Pathogen Definition of Terms

 Bacteria Decontamination—process where physical or chemical

 Virus means are used to remove, inactivate, or destroy
 Fungi pathogens on a surface or item making them safe for
 Parasite handling or use and incapable of transmitting infectious
agents.
Reservoir
Disinfection—the process of using physical or chemical
 People means to destroy pathogens, excluding the spores.
 Animals
 Soil Sterilization—process by which all pathogens are
 Food destroyed, including the spores.
 Water Antiseptic—chemical solution that inhibits the growth
Portal of Exit of some microorganisms. Can be used in living tissues

 Coughing/sneezing Healthcare-associated/Nosocomial infection—any

 Bodily secretion infection that is acquired during the time a patient is
 Feces admitted in a healthcare facility.

Susceptible Host Iatrogenic infection—infection that is acquired in the

course of undergoing diagnostic tests or therapeutic
 Elderly procedures.
 Infants
Personal protective equipment (PPE) —specialized
 Immunocompromised
equipment attire used by healthcare workers to protect
 Anyone
them from infections. It includes masks, gowns, and
Portal of Entry googles.

 Mouth Sepsis—refers to the clinical condition where infectious

 Nose disease agents are spread throughout the body of an
 Eyes individual from a localized site of infection and manifest
 Cuts in skin with symptoms of organ damage.

Mode of Transmission Asepsis—the absence of disease-producing organisms

and is divided into medical asepsis and surgical asepsis.
 Direct contact  Medical Asepsis— aimed at reducing the number of
 Indirect contact disease-producing organisms to prevent its spread
 Vectors from healthcare workers to the patients and vice
versa.
Medical Asepsis Isolation Precaution  Surgical asepsis— aimed at total elimination of
Nosocomial infections disease- producing organisms particularly in areas in
the body where surgical procedures will be
 also referred to as healthcare-associated infections performed as well as the location where the surgical
(HAI) procedure will be carried out.
 infection(s) acquired during the process of receiving
health care that was not present during the time of Goals of Asepsis
admission. They may occur in different areas of
healthcare delivery, such as in hospitals, long-term ✓ Protect the patient from hospital-acquired or
care facilities, and ambulatory settings, and may nosocomial infections.
also appear after discharge. HAIs also include
occupational infections that may affect staff. ✓ Prevent the spread of pathogenic microorganisms.
Factors that play a role in the occurrence of infection  Are good hygiene habits e.g., hand washing, use of
among patients include: gloves & other barriers, correct sharps handling.
aseptic techniques
 Suppression of the immune system
 Prolonged duration of illness
 Procedures that patients undergo in the healthcare
facility such as insertion of in-dwelling catheters,
and insertion of intravenous lines or endotracheal
tubes.

General Aseptic Procedures

1. Handwashing
Body Substance Isolation
2. Prompt and safe disposal of contaminated
materials.  Focused on protecting patients and health
3. Regular checking and emptying of containers for personnel from all moist body fluids not just blood:
surgical drains. semen, vaginal secretions, wound drainage, sputum,
4. Prompt cleaning od soiled or moist areas. saliva etc.
5. Proper labelling of containers regarding the date
and time of disposal. ELEMENTS OF STANDARD PRECAUTION

Isolation Precautions 1. Proper handwashing.

2. Use of personal protective equipment.
Isolation– process of separating an individual with an 3. Proper handling and disposal of secretions.
infectious disease from the rest of healthy population 4. Proper handling and disposal of soiled linen and
to prevent spread of infection. equipment.
5. Clean and disinfected environmental surfaces.
6. Safe injection practices and Proper
handling/disposal of sharps.
7. Patient Placement (isolation).
8. Respiratory hygiene/cough etiquette.

Hands—most frequent source of microorganisms.

Importance of Handwashing
Standard Precautions
 To reduce the flora on the healthcare worker's skin
 The minimum infection prevention practices that  Protect the healthcare worker in the event that
apply to all patient care, regardless of suspected or there is a break in his or her skin
confirmed infection status of the patient, in any  To reduce risk of contact with infectious agents if
setting where health care is delivered. gloves worn are punctured
 Combination of Universal Precautions (UP) and  To reduce the chances of disease transmission.
Body substance Isolation (BSI)
Healthcare-acquired infections
 Assumes that all body fluids except sweat, non-
 Methicillin-resistant Staphylococcus aureus (MRSA)
intact skin and mucous membranes may have
 Vancomycin-resistant Enterococcus (VRE)
transmissible infectious disease.  Penicillin-resistant Streptococcus pneumoniae
Universal Precaution

 Guidelines for protecting healthcare worker because

the emergence of HIV & other bloodborne
pathogens.
  Provide protection from microorganisms
 Single-use item
 Avoid touching masks while worn
 Replace once damped

Sterile Gowns
 Sufficient to protect the skin
 Prevent soiling of clothing during procedures or
Handwashing is the most basic and universally accepted
other in-patient activities that may lead to splashing
measure used to prevent the spread of infection.
or spraying of blood and body substances
Routine handwashing for at least 15 seconds with a 10-
second rinse is recommended.  Single-use item

Handwashing Sterility Parameters

Water plus soap In cases of surgical procedures and other invasive
palm to palm procedures, care must be taken to prevent the invasion
fingers interlaced of microorganism into the surgical site Sterility
finger nails parameters have been developed to maintain the sterile
wrists field. These parameters are as follows:
thumbs
rinse 1. The front of a sterile gown is considered sterile from
disinfected hands the chest down to the level of the sterile field. The
reason for this is because most scrubbed personnel
My 5 moments of hand hygiene work next to a sterile table and/or bed.
1. At the beginning and end of each shift 2. The gown sleeves are sterile from two inch above the
2. When the hands are visibly soiled elbow to the cuff, circumferentially.
3. After contact with possible sources of 3. The back of the gown is not considered sterile
microorganisms such as blood or body fluids, because it cannot be constantly monitored.
mucous membrane, non-intact skin, contaminated 4. The neck, sleeve cuffs, and underarms of the gloves
objects are not considered sterile and are not considered as
4. Before and after performing invasive procedures effective microbial barriers
5. Before removing gloves if they are visibly soiled and
after removing gloves Guidelines for the Proper Use of Gloves
The World Health Organization (WHO) had come up
Personal Protective Equipment (PPE) with guidelines for the proper use of gloves in
Mask—blocking the transmission of pathogens healthcare facilities. Some of the recommendations
Goggles—prevent particulates/fluids from striking the listed in the guidelines are include the following:
eyes
Gown—used to protect the wearer from the spread of 1. Gloves are not meant to replace observance of
infection or illness proper hand hygiene. The practice of hand hygiene must
Gloves—to help prevent cross-contamination still be observed before and after wearing of gloves.
Footwear—barrier against possible exposure 2. Gloves must be worn if contact with blood or body
fluids, mucous membranes, open wounds, or potentially
Gloves infectious material is anticipated. 3. Gloves must be
removed and disposed of after caring for a patient.
 Serve as protective barrier when handling or
Healthcare workers must not wear the same gloves if
touching open wounds, blood or body fluids
caring for more than one patient.
 Provide protection from microorganisms
4. Gloves must be removed or changed if moving from a
 Help prevent the spread of infectious agents from
contaminated body site to another body site in the
one person to another
course of caring for a patient.
 Disposable
5. Re-using of gloves after decontamination is not
recommended.
Mask
 Must cover the mouth and nose
Furthermore, WHO recommends the use of gloves in
the following situations:
1. Before performing a sterile procedure.
2. When in contact with a patient and his or her
surroundings in conditions where contact precautions
are warranted.
3. When contact with blood or body fluids, non-intact
skin, and mucous membrane is anticipated.
The removal of gloves is indicated in the following:
1. When hand hygiene is indicated
2. After contact with a single patient and his or her
surroundings is ended or when contact with a
contaminated body site is ended.
3. As soon as the gloves are damaged or there is loss of
integrity of the gloves.
4. After contact with blood or body fluids, non-intact
skin, and mucous membrane.

TRANSMISSION BASED PRECAUTION—Transmission-

Based Precautions are the second tier of basic infection
control and are to be used in addition to Standard
Precautions for patients who may be infected or
colonized with certain infectious agents for which
additional precautions are needed to prevent infection
transmission

Contact Precautions—for patients with known or

suspected infections that represent an increased risk for
contact transmission.

Airborne Precautions—for patients known or suspected

to be infected with pathogens transmitted by the
airborne route (e.g., tuberculosis, measles. chickenpox,
disseminated herpes zoster) increased risk for contact
transmission.

Droplet Precautions—for patients known or suspected

to be infected with pathogens transmitted by
respiratory droplets that are generated by a patient who
is coughing. sneezing, or talking.
Disease-Specific Isolation Recommendations
Standard Precautions
 CMV
 HIV
 Hepatitis B and C
 Aspergillosis

Contact Precautions
 MRSA
 VRE
 Adenovirus
 Diarrhea
 C. Difficile
 Rotavirus  Wrapped kits of instruments are opened in such a
 E coli 0157 way that the contents do not touch non-sterile
 Enterovirus items or surfaces.
 Salmonella  Patient must be prepared prior to surgery.
 Shigella  Surgical scrub must be performed by all the
 Hepatitis A members of the surgical team and all others who
 Herpes Zoster (shingles, localized) will perform the surgical procedure
 Herpes simplex  During the operation, only properly scrubbed
 Parainfluenza (mask if coughing) personnel must be allowed at the vicinity of the
 RSV (mask if productive cough) sterile field.
 Lice  Talking, laughing, coughing, or sneezing are not
 Scabies allowed across the sterile field.
 Chickenpox (symptomatic, until all lesions crusted
and dried)
Preventing Infection in the Community
Droplet Precautions Infection control in the community includes:
 Pertussis 1. Sanitation techniques
 Influenza A or B  Water purification
 MRSA (respiratory infection)  Improvement of health practices
 Neissera meningitides (suspected or confirmed)  Proper sewage disposal
 Coxsackie  Other measures that will ensure clean environment
 Bacterial meningitis (for 24 hours after effective 2. Improvement of health practices
antibiotic therapy)  Educating the members of the community on the
 RSV (droplet and contact) proper handling, storage, and preparation of food
 Mumps  The members of the community must be made
 Rubella aware that infectious and parasitic diseases can be
obtained from contaminated and improperly
Airborne Precautions cooked food as well as contaminated water.
 Chickenpox 3. Vaccination
 Disseminated herpes zoster (shingles)  People should be made aware of the value of
 Measles immunization
 SARS  Information about individual vaccines. and vaccine
 Tuberculosis schedules should be made available to the people.
 Avian influenza

Aseptic Measures in the Operating Room

To prevent post-operative infection, asepsis must be
strictly observed in the O.R
 Thorough cleaning of the OR with detergent /
detergent germicides, soap, and water must be
done
 All equipment used must be sterilized
 Personnel must ensure sterility by making sure that
sterile packages are dry and intact.
 Sterile surgical clothing and operating room gowns
and other protective devices must be used to
maintain asepsis in the O.R.
 Drapes must be used to cover the patient,
furniture, and equipment to be included in the
sterile field so that only the incisional site is
exposed.
Physical and Chemical Methods of Sterilization Pasteurization –this is the method of destroying
DEFINITION OF TERMS disease-producing organisms in milk and milk products
as well as other beverages.
Disinfection—the process of using physical or chemical
means to destroy pathogens, excluding the spores Variations:

Sterilization—process by which all pathogens are  Conventional Method (heated at 60°C -65°C then
destroyed, including the spores Antiseptics - use of cooling)
chemical agents on living tissues (e.g., skin) to prevent  Flash Method (heated 72° for 15 sec then quick
the spread of microorganisms either by inhibiting their cooling to 13°C)
growth or destroying them.  Ultra-high temperature (UHT) Method (heated
140°C for 15 sec and 149 ℃ for 0.5 sec)
Bactericidal/Germicidal Agent—agent, physical or
chemical that kills bacteria. Vaccine Bath—used to destroy contaminating bacteria
in vaccine preparations.
Bacteriostatic agent—agent, physical or chemical,
capable of inhibiting the growth of bacteria without Vaccine Preparation (heated in water bath 60°C for 1
necessarily killing them. hour)

Sporicidal, fungicidal, viricidal—agents capable of —the procedure is not sporicidal

destroying spores, fungi and viruses, respectively. —Only the vegetative forms of the bacteria are
destroyed

Physical Methods of Sterilization Serum Bath - used to inactivate bacteria contaminating

serum preparations and is done by heating at 56°C for
HEATING several successive days.
Thermal Death Time—the minimum time required to —Only the vegetative forms are destroyed since higher
kill a suspension of an organism at a predetermined temperatures will cause coagulation of proteins present
temperature and environment. in the serum.
Mechanisms of action Inspissation—used to solidify and disinfect egg –
1. Formation of single—strand breaks in the bacterial containing andserum – containing media.
DNA —Culture medium is placed in the slopes of a device
2. Coagulation and denaturation of proteins. called an inspissator and is heated at 80 ̊C - 85 ̊C for 30
mins for three successive days.
3. Accumulation of toxic levels of electrolytes
—The first day, vegetative forms will die and the spores
4. Alteration of cell membrane structure.
that will germinate the following day will also die.
Factors affecting process of Sterilization through
Boiling—method involves utilizing water at boiling
heating
temperature of 100 ̊C
 Nature of heat
—Not sporicidal and will destroy only the vegetative
 Temperature and time
forms
 Number of
 Nature of microorganisms —Killing action can be enhanced by addition of 2%
 Type of material sodium bicarbonate
 Presence of organic material —Certain metal articles and glass wares can be
TYPES OF HEAT disinfected using this method for 10 – 20 minutes w/o
opening the lid of the boiler.
a. MOIST HEAT
Fractional Sterilization (Tyndallization) —a.k.a
—Preferred over dry heat because of its more rapid
intermittent sterilization
killing action
—Involves exposing the material to be sterilized to live
—Main mechanism of action is to cause coagulation and
steam at 100 ̊ C for 30 – 90 minutes for three
denaturation of proteins.
consecutive days (depending on the material to be
Methods of Moist Heat according to Temperature sterilized)
Temperature below 100°C
—Can be used to sterilize culture media such as TCBS —The only method used to sterilize powders and
and selenite broth ointments
—Vegetative forms can be killed on the first day and the —Disadvantage of using this method is that because air
spores that will germinate will be destroyed on the next is a poor conductor of heat, hot air will have poor
successive days. penetration of the materials to be sterilized.

—Only vegetative forms of bacteria are destroyed with d. INFRARED RAYS

method —Articles to be sterilized are placed in a conveyor belt
Autoclave (Steam under pressure) —the most efficient and passed through a tunnel that is heated by infrared
method of sterilization because it can destroy all radiators.
microbial forms. —Temperature to which the materials are subjected to
is 180 ̊ for a period of 7.5 minutes.
—When the pressure reaches 15 pounds per square
—It can be used to sterilize metallic equipment and
inch(psi), the temperature inside the vessel reaches 121
glass wares.
̊C.
—Due to high temperature, it would only take 15 – 20 Physical Methods of Sterilization
minutes to sterilize the material. DESSICATION
Used to sterilize instruments, surgical bandages, culture —This method is based on the principle of depriving
media, and other contaminated materials that can the microorganism of moisture
withstand high temperature and high pressure. —It is used mainly for food preservation such as in
the preparation of dried fish and fruits
b. DRY HEAT —It may destroy vegetative forms
—Effectiveness of dry heat depends on the penetration —Endospores are resistant to drying
of heat through the material to be sterilized. FREEZING
—Used to sterilize materials in enclosed tubes, oils, —Not reliable method of sterilization because most
jellies, powders and glass wares such as test tubes and pathogenic organisms are resistant to low temperature
petri dishes. —Lyophilization – freeze – drying where the organism
is rapidly frozen then dehydrated in high vacuum
Red Flame—used to sterilize articles like bacteriological and stored in a vacuum – sealed container
wire loops, straight wires, tips of forceps and searing FILTRATION
spatulas. —This does not kill microorganisms but merely
Open Flame (Flaming) separates them from the fluid
—The material to be sterilized is passed over the flame —Used for liquid solutions that will be destroyed by
several times but is not heated to redness. heat or freezing such as serum, antibiotic solutions,
—Aimed at burning the organism into ashes and is used sugar solutions or urea solutions.
to sterilize such articles as mouths of test tubes, —Used to remove bacteria from culture media or to
scalpels, glass slides and cover slips. prepare suspensions of viruses and phages.
Incineration RADIATION
—Aimed at burning the organism into ashes 1. ULTRAVIOLET LIGHT (UVL)/NON –IONIZING
—Contaminated material is burned using an incinerator RADIATION
—Articles that must be incinerated include soiled 2. IONIZING RADIATION
dressings, beddings, animal carcasses and pathological a. Electron Beams
material. b. Electromagnetic Rays (Gamma Rays)
SONIC AND ULTRASONIC VIBRATIONS
c. HOT AIR OVEN —Some bacteria can be killed after exposure to
—First introduced by Louis Pasteur certain frequency of sound waves
—Articles to be sterilized are placed in the oven with a —Used to disinfect and clean instruments and reduce
temperature of 160 ̊for a period of one hour microbial load
—Used to sterilize metallic instrument such as forceps, OSMOTIC PRESSURE
scalpels, and scissors —This method is based on the principle of osmosis so
—Used to sterilize certain glass wares (e.g., petri dishes, that when the concentration of the fluid surrounding
pipettes and flasks) the organism is altered this will cause the bacterial cell
to collapse
—Used for preservation of fruits in syrup and meats in
brine