Running Head: EVIDENCE BASED PRACTICE IN STERILE TECHNIQUE

Evidence Based Practice in Sterile Technique Emily West Ferris State University

EVIDENCE BASED PRACTICE IN STERILE TECHNIQUE Evidence Based Practice in Sterile Technique Evidence Based Practice has played a key role is shaping todays standard of sterile technique. The concept of evidence based practice is ultimately to provide the best patient care in sterile techniques through best practice principles. As stated by Schaffer, Sandau , and Diedrick (2012), Evidence based practice is a paradigm and life-long problem solving approach to clinical decision making that involves the conscious use of best available evidence with ones own clinical expertise and patient values (p. 1198). Sterile technique is a crucial element in any health care setting. Proper sterile technique minimizes the risk of bacteria and other pathogens to enter a susceptible site on the body. However, evidence based practice within the past five years finds insufficient proof that sterile technique is more effective than properly executed clean technique. It is important as nurses to remain educated and utilize evidence based practice when performing procedures which put the patient at risk for infections. Safety in Sterile Technique Safety should always be the top priority while caring for patients. Maintaining a sterile field to prevent infection should be a key safety component. Taylor, Lillis, LeMone, and Lynn (2011), discuss the importance of sterile technique to maintain patient safety by stating it is far better to err on the side of safety when using surgical asepsis than to take the slightest chance of possible contamination (p.674). There is a correlation between cleanliness of an environment and risk for contamination; the same would be true of a relationship between sterile technique and infection rate. In the health care setting, there are numerous procedures requiring aseptic technique that include but are not limited to: wound care, urinary catheterization, tracheostomy care, and central line dressing changes. Although health care professionals do not intentionally break the sterile field, it often happens during procedures. As discussed by Hopper and Moss (2010), even the most

EVIDENCE BASED PRACTICE IN STERILE TECHNIQUE knowledgeable and experienced health care providers can have breaks in the sterile field. The sterile field begins in the processing department. Therefore, it is important to examine sterile equipments expiration date and any tears or holes in the packaging which would result in contamination of equipment. While preparing, the professional must always keep sterile protocol in mind while opening kit, donning gloves, positioning equipment, draping client, and executing given sterile task (p.353). The notion of a sterile field being easily breached with minimal recognition of doing so may make one question the true effectiveness of sterile technique during procedures. Correlation According the Center for Disease Control (CDC) as stated by Mangram, Horan, Pearson, Silver, and Jarvis, Lack of adherence to the principles of asepsis during such procedures including use of common syringes and contaminated infusion pumps and the assembly of equipment and solutions in advance of procedures have been associated with outbreaks of postoperative infections, including SSI (p.263). Evidence of sterile technique as best practice was difficult to find as many articles written within the past five years found nominal difference on spread of infection between using proper clean and sterile technique. Articles relating to sterile technique practice in the 1990s and early 2000s did not provide evidence based research indicating that clean technique can be just as effective as sterile when executed properly. A study by Stotts (1997) as reported in Wound, Ostomoy, and Continence Nurses Society (2011), The healing rates and costs of sterile vs. clean technique in post-operative patients who had wounds healing by secondary intentions following GI surgery. Reports indicate there was no statistically significant difference in the rate of wound healing between the two groups the cost however was significantly higher with sterile technique (S32).

EVIDENCE BASED PRACTICE IN STERILE TECHNIQUE Clean technique stresses the importance of proper hand-washing as well as avoidance of contacting surrounding surfaces while donning gloves. Although the technique is considered clean sterile instruments are still being used. For example, the urinary catheter tip is to remain sterile. While cleansing the peri-area, the nurse would follow sterile procedure protocol and use sterile iodine swabs to cleanse the area and to not touch the waste container with gloves. Prior to inserting a catheter into the vagina, the nurse would make sure as to not touch the tubing that will be inserted into the body to avoid the risk of spread of bacteria. Several considerations must be taken into account when choosing between sterile and clean technique. Nurses must recognize risks and benefits of each procedure and evaluate which technique provides the safest environment for the patient. For example,an individual with a highly suppressed immune would be a much better candidate for a sterile technique procedure to offset the risk of potential exposure to infection. As reported by the WONC, 90% of patients with open wounds being discharged from hospitals were taught to perform non-sterile technique at home regardless of whether clean or sterile technique were used during hospitalization(S32). In the home care setting, a sterile environment is harder to maintain due to unknown cleanliness of environment, potential contamination of patient provided supplies, and patient knowledge/understanding of performing sterile technique. The (WOCN) Wound Committee in Infection Control (2011) reports on gaps in the research practice relating sterile versus clean technique. From lacking definitive evidence (significant differences in infection rate and healing) to disagreement amongst health-care professionals of when to use sterile or clean technique, there is a scarcity of research defining best practice (p. S31-S32).

EVIDENCE BASED PRACTICE IN STERILE TECHNIQUE As discussed by Flores (2008), there is a discrepancy between health care providers over which techniques require clean (use of clean gloves instead of sterile as well as maintaining a clean environment and maintaining a clean field) or sterile technique. It has been argued that sterile (gloves) are necessary for procedures that come in contact with internal body systems such as surgery or urinary catheterization. However with adequate hand decontamination nonsterile gloves are just as effective in promoting infection control (p. 37). Although this article discusses minimal differences in infection control between clean and sterile technique, it is still important to evaluate which evidence based practice is best for the patient. Conclusion In summation, infection control must not be taken lightly when the patients safety and quality of life are in jeopardy. Regulation of clean versus sterile technique in the health care setting will be a difficult undertaking as policies and procedures will vary as well as compliance in adhering in clean or sterile standards. The lack of evidence in correlating infection control to clean versus sterile technique puts best practice into question. Furthermore, when considering patient health and cost; if there are no clear advantages to using sterile technique health care providers should make a more time and cost efficient policies(clean technique) as the national standard for procedures.

EVIDENCE BASED PRACTICE IN STERILE TECHNIQUE References Flores, A. (2008, October 15). Sterile versus non-sterile glove use and aseptic technique. Nursing Standard, 23(6), 35-39. Retrieved June 17, 2013, from http://0go.galegroup.com.libcat.ferris.edu/ps/retrieve.do?retrieveFormat=PDF_FROM_CALLIS TO&inPS=tru. Hopper, W. R., & Moss, R. (2010, March). Common breaks in sterile technique: clinical perspectives and perioperative implications. AORN Journal, 91(3), 350-367. Retrieved June 14, 2013, from http://0www.sciencedirect.com.libcat.ferris.edu/science/article/pii/S0001209209009405. Mangram, A. J., Horan, T. C., Pearson, M. L., Silver, L. C., & Jarvis, W. R. (1999). Guideline for prevention of surgical site infection. Infection Control and Hospital Epidemiolgly , 20(4), 263. Retrieved June 16, 2013 from http://www.cdc.gov/hicpac/pdf/guidelines/SSI_1999.pdf Schaffer, M. A., Sandau, K. E., & Diedrick, L. (2012, July). Evidence-based practice models for organizational change: overview and practical applications. Journal of Advanced Nursing, 69(5), 1198. Retrieved June 16, 2013, from http://0onlinelibrary.wiley.com.libcat.ferris.edu/doi/10.1111/j.1365-2648.2012.06122.x/pdf. Taylor, C. R., Lillis, C., LeMone, P., & Lynn, P. (2011). Fundamentals of Nursing: The Art and Science of Nursing (7th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Wound, Ostomoy, and Continence Nurses Society . (2011). Clean vs. sterile dressing techniques for management of chronic wounds. Journal of Wound, Ostomy & Continence Nursing, 39(26), S31-S32. Retrieved June 16, 2013 from

EVIDENCE BASED PRACTICE IN STERILE TECHNIQUE http://journals.lww.com/jwocnonline/Fulltext/2012/03001/Clean_vs__Sterile_Dressing_T echniques_for.7.aspx

EVIDENCE BASED PRACTICE IN STERILE TECHNIQUE