Review of Asepsis

Learning Objectives

Upon successful completion of this chapter, the student will be able to:

• Explain the importance of quality hand hygiene.

• Explain the difference between medical aseptic technique and sterile technique.

• Discuss the importance of maintaining sterile technique in the administration of IV fluids.

• List and discuss Universal Precautions related to IV therapy.

• List and discuss OSHA regulations related to IV therapy.

Key Terms

bloodborne pathogens

microorganisms capable of causing disease in humans and transmitted in human blood.

contaminated

no longer sterile, soiled, unclean.

exposure incident

occurrence when the clinician is exposed to a potent bloodborne pathogen from body fluids.

medical asepsis

clean techniques to decrease pathogens to reduce the incidence of cross-contamination; also known as the clean technique.

nosocomial infection

infection acquired in health care setting.

occupational exposure

being exposed to harmful microorganisms or other harmful factors through employment.

surgical asepsis

using sterile technique; to use methods to kill all microorganisms in a given situation.

Infection control is a major factor in patient safety with intravenous (IV) therapy. Handwashing/hand hygiene, medical asepsis, and sterile technique all play a part in infection control. Compliance with Occupational Safety and Health Administration (OSHA) guidelines and Universal Precautions also contribute to initiating and maintaining infection control. Other factors that may affect the incidence of infection in a patient include natural defenses against infection such as an intact skin, a functional immune system, and the person’s general state of good health (or homeostasis). Additionally, the type of microorganism and its state of mutation for antibiotic resistance are involved in the progression or arresting of an infection.

PROPER HYGIENE/DISINFECTION

The incidence of infection can be reduced by the use of both aseptic and sterile techniques. The health care professional who has the responsibility for initiating or caring for an IV must practice both techniques and be cognizant of both of these techniques at all times to maintain patient safety.

Microorganisms can be pathogenic or nonpathogenic with disease-producing organisms being identified as pathogens. Medical asepsis refers to an area or object that is free from pathogens. It is possible for nonpathogens to be present on a medical aseptic or clean surface. Proper disinfection of an area and hand washing are key elements in medical aseptic technique.

Hand Hygiene

Historically, cleansing of the hands has been referred to in the traditional term of hand washing. With the advent of antimicrobial hand sanitizing agents, the term hand hygiene has become the term of choice. A thorough washing of hands with soap and warm water at the beginning of the workday and several times throughout the day is still recommended. However, it is acceptable to use the waterless, alcohol-based antimicrobial scrub/wash between hand washing when clean hands are essential. The prevention of nosocomial infection is the goal of excellent health care, and hand hygiene plays an important role in that goal. It is good practice to review proper hand washing techniques on a regular basis and to practice them daily, according to aseptic technique. Basic infection control practices must be followed at all times by all personnel for infection control.

Other factors to be considered in appropriate hand hygiene include the length of the nails and the use of nail polish. Nails should be smooth and should not extend over the end of the fingertip. Long nails may puncture the tips of latex or other protective gloves. Acrylic or artificial nails should not be on the fingertips because these additions may harbor fungus and other microorganisms, resulting in infections. If polish is used, it should be clear so the underside of the nail tips can be seen and examined for the presence of dirt or foreign matter. Nail polish should be free of any chips. Rings should not be worn because they also may harbor pathogens under the band or in mountings for stones.

Cleansing Agents

Altering the conditions that allow pathogens to live, multiply, and spread eliminates infectious pathogens. This can be accomplished by the use of disinfectants and antiseptic preparations.

Disinfectants are chemical preparations used to kill or eliminate pathogens from objects. They do not have the capability of killing bacterial spores. Often referred to as germicides or bactericides, these products kill living and active microorganisms. As a result of the chemical strength, disinfectants are usually not used on skin or mucous membranes. Their intended action is to kill microorganisms on inanimate objects such as equipment, environmental surroundings, and supplies. Examples of disinfectants are full-strength household bleach, phenol, and formaldehyde. When using these solutions, the health care provider should take protective skin precautions such as wearing gloves and using splash protection equipment.

Antiseptics tend to inhibit the growth and reproduction of microorganisms; however, they do not completely kill microorganisms. Antiseptics interfere with cellular metabolism, thus preventing survival and replication. These products can be applied to skin and mucous membranes. Additionally, they may be used as cleansing agents. Examples of antiseptics are 70% isopropyl alcohol, iodine preparations, and chlorhexidine gluconate. Caution must be exercised when using iodine preparations on patients because many individuals are allergic to iodine. Prior to use, the patient must be questioned about the incidence of any reaction, local or systemic, to iodine and evaluate these reactions, if applicable. The clinician must constantly observe the site where the iodine preparation was applied for any local reaction, such as itching or a rash at the site. Additionally, they must be aware of any signs of possible systemic reaction, such as hives, difficulty breathing, or other signs of allergic reaction.

TYPES OF PATHOGENS

The skin harbors numerous pathogens and nonpathogens. The staphylococcal bacteria Staphylococcus aureus are frequently found on the skin and are often the cause of infections that enter the body through the catheter lumen or the outside of the catheter. This pathogen is found on many surfaces of the clinical environment and on pieces of equipment. Other pathogens or common microorganisms responsible for nosocomial infections are Pseudomonas aeruginosa, Escherichia coli, enterococci, and staphylococci with Staphylococcus epidermis responsible for many infections. Although these microorganisms reside on the skin the majority of the time, they usually do not become pathogens until they enter the bloodstream or a body cavity. Another frequently found and considered almost-normal flora found on body surfaces is a fungus, Candida albicans. Subsequent fungal infection can be the result of introduction of the pathogen by contaminated fluids, equipment, or cross-infection or from colonized hands of clinicians.

A case in point deals with a neonate who was respiratory compromised and in a neonatal intensive care unit (NICU) receiving IV fluids. The infant developed a nosocomial infection in the second week of life and subsequently died. Cultures obtained during the illness identified Candida albicans as the causative agent. Among the items used in his care, the IV tubing tested positive for Candida albicans as did one of the care provider’s hands. Proper hand sanitizing technique and proper frequency may have prevented the nosocomial infection and the infant’s demise.

The presence of normal body flora on the skin is always a factor in the possibility of infection during IV therapy, because the normal flora may be injected under the skin as it is punctured by the needle (Figure 3-1). Proper cleansing of the skin prior to the initiation of the IV therapy is essential to prevent this contamination. Although any of the aforementioned antiseptics may be used to cleanse the skin prior to the insertion of a catheter, cannula, or needle, chlorhexidine gluconate is usually preferred. The skin must be gently and thoroughly scrubbed or cleansed with the selected antiseptic solution and then allowed to air dry for a minimum of 2 minutes. Once the insertion is completed a sterile dressing is applied to the site. Refer to Chapter 8 for additional information on dressings.