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Aseptic Technique

Aseptic technique protects patients during invasive clinical procedures by employing infection control measures that minimise, as far as practicably possible, the presence of pathogenic organisms.

While the principles of aseptic technique remain constant for all procedures, the level of practice will change depending upon a standard risk assessment.

Table 1: Core components of Aseptic Technique

 

Core Components

Rationale

Key-Sites Open wounds, including insertion and puncture sites.
Key Parts Parts of the procedure equipment that come into  direct or indirect contact with the key-sites, other key-parts, or liquid infusions.  Examples of key-parts are: needles or introducers; surgical instruments such as scalpel blades, forceps, and retractors; invasive devices such as PICC lines or urinary catheters.
Key-part and key-site identification and
protection
The best way to protect a key-site or key-part is not to touch it. Key-sites and key-parts are identified and protected by use of a non touch technique.  Only aseptic key parts contact other aseptic key parts and/or key sites.  If a key-site or key-part must be handled directly, sterile gloves are required.  Contamination of key-sites or key-parts poses a high risk of infection to the patient.
Hand hygiene Hand hygiene is performed as per the Queensland Health Hand Hygiene Guideline and the World Health Organisation 5 Moments for Hand Hygiene.  In surgical aseptic technique, a surgical hand scrub is required.
Glove use If it is necessary to touch key parts or key sites directly, sterile gloves are required.  This is normally required for surgical aseptic technique. Otherwise non-sterile gloves are used in line with standard precautions.
Aseptic Fields These provide a controlled aseptic working space. Aseptic fields are increased in size and sterile drapes added on the basis of procedure complexity.
Critical aseptic fields; ensuring asepsis Used when key parts/sites cannot be protected with covers and caps, or handled at all times by a non-touch technique, or when open and invasiveprocedures require large working areas for long durations. The critical aseptic field itself is managed as a key part - only sterilized equipment may come in contact with it. Sterile gloves and often, full barrier precautions are required.
Critical micro aseptic fields This is the protection of key parts and sites by syringe caps, sheathed needles, covers/packaging and non touch technique. Critical micro aseptic fields are used as part of both surgical and standard aseptic non touch technique, and may be used as a component of a larger critical aseptic field, or as the critical component of a general aseptic field.
General aspetic fields; promoting asepsis Used when key parts can easily and optimally be protected by critical micro aseptic fields and a non touch technique. The main general aseptic field is not managed as a key part and is used to promote asepsis. Aseptic technique is simplified and usually involves non-sterile gloves.
Environmental control Avoid nearby environmental risk factors that could compromise aseptic technique, such as bed making or cleaning activities.
Sequencing Procedures should be performed in a sequence that ensures efficient, logical and safe practice, allowing the protection of key-sites and key-parts at all times.
Risk assessment

The healthcare worker is required to perform a risk assessment for procedures to decide:

  • whether aseptic technique is required
  • which type of aseptic field is required
    - a general aseptic field with use of critical micro aseptic fields,
    - a critical aseptic field.

Evidence examples for Queensland Health facilities

This resource has been developed as an adjunct to the Quick Start Guide developed by the Australian Council on Safety and Quality in Healthcare (ACSQHC) to support infection control staff in implementing and providing evidence for the aseptic technique section of Standard 3 of the National Safety and Quality Health Service Standards.  This table of examples of evidence may be used as guidance on how best to meet the requirements of Measure 3.10 of the Standard within existing programs and resources.

Table 2: Suggested examples of evidence

 

Measure/Action

Explanation

3.10 Developing and implementing protocols for aseptic technique

A local policy document shall be in place for aseptic technique - this does not mean the procedures should be about aseptic technique but they should outline the components of procedures that are essential to perform the procedure using safe aseptic technique.  For example, elements of a procedure for a device insertion that should be mentioned specifically, to address aseptic technique, are requirements for;

  • Hand hygiene
  • Site preparation
  • Aseptic field use
  • Use of non touch technique to protect key-sites/parts.

To satisfactorily meet (SM) this measure your facility/HHS should have procedures in place for the following (for example) including the relevant elements of aseptic technique;

  • Peripheral intravenous catheter (PIVC) device insertion
  • Intravenous (IV) therapy maintenance
  • Peripherally inserted central catheter (PICC) and central venous line (CVL) insertion and management
  • Indwelling urinary catheters
  • Wound dressings
  • Aseptic practice in surgical procedures
3.10.1 The clinical workforce is trained in aseptic technique

Training for aseptic technique may already by incorporated into existing education strategies.  Documentation to evidence this may be:

  • Attendance records / content / planning records of:
    - Orientation 
     -General orientation sessions
    - Orientation run by medical education units
  • Clinical unit-specific orientation programs (a sample)
  • Routine/regular training/education sessions/competency assessments covering aseptic technique or training in performing specific procedures which require use of aseptic technique. For example: 
    - PIVC/CVL/PICC insertion/management
    - urinary catheter insertion/management
    - dressing/managing wounds
    - Surgical techniques
    - Procedures such as nasopharyngeal aspirate collection, blood culture collection
  • Provide examples of profession-specific standards/competency standards/codes of practice available from AHPRA website
  • Records of assessment of perioperative staff against ACORN competency standards - liaise with your facility's operating theatres NUM/Management team, they will have access to a copy of the ACORN standards, and will likely have records of training or assessment to meet ACORN standards
  • Completed I-CARE Compliance and Investigation Checklists
  • Evidence of use/accessibility of local or state guidance documents for insertion and management of invasive devices e.g.
    - Urinary catheter
    - IV Devices (I-CARE)
  • This could be evidenced by the documents being available on the facility intranet site, by a record of number of hits to the site (may be available from information division).
3.10.2 Compliance with aseptic technique is regularly audited
  • Records of any auditing or monitoring that occurs routinely in operating theatres as part of compliance with ACORN standards - liaise with operating theatres NUM/Management team
  • Records of hand hygiene auditing in line with the 5 moments for hand hygiene program, particularly records of auditing moments 2 (before a procedure) and 3 (after a procedure or body fluid exposure risk), and action taken to increase compliance with these moments
  • Completed I-CARE compliance and investigation checklists
  • Records of unit-based auditing or regular competency assessments for procedures requiring aseptic technique, such as (for example);
    - PIVC/PICC/CVL management
    - Urinary catheter management
  • Records of planning for auditing, e.g.; tool development
  • Records of other indicator monitoring that may indirectly demonstrate compliance with aseptic technique, e.g. blood stream infection (BSI) rates related to intravascular devices (IVD), I-CARE BSI investigation checklists
  • Self-assessment survey of practice or of understanding of aseptic technique principles
3.10.3 Action is taken to increase compliance with the aseptic technique protocols

Documented record of a gap analysis to assess compliance of facility with this standard:

  • Existence of procedures
  • Existence of training
  • Existence of auditing
  • Planning to improve compliance - records of meeting agendas/minutes for development of plan and materials

Actions taken as a result of auditing of compliance:

  • Records of hand hygiene auditing in line with the 5 moments for hand hygiene program, particularly records of auditing moments 2 (before a procedure) and 3 (after a procedure or body fluid exposure risk), and action taken to increase compliance with these moments, e.g. feeding back audit results to clinical units
  • Action taken as a result of I-CARE compliance and investigation checklists or observational auditing, e.g. meeting agenda/minutes where results tabled and action discussed.  Record of action taken - again, meeting agenda/minutes, record of attendance of training, record of education resource development

Documentation of general infection control interventions that impact on performance of aseptic technique, for example, hand hygiene program, infection control education/awareness programs on specific procedures/elements of procedures, e.g. change of skin prep products.

Self assessment survey of practice or of understanding of aseptic technique principles, and action taken as a result of this survey.  For example, use of results of survey to guide education to be delivered to specific areas.

References & further reading

  1. Weller B. Encyclopedic Dictionary of Nursing and Health Care. Balliere Tindall, London:81 1997.
  2. The Association for Safe Aseptic Practice. Aseptic Non Touch Technique [Internet]. 2012 [cited 2012 June 20]. Available from: http://www.antt.org.uk/ANTT_Site/Home.html
  3. Rowley S, Clare S. ANTT: An essential tool for effective blood culture collection. British Journal of Nursing 2011; 20(14) s9-s14.
  4. Rowley S, Clare S. ANTT: a standard approach to aseptic technique. Nursing Times 2011; 107(36)12-14.

NHMRC Australian Guidelines for the Prevention and Control of Infection in Healthcare. 2010. Available from: http://www.nhmrc.gov.au/guidelines/publications/cd33

Rowley S, Clare S. Improving standards of aseptic practice through an ANTT trust-wide implementation process: a matter of prioritisation and care. Journal of Infection Prevention 2009; 10(s1) s18-s23

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Other Resources

CLABSI Prevention Project

Tools & Resources

Aseptic Technique Workbook - developed by SA Health Infection Control Service


Last Updated: 18 September 2013
Last Reviewed: 18 September 2013