Aseptic Technique: Preventing Infections

• Aseptic Technique aims to prevent pathogenic organisms, in sufficient quantity to cause infection, from being introduced to susceptible sites by hands, surfaces, and equipment, as per the National Health and Medical Research Council (2010)
• Aseptic Technique also protects patients during invasive clinical procedures by employing infection control measures to minimise the presence of pathogenic microorganisms

Why Practice Aseptic Technique

• Reduces the risk of health care-associated infections
• Is required for all invasive procedures
• Has been shown to significantly improve clinical practices and reduce infection risk

Preventing Infections

• Correct Aseptic Technique prevents contamination and transfer of pathogens from hands, surfaces, and equipment to the patient during procedures
• Requires key parts and key sites to be identified and protected at all times
• Key parts must only contact other key parts and/or key sites

Key Sites

• Any non-intact skin and insertion or access sites for medical devices connected to the patient are key sites
• Examples of key sites include insertion/access sites of intravenous devices and urinary devices, and open wounds

Key Parts

• Sterile components of equipment used during the procedure are key parts
• Examples of key parts include bungs, needle hubs, syringe tips, dressing packs

Key Infection Control Components

• There are several key infection control components to consider when performing any invasive procedure:
  • Environmental control
  • Hand hygiene
  • PPE selection
  • Aseptic Field Management
  • Non-touch technique
  • Sequencing

Environmental Control

• Clinicians must ensure there are no avoidable nearby environmental risk factors prior to aseptic procedures
• Examples include bed making, patients using commodes, waste management, cleaning, and patient bed curtains across the work area

Hand Hygiene

• Effective hand hygiene is an essential component of Aseptic Technique
• Routine or surgical hand hygiene is required depending on the procedure being performed
  • Routine hand hygiene involves using soap/solution and water or an alcohol-based hand rub
  • Surgical hand scrub requires the use of an approved antimicrobial skin cleanser or waterless hand rub formulation
• To use alcohol-based hand rub, apply the manufacturer’s recommended amount to dry hands, rub hands together to ensure all surfaces are covered, paying particular attention to fingertips, thumbs, and areas between fingers until the solution has evaporated and hands are dry (approx. 20-30 seconds)
• To use soap and water, wet hands under tepid running water, apply recommended amount of liquid soap, rub hands together for a minimum of 15 seconds, paying particular attention to the fingertips, thumbs, and areas between the fingers, then rinse thoroughly under running water and pat dry with single-use towels

Surgical Hand Hygiene

• Surgical hand preparations reduce the release of skin bacteria from the hands for the duration of the procedure
• Surgical hand preparation must eliminate the transient and reduce the resident flora
• Specific facility policies and procedures should be followed regarding surgical hand hygiene products and methods

Protective Personal Equipment (PPE)

• Gloves are single-use items
• Sterile gloves must be used to minimise the risk of contamination if it is necessary to touch key parts or key sites directly
• Non-sterile gloves may be necessary to protect the clinician from blood or body fluids or exposure to toxic drugs during administration if key parts or key sites are not touched directly
• Gloves do not replace the need for hand hygiene; hand hygiene must be performed before and after glove use
• Selection of sterile or non-sterile gloves depends upon clinician competency
• The clinician should assess their competence and experience in performing the procedure and determine whether touching key parts or sites is required when preparing for the procedure
• Sterile gloves are required if touching may take place
• Protective Personal Equipment (other than gloves) may be required if indicated to reduce the risk of blood and body fluid exposure to the clinician
• Maximum barrier precautions may be required during some procedures (such as CVC insertion) to reduce the risk to the patient of acquiring a healthcare-associated infection
• Local policy and procedures will determine if maximum barrier precautions are necessary

Aseptic Field Management

• It is imperative the clinician determines the aseptic field required and how that field will need to be managed before commencing a procedure requiring AT
• Key parts and key sites must be protected via aseptic field management
• The aseptic field should be prepared as close as possible to the time of actual use
• To ensure key parts are adequately contained, the clinician should choose a tray or trolley of appropriate size
• The tray or trolley must be cleaned appropriately and allowed to dry before placing items in or on it, as asepsis will be compromised if the surface remains wet
• The aseptic field may also need to be extended by draping the patient; the sterile drape will provide additional work space to place sterile equipment and also protect the key site from contamination

Non-Touch Technique

• An important component of AT, even when sterile gloves are used, is a non-touch technique
• It is well documented that hand hygiene can fail to remove all pathogenic organisms, hence the need for non-touch technique
• A non-touch technique avoids touching and thereby contaminating key parts and key sites; the safest way to protect a key part is not to touch it

Sequencing

• Practice must be sequenced to ensure an efficient, logical, and safe order of procedure events
• Practice guidelines provide direction as to the correct order in which preparation and completion of the procedure should be undertaken
• Clinicians should be familiar with the sequence of these events prior to commencing the procedure to ensure preparation for the procedure is complete and to ensure adherence to AT

Types of Procedures

• Depending on the clinician's assessment, there are two types of Aseptic Technique:
  • Standard AT
  • Surgical AT

Standard AT

• Standard AT is required for clinical procedures that are:
  • Technically simple
  • Short in duration (approximately less than 20 minutes)
  • Involve relatively few and small key sites and key parts
  • Clinician should feel competent and experienced to perform the procedure without touching key sites or parts
• Standard AT requires a main general aseptic field and may permit the use of non-sterile gloves if no contact is being made with key parts and sites, employing critical micro aseptic fields and a non-touch technique to protect key parts and key sites

Surgical AT

• Surgical AT is required when procedures are:
  • Technically complex
  • Long in duration (longer than 20 minutes)
  • Involve large open key sites or numerous key parts
  • Clinician is inexperienced or does not feel confident to perform the procedure without touching key sites or parts
• A main critical aseptic field and sterile gloves are required, as are often full barrier precautions; critical micro aseptic fields and non-touch technique should still be utilised where practical

Performing the Procedure

• Determine whether the procedure requires standard or surgical AT and apply any required environmental control measures and ensure access to the appropriate PPE
• Ensure all key parts/components are protected at all times
• Sterile items must be used once and disposed of in a waste bag; only sterile items may contact key sites, and sterile items should not contact non-sterile items

Waste Management

• On completion of the procedure:
  • Remove gloves (if used) and perform hand hygiene
• Dispose of all waste (including sharps) in the appropriate receptacle

Equipment Cleaning

• Clean all equipment used during the procedure with detergent and, when required, followed by a disinfectant; cleaning followed by disinfection may be a two-step or one process
• Ensure all touch surfaces have been cleaned
• Allow equipment to dry before being put away, and perform hand hygiene again

Summary

• Aseptic technique is required for all invasive procedures
• Ensures asepsis of hands, surfaces and equipment, thus minimising the risk of introducing pathogenic material into susceptible sites on the patient to reduce the risk of patients acquiring an infection
• Risk assessment is required to determine appropriate aseptic technique
• Standard AT is used for simple, short procedures with few key sites/parts when the clinician is experienced and competent enough to avoid touching key sites/parts
• Surgical AT is used for complex, long procedures with large open key sites or numerous key parts, or when the clinician is inexperienced
• Key sites and key parts should be protected at all times
• Non-touch technique is a vital component of achieving asepsis