by health care personnel to protect them from contact with infectious material from patients (e.g., respiratory secretions and sprays of blood or body fluids), consistent with standard precautions and droplet transmission precautions
• Used by health care personnel when engaged in procedures requiring sterile technique to protect patients from exposure to infectious agents potentially carried in a health care worker’s mouth or nose
• Placed on coughing patients to limit potential dissemination of infectious respiratory secretions from the patient to others in public areas (i.e., respiratory hygiene)[25]

Masks may be used in combination with goggles or a face shield to provide more complete protection for the face. Masks should not be confused with respirators used during airborne transmission-based precautions to prevent inhalation of small, aerosolized infectious droplets.[26]

It is important to properly wear and remove masks to avoid contamination. See Figure 4.9 [27] for CDC face mask recommendations for health care personnel.

CDC Face Mask Recommendations

Goggles/Face Shields

Eye protection chosen for specific work situations (e.g., goggles or face shields) depends upon the circumstances of exposure, other PPE used, and personal vision needs. Personal eyeglasses are not considered adequate eye protection. See Figure 4.10 [28] for an image of a health care professional wearing a face shield along with a N95 respirator.

Figure 4.10

Face Shield and a N95 Respirator

Respirators and PAPRs

Respiratory protection used during airborne transmission precautions requires the use of special equipment. Traditionally, a fitted respirator mask with N95 or higher filtration has been worn by health care professionals to prevent inhalation of small airborne infectious particles. A user-seal check (formerly called a “fit check”) should be performed by the wearer of a respirator each time a respirator is donned to minimize air leakage around the facepiece.

A newer piece of equipment used for respiratory protection is the powered air-purifying respirator (PAPR). A PAPR is an air-purifying respirator that uses a blower to force air through filter cartridges or canisters into the breathing zone of the wearer. This process creates an air flow inside either a tight-fitting facepiece or loose-fitting hood or helmet, providing a higher level of protection against aerosolized pathogens, such as COVID-19,  than a N95 respirator. See Figure 4.11 [29] for an example of PAPR in use.

Figure 4.11

PAPR In Use

The CDC currently recommends N95 or higher level respirators for personnel exposed to patients with suspected or confirmed tuberculosis and other airborne diseases, especially during aerosol-generating procedures such as respiratory-tract suctioning.[30]  It is important to apply, wear, and remove respirators appropriately to avoid contamination. See Figure 4.12 [31] for CDC recommendations when wearing disposable respirators.

Figure 4.12

CDC Recommendations for Wearing Disposable Respirators

How to Put On (Don) PPE Gear

Follow agency policy for donning PPE according to transmission-based precautions. More than one donning method for putting on PPE may be acceptable. The CDC recommends the following steps for donning PPE:[32]

• Identify and gather the proper PPE to don. Ensure the gown size is correct.
• Perform hand hygiene using hand sanitizer or wash hands with soap and water.
• Put on the isolation gown. Tie all of the ties on the gown. Assistance may be needed by other health care personnel to tie back ties.
• Based on specific transmission-based precautions and agency policy, put on a mask or N95 respirator. The top strap should be placed on the crown (top) of the head, and the bottom strap should be at the base of the neck. If the mask has loops, hook them appropriately around your ears. Masks and respirators should extend under the chin, and both your mouth and nose should be protected. Perform a user-seal check each time you put on a respirator. If the respirator has a nosepiece, it should be fitted to the nose with both hands, but it should not be bent or tented. Masks typically require the nosepiece to be pinched to fit around the nose, but do not pinch the nosepiece of a respirator with one hand. Do not wear a respirator or mask under your chin or store it in the pocket of your scrubs between patients.
• Put on a face shield or goggles when indicated. When wearing an N95 respirator with eye protection, select eye protection that does not affect the fit or seal of the respirator and one that does not affect the position of the respirator. Goggles provide excellent protection for the eyes, but fogging is common. Face shields provide full-face coverage.
• Put on gloves. Gloves should cover the cuff (wrist) of the gown.
• You may now enter the patient’s room.

Video Reviews of PPE Use

How to Put On a Respirator[33]

Donning and Doffing PPE[34]

How to Take Off (Doff) PPE Gear

More than one doffing method for removing PPE may be acceptable. Train using your agency’s procedure, and practice until you have successfully mastered the steps to avoid contamination of yourself and others. There are established cases of nurses dying from disease transmitted during incorrect removal of PPE. Below are sample steps of doffing established by the CDC:[35]

• Remove the gloves. Ensure glove removal does not cause additional contamination of the hands. Gloves can be removed using more than one technique (e.g., glove-in-glove or bird beak).
• Remove the gown. Untie all ties (or unsnap all buttons). Some gown ties can be broken rather than untied; do so in a gentle manner and avoid a forceful movement. Reach up to the front of your shoulders and carefully pull the gown down and away from your body. Rolling the gown down is also an acceptable approach. Dispose of the gown in a trash receptacle. If it is a washable gown, place it in the specified laundry bin for PPE in the room.
• Health care personnel may now exit the patient room.

Perform hand hygiene.

• Remove the face shield or goggles. Carefully remove the face shield or goggles by grabbing the strap and pulling upwards and away from head. Do not touch the front of the face shield or goggles.
• Remove and discard the respirator or face mask. Do not touch the front of the respirator or face mask. Remove the bottom strap by touching only the strap and bringing it carefully over the head. Grasp the top strap and bring it carefully over the head, and then pull the respirator away from the face without touching the front of the respirator. For masks, carefully untie (or unhook ties from the ears) and pull the mask away from your face without touching the front.
• Perform hand hygiene after removing the respirator/mask. If your workplace is practicing reuse, perform hand hygiene before putting it on again.

Additional Video Reviews of PPE Use:

Putting on PPE[36]

https://youtu.be/H4jQUBAlBrI

Removing PPE[37]

https://www.youtube.com/watch?v=PQxOc13DxvQ

Respiratory Hygiene

Respiratory hygiene is targeted at patients, accompanying family members and friends, and health care workers with undiagnosed transmissible respiratory infections. It applies to any person with signs of illness, including cough, congestion, rhinorrhea, or increased production of respiratory secretions when entering a health care facility. See Figure 4.13 [38] for an example of a  “Cover Your Cough” poster used in public areas to promote respiratory hygiene. The elements of respiratory hygiene include the following:

Figure 4.13

Cover Your Cough Poster

• Education of health care facility staff, patients, and visitors
• Posted signs, in language(s) appropriate to the population served, with instructions to patients and accompanying family members or friends
• Source control measures for a coughing person (e.g., covering the mouth/nose with a tissue when coughing and prompt disposal of used tissues, or applying surgical masks on the coughing person to contain secretions)
• Hand hygiene after contact with one’s respiratory secretions
• Spatial separation, ideally  greater than 3 feet, of persons with respiratory infections in common waiting areas when possible.[39]

Health care personnel are advised to wear a mask and use frequent hand hygiene when examining and caring for patients with signs and symptoms of a respiratory infection. Health care personnel who have a respiratory infection are advised to avoid direct patient contact, especially with high-risk patients. If this is not possible, then a mask should be worn while providing patient care.[40]

Environmental Measures

Routine cleaning and disinfecting surfaces in patient-care areas are part of standard precautions. The cleaning and disinfecting of all patient-care areas are important for frequently touched surfaces, especially those closest to the patient that are most likely to be contaminated (e.g., bedrails, bedside tables, commodes, doorknobs, sinks, surfaces, and equipment in close proximity to the patient).

Medical equipment and instruments/devices must also be cleaned to prevent patient-to-patient transmission of infectious agents. For example, stethoscopes should be cleaned before and after use for all patients. Patients who have transmission-based precautions should have dedicated medical equipment that remains in their room (e.g., stethoscope, blood pressure cuff, thermometer). When dedicated equipment is not possible, such as a unit-wide bedside blood glucose monitor, disinfection after each patient’s use should be performed according to agency policy.[41]

Disposal of Contaminated Waste

Medical waste requires careful disposal according to agency policy. The Occupational Safety and Health Administration (OSHA) has established measures for discarding regulated medical waste items to protect the workers who generate medical waste, as well as those who manage the waste from point of generation to disposal. Contaminated waste is placed in a leak-resistant biohazard bag, securely closed, and placed in a labeled, leakproof, puncture-resistant container in a storage area. Sharps containers are used to dispose of sharp items such as discarded tubes with small amounts of blood, scalpel blades, needles, and syringes.[42]

Sharps Safety

Injuries due to needles and other sharps have been associated with transmission of blood-borne pathogens (BBP), including hepatitis B, hepatitis C, and HIV to health care personnel. The prevention of sharps injuries is an essential element of standard precautions and includes measures to handle needles and other sharp devices in a manner that will prevent injury to the user and to others who may encounter the device during or after a procedure. The Bloodborne Pathogens Standard is a regulation that prescribes safeguards to protect workers against health hazards related to blood-borne pathogens. It includes work practice controls, hepatitis B vaccinations, hazard communication and training, plans for when an employee is exposed to a BBP, and record keeping.

When performing procedures that include needles or other sharps, dispose of these items immediately in FDA-cleared sharps disposal containers. Additionally, to prevent needlestick injuries, needles and other contaminated sharps should not be recapped. See Figure 4.14 [43] for an image of a sharps disposal container. FDA-cleared sharps disposal containers are made from rigid plastic and come marked with a line that indicates when the container should be considered full, which means it’s time to dispose of the container. When a sharps disposal container is about three-quarters full, follow agency policy for proper disposal of the container.

Figure 4.14

Sharps Disposal Containers

If you are stuck by a needle or other sharps or are exposed to blood or other potentially infectious materials in your eyes, nose, mouth, or on broken skin, immediately flood the exposed area with water and clean any wound with soap and water. Report the incident immediately to your instructor or employer and seek immediate medical attention according to agency and school policy.

Textiles and Laundry

Soiled textiles, including bedding, towels, and patient or resident clothing may be contaminated with pathogenic microorganisms. However, the risk of disease transmission is negligible if they are handled, transported, and laundered in a safe manner. Follow agency policy for handling soiled laundry using standard precautions. Key principles for handling soiled laundry are as follows:

• Do not shake items or handle them in any way that may aerosolize infectious agents.
• Avoid contact of one’s body and personal clothing with the soiled items being handled.
• Place soiled items in a laundry bag or designated bin in the patient’s room before transporting to a laundry area. When laundry chutes are used, they must be maintained to minimize dispersion of aerosols from contaminated items.[44]

4.3. ASEPTIC TECHNIQUE

In addition to using standard precautions and transmission-based precautions,  aseptic technique  (also called medical asepsis) is the purposeful reduction of pathogens to prevent the transfer of microorganisms from one person or object to another during a medical procedure. For example, a nurse administering parenteral medication or performing urinary catheterization uses aseptic technique. When performed properly, aseptic technique prevents contamination and transfer of pathogens to the patient from caregiver hands, surfaces, and equipment during routine care or procedures. The word “aseptic” literally means an absence of disease-causing microbes and pathogens. In the clinical setting, aseptic technique refers to the purposeful prevention of microbe contamination from one person or object to another. These potentially infectious, microscopic organisms can be present in the environment, on an instrument, in liquids, on skin surfaces, or within a wound.

There is often misunderstanding between the terms aseptic technique and sterile technique in the health care setting. Both  asepsis  and sterility are closely related, and the shared concept between the two terms is removal of harmful microorganisms that can cause infection. In the most simplistic terms, asepsis is creating a protective barrier from pathogens, whereas  sterile technique  is a purposeful attack on microorganisms. Sterile technique (also called surgical asepsis) seeks to eliminate every potential microorganism in and around a sterile field while also maintaining objects as free from microorganisms as possible. It is the standard of care for surgical procedures, invasive wound management, and central line care. Sterile technique requires a combination of meticulous hand washing, creation of a sterile field, using long-lasting antimicrobial cleansing agents such as betadine, donning sterile gloves, and using sterile devices and instruments.

Principles of Aseptic Non-Touch Technique

Aseptic non-touch technique  (ANTT) is the most commonly used aseptic technique framework in the health care setting and is considered a global standard. There are two types of ANTT: surgical-ANTT (sterile technique) and standard-ANTT.

Aseptic non-touch technique starts with a few concepts that must be understood before it can be applied. For all invasive procedures, the “ANTT-approach” identifies key parts and key sites throughout the preparation and implementation of the procedure. A  key part  is any sterile part of equipment used during an aseptic procedure, such as needle hubs, syringe tips, needles, and dressings. A  key site  is any nonintact skin, potential insertion site, or access site used for medical devices connected to the patients. Examples of key sites include open wounds and insertion sites for intravenous (IV) devices and urinary catheters.

ANTT includes four underlying principles to keep in mind while performing invasive procedures:

• A lways wash hands effectively.
• N ever contaminate key parts.
• T ouch non-key parts with confidence.
• T ake appropriate infective precautions.

Preparing and Preventing Infections Using Aseptic Technique

When planning for any procedure, careful thought and preparation of many infection control factors must be considered beforehand. While keeping standard precautions in mind, identify anticipated key sites and key parts to the procedure. Consider the degree to which the environment must be managed to reduce the risk of infection, including the expected degree of contamination and hazardous exposure to the clinician. Finally, review the expected equipment needed to perform the procedure and the level of key part or key site handling. See Table 4.3 for an outline of infection control measures when performing a procedure.

Infection Control Measures When Performing Procedures

Use of Gloves and Sterile Gloves

There are two different levels of medical-grade gloves available to health care providers: clean (exam) gloves and sterile (surgical) gloves. Generally speaking, clean gloves are used whenever there is a risk of contact with body fluids or contaminated surfaces or objects. Examples include starting an intravenous access device or emptying a urinary catheter collection bag. Alternatively, sterile gloves meet FDA requirements for sterilization and are used for invasive procedures or when contact with a sterile site, tissue, or body cavity is anticipated. Sterile gloves are used in these instances to prevent transient flora and reduce resident flora contamination during a procedure, thus preventing the introduction of pathogens. For example, sterile gloves are required when performing central line dressing changes, insertion of urinary catheters, and during invasive surgical procedures. See Figure 4.15 [1] for images of a nurse opening and removing sterile gloves from packaging.

Figure 4.15

Sterile Gloves

See the “ Checklist for Applying and Removing Sterile Gloves ” for details on how to apply sterile gloves.

Video Review of Applying Sterile Gloves[2]

4.4. STERILE FIELDS

A sterile field is established whenever a patient’s skin is intentionally punctured or incised, during procedures involving entry into a body cavity, or when contact with nonintact skin is possible (e.g., surgery or trauma). Surgical asepsis requires adherence to strict principles and intentional actions to prevent contamination and to maintain the sterility of specific parts of a sterile field during invasive procedures. Creating and maintaining a sterile field is foundational to aseptic technique and encompasses practice standards that are performed immediately prior to and during a procedure to reduce the risk of infection, including the following:

• Handwashing
• Using sterile barriers, including drapes and appropriate personal protective equipment
• Preparing the patient using an approved antimicrobial product
• Maintaining a sterile field
• Using aseptically safe techniques

There are basic principles of asepsis that are critical to understand and follow when creating and maintaining a sterile field. The most basic principle is to allow only sterile supplies within the sterile field once it is established. This means that prior to using any supplies, exterior packaging must be checked for any signs of damage, such as previous exposure to moisture, holes, or tears. Packages should not be used if they are expired or if sterilization indicators are not the appropriate color. Sterile contents inside packages are dispensed onto the sterile field using the methods outlined below. See Figure 4.16 [1] for an image of a nurse dispensing sterile supplies from packaging onto an established sterile field.

Figure 4.16

Dispensing Sterile Supplies onto a Sterile Field

When establishing and maintaining a sterile field, there are other important principles to strictly follow:

• Disinfect any work surfaces and allow to them thoroughly dry before placing any sterile supplies on the surface.
• Any part of the field within 1 inch from the edge.
• Any part of the field that extends below the planar surface (i.e., a drape hanging down below the tray tabletop).
• Any part of the field below waist level or above shoulder level.
• Any supplies or field that you have not directly monitored (i.e., turned away from the sterile field or walked out of the room).
• Within 1 inch of any visible holes, tears, or moisture wicked from an unsterile area.
• Sterile kits and trays generally have an outer protective wrapper and four inner flaps that must be opened aseptically.
• Open sterile kits away from your body first, touching only the very edge of the opening flap.
• Using the same technique, open each of the side flaps one at a time using only one hand, being careful not to allow your body or arms to be directly above the opened drape. Take care not to allow already-opened corners to flip back into the sterile area again.
• Open the final flap toward you, being careful to not allow any part of your body to be directly over the field. See Figure 4.17 [2] for images of opening the flaps of a sterile kit.
• If you must remove parts of the sterile kit (i.e., sterile gloves), reach into the sterile field with the elbow raised, using only the tips of the fingers before extracting. Pay close attention to where your body and clothing are in relationship to the sterile field to avoid inadvertent contamination.

Figure 4.17

Opening a Sterile Kit

• Before dispensing sterile supplies to a sterile field, do not allow sterile items to touch any part of the outer packaging once it is opened, including the former package seal.
• Heavy or irregular items should be opened and held, allowing a second person with sterile gloves to transfer them to the sterile field.
• Wrapped sterile items should be opened similarly to a sterile kit. Tuck each flap securely within your palm, and then open the flap away from your body first. Then open each side flap; secure the flap in the palm one at a time and open.  Finally, open the flap (closest to you) toward you, while also protecting the other opened flaps from springing back onto the wrapped item.
• Peel pouches (i.e., gloves, gauze, syringes, etc.) can be opened by firmly grasping each side of the sealed edge with the thumb side of each hand parallel to the seal and pulling carefully apart.
• Drop items from six inches away from the sterile field.
• Sterile solutions should be poured into a sterile bowl or tray from the side of the sterile field and not directly over it. Use only sealed, sterile, unexpired solutions when pouring onto a sterile field. Solution should be held six inches away from the field as it is being poured. Avoid splashing solutions because this allows wicking and transfer of microbes. After pouring of solution stops, it should not be restarted because the edge is considered contaminated. See Figure 4.18 [3] of an image of a nurse pouring sterile solution into a receptacle in a sterile field before the procedure begins.
• Don sterile gloves away from the sterile field to avoid contaminating the sterile field.

Figure 4.18

Pouring Sterile Solution

4.5. CHECKLIST FOR HAND HYGIENE WITH SOAP AND WATER

Use the checklist below to review the steps for completion of “Hand Hygiene with Soap and Water.”

Disclaimer: Always review and follow agency policy regarding this specific skill.

Remove jewelry according to agency policy; push your sleeves above your wrists.

Turn on the water and adjust the flow so that the water is warm. Wet your hands thoroughly, keeping your hands and forearms lower than your elbows. Avoid splashing water on your uniform.

Apply a palm-sized amount of hand soap.

Perform hand hygiene using plenty of lather and friction for at least 15 seconds:

• Rub hands palm to palm
• Back of right and left hand (fingers interlaced)
• Palm to palm with fingers interlaced
• Rotational rubbing of left and right thumbs
• Rub your fingertips against the palm of your opposite hand
• Repeat sequence at least 2 times
• Keep fingertips pointing downward throughout

Clean under your fingernails with disposable nail cleaner (if applicable).

Wash for a minimum of 20 seconds.

Keep your hands and forearms lower than your elbows during the entire washing.

Rinse your hands with water, keeping your fingertips pointing down so water runs off your fingertips. Do not shake water from your hands.

Do not lean against the sink or touch the inside of the sink during the hand-washing process.

Dry your hands thoroughly from your fingers to wrists with a paper towel or air dryer.

Dispose of the paper towel(s).

Use a new paper towel to turn off the water.

Dispose of the paper towel.

4.6. CHECKLIST FOR HAND HYGIENE WITH ALCOHOL-BASED HAND SANITIZER

Use the checklist below to review the steps for completion of “Hand Hygiene with Alcohol-Based Hand Sanitizer.”

Gather supplies (antiseptic hand rub).

Apply enough product into the palm of one hand and enough to cover your hands thoroughly, per product directions

Rub your hands together, covering all surfaces of your hands and fingers with antiseptic until the alcohol is dry (a minimum of 30 seconds):

• Rub your wrists

Repeat hand sanitizing sequence a minimum of two times.

Repeat hand sanitizing sequence until the product is dry.

4.7. CHECKLIST FOR PERSONAL PROTECTIVE EQUIPMENT (PPE)

Use the checklist below to review the steps for completion of  “Applying and Removing Personal Protective Equipment.” [1]

Check the provider’s order for the type of precautions.

Ensure that all supplies are available before check-off begins: isolation cart, gowns, gloves, mask, goggles/face shields, etc.

Apply PPE in the correct order:

• 1st (GOWN): Gown should cover outer garments. Pull the sleeves down to the wrists, and tie at neck & waist.
• 2nd (MASK/RESPIRATOR): Apply surgical mask or N95 respirator if indicated by transmission-based precaution. Fit the mask around the nose and chin, securing bands around ears or tie straps at top of head and base of neck.
• 3rd (EYE PROTECTION): Apply goggles/face shield if indicated for patient condition or transmission-based precautions.
• 4th (CLEAN GLOVES): Pull on gloves to cover the wrist of the gown.

Remove PPE in the correct order:

• 1st REMOVE GLOVES: REMEMBER: GLOVE TO GLOVE; SKIN TO SKIN. Do not touch contaminated gloves to your skin. Take off the contaminated glove with your gloved hand, wrapping the contaminated glove in the palm of your gloved hand. Take off the glove with your bare hand to the skin of your wrist, moving inside of the glove to remove the contaminated glove inside out over the other glove. Note: If the gown is tied in front, untie it prior to removing your glove.
• 2nd REMOVE GOWN: Untie all ties (or unsnap all buttons). Some gown ties can be broken rather than untied. Do so in a gentle manner, avoiding a forceful movement. Reach up to the shoulders and carefully pull the gown down and away from the body. Rolling the gown down is an acceptable approach. Dispose in trash receptacle.
• 3rd PERFORM HAND HYGIENE.
• 4th REMOVE FACE SHIELD or GOGGLES: Carefully remove face shield or goggles by grabbing the strap and pulling upwards and away from head. Do not touch the front of face shield or goggles.
• Respirator: Remove the bottom strap by touching only the strap and bringing it carefully over the head. Grasp the top strap and bring it carefully over the head, and then pull the respirator away from the face without touching the front of the respirator.
• Face mask: Carefully untie (or unhook from the ears) and pull it away from the face without touching the front.
• 6th PERFORM HAND HYGIENE after removing the mask.

4.8. CHECKLIST FOR APPLYING AND REMOVING STERILE GLOVES

Use the checklist below to review the steps for completion of “Applying and Removing Sterile Gloves.”

Video Review of Applying Sterile Gloves:[1]

Gather the supplies: hand sanitizer and sterile gloves.

Open the sterile gloves on a dry, flat, clean work surface.

Remove the outer package by separating and peeling apart the sides of the package.

Grasp the inner package and lay it on a clean, dry, flat surface at waist level.

Open the top flap away from your body; open the bottom flap toward your body.

Open the side flaps without contaminating the inside of the wrapper or allowing it to close.

With your nondominant hand, use your thumb and index finger to only grasp the inside surface of the cuff of the glove for your dominant hand.

Lift out the glove, being careful to not touch any surfaces and holding the glove no more than 12-18″ above the table without contaminating the sterile glove; carefully pull the glove over your hand.

Use your nondominant, nonsterile hand to grasp the flap of the package, and hold the package steady. With the sterile glove on your dominant hand, hold 4 fingers together of the gloved hand to reach in the outer surface of the cuff of the sterile glove, reaching under the folded cuff and with the thumb outstretched to not touch the second sterile glove. Lift the glove off the package without breaking sterility.

While holding the fingers of the nondominant hand outstretched and close together, tuck your thumb into the palm, and use the sterile dominant hand to pull the second sterile glove over the fingers of the nondominant hand.

After the second sterile glove is on, interlock the fingers of your sterile gloved hands, being careful to keep your hands above your waist.

Do not touch the inside of the package or the sterile part of the gloves with your bare hands during the process.

Maintain sterility throughout the procedure of donning sterile gloves.

Removing Sterile Gloves

Grasp the outside of one cuff with the other gloved hand. Avoid touching your skin.

Pull the glove off, turning it inside out and gather it in the palm of the gloved hand.

Tuck the index finger of your bare hand inside the remaining glove cuff and peel the glove off inside out and over the previously removed glove.

Dispose of contaminated wastes appropriately.

4.9. ASEPSIS LEARNING ACTIVITIES

Learning activities.

(Answers to “Learning Activities” can be found in the “Answer Key” at the end of the book.  Answers to interactive activity elements will be provided within the element as immediate feedback.)

You are caring for an elderly male patient who is experiencing urinary retention. The provider has just ordered an intermittent catheterization for the patient based on the results of a recent bladder scan of 375 mL. You gather the equipment and enter the patient’s room. Based on the five moments of hand hygiene, describe the instances in which you will sanitize your hands when working with the patient and performing the intermittent catheterization.

Based upon the information provided, which clinical scenarios require the use of soap and water (versus alcohol-based hand scrubs) for proper hand sanitization?

a. Entry into patient’s room with no contact precautions

b. Patient on  Clostridium Difficile  (C-Diff) contact precautions

c. Prior to Foley catheter insertion for a patient with no contact precautions

d. Hands are visibly soiled

IV. GLOSSARY

Infection prevention and control interventions to be used in addition to standard precautions for diseases spread by airborne transmission, such as measles and tuberculosis.

A state of being free of disease-causing microorganisms.

A standardized technique, supported by evidence, to maintain asepsis and standardize practice.

The purposeful reduction of pathogen numbers while preventing microorganism transfer from one person or object to another. This technique is commonly used to perform invasive procedures, such as IV starts or urinary catheterization.

Infection prevention and control interventions to be used in addition to standard precautions for diseases spread by contact with the patient, their body fluids, or their surroundings, such as C-diff, MRSA, VRE, and RSV.

To take off or remove personal protective equipment, such as gloves or a gown.

To put on equipment for personal protection, such as gloves or a gown.

Infection prevention and control interventions to be used in addition to standard precautions; used for diseases spread by large respiratory droplets such as influenza, COVID-19, or pertussis.

Hand hygiene should be performed during the five moments of patient care: immediately before touching a patient; before performing an aseptic task or handling invasive devices; before moving from a soiled body site to a clean body site on a patient; after touching a patient or their immediate environment; after contact with blood, body fluids, or contaminated surfaces (with or without glove use); and immediately after glove removal.

A way of cleaning one’s hands to substantially reduce the number of pathogens and other contaminants (e.g., dirt, body fluids, chemicals, or other unwanted substances) to prevent disease transmission or integumentary harm, typically using soap, water, and friction. An alcohol-based hand rub solution may be appropriate hand hygiene for hands not visibly soiled.

Unintended infections caused by care received in a health care setting.

Any sterile part of equipment used during an aseptic procedure, such as needle hubs, syringe tips, dressings, etc.

The site contacted during an aseptic procedure, such as nonintact skin, a potential insertion site, or an access site used for medical devices connected to the patients. Examples of key sites include the insertion or access site for intravenous (IV) devices, urinary catheters, and open wounds.

Personal protective equipment, such as gloves, gowns, face shields, goggles, and masks, used to prevent transmission of disease from patient to patient, patient to health care provider, and health care provider to patient.

The minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where health care is delivered.

Techniques used to eliminate every potential microorganism in and around a sterile field while maintaining objects and areas as free from microorganisms as possible. This technique is the standard of care for surgical procedures, invasive wound management, and central line care.

Licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/ .

• Cite this Page Open Resources for Nursing (Open RN); Ernstmeyer K, Christman E, editors. Nursing Skills [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2023. Chapter 4 Aseptic Technique.
• PDF version of this title (449M)

In this Page

• ASEPTIC TECHNIQUE INTRODUCTION
• ASEPTIC TECHNIQUE BASIC CONCEPTS
• ASEPTIC TECHNIQUE
• STERILE FIELDS
• CHECKLIST FOR HAND HYGIENE WITH SOAP AND WATER
• CHECKLIST FOR HAND HYGIENE WITH ALCOHOL-BASED HAND SANITIZER
• CHECKLIST FOR PERSONAL PROTECTIVE EQUIPMENT (PPE)
• CHECKLIST FOR APPLYING AND REMOVING STERILE GLOVES
• ASEPSIS LEARNING ACTIVITIES

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Chapter 1. Infection Control

1.2 Infection Prevention and Control Practices

Infection prevention and control (IPAC) practices  are evidence-based procedures and practices that can prevent and reduce disease transmission, and eliminate sources of potential infections (PIDAC, 2012). When used consistently,  IPAC practices will prevent the transfer of  health care associated infections (HAIs)  in all health care settings. HAIs, also known as   nosocomial infections , are infections that occur in any health care setting as a result of  contact with a pathogen that was not present at the time the person infected was admitted (World Health Organization[WHO], 2009a).

Two types of techniques are used to prevent infection in the hospital setting. The first, medical asepsis , or clean technique , has been used in the past to describe measures for reducing and preventing the spread of organisms (Perry, Potter & Ostendorf, 2014). The second, sterile technique , also known as sterile asepsis , is a strict technique to eliminate all microorganisms from an area (Perry et al., 2014). When a patient is suspected of having or is confirmed to have certain pathogens or clinical presentations, additional  precautions  are implemented by the health care worker, in addition to routine practices (PIDAC, 2012). These additional precautions are based on how an infection is transmitted, such as by contact, droplet, or air. Additional precautions use personal protective equipment (PPE), such as gowns, eyewear, face shields, and masks, along with environmental controls to prevent transmission of infection.

To reduce, and prevent the spread of, HAIs, routine practices , a system of recommended IPAC practices, are to be used consistently with all patients at all times in all health care settings (Public Health Agency of Canada [PHAC], 2012b). The principles of   routine practices are based on the premise that all patients are potentially infectious, even when asymptomatic, and IPAC routine practices should be used to prevent exposure to blood, body fluids, secretions, excretions, mucous membranes, non-intact skin, or soiled items (PIDAC, 2012).

To learn the steps for routine practices, see Checklist 1.

Critical Thinking Exercises

• Name four environmental procedures that can break the chain of infection.
• What types of patents are at an increased risk for an HAI?
• How can health care providers reduce patient susceptibility to infection?

Clinical Procedures for Safer Patient Care Copyright © 2015 by Glynda Rees Doyle and Jodie Anita McCutcheon is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

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6.2 Asepsis and PPE

Learning objectives.

By the end of this section, you will be able to:

• Define the two types of asepsis
• Recognize the negative implications healthcare-associated infections have on healing
• Correlate appropriate personal protective equipment with their necessary uses

Nurses in all roles are in a unique position to create a safe patient care environment. From bedside nurses to executives, fostering safe healthcare environments can prevent the transfer of pathogens and the spread of infection. With evidence-based practices, nurses can facilitate a patient’s plan of care and recovery while minimizing risks and complications related to infections. Proper use of infection-control measures can directly affect patient morbidity and mortality.

The state of being free from disease-causing contaminant is referred to as asepsis . These contaminants include bacteria , viruses, fungi, and parasites. The term asepsis can also refer to the process of preventing infection by minimizing the number of contaminants present and decreasing the ability to transport pathogens. The two types of asepsis include medical and surgical ( Table 6.3 ). Furthermore, medical asepsis has three degrees: sanitization , antisepsis, and disinfection. An example of sanitization is physically removing microorganisms by cleaning linen. An example of antisepsis would be preoperative skin cleansing. Disinfection kills microorganisms on objects such as tables or blood pressure cuffs that come into contact with the patient or patients. This process utilizes strong chemicals called disinfectants, which should not be used on skin.

Medical Asepsis

The techniques and procedures used to decrease the potential for the spread of microorganisms and infection is called medical asepsis . Medical asepsis is also referred to as “clean technique” in the healthcare environment because it is a standard practice used to avoid spreading infection from one person to another throughout a facility. The core practices of medical asepsis include hand hygiene , environmental cleanliness, and the use of protective equipment and isolation.

Surgical Asepsis

The absence of all microorganisms within any type of invasive procedure is called surgical asepsis . Maintaining surgical asepsis requires the use of sterile technique, a set of specific practices and procedures that are performed to make an environment and equipment in that environment free of all microorganisms. Principles of sterile technique help control and prevent infection. Sterile technique is discussed in depth in 6.3 Sterile Technique .

Hand Hygiene

The term hand hygiene refers to the act of handwashing, hand rubbing (using alcohol-based hand sanitizer), or surgical hand antisepsis. Hand hygiene is regarded as one of the most important elements in the prevention and control of infections. Hand hygiene that is timely and effective protects patients, healthcare workers, and the healthcare environment from the spread of infection. Hand hygiene should be performed when arriving and leaving a patient care unit, before direct contact with a patient, before and after removing gloves , after contact with patient’s skin, and when hands are visibly dirty or soiled with blood or bodily fluids. Healthcare providers may be required to wash their hands as many as 100 times in a twelve-hour shift, depending on the number and acuity of patients.

Link to Learning

The World Health Organization has created the Five Moments of Hand Hygiene to help healthcare workers improve understanding of hand hygiene and the five moments when it is required.

Cleaning hands using an alcohol-based sanitizer is an effective form of hand hygiene if the hands are not visibly soiled. The advantages of alcohol-based hand hygiene are that it takes only twenty to thirty seconds, can be completed directly at the point of care, and does not require a sink, water, or towel. Alcohol-based hand sanitizers can kill most pathogens. Keep in mind, however, that certain bacteria are not removed by hand sanitizers. These bacteria are only removed by handwashing. One example of bacteria that is only removed with soap and water is Clostridioides difficile ( C. diff ). Nurses who take care of patients with C. diff or other stubborn bacteria will usually be told before they commence care. When these instances occur, the nurse will know to avoid the hand sanitizer and choose to wash their hands with soap and water instead. When in doubt, washing your hands is the best choice.

Washing hands with soap and water is recommended if the hands are visibly dirty, soiled, or are contaminated with blood or other bodily fluids. It is essential to spend the proper amount of time on handwashing; washing hands for at least thirty seconds removes up to ten times the number of bacteria as does washing for fifteen seconds.

Patient Conversations

Understanding when to use soap and water for hand hygiene.

Scenario: The nurse is entering a patient’s room to complete q4h vital signs. This patient is currently positive for Clostridioides difficile . After donning personal protective equipment, the nurse enters the room.

Nurse: Hi, Ms. Lee, it’s your nurse Bryan. I’m here to get your vital signs. Let me wash my hands, and we will get started. How are you feeling?

Patient: I’m doing okay, I suppose. I’m not in any pain right now, so that’s good news.

Nurse: That’s excellent. Let me just put on a pair of gloves, so I can verify your name on your wristband. Can you tell me your name, date of birth, and if you have any allergies?

Patient: Yang Lee, 03/27/1942. I’m allergic to iodine. Why did you wash your hands when you came in here when there’s hand sanitizer over by the door?

Nurse: Performing proper hand hygiene is a critical component of preventing the spread of infections, especially in the hospital. Alcohol-based hand sanitizers are a great method for cleaning your hands, but there are times when it is not effective.

Patient: Is getting my vital signs one of those times?

Nurse: The stool sample that was sent to the lab on Monday came back positive for a bacteria called Clostridioides difficile , or C. diff . Alcohol alone cannot kill C. diff spores, and studies have shown soap and water to be much more effective at removing them. In order to prevent the spread of infection, you’ll notice that all of the healthcare workers will be washing their hands with soap and water when they enter and exit your room.

Patient: So, should I wash my hands too?

Nurse: Since you already have C. diff , you cannot infect or re-infect yourself. However, washing your hands will prevent you from getting bacteria such as C. diff in the future. Additionally, washing your hands will help prevent spread to others inside and outside of the hospital. Nurses always wash our hands frequently because it washes away all kinds of bacteria. It really is the best way to prevent spreading bacteria.

Patient: That makes sense. I wouldn’t want anyone else to get sick from what I have. Thank you for being so careful.

Healthcare-Associated Infections

Healthcare-associated infections (HAIs), also known as nosocomial infections, are infections acquired while receiving medical treatment in a healthcare facility. Although preventable, HAIs are some of the most common complications for patients within a healthcare setting and can prolong hospital stays and recovery time. According to the CDC, one in every twnty-five hospitalized patients will contract an HAI (CDC, 2022). The most common HAIs are associated with invasive devices such as catheter-associated urinary tract infections (CAUTIs), central line–associated bloodstream infections (CLABSIs), ventilator-associated pneumonia (VAP), and surgical site infections (SSIs).

The risk for developing an HAI is dependent on the infection-control policies within a facility and the degree of adherence to them. Additional risk factors include a patient’s immune status, age, underlying comorbidities, and the prevalence of pathogens within the environment. Length of hospitalization, number of invasive procedures, and amount of antibiotic therapy received all increase a patient’s risk for acquiring an HAI.

The Global Alliance for Infections in Surgery has outlined seven strategies to prevent healthcare-associated infections in the healthcare setting.

Preventing Healthcare-Associated Infections

Nurses are at the front line for preventing the transmission of pathogens through infection-control policies and procedures. These evidence-based prevention strategies and control practices can directly reduce HAIs. Appropriate hand hygiene and glove usage heavily contributes to an increase in patient safety and the prevention of HAIs. Keeping a healthcare environment clean by disinfecting equipment between patients is an additional vital prevention measure. Additionally, the use of proper personal protective equipment can prevent the transmission of pathogens. Nurses must stay current with how to protect themselves from newly identified pathogens and adhere to the protocols put in place. In recent history, viruses such as Ebola and the coronavirus that caused the COVID-19 pandemic all required specific infection-control measures. Healthcare providers were and still are on the front lines in these instances and must also educate the public and their patients about necessary protocols.

Clinical Safety and Procedures (QSEN)

Qsen competency: safety: preventing hais.

Definition: Quality and Safety Education for Nurses (QSEN) competencies were designed to emphasize key elements that pre-licensure nursing students should be competent in at the time of graduation. Safety is defined as minimizing risk of harm to patients through both systems effectiveness and individual performance.

Knowledge: Students will examine human factors and other basic safety design principles as well as commonly used unsafe practices, using evidence-based sources to enhance knowledge.

Skills: Students will demonstrate effective use of strategies to reduce risk of harm to self or others.

Attitudes: Students will value their own role in preventing errors and reducing the spread of infections.

Clinical scenario: A new nurse is working on a medical-surgical unit. Bedside shift report is beginning, and the nurse notices a sign on one patient’s door stating that the patient is on airborne precautions. The box of masks located outside the patient’s room is empty.

Step 1: The nurse uses knowledge to recognize that the patient’s condition warrants airborne precautions and that masks are the first line of defense for reducing the spread of airborne pathogens. The nurse uses knowledge of evidence-based sources to confirm that entering the room without a mask would place themselves and other patients on the unit at risk for exposure to the identified pathogen.

Step 2: The nurse identifies the skill of replacing the empty box before anyone can enter the room as an effective use of infection-control strategies to reduce risk of harm to self or others.

Step 3: The nurse stops and replaces the supplies outside the patient’s room before continuing with the morning report. The nurse can now begin the shift with a positive attitude , knowing value is placed on their role in reducing the spread of infection and providing quality, competent nursing care.

Reporting Healthcare-Associated Infections

As part of its mission in healthcare safety, the CDC has developed the National Healthcare Safety Network (NHSN), the nation’s most widely used system for tracking and surveillance of HAIs (CDC, 2022). More than 38,000 healthcare facilities provide data to the NHSN, which are, in turn, used for analysis and development of prevention initiatives by states, regions, and national public health agencies. These agencies include acute care/critical access hospitals, long-term care facilities, ambulatory surgery centers, long-term acute care facilities, inpatient psychiatric facilities, inpatient rehabilitation facilities, and dialysis facilities. The report provides data on CLABSIs, CAUTIs, ventilator-associated events (VAEs), SSIs, methicillin-resistant Staphylococcus aureus (MRSA) bloodstream events, and C. diff events. Federal government bodies such as the Centers for Medicare and Medicaid Services (CMS) use these data to determine performance incentives. Community members can use this information to select the healthcare facilities that they feel best fits their needs.

Personal Protective Equipment

Healthcare workers use personal protective equipment (PPE) as a means of barrier protection for their eyes, nose, mouth, and skin from exposure to blood and other potentially infectious bodily fluids and materials. The most commonly worn PPE includes gloves , gowns, face masks, protective eyewear, and face shields. These barriers are used in both standard precaution s as well as in transmission -based precautions. Every nurse must be knowledgeable about the appropriate PPE to wear in various situations. Simply wearing all available PPE is not appropriate practice and is wasteful considering healthcare resources.

Clinical Judgment Measurement Model

Take action: initiating the use of additional personal protective equipment.

This scenario requires a nurse to take action to prevent infection from spreading. A nurse is reviewing a patient’s morning laboratory results. The nurse notes that the patient’s stool culture has come back positive for vancomycin-resistant Enterococci (VRE). Knowing the method of transmission of VRE (contaminated equipment, surfaces, hands), the nurse analyzes these data and prioritizes how they will be incorporated into the patient’s care. The nurse knows that additional interventions will need to be implemented.

The nurse hangs a contact isolation sign on the door and places a PPE cart next to the room. The cart contains masks, gloves, face shields, hand sanitizer, and disinfectants, among other PPE items. When the nurse enters the patient’s room, they don the appropriate PPE per facility policy. They also provide the patient with education regarding why they will be seeing staff wearing additional PPE.

The use of gloves in the healthcare setting prevents contamination of the hands and reduces the likelihood of the transmission of pathogens ( Figure 6.5 ). Medical gloves should be worn when providing care to protect the healthcare provider as well as the patient. Further, sterile gloves should be worn for procedures that pose greater risk of contamination to the patient, which are indicated as sterile procedures. Gloves are only effective in infection prevention if they are used properly, and the wearer performs proper hand hygiene before and after wear. Gloves should be removed and hand hygiene should occur once contact with blood or bodily fluids has ended, once contact with a single patient has ended, when leaving a patient’s room, and when there is a need for hand hygiene. The same pair of gloves should never be worn more than once.

A medical isolation gown is a long-sleeved garment that covers the body front and back from the neck to the thighs, overlaps or meets in the back, fastens at the neck and waist, and is easy to put on and take off. They are used in the healthcare setting as a broad barrier against blood or bodily fluids. Gowns are used for patients who are on contact and droplet precaution s and for any potentially splash-generating procedures. Medical isolation gowns must be removed before leaving an individual patient area and hand hygiene must occur. A surgical gown is worn by healthcare personnel during a surgical procedure to protect both the patient and the personnel from transmission of pathogens. Examples of gowns can be seen in Figure 6.6 .

Healthcare workers should wear a mask when caring for a patient on droplet precautions or when providing care to patients who are immunocompromised. A surgical mask is worn over the nose and mouth to prevent the transmission of large particle droplet matter generated through coughing or splash-generating procedures. These masks have either ear loops or ties and can be either pleated or made of molded material. An N95 respirator mask is a tight-fitting cover that, when properly fitted, protects the wearer from very small particles that float in the air, such as tuberculosis (TB), measles, chickenpox, and COVID-19 ( Figure 6.7 ). When properly worn, an N95 mask can block at least 95 percent of non-oil-based particles that are 0.3 microns or larger. Any time a mask becomes wet from exhaled moist air, it weakens the integrity of the mask, warranting a mask change.

Eyewear and Shields

The use of eyewear and shields form a barrier and protect the membranes of the eyes, nose, and mouth when performing tasks that could produce splashes of bodily fluids or blood. Goggles should fit snugly around the eyes and protective face shields should cover the entire forehead, extend past the chin, and wrap around the sides of the face ( Figure 6.8 ).

Donning PPE

The type of PPE used in a healthcare setting is based on the level of precaution and isolation that is required. The meticulous use of PPE is a vital step to reduce contamination and transfer of infectious diseases. The CDC recommends a standardized procedure for donning, or applying, PPE, but the procedure should always be tailored to the specific type of PPE being used. Prior to donning PPE, always perform hand hygiene . The steps for donning PPE should follow the guidelines outlined by the CDC.

QSEN Competency: Donning Personal Protective Equipment, Evidence-Based Practice

Definition: Quality and Safety Education for Nurses (QSEN) competencies were designed to emphasize key elements that pre-licensure nursing students should be competent in at the time of graduation. Employing evidence-based practice means “integrating best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.”

Clinical scenario: Here are some evidence-based steps issued by the CDC (n.d.) on donning PPE:

Step 1: An isolation gown should be donned first. The gown should be picked up by the shoulders, which allows it to fall open without touching the floor. The gown should be positioned to fully cover the torso (from the neck to the knees) and arms (to wrists), and it should wrap around the back. Fasten the ties at the neck and the waist.

Step 2: After securing the gown, don the face mask or N95 mask. Ensure that the ties or elastic band fits at the middle of the head and neck. The mask should be snug to the face and below the chin. N95 masks should be fit checked to ensure proper seal.

Step 3: Once the face mask is in place, goggles will be placed over the top of the edge of the mask. A face shield is placed over the eyes.

Step 4: The final step for donning PPE is the application of gloves. The glove cuff should extend over the gown cuff. Ensure that the correct size gloves are selected to prevent them from falling off or ripping.

Doffing and Disposal of PPE

Once patient care is completed, all PPE except for a respirator will be removed, or doffed, prior to exiting a patient’s room. All PPE is discarded in the appropriate receptacle as outlined by facility policy. Following the removal of PPE, perform hand hygiene immediately. The steps for doffing PPE should follow the guidelines outlined by the CDC.

QSEN Competency: Hand Hygiene and Donning and Doffing PPE

See the competency checklist for Hand Hygiene and Donning and Removing PPE. You can find the checklists on the Student resources tab of your book page on openstax.org.

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• Book title: Clinical Nursing Skills
• Publication date: Jun 26, 2024
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• Book URL: https://openstax.org/books/clinical-nursing-skills/pages/1-introduction
• Section URL: https://openstax.org/books/clinical-nursing-skills/pages/6-2-asepsis-and-ppe

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4 Lab 01: ASEPSIS

Unit one: infection control and aseptic.

ASEPSIS LAB OBJECTIVES

Type your learning objectives here.

• Define asepsis, medical sepsis, surgical asepsis, and contamination.
• Define clean and sterile technique
• Describe the cycle of cross-contamination and infection
• Explain the use of standard precautions and transmission-based precautions and related protocols
• Describe the OSHA infectious disease regulations that pertain to health care facilities and employees
• Select appropriate infection control procedures for a given case scenario
• Perform proper techniques of hand hygiene for clean situations
• Demonstrate proper procedure when donning and doffing personal protective equipment

PRELAB ACTIVITIES:  

• Please read and submit signature page for: NEED to ADD LAB POLICY DOCUMENT HERE – Or a link to it – and Post it on Canvas
• How to Donn PPE  and  How to Doff PPE
• Triad of Infectious Disease
• Overview video of chain of infection
• CDC Hand Hygiene
• View ASEPSIS
• VIDEO posted on Canvas. You may find it helpful to print the PPT that accompanies the video for taking notes. Bring this printed, full-of-your-notes PPT will greatly help you in the lab. 
• Read and print the Asepsis Lab Skills Check.  While we will complete our Asepsis Skills Check during week 2 of the semester, we will be preforming infection control procedures including hand hygiene week 1.     It will be best if you do NOT wear (very) loose fitting clothes or sweatshirts as the gowns may not fit over them.  Additionally, keep jewelry to a minimum.
• For completion of this text, you may want to have PPT for Lab Video 1 with you. 

ASEPSIS Overview and Activities: Lab and Quiz preparation 

• Student introduction provided to instructor.
• Procedure is explained in a clear and concise manner to instructor.
• Hand hygiene is correctly performed prior to donning mask
• Mask is fitted over nose, mouth and chin area.
• Mask is fitted to avoid the need for repositioning when in use (speaking)
• Inside and outside of mask are correctly oriented.
• Doffing procedure avoids contact with outside of mask
• Hand Hygiene is correctly performed after doffing mask
• Jewelry is removed; sink fixtures are not touched; water turned on/off with paper towel
• Hands and wrists are wet with warm water in a downward direction
• Soap is applied; all parts of wrist and hand are thoroughly washed for at least 20 seconds
• Hands are rinsed from wrist to fingers; thoroughly dried.
• Sufficient product is used to cover all areas of hands
• Product is rubbed thoroughly on hands, fingers and wrists until dry (20 seconds)
• Perform Hand Hygiene
• Arrange gown onto workspace.
• Hold gown by the inside surface and shake open, avoid touching the outside surface of the gown.
• Put arms through the sleeves of the gown.
• Your assistant will tie neck and waist straps without touching outside of gown.
• Donn your non-sterile gloves without contaminating outer surface; covering the sleeves of your gown.
• Grasp the outside of one glove at the wrist. Do not touch your bare skin.
• Peel the glove away from your body, pulling it inside out.
• Hold the glove you just removed in your gloved hand.
• Peel off the second glove by putting your fingers inside the glove at the top of your wrist.
• Turn the second glove inside out while pulling it away from your body, leaving the first glove inside the second.
• Dispose of the gloves safely.
• Untie waist strap of your gown; your partner will untie your neck strap without touching the back of the gown, neck or head.
• Remove gown by turning it gently inside out keeping it away from your body.
• Safely dispose of gown.
• Perform hand hygiene.
• Perform Hand hygiene.
• Remove goggles away from the body; do not touch the front of the goggles.
• Place goggles in prescribed area.

Introduction:

Our Asepsis Lab is typically our third unit, rather than our first one. No surprise, though, given all that has changed due to COIVID-19, that we needed to move this topic to the very beginning. Maybe that is best anyway as asepsis is such a crucial component of our practice as health care providers

While the Asepsis Video and its PPT contain the highlights of our unit and walk us through the Lab Objectives, there are a few points that need to be explained in a little more depth…and maybe joined with a few learning activities to help you remember them too.  To that end, perhaps the best place to begin is at the end: “Why” does Infection Control and Asepsis Techniques even matter?

Why: Why it matters

You have, no doubt, have heard much in the media (and here at Penn State) about the strategies we use to mitigate (prevent, reduce, eliminate) the possibility of spreading the infectious agent that is causing us all so much consternation: COVID-19. For those of us in healthcare however, these strategies are not new: they are a necessary component of our world…and for a very good reason.  Infectious diseases can kill people.  They can, more frequently, make people very (very) ill or a (very) long time.

Perhaps you have had the experience of being ill; maybe the flu, a cold or sinus infection.  Nasty experience for sure.  Perhaps you were under the weather for a week or more. No fun.  However, when viruses or bacteria infect folks who are already ill, injured, aged or otherwise inflicted with a weakened immune system, the outcome is much more dire.  

On one hand : we have learned much over the last century or so regarding infectious diseases. For example, before World War II, more soldiers died from disease than of battle injuries.  

• The ratio of disease-to-battle casualties was approximately 5-to-1 in the  Spanish-American War .
• If we were to look at the Civil War, Pneumonia, typhoid, diarrhea, and malaria collectively led to the death of almost 450,000 soldiers. Disease outbreaks and epidemics played a major role in halting several major campaigns during the war as well.
• Following WWI, the Spanish Influenza killed almost three times more people than the 17 million soldiers and civilians killed during the war.

On the other hand : In the US, the Centers for Disease Control (CDC) estimates that Healthcare Acquired Infections (HAI) account for  almost 2 million infections  and  99,000  associated deaths each year.  The National Institutes of Health estimate that the cost of these infections is between $28 – $45 billion dollars annually. Some of the common HAI infections include:

HOW: How this happens

As you have seen from watching your prelab videos, there is a chain of cross contamination that exists to help explain how an infectious agent causes an illness. One wonders why, since we have identified this process, any disease spreads…it seems so easy to just break this chain.  And yet…

Maybe part of the difficulty lies in the invisible nature of viruses and bacteria. Maybe it lies in the fact that when we are feeling healthy, we can’t imagine that ‘we’ are acting as a host for an infectious agent.  Maybe it is just that we are in a hurry these days and that the simple acts of hand hygiene and sanitizing our work areas seems to be a waste of our time.   

However, as healthcare professionals it is our duty to be vigilant protecting our patients, their families, our colleagues and ourselves from being part of this cycle of cross contamination. Indeed, when you are assessed in the clinic as a student, the student assessment tool used, the Clinical Performance Instrument, listed Safety as its #1 criteria…and infection control techniques and practices are top within that criteria. 

Please review the cycle of cross contamination :

a. Reservoir for organism to grow and reproduce

b. Method of exit for organism

c. Method of transmission of the organism

d. Method of entry of the organism into a new host

e. Susceptible host

f. INFECTION DEVELOPS IN HOST

WHAT: What we can do about this: Aseptic Engineering and Techniques

By now you can see what is coming next: If we can create strategies to break the cycle of cross contamination, well then, we can prevent a great many infections. You are certainly well aware of the benefits of wearing a mask, performing hand hygiene and maintaining social distancing regarding minimizing the spread of COVID-19.  You may, however, wonder why all three of those interventions are being enforced.  Good question…It all has to do with how the infectious agent is transmitted. …but first…

Sometimes we know how an infectious agent is transmitted; sometimes we don’t.  When we work with our patients who do not have a diagnosis of an infectious disease, we use something called Standard Precautions.  Standard precautions is a concept that holds we are safest, and therefore should treat all individuals as if their bodily fluids contain transmissible infectious agents.   

Sometimes we know if a patient has an infectious disease.  If we do, we can then take very specific precautions to prevent the spread of that disease: Based on how that disease is transmitted: By contact, droplet, airborne, airborne plus contact.  

• STANDARD PRECAUTIONS:  Based on the concept that all bodily fluids may contain transmissible infectious agents
• TRANSMISSION-BASED PRECAUTIONS:  Precautions for specific patients with specific highly contagious infections when the mode of transmission is known.

Modes of Transmission include: 

• Airborne plus contact

Now we can see why we might need some means of protecting ourselves from these various modes of transmission an infectious agent may take.  Enter now: Personal Protective Equipment or PPE. The common types of PPE include

• Gloves, respirators, masks, face shields, goggles, shoe covers, and gowns.

Let’s see if this is making sense.  Below we have some common diseases and how they are transmitted.  Can you determine what type of PPE you would need in each case?

ACTIVITY 3:  Asepsis Matching

Hand Hygiene: A most powerful tool

It is estimated that we touch our face about 3-5 times per minute or about 3,000 – 5,000 times per day.  Who knew?? Given that this is one on the best routes an infectious agent can take to enter our nose, mouth or eyes and then enter our systems, it seems like we should all ties our hands at our sides. An idea, but maybe not the most reasonable one.  However, if we are intentional and vigilant about hand hygiene, even if we are touching our face repeatedly through the day, we will be less likely to be transferring contaminants from our hands to our face.   So….when do we perform hand hygiene?  Good question:

• Before and after patient contact
• Before and after contact with wounds, dressings, specimens, bed linen and protective clothing
• After contact with secretions excretions when hands are soiled or considered to be contaminated.
• Before and after toileting
• After sneezing, coughing or blowing nose
• After removing gloves
• Before and after eating

And how do we do so?

Another good question. Please click to review this website from the CDC.  CDC Hand Hygiene

Highlights include:

• Remove jewelry from the hands and wrists.
• Apply a cleansing agent from the dispenser to one palm. Rub the hands vigorously using friction or rubbing motions
• Palms together – Interlace fingers; rub web space and between and around each finger
• Dorsum of each hand with the palm of the opposite hand – Fingertips of each hand in the opposite palm
• Dorsal finger creases of each hand with the opposite palm
• Each thumb while it is clasped by the opposite palm- Each wrist while it is clasped by the opposite palm
• Rub for at least 20 seconds or until the hands are dry. Do not rinse the hands with water or dry them with a towel.

CLINICAL APPLICATION:  

Activity 1:

Sequence for correctly DOFFING PPE to avoid self-contamination.

Your Case Study: 

You are at completing a clinical affiliation at skilled nursing facility (SNF).   Your patient is an 85 year old female (yof) who fractured her right hip following a fall at home. She spent 3 days in acute care hospital and was found to be medically stable, but not strong enough to return to her home – a small cottage at a retirement center.  She was transferred to the SNF for rehabilitation prior to returning to her home.

Before leaving the hospital, she was tested for COVID-19 and found to be negative. However, upon admission to the SNF, as per their policy, she was re-tested and is now in her room on isolation until the results come back tomorrow.  You and your clinical instructor (CI) are to see this patient in her hospital room.

• What types of PPE will you need to put on (donn) prior to entering the room?
• When will you doff the PPE?

REFLECTION:

Can you explain to a non-healthcare provider (or student) why we use hand hygiene, masks and social distancing to mitigate COVID-19?

The state of being free from disease causing microorganisms.

Putting on PPE.

Taking off PPE.

In medicine, a catheter is a thin tube made from medical grade materials serving a broad range of functions. Catheters are medical devices that can be inserted in the body to treat diseases or perform a surgical procedure.  Wikipedia

the process by which bacteria or other microorganisms are unintentionally transferred from one substance or object to another, with harmful effect.

Introduction to the Practice and Policies of the Physical Therapist Assistant Copyright © by Dan Dandy PT, DPT, ACCE is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

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' ' : ' ' ; theseOptions += (glideSpeed == 4) ? ' ' : ' ' ; theseOptions += (glideSpeed == 5) ? ' ' : ' ' ; theseOptions += (glideSpeed == 6) ? ' ' : ' ' ; document.write(theseOptions); // --> 1. (optional) Enter a note here: 2. (optional) Select some text on the page (or do this before you open the "Notes" drawer). 3. Highlighter Color: 4. Search for: Search in: Course-wide Content Quizzes More Resources Instructor Resources Course-wide Content 327 IMAGES Solved CRITICAL THINKING ACTIVITIES A. Medical and Surgical Solved CRITICAL THINKING ACTIVITIES A. Medical and Surgical Medical And Surgical Asepsis Ati Template Medical And Surgical Asepsis Ati Template Surgical asepsis and sterile technique: Nursing skills Student Medical Asepsis and Precaution Learning Activities 3 1 .docx COMMENTS Medical and surgical asepsis: Clinical skills notes Now, there are two basic types of asepsis: medical asepsis and surgical asepsis. Medical asepsis (a.k.a. "clean technique"): practices that kill some microorganisms to prevent them from spreading. Surgical asepsis (a.k.a. "sterile technique"): practices that completely kill and eliminate microorganisms. Figure 1: The differences between ... Medical Asepsis Flashcards Critical Thinking. 338 terms. BDELM123. Preview. lA. 10 terms. Quentin_Beitler. Preview. Philosophy of mind. 26 terms. Janay_Wade. ... Medical Asepsis - Clean - Reduces or inhibits number and growth of microorganism Surgical Asepsis - Sterile - Eliminates all organisms, both pathogenic and non-pathogenic, ... Medical and Surgical Asepsis Maintain medical and/or surgical asepsis for procedure (e. providing personal hygiene, sterile dressing change) Early recognition of infection to allow prompt treatment. Pre: Maintain a sterile field, only sterile items in the sterile field. Outer wrapping and 1 inch border around the edges are not sterile. ATI Skills Module 3.0- Surgical Asepsis Flashcards A liquid is poured into a sterile container from a distance of 4 inches. A. Principles of surgical asepsis state that a sterile field becomes contaminated by capillary action when it comes into contact with moisture. D. Principles of surgical asepsis state that sterile field becomes contaminated when it is out of visual range. 4.9: Asepsis Learning Activities Prior to Foley catheter insertion for a patient with no contact precautions. Hands are visibly soiled. Query 4.9.1 4.9. 1. Query 4.9.2 4.9. 2. This page titled 4.9: Asepsis Learning Activities is shared under a CC BY-SA 4.0 license and was authored, remixed, and/or curated by Ernstmeyer & Christman (Eds.) ( OpenRN) via source content that was ... 1.5 Surgical Asepsis and the Principles of Sterile Technique 1.5 Surgical Asepsis and the Principles of Sterile Technique Surgical Asepsis. Asepsis refers to the absence of infectious material or infection. Surgical asepsis is the absence of all microorganisms within any type of invasive procedure.Sterile technique is a set of specific practices and procedures performed to make equipment and areas free from all microorganisms and to maintain that ... PDF the principles and practice of asepsis Principles and Practices of Asepsis Medical Asepsis. Medical asepsis, also known as "clean technique" is aimed at controlling the number of microorganisms. Medical asepsis is used for all clinical patient care activities. Necessary components of medical asepsis include: Knowing what is dirty. Knowing what is clean. 1.5 Principles of Asepsis 1.5 Principles of Asepsis Asepsis refers to the absence of infectious material or infection. Surgical asepsis is the absence of all microorganisms within any type of invasive procedure.Sterile technique is a set of specific practices and procedures performed to make equipment and areas free from all microorganisms and to maintain that sterility (Centre for Disease Control, 2007). Medical and surgical asepsis Medical and surgical asepsis is the practice of preventing infection by eliminating or reducing the number of microorganisms on an object or in an environment. It is done through various means such as hand hygiene, disinfection, sterilization, and proper waste management.. Medical and surgical asepsis are essential for the prevention of hospital-acquired infections (HAIs), which cause about ... 4.3 Aseptic Technique 4.3 Aseptic Technique In addition to using standard precautions and transmission-based precautions, aseptic technique (also called medical asepsis) is the purposeful reduction of pathogens to prevent the transfer of microorganisms from one person or object to another during a medical procedure. For example, a nurse administering parenteral medication or performing urinary catheterization uses ... 4.3: Aseptic Technique 4.3: Aseptic Technique. In addition to using standard precautions and transmission-based precautions, aseptic technique (also called medical asepsis) is the purposeful reduction of pathogens to prevent the transfer of microorganisms from one person or object to another during a medical procedure. Chapter 4 Aseptic Technique According to the Centers for Disease Control and Prevention (CDC), over 2 million patients in America contract a healthcare-associated infection, and 99,000 patients die from a healthcare-associated infection every year.[1] Healthcare-associated infections (HAIs) are unintended and often preventable infections caused by care received in a health care setting. Healthcare-associated infections ... 1.2 Infection Prevention and Control Practices The first, medical asepsis, or clean technique, has been used in the past to describe measures for reducing and preventing the spread of organisms (Perry, Potter & Ostendorf, 2014). The second, sterile technique , also known as sterile asepsis , is a strict technique to eliminate all microorganisms from an area (Perry et al., 2014). 6.2 Asepsis and PPE The term asepsis can also refer to the process of preventing infection by minimizing the number of contaminants present and decreasing the ability to transport pathogens. The two types of asepsis include medical and surgical . Furthermore, medical asepsis has three degrees: sanitization, antisepsis, and disinfection. An example of sanitization ... 1.5: Surgical Asepsis and the Principles of Sterile Technique Surgical Asepsis. Asepsis refers to the absence of infectious material or infection.Surgical asepsis is the absence of all microorganisms within any type of invasive procedure.Sterile technique is a set of specific practices and procedures performed to make equipment and areas free from all microorganisms and to maintain that sterility (BC Centre for Disease Control, 2010). PDF PRINCIPLES AND PRACTICES OF ASEPSIS Medical asepsis, also known as "clean technique" is aimed at controlling the number of microorganisms and is used for all clinical patient care activities. Necessary components of medical asepsis include: Knowing what is dirty versus clean versus sterile. How to keep the first three conditions separate. Surgical asepsis and sterile technique: Nursing skills Sterile technique is a set of practices that create a sterile environment during surgical procedures. It involves the use of sterile gowns, masks, and gloves; use of single-use instruments; and proper cleaning and sterilization of equipment. Sterile technique also requires strict adherence to aseptic principles, including proper handwashing and ... Lab 01: ASEPSIS ASEPSIS LAB OBJECTIVES. Type your learning objectives here. Define asepsis, medical sepsis, surgical asepsis, and contamination. Define clean and sterile technique. Describe the cycle of cross-contamination and infection. Explain the use of standard precautions and transmission-based precautions and related protocols. Chapter 25 Flashcards Medical OR Surgical asepsis (If surgical, WHY?) 10 terms. Emilou1211. Preview. Violation of Surgical Asepsis. 10 terms. Emilou1211. Preview. Mid term Skills . 68 terms. teerza_misner2. ... What is surgical asepsis? Practices that keep objects and areas sterile or free from microorganism. Chapter Overview 2.1 Describe the medical assistant's role in infection control. 2.2 Describe methods of infection control. 2.3 Compare and contrast medical and surgical asepsis. 2.4 Describe how to perform aseptic hand washing. 2.5 Compare and contrast the procedures for sanitization, disinfection, and sterilization. 2.6 Describe measures used in sanitization. Medical Asepsis vs. Surgical Asepsis While both medical and surgical asepsis play crucial roles in infection prevention, they differ in significant ways: Medical Asepsis: This method focuses on reducing the presence of microorganisms and preventing their spread. It generally involves practices like hand hygiene and disinfection. ... This is critical in surgical environments, where ... PDF PRINCIPLES AND PRACTICES OF ASEPSIS Medical asepsis, also known as "clean technique" is aimed at controlling the number of microorganisms and is used for all clinical patient care activities. Necessary components of medical asepsis include: • Knowing what is dirty versus clean versus sterile. • How to keep the first three conditions separate. Solved CRITICAL THINKING ACTIVITIES A. Medical and Surgical Question: CRITICAL THINKING ACTIVITIES A. Medical and Surgical Asepsis Refer to Chapter 2, and describe the difference between medical asepsis and surgical asepsis. wecque medical sogical condition ng palasence of the otheca or broken sin penetrate ascime, or body city they Adesional medication 2. Inserting suures 3 Measuring oral temperature 4. essay homework paper phd project resume review study thesis