All About Aseptic Technique
Published: 04 October 2020
Published: 04 October 2020
Aseptic technique aims to achieve asepsis during invasive clinical procedures - that is, the absence of sufficient pathogens to cause an infection in the client (VIC DoH 2014; NHMRC 2019).
It should be used when performing procedures that could potentially introduce pathogens to the client’s susceptible body sites to ensure that no contamination occurs via surfaces, equipment or the healthcare worker’s hands (SA DoH 2020).
Poorly-performed aseptic technique has been identified as a significant contributor to preventable HAI (VIC DoH 2014).
It is important to note that achieving asepsis is not the same as being sterile, i.e. completely free from microorganisms. This is almost impossible to achieve unless the procedure is taking place in a specially equipped controlled environment (e.g. operating theatres) (VIC DoH 2014).
Aseptic technique is outlined in Action 3.9 of the National Safety and Quality Health Service Standards, under Standard 3: Preventing and Controlling Healthcare-Associated Infection.
This action aims to minimise the risk of HAIs being transmitted during clinical procedures by ensuring health service organisations implement a risk-based aseptic technique process (ACSQHC 2019).
Health service organisations are required to:
(ACSQHC 2019)
Activities that require aseptic technique include:
(VIC DoH 2014; ACSQHC 2019)
The following two terms are integral to aseptic technique:
Key sites include wounds, puncture sites and other breaches in skin integrity through which pathogens can enter the client’s body (Vic DoH 2014).
Key parts are parts of equipment that make direct contact with the client or procedural equipment. Examples include:
(Vic DoH 2014)
If key parts become contaminated, they may transmit pathogens to the client.
The primary goal of aseptic technique is to prevent key sites and key parts from coming into contact with pathogens. This is ensured through the following components of infection control:
Prior to commencing the procedure, staff must conduct a risk assessment. This should be the first step of the aseptic technique process. The aim is to determine whether there are any environmental risks present that could cause contamination through movement, touch or proximity (ACIPC 2015). Examples include:
(ACIPC 2015; VIC DoH 2014)
Any environmental risks should be removed prior to performing the procedure (VIC DoH 2014).
Hand hygiene is the most important measure for preventing infection transmission (VIC DoH 2014). In aseptic procedures, hand hygiene is used to ensure that:
Clients are not infected via the staff member’s hands or their own flora; and Staff do not spread or contract infections while performing the procedure.
(VIC DoH 2014)
Staff must perform hand hygiene:
(VIC DoH 2014)
Gloves should be used to protect the client from contamination, as well as to protect the staff member from exposure to bodily fluids. They must be single use. If the staff member needs to touch a key site or key part, or if there is any risk of the staff member accidentally touching a key site or key part, sterile gloves must be worn. Non-sterile gloves are appropriate otherwise (VIC DoH 2014).
Staff should avoid touching key parts and key sites whenever possible, even if they are wearing sterile gloves. This is the safest way to avoid contamination of key sites and key parts (ACIPC 2015).
Once the key sites and key parts have been identified, they must be protected. Aseptic key parts must only make contact with key sites and other aseptic key parts (VIC DoH 2014).
The aseptic field is the working space wherein key parts are held and protected from contamination. The type of aseptic field that is required depends on the procedure, as well as the key sites and key parts involved (VIC DoH 2014).
There are three types of aseptic field:
(VIC DoH 2014; ACIPC 2015)
All key parts must be made aseptic before being re-used. For example, if a client has an IV cannula in-situ that has been disconnected from the intravenous fluid line 1, the intravenous line must be replaced with a new line and the IV cannula access site must be made aseptic before re-accessing it. Follow your organisation’s policies and procedures. (VIC DoH 2014).
Equipment such as trolleys should also be decontaminated before use (VIC DoH 2014).
There are two types of aseptic technique: standard aseptic technique and surgical aseptic technique. The most appropriate type of aseptic technique should be chosen based on the procedure as well as the key sites and key parts involved.
Note that the terms ‘sterile technique’ and ‘clean technique’ are no longer used. They have been replaced by surgical aseptic technique and standard aseptic technique respectively.
Standard aseptic technique | Surgical aseptic technique | |
---|---|---|
Number of key parts and key sites | Few | Many |
Size of key parts and key sites | Small | Large |
Complexity of procedure | Simple | Complex |
Duration of procedure | Less than 20 minutes | More than 20 minutes |
Aseptic field required | General aspect field and micro critical aseptic fields | Critical aseptic fields |
Type of gloves required | Non-sterile (unless there is a risk of accidentally touching key sites or key parts) | Sterile gloves |
Procedure examples |
|
|
(VIC DoH 2014; CHHS 2018)
(ACIPC 2015)
Always follow WHO’s My 5 Moments for Hand Hygiene while performing the procedure (VIC DoH 2014).
The Australian Commission on Safety and Quality in Health Care has developed a risk matrix to help organisations identify high-risk clinical areas or procedures, and determine whether staff competency needs to be reassessed. The matrix assesses:
(ACSQHC 2018)
This tool uses a scoring system. Each component of the matrix should be added together to determine the risk score for a specific procedure.
1. The clinical context where aseptic technique occurs | |||
Frequency (how often aseptic technique occurs in this setting) |
Controlled (e.g. theatres, interventional radiology, oncology units) |
Semi-controlled (e.g. medical wards) |
Uncontrolled (e.g. emergency department) |
Infrequently | 1 = Low | 4 = Low | 6 = Medium |
Occasionally | 4 = Low | 6 = Medium | 8 = High |
Frequently | 6 = Medium | 8 = High | 10 = Very High |
2. Type of procedure | |||
Frequency (how often the procedure is performed) |
Simple procedure (e.g. simple wound dressing) |
Complex procedure (e.g. wound debridement) |
Invasive procedure (e.g. insertion of a peripheral or central venous access device) |
Infrequently | 1 = Low | 4 = Low | 6 = Medium |
Occasionally | 4 = Low | 6 = Medium | 8 = High |
Frequently | 6 = Medium | 8 = High | 10 = Very High |
3. How recently the specific staff member was last assessed for competency | ||||
Recently (within the last 12 months) | Recently, but the staff member is working in a changed clinical context | 1-3 years ago | More than 3 years ago or unknown | |
1 = Low | 4 = Medium | 4 = Medium | 8 = High |
Once the score for each of these three components has been determined, add them together to determine their total risk score. The organisation can then use this information to determine whether a reassessment of staff competency or other actions are required (ACSQHC 2018).
Score | Risk |
---|---|
3 - 9 | Low |
10 - 16 | Medium |
17 - 24 | High |
25 - 28 | Very high |
(All tables adapted from ACSQHC 2018)
Note: This article is intended as a refresher and should not replace best-practice care. Always refer to your organisation's policy on aseptic technique.
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Question 1 of 3
Pam is about to perform a simple wound dressing in a medical ward where aseptic technique is often used. Simple wound dressing is a common procedure in Pam’s organisation. Pam was last assessed for aseptic technique competency two years ago. Based on this information, what is the level of risk for this particular procedure?
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