29-Feb-20

Clean, Aseptic and

Sterile Technique
Dr Omnia Mohamed

omnia mohamed

The Goal: Reduce Health Care

Associated Infections
 The goal is to reduce health care-associated
infections that occur when staff spread microbes
to patients
 Germs move to patients from hands, and from
objects used for patient care
 Use of clean, aseptic or sterile technique reduces
the number of germs transferred and thus,
reduces the risk of infection

omnia mohamed

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Definition: Clean Technique

 Use clean technique if staff or objects will touch
intact skin
 Clean technique refers to the use of routine
hand washing, hand drying and use of non-
sterile gloves
 Clean tech is appropriate for:
 Taking blood pressures
 Examining patients
 Feeding patients

omnia mohamed

Definition: Invasive Procedures

 Acts done to patients that come in contact with
the wounds, blood stream, the inside of the
body, or normally sterile parts of the body
 Remember invasive procedures invade the inside
of the body

omnia mohamed

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Aseptic Technique
 Use aseptic technique for
brief invasive procedures
that may break skin or
mucous membranes

Clean Aseptic Sterile

Procedure space On ward or at Dedicated Dedicated room

beside area

Gloves Clean or none Sterile Sterile surgical

Hand hygiene before the Routine Aseptic, e.g. Surgical scrub

procedures alcohol Iodophors,
chlorheximide

Skin antisepsis No Alcohol Long acting

agent

Sterile field No yes* Yes

Sterile gown, mask, head No yes Yes

covering

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Risk assessment

 Procedure risk assessment

 Risk on the patient

 Risk on the health care worker

 Risk on the community

Plan infection control interventions

Select aseptic measures appropriate for different
levels of risk of infection:
 Minimal Risk Clean Technique
 Medium Risk Aseptic Technique
 High Risk Surgical Asepsis

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Risk of Types of Patients Types of Procedures

Infection
1 Minimal Not immunocompromised; Non-invasive
No significant underlying No exposure to
disease biological fluids
2 Medium - Infected patients -Exposure to:
- Patients with some risk biological fluids
factors : Mucus membrane
Age :neonates & elderly - Invasive non surgical
Neoplasm procedures ( PVC ,
urinary catheter)
3 Maximum Severely Surgery or high risk
immunocompromised invasive procedures
Burn patients (CVC )
Organ transplant

Prevention of hospital-acquired infections

A practical guide, 2nd edition , WHO/CDS/CSR/EPH/2002.12

Risk on the patient

 How risky is the procedure?
 Invasion to a naturally sterile area-----High risk
Sterilization
 Contact with mucous membranes------Intermediate risk
High level disinfection
 Contact with intact skin------low risk cleaning or Low
level disinfection
 No contact with the patient----minimal cleaning or Low
level disinfection

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Risk on the health care worker

 How risky is the procedure?

 Contact with blood or body fluids
 Airborne/droplet disease infection
 Need for isolation precautions

Risk on the Community

 How risky is the procedure?

 Need for environmental cleaning or disinfection
 Waste management

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Aseptic technique
Aseptic technique is a general term involving practices that minimize the
introduction of microorganisms to patients during patient care.
There are two categories of asepsis;
-General asepsis which applies to patient care procedures outside the
operating theatre as insertion of intravenous catheters or urinary
catheter.

-Surgical asepsis relating to procedures/processes designed to prevent

surgical site infection.

Aseptic techniques include practices performed just

before, during, or after any invasive procedures.

Aseptic techniques

 Aseptic techniques are used to

* Reduce the risk of post-procedure infections and
* * Minimize the exposure of health care providers to
potentially infectious microorganisms.
** Minimize the risk of exposure of community to potentially
infectious microorganisms.

 Poor adherence to aseptic techniques results in

considerable morbidity and mortality. Even in countries
with well-established infection control programs, hospital-
acquired infections (HAI) related to poor compliance with
aseptic techniques is an important public health problem.

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Disease Transmission Cycle in the Health

Care Setting (Germ theory)

Reservoir

Susceptible Host Places of exit

Modes of
Places of entry
transmission

Reservoirs Related to the Development of

Nosocomial Infections
 Patients and staff

 Air
(tuberculosis, measles…)

 Water
(Acinitobacter, Klebsiella)

 Environmental surfaces and

inanimate objects
(VRE, MRSA)

 Contaminated supplies and

equipment (HBV), bacteria

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Places of Entry in the Development of

Nosocomial Infections

 Portals of entry
 Percutaneous
 Mucous membrane
 Surgical site

Others e.g.

U.bladder, veins …etc.
 Contributing factors
 Equipment
 Invasive devices
- new portals of entry

Key processes for performing Aseptic

Techniques
1. Hand Hygiene
2. Protective barriers (gloves, mask,……
3. Patient preparation (skin antisepsis)
4. Maintaining a sterile field (Sterile drapes).
5. Using safe operative technique :
 small incisions
 avoiding trauma to tissue
 controlling bleeding
6. Use Sterile equipment
7. No Touch Technique
8. Environmental control

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1-Hand Hygiene
 Hand washing

 Hand antisepsis:
antiseptic hand
washing or
antiseptic hand rub

 Surgical scrubbing

2-Protective Barriers
Personal protective equipment:
 Gloves

 Masks

 Eye protection

 Gowns, other protective apparel

 Caps

 Foot wear

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3-Patient Preparation

 Be sure that the skin is clean and free from obvious

dirt
 Apply skin antiseptic in a circular manner or in one
direction

 Hair removal if indicated directly before operation

out side OR !!!!!!
 Pre-operative antiseptic shower
 Pre-procedure mouth rinse !!!

4-Creating and maintaining a sterile

field
 A sterile field is an area created by placing
sterile towels or surgical drapes around the
procedure site and on the stand that will hold
sterile instruments and other items needed
during the procedure.

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Sterile Field

Sterile attire 

Sterile drapes 

maintaining a sterile field

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maintaining a sterile field

 Once a sterile object comes in contact with

a nonsterile object or person the object is
no longer sterile. If even one nonsterile
object or person enters the sterile field, the
field is no longer sterile.

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To maintain the sterile field:

 Do not contaminate sterile items when

opening, dispensing, or transferring them.
 Recognize that the edges of a package
containing a sterile item are considered
unsterile.

Sterile Equipment
 Single use

 Proper reprocessing

 Recognize that a sterile pack that has been

penetrated (wet, cut, or torn) is considered
contaminated

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5- Apply no touch technique

 Clean Clean
 Sterile Sterile

 Do not contaminate sterile/disinfected items while

Opening, transferring or applying them.

6- Environmental Control

 Dedicate specific area for interventions

 Environmental cleaning and disinfection
 Surface barriers
 Limit the number of people who enter these areas.
 Close doors
 Appropriate ventilation (air changes, negative or
positive pressure)
 Safe waste disposal including sharps

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Principles of safe procedure

 Skin preparation:
 HCW skin= Hand hygiene:
 Routine, Aseptic and surgical (alcohol hand rub ?)
 Before and after

 Patient skin:
 Cleaning of skin or skin antisepsis
 Use of personal protective equipments:
 HCW:
 Gloves, gowns, aprons…etc
 Patient:
 Sterile drapes, need for sterile PPE

Principles of safe procedure-cont.

 Use of safe instruments and devices:

 HCW:
 Appropriate, functioning, and maintained
 Patient :
 Properly reprocessed: clean, disinfected or sterile
 Working in safe environment:
 Environmental cleaning or disinfection
 Ventilation and temperature
 Work traffic
 Separation of clean and dirty areas

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Principles of safe procedure-cont.

 Maintaining closed circuits

 Urinary catheters
 IV lines

 Decrease unnecessary handling

 Proper waste management

Working in safe environment

 Clean storage areas:
 Separate clean and dirty areas
 Separate sterile supplies from clean re-processed
from used and heavily contaminated.
- Low traffic
• Clean work areas
- Low traffic and a means of handwashing
-Only small stock at point of use prep area
-Medication cart as a clean area:, ZERO visible dirt, no
dirty garbage. Needle box OK.

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S.C.R.I.P.T Procedures
 Space and work flow?
 Clean, aseptic, or sterile technique?
 Routine, aseptic or surgical hand hygiene?
 Instruments and supplies?
 Personal protective equipment?
 Trash: sharps, infectious waste, radioactive
waste, pathology or routine waste?

omnia mohamed

Procedures with the highest risk for

causing infections
 Aseptic techniques are practiced for all invasive medical procedures .
Procedures with the highest risk for causing infections include:

 The placement of medications or devices into sterile body spaces such

- The placement of intravenous lines.
- The placement of indwelling urinary catheters.

 During the preparation and administration of intravenous fluids

 During insertion of intravenous and intramuscular injections of

medication, especially from multidose vials.

 Wound care.

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1. Central venous catheter insertion

2. Peripheral venous catheter insertion
3. Indwelling urinary catheter insertion
5. Chest drain insertion
6. Cervical smear
7. Lumbar puncture
9. IUD insertion
11. Endotracheal intubation
13. Surgical wound dressing
14. Care of a bed sore

Clean area?

 Separate personal items

from hospital items
 No staff eating or drinking
 Store clean items, including
linen, cottons, gauze,
towels covered
 If cotton is torn by hand it
is contaminated.

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No! Sterile items and disinfected items should

never be in the same area. Separate sterile from clean
from dirty

Can sterile procedures be done safely in

this setting?
No

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 ‫‪29-Feb-20‬‬

‫غسيل صحي‬
‫تركيب قسطرة وريدية مركزية‪:‬‬
‫وقفاز معقم‬
‫وأساليب مانعة‬ ‫عالي الخطورة‬
‫للتلوث‬

‫عالي الخطورة‬
‫‪ ‬مثال‪:‬‬
‫العالج عن طريق التنقيط بالوريد‪:‬‬
‫ارتداء القفازات‬
‫الطبية وغسل‬
‫اليدين‬
‫أفراد هيئة التمريض‪:‬‬

‫المريض‪:‬‬
‫عالي الخطورة‬

‫اتباع األساليب مانعة‬

‫التلوث‬

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‫ليس هناك حاجة‬

‫إلستخدام أي واقيات‬
‫قليل الخطورة‬ ‫قياس ضغط الدم‪:‬‬
‫شخصية‬

‫غسيل صحي وقفاز‬ ‫عالي الخطورة‬

‫معقم وأساليب مانعة‬ ‫تركيب قسطرة بولية‪:‬‬
‫للتلوث‬

‫قفاز شديد التحمل‬ ‫قليل الخطورة‬ ‫تنظيف أرض المستشفي‪:‬‬

‫ال حاجة إلستخدام‬

‫أي واقيات شخصية‬

‫استحمام المريض‪:‬‬
‫قليل الخطورة‬

‫غسيل صحي‬
‫وقفاز معقم‬
‫وجاون وماسك‬
‫وأساليب مانعة‬
‫للتلوث‬ ‫خلط محاليل وريدية‪:‬‬
‫عالي الخطورة‬

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Sterilization Disinfection

Intermediate Low
High level High level
Autoclave Dry heat Chemical level level

Use or Storage

Disposal Critical items Semi-critical Non-critical

items items items

Cleaning Cleaning
Cleaning
Dispose
High level Disinfected if
Sterilization used on infectious
Syringe- disinfection patient
Tongue
depressor Use or Storage Use or Storage Use or Storage

Items penetrate sterile Don’t penetrate skin,

tissues as body cavity- but in close contact with
vascular sustem mucous membrane

Surgical instrument- Respiratory equip-flexible

Vascular catheter- endoscope-laryngoscope- ‫ا‬Stethoscope
Intra-uterine device. endotracheal tube

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