SUMERA, Wela Mae C.

PN 2 MEDICAL ASEPSIS: The practice of medical asepsis helps to contain infectious organisms and to maintain an environment free from contamination. The techniques used to maintain medical asepsis include hand washing, gowning and wearing facial masks when appropriate, as well as separating clean from contaminated or potentially contaminated materials and providing information to patients about basic hygienic practices. Appropriate hand washing by the nurse and the patient remains the most important factor in preventing the spread of microorganisms. One common example of medical asepsis involves the steps taken by the nurse to ensure that only clean linen is applied to each patient's bed. Clean linen remains in the clean linen cabinet until taken to the patient's room. The hands of the health care worker are washed before handling the clean linen. Unused bed linen from one patient's room cannot be returned to the clean linen cabinet and cannot be used for any other patient. This linen is considered soiled and placed in the soiled linen bag. Standard Precautions Standard precautions combine the major features of universal precautions and body substance isolation. These standard precautions alert the health care worker to patient situations that require special barrier techniques. These barrier techniques are used when working with any patient where potential or actualized contact with blood or body fluid exists. Universal Precautions Universal precautions help control contamination from bloodborne viruses such as human immunodeficiency virus (HIV) and hepatitis viruses. When in contact with a patient's blood or any body secretion that may be contaminated with blood, protective measures such as wearing gloves, gown, facial mask, and/or goggles must be followed.Go to External Links page Body Substance Isolation Body substance isolation protects against bacterial organisms that may exist in body substances. Body substance isolation applies in all patient encounters regardless of the diagnosis. The application of gloves for contact with moist body surfaces and areas of nonintact skin, gowns when in contact with body secretions, and facial mask when in danger of contact with respiratory droplet secretions, prevents the contamination of both health care worker and patient. SURGICAL ASEPSIS: Asepsis and concern for patient safety in the operating room are team responsibilities involving nurses, surgeons, and anesthesiologists. Meaningless rituals now being observed in the OR must be replaced by practices and procedures based on sound principles of aseptic technique. Modern instrumentation and technology, though relieving the surgeon and anesthesiologist of many of the manual tasks which once occupied them, have not solved the problems of infection

control in the operating suite. Apathy, carelessness, and indifference may even increase as a by-product of technology, unless curbed by moral, ethical and legal constraints. Asepsis is not a static concept. Operating room policies and procedures need constant review and reexamination. Enforcement of these policies and rules to maintain good aseptic technique requires the cooperation of all who enter the OR suite. ANTI MICROBIAL AGENTS An antimicrobial is an agent that kills microorganisms or inhibits their growth. Antimicrobial medicines can be grouped according to the microorganisms they act primarily against. For example, antibacterials (commonly known as antibiotics) are used against bacteria and antifungals are used against fungi. They can also be classed according to their function. Antimicrobials that kill microbes are called microbicidal; those that merely inhibit their growth are called microbiostatic. Disinfectants such as bleach are non-selective antimicrobials. Antimicrobial Agents in the Treatment of Infectious Disease Most microbiologists distinguish two groups of antimicrobial agents used in the treatment of infectious disease: antibiotics, which are natural substances produced by certain groups of microorganisms, and chemotherapeutic agents, which are chemically synthesized. A hybrid substance is a semisynthetic antibiotic, wherein a molecular version produced by the microbe is subsequently modified by the chemist to achieve desired properties. Furthermore, some antimicrobial compounds, originally discovered as products of microorganisms, can be synthesized entirely by chemical means. In the medical and parmaceutical worlds, all these antimicrobial agents used in the treatment of disease are referred to as antibiotics, interpreting the word literally. CHAIN OF INFECTION The chain of infection is a way of gathering the information needed to interrupt or prevent an epidemic. Each of the links in the chain must be favorable to the organism for the epidemic to continue. Breaking any link in the chain can disrupt the epidemic. Which link it is most effective to target will depend on the organism.

Links in the Chain:

The Organism: What is the organism? Bacteria, virus, protist, parasite, or fungi? The type of organism informs you of the types of disinfectants, antiseptics and antimicrobials to use. Is it aerobic or anaerobic? What are its virulence factors? Toxin production in particular effect the course of the infection. What is its target host tissue?

The Reservoir: Where do you find the organism in between outbreaks? What is the continual source of the infection? A reservoir can be environmental, the hospital setting or the water supply, or in a living organism, a rodent, bird or even snail. Humans are the only reservoir for many human pathogens.

Portal of Exit: How does the organism leave the reservoir? Does it leave in feces, blood or mucus; in contaminated water; or in the blood meal of an insect.

Transmission: How is the organism transmitted from one host to the next host? Does it need a living vector like a mosquito or flea? Some organisms like malaria have complicated life cycles involving more than one species. Can it be passed human to human? When passed human to human, it is transmitted by respiratory droplets, blood contact, semen or other secretions? Is it transmitted on the hands of health care workers or the hospital ventilation system? Hand-to-mouth is a common mode for gastrointestinal pathogens.

Portal of Entry: How does the organism enter the body? Does it come through inhalation, a break in the skin or mucus membrane, an insect bite, contaminated food? The portals of entry would be through the nose, skin, or mouth. Portal of entry tells you what type of personal protective equipment (PPE) to use to keep health care workers, family and visitors safe.

Vulnerable Populations: Who is most vulnerable to this organism? Common vulnerable populations are the very young and the very old, and the immune suppressed (due to genetics, transplant drugs, malnutrition, or viral infection like HIV). Occupational exposure should be considered. For many human pathogens, all of the non-immune are vulnerable. The non-immune are everyone who has not been previously exposed and generated a specific immune response to the pathogen. Previous exposure comes from

either a previous infection or vaccination, or rarely with infection of a similar species that gives cross-immunity. IMMUNITY Immunity is the state of having sufficient biological defences to avoid infection, disease, or other unwanted biological invasion. It is the capability of the body to resist harmful microbes from entering it. Immunity involves both specific and non-specific components. The non-specific components act either as barriers or as eliminators of wide range of pathogens irrespective of antigenic specificity. Other components of the immune system adapt themselves to each new disease encountered and are able to generate pathogen-specific immunity. Types of Immunity: 1. Naturally Acquired Active

Naturally exposed to an antigen (usually long lasting)

2. Artificially Acquired

Being injected with a pathogen (immunizations or vaccines)

3. Naturally Acquired Passive

Immunity through his mother (short-lived)

4. Artificially Acquired Passive

Immunity when person is injected with antibodies (short-lived)

SPECIFIC HOST RESISTANCE cellular arm of the immune system

NON-SPECIFIC HOST RESISTANCE prevention of entrance to the body inhibition within the body