Clean_ Aseptic and Sterile Technique

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					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

Procedure space       On ward or at   Dedicated       Dedicated
                         beside         area            room
Gloves                  Clean or        Sterile         Sterile
                         none                          surgical
Hand hygiene before     Routine         Aseptic,        Surgical
the procedures                        e.g. alcohol       scrub
                                                      Iodophors,
                                                     chlorheximide
Skin antisepsis            No           Alcohol       Long acting
                                                        agent
Sterile field              No             No*            Yes

Sterile gown, mask,        No             No             Yes
head covering
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

				
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