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1. Concept of Asepsis: Medical and
Surgical Asepsis
Part-1
Mentor
Aleena Khan, Lecturer
College of Nursing, Islamabad
Lecture # 11, 12

2. Objective of Today’s Lecture
• Asepsis
• Why should we follow asepsis
• Types of asepsis
• Source of infection
• Chain of infection
• Medical asepsis
• Principles of medical asepsis
• Guidelines for maintaining MedicalAsepsis
• Essential components of maintaining medical asepsis
✓ Hand washing
✓ Use of face masks
✓ Eye wear
✓ Wearing of gown
✓ Wearing of gloves

3. Introduction
• The dramatic reduction in the incidence of infectious disease that occurred
during the late 1800s and early 1900s resulted largely from the understanding
that microorganisms cause disease and that they can be controlled through
aseptic practices.
• Nosocomial infections continue to occur in all health care settings. The risk of
nosocomial infections can be reduced simply by understanding and practicing
aseptic technique
Asepsis:
• Asepsis is the state of being free from disease-causing micro-organisms (such as
pathogenic bacteria, viruses, pathogenic fungi, and parasites)
• Reducing the number of microbes to an irreducible number
• Sum total of the effort to keep the patient's environment free from
contamination and the patient free from colonization

4. Why should we follow Aseptic Technique?
• Aseptic technique is employed to maximize and maintain asepsis, thus
protecting the patient from infection & to prevent the spread of the
pathogen.
• Patients with infections or carriers of pathogenic microorganisms are
admitted in the hospital.
• Hospitals house large numbers of people whose immune systems are
often in a weakened state.
• Medical staff move from patient to patient, providing a way for
pathogens to spread.
• Many medical procedures bypass the body's natural protective barriers.

5. Asepsis
Aseptic Technique:
• The nurse’s efforts to minimize the onset & spread of infection
are based on the principles of aseptic technique.
• Aseptic technique is an effort to keep the patient as free from
exposure to infection-causing pathogens as possible.
• Aseptic technique is vital to prevent and minimize post-operative
infections
Types of Asepsis:
• Medical asepsis (any practice that helps reduce the number and spread of
microorganisms)
• Surgical asepsis (the complete removal of microorganisms and their spores
from the surface of an object)

7. Source of Infection
• The source of infection are numerous, and for each type of infection a
specific source becomes more significant than the others in the delivery of
the infectious agent to the host
• The source of infection can be divided into two main groups
Exogenous Endogenous
• Infectious organism is introduced
from any where outside to inside
of body
• Personal visitors, Operating room,
surgical instruments and surgical
teams are the major source of
exogenous infection in a hospital
• Infectious agent is patient’s
own normal flora.
• Examples: staphylococci
and streptococci (can
become pathogenic under
certain circumstances)

8. The Chain of Infection
A series of events has to happen to enable germs (bacteria, fungi
and viruses) to cause infections in a person. It is known as the
‘Chain of Infection’. We can think of each part of the process as a
separate ‘link’ in the chain. And if we can break a link at any part
of the chain, we can stop infection arising.

10. The reservoir:
• The reservoir of an infectious agent is the habitat in which the agent
normally lives, grows, and multiplies.
• The reservoir can be a person – a patient/client or a member of staff
• But it can also be any part of the surrounding area of a health care
setting, furnishings in the patient’s/client’s room and the equipment
we use in health care.
• The reservoir may or may not be the source from which an agent is
transferredto a host.
• For example, the reservoir of Clostridium botulinum is soil, but the
source of most botulism infections is improperly canned food
containing C. botulinum spores

11. The portal of exit from the reservoir:
• The ‘portal of exit’ is the means by which the germ can escape from the reservoir.
• For instance, think about some germs (the infectious agent) sitting on top of a used
commode (the reservoir). A health care worker comes along and touches the
commode, and some of the germs move onto her hands. The health care worker’s
hands are now the ‘portal of exit’ – the means by which the germs are able to move
from the commode to another place.
• Other ‘portals’ can be people’s normal excretions (stools, vomit), body fluids (blood,
saliva) and the air they breathe from their lungs, especially when they cough.
• For example, influenza viruses and Mycobacterium tuberculosis exit the respiratory
tract, schistosomes through urine, cholera vibrios in feces, Sarcoptes scabiei in scabies
skin lesions, and enterovirus 70, a cause of hemorrhagic conjunctivitis, in conjunctival
secretions. Some bloodborne agents can exit by crossing the placenta from mother to
fetus (rubella, syphilis, toxoplasmosis), while others exit through cuts or needles in the
skin (hepatitis B) or blood-sucking arthropods (malaria).
• The portal can vary from one infection to another (for example diarrhoeal infections
are usually passed on via the patient's faeces).
• Non-human portals of exit for germs include items of equipment that haven’t been
properly cleaned, such as commodes, bed mattresses, pillows and reusable equipment.

12. The mode of transmission:
• This is how the germs move, or spread, from one place to another. This can happen
in a number of ways, such as health care workers’ hands touching dirty equipment
or contaminated medical instruments, or through the air (coughs, sneezes).
• An infectious agent may be transmitted from its natural reservoir to a susceptible
host in different ways. There are different classifications for modes of transmission.
Here is one classification:
Direct (Direct contact, Droplet spread)
Indirect (Airborne, Vehicle borne, Vector borne (mechanical or biologic))
Horizontal Transmission:
Horizontal transmission is the transmission of organisms between biotic and/or abiotic
members of an ecosystem that are not in a parent-progeny relationship.
Vertically transmitted infection:
A vertically transmitted infection is an infection caused by pathogens (such as bacteria
and viruses) that use mother-to-child transmission, that is, transmission directly from
the mother to an embryo, fetus, or baby during pregnancy or childbirth.

13. The portal of entry into the ‘host’:
• This means that the germs that have been moved from the reservoir now invade
the person (the ‘host’). They can do this by entering wounds and cuts, being
swallowed and being breathed in.
• Patients who are having treatments that involve cutting the skin or placing
medical instruments inside the body, such as a catheter being placed into the
bladder or a feeding tube being passed down the throat, are also at risk of
infection. Another example is people who inject drugs with used needles.
• Often, infectious agents use the same portal to enter a new host that they used
to exit the source host. For example, influenza virus exits the respiratory tract
of the source host and enters the respiratory tract of the new host.
• In contrast, many pathogens that cause gastroenteritis follow a so-called “fecal-
oral” route because they exit the source host in feces, are carried on
inadequately washed hands to a vehicle such as food, water, or utensil, and
enter a new host through the mouth.
• Other portals of entry include the skin (hookworm), mucous membranes
(syphilis), and blood (hepatitis B, human immunodeficiency virus).

14. The susceptible host:
• Healthy people have their own defenses which help them fight infection. This
means that even if some harmful germs enter the body, the person can ‘fight
them off’ and stay well.
• The ability of the body to defend itself against infection is called ‘immunity’.
Some people, however, can’t fight infection effectively.
• These include very young children, older people, people who are ill or who are
receiving particular medicines that reduce their immunity, people with long-term
health conditions like diabetes and those who are physically weak due to, for
instance, malnutrition or dehydration.
• People such as these are ‘susceptible hosts’ – meaning they are vulnerable to
developing infection when their bodies are invaded by germs.

15. The infectious agent:
• The infectious agent is simply the germ that causes the infection. Germs are all
around us and within us, and many play very important roles in keeping us
healthy.
• The problem comes when a germ leaves its normal place to go elsewhere in the
body – the germs that sit on your skin and which usually cause no harm, for
instance, getting into a cut.
• The germ could then cause infection. There are also many germs that are not
helpful to health and which cause disease.
• Entry of any of these germs into the body is likely to cause problems.

18. Medical Asepsis

19. • Medical asepsis, sometimes called clean technique, is based on maintaining
cleanliness to prevent the spread of infectious diseases and to assure that the
environment is as free of microorganisms as possible.
• Medical asepsis involves confining microorganisms to specific areas and making
objects clean
• Procedures used to protect the client and his environment from the transmission of
disease producing organisms that can transmit from one to the other
Cornerstones of Medical Asepsis
• Know what is dirty
• Know what is clean
• Know what is sterile
• Keep these conditions separate
• Remedy contamination
Medical Asepsis

20. Principle for Medical Asepsis
The basic principles of medical asepsis include:
• Cleanse hands frequently following CDC’s Hand Hygiene Guidelines.
• Keep soiled items and equipment from touching clothing.
• Do not place soiled bed linens or other items on the floor.
• Avoid having the patient cough, sneeze, or breathe directly on others.
• Move equipment away from you when sweeping, dusting, or scrubbing
articles.
• Clean the least soiled items first then the more soiled ones.
• Dispose off soiled or used items directly into the appropriate containers.
• Pour liquids that are to be discarded directly into the drain to avoid
splattering in the sink and onto you.

21. • Avoid leaning against sinks, supplies, and equipment.
• Avoid touching your eyes, face, and mouth.
• Use practices of personal grooming that help prevent spreading microorganisms.
• Follow your facility’s guidelines for solation and barrier techniques
• All body fluids from any patient is considered contaminated
• The healthcare team and the environment can be a source of contamination for
the patient.
• Isolate the disease not the patient.
Medical aseptic practices are involved in all nursing activities because
microorganisms are always present in the environment
Principle for Medical Asepsis

22. Guidelines for maintaining Medical Asepsis
1. Remember that thorough hand washing is the most important and basic technique
for infection control.
2. Always know a patient's susceptibility to infection. Age, nutritional status, stress,
disease processes, and forms of medical therapy can place patients at risk.
3. Recognize the elements of the infection chain and initiate measures to prevent the
onset and spread of infection.
4. Never practice aseptic techniques haphazardly. Rigid adherence to aseptic
procedures is the only way to ensure that a patient is at minimal risk for infection.
5. Protect fellow health care workers from exposure to infectious agents. Nosocomial
infections occur with greater frequency when patients become exposed to health
care workers who are carriers of infection.
6. Be aware of body sites where nosocomial infection is most likely to develop.

23. • Hand washing
• Use of gown, mask, gloves, glasses
• Use of disposables, clean surfaces
• Handling linens in ways that prevent germs from spreading
• Cleaning / Disinfection of equipment
• Concurrent and terminal disinfection
• Control and teaching of visitors/ relatives
• Developing staff health and hygiene and education
• Preventive vaccination, inoculation and medicines
• Use of labor saving and efficient devices for aseptic practices
Essential components of maintaining
medical asepsis

24. WHAT IS HAND HYGIENE?
• Handwashing
• Antiseptic Hand wash
• Alcohol‐based Hand Rub
• Surgical Antisepsis
Hand Washing
WHY IS HAND HYGIENE SO IMPORTANT?
• Hands are the most common mode of pathogen
transmission
• Reduces the spread of antimicrobial resistance
• Prevents healthcare‐associated infections
HAND‐BORNE MICROORGANISMS
Healthcare providers contaminate their hands with
100‐1000 colony‐forming units (CFU)of bacteria
during “clean” activities (lifting patients, taking vital
signs).

26. Healthcare workers can get 100s to 1000s of bacteria on their hands by doing
simple tasks like:
• pulling patients up in bed
• taking a blood pressure or pulse
• touching a patient’s hand
• rolling patients over in bed
• touching the patient’s gown or bed sheets
• touching equipment like bedside rails, overbed tables, IV pumps
Why it is the single most important measure??

27. • To reduce risk of transmission by droplet contact, air borne routes and
splatters of body substances
• To be worn by
✓ Those close to the client (in measles, mumps,) – large particle
aerosols travel short distances (1 m of 3 ft)
✓ All persons entering the room ( in Pulm TB)- small particle
aerosols remain suspended in the air, and thus travel great
distances
• Masks – Should have good filtration effectiveness and fit
✓ Do not carry them in the pocket or around the neck
✓ Do not use them outside the unit
✓ Use fresh mask each time (Disposable and non disposable masks)
✓ Disinfect / Sterilize before next use
Use Of Face Masks

28. • Keep in a clean container near hand washing facility
• Mask should cover mouth and nose
• A secure fit prevents escape of exhaled air and fogging of eye
glasses
• Fit the upper edges of the mask under the frame of eye glasses
• Avoid talking, sneezing, coughing
• Use only once, and not after it gets moist
• When removing mask first untie the lower strings
• Discard disposable mask in a waste container
• Wash hands
Use Of Face Masks

29. • Goggles or glasses
• Indicated when body substances may
splatter the face
• Protects against highly infectious
diseases like ebola virus
• Watch:
https://www.youtube.com/watch?v=
TmpQbh9PbAU
Eye Wear

30. • Clean or disposable gowns or plastic gowns – to protect
nurse’s uniform
• Best – The fresh gown/ discard technique
• For repeated use – Provide a stand to hang on. Follow
method to hang the gown
• Remove watch & jewelry
• Follow method to don a clean gown
• Follow precautions to remove a soiled gown and discard in
proper container
Wearing Of Gown

31. • To protect the hands
• To protect the client
• Use clean gloves for medical asepsis
• No special technique while wearing clean gloves
• Pull up the gloves to cover the wrist/ sleeves of
the gown Wash gloved hand before removing
• No special precautions to remove gloves
• If soiled, then follow precautions to remove them
Wearing Of Glove

32. • https://www.healthline.com/health/infections
• https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section10.html
Helping Material:

33. Objective of Today’s Lecture
• Surgical asepsis
• Surgical infections
• Principles in surgical asepsis
• Steps for surgical asepsis
✓ Preparing the patient
✓ Surgeon's dress code
✓ Scrubbing
✓ Gowning
✓ Gloving
✓ Skin preparation
✓ Draping

34. Surgical Asepsis

35. • Surgical asepsis or sterile technique
• It is defined as the complete removal of microorganisms and their
spores from the surface of an object.
• The practice of surgical asepsis begins with cleaning the object using
the principles of medical asepsis followed by a sterilization process.
Surgical asepsis
• Major & minor surgeries
• Tracheotomy care
• Dressing change
• Catheterization of the urinary bladder..etc
Which procedures require surgical aseptic technique?

36. Surgical Infections
Surgical infections occur during an operation because –
1. Atmosphere – the air in the OT is contaminated mainly due to technical
issues – poor design of surgical installations, irregular air flow between
different rooms, filter deficiency.
2. Staff hygiene – Improper aseptic techniques.
3. Patient - The patient’s own bacterial flora is the principle source of
infection in surgical wounds.

37. Principles in surgical asepsis
Principle Rationale
Always face the sterile field. Do not
turn back or side on a sterile field
Sterile objects which are out of vision are
considered questionable and their sterility
cannot be guaranted.
Keep sterile equipment above your
waist level or above table level
Waist level and table level are considered
margins of safety level. and will promote
maximum visibility of the sterile field.
Do not speak, sneeze and cough over a
sterile field.
To prevent or droplet infection.
Never reach across sterile field When a nonsterile object is held above a
sterile object, Gravity causes micro organisms
to fall into the sterile field.
Keep the unsterile objects away from
the sterile field
Micro organisms may be transferred whenever
a non sterile object touches a sterile field
Keep the sterile field dry Micro organisms do not pass easily through a
dry surface.

38. Principles Rationale
The edge of the sterile field is considered
unsterile
Proximity to a contaminated area makes
sterility doubtful.
Handle liquids cautiously near the sterile
field or prevent drapes or wrappers from
becoming wet.
When a liquid wets it connects a nonsterile
field with a sterile field.
Each sterile supply should be clearly
labeled as to its contents, time and date of
sterilization.
To ensure sterility.
Never assume that a object is sterile.
Always check the sterility expiration date.
Sterility of an object wrapped in paper or
cloth becomes doubtful after 4 weeks.
Avoid sweeping and dusting when the
sterile objects are opened.
Micro –organisms travel in the dust
particles
Put on mask, Wash hands, put on gowns
and gloves before handling sterile supplies.
To prevent contamination
Principles in surgical asepsis

39. 1. Preparing the patient
2. Surgeon's dress code
3. Scrubbing
4. Gowning
5. Gloving
6. Skin preparation
7. Draping
8. Others – operation theatre structure, sterilization of instruments
Steps for Surgical asepsis

40. • The preparation of the patient begins with the preoperative assessment.
• Any focal source of infection should be treated prior to surgery.
• The patient should be transferred to the theatre wearing a clean gown in a
clean bed or trolley.
• The best time to perform preoperative shaving is immediately prior to the
surgeon scrubbing.
• It should be done by a suitable, trained person to avoid skin abrasions.
Preparing the patient

41. BEFORE ENTERING THE OPERATION THEATRE!!!

42. • Don a scrub suit, and tuck the suit into the pants or wear a scrub that fits
close to the body.
• All hair, beards, or mustaches must be covered with a surgical cap and mask.
Hair must be confined as it sheds microorganisms with movement.
• Personal hygiene must be meticulous. A shower should be taken shortly before
beginning a work day in the operating room or special procedure area.
• Jewelry, long or artificial fingernails, and nail polish are prohibited as they
harbor microorganisms
• Any body piercing jewelry must be removed as it may become loose and fall
onto the sterile field.
• Shoes must be comfortable with closed heel and toe and not cloth covered.
Cloth-covered shoes may allow blood, body fluids, and other liquids to
permeate

44. Definition.
• The surgical scrub is the process of removing as many microorganisms as
possible from the hands and arms by mechanical washing and chemical
antisepsis before participating in a surgical procedure
• Despite the mechanical action and the chemical antimicrobial component of
the scrub process, skin is never sterile.
The Surgical Scrub
Before scrubbing
• Remove all the jewelry to your hands & trim your nails.
• Do not scrub if u have an infection or an open wound.

45. Methodology of the Scrub
The Timed Method
• All surgical scrubs are 5 minutes in length.
– All are performed using a surgical scrub brush and an antimicrobial soap
solution.