# Asepsis & Aseptic Technique

## Overview

Infection Prevention and Control (IPC) during procedures includes the safe management of ‘sharps’, encompasses high-level measures such as health facility design and management, protocol-based measures such as adherence to national and facility level guidelines, and individual actions by each health care provider and ancillary staff member. The health care provider is encouraged to familiarise themselves with their facility’s specific IPC protocols and reporting systems, which is outside the scope of this module.

All clinical procedures pursue the IPC goal of asepsis. The traditional hierarchy of sterile, aseptic, and clean is outdated, poorly-defined and misleading, and is no longer recommended. This module describes how to pursue medical or surgical asepsis through the choice of your aseptic technique (the range of actions employed to prevent contamination of items, persons and surfaces with potential pathogens).

#### Asepsis

is defined as a state ‘free of pathogenic microorganisms’.

- 'Surgical asepsis' is the IPC goal for long, technically complex procedures usually performed in theatre but also in the ward, such as central line insertion. It requires maximum barrier precautions as well as aseptic critical fields and surgical ANTT.
- 'Medical asepsis' is the IPC goal for short (less than 20 mins) clinical procedures performed in the ward. It requires standard barrier precautions with general, micro or critical aseptic fields and standard or medical ANTT.

####

#### Aseptic non-touch technique (ANTT)

is an approach or framework aimed at achieving the goal of asepsis. To prevent micro-organisms being transferred to the patient from the clinician or from the immediate environment, ANTT considers the technical difficulty of each procedure (are there multiple parts that may become contaminated), and the skills of the clinician (can the clinician refrain from touching key-sites and key-parts).

While

'surgical' ANTT

'surgical' ANTT

Typically involves hand cleaning or surgical scrub, sterile gloves, sterile gowns and mouth/eye protection, preparing one main draped 'critical aseptic field' and maintaining it by using sterile gloves and placing only sterilised equipment on it.

is used for longer, complicated procedures with multiple key-sites/ key-parts and

'standard' or 'medical' ANTT

'standard' or 'medical' ANTT

involves preparing and maintaining 'micro-critical aseptic fields'. Non-sterile gloves may be worn as long as key-parts and key-sites are protected from contamination, for example, the clinician is skilled enough to obtain IV access without touching the cleaned puncture site as well as key-parts such as the cannula or IV infusion ports. Sterile gloves must be worn when key-parts or key-sites must be touched.

for shorter, more uncomplicated procedures, the basic safe-guards are the same:

- using basic infective precautions such as hand cleaning and environmental controls
- identifying key-parts (critical parts of equipment that, if contaminated, are most likely to cause infection, such as catheter tips, syringe tips, IV line connections, the tops of ampoules) and key-sites (open wounds and insertion/puncture sites)
- employing 'non-touch' skills to protect key-parts and key-sites from contamination
- managing the aseptic field, depending on the complexity of the procedure

Key IPC components for promoting/ensuring asepsis:

## Key Steps

### Consider environmental control

Limit airborne pathogens by relocating to a procedure room, if available, or drawing curtains around the workspace and avoiding procedures during

- nearby bedmaking
- patients using commodes and bedpans
- nearby cleaning and waste management

### Perform hand hygiene

Depending on the type of procedure, perform routine hand hygiene (soap and water or alcohol based hand rub) or surgical hand hygiene (scrub using antimicrobial skin cleanser or waterless hand rub).

Routine Hand Hygiene

Using alcohol-based hand rub:

Using soap and water:

Surgical Hand Hygiene

Surgical hand hygiene follows a more stringent process, which may involve a brush and nail pick, repeated cycles of washing, and washing up to the elbow. See Scrubbing and Gowning for detailed instructions.

### Select gloves

### Select other PPE

Use other PPE in line with standard precautions to reduce the clinician’s risk of blood and body fluid exposure.

Use maximum barrier precautions (mask, cap, sterile gown and sterile draping) when risk of infection is high, such as placing central lines.

### Manage the Aseptic Field

Determine what type of aseptic field is required, based on the type of procedure and the skill of the clinician, and use aseptic, non-touch technique (ANTT) during the procedure.

- General aseptic field

After performing hand hygiene, the assembled equipment is opened onto a cleaned trolley or tray (washed or wiped with detergent and allowed to dry). Key-parts such as needle tips remain sheathed until needed. Non-sterile gloves may be used for the procedure as long as ANTT is used.

- Micro aseptic field

Uncontaminated key-parts and cleaned key-sites are considered micro aseptic fields. Every effort should be made to avoid touching key-sites and key-parts, but if touching them is unavoidable, sterile gloves must be worn.

- Critical aseptic field

The work surface (or part thereof) is treated as a non-touch key-part. After hand hygiene, remove a sheet from a sterile pack by its corners, carefully drape over a prepared general aseptic tray and open sterile-packaged equipment onto the sheet without touching any part of the aseptic field. After cleaning the skin with alcohol-based solution, the patient is draped to expose only the aseptic key-site. Sterile gloves are donned for the procedure and an assistant must handle non-sterile items such as medication vials. See Preparing an aseptic field for detailed steps.

### Plan sequencing and decontamination

Plan what equipment and actions are needed prior to starting with the invasive procedure. Assemble all equipment, check for an assistant within calling distance, plan for post-procedure sharps disposal and get informed consent before donning the correct PPE. Prepare the aseptic field only once you are ready to start the procedure.

Decontaminate after the procedure by removing gloves, disposing of waste, wiping down surfaces and performing hand hygiene.

## References