All About Aseptic Technique

There are approximately 165,000 incidences of healthcare-associated infection (HAI) every year in Australia, with over half of these being preventable (NHMRC 2019).

Aseptic technique is a fundamental component of infection control and prevention that helps to decrease the risk of HAIs.

What is Aseptic Technique?

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 in the National Safety and Quality Health Service Standards

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:

• Identify procedures where aseptic technique should be used;
• Assess the ability of staff to perform aseptic technique;
• Address any competency gaps with training; and
• Ensure staff are complying with aseptic technique policies.

(ACSQHC 2019)

When is Aseptic Technique Used?

Activities that require aseptic technique include:

• Intravenous fluid or medicine preparation and administration;
• Simple and complex wound dressing;
• Urinary catheter insertion;
• Intravenous cannula or central venous catheter insertion and maintenance;
• Drainage bag emptying or changing;
• Surgical procedures;
• Venepuncture;
• Collecting swabs and specimens; and
• Gowning and gloving.

(VIC DoH 2014; ACSQHC 2019)

Key Sites and Key Parts

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:

• IV cannula bungs;
• Needle tips;
• Sterile gauze;
• Invasive devices connected to the client; and
• Liquid infusions.

(Vic DoH 2014)

If key parts become contaminated, they may transmit pathogens to the client.

Principles of Aseptic Technique

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:

Environmental Risks

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:

• An excessive amount of people in close proximity;
• A confined working area;
• The privacy curtain moving or being in close proximity to the client;
• Other clients in the same room using commodes;
• Cleaning being performed in the same room;
• Beds being made in the same room;
• Soiled linen;
• Bedside curtains;
• Open windows; and
• Air conditioners or heaters in close proximity.

(ACIPC 2015; VIC DoH 2014)

Any environmental risks should be removed prior to performing the procedure (VIC DoH 2014).

Hand Hygiene

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:

• Before touching the client;
• Before performing the procedure;
• After exposure to bodily fluids;
• After touching the client; and
• After touching the client’s surroundings or equipment.

(VIC DoH 2014)

Gloves

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).

Non-Touch Technique

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).

Protecting Key Sites and Key Parts

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).

Aseptic Fields

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:

• Micro critical aseptic fields are used to contain singular key parts. Examples include caps to protect syringes, sheaths to protect needles and covers or packaging.
• General aseptic fields are used to contain key parts that can be adequately protected by micro critical aseptic fields and non-touch technique. For example, a tray (the general aseptic field) containing capped syringes (the key parts). General aseptic fields must be used together with micro critical aseptic fields.
• Critical aseptic fields are used when key sites and key parts are more difficult to protect from contamination. In this case, the aseptic field itself is treated as a key part, meaning it must only make contact with other aseptic equipment. A critical aseptic field may be required if:
  • The key sites or key parts are large;
  • There are several key sites or key parts;
  • The key parts cannot be protected with micro critical aseptic fields; or
  • Non-touch technique is not feasible throughout the whole procedure.

(VIC DoH 2014; ACIPC 2015)

Decontamination

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).

Types of Aseptic Technique

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.

(VIC DoH 2014; CHHS 2018)

Performing a Procedure Using Aseptic Technique

1. Obtain consent from the client, check for allergies and ensure the client has been correctly identified.
2. Perform risk assessment and control any environmental risks.
3. Perform hand hygiene.
4. Clean the work surface/tray/trolley.
5. Determine whether a general or critical aseptic field is required. Prepare appropriately.
6. Identify and gather the necessary equipment. Ensure there is no damage to packaging and check expiry dates and sterility indicators. Ensure all other equipment is clean.
7. Perform hand hygiene.
8. Prepare the client. If there is a risk of exposure to bodily fluids, don gloves and remove them once you have finished preparing the client.
9. Open equipment from the corners and drop it into the sterile field.
10. Perform hand hygiene.
11. Don gloves if required (either sterile or non-sterile, depending on whether you need to touch key sites or key parts or may accidentally do so).
12. Perform the procedure, ensuring that:
    • Sterile items are used once, then appropriately disposed of.
    • Only sterile items make contact with the key site.
    • Sterile items do not make contact with non-sterile items.
13. Remove gloves and perform hand hygiene.
14. Dispose of waste appropriately, then remove gloves.
15. Clean equipment and perform hand hygiene.
16. Document procedure on the appropriate form, such as wound chart etc.

(ACIPC 2015)

Always follow WHO’s My 5 Moments for Hand Hygiene while performing the procedure (VIC DoH 2014).

Aseptic Technique Risk Matrix

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:

• The clinical context wherein aseptic technique occurs and how often it occurs in that setting;
• The type and frequency of the specific procedure; and
• How recently the specific staff member was assessed for competency in aseptic technique.

(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.

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).

(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.

Additional Resources

• ACIPC, Aseptic Technique - Technique During Invasive Clinical Procedures
• ACSQHC, Action 3.9: Aseptic Technique
• ANNT Aseptic Non Touch Technique
• NHMRC, Australian Guidelines for the Prevention and Control of Infection in Healthcare (2019)
• Vic DoH, Aseptic Technique
• Wounds Australia, Application of Aseptic Technique in Wound Dressing Procedure
• Hand Hygiene 101
• Infectious Diseases: How Do You Break the Chain?

References

• Australasian College for Infection Prevention and Control 2015, Aseptic Technique - Technique During Invasive Clinical Procedures, ACIPC, viewed 28 September 2020, https://www.acipc.org.au/wp-content/uploads/2017/07/Aseptic-Technique-Aseptic-Technique-during-invasive-clinical-procedures.doc
• Australian Commission on Safety and Quality in Health Care 2019, Action 3.9: Aseptic Technique, ACSQHC, viewed 28 September 2020, https://www.safetyandquality.gov.au/standards/nsqhs-standards/preventing-and-controlling-healthcare-associated-infection-standard/infection-prevention-and-control-systems/action-39
• Australian Commission on Safety and Quality in Health Care 2018, Aseptic Technique Risk Matrix, ACSQHC, viewed 28 September 2020, https://www.safetyandquality.gov.au/sites/default/files/migrated/Aseptic-Technique-Risk-Matrix-Updated-November-2018.pdf
• Canberra Hospital and Health Services 2018, Clinical Procedure: Aseptic Technique, CHHS, viewed 28 September 2020, http://www.health.act.gov.au/sites/default/files/2020-02/Aseptic%20Technique.docx
• National Health and Medical Research Council 2019, Australian Guidelines for the Prevention and Control of Infection in Healthcare (2019), NHMRC, viewed 28 September 2020, https://www.nhmrc.gov.au/about-us/publications/australian-guidelines-prevention-and-control-infection-healthcare-2019
• South Australia Department of Health 2020, Aseptic Technique, SA DoH, viewed 28 September 2020, https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+programs+and+practice+guidelines/infection+and+injury+management/
• Victoria Department of Health 2014, Aseptic Technique, VIC DoH, viewed 28 September 2020, https://www2.health.vic.gov.au/about/publications/policiesandguidelines/standard-3-aseptic-technique-learning-module-preventing-and-controlling-healthcare-associated-infections