Aseptic Technique December 2014
Healthcare Associated Infection HCAI Infection is one of the most frequent adverse events associated with healthcare intervention.
Why do some people develop infection? Risk of infection=virulence x dose Susceptibility Susceptibility Extremes of age Invasive procedures Indwelling devices Underlying health problems Existing infection Medication Communal facilities
Organisms That Can Cause HAI S A whole recipe of pathogens, including: Meticillin-resistant staphylococcus aureus (MRSA). Clostridium difficille. Pseudomonas. Diarrhoeal viruses Norwalk! Blood borne viruses hep.b, hep.c, H.I.V. To name but a few.
Breaking the Chain
The National Picture Winning Ways Towards Cleaner Hospitals National Decontamination Strategy Essential Steps to Safe Clean Care The Health Act/ Hygiene Code 2006 Health and Social Care Act 2010
Criterion 6 & 9 Where staff undertake procedures, which require skills such as aseptic technique, staff must be trained and demonstrate proficiency before being allowed to undertake such procedures independently. Personal care givers need to have a knowledge of asepsis and a understanding of the importance of not introducing contamination to devices.
Community Asepsis Guidelines
The Importance of Asepsis Aseptic technique is the most commonly performed critical infection control procedure in healthcare. To this end, it is essential that healthcare workers understand the principles of asepsis and apply them to safe practice. Aseptic technique is an essential procedure aimed at protecting patients from infection during invasive procedures, and is achieved by minimizing the presence of pathogenic microorganisms as far as is practically possible. Aseptic Non Touch Technique (ANTT) is a specific type of aseptic technique with a unique theory and practice framework. All staff who undertake procedures requiring asepsis must have received training and be able to demonstrate competence to perform the procedures.
What is Asepsis? An Aseptic Technique is a method used to prevent contamination of wounds and other susceptible sites by organisms that could cause infection. Contamination may occur when such wounds and susceptible sites are being manipulated.
Definitions Asepsis Means without sepsis/infection. The aim of asepsis is always to prevent introducing pathogenic micro-organisms onto or into the patient. Aseptic technique Defines the precautions taken during invasive clinical procedures to prevent the transfer of micro- organisms from the health care worker; procedure, equipment or the immediate environment to the patient. It is achieved by ensuring the asepsis of key-parts and key-sites
Aseptic Non Touch Technique (ANTT) is the method whereby key-parts of a procedure are identified. A key-part is the part of the device/equipment that comes into direct contact with the patient. This term is both accurate and achievable in normal clinical or non-clinical settings such as on hospital wards or a patient s home. Pathogenic organisms cannot always be removed by effective hand washing. Additionally even when sterile gloves are worn they rarely remain sterile throughout the procedure and therefore, a non-touch technique is required where possible. A non-touch technique (i.e. being able to identify the keyparts and not touching them either directly or indirectly) is therefore perhaps the single most important component of achieving asepsis.
Clean Technique Describes a technique where non-sterile gloves are worn and non-sterile water may be used to cleanse the wound. This technique could be used for dressing chronic wounds eg. leg ulcers, healing by secondary intention as they potentially will already be heavily colonised with environmental micro-organisms This technique can also be used for simple grazes; when removing sutures; and for endo-tracheal suction. Personal protective equipment such as clean, non-sterile gloves and a disposable plastic apron should still be worn. However, chronic wounds may be irrigated or cleansed using potable/drinkable tap water rather sterile fluids. The value of aseptic technique in chronic wounds is to prevent introducing new pathogenic microorganisms which could further delay healing and therefore a dressing pack must be used including sterile gloves when re-applying a wound dressing
Key Part/s Is the part of the equipment that comes into direct contact with the liquid infusion or sterile site. Key parts are those parts or sites that if contaminated with micro-organisms increase the risk of infection. In intravenous therapy, key-parts are those parts of equipment which come into direct contact with the liquid infusion or the patient e.g. needles, syringe tips, IV line connections, exposed central line lumens, spikes of the administration set etc. In urinary catheterisation key-parts are the urinary catheter pack, the urinary catheter, lubricating jelly any parts that comes into contact with the mucous membranes. In wound care key-parts are the dressing and equipment that come into contact with the wound and the wound itself is a key-site.
How can we minimise the risk of microbial contamination? Asepsis procedure trolley/tray Designated for asepsis procedures only Ensure regular cleaning regime implemented and maintained Use of a dressing packs Adherence to asepsis guidelines
Cleaning of Trolleys Trolley cleaning must take place on every day of use using a general purpose detergent, or soap and water wipes, to include: Top and bottom shelves which should be flipped to clean underside. Smooth side should always remain uppermost Side bars, legs, and wheels Dry thoroughly using paper towels Always clean from top down to bottom Trolleys should then be cleaned between uses and when visibly soiled Prior to an aseptic procedure the trolley should be cleaned with a spirit based cleanser
Appropriate Environment Aseptic Procedures should not take place: During or shortly after bed making Near open windows When fans are switched on Screens/Bed curtains must be disturbed as little as possible Patient s dignity must be maintained at all times
Aseptic Field A designated aseptic working space; that contains and protects the procedure equipment from direct and indirect environmental contact contamination by micro-organisms. General aseptic field An aseptic field that promotes asepsis during procedures and does not require critical management (i.e. non aseptic as well as aseptic items may come into contact with it). Critical aseptic field An aseptic field that requires critical management; (i.e. only sterilised or aseptic equipment may come into contact with it). Micro critical aseptic field (MCAF)A small critical aseptic field used to protect a specific key-part, e.g. syringe cap or needle cover.
What is Aseptic Non touch Technique (ANTT)? Always wash hand effectively Never contaminate key-parts Touch non key-parts with confidence Take appropriate infection control precautions For further information go to www.antt.co.uk
Hand Hygiene
Glove Use Sterile glove use sterile gloves must be worn if the procedure would involve touching a key part or susceptible site. Non sterile gloves gloves are single-use items. Single use items cannot be cleaned and reused for the same or another patient (MHRA 2002: E). Gloves provide a barrier to the hands from contamination from blood, body fluids, excretions, secretions and micro-organisms and are worn to protect the wearer. Glove risk assessment: Can I perform this procedure without touching the key parts/key site If YES, put on non-sterile gloves. If NO, put on sterile gloves Gloves protect the user from exposure to drugs and blood products (COSHH regulations)
Key Principles Prepare the patient Prepare the environment Preparation of staff
Preparation Ensure all appropriate sterile items are available Use a dedicated dressing trolley or tray that is decontaminated using a recommended preparation Ensure the patient and their environment are prepared ensuring no unnecessary movement occurs Keep the exposure of the susceptible site to a minimum Ensure the correct number of personnel are available to assist in the process Ensure that the health care worker has the relevant knowledge and skills Ensure that the health care worker has the relevant personal protective equipment ready for use which must include aprons and gloves glove risk assessment must be performed
Continued.. Ensure that the health care worker performs effective hand decontamination Ensure that the health care worker takes every precaution to avoid contamination of the sterile area Ensure alcohol hand gel is available during the procedure Ensure standard precautions are employed at all times All fluids and materials must be sterile and sterile packs should be checked for evidence of damage or moisture penetration and that the item is sterile and in date. Single-use items must only be used once Single patient use items are only used for one patient
Re-usable items are decontaminated according to manufacturers instructions Contaminated/non sterile items must not be placed on the sterile field Sterile equipment is stored in a clean dry area, free from dust and off the floor and from other particulate matter to protect the integrity of the packaging and equipment Minimise the amount of times manipulation is performed at intravenous sites in particular An appropriate aseptic field must be chosen and applied including identifying general, micro and critical fields. The key-part must be protected at all times and must not be touched All disposable items should be disposed of in accordance with the waste management policy
The Procedure Choose an appropriate aseptic field Sterile packs must be opened using only the corners of the paper, taking care not to touch any of the sterile contents. PPE Ensure items are arranged on the sterile field in a manner that prevents contamination (glove or dressing bag to re-arrange pack contents) Ensure dressing or device is removed using a pair of non-sterile gloves and that hands are decontaminated prior to the aseptic procedure Ensure gloves are donned in a manner that prevents contamination
The Procedure Waste disposal Hand decontamination after glove removal Clean trolley/tray Documentation
Questions