3 Lab 01: ASEPSIS

UNIT ONE: INFECTION CONTROL AND ASEPSIS

ASEPSIS LAB OBJECTIVES

Type your learning objectives here.

  • Define asepsis, medical sepsis, surgical asepsis, and contamination.
  • Define clean and sterile technique
  • Describe the cycle of cross-contamination and infection
  • Explain the use of standard precautions and transmission-based precautions and related protocols
  • Describe the OSHA infectious disease regulations that pertain to health care facilities and employees
  • Select appropriate infection control procedures for a given case scenario
  • Demonstrate competence in infection control procedures when performing common physical therapy interventions.
    • Perform proper techniques of hand hygiene for clean situations
    • Demonstrate proper procedure when donning and doffing personal protective equipment

 

ROADMAP: 

PRELAB ACTIVITIES:  

  1. View the following Videos before this week’s lab:
    1. How to Don and Doff PPE
    2. Triad of Infectious Disease
    3. Overview video of chain of infection
  2. Please read this review of hand hygiene from the CDC 
    1. CDC Hand Hygiene
  3. Read the Asepsis Lab Skills Check.  While we will complete our Asepsis Skills Check during week 2 of the semester, we will be performing infection control procedures including hand hygiene week 1.  It will be best if you do NOT wear (very) loose fitting clothes or sweatshirts as the gowns may not fit over them.  Additionally, keep jewelry to a minimum with nails trimmed. 

 

    1. ASEPSIS

      Skills Check:
      PT100S: SKILL EVAL – HANDWASHING, DONNING/DOFFING PROTECTIVE GARB The student will correctly perform the proper techniques in a safe and effective manner in accordance with the following criteria. The student is required to demonstrate competency for all criteria.

      1. Introduction  
        1. Student introduction provided to instructor.
        2. Procedure is explained in a clear and concise manner to instructor.
      2. Donning and Doffing Mask
        1. Hand hygiene is correctly performed prior to donning mask
        2. Mask is fitted over nose, mouth and chin area.
        3. Mask is fitted to avoid the need for repositioning when in use (speaking)
        4. Inside and outside of mask are correctly oriented.
        5. Doffing procedure avoids contact with outside of mask
        6. Hand Hygiene is correctly performed after doffing mask
      3. Hand Hygiene: Soap and Water.
        1. Jewelry is removed; sink fixtures are not touched; water turned on/off with paper towel
        2. Hands and wrists are wet with warm water in a downward direction
        3. Soap is applied; all parts of wrist and hand are thoroughly washed for at least 20 seconds
        4. Hands are rinsed from wrist to fingers; thoroughly dried.
      4. Hand Hygiene: Hand Sanitizer
        1. Sufficient product is used to cover all areas of hands
        2. Product is rubbed thoroughly on hands, fingers and wrists until dry (20 seconds)
      5. Donning Gown and Gloves
        1. Perform Hand Hygiene
        2. Arrange gown onto workspace.
        3. Hold gown by the inside surface and shake open, avoid touching the outside surface of the gown.
        4. Put arms through the sleeves of the gown.
        5. Your assistant will tie neck and waist straps without touching outside of gown.
        6. Don your non-sterile gloves without contaminating outer surface; covering the sleeves of your gown.
      6. Doffing Gloves:
        1. Grasp the outside of one glove at the wrist. Do not touch your bare skin.
        2. Peel the glove away from your body, pulling it inside out.
        3. Hold the glove you just removed in your gloved hand.
        4. Peel off the second glove by putting your fingers inside the glove at the top of your wrist.
        5. Turn the second glove inside out while pulling it away from your body, leaving the first glove inside the second.
        6. Dispose of the gloves safely.
      7. Doffing Gown:
        1. Untie waist strap of your gown; your partner will untie your neck strap without touching the back of the gown, neck or head.
        2. Remove gown by turning it gently inside out keeping it away from your body.
        3. Safely dispose of gown.
        4. Perform hand hygiene.
      8. Doffing goggles:
        1. Perform Hand hygiene.
        2. Remove goggles away from the body; do not touch the front of the goggles.
        3. Place goggles in prescribed area.
        4. Perform hand hygiene.

 

Introduction:

Our Asepsis Lab was typically our third unit, rather than our first one. No surprise, though, given all that has changed due to COVID-19, we needed to move this topic to the very beginning. Maybe that is best anyway as asepsis is such a crucial component of our practice as health care providers

Why does Infection Control and ASEPSIS Techniques even matter?

 

Why: Why it matters

You have, no doubt, have heard much in the media (and here at Penn State) about the strategies we use to mitigate (prevent, reduce, eliminate) the possibility of spreading infectious agents.  The COVID-19 pandemic put the consequences of infectious diseases at the top of the headlines. For those of us in healthcare however, strategies of prevention of infectious disease spread are not new: they are a necessary component of our world…and for a very good reason.  Infectious diseases can kill people.  They can, more frequently, make people very (very) ill or a (very) long time.

Perhaps you have had the experience of being ill; maybe the flu, a cold or sinus infection. Nasty experience for sure. Perhaps you were under the weather for a week or more. No fun.  However, when viruses or bacteria infect folks who are already ill, injured, aged or otherwise inflicted with a weakened immune system, the outcome is much more dire.  

On one hand: we have learned much over the last century or so regarding infectious diseases. For example, before World War II, more soldiers died from disease than of battle injuries.  

    • The ratio of disease-to-battle casualties was approximately 5-to-1 in the Spanish-American War.
    • If we were to look at the Civil War, Pneumonia, typhoid, diarrhea, and malaria collectively led to the death of almost 450,000 soldiers. Disease outbreaks and epidemics played a major role in halting several major campaigns during the war as well.
    • Following WWI, the Spanish Influenza killed almost three times more people than the 17 million soldiers and civilians killed during the war.

On the other hand: In the US, the Centers for Disease Control (CDC) estimates that Healthcare Acquired Infections (HAI) account for almost 2 million infections and 99,000 associated deaths each year.  The National Institutes of Health estimate that the cost of these infections is between $28 – $45 billion dollars annually. Some of the common HAI infections include:

Catheter-associated urinary tract infections.
Surgical site infections.
Bloodstream infections.
Pneumonia.
Clostridium difficile.www.ncbi.nlm.nih.gov › pmc › articles › PMC2827870

HOW: How this happens

There is a chain of cross contamination that exists to help explain how an infectious agent causes an illness. One wonders why, since we have identified this process, any disease spreads…it seems so easy to just break this chain.  And yet…

Maybe part of the difficulty lies in the invisible nature of viruses and bacteria. Maybe it lies in the fact that when we are feeling healthy, we can’t imagine that ‘we’ are acting as a host for an infectious agent.  Maybe it is just that we are in a hurry these days and that the simple acts of hand hygiene and sanitizing our work areas seems to be a waste of our time.   

However, as healthcare professionals it is our duty to be vigilant protecting our patients, their families, our colleagues and ourselves from being part of this cycle of cross contamination. Indeed, when you are assessed in the clinic as a student, the student assessment tool used, the Clinical Performance Instrument, listed Safety as its #1 criteria…and infection control techniques and practices are top within that criteria. 

 

Please review the cycle of cross contamination:

a. Reservoir for organism to grow and reproduce

b. Method of exit for organism

c. Method of transmission of the organism

d. Method of entry of the organism into a new host

e. Susceptible host

f. INFECTION DEVELOPS IN HOST

 

 

WHAT: What we can do about this: Aseptic Engineering and Techniques

By now you can see what is coming next: If we can create strategies to break the cycle of cross contamination, well then, we can prevent a great many infections. The world became aware of the benefits of wearing a mask, performing hand hygiene and maintaining social distancing regarding minimizing the spread of COVID-19.  You may, however, wonder why all three of those interventions are being enforced.  Good question…It all has to do with how the infectious agent is transmitted. …but first…

Sometimes we know how an infectious agent is transmitted; sometimes we don’t.  When we work with our patients who do not have a diagnosis of an infectious disease, we use something called Standard Precautions.  Standard precautions is a concept that holds we are safest, and therefore should treat all individuals as if their bodily fluids contain transmissible infectious agents.   

Sometimes we know if a patient has an infectious disease.  If we do, we can then take very specific precautions to prevent the spread of that disease: Based on how that disease is transmitted: By contact, droplet, airborne, airborne plus contact.  

    • STANDARD PRECAUTIONS: Based on the concept that all bodily fluids may contain transmissible infectious agents
    • TRANSMISSION-BASED PRECAUTIONS: Precautions for specific patients with specific highly contagious infections when the mode of transmission is known.

Modes of Transmission include: 

    • Contact
    • Droplet
    • Airborne
    • Airborne plus contact

Now we can see why we might need some means of protecting ourselves from these various modes of transmission an infectious agent may take.  Enter now: Personal Protective Equipment or PPE. The common types of PPE include

    • Gloves, respirators, masks, face shields, goggles, shoe covers, and gowns.

Let’s see if this is making sense.  Below we have some common diseases and how they are transmitted.  Can you determine what type of PPE you would need in each case?

 

 

 

ACTIVITY 3:  Asepsis Matching

 

Hand Hygiene: A most powerful tool

It is estimated that we touch our face about 3-5 times per minute or about 3,000 – 5,000 times per day.  Who knew?? Given that this is one on the best routes an infectious agent can take to enter our nose, mouth or eyes and then enter our systems, it seems like we should all ties our hands at our sides. An idea, but maybe not the most reasonable one.  However, if we are intentional and vigilant about hand hygiene, even if we are touching our face repeatedly through the day, we will be less likely to be transferring contaminants from our hands to our face.   So….when do we perform hand hygiene?  Good question:

  1. Before and after patient contact
  2. Before and after contact with wounds, dressings, specimens, bed linen and protective clothing
  3. After contact with secretions excretions when hands are soiled or considered to be contaminated.
  4. Before and after toileting
  5. After sneezing, coughing or blowing nose
  6. After removing gloves
  7. Before and after eating

And how do we do so?

Another good question. Please click to review this website from the CDC. CDC Hand Hygiene

 

Highlights include:

  • Remove jewelry from the hands and wrists.
  • Apply a cleansing agent from the dispenser to one palm. Rub the hands vigorously using friction or rubbing motions
  • Palms together – Interlace fingers; rub web space and between and around each finger
  • Dorsum of each hand with the palm of the opposite hand – Fingertips of each hand in the opposite palm
  • Dorsal finger creases of each hand with the opposite palm
  • Each thumb while it is clasped by the opposite palm- Each wrist while it is clasped by the opposite palm
  • Rub for at least 20 seconds or until the hands are dry. Do not rinse the hands with water or dry them with a towel.

 

CLINICAL APPLICATION: 

Activity 1:

Sequence for correctly DOFFING PPE to avoid self-contamination.

 

Your Case Study: 

You are at completing a clinical affiliation at skilled nursing facility (SNF).   Your patient is an 85 year old female (yof) who fractured her right hip following a fall at home. She spent 3 days in acute care hospital and was found to be medically stable, but not strong enough to return to her home – a small cottage at a retirement center.  She was transferred to the SNF for rehabilitation prior to returning to her home.

Before leaving the hospital, she was tested for COVID-19 and found to be negative. However, upon admission to the SNF, as per their policy, she was re-tested and is now in her room on isolation until the results come back tomorrow.  You and your clinical instructor (CI) are to see this patient in her hospital room.

  1. What types of PPE will you need to put on (don) prior to entering the room?
  2. Why?
  3. When will you doff the PPE?

 

REFLECTION:

Can you explain to a non-healthcare provider (or student) why we use hand hygiene, masks, and/ or gloves to mitigate known infectious diseases, including Covid-19?

 

 

definition

License

Icon for the Creative Commons Attribution 4.0 International License

PT100 Mont Alto Copyright © by Julie Meyer, MSIT; Anne Hill; Dan Dandy PT; and DPT is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted.

Share This Book