Medical and Surgical Asepsis –
Terminology, Cross infection
and its prevention and
Barrier Nursing
Healthcare care providers are focusing on providing a safe and therapeutic environment to protect clients and their family. Prevention of infection is a major focus for nurses. As primary caregivers, nurses are involved in identifying, preventing, controlling and teaching the client about infection.
Terminology
Asepsis: freedom from infection or prevention of contact with micro-organisms.
Antiseptic: an agent that will inhibit the growth and development of micro-organisms without necessarily killing them.
Autoclaving: It is the process of sterilization of articles by steam under pressure using an apparatus called autoclave.
Bacteriostasis: it is a condition in which bacterial growth is checked without necessarily killing them.
Bacteriostat: an agent that inhibits the growth of bacteria.
Bacteriocide: an agent that has the power to kill microorganisms.
Contamination: the word contamination come from the latin word con = together, tangere = to touch. Contamination means the act of soiling or making dirty or impure by contact.
Culture: growth of micro-organisms or other living cells, usually used for the growth of micro-organisms.
Cross infection: infection transmitted between individuals infected with different pathogenic organisms. Cross infection occurs usually in the hospitals. It is the infection of a client with a disease other than that, for which he had been admitted. In other words, a client gets the infection from someone else during his stay in the hospital.
Carrier: a person who harbors pathogenic organisms of a disease in his body without showing the signs and symptoms of that disease, and thus acts as a carrier or distributor of that disease.
Colonization: it occurs when a micro-organism is present or invades a host, grows and multiplies there but does not cause disease or infection.
Complication: a new illness or condition that arises during the course of another illness or condition.
Disinfection: it means destroying of all the pathogenic organisms.
Concurrent disinfection: it is the immediate disinfection of all contaminated articles and bodily discharges during the course of the disease.
Terminal disinfection: it means the disinfection of the client’s unit with all the articles (furniture, linen, mattress, pillows, utensils etc) used by the client on his discharge, death or release from isolation.
Disinfectant: an agent which kills pathogenic organisms. It is applied particularly to agents used on inanimate objects.
Droplet infection: it is the infection of the individual by means of fine particles of saliva and mucus that are expelled from the mouth and nose of another person during coughing, sneezing or speaking.
Fomites: objects which have been in contact with a contagious disease and are capable of transmitting that disease are called fomites. E.g., cups, spoons, linen toys, bedpans etc.
Fumigation: it is the process of disinfection by exposure to the fumes of a vaporized germicide.
Infection: the entry and development (multiplication) of a disease producing agent in the body. It is the invasion of a susceptible host by pathogens or micro-organisms resulting in disease.
Immunization: it is the act of creating immunity artificially against a particular disease.
Isolation: it is the separation of infected persons from the non-infected persons for the period of communicability under conditions which will prevent the transmission of infection to others.
Nosocomial Infection: it refers to hospital acquired infection. A client develops an infection that are not present or was incubating at the time of admission to the health care setting.
Pathogenic: micro-organism that are capable of producing disease.
Portals of entry: portal = a door or entrance. The pathways by which the microorganism enters the body are called the portals of entry, E.g. the respiratory tract, the digestive tract, genitourinary tract, the skin.
Prophylactic: measures taken to prevent a disease.
Quarantine: it is the detention or isolation of well persons who have come in contact with infectious diseases for a period of time equal to the longest incubation period of that disease.
Refuse: the unwanted or discarded waste material from houses, street sweepings, commercial, industrial and agricultural operations arising from man’s activities.
Reservoir: it means a place where micro-organisms can survive, multiply and await transfer to a susceptible host.
Resistance: the natural power of the body to withstand the toxins or the organisms of a disease.
Rodent: the small plant eating animals with strong sharp teeth. It includes rats, mice, rabbits etc.
Sepsis: it is the infection of the body by pus forming bacteria.
Sensitivity: reacting to something. It is usually applied to drugs.
Septicemia: it occurs when infection or products of infection are carried throughout the body by the blood.
Soiled: to make or become dirty especially with human excreta.
Sterilization: it is the destruction of all the microorganism, both pathogenic and non-pathogenic including their spores.
Transmission: a transfer, e.g., transmission of disease from one person to another.
Infection Process Cycle (chain of infection)
Infectious agent – Reservoir – portal of exit from reservoir – mode of transmission – portal of entry – susceptible host
Cross Infection
The following are the methods of transmission of cross infection:
Direct method: the organisms can be transmitted directly from person to person through kissing, sexual contact, droplet infection and infected hands.
Indirect contact: contact with the secretions and excretions of the infected persons.
Through fomite e.g. instruments, utensils etc
Through contaminated food and water
Through insects
Through dusts
Through carrier
Infectious Cycle
1. Bacteria, virus, fungi, protozoa.
2. Human beings, animals, inanimate objects
3. Sputum, vomitus, urine, stool blood
4. Contact vehicle, airborne, vector borne
5. Mucus membrane, broken skin, G.I. tract, G.U. tract, respiratory tract
6. Surgery, trauma, immune-suppressed, chronically ill elderly
Breaking of Infectious Cycle
1. Hygiene of hands, sterilization, antibiotics
2. Sterilization, use of disposable items
3. Hand hygiene, use of mask, gloves, isolation and barrier techniques
4. Hand hygiene, climate, vectors using pesticides, adequate refrigeration
5. Hand hygiene, proper disposal of waste, use of mask and gloves
6. Immunization, nutrition hygiene, adequate rest, regular exercise.
Prevention of Cross Infection in the Hospital
1. The hospital should be well ventilated
2. Maintain the general cleanliness of the hospital. Sweeping and mopping of the floor should be done daily with antiseptic lotions and damp dusting should be done to keep the articles free from dust. All articles are kept clean and dry. Once in a week, roof is swept to remove the cobwebs. Bed lockers, stools etc., washed and cleaned. The mattress, pillows and other unwashable articles are exposed to sunlight and aired. Periodical white washing of the walls, painting of the doors and windows etc., should be done.
3. Safe food and water supply: many diseases are transmitted through food and water. Kitchen and pantry are protected from flies. There must be provision for safe water supply.
4. Safe disposal of excreta: urine, stool, sputum etc., should be disposed safely. The bedpans, urinals, sputum cups etc., are cleansed and disinfected before it is used for the next client.
5. Safe disposal of refuse: discarded dressing, garbage etc., are collected daily and burnt to prevent the spread of infection.
6. Destruction of rodents and insects: rodents and insects play a major role in the spread of diseases, so, they should be destroyed.
PREVENTION OF DIRECT CONTACT WITH THE INFECTED PERSON (BARRIER NURSING)
Barrier nursing or isolation technique is intended to confine the micro-organisms within a given and recognized area. There are a number of isolation techniques and precautions used to prevent the spread of infection.
Respiratory Isolation
Respiratory isolation is indicated in situations where the pathogens are spread on droplets from the respiratory tract. In this type of isolation, masks are generally worn by the nurses. Gowns are also worn when caring for the small infants because of the possibility of drooling by the infants.
When possible the clients are taught to cover their noses and mouths with several layers of tissue paper or handkerchief. If tissue paper is used they should be disposed properly. Handkerchiefs are cleaned and disinfected before it is used again. Restrict the number of visitors. Precautions must be taken while collecting sputum specimens from the clients. When attending to client with respiratory infection, the nurses should keep a reasonable distance to prevent the droplet infection and to prevent breathing contaminated air. The nurse suffering from respiratory disease should not attend to the client.
Enteric Isolation
Enteric isolation is indicated when the pathogens are transmitted in faeces. For this type of isolation it is not necessary to wear a mask, but it is recommended that gloves and gowns while handing soiled articles.
Through hand-washing should be emphasized both by the client and nurses. The excreta may be disinfected by adding lime before disposal. The soiled articles such as linen should be disinfected before it is sent to washing.
Wound and Skin Isolation
This type of isolation is for pathogens which are found in wounds and can be transmitted by the contact with the wounds or by contact with the articles contaminated with the wound discharges. Usually gowns and gloves are worn in this type of isolation. It is important to be noted that safe disposable of dressings and discharges from the wounds and the disinfection of articles.
Strict isolation techniques should be followed while caring for client with abscesses, boils, infected burns, gas-gangrene, anthrax, rabies, tetanus, venereal diseases, scabies etc. all the articles used for these clients should be kept separate.
Great care should be taken by the nurses to prevent cuts or abrasions on their hands. Frequent and thorough hand washing reduces the chances of infection.
Blood Isolation
This type of isolation is intended to prevent transmission of pathogens that are found in the blood. Therefore, any equipment that comes in contact with the client’s blood should be carefully disinfected before touching another object or person. Uses of mosquito nets is also emphasized to prevent this type of infection.
General Precautions
1. Maintain a high degree of cleanliness.
2. Health Teaching: the client and his relatives are to be taught about the spread of infection and its prevention etc.
3. Minimize the number of visitors. Children under 10 years should not be allowed to enter into the hospital wards.
4. Emphasize on hand washing. Wash hands after elimination, before eating and after handling the client or his articles.
5. Keep toilet articles separate for each person.
6. All personnel caring for the sick and also the public should have the immunization against communicable diseases.
7. Persons with lower resistance (e.g., clients with anemia, after radiation) should be protected.
8. As far as possible, the clients should be nursed in separate rooms. If separate rooms are not available, there should be at least a sufficient space in between the beds. Screens may be provided to separate one client from the other.
