Clean, Aseptic and Sterile Technique

1. Clean, Aseptic and Sterile Technique Session 4: Infection Control Basics

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

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. Definition: Clean Technique For this training: • Clean technique refers to the use of routine hand washing, hand drying and use of non-sterile gloves

5. Clean Technique • Use clean technique if staff or objects will touch intact skin, intact mucous membranes or dirty (contaminated) items

6. Examples of When Clean Technique is Used • Clean tech is appropriate for: • Taking blood pressures • Examining patients • Feeding patients

7. 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 Definition: Invasive Procedures

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

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

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

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

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

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

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

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

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

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?

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?

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?

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

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

23. Work Flow Chart: Decontamination Cycle

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

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

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

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

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

29. “Separating Clean and Dirty” & “Giving Injections Safely” Nursing Demonstration Videos

30. Break