LEARNING OBJECTIVE: Recall medical asepsis principles and recognize medical asepsis practices.

All health care, regardless of who provides it or where it is provided, must be directed toward maintaining, promoting, and restoring health. Because of this goal, all persons seeking assistance in a healthcare facility must be protected from additional injury, disease, or infection. Adherence to good safety principles and practices protects a patient from personal injury. Additionally, attention to personal and environmental hygiene not only protects against further injury, but also constitutes the first step in controlling the presence, growth, and spread of pathogenic organisms. The discussion that follows addresses infection control, particularly in the context of medical and surgical aseptic practices.

MEDICAL ASEPSIS
Medical asepsis is the term used to describe those practices used to prevent the transfer of pathogenic organisms from person to person, place to place, or person to place. Medical aseptic practices are routinely used in direct patient care areas, as well as in other service areas in the healthcare environment, to interrupt a chain of events necessary for the continuation of an infectious process. The components of this chain of events consist of the elements defined below.

Infectious Agent
An infectious agent is an organism that is capable of producing an infection or infectious disease.

Reservoir of Infectious Agents
A reservoir of infectious agents is the carrier on which the infectious agent primarily depends for survival. The agent lives, multiplies, and reproduces so that it can be transferred to a susceptible host. Reservoirs of infectious agents could be man, animal,  plants, or soil. Man himself is the most frequent reservoir of infectious agents pathogenic to man.

PORTAL OF EXIT.-The portal of exit is the avenue by which the infectious agent leaves its reservoir. When the reservoir is man, these avenues include various body systems (such as respiratory, intestinal, and genitourinary tracts) and open lesions.

MODE OF TRANSMISSION.-The mode of transmission is the mechanism by which the infectious agent is transmitted from its reservoir to a susceptible being (host). Air, water, food, dust, dirt, insects, inanimate objects, and other persons are examples of modes of transmission.

PORTALOFENTRY.-The portal of entry is the avenue by which the infectious agent enters the susceptible host. In man, these portals correspond to the exit route avenues, including the respiratory and gastrointestinal tracts, through a break in the skin, or by direct infection of the mucous membrane.

SUSCEPTIBLE HOST.-The susceptible host is man or another living organism that affords an infectious agent nourishment or protection to survive and multiply.

Removal or control of any one component in the above chain of events will control the infectious process.

Two Basic Medical Asepsis Practices
The two basic medical asepsis practices that are absolutely essential in preventing and controlling the spread of infection and transmittable diseases are frequent hand washing and proper linen-handling procedures.

HAND WASHING.-The following are some common instances when provider hand washing is imperative:

Before and after each patient contact
Before handling food and medications
After coughing, sneezing, or blowing your nose
After using the toilet
LINEN HANDLING.-Improper handling of linen results in the transfer of pathogenic organisms through direct contact with the healthcare provider's clothing and subsequent contact with the patient, patient-care items, or other materials in the care environment. Proper linen handling is such an elementary procedure that, in theory, it seems almost unnecessary to mention. However, it is a procedure so frequently ignored that emphasis is justified.

All linen, whether clean or used, must never be held against one's clothing or placed on the floor. The floors of a healthcare facility are considered to be grossly contaminated, and, thus, any article coming in contact with the floor will also be contaminated. Place all dirty linen in appropriate laundry bags. Linen from patients having infectious or communicable diseases must be handled in a special manner.

Isolation Technique
Isolation technique, a medical aseptic practice, inhibits the spread and transfer of pathogenic organisms by limiting the contacts of the patient and creating some kind of physical barrier between the patient and others. Isolation precautions in hospitals must meet the following objectives. They must

be epidemiologically sound;
recognize the importance that body fluids, secretions, and excretions may have in the transmission of nosocomial (hospital originating) pathogens;

contain adequate precautions for infections transmitted by airborne droplets and other routes of transmission; and
be as simple and as patient friendly as possible.
In isolation techniques, disinfection procedures are employed to control contaminated items and areas. For purposes of this discussion, disinfection is described as the killing of certain infectious (pathogenic) agents outside the body by a physical or chemical means. Isolation techniques employ two kinds of disinfection practices, concurrent and terminal.

CONCURRENT DISINFECTION.- Concurrent disinfection consists of the daily measures taken to control the spread of pathogenic organisms while the patient is still considered infectious.

TERMINAL DISINFECTION.-Terminal disinfection consists of those measures taken to destroy pathogenic organisms remaining after the patient is discharged from isolation. There are a variety of chemical and physical means used to disinfect supplies, equipment, and environmental areas, and each facility will determine its own protocols based on the recommendation of an Infection Control Committee.