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

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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 patient’s 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

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

“Separating Clean and Dirty” & “Giving Injections

Safely”Nursing Demonstration Videos

Break