Download Best Practice Guidelines – BPG 6 Aseptic Technique

Best Practice Guidelines – BPG 6
Aseptic Technique
Wolverhampton Clinical Commissioning Group Best Practice Guideline – Aseptic Technique 1
DOCUMENT STATUS:
DATE ISSUED:
DATE TO BE REVIEWED:
Approved
28th April 2015
14th April 2017
AMENDMENT HISTORY
VERSION
1
2
2
DATE
March 2014
September 2014
14th April 2015
AMENDMENT HISTORY
Draft
Final
Reviewed
REVIEWERS
This document has been reviewed by:
NAME
Charlotte Hall
Vanessa Whatley
TITLE/RESPONSIBILITY
Deputy Chief Nurse, RWT
Lead Nurse Infection prevention RWT
DATE
March 2014
23rd Sept 2015
VERSION
V1
V2
APPROVALS
This document has been approved by:
GROUP/COMMITTEE
Practice Development Group
Quality & Safety Committee
Quality & Safety Committee
DATE
March 2014
Sept 2014
14th April 2015
VERSION
V1
V2 Final
Revised Final
DISTRIBUTION
This document has been distributed to:
Distributed To:
Paper or
Electronic
Paper
Document Location
Care and Nursing
Home Staff and
Managers
Distributed
by/When
Care Home
Managers Training
events in
April, July, Oct
2015
Care Home
Managers
Mailshot
December 2015
Electronic
WCCG Intranet
Resource Folders
DOCUMENT STATUS
This is a controlled document. Whilst this document may be printed, the electronic version
posted on the intranet is the controlled copy. Any printed copies of the document are not
controlled.
Wolverhampton Clinical Commissioning Group Best Practice Guideline – Aseptic Technique 2
RELATED DOCUMENTS
These documents will provide additional information:
REF
NUMBER
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
DOCUMENT
REFERENCE
NUMBER
TITLE
VERSION
BPG 1
BPG 2
BPG 3
BPG 4
BPG 5
BPG 7
BPG 8
BPG 9
BPG 10
BPG 11
BPG 12
BPG 13
Pressure Ulcer Prevention & Management
Enteral feeding
Prevention and Management of Malnutrition
Infection Prevention
Catheter care
VTE
Management and Prevention of Falls
Medicines Management
Care Risk Assessment
Care of the deteriorating Resident
Care of resident with Diabetes
Good Record keeping
Final
Final
Final
Final
Final
Final
Final
Final
Final
Final
Final
Final
RELATED REFERENCES
Links to these documents will provide additional information:
REFERENCES
Department of Health (2008) The Health and Social Care Act – Code of practice for the
NHS on the prevention and control of healthcare associated infections and related
guidance. London: DH, 2008
Department of Health (2006) The Health Act: Code of Practice for the Prevention and
Control of Health Care Associated Infections. London: DH, 2006.
Department of Health (2006) Essential Steps to Safe, Clean Care: Reducing health care
associated infection. London: DH, 2006.
French GL, Otter JA, Shannon KP, Adams NMT, Watling D, Parks MJ. (2004) Tackling
contamination of the hospital environment by methicillin-resistant Staphylococcus aureus
(MRSA): a comparison between conventional terminal cleaning and hydrogen peroxide
vapour decontamination. Journal of hospital infection; 57: 31- 37
Dougherty L, Lister S (2004)
Winning Ways: Working together to reduce healthcare associated infection including MRSA,
London DH 2003.
National Institute for Clinical Excellence (2003) Infection control: Prevention of healthcare
associated
infection in primary and community care. London: NICE, 2003.
Pratt RJ, Pellowe CM, Wilson JA, Loveday H P, Harper PJ, Jones SRLJ, McDougall
C,Wilcox MH (2007), epic 2:
National Evidence-based Guidelines for Preventing HealthcareAssociated Infections in NHS Hospitals in England.
Journal of Hospital Infection 2007; 65
(Supplement):S1- S31.
Pratt RJ, Pellowe C, Loveday HP, Robinson N, Smith GW. (2001), and the epic guideline
development team; Barrett S, Davey P, Harper P, Loveday C, McDougall C, Mulhall A,
Privett S, Smales C, Taylor L, Weller B, Wilcox M. The epic Project:
Wolverhampton Clinical Commissioning Group Best Practice Guideline – Aseptic Technique 3
Guidelines for Preventing Hospital – acquired Infections. Journal of Hospital Infection 2001;
47 (Supplement): S1 - S82.
Rampling A, Wiseman S, Davies L, Hyett AP, Walbridge AN, Payne GC, Cornaby AJ,
(2001), Evidence that hospital hygiene is important in the control of methicillin-resistant
Staphylococcus aureus.
Journal of Hospital Infection 2001; 49: 109 -116
1.0
Introduction
The purpose of the guideline is to ensure that residents are protected through
application of evidence-based practice during invasive procedures to reduce
the risks of cross infection and that an aseptic non touch technique is
achieved by preventing direct and indirect contact of key parts using a nontouch method.
Compliance with the guidance will ensure that procedures that are
standardised across the home are carried out safely to maintain and promote
the principles of asepsis.
Implementation of the guidance will also demonstrate compliance with the
Health and Social Care Act 2008 – Code of Practice for the Prevention and
Control of Healthcare Associated Infections, (DH 2008).
Aseptic non-touch technique (ANTT) is defined as a means of preventing or
minimising the risk of introducing harmful microorganisms into sterile areas of
the body when undertaking procedures that breach the body’s natural
defences. The aim is to prevent contamination of wounds and other
susceptible body sites which could lead to infection.
ANTT should be used during any invasive procedure that by-passes the
body’s natural defences, e.g. the skin or mucous membranes. Asepsis must
be maintained when handling equipment prior to carrying out invasive
procedures e.g. wound care dressings and urinary catheters. Maintaining
sterility can be difficult but it is important to prevent contamination of sterile
equipment.
Staff members have a duty to safeguard the wellbeing of their patients. Poor
asepsis can lead to the risk of cross transmission of microorganisms from the
healthcare worker’s hands and/or the equipment to susceptible patient sites
which can result in serious life threatening infections (Pratt et al 2007).
1.1
Using the guideline
This guideline is designed to be used and implemented by adult care homes
registered for nursing across Wolverhampton and to provide staff with
evidence-based aseptic technique guidelines for the prevention of cross
infection when undertaking invasive procedures.
Wolverhampton Clinical Commissioning Group Best Practice Guideline – Aseptic Technique 4
Application of the guidance will result in a reduction in the incidence of
preventable infections which leads to reduced patient morbidity and mortality
(Pratt et al, 2007)
1.2
Specialist Advice and Support
Advice is available from the RWT Infection Prevention Team.
The Clinical Commissioning Group (CCG) has a dedicated Quality Nurse
Advisor Team who will support the implementation of this guideline and can
offer specialist advice for any specific queries.
Contact the Quality Nurse Advisor Team on 01902 444840 or email
[email protected]
1.3
Accountability
The care home manager is responsible for ensuring dissemination and
implementation of these guidelines within the care home.
2.0
Detail
2.2.1 Indications for ANTT

Dressing wounds that are healing by primary intention, e.g. surgical
wounds, burns, lacerations including self-harm injuries.

Dressing wounds that are healing by secondary intention, e.g. pressure
sores, leg ulcers, simple grazes.

Insertion of a urinary catheter (providing contact with the actual catheter is
avoided) and change of drainage bags.

When taking a sample of urine from an indwelling urinary catheter.
2.2.2 Equipment

Dressing Trolley.

Sterile dressing pack containing a disposable plastic tray, low-linting
swabs, gloves, sterile field, dressing towel, disposable clinical waste bag.

Single use sterile scissors if sterile dressings need to be cut.

Sterile non-latex gloves.

Non sterile gloves.

Sterile fluids for wound cleaning/irrigation, a 20 ml sterile saline in a pot or
a 20ml syringe for wound irrigation.

Appropriate dressings including water impermeable outer dressings where
necessary.
Wolverhampton Clinical Commissioning Group Best Practice Guideline – Aseptic Technique 5
2.2.3
2.2.4


Other dressings depending on the nature of the wound or the procedure
and as directed by prescription or tissue viability.

A local wound care assessment form as appropriate.
Preparation

The spread of infection is more likely to occur after cleaning, bed making
or other high activity times in the clinical area. Aseptic non-touch
procedures must be carried out at least 30 minutes after bed making. To
avoid air movement windows and doors should be closed and the
movement of people restricted.

Long hair, staff identification tags, scarves or ties must be tied back to
avoid contamination of the sterile field, in line with local policy.

Remove cardigans ensuring that arms are bare below the elbows, (DH
2007).

Prior to carrying out an invasive procedure, always remove jewellery.
Cover cuts and grazes and perform antiseptic hand hygiene prior to
aseptic procedure.

Non latex sterile gloves must be worn for invasive procedures, contact with
sterile sites, non-intact skin or mucous membranes. Gloves are a single
use item and must be removed and hands washed with liquid soap and
water on removal, (Pratt et al, 2007).

Avoid unnecessary or prolonged exposure of the wounds to maintain
wound temperature and to avoid contamination.

Clean dressing trolley using a detergent wipe, check the integrity of the
trolley whilst cleaning to ensure there is no damage or rust.

Whilst the trolley is drying, gather all the equipment required.

Check expiry dates of all equipment

Carry out procedure at the resident’s bedside.
Aseptic Non-Touch Technique Procedure
Hand hygiene must be carried out using liquid soap and water and wherever
possible non touch taps to avoid re-contamination. Microorganisms have been
found on hand wash basins and taps, (French et al 2004). The six step
technique must be adhered to (Please refer to Infection Prevention
Guidelines).
Wolverhampton Clinical Commissioning Group Best Practice Guideline – Aseptic Technique 6

Aseptic non -touch technique is essential even after the hands have been
effectively to prevent contamination of the sterile field. Forceps can be used to
rearrange the contents of the sterile field if necessary.
Explain the procedure to the resident. Wear a disposable apron to avoid
contamination of uniform or clothing.

Open the sterile field touching only the corners of the paper.

Add any extra items without touching the field and pour the contents into the
containers without touching the sterile field also.

Avoid contamination of sterile equipment, and should this occur the
equipment must be disposed of.

Put on non-sterile gloves.

Carefully remove dressings without touching the wound (A large amount of
microorganisms can be shed into the air).

Assess the wound and if there are any signs of redness, inflammation or
discharge take a wound swab for culture and sensitivity, or access
appropriate services to assess the resident.

Remove gloves.

Decontaminate the hands using alcohol gel.

Apply the sterile gloves ensuring that only the inside wrist end is touched.

Perform the procedure including skin preparation. Secure the outer dressings
and dispose of all products as clinical waste.

The user is required to dispose of instruments including single use scissors or
any other contaminated sharp device used during the procedure immediately
after use, at the point of care into a sharps bin (conforming to UN 3291 and
BS 7320 standards.

Dispose of single use items after single patient treatment as clinical waste.

Dispose of soiled wound dressings, foul or infected material as clinical waste.

Decontaminate re-usable equipment according to the manufacturer’s
guidelines and in line with the home’s Decontamination of Medical Devices
Policy and use single use equipment whenever possible.
Wolverhampton Clinical Commissioning Group Best Practice Guideline – Aseptic Technique 7
The nurse should document the procedure in the resident’s notes noting time, date
and type of procedure undertaken.
3.0
Dissemination
The care home manager is responsible for ensuring this guideline is
disseminated to all staff and can evidence that staff have read it. This can be
done via team or individual meetings.
4.0 Monitoring Arrangements
Implementation will be monitored utilising Wolverhampton CCG quality
monitoring framework e.g.
 Internal audits
 Quality Indicators returns
 Quality monitoring visits
Wolverhampton Clinical Commissioning Group Best Practice Guideline – Aseptic Technique 8