CLEAN, ASEPTIC AND STERILE TECHNIQUE

Objectives

Be able to assess procedures for the risk of infection to patient Describe the level of precautions needed for different invasive procedures

Any time we touch a patient we put them at risk for an infection

Touching intact skin: may transfer germs that colonize the patient and cause infection 18 months later. Procedures touching respiratory tract, mouth and mucous membranes: germs may enter through micro cuts, or become colonized Procedures that cut into sterile body parts: most acute risk.

Reduce the risk of infection by using clean, aseptic or sterile technique depending on the risk of the procedures

How do you determine what is the risk of the procedure? What exactly is clean or sterile technique?

Risk: even with perfect technique, patient infect themselves

Patients germs may enter from their endogneous flora

Dirty cases more likely: respiratory track, GI, open wounds Reproductive tract involved Or if the patient is already colonized with multi drug resistant organisms (MDRO)

Risk: Even with perfect patients, hospitals infect patients

Through germs on the hands of hospital staff Through germs from contaminated items, air, or the environment
Items shared between patients without reprocessing Facilities and waiting areas that share space

Risk of infection is increased by:

The length of the procedure Length of hospital stay Size of incision and manipulation of operation If indwelling item left (transplant, line, drain, catheter, hardware, mesh, graft) Dusty, dirty, contaminated environment (e.g. not a procedure room or surfaces not disinfected) Contamination of irrigations and medications

Infections are reduced by the measure we have discussed :

Hand hygiene, use of sterile instruments, use of barriers to prevent shedding onto the patient, masks, use of procedure rooms, minimizing the number of persons in the room, disinfecting surfaces, special ventilation

All procedures require:

Hand washing before and after to first remove all visible dirt Complete separation of clean and dirty areas and a designated place for waste. There should be no uncovered storage in the procedure room.

Never place clean items in a dirty area, never place dirty items in a clean area; never place nonsterile items in a sterile field.

Clean area?

Separate personal items from hospital items No staff eating or drinking

Store clean items, including linen, cottons, gauze, towels covered If cotton is torn by hand it is contaminated.

Aseptic, not sterile technique

Done before short invasive procedures Generally done with sterile gloves if hands may touch sterile items or to reduce transferring environmental germs Recommended when: Mixing IV medications Suctioning Placing a urinary catheter Placing a peripheral venous catheter Dressing changes

Aseptic technique uses clean or sterile gloves: assess risk

Clean gloves
Drawing blood samples Getting urine sample from line for specimen

Sterile gloves
Suctioning resp. tract Changing central line tubing Placing clean dressings Preparing art. line transducers

Drawing blood cultures Urinary cannula insertion

No gloves:
IM injections

Sterile technique means

Maximally sterile precautions for high-risk invasive procedures including surgery: Sterile surgical gloves Surgical hand wash Head and beard cover Sterile gown Mask that covers nose, mouth Sterile drape

Sterile technique requires

Clean area or dedicated area with barriers between other patients or contaminated objects Minimal number of staff present Distinction between sterile and non-sterile areas -No non-sterile items on sterile field -Assistant to hand off dirty and non-sterile items

Can sterile procedures be done safely in this setting?

No

When to do sterile technique

Compounding medication for large numbers of people or preparing IV fluids for multiple patients Surgery Long procedures, Procedures with long dwelling implants other than an IV or urinary cannula Procedures for which you have unexplained high infection rates

Sterile technique is also used for:

Mixing of IV fluids Pharmacy procedures for parenteral medications Preparation of implants and transducers Insertion of central lines Changing of central lines Some laboratory procedures to minimize contamination

What precautions are needed for this procedure?

ENT surgery

Ophthalmology

Shared operating theatre facilities

What technique do you need for the following?

Helping change a colostomy Inserting an IV Inserting a central line Getting a blood culture Suctioning a patient Getting a sputum speciemen

Helping a patient with physiotherapy Removing linen Taking out the trash Inserting a chest tube Mixing IV fluid Cleaning a blood spill Endo-tracheal insertion

Practice procedures:

Practice demonstrating these clean and sterile techniques for a dressing change, IV or central line placement and urinary catheter procedure, including the sequence of donning and doffing PPE.