Clean, Aseptic and Sterile Technique

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Clean, Aseptic and Sterile Technique

• Session 4 Infection Control Basics

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Learning Objectives

• Be able to state the requirements for clean,
  aseptic or sterile technique recommended for
  common procedures
• Demonstrate use of the SCRIPT method to prepare
  for and carry out procedures
• Be able to demonstrate aseptic and sterile
  technique for 4 procedures

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The Goal Reduce Health Care Associated
Infections

• The goal is to reduce health care-associated
  infections that occur when staff spread microbes
  to patients
• Germs move to patients from hands, and from
  objects used for patient care
• Use of clean, aseptic or sterile technique
  reduces the number of germs transferred and thus,
  reduces the risk of infection

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Definition Clean Technique

• For this training
• Clean technique refers to the use of routine hand
  washing, hand drying and use of non-sterile gloves

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Clean Technique

• Use clean technique if staff or objects will
  touch intact skin, intact mucous membranes or
  dirty (contaminated) items

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Examples of When Clean Technique is Used

• Clean tech is appropriate for
• Taking blood pressures
• Examining patients
• Feeding patients

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Definition Invasive Procedures

• Acts done to patients that come in contact with
  the wounds, blood stream, the inside of the body,
  or normally sterile parts of the body
• Remember invasive procedures invade the inside of
  the body

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Definition Aseptic Technique

• Aseptic technique is used for short invasive
  procedures. It involves
• Antiseptic hand hygiene (alcohol, betadine or
  chlorhexidine)
• Usually sterile gloves
• Antiseptic (e.g alcohol) on patients skin
• Use of clean, dedicated area

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Aseptic Technique

• Use aseptic technique for brief invasive
  procedures that may break skin or mucous
  membranes, or normally sterile parts of the body
• Example placing a urinary catheter, suctioning,
  placing an IV, emptying a ICD drain

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Definition Sterile Technique

• Sterile technique is used for surgery or the
  preparation of sterile materials for multiple
  patients. It involves
• Surgical hand rub with long acting antiseptic
• Hands dried with sterile towels
• Sterile field
• Sterile gown, mask
• Sterile gloves
• Sterile supplies
• Skin prep
• A dedicated room

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Sterile Technique

• Use during surgery and for invasive procedures
  with high rates of infection
• Examples
• Any long invasive procedure
• Placement of central lines and thoracic lines
• Bulk preparation of IV fluids or medications

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Differences Between the Types of Techniques

• Space and work flow where procedures are done
• Type of hand hygiene
• Use of Personal Protective Equipment, including
  clean, or sterile gloves
• Use of patient skin antisepsis
• Use of a sterile drape or sterile field

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Clean Aseptic Sterile
Procedure space On ward or at beside Dedicated area Dedicated room
Gloves Clean or none Sterile Sterile surgical
Hand hygiene before the procedures Routine Aseptic, e.g. alcohol Surgical scrub Iodophors, chlorheximide
Skin antisepsis No Alcohol Long acting agent
Sterile field No No Yes
Sterile gown, mask, head covering No No Yes
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Facilities Differ in Their Ability to Prevent
Nosocomial Infections

• Increase the level of technique from clean to
  aseptic, or aseptic to sterile if nosocomial
  infections persist

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Exercise Matching Procedures and Techniques

• Matching procedures to the kind of technique
  required
• Objective to discuss measures currently done,
  and to discuss current recommendations

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To Prevent Contamination

• Keep clean, dirty, and sterile items separate
• Only put sterile items in a sterile field
• Change gloves and wash hands if going from a
  contaminated act to a aseptic or sterile act
• Time skin antisepsis and surgical hand hand
  hygiene with a clock
• The sterile field is considered sterile except
  for the 2.5 cm border
• Wet items are considered contaminated

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Planning Reduces Errors in Technique

• Use the S.C.R.I.P.T. reminder to plan
• Visualise every step in advance, to make sure
  supplies are available

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S.C.R.I.P.T Procedures

• Space and work flow?
• Clean, aseptic, or sterile technique?
• Routine, aseptic or surgical hand hygiene?
• Instruments and supplies?
• Personal protective equipment?
• Trash sharps, infectious waste, radioactive
  waste, pathology or routine waste?

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Space and Work Flow?

• Should the procedure be done in a dedicated room
  or space?
• Who will ensure that all visible dirt is removed
  form the space ahead of time, and surfaces
  disinfected if necessary?

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Space and Work Flow?

• Work flow can staff move from hand washing to
  hand drying to separate clean and sterile areas
  without passing or touching contaminated areas?
• Where will used instruments and specimens be
  placed?

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Clean, Aseptic, or Sterile Technique?

• All team members should be clear on who should be
  using clean, aseptic or sterile technique and
  what elements are intended
• Example a physician places a thoracic drain with
  sterile technique,the nurse assisting uses clean
  technique, and the person who empties the drain
  in subsequent days uses aseptic technique

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Instruments and Supplies

• Plan what medical devices and supplies are needed
  
• Plan where each item should be placed
• Plan where and how each item should be discarded
  or sterilised

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Work Flow Chart Decontamination Cycle
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Routine, Aseptic or Surgical Hand Hygiene?

• Prepare in advance for the type of hand hygiene
  that is necessary
• Arrange the supplies including hand drying
  towels, as appropriate

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Personal Protective Equipment

• Discuss what other items are expected and needed
• These may include aprons, shoe covers for bloody
  procedures, masks, hair coverings, face shields
  or goggles

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Trash

• Plan appropriate leak proof, puncture proof
  containers for the transfer and disposal of
  sharps, infectious waste, and specimens
• Sharps containers should be moved to the point of
  use so sharps can be discarded by the original
  team and not left for later staff to find and
  discard

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Summary

• Clean, aseptic and sterile
• Examples of procedures
• SCRIPT the procedure to clearly define what is
  expected and needed from all team members to
  reduce contamination

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Exercise Practising Procedures

• Team
• Script
• Processing sputum for NT culture
• Emptying a urinary catheter bag
• Inserting an intravenous line
• Inserting a urinary catheter
• Inserting a thoracic drain
• Assign roles and demonstrate procedure
• Assign observers who note contamination

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Separating Clean and Dirty Giving Injections
Safely

• Nursing Demonstration Videos

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Break