Aseptic technique





Definition

Aseptic technique is a set of specific practices and procedures performed under carefully controlled conditions with the goal of minimizing contamination by pathogens.


Purpose

Aseptic technique is employed to maximize and maintain asepsis, the absence of pathogenic organisms, in the clinical setting. The goals of aseptic technique are to protect the patient from infection and to prevent the spread of pathogens. Often, practices that clean (remove dirt and other impurities), sanitize (reduce the number of microorganisms to safe levels), or disinfect (remove most microorganisms but not highly resistant ones) are not sufficient to prevent infection.

The Centers for Disease Control and Prevention (CDC) estimates that over 27 million surgical procedures are performed in the United States each year. Surgical site infections are the third most common nosocomial (hospital-acquired) infection and are responsible for longer hospital stays and increased costs to the patient and hospital. Aseptic technique is vital in reducing the morbidity and mortality associated with surgical infections.

Description

Aseptic technique can be applied in any clinical setting. Pathogens may introduce infection to the patient through contact with the environment, personnel, or equipment. All patients are potentially vulnerable to infection, although certain situations further increase vulnerability, such as extensive burns or immune disorders that disturb the body's natural defenses. Typical situations that call for aseptic measures include surgery and the insertion of intravenous lines, urinary catheters, and drains.


Asepsis in the operating room

Aseptic technique is most strictly applied in the operating room because of the direct and often extensive disruption of skin and underlying tissue. Aseptic technique helps to prevent or minimize postoperative infection.

PREOPERATIVE PRACTICES AND PROCEDURES. The most common source of pathogens that cause surgical site infections is the patient. While microorganisms normally colonize parts in or on the human body without causing disease, infection may result when this endogenous flora is introduced to tissues exposed during surgical procedures. In order to reduce this risk, the patient is prepared or prepped by shaving hair from the surgical site; cleansing with a disinfectant containing such chemicals as iodine, alcohol, or chlorhexidine gluconate; and applying sterile drapes around the surgical site.

In all clinical settings, handwashing is an important step in asepsis. The "2002 Standards, Recommended Practices, and Guidelines" of the Association of Perioperative Registered Nurses (AORN) states that proper handwashing can be "the single most important measure to reduce the spread of microorganisms." In general settings, hands are to be washed when visibly soiled, before and after contact with the patient, after contact with other potential sources of microorganisms, before invasive procedures, and after removal of gloves. Proper handwashing for most clinical settings involves removal of jewelry, avoidance of clothing contact with the sink, and a minimum of 10–15 seconds of hand scrubbing with soap, warm water, and vigorous friction.

A surgical scrub is performed by members of the surgical team who will come into contact with the sterile field or sterile instruments and equipment. This procedure requires use of a long-acting, powerful, antimicrobial soap on the hands and forearms for a longer period of time than used for typical handwashing. Institutional policy usually designates an acceptable minimum length of time required; the CDC recommends at least two to five minutes of scrubbing. Thorough drying is essential, as moist surfaces invite the presence of pathogens. Contact with the faucet or other potential contaminants should be avoided. The faucet can be turned off with a dry paper towel, or, in many cases, through use of a foot pedal. An important principle of aseptic technique is that fluid (a potential mode of pathogen transmission) flows in the direction of gravity. With this in mind, hands are held below elbows during the surgical scrub and above elbows following the surgical scrub. Despite this careful scrub, bare hands are always considered potential sources of infection.

Sterile surgical clothing or protective devices such as gloves, face masks, goggles, and transparent eye/face shields serve as barriers against microorganisms and are donned to maintain asepsis in the operating room. This practice includes covering facial hair, tucking hair out of sight, and removing jewelry or other dangling objects that may harbor unwanted organisms. This garb must be put on with deliberate care to avoid touching external, sterile surfaces with nonsterile objects including the skin. This ensures that potentially contaminated items such as hands and clothing remain behind protective barriers, thus prohibiting inadvertent entry of microorganisms into sterile areas. Personnel assist the surgeon to don gloves and garb and arrange equipment to minimize the risk of contamination.

Donning sterile gloves requires specific technique so that the outer glove is not touched by the hand. A large cuff exposing the inner glove is created so that the glove may be grasped during donning. It is essential to avoid touching nonsterile items once sterile gloves are applied; the hands may be kept interlaced to avoid inadvertent contamination. Any break in the glove or touching the glove to a nonsterile surface requires immediate removal and application of new gloves.

Asepsis in the operating room or for other invasive procedures is also maintained by creating sterile surgical fields with drapes. Sterile drapes are sterilized linens placed on the patient or around the field to delineate sterile areas. Drapes or wrapped kits of equipment are opened in such a way that the contents do not touch non-sterile items or surfaces. Aspects of this method include opening the furthest areas of a package first, avoiding leaning over the contents, and preventing opened flaps from falling back onto contents.

Equipment and supplies also need careful attention. Medical equipment such as surgical instruments can be sterilized by chemical treatment, radiation, gas, or heat. Personnel can take steps to ensure sterility by assessing that sterile packages are dry and intact and checking sterility indicators such as dates or colored tape that changes color when sterile.

INTRAOPERATIVE PRACTICES AND PROCEDURES. In the operating room, staff have assignments so that those who have undergone surgical scrub and donning of sterile garb are positioned closer to the patient. Only scrubbed personnel are allowed into the sterile field. Arms of scrubbed staff are to remain within the field at all times, and reaching below the level of the patient or turning away from the sterile field are considered breaches in asepsis.

Other "unscrubbed" staff members are assigned to the perimeter and remain on hand to obtain supplies, acquire assistance, and facilitate communication with outside personnel. Unscrubbed personnel may relay equipment to scrubbed personnel only in a way that preserves the sterile field. For example, an unscrubbed nurse may open a package of forceps in a sterile fashion so that he or she never touches the sterilized inside portion, the scrubbed staff, or the sterile field. The uncontaminated item may either be picked up by a scrubbed staff member or carefully placed on to the sterile field.

The environment contains potential hazards that may spread pathogens through movement, touch, or proximity. Interventions such as restricting traffic in the operating room, maintaining positive-pressure airflow (to prevent air from contaminated areas from entering the operating room), or using low-particle generating garb help to minimize environmental hazards.

Other principles that are applied to maintain asepsis in the operating room include:

  • All items in a sterile field must be sterile.
  • Sterile packages or fields are opened or created as close as possible to time of actual use.
  • Moist areas are not considered sterile.
  • Contaminated items must be removed immediately from the sterile field.
  • Only areas that can be seen by the clinician are considered sterile (i.e., the back of the clinician is not sterile).
  • Gowns are considered sterile only in the front, from chest to waist and from the hands to slightly above the elbow.
  • Tables are considered sterile only at or above the level of the table.
  • Nonsterile items should not cross above a sterile field.
  • There should be no talking, laughing, coughing, or sneezing across a sterile field.
  • Personnel with colds should avoid working while ill or apply a double mask.
  • Edges of sterile areas or fields (generally the outer inch) are not considered sterile.
  • When in doubt about sterility, discard the potentially contaminated item and begin again.
  • A safe space or margin of safety is maintained between sterile and nonsterile objects and areas.
  • When pouring fluids, only the lip and inner cap of the pouring container is considered sterile; the pouring container should not touch the receiving container, and splashing should be avoided.
  • Tears in barriers and expired sterilization dates are considered breaks in sterility.

Other clinical settings

A key difference between the operating room and other clinical environments is that the operating area has high standards of asepsis at all times, while most other settings are not designed to meet such standards. While clinical areas outside of the operating room generally do not allow for the same strict level of asepsis, avoiding potential infection remains the goal in every clinical setting. Observation of medical aseptic practices will help to avoid nosocomial infections. The application of aseptic technique in such settings is termed medical asepsis or clean technique (rather than surgical asepsis or sterile technique required in the operating room).

Specific situations outside of the operating room require a strict application of aseptic technique. Some of these situations include:

  • wound care
  • drain removal and drain care
  • intravascular procedures
  • vaginal exams during labor
  • insertion of urinary catheters
  • respiratory suction

For example, a surgical dressing change at the bedside, though in a much less controlled environment than the operating room, will still involve thorough handwashing, use of gloves and other protective garb, creation of a sterile field, opening and introducing packages and fluids in such a way as to avoid contamination, and constant avoidance of contact with nonsterile items.

General habits that help to preserve a clean medical environment include:

  • safe removal of hazardous waste, i.e., prompt disposal of contaminated needles or blood-soaked bandages to containers reserved for such purposes
  • prompt removal of wet or soiled dressings
  • prevention of accumulation of bodily fluid drainage, i.e., regular checks and emptying of receptacles such as surgical drains or nasogastric suction containers
  • avoidance of backward drainage flow toward patient, i.e., keeping drainage tubing below patient level at all times
  • immediate clean-up of soiled or moist areas
  • labeling of all fluid containers with date, time, and timely disposal per institutional policy
  • maintaining seals on all fluids when not in use

The isolation unit is another clinical setting that requires a high level of attention to aseptic technique. Isolation is the use of physical separation and strict aseptic technique for a patient who either has a contagious disease or is immunocompromised. For the patient with a contagious disease, the goal of isolation is to prevent the spread of infection to others. In the case of respiratory infections (i.e., tuberculosis), the isolation room is especially designed with a negative pressure system that prevents airborne flow of pathogens outside the room. The severely immunocompromised patient is placed in reverse isolation, where the goal is to avoid introducing any microorganisms to the patient. In these cases, attention to aseptic technique is especially important to avoid spread of infection in the hospital or injury to the patient unprotected by sufficient immune defenses. Entry and exit from the isolation unit involves careful handwashing, use of protective barriers like gowns and gloves, and care not to introduce or remove potentially contaminated items. Institutions supply specific guidelines that direct practices for different types of isolation, i.e., respiratory versus body fluid isolation precautions.

In a multidisciplinary setting, all personnel must constantly monitor their own movements and practices, those of others, and the status of the overall field to prevent inadvertent breaks in sterile or clean technique. It is expected that personnel will alert other staff when the field or objects are potentially contaminated. Health care workers can also promote asepsis by evaluating, creating, and periodically updating policies and procedures that relate to this principle.


Resources

PERIODICALS

Mangram, Alicia, Teresa Horan, Michele Pearson, Leah Christine Silver, and William Jarvis. "Guideline for Prevention of Surgical Site Infection, 1999." Infection Control and Hospital Epidemiology 20 (April 1999): 247–78.

Pittet, Didier. "Improving Adherence to Hand Hygiene Practice: A Multidisciplinary Approach." Emerging Infectious Diseases 7 (March/April 2001).


ORGANIZATIONS

Association of Perioperative Registered Nurses (AORN). 2170 South Parker Road, Suite 300, Denver, CO 80231-5711. (303) 755-6300 or (800) 755-2676. http://www.aorn.org .

Centers for Disease Control and Prevention (CDC). 1600 Clifton Road, Atlanta, GA 30333. (404) 639-3534 or (800) 311-3435. http://www.cdc.gov .


OTHER

Bjerke, Nancy. "Hand Hygiene in Healthcare: Playing by the New Rules." Infection Control Today February 2003 [cited February 2003]. <http://www.infectioncontroltoday.com/articles/321bpraaact.html&# 003E; .

Dix, Kathy. "Observing Standard Precautions in the OR." Infection Control Today October 2002 [cited February 2003]. <http://www.infectioncontroltoday.com/articles/2a1topics.html� 3E; .

Osman, Cathy. "Asepsis and Aseptic Practices in the Operating Room." Infection Control Today July 2000 [cited February 2003]. <http://www.infectioncontroltoday.com/articles/071best.html ; .


Katherine Hauswirth, APRN

Stephanie Dionne Sherk



User Contributions:

diane reehil
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Apr 19, 2006 @ 6:18 pm
I have a question. What is the acceptable practice for surgical wound dressing change? Sterile technique or clean method?
Seiki Ito
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Aug 2, 2007 @ 5:05 am
HELLO
MY NAME IS SEIKI ITO, I WORK AT CMH HOSPITAL AS A SURGICAL TECH.
I WANT TO KNOW ARE NON-STERILE PERSONEL ALLOWED TO GRAB OBJECTS OFF THE STERILE FIELD, OR STERILE PERSONEL ALLOWED TO PASS OBJECTS OFF TO THE CIRCULATOR, WHO IS NOT STERILE.
(I THINK THAT WOULD CAUSE A RISK FOR INFECTION)
COULD YOU SEND ME SOME LITERATURE ABOUT THIS?
David Howell
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Sep 19, 2007 @ 2:14 pm
I need some information on where staff can wear scubs and if they need to be changed after being outside the OR area. Staff thinks they can wear scrubs outside the hospital and to lunch and they are still steril. Anything you can give me. Thanks.
LaToya Frazier
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Nov 6, 2007 @ 8:08 am
My name is LaToya Frazier, and i was thinking about going into a career in surgical tech. And I was just wondering is this a good career to go into. I really don't know much about it, and I was wondering if you happened to have any information on the program.
mika
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Dec 21, 2007 @ 1:01 am
hi iam currently enrolled in my masters and having my thesis which entitles extent of care nursing provided to surgical clients and i need related literatures on the pre operative, intra operative and post operative care and standards i hope you can send me some thanx
Glenda Joy Barlizo Guillergan
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May 4, 2008 @ 1:01 am
How many principles of surgical asepsis must we follow in the operating room, twelve (12) or seven (7)...?

I am on the problem identification phase of my research this summer. Since I am and OR nurse, I wish to look into the practice of surgical asepsis as practiced by the nurses in the hospital where I work. It's for my master's project paper and hopefully, thesis, thus this question...Must my study be focused on OR nurses only or the entire surgical team - student-nurses, junior interns, post-graduate interns, resident surgeons, anesthesiologists, etc...? If this has already been studied, can you give me the result of such study as to the adherance to the surgical aseptic practice...thanks...
Angela
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Jul 3, 2008 @ 12:12 pm
Hi, I 'm interested in learning the Aseptic Technique in Microbiology and Biology Laboratory procdure. If you have the procdure of Aseptic Technique for this kind of Lab, would you e-mail it to me. thank you very much. agelazare@yahoo.com

your
angela
alytz
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Jul 16, 2008 @ 12:12 pm
sterile technique is more acceptable for surgical wound dressing
abby
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Aug 1, 2008 @ 5:05 am
im looking for the related studies on my thesis class.. can you help me guys, asap.... about proper aseptic technique on the operating room... plssssssss...... tnx a lot....
Kate Weber
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Aug 6, 2008 @ 3:15 pm
Interested in your reply to the August 2nd 2007 question in regards to non-sterile personel removing objects from a sterile field? Any information in these regards would be appreciated.
nigel dzorwa
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Jun 4, 2009 @ 4:04 am
where did it come how was it created or produced
and i need to know this soon
many years of experience
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Jul 17, 2009 @ 11:11 am
jUS replying to a couple of questions. NO ONE should ever take anything from your back table unless they are a dressed in sterile attire. NO ONE!!!!!!! and to the person that commented on the o.r. staff leaving operating room suite and returning w/o changing clothes.....there are still studies out determining what is correct, but remember a person is never sterile only the gown and gloves that are downed is considered sterile.
Sandra
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Jul 21, 2009 @ 6:06 am
I have received my Sterile Technician Certificate. Now I'm interested in completing the Surgical Technican program to work in the OR. In your opinion, do I have an "edge up" on someone else in getting a job in the OR as opposed to someone who does not have the Sterile Technican Certificate. Additionally, I did a 7 week internship at a hospital in their Central Sterile Department. Question #2: What else can I do to be more marketable than the other person in order to get a job in the OR?
David Tsatsa
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Jul 27, 2009 @ 4:04 am
l would like to know waht we will happen if you cantaminate the sterile and non sterile
pearl lawrence
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Aug 21, 2009 @ 9:21 pm
i need information on when doing a vaginal delivery in the delivery room is it a asceptic technique and is it used through out the delivery
is it international standard
or is it a surgical clean procedure
waisea
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Nov 4, 2009 @ 10:10 am
WHEN WAS THIS ASEPTIC TECHNEQE FOUND I WANT TO KNOW PLIZ
Desert Mom
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Nov 10, 2009 @ 6:18 pm
I too must answer some of these questions that are posted. For vaginal deliveries, always treat the delivery as sterile. Always wear proper protective equipment. You will see many L&D nurses not doing this, you know better as a tech. Don't follow bad habits!

As for handing off sterile specimens, instruments etc off the field to a circulating nurse, it depends on if you are properly trained in doing so. After several years in the field and teaching for 5 years, you can hand off items but you must be careful not to contaminate. If you do contaminate you MUST know how to fix your mistake. So unless you know how to fix the mistake I advise on you not doing it until you are taught.

To know who began the movement on Asepsis, read up on Joseph Lister and his accomplishments, you will find good information there regarding the origin of asepsis.

And lastly there are 12 principles even though AORN lists 14, they broke two of the 12 up which made it come to 14, There is only 12, know them forwards and backwards my fellow comrades.

Blessings
berry
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Dec 2, 2009 @ 11:11 am
in case laboratory tsting ask you about aseptic technique is you will know although you never done it.
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Feb 13, 2010 @ 8:08 am
Hello..
my name's refina sofianna. im working at private hospital.
Very sorry, im asking very odd question because im still new in this field.
What types of gas that they use for sterilize the equipments?
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Apr 26, 2010 @ 7:07 am
That is good information about Aspetic Techniques, and it's usefull.
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Jul 15, 2010 @ 1:13 pm
I am the Manager for Field Sales Training for Bracco Diagnostics Inc. We sell contrast media to cath labs. As such, with the new vendor registraions I need to develop a program on Aseptic Technique. I would like to use your artticle as a reference. Would you give me permissionj to do this?
Kim Hicks
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Aug 26, 2010 @ 7:19 pm
I'm looking for any research that will confirmed the importance of maintaining a sterile field. Data that will convince a surgeon that picking up an item off the surgical field, changing his gloves only then changing the item with sterile tips. This was a type of medication. He claims that the medication remained sterile inside the tube.
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Nov 3, 2010 @ 5:17 pm
I have two questions for you. First I wondered if a situation happened where a surgical tech noticed a hair on their sterile back table what should they do? I have always heard when in doubt re do it but what if you ( the surgical tech) noticed the hair after the surgical procedure has already started. Also during a c-section if there happens to be a gush of a lot of amniotic fluid come out and soak a lot of the drapes what should I do? Could you please help me in answering these questions I have I would really appreciate it! Thank you

Shannon
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Nov 27, 2010 @ 11:11 am
MY NAME IS SANGA CLAUDINE AND I AM A STUDENT.WHAT ARE THE INFECTION CONTROL TECHNIQUES PRACTICED BY NURSES?
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Feb 15, 2011 @ 1:01 am
hi! i just want to know if there are any disadvantages regarding infection control in dentistry like the use of HVE during practice,i'm studying dental assisting so just want to know about risks also.
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Feb 17, 2011 @ 11:23 pm
hi...can you send me some information about asceptic technique for clinical laboratory not mentioning microbiology.im working in a hospital based laboratory. thank you
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Apr 25, 2011 @ 7:07 am
Article is very good.
please include article on "Hair going in Human Body during surgical procedure & its Effect"


Thanks
Arshad
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Jun 19, 2011 @ 11:11 am
Aseptic technique is paramount in medical and surgical settings; aiming at eliminating or reducing infectivity and growth of microbes.
Note: This is not the practice in some government hospitals in Nigeria. How can this organization help the country out_knowing the implication of such practice?
chris "sss"
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Jul 19, 2011 @ 4:04 am
I am trying to learn about the procedurs of this topic and i have been stuck for some time now trying to figure out what this all means i am a level 3 in micro science and i really do need help with this work if any one has any thng that could help me please do
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Sep 16, 2011 @ 7:19 pm
I'm trying to find literature, research data, standards, etc. that address the number of layers (as with traditional muslin drapes) required to establish a sterile field. I was taught that a sterile field requires 4 layers. When disposable drapes became the norm, I was taught that an unreinforced paper drape was equivalent to 2 layers. Embossed sheets that have 2 sheets sealed together around the edges are equivalent to 4 layers. If anyone has information that can support or dispute this issue will be greatly appreciated!
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Sep 24, 2011 @ 11:11 am
i am a Bsc student working on my thesis,the imlementation of aseptic technic in wound dressing by nurses.i wish to have literature on this. thanks
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Sep 30, 2011 @ 10:10 am
I am researching sterilation practices for instruments, trays and other items for Labor and Delivery in a hospital setting. I would also like to know infection rates in Labor and Delivery. I am only interested in Labor and Delivery, no other areas of hospital. Thank you.
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Oct 19, 2011 @ 9:21 pm
I would like to know the Aseptic Cleaning Standars for a Hospital.
I am the Facilities Coordinator at one of the local hospitals in Santa Cruz, CA
patti
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Dec 17, 2011 @ 5:17 pm
Once a labor table has been set for a vagninal delivery, how long is that table good for it is has not been in the pt. room yet
Virginia
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Feb 7, 2012 @ 11:11 am
After a C-section is completed, what is considered proper on removing the drapes? Is it ok to place a sterile blue towel on the incision site and remove drapes or should you first place the sterile dressing???
samantha
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Feb 5, 2013 @ 5:17 pm
thanks for the information it helped me a lot with my project!

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