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CLEAN, ASEPTIC AND STERILE TECHNIQUE

Objectives

Be able to assess procedures for the risk of infection to patient Describe the level of precautions needed for different invasive procedures

or become colonized Procedures that cut into sterile body parts: most acute risk. mouth and mucous membranes: germs may enter through micro cuts.Any time we touch a patient we put them at risk for an infection    Touching intact skin: may transfer germs that colonize the patient and cause infection 18 months later. Procedures touching respiratory tract. .

“Reduce the risk of infection by using clean. aseptic or sterile technique depending on the risk of the procedures”  How do you determine what is the risk of the procedure? What exactly is clean or sterile technique?  .

open wounds Reproductive tract involved  Or if the patient is already colonized with multi drug resistant organisms (MDRO)  . patient infect themselves  Patient’s germs may enter from their endogneous flora “Dirty cases” more likely: respiratory track.Risk: even with perfect technique. GI.

or the environment Items shared between patients without reprocessing  Facilities and waiting areas that share space   .Risk: Even with perfect patients. hospitals infect patients  Through germs on the hands of hospital staff Through germs from contaminated items. air.

Risk of infection is increased by: • • • • • • The length of the procedure Length of hospital stay Size of incision and manipulation of operation If indwelling item left (transplant. graft) Dusty. dirty.g. drain. contaminated environment (e. not a procedure room or surfaces not disinfected) Contamination of irrigations and medications . mesh. line. hardware. catheter.

use of procedure rooms.Infections are reduced by the measure we have discussed :  Hand hygiene. special ventilation . use of sterile instruments. minimizing the number of persons in the room. use of barriers to prevent shedding onto the patient. masks. disinfecting surfaces.

never place dirty items in a clean area. – Never place clean items in a dirty area. There should be no uncovered storage in the procedure room.All procedures require: • • Hand washing before and after to first remove all visible dirt Complete separation of clean and dirty areas and a designated place for waste. . never place nonsterile items in a sterile field.

  . cottons. towels covered If cotton is torn by hand it is contaminated.Clean area?   Separate personal items from hospital items No staff eating or drinking Store clean items. gauze. including linen.

“Aseptic”. not sterile technique” Done before short invasive procedures  Generally done with sterile gloves if hands may touch sterile items or to reduce transferring environmental germs Recommended when:  Mixing IV medications  Suctioning  Placing a urinary catheter  Placing a peripheral venous catheter  Dressing changes  .

Aseptic technique uses clean or sterile gloves: assess risk Clean gloves Drawing blood samples Getting urine sample from line for specimen Sterile gloves Suctioning resp. line transducers Drawing blood cultures Urinary cannula insertion No gloves: IM injections . tract Changing central line tubing Placing clean dressings Preparing art.

mouth Sterile drape • • • • • • .Sterile technique means Maximally sterile precautions for high-risk invasive procedures including surgery: Sterile surgical gloves Surgical hand wash Head and beard cover Sterile gown Mask that covers nose.

Sterile technique requires Clean area or dedicated area with barriers between other patients or contaminated objects Minimal number of staff present Distinction between sterile and non-sterile areas -No non-sterile items on sterile field -Assistant to hand off dirty and non-sterile items .

Can sterile procedures be done safely in this setting?  No .

Procedures with long dwelling implants other than an IV or urinary cannula Procedures for which you have unexplained high infection rates .When to do sterile technique • • • • • Compounding medication for large numbers of people or preparing IV fluids for multiple patients Surgery Long procedures.

Sterile technique is also used for: Mixing of IV fluids  Pharmacy procedures for parenteral medications  Preparation of implants and transducers  Insertion of central lines  Changing of central lines  Some laboratory procedures to minimize contamination  .

What precautions are needed for this procedure? .

ENT surgery Ophthalmology Shared operating theatre facilities .

What technique do you need for the following?       Helping change a colostomy Inserting an IV Inserting a central line Getting a blood culture Suctioning a patient Getting a sputum speciemen        Helping a patient with physiotherapy Removing linen Taking out the trash Inserting a chest tube Mixing IV fluid Cleaning a blood spill Endo-tracheal insertion .

IV or central line placement and urinary catheter procedure. including the sequence of donning and doffing PPE. .Practice procedures:  Practice demonstrating these clean and sterile techniques for a dressing change.