Asepsis or aseptic means the absence of germs, such as bacteria, viruses, and other microorganisms that can cause disease. Healthcare professionals use aseptic technique to protect patients from infection.
Aseptic technique is a standard healthcare practice that helps prevent the transfer of germs to or from an open wound and other susceptible areas on a patient’s body.
This article will explain different types of aseptic technique, how it differs from clean technique, and how to use it at home.
Share on PinterestFatCamera/Getty Images
The skin is the body’s first line of defense against germs. A person is vulnerable to infection as soon as there is a break in their skin, regardless of whether it occurs as a result of an accidental injury or a surgical incision.
Aseptic technique helps prevent healthcare-associated infections (HCAIs). An HCAI is an infection that a person acquires as a result of treatment from a healthcare professional.
According to the Centers for Disease Control and Prevention (CDC), one in every 31 hospital patients will have at least one HCAI.
Common HCAIs include:
- catheter-associated urinary tract infection
- central line-associated bloodstream infection
- Clostridium difficile infection
- surgical site infection
- ventilator-associated pneumonia
These types of infections are a significant concern in the healthcare community. HCAIs can lead to severe health complications for affected individuals and disciplinary consequences for medical facilities.
Additionally, HCAIs have a significant economic impact. According to the Center for Disease Dynamics, Economics & Policy, the five most common HCAIs cost the United States approximately $9.8 billion a year.
Aseptic techniques range from simple practices, such as using alcohol to sterilize the skin, to full surgical asepsis, which involves the use of sterile gowns, gloves, and masks.
Healthcare professionals use aseptic technique practices in hospitals, surgery rooms, outpatient care clinics, and other healthcare settings.
Using aseptic technique prevents the spread of infection by harmful germs. Healthcare professionals use aseptic technique when they are:
- performing surgical procedures
- performing biopsies
- dressing surgical wounds or burns
- suturing wounds
- inserting a urinary catheter, wound drain, intravenous line, or chest tube
- administering injections
- using instruments to conduct a vaginal examination
- delivering babies
Aseptic technique and clean technique are two closely related healthcare practices that both aim to keep people safe from infection. The aim of using aseptic technique is to eliminate germs, which are disease-causing microorganisms. Clean technique focuses on reducing the number of microorganisms in general.
Healthcare professionals learn both aseptic and clean techniques and use them in different situations. They will use aseptic technique during surgical operations or when inserting a foreign object, such as a catheter, into a person’s body.
Clean technique is often sufficient for long-term care, in-home care, and some outpatient clinical settings. Healthcare professionals use clean technique for people who are not at high risk of infection. For example, they may use clean technique when changing the dressing on a wound that is healing.
Some examples of clean technique practices include thorough handwashing, wearing gloves, and maintaining a clean environment or work area.
Clean technique uses non-touch practices. Non-touch practices prohibit healthcare professionals from touching key parts of objects, such as syringe tips and the inside of sterile dressings, even when they are wearing gloves.
The medical community defines clean technique as a modified form of aseptic technique, as maintaining proper hygiene and a clean environment will help achieve asepsis.
People working in a variety of healthcare settings use aseptic technique. Aseptic technique is not the same as sterile technique, which refers to a set of infection control practices that are necessary to use in operating rooms.
According to the U.S. Joint Commission, there are several different aspects of aseptic technique practices:
- barriers
- patient and equipment preparation
- environmental controls
- contact guidelines
We discuss each of these below.
Barriers
Barriers prevent the transfer of germs between healthcare professionals, patients, and the environment. Aseptic barriers include:
- sterile gloves
- sterile gowns
- sterile masks
- sterile drapes
- protective wrappers on sterilized instruments
Patient and equipment preparation
Healthcare professionals must thoroughly prepare both the patient and the equipment before a medical procedure takes place.
Aseptic preparation may involve:
- disinfecting a patient’s skin using antiseptic wipes
- sterilizing equipment and instruments before a procedure
- keeping sterilized instruments inside plastic wrappers to prevent contamination before use
Environmental controls
Healthcare professionals also have to consider the patient’s immediate surroundings. It is essential to maintain an aseptic environment before and during procedures. The designated procedural area is also called an aseptic field.
Maintaining an aseptic field involves:
- keeping doors closed
- minimizing movement in and out of the aseptic field
- limiting entry to necessary personnel only
- permitting only one patient per aseptic field
Contact guidelines
Once a healthcare professional has washed their hands and donned their sterile barriers, they must follow sterile-to-sterile contact guidelines. These guidelines prohibit any contact between sterile and nonsterile items.
At this point, healthcare professionals can only touch sterile objects and surfaces, and they must avoid touching nonsterile items and surfaces at all costs.
The same guidelines apply to sterile devices. If a sterile instrument falls on the ground and the wrapper sustains damage, a healthcare professional must remove the instrument and re-sterilize it before use.
The proper execution of aseptic technique requires training. If a person needs to use aseptic technique at home, a trained healthcare professional can demonstrate the proper practices to them.
Anyone performing aseptic techniques at home will need to have sterile gloves and special dressing kits at hand.
While aseptic technique requires proper training and the use of specialist equipment, clean technique is much easier to achieve at home. Clean technique involves thoroughly washing the hands, wearing gloves, and maintaining a clean environment.
Aseptic technique is a standard set of healthcare practices that aim to eliminate the transfer of germs. The proper use of aseptic technique should prevent HCAIs, which are a significant healthcare concern that can lead to consequences for both patients and healthcare facilities.
Healthcare professionals receive specialized training in aseptic technique practices. However, a person can also receive aseptic technique training if they need to use these practices at home.
Clean technique is much easier for untrained individuals to achieve, and it involves limiting the number of germs in a patient’s vicinity.
Clean technique does not require the use of sterile instruments and equipment. Instead, the aim of using this technique is to avoid directly contaminating instruments and materials that will come into contact with the patient.
Open Resources for Nursing (Open RN)
In addition to using standard precautions and transmission-based precautions, (also called medical asepsis) is the purposeful reduction of pathogens to prevent the transfer of microorganisms from one person or object to another during a medical procedure. For example, a nurse administering parenteral medication or performing urinary catheterization uses aseptic technique. When performed properly, aseptic technique prevents contamination and transfer of pathogens to the patient from caregiver hands, surfaces, and equipment during routine care or procedures. The word “aseptic” literally means an absence of disease-causing microbes and pathogens. In the clinical setting, aseptic technique refers to the purposeful prevention of microbe contamination from one person or object to another. These potentially infectious, microscopic organisms can be present in the environment, on an instrument, in liquids, on skin surfaces, or within a wound.
There is often misunderstanding between the terms aseptic technique and sterile technique in the health care setting. Both and sterility are closely related, and the shared concept between the two terms is removal of harmful microorganisms that can cause infection. In the most simplistic terms, asepsis is creating a protective barrier from pathogens, whereas is a purposeful attack on microorganisms. Sterile technique (also called surgical asepsis) seeks to eliminate every potential microorganism in and around a sterile field while also maintaining objects as free from microorganisms as possible. It is the standard of care for surgical procedures, invasive wound management, and central line care. Sterile technique requires a combination of meticulous hand washing, creation of a sterile field, using long-lasting antimicrobial cleansing agents such as betadine, donning sterile gloves, and using sterile devices and instruments.
Principles of Aseptic Non-Touch Technique
Aseptic non-touch technique (ANTT) is the most commonly used aseptic technique framework in the health care setting and is considered a global standard. There are two types of ANTT: surgical-ANTT (sterile technique) and standard-ANTT.
Aseptic non-touch technique starts with a few concepts that must be understood before it can be applied. For all invasive procedures, the “ANTT-approach” identifies key parts and key sites throughout the preparation and implementation of the procedure. A is any sterile part of equipment used during an aseptic procedure, such as needle hubs, syringe tips, needles, and dressings. A is any nonintact skin, potential insertion site, or access site used for medical devices connected to the patients. Examples of key sites include open wounds and insertion sites for intravenous (IV) devices and urinary catheters.
ANTT includes four underlying principles to keep in mind while performing invasive procedures:
- Always wash hands effectively.
- Never contaminate key parts.
- Touch non-key parts with confidence.
- Take appropriate infective precautions.
Preparing and Preventing Infections Using Aseptic Technique
When planning for any procedure, careful thought and preparation of many infection control factors must be considered beforehand. While keeping standard precautions in mind, identify anticipated key sites and key parts to the procedure. Consider the degree to which the environment must be managed to reduce the risk of infection, including the expected degree of contamination and hazardous exposure to the clinician. Finally, review the expected equipment needed to perform the procedure and the level of key part or key site handling. See Table 4.3 for an outline of infection control measures when performing a procedure.
Table 4.3 Infection Control Measures When Performing Procedures
|
|
|
|
|
|
Determine level of aseptic field needed and how it will be managed before the procedure begins:
|
General aseptic field:
IV irrigation Dry dressing changes Critical aseptic field: Urinary catheter placement Central line dressing change Sterile dressing change |
|
|
|
|
Use of Gloves and Sterile Gloves
There are two different levels of medical-grade gloves available to health care providers: clean (exam) gloves and sterile (surgical) gloves. Generally speaking, clean gloves are used whenever there is a risk of contact with body fluids or contaminated surfaces or objects. Examples include starting an intravenous access device or emptying a urinary catheter collection bag. Alternatively, sterile gloves meet FDA requirements for sterilization and are used for invasive procedures or when contact with a sterile site, tissue, or body cavity is anticipated. Sterile gloves are used in these instances to prevent transient flora and reduce resident flora contamination during a procedure, thus preventing the introduction of pathogens. For example, sterile gloves are required when performing central line dressing changes, insertion of urinary catheters, and during invasive surgical procedures. See Figure 4.15 for images of a nurse opening and removing sterile gloves from packaging.
See the “Checklist for Applying and Removing Sterile Gloves” for details on how to apply sterile gloves.
Figure 4.15 Sterile Gloves
The purposeful reduction of pathogen numbers while preventing microorganism transfer from one person or object to another.
A state of being free of disease-causing microorganisms.
Techniques used to eliminate every potential microorganism in and around a sterile field while maintaining objects and areas as free from microorganisms as possible.
A standardized technique, supported by evidence, to maintain asepsis and standardize practice.
A key part is any sterile part of equipment used during an aseptic procedure, such as needle hubs, syringe tips, dressings, etc.
A key site is the site contacted during an aseptic procedure, such as non-intact skin, a potential insertion site, or an access site used for medical devices connected to the patients.