The ABCs of Infection Control
By Melba Rhodes, RN, BSN
Practicing aseptic technique, good body hygiene and developing a caring
attitude comprise the ABCs of infection control. In this article, we will
discuss the three major components of Asepsis -- handwashing,
disinfection and sterilization -- Body Hygiene -- personal hygiene and
dress code -- and a Caring Attitude -- a good sense of right and wrong
essential to the practice of the ABCs of infection control. The ABCs of
infection control are fundamental in preventing adverse events.
Infectious diseases may become a major health hazard to healthcare workers
and patients. Knowing the hazards and following established guidelines and
policies can reduce your and the patient's risk of transmission of infection.
Safety guidelines are established for a reason -- to protect you, the employee
and the patient. Even though at times some policies may seem to take too much
time, if you consider the risks of not following these guidelines, you will
realize the importance of the measures to help protect you and provide a safe
and healthy workplace.
A person entering the hospital or clinic with an infectious disease, such as
AIDS or hepatitis B, does not always have this condition diagnosed at the time
of admission. The diagnosis may not be made until 2-3 days after admission,
after several visits, until the patient is discharged or not at all (if the
person is an asymptomatic carrier). To protect yourself, you must consider all
patients to have an infectious disease or, in other words, universally apply the
same precautions to all body substances regardless of the source patient.
The first letter in our ABCs of infection control is "A", or
asepsis. Practicing asepsis is a vital part of infection control practices.
Handwashing, disinfection and sterilization are key parts of asepsis.
Definition: Aseptic technique can be defined as all the measures we take to
purposefully reduce the number of microorganisms (germs) to an irreducible
number for the purpose of preventing transmission of infection. These include
handwashing, disinfection and sterilization.
There Are Many Levels of Asepsis
The strictness (or level) of aseptic technique increases as you perform more
invasive procedures. For example, taking a blood pressure requires only clean
technique, while starting an IV requires sterile technique. The most invasive
procedures (entering a sterile body cavity) require sterile technique.
Disinfection: Removal of most pathogens (or disease-causing organisms)
by the use of friction (cleaning) and a use of a disinfectant.
- Clean high-touch items with a disinfectant frequently (bed rails, door
knobs, over-the-bed tables, faucet handles, phones, etc.).
- Use warm (not hot) water for mopping; hot water may burn someone if
splashed and may strip the wax on floors when a "quat" is used.
- Do not use a phenol in food preparation areas or on an infant
crib/bassinet. Phenols are toxic if ingested and may harm an infant. Use a
sanitizer in food preparation areas.
- Check the label for "contact time," the amount of time the item
must remain wet with the disinfectant to "kill" most of the
pathogens, usually 10 to 20 minutes.
- Dirt and soil inactivate disinfectants, so clean the area first. Then
reapply a fresh layer of disinfectant and allow the area to remain wet for
the contact time.
Sterilization: The highest level of asepsis is defined by the removal of all
microorganisms. It is achieved by autoclaving or by another sterilization
process. Items must be thoroughly cleaned before sterilization can occur.
- Reserved for instruments and other objects that enter sterile parts of the
- When entering a sterile body cavity, skin antisepsis is needed with a skin
antiseptic such as CHG or Betadine.
- When opening sterile packets, make sure the sterilization indicators are
changed. If not, report to Central Supply and do not use the item(s). All
packages in that load need to be recalled.
- Sterile items should remain sterile; protect the sterile field.
Microorganisms Live in And on Our Bodies
Transient: Transient microorganisms are easily picked up on hands, clothing,
inanimate objects, etc., and are easily removed by handwashing and cleaning
(physical removal of "germs"), antisepsis and disinfection. Antisepsis
(or handwashing and pre-op skin preparation) is the removal of transient
microorganisms from the skin with a reduction in the resident flora.
Resident or Normal Flora: Those microorganisms that are constantly present on
our bodies; no amount of scrubbing will totally remove them (the skin cannot be
made sterile). These organisms cause "trouble" when introduced into
normally sterile areas (like the bladder or bloodstream).
Pathogens: Microorganisms that nearly always produce disease. For example:
Salmonella and Shigella cause diarrheal illness upon ingestion of enough
organisms. Normal flora can become pathogens when introduced into areas where
they don't belong, for example, through insertion of a catheter or through
surgery. Staph epidermis, normal flora of the skin, causes most central line
infections and hip implants.
The Seven Keys of Asepsis
1. Know what is clean
2. Know what is contaminated
3. Know what is sterile
4. Keep clean, contaminated and sterile items separated
5. Keep sterile sites sterile
6. Resolve contamination immediately
7. Train yourself to realize when you have broken technique
Know what is clean: Clean techniques are any procedures that involve contact
with intact skin or mucous membranes only. For example, when you are taking
blood pressure or temperature, these articles need to be clean only.
Know what is contaminated: Certain procedures like dressing changes produce
contaminated materials. These contaminated materials must be disposed of
properly by incineration or autoclave. Touching non-intact skin is a
contaminated procedure; wear clean gloves unless a sterile procedure (like a
dressing change) is being done.
Know what is sterile: During certain procedures (for example, the insertion
of an IV or urinary catheter), sterile technique should be used. The level of
sterile procedures increases with the level of invasiveness. For example,
surgical procedures require stricter aseptic technique than starting an IV.
Sterile gloves are required for sterile procedures.
Keep clean, contaminated and sterile items separated: Keep contaminated
articles from touching clean or sterile items. Store clean and sterile items
separately from contaminated areas or items. Keep sterile items from touching
anything but a sterile field or another sterile item.
Keep sterile sites sterile: Once a tube has been inserted into the body, care
must be given to mitigate the travel of microorganisms up the catheter or tube.
Give dressing changes or catheter care and replace catheters per your facility's
policy and procedure.
Resolve contamination immediately: If sterile technique cannot be used
(during an emergency) or is broken, resolve contamination when it occurs. For
example, if an IV is inserted during an emergency, replace the IV as soon as
possible after the code is completed.
Train yourself to realize when you have broken technique. If a technique is
broken, remedy the problem if possible. For example, if during the insertion of
an IV the catheter is contaminated (by dropping on floor, etc.), replace the
catheter before insertion. If contamination cannot be resolved, report it to the
proper person. For example, if the bowel is nicked during surgery, the case
classification will change from clean contaminated to contaminated and extra
care should be given to prevent infection.
There Are Three Methods of Transmission of Infection
Direct: Contact with a patient's blood and body fluid, secretions or
excretions or by contact with items soiled with these substances (example:
over-the-bed table, instruments, etc.).
Indirect: Contact with food/drink or vermin.
a. Vehicle: Contaminated food, water or article (VRE, Hepatitis A,
b. Vector: Rats, roaches or insects (malaria, plague, hantavirus, West
Nile virus). Vector is an uncommon means of transmission of nosocomial
infections; in other words, "two-legged rats" (or humans) transmit
more infections in the hospital than those with four legs!
c. Airborne: Transmitted through bacteria contained in dust particles
that remain airborne for long periods of time (chicken pox and tuberculosis).
These diseases are highly infectious. A mask is needed for protection from these
diseases. A special respirator is needed for tuberculosis.
Handwashing is the single most important means of preventing the spread of
infection. Handwashing is a critical part of asepsis.
Handwashing is stressed in the following areas: (This is not an all-inclusive
list. Use your own conscience when washing hands.)
1) Before and after performing invasive procedures, whether or not sterile
gloves are worn.
2) Before and after contact with wounds, whether surgical, accidental, or
associated with an invasive device (e.g., an intravenous cannula entrance wound)
whether or not sterile gloves are worn.
3) Before contact with particularly susceptible patients.
4) After contact with a source that is likely to be contaminated with
virulent microorganisms or hospital pathogens, such as an infected patient or an
object or device contaminated with secretions or excretions from patients (e.g.,
a urinary catheter system).
5) Between giving care to different sites of the body (e.g., measuring urine
and giving IV site care).
6) Between direct contacts with different patients.
7) Before and after your shift.
8) Before and after eating, drinking or handling food.
9) After using the toilet, coughing or sneezing.
10) Whenever hands are visibly soiled.
Antiseptics (such as CHG, PCMX, Triclosan, Betadine) should be used when
performing invasive procedures, upon entering and leaving isolation rooms and in
special care units (i.e., ICU, Nursery, Surgery).
Antiseptic alcohol solutions may be used when handwashing facilities are not
convenient, after casual contact with a patient (such as taking a pulse), but
not when hands are visibly soiled. Rub hands together in the same manner as when
washing hands. Allow to air dry. After approximately 10 applications, you may
notice a buildup on hands. Simply remove by washing with soap and water.
Friction is the most important part of handwashing. Rub for 10 to 15 seconds.
Be sure to cleanse under and around nails and rings and backs of fingers. Rinse
and dry hands adequately. Use a paper towel to turn off the faucet.
1. Rinsing hands thoroughly and carefully drying hands will help to prevent
chapping and cracking of hands. Pat hands dry. Roughly drying hands removes the
top layer of your protective skin.
2. In patient care areas, use only hospital approved lotion in pump
dispensers. Petroleum-based products (such as Vaseline Intensive Care) degrade
latex. Most hand lotions inactivate the antimicrobial residue left on hands by
agents such as chlorhexidine gluconate (CHG). A pump dispenser helps to protect
the lotion from contamination.
3. In clinical areas, keep fingernails short and unpolished. Germs
"hide" in the cracks in polish and under long or false nails and have
been established as a link to transmission of infection. You can get naturally
"polished" nails using a four-step buffing file. A good rule of thumb
for nail length is to hold your hands with the palm side to you. If your nails
are visible over your fingers, your nails are too long.
BODY HYGIENE AND DRESS CODE
The next letter of the ABCs of infection control is "B," or
"Body Hygiene." Body hygiene is an extension of handwashing. Keeping
clean and looking great help to form an atmosphere conducive to the practicing
of asepsis and the ABCs of infection control.
Scrub Attire Dress Code
Wearing of scrub attire is usually designated as mandatory for the control of
infection in the operating room. However, some operating rooms have recently
allowed home laundering of scrub attire as a sterile gown is used to cover the
uniform during the surgical procedure.
Wearing of scrub attire (as uniforms) is usually permissible in other areas
but not necessary for infection control purposes.
Follow Good Habits of Personal Hygiene
- Bathe or shower daily.
- Keep your hair clean.
- Cover, pull back or wear a hairnet for long hair at work.
- Keep nails trimmed and clean.
- Wear clean clothes every day.
- Keep jewelry and cologne to a minimum.
- Wash your uniform separately from household laundry.
- in exposure prone areas: dietary, clinical personal
Scrub Attire "Rules"
Do not enter a restricted area without proper attire.
Shoe covers, masks and head covers are not to be worn outside your work area
(usually your department or the isolation room). Dispose of properly before
leaving the area.
Know and Follow Your Department Dress Code
- Some departments have special dress codes.
- Wear your identification badge.
- Wear clean lab coats and shoes.
Maintain Good Health
If you maintain good health, you will be less likely to get and transmit
- Eat a balanced diet.
- Get enough sleep.
- Exercise regularly.
- Practice healthy stress reduction measures.
The last letter in our acronym for the ABCs of infection control is
"C," or a Caring Attitude. A caring attitude will be reflected in work
practices that support sound infection control principles. Work practices that
support the maintenance of aseptic technique and embrace responsibility for each
individual's role in Infection Control can only come from staff with caring
attitudes. This can be accomplished by fostering a team approach through
education and support of the clinician as they perform duties that are pivotal
in the prevention and control of infection. Focus should be placed on the last
of the ABCs of infection control (focusing on the right and wrong of infection
control). Our attitudes should mirror the plan of asepsis -- common sense. By
using common sense we can safely protect our patients and ourselves. Use common
sense and a caring attitude to develop a good aseptic conscious (or a continuous
awareness of asepsis). Your "aseptic consciousness" is your set of
internal ideals. We have set ideals (in the form of policies and procedures) to
protect our patients and ourselves. Set your ideals at the highest level to give
care without doing harm.
The ABCs of infection control -- Asepsis, Body Hygiene and Caring Attitude --
comprise what we should do to help protect our patients and ourselves. Your
diligence and common sense is key to protecting yourself, your co-workers and
the patient. Handwashing and skin preparation, disinfectant and sterilization,
vital parts of asepsis and a caring attitude, are essential to the ABCs of
infection control. Infection control is a valuable asset to the facility and it
is our responsibility to demonstrate this.
1. Discuss the three major components of asepsis.
2. Discuss handwashing, disinfection and sterilization as they apply to
3. Discuss body hygiene -- personal hygiene and dress code.
4. Explore developing a caring attitude -- a good sense of right and wrong
essential to the practice of the ABCs of infection control.
|TEST QUESTIONS: TRUE OR FALSE||T||F|
|1. Handwashing is a major part of asepsis.|
|2. The highest level of asepsis is sterilization.|
|3. Most infections transmitted in the hospital are vector-borne.|
|4. These comprise the ABCs of infection control: practicing aseptic
technique, good body hygiene and developing a caring attitude.
|5. Contact time is the time it takes for a disinfectant to kill what the
label claims it will kill.
|6. Asepsis is defined as the absence of bacteria.|
|7. Disinfection is defined as the total removal of all bacteria.|
|8. Airborne infections are transmitted by airborne dust particles.|
|9. Clean high-touch areas frequently.|
|10 If a sterile items indicator has not turned, report it to Central
|11. Do not use a phenol in a food preparation area.|
|12. Dispose of protective attire when leaving your work area.|
|13. Infection control measures are not cost-effective.|
|14. A special respirator is required for tuberculosis.|
|15. Sterilization, a vital part of asepsis, means the absence of all
|16. Airborne infections are transmitted through bacteria contained in
dust particles that remain airborne for long periods of time (such as
chicken pox and tuberculosis).
|17. Use warm (not hot) water to mop.|
|18. Dirt and soil inactivate disinfectants, so clean the area first.
Then reapply a fresh layer of disinfectant and allow the area to remain
wet for the contact time.
|19. If laundering scrubs at home, it's okay to wash them with household
|20. Getting enough sleep and eating healthy will help prevent