Aseptic Technique

Dr. Soha El-Hady

Prof. of Medical Microbiology & Immunology
Learning Objectives

• Define clean, aseptic or sterile techniques.

• Be able to state the requirements for clean,
aseptic or sterile technique recommended
for common procedures.
• Be able to demonstrate aseptic and sterile
technique for 6 procedures.
The Goal: Reduce Health Care
Associated Infections
• The goal is to reduce health care-associated
infections that occur when staff spread
microbes to patients
• Germs move to patients from hands, and
from objects used for patient care
• Use of clean, aseptic or sterile technique
reduces the number of germs transferred
and thus, reduces the risk of infection
 Asepsis
• Asepsis: is the method by which
we prevent microbial contamination
during clinically invasive
interventions.

• Aseptic technique: is the procedure

undertaken in relation to the type of
asepsis.
 Aseptic Technique

• It’s an infection prevention method that is

basic to all HC settings.
• Aim to preventing introduction of m.o from
outside & / or from one body site to another in
the same patient to minimize the risk of post-
exposure infections.
Aseptic Technique factors that control
prevention of post procedure infection:

• 1. Risk of procedure.

• 2. Degree of complexity.

• 3. Patient characteristics.
 Aseptic Techniques
Practices to ensure that bacteria are excluded from
open sites during surgery, wound dressing, blood
sampling, and other medical procedures.
Aseptic technique is the first line of defense against infection.
It refers to the practices performed immediately
before and during a clinical procedure. They include:
➢ Handwashing or Surgical scrub
➢ Using barriers (personal protective equipment)
➢ Patient preparation
➢ Maintaining the sterile field
➢ Using safe operative technique (making small incisions,
avoiding trauma to tissue and surrounding structures, and
controlling bleeding)
➢ Maintaining a safer environment in the surgical procedure
area
Key process for performing aseptic technique:
1. Hand Hygiene
2. Suitable attire.
3. Patient preparation.
4. Sterile equipment.
5. Environmental control
6. Sterile field.
7. Asepsis.
• It protects both the patient and the HCW.
• Thus , using good aseptic technique minimizes, controls, and
helps to contain the pathogenic microorganisms that cause
infection .
• The purpose of this policy is to reduce the risk of infection
transmission both to and from patients and staff undertaking
this procedure.
• It is a key policy in relation to ensuring the safety and
reducing the risk of harm to patients and staff.

• Policy Objectives
‘’Every clinical member of staff should be able to practice
the principles of asepsis correctly at all times’’.
1. Hand Hygiene:
Is a corner stone for any process.
2. Suitable attire:
Gloves Patient Prevent m.o on HCW hands from entering patient’s body.

HCW Protect HCW hands from contact with bloods, other body
fluid & tissues.

Masks Patient Prevent m.o expelled during talking, coughing & sneezing
from entering patient’s body.

HCW Protect HCW nose & mouth from contact with blood & other
body fluid.
Eye Patient No protect documented.
protection
HCW Protect HCW eyes from contact with blood & other body
fluid.
Patient Prevent m.o on HCW arms & clothes from entering
Gowns patients body.

HCW Protect HCW skin & clothes from contact with blood &
other body fluids.

Patient
Head caps Prevent m.o on HCW & scalp from entering patients body.

HCW
No protection documented.

Patient
Foot wear No protection documented.

HCW
Protect HCW foot from blood, other body fluids & fallen
sharp objects.
3. Patient preparation:
Minimize the number of m.o on the
patient’s skin.
Apply antiseptic in a circular manner or
in one direction.
Hair removal.
Pre-operative antiseptic shower.
4. Sterile equipment:
Single use.
Assure sterility.
No touch technique.
No touch technique → meaning clean
not touch sterile.
5. Environmental control:
Managing activity.
Keeping doors closed during procedures.
Excluding visitors & unnecessary
personnel.
Avoiding cleaning activities in the area
during procedures.
6. Sterile field:
Created by sterile barrier (drapes &
attire)
Assemble all appropriate packaged
sterile items.
Check packaging is intact & expiry date
has not been exceeded.
Procedures of Aseptic techniques:
1. Select the appropriate work environment.
2. Prepare the setting including decontamination
of the working surface or tray to be used with
detergent & water or detergent wipes & then
dry.
3. Type of H.H will depend on the procedure.
4. Avoid any aseptic procedures for at least 30
minutes after bed making.
The extent of the use of drapes:
1. Large drapes & maximal barrier
precautions → surgical procedures & CVC
insertion.
2. Sterile gloves, plastic apron & small
drape → wound dressing procedure.
3. Clean non-sterile gloves → phlebotomy &
IV drug administration as long as no touch
aseptic technique is used.
Key points for developing &
maintaining a sterile field:
1. Assurance of equipment sterility:
o Any items falls on the floor consider
unsterile.
o Circulating nurse should check the package
integrity, the expiration date, chemical
process indicator.
2. Sterile field created by the gowns:
o Under the neckline to the waist.
o Tip of fingers to 2 inches above the
elbow.
o Shoulders, back, under axilla, under the
waist → not sterile.
3. Sterile field created by the drapes:
o Only top surface of draped table
consider sterile.
o Side of table can’t be considering
sterile.
o Any item extends beyond the sterile
boundary considered contaminated.
4. Items should be dispensed to a sterile
field by methods that preserve the sterility
of the item & the integrity of sterile field:
o Wraps →
Edge of opened sterile package or
container is considered unsterile.
1 inch safety margin is usually considered
standard.
5. Motions of the surgical team are from
sterile to sterile area & from unsterile to
unsterile area:
o Scrubbed person stay close to the sterile
field.
o If they change positions → they turn face to
face or back to back while maintaining a
safe distance between.

6. Sterile fields should be prepared as close

as possible to the scheduled time.
7. Aseptic Technique:
1. Maximal barrier sterile technique.
2. Aseptic technique.
3. Medical Asepsis or clean technique
1. Maximal barrier sterile technique:
Applied inside OR
Examples → CVC
2. Aseptic Technique:
Include appropriate preparation of setting, hand antisepsis,
donning sterile gloves, sterile drapes, no touch technique.
Examples →
o Urinary catheter.
o Wound dressing with debridement.
o Total parenteral nutrition.
o Lumbar puncture.
3. Clean technique:
Clean gloves should be used instead of sterile gloves.
No touch technique should be used to prevent
contamination of sterile items.
A clean gowns should be worn to ↓ contamination of
clothing follow SP.

Examples →
o PVC,
o Respiratory suctioning.
 Procedure Peripheral Venous Cannula Central Venous Catheter

Relative Low risk High risk

Risk
Level of Clean no touch technique. Maximal barrier sterile technique
asepsis
Hand H.W or H.R Surgical scrub or surgical Rub
hygiene
Attire Clean gloves. Sterile gloves.
Sterile gown.
Surgical mask.
Eye goggle.
Head cap.
Components

Patient Skin antisepsis with alcohol,
preparation circular movement starting
from the insertion site to
outwards.
Environment Clean disinfected tray
Hair removal if interfere with the insertion site,
immediately before insertion, at least 30
minutes preoperatively, with clipper or shaving.
Antiseptic shower.
Skin antisepsis with chlorhexidine in one
direction.
Large drape.
Antimicrobial prophylaxis, 1 – 2 doses,
before operation
Sterile field.
Differentiation between Aseptic Technique
and Clean Technique:
The clean technique hand decontamination procedure is
now the same as the aseptic technique as per guidance from,
National Patient Safety (WHO), Patient Safety Alert, Clean
Hands Saves Lives
The clean technique is a modified aseptic technique that can
be used for non-surgical wounds, for example pressure sores,
leg ulcers.
A no touch technique is still used, but gloves are non-
sterile.
In certain situations it may be necessary to use aseptic
technique (rather than clean), this would be dictated by a risk
assessment of the patient’s medical history/current condition,
for example patients with chronic diseases, such as diabetes or
immuno-compromised patients.
I-Clean Technique
• Definition: Clean technique refers to the use
of routine hand washing, hand drying and use
of non-sterile gloves.
• Use clean technique if staff or objects will
touch intact skin, intact mucous membranes
or dirty (contaminated) items .
• Clean tech is appropriate for:
– Taking blood pressures
– Examining patients
– Feeding patients
II-Invasive Procedures
• Definition: Acts done to patients that
come in contact with the wounds, blood
stream, the inside of the body, or
normally sterile parts of the body.
 III-Aseptic Technique
Aseptic technique is used for short invasive
procedures.
It involves:
➢ Antiseptic hand hygiene (alcohol, betadine or
chlorhexidine)
➢ Using sterile or clean gloves
➢ Antiseptic (e.g alcohol) on patient’s skin
➢ Use of clean, dedicated area
• Use aseptic technique for brief invasive procedures
that may break skin or mucous membranes, or
normally sterile parts of the body.
Examples when to use aseptic technique:
• Dressing of wounds healing by primary intention
(first 48 hours)
• Dressing of surgical wounds continuing to seep
serous fluid after the first 48 hours
• Intravenous cannulation (peripheral vascular)
• Suturing (superficial)
• Medical invasive procedures
• Invasive vaginal examination using
instruments/equipment – when inserting a devise
such as an Intrauterine Device
• Assisted vaginal deliveries including forceps and
ventouse
 IV-Sterile Technique
Sterile technique is used for surgery or the preparation of
sterile materials for multiple patients.
It involves:
• Surgical hand rub with long acting antiseptic
• Hands dried with sterile towels
• Sterile field
• Sterile gown, mask
• Sterile gloves
• Sterile supplies
• Skin prep
• A dedicated room
• Use during surgery and for invasive
procedures with high rates of infection
• Examples:
– Any long invasive procedure
– Placement of central lines and thoracic
lines
– Placement of urinary catheter
– Bulk preparation of IV fluids or medications
 Differences Between the Types of
Techniques
• Space and work flow where procedures are
done
• Type of hand hygiene
• Use of Personal Protective Equipment,
including clean, or sterile gloves
• Use of patient skin antisepsis
• Use of a sterile drape or sterile field
 Clean Aseptic Sterile

Procedure space On ward or at Dedicated Dedicated

beside area room
Gloves Clean or none Clean or Sterile surgical
Sterile
Hand hygiene before the Routine Aseptic, e.g. Surgical scrub
procedures alcohol Iodophors,
chlorheximide

Skin antisepsis No Alcohol Long acting

agent

Sterile field No No* Yes

Sterile gown, mask, head No No Yes

covering
 To Prevent Contamination
Keep clean, dirty, and sterile items separate:
• Only put sterile items in a sterile field
• Change gloves and wash hands if going from a
contaminated act to a aseptic or sterile act
• Time skin antisepsis and surgical hand hygiene with a clock
• The sterile field is considered sterile except for the 2.5 cm
border
• Wet items are considered contaminated
Planning Reduces Errors in
Technique

• Use the S.C.R.I.P.T. reminder to plan

• Visualise every step in advance, to
make sure supplies are available
S.C.R.I.P.T Procedures
• Space and work flow?
• Clean, aseptic, or sterile technique?
• Routine, aseptic or surgical hand hygiene?
• Instruments and supplies?
• Personal protective equipment?
• Trash: sharps, infectious waste, radioactive waste,
pathology or routine waste?
1-Space and Work Flow?

• Should the procedure be done in a

dedicated room or space?
• Who will ensure that all visible dirt is
removed from the space ahead of time,
and surfaces disinfected if necessary?
Space and Work Flow?
• Work flow: can staff move from hand
washing to hand drying to separate
clean and sterile areas without passing
or touching contaminated areas?
• Where will used instruments and
specimens be placed?
 2-Clean, Aseptic, or Sterile
Technique?
• All team members should be clear on who should
be using clean, aseptic or sterile technique and
what elements are intended
• Example: a physician places a thoracic drain with
sterile technique, The nurse assisting uses clean
technique, and the person who empties the drain
in subsequent days uses aseptic technique
3-Routine, Aseptic or
Surgical Hand Hygiene?

• Prepare in advance for the type of hand

hygiene that is necessary
• Arrange the supplies including hand
drying towels, as appropriate
4-Instruments and Supplies
• Plan what medical devices and supplies
are needed
• Plan where each item should be placed
• Plan where and how each item should
be discarded or sterilised
Work Flow Chart:
Decontamination Cycle
5-Personal Protective Equipment

• Discuss what other items are expected and

needed
• These may include aprons, footwear for
bloody procedures, masks, hair coverings,
face shields or goggles
6-Trash
• Plan appropriate leak proof, puncture
proof containers for the transfer and
disposal of sharps, infectious waste,
and specimens
• Sharps containers should be moved to
the point of use so sharps can be
discarded by the original team and not
left for later staff to find and discard
 Examples of Clean , Aseptic &
Sterile techniques :
1-Procedure for Insertion of a Urinary
Catheter
2-Collecting Urine Samples
3- Emptying the Drainage Bag
4- Procedure for Inserting Central Venous
Catheters (CVC)
5- Procedure for Inserting Peripheral IV
Cannulae (PVC)
6- Procedure for Wound Care
 1-Procedure for Insertion of a Urinary
Catheter
(Sterile Technique)
1. Inform the patient and explain the indication and the
procedure of catheterization.
2. Lay all necessary equipment on a trolley on a sterile towel .
Select a catheter that fits the urethra without traumatizing the
patient.
3. Perform routine hand wash and wear clean gloves.
4. If the patient is male, clean the glans thoroughly with soap
and water to remove secretions If the patient is a woman,
clean the periurethral area using front to back technique.
Discard clean gloves.
5. Wash hands thoroughly with an antiseptic hand wash
preparation (Surgical scrub) .
6. Put on sterile gloves and use a “no touch” technique ,
followed by swabbing the area with antiseptic solution .
7. Connect the catheter to the closed drainage bag
8. Insert 2-3 ml of the lubricant (e.g. anesthetic jelly on the
catheter tip).
9. Insert the catheter gently – advance it by holding the inner
sterile sleeve. A “no touch technique” should be used in which
the operator has no contact with the sterile shaft of the
catheter.
10.Inflate the balloon by instilling the manufacturer’s
recommended amount of sterile water.
11. Anchor the catheter to the patient’s thigh.
12. Hang it below the level of the bed to stop reflux.
13. Wash and dry hands.
 2-Collecting Urine Samples
(Aseptic Technique)
• Do not disconnect the drainage bag to obtain a urine sample as
this causes an interruption in the closed drainage system and
may pose a risk of infection to the patient.
• If a sample of urine is required for bacteriological examination,
it should be obtained from a sampling port . This must first be
disinfected by wiping with a 70% ethyl alcohol impregnated
swab. The sample may then be aspirated using a sterile needle
and syringe and transferred into a sterile container. Do not
obtain a sample for bacteriological culture from the drainage
bag.
• If there is no port for collecting urine samples, antiseptic
handwash and wearing sterile gloves should be done . Wipe
the catheter below the site of bifurcation with a 70% ethyl
alcohol impregnated swab , then aspirate urine sample using a
sterile needle and syringe and transfere it into a sterile
 3-Emptying the Drainage Bag
(Clean Technique)
• This should be done wearing non-sterile gloves and via the
drainage tap at the bottom of the bag.
• When the bag is empty, the tap should be closed securely
and wiped with a tissue. If the bag does not have a tap, then
replace it when full.
• Do not disconnect the bag to empty and then reconnect it.
• Separate urine bag-collecting receptacle must be used for
each patient and each bag should be emptied separately as
required.
• The urine receptacle should be heat disinfected if possible
and should be stored dry after each use. If heat labile,
chemical disinfection could be used.
• After emptying the receptacle, the gloves should be
discarded and hands washed and dried thoroughly.
 4-Procedure for Inserting Central
Venous Catheters (CVC)
(Sterile Technique)
1. Collect all necessary equipment.
2. Place the patient in a suitable position.
3. Wash hands using an antiseptic solution
or an alcohol handrub (Surgical
Scrub).
4. Wear sterile gloves.
5. Apply antiseptic to the insertion site
(e.g. alcoholic povidone iodine), with
friction for at least 3 minutes prior to
venipuncture. Allow the site to dry (2
min) before inserting the catheter.
6. Surround the site with a large sheet of
sterile drapes.
7.Insert the central line as swiftly as possible maintaining “no
touch” technique throughout the procedure.
8. Blood should be aspirated freely to ensure that the
catheter is in a vascular space before injecting fluid.
9. Leave the site clean and dry after insertion.
10. Cover the site with a sterile (transparent) dressing for
easy inspection. Sterile gauze may be used but should not
be covered with an impervious dressing, as this increases
the risk of infection.
11. Disinfect the hub with an alcohol swab before each
connection to the administration set.
12. Check drug incompatibilities.
13. Do not routinely replace CVCs to prevent catheter-related
infection.
14. Central venous catheters should be removed if infected or
at the end of therapy.
15. Gloves should be removed and hands washed.
 Protective Clothing during
Insertion of CVC
The insertion of CVC lines requires medical asepsis
and should be carried out wearing a cap, mask, sterile
gown, sterile gloves, and a large sterile sheet, for the
insertion of CVCs or guide-wire exchange.
Catheter-site dressing regimens
• Use either sterile gauze or sterile, transparent, semipermeable
dressing to cover the catheter site
– If the patient is diaphoretic, or if the site is bleeding or
oozing, a gauze dressing is preferable to a transparent,
semi-permeable dressing. .
• Replace catheter-site dressing if the dressing becomes damp,
loosened, or visibly soiled
• Change dressings at least weekly for adult and adolescent
patients depending on the circumstances of the individual
patient.
• Do not use topical antibiotic ointment or creams on insertion
sites (except when using dialysis catheters) because of their
potential to promote fungal infections and antimicrobial
resistance.
 5-Procedure for Inserting Peripheral IV
Cannulae (PVC)
(Aseptic Technique)
1. Ensure that the patient is comfortable and is aware of the procedure – this
reduces anxiety.
2. Collect all equipment necessary to set up an IV infusion.
3. Select a cannula that will fit easily into the vein – size 18 or 20 gauge is
usually appropriate. The correct sized cannula reduces trauma and
congestion of the vein.
4. Place the patient’s arm on a sterile towel.
5. Avoid shaving the skin insertion site. Instead, clip hair if necessary.
6. Wash hands hygenically & wear clean gloves. If the patient is in high risk
ward or immunocompromised, use antiseptic hand wash or antiseptic
handrub &sterile gloves.
7. Apply a tourniquet to the patient’s non-
dominant forearm and palpate vein – you will
not be able to palpate following disinfection.
8. Apply skin antiseptic to the IV insertion site
with 70% ethyl alcohol for at least 30 seconds
and allow to dry before inserting the cannula.
DO NOT RE-PALPATE
For complicated PVC insertion you may
require to re-palpate the vein. It is
therefore essential that you ensure that
sterility of the insertion site is maintained
(wear sterile gloves).
9.Insert the cannula into a vein, preferably of
an upper limb, using the no touch technique.
10. Look out for flash-back and advance the
cannula slowly.
11. Release the tourniquet and apply a sterile
dressing.
12. Connect up the administration set.
13. Clean site with a 70% ethyl alcohol
swab.
14. Anchor the cannula with clean tape and
label the tape with insertion date and
time.
15. Leave the site visible and dry.
16. Discard all sharps carefully in the
container provided.
17. Wash and dry hands.
Hand hygiene
• Observe proper hand-hygiene procedures either by washing
hands with conventional antiseptic-containing soap and water or
with waterless alcohol-based gels or foams.
• Observe hand hygiene before and after palpating catheter
insertion sites, as well as before and after inserting, replacing,
accessing, repairing, or dressing an intravascular catheter.
• Palpation of the insertion site should not be performed after the
application of antiseptic, unless aseptic technique is maintained
• Use of gloves does NOT obviate the need for hand hygiene
Aseptic technique
• Wearing clean gloves rather than sterile gloves is
acceptable for the insertion of peripheral intravascular
catheters if the access site is not touched after the application
of skin antiseptics. Sterile gloves should be worn for the
insertion of arterial and central catheters .
• Wear clean gloves when changing the dressing on
intravascular catheters.
• Do not attempt repeated insertions with the same cannula. If
the first insertion is not successful, then the procedure should
be repeated with a new cannula.
• Remove the cannula once not needed , after 72 hours or if
showing signs of infection (Blood transfusion? -Total
parentral nutrition?)
Cutaneous antisepsis
• Disinfect clean skin with an appropriate antiseptic before catheter
insertion and during dressing changes. Although a 2%
chlorhexidine-based preparation is preferred, tincture of iodine, an
iodophor, or 70% alcohol can be used .

• Allow the antiseptic to remain on the insertion site and to air dry
before catheter insertion. Allow povidone iodine to remain on the
skin for at least 2 minutes, or longer if it is not yet dry before
insertion.
 6-Procedure for Wound Care
(Aseptic or Sterile Technique)
Wounds must not be touched with dirty hands
and wound care should be an aseptic
procedure:
1. Lay up a trolley with a sterile wound dressing
pack.
2. Remove old dressing (using clean gloves)and
inspect the wound. Discard the gloves.
3. Wash hands aseptically (Surgical or Hygenic
hand wash depending on the size of the
wound or area of devitalized skin ) , dry hands
and wear Sterile gloves.
4. Clean the wound thoroughly using forceps and
cotton wool or gauze soaked in a cleaning
solution. Do not use hands.
5. Exude any fluids from an infected wound by
pressing with two sterile gauze pieces held
with two forceps.
6. Take specimens of pus or exudates for
bacteriological examination.
7. Apply necessary medication.
8. Wipe the wound site as dry as possible.
9. Cover the wound if indicated.
10. Discard all dirty dressings in a clinical waste
bag.
11. Wash and dry hands.
Thank You