Nursing Procedure 1.2
- Using Principles of Medical Asepsis
Prevents the growth and spread of pathogenic microorganisms from one individual or environment to another individual or environment.
Nursing Procedure 1.2
Prevents the growth and spread of pathogenic microorganisms from one individual or environment to another individual or environment.
For hand hygiene in between clients and for visibly unsoiled hands:
Assessment should focus on the following:
Nursing diagnoses may include the following:
Outcome Identification and Planning
Sample desired outcomes include the following:
Special Considerations in Planning and Implementation
Display 1.1 discusses hand hygiene. Keep your fingernails short and filed. Dirt and secretions that lodge under fingernails contain microorganisms. Long fingernails can scratch client's skin.
If a child is restless or too young to understand the importance of maintaining a sterile field, prevent the child from moving by using linen or soft restraints during the procedure. Use a family member to assist in holding the child still and allaying fears, if possible; otherwise, seek assistance from other personnel. Consider that some parents may be conflicted about the use of physical assistance to perform procedure while maintaining a sterile area. Take the time to provide explanations to parents if parental or other assistance is necessary. If necessary, provide sedation or pain medication before the procedure to comfort and calm the child.
If a client is disoriented and restless, enlist assistance or use manual protective devices to hold client still during procedures that require maintenance of sterile materials (see Nursing Procedure 1.6).
Bar pets from the room in which a sterile or clean procedure is being performed. Keep in mind that most procedures are performed with clean rather than sterile technique. Enlist and instruct a family member to serve as an assistant. Remove biohazardous waste from home each visit. See Display 1.2 for various considerations in teaching the client/family about infection control and disposal of biohazardous waste in the home. Disposal requirements for biohazardous waste vary by state and by agency.
| Action | Rationale | |
|---|---|---|
| Performing Hand Hygiene: Handwashing (Medical) | ||
| 1 | Stand in front of sink, being careful that uniform or clothing does not touch the sink during the washing procedure. | Sinks are considered contaminated; uniforms can carry microorganisms from place to place |
| 2 | Remove rings (often may retain wedding band) and chipped nail polish; move watch to position high above wrist on lower arm. | Removes sources that harbor and promote growth of microorganisms |
| 3 | Wet hands from wrist to fingertips under flowing water. | Aids in removal of microorganisms from least to most dirty |
| 4 | Keep hands and forearms lower than elbows when washing. | Water flows from least to most contaminated area; hands are the most contaminated parts to be washed; permits cleaning of the dirtiest areas without risking contamination of other less dirty areas |
| 5 | Place soap, preferably bacteriostatic soap, on hands and rub vigorously for 15–30 s, massaging all skin areas, joints, fingernails, between fingers, and so forth; slide ring up and down while rubbing fingers (if unable to remove). | Creates friction to remove microorganisms; permits cleaning around and under ring |
| 6 | Rinse hands from fingers to wrist under flow of water. | Washes dirt and microorganisms from cleanest to least clean area |
| 7 | Dry hands with paper towel, moving from fingers to wrist to forearm. | Dries hands from cleanest to least clean area |
| 8 | Turn off faucet with paper towel. | Prevents recontamination of hand |
| Performing Hand Hygiene: Using an Antiseptic Handrub | ||
| 1 | Apply amount of product recommended by manufacturer to palm of one hand. | Ensures that correct amount of handrub is used |
| 2 | Rub hands together, covering all surfaces of the hands from wrists to fingers. Continue rubbing until hands are dry. | Distributes handrub; decontaminates hands |
| Managing Contaminated Materials | ||
| 1 | Don gloves when contact with body fluids or infected area is possible. | Prevents contamination of hands; reduces risk of infection transmission |
| 2 | Use specimen bags for any specimens collected. | Prevents exposure to microorganisms found in specimens |
| 3 | Don mask if microorganisms can be transmitted by airborne route through contact with mucous membranes. | Prevents exposure to airborne microorganisms or projectile body fluids |
| 4 | Don gown if contact with body secretions or contaminated area is likely, if client has highly contagious condition, or if client is immunosuppressed. | Avoids contact with potentially infectious material; avoids spread of infection; protects client from exposure to microorganisms |
| 5 | Place disposable contaminated materials in bag before leaving bedside; place in dirty utility room or send for waste disposal personnel; or place in precaution (isolation) bag or mark “BIOHAZARD” or “Precaution (isolation)” on bag; use double bagging, if agency policy. | Provides added protection against exposure to body fluids or infectious materials; alerts housekeeping department to dispose of materials properly |
| 6 | Place reusable items in bag labeled “Precaution (isolation),” and send to central supply unit for sterilization or to appropriate department for cleaning; items too large to be placed in a bag should be sprayed with disinfectant and sent for thorough cleaning. | Decreases spread of microorganisms on used medical equipment |
| 7 | Place linens in linen bags before leaving bedside and then place these in central hamper or linen chute (agency may require double bagging). | Decreases spread of microorganisms; clears environment of dirty materials |
| 8 | Clean stethoscope between use for different clients with soap and water and wipe with alcohol swab (if used in an infected area or with an infected client, thorough disassembly and cleaning may be needed). Use a separate stethoscope for a client with an infection, if possible. | Decreases spread of microorganisms on stethoscope; limits exposure to infection |
| 9 | Spray or wipe sphygmomanometers, thermometers, ECG leads, or similar daily-use items with a bacteriostatic substance between use with different clients. | Decreases exposure to potentially infectious medium because these items provide a good medium for microorganism growth |
| 10 | Place used syringes and needles, scalpels, and other sharp disposables in appropriately marked container. Ascertain that safety locks have been applied to used needles. | Prevents accidental stick and contact with client’s blood |
| 11 | Discard gown, gloves, and mask before leaving client’s room. | Prevents spread of infection |
| 12 | Perform hand hygiene. | Reduces microorganism transfer |
| Handling Clients’ Personal Items | ||
| 1 | Place items in bags and send home with family; if client is discharged and does not want certain items, dispose of these as described. | Reduces clutter; reduces additional items that could harbor microorganisms |
| 2 | NEVER SHARE PERSONAL-CARE ITEMS BETWEEN CLIENTS. | Prevents general spread of infection |
| 3 | If papers, books, or other items become soiled with infectious material, discard items unless sterilization is possible and desired. | Prevents spread of microorganisms from contaminated materials to client or others |
| Determining Room Assignment | ||
| 1 | Placement in a private room is preferable but is required only when a highly virulent or infectious microorganism is present, the microorganism is airborne, or the client is highly susceptible to infection. | Protects client or other clients from cross-contamination |
| 2 | Use a semiprivate room when the microorganism is limited to one body area; however, good medical asepsis must be maintained by staff, client, family, and visitors. | Prevents spread of infection |
| Cleaning Room | ||
| 1 | Ensure that room is cleaned with disinfectant daily. If soiled materials spill on floor, clean area with disinfectant or bactericidal agent specific to microorganism, if known. | Reduces microorganisms in the environment |
| 2 | When client with known infection is discharged, transferred, or dies, ensure that room is cleaned and disinfected thoroughly and allowed to remain vacant for 12–24 hr. (See Nursing Procedure 12.3 for postmortem care and Nursing Procedure 1.4 for additional information on precaution [isolation] techniques.) | Promotes thorough removal of microorganisms |
Were desired outcomes achieved? Examples of evaluation include:
