Aseptic Technique Fundamentals

Aseptic Technique Basics

• Aseptic technique prevents bacterial contamination, but not viruses and fungi.
• It is required for all procedures, not just surgical ones.
• Surfaces and equipment are potential contamination sources.
• Healthcare-associated infection risks are lowered by using aseptic technique.
• Aseptic technique aims to prevent pathogenic organisms, in sufficient quantities, from causing infection when introduced to susceptible sites.
• Environmental control, hand hygiene, PPE selection, aseptic field management, & non-touch technique are key components to consider when performing procedures.
• Clinicians should address avoidable nearby environmental risk factors prior to aseptic procedures.
• Effective hand hygiene is an essential component of Aseptic Technique, determined as routine or surgical.
• Sterile gloves do not replace the need for non-touch technique.
• Clinician skill, procedure complexity, time and the number of parts or sites determines if standard Aseptic Technique will be standard or surgical.
• Single-use gloves should be used
• All equipment must be cleaned with detergent after an aseptic procedure.
• Hand hygiene is necessary before and after glove use, since gloves may have imperfections.
• Aseptic field management involves protecting key parts and key sites.
• Key parts touching key sites directly requires sterile gloves for contamination risk.
• A wet trolley surface is most concerning during aseptic field management due to contamination risk.

Key Parts and Sites

• Key sites include non-intact skin & insertion or access sites for medical devices.
• Key parts are the sterile components of equipment and must only contact other key parts/sites.

Hand Hygiene

• Hand hygiene is an essential component of Aseptic Technique.
• Routine hand hygiene typically involves using antimicrobial skin cleanser or waterless hand rub formulation.
• Alcohol's quick-drying properties makes it good for hand hygiene when soap and water are not available.

Non-Touch Technique

• Non-touch technique minimizes direct contact with key parts/sites during a procedure.

Environmental Control

• Environmental control is a key component for infection control during invasive procedures.
• Presence of patient bed curtains near the immediate work area is a risk factor in environmental control.
• Environmental cleaning refers to maintaining a clean, healthy, and pleasing patient and work environment by removing visible dirt and contaminated surfaces.

Sterile Equipment

• Key parts include the sterile components of equipment.
• Standard Aseptic Technique is required for clinical procedures that are technically simple, short duration (less than 20 minutes).

Cleaning and Disinfecting

• Disinfectants are for cleaning surfaces and equipment.
• Use a systematic cleaning pattern, like left-to-right or clockwise with overlapping strokes.
• Use a double-bucket system to separate clean and dirty water when mopping.
• Microfiber cloths are effective at removing and trapping bacteria.

Water and Disinfectants

• Cold water should be used when diluting chlorine solutions

Disinfectants

• Always follow manufacturer directions for correct disinfectant concentration
• Ensure adequate ventilation when preparing and using chlorine solutions.
• After spill removal, disinfect spill areas using an appropriate concentration of bleach solution.
• Disinfectants are toxic to human tissues/cells, and designed only for surface/equipment cleaning.

Antiseptics

• Antiseptics are chemicals used for sterilization on living tissues.

Alcohol-Based Disinfectants

• The concentration of ethyl alcohol for surface disinfection should be 70%.
• A minimum wet contact time of 30 seconds when disinfecting with alcohol is needed.
• Alcohol's effectiveness is limited by inability to kill bacterial spores and poor penetration of organic material.
• Flammability is a primary safety concern with alcohol-based disinfectants.
• Ethyl alcohol is commonly used for surface disinfection and skin antisepsis.
• Ethanol and isopropanol are most effective at a 70% concentration for disinfection. Poor penetration into organic matter is a key limitation.
• Rapid evaporation limits the contact time, reducing efficacy.

Chlorine

• Adequate ventilation and the use of cold water are important when preparing/using chlorine solutions.
• Reapply chlorine-based disinfectants if the surface dries before the recommended contact time to ensure it remains wet to kill pathogens.
• Chlorine's effectiveness is reduced by organic matter.
• Optimal pH range for chlorine disinfection is 6.0-7.5.
• Chlorine and tincture iodine are examples of halogens.

Hydrogen Peroxide

• A key advantage of hydrogen peroxide as a disinfectant is that it breaks down into water and oxygen, leaving no toxic residue.

Detergents

• Cationic detergents disrupt microbial cell membranes to kill bacteria, fungi, and enveloped viruses, but not bacterial spores.

Quaternary Ammonium Compounds (QACs)

• Quaternary Ammonium Compounds (QACs) are less irritating and noncorrosive.

The 10-Minute Rule

• This rule requires surface saturation with disinfectant for the entire duration.

Mixing Chemicals

• Chlorine should never be mixed with ammonia, acids, or other cleaning products to prevent toxic gas formation.

Aldehydes

• Glutaraldehyde and formalin are effective in killing all microorganisms, including spores.

Phenol

• Dettol and its derivatives are examples of phenol.

Chain of Infection

• Regular hand hygiene practices is most crucial in breaking the chain of infection in a healthcare setting.
• Environmental cleaning is a key element in breaking the chain of infection.

Cleaning Types

• Routine cleaning should focuses on the daily cleaning and disinfection of high-touch surfaces in patient care areas.
• Terminal cleaning is the thorough cleaning and disinfection of patient rooms after patient discharge.

Corrective Actions for Environmental Concerns:

• Check for avoidable nearby environmental risk factors, such as patients using commodes.
• Check for presence of patient bed curtains across the immediate work area.

Waste Management

• Hospital waste is defined as waste produced during healthcare activities.
• Contamination of water sources by improperly disposed medical waste is environmental pollution.
• Improper disposal of medical waste can cause widespread community health issues
• Corrective Action: Ensure handlers are vaccinated against HBV and tetanus.
• Healthcare waste management includes diagnosis procedures.

Waste Streams

• There are different waste types, the management activities for each may differ
• Sorting, Handling, and Transport are processes in waste management handling.
• Waste should be separated by type at the point of generation.
• The separation by type at the point of generation is the 1st step in the waste sorting process.
• The 1st step in effective waste sorting is separating waste by type at the point of origin
• There should be proper segregation following interim storage guidelines.
• Liquid waste should be poured down designated sinks/drains

Healthcare Workers

• Medical personnel and waste handlers face exposure risks (direct and potential health hazards) from waste

Color-Coded Bags

• Color coding helps to easily distinguish between different types of waste.
• Color coding uses designated colors to separate waste by type

Solid Waste

• General waste is waste that poses no risk to human health, such as paper and wrappers; is not hazardous.
• Solid general waste is not incinerated or autoclaved before disposal.

Sharp Waste

• Sharp waste includes needles/scalpels, requiring extreme caution.
• Sharps and chemicals are examples of hazardous waste.

Containers:

• Sharps containers should be puncture-resistant and leak-proof and discarded when they are three-quarters full to prevent injuries.

Bag Colors:

• Red bags are typically designated for infectious waste.
• Yellow bags are not exclusively for pathological waste.

Waste Storage

• Waste can be stored in the generation area for no more than 4-6 hours.

What goes where?

• Human tissue and bodily fluids are considered pathological waste.
• Office paper, wrappers and kitchen waste are not examples of pathological waste.
• Expired medications should be categorized as pharmaceutical waste.
• Waste from human/animal healthcare and not agriculture, residential areas, or industrial manufacturing is included under the scope of hospital waste management.

Transportation and Storage

• Should be done using seprate corridors and lifts, and regularly checked by sanitation supervisors.

Chemical waste

• Is defined as things used for cleaning and sterilizing healthcare settings.
• Chemical waste does not include only laboratory reagents and not disinfectants.

Radioactive waste

• Radioactive contamination can occur with unused liquids from radiotherapy and they are considered Radioactive waste
• Unused liquids from radiotherapy or laboratory research are considered radioactive waste and require careful handling.

Infectious Waste

• Waste that transmits bacterial, viral, or parasitic diseases with infectious waste, so it requires special handling.
• Hepatitis B and C can be transmitted through infected needles and other sharp instruments: is a viral disease for medical waste called HIV and requires special handling

Improper disposal

• Improper disposal of medical waste is an environmental and food chain threat

Procedures

• Correct aseptic technique involves preventing contamination and pathogen transfer from hands, surfaces, and equipment to the patient during procedures.