148. CCA Study Notes: Medical Asepsis, Hand Hygiene, Gloves & Decontamination

The Big Picture

Medical asepsis focuses on reducing harmful microorganisms and stopping them from spreading. Your hands, gloves, equipment, linens, surfaces, and other items can all carry microbes from one place or person to another.

Hand hygiene is one of the most important parts of preventing this spread. Gloves add protection when you need them, but they never replace cleaning your hands.

Reusable equipment also needs the right level of decontamination. Depending on the item, this involves cleaning, disinfection, or sterilization.

Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.

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Course Notes: Key Ideas You Need to Know

Medical Asepsis

Medical asepsis, also called clean technique, includes practices that reduce the number of pathogens and prevent their spread.

Microbes live on people and objects. This means contaminated hands, equipment, supplies, linens, and surfaces can help spread infection if they are not handled correctly.

Contamination means exposure to microorganisms, including pathogens.

Hand Hygiene

Hand hygiene means cleaning your hands. It includes handwashing with soap, friction, and running water, as well as waterless, alcohol-based hand rubs.

Your hands touch clients, objects, equipment, and surfaces throughout care. They can pick up microbes and carry them somewhere else. Contaminated hands can also transfer microbes to your own eyes, nose, or mouth.

Practise hand hygiene before and after client contact. Gloves do not replace this step. Clean your hands after taking gloves off and before putting on a new pair.

The Four Moments for Hand Hygiene

These four moments help you recognize when your hands need cleaning.

1. Before initial client or environment contact. Clean your hands when entering the room, before touching the client, and before touching objects or furniture in the client’s environment. This protects the client and the environment from microbes carried on your hands.
2. Before a procedure. Clean your hands immediately before a clean or sterile procedure. This helps prevent harmful microbes from entering the client’s body.
3. After a body-fluid exposure risk. Clean your hands immediately after the risk and after removing gloves. This protects you and the care environment from the client’s microbes.
4. After client or environment contact. Clean your hands when leaving and after touching the client or objects in the client’s environment. This protects you and the care environment.

When to Practise Hand Hygiene

Practise hand hygiene:

• immediately before and after giving care
• whenever your hands are visibly soiled
• after contact with blood, body fluids, secretions, or excretions
• after touching contaminated items such as soiled linens, tissues, garbage, bedpans, diapers, or incontinence products
• before and after preparing, handling, or eating food
• before and after feeding a client
• before putting on disposable gloves and after removing them
• after personal body functions such as toileting, changing menstrual products, sneezing, coughing, or blowing your nose

If your hands have visible contamination, or you touched an object contaminated with pathogens such as feces, wash thoroughly with soap and running water instead of relying on waterless hand sanitizer.

Waterless, Alcohol-Based Hand Rubs

Waterless, alcohol-based hand rubs clean hands and are convenient when appropriate.

Your hands must be dry before applying the product. Moisture dilutes the alcohol and reduces its effectiveness. Hand rub is also ineffective when hands are visibly soiled.

Some manufacturers recommend washing with soap and water after a maximum of 10 applications of their hand rub. This removes accumulated dead skin and bacteria.

How to Use Waterless, Alcohol-Based Hand Rub

1. Apply about 3 to 5 mL, or 1/2 to 1 teaspoon, to both hands.
2. Rub your hands together for about 15 seconds. Cover all areas, including between your fingers.
3. Rub your fingertips over your wet palms to clean under your fingernails.
4. Keep rubbing until your hands are dry. This takes about 30 seconds to 1 minute.
5. Never dry the hand rub with a towel or paper napkin. Let it dry on your hands.

Handwashing with Soap and Running Water

Handwashing removes soil, dead skin cells, and excess microbes using soap, friction, and running water.

Keep the procedure in order. Each step helps reduce contamination or prevents your clean hands from becoming contaminated again.

Handwashing Steps

1. Gather soap, paper towels, and a wastebasket.
2. Push your sleeves and watch above your wrists. Remove rings.
3. Stand away from the sink. Keep your hands, body, and uniform from touching it because the sink is considered contaminated.
4. Turn on the water and adjust it until it feels warm.
5. Wet your hands and wrists thoroughly. Keep your hands lower than your elbows.
6. Apply about 5 mL, or 1 teaspoon, of liquid soap. If using bar soap, avoid touching the soap dish and rinse the bar before use. Return it without touching the dish. Do not use excessive soap.
7. Rub your palms together and interlace your fingers to build a lather.
8. Wash each hand and wrist thoroughly. Clean carefully between your fingers.
9. Clean your fingernails by rubbing your fingertips against the opposite palm. Clean under each nail with a fingernail from your other hand. Pay extra attention to this during the first handwashing of the day and when your hands are heavily soiled.
10. Rinse your wrists and hands thoroughly.
11. Spend enough time lathering and rinsing. Follow employer policy for the required duration. At least 15 to 20 seconds is needed to remove most microbes. Wash longer when your hands are dirty or soiled with blood, body fluids, secretions, or excretions.
12. Repeat the soap, rubbing, cleaning, and rinsing steps if needed.
13. Pat the skin completely dry. Pay particular attention between the fingertips. Dry the cleaner areas first.
14. Use a clean paper towel to turn off the faucet so the faucet does not contaminate your clean hands.
15. Apply hand lotion or cream after washing to help prevent chapping and dry, broken skin.

Gloves Add Protection, They Do Not Replace Hand Hygiene

Disposable gloves create a barrier between your hands and a client’s:

• blood
• body fluids
• secretions
• excretions
• non-intact skin
• mucous membranes

Gloves help protect you from microbes from the client. They also help protect the client from microbes on your hands.

Most routine care involving only intact skin does not require gloves. Wearing gloves when they are not needed can make the hands sweat, dry out, and eventually crack. Cracked skin provides a portal of entry for microbes.

Rules for Wearing Disposable Gloves

Remember these glove rules:

• Wear gloves when you have cuts, abrasions, or bitten fingernails.
• Wash and dry your hands before putting gloves on.
• Use a new pair for each client.
• Immediately remove and discard gloves that become torn, cut, or punctured. Wash your hands, then put on a new pair.
• Practise hand hygiene every time you remove gloves.
• Use disposable gloves once, then discard them.
• Never apply waterless hand rub to gloves because it can weaken them.
• Put on clean gloves before touching mucous membranes or non-intact skin ⓘ.
• Wear gloves when contact with items or surfaces contaminated by blood, body fluids, secretions, or excretions is likely.
• Change gloves as soon as they become contaminated with blood, body fluids, secretions, or excretions.
• More than one pair may be needed during one task to prevent cross-contamination between body sites.
• Replace gloves after touching an unclean surface.

Prevent Tears in Gloves

Disposable gloves do not require a special technique for putting them on, but they must remain intact.

Long fingernails, rings, or careless handling can tear gloves. A tear creates an opening through which pathogens can pass.

Latex Allergy

Latex is a rubber product. A latex allergy can cause a skin rash and more serious problems such as asthma or shock.

Report skin rashes or difficulty breathing to your supervisor right away. Report a known latex allergy immediately as well.

If a client has a latex allergy, latex products should not be allowed on that client’s unit. Check the client’s care plan for this information.

How to Remove Disposable Gloves

Keep contaminated glove surfaces away from bare skin.

1. Keep glove surfaces touching only other glove surfaces. Do not let the gloves touch the bare skin of your wrists or arms.
2. With one gloved hand, grasp the outside of the opposite glove just below its cuff.
3. Pull the glove down and off so it turns inside out.
4. Hold the removed glove in your still-gloved hand.
5. Slide two fingers of your bare hand inside the cuff of the remaining glove without touching its contaminated outside surface.
6. Pull the second glove down and inside out over your hand and over the first removed glove.
7. Drop both gloves together into the proper container. Follow employer policy.
8. Practise hand hygiene.

Care of Supplies and Equipment

Contaminated supplies and equipment can become sources of infection.

Many items used in facilities and home care are disposable. They are used once and discarded.

Reusable items include bedpans, urinals, washbasins, water pitchers, and drinking cups. In facilities, reusable items are labelled for the individual client and are never borrowed for another client.

Three Levels of Decontamination

Decontamination of reusable items has three levels.

Level	What It Does
Cleaning	Reduces the number of microbes and removes visible organic material
Disinfection	Destroys pathogens except their spores
Sterilization	Destroys pathogens, nonpathogens, and spores

A sterile item is free from microbes, including pathogens, nonpathogens, and spores.

Cleaning Reusable Equipment

Cleaning lowers the number of microbes and removes visible organic material such as dirt, blood, body fluids, secretions, and excretions.

Some equipment, including crutches and blood pressure cuffs, needs cleaning only when visibly soiled and between uses on different clients. Follow employer policy about when and how equipment must be cleaned.

Equipment-Cleaning Order

1. Put on the personal protective equipment required when the item may contain blood, body fluids, secretions, or excretions. Follow employer PPE policies.
2. Rinse organic material away with cold water first. Warm or hot water makes protein-containing material thicker, stickier, and harder to remove.
3. Wash the item with soap and hot water.
4. Scrub it thoroughly. Use a brush when necessary.
5. Rinse it with warm water.
6. Dry it.
7. Disinfect or sterilize it as required.
8. Disinfect the equipment and the sink used during cleaning.
9. Discard gloves and other PPE.
10. Practise hand hygiene.

Personal Protective Equipment

Personal protective equipment, or PPE, includes special clothing and equipment that creates a barrier between microbes and your hands, eyes, nose, mouth, and clothing.

Examples include:

• gloves
• gowns
• masks
• goggles or face shields

Follow employer policy for PPE when cleaning contaminated equipment.

Disinfection

Disinfection destroys pathogens except spores. Thoroughly clean an item before disinfecting it.

Items that may require chemical disinfection include:

• metal bedpans
• commodes
• countertops
• tubs
• room furniture

Alcohols and chlorines are examples of chemical disinfectants used for reusable items. Follow employer policy for when and how to disinfect equipment and supplies.

Working Safely With Chemical Disinfectants

Chemical disinfectants can burn or irritate the skin.

Wear waterproof utility gloves or rubber household gloves. Do not use disposable gloves with chemical disinfectants because the chemicals can break them down.

Some disinfectants require special handling or storage. Check the material safety data sheet, or MSDS ⓘ, before handling a disinfectant, and follow employer policy.

Sterilization

Sterilization destroys all pathogens and nonpathogens, including spores.

Methods listed for sterilization include:

• boiling water
• radiation
• liquid or gas chemicals
• dry heat
• steam under pressure

Items that enter the body or are used during surgery must be sterilized. Examples include IV catheters, urinary catheters, and needles.

Role Limit for Sterilization in Facilities

Specially trained workers perform sterilization in facilities. Support workers are not responsible for sterilizing equipment in that setting.

A support worker may be required to clean equipment before it goes through sterilization.

Home Care: Hand Hygiene Supplies

A client’s home might not have soap, paper towels, or other supplies needed for proper handwashing.

Do not use the client’s cloth towels to dry your hands. Use paper towels instead. Check with your supervisor before the home visit, bring paper towels, and carry waterless alcohol-based hand rub in case proper hand-hygiene supplies are unavailable.

Home Care: Disinfectants

For utensils, linens, and clothing, detergent and hot water are identified as common disinfectants. Household surface products may be used for sinks, counters, floors, toilets, tubs, and showers.

In home care, use the products preferred by the client’s family or those directed by your supervisor.

A vinegar solution can be used for bedpans, urinals, commodes, and toilets. The mixture is:

• 250 mL, or 1 cup, white vinegar
• 750 mL, or 3 cups, water

Label the container “vinegar solution.” Add the date and your name.

Home Care: Sterilization

Almost all medical items that must be sterile in home care are commercially prepared and disposable.

A support worker may be required to sterilize some noninvasive items, including cloth diapers or glass baby bottles.

Colour-Fast Linens and Cloth Diapers

Colour-fast linens ⓘ and cloth diapers can be soaked in a solution of:

• 1 part household bleach
• 10 parts water

One cup of bleach can also be added when washing items soiled with blood or body fluids.

Always check with the client and your supervisor before using bleach. Check clothing labels because some fabrics cannot be bleached.

Glass Baby Bottles and Similar Items

For boiling-water sterilization in the home:

1. Put the items in a large pot of cold water.
2. Cover the pot.
3. Bring the water to a full boil.
4. Boil the items for at least 15 minutes.
5. Turn off the heat and allow the water and items to cool.
6. Remove the items with tongs.
7. Let them air-dry on a clean towel.

Boiling does not always destroy every spore and virus. Facilities therefore do not use boiling water to sterilize items.

Medical Asepsis Measures

Medical asepsis also involves controlling places where microbes live, the ways they leave and enter the body, and how they spread.

Controlling Reservoirs

Actions include:

• Maintain daily personal hygiene, including bathing, hair care, oral care, and clean clothing.
• Never wear artificial nails while providing care. They can hold microorganisms, scratch a client, and tear gloves. Rings, bracelets, and watches can cause similar problems.
• Keep vaccinations up to date.
• Store or discard soiled tissues, linens, and other materials in leak-proof plastic bags.
• Empty garbage at least daily.
• Keep tables, countertops, wheelchair trays, and other surfaces clean and dry.
• Wash contaminated areas with soap and water.
• Clean work surfaces after a task, when dirty, and after blood or other potentially infectious material spills. Follow employer policy.
• Provide for the client’s hygiene.
• Keep drainage containers below the drainage site.
• Cook meats and poultry adequately. Wash raw fruits and vegetables before serving or eating them, and handle and store food safely.
• Wash cooking and eating utensils with soap and water after use.

Controlling Portals of Exit

• Cover your nose and mouth when coughing or sneezing, then wash your hands immediately.
• Give clients tissues when they cough or sneeze.
• Wear PPE as needed.
• Check your hands often for cuts, scrapes, and other skin breaks. Report any to your supervisor.

Controlling Transmission

Several actions help prevent microbes from moving between people, objects, and surfaces.

Hand Hygiene and Personal Items

• Wash your hands correctly and at appropriate times.
• Assist clients with hand hygiene before and after food, after elimination, after coughing or sneezing, after changing personal hygiene products, after contact with body substances, and whenever their hands are soiled.
• Make sure each client has their own care equipment and personal items.
• Do not share these items between clients or family members.
• Never take equipment or supplies from one client’s room for another client, even when the item has not been used.

Equipment, Linens, and Cleaning Direction

• Keep clean and contaminated equipment and linens away from your uniform.
• Do not shake linens because moving dust can spread microbes.
• Use a damp cloth for dusting.
• Fold soiled linens with the dirtiest areas toward the centre.
• Clean from the cleanest area toward the dirtiest area.
• Clean away from your body rather than wiping, brushing, or dusting toward yourself.

Contaminated Waste and Surfaces

• Pour urine and stool carefully into the toilet and avoid splashing. Close the toilet lid before flushing.
• Cover bedpans and commodes with a lid during transport to contain microbes and odours.
• Pour contaminated liquids directly into sinks or toilets without splashing.
• Clean and disinfect contaminated sinks and areas immediately.
• Avoid sitting on a client’s bed.
• Do not use items that have touched the floor.
• Keep both clean and soiled linens off the floor.
• Disinfect tubs, showers, shower chairs, bedpans, urinals, and commodes after each use according to employer procedures.
• Report pests such as ants, spiders, or mice in the room.

Controlling Portals of Entry

Protecting intact skin and mucous membranes helps control places where microbes can enter.

• Provide skin care and oral hygiene according to the care plan.
• Do not let the client lie on tubes or other objects that can injure the skin.
• Keep linens dry and free of wrinkles.
• Turn and reposition the client as directed in the care plan.
• Provide or assist with perineal care ⓘ as needed. Clean from the urethra, the cleaner area, toward the rectum, the dirtier area. Cleaning in this direction helps prevent urinary tract infections.
• Make sure drainage tubes remain properly connected. Otherwise, microbes can enter the drainage system.

Protecting the Susceptible Host

Follow the care plan to:

• meet the client’s hygiene needs and protect the skin and mucous membranes
• meet nutrition and fluid needs to support the immune system and help prevent infection
• assist with coughing and deep-breathing exercises as directed to help prevent respiratory infections

Client Quality of Life During Procedures

During handwashing, alcohol-based hand-rub use, and glove removal, care should support:

• dignity
• independence
• individualized care
• preferences
• privacy
• safety

Common Mix-Ups

Wrong Idea	Better Idea
Gloves replace hand hygiene.	Gloves add protection. Clean your hands before and after glove use.
Hand rub works when hands are visibly dirty.	Use soap and running water when hands are visibly soiled.
Cleaning, disinfection, and sterilization mean the same thing.	Cleaning reduces microbes, disinfection destroys pathogens except spores, and sterilization destroys all microbes including spores.
Disposable gloves protect your hands when using chemical disinfectants.	Chemical disinfectants can break down disposable gloves. Use waterproof utility or rubber household gloves.
A reusable item assigned to one client can be borrowed for another client.	Client-specific reusable equipment must stay with that client.
Support workers sterilize equipment in facilities.	Specially trained workers handle facility sterilization. Support workers may clean equipment before sterilization.