aseptik teknik

8/19/2019 Aseptik Teknik

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Clinical Skills Learning

septic Technique

septic Technique

Faculty of Health & SciencesFaculty of Health & Sciences

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Key Terms:

ey Terms:

• The overarching aim of asepsis is to prevent sepsis/infection.

• Asepsis is defined by Xavier (1999) as the prevention of microbialcontamination of living tissuefluid or sterile materials by means ofe!cluding" removing or killing micro#organisms$

• Aseptic technique is a method of carrying out clinical procedures inan environment that is rendered as free from micro organisms andcontaminants as possible$

• %septic techni&ue is a collective term used to describe the varyingtechni&ues employed 'ithin practice in order to achieve asepsis$herefore 'hen using aseptic techni&ue(s) the clinicians aim is toprevent transmission of infection or contaminants bet'een" staff"patients" e&uipment and environment in order to maintain asepsis$

• he principles of infection control must therefore be applied duringan aseptic procedure$


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Principles:

rinciples:

Several Principles need to be considered in order to achieveaseptic technique.

• ffective hand 'ashingdecontamination" before during and after theprocedure # remember the *C+% guidelines for hand 'ashing$

• Creating and maintaining a sterile field$

• ,sing the sterile field appropriately$

• ,sing a sterile gloved hand to handle e&uipment or applying a -notouch. techni&ue (ie using forceps or touching non key parts)$

• %void the introduction of contaminants onto the sterile field$

•Safe disposal of contaminants a'ay from the sterile field$• %chieving and maintaining competency in accordance 'ith evidencebased policy guidelines$

• %lso consider any underpinning principles regarding health andsafety" infection control and universal precautions$


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septic

eptic

Non

n

Touch

uch

Technique

chnique

• /o'ley (01) (cited in 2orkman and 3ennett 04) has suggested

a frame'ork to support a consistent approach to aseptic

procedures$ his frame'ork is %+ 5 %septic +on ouch

echni&ue$

• AL2%6S 'ash hands effectively• 7/ contaminate key parts

• T8,C non key parts 'ith confidence

• T %: appropriate infective precautions

%+ can be applied to varying clinical procedures 'hich you may not

instantly associate 'ith aseptic techni&ue$ hink about ho' %+ is

used 'hen preparing medication for intramuscular in;ection$ o' do

you prevent contamination of hands" e&uipment and key parts


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Preparation

reparation

• 2hen preparing to carry out an aseptic

procedure there are four elements of

preparation to consider

• he patient

• he environment

• he nurse• %ny information


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Preparation: The Patient

reparation: The Patient

• !planation of the procedure and obtain consent$

• =oes the patient have any allergies to any products to be used$

• =o you need assistance to support the patient during the procedure$

• nsure the patient is comfortable" think of positioning$ %chieve this

prior to bringing e&uipment for the procedure to the bedside$ 8ffertoilet facilities$

• =oes the patient re&uire analgesia prior to commencing the

procedure$

• =ignity" privacy" bed area curtain and arrangement of bed clothes$ %ll

should be arranged prior to bringing e&uipment to patient bedside$• /efer to patients care plan$

• %ccessibility of 'oundarea and light source$


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Preparation: The Environment

reparation: The Environment

• he aim of preparing the environment is to ensure the reduction in

airborne bacterial dispersion so to reduce the risk of contamination$

• nsure that no 'ard cleaning activities are in progress$ (%llo' half

an hour after completion of cleaning for dust and airborne particles

to settle)$• 2indo's and doors to be closed$

• >ans should be off so to not create e!cessive air flo'$

• 3ed making should not be taking place in the vicinity due to the

increase in airborne bacteria and dust particles$

• Curtains should be closed prior to commencing the procedure and'here possible movement in and out of the curtains should be

minimal$ %lso consider the patients dignity if privacy is not

maintained$


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Preparation: The Nurse

reparation: The Nurse

• air should be off the collar" tied back suitably$ % hair clip for longfringes is also useful to stop hair falling over your face or in youreyes during the procedure$

• +ails should be short$ +o nail varnish 'orn$ +o falseacrylic nails$

• +o stoned rings to be 'orn$ 8nly a 'edding ringband style ring'hich should be 'ashed and dried thoroughly underneath$

• +o 'rist 'atches to be 'orn$ 8r 'rist devices$

• Check hands for cuts and abrasions all cuts and abrasions shouldbe covered 'ith a 'ater proof dressing$

• ,niform should be 'orn as per policy" no cardigans or outdoor 'ear

should be 'orn$• ands 'ashed as per *C+% guidelines$

• Self preparation and ac&uisition of kno'ledge$ =o you kno' ho' tocarry out the procedure and is your underpinning kno'ledge sound$


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Preparation:

reparation:

Information

nformation

• !amine the care plan prior to carrying out the procedure$ =oes the

'ound need reassessing$

• *s the dressing appropriate or is a ne' product re&uired$

• *dentify any previous problems 'ith the 'ound$

• %re you familiar 'ith the procedure" products and plan of care$



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Equipment Needed

quipment Needed

• =ressing trolley? Should have been cleaned using hot detergent 'ater

and or cleaning agent as specified in trust guidelines$ =ry before useusing disposable to'el to remove micro#organisms$

• =ressing pack$

•Sterile gloves$

• %pron$

• and gel$

• ape$

• %dditional dressing and 'ound care products$



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Equipment Needed:

quipment Needed:

continued

ontinued

• Sterile scissors for modifying sterile dressings and cutting 'oundcare products$

• Clean scissors for cutting tape$

• *rrigation fluid if re&uired$

• 2aterproof protection for bed if re&uired$• /eceiver to collect irrigation fluid if re&uired$

• 1ml syringe for irrigation if re&uired$

• /efer to care plan for additional e&uipment$

• %lso check contents of dressing pack and collect additional

e&uipment from stores ie gau@e" gallipot as dressing packs mayvary from area to area$

Al!ays chec" the integrity of the equipment and pac"aging priorto use. #nsure all seals are secure and chec" the e$piry dates.


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Procedure Rationale

rocedure Rationale

• /efer to patients records$

• *dentify the patient by name"

e!plain the procedure and gain

verbal consent if possible to

ensure co#operation$• Arepare" the patient" yourself

and the environment$

• nsure privacy for the patient$

*nform colleagues that you are

carrying out a clinicalprocedure so to avoid

interruptions$

• Check instructions and type of

dressing re&uired$ Some

'ounds need monitoring or

reassessment$ 2ound maps

or photographs may be

re&uired$

• nsure patient comfort and

dignity throughout procedure$


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Procedure:

rocedure:

Rationale

ationale

• nsure patient is comfortable

and 'arm" offer analgesia

'here appropriate prior to

procedure$

• nsure the trolleysurface isphysically clean$ Clean 'ith

detergent and or alcohol spray

as per guidelines$

• 2ash hands 'ith a socially

clean 'ash eg *C+%guidelines$ Aut on a clean

disposable apron for each

procedure$

• %llo' time for pain relief to

'ork in order to maintain

patient comfort$

• o minimise the risk ofcontamination and cross

infection$ *f in the patients

home use a suitable flat

surface that can be cleaned$

• o minimise the risk ofcontamination and cross

infection$


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Procedure:

rocedure:

Rationale

ationale

• Collect all the necessary

e&uipment checking the integrity"

e!piry dates and seals of all

packaging$ Alace on the bottom of

the trolley for transportation to the

patients bedside$• %ssist the patient into comfortable

position" ensuring privacy and

dignity$ Check the bed height$

Check light source is good and

ensure curtains closed$ Aosition

the trolley nearest the area to be'orked on so you can see the

patients face if possible$

• o ensure sterility is maintained$

• nsure comfort and dignity are

maintained$

• /educe the strain on the back$

• So that you can clearly see the

area for treatment and if the

patient becomes distressed$


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Procedure:

rocedure:

Rationale

ationale

• nsure bedding and clothing havebeen protected$

• 8pen the dressing pack using %+ and place onto the dressingtrolley$

• 2ash hands or gel hands$• 8pen the pack using only the

corners of the sterile to'el$ 8penfurthest side a'ay" then the sides"then the front sheet$

• Lay out the e&uipment on the field

by placing your hand inside theyello' bag and using it like aglove$ hen leave the yello' bagon the trolley ready to use toremove the old dressing$

• o protect the bed linen andclothing from contamination duringthe procedure$

• *n order to ensure sterility of theinner packaging$

• o decontaminate hands$• =o not lean over the sterile field to

prevent contamination of thesterile field$

• o prevent your hand from

contaminating the sterile field$• 3e careful to not allo' the touched

part of the yello' bag contaminatethe sterile filed$


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Procedure:

rocedure:

Rationale

ationale

• 8pen any additional packsusing %+ and place onsterile field$ 2hen pouringlotions into the gallipot al'ayspour from the side$ 2hen

opening sachets clean themarked area 'ith an alcohols'ab and cut using sterilescissors or cleaned scissors$

%n assistant could help you'ith this$

• Loosen tapeadhesive on thepatients dressing and removeusing the yello' bag like aglove as before$

• o maintain sterility$

• *f you have an assistant theycan support you during thispart of the procedure byopening any further packagingfor you and offering you thecontents so that you mayremove them from thepackaging 'ith sterile gloved

hands$ he assistant can alsopour solutions into the gallipotfor you and remove thepatients old dressing for you$


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Procedure:

rocedure:

Rationale

ationale

• Clean hands and dry thoroughly or

gel hands and allo' to dry

thoroughly$

• Aut on sterile gloves$

• %ssess the 'ound and clean only

if necessary$

• *f the skin around the 'ound

needs cleaning it can be s'abbed

using gau@e slightly moistened

'ith sterile saline$ he 'ound

should not be cleaned 'ith gau@eor cotton 'ool as fibre shed can

occur and can cause a reaction$

(3riggs et al$ 199B cited in

2orkman and 3ennett" 04)$

• o decontaminate hands$

• o maintain asepsis$

• ,nnecessary 'ound cleansingcan cause damage to the healing

'ound$

• =o not leave the 'ound e!posed

for too long as the temperature of

the 'ound 'ill drop and interrupt

'ound healing$


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Procedure:

rocedure:

Rationale

ationale

• Clean around the 'ound from

top to bottom or from clean to

dirty$ 8ne s'ab then remove

and dispose$

•*f inside the 'ound needscleaning fill a 1ml syringe 'ith

sterile normal saline$ Alace a

receiver belo' the 'ound and

irrigate gently$ he syringe tip

is not to touch the tissue$ *f

only a small amount of

irrigation is re&uired a gau@e

can be used at the base of the

'ound to catch the drips$

• o avoid cross infection$

• Aressure applied should besufficient to flush a'ay debris

but not to cause trauma

(8liver" 199 cited in 2orkman

and 3ennett" 04)$

• 3est practice 'ould be to 'ear

goggleseye protection to

avoid micro spray$


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Procedure:

rocedure:

Rationale

ationale

• Skin edges should be dried'orking from clean to dirty asbefore$ *f the 'ound ise!cessively 'et then removethe e!cess moisture only$

•Aosition the prescribeddressing and securemaintaining sterility of thedressing$

• 8n completion repositionpatient and ensure comfortfollo'ing the procedure$

• >old up the sterile field removeaprons and gloves and placethem all in the 'aste bagbefore leaving the area$Sharps in sharps bin$

• So to prevent maceration and deterioration of the 'ound$

• o prevent contamination ofthe 'ound$

• o reduce transmission ofinfection outside the treatmentarea (Xavier" 1999)$

• o dispose of contaminants asper guidelines$


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Procedure:

rocedure:

Rationale

ationale

• &uipment for re#sterilising

should be placed in the special

CSS= collection containers$

=ispose of clinical 'aste$

• =econtaminate hands at the

sink$

• /ecord activity and

observations in patients notes$

%dapted from :ey +ursing

Skills$ 3"2orkman and C"

3ennett (04)$ London"

2hur


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Safety:

afety:

• /isk of contamination and cross infection be it direct" indirect

or blood borne so follo' universal precautions$

• Sharps in;uries

• Splashes to eyes


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septic or Clean

septic or Clean

• *n clinical practice there are times 'hen a clean techni&ue asopposed to an aseptic techni&ue 'ill be used$ *t is thereforeimportant to be able to differentiate bet'een the t'o in order toensure that the most appropriate method is used$

• >or invasive procedures or in cases of surgical 'ounds" acute'ounds or trauma 'ounds aseptic techni&ue and the principles of

%+ should be used because of the risk of contamination andcross infection$

• 2here chronic long standing 'ounds such as leg ulcers are presenta clean techni&ue can be used$ o'ever sterility of the dressingproducts and associated materials should be maintained" theprinciples of non touch techni&ue of key parts should then befollo'ed$


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actors !hich may indicate

actors !hich may indicate

!ound infection

ound infection

• Spontaneous bleeding or bleeding on light contact

• *nflammation or cellulitis

• /edness

• Aartial 'ound breakdo'n

• Aus formation or discharge

• Aain

• eat

•=elayed 'ound healing• 2ound enlargement

• 8ffensive 'ound e!udate


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References and further readin":

eferences and further readin":

• 3lunt" D$ (01) 2ound Cleansing? ritualistic or research based

practice < +ursing Standard$ vol19" no1B" pp44#4B• Casey" E$ (00) 2ound dressings$ Arimary ealth Care$ vol10" noF"

ppG4#G9$

• Casey" E$ (1999) 2ound management in children$ mergency +urse$

vol " no B"pp44#49$

• Dohnstone" C$C$ ">arley" %$ and endry" C$ (0F) he physiology

basics of 'ound healing$ +ursing Standard$ vol19" noG4" ppF9#BB$

• Scanlon" $ (0F) 2ound infection and colonisation$ +ursing

Standard$ vol19" no0G ppF#B$

•2orkman" 3$%$ and 3ennett" C$L$ (04) :ey +ursing Skills$ London$2hur$

• Xavier" E$ (1999) %sepsis$ +ursing Standard$ 7ol 14" no 4B" ppG9#F4$


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urther Information # $e% &in's:

urther Information # $e% &in's:

• *nfection control

• ,niversal Arecautions

• %natomy and Ahysiology 5 structure and function of the skin

• %natomy and physiology # the 'ound healing process

• ealth and Safety

• %lso refer to photograph slide sho' for further information

relating to aseptic techni&ue$

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