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Open Resources for Nursing (Open RN); Ernstmeyer K, Christman E, editors. Nursing Skills [Internet]. Eau Claire (WI): Chippewa Valley Technical College; 2021.

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Nursing Skills [Internet].

Open Resources for Nursing (Open RN); Ernstmeyer K, Christman E, editors. Eau Claire (WI): Chippewa Valley Technical College; 2021.

Chapter 4 Aseptic Technique

4.1. ASEPTIC TECHNIQUE INTRODUCTION

Learning Objectives

Perform appropriate hand hygiene Use standard precautions Use category-specific, transmission-based precautions Maintain a sterile field and equipment Apply and safely remove sterile gloves and personal protective equipment Dispose of contaminated wastes appropriately

According to the Centers for Disease Control and Prevention (CDC), over 2 million patients in America contract a healthcare-associated infection, and 99,000 patients die from a healthcare-associated infection every year. [ 1 ] Healthcare-associated infections (HAIs) are unintended and often preventable infections caused by care received in a health care setting. Healthcare-associated infections can be prevented by consistently following standard precautions and transmission-based precautions outlined by the CDC (2020). Standard precautions are used when caring for all patients and include performing appropriate hand hygiene; wearing personal protective equipment when indicated; implementing category-specific transmission precautions; encouraging respiratory hygiene; and following environmental infection control measures, including handling of sharps, laundry, and hazardous waste. Additional infection control measures include the appropriate use of aseptic technique and sterile technique when performing nursing procedures to protect the patient from transmission of microorganisms. [ 2 ] Each of these strategies to keep patients and health care workers free of infection is discussed in further detail in this chapter.

References

Collins, A. S. (2008). Preventing health care-associated infections. In Hughes, R.G. (Ed.). Patient safety and quality: An evidence-based handbook for nurses. https://www .ncbi.nlm .nih.gov/books/NBK2683/ ↵. [PubMed : 21328752 ]

4.2. ASEPTIC TECHNIQUE BASIC CONCEPTS

Standard Versus Transmission-Based Precautions

Standard Precautions

Standard precautions are used when caring for all patients to prevent health care associated infections. According to the Centers for Disease Control and Prevention (CDC), standard precautions are “the minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where health care is delivered.” [ 1 ] They are based on the principle that all blood, body fluids (except sweat), nonintact skin, and mucous membranes may contain transmissible infectious agents. These standards reduce the risk of exposure for the health care worker and protect the patient from potential transmission of infectious organisms.

Current standard precautions according to the CDC (2019) include the following:

Appropriate hand hygiene

Use of personal protective equipment (e.g., gloves, gowns, masks, eyewear) whenever infectious material exposure may occur

Appropriate patient placement and care using transmission-based precautions when indicated

Respiratory hygiene/cough etiquette

Proper handling and cleaning of environment, equipment, and devices

Safe handling of laundry

Sharps safety (i.e., engineering and work practice controls)

Aseptic technique for invasive nursing procedures such as parenteral medication administration [ 2 ]

Each of these standard precautions is described in more detail in the following subsections.

Transmission-Based Precautions

In addition to standard precautions, transmission-based precautions are used for patients with documented or suspected infection, or colonization, of highly-transmissible or epidemiologically-important pathogens. Epidemiologically-important pathogens include, but are not limited to, Coronavirus disease (COVID-19), Clostridium difficile (C-diff), Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant enterococci (VRE), Respiratory Syncytial Virus (RSV), measles, and tuberculosis (TB). For patients with these types of pathogens, standard precautions are used along with specific transmission-based precautions.

There are four categories of transmission-based precautions: contact precautions,enhanced barrier precautions, droplet precautions, and airborne precautions. Transmission-based precautions are used when the route(s) of transmission is (are) not completely interrupted using standard precautions alone. Some diseases, such as tuberculosis, have multiple routes of transmission so more than one transmission-based precautions category must be implemented. See Table 4.2 outlining the categories of transmission precautions with associated PPE and other precautions. When possible, patients with transmission-based precautions should be placed in a single occupancy room with dedicated patient care equipment (e.g., blood pressure cuffs, stethoscope, thermometer). Transport of the patient and unnecessary movement outside the patient room should be limited. However, when transmission-based precautions are implemented, it is also important for the nurse to make efforts to counteract possible adverse effects of these precautions on patients, such as anxiety, depression, perceptions of stigma, and reduced contact with clinical staff.

Table 4.2

Dedicated equipment Goggles or face shield Airborne infection isolation room Single patient room Patient door closed Restricted susceptible personnel room entry

View a list of transmission-based precautions used for specific medical conditions at the CDC Guideline for Isolation Precautions.

PATIENT TRANSPORT

Several principles are used to guide transport of patients requiring transmission-based precautions. In the inpatient and residential settings, these principles include the following:

Limiting transport for essential purposes only, such as diagnostic and therapeutic procedures that cannot be performed in the patient’s room

Using appropriate barriers on the patient consistent with the route and risk of transmission (e.g., mask, gown, covering the affected areas when infectious skin lesions or drainage is present)

Notify other health care personnel involved in the care of the patient of the transmission-based precautions. For example, when transporting the patient to radiology, inform the radiology technician of the precautions. [ 4 ]

Appropriate Hand Hygiene

Hand hygiene is the single most important practice to reduce the transmission of infectious agents in health care settings and is an essential element of standard precautions. [ 5 ] Routine handwashing during appropriate moments is a simple and effective way to prevent infection. However, it is estimated that health care professionals, on average, properly clean their hands less than 50% of the time it is indicated. [ 6 ] The Joint Commission, the organization that sets evidence-based standards of care for hospitals, recently updated its hand hygiene standards in 2018 to promote enforcement. If a Joint Commission surveyor witnesses an individual failing to properly clean their hands when it is indicated, a deficiency will be cited requiring improvement by the agency. This deficiency could potentially jeopardize a hospital’s accreditation status and their ability to receive payment for patient services. Therefore, it is essential for all health care workers to ensure they are using proper hand hygiene at the appropriate times. [ 7 ]

There are several evidence-based guidelines for performing appropriate hand hygiene. These guidelines include frequency of performing hand hygiene according to the care circumstances, solutions used, and technique performed. The Healthcare Infection Control Practices Advisory Committee (HICPAC) recommends health care personnel perform hand hygiene at specific times when providing care to patients. These moments are often referred to as the “Five Moments for Hand Hygiene.” [ 8 ] See Figure 4.1 [ 9 ] and Figure 4.2 [ 10 ] for an illustration and application of the five moments of hand hygiene. The five moments of hand hygiene are as follows:

Figure 4.1

Five Moments of Hand Hygiene

Figure 4.2

Five Moments of Hand Hygiene Expanded

Immediately before touching a patient Before performing an aseptic task or handling invasive devices Before moving from a soiled body site to a clean body site on a patient After touching a patient or their immediate environment After contact with blood, body fluids, or contaminated surfaces (with or without glove use)

When performing hand hygiene, washing with soap and water, or an approved alcohol-based hand rub solution that contains at least 60% alcohol, may be used. Unless hands are visibly soiled, an alcohol-based hand rub is preferred over soap and water in most clinical situations due to evidence of improved compliance. Hand rubs are also preferred because they are generally less irritating to health care worker’s hands. However, it is important to recognize that alcohol-based rubs do not eliminate some types of germs, such as Clostridium difficile (C-diff).

When using the alcohol-based handrub method, the CDC recommends the following steps. See Figure 4.3 [ 11 ] for a handrub poster created by the World Health Organization.

Figure 4.3

WHO Handrub Poster

Apply product to the palm of one hand in an amount that will cover all surfaces.

Rub hands together, covering all the surfaces of the hands, fingers, and wrists until the hands are dry. Surfaces include the palms and fingers, between the fingers, the backs of the hands and fingers, the fingertips, and the thumbs.

The process should take about 20 seconds, and the solution should be dry. [ 12 ]

When washing with soap and water, the CDC recommends using the following steps. See Figure 4.4 [ 13 ] for an image of a handwashing poster created by the World Health Organization.

Figure 4.4

WHO Handwashing Poster

Wet hands with warm or cold running water and apply facility-approved soap.

Lather hands by rubbing them together with the soap. Use the same technique as the handrub process to clean the palms and fingers, between the fingers, the backs of the hands and fingers, the fingertips, and the thumbs.

Scrub thoroughly for at least 20 seconds. Rinse hands well under clean, running water. Dry the hands using a clean towel or disposable toweling. Use a clean paper towel to shut off the faucet. [ 14 ]

By performing hand hygiene at the proper moments and using appropriate techniques, you will ensure your hands are safe and you are not transmitting infectious organisms to yourself or others.

Video Reviews of Handwashing

Hand Hygiene for Healthcare Workers [ 15 ]

Image ch4aseptic-Image001.jpg

CDC Handwashing for Children in School [ 16 ]

For more information about hand hygiene recommendations, use the following links:

Personal Protective Equipment (PPE)

Personal Protective Equipment (PPE) includes gloves, gowns, face shields, goggles, and masks used to prevent the spread of infection to and from patients and health care providers. Depending on the anticipated exposure, PPE may include the use of gloves, a fluid-resistant gown, goggles or a face shield, and a mask or respirator. When used for a patient with transmission-based precautions, PPE supplies are typically stored in an isolation cart next to the patient’s room, and a card is posted on the door alerting staff and visitors to precautions needed before entering the room.

Gloves

Gloves protect both patients and health care personnel from exposure to infectious material that may be carried on the hands. Gloves are used to prevent contamination of health care personnel hands during activities such as the following:

anticipating direct contact with blood or body fluids, mucous membranes, nonintact skin, and other potentially infectious material

having direct contact with patients who are colonized or infected with pathogens transmitted by the contact route, such as Vancomycin-resistant enterococci (VRE), Methicillin-resistant Staphylococcus aureus (MRSA), and Respiratory Syncytial Virus (RSV)

handling or touching visibly or potentially contaminated patient care equipment and environmental surfaces [ 17 ]

Nonsterile disposable medical gloves for routine patient care are made of a variety of materials, such as latex, vinyl, and nitrile. Many people are allergic to latex, so be sure to check for latex allergies for the patient and other health care professionals. See Figure 4.5 [ 18 ] for an image of nonsterile medical gloves in various sizes in a health care setting. At times, gloves may need to be changed when providing care to a single patient to prevent cross-contamination of body sites. It is also necessary to change gloves if the patient interaction requires touching portable computer keyboards or other mobile equipment that is transported from room to room. Discarding gloves between patients is necessary to prevent transmission of infectious material. Gloves must not be washed for subsequent reuse because microorganisms cannot be reliably removed from glove surfaces and continued glove integrity cannot be ensured. [ 19 ]

Figure 4.5

Non-Sterile Medical Gloves

Figure 4.5 Nonsterile Medical GlovesWhen gloves are worn in combination with other PPE, they are put on last. Gloves that fit snugly around the wrist should be used in combination with isolation gowns because they will cover the gown cuff and provide a more reliable continuous barrier for the arms, wrists, and hands.

Gloves should be removed properly to prevent contamination. See Figure 4.6 [ 20 ] for an illustration of properly removing gloves. Hand hygiene should be performed following glove removal to ensure the hands will not carry potentially infectious material that might have penetrated through unrecognized tears or contaminated the hands during glove removal. One method for properly removing gloves includes the following steps:

Figure 4.6

Proper Removal of Gloves to Prevent Contamination

Grasp the outside of one glove near the wrist. Do not touch your skin. Peel the glove away from your body, pulling it inside out. Hold the removed glove in your gloved hand. Put your fingers inside the glove at the top of your wrist and peel off the second glove.

Turn the second glove inside out while pulling it away from your body, leaving the first glove inside the second.

Dispose of the gloves safely. Do not reuse. Perform hand hygiene immediately after removing the gloves. [ 21 ]

Isolation gowns are used to protect the health care worker’s arms and exposed body areas and to prevent contamination of their clothing with blood, body fluids, and other potentially infectious material. Isolation gowns may be disposable or washable/reusable. See Figure 4.7 [ 22 ] for an image of a nurse wearing an isolation gown along with goggles and a respirator. When using standard precautions, an isolation gown is worn only if contact with blood or body fluid is anticipated. However, when contact transmission-based precautions are in place, donning of both gown and gloves upon room entry is indicated to prevent unintentional contact of clothing with contaminated environmental surfaces.

Figure 4.7

Gowns are usually the first piece of PPE to be donned. Isolation gowns should be removed before leaving the patient room to prevent possible contamination of the environment outside the patient’s room. Isolation gowns should be removed in a manner that prevents contamination of clothing or skin. The outer, “contaminated,” side of the gown is turned inward and rolled into a bundle, and then it is discarded into a designated container to contain contamination. See more information about putting on and removing PPE in the subsection below. [ 23 ]

Masks

The mucous membranes of the mouth, nose, and eyes are susceptible portals of entry for infectious agents. Masks are used to protect these sites from entry of large infectious droplets. See Figure 4.8 [ 24 ] for an image of nurse wearing a surgical mask. Masks have three primary purposes in health care settings:

Figure 4.8

Used by health care personnel to protect them from contact with infectious material from patients (e.g., respiratory secretions and sprays of blood or body fluids), consistent with standard precautions and droplet transmission precautions

Used by health care personnel when engaged in procedures requiring sterile technique to protect patients from exposure to infectious agents potentially carried in a health care worker’s mouth or nose

Placed on coughing patients to limit potential dissemination of infectious respiratory secretions from the patient to others in public areas (i.e., respiratory hygiene) [ 25 ]

Masks may be used in combination with goggles or a face shield to provide more complete protection for the face. Masks should not be confused with respirators used during airborne transmission-based precautions to prevent inhalation of small, aerosolized infectious droplets. [ 26 ]

It is important to properly wear and remove masks to avoid contamination. See Figure 4.9 [ 27 ] for CDC face mask recommendations for health care personnel.

Figure 4.9

CDC Face Mask Recommendations

Goggles/Face Shields

Eye protection chosen for specific work situations (e.g., goggles or face shields) depends upon the circumstances of exposure, other PPE used, and personal vision needs. Personal eyeglasses are not considered adequate eye protection. See Figure 4.10 [ 28 ] for an image of a health care professional wearing a face shield along with a N95 respirator.

Figure 4.10

Face Shield and a N95 Respirator

Respirators and PAPRs

Respiratory protection used during airborne transmission precautions requires the use of special equipment. Traditionally, a fitted respirator mask with N95 or higher filtration has been worn by health care professionals to prevent inhalation of small airborne infectious particles. A user-seal check (formerly called a “fit check”) should be performed by the wearer of a respirator each time a respirator is donned to minimize air leakage around the facepiece.

A newer piece of equipment used for respiratory protection is the powered air-purifying respirator (PAPR). A PAPR is an air-purifying respirator that uses a blower to force air through filter cartridges or canisters into the breathing zone of the wearer. This process creates an air flow inside either a tight-fitting facepiece or loose-fitting hood or helmet, providing a higher level of protection against aerosolized pathogens, such as COVID-19, than a N95 respirator. See Figure 4.11 [ 29 ] for an example of PAPR in use.

Figure 4.11

The CDC currently recommends N95 or higher level respirators for personnel exposed to patients with suspected or confirmed tuberculosis and other airborne diseases, especially during aerosol-generating procedures such as respiratory-tract suctioning. [ 30 ] It is important to apply, wear, and remove respirators appropriately to avoid contamination. See Figure 4.12 [ 31 ] for CDC recommendations when wearing disposable respirators.

Figure 4.12

CDC Recommendations for Wearing Disposable Respirators

How to Put On (Don) PPE Gear

Follow agency policy for donning PPE according to transmission-based precautions. More than one donning method for putting on PPE may be acceptable. The CDC recommends the following steps for donning PPE: [ 32 ]

Identify and gather the proper PPE to don. Ensure the gown size is correct. Perform hand hygiene using hand sanitizer or wash hands with soap and water.

Put on the isolation gown. Tie all of the ties on the gown. Assistance may be needed by other health care personnel to tie back ties.

Based on specific transmission-based precautions and agency policy, put on a mask or N95 respirator. The top strap should be placed on the crown (top) of the head, and the bottom strap should be at the base of the neck. If the mask has loops, hook them appropriately around your ears. Masks and respirators should extend under the chin, and both your mouth and nose should be protected. Perform a user-seal check each time you put on a respirator. If the respirator has a nosepiece, it should be fitted to the nose with both hands, but it should not be bent or tented. Masks typically require the nosepiece to be pinched to fit around the nose, but do not pinch the nosepiece of a respirator with one hand. Do not wear a respirator or mask under your chin or store it in the pocket of your scrubs between patients.

Put on a face shield or goggles when indicated. When wearing an N95 respirator with eye protection, select eye protection that does not affect the fit or seal of the respirator and one that does not affect the position of the respirator. Goggles provide excellent protection for the eyes, but fogging is common. Face shields provide full-face coverage.

Put on gloves. Gloves should cover the cuff (wrist) of the gown. You may now enter the patient’s room.

Video Reviews of PPE Use

How to Put On a Respirator [ 33 ]

Image ch4aseptic-Image002.jpg

Donning and Doffing PPE [ 34 ]

Image ch4aseptic-Image003.jpg

How to Take Off (Doff) PPE Gear

More than one doffing method for removing PPE may be acceptable. Train using your agency’s procedure, and practice until you have successfully mastered the steps to avoid contamination of yourself and others. There are established cases of nurses dying from disease transmitted during incorrect removal of PPE. Below are sample steps of doffing established by the CDC: [ 35 ]

Remove the gloves. Ensure glove removal does not cause additional contamination of the hands. Gloves can be removed using more than one technique (e.g., glove-in-glove or bird beak).

Remove the gown. Untie all ties (or unsnap all buttons). Some gown ties can be broken rather than untied; do so in a gentle manner and avoid a forceful movement. Reach up to the front of your shoulders and carefully pull the gown down and away from your body. Rolling the gown down is also an acceptable approach. Dispose of the gown in a trash receptacle. If it is a washable gown, place it in the specified laundry bin for PPE in the room.

Health care personnel may now exit the patient room. Perform hand hygiene.

Remove the face shield or goggles. Carefully remove the face shield or goggles by grabbing the strap and pulling upwards and away from head. Do not touch the front of the face shield or goggles.

Remove and discard the respirator or face mask. Do not touch the front of the respirator or face mask. Remove the bottom strap by touching only the strap and bringing it carefully over the head. Grasp the top strap and bring it carefully over the head, and then pull the respirator away from the face without touching the front of the respirator. For masks, carefully untie (or unhook ties from the ears) and pull the mask away from your face without touching the front.

Perform hand hygiene after removing the respirator/mask. If your workplace is practicing reuse, perform hand hygiene before putting it on again.

Additional Video Reviews of PPE Use:

Respiratory Hygiene

Respiratory hygiene is targeted at patients, accompanying family members and friends, and health care workers with undiagnosed transmissible respiratory infections. It applies to any person with signs of illness, including cough, congestion, rhinorrhea, or increased production of respiratory secretions when entering a health care facility. See Figure 4.13 [ 38 ] for an example of a “Cover Your Cough” poster used in public areas to promote respiratory hygiene. The elements of respiratory hygiene include the following:

Figure 4.13

Cover Your Cough Poster

Education of health care facility staff, patients, and visitors

Posted signs, in language(s) appropriate to the population served, with instructions to patients and accompanying family members or friends

Source control measures for a coughing person (e.g., covering the mouth/nose with a tissue when coughing and prompt disposal of used tissues, or applying surgical masks on the coughing person to contain secretions)

Hand hygiene after contact with one’s respiratory secretions

Spatial separation, ideally greater than 3 feet, of persons with respiratory infections in common waiting areas when possible. [ 39 ]

Health care personnel are advised to wear a mask and use frequent hand hygiene when examining and caring for patients with signs and symptoms of a respiratory infection. Health care personnel who have a respiratory infection are advised to avoid direct patient contact, especially with high-risk patients. If this is not possible, then a mask should be worn while providing patient care. [ 40 ]

Environmental Measures

Routine cleaning and disinfecting surfaces in patient-care areas are part of standard precautions. The cleaning and disinfecting of all patient-care areas are important for frequently touched surfaces, especially those closest to the patient that are most likely to be contaminated (e.g., bedrails, bedside tables, commodes, doorknobs, sinks, surfaces, and equipment in close proximity to the patient).

Medical equipment and instruments/devices must also be cleaned to prevent patient-to-patient transmission of infectious agents. For example, stethoscopes should be cleaned before and after use for all patients. Patients who have transmission-based precautions should have dedicated medical equipment that remains in their room (e.g., stethoscope, blood pressure cuff, thermometer). When dedicated equipment is not possible, such as a unit-wide bedside blood glucose monitor, disinfection after each patient’s use should be performed according to agency policy. [ 41 ]

Disposal of Contaminated Waste

Medical waste requires careful disposal according to agency policy. The Occupational Safety and Health Administration (OSHA) has established measures for discarding regulated medical waste items to protect the workers who generate medical waste, as well as those who manage the waste from point of generation to disposal. Contaminated waste is placed in a leak-resistant biohazard bag, securely closed, and placed in a labeled, leakproof, puncture-resistant container in a storage area. Sharps containers are used to dispose of sharp items such as discarded tubes with small amounts of blood, scalpel blades, needles, and syringes. [ 42 ]

Sharps Safety

Injuries due to needles and other sharps have been associated with transmission of blood-borne pathogens (BBP), including hepatitis B, hepatitis C, and HIV to health care personnel. The prevention of sharps injuries is an essential element of standard precautions and includes measures to handle needles and other sharp devices in a manner that will prevent injury to the user and to others who may encounter the device during or after a procedure. The Bloodborne Pathogens Standard is a regulation that prescribes safeguards to protect workers against health hazards related to blood-borne pathogens. It includes work practice controls, hepatitis B vaccinations, hazard communication and training, plans for when an employee is exposed to a BBP, and record keeping.

When performing procedures that include needles or other sharps, dispose of these items immediately in FDA-cleared sharps disposal containers. Additionally, to prevent needlestick injuries, needles and other contaminated sharps should not be recapped. See Figure 4.14 [ 43 ] for an image of a sharps disposal container. FDA-cleared sharps disposal containers are made from rigid plastic and come marked with a line that indicates when the container should be considered full, which means it’s time to dispose of the container. When a sharps disposal container is about three-quarters full, follow agency policy for proper disposal of the container.

Figure 4.14

Sharps Disposal Containers

If you are stuck by a needle or other sharps or are exposed to blood or other potentially infectious materials in your eyes, nose, mouth, or on broken skin, immediately flood the exposed area with water and clean any wound with soap and water. Report the incident immediately to your instructor or employer and seek immediate medical attention according to agency and school policy.

Textiles and Laundry

Soiled textiles, including bedding, towels, and patient or resident clothing may be contaminated with pathogenic microorganisms. However, the risk of disease transmission is negligible if they are handled, transported, and laundered in a safe manner. Follow agency policy for handling soiled laundry using standard precautions. Key principles for handling soiled laundry are as follows:

Do not shake items or handle them in any way that may aerosolize infectious agents. Avoid contact of one’s body and personal clothing with the soiled items being handled.

Place soiled items in a laundry bag or designated bin in the patient’s room before transporting to a laundry area. When laundry chutes are used, they must be maintained to minimize dispersion of aerosols from contaminated items. [ 44 ]

References

Centers for Disease Control and Prevention. (2016, January 26). Standard precautions for all patient care. https://www .cdc.gov/infectioncontrol /basics /standard-precautions.html ↵.

Siegel, J. D., Rhinehart, E., Jackson, M., Chiarello, L., & Healthcare Infection Control Practices Advisory Committee. (2019, July 22). 2007 guideline for isolation precautions: Preventing transmission of infectious agents in healthcare settings. https://www .cdc.gov/infectioncontrol /guidelines /isolation/index.html ↵. [PMC free article : PMC7119119 ] [PubMed : 18068815 ]

Centers for Disease Control and Prevention (2019, April 29). Hand hygiene in healthcare settings. https://www .cdc.gov/handhygiene/ ↵.

RegisteredNurseRN. (2018, December 1). Hand hygiene for healthcare workers | Hand washing soap and water technique nursing skill. [Video]. YouTube. All rights reserved. Video used with permission. https://youtu .be/G5-Rp-6FMCQ ↵.

Centers for Disease Control and Prevention (2016, January 26). Standard precautions for all patient care. https://www .cdc.gov/infectioncontrol /basics /standard-precautions.html ↵.

“Surgery Centre Accriditation.jpg” by Accredia is licensed under CC BY-SA 4.0 ↵.

"PAPRs_in_use_01 .jpg" by Ca .garcia.s is licensed under CC BY-SA 4.0 ↵.

Centers for Disease Control and Prevention. (2020, August 19). Using personal protective equipment (PPE). https://www .cdc.gov/coronavirus /2019-ncov/hcp/using-ppe.html ↵.

Centers for Disease Control and Prevention. (2020, July 14). Demonstration of donning (putting on) personal protective equipment (PPE). [Video]. YouTube. All rights reserved. https://youtu .be/H4jQUBAlBrI ↵ .

Centers for Disease Control and Prevention. (2020, April 21). Demonstration of doffing (taking off) personal protective equipment (PPE). [Video]. YouTube. All rights reserved. https://youtu .be/PQxOc13DxvQ ↵.

“cycphceng .pdf” by Error! Hyperlink reference not valid. is in the Public Domain ↵.

4.3. ASEPTIC TECHNIQUE

In addition to using standard precautions and transmission-based precautions, aseptic technique (also called medical asepsis) is the purposeful reduction of pathogens to prevent the transfer of microorganisms from one person or object to another during a medical procedure. For example, a nurse administering parenteral medication or performing urinary catheterization uses aseptic technique. When performed properly, aseptic technique prevents contamination and transfer of pathogens to the patient from caregiver hands, surfaces, and equipment during routine care or procedures. The word “aseptic” literally means an absence of disease-causing microbes and pathogens. In the clinical setting, aseptic technique refers to the purposeful prevention of microbe contamination from one person or object to another. These potentially infectious, microscopic organisms can be present in the environment, on an instrument, in liquids, on skin surfaces, or within a wound.

There is often misunderstanding between the terms aseptic technique and sterile technique in the health care setting. Both asepsis and sterility are closely related, and the shared concept between the two terms is removal of harmful microorganisms that can cause infection. In the most simplistic terms, asepsis is creating a protective barrier from pathogens, whereas sterile technique is a purposeful attack on microorganisms. Sterile technique (also called surgical asepsis) seeks to eliminate every potential microorganism in and around a sterile field while also maintaining objects as free from microorganisms as possible. It is the standard of care for surgical procedures, invasive wound management, and central line care. Sterile technique requires a combination of meticulous hand washing, creation of a sterile field, using long-lasting antimicrobial cleansing agents such as betadine, donning sterile gloves, and using sterile devices and instruments.

Principles of Aseptic Non-Touch Technique

Aseptic non-touch technique (ANTT) is the most commonly used aseptic technique framework in the health care setting and is considered a global standard. There are two types of ANTT: surgical-ANTT (sterile technique) and standard-ANTT.

Aseptic non-touch technique starts with a few concepts that must be understood before it can be applied. For all invasive procedures, the “ANTT-approach” identifies key parts and key sites throughout the preparation and implementation of the procedure. A key part is any sterile part of equipment used during an aseptic procedure, such as needle hubs, syringe tips, needles, and dressings. A key site is any nonintact skin, potential insertion site, or access site used for medical devices connected to the patients. Examples of key sites include open wounds and insertion sites for intravenous (IV) devices and urinary catheters.

ANTT includes four underlying principles to keep in mind while performing invasive procedures:

Always wash hands effectively. Never contaminate key parts. Touch non-key parts with confidence. Take appropriate infective precautions.

Preparing and Preventing Infections Using Aseptic Technique

When planning for any procedure, careful thought and preparation of many infection control factors must be considered beforehand. While keeping standard precautions in mind, identify anticipated key sites and key parts to the procedure. Consider the degree to which the environment must be managed to reduce the risk of infection, including the expected degree of contamination and hazardous exposure to the clinician. Finally, review the expected equipment needed to perform the procedure and the level of key part or key site handling. See Table 4.3 for an outline of infection control measures when performing a procedure.

Table 4.3

Infection Control Measures When Performing Procedures