Clean Asceptic and Sterile Techniques

7/28/2019 Clean Asceptic and Sterile Techniques

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CLEAN, ASEPTIC AND STERILE

TECHNIQUE


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Objectives

Be able to assess procedures for the risk of

infection to patient

Describe the level of precautions needed for

different invasive procedures


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Any time we touch a patient we put

them at risk for an infection

Touching intact skin: may transfer germs that

colonize the patient and cause infection 18

months later.

Procedures touching respiratory tract, mouthand mucous membranes: germs may enter

through micro cuts, or become colonized

Procedures that cut into sterile body parts:most acute risk.


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Reduce the risk of infection by using clean,

aseptic or sterile technique depending on the risk

of the procedures

How do you determine what is the risk of the

procedure?

What exactly is clean or sterile technique?


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Risk: even with perfect technique,

patient infect themselves

Patients germs may enter from theirendogneous flora

Dirty cases more likely: respiratory track, GI, openwounds Reproductive tract involved

Or if the patient is already colonized with multi drugresistant organisms (MDRO)


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Risk: Even with perfect patients,

hospitals infect patients

Through germs on the hands of hospital staff

Through germs from contaminated items, air, or

the environment Items shared between patients without reprocessing

Facilities and waiting areas that share space


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Risk of infection is increased

by:

The length of the procedure

Length of hospital stay

Size of incision and manipulation of operation

If indwelling item left (transplant, line, drain,

catheter, hardware, mesh, graft)

Dusty, dirty, contaminated environment (e.g.

not a procedure room or surfaces notdisinfected)

Contamination of irrigations and medications


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Infections are reduced by the

measure we have discussed :

Hand hygiene, use of sterile instruments, use

of barriers to prevent shedding onto the

patient, masks, use of procedure rooms,minimizing the number of persons in the room,

disinfecting surfaces, special ventilation


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All procedures require:

Hand washing before and after to first remove

all visible dirt

Complete separation of clean and dirty areas

and a designated place for waste. Thereshould be no uncovered storage in the

procedure room.

Never place clean items in a dirty area, neverplace dirty items in a clean area; never place non-

sterile items in a sterile field.


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Clean area?

Separate personalitems from hospitalitems

No staff eating ordrinking

Store clean items,

including linen, cottons,gauze, towels covered

If cotton is torn by handit is contaminated.


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Aseptic, not sterile

technique

Done before short invasive procedures

Generally done with sterile gloves if hands may touchsterile items or to reduce transferring environmental

germsRecommended when:

Mixing IV medications

Suctioning

Placing a urinary catheter

Placing a peripheral venous catheter

Dressing changes


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Aseptic technique uses clean or

sterile gloves: assess risk

Clean gloves Sterile gloves

Drawing blood cultures Urinary cannula insertion

Drawing blood samples Suctioning resp. tract

Getting urine sample

from line for specimen

Changing central line

tubing

No gloves: Placing clean dressings

IM injections Preparing art. line

transducers


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Sterile technique means

Maximally sterile precautions for high-risk

invasive procedures including surgery:

Sterile surgical gloves

Surgical hand wash

Head and beard cover

Sterile gown

Mask that covers nose, mouth Sterile drape


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Sterile technique requires

Clean area or dedicated area with barriers

between other patients or contaminated objects

Minimal number of staff present

Distinction between sterile and non-sterile areas

-No non-sterile items on sterile field

-Assistant to hand off dirty and non-sterile items


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Can sterile procedures be done

safely in this setting?

No


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When to do sterile technique

Compounding medication for large numbers of

people or preparing IV fluids for multiple

patients

Surgery

Long procedures,

Procedures with long dwelling implants other

than an IV or urinary cannula Procedures for which you have unexplained

high infection rates


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Sterile technique is also used

for:

Mixing of IV fluids

Pharmacy procedures for parenteralmedications

Preparation of implants andtransducers

Insertion of central lines

Changing of central lines

Some laboratory procedures tominimize contamination


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What precautions are needed for

this procedure?


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OphthalmologyENT surgery

Shared operating theatre facilities


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What technique do you need for

the following?

Helping change a

colostomy

Inserting an IV

Inserting a centralline

Getting a blood

culture Suctioning a patient

Getting a sputum

speciemen

Helping a patientwith physiotherapy

Removing linen

Taking out the trash Inserting a chest

tube

Mixing IV fluid

Cleaning a bloodspill

Endo-tracheal

insertion


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Practice procedures:

Practice demonstrating these clean and sterile

techniques for a dressing change, IV or central

line placement and urinary catheter procedure,

including the sequence of donning and doffingPPE.

Clean Asceptic and Sterile Techniques

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