Asepsis Guideline

Publication: 01/05/2009  --
Last review: 07/08/2017  
Next review: 07/08/2020  
Clinical Guideline
CURRENT 
ID: 1672 
Approved By: Trust Clinical Guidelines Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2017  

 

This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Asepsis Guideline

Please check the patients allergy status, as they may be allergic to Chlorhexidine, and alternative ( Providine iodine) solution will be required.

Be aware: Chlorhexidine is considered an environmental allergen.

Summary of Guideline

The Health and Social Care Act 2008 Code of Practice for health and adult social care on the prevention and control of infections and related guidance stipulates that NHS bodies and adult social care providers must have core policies in place, including aseptic technique, in relation to preventing and controlling the risks of HCAI’s. Patients have a right to be protected from avoidable infection and healthcare workers have a duty to Safeguard the wellbeing of patients. This Guideline sets out the expectations in practice of all clinical LTHT staff when undertaking practices requiring the use of an aseptic technique.

It applies specifically to types of procedures included under asepsis which aims to reduce the number of organisms and prevents their spread.  This guideline does not include procedures practised by clinical staff in operating theatres and treatment areas which may require contact with a sterile body site.
 
Only staff that have received appropriate training can carry out a clinical procedure which requires asepsis in LTHT. 
Staff are personally responsible to ensure that they have the required knowledge and skill to undertake procedures that require asepsis.

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Definitions

Asepsis is defined as “the absence of infectious organisms. Aseptic techniques are those aimed at the elimination of all infectious micro-organisms during procedures”
(Humes and Lobo 2009).

TYPES OF ASEPSIS
There are two types of asepsis; medical and surgical as described by Ayliffe et al (2000).

Medical Asepsis
Medical asepsis aims to minimise the risk of contamination by microorganisms, and prevent their transmission.

Surgical Asepsis
Surgical asepsis is a complex procedure to eliminate microorganisms from an area (thus creating an aseptic environment), and is practised in operating theatres and for invasive procedures, such as the insertion of a central venous catheter (CVC).

Antisepsis – is the removal / reduction of microbes from the susceptible site; this is usually carried out by using an antiseptic solution.

Aseptic non-touch technique (ANTT) - only sterile equipment and fluids are used during invasive clinical procedures along with the use of non-touch principles in handling sterile equipment and instruments.

Susceptible site - a site where there is the potential for the introduction of microbes e.g. peripheral cannula site

Health care worker (HCW) - all staff employed at LTHT who have direct patient contact

Key-part - is the part of the equipment that comes into direct contact with the liquid infusion or sterile site. The following list identifies some of the equipment which is classified as a key part; needles, syringe tips, IV line connections, exposed lumens of catheters, tops of ampoules.

Competent individual - for the purposes of this guideline is someone who has     completed asepsis training and has been assessed as competent.

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Background

‘Aseptic technique’ is a term applied to a set of specific  practices and procedures used to assure asepsis and prevent the transfer of potentially pathogenic microorganisms
to a susceptible site on the body (e.g. an open wound or insertion site for an invasive medical device) or to sterile equipment/devices. It involves ensuring that susceptible
body sites and the sterile parts of devices in contact with a susceptible site are not contaminated during the procedure, (EPIC 3 2014)

ASEPTIC TECHNIQUE

Please check the patients allergy status, as they may be allergic to Chlorhexidine, and alternative ( Providine iodine) solution will be required.

Be aware: Chlorhexidine is considered an environmental allergen.

Asepsis can be achieved through:

  • The correct use of infection precautions.
  • PPE
  • Decontamination of hands
  • Not touching susceptible sites, (key parts), or the surface of invasive devices.

Aseptic technique should be used as described in the Marsden Manual (2015) (see appendix 1 for guidance).

Maintaining asepsis does not only refer to carrying out procedures but should be considered in undertaking daily activities.
Lines such as Intravenous or central lines or urinary catheters should only be disconnected when absolutely necessary. In doing so the risk of contamination to is increased. For example at the end of a treatment. It is not acceptable to disconnect and reconnect lines when there is no clinical justification. An example of when it is not acceptable to disconnect and reconnect lines is disconnecting a line to put patients top on.

Aseptic Field

A clean working environment is essential to ANTT. Before an ANTT procedure is begins the aseptic field should be prepared. This may be a plastic tray or a dressing trolley depending upon the task to be undertaken.
Before the procedure can commence the aseptic field must be thoroughly cleaned with detergent wipes. It is essential that the aseptic field is allowed time to dry before starting the procedure to ensure that the disinfection process has been completed.
After the procedure the trays/trolleys should be cleaned and stored in a clean and dry area of the unit or ward.

ANTT forms part of Aseptic practice.

Aseptic non-touch principles (ANTT)®

ANTT® (Rowley 2009) can provide a method of delivering asepsis that does not allow the HCW to touch any of the key-parts (susceptible sites) that would result in contamination of wounds and other key-parts by organisms that could cause infection.

To determine if an ANTT® can be used for a clinical procedure the HCW must establish that the procedure can be completed without touching key-parts.

The use of sterile or non-sterile gloves is dependent upon the clinicians risk assessment in determining the likely hood of contaminating key parts or susceptible sites.

Key Parts and Key Sites
Key parts are those parts of equipment that if contaminated pose an increased risk of the patient acquiring an infection. Key parts come into contact with the patient directly or via an infusion or connection.

Example:
In intravenous therapy key parts, would be the liquid to be infused and the equipment that comes into contact with the liquid such as needles tips, syringe tips and needle free connectors.

If a key part becomes contaminated during a procedure then the contaminated part should be disposed of and a new one obtained.

Key Sites are any active parts that are connected to the patient.
Examples:

  • Wounds, when they are exposed without a dressing.
  • Insertion sites of venous access devices.

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Management

When to use Asepsis/ ANTT

Clinical Procedure

       Equipment

  • Dressings of wounds healing by primary intention
  • Intravenous cannula insertion
  • Urinary Catheterisation
  • Invasive Vaginal examination
  • Suturing
  • Minor Surgical procedures
  • Medical invasive procedures e.g central line insertion
  • Cleaning and administration via tunnelled central venous devices e.g. portocath.
  • Sterile pack appropriate to the procedure e.g.
    Cannulation pack
    CVC insertion pack
    Dressing pack
    Urinary insertion pack
  • Dressing Trolley
  • Sterile equipment
  • Sterile Gloves
  • Cleaning of peripheral and central cannula with needle-free access device
  • Administration of intravenous medicines via needle-free access devices
  • Administration of TPN
  • Chronic wounds in patients who are not immunosuppressed and do not have compromise circulation
  • Venepuncture
  • Preparation of intravenous medicines within clinical areas

This list is not exhaustive and the clinician must determine what is required for any procedure they carry out.

  • Local sterile field, clinically clean receiver
  • Sterile equipment
  • Non sterile gloves

Breach in Asepsis
If asepsis is breached during a procedure it is the responsibility of the clinical member of staff to ensure that all potentially contaminated parts are discarded and the procedure restarted from a point before the breach occurred with new equipment unless to do so would put the patient at risk.

If the procedure involves the insertion of a device and needs to be completed, this must be communicated at the earliest opportunity to a senior member of the team and serious consideration should be given to the possibility of replacing the device.

The breach in asepsis must be documented in the patient’s notes together with the rationale for the subsequent action taken, and an incident report should be completed on Datix web .

Personal Protective Equipment
for the procedure, to be undertaken. (LTHT Standard Infection Prevention and Control Precaution guideline 2017).
Sterile gloves must be worn when there is a potential or actual risk of a key part being touched during the procedure, for example, wound care or catheterisation.

Non-Sterile gloves are worn where there is no risk of a key part being contaminated, for example,    drug preparation, drug delivery, cannulation or phlebotomy.

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Monitoring compliance/effectiveness

Key Performance Indicator

Target

Method of Assessment

Frequency

Responsibility

Body/Individual Outcome Reported to for Action

Identify all clinical staff who have been trained in Asepsis  and ensure ESR is accurate

100%

ESR report

On appointment
To LTHT

Matrons/Ward Sister

Clinical Service Unit Governance Meeting

All identified staff to have been assessed as competent before carrying out procedures that require asepsis on Induction

100%

ESR report

On Induction to LTHT

Clinical Directors/
Matrons/Ward Sister

Clinical Service Unit Governance Meeting

All clinical  areas to list procedures  performed in their area and aseptic technique required

100%

Audit

Annually

Matrons/Ward Sister

Clinical Service Unit Governance Meeting

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Appendix 1 - Guidelines for undertaking an Aseptic technique

Please check the patients allergy status, as they may be allergic to Chlorhexidine, and alternative ( Providine iodine) solution will be required.

Be aware: Chlorhexidine is considered an environmental allergen.

  • Ensure that all equipment required is readily available and there is a clear field in which to carry out the procedure, if dressing trolley to be used ensure it is cleaned prior to use.
  • Explain the procedure to the patient, obtain verbal consent and position the patient so that the procedure can be performed easily
  • Decontaminate hands using the 7 step technique.
  • Open the sterile pack carefully to prevent contamination of the contents
  • Wear single use disposable apron and single use disposable gloves for the procedure to prevent the introduction of pathogenic bacteria to the site or direct contact with body fluids.  At this point assess if sterile gloves are required.
  • Use an aseptic non touch technique to ensure that only sterile items come into contact with the susceptible site and that sterile items do not come into contact with non-sterile objects and that key parts are not touched
  • Single use items must not be reused
  • On completion of procedure remove gloves then apron, dispose of all waste as per policy
  • Decontaminate hands using the 7 step technique and record care in the patients notes- refer to the Royal Marsden Manual for further information.

Provenance

Record: 1672
Objective:

Aim
To prevent contamination of wounds and other susceptible sites by micro-organisms that could cause infection during clinical procedures.

Objectives

  • To provide the knowledge and skills for clinical staff to maintain asepsis during clinical procedures.
  • To outline the principles of asepsis.
  • To ensure all staff employed at LTHT who undertake clinical procedures that require asepsis have received training and demonstrate clinical competence.
Clinical condition:
Target patient group: Clinical staff who undertake procedures involving asepsis
Target professional group(s): Secondary Care Doctors
Secondary Care Nurses
Adapted from:

Evidence base

References  and Evidence levels: Further information / References

Ayliffe G, et al, 2000. Control of Hospital Infection. Arnold. London

Department of Health. Health and Social Care Act (2008), A Code of Practice on Prevention and Control of infections and related guidance. Department of Health. London.

Loveday HP, et al, epic3: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England Journal of Hospital Infection 86S1 (2014) SA-S70

Health & Safety at Work etc Act 1974, Health & Safety Executive

Control of substances hazardous to health. The Control of Substances Hazardous
to Health Regulations 2002 (as amended). Approved Code of Practice and
Guidance L5 (Fifth edition) HSE Books 2005 ISBN 0 7176 2981 3

Rowley, S; Clare, S (2009) Improving Standards of Aseptic Practice through an ANTT Trustwide Implementation Process: a Matter of Prioritisation and Care. Journal of Infection Prevention 10:s18

Royal Marsden (March 2015) The Royal Marsden Hospital Manual of Clinical Nursing Procedure 9th Edition. 3.10 Aseptic technique example: changing a wound dressing (Procedure) [online] Available at www.rmmonline.co.uk

National Institute for Health and Clinical Excellence (NICE) (2012) Infection prevention and Control of healthcare-associated infections in primary and community care. NICE clinical guideline 139.

Rowley S and Clare S (2011) ANTT: a standard approach to aseptic technique. Nursing Times Vol 107 No 36

Rowley et al 2010 ANTT v2: An updated framework for aseptic technique. British Journal of Nursing (Intravenous Supplement ) Vol 19 No 5

Approved By

Trust Clinical Guidelines Group

Document history

LHP version 1.0

Related information

Not supplied

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