Introduction to Aseptic Technique

To minimise the risk of infection through the presence of pathogenic microorganisms to patients during clinical procedures, it is critical for healthcare professionals in operating suites to practice aseptic technique (Australasian College for Infection Prevention and Control 2017). As part of the National Safety and Quality Health Service (NSQHS) standard developed by the Australian Commission on Safety and Quality in Health Care (ACSQHC), the aseptic technique aims to prevent and control healthcare associated infections (Department of Health Victoria 2014).

Preventing Infections with Aseptic Technique

Aseptic technique is a requirement for all invasive procedures, with the central goal for clinicians to maintain asepsis in the healthcare setting through hand hygiene, non-touch technique, glove usage and the sterility of equipment. A key factor of aseptic non-touch technique is hand hygiene, which must be performed correctly to achieve a higher level of protection against pathogens. Based on the most recent WHO guidelines, alcohol-based formulation provides the best antimicrobial efficacy compared to other hand hygiene solutions and is recommended for preoperative surgical hand preparation (National Health and Medical Research Council 2010).

According to Rowley and Clare (2011), performing aseptic technique involves identifying and protecting key parts (medical equipment) and key sites (devices connected to the patient). The choice of which glove to wear draws a parallel to the risk of contamination between the healthcare worker and the patient. Sterile gloves are required for complicated procedures that may require touching of key parts and sites, whereas non-sterile gloves are the preferred choice for basic procedures where there is no contact with key parts and sites. With the right level of training and experience in how to prevent infections with aseptic technique, clinicians are better able to protect their patients during invasive procedures, as well as reduce postoperative complications.

Types of Aseptic Technique

Aseptic technique is classified into two different categories: standard aseptic technique and surgical aseptic technique. As shown in Table 1, there are many risk factors and infection control components for clinicians to consider for invasive clinical procedures. Determining the most suitable aseptic technique and performing it correctly requires a thorough understanding of the process to undertake both types of aseptic technique.

The Australasian College for Infection Prevention and Control (2015) highlights this process:

  1. Environmental Control Measures
  2. Infection Control Measures
  3. Aseptic Field Selection and Management
  4. Non-Touch Technique
  5. Waste Management
  6. Cleaning of Equipment

 

Table 1: Aseptic technique overview for invasive clinical procedures (ACIPC 2015)

Standard Aseptic TechniqueSurgical Aseptic Technique
• Complexity: Simple
• Duration: Short
• Involve relatively few and small key parts/sites
• Complexity: Complex
• Duration: Long
• Involve large open key sites or many key parts
Environmental RisksEnvironmental Risks
• Be aware of risks associated with the environment prior to operating, such as a restricted working area, crowded room and nearby cleaning• Be aware of risks associated with the environment prior to operating, such as a restricted working area, crowded room and nearby cleaning
Infection Control MeasuresInfection Control Measures
Routine Hand HygieneSurgical Hand Scrub
• Use soap and water or ABHR to clean hands effectively• Use an approved antimicrobial skin cleanser or waterless hand rub formulation for full barrier precautions
Non-Sterile Glove UseSterile Glove Use
• Wear non-sterile gloves if no contact is being made with key parts/sites
• Clinician should feel competent and experienced to perform the procedure without touching key sites or parts
• Wear sterile gloves for full barrier precautions
• Clinician may be inexperienced and does not feel confident to perform the procedure without touching key parts/sites
Aseptic Field Selection and ManagementAseptic Field Selection and Management
General Aseptic Field ManagementCritical Aseptic Field Management
• Key parts are easily protected by critical micro aseptic fields and non-touch technique
• Main aseptic field does not have to be managed as a key part
• Key parts/sites are large or numerous and can’t be easily protected by covers or caps or can’t be handled with a non-touch technique
• Invasive procedures require a large aseptic working area
Non-Touch TechniqueNon-Touch Technique
• Using sterile gauze or sterile forceps
• Must not touch key parts/sites
• Wearing sterile gloves
• Can only touch key parts/sites if necessary
Waste ManagementWaste Management
• Discard all waste and sharps in the appropriate container• Discard all waste and sharps in the appropriate container
Cleaning of EquipmentCleaning of Equipment
• Perform hand hygiene before cleaning
• Clean used equipment with detergent first, then disinfectant
• Be sure to clean all touch surfaces
• Allow cleaned equipment to dry properly before storing away
• Perform hand hygiene after cleaning
• Perform hand hygiene before cleaning
• Clean used equipment with detergent first, then disinfectant
• Be sure to clean all touch surfaces
• Allow cleaned equipment to dry properly before storing away
• Perform hand hygiene after cleaning

What Procedures Require Aseptic Technique?

Knowing which clinical procedures require aseptic technique is just as important as understanding which type of aseptic technique to perform. The below shows some common clinical examples requiring the application of either the standard or surgical aseptic technique (ACSQHC 2018; Department of Health Victoria 2014; The Royal Children’s Hospital Melbourne 2013).

Standard Aseptic Technique

Preparation-of-medicine

1. Preparation and Administration of Medical Treatment

Preparation and administration of medication for patients, such as chemotherapy

Gloved-hand-applying-simple-wound-dressing

2. Simple Wound Management

Application of simple wound dressings; for example, patients with wrist lacerations and skin abrasions

Blood-Transfusion

3. IV Therapy and Transfusion Therapy

Insertion of an intravenous (IV) cannula to administer IV fluids, as well as blood transfusions

Gloved-hand-with-syringe

4. Catheter and Drainage Bag Management

Emptying drainage bags in a sterile field, such as a urinary drainage bag

Surgical Aseptic Technique

1. Surgery

Performing surgical procedures, such as cardiac operations

Gloved-hands-applying-wound-dressing

2. Complex Wound Management

Application of large complex wound dressings; for example, patients with burn wounds

PICC-Insertion

3. Vascular Access Device Management

Insertion of vascular access devices, such as peripherally inserted central catheter (PICC) for intravenous therapy of antibiotics

References

  1. Australasian College of Infection Prevention and Control (ACIPC) 2015, Aseptic Technique during invasive clinical procedures, viewed 2 May 2019, <https://www.acipc.org.au/aseptic-technique-resources/>
  2. Australasian College of Infection Prevention and Control (ACIPC) 2017, AT Presentation (Applying Aseptic Technique), viewed 2 May 2019, <https://www.acipc.org.au/aseptic-technique-resources/>
  3. Australian Commission on Safety and Quality in Health Care (ACSQHC) 2018, 3. Preventing and Controlling Healthcare-Associated Infection – Aseptic Technique: Action 3.9, viewed 8 May 2019, <https://www.nhmrc.gov.au/about-us/publications/australian-guidelines-prevention-and-control-infection-healthcare-2010>
  4. Department of Health Victoria 2014, Standard 3: Aseptic Technique Learning Module (Preventing and Controlling Healthcare Associated Infections)
  5. National Health and Medical Research Council (NHMRC) 2010, Australian Guidelines for the Prevention and Control of Infection in Healthcare, viewed 8 May 2019, <https://www.nhmrc.gov.au/about-us/publications/australian-guidelines-prevention-and-control-infection-healthcare-2010>
  6. Rowley, S & Clare, S 2011, ‘ANTT: a standard approach to aseptic technique’, Nursing Times, vol.107, no.36, pp.12-14, viewed 6 May 2019, <https://www.nursingtimes.net/clinical-archive/infection-control/antt-a-standard-approach-to-aseptic-technique/5034771.article>
  7. The Royal Children’s Hospital Melbourne 2013, An Introduction to Aseptic Technique – National Safety and Quality Health Service Standard 3: Preventing and Controlling Healthcare Associated Infections, viewed 3 May 2019,<https://www.rch.org.au/WorkArea/DownloadAsset.aspx?id=38303>