ASEPTIC TECHNIQUE LEARNING PACKAGE - South...

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ainingDocs\Aseptic Technique Learning Package .docx, Form 690, Issue 3, February

2014

ASEPTIC TECHNIQUE LEARNING PACKAGE

Staff Name: .....................................................

Date: .........................................

http://www.southgippslandhospital.org.au/



2014

Table of Contents

What is Aseptic technique? 3 Core infection control components 3 Key parts 5 References 6 Aseptic technique questionnaire 7 Competency Assessments 9 Peripheral IV cannulation 9 Accessing a ‘closed’ system on vascular access device 11

Accessing an open system on a vascular access device 12

Insertion of a urinary catheter 13

Wound care 14

Aseptic technique assessment sheet 16

We would like to acknowledge that this package was based on the:

Central Gippsland Health Service Aseptic Technique Learning Package Government of South Australia Aseptic Technique Workbook January 2013, Version 1.1.



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What is Aseptic technique?

Aseptic technique aims to prevent pathogenic organisms, in sufficient quantity to cause infection, from being introduced to susceptible sites by hands, surfaces and equipment. It protects patients during invasive clinical procedures by utilizing infection prevention measures that minimize the presence of micro-organisms.

Aseptic technique is a framework for aseptic practice. In aseptic technique, asepsis is ensured by identifying and then protecting key parts and key sites from contamination.

This is achieved by correct:

1. hand hygiene,

2. non touch technique,

3. appropriate aseptic field

4. using new sterilised equipment and or

5. cleaning existing key parts to a standard that renders them aseptic prior to use.

Whilst the principles of aseptic technique remain the same, the level of practice will change according to the risk identified using a standard aseptic technique risk assessment. The standard risk assessment involves assessment of technical difficulty and staff competence in maintaining asepsis.

This self-directed learning package has been developed to provide all clinical staff with knowledge in aseptic technique in accordance with the Australian Guidelines for the Prevention and Control of Infection in Healthcare (2010).

Core infection control components

1. Key parts and key sites identification and protection - key parts must be identified and protected at all times. Aseptic key parts must only come into contact with other aseptic key parts and / or key sites.

2. Hand hygiene – Effective hand hygiene is an essential part of aseptic technique. In standard aseptic technique hand hygiene should be performed using neutral pH soap and running water or alcohol based hand rub. A surgical hand scrub is required for surgical aseptic technique. It is known that hand hygiene is not always performed correctly thus identifying key parts and not touching them is vital in maintaining asepsis.

3. Glove use – if it is necessary to touch key parts or key sites directly, sterile gloves are used to minimize risk of contamination, body fluid exposure and / or exposure to any drugs that may be administered during the procedure. For example during IV cannulation, if you have swabbed the vein and need to repalpate you need to wear sterile gloves.

4. Aseptic fields – aseptic fields are important in providing a controlled aseptic working space to help maintain integrity of the asepsis during clinical procedures. Size of the aseptic field will be dependent upon the complexity of the procedure to be performed.

There are 3 types of aseptic fields

> Critical aseptic fields are used when key parts and or key sites (usually due to their size or number), cannot be easily protected at all times with covers and caps, or handled at all times by non-touch technique. The critical aseptic field eg. a



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dressing tray or surgical sterile drape, must be managed as a key part. This means that only sterile equipment may come into contact with it. Critical aseptic fields require the use of sterile gloves and often, full barrier precautions.

> Examples of procedures requiring a critical aseptic field are CVC insertion and complex wound care. Critical aseptic fields are used in the Operating Theatre (see Appendix 1).

> Critical micro aseptic fields involve covering or protecting key parts with syringe caps, sheaths, covers or packaging. The inside of caps and covers is sterile and provides optimum aseptic field for key parts. An example is an intramuscular needle. It is protected by the cap which ensures the needle, which is the key part, remains sterile and when utilising non touch technique the aseptic field is maintained (see Appendix 1).

> General aseptic fields are used for standard aseptic technique when key parts can be easily and optimally protected. The main general aseptic field does not have to be managed as a key part and is essentially promoting rather than ensuring asepsis. An example is administering IV antibiotics. The key parts - the syringe tip and drawing up needle are easily protected by packaging, caps and non-touch technique. Therefore, a clean area is adequate as the key parts are protected using these critical micro aseptic fields.

5. Standard Aseptic technique

> Typically short duration procedures (less than 20 minutes) > Technically simple procedures > Involve relatively few and small key sites and key parts > Requires a main general aseptic field and non-sterile gloves > Use of critical micro aseptic fields and non-touch technique is essential to protect

key parts and key sites

Examples include, any break/access to the sterile intravenous line/device such as changing lines, administrating drugs, flushing bung etc. Simple wound dressings, and where the staff member is experienced in urinary catheterization and IV cannulation standard aseptic technique may be adequate.

6. Surgical Aseptic technique > Technically complex procedures

> Involve extended period of time

> Large open key sites or large or numerous key parts

> Require main critical aseptic field and sterile gloves and full barrier precautions

> Use of critical aseptic fields and non-touch technique is used where practical to do so

Examples include urinary catheterization in non-experienced staff member, IV cannulation with non-experienced staff member, plus complex / large dressings, PICC / CVC insertion & surgery.

7. Environment Control



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Prior to conducting an aseptic procedure, health care workers should ensure that there are no avoidable environmental risk factors nearby such as bed making or patients using commodes.

Key Parts

1. Aseptic technique for Peripheral and Central Venous Intravenous Therapy

Key Parts include –

> syringe tip

> needle – both needle tip and hub

> needle Free Access device / bung on catheter lumen

> IV infusion lines including fluid bag spikes, all bungs, caps, 3 way taps, all infusion ports, the end of the infusion line which connects to patient

> extension lines – both end that connects to patient and end that connects to IV administration set

> the hub of both central and peripheral access devices

> the tip of the implanted port needle & the hub end

> the dressing

> rubber tops on vials containing medication

> syringe access point of any IV medication / fluid

2. Aseptic technique for wound care (outside the operating theatre)

Key parts include –

> tips of forceps

> gauze / swabs used to cleanse wound

> suture remover tip (if applicable)

> staple remover tips (if applicable)

> scissor tips (if applicable)

> dressing to be applied / side directly over the wound

3. Aseptic technique for insertion of urinary catheter (male / female)

Key parts include –

> forcep handle in dominant hand

> urinary catheter – both ends and hub for injecting sterile water

> lubricant tip & handle (used in dominant hand)

> tip of urinary drainage bag that connects to urinary catheter

> syringe tip

> sterile water for injection opening



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References

1. Aseptic Technique Workbook January 2013 -Version 1.1. Government of South Australia.

2. Central Gippsland Health Service, Aseptic Technique Learning Package 2013.

3. National Health & Medical Research Council. (2010) Australian Guidelines for the Prevention and Control of Infection in Healthcare.

4. Noosa & Nambour Selangor Private Hospital. (2012) Aseptic technique workbook & competencies.

5. The Australian College of Operating Room Nurses Ltd. ACORN Standards for perioperative nursing. 2012 – 2013. Adelaide, South Australia.



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Aseptic technique Questionnaire

Please select the most appropriate response to these questions prior to completing a competency in aseptic non touch technique.

1. Which of these activities uses aseptic technique?

a) Monitoring blood pressure

b) Feeding a patient via a nasogastric tube

c) Giving intravenous antibiotics.

d) Pressure area care

2. What is the aim of aseptic technique?

a) To protect patients from infection during invasive clinical procedures by utilizing measures that minimise the presence of micro-organisms.

b) To ensure cleanliness when performing procedures c) To bypass the need for hand washing before procedures d) To remove nosocomial organisms and allow safe normal flora to remain

3. Which is an example of a key part?

a) The dressing trolley b) Hand washing c) Unsheathed intra muscular injecting needle d) Non-sterile gloves

4. When would you use critical aseptic fields?

a) Only in the operating theatre for major invasive procedures b) In more complex and invasive aseptic procedures that involve multiple sterile

components eg. Insertion of a central venous catheter, surgical procedures c) Critical aseptic fields are used in all aseptic procedures d) For undertaking activities of daily living eg showering

5. Which is an example of a critical micro aseptic field?

a) The skin prep solution b) A urinary catheter bag c) The capped insertion end of a peripheral line d) A bandage for securing the dressing

6. In which scenario would you use sterile gloves?

a) Performing a simple dressing b) When you can’t perform hand hygiene before the procedure c) If the patient is immunosuppressed. d) Insertion of a central venous line

7. Which is an example of standard aseptic technique?

a) Giving oral medications

b) Changing the line of an intravenous infusion

C) Performing an ECG



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8. Which is an example of a surgical aseptic technique?

a) A simple wound dressing

b). Giving a subcutaneous injection

c). Insertion of a PICC line

9. What is a key part when accessing an intravascular device?

a) The handle of the device

b) Non sterile gloves used by the health professional

c) The intravascular insertion site dressing

10. What is a key part when performing a dressing outside the operating theatre?

a) The tips of forceps

b) The nurse’s gloves

c) The dressing tray

11. What is a key part when inserting a urinary catheter?

a) The catheter bag

b) The urinary catheter

c) The swabs used to clean the genital area



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Competencies

Peripheral IV Cannulation

Standard Aseptic Technique

* Of note: The following workflow has been used as an example only. Health Care Workers

(HCWs) should be deemed compliant to aseptic practice providing individual technique does not breech the aseptic field.

Steps Procedure Competent

Yes No

Step 1 Inform the patient and with verbal consent and prepare the patient.

Step 2 Perform hand hygiene.

Step 3 Clean trolley or tray with Tuffie 5 wipe and collect required equipment.


Step 5 Prepare IV flush, IV extension set, IV therapy and pathology equipment if required, ensuring key parts are protected from contamination at all times and place in kidney dish.

Step 6 Peel open sterile equipment required ensuring key parts remain sterile (IVC, bung, dressing etc.). Assess the patient’s access, determine site and apply tourniquet.


Step 8 Apply non sterile gloves to protect from potential body fluid exposure. If required to touch key parts apply sterile gloves. Asepsis is maintained by ensuring key parts are not touched / contaminated.

Step 9 Clean skin with chlorhexidine & alcohol swab / solution (unless contraindicated). Apply liberally and allow area to completely dry. Use only one side of the swab. One side will be exposed to the gloves and one side to the skin.

Step 10 Once area is dry, insert cannula ensuring tip and site of entry are not touched / not contaminated. Do not repalpate vein unless sterile gloves are worn. Apply dressing and secure the device. Document date and sign identification strip and place on dressing.

Step 11 Option 1:Flush cannula ensuring syringe tip and cannula hub are not contaminated by touch (disinfect with chlorhexidine and alcohol swab if key part is contaminated)

Option 2: Apply vacutainer and draw pathology. Clean hub with alcohol & chlorhexidine wipe and flush with 10 mls normal saline.

Step 12 Attach IV therapy devices / extension tubing whilst maintaining non touch of all key parts.

Step 13 Discard all sharp devices into sharps containers

Step 14 Remove gloves & perform hand hygiene



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Step 15 Document IV cannulation details on Observation Chart and Medical Care Plan.

Step 16 Advise the patient on how to care for the device and when to seek medical advice

Step 17 Discard all used equipment, clean trolley using a tuffie 5 wipe

Step 18 Perform hand hygiene



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Accessing a ‘closed’ system on Vascular Access Devices

Standard Aseptic technique

* Of note: The following workflow has been used as an example only. HCWs should be

deemed compliant to aseptic practice providing individual technique does not breech the aseptic field.


Yes No


Step 2 Clean trolley or tray with tuffie 5 wipe and gather required equipment – syringe, bung, chlorhexidine & alcohol wipes, required drugs and any other associated equipment. Perform hand hygiene

Step 3 > Open normal saline or water for injection if required & connect syringe without contaminating key parts

> Clean top of drug vials using alcohol & chlorhexidine wipe and allow to dry before penetrating

> Option 1: Mix powder with dilutent. Leave needle and syringe in vial

> Option 2: Mix powder with dilutent. Remove syringe and needle from vial and place cap back on needle via kidney dish

> Place prepared syringe / drug into clean injection tray with chlorhexidine & alcohol wipes

> If adding drug to a small bag of IV Fluid, perform hand hygiene then clean port of bag with chlorhexidine & alcohol wipe and allow port to dry before adding drug ensuring key parts are not contaminated


Step 5 Identify patient. After explaining procedure to patient pause any IV pumps.


Step 7 > Swab port to be accessed with chlorhexidine & alcohol wipe. Allow area to dry before connecting syringe / IV therapy ensuring key parts are not contaminated.


Step 9 Recommence pump, document procedure, discard used equipment. Clean trolley using a tuffie 5 wipe.


If using gloves they must be changed prior to each hand hygiene moment.



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Accessing an ‘open’ system on Vascular Access Devices

Standard Aseptic technique



STEPS PROCEDURE COMPETENT

YES NO


Step 2 Clean trolley with alcohol wipe and collect required equipment placing pre-packaged insertion pack on top shelf and all other equipment on the bottom shelf.

Step 3 The staff member checks that the patient has been informed of the procedure by the person inserting or accessing the device. Assess patient for any allergies to skin antiseptics.


Step 5 Prepare IV therapy and / or flush as required ensuring key parts are protected from contamination at all times.

Step 6 Open sterile equipment onto trolley. Open sterile gloves onto separate surface cleaned prior to use with tuffie 5 wipes.

Step 7 > perform a surgical hand scrub using an antimicrobial hand wash solution for 3 mins

> Dry hands using a sterile towel

> Don sterile gloves

> Access the site and prepare equipment as per policy for PORT/PICC in Care Practice Manual

> ensure key parts are protected from contamination at all times

> Secure the device to prevent movement at the site

Step 8 Before handling IV giving set / IV therapy connect to vascular access device and ensure key parts are not contaminated during connection. (Disinfect with alcohol & chlorhexidine wipe if key part is contaminated)

Step 9 Remove sterile gloves and perform hand hygiene.

Step 10 Organise X-ray to confirm position

Step 11 Document the procedure and inform the patient how to care for the device and when to seek medical advice.

Step 12 Discard all equipment / sharps into correct waste receptacles, clean trolley with a detergent or detergent/disinfectant wipe.




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Insertion of Urinary Catheter Standard Aseptic Technique

Of note: The following workflow has been used as an example only. HCWs should be deemed compliant to aseptic practice providing individual technique does not breech the aseptic field.


Yes No

Step 1 Inform patient about the procedure and obtain verbal consent to proceed.


Step 3 > Clean trolley with a tuffie 5 wipe and gather catheter insertion equipment including sterile gloves

> Place catheter pack on the top shelf and all items on the bottom shelf. If the trolley has a draw – (do not go into the draw without performing hand hygiene).

> Upon entering patient room, open catheter pack and add items required ensuring items remain sterile.

> Organise & prepare all items in the sterile field to enable access with one hand. (You may wish to draw privacy curtain at this point).

Step 4 Perform hand hygiene & put on gloves.

Step 5 > Prepare the patient.

> Place sterile field on patient and using non dominant hand expose the entrance to the urethra.

> Using dominant hand cleanse area with forceps & moist gauze. Insert lubricant.

> Remove gloves.

Step 6 Perform a surgical hand scrub using an antimicrobial hand wash for 3 mins. Dry hands with a sterile towel.

Step 7 > Apply a pair of sterile gloves

> Insert catheter ensuring other end is in water proof dish.

> Once urine flows into dish using two hands, attach syringe (prepared in step 3) to catheter hub and inject required water to inflate balloon.

> If unsuccessful attempt in woman, leave IDC in situ to avoid second unsuccessful reinsertion

Step 8 > Collect specimens aseptically if required before connecting urinary drainage bag to catheter.

> Secure the catheter to the patient’s leg preventing drag.

> Remove gloves.


Step 10 Ensure patient is comfortable and document procedure in patient notes. Inform the patient how to care for the device.

Step 11 Discard items from trolley top, clean trolley using detergent or detergent/disinfectant wipe.




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Wound Care

Standard Aseptic Technique




Yes No

Step 1 Inform patient about the procedure and obtain verbal consent to proceed.


Step 3 Clean trolley with tuffie 5 wipe, and gather dressing equipment.

Place dressing pack on the top shelf and all items on the bottom shelf. If the trolley has a draw – (do not go into the draw without removing gloves and performing hand hygiene).


Step 5 Entering patient room, open dressing pack and add items required ensuring items remain sterile. Prepare the patient.

Step 6 Don a pair of non sterile gloves and loosen old dressing so it can be removed with a pair of forceps. Remove gloves.

Step 7 Perform hand hygiene. If sterile gloves are being used dry hands with a sterile towel.

Step 8 > Option 1 - Using non sterile gloves remove the old dressing without touching the wound and discard with gloves.

> Option 2 - Using non sterile gloves and a forcep, remove old dressing and discard with dressing items.

> Option 3 - Using no gloves and a forcep remove old dressing and discard dressing items and forcep

> Option 4 - If required to touch the wound – use sterile gloves and a forcep and discard as per option 3.

If extra items are required for use, remove gloves if being worn and perform hand hygiene prior to getting items out of a draw in the trolley or before leaving the room to obtain further items.

Open items, perform hand hygiene and put on gloves before continuing with dressing.


Step 10 Using sterile forceps cleanse area as required without contaminating the forceps and the other items on the trolley / clean field. Cleansing should go from inside to out.

Complete dressing and remove gloves if applicable.




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Step 12 Document procedure in patient notes and ensure patient is comfortable.

Explain to the patient how to care for the dressing and when to seek medical advice.

Discard all dressing equipment used / opened and clean trolley using a tuffie 5 wipe.

Step 13 Perform hand hygiene



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Aseptic technique Assessment Sheet

1. During the assessment, the assessor assigns a category corresponding to the

performance level for each of the performance criteria (see below key)

2. If the performance falls into the category “NYC”, comments must be included, comments are optional if category “C” is demonstrated/achieved

3. A copy of the completed assessment tool is provided for the nurse, the original is given to the Nurse Educator.

Category Performance Level Action Required

C

(Competent)

Standard of practice is at or above the performance criteria outlined

> Aspects of performance that are satisfactory are documented and positive feedback given to the nurse.

> Positive feedback is given when appropriate.

NYC

(Not Yet Competent)

Standard of practice is below the performance criteria outlined

> All areas in which the standard of performance is below the criteria and discussed & documented through the use of examples of actual & expected practice

> The nurse is provided with a learning program and times may be arranged for further practice so that the expected standard can be achieved within a prescribed timeframe.

Comments:

Action plan for non compliance:

Proposed reassessment date:

Competency Assessment - Details Please complete the details below: Employee Name: ..............................................................................................................................

Signature: .............................................................................. Date: .............. / ................ / ..............

Assessor Name: ...............................................................................................................................

Signature: .............................................................................. Date: .............. / ................ / ..............

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Appendix 1

CRITICAL MICRO ASEPTIC FIELD CRITICAL ASEPTIC FIELD

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