Document name:

Aseptic Technique

Portfolio Document type:

Nursing, Innovation and Compliance

Policy

Staff group to whom it applies:

All clinical staff

Distribution:

The whole of the Trust

How to access:

Intranet and internet

Issue date:

March 2008 October 2010 March 2012

Next review:

Approved by:

Executive Management Team

Developed by:

Infection Prevention and Control Trust Action Group Director of Infection Prevention and Control Ali Perring, Senior infection prevention practitioner

Director leads:

Contact for advice:

Contents

1. Where does infection come from?

2. Microbiology of your hands

3. What is aseptic technique?

4. What is a clean technique?

5. When should an aseptic technique be used?

6. Who should undertake an aseptic technique?

7. Aseptic technique principles

8. When should a clean technique be used?

9. Technique for commonly performed procedures

10. References

Aseptic Technique Policy Rider. This policy is an index sub section within the main overarching Infection Prevention & Control Policy, and was consulted on by members of the Infection Prevention & Control Team. The main overarching policy meets all the requirements of the Policy for the Development, Approval and Dissemination of Policy and Procedural Documents. 1. There are no specific duties or equality impacts to consider outside the main overarching policy, and specific duties are outlined separately.

2. There are no equality impacts to consider outside the main overarching policy, and specific duties are outlined separately. 1. Where does infection come from? There are 3 sources of infection: The hands and bodies of other people Our own body hands, skin, bowel, mouth The environment dust or liquid reservoirs Healthcare workers must ensure effective hand hygiene. The wearing of protective clothing, e.g. gloves and an apron will provide a barrier between microbes present on hands and clothing and the susceptible site, e.g. a wound. Large amounts of micro organisms are shed into the air when a dressing is removed, therefore, this should be undertaken carefully.

2. Microbiology of hands Hands are colonized by resident and transient bacteria. Resident skin flora: These comprise mainly Gram positive organisms of low pathogenicity, e.g. diphtheroids, micrococci, coagulase negative staphylococci. Their function is mainly protective and they are difficult to remove without the use of a disinfectant hand wash. However, these organisms are opportunists and may cause infection if introduced into an invasive device, or wound. The use of an alcohol hand gel will slow down bacterial growth. 5

Transient skin flora: These comprise a mixture of Gram negative and positive organisms, many of which are harmful to man if introduced into a susceptible site or to a susceptible person, e.g. coliforms Klebsiella, Proteus, Acinetobacter, E.coli and MRSA. These organisms particularly favour damp conditions, e.g. under rings and false nails, but they can be found on all parts of the hands, clothing and in the environment.

Only physically washing hands with soap and water will remove soiling and spores.

3. What is an aseptic technique? Aseptic technique is a practice or procedure undertaken for a service user which is designed to prevent contamination of wounds and other susceptible sites by organisms that could cause infection.

4. What is a clean technique? This is a modified technique that can be used for wounds healing by secondary intention. e.g. pressure sores, wounds, grazes.

5. When should an aseptic technique be used? when inserting, re-siting or dressing an invasive device, e.g. intravenous line, urinary catheter, wound drain. when dressing wounds healing by primary intention, e.g. surgical wounds, burns. when a clean technique is insufficient in relation to the persons risk-assessment, e.g. sterile body areas are entered, there is tracking to deeper areas or the person is immunocompromised.

6. Who should undertake an aseptic technique? only those staff assessed as competent staff should perform an aseptic technique.

7. Aseptic technique principles avoid exposing or dressing wounds or performing an aseptic procedure for at least 30 minutes after bed making or domestic cleaning. 6

assemble all appropriate sterile items for the procedure. prepare the setting including decontamination of the working surface to be used with detergent and water then dry. Alternatively, it can be disinfected with a 70% alcohol wipe. a plastic disposable apron should be worn over clothing or uniform. remove hand jewellery, wash hands before commencing procedure with an antimicrobial solution, e.g. chlorhexidine OR if hands are not visibly soiled, an alcohol hand rub/gel can be applied to all areas of the hands. carefully remove the dressing (a large amount of micro organisms are shed into the air). expose the wound for the minimum time to avoid contamination and maintain temperature. decontaminate hands again after removing dressing. put on sterile latex/non latex gloves. perform the procedure including skin preparation where applicable, avoiding accidental contamination of sterile equipment/vulnerable site

Always use Standard Precautions. Please refer to Trust Infection Prevention and Control Policy for current information. dispose of single-use items after one use. dispose of single person use items after treatment. decontaminate re-usable items according to Trust policy and manufacturers instructions. store sterile equipment in clean, dry conditions, off the floor and away from potential damage. dispose of waste as per Trust policy. consider the following as high risk of infection: babies people with diabetes the frail/immunocompromised those with chronic disease or poor nutritional status

8. When should a clean technique be used? This is a modified technique that can be used for wounds healing by secondary intention, e.g. pressure sores, leg ulcers, wounds that have split open (dehisced), simple grazes, 7

removing drains or sutures, endo-tracheal suction. Clean, non-sterile latex or non latex gloves should be worn and a disposable plastic apron. If these wounds enter deeper sterile body areas, then an ASEPTIC TECHNIQUE must be used. If two procedures are being undertaken, e.g. suction and a wound dressing, change gloves and wash hands between procedures. Gloves will soon become heavily contaminated.

Aseptic technique Gloves Dressings Technique Hand decontamination Sterile latex/ non latex Sterile No-touch Wash, with an antimicrobial solution OR apply alcohol gel to all areas of physically clean hands Sterile water/saline OR chlorhexidine

Clean technique Non-sterile latex/ Non latex Sterile No-touch Wash with liquid soap and dry with paper towels OR alcohol gel to all areas of hands if physically clean Potable/drinking OR tap water

Cleansing solution

9. Technique for commonly performed procedures

Procedure Indwelling urinary catheter insertion

Technique Clean area first with soap and water Aseptic

Comments Use sterile lubricant to reduce trauma. Maintain daily personal hygiene and the closed drainage system Treat as surgical 8

Suprapubic

Aseptic

catheter Intermittent catheterisation Clean Aseptic

wound until healed Persons home Hospital

References Symbols and their meanings

1998 -06 30
Use by date, i.e. use by 30th June 1998

1996 06
Date of manufacture, i.e. manufactured during June 1996

Do not re-use, Single use, Use only once

Batch code

Infection Control Nurses Association. Asepsis: Preventing Healthcare Associated Infection 2003 Dougherty, L. & Lister, S. (eds) (2005) The Royal Marsden Hospital Manual of Clinical Nursing procedures. Sixth edition. Blackwell Publishing