Download aseptic technique learning package

ASEPTIC TECHNIQUE
LEARNING PACKAGE
Staff Name: .....................................................
Date: .........................................
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Table of Contents
What is Aseptic technique?
3
Core infection control components
3
Key parts
5
References
6
Aseptic technique questionnaire
7
Competency Assessments
9
Peripheral IV cannulation
9
Accessing a ‘closed’ system on vascular access device
11
Accessing an open system on a vascular access device
12
Insertion of a urinary catheter
13
Wound care
14
Aseptic technique assessment sheet
16
We would like to acknowledge that this package was based on the:
Central Gippsland Health Service Aseptic Technique Learning Package
Government of South Australia Aseptic Technique Workbook January 2013,
Version 1.1.
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What is Aseptic technique?
Aseptic technique aims to prevent pathogenic organisms, in sufficient quantity to cause
infection, from being introduced to susceptible sites by hands, surfaces and equipment.
It protects patients during invasive clinical procedures by utilizing infection prevention
measures that minimize the presence of micro-organisms.
Aseptic technique is a framework for aseptic practice. In aseptic technique, asepsis is
ensured by identifying and then protecting key parts and key sites from contamination.
This is achieved by correct:
1.
hand hygiene,
2.
non touch technique,
3.
appropriate aseptic field
4.
using new sterilised equipment and or
5.
cleaning existing key parts to a standard that renders them aseptic prior to use.
Whilst the principles of aseptic technique remain the same, the level of practice will
change according to the risk identified using a standard aseptic technique risk
assessment. The standard risk assessment involves assessment of technical difficulty
and staff competence in maintaining asepsis.
This self-directed learning package has been developed to provide all clinical staff with
knowledge in aseptic technique in accordance with the Australian Guidelines for the
Prevention and Control of Infection in Healthcare (2010).
Core infection control components
1.
Key parts and key sites identification and protection - key parts must be identified
and protected at all times. Aseptic key parts must only come into contact with other
aseptic key parts and / or key sites.
2.
Hand hygiene – Effective hand hygiene is an essential part of aseptic technique. In
standard aseptic technique hand hygiene should be performed using neutral pH
soap and running water or alcohol based hand rub. A surgical hand scrub is
required for surgical aseptic technique. It is known that hand hygiene is not always
performed correctly thus identifying key parts and not touching them is vital in
maintaining asepsis.
3.
Glove use – if it is necessary to touch key parts or key sites directly, sterile gloves
are used to minimize risk of contamination, body fluid exposure and / or exposure to
any drugs that may be administered during the procedure. For example during IV
cannulation, if you have swabbed the vein and need to repalpate you need to wear
sterile gloves.
4.
Aseptic fields – aseptic fields are important in providing a controlled aseptic
working space to help maintain integrity of the asepsis during clinical procedures.
Size of the aseptic field will be dependent upon the complexity of the procedure to
be performed.
There are 3 types of aseptic fields
> Critical aseptic fields are used when key parts and or key sites (usually due to
their size or number), cannot be easily protected at all times with covers and caps,
or handled at all times by non-touch technique. The critical aseptic field eg. a
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dressing tray or surgical sterile drape, must be managed as a key part. This means
that only sterile equipment may come into contact with it. Critical aseptic fields
require the use of sterile gloves and often, full barrier precautions.
> Examples of procedures requiring a critical aseptic field are CVC insertion and
complex wound care. Critical aseptic fields are used in the Operating Theatre (see
Appendix 1).
> Critical micro aseptic fields involve covering or protecting key parts with syringe
caps, sheaths, covers or packaging. The inside of caps and covers is sterile and
provides optimum aseptic field for key parts. An example is an intramuscular
needle. It is protected by the cap which ensures the needle, which is the key part,
remains sterile and when utilising non touch technique the aseptic field is
maintained (see Appendix 1).
> General aseptic fields are used for standard aseptic technique when key parts
can be easily and optimally protected. The main general aseptic field does not
have to be managed as a key part and is essentially promoting rather than
ensuring asepsis. An example is administering IV antibiotics. The key parts - the
syringe tip and drawing up needle are easily protected by packaging, caps and
non-touch technique. Therefore, a clean area is adequate as the key parts are
protected using these critical micro aseptic fields.
5.
Standard Aseptic technique
> Typically short duration procedures (less than 20 minutes)
> Technically simple procedures
> Involve relatively few and small key sites and key parts
> Requires a main general aseptic field and non-sterile gloves
> Use of critical micro aseptic fields and non-touch technique is essential to protect
key parts and key sites
Examples include, any break/access to the sterile intravenous line/device such as
changing lines, administrating drugs, flushing bung etc. Simple wound dressings,
and where the staff member is experienced in urinary catheterization and IV
cannulation standard aseptic technique may be adequate.
6.
Surgical Aseptic technique
> Technically complex procedures
> Involve extended period of time
> Large open key sites or large or numerous key parts
> Require main critical aseptic field and sterile gloves and full barrier precautions
> Use of critical aseptic fields and non-touch technique is used where practical to do so
Examples include urinary catheterization in non-experienced staff member, IV
cannulation with non-experienced staff member, plus complex / large dressings,
PICC / CVC insertion & surgery.
7.
Environment Control
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Prior to conducting an aseptic procedure, health care workers should ensure that
there are no avoidable environmental risk factors nearby such as bed making or
patients using commodes.
Key Parts
1.
Aseptic technique for Peripheral and Central Venous Intravenous Therapy
Key Parts include –
> syringe tip
> needle – both needle tip and hub
> needle Free Access device / bung on catheter lumen
> IV infusion lines including fluid bag spikes, all bungs, caps, 3 way taps, all infusion
ports, the end of the infusion line which connects to patient
> extension lines – both end that connects to patient and end that connects to IV
administration set
> the hub of both central and peripheral access devices
> the tip of the implanted port needle & the hub end
> the dressing
> rubber tops on vials containing medication
> syringe access point of any IV medication / fluid
2.
Aseptic technique for wound care (outside the operating theatre)
Key parts include –
> tips of forceps
> gauze / swabs used to cleanse wound
> suture remover tip (if applicable)
> staple remover tips (if applicable)
> scissor tips (if applicable)
> dressing to be applied / side directly over the wound
3.
Aseptic technique for insertion of urinary catheter (male / female)
Key parts include –
> forcep handle in dominant hand
> urinary catheter – both ends and hub for injecting sterile water
> lubricant tip & handle (used in dominant hand)
> tip of urinary drainage bag that connects to urinary catheter
> syringe tip
> sterile water for injection opening
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References
1. Aseptic Technique Workbook January 2013 -Version 1.1. Government of South
Australia.
2. Central Gippsland Health Service, Aseptic Technique Learning Package 2013.
3. National Health & Medical Research Council. (2010) Australian Guidelines for the
Prevention and Control of Infection in Healthcare.
4. Noosa & Nambour Selangor Private Hospital. (2012) Aseptic technique
workbook & competencies.
5. The Australian College of Operating Room Nurses Ltd. ACORN Standards for
perioperative nursing. 2012 – 2013. Adelaide, South Australia.
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Aseptic technique Questionnaire
Please select the most appropriate response to these questions prior to
completing a competency in aseptic non touch technique.
1.
Which of these activities uses aseptic technique?
a) Monitoring blood pressure
b) Feeding a patient via a nasogastric tube
c) Giving intravenous antibiotics.
d) Pressure area care
2.
What is the aim of aseptic technique?
a) To protect patients from infection during invasive clinical procedures by utilizing
measures that minimise the presence of micro-organisms.
b) To ensure cleanliness when performing procedures
c) To bypass the need for hand washing before procedures
d) To remove nosocomial organisms and allow safe normal flora to remain
3.
Which is an example of a key part?
a)
b)
c)
d)
4.
The dressing trolley
Hand washing
Unsheathed intra muscular injecting needle
Non-sterile gloves
When would you use critical aseptic fields?
a) Only in the operating theatre for major invasive procedures
b) In more complex and invasive aseptic procedures that involve multiple sterile
components eg. Insertion of a central venous catheter, surgical procedures
c) Critical aseptic fields are used in all aseptic procedures
d) For undertaking activities of daily living eg showering
5.
Which is an example of a critical micro aseptic field?
a)
b)
c)
d)
6.
In which scenario would you use sterile gloves?
a)
b)
c)
d)
7.
The skin prep solution
A urinary catheter bag
The capped insertion end of a peripheral line
A bandage for securing the dressing
Performing a simple dressing
When you can’t perform hand hygiene before the procedure
If the patient is immunosuppressed.
Insertion of a central venous line
Which is an example of standard aseptic technique?
a) Giving oral medications
b) Changing the line of an intravenous infusion
C) Performing an ECG
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8.
Which is an example of a surgical aseptic technique?
a) A simple wound dressing
b). Giving a subcutaneous injection
c). Insertion of a PICC line
9.
What is a key part when accessing an intravascular device?
a) The handle of the device
b) Non sterile gloves used by the health professional
c) The intravascular insertion site dressing
10.
What is a key part when performing a dressing outside the operating
theatre?
a) The tips of forceps
b) The nurse’s gloves
c) The dressing tray
11.
What is a key part when inserting a urinary catheter?
a) The catheter bag
b) The urinary catheter
c) The swabs used to clean the genital area
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Competencies
Peripheral IV Cannulation
Standard Aseptic Technique
* Of note: The following workflow has been used as an example only. Health Care Workers
(HCWs) should be deemed compliant to aseptic practice providing individual technique does
not breech the aseptic field.
Steps
Procedure
Step 1
Inform the patient and with verbal consent and prepare the
patient.
Step 2
Perform hand hygiene.
Step 3
Clean trolley or tray with Tuffie 5 wipe and collect required
equipment.
Step 4
Perform hand hygiene.
Step 5
Prepare IV flush, IV extension set, IV therapy and pathology
equipment if required, ensuring key parts are protected from
contamination at all times and place in kidney dish.
Step 6
Peel open sterile equipment required ensuring key parts
remain sterile (IVC, bung, dressing etc.). Assess the
patient’s access, determine site and apply tourniquet.
Step 7
Perform hand hygiene.
Step 8
Apply non sterile gloves to protect from potential body fluid
exposure. If required to touch key parts apply sterile gloves.
Asepsis is maintained by ensuring key parts are not
touched / contaminated.
Step 9
Clean skin with chlorhexidine & alcohol swab / solution
(unless contraindicated). Apply liberally and allow area to
completely dry. Use only one side of the swab. One side will
be exposed to the gloves and one side to the skin.
Step 10
Once area is dry, insert cannula ensuring tip and site of
entry are not touched / not contaminated. Do not repalpate
vein unless sterile gloves are worn. Apply dressing and
secure the device. Document date and sign identification
strip and place on dressing.
Step 11
Option 1:Flush cannula ensuring syringe tip and cannula
hub are not contaminated by touch (disinfect with
chlorhexidine and alcohol swab if key part is contaminated)
Option 2: Apply vacutainer and draw pathology. Clean hub
with alcohol & chlorhexidine wipe and flush with 10 mls
normal saline.
Step 12
Attach IV therapy devices / extension tubing whilst
maintaining non touch of all key parts.
Step 13
Discard all sharp devices into sharps containers
Step 14
Remove gloves & perform hand hygiene
Competent
Yes
No
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Step 15
Document IV cannulation details on Observation Chart and
Medical Care Plan.
Step 16
Advise the patient on how to care for the device and when
to seek medical advice
Step 17
Discard all used equipment, clean trolley using a tuffie 5
wipe
Step 18
Perform hand hygiene
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Accessing a ‘closed’ system on Vascular Access Devices
Standard Aseptic technique
* Of note: The following workflow has been used as an example only. HCWs should be
deemed compliant to aseptic practice providing individual technique does not breech the
aseptic field.
Steps
Procedure
Step 1
Perform hand hygiene.
Step 2
Clean trolley or tray with tuffie 5 wipe and gather required
equipment – syringe, bung, chlorhexidine & alcohol wipes,
required drugs and any other associated equipment.
Perform hand hygiene
> Open normal saline or water for injection if required &
connect syringe without contaminating key parts
> Clean top of drug vials using alcohol & chlorhexidine
wipe and allow to dry before penetrating
> Option 1: Mix powder with dilutent. Leave needle and
syringe in vial
> Option 2: Mix powder with dilutent. Remove syringe and
needle from vial and place cap back on needle via
kidney dish
> Place prepared syringe / drug into clean injection tray
with chlorhexidine & alcohol wipes
> If adding drug to a small bag of IV Fluid, perform hand
hygiene then clean port of bag with chlorhexidine &
alcohol wipe and allow port to dry before adding drug
ensuring key parts are not contaminated
Step 3
Step 4
Perform hand hygiene.
Step 5
Identify patient. After explaining procedure to patient pause
any IV pumps.
Step 6
Perform hand hygiene.
Step 7
> Swab port to be accessed with chlorhexidine & alcohol
Competent
Yes
No
wipe. Allow area to dry before connecting syringe / IV
therapy ensuring key parts are not contaminated.
Step 8
Perform hand hygiene.
Step 9
Recommence pump, document procedure, discard used
equipment. Clean trolley using a tuffie 5 wipe.
Step 10
Perform hand hygiene.
If using gloves they must be changed prior to each hand hygiene moment.
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Accessing an ‘open’ system on Vascular Access Devices
Standard Aseptic technique
* Of note: The following workflow has been used as an example only. HCWs should be
deemed compliant to aseptic practice providing individual technique does not breech the
aseptic field.
STEPS
PROCEDURE
COMPETENT
YES
Step 1
Perform hand hygiene.
Step 2
Clean trolley with alcohol wipe and collect required equipment
placing pre-packaged insertion pack on top shelf and all other
equipment on the bottom shelf.
Step 3
The staff member checks that the patient has been informed of
the procedure by the person inserting or accessing the device.
Assess patient for any allergies to skin antiseptics.
Step 4
Perform hand hygiene.
Step 5
Prepare IV therapy and / or flush as required ensuring key
parts are protected from contamination at all times.
Step 6
Open sterile equipment onto trolley. Open sterile gloves onto
separate surface cleaned prior to use with tuffie 5 wipes.
Step 7
>
>
>
>
>
>
NO
perform a surgical hand scrub using an antimicrobial hand
wash solution for 3 mins
Dry hands using a sterile towel
Don sterile gloves
Access the site and prepare equipment as per policy for
PORT/PICC in Care Practice Manual
ensure key parts are protected from contamination at all
times
Secure the device to prevent movement at the site
Step 8
Before handling IV giving set / IV therapy connect to vascular
access device and ensure key parts are not contaminated
during connection. (Disinfect with alcohol & chlorhexidine wipe
if key part is contaminated)
Step 9
Remove sterile gloves and perform hand hygiene.
Step 10
Organise X-ray to confirm position
Step 11
Document the procedure and inform the patient how to care for
the device and when to seek medical advice.
Step 12
Discard all equipment / sharps into correct waste receptacles,
clean trolley with a detergent or detergent/disinfectant wipe.
Step 13
Perform hand hygiene.
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Insertion of Urinary Catheter
Standard Aseptic Technique
Of note: The following workflow has been used as an example only. HCWs should be deemed
compliant to aseptic practice providing individual technique does not breech the aseptic field.
Steps
Procedure
Step 1
Inform patient about the procedure and obtain verbal
consent to proceed.
Step 2
Perform hand hygiene.
Step 3
> Clean trolley with a tuffie 5 wipe and gather catheter
Competent
Yes
No
insertion equipment including sterile gloves
> Place catheter pack on the top shelf and all items on the
bottom shelf. If the trolley has a draw – (do not go into
the draw without performing hand hygiene).
> Upon entering patient room, open catheter pack and add
items required ensuring items remain sterile.
> Organise & prepare all items in the sterile field to enable
access with one hand. (You may wish to draw privacy
curtain at this point).
Step 4
Perform hand hygiene & put on gloves.
Step 5
> Prepare the patient.
> Place sterile field on patient and using non dominant
hand expose the entrance to the urethra.
> Using dominant hand cleanse area with forceps & moist
gauze. Insert lubricant.
> Remove gloves.
Step 6
Step 7
Step 8
Perform a surgical hand scrub using an antimicrobial hand
wash for 3 mins. Dry hands with a sterile towel.
> Apply a pair of sterile gloves
> Insert catheter ensuring other end is in water proof dish.
> Once urine flows into dish using two hands, attach
syringe (prepared in step 3) to catheter hub and inject
required water to inflate balloon.
> If unsuccessful attempt in woman, leave IDC in situ to
avoid second unsuccessful reinsertion
> Collect specimens aseptically if required before
connecting urinary drainage bag to catheter.
> Secure the catheter to the patient’s leg preventing drag.
> Remove gloves.
Step 9
Perform hand hygiene.
Step 10
Ensure patient is comfortable and document procedure in
patient notes. Inform the patient how to care for the device.
Step 11
Discard items from trolley top, clean trolley using detergent
or detergent/disinfectant wipe.
Step 12
Perform hand hygiene.
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Wound Care
Standard Aseptic Technique
* Of note: The following workflow has been used as an example only. HCWs should be
deemed compliant to aseptic practice providing individual technique does not breech the
aseptic field.
Steps
Procedure
Step 1
Inform patient about the procedure and obtain verbal
consent to proceed.
Step 2
Perform hand hygiene.
Step 3
Clean trolley with tuffie 5 wipe, and gather dressing
equipment.
Place dressing pack on the top shelf and all items on the
bottom shelf. If the trolley has a draw – (do not go into the
draw without removing gloves and performing hand
hygiene).
Step 4
Perform hand hygiene.
Step 5
Entering patient room, open dressing pack and add items
required ensuring items remain sterile. Prepare the patient.
Step 6
Don a pair of non sterile gloves and loosen old dressing so
it can be removed with a pair of forceps. Remove gloves.
Step 7
Perform hand hygiene. If sterile gloves are being used dry
hands with a sterile towel.
Step 8
> Option 1 - Using non sterile gloves remove the old
Competent
Yes
No
dressing without touching the wound and discard with
gloves.
> Option 2 - Using non sterile gloves and a forcep,
remove old dressing and discard with dressing items.
> Option 3 - Using no gloves and a forcep remove old
dressing and discard dressing items and forcep
> Option 4 - If required to touch the wound – use sterile
gloves and a forcep and discard as per option 3.
If extra items are required for use, remove gloves if being
worn and perform hand hygiene prior to getting items out of
a draw in the trolley or before leaving the room to obtain
further items.
Open items, perform hand hygiene and put on gloves
before continuing with dressing.
Step 9
Perform hand hygiene.
Step 10
Using sterile forceps cleanse area as required without
contaminating the forceps and the other items on the trolley
/ clean field. Cleansing should go from inside to out.
Complete dressing and remove gloves if applicable.
Step 11
Perform hand hygiene.
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Step 12
Document procedure in patient notes and ensure patient is
comfortable.
Explain to the patient how to care for the dressing and when
to seek medical advice.
Discard all dressing equipment used / opened and clean
trolley using a tuffie 5 wipe.
Step 13
Perform hand hygiene
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Aseptic technique Assessment Sheet
1. During the assessment, the assessor assigns a category corresponding to the
performance level for each of the performance criteria (see below key)
2. If the performance falls into the category “NYC”, comments must be included,
comments are optional if category “C” is demonstrated/achieved
3. A copy of the completed assessment tool is provided for the nurse, the original is
given to the Nurse Educator.
Category
Performance Level
C
(Competent)
Standard of practice is
at or above the
performance criteria
outlined
Action Required
> Aspects of performance that are
satisfactory are documented and
positive feedback given to the nurse.
> Positive feedback is given when
appropriate.
> All areas in which the standard of
NYC
(Not Yet
Competent)
Standard of practice is
below the performance
criteria outlined
performance is below the criteria and
discussed & documented through the
use of examples of actual & expected
practice
> The nurse is provided with a learning
program and times may be arranged
for further practice so that the
expected standard can be achieved
within a prescribed timeframe.
Comments:
Action plan for non compliance:
Proposed reassessment date:
Competency Assessment - Details
Please complete the details below:
Employee Name: ..............................................................................................................................
Signature: .............................................................................. Date: .............. / ................ / ..............
Assessor Name: ...............................................................................................................................
Signature: .............................................................................. Date: .............. / ................ / ..............
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Appendix 1
CRITICAL MICRO ASEPTIC FIELD
CRITICAL ASEPTIC FIELD
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