Aseptic Non Touch Technique Jennifer Manning Clinical Nurse Educator Medical and Community Care RMH City Campus 2013

Introduction Discuss aseptic technique and what this means At the end of this session, the RN will be able to state the different rationales and techniques for standard and surgical aseptic non touch technique procedures

Definitions Sterile: “free from microorganisms” (Weller 1977) Asepsis: “freedom from infection or infectious (pathogenic) material” (Weller 1977) Clean “Free from dirt, marks or stains” (McLeod 1991)

The aim of any aseptic technique is asepsis Ultimate goal…… The aim of any aseptic technique is asepsis

Overview Aseptic technique is a set of specific practices and procedures performed under carefully controlled conditions with the goal of minimising contamination by eliminating pathogens Aseptic technique is used to maximize and maintain asepsis, which is the absence of pathogenic organisms in the clinical setting. The goals of aseptic technique are to protect the patient from infection and to prevent the spread of pathogens.

Aseptic technique Aseptic technique can be applied in any clinical setting. Pathogens may introduce infection to the patient through contact with the environment, personnel, or equipment. All patients are potentially vulnerable to infection, although certain patients have increased vulnerability: transplant recipients (Renal or BMT), elderly patients with multiple co-morbidities, diabetic patients or patients with immunological disorders that disturb the body's natural defenses.

Overview Aseptic technique involves employing methods to reduce the number of overall pathogens, rather than eliminate all pathogens as is the goal of asepsis Aseptic technique methods involve hand hygiene, clinical handwashing, (using appropriate handwashing solutions) the use of clean equipment, clean or sterile gloves and a clean or sterile field

Aseptic Non Touch Technqiue: ANTT Standard vs Surgical?? Risk Assessment Consider the risk of infection to the patient and their presenting condition: abdominal surgery/or infected wound > surgical aseptic technique

Aseptic Non Touch Technique: 2 approaches Standard aseptic technique Examples: Intravenous medication preparation and administration, intravenous cannulation, venepuncture, simple, clean wound dressings Risk Assessment: Short procedures without many key parts or sites involved

Aseptic Non Touch Technique: 2 approaches Surgical aseptic technique Urinary catheterisation, complex or infected wound dressings eg VAC, blood cultures. Risk assessment: Longer, more complicated procedures with many key parts and sites involved

Aseptic technique: Prepare all equipment required in advance. Inform patient and obtain consent. Prepare sterile field. Perform surgical handwash last and don sterile gloves, perform procedure. Dispose of waste appropriately. Sterile packages or fields are opened or created as close as possible to time of actual use. Contaminated items must be removed immediately from the sterile field. Only areas that can be seen by the clinician are considered sterile (i.e., the back of the clinician is not sterile).

Aseptic technique: procedure Gowns are considered sterile only in the front, from chest to waist and from the hands to slightly above the elbow As a general rule, above the waist = sterile, below the waist = non-sterile There should be no talking, laughing, coughing or sneezing across a sterile field. Edges of sterile areas or fields (generally the outer inch) are not considered sterile.

Aseptic technique: procedure When in doubt about sterility, discard the potentially contaminated item and begin again. A safe space or margin of safety is maintained between sterile and nonsterile objects and areas. When pouring fluids, only the lip and inner cap of the pouring container is considered sterile; the pouring container should not touch the receiving container, and splashing should be avoided. Tears in barriers and expired sterilization dates are considered breaks in sterility.

When to use Surgical Aseptic technique? Dressing Surgical wounds Dressing Infected wounds Urinary catheterisation MSU Blood cultures Accessing an “open” central venous catheter (CVC) Dressing changes or removal of central lines CVC, PICC, Hickman’s catheter

When to use Surgical Aseptic technique? Insertion of intravenous cannula Insertion/removal of drain tubes Taking wound swabs for M/C/S Interventions for immunocompromised patients Generally any complex, invasive procedures lasting >20 minutes

When to use Standard technique? Simple or “clean” dressings (non-infected wounds) Flushing or accessing intravenous cannulas/lines Preparation & administration of IV medications Handling intravenous lines, pumps, burettes Removal of IDC, IVC, ICC Suctioning tracheostomy, dressing changes, inner cannula changes

Summary Check the expiry dates of sterilised equipment: eg dressing packs, syringes Prepare your work environment in advance Clean trolleys and work surfaces Use a kidney dish every time when preparing and administering IV medications Use a dressing trolley whenever possible, not the bedside table

Summary Don’t use open containers of fluids (eg chlorhexidine) for aseptic procedures Consider appropriate disposal of waste products Clinical or social handwash or ABHR Vs Surgical handwash

References ANTT Clinical Practice framework Version 3.0b 2012 National Health and Medical Research Council 2010 http://www.nhmrc.gov.au/guidelines/publications/cd33 YouTube: Aseptic Non Touch Technique from the ANTT organisation UK