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Abstract
The fact that there is a relationship between the standards of aseptic technique
performance and the rise in hospital infection rates has been suggested by the
Department of Heaths (DoHs, 2004) Winning Ways document. This literature review
considers how the aseptic technique is performed in the UK, and examines the nature
of ritualistic and evidence-based practice underpinning this skill-based procedure.
The findings have identified an emerging glove culture and continuing poor
hand-hygiene practices.The alternative clean technique is also adopted widely in
clinical practice which confuses the aseptic theorypractice gap.While it is hard to
pinpoint an actual time or event that causes infection, it is unlikely nurses will ever
become involved in litigation as a result of a poorly performed aseptic technique.
However, the review concludes that nurses should not become too complacent. It briefly
considers how performance of the aseptic technique can be improved, through creative
educational strategy, applied risk assessment and clinical audits of nurses practices.
Key words: Infection control Nursing: role Patients: welfare
Bacillus
Staphylococcus
Cover picture: Bacterial contamination of hands, showing areas of the skin that are often left contaminated after washing.
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2004). Gilmour (2000) goes on to argue that
despite its ritualistic nature (of being a formal
procedure that is followed consistently), the
aseptic technique (Table 1), is an effective
infection control strategy.
However, in an observational study of
healthcare practitioners in two accident and
emergency departments, Al-Damouk et al
(2004) found that there was poor compliance
with good-practice guidelines for the aseptic
technique. This study was conducted in the
UK and New Zealand and it showed UK doctors rate of compliance to be as low as 27%.
Although it was accepted that a compromise in
standards of asepsis in very sick patients would
be likely to occur, this low figure contrasted
sharply with New Zealands doctors who
scored 58%. This result could imply that both
nurses and doctors in the UK may have
become confused and complacent about the
term aseptic in their everyday practice. It may
also be the result of the differences in how
professional practitioners are trained in the
UK, combined with other sociocultural and
Parker (2000) observed that the clean technique was an alternative approach when dealing
with some chronic wounds using non-sterile
solutions such as tap water for irrigation (Riyat
and Quinton, 1997; Hollinworth and Kingston,
1998). Therefore, it must be asked whether the
nurses in Halletts study (2000) believed they
were doing the best they could when adopting
this alternative approach. For example, one Fgrade sister in the study commented she didnt
really believe in this clean-aseptic procedure
she did the best she could. This may be why
she and her colleagues felt the aseptic technique
had become virtually obsolete in their community practice. If so, it could be a reason why
nurses in other practice areas are similarly confused about when to apply the clean or aseptic
approaches for a range of aseptic-type procedures (Table 2).
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care (Wilson, 2003). Successive studies on
wound care (Filetoth, 2003; Michalopoulos
and Sparos, 2003), hand hygiene (Patel, 2004;
Rickard, 2004) and glove use (Ross, 1999)
have been well reported in the last 5 years.
For example, both Filetoth (2003) and
Michalopoulos and Sparos (2003) reported on
the need to improve aseptic technique practice
in wound care to reduce the rates of wound
infection. In handwashing practices, both Patel
(2004) and Rickard (2004) have reviewed the
various factors which inhibit good handwashing
techniques and have offered suggestions on how
professionals can be helped to improve their
performance. In glove selection and technique,
Ross (1999) reported on an audit that identified
that practitioners were using gloves inappropriately and that latex sensitivity was becoming a
problem for healthcare workers.This report also
highlighted the importance of risk assessment
for glove use in the healthcare setting.
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Alcohol gels
The use of hand gels and alcohol rubs are an
additional aid to promoting hand hygiene
(Rickard, 2004).These have proved to be effective in reducing the time it takes to effect
decontamination of the hands compared with
using soap, water and paper towels (Jones et al,
2000; Bissett, 2002; Pittet, 2002; Patel, 2004).
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Conclusion
Patient safety when performing the aseptic
technique is of the highest importance.
Considering the relationship between contamination, colonization and infection is not easy
for the nurse to perceive in practice.This makes
it harder to pinpoint the actual time, occasion
or event that caused the infection. While drug
errors are more easily identified (Preston,
2004), errors in applying the aseptic technique
are more difficult to prove in law.Therefore, it is
unlikely that nurses will be involved in some
form of litigation as a result of a poor performance leading to HAI (Oxtoby, 2003).
However, nurses should not be complacent
about this area of their practice. It is recommended that all nurses use risk-assessment protocols, attend educational updates, and conduct
regular audits in their practice areas. Such
strategies should promote ownership of the
problems identified in their practice and
improve the standard of aseptic technique performance. This will not only have benefits in
promoting the safety and wellbeing of the
patients, but also provide a safe environment for
student nurses to learn and practice this skill in
BJN
a safe and competent manner.
Al-Damouk M, Pudney E, Bleetman A (2004) Hand hygiene
and aseptic technique in the emergency department. J
Hosp Infect 56(2): 13741
Aspock C, Koller W (1999) A simple hand hygiene (practice
forum). Am J Infect Control 27(4): 3702
Baillie L, ed (2005) Developing Practical Nursing Skills. 2nd
edn.Arnold, London: 817, 2145
Bissett L (2002) Can alcohol hand rubs increase compliance
with hand hygiene? Br J Nurs 11(16): 10727
KEY POINTS
The practice of aseptic technique is causing
concern for patient safety.
Glove culture is emerging as a threat
to controlling infection risks.
Poor hand hygiene practices continue
to be observed.
Hand disinfectants are only effective
if applied for longer than 30 seconds.
Risk assessment should precede all aseptic
technique procedures.
Education strategies are needed
to visualize microbial fallout.
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