The document discusses key concepts regarding infection prevention and control in healthcare settings. It covers three main points:
1) The importance of understanding microorganisms, their modes of transmission, life cycles, and methods of control in preventing infections. Accurate identification of microbes is critical for selecting appropriate treatment.
2) The three lines of defense against infection - the first involves general health and anatomical barriers, the second involves the immune response, and the third can be acquired through passive or active immunity.
3) Key principles of aseptic technique which aim to prevent transmission of microorganisms and surgical site infections, including proper use of protective barriers and equipment, sterile fields, surgical hand antisepsis, and maintaining
2. • Knowledge of causative microorganisms including their modes of
transmission, life cycles, and methods of control is the basis of prevention
of infection
MICROORGANISM
NON PATHOGENS PATHOGENS
• Natural resident florae found
in the reproductive tract secretions,
gastrointestinal tract, nasopharyngeal
mucus, respiratory passages & any
superficial ductal opening such as
sweat & oil glands
INFECTION
• when non resident florae
invade a susceptible area;out
balance cause a pathogenic
condition - SEPSIS
• Accurate identification of the microorganism is critical to the selection of
the appropriate therapy
• Changes in temperature, moisture, illumination, nutrients & pH can
influence the rate at which any microbe passes through doubling time
3. THREE LINES OF DEFENSE
•First line of defense: involves generalized good health & incorporates
Natural biochemical, mechanical & anatomic protection through the ff:
Skin
Mucous membranes
Reflexes
Sneeze
Genitourinary / reproductive tracts
Eyes
Cellular Level
Stomach Acid
Muscular closure of orifices
• Second line of defense: involves the collaborative effort of several body
systems to prevent the proliferation of pathogenic microorganism;it includes
the following:
Inflammatory response
Antibody production
Temperature elevation
4. THREE LINES OF DEFENSE
• Third line of defense: can be acquired naturally or induced therapeutically
it requires actual exposure to the pathogen in some form during which
temporary or quasi-permanent resistance is attained. Methods include the
following:
Passive immunity
Active immunity
PATHOGENIC
INVASION
Local: surface of the wound, necrosis of tissue,
diminished inflammatory response, & absence of
anatomic barrier
Body orifice, duct, lumen of a broken vessel
Central nervous system
Lymphatic system
Major organ systems
Any body fluid or substance
5. Knowledge of how the cycle of infection works is the most important
element of prevention;Considerations include but are not limited to the
following:
• Identifying the reservoir of the pathogen
• Identifying the portal of exit of the pathogen from the reservoir
• Identifying how pathogens are transmitted
• Identifying the portal of entry into a susceptible host
• Identifying the invasion of the susceptible host
INFECTIOUS PROCESSES IN THE BODY
1. Localized infection: inflammatory response
2. Regional infection: if localization is inadequate & does not contain the
infectious process, spreading & extension occur
3. Systemic infection: or septic shock is a multiple infection sites;Diagnosis
of systemic infection may include any 2 of the following:
• Temperature more than 38C (100.4F) or less than 36C (96.8F)
6. INFECTIOUS PROCESSES IN THE BODY
• changes in Vital signs
• lab tests
• clinical manifestations
RISK FOR EXPOSURE
Surgeon,assistants & scrub person have higher risk by role & proximity
because of incidence of needle sticks & puncture wound
Circulator, environmental services personnel & instrument processors are
also at increased risk for body substance exposure because of specimen
handling, cleaning processes & other contaminants in the environment
7. RISK FOR EXPOSURE
Patients is also at risk to include immunosuppression, an immature
immune system, radiation therapy, burns, diabetes, nutritional depletion,
smoking, chemotherapy for cancer, older patients, steroid use, sickle
cell disease, alcoholism, liver & kidney disease & preexisting infection
being treated with antibiotic therapy
TYPES OF PATHOGENIC MICROORGANISMS
infections may be caused by one or several combinations of
microorganisms;each of the five main main types is described according to
structure, life cycle & mode of transmission
8. COMMON MICROORGANISMS IN AN
OPERATING ROOM ENVIRONMENT
Microorganism Usual Environment Mode of Transmission
Staphylococci Skin, hair, upper respiratory Direct contact
tract Airborne
Escherichia coli Intestinal tract Feces, urine
urinary tract Direct contact
Streptococci Oronasopharynx Airborne
Skin, perianal area Direct contact
Mycobacterium Respiratory tract Airborne, droplet
tuberculosis urinary tract Direct contact
Pseudomonas Intestinal tract Direct contact
Respiratory tract Urine, feces,water
Serratia marcesens Urinary tract Direct contact,water
Respiratory tract
Clostridium Intestinal tract Direct contact
Fungi Dust,soil,inanimate objects Airborne, Direct contact
Hepatitis virus Blood, body fluids Bloodborne,direct
contact
9. ASEPTIC & STERILE TECHNIQUE
are based on sound scientific principles & are carried out
primarily to prevent the transmission of microorganism that
can cause infection
Break in sterile technique
Post operative infection
Prevention is the knowledge of causative agents & their control
As well as the principles of aseptic & sterile technique
10. ASEPSIS: A state of being free from disease causing contaminants or
preventing contact with microorganisms
ASEPTIC TECHNIQUE: Methods or ways by which microbial contamination is
prevented in the sterile environment
12. Ignaz Semmelweis advocated the value of handwashing
Louis Pasteur taught his germ theory that physicians begin to study the cause
of infections and means of controlling them
Robert Koch isolated the tubercle bacillus, advocated the use of bichloride of
mercury as an antiseptic
Joseph Lister pursued the work of Pasteur;first to use carbolic solution on
dressings that reduce the mortality of his patients; He believed infections were
borne
In Amsterdam, Lister’s antiseptic principles of surgery were truly accepted by the
medical profession
German surgeons played a role in the transition from antisepsis to asepsis
Gustav Adolf Neuber introduced mercuric chloride to clean his apron; he advocate
scrubbing the furniture with disinfectant, wearing gowns, boots & caps and
sterilized everything that came in contact with wounds
13. Surgical team is the most common source of transmission followed
followed by contaminated instrumentation
Transmission-Based Precautions (Box 15-2)should be implemented in the
perioperative environment and in any area with the potential to transmit potentially
pathogenic microorganisms
Areas critical for the introduction & spread of microorganisms: semirestricted
And restricted areas
Considering how microorganism proliferate fast certain advances in aseptic
technique & infection control were introduced that include the following:
• Operating Room ventilation
• Sterilization & disinfection methods
• Improved barriers between sterile, clean & contaminated surfaces
• Surgical technique
• Antimicrobial prophylaxis
Despite advances, surgical-site infections (SSI) continue to cause significant
Morbidity & mortality in surgical patients (Table 15-1)
14. Factors to consider when evaluating the reasons for the emergence of resistant
Microorganisms include the following:
• Inadequate doses of antibiotic
• Improper selection of antibiotic
• Previous use of ineffective antibiotic
• Sequestered infectious site or retained foreign body
• Inadequate infection control practices
HUMAN-BORNE SOURCES OF
CONTAMINATION
• Skin
• Hair
• Nasopharynx
• Human Error
• Cross infection
15. NONHUMAN FACTORS IN CONTAMINATION
1. Fomites
contaminated particles are present in the dust that rests on inanimate objects
such as furniture, OR surfaces, equipment, supplies and fabrics
in maintaining an aseptic environment, the following key points should be
considered:
• prompt decontamination of used equipment & reusable supplies
• prompt disinfection of OR surfaces
• separation of clean and soiled items
• proper packaging & storing of supplies
• placement of dust covers over sterile items during transport and while in
prolonged storage
2. Air
microorganisms have an affinity for horizontal surfaces –floor; from the floor
microorganisms are projected into the air
an effective ventilation system is essential to prevent patients and personnel
From breathing potentially contaminated air which can predispose them to infection
16. • Community –Acquired Infection
• Communicable Infection
• Spontaneous Infection
• Nosocomial Infection
STANDARD PRECAUTIONS
established by the CDC (Center for Disease Control & Prevention) and
enforced by OSHA
formerly referred to as Universal Precautions
protect health care workers from contact with blood and body fluids of all
patients
it include considerations for the following:
All body fluids
• Handwashing
• Barrier clothing
• Handling of used patient care equipment
• Occupational exposure to bloodborne pathogens
• Patient placement
17. 1. Protective barriers & personal protective equipment (PPE)
appropriate barriers prevent contact of the skin & mucous membranes
with blood and body substances
other barriers materials must prevent blood & other fluids from passing
through or reaching the wearer’s clothing or body
include gloves, eyewear, gowns, hair covers & masks
a. GLOVES: reduce contamination of hands; Latex, vinyl & other materials
are used in manufacturing of these gloves
(1) Sterile gloves are worn for procedures that involve the invasion of
body tissues when sterile field is created; double gloving does not
prevent puncture wounds but may be appropriate for procedures in
which the risk of glove tears is high
(2) Unsterile latex or vinyl examination gloves are worn for procedures
That do not require a sterile field such as handling specimens
(3) General-purpose utility gloves are worn for cleaning instruments
& for decontaminating & housekeeping procedures involving potential
blood contact
18. (4) Gloves are changed after every contact with patients or contaminated
Items; washing gloves between patient contacts is not an acceptable
practice
(5) The hands are washed immediately after glove removal
b. MASKS: protect personnel from aerosols and patients from droplets;they
are worn for all invasive procedures;specialty masks to filter laser
plume;should be changed immediately if grossly contaminated by a
splash of blood or body fluid
c. EYEWEAR: with shields protects the mucous membranes of the eyes, &
full face shields protect the mucous membranes of the eyes, nose and
mouth;they are worn for procedures in which blood, bone chips,
amniotic fluid,and the aerosol of other body fluids may splash or be
projected into the eyes;Googles with enclosed sides & chin-length face
offer better protection than do simple eyeglasses
d. GOWNS/APRON: made of fluid-resistant material protect the wearer from
a splash with blood & body fluids; a plastic apron may be worn under a
woven fabric gown
19. e. SHOE COVERS / BOOTS: protect the wearer when gross contamination
on the floor can be anticipated;grossly soiled shoe covers or knee
high disposable boots are removed before the wearer leaves the
room
2. Prevention of puncture injuries
needles, knife blades, and sharp instruments present a potential hazard
for the handler and user
skin may be punctured or cut if caution is not taken
a. Do not manipulate sharps by hand;
b. use an instrument, such as a heavy hemostat, to attach and remove
the scalpel blade;
c. arm the needle directly from the suture packet when possible
d. do not bend or break an injection needle
e. Pass needles in a needle holder or use a “neutral zone” to transfer sharps
on field
f. Remove instruments from the surgical field after use and return them to
mayo stand or instrument promptly
20. g. Do not recap used injection needles except with a recapping safety device
h. Do not remove the needle from disposable syringe by hand after use;if a
needle must be change use hemostat or other instrument to exchange a
hypodermic needle
i. Place all used sharps in a puncture-resistant container for disposal
3. Management of puncture injuries
if a glove is torn or punctured, removed the puncturing sharp or instrument
from the sterile field immediately and change the glove promptly using the
open glove method
squeeze the skin to release the blood & wash out contaminants under
running water with an antiseptic then irrigate the wound with a virucidal
disinfectant such as an iodophor, bleach or peroxide
report the incident immediately & document all actions on the appropriate
forms and baseline testing may be necessary for the punctured individual
and the patient
21. 4. Oral procedures
blood contaminated saliva and gingival fluid is expected during dental &
surgical procedures in the oropharyngeal cavity
mouth protection, Ambu bags and/or other ventilation devices should be
available for emergency airway resuscitation
respiratory secretions coughed up during endotracheal procedures are
often infectious
5. Care of specimens
all specimens of blood, body fluids and tissues should be contained to
prevent leaking during transport to the laboratory
the outside of the container should be clean
the circulator while wearing gloves needs to disinfects the outside of the
culture tube handed from the sterile field or a container if it has been
contaminated
6. Decontamination
all instruments are thoroughly cleaned before sterilization or high level
disinfection;gloves, masks and eyewear are worn fro cleaning procedures
22. 7. Laundry
soiled woven fabrics should be handled as little as possible and are
transported to the laundry in leak proof bags
all laundry is considered contaminated and should be handled only by
glove hands
8. Waste
blood suctioned fluids may be safely poured down a drain that is
Connected to a sanitary sewer
a solidifying agent can be added to disposable suction containers to
Disinfect the produce and convert it into solid waste
trash is disposed of by incineration or sent to a sanitary landfill in sealed
Containers as required by local ordinances or state regulations
trash bags must be leak proof and of sufficient thickness and strength to
Ensure integrity during transport
waste segregation should be observed
23. 9. Handwashing
thorough handwashing with an improved antimicrobial agent after every
contact with a patient, contaminated items or suspected contamination
protects both patient and personnel
10. No touching of mucous membranes
eating and drinking is prohibited in any area where there is a risk for
exposure
applying lip balm or cosmetics or adjusting contact lenses in the
perioperative environment significantly increases the risk of exposure
hand to mouth and hand to eye contact can contribute to microbial
transmission
11. Prophylaxis
perioperative personnel are encouraged to know their HIV, HBV, HCV
Antibody status
personnel who participate in invasive procedures are at risk for bloodborne
Exposure and should have the HBV immunization series
24. is the foundation of modern surgery
the patient is the center of the sterile field, which includes the personnel
wearing sterile attire and the areas of the patient, operating bed & furniture
that are covered with sterile drapes
strict adherence to the recommended practices of sterile technique
reflects the surgical conscience of the perioperative team and is mandatory
for the safety of the patient and personnel in the environment
principles of sterile technique are applied under the following conditions:
• In preparation for an invasive procedure by sterilization of necessary
Materials & supplies
In preparation of the sterile team to handle sterile supplies & intimately
Contact the surgical site by scrubbing, gowning and gloving
In the creation and maintenance of the sterile field including skin
Preparation and draping of the patient
In the maintenance of sterility throughout the entire surgical procedure
In terminal sterilization & disinfection at the conclusion of the surgical procedure
25. 14 COMMANDMENTS IN THE OPERATING ROOM
ONLY STERILE ITEMS ARE USED
WITHIN THE STERILE FIELD
1.
2.
STERILE PERSONS ARE GOWNED
AND GLOVED
26. 14 COMMANDMENTS IN THE OPERATING ROOM
3. TABLES ARE STERILE ONLY
AT TABLE LEVEL
4.
STERILE PERSONS TOUCH ONLY STERILE ITEMS
OR AREAS, WHILE UNSTERILE PERSONS TOUCH
ONLY UNSTERILE ITEMS OR AREAS
27. 14 COMMANDMENTS IN THE OPERATING ROOM
5.
UNSTERILE PERSONS AVOID REACHING OVER
THE STERILE FIELD WHILE STERILE PERSONS
AVOID LEANING OVER AN UNSTERILE ITEMS OR
AREAS
6.
THE EDGES OF ANYTHING THAT ENCLOSES
STERILE CONTENTS ARE CONSIDERED
UNSTERILE
28. 14 COMMANDMENTS IN THE OPERATING ROOM
7. WHEN IN DOUBT, DISCARD!
8.
THE STERILE FIELD IS CREATED AS
CLOSE AS POSSIBLE TO THE TIME OF USE
29. 14 COMMANDMENTS IN THE OPERATING ROOM
9. STERILE AREAS ARE CONTINUOUSLY
KEPT IN VIEW
10.
STERILE PERSONS KEEP WELL WITHIN
THE STERILE AREA
30. 14 COMMANDMENTS IN THE OPERATING ROOM
11. STERILE PERSONS KEEP CONTACT
WITH STERILE AREAS TO A MINIMUM
12.
UNSTERILE PERSONS AVOID
STERILE AREAS
31. 14 COMMANDMENTS IN THE OPERATING ROOM
13.
DESTRUCTION OF THE INTEGRITY OF
MICROBIAL BARRIERS RESULTS IN
CONTAMINATION
14.
MICROORGANISMS MUST BE KEPT TO
AN IRREDUCIBLE MINIMUM
32. 1. The sterile team wears sterile attire
2. When in doubt, discard!
3. Gowns are considered sterile only from waist to shoulder level and in front
4. Sterile to sterile; unsterile to unsterile
5. Once opened, use at once and do not reuse
6. Sterile person should pass each other back to back
7. Sterile person faces the sterile area when passing it
8. Sterile person turn his back to a non-sterile person or area when passing
9. A sterile table is created as close as possible to the scheduled time of use
10. Sterile areas must be constantly kept in sight
11. Unsterile persons avoid sterile areas or reaching over a sterile field
12. Once the sterile pack or drape is damaged, it becomes contaminated and unsterile
13. Surgeons makes an effort in sponge only once for mopping, then discard it into a pail
14. Sterile packages are laid on dry areas
15. The skin cannot be sterilized
16. Infected areas are grossly contaminated, avoid scattering the contamination
17. The GIT more especially the colon is contaminated.
Please remember the PRINCIPLES!
33. Principles of sterile technique are applied in the following
conditions:
1.Prior the operation, materials and supplies to be used must be
sterilized
2.Prior the operation, the number of bacteria in the skin must be
minimized through surgical scrub and skin prep
3.Before surgery, the sterile field should be established by draping the
client with sterile drapes.
4.During the surgery, sterilitty should be observed while handling the
sterile supplies and when in contact with the incision.
5.At the end of the operation, the room should be disinfected.