One person disconnects and reconnects the ventilator tubing or Ambu  bag to the endotracheal / tracheostomy tube. Change ), You are commenting using your Twitter account. They can be disinfected using disinfectants (glutaraldehyde [CidexTM], 70% Alcohol, Gigasept, Peracetic acid, Formaldehyde, Trigene, Sodium hypochlorite). I am a retired surgeon, currently offering consultancy services in Information Management in Health Care Services. Indeed, as far back as the mid-1800s, the association between good hand hygiene and reduced infection rates was identified by Ignaz Semmelweis (Wilson, 2019). This first article in a two-part series outlines the principles of medical asepsis. Their content in the air is dependent on: These facts and that the bacteria can be killed by heat was known to Louis Pasteur 1887 Ref: http://en.wikipedia.org/wiki/Louis_Pasteur. The sterility of sterilized items are maintained by packing them in envelops, wrappers or containers. Principles of aseptic technique . The outside nurse opens the outer covering of the dressing set. Sterile instruments should not protrude out. Ideally the equipment should be kept out of direct sunlight as this could also affect the packaging, as well as the quality of the sterile products of the equipment. PERSONS WHO ARE STERILE TOUCH ONLY STERILE ITEMS/AREAS. The performer picks the external end of the tube and inserts the internal end directly into the trachea without touching structures in the mouth and throat (nor should he/she bend the tube on the bare OT table!). THE PRINCIPLES OF ASEPTIC TECHNIQUE Aseptic technique encompasses the practices used to create, protect, and maintain the surgical field. If the glove is punctured torn or contaminated, replace it. Hence the most effective way of maintaining sterility of sterilized instruments and other items is the non-touch technique. Aseptic technique improves patient safety and prevents healthcare-associated infections that may negatively impact outcomes including: increasing patient morbidity and mortality, increasing healthcare costs for patients and their families, prolonging length of stay, increasing resistance of microorganisms to antimicrobials, and increasing physical and mental discomfort for the patient.Ref … Therefore, hand washing according to the accepted procedure is mandatory especially when performing surgery. Aseptic Technique is based on surgical conscience; that is, the ethical and professional motivation that regulates a professional’s behaviors regarding disease transmission. For the first case for the day, scrub the nails and fingers with a soft brush until clean. Wash hands until the elbow, preferably with Propyl alcohol plus Chlorohexidine mixture or Povidone iodine, for 5 minutes. A clean technique is a modified aseptic technique. The patient’s skin harbour commensals (e.g. If they become contaminated, this can result in the patient acquiring a preventable infection. At the end of the procedure, all waste must be disposed of in the appropriate waste stream bin, such as a healthcare waste bin. Principles of Aseptic Technique The primary goal of aseptic technique is to prevent key sites and key parts from coming into contact with pathogens. The principles of Sterile Technique are applied in various ways. Nursing Times [online]; 116: 38-41. ( Log Out /  Normal spontaneous delivery may be performed by one obstetrician or midwife but for instrumental delivery (vacuum extraction or forceps) at least two persons is required. When the wound is rid of infection then gauze moistened with saline or plain proprietary dressing is used. Chemical sterilization differs from disinfection in the duration of soaking i.e. This is unlikely if cannulas are retained for short periods (not > 48 hours). SterradTM) is used. Once disinfected, they can be kept in a clean environment. Storage areas should be kept clean, free of vermin and away from water sprays. Some species consistently cause infection while others cause infection only in certain conditions and situations. It is estimated that 300,000 patients each year in England will develop a healthcare-associated infection (HCAI) (National Institute for Health and Care Excellence, 2012). Box 1. The first area is a place that accommodates the instruments, dressing and lotions to place instruments used for the intended procedure. Your own invaluable information implies a whole lot a person like me and even further to my peers. The assistant places all tubes and containers into the sterile field using a non-touch technique. To reduce the risk from airborne dispersal of micro-organisms, the procedure area should be prepared by closing windows, turning off any fans that are in use and avoiding any bed making being undertaken in close proximity (Lloyd Jones, 2014). the first rule of aseptic technique, this states that the cont… this is the second rule of aseptic technique. ( Log Out /  It has been updated, the latest being 19 June 2017. Principles of Aseptic Technique in Operating Room All materials that enter the sterile field must be sterile. The term asepsis means the absence of potentially pathogenic micro-organisms, Aseptic technique is used to achieve asepsis in order to prevent the transfer of potentially pathogenic micro-organisms to a susceptible site, Medical asepsis aims to reduce the number of organisms and prevent their spread by use of standard principles of infection prevention, An aseptic technique is required for many clinical interventions including wound dressing, peripheral cannula or other vascular access device insertion, Prevention of infection can help to reduce the requirement for antimicrobial prescribing. The purpose of these guidelines is to provide to a safe and effective technique for all aseptic procedures. The other person performs the suction with a sterile catheter using both gloved hands. She then cleans the skin around the wound with 70% Alcohol or Chlorohexidine. The new blended learning nursing degree at the University of Huddersfield offers…, Please remember that the submission of any material is governed by our, EMAP Publishing Limited Company number 7880758 (England & Wales) Registered address: 7th Floor, Vantage London, Great West Road, Brentford, United Kingdom, TW8 9AG, We use cookies to personalize and improve your experience on our site. This publication is an RCN investigation into clinical views to guide the practice of aseptic technique. ‘If you read one thing today, make sure it’s Vicky Neville’s open letter’, Aseptic technique is a core competency for many nurses and is required for everyday procedures such as catheterisation and wound dressing. … It is made up of two areas i.e. 2. The purpose of aseptic technique is to minimize the risk of introducing pathogenic organisms into wounds or other susceptible sites while preventing transfer of pathogens from such sites to other patients and staff.1 These underpinning principles were established in the nineteenth century, 2 and their effectiveness in complex care bundles during the insertion and maintenance of intravascular … Place a spigot or stopper into the flange of the cannula. skin, mucous membranes, or when handling equipment such as intravenous and urinary catheters. Other surfaces including the mucosa of oral cavity, pharynx, nose, and vagina have different sets of resident bacteria and similar but appropriate antiseptics can be used. The Aseptic Technique e-learning programme consists of 7 modules. Problems arise when the sterile catheter or tubes need to be connected to connectors outside of the sterile zone. There are a number of stages and principles for aseptic technique (Table 1); the fundamental initial stage is hand hygiene, which must be performed before any aseptic technique (World Health Organization, 2019; Loveday et al, 2014). The technique consists of the following set of processes: The sterile field is a microorganism-free  area  without danger of them being contaminated. Principles of sterile technique help control and prevent infection, prevent the transmission of all microorganisms in a given area, and include all techniques that are practised to maintain sterility. Sterilization removes all forms of microorganisms including spores. Instruments and endoscopes passed into body cavities that has resident bacteria or are likely to be colonized by bacteria such as the mouth, vagina, nose, pharynx, external ear, esophagus, stomach, duodenum and colon, must be disinfected but not necessarily asterilized. Microorganisms are everywhere in the environment. The sterile packages should not be allowed to become wet or damaged as this affects the sterility of the equipment inside. Endoscopic therapeutic procedures (performer and assistant). Antiseptic solutions, including saline, should be of adequate strength and not diluted (e.g. Where the patient has capacity, this can usually be done verbally and then documented in the patient’s record (RCN, 2017). It provides a comprehensive set of principles including ANTT, which aims to achieve surgical asepsis; the ANTT approach is widely used in hospitals and community settings (NICE, 2012). Learn vocabulary, terms, and more with flashcards, games, and other study tools. An aseptic non touch-technique, ANTT (i.e. Key sites are defined as open wounds, including insertion sites and puncture sites. If MRSA is present Povidone iodine should be used and if it is Pseudomonas, it is customary to use Acetic acid. To disconnect, grasp the base of the cannula firmly, occlude the vein or artery with a finger and untwist the tip of the line with the other hand. The correct practice of this technique requires the understanding of some principles and facts. It is customary to name the two parties as clean nurse and dirty nurse. The ANTT® (aseptic non-touch technique) framework was developed to provide consistent step-by-step guidance for an aseptic non-touch technique that can be applied to several invasive procedures, including insertion of urinary catheters and peripheral cannulas, phlebotomy and administration of intravenous drugs (Box 1) (Rowley et al, 2010). at least 30 minutes or more for sterilization as opposed to 10 minutes for disinfection. 3. Chlorohexidine 1: 2000 is ineffective). Examples of when to use a medical aseptic technique. 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I must point out my admiration for your kindness supporting individuals that must have help with this particular theme. A sheathed needle or spigot is then used to occlude and cover the tip of the infusion line. He/she need to drape the patient with sterile sheets exposing only the perineum and the introitus. Strict adherence to aseptic technique is indicated when performing invasive procedures including those: Where a body canal or cavity normally free of microorganism (like trachea, bronchus, urethra, bladder, ureter, kidney pelvis and calices, uterine cavity, CSF and peritoneum), is entered (e.g. Stages of medical aseptic technique Environment. I helped implement computerized hospital information systems in several hospitals. In most clinical settings the amount and type of organisms in the air is minimal. Start studying Principles of Aseptic Technique. it states that b… this is the third principle of aseptic technique. Hand hygiene must be performed before preparation of the sterile equipment to avoid contamination of the equipment, and may need to be repeated immediately before the procedure if the hands have become contaminated (Loveday et al, 2014). However central lines, femoral lines and umbilical artery & vein catheters pose a higher risk which in turn may cause systemic sepsis or infection at distant sites. Surgical asepsis includes procedures to eliminate, rather than reduce, micro-organisms from an area and is practised by surgical teams and nurses in operating theatres and procedure areas, including interventional radiology (NICE, 2012). The quantity of bacterial contamination increases with large surgical fields, with reoperation, with long operating times, with inadequate aseptic technique, and with poor ventilation of the operating room. A ‘clean technique’ can be classed as medical asepsis or standard aseptic technique, as it uses the same principles. This is ensured through the following components of infection control: Reusable items are sterilized by steam at high temperature (autoclaving) or chemicals (Ethylene oxide etc.). Proprietary dressings are usually sterilized by Gamma radiation whereas gauze is autoclaved at the hospital’s Central Sterile Supplies Department (CSSD). This site uses Akismet to reduce spam. (Fuller) All patients are bound to get an infection. The assistant introduces the IV cannula and all connecting tubes into the sterile field. Change ), You are commenting using your Facebook account. The fundamental principle of an aseptic technique/ANTT incorporates protecting key elements of the equipment that should remain free from micro-organisms, for example, the inside of a sterile dressing or the barrel of a sterile needle (NICE, 2012). The instruments can be disinfected using chemicals such as glutaraldehyde (CidexTM), Gigasept and Peracetic acid. Managing the baby (resuscitation and so on) should be a  separate procedure from the delivery itself. This will prevent any foreign contaminants from coming in contact with the customers and sample during testing. It is important to inform the patient before undertaking any procedure and to obtain consent, allowing time to explain the specific procedure and to help reduce any anxieties the patient may have (Royal College of Nursing, 2017). Type of document Policy Target audience All CWP staff Document purpose The Aseptic technique policy relates to all CWP NHS Trust staff. 2. Endoscopes passed into body cavities that do not have indigenous bacteria or are not colonized by bacteria, must be disinfected before use. The practice of Aseptic Technique during some of the more common procures are discussed below. I served as invited lecturer and taught undergraduate and postgraduate students at various medical faculties (UITM, UKM and USM) in Malaysia. To reconnect, remove the needle or spigot from the line tip. Sharps, including needles, suture cutters, scissors and blades must be disposed of at the point of use in an approved sharps container (Loveday et al, 2014). they are properly opened and introduced into the sterile field before use, kept within the sterile field without being contaminated during use, the cleanliness of the room and equipment within it, air exchange (removal of stale air in exchange for fresh air), direction of flow (from clean to non-clean areas). When fresh, the solutions will not contain bacteria. A clean disposable apron provides an ideal barrier between potentially contaminated uniforms and the procedure, reducing any contamination that may arise from the procedure. The assistant connects the tubing to the bag and the fluid is run in to prime the line. To reduce patients’ risk of developing a HCAI, it is vital to prevent the transmission of micro-organisms between staff and patients when undertaking any invasive procedure (Loveday et al, 2014); this can be achieved by asepsis. The term asepsis means “the absence of potentially pathogenic micro-organisms” (Loveday et al, 2014). The patient’s skin can never be made sterile, but the amount of bacteria can be reduced by the use of antiseptics such as: Povidone iodine, 70% alcohol, Chlorhexidene 1:200 or mixtures of these. We can start with the food industry. Therefore, efforts must be made to reduce the breach of aseptic technique to the minimum. At Hospital Selayang, Malaysia, I was Chairman of the Clinical Advisory Committee, the Clinical-IT Coordinator and Quality Coordinator, for close to 10 years. A best-interest decision may need to be made for a patient who is unable to give consent and this decision needs to be clearly documented in the patient’s record (NHS, 2018). The terms aseptic technique and sterile technique are used interchangeably by some authors (Box 1-1), but in strict terms, asepsis is defined as the absence of microorganisms that cause disease, whereas sterile is defined as being free of all living microorganisms. If for any reason the ETT tube need to be put down, place it back onto the sterile package looked after by the assistant. Once gloved, do not touch non-sterile areas or articles with the gloved hand. 14. Staphylococus epidermidis), which are harmless on the skin surface but may induce disease in the blood circulation or through it to distant sites like heart valves, the urinary tract, the biliary tract, the lungs or the brain. UN-STERILE PERSONS AVOID STERILE AREAS. Permissions beyond the scope of this license is available via e-mail: drdollah@gmail.com, a microorganism-free environment (sterile field), Disinfection and Use of Endoscopes in Sterile Body Passages, Use of Speculum & Endoscopes in Non-Sterile Body Passages, http://en.wikipedia.org/wiki/Louis_Pasteur, Penyediaan Rencana “Carta Masuk-Keluar Cecair”, Tugas Seorang Jururawat dan Fungsi Merawat, Creative Commons Attribution-NonCommercial 4.0 International License, Predisposition of host environment to infection. ANTT® has become the de facto national standard aseptic technique in England, Australia and Wales and is now used in over 30 countries and is rapidly expanding (ANTT® website). The procedure is explained and … These infections are more likely to occur in patients with invasive devices, such as peripheral canulas, vascular access devices or urinary catheters in situ, or after invasive procedures (NICE, 2012). For the subsequent cases a 2-3 minute hand wash until the elbow is sufficient. During the performance of clinical procedures, the prevention of infection are be achieved through approaches based on the facts mentioned above. Remember that the patient’s skin is non-sterile. They should be re-sterilized if possible. They need to have a ‘use by’ date. Otherwise low temperature hydrogen peroxide plasma sterilization sterilizer (e.g. Always wipe your hands and work area with 70% ethanol. The wound is flushed thoroughly with sterile saline or water using a syringe. 3.3.5 It is essential to ensure that hands, even though they have been decontaminated, do not During the procedure, the sterile field needs to be maintained; this can be achieved by careful opening of the sterile packets to avoid contamination of the sterile equipment and the sterile surfaces of the inside packaging. While vigilance and supervision is essential, compliance can only be achieved through individual commitment and attention to details. However, contact with any other non-sterilized object renders the instrument or item non-sterile. The procedure should be carried out in a location that maintains the patient’s privacy and dignity, such as a treatment room, at the bedside with the curtains drawn or in the patient’s own home (Lloyd Jones, 2014). The practitioner should perform the aseptic technique procedure demonstrating that the principles of asepsis are adhered to. Enter your email address to follow this blog and receive notifications of new posts by email. Principles of nursing practice ... Aseptic technique is recognised as an essential component of all infection prevention programmes but terminology used to define it varies. The inside of the tip of the line must be kept sterile. If gloves are not used, it is necessary to wash hands before and after testing. Are short in duration (usually less than 20 minutes); Involve small sites such as puncture sites; Have a minimal numbers of key parts (usually considered to be less than five although there is no evidence to support this). I graduated with MBBS from University of Malaya in 1977. The main aseptic field needs to be managed as a critical aseptic field (a controlled working space that ensures asepsis by providing protection from the procedure environment – typically by using a sterilised drape), using sterile gloves and often with full barrier precautions to include sterile gown, mask and cap (ASAP, 2015). TABLES ARE STERILE ONLY AT TABLE LEVEL. ( Log Out /  Fill in your details below or click an icon to log in: You are commenting using your WordPress.com account. Principles of Sterile Technique. The obstetrician should wear a sterile gown. Aseptic technique and clean technique are two closely related healthcare practices that both aim to keep people safe from infection. 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