Aseptic Technique

Dr Lubega

outline
Definition Key principles of aseptic technique Sources of infection Standard precautions The Sterile field

Definitions
Infection Control Program of disease surveillance, designed to investigate, prevent, and control the spread of infections and their causative microorganisms Aseptic Techniques Are the methods and procedures used to create and maintain a sterile field

Types of Aseptic Technique

ASEPTIC NON-TOUCH TECHNIQUE: Operates on a basis of identifying key parts of equipment which if touched could potentially cause infection. Key parts can be for example needles, syringe tips, IV connections. SURGICAL ASEPTIC TECHNIQUE: This is practiced only within operating theatres under strict conditions. Requires the use of surgical hand scrub, sterile theatre gown, sterile surgical equipment and surgical field. However a modified version maybe used in ward areas for procedures which are more invasive.

Examples of when to use an Aseptic Technique

Insertion of invasive vascular devices, for example Peripheral Venous Catheter, Central Venous Catheter, Peripherally Inserted Central Lines Obtaining blood samples for example, blood cultures Undertaking medical procedures where the skin or mucous membranes are breached Insertion of urinary catheters Undertaking wound dressings Suturing of wounds

Key Principles of Aseptic Technique

1. Perform Hand Hygiene 2. Create a sterile field where possible 3. Open and prepare the sterile equipment without touching the critical parts 4. Use non-sterile or sterile gloves appropriate to procedure 5. Appropriate patient and equipment preparation. 6. Do not touch critical parts of equipment during procedure e.g. PVC tip, do not re-palpate vein during PVC insertion 7. Safe technique

How to ensure an effective Aseptic Technique

Sterile equipment is stored in a clean dry environment, free from dust, and off the floor to protect the integrity of the packaging and equipment Single-use items are only used once

Single patient use items are only used for one patient
If using reusable items, these should be decontaminated following use as per manufacturers instructions and local policy/ procedures.

Sources of Infection
Humans Sources
Include
patients personnel visitors

Can be
Carrying an acute disease In the incubation period of a disease Colonized by an infectious agent Chronic carriers of an infectious agent

Other Sources
Pts own Endogenous Flora (internal microbes useful to the body) Contaminated Objects
Equipment Medications

Standard Precautions
Apply to
All patients receiving care in hospitals regardless of diagnosis or presumed infection status Blood All body fluids, secretions, and excretions except sweat Non-intact skin Mucous membranes

Are designed to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection in hospitals

Standard Precautions
Include:
Handwashing Gloves Mask and eye protection Gown Patient care equipment Environmental control Linen Occupational health and bloodborne pathogens

Handwashing
Hands should be washed:
Immediately after touching,
Blood Body fluids Secretions Excretions Contaminated items

Immediately after gloves are removed Between tasks and procedures on the same patient

Plain soap should be used Procedures

Should last a minimum of 15 seconds Involves vigorous rubbing together of all surfaces of lathered hands Followed by rinsing under a stream of water

In the case of specific circumstances such as control of outbreak or hyperendemic infections, an antimicrobial agent may be used

Gloves
Clean gloves should be worn when:
Touching
Blood Body fluids Secretion Excretions Contaminated items Mucous membranes Non-intact skin

Gloves should be changed in between tasks and procedures on the same patient Gloves should be removed promptly after use

Gloving Procedures
Glove pack is opened Sterile wrapping containing gloves should be opened on a sterile surface with cuffs toward person gloving Sterile portion of a glove pack is opened by grasping the folds of the paper enclosing the gloves Grasp the left glove with your right hand by its cuff on the non-sterile portion and work your left hand into it. Once left is in place, place the first two or three fingers of the left hand inside the sterile side of the cuff of the other glove He lift the right glove using the fingers inside the cuff only Then work the right hand into the glove pulling the sleeve over the gown Now place the right fingers on the inside of the left glove cuff and pull that over the gown Once gloved both hands must remain above waist level

Removal of Gloves
One hand grasps the cuff of the other glove The glove that is grasped is turned inside out as it is removed The glove that is removed is compacted into the other glove The thumb of the ungloved hand is hooked inside the remaining glove The remaining glove is pulled towards the fingers while being turned inside out Both gloves are removed with contaminated sides inward Do not snap the gloves Dispose the gloves in the appropriate container

Mask and Eye Protection

Are worn to protect mucous membranes of the eyes, nose & mouth of health care providers Should be worn when performing procedures and patient care activities that are likely to generate splashes or sprays of blood, body fluids, secretions and excretions

Gown
A clean sterile gown can protect the skin and prevent soiling of clothing of health care workers Should be worn when performing procedures and patient care activities that are likely to generate splashes or sprays of blood, body fluids, secretions and excretions Should be removed promptly after procedure

Gowning Procedures
Open sterile pack Grasp gown with hands above waist at all times Shake open gown so it unfolds Locate the neck and armholes of the gown Without touching the outside, work both arms into the sleeves Have a nurse or other personnel tie the gown at the back and neck

Patient Care & Equipment

Used patient care equipment that is soiled in blood, body fluids, secretions or excretions should be handled in a manner that prevents skin and mucous membrane exposure, contamination of clothing, and transfer of microorganisms Ensure that equipment is not used for another patient until it is cleaned appropriately Ensure that single use items are discarded properly

Environmental Control & Linen

Ensure that hospital protocols are in place regarding routine care, cleaning, disinfection of environmental surfaces, beds, bedrails, bedside equipment and other frequently touched surfaces Handle, transport, and process linen soiled with blood, body fluids, secretions, and excretions in a manner that prevents skin and mucous membrane exposures and contamination of clothing

Occupational Health & Bloodborne Pathogens

Disposable syringes and needles, scalpel blades and other sharp items should be
Handled with care Disposed of in proper puncture proof containers.

Never
Recap used needles Manipulate them using both hands Direct the point of a used needle toward any part of the body Remove needles from disposable syringes by hand Bend, break, or manipulate used needles by hand

Mouthpieces, resuscitation bags & other devices should be used as an alternative to mouth to mouth rescusitation

Sterile Field
Another aseptic technique is to provide and maintain a sterile field. A sterile field is most commonly required in an operating room There are 8 requirements for providing and maintaining a sterile field.

Requirement 1
All items used within the boundary of a sterile field must be sterile Single use items are preferred Packages are considered sterile only when
Initial packaging was performed properly Package was stored in a proper manner Package was not mishandled during distribution Shelf life data has not been exceeded

Requirement 2
Once a package is opened, the edges are not considered sterile Care in opening sterile packages is required to avoid having edges touch the contents of the package, or having the edges touch the gloved hands or sterile gown

Requirement 3
Once donned properly, sterile gowns are considered sterile in the front from the shoulder level to table top level, including the sleeves Hands should be held above table top level, in front of body during and after scrubbing, gowning & gloving

Requirement 4
Only the top surface of a table is considered sterile Any surface above the level of the instrument table, or above waist level, whichever is higher, is a sterile surface as long as it is draped properly Undraped or improperly draped surfaces, or surfaces below the top level of the instrument table or waist, are considered unsterile

Requirement 5
Only sterile items and personnel in sterile attire may enter the field or touch items in a sterile area. Forceps can be used to transfer items into a sterile area, but are considered contaminated after one use.

Requirement 6
Activity in a sterile area cannot be allowed to render the area unsterile. Movement within the sterile area must be measured and careful to avoid contact between sterile and unsterile surfaces. Any contamination of a sterile area must be pointed out immediately by any personnel present for the protection of the patient

Requirement 7
Penetration of a sterile barrier is considered to cause contamination of a sterile field. Penetration can be via
Liquid (most likely) Airflow

Requirement 8
Sterile areas and fields should be prepared as close to the time of use as feasible They should not be left unattended Where there is doubt about the sterile quality of an area, a field, or an item, it should be considered unsterile.

conclusion
Its the responsibility of everyone involved in the patients care to observe infection prevention procedures when caring for the patients. In healthcare standard precautions should always be used.