Aseptic Technique

Faculty of Health & Sciences

Clinical Skills Learning

Key Terms:
The overarching aim of asepsis is to prevent sepsis/
infection.
Asepsis is defined by Xavier (1999) as the prevention of microbial

contamination of living tissue/fluid or sterile materials by means of

excluding, removing or killing micro-organisms.
Aseptic technique is a method of carrying out clinical procedures in
an environment that is rendered as free from micro organisms and
contaminants as possible.
Aseptic technique is a collective term used to describe the varying
techniques employed within practice in order to achieve asepsis.
Therefore when using aseptic technique(s) the clinicians aim is to
prevent transmission of infection or contaminants between, staff,
patients, equipment and environment in order to maintain asepsis.
The principles of infection control must therefore be applied during
an aseptic procedure.

Clinical Skills Learning

Principles:
Several Principles need to be considered in order to achieve
aseptic technique.
Effective hand washing/decontamination, before during and after the
procedure - remember the ICNA guidelines for hand washing.
Creating and maintaining a sterile field.
Using the sterile field appropriately.
Using a sterile gloved hand to handle equipment or applying a no
touch technique (ie using forceps or touching non key parts).
Avoid the introduction of contaminants onto the sterile field.
Safe disposal of contaminants away from the sterile field.
Achieving and maintaining competency in accordance with evidence
based policy guidelines.
Also consider any underpinning principles regarding health and
safety, infection control and universal precautions.
Clinical Skills Learning

A septic N on T ouch T echnique

Rowley (2001) (cited in Workman and Bennett 2003) has suggested

a framework to support a consistent approach to aseptic
procedures. This framework is ANTT Aseptic Non Touch
Technique.
ALWAYS wash hands effectively
NEVER contaminate key parts
TOUCH non key parts with confidence
TAKE appropriate infective precautions

ANTT can be applied to varying clinical procedures which you may not
instantly associate with aseptic technique. Think about how ANTT is
used when preparing medication for intramuscular injection. How do
you prevent contamination of hands, equipment and key parts?
Clinical Skills Learning

Preparation
When preparing to carry out an aseptic
procedure there are four elements of
preparation to consider
The patient
The environment
The nurse
Any information
Clinical Skills Learning

Preparation: The Patient

Explanation of the procedure and obtain consent.

Does the patient have any allergies to any products to be used.
Do you need assistance to support the patient during the procedure.
Ensure the patient is comfortable, think of positioning. Achieve this
prior to bringing equipment for the procedure to the bedside. Offer
toilet facilities.
Does the patient require analgesia prior to commencing the
procedure.
Dignity, privacy, bed area curtain and arrangement of bed clothes. All
should be arranged prior to bringing equipment to patient bedside.
Refer to patients care plan.
Accessibility of wound/area and light source.
Clinical Skills Learning

Preparation: The Environment

The aim of preparing the environment is to ensure the reduction in

airborne bacterial dispersion so to reduce the risk of contamination.
Ensure that no ward cleaning activities are in progress. (Allow half
an hour after completion of cleaning for dust and airborne particles
to settle).
Windows and doors to be closed.
Fans should be off so to not create excessive air flow.
Bed making should not be taking place in the vicinity due to the
increase in airborne bacteria and dust particles.
Curtains should be closed prior to commencing the procedure and
where possible movement in and out of the curtains should be
minimal. Also consider the patients dignity if privacy is not
maintained.
Clinical Skills Learning

Preparation: The Nurse

Hair should be off the collar, tied back suitably. A hair clip for long
fringes is also useful to stop hair falling over your face or in your
eyes during the procedure.
Nails should be short. No nail varnish worn. No false/acrylic nails.
No stoned rings to be worn. Only a wedding ring/band style ring
which should be washed and dried thoroughly underneath.
No wrist watches to be worn. Or wrist devices.
Check hands for cuts and abrasions all cuts and abrasions should
be covered with a water proof dressing.
Uniform should be worn as per policy, no cardigans or outdoor wear
should be worn.
Hands washed as per ICNA guidelines.
Self preparation and acquisition of knowledge. Do you know how to
carry out the procedure and is your underpinning knowledge sound.
Clinical Skills Learning

Preparation:

Information

Examine the care plan prior to carrying out the procedure. Does the
wound need reassessing.
Is the dressing appropriate or is a new product required.
Identify any previous problems with the wound.
Are you familiar with the procedure, products and plan of care.

Clinical Skills Learning

Equipment Needed
Dressing trolley: Should have been cleaned using hot detergent water
and or cleaning agent as specified in trust guidelines . Dry before use
using disposable towel to remove micro-organisms.
Dressing pack.
Sterile gloves.
Apron.
Hand gel.
Tape.
Additional dressing and wound care products.

Clinical Skills Learning

Equipment Needed:
continued

Sterile scissors for modifying sterile dressings and cutting wound

care products.
Clean scissors for cutting tape.
Irrigation fluid if required.
Waterproof protection for bed if required.
Receiver to collect irrigation fluid if required.
10ml syringe for irrigation if required.
Refer to care plan for additional equipment.
Also check contents of dressing pack and collect additional
equipment from stores ie gauze, gallipot as dressing packs may
vary from area to area.
Always check the integrity of the equipment and packaging prior
to use. Ensure all seals are secure and check the expiry dates.
Clinical Skills Learning

Procedure

Rationale

Refer to patients records.

Identify the patient by name,
explain the procedure and gain
verbal consent if possible to
ensure co-operation.
Prepare, the patient, yourself
and the environment.
Ensure privacy for the patient.
Inform colleagues that you are
carrying out a clinical
procedure so to avoid
interruptions.

Check instructions and type of

dressing required. Some
wounds need monitoring or
reassessment. Wound maps
or photographs may be
required.

Ensure patient comfort and

dignity throughout procedure.

Clinical Skills Learning

Procedure:

Rationale

Ensure patient is comfortable

and warm, offer analgesia
where appropriate prior to
procedure.
Ensure the trolley/surface is
physically clean. Clean with
detergent and or alcohol spray
as per guidelines.
Wash hands with a socially
clean wash eg ICNA
guidelines. Put on a clean
disposable apron for each
procedure.

Allow time for pain relief to

work in order to maintain
patient comfort.

To minimise the risk of

contamination and cross
infection. If in the patients
home use a suitable flat
surface that can be cleaned.
To minimise the risk of
contamination and cross
infection.

Clinical Skills Learning

Procedure:

Collect all the necessary

equipment checking the integrity,
expiry dates and seals of all
packaging. Place on the bottom of
the trolley for transportation to the
patients bedside.
Assist the patient into comfortable
position, ensuring privacy and
dignity. Check the bed height.
Check light source is good and
ensure curtains closed. Position
the trolley nearest the area to be
worked on so you can see the
patients face if possible.

Rationale

To ensure sterility is maintained.

Ensure comfort and dignity are

maintained.
Reduce the strain on the back.
So that you can clearly see the
area for treatment and if the
patient becomes distressed.

Clinical Skills Learning

Procedure:

Ensure bedding and clothing have

been protected.
Open the dressing pack using
ANTT and place onto the dressing
trolley.
Wash hands or gel hands.
Open the pack using only the
corners of the sterile towel. Open
furthest side away, then the sides,
then the front sheet.
Lay out the equipment on the field
by placing your hand inside the
yellow bag and using it like a
glove. Then leave the yellow bag
on the trolley ready to use to
remove the old dressing.

Rationale

To protect the bed linen and

clothing from contamination during
the procedure.
In order to ensure sterility of the
inner packaging.
To decontaminate hands.
Do not lean over the sterile field to
prevent contamination of the
sterile field.
To prevent your hand from
contaminating the sterile field.
Be careful to not allow the touched
part of the yellow bag contaminate
the sterile filed.

Clinical Skills Learning

Procedure:

Open any additional packs

using ANTT and place on
sterile field. When pouring
lotions into the gallipot always
pour from the side. When
opening sachets clean the
marked area with an alcohol
swab and cut using sterile
scissors or cleaned scissors.
An assistant could help you
with this.
Loosen tape/adhesive on the
patients dressing and remove
using the yellow bag like a
glove as before.

Rationale

To maintain sterility.

If you have an assistant they

can support you during this
part of the procedure by
opening any further packaging
for you and offering you the
contents so that you may
remove them from the
packaging with sterile gloved
hands. The assistant can also
pour solutions into the gallipot
for you and remove the
patients old dressing for you.

Clinical Skills Learning

Procedure:

Clean hands and dry thoroughly or

gel hands and allow to dry
thoroughly.
Put on sterile gloves.
Assess the wound and clean only
if necessary.
If the skin around the wound
needs cleaning it can be swabbed
using gauze slightly moistened
with sterile saline. The wound
should not be cleaned with gauze
or cotton wool as fibre shed can
occur and can cause a reaction.
(Briggs et al. 1996 cited in
Workman and Bennett, 2003).

Rationale

To decontaminate hands.

To maintain asepsis.
Unnecessary wound cleansing
can cause damage to the healing
wound.
Do not leave the wound exposed
for too long as the temperature of
the wound will drop and interrupt
wound healing.

Clinical Skills Learning

Procedure:

Clean around the wound from

top to bottom or from clean to
dirty. One swab then remove
and dispose.
If inside the wound needs
cleaning fill a 10ml syringe with
sterile normal saline. Place a
receiver below the wound and
irrigate gently. The syringe tip
is not to touch the tissue. If
only a small amount of
irrigation is required a gauze
can be used at the base of the
wound to catch the drips.

Rationale

To avoid cross infection.

Pressure applied should be

sufficient to flush away debris
but not to cause trauma
(Oliver, 1997 cited in Workman
and Bennett, 2003).

Best practice would be to wear

goggles/eye protection to
avoid micro spray.

Clinical Skills Learning

Procedure:

Skin edges should be dried

working from clean to dirty as
before. If the wound is
excessively wet then remove
the excess moisture only.
Position the prescribed
dressing and secure
maintaining sterility of the
dressing.
On completion reposition
patient and ensure comfort
following the procedure.
Fold up the sterile field remove
aprons and gloves and place
them all in the waste bag
before leaving the area.
Sharps in sharps bin.

Rationale

So to prevent maceration and

deterioration of the wound.

To prevent contamination of
the wound.

To reduce transmission of
infection outside the treatment
area (Xavier, 1999).
To dispose of contaminants as
per guidelines.

Clinical Skills Learning

Procedure:

Equipment for re-sterilising

should be placed in the special
CSSD collection containers.
Dispose of clinical waste.

Decontaminate hands at the

sink.

Record activity and

observations in patients notes.

Rationale

Adapted from Key Nursing

Skills. B,Workman and C,
Bennett (2003). London,
Whur

Clinical Skills Learning

Safety:
Risk of contamination and cross infection be it direct, indirect
or blood borne so follow universal precautions.
Sharps injuries
Splashes to eyes

Clinical Skills Learning

Aseptic or Clean
In clinical practice there are times when a clean technique as
opposed to an aseptic technique will be used. It is therefore
important to be able to differentiate between the two in order to
ensure that the most appropriate method is used.
For invasive procedures or in cases of surgical wounds, acute
wounds or trauma wounds aseptic technique and the principles of
ANTT should be used because of the risk of contamination and
cross infection.
Where chronic long standing wounds such as leg ulcers are present
a clean technique can be used. However sterility of the dressing
products and associated materials should be maintained, the
principles of non touch technique of key parts should then be
followed.
Clinical Skills Learning

Factors which may indicate

wound infection

Spontaneous bleeding or bleeding on light contact

Inflammation or cellulitis
Redness
Partial wound breakdown
Pus formation or discharge
Pain
Heat
Delayed wound healing
Wound enlargement
Offensive wound exudate
Clinical Skills Learning

References and further reading:

Blunt, J. (2001) Wound Cleansing: ritualistic or research based
practice ? Nursing Standard. vol19, no16, pp33-36
Casey, G. (2002) Wound dressings. Primary Health Care. vol12, no5,
pp43-49.
Casey, G. (1999) Wound management in children. Emergency Nurse.
vol 7, no 6,pp33-39.
Johnstone, C.C. ,Farley, A. and Hendry, C. (2005) The physiology
basics of wound healing. Nursing Standard. vol19, no43, pp59-66.
Scanlon, E. (2005) Wound infection and colonisation. Nursing
Standard. vol19, no24 pp57-67.
Workman, B.A. and Bennett, C.L. (2003) Key Nursing Skills. London.
Whur.
Xavier, G. (1999) Asepsis. Nursing Standard. Vol 13, no 36, pp49-53.

Clinical Skills Learning

Further Information & Web Links:

Infection control
Universal Precautions
Anatomy and Physiology structure and function of the skin
Anatomy and physiology - the wound healing process
Health and Safety
Also refer to photograph slide show for further information
relating to aseptic technique.

Clinical Skills Learning