Medical asepsis & SURGICAL ASEPSIS

Hand Washing ,GOWNING,GLOVING,PPE,ISOLATION TECHNIQUE ,STERILIZATION

1. Medical & Surgical Aseptic Practices and Isolation Techniques Demonstration - On Hand washing, Using PPE & I solation techniques MATHEW VARGHESE V MSN(RAK),FHNP (CMC Vellore), CSTPN,CCEPC Nursing officer AIIMS Delhi

2. INTRODUCTION Florence Nightingale once said that the first requirement of a hospital is to do the patient no harm. It is really obvious Hospital acquired infections leads to waste of resources and elevating mortality rate. According to WHO, 15 % of all hospitalized patients suffer from these. Most of these could be easily preventable by taking simple measures by healthcare professionals.

3. RELATED TERMINOLOGY Asepsis: It means a state of being free from pathogenic organisms or infection. Antisepsis : It means the prevention of sepsis / infection. It inhibits the growth and development of microorganisms on skin and other body tissues by’ using a chemical agent ( antiseptic ). Pathogenic Organism : Organism which can produce disease.

4. RELATED TERMINOLOGY Spore : A resistant encapsulated form taken by certain organism when conditions are not suitable for their existence. This is important in surgical asepsis because the protective shells of the micro-organisms are resistant to heat and are difficult to destroy. Direct Transmission: Infection spreads through direct contact with the diseased person e.g. touch droplet infection etc. Sepsis : It is the infection of the body by pus-forming bacteria, or the presence of bacteria and their toxin in the body (usually following the infection of a wound), which kill tissues and produce pus.

5. RELATED TERMINOLOGY Sterilization : It is the process of destruction of all the micro-organisms, both pathogenic and non-pathogenic, including their spores . Droplet infection : In this the infection spreads by means of fine particles i.e. nuclei of saliva and mucus that are expelled through sneezing, coughing and speaking. Fumigation : It is the process of disinfection by exposure to the fumes of a vaporized germicide.

6. RELATED TERMINOLOGY Isolation : lt is the separation of infected persons from a non-infected person for the period of communicability under conditions. This will prevent the transmission of infection to others. Portal of entry: They are ways through which pathogens enter the body. E.g. respiratory tract, gastro-intestinal tract etc. Portal of exit : They are ways through which pathogens leave the body.e.g.Excretion of body fluids through urinary tract etc.

7. RELATED TERMINOLOGY Quarantine : It is detention or isolation of a well person who has come in contact with an infectious disease for a period of time equal to the longest incubation period of that disease. Carrier: A person who harbors pathogens of a disease in his body without showing signs and symptoms of that disease. Disinfection : It means destroying of all the pathogenic organisms outside the human body by direct exposure to a chemical or physical agent.

8. RELATED TERMINOLOGY Concurrent disinfection : It is the immediate disinfection of all contaminated articles and bodily discharges during the course of the disease. Terminal disinfection : It means disinfection of the patient's unit with all the articles (furniture, linen, mattress, pillows, utensils etc.) used by the patient on his discharge, death or release from isolation . Epidemic: A disease which attacks a large number of people in a community at the same time or during the same season

9. NORMAL BODY DEFENCES NON SPECIFIC DEFENCE SPECIFIC BODY DEFENCE Active immunity Passive immunity

10. CHAIN OF INFECTION:

11. MODES OF TRANSMISSION OF INFECTION CONTACT Direct Contact Indirect contact Droplet contact AIR Droplet nuclei Dust VEHICLES Contaminated item, liquids, water, drugs, blood, food and improperly handled or stored fruit and vegetables. VECTORS Insects

12. COURSE OF INFECTION Incubation period -Interval between entrance of pathogen into body and appearance of first symptoms; e.g. Chicken pox 2 to3 weeks Prodromal stage- Interval from the onset of non-specific signs and symptoms .Micro-organisms grow and multiply and the client is more capable of spreading disease to others during this time

13. COURSE OF INFECTION Period of illness -Interval when the client manifests signs and symptoms specific to the type of infection Convalescence Stage -Interval when acute symptoms of an infection disappear, length of recovery depends on severity of infection and the clients’ general state of health. Recovery may take several days to months

14. RISK FACTORS FOR INFECTION : INADECQUATE PRIMARY DEFENCE Broken skin or mucous membrane. Traumatized tissue. Decreased ciliary action. Obstructed urine outflow INADECQUATE SECONDARY DEFENCE: Reduced hemoglobin level. Suppression of white blood corpuscles (drug or disease-related). Suppressed inflammatory response (drug or disease-related). Low WBC count ( leukopenia ).

15. RISK FACTORS IN OLDER ADULTS Thinner dermal and epidermal layers of skin, decreased sweat and skin elasticity. Reduced sensitivity. Circulatory and heart disorders like congestive heart disease, calcified valves of heart. Reduce elasticity of veins, blood pooling in lower extremities. Decreased cough reflex Exposure to nosocomial infections

16. NOSOCOMIAL INFECTIONS: Iatrogenic infections : type of nosocomial infections that result from a diagnostic or therapeutic procedure, e.g. urinary tract infection may result due to catheterization. Exogenous infection: arises from micro-organisms external to the individual, which do not exist as normal flora. e.g. clostridium tetani. Endogenous infection: can occur when part of the client’s flora becomes altered and an overgrowth results; e.g. infections due to enterococci ,

17. NURSING PROCESS IN CONTROL OF INFECTION NURSING ASSESSMENT LOCAL : Redness, swelling/edema, pain, tenderness, inflammation, drainage from open lessons or wounds. SYSTEMIC INFECTION : More generalized symptoms can be seen. Fever, fatigue, tachypnea , tachycardia, malaise, enlarged swollen lymph nodes, anorexia, nausea and vomiting.

18. NURSING DIAGNOSIS RELATED TO INFECTION: High Risk for infection related to altered immunity,tissue destruction and malnutrition High risk for Injury related to altered nutrition Impaired tissue integrity related to altered circulation and exposure ton irritants Altered oral mucous membrane related to traumatic irritation of nasogastric tube Social Isolation related to Misconceptions about various diseases like STDs. etc. Body image disturbance related to Client's aversion to open wound

19. GOAL OF NURSING CARE Prevent exposure to infectious organisms. Control or reduce the extent of infection. Maintain resistance to infection. Understand infection control self-care practices.

20. NURSING MEASURES TO PREVENT AND CONTROL INFECTION General measures : Maintain general cleanliness of the hospital and ensure good ventilation. Daily antiseptic mopping and sweeping of floors must be ensured. Practice good housekeeping. Ensure safe water supply and food in health setting. Safe disposal of excreta, urine, stool, Sputum etc. is important. They should be disinfected before disposal. Destruction of rodents and insects by using appropriate chemicals is important as they play a great role in Spread of an infection. Ensure routine hygienic measures such as personal hygiene, oral hygiene etc. for the clients.

21. DIFFERENCES BETWEEN MEDICAL ASEPSIS AND SURGICAL ASEPSIS Medical Asepsis Surgical Asepsis The number growth and transmission of microorganisms are /is controlled. Objects / articles are free from pathogenic and non-pathogenic organisms. Transmission of pathogenic organisms is prevented. Pathogenic and non-pathogenic organisms are totally destroyed. A clean technique is used eg. hair combing, mouthwash etc. A sterile technique is used, giving injection and doing surgical dressing.

22. MEDICAL ASEPSIS Medical asepsis is the combination of all practices that are intended to confine a specific micro-organism to a specific area, limiting the number, growth and transmission of micro-organisms. In medical asepsis, objects are often referred to as clean or dirty. Clean denotes the absence of almost all micro-organisms. Dirty (soiled, contaminated) denotes the likely presence of micro-organisms, some of which may be capable of causing infection.

23. Control or elimination of infectious agents including Proper cleaning by water and mechanical action with or without detergents Disinfection Sterilization of contaminated objects.

24. Measures for control or elimination of reservoirs of infections Bathing with soap and water to remove secretion, drainage, perspiration, etc. Frequent change of dressings. Proper disposal of wastes and contaminated articles. Keep the patient's bedside unit clean, dry and biologically safe. Bottled solutions should be placed with tight caps as per instructions.

25. Control of portals of exit Practice aseptic precautions. Avoid talking directly into the client's face to prevent droplet infections. Wearing of masks is important once the nurse herself has infection or deals with clients suffering from infections. Careful handling of wastes like urine, faces, emesis and blood is important.

26. Control of transmission of infection Discourage sharing of bedpans, urinals, basins, eating utensils, etc. Use separate thermometers for infectious patients. Practice hand-washing technique.

27. Control of portals of entry Maintain integrity of skin and mucous membranes. Proper positioning of tubing, etc. may prevent injuries and skin breakdown. Turning and positioning of debilitated clients will help in preventing a skin breakdown. Ensure personal hygiene of clients regularly.

28. Protection of susceptible host Maintaining an adequate fluid intake. Encouraging deep breathing and coughing exercises. Encouraging proper immunization of children and adult clients. Promotion of intake of a well-balanced diet containing essential proteins, vitamins, fats and carbohydrates.

29. SURGICALASEPSIS Surgical asepsis is the combination of all practices that ensure absence of all micro-organisms, including pathogens and spores from an object. In surgical asepsis, sterile field is important

30. These involve: Hand washing Opening of sterile wrapped packages Gowning Gloving Wearing mask Sterilization of articles.

31. PRINCIPLES OF SURGICAL ASEPSIS: PRINCIPLES RATIONALE Always face the sterile field. Don’t turn your back or side on a sterile field. Sterile objects which are out of vision are considered questionable and their sterility is not guaranteed. Keep sterile equipment above your waist level or above table level. Because waist level and table level are considered margins of safety and will promote a maximum sterile field. Don’t speak or cough over a sterile field. If it is necessary to do so, turn your head from the sterile field. To prevent droplet infection. Never search or cross a sterile field. When a non-sterile object crosses the sterile field, gravity causes the micro-organisms to fall into the sterile field.

32. PRINCIPLES RATIONALE Prevent excessive air currents around sterile areas. Air current can be caused by/moving fast, flapping the cloth sand drapes and by closing the doors etc. Micro-organisms are present in the air and they travel in air current. Keep the wet unsterile object away from the sterile. Micro-organisms may be transferred whenever a non-sterile wet field. Object touches a sterile field. The micro-organisms may be transferred consequently. The sterile area becomes unsterile by capillary action. Keep the sterile field dry Micro-organisms do not pass easily through a dry surface Handle liquids cautiously near the sterile field or prevent drapes or wrappers from becoming wet. When a liquid comes in contact with a non-sterile field, the micro-organisms may be transferred. Consequently, the sterile area becomes unsterile by capillary action.

33. PRINCIPLES RATIONALE The edge of the sterile field is considered unsterile. Proximity to a contaminated area makes sterility doubtful. Each sterile supply should be clearly labeled as to its contents, time and date of sterilization. To ensure sterility. Never assume that an object is sterile. Always check the expiry date of sterility. Sterility of an object wrapped in paper or cloth becomes doubtful after four weeks and those sealed in polythene bags after one year Avoid sweeping and dusting when sterile objects are opened. Micro-organism travel in dust particles.

34. PRINCIPLES RATIONALE Wash hands, put on gowns, gloves and mask before handling the sterile supplies. To prevent contamination. Open the sterile package in such a way that the edges of the wrapper are directed away from the worker. To avoid the possibility of a sterile surface touching the uniform. Hold the transfer forceps pointing downwards. To prevent the solution from flowing into the contaminated areas (the handle of the forceps) and then back to the sterile area (the up of the forceps). When removing the forceps from the container lift it without touching the sides and the rim of the container. The tip of the forceps becomes contaminated when touching the container that is not in direct contact with the disinfectant solution. Keep the prongs together directly over the container to remove the excess solution. To prevent the solution from dribbling onto the sterile held and wet it. Transfer forceps and the container should be sterilized daily. There is a great possibility of these articles becoming contaminated because of the frequency and varied use.

35. USE OF THE CONTAINER: WITH STERILE SUPPLIES Remove the cover from the container when necessary and only for a short period. Air currents can contaminate the cover. Leave the cover of the container in such a way that the inside of the lid is pointing downwards. Air currents can contaminate the inside of the cover Consider the rim of the container to be contaminated. Contact with, the unsterile surface contaminates sterile objects. Don’t return the container, once the cover container to be contaminated. Proximity to a contaminated area makes the sterility doubtful. Don’t return the unused sterile objects to the container, once they have been taken out. It is considered to be contaminated by air currents.

36. DISINFECTION Disinfection refers to chemical or physical processes used to reduce the numbers of pathogens from an object’s surface. Concurrent disinfection Immediate disinfection of contaminated articles and bodily discharges during the course of the disease eg ; daily cleaning of the ward Terminal disinfection D isinfection of the unit and articles on discharge, transfer or death of the patient.eg; fumigation using baccishield

37. STERILIZATION Sterilization is the process by which an object becomes free of all micro-organisms . By sterilization both pathogenic and nonpathogenic organisms are destroyed. There are various methods used for sterilization of articles.

38. METHODS OF STERILIZATION DIRECT SUNLIGHT Direct sunlight will have an effect on acid fast micro-organisms. Place the linen or bed pans in direct sunlight for six hours for two consecutive days. BOILING Boiling is an effective method of sterilization. Boiling for five to ten minutes at boiling point kills all the bacteria except spores and virus. It is used in home environment. CHEMICAL DISINFECTION A chemical disinfectant acts by coagulating the bacterial protein or by changing the composition of protein so that it no longer exits in the same form. It is used to sterilize articles destroyed by heat.

39. METHODS OF STERILIZATION RADIATION BY UV RAYS Ultraviolet light sterilization is effective for disinfecting working surface and air inside rooms HOT AIR STERILIZATION High temp and comparatively long exposure time are required. It is not a suitable sterilization agent for fabrics and dresses which are poor and uneven conductors and are ruined by excessive heat. It is, however, the method of choice for fine metal cannula (e.g. L.P. needles) and for glass syringe AUTOCLAVING Steam under pressure; Autoclaving is a method of sterilization by steam under pressure. It is the most widely used, economical and one of the most effective methods of destroying micro-organisms. This method uses high temperature, pressure and humidity to destroy all types of micro-organisms, including spore forming. For effective sterilization autoclaving is done at 15lbs per square inch pressure and 121°C temperature for at least 20 minutes.

40. METHODS OF STERILIZATION FLAMING It is a method of sterilization by putting instrument in a flame for a while FUMIGATION OR GAS STERILIZATION: Total surface exposure to formaldehyde gas under conditions of controlled humidity temperature and time exposure will destroy all vegetative forms of bacteria, viruses and most of the spores. The best results can be obtained with high concentration of gas. humidity above 60 and temperature of not less than 18°C. The exposure time varies from one to 16 hours. The agents commonly used for the fumigation are formalin tablets, ethylene oxide liquids etc.

41. PROCEDURES IN MEDICAL AND SURGICAL ASEPSIS: HANDWASHING Hand washing is important in every setting, including hospitals. It is an effective infection control measure, as it prevents spread of micro-organisms. For routine client care, the vigorous hand washing under a stream of water for at least 20 seconds using soap.

42. Hand washing should be done in the following situations: - Before contact with clients who are susceptible to infection. -After caring for an infected client. -After touching infected material. -Before performing invasive procedures like administration of injections, suction, catheterization, etc. -Before and after handling dressings or touching open wounds. -After handling contaminated equipment. -Between contact with different clients in high-risk units.

43. PURPOSE To remove transient and resident bacteria from fingers, hands and forearms. To prevent the risk of transmission of infection to patients. To reduce the risk of transmission of infection organisms to oneself. To prevent cross infection among clients.

44. EQUIPMENT / ARTICLES Articles Rationale Soap in a soap dish Soap contains antibacterial agents and has a lasting bacteria static effect. Nail brush To clean nails. Running water To rinse soap and thoroughly wash hands. Towel To dry hands. To dry hands.

45. STEPS OF PROCEDURE 7 Important hand movements in hand washing: Wash palms and fingers Wash back of hands Wash fingers and knuckles Wash thumbs Wash finger tips Interlocking of hands Wash wrists.

46. Steps Rationale Scientific Principles Nursing principle File the nails short, ensure that nails are free of nail polish Short nails are less likely to harbor transient micro-organism Microbiology Safety Remove all jeweler and wrist watch. Micro-organisms can be inside the settings of jewellery and under rings . Removal facilitates proper cleaning of hands and arms. -do- -do- Turn on the water to adjust the flow so that water is lukewarm Warm water remove less of the protective oil of the skin than of hot water Physics Comfort and safety Medical asepsis: wash the hands thoroughly by holding the hands lower than the elbows so that water flows from arms to finger tips . It allows water to now from the least contaminated area (elbow) to the most contaminated area (hands). Microbiology Safety

47. Steps Rationale Scientific Principles Nursing principle Surgical hand washing : Wet the hands and forearms under the running water, letting it run from the fingertips to the elbows so that the hands become cleaner Apply the soap and wash as described in step 4, but hold the hands higher than the elbows during this hand wash. Water run by gravity from finger tips to elbows. Keeping hands elevated allows water to flow from least to the most contaminated area. Physics Safety Apply liberal amounts of soap into hands and lather hands and arms using hand brushes. Soap emulsifies the oil and lowers the surface tension of water, facilitates the removal of micro-organisms, dust and oils. Brushes are used to enhance mechanical friction during hand washing. Physics and Chemistry Safety and Therapeutic effectiveness

48. Steps Rationale Scientific Principles Nursing principle Thoroughly wash and rinse the hand using firm rubbing and circular movements to wash the palms back and wrist of reach hand . Interlace the fingers during hand washing. The circular action helps to remove micro-organisms mechanically. Running water and friction used in cleaning are the mechanical action of cleaning. Physics Safety Dry arms and hands thoroughly from fingers to wrists and forearms . Discard the towel in a proper container. Drying helps in removing moisture, prevents chapping and toughening of skin. Drying from cleaner to least clean am prevents contamination. Microbiology ,Anatomy and Physiology Safety

49. Steps Rationale Scientific Principles Nursing principle Turn off the water tap using a paper towel or using an elbow. Handle is contaminated. Use of a paper towel or an elbow prevents contamination of washed hands. Microbiology Safety

50. GOWNING Clean or plastic aprons are worn during procedures when the nurse’s uniform is likely to become soiled. Sterile gown may be indicated when the nurse changes the dressings with extensive wound s, burns etc . PROCEDURE : GOWNING TECHNIQUE (STERILE) PURPOSE To prevent soiling of clothes during contact with the patient. To protect health care personnel from coming in contact with infected material

51. STEP OF PROCEDURE Steps Rationale Scientific Principles Nursing Principles Pick up a sterile gown and allow it to unfold keeping inside of the gown towards the body without allowing the outside of the gown to touch any area. To prevent soiling/ contamination of the sterile gown. Microbiology Safety With hands at shoulder level, slip both arms into armholes simultaneously. Ask circulating nurse to bring the gown over shoulders. It prevents contamination of the sterile gown. Microbiology Safety The circulating nurse fastens the ties at neck. Overlap the gown at the back as much as possible and fasten the waist, ties or belt. It keeps the gown at place and covers the uniform at the back. Microbiology Safety Prevent the gown from becoming wet. Moisture allows organisms to travel through the gown to the uniform. Microbiology Safety While removing avoid touching soiled parts on the outside of the gown. Roll up the gown with the soiled part inside and discard in the appropriate container. It prevents contamination of the uniform. It prevents cross-infection. Microbiology Safety

52. GLOVING Gloves are worn to protect hands when the nurse is likely to handle any body substances, eg . Urine, faces, Sputum, mucous membranes and non- intactskin . Gloves also reduce the likelihood of transmission of own endogenous micro-organisms to individuals receiving care. For most activities , disposableclean gloves are used. Sterile gloves are used when the hands will come in contact with an open wound or when handsintroduce micro- organismsinto a body orifice.

53. GLOVING Gloving Rationale Scientific principle Nursing principle Thoroughly wash hands. Removes bacteria from skin and surfaces and reduces transmission of infection. Microbiology Safety and Therapeutic effectiveness Open a sterile glove packet of proper size on a flat surface above waist level. A sterile object held below waist get contaminated. Microbiology Safety and Therapeutic effectiveness If gloves are not powdered ,take a packet of powder and apply lightly to hands. Powder allows the hands to slip on easily. Microbiology Safety and Therapeutic effectiveness Identify the right and left hand. Glove dominant hand first. Proper identification of gloves prevents contamination by improper fit. Microbiology Safety and Therapeutic effectiveness With the thumb and the first two fingers of the non- dominant hand, grasp an edge of glove’s cuff. For dominant hand, touch only the glove’s inside surface.( step1) Inner edge of the cuff will lie against skin and thus it is not sterile. Microbiology Safety and Therapeutic effectiveness

54. GLOVING(contd.) Gloving Rationale Scientific principle Nursing principle Carefully pull the gloves over the dominant hand. Ensure the thumb and the finger are in proper spaces.(step 2) Proper fitting of gloves on fingers. Microbiology Comfort With gloved dominant hand , slip fingers underneath the second glove’s cuff. (step3) This prevents glove contamination. Microbiology Safety and Therapeutic effectiveness Carefully pull the second glove over the non-dominant hand. Don’t allow fingers of the thumb of the gloved dominant hand to touch any part of the exposed non-dominant hand . (step4) Contact of the gloved hand with the exposed hand results in contamination. Microbiology Safety and Therapeutic effectiveness After the second glove is on interlock hands together. Ensures smooth fit over fingers. Microbiology Safety, Comfort and Therapeutic effectiveness

55. REMOVING DISPOSABLE GLOVES Steps Rationale Scientific principle Nursing principle Remove the first glove by grasping it on its palmar surface just below the cuff, taking care to touch only glove to glove. Pull the first glove completely off by inverting or rolling the glove inside out. This keeps the soiled parts of the used gloves from touching the skin of the wrist or hand. Microbiology Safety Place the first two fingers of the bare hand inside the glove and remove the second contaminated glove. To prevent touching the outside of the second soiled glove with the bare hand. Microbiology Safety Dispose them of in the appropriate container. To prevent cross infection. Microbiology Safety

56. WEARING MASKS Masks are worn to reduce the risk for transmission of organisms by the droplet contact, air borne routes, and splatters of body substances. The CDC r ecommends (7 december 2020) that masks should be worn All people should wear masks in public settings and when around people who don’t live in their household.​ Wash your hands with soap and water for at least 20 seconds or use hand sanitizer with at least 60% alcohol after touching or removing your mask.

57. WEARING MASKS Putting mask Rationale Scientific principle Nursing principle Hold mask by top two strings. Tie two top ties at of top of the back of the head with ties above ears. Position of tie at the top of the the head provides a tight fit. Ties above ears may cause irritation. Microbiology Safety Tie two lower ties snugly around the neck with the mask well under the chin. Prevents ( inhalation & escape of) micro-organisms from and it to the air. Microbiology Safety If glasses are worn, fit the upper edge of the To prevent glasses from clouding. mask under the glasses. To prevent glasses from clouding. Microbiology Safety Avoid unnecessary talking and, if possible, 0 prevent the mask from getting sneezing or coughing. moist. To prevent glasses from getting moist. Microbiology Safety When removing a mask with strings, first To prevent the top part of the mask untie the lower strings of the mask. from falling on to the chest. To prevent top part of the mask from falling on to the chest. Microbiology Safety Discard a disposable mask in the waste. To prevent cross infection. Microbiology Safety Wash the hands if they have become contaminated by accidentally touching the soiled part of the mask. To prevent infection Microbiology   Safety

58. PERSONAL PROTECTIVE EQUIPMENT Health care agencies are supposed to provide their employers with necessary equipment and supplies so that they can protect themselves from infections. These include use of gloves, gown, mask, and protective eye gear.Get into scrubs or comfortable clothes, remove jewellery, ensure you had water and food and visited washrooms etc. nurses are expected to stay inside for at least 6 hrs. . The observer needs to be in PPE when observing doffing. . Two chairs should be placed in doffing area labeled DIRTY & CLEAN Check all PPE before starting donning.

59. PERSONAL PROTECTIVE EQUIPMENT DONNING Wash hands with soap and water Wear shoe cover Wear 1st pair of gloves Wear gown Wear the mask/respirator (check for any leaks) Wear goggles/face shield Wear hood Wear 2nd pair of gloves Gown fitness check (ask buddy to help)

60. DOFFING OF PPE Check for any leak or soiling in PPE before doffing, (disinfect site if contaminated) Disinfect the hands while wearing gloves (similar to hand hygiene procedure). Remove shoe covers only by touching the outer surface (by sitting on DIRTY chair) Perform hand hygiene Remove outer gloves Perform hand hygiene Remove hood Perform hand hygiene Remove gown Perform hand hygiene

61. DOFFING OF PPE Remove goggles/face shield Perform hand hygiene. Remove second pair of gloves Perform hand hygiene Wear new pair for gloves Remove mask (don’t touch the front of mask, handle with slings/bands) Perform hand hygiene Clean shoes with alcohol swabs (by sitting on CLEAN chair) Remove last pair of gloves and perform hand hygiene

62. ISOLATION PRACTICES: Isolation precautions control the transmission of pathogens by prevention of direct contact with the infected client, Barrier Nursing or Isolation Technique is intended to confine the micro-organisms within a given and recognized area. There are various isolation techniques, which are broadly classified into two methods for implementation as given by Gamer, Simmons, 1984. These are: Disease specific isolation method: Certain practices are followed for each infectious disease, e.g. covid 19 in which the client is placed in a private room with precautions to prevent respiratory spread. category Specific isolation : Diseases requiring similar isolation perceptions are grouped in eight categories

63. category Purpose Strict isolation Prevents transmission of highly contagious virulent infections spread by air and contact. Contact isolation Prevents transmission of highly transmissible infections spread by close or direct contacts that do not warrant strict precautions. . Respiratory isolation Prevents transmission of highly transmissible infections spread by close or direct contacts that do not warrant strict precautions. Enteric isolation Prevents infections transmitted by direct or indirect contact with faeces

64. category Purpose Drainage and secretion precaution (wound &skin isolation Prevents infections transmitted by direct or indirect contact with purulent material or drainage from infected body site. Universal blood and body fluid precaution (blood isolation Prevents contact with pathogens transmitted by direct or indirect contact with infected blood or body fluids containing blood. Care ofseverelyimmune-compromised client Protects the client with lowered immunity and resistance from acquiring infectious organisms

65. BMW Management

66. CONCLUSION In every aspect of practice, the nurse encounters various situations that have a risk of infection. A broad knowledge base of the nurse about infections, their prevention and control is important. Any lapse on the part of the nurse in handling such infection prone situations may further aggravate the problems of the clients and may pose a serious threat to the health of the patient. The success of the nurse who practices infection control techniques is measured by determining whether the goals for preventing infections are achieved .Hence medical and surgical asepsis require more challenging efforts on the part of the nurse to prevent disease and promote health.  

67. BIBLIOGRAPHY: 1 ) Fundamentals of nursing a procedure manual TNAI, FIRST EDITION,TNAI Pp-75-100 2) Fundamentals of nursing -the art and science of nursing care, Fifth edition, Carol Taylor, Lippincott Williams& Wilkins Pp-649-682 3) Potter ,Patricia A and Perry,Anne G . Fundamentals of Nursing.3rdEd.St Louis :Mosby year Book Inc;1993 4) Kozier ,Barbara black wood. Fundamentals of patient care.Philadelphia:W.Bsaunders company;1967 5) Sr. Nancy .Principles and practice of nursing Vol 1.Ed 3rd .Kerala:N.R Brothers;1997 6)6 ).https://covid.aiims.edu/wpcontent/uploads/2020/03/COVID_19_HIC_SUPPLEMENT_VERSION_1.2__26_3_2020