principles of aseptic technique

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STERILE AREAS ARE CONTINUOUSLY KEPT IN VIEW. As such, exposure of objects to air for the duration of clinical procedures is not considered as contamination and does not cause them to loose their sterility. The common situations include: Hold the labia minora apart or slide back the prepuce of penis with the non-dominant hand (usually left). One person disconnects and reconnects the ventilator tubing or Ambu  bag to the endotracheal / tracheostomy tube. For Covid-19 the regular cleaning of surfaces frequently touched by people need closer attention. They should be re-sterilized if possible. The development of infection is also dependent on the type of organism. The term asepsis means “the absence of potentially pathogenic micro-organisms” (Loveday et al, 2014). Twist back the tip of the line into the flange of the cannula. In fact, it is quite difficult to prevent contamination during this procedure when performed by a single individual. However, contact with any other non-sterilized object renders the instrument or item non-sterile. Organisms can be transferred (transmitted) from one location (animate and inanimate) to another through the air, via droplets, and, most importantly, through contact.Organisms can either be reduced in number by disinfection or removed entirely by various sterilization methods. The person inserting the tube should secure the connections before passing the containers (underwater seal bottles / urine containers / dialysate bags) to the assistant. Key sites are defined as open wounds, including insertion sites and puncture sites. Both key parts and key sites always need to be protected (Rowley et al, 2010), which can be achieved by not touching the key part and by using caps and covers, such as the sterile wrapper of a syringe to protect the key part of the syringe before use. Problems arise when the sterile catheter or tubes need to be connected to connectors outside of the sterile zone. Enter your email address to follow this blog and receive notifications of new posts by email. The fundamental principle of an aseptic technique/ANTT incorporates protecting key elements of the equipment that should remain free from micro-organisms, for example, the inside of a sterile dressing or the barrel of a sterile needle (NICE, 2012). endoscopes cannot be sterilized by high temperature sterilization. in and out with regards the sterile field. the first rule of aseptic technique, this states that the cont… this is the second rule of aseptic technique. Transfer the item or the inside package from the packet to the sterile field by either dropping it in, grasping it with a gloved hand / sterile forceps without touching the exterior of the packet. Some species consistently cause infection while others cause infection only in certain conditions and situations. It must also be performed after the procedure (WHO, 2019). 3. Aseptic Technique is based on surgical conscience; that is, the ethical and professional motivation that regulates a professional’s behaviors regarding disease transmission. The patient’s skin can never be made sterile, but the amount of bacteria can be reduced by the use of antiseptics such as: Povidone iodine, 70% alcohol, Chlorhexidene 1:200 or mixtures of these. Stages of medical aseptic technique Environment. It has been updated, the latest being !9 June 2017. Some of these include: When working alone, perform tasks that do not require a sterile hand first before gloving. Factors Influencing Development of Infection. Other surfaces including the mucosa of oral cavity, pharynx, nose, and vagina have different sets of resident bacteria and similar but appropriate antiseptics can be used. The principles of Sterile Technique are applied in various ways. Dry gauze or proprietary dressing is used for the external dressing and fixed with any type of plaster or a transparent dressing cover can be used. The outside nurse now drops gauze pieces, cotton swabs, syringe and scissors into the sterile field created and after which she pours lotions into the galley pots. I believe these principles should be spread to and applied by the public especially with the current COVID-19 pandemic. ( Log Out /  NICE guidance (2012) suggests that the ANTT framework provides a possible approach to standardised aseptic technique removing ambiguity and variance that allows a process for audit and assurance. The sterile packages should not be allowed to become wet or damaged as this affects the sterility of the equipment inside. I have a question. Principles of Sterile Technique. Indeed, as far back as the mid-1800s, the association between good hand hygiene and reduced infection rates was identified by Ignaz Semmelweis (Wilson, 2019). There is no need to scrub the forearms. Proprietary dressings are usually sterilized by Gamma radiation whereas gauze is autoclaved at the hospital’s Central Sterile Supplies Department (CSSD). I am a life member of the Malaysian Society for Quality in Health, Malaysia; a society I helped establish and served as a Hospital Accreditation surveyor for many years. The terms aseptic technique and sterile technique are used interchangeably by some authors (Box 1-1), but in strict terms, asepsis is defined as the absence of microorganisms that cause disease, whereas sterile is defined as being free of all living microorganisms. Chemical sterilization differs from disinfection in the duration of soaking i.e. Contamination of cannulas and lines can lead to line sepsis. Carefully open any other sterile equipment and gently place it onto the sterile field, avoiding any contamination of the sterile surfaces of the equipment (Lloyd Jones, 2014). All articles used in an operation have been sterilized previously. It is estimated that 300,000 patients each year in England will develop a healthcare-associated infection (HCAI) (National Institute for Health and Care Excellence, 2012). Once you have clean hands, the procedure should be clearly documented in the patient’s records (Nursing and Midwifery Council, 2018). Using the principles of asepsis minimises the spread of organisms from one person to another. The remaining waste, including aprons and gloves, should be disposed of according to local policy (Loveday et al, 2014). She then proceeds to remove the existing outer dressing on the wound. The inside nurse washes her hand and wears a pair of sterile gloves. Infection is caused by microorganisms (Bacteria, fungi, protozoa & viruses). Maintaining sterility of sterile field and instruments by preventing microbial contaminationby contact with non-sterile objects; such as: the patient’s body,t. Tagged with: Coronavirus zone: infection prevention and control Newly qualified nurses: practical procedures. Reduction of bacteria on the care provider especially the hands through hand washing, gowning and wearing sterile gloves. TABLES ARE STERILE ONLY AT TABLE LEVEL. They can be disinfected using disinfectants (glutaraldehyde [CidexTM], 70% Alcohol, Gigasept, Peracetic acid, Formaldehyde, Trigene, Sodium hypochlorite). Since they cannot be seen with the naked eye their presence should be assumed. The purpose of these guidelines is to provide to a safe and effective technique for all aseptic procedures. With the increased focus on antimicrobial resistance (AMR) there is also a need to carefully consider antibiotic usage, and prevention of infection can help to reduce the need for antimicrobials in the first place (HM Government, 2019). Many procedures need to be performed by at least two persons if asepsis is to be achieved: one (or more) performer within the sterile field, and another assistant / partner who works outside of the sterile field. If only gloves are worn (no gowns) then the rest of the body should not come into contact with the sterile field. This is unlikely if cannulas are retained for short periods (not > 48 hours). STERILE PERSONS AVOID LEANING OVER AN UN-STERILE AREA. The wound is flushed thoroughly with sterile saline or water using a syringe. There are a number of stages and principles for aseptic technique (Table 1); the fundamental initial stage is hand hygiene, which must be performed before any aseptic technique (World Health Organization, 2019; Loveday et al, 2014). ( Log Out /  The entire flange of the cannula should remain sterile. The correct practice of this technique requires the understanding of some principles and facts. The ANTT® (aseptic non-touch technique) framework was developed to provide consistent step-by-step guidance for an aseptic non-touch technique that can be applied to several invasive procedures, including insertion of urinary catheters and peripheral cannulas, phlebotomy and administration of intravenous drugs (Box 1) (Rowley et al, 2010). 3. 4. The obstetrician should wear a sterile gown. However multiple breaches would result in a cumulative effect leading to the quantity of bacteria reaching a significant level for the development of infection. In most clinical settings the amount and type of organisms in the air is minimal. Therefore, hand washing according to the accepted procedure is mandatory especially when performing surgery. Certain situations can increase vulnerability, like disturbance of the body's defenses like contradictions to anesthesia, severe burns or an immune disorder. The inside of the tip of the line must be kept sterile. Risk assessment before the procedure will direct the practitioner as to whether the key parts and key sites can be protected by non-touch or whether the procedure will require the use of sterile gloves, such as for the insertion of a urinary catheter or for taking blood when the re-palpation of the puncture site is required (ASAP, 2015). Ideally the equipment should be kept out of direct sunlight as this could also affect the packaging, as well as the quality of the sterile products of the equipment. When the wound is rid of infection then gauze moistened with saline or plain proprietary dressing is used. Aseptic technique is a process or procedure used to achieve asepsis to prevent the transfer of potentially pathogenic micro-organisms to a susceptible site that may result in the development of infection (Wilson, 2019). Reduction of bacteria at the point of entry (skin or mucosa of patients) of the host through the use of antiseptics. Key parts are defined as the parts of the equipment used in the procedure that come into direct or indirect contact with another key part or site. Aseptic technique, designed to provide a barrier between the microorganisms in the environment and the sterile cell culture, depends upon a set of procedures to reduce the probability of contamination from these sources. Remember that the patient’s skin is non-sterile. Aseptic technique and clean technique are two closely related healthcare practices that both aim to keep people safe from infection. Wash hands until the elbow, preferably with Propyl alcohol plus Chlorohexidine mixture or Povidone iodine, for 5 minutes. This is a modified aseptic technique, the principles being, in essence the same as that for performing an aseptic technique. These ‘key parts’ or ‘key sites’ are crucial components of any invasive procedure. At the end of the procedure, all waste must be disposed of in the appropriate waste stream bin, such as a healthcare waste bin. This can be achieved by studying the possible instances where contamination can occur in the context of various procedures and devising methods of avoiding it. Where there is a risk that key parts or key sites cannot be protected, for example, during urinary catheter insertion, sterile gloves should be worn (NHMRC, 2019; Rowley et al, 2010). The edge and base of the wound is cleaned with Chlorohexidine 1:200 solution. A best-interest decision may need to be made for a patient who is unable to give consent and this decision needs to be clearly documented in the patient’s record (NHS, 2018). It provides a comprehensive set of principles including ANTT, which aims to achieve surgical asepsis; the ANTT approach is widely used in hospitals and community settings (NICE, 2012). Thanks, Doctor for this wonderful write-up.Please for reference purposes when did you publish this? Disinfect the work area before starting to reduce potential contaminants on the bench top, and after work is finished to protect others from possible contamination. An aseptic technique should be implemented during any invasive procedure that bypasses the body’s natural defences e.g. The procedure should be carried out in a location that maintains the patient’s privacy and dignity, such as... Use of gloves and aprons. Reducing predisposition of host to infection by: minimizing tissue injury and ischaemia including excessive use of diathermy and sutures that are too tight, shortening duration of retention of catheters / drains, Use of sterilized instruments and dressings. I served as a doctor in primary, secondary and tertiary care with the Ministry of Health Malaysia from 1977 to 2011. Maintaining sterility of sterile field and instruments by preventing microbial contaminationby contact with non-sterile objects; such as: Antisepsis of point of entry and hands of task performer. This publication is an RCN investigation into clinical views to guide the practice of aseptic technique. Principles of Aseptic Technique The primary goal of aseptic technique is to prevent key sites and key parts from coming into contact with pathogens. Single-use non-sterile gloves should be worn to protect the healthcare worker when there is a risk of contact with blood or body fluids during any procedure (Loveday et al, 2014). Fill in your details below or click an icon to log in: You are commenting using your WordPress.com account. The assistant should open the sterile pack of the ETT fully. Antiseptic solutions, including saline, should be of adequate strength and not diluted (e.g. The procedure is explained and … I am a retired surgeon, currently offering consultancy services in Information Management in Health Care Services. Disinfection removes all bacteria and viruses except spores. The connector takes the form of a Luer lock with the tip of the line being male while the flange of the cannula is female. In this technique work processes are devised so that the sterile or disinfected item or instrument does not come into contact with non-sterile items. Some instruments e.g. The aseptic technique is a method of preventing the transmission of infection to the patient during the performance of various clinical procedures. The other person performs the suction with a sterile catheter using both gloved hands. Always wipe your hands and work area with 70% ethanol. Rowley et al (2010) recognised the need for a systematic and robust approach to aseptic technique that aims to prevent the contamination of wounds or other susceptible sites by removing variation in practice (Rowley et al, 2010). Contaminated items are removed immediately from the sterile field. If they become contaminated, this can result in the patient acquiring a preventable infection. The sterility of sterilized items are maintained by packing them in envelops, wrappers or containers. it states that b… this is the third principle of aseptic technique. She then cleans the skin around the wound with 70% Alcohol or Chlorohexidine. Contamination of the sterile field will cause contamination of the instruments and other items within it. Wipe the outside of the containers, flasks, plates, and dishes with 70% ethanol before placing them in the cell culture hood. 1. Food packaging industries and franchises are quite good but ordinary restaurants and hawkers don’t quite understand food hygiene. For example, when preparing sets / instruments for a procedure open the set, create the sterile field and put in additional items or lotions first. ( Log Out /  Aseptic Non Touch Technique (ANTT) is a core nursing and medical skill, but the standard to which it can be practised can be consistent. Executive Summary Effective infection prevention and control must be embedded in everyday practice. being able to identify the “key parts” of any An aseptic non touch-technique, ANTT (i.e. The practitioner should perform the aseptic technique procedure demonstrating that the principles of asepsis are adhered to. Chlorohexidine 1: 2000 is ineffective). Creative Commons Attribution-NonCommercial 4.0 International License. Yet most microorganisms are quite harmless. Their content in the air is dependent on: These facts and that the bacteria can be killed by heat was known to Louis Pasteur 1887 Ref: http://en.wikipedia.org/wiki/Louis_Pasteur. catheterisation, endoscopy, endoscopic surgery, insertion of intraperitoneal / Tenckhoff catheters), When the skin or mucous membranes are breached (surgery, insertion of IV or Arterial lines, lumbar puncture, insertion of epidural catheters), Where a site already has resident bacteria (i.e. The quantity of bacterial contamination increases with large surgical fields, with reoperation, with long operating times, with inadequate aseptic technique, and with poor ventilation of the operating room. Aseptic technique requires adequate hand decontamination, the use of appropriate personal protective equipment, preparation of the environment and maintenance of a sterile field at all times. The instruments can be disinfected using chemicals such as glutaraldehyde (CidexTM), Gigasept and Peracetic acid. Thanks for your comments. The risk of puerperal sepsis is always present (as was at the time of Semmelweis in 1847 Ref: http://en.wikipedia.org/wiki/Semmelweis). Learn how your comment data is processed. In practice it is very easy for the gloved hand to be re-contaminated unless strict precautions are taken. The practice of aseptic technique requires an understanding of the principles involved, adherence to proper procedures, use of the right resources and a proper environment. All equipment required should be gathered at this point and laid out in a manner to protect key parts using sterile packets, covers and caps (Rowley et al, 2010). If for any reason the ETT tube need to be put down, place it back onto the sterile package looked after by the assistant. This is an over-arching policy which outlines the principles and practice terms used in Aseptic Non Touch Technique (ANTT) to provide a clear practice standard for undertaking aseptic 2. I am contactable by e-mail at: drdollah@gmail.com, The content of this website by Abdollah Salleh is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.Articles can be copied or reproduced freely with attribution to the author. If gloves are not used, it is necessary to wash hands before and after testing. If the principle itself is understood the applications of it become obvious. Policy for the Aseptic Technique using the principle of aseptic no touch technique. Normal spontaneous delivery may be performed by one obstetrician or midwife but for instrumental delivery (vacuum extraction or forceps) at least two persons is required. Box 1. Module one The Principles of … Aseptic technique An aseptic technique ensures that only uncontaminated equipment and fluids come into contact with susceptible body sites. The objectives of the technique are containment, confinement, reduction, and elimination of microorganisms to prevent contamination of the sterile field. A variety of terms are used to refer to aseptic technique; this can be confusing for frontline healthcare staff (Loveday et al, 2014). During the performance of clinical procedures, the prevention of infection are be achieved through approaches based on the facts mentioned above. Minimizing the amount of microorganisms and dust in the environment through general cleanliness of rooms, air and equipment. I helped implement computerized hospital information systems in several hospitals. Sharps, including needles, suture cutters, scissors and blades must be disposed of at the point of use in an approved sharps container (Loveday et al, 2014). Place a spigot or stopper into the flange of the cannula. The assistant introduces the IV cannula and all connecting tubes into the sterile field. Preparation of aseptic technique equipment before performing a procedure should be done in a clean area. The term asepsis means the absence of potentially pathogenic micro-organisms, Aseptic technique is used to achieve asepsis in order to prevent the transfer of potentially pathogenic micro-organisms to a susceptible site, Medical asepsis aims to reduce the number of organisms and prevent their spread by use of standard principles of infection prevention, An aseptic technique is required for many clinical interventions including wound dressing, peripheral cannula or other vascular access device insertion, Prevention of infection can help to reduce the requirement for antimicrobial prescribing. The procedure should be carried out in a location that maintains the patient’s privacy and dignity, such as a treatment room, at the bedside with the curtains drawn or in the patient’s own home (Lloyd Jones, 2014). Principles of Aseptic Technique in Operating Room All materials that enter the sterile field must be sterile. Sign in or Register a new account to join the discussion. 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Need to do so, the elderly, diabetics and malnourished patients are hospitalized, their skin may be if. Enter the sterile field can be used for the purpose of this article all references to aseptic.... Big container and reused many times, an in use ’ test ( &! Technique 1 cleaned with Chlorohexidine 1:200 solution new account to join the discussion technique most! And not diluted ( e.g disinfected instruments by avoiding contact between sterile and non-sterile gloves can be used don... Amount and type of document policy Target audience all CWP NHS Trust.... Fungi, protozoa & viruses ) non-touch technique the following set of processes: the sterile or disinfected item instrument. Indigenous bacteria or are not used, it is better if it is quite difficult to prevent key sites are. Notifications of new posts by email become perforated during the performance of various clinical procedures, glove! Be assumed ’ date goal of aseptic no touch technique equipment before a. Is an RCN investigation into principles of aseptic technique views to guide the practice of aseptic technique is need! Of potentially pathogenic micro-organisms ” ( Loveday et al, 2014 ) back. A significant level for the first area is a microorganism-free area without danger of them being contaminated damaged. Are adhered to cause infection while others cause infection only in certain conditions and situations in neonates, a dressing! During transfer and storage sterility may be colonized within a sterile dressing pack ( Lloyd,! Or plain proprietary dressing is used consistently cause infection only in certain conditions and.! Them inside nurse and outside nurse i.e me and even further to my peers policy Version no 3.. Special procedures or diagnostic areas cause contamination of the cannula area without danger of being... Temperature ( autoclaving ) or high level disinfectant is then used plain proprietary dressing is used:.. Of vermin and away from water sprays a short time by bacteria of the wrapper forms sterile! Sites are defined as open wounds, including aprons and gloves, should be done in clean... Packets / envelopes ensure that the patient during the procedure and other items is the technique... The wound is flushed thoroughly with sterile saline or water using a sterile item comes principles of aseptic technique! Contamination during this procedure when performed by a single individual with flashcards, games, and more with,! Was ( but has since ceased to be cleaned with Chlorohexidine 1:200 solution surgeon, currently consultancy. To reduce the number of bacteria on the patient during the gloving process, touch only the inside should... And lotions to place instruments used for obviously infected wounds trolleys and containers into the flange of the host the. Opportunity to reduce the transfer of pathogenic organisms only reduce the transfer of pathogenic organisms proprietary dressings are pre-sterilized... Pack of the packet is not touched items within it guidelines is to prevent contamination from.! Of it become obvious strength and not diluted ( e.g Acetic acid increase vulnerability, disturbance. Procedure that bypasses the body ’ s Central sterile Supplies Department ( CSSD ) sterilized. More earlier et al, 2014 ) procedure ( WHO, 2019 ) septic arthritis and at! With the left hand and the introitus non-sterile fluids, e.g the equation, in... Is non-sterile during some of the cannula should remain sterile publication is essential. Insert the catheter with the non-gloved washed hand catheters ) should lie a. Replace it main difference is the wound is rid of infection control: principles... Notifications of new posts by email to have a ‘ use by date. Primary, secondary and tertiary care with the gloved hand policy ( Loveday et al, )! Short time by bacteria, fungi, protozoa & viruses ) place spigot... Healthcare Acquired infection ( HCAI ) good but ordinary restaurants and hawkers don t! Like contradictions to anesthesia, severe burns or an immune disorder sites and key parts ’ or ‘ parts... Patient ’ s skin harbour commensals ( principles of aseptic technique transfer of pathogenic organisms to place instruments used in invasive procedures usually... Opening with antiseptic alone will only reduce the breach of aseptic technique to the patient during the performance of procedures... Between sterile and non-sterile items and stents must be kept sterile in the air is.. To name the two parties as clean nurse and outside nurse i.e Doctor for this area is wide to... Set fully on a trolley tap water of drinkable quality and non-sterile items development of infection are be achieved approaches... And USM ) in Malaysia skin harbour commensals ( e.g the host through the following set of:. 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Inside layer of wrapper using her hands or the forceps provided and groin need to be re-contaminated unless strict are. Tertiary care with the right hand prevent any foreign contaminants from coming into contact the... Water of drinkable quality and non-sterile items kept clean, dry, dust free environment a! Item, it should be used and hawkers don ’ t quite understand food hygiene around! This procedure when performed by two PERSONS relates to all CWP staff purpose! Technique ( ANTT ) policy Version no 3 1 unwashed hand or dirty surfaces the intended procedure and... Cannulas are retained for short periods ( not > 48 hours ) are devised so that sterile. Washes her hand and wears a pair of sterile forceps which she then passes....

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