OBJECTIVES
1. Discuss the three major components of asepsis.
2. Discuss handwashing, disinfection and sterilization as they apply to
asepsis.
3. Discuss body hygiene -- personal hygiene and dress code.
4. Explore developing a caring attitude -- a good sense of right and wrong
essential to the practice the ABCs of infection control.
Practicing
aseptic technique, good body hygiene and developing a caring attitude
comprise the ABCs of infection control. In this article, we will discuss
the three major components of Asepsis -- handwashing, disinfection and
sterilization -- Body Hygiene -- personal hygiene and dress code --
and a Caring Attitude -- a good sense of right and wrong essential to
the practice of the ABCs of infection control. The ABCs of infection
control are fundamental in preventing adverse events.
Infectious
diseases may become a major health hazard to healthcare workers and
patients. Knowing the hazards and following established guidelines and
policies can reduce your and the patient's risk of transmission of infection.
Safety guidelines are established for a reason -- to protect you, the
employee and the patient. Even though at times some policies may seem
to take too much time, if you consider the risks of not following these
guidelines, you will realize the importance of the measures to help
protect you and provide a safe and healthy workplace.
A person
entering the hospital or clinic with an infectious disease, such as
AIDS or Hepatitis B, does not always have this condition diagnosed at
the time of admission. The diagnosis may not be made until 2-3 days
after admission, after several visits, until the patient is discharged
or not at all (if the person is an asymptomatic carrier). To protect
yourself, you must consider all patients to have an infectious disease
or, in other words, universally apply the same precautions to all body
substances regardless of the source patient.
ASEPSIS
The first
letter in our ABCs of infection control is "A", or asepsis.
Practicing asepsis is a vital part of infection control practices. Handwashing,
disinfection and sterilization are key parts of asepsis.
Definition:
Aseptic technique can be defined as all the measures we take to purposefully
reduce the number of microorganisms (germs) to an irreducible number
for the purpose of preventing transmission of infection. These include
handwashing, disinfection and sterilization.
ASEPSIS
= Common Sense
Grasp these
simple points and you'll have aseptic technique down pat.
There
Are Many Levels of Asepsis
The strictness (or level) of aseptic technique increases as you perform
more invasive procedures. For example, taking a blood pressure requires
only clean technique, while starting an IV requires sterile technique.
The most invasive procedures (entering a sterile body cavity) require
sterile technique.
Disinfection:
Removal of most pathogens (or disease-causing organisms) by the use
of friction (cleaning) and a use of a disinfectant.
- Clean high-touch items with a disinfectant frequently (bed rails,
door knobs, over-the-bed tables, faucet handles, phones, etc.).
- Use warm (not hot) water for mopping; hot water may burn someone
(YOU) if splashed and may strip the wax on floors when a "quat"
is used.
- Do not use a phenol in food preparation areas or on an infant crib/bassinet.
Phenols are toxic if ingested and may harm an infant. Use a sanitizer
in food preparation areas.
- Check the label for "contact time," the amount of time
the item must remain wet with the disinfectant to "kill"
most of the pathogens, usually 10 to 20 minutes.
- Dirt and soil inactivate disinfectants, so clean the area first.
Then reapply a fresh layer of disinfectant and allow the area to remain
wet for the contact time.
Sterilization: The highest level of asepsis is defined by the
removal of all microorganisms. It is achieved by autoclaving or by another
sterilization process. Items must be thoroughly cleaned before sterilization
can occur.
- Reserved for instruments and other objects that enter sterile parts
of the body.
- When entering a sterile body cavity, skin antisepsis is needed with
a skin antiseptic such as CHG or Betadine.
- When opening sterile packets, make sure the sterilization indicators
are changed. If not, report to Central Supply and do not use the item(s).
- All packages in that load need to be recalled.
- Sterile items should remain sterile; protect the sterile field.
Microorganisms Live in And on Our Bodies
Transient: Transient microorganisms are easily picked up on
hands, clothing, inanimate objects, etc., and are easily removed by
handwashing and cleaning (physical removal of "germs"), antisepsis
and disinfection. Antisepsis (or handwashing and pre-op skin preparation)
is the removal of transient microorganisms from the skin with a reduction
in the resident flora.
Resident or Normal Flora: Those microorganisms that are constantly
present on our bodies; no amount of scrubbing will totally remove them
(the skin cannot be made sterile). These organisms cause "trouble"
when introduced into normally sterile areas (like the bladder or bloodstream).
Pathogens:
Microorganisms that nearly always produce disease. For example:
Salmonella and Shigella cause diarrheal illness upon ingestion of enough
organisms. Normal flora can become pathogens when introduced into areas
where they don't belong, for example, through insertion of a catheter
or through surgery. Staph epidermis, normal flora of the skin, causes
most central line infections and hip implants.
The
Seven Keys of Asepsis
1. Know what is clean
2. Know what is contaminated
3. Know what is sterile
4. Keep clean, contaminated and sterile items separated
5. Keep sterile sites sterile
6. Resolve contamination immediately
7. Train yourself to realize when you have broken technique
Know
what is clean: Clean techniques are any procedures that involve
contact with intact skin or mucous membranes only. For example, when
you are taking blood pressure or temperature, these articles need to
be clean only.
Know
what is contaminated: Certain procedures like dressing changes
produce contaminated materials. These contaminated materials must be
disposed of properly by incineration or autoclave. Touching non-intact
skin is a contaminated procedure; wear clean gloves unless a sterile
procedure (like a dressing change) is being done.
Know
what is sterile: During certain procedures (for example, the insertion
of an IV or urinary catheter), sterile technique should be used. The
level of sterile procedures increases with the level of invasiveness.
For example, surgical procedures require stricter aseptic technique
than starting an IV. Sterile gloves are required for sterile procedures.
Keep
clean, contaminated and sterile items separated: Keep contaminated
articles from touching clean or sterile items. Store clean and sterile
items separately from contaminated areas or items. Keep sterile items
from touching anything but a sterile field or another sterile item.
Keep
sterile sites sterile: Once a tube has been inserted into the body,
care must be given to mitigate the travel of microorganisms up the catheter
or tube. Give dressing changes or catheter care and replace catheters
per your facility's policy and procedure.
Resolve
contamination immediately: If sterile technique cannot be used
(during an emergency) or is broken, resolve contamination when it occurs.
For example, if an IV is inserted during an emergency, replace the IV
as soon as possible after the code is completed.
Train yourself
to realize when you have broken technique. If a technique is broken,
remedy the problem if possible. For example, if during the insertion
of an IV the catheter is contaminated (by dropping on floor, etc.),
replace the catheter before insertion. If contamination cannot be resolved,
report it to the proper person. For example, if the bowel is nicked
during surgery, the case classification will change from clean contaminated
to contaminated and extra care should be given to prevent infection.
There
Are Three Methods of Transmission of Infection
Direct: Contact with a patient's blood and body fluid, secretions
or excretions or by contact with items soiled with these substances
(example: over-the-bed table, instruments, etc.).
Indirect: Contact with food/drink or vermin.
a. Vehicle: Contaminated food, water or article (VRE, Hepatitis A, Salmonella).
b. Vector: Rats, roaches or insects (malaria, plague, hantavirus, West
Nile virus). Vector is an uncommon means of transmission of nosocomial
infections; in other words, "two-legged rats" (or humans)
transmit more infections in the hospital than those with four legs!
Airborne: Transmitted through bacteria contained in dust particles
that remain airborne for long periods of time (chicken pox and tuberculosis).
These diseases are highly infectious. A mask is needed for protection
from these diseases. A special respirator is needed for tuberculosis.
Handwashing
Handwashing is the single most important means of preventing the spread
of infection. Handwashing is a critical part of asepsis.
Handwashing
is stressed in the following areas: (This is not an all-inclusive
list. Use your own conscience when washing hands.)
1) Before and after performing invasive procedures,
whether or not sterile gloves are worn.
2) Before and after contact with wounds, whether surgical,
accidental, or associated with an invasive device (e.g., an intravenous
cannula entrance wound) whether or not sterile gloves are worn.
3) Before contact with particularly susceptible patients.
4) After contact with a source that is likely to be
contaminated with virulent microorganisms or hospital pathogens, such
as an infected patient or an object or device contaminated with secretions
or excretions from patients (e.g., a urinary catheter system).
5) Between giving care to different sites of the body
(e.g., measuring urine and giving IV site care).
6) Between direct contacts with different patients.
7) Before and after your shift.
8) Before and after eating, drinking or handling food.
9) After using the toilet, coughing or sneezing.
10) Whenever hands are visibly soiled.
Thought
For Reflection...
If everyone washed his or her hands as often and as well as you do,
would your infection rate go up or down?
Antiseptics
(such as CHG, PCMX, Triclosan, Betadine) should be used when performing
invasive procedures, upon entering and leaving isolation rooms and in
special care units (i.e., ICU, Nursery, Surgery).
Soap and
water should be used for routine handwashing.
Antiseptic
alcohol solutions may be used when handwashing facilities are not convenient,
after casual contact with a patient (such as taking a pulse), but not
when hands are visibly soiled. Rub hands together in the same manner
as when washing hands. Allow to air dry. After approximately 10 applications,
you may notice a buildup on hands. Simply remove by washing with soap
and water.
Friction
is the most important part of handwashing. Rub for 10 - 15 seconds.
Be sure to cleanse under and around nails and rings and backs of fingers.
Rinse and dry hands adequately. Use a paper towel to turn off the faucet.
Handwashing
helps protect you from all infectious disease except those transmitted
by the air. Handwashing can significantly decrease the number of colds
and flu-like illnesses you experience each year. Break the chain of
infection; wash your hands!
Key
Points:
1. Rinsing hands thoroughly and carefully drying hands
will help to prevent chapping and cracking of hands. Pat hands dry.
Roughly drying hands removes the top layer of your protective skin.
2. In patient care areas, use only hospital approved
lotion in pump dispensers. Petroleum-based products (such as Vaseline
Intensive Care) degrade latex. Most hand lotions inactivate the antimicrobial
residue left on hands by agents such as chlorhexidine gluconate (CHG).
A pump dispenser helps to protect the lotion from contamination.
3. In clinical areas, keep fingernails short and unpolished.
Germs "hide" in the cracks in polish and under long or false
nails and have been established as a link to transmission of infection.
You can get naturally "polished" nails using a four-step buffing
file. A good rule of thumb for nail length is to hold your hands with
the palm side to you. If your nails are visible over your fingers, your
nails are too long.
BODY
HYGIENE AND DRESS CODE
The next letter of the ABCs of infection control is "B," or
"Body Hygiene". Look on Body Hygiene as an extension of handwashing.
Keeping clean and looking great help to form an atmosphere conducive
to the practicing of asepsis and the ABCs of infection control.
Scrub
Attire Dress Code
Wearing of scrub attire is usually designated as mandatory for the control
of infection in the operating room. However, some operating rooms have
recently allowed home laundering of scrub attire as a sterile gown is
used to cover the uniform during the surgical procedure.
Wearing
of scrub attire (as uniforms) is usually permissible in other areas
but not necessary for infection control purposes.
Follow
Good Habits of Personal Hygiene
- Bathe or shower daily.
- Keep your hair clean.
- Cover, pull back or wear a hairnet for long hair at work. *
- Keep nails trimmed and clean.
- Wear clean clothes every day.
- Keep jewelry and cologne to a minimum.
- Wash your uniform separately from household laundry. *
* in exposure prone areas: Dietary, Clinical Personal
Scrub Attire "Rules"
- Do not
enter a restricted area without proper attire.
- Shoe covers, masks and head covers are not to be worn outside your work
area (usually your department or the isolation room). Dispose of properly
before leaving the area.
Know and Follow Your Department Dress Code
- Some departments
have special dress codes.
- Wear your identification badge.
- Wear clean lab coats and shoes.
Maintain Good Health
If you maintain good health, you will be less likely to get and transmit
infections.
- Eat a balanced diet.
- Get enough sleep.
- Exercise regularly.
- Practice healthy stress reduction measures.
CARING ATTITUDE
The last letter in our acronym for the ABCs of infection control is "C,"
or a Caring Attitude. A caring attitude will be reflected in work practices
that support sound infection control principles. Work practices that support
the maintenance of aseptic technique and embrace responsibility for each
individual's role in Infection Control can only come from staff with caring
attitudes.
This can be accomplished by fostering a team approach through education
and support of the clinician as they perform duties that are pivotal in
the prevention and control of infection. Focus should be placed on the
last of the ABCs of infection control (focusing on the right and wrong
of infection control). Our attitudes should mirror the plan of asepsis
-- common sense.
By using common sense we can safely protect our patients and ourselves.
Use common sense and a caring attitude to develop a good aseptic conscious
(or a continuous awareness of asepsis). Your "aseptic consciousness"
is your set of internal ideals. We have set ideals (in the form of policies
and procedures) to protect our patients and ourselves. Set your ideals
at the highest level to give care without doing harm.
Conclusion
The ABCs of infection control -- Asepsis, Body Hygiene and Caring Attitude
-- comprise what we should do to help protect our patients and ourselves.
Your diligence and common sense is key to protecting yourself, your
co-workers and the patient. Handwashing and skin preparation, disinfectant
and sterilization, vital parts of asepsis and a caring attitude, are
essential to the ABCs of infection control. Be ever-vigilant as to asepsis.
The importance of asepsis cannot be over-emphasized.
The bottom line of infection control is those dollars saved through
the prevention of injury to patients and employees. Infection control
is a valuable asset to the facility and it is our responsibility to
demonstrate this. Place an emphasis on cost up front to demonstrate
cost savings and to demonstrate improvement in patient care and safety
through monitoring levels of infections specialized to your facility.
Consult your Safety and Infection Control manuals or your Infection
Control Practitioner for more detailed information.
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