Asepsis Guideline

Publication: 01/05/2009  
Next review: 17/01/2025  
Clinical Guideline
CURRENT 
ID: 1672 
Approved By: Trust Clinical Guidelines Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2022  

 

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 updated 2012 is a 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. Asepsis is an essential component of infection prevention and control practice to protect patients from potential HCAIs (Loveday et al, 2014).

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

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).

Medical Asepsis

Medical asepsis aims to minimise the risk of contamination by microorganisms, and prevent their transmission by applying standard principles of infection prevention, including decontaminating hands, use of PPE, maintaining an aseptic area, and not touching susceptible sites or the surface of invasive devices (NICE 2012)

Surgical Asepsis

Surgical asepsis is a more complex process, including procedures 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) (NICE 2012).

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) -

Is the practice of avoiding contamination by not touching key elements, in handling sterile equipment and instruments such as the tip of a needle, the seal of an intravenous connector after it has been decontaminated or the inside surface of a sterile dressing where it will be in contact with the wound (Rowley and Clare (2011) Only sterile equipment and fluids are used during invasive clinical procedures

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 (Loveday et al, 2014).

ASEPTIC TECHNIQUE 

Please check the patients allergy status, as they may be allergic to Chlorhexidine, and alternative 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 (2020) (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.

Key Parts and Key Sites

Key parts are defined as the parts of the equipment used in the procedure that come into direct or indirect contact with another key part or site. Key sites are defined as open wounds, including insertion sites and puncture sites. Both key parts and key sites always need to be protected (Rowley et al, 2010)

Risk assessment before the procedure will direct the practitioner as to whether the key parts and key sites can be protected by non-touch or whether the procedure will require the use of sterile gloves -ASAP(2015)

The decision as to whether single-use sterile or single-use non-sterile examination gloves should be worn  should be based on a risk assessment (Loveday et al) 2014

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:

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

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Management

When to use Asepsis/ ANTT

Examples of  clinical procedures that require the use of Asepsis

  • 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.

Examples of equipment used in asepsis clinical procedures

  • Sterile pack appropriate to the procedure e.g.
    Cannulation pack
    CVC insertion pack
    Dressing pack
    Urinary insertion pack
  • Dressing Trolley
  • Sterile equipment
  • Sterile Gloves

Examples of  clinical procedures that require use of ANTT

  • 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.

Examples of equipment used in ANTT clinical procedures

  • 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

Prior to the task a risk assessment to determine appropriate Personal Protective Equipment

for the procedure, to be undertaken. (LTHT Standard Infection Prevention and Control Precaution guideline 2018).

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 appointment

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 solution will be required.

Be aware; Chlorhexidine is considered an environmental allergen 

  • Check that all the equipment required for the procedure is available and, where applicable, is sterile (i.e. that packaging is undamaged, intact and dry)
  • Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed and position the patient so that the procedure can be performed easily.
  • Clean hands with an alcohol‐based handrub or wash with soap and water and dry with paper towels.
  • Hands must be cleaned before and after every patient contact and before commencing the preparations for aseptic technique, to prevent cross‐infection
  • 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. Clean from the top surface and work down to the bottom.
  • 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. Gloves should be worn whenever any contact with body fluids is anticipated (Loveday eta al 2014)
  • Verify that the sterile pack is the correct way up and open the outer cover. Slide the contents, without touching them then open the sterile pack carefully to prevent contamination of the contents
  •  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 and record care in the patients notes.

 Refer to the Royal Marsden Manual for further information.

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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:

Association of Safe Aseptic Practice (2015) The ANTT Clinical Practice Framework, Version 4.0. ASAP

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

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.

Department of Health. Health and Social Care Act 2012 Department of Health. London.

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

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

National Clinical guideline centre: prevention and control of healthcare- associated infections in primary and community care: partial update of NICE clinical guideline 2.

NICE clinical guidelines no.139 Royal college of Physicians 2012

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

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

Royal Marsden (March 2020) The Royal Marsden Hospital Manual of Clinical Nursing Procedure 10th Edition. Aseptic technique example: changing a wound dressing (Procedure) [online] Available at www.rmmonline.co.uk

Approved By

Trust Clinical Guidelines Group

Document history

LHP version 2.0

Related information

Not supplied

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