Aseptic Technique Policy

Version / 4
Name of responsible (ratifying) committee / Infection Prevention Management Committee
Date ratified / 28 January 2015
Document Manager (job title) / Consultant Infection Prevention
Date issued / 05 February 2015
Review date / 01 February 2017
Electronic location / Infection Control Policies
Related Procedural Documents / Hand Hygiene, Standard Precautions
Key Words (to aid with searching) / Aseptic Technique, Asepsis, ANTT, Clean Technique, Decontamination, Standard Precautions, Single Use Item, Clinical Hand washing.

Version Tracking

Version / Date Ratified / Brief Summary of Changes / Author
4 / 28/01/2015 / Minor revision and review / IPCT

CONTENTS

QUICK REFERENCE GUIDE

1.INTRODUCTION

2.PURPOSE

3.SCOPE

4.DEFINITIONS

5.DUTIES AND RESPONSIBILITIES

6.PROCESS

7.TRAINING REQUIREMENTS

8.REFERENCESAND ASSOCIATED DOCUMENTATION

9.EQUALITY IMPACT STATEMENT

10.MONITORING COMPLIANCE WITH PROCEDURAL DOCUMENTS

QUICK REFERENCE GUIDE

This policy must be followed in full when developing or reviewing and amending Trust procedural documents.

For quick reference the guide below is a summary of actions required. This does not negate the need for the document author and others involved in the process to be aware of and follow the detail of this policy. The quick reference can take the form of a list or a flow chart, if the latter would more easily explain the key issues within the body of the document

  1. “Asepsis prevents microbial contamination during invasive procedures” “or care of breaches in the skin’s integrity” (ICNA 2003). An aseptic technique is the method employed to help prevent contamination of wounds and other susceptible sites by organisms that could cause infection.

2.Two types of asepsis can be classified: medical and surgical asepsis (Ayliffe, et al. 2000). This policy focuses upon medical asepsis and the procedures that are currently carried out in ward and other treatment areas, using an aseptic non-touch technique.

  1. Aseptic Non-Touch Technique (ANTT) – when handling sterileequipment, only the part of the equipment not in contact with the susceptible site is handled. Even hands that have been washed should not contaminate the sterile equipment or the patient.

The principle is that:

  • You cannot infect a key part if it is not touched
  • Any key part must only come into contact with other key parts.
  • Non-key parts should be touched with confidence

Remember to…

  • Always wash hands effectively
  • Never contaminate key parts
  • Touch non-key parts with confidence
  • Take appropriate infective precautions
  1. Clean Technique – is a modified aseptic technique. It differs from the aseptic technique as the use of sterile equipment and the environment are not as crucial as would be required for asepsis.
  1. When undertaking procedures such as re-dressing wounds, the environment plays an important part. These tasks should not be carried out when tasks such as bed-making are ongoing.
  1. Clean, non-infected wounds should be dressed first. Colostomies and infected wounds last.

1.INTRODUCTION

Implementing the Code of Practice for Prevention and Control of Healthcare Associated Infections (Health Act 2008) is now a legal requirement for acute hospitals and other care providers. The Code of Practice states that “effective prevention and control of infection must be part of everyday practice and be applied consistently by everyone”.

Saving Lives: reducing infection, delivering clean and safe care provides the tools and resources for Trusts to achieve this.

2.PURPOSE

Aims of an Aseptic Technique

• To prevent the introduction of potentially pathogenic micro-organisms into susceptible or sterile sites e.g. wounds or the bladder.

• To prevent the transfer of potentially pathogenic micro-organisms from one patient to another.

3.SCOPE

This policy applies to all PHT healthcare workers (HCWs), including students, agency, bank and locum staff. Only those staff that have received appropriate training and have been assessed as competent should carry out an aseptic procedure.

‘In the event of an infection outbreak, flu pandemic or major incident, the Trust recognises that it may not be possible to adhere to all aspects of this document. In such circumstances, staff should take advice from their manager and all possible action must be taken to maintain ongoing patient and staff safety’

4.DEFINITIONS

4.1 “Asepsis prevents microbial contamination during invasive procedures “”orcare of breaches in the skin’s integrity“(ICNA 2003). Two types of asepsis can be classified: medical and surgical asepsis (Ayliffe, et al. 2000).

4.2 Medical asepsis reduces the number of organisms and prevents their spread. It is mainly employed in ward areas and some other treatment areas, e.g. outpatient clinics.

4.3 Surgical asepsis is a strict process and includes procedures to eliminate micro-organisms from an area. It is used mainly in operating theatres and some other treatment areas (Royal Marsden Manual, p.50). It is also appropriate in wards and other departments for invasive procedures such as the insertion of a central venous catheter.

An aseptic technique is the method employed to help prevent contamination of wounds and other susceptible sites by organisms that could cause infection. It ensures uncontaminated equipment and fluids come into contact with sterile/susceptible body sites during certain clinical procedures. It should be used during any procedure that bypasses the body’s natural defences. Organisms can be transferred from one person to another if techniques to prevent such spread are not adopted.

This policy aims to focus upon medical asepsis and the procedures that are currently carried out in ward and other treatment areas, using an aseptic non-touch technique.

4.4 Aseptic Non Touch Technique (ANTT)
Aseptic Non-Touch Technique (ANTT) is a standard for safe and effective practice that can be applied to certain aseptic procedures such as intravenous therapy administration via peripheral cannulae, wound care and urinary catheterisation. It standardises practice and rationalises the many different techniques currently in use. An ANTT means that when handling sterile equipment, only the part of the equipment not in contact with the susceptible site is handled. It is essential to ensure that hands, even though they have been washed, do not contaminate the sterile equipment or the patient.

The aim is for asepsis not sterility. The principle is that:

  • You cannot infect a key part if it is not touched.
  • Any key part must only come into contact with other key parts (i.e. syringe tip and needle hub)
  • Non-key parts should be touched with confidence.

Remember:

  • Always wash hands effectively
  • Never contaminate key parts
  • Touch non-key parts with confidence
  • Take appropriate infective precautions

4.5 Clean Technique

  • A clean technique is a modified aseptic technique and aims to avoid introducing micro-organisms to a susceptible site and also to prevent cross-infection to patients and staff (Royal Marsden Manual).
  • It differs from an aseptic technique, as the use of sterile equipment and the environment are not as crucial as would be required for asepsis. The non-touch technique is incorporated as part of a clean procedure i.e. the ends of sterile connections should not be touched or other items that could contaminate a susceptible site. Clean, single-use gloves are worn rather than sterile gloves.

5.DUTIES AND RESPONSIBILITIES

This applies to all PHT employees including agency, bank and locum staff who are deemed competent to perform an aseptic technique.

5.1 All Managers - To be aware of Trust Policy and Guidelines and to ensure their Staff comply with the requirements of these documents.

5.2 Supervisors of clinical practice will be responsible for monitoring compliance with the policies on an ongoing basis.

5.3 Individual members of Staff must ensure they follow this policy to ensure safe practice and highlight to their Line Manager if they do not feel competent to undertake task.

6.PROCESS

6.1 General Principles

The environment for the undertaking of procedures such as re-dressing wounds in a ward area can be an important factor in helping to reduce the risk of infection. They should not be carried out when tasks such as bed-making are taking place, due to the risk of micro-organisms being dispersed into the air and potentially contaminating the sterile equipment or wound. Ideally, these should be carried out at a time when ward activities are less and cleaning activities suspended. Clean, non-infected wounds should be dressed first; colostomies and infected wounds should be dressed last, to minimise environmental contamination and cross-infection.

6.2 Indications for Aseptic Technique

• Care of wounds healing by primary intention, e.g. surgical incisions and fresh breaks.

• Suturing of wounds.

• Insertion of urinary catheters.

• Insertion, re-siting or dressing intravenous cannulae or other intravascular devices, such as CVP lines, Hickman lines and Arterial lines.

• Insertion of gastrostomy and jejunostomy tubes.

• Insertion of tracheostomy tubes or chest drains.

• Vaginal examination using instruments (e.g. smear taking, high vaginal swabbing,

colposcopy).

• Assisted delivery (e.g. forceps and ventouse).

• Biopsies.

6.3 Principles of Aseptic Non-Touch Technique

The principles of carrying out an aseptic technique remain the same, but components of the technique may vary according to the degree of risk.

Assess the individual patient’s infection risk, and plan appropriate care:

  • What is the patient’s general health status?
  • What is the patient’s nutritional state?
  • Has the patient previously been exposed to infection, or does the patient suffer from an existing infection?
  • Inform the patient and obtain consent.
  • Collect appropriate PPE for the task (PHT Standard Precautions Policy).
  • Select appropriate dressings/devices.
  • Prepare the area.
  • Decontaminate your hands (PHT Hand Hygiene Policy).
  • Carry out the procedure (see below)
  • Ensure the correct disposal of any waste. (PHT Waste Handling Policy), PHT Safe Handling and disposal of sharps Policy
  • Document the procedure undertaken.

Full details of Clinical Nursing Procedures can be found in the Royal Marsden Hospital Manual of Clinical Nursing Procedures (6th edition). An up-to-date copy of this manual should be kept in all clinical areas, it is also available via the intranet (The Royal Marsden Hospital Manual of Clinical Nursing Procedures, 6th Edition).

6.4 Quick reference guide to be used for commonly performed procedures

Procedure / Technique / Relevant Trust Policy
Cervical smear. / Aseptic
Enteral feed:
Administration and
management.
Insertion site:
Jejunostomy and PEG. / Clean
Aseptic / Insertion and Management of Adult
Fine Bore Feeding Tubes
Indwelling urinary catheter insertion. / Clean area first with soap and water. Aseptic / Royal Marsden Urinary Catheterisation
Intermittent catheterisation. / Clean
Aseptic / Royal Marsden Intermittent catheterisation
IUD insertion. / Aseptic
s/c device insertion / Clean
IV device insertion:
Peripheral
Central
Tunnelled / Aseptic
Aseptic
Aseptic / Adult Peripheral Venous Cannula Insertion and Management (Adults)
CVC Policy
IV device accessing:
Peripheral(not PICC)
Central
PICC / ANTT
Aseptic
ANTT / Central Venous Catheters: Care and management
Supra pubic catheterisation. / Aseptic / Royal Marsden Suprapubic Catheterisation
Suction:
Laryngeal
Endotracheal
Tracheosotomy / Clean
Aseptic
Aseptic / Royal Marsden Suctioning

However in an emergency situation such as a respiratory or cardiac arrest a balance of risks must be undertaken so that the clinical need of the patient is assessed and the infection risks when inserting or replacing lines are secondary to the primary need to the resuscitation of the patient.

7.TRAINING REQUIREMENTS

  • The Infection Prevention and Control Team (IPCT) will provide direct or indirect (electronic) training to increase education and compliance with Modern Matrons, Clinical Directors, Clinical Leads, Practice Development Teams and infection control link advisors.
  • All staff has a duty of care to their patients to ensure they deliver a high standard of care in line with current research and recommendations.
  • Modern Matrons have a duty to report any deficiencies in knowledge and ensure appropriate training is undertaken.
  • Modern Matrons must ensure that all staff attends annual mandatory infection control updates according to hospital policy.
  • Medical Staff will receive Infection Prevention education on induction.

8.REFERENCES AND ASSOCIATED DOCUMENTATION

Ayliffe G A J., Fraise A P., Geddes A M., Mitchell K., (2000) Control of Hospital Infection: A Practical Handbook 4th edition, Arnold Publishers, London.

Briggs M., Wilson S. & Fuller A. (1996) ‘The Principles of Aseptic Technique in Wound Care.’ Prof Nurse, 11 (12), 805-8.

Calderdale and Huddersfield NHS Foundation Trust (2008) Aseptic Technique Policy

Getting Ahead of the Curve (2002), DoH.

Gilmour D., (1999) ‘Redefining aseptic technique.’ Journal of Community Nursing, 13; 7:22-26.

Gilmour D., (2000) ‘Is aseptic technique always necessary?’Journal of Community Nursing, 14; 4.

Hollinworth H., Kingston J (1998) ‘Using a non-sterile technique in wound care’Professional Nurse, 13; 4: 226-229.

Infection Control Nurses Association. Asepsis: Preventing Healthcare Associated Infection 2003.

Meers P, McPherson, Sedgwick J (1997) Infection Control in Health Care 2nd Edition, Stanley Thomas Publishers Ltd., Cheltenham.

The Health Act 2006Department of Health.

Wilson J. (2001), Infection Control in Clinical Practice 2nd Edition, Bailliere Tindall, London.

Winning Ways: Working Together to Reduce Healthcare Associated Infection In England. A report by the CMO, Department of Health, 2003.

Xavier G. (1999) Asepsis.Nursing Standard 13, 36, 49 – 53.

DOH, (2007) Epic 2 guidelines

University College London Hospital (2007) Injectable medicines administration guide. 2nd Ed. Pharmacy Dept. UCLH NHS Foundation Trust

9.QUALITY IMPACT STATEMENT

Portsmouth Hospitals NHS Trust is committed to ensuring that, as far as is reasonably practicable, the way we provide services to the public and the way we treat our staff reflects their individual needs and does not discriminate against individuals or groups on any grounds.

This policy has been assessed accordingly

Our valuesare the core of what Portsmouth Hospitals NHS Trust is and what we cherish. They are beliefs that manifest in the behaviours our employees display in the workplace.

Our Values were developed after listening to our staff. They bring the Trust closer to its vision to be the best hospital, providing the best care by the best people and ensure that our patients are at the centre of all we do.

We are committed to promoting a culture founded on these values which form the ‘heart’ of our Trust:

Respect and dignity

Quality of care

Working together

No waste

This policy should be read and implemented with the Trust Values in mind at all times.

Aseptic Technique Policy

Version 4

Issue Date:05 February 2015
Review date: 01February 2017 (unless requirements change)

Page 1 of 12

10.MONITORING COMPLIANCE WITH PROCEDURAL DOCUMENTS

This document will be monitored to ensure it is effective and to assurance compliance.

Minimum requirement to be monitored / Lead / Tool / Frequency of Report of Compliance / Reporting arrangements / Lead(s) for acting on Recommendations
100% of staff carrying out an appropriate aseptic technique when required / CSC Matron / Vital PAC / Daily / Policy audit report to:
  • Infection Prevention Management Committee
/ Infection Prevention & Control Team
Matron
Infection Prevention Link Advisors
100% of staff carrying out an appropriate aseptic technique when required / Peer review / Indwelling device and Urinary Catheter audits / Quarterly / Policy audit report to:
  • Infection Prevention Management
Committee / Infection Prevention & Control Team

Aseptic Technique Policy

Version 4

Issue Date:05 February 2015
Review date: 01February 2017 (unless requirements change)

Page 1 of 12

Appendix 1

Infection

Infection is the ‘invasion and multiplication of micro-organisms within tissue, which then results in destruction of the tissue’ (ICNA 2003). It is part of a chain of events that can occur within the healthcare setting.

Links in the Chain of Infection

• Infectious agents such as bacteria, viruses, fungi or parasites.

• A reservoir that supports the infectious agent, allowing it to survive and multiply.

• A portal of exit that allows the infectious agent to leave the reservoir.

• A mode of spread i.e. through direct or indirect contact or via airborne droplets.

• A portal of entry – often the same route as the portal of exit e.g. the skin, respiratory, gastrointestinal, circulatory, urinary or reproductive system.

• A susceptible host – i.e. a person at risk of infection. People are more vulnerable to infection when the balance of the body’s defence system is upset, due to disease or devices that breach the body’s defences.

Breaking any link in the chain will assist in preventing the spread of microorganisms (ICNA 2003).

Techniques used to contribute to breaking the links of the chain are:

A) Standard Precautions: hand hygiene; wearing personal, protective equipment; aseptic techniques; safe handling of sharps, waste and linen.

B) Decontamination of patient care equipment (PHT Decontamination Policy, PHT

Decontamination Manual)

C) Environmental cleanliness – ensuring that standards of hygiene and cleanliness adhere to local and national guidelines.

The most usual means for spread of infection include:

Direct contact – e.g. the hands of others.

Indirect contact – objects such as instruments, clothes and equipment.

Dust particles or droplet nuclei suspended in the atmosphere.

Hand Hygiene

Hand hygiene is a means of achieving a reduction in, or removal of, visible soiling and transient or resident micro-organisms.

Transient micro-organisms are picked up during daily activities and shed on skin scales. They can be effectively removed, or reduced to a low level by hand washing.

Resident micro-organisms are permanently resident on the skin and can only be reduced to a low level for a short time.

Hand washing is the single most important means of preventing the spread of HCAIs.

Personal Protective Equipment (PPE)

Gloves must be worn for invasive procedures, contact with sterile sites, non-intact skin or mucous membranes, and all activities where a risk assessment indicates that exposure to blood, body fluids, secretions, excretions and contaminated instruments can occur. Wearing PPE, such as gloves and apron will provide a barrier between micro-organisms present on hands and clothing and the susceptible site. It has been reported that prolonged glove use can produce occlusion conditions that encourage the rapid growth of skin flora on nurses’ hands. It is therefore essential to clean hands both before applying gloves and following their removal (Pereira et al, 1997).