Post on 29-Mar-2015
Clean, Aseptic and Sterile Technique
Session 4: Infection Control Basics
4: Clean, Aseptic, Sterile Slide 2
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
4: Clean, Aseptic, Sterile Slide 3
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
4: Clean, Aseptic, Sterile Slide 4
Definition: Clean Technique
For this training:
Clean technique refers to the use of routine hand washing, hand drying and use of non-sterile gloves
4: Clean, Aseptic, Sterile Slide 5
Clean Technique
Use clean technique if staff or objects will touch intact skin, intact mucous membranes or dirty (contaminated) items
4: Clean, Aseptic, Sterile Slide 6
Examples of When Clean Technique is Used
Clean tech is appropriate for:
Taking blood pressures
Examining patients
Feeding patients
4: Clean, Aseptic, Sterile Slide 7
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
4: Clean, Aseptic, Sterile Slide 8
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 patient’s skin
Use of clean, dedicated area
4: Clean, Aseptic, Sterile Slide 9
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
4: Clean, Aseptic, Sterile Slide 10
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
4: Clean, Aseptic, Sterile Slide 11
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
4: Clean, Aseptic, Sterile Slide 12
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
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
4: Clean, Aseptic, Sterile Slide 14
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
4: Clean, Aseptic, Sterile Slide 15
Exercise: Matching Procedures and Techniques
Matching procedures to the kind of technique required
Objective: to discuss measures currently done, and to discuss current recommendations
4: Clean, Aseptic, Sterile Slide 16
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
4: Clean, Aseptic, Sterile Slide 17
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
4: Clean, Aseptic, Sterile Slide 18
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?
4: Clean, Aseptic, Sterile Slide 19
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?
4: Clean, Aseptic, Sterile Slide 20
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?
4: Clean, Aseptic, Sterile Slide 21
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
4: Clean, Aseptic, Sterile Slide 22
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
4: Clean, Aseptic, Sterile Slide 23
Work Flow Chart: Decontamination Cycle
4: Clean, Aseptic, Sterile Slide 24
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
4: Clean, Aseptic, Sterile Slide 25
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
4: Clean, Aseptic, Sterile Slide 26
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
4: Clean, Aseptic, Sterile Slide 27
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
4: Clean, Aseptic, Sterile Slide 28
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
“Separating Clean and Dirty” & “Giving Injections
Safely”Nursing Demonstration Videos
Break