PERSONAL PROTECTIVE EQUIPMENT, ASEPSIS, AND ASEPTIC TECHNIQUES.

Definition of aseptic technique: is a set of practices that protect patients from healthcare
associated infection and protects health workers (HCWs) from contact with blood, body fluid,
and body tissue.

IMPORTANCE OF ASEPTIC TECHINQUE

1. It minimizes the contamination of key sites.

2. It protects patients from their own pathogenic microorganisms that may cause infection.
3. Reduce the transmission of microorganisms.
4. It maintains the sterility of equipment and key parts used for aseptic procedures.

PRINCIPLES OF ASEPTIC TECHINQUES

There are essential principles that should be applied with performing a procedure that
requires aseptic techniques. These principles are:

1. Sequencing: involves a series of actions that ensure each procedure is performing in a

safe and appropriate order. Sequencing includes assessing for risks to patients safety and
the (HCWs) and identifying strategies to mitigate these risks prior to starting the
procedure.

Points to consider for sequencing.

1. Perform a risk assessment:

a. Are there environment or patient factors that increase the risk for this procedure?
b. Is the procedure technically difficult or an emergency situation?
c. Will this procedure required a standard or surgical aseptic technique?
d. What PPE do you need for this procedure?
2. Pre-procedure preparation:
a. Prepare the environment.
b. Select the correct equipment; check the condition, integrity, and expiry date of each
item required for the procedure.
c. Plan each step for the procedure to avoid a breach in asepsis.
d. Inform the patient and prepare them for the procedure.
3. Performing the procedure:
a. Set up the equipment immediately prior to performing the procedure.
b. Maintain standard precautions.
c. Perform the procedure in a safe, logical order.
4. Post procedure practices:
a. Remove gloves and perform hand hygiene.
b. Settle the patient.
c. Pack away equipment and dispose of waste.
d. Document the outcome from the procedure.
2. Environmental control: there are many factors in clinical environment which can
increase the risk of infection and patient from during a procedure. These factors includes:
a. Activities that occur in nearby environment (e.g. bed making, dusting or cleaning)
that may increase the risk of contamination during the procedure.
b. The environment maybe controlled setting, such as laboratory, pharmacy, or
operating suite, or an uncontrolled setting such as an emergency department.
c. Fans and open windows can cause air turbulence and contamination of the aseptic
field.
3. Hand hygiene: there are critical moments before, during and after an invasive procedure
or a procedure requiring aseptic technique when hand hygiene should be performed.
These moments are:
a. Before and after collecting the equipment
b. After setting up an aseptic field
c. Immediately before donning gloves( if gloves are required)
4. Maintenance of aseptic field: the HCW should ensure that the aseptic field, the key
parts and key sites are always protected. The HCW should always:
a. Prepare the key sites with the correct solution, examples cleanse with normal saline,
chlorhexidine, or other suitable solution.
b. Clean and/ or disinfect all the equipment and key parts to be used
c. Establish an aseptic field, example, by using a sterile tray, or using a laminar flow
hood.
 5. Personal protective equipment (PPE): is important for protecting both patients and
HCW during aseptic procedure. The HCW should consider the following point:
a. What PPE required to protect the patient, the aseptic field and yourself during the
procedure?
b. Do you require protective eyewear, a face shield and/ or a surgical mask?
c. Can you perform this procedure with non-sterile gloves or are sterile glove required?

THE DIFFERENCE BETWEEN ASEPTIC TECHNIQUES AND STERILE

TECHNIQUE

The term “aseptic technique and sterile technique” are used interchangeably, not accurately
reflecting important differences between these two techniques.

An “aseptic techniques” aims to prevent pathogenic organisms, in sufficient quantity to cause

infection, from being introduced into susceptible body sites by the hand of staffs, surface of
equipment. It protects patients during invasive clinical procedure by utilizing infection
prevention and control measures that minimize the presence of microorganisms.

Aseptic technique does include the use of standard precautions, sterile equipment, sterile
personal protective equipment (PPE) and controlled environments such as operating theatres and
procedure suite of items used for aseptic technique in the clinical setting.

A “sterile technique” uses practices aimed at preventing the introduction of all microorganisms
into a sterile field, equipment, procedure sites. This is near impossible to achieve in the clinical
setting due to the presence of microorganisms in the air and the clinical environment. Sterile
conditions are only achieved in strictly controlled environment such as laminar flow hoods used
in laboratories and pharmacies.

ASEPTIC TECHNIQUES AS A PART OF STANDARD PRECAUTIONS.

Aseptic technique is an important patient safety strategy and is one of the key elements of
standard precautions.

Standard precautions are infection control practices that are used to prevent the transmission of
infection. A standard precaution includes:

1. Hand hygiene
 2. Aseptic technique
3. Use of PPE
4. Respiratory hygiene and cough etiquette
5. Safe use of sharps
6. Environmental cleaning
7. Reprocessing of medical equipment
8. Appropriate handling of linen and waste management.

ASEPTIC TECHNIQUE IN DIFFERENT SETTINGS

Aseptic technique is routinely used in clinical areas other settings such as pharmacies and
laboratories.

1. THE CLINICAL SETTING:

In the clinical setting, aseptic techniques should be used when a procedure or medical device
enters one or more of the body’s normal defenses, such as skin, mucous membranes, body
cavity, for examples;

a. Suturing a wound.
b. Inserting a drain or urinary catheter.
c. Accessing indwelling devices.
d. Taking a blood sample.
e. Preparing and administering medications via an intravenous or central line.
f. Performing endotracheal suction.
2. THE PHARMACY SETTING:

In the pharmacy setting, aseptic technique is used to reduce the risk of contamination of
medicines. For example:

a. During the preparation of chemotherapy or eye injection.

3. THE LABORATORY SETTING:

In the laboratory setting, aseptic techniques is used to prevent contamination during diagnostic
testing to ensure accurate result to inform patient treatment.

ASEPTIC FIELDS.
Aseptic fields are controlled work spaces that are designed to maintain the integrity of key parts
and key sites during clinical procedure.

Key parts: is the equipment or item that must be protected from contamination during an aseptic
procedure (eg, the hub of an injection port, or the content of a dressing pack).

Key site: is a site on the patient that must be protected from contamination during an aseptic
procedure (eg, a drain site, a cannula site, a wound site).

Asepsis is freeing from pathogenic materials.

There are three types of aseptic fields which commonly need to be consider during aseptic
procedures are:

1. Critical aseptic field: is area where sterile equipment is placed during an aseptic
procedure. It involves many key parts and/ or large key sites, and is used for complex
procedure such as a urinary catheter insertion or large burns dressings, and requires the
used sterile gloves as it is not possible to perform the procedure using non-touch
techniques.
2. Micro critical aseptic field: are smaller parts of equipment that must be protected and
kept sterile during an aseptic procedure, such as the tip of a needle while performing an
intravenous injection.
3. General aseptic field: is a simple aseptic field where there may be a small number of
key parts and small key sites. It is used when the procedure can be undertaken using a
standard non-touch aseptic technique, such as a simple wound dressing.

PERSONAL PROTECTIVE EQUIPMENT (PPE).

Definition of PPE:

PPE act as physical barrier that prevent healthcare staff, including nurses from becoming
contaminated with blood and other bodily fluid.

These include bodily secretions and excretions that maybe transmitted from direct contact with a
patient or the patient’s environment, including infectious airborne particle (Beam et al 2011).
PPE used is part of standard precautions for all healthcare workers to prevent skin and mucous
membrane exposure when in contact with blood and body fluid of any patient. PPE includes:

a. Disposable gown, apron and coverall

b. Disposable gloves
c. Eye protection (safety glasses or goggle, face shields)

PPE AS TRANSMISSION BASED PRECAUTIONS

Transmission based precautions are safety measures designed for the care of patients who are
documented or suspected to be infected with transmissible pathogens. This requires additional
precaution beyond standard precautions to interrupt transmission in hospital. There are three
types of transmission-based precaution:

1. Air-bone precaution: is the spread of an infectious agent caused by the dissemination of

droplet nuclei that remain infectious when suspend in air over long distance and time.
Examples of air-borne precaution; Rubeola virus (measles), Varicella (chicken pox),
Mycobacterium tuberculosis and possible SARS-COV.
2. Droplet precaution: is the spread of an infection caused by dissemination of droplet
(through close respiratory or mucous membrane contact with respiratory secretion.
Examples of droplet precaution; Influenza virus, pertussis, rubella virus (German
measles).
3. Contact precaution: is the spread of an infectious agent caused by physical contact of a
susceptible host with people or object. There are two types of contact precaution;
a. Direct contact: is an infectious agent that passed from one body-surface to another
without an intermediate object or person.
b. Indirect contact: is an infectious agent that passed through a contaminated object or
person. Examples of contact transmission (direct and indirect) are viral
gastroenteritis, clostridium difficile, MRSA, scabies.

IMPORTANT OF PPE

a. It protects from exposure to infectious materials and helps prevent the spread of
infections.
b. It makes HCWs to be aware of risk of exposure to transmissible pathogens from
direct or indirect contact with blood or bodily fluid.
c. To maintain a safe and healthy environment.