Students learning outcomes

At the end of this lesson, the student will be able to: define the terms asepsis and aseptic technique differentiate between medical and surgical asepsis discuss the general guidelines and principles of medical and surgical asepsis appreciate the importance of applying asepsis principles and aseptic technique for infection prevention and control in the care of patients

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Introduction
Asepsis: - Asepsis or aseptic means free (absences) from pathogenic (infection-causing) microorganisms. (Rowley et al., 2010) - Aseptic technique is the practice of carrying out a procedure in such a way that you minimise the risk of introducing contamination into a vulnerable area or contaminating an invasive device. (Royal Marsden Hospital of Clinical Nursing Procedure, 2011)

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Aseptic technique
How does one applies this aseptic technique?

Medical asepsis Surgical asepsis

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Medical asepsis

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Aseptic technique
Medical asepsis: (is also known as clean technique) - consists of techniques that limit the growth and spread of pathogenic microorganisms - is used in many daily activities, such as hand hygiene and changing patients bed linen.

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Principles of Medical Asepsis

1. Practice good hand hygiene techniques 2. Carry soiled items, including linens, equipment and other used articles away from the body to prevent them from touching the clothing. 3. Do not place soiled bed linen or any other items on the floor, which is grossly contaminated. It increases contamination of both surfaces.

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Principles of Medical Asepsis

4. Avoid having patients cough, sneeze or breathe directly on others. Provide patients with disposable tissues and instruct them as indicated to cover their mouth or nose to prevent spread by airborne droplets. 5. Move equipment away from you when brushing, dusting or scrubbing articles. This helps prevent contaminated particles from settling on your hair, face and uniform.

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Principles of Medical Asepsis

6. Avoid raising dust. Use a specially treated or a dampened cloth. Do not shake linens. Dust and lint particles constitute a vehicle by which organisms may be transported from one area to another. 7. Clean the least soiled areas first and then move to the more soiled ones. This helps prevent having the cleaner areas soiled by the dirtier areas.

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Principles of Medical Asepsis

8. Dispose of soiled or used items directly into appropriate containers. Wrap items that are moist from body discharge or drainage in waterproof receptors, such as plastic bags, before discarding into refuse holder so that handlers will not come in contact with them.

9. Pour liquids that are to be discarded such as bath water and mouth rinse gently into the sink to avoid splattering of fluid onto you.

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Principles of Medical Asepsis

10. Use personal grooming habits that help prevent spreading microorganisms. Shampoo your hair regularly, keep your fingernails short and free of broken cuticles and ragged edges, do not wear rings with grooves and stones that may harbor microorganisms. 11. Follow guidelines conscientiously for infection control or barrier techniques as prescribed by the institutions concern.

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Surgical asepsis

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Aseptic technique
Surgical asepsis: (is also known as sterile technique = sterilisation) - consists of techniques that eliminate the growth and spread (complete absence) of pathogenic microorganisms

- application of series of practices for manipulation of sterile equipment and dressings in such a manner that areas are not contaminated with pathogenic microorganisms, between the beginning of a process to the completion of the process.
- the intention is to avoid introducing pathogenic organism into the wound or tissues of the patient.
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Where do we use Sterile Equipment and Implement Sterile Technique?

Operating room Labour and delivery Major diagnostic / special procedure areas At the bedside in 3 main situations: 1. procedures requiring intentional perforation of the skin ie. inserting an IV or an injection 2. if the skins integrity is broken due to surgery or burns ie. dressing changes / cleansing wounds 3. during procedures involving insertion of devices, into normally sterile body cavities, i.e. urinary catheter **all requires use of sterile glove or an aseptic-non-touchtechnique (ANTT)
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Principles of Surgical Asepsis

1. Never assume that an object is sterile. Check for sterility by checking expiry dates, intactness and integrity of outer wraps and sterilisation indicators inside the package. 2. If there is a question of sterility, it is considered contaminated. 3. Only sterile objects may be placed on a sterile field. 4. Sterile objects out of the field of vision or below waist level are considered contaminated.

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Principles of Surgical Asepsis

5. Only sterile items can contact sterile items or they are considered contaminated.
6. Any items brought into contact with broken skin, used to penetrate the skin to inject substances into the body or used to enter normally sterile body cavities must be sterile. These items include dressings used to cover wounds and incisions, needle for injection and tubes (catheters) used to drain urine from the bladder.

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Principles of Surgical Asepsis

7. Reduce air currents around a sterile object by not reaching across a sterile field, keep doors and curtain closed and move sterile objects as little as possible on a sterile field. Reduce respiratory droplets in contact with sterile field wear mask. Capillary action can move fluids against gravity and contaminate a sterile object / field. Keep caps of open sterile bottles right side up to prevent contamination of rim.

8.

9.

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Principles of Surgical Asepsis

10. A sterile object or field becomes contaminated by prolonged exposure to air.
11. The outer edges of a sterile field (2.5cm or 1 inch) are considered contaminated. 12. The minimum distance a non-sterile person should remain from a sterile field is 30cm.

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Principles of Surgical Asepsis

13. Fluids flow in the direction of gravity keep tips of sterile instruments pointed down, hands should be held higher than the elbow after performing hand hygiene prior to any surgical aseptic procedures.
** in medical asepsis / clean technique, the hand should be held lower than the elbows so that water flows from least contaminated area (elbows) to the most contaminated area (hands) during hand washing.

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Take home message ?? Tell your colleagues to adhere to strict aseptic technique!

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References

Dougherty, L., & Listers, S. (2011). The Royal Marsden Hospital Manual of Clinical Nursing Procedures. (8th ed). The Royal Marsden Hospital: Wiley-Blackwell. Rowley, S., Clare, S., Macqueen, S., & Molyneux, R. (2010). ANTT v2: An updated practice framework for aseptic technique. British Journal of Nursing, 19, S5S11. Wound, Ostomy and Continence Nurses Society Wound Committee and the Association for Professionals in Infection Control and Epidemiology, Inc. (APIC) 2000 Guidelines Committee Updated/Revised: WOCN Wound Committee, 2011. Clean vs. Sterile Dressing Techniques for Management of Chronic Wounds: A Fact Sheet

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