Plymouth Community Healthcare CIC
Aseptic Technique Policy
Version No 3.2
Notice to staff using a paper copy of this guidance
The policies and procedures page of Intranet holds the most
recent version of this guidance. Staff must ensure they are
using the most recent guidance.
Author:
Professional Lead
Asset Number:
589
Page 1 of 22
Aseptic Technique Policy. V.3.2
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Aseptic Technique Policy. V.3.2
589
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Professional Lead
15th January 2014. Policy Ratification Group.
Public
Policy
Clinical
Microsoft Word 2003 and PDF
English
Aseptic technique
To ensure health care staff understand the principles of
asepsis and so reduce the risk of Health Care Associated
Infections
Job Title of Person
Responsible for
Review
24/01/2014
2 years after publication, or earlier if there is a change in
evidence.
The policy ratification group will retain an e signed copy
for the database in accordance with the Retention and
Disposal Schedule, all previous copies will be destroyed.
Clinical Specialist Tissue Viability Nurse/
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Electronic: Plymouth Intranet and PCH website
Written:
Upon request to the Policy Ratification
Secretary on  01752 435104.
Consultation Process
Please note if this document is needed in other formats or
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Infection Prevention and Control Team
Inpatient Registered Nurse Forum
District Nurse Forum
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Impact Assessment
Yes
References/Source
AfPP Standards and Recommendations for Safe
Perioperative Practice. Association for Perioperative
Practice, Harrogate 2007
Department of Health (2003), Winning Ways: Working
together to reduce Healthcare Associate Infection in
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Aseptic Technique Policy. V. 3.2
England; Department of Health: London
Department of Health, (2005), Saving Lives: a delivery
programme to reduce Healthcare associated infection
including MRSA; Department of Health: London
Hart. S, (2007) Using an aseptic technique to reduce the
risk of infection. Nursing Standard 21.47 p43-48
Pratt RJ, Pellowe CM, Loveday HP, Robinson N, Smith
GW et al (2001). The EPIC project: developing national
evidence-based guidelines for preventing healthcare
associated infections. Phase 1 guidelines for preventing
hospital-acquired infections. Journal of Hospital Infection,
47:S3-S82
Preston RM, (2006) Aseptic Technique: Evidenced-based
approach for patient safety. British Journal of Nursing
14(10), pp.540-546
Wilson, J (2006), Infection Control in Clinical Practice, 3rd
Edition, Baillière Tindall: London
World Health Organisation (2009) Guidelines on hand
care, Geneva, Switzerland: World Health Organisation
Associated
Documentation
The Hygiene Code
Supersedes
Document
Author Contact
Details
V.3
Publisher (for
externally produced
information):
1. Hand Hygiene Guidelines.
2. Safe Disposal of Sharps Guidelines.
3. Guidelines on the Management of Urinary
Catheters.
4. Guidelines for the Management of Peripheral
Intravenous Devices.
5. Guidelines for the Management of Central Venous
Catheters.
By post:
Local Care Centre Mount Gould Hospital
200 Mount Gould Road
Plymouth
Devon PL4 7PY
Tel:
Fax:
0845 155 8085
01752 272522 (LCC Reception)
N/A
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Aseptic Technique Policy. V. 3.2
Document Version Control
Version
Number
Type of
change
e.g.
Updated or
full review
1
Date
Author of
Change
Feb. 2007
Description of
Changes and reason for
change
New policy.
2
Updated
Feb 2009
2.1
Updated
Sept 2011
Nurse
Consultant
Infection
Prevention &
Control.
3
Ratified
Sept 2011
Policy
Ratification
Group
3.1
Extended
PRG Secretary Extended no changes.
3.2
Formal
review
November
2013
December
2013
Professional
Lead
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Aseptic Technique Policy. V. 3.2
Contents of Aseptic Technique Policy. V.3.2
Page
1
Introduction
6
2
Purpose
6
3
Duties
6
4
Principles of Aseptic Technique
7
5
Aseptic Non-Touch Technique
7
6
Indications for Aseptic Technique
8
7
Principles of asepsis
8
8
Aseptic Technique Guidelines
8
9
Hand Decontamination
9
10
Procedure
9
11
Post-Procedure
10
12
Documentation
10
13
Competence
10
Appendix A
Appendix B
Appendix C
Appendix D
Aseptic Technique procedure and competencies
Ten-stage Hand Decontamination Technique
Aseptic Technique Guidelines
18
20
Application of Sterile Gloves
22
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Aseptic Technique Policy. V. 3.2
12
Aseptic Technique Policy
1.
Introduction
1.1.
Aseptic non-touch technique prevents the introduction of micro-organisms
that could cause infection to susceptible sites and hence is important in
reducing the risk of Healthcare Associated Infection.
1.2.
Clinical procedures involving aseptic technique should only be performed
by staff who have been assessed to be competent in the technique.
1.3.
The guidelines outlined in this document should be followed when
performing clinical procedures that require aseptic technique.
2.
Purpose
These guidelines aim to:
2.1.
Ensure clinical procedures are performed in an appropriate manner to
maintain asepsis
2.2.
Minimise the risk of acquisition of Healthcare Associated Infection (HCAI)
during clinical procedures.
3.
Duties
3.1
The Chief Executive is ultimately responsible for infection prevention and
control and the content of all Policies and their implementation. The Chief
Executive delegates the day to day responsibility of implementation of the
policies to the Deputy Director of Professional Practice and the
Infection Prevention and Control team (IPCT).
3.2
Directors are responsible for identifying, producing and implementing
policies in relevant to their area.
3.3
The Locality Managers and Deputy Locality Managers will support and
enable operational Clinical Leads and Managers to fulfil their
responsibilities and ensure the effective implementation of this Policy
within their speciality.
3.4
Ward Managers/Team Leaders are responsible for ensuring that good
Practice is embedded into their clinical areas.
3.5
All staff, both clinical and non clinical have a responsibility for ensuring
they have read, understood and adhere to local Protocols and Policies.
Guidance and competencies will be included within clinical training
sessions.
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Aseptic Technique Policy. V. 3.2
3.6
Clinical procedures involving aseptic technique should only be performed
by staff who have been assessed as competent in the technique.
Education, training and assessment in the aseptic technique will be
provided to all staff undertaking such procedures. These competencies
can be found within specific procedures e.g. urinary catheterisation, pleurx
drain.
4.
Principles of Aseptic Technique
The principles of aseptic technique are as follows:
4.1.
Aseptic technique aims to prevent micro-organisms on hands, surfaces or
equipment from being introduced to susceptible sites.
4.2.
The susceptible site should not come into contact with any item that is not
sterile.
4.3.
A non-touch technique should be maintained throughout the procedure.
4.4.
If there are any breaches during the procedure, the operator must stop the
procedure and continue only when asepsis can be resumed.
4.5.
Where possible, ‘clean’ procedures should be carried out prior to ‘infective’
or ‘contaminated’ procedures.
4.6.
All open wounds should only be exposed for a minimum amount of time.
5.
Aseptic Non-Touch Technique
5.1
The Aseptic Non-Touch Technique (ANTT) is a framework to both
‘standardise and raise clinical standards whilst undertaking aseptic clinical
procedures’ (Hart 2007).
5.2
It is essential to ensure that hands, even though they have been washed,
do not contaminate the sterile equipment or the patient.
The aim is for asepsis not sterility. The individual healthcare professionals
need to decide between sterile or non sterile field/gloves and simply ask
themselves ‘can I do this procedure without touching key-parts?’
If the answer is NO – they use a sterile dressing pack and sterile gloves.
If YES – they wear non-sterile gloves.
5.3
The principle is that you cannot infect a key part if it is not touched.
Any key part must only come into contact with other key parts (i.e. syringe
tip and needle hub);.
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Aseptic Technique Policy. V. 3.2
● Always wash hands effectively
● Never contaminate key parts
● Touch non key - parts with confidence
● Take appropriate standard infection control precautions
6.
Indications for Aseptic Technique
Procedures that require the full use of aseptic technique (as outlined in
Section 6) include:
6.1.
Any medical invasive procedure that breaches the skin or mucous
membranes, including tracheostomy care.
6.2.
Dressing of wounds healing by primary intention (e.g. surgical wounds).
6.3.
Urinary catheterisation.
6.4.
Central venous lines insertion and access/manipulation.
6.5.
Intravenous feeding lines insertion and access.
6.6.
Suturing.
6.7.
Vaginal examination during labour.
6.8.
Removal of surgical drains.
7.
Principles of asepsis:
The principles of asepsis including clean procedures also apply to other
procedures including:
7.1.
Tracheal suctioning.
7.2.
Central venous lines access and manipulation.
7.3.
Peripheral intravenous cannulae insertion and access.
7.4.
Taking blood cultures.
7.5.
Enteral feeding care.
7.6.
Urinary catheter care (changing and emptying catheter bags, and
obtaining urine samples.
8.
Aseptic Technique Guidelines
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Aseptic Technique Policy. V. 3.2
8.1
Preparation
8.2
Explain and discuss the procedure with the patient and gain their consent.
If English is not the patient’s first language, ensure there are suitable
arrangements for an interpreter. In the case of children, ensure they and a
legal guardian are involved in the consent process.
8.3
Planning is an essential part of the process. Obtain all the equipment
needed for the procedure.
8.4
Prepare the patient and environment to allow any organisms to settle
before the sterile field is exposed. Ideally, all activities that can disperse
micro-organisms into the air, for example bed-making or cleaning, should
cease 30 minutes before a dressing is undertaken. Air movement should
be kept to a minimum during the procedure. Ideally, aseptic procedures
should be undertaken in a designated clean area, for example a clinical
room.
9.
Hand Decontamination
9.1
Decontaminate hands using the ten-stage hand decontamination
technique (Appendix B; please see Hand Hygiene Policy).
9.2
There must be a dedicated dressing trolley available. This should be
cleaned with a detergent wipe prior to use. For venepuncture or
cannulation, use the sharps tray provided. For community settings, ensure
there is a clean and dry surface to put your sterile field on.
Refer to the Decontamination guidelines and procedures (cleaning and
disinfection) for correct decontamination of equipment.
9.3
Place all equipment required for the procedure on the bottom of the trolley.
This is your non-sterile field. Check all equipment is in date and sterile.
9.4
Put on a single-use, disposable plastic apron. Assess the need for other
personal protective equipment.
9.5
In Inpatient ward areas take the trolley or tray to the patient, disturbing the
screens as little as possible.
10.
Procedure
10.1 If carrying out a wound dressing, loosen the outer dressing tape, taking
care not to expose wound.
10.2 Decontaminate hands using alcohol hand rub.
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Aseptic Technique Policy. V. 3.2
10.3 Open the outer cover of the sterile pack and turn out the sterile pack on to
the top shelf of the trolley (Appendix C).
10.4 Open the sterile field using only the corners of the paper, taking care not to
lean over the sterile field.
10.5 Open any other equipment and drop on to the centre of the sterile field.
Ensure that this is performed without touching the equipment itself.
10.6 Place hand in the sterile disposable clinical waste bag and arrange the
contents on the sterile field.
10.7 If carrying out a wound dressing, remove loosened dressing with hand
covered with the clinical waste bag, invert the bag and secure the bag with
the adhesive tape to the side of the trolley, ensuring it falls below the sterile
field.
10.8 Where appropriate, swab along the ‘tear line’ of sachets of saline using
swab impregnated with 70% isopropyl alcohol or Chlorhexidine in 70%
alcohol (or Chloraprep if available).Tear open sachets of saline and pour
contents into a sterile gallipot.
10.9 Decontaminate hands using alcohol rub.
10.10Put on sterile gloves (Appendix D).
10.11Carry out procedure as per Trust policy or local protocol ensuring you
maintain asepsis and use a non-touch technique throughout application.
11.
Post-Procedure
11.1
Ensure correct disposal of sharps (see Safe Disposal of Sharps Policy).
11.2
Place all used disposable items, including the apron and gloves, in an
clinical waste bag for incineration. Ensure correct disposal of waste. In
the community this is the refuse collection. For infected waste refer to the
Safe Handling and Disposal of Healthcare Waste Policy and Procedures
v2:4.
11.3
The trolley/sharps tray should be cleaned with a detergent wipe. Spillages
of blood or high-risk body fluids should be dealt with according to the
Decontamination guidelines and procedures (cleaning and disinfection)
11.4
Decontaminate hands using the ten`-stage hand decontamination
technique (Appendix B; please see Hand Hygiene Policy).
12.
Documentation
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Aseptic Technique Policy. V. 3.2
Document fully the procedure in nursing and/or medical notes.
13.
Competence
Clinical procedures involving aseptic technique should only be performed
by staff who have been assessed as competent in the technique using the
competency framework.
Control T
All policies are required to be electronically signed by the Lead Director.
Proof of the e-signature is stored in the policies database.
The Lead Director approves this document and any attached appendices. For
operational policies this will be the Locality Manager.
Signed: Director of Operations
Date: 15th January 2014
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Aseptic Technique Policy. V. 3.2
Appendix A
Aseptic Technique procedure and competencies
Essential Equipment
•
•
Appropriate hand hygiene preparation as per Plymouth Community
Healthcare Policy
•
Identified clean dry surface
•
Appropriate sterile dressing pack*, Frontier Medical Supplies
•
Warm clean tap water or sterile saline for cleaning and/or irrigation or
specific specified solution for procedure.
•
A sterile/clean container to hold solution (if not included in sterile pack)
•
Appropriate wound management materials and/or dressings
•
Any other material will be determined by the nature of the dressing
•
Special features of a dressing should be referred to in the patient’s care
plan.
•
Any extra equipment that may be needed during procedure e.g. sterile
scissors. (Patient single use scissors/dedicated patient use scissors)
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Aseptic Technique Policy. V. 3.2
Final assessment by assessor :
Name
O
Awareness through observation
A
Performing with assistance
S
Performing under supervision
C
Competent, performing independently
Date
O
Action
Rationale
1
Explain and discuss the
procedure with the patient and
obtain verbal consent and
document
To ensure that the patient
understands the procedure
and gives his/her valid
consent
2
Wash hands using protocol
for Plymouth Community
Healthcare.
Washing hands is the
single most important
contribution to minimising
infection. Hands must be
washed before and after
every patient contact and
cleansed before
commencing the
preparations for aseptic
technique, to minimise risk
of introducing potential
infection.
3
Identify a clean work surface
such as a stool, table or tray.
In a clinical setting staff
should use a dressing trolley,
cleaned with a detergent wipe
and dried with a paper towel.
To provide a clean working
surface. In a home
situation, the surface
should be rendered as
clean as possible and
protect the environment
from any damage
4
Place all the equipment
required for the procedure on
the surface or on the bottom
of the trolley
To establish an identified
working field
A
Page 13 of 22
Aseptic Technique Policy. V. 3.2
S
C
ACTION
Reassure patient and position
them comfortably so that the
area to be dealt with is easily
accessible without exposing
the patient unduly.
Use screens / curtains as
appropriate
RATIONALE
To ensure access to the
patient whilst maintaining
the patient’s dignity and
comfort.
Put on a disposable plastic
apron and unsterile gloves
To reduce the risk of cross
infection and protect
uniform or clothing from
possible contaminants
Loosen the product and/or
dressing tape. The patient
may prefer to do this
themselves.
Remove and dispose of
gloves and apron and wash
hands
To reduce traumatic
removal of adhesive
materials and ensure
wound is not exposed for a
prolonged time. This
reduces the risk of
infection and a drop in
temperature of the wound,
which will delay wound
healing (Lock 1980;Naylor
et al 2001)
8
Check dressing pack is sterile
(undamaged, intact and dry)
Open the sterile dressing
pack and slide on to the
trolley/work surface
Gel hands
To minimize airborne
contamination.
9.
So that areas of potential
Open the sterile field using
contamination are kept to a
only the corners of the paper
for areas where dressing must minimum
be kept and laid out within the
confines of their packaging
10
Check any other packs
(dressings etc) for sterility,
open and tip contents onto the
centre of the sterile field
5
6
7
O
A
To prepare the equipment
to reduce the amount of
time the wound is kept
uncovered once the
procedure is in progress
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Aseptic Technique Policy. V. 3.2
S
C
ACTION
Cleanse hands with alcohol
hand rub
RATIONALE
12
Place hand in disposable bag,
and arrange contents of
dressing pack
To maintain sterility of
pack
13
Remove loosened dressing
with hand (still covered with
the disposable bag), invert
bag and stick to trolley (or
appropriate surface) Observe
what has come away with the
dressing – exudates, blood
etc.
To minimise risk of
contamination by keeping
dressing in the bag)
and ongoing assessment
of the wound bed.
14
Pour lotion into gallipots or
other sterile receptacle and
wash hands.
15
Put on sterile gloves, touching
only the inside wrist
To reduce the risk of
infection. Gloves provide
greater sensitivity than
forceps and are less likely
to cause trauma to the
patient (David 1991)
16
Carry out procedure
according to plan of care.
Any changes must be
reflected in a new plan of
care
17
Keep one hand for contact
with the trolley and its
contents (clean) and one
hand for contact with the
wound or site of procedure
(dirty).
Maintain asepsis and
reduce risk of
contaminating sterile
materials on the trolley.
11
O
A
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Aseptic Technique Policy. V. 3.2
S
C
ACTION
RATIONALE
This section (18,19,20,21) applies to wound care only
O
18
Using ‘clean’ hand, dip gauze
into cleaning solution, transfer
to ‘dirty hand and clean
surrounding skin of wound
from top-to-bottom or away
from the body (inside-tooutside) with single stroke of
each swab. Observe surface
of swab. Discard into
disposal bag.
Repeat as necessary using
each swab once only. Not
every wound needs to be
cleansed at dressing change.
Cleansing to the wound bed
should be with warmed
irrigation
To remove debris and
cleanse wound surface
where necessary.
19
Dry surrounding area with
clean gauze top-to-bottom or
away from the site.
To prevent cross infection
and facilitate adherence of
wound management
dressing.
20
Apply chosen dressing
according to Wound
Management Protocol
Formulary or Plan of Care.
Following Manufacturers
guidelines and instructions
To continue to promote
wound healing and prevent
complications
21
Secure dressing to provide
comfort and security.
To prevent dressing
becoming detached
A
For all procedures
22
Inform patient that procedure
is complete and leave them
comfortably
.It allows patients to ask
questions and confirms
prescribed care plan
23
Dispose of Clinical Waste as
per PCH Policy
Remove and dispose of
Safe disposal of waste
prevents cross
contamination
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Aseptic Technique Policy. V. 3.2
S
C
gloves and apron and wash
hands
24
ACTION
Dispose of any opened but
unused dressings
RATIONALE
O
To avoid inadvertent use of
non-sterile dressings at a
future date
25
Wash and dry work surface/
trolley
To reduce the risk of
spreading infection (Ayliffe
et al 2000)
26
Document procedure and
observations as per PCH
Policy
Ensure any adhesive labels
(e.g. on catheters)are placed
in the patient record as
evidence
Documentation ensures
continuity of care, provides
communication between
patients and disciplines. It
ensures safe practice as
dictated by Nursing and
Midwifery Council
regulations.
A
Statement of competency
I certify that I am aware of my professional responsibility for continuing professional
development and that I am accountable for my actions. With this in mind I make the
following statement:
I am competent to undertake an aseptic technique
training.
Signature of practitioner:
Date:
Assessors signature:
Date:
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Aseptic Technique Policy. V. 3.2
S
C
Appendix B
Ten-stage Hand Decontamination Technique
Effective hand washing technique involves three stages: preparation, washing,
rinsing and drying.
Preparation requires wetting hands under tepid running water before applying
liquid soap or an antimicrobial preparation. The hand wash solution must come
into contact with all surfaces of the hand. The hands must be rubbed together
vigorously for a minimum of 10-15 seconds paying particular attention to the tips
of the fingers, the thumbs and the areas between the fingers. Hands should be
rinsed thoroughly prior to drying with good quality paper towels.
When decontaminating using alcohol hand rub, hands should be free of dirt and
organic material. The hand rub must come into contact with all surfaces of the
hand. The hands must be rubbed together vigorously, paying particular attention
to the tips of the fingers, the thumbs and the areas between the fingers until the
solution has evaporated and dried.
1. Wet hands with water
6. Rub the backs of fingers
to opposing palms with
fingers interlocked
2. Apply enough soap to
cover all hand surfaces
7. Rotational rubbing of left
thumb clasped in right
palm and vice versa
move to rotational
rubbing of both wrists
3. Rub hands palm to palm
8. Rotational rubbing,
backwards and forwards
with tops of fingers of
right hand in left palm
and vice versa
4. Rub the palm of one
hand over the back of
the other with interlaced
fingers and vice versa
9. Rinse hands with water
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Aseptic Technique Policy. V. 3.2
5. Rub palm to palm with
fingers interlaced
10. Dry thoroughly with a
towel
Hand Drying
Wet surfaces transfer micro-organisms more effectively than dry ones.
Consequently, the method of hand drying is also important.
Skin Care/Staff Issues
Staff are encouraged to apply an emollient hand cream regularly to protect skin
from the drying effects of regular hand decontamination. Staff should only use
the products available in the clinical areas as these have been specifically
designed not to interact with soaps and alcohol hand rub.
If a particular soap, antimicrobial hand wash or alcohol product causes skin
irritation, seek advice from the Staff Health and Wellbeing Department.
Page 19 of 22
Aseptic Technique Policy. V. 3.2
Appendix C
Aseptic Technique Guidelines
1. Explain and discuss
the procedure with the
patient. Assess and
identify all equipment
needed. Prepare
environment
2. Clean the trolley with a
detergent wipe and place all
equipment required onto the
bottom shelf of the trolley.
4. Open dressing pack and
empty contents onto the top
shelf of the trolley.
3. Wash hands with soap and water
using the ten-stage hand washing
technique.
Put on a single–use, disposable plastic
apron.
Take the trolley to the patient.
5. Decontaminate hands
using the alcohol hand rub.
If carrying out a wound
dressing, loosen the
dressing tape taking care
not to expose wound, and
decontaminate hands.
6. Open the sterile field.
7. Empty the contents of any
additional packs/equipment
required onto the sterile field.
8. Decontaminate hands
using alcohol hand rub.
10. Keeping the bag on
your hand remove the
dressing and invert the bag
to enclose the soiled
dressing.
Aseptic Technique Policy. V. 3.2
11. Secure the bag to the
side of the trolley below
the sterile field.
9. Place hand in yellow bag and
arrange sterile field as required.
12. Decontaminate hands
using alcohol hand rub.
Page 20 of 22
13. Put on sterile gloves –
see Appendix D.
14. Once procedure
completed, fold up remaining
items of the dressing field and
place in disposal bag.
Remove gloves and apron
and place in disposal bag.
15. Seal the disposal bag and
dispose of according to Trust
policy.
16. Wash hands with soap
and water using the six-stage
hand washing technique.
17. Document procedure in nursing
and/or medical notes.
Page 21 of 22
Aseptic Technique Policy. V. 3.2
Appendix D
Application of Sterile Gloves
Fig. 1
Fig. 3
Fig. 2
Fig. 4
Fig. 5
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Aseptic Technique Policy. V. 3.2