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Clinical Skills Learning
septic Technique
septic Technique
Faculty of Health & SciencesFaculty of Health & Sciences
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Clinical Skills Learning
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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Clinical Skills Learning
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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Clinical Skills Learning
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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Clinical Skills Learning
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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Clinical Skills Learning
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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Clinical Skills Learning
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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Clinical Skills Learning
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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Clinical Skills Learning
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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Clinical Skills Learning
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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Clinical Skills Learning
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$piry dates.
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Clinical Skills Learning
Procedure Rationale
rocedure Rationale
• /efer to patients records$
• *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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Clinical Skills Learning
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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Clinical Skills Learning
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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Clinical Skills Learning
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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Clinical Skills Learning
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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Clinical Skills Learning
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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Clinical Skills Learning
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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Clinical Skills Learning
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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Clinical Skills Learning
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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Clinical Skills Learning
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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Clinical Skills Learning
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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Clinical Skills Learning
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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Clinical Skills Learning
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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Clinical Skills Learning
urther Information # $e% &in's:
urther Information # $e% &in's:
• *nfection control
• ,niversal Arecautions
• %natomy and Ahysiology 5 structure and function of the skin
• %natomy and physiology # the 'ound healing process
• ealth and Safety
• %lso refer to photograph slide sho' for further information
relating to aseptic techni&ue$