Chapter 4: Infection prevention and control
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Aseptic technique
Definition
Aseptic technique is the practice of carrying out a procedure in such a way as to minimize the risk of introducing contamination into a vulnerable area or an invasive device. The area or device will not necessarily be sterile – wounds, for example, will be colonized with micro‐organisms – but the aim is to avoid introducing additional contamination.
Aseptic non‐touch technique (ANTT) is the practice of avoiding contamination by not touching key elements, such as the tip of a needle, the seal of an intravenous connector after it has been decontaminated (Figure 4.51), or the inside surface of a sterile dressing where it will be in contact with the wound (Rowley and Clare [107]).
Related theory
As with other infection prevention and control measures, the actions taken to reduce the risk of contamination will depend on the procedure being undertaken and the potential consequences of contamination (Rowley and Clare [107]). Examples of different levels of aseptic technique are given in Table 4.7. It would be difficult to provide a procedure guideline that would apply to the whole range of aseptic procedures; however, the topic is covered in other relevant procedures within this manual, such as those for the insertion of an indwelling urinary catheter (see Chapter c06: Elimination). To provide a context, Procedure guideline 4.11 contains steps for changing a wound dressing but is presented as a guide to aseptic technique in general. Local guidance and training should be sought before carrying out specific procedures.
Table 4.7 Examples of different levels of aseptic procedures
Procedure | Precautions required |
---|---|
Surgery | Carried out in an operating theatre with specialist ventilation by a team whose members wear sterile gowns and gloves |
Urinary catheterization | Can be carried out in an open ward by a practitioner wearing an apron and sterile gloves |
Peripheral intravenous cannulation | Can be performed in an open ward by a practitioner wearing non‐sterile gloves and using an appropriate non‐touch technique |
Pre‐procedural considerations
Equipment
Gloves
Gloves are normally worn for ANTT but they are mainly for the practitioner's, rather than the patient's, protection. Non‐sterile gloves are therefore perfectly acceptable.
Sterile dressing pack
This may contain gallipots or an indented plastic tray, low‐linting swabs and/or medical foam, disposable forceps, gloves, a sterile field and a disposal bag. There are specific packs available for particular procedures, for example intravenous packs. The usage and availability of these vary between organizations, so reference is generally made to a ‘sterile dressing pack’.
Traceabilty system
This is a system for labelling instruments and equipment in such a way that they can be recorded in the patient record, usually as a sticker or a scanned barcode. It allows the opportunity to look back to identify what equipment has been used, where and on whom, in the event of a problem (e.g. with a batch of a product).
Trolley
Dressing trolleys should be cleaned with a detergent wipe prior to each use to remove any dust or soiling. Disinfectant wipes may be used if the trolley is physically clean.
Pharmacological support
Cleansing agents are discussed in more detail in Chapter c18: Wound management.
Specific patient preparation
Education
Wherever possible, patients should be informed about the rationale behind procedures and the steps being taken to reduce the risk of them being exposed to an HCAI during their care. Patients may be offered additional information to help them make informed choices on things that they can do to stay well and prevent infection while they are in hospital or indeed when they are at home. In particular, programmes that encourage patients to ask healthcare workers ‘Did you wash your hands?’ have been demonstrated to increase healthcare workers’ compliance with hand hygiene (McGuckin et al. [75]). They may also empower patients and increase their confidence in the care they are receiving.
Procedure guideline 4.11