Clean, Aseptic and Sterile
Technique
Session 4: Infection Control Basics
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
4: Clean, Aseptic, Sterile
Slide 2
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: Clean, Aseptic, Sterile
Slide 3
Definition: Clean Technique
For this training:

Clean technique refers to the use of routine hand
washing, hand drying and use of non-sterile
gloves
4: Clean, Aseptic, Sterile
Slide 4
Clean Technique

Use clean technique if staff or objects will touch
intact skin, intact mucous membranes or dirty
(contaminated) items
4: Clean, Aseptic, Sterile
Slide 5
Examples of When Clean Technique is Used

Clean tech is appropriate
for:

Taking blood pressures

Examining patients

Feeding patients
4: Clean, Aseptic, Sterile
Slide 6
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
4: Clean, Aseptic, Sterile
Slide 7
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
4: Clean, Aseptic, Sterile
Slide 8
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
4: Clean, Aseptic, Sterile
Slide 9
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
4: Clean, Aseptic, Sterile
Slide 10
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
4: Clean, Aseptic, Sterile
Slide 11
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
4: Clean, Aseptic, Sterile
Slide 12
Clean
Aseptic
Sterile
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
Procedure space
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
4: Clean, Aseptic, Sterile
Slide 14
Exercise: Matching Procedures and
Techniques

Matching procedures to the kind of technique
required

Objective: to discuss measures currently done,
and to discuss current recommendations
4: Clean, Aseptic, Sterile
Slide 15
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
4: Clean, Aseptic, Sterile
Slide 16
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
4: Clean, Aseptic, Sterile
Slide 17
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?
4: Clean, Aseptic, Sterile
Slide 18
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?
4: Clean, Aseptic, Sterile
Slide 19
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?
4: Clean, Aseptic, Sterile
Slide 20
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
4: Clean, Aseptic, Sterile
Slide 21
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
4: Clean, Aseptic, Sterile
Slide 22
Work Flow Chart: Decontamination Cycle
4: Clean, Aseptic, Sterile
Slide 23
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
4: Clean, Aseptic, Sterile
Slide 24
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
4: Clean, Aseptic, Sterile
Slide 25
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
4: Clean, Aseptic, Sterile
Slide 26
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
4: Clean, Aseptic, Sterile
Slide 27
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
4: Clean, Aseptic, Sterile
Slide 28
“Separating Clean and Dirty” &
“Giving Injections Safely”
Nursing Demonstration Videos
Break