1 of 26

Course: Fundamentals of Nursing

Topic: Asepsis

The Nurses International Community

Contact info: info@nursesinternational.org

2 of 26

COPYRIGHT

NI Privacy Policy and Terms of Use.

Contact info: info@nursesinternational.org

3 of 26

Student Learning Outcomes

Learners will be able to:

Define asepsis.
Differentiate between surgical and medical asepsis.
Explain when surgical and medical asepsis are required.
Provide examples of surgical and medical asepsis.

Contact info: info@nursesinternational.org

4 of 26

Asepsis

LibreTexts, 2020
Wilson,2019, as cited in Denton & Hallam, 2020
Department of Health Victoria, 2014

Asepsis is the absence of infectious material or infection¹.
Fundamental principle of asepsis is prevention of transfer of potentially pathogenic microorganisms to a susceptible site that may result in infection².
Aseptic technique is the range of infection prevention and control practices which are used to minimise the presence of pathogenic microorganisms during clinical procedures³.

Contact info: info@nursesinternational.org

5 of 26

Asepsis

Asepis breaks the chain of infection.
Asepsis must be maintained during every clinical procedure
Nurses must be able to:

Know what is dirty
Know what is clean
Know what is sterile
Keep above three separate
Remedy contamination immediately

Contact info: info@nursesinternational.org

6 of 26

Components of Asepsis

Hand hygiene

Personal Protective Equipment

Non Touch Technique

Aseptic Field

Ensuring Asepsis and Sterility of Equipment

Department of Health Victoria, 2014

Contact info: info@nursesinternational.org

7 of 26

Hand Hygiene

Single most important measure to prevent transmission of infection¹
Must be performed²-

Before touching a client
Before performing clean/aseptic procedure on client
After any body fluid exposure or risk
After touching a client
After touching client’s surroundings or equipment

Department of Health, Victoria, 2014
WHO, 2009

Contact info: info@nursesinternational.org

8 of 26

Hand Hygiene: Methods

World Health Organization & WHO Patient Safety, 2009

Hand Rub technique

Involves rubbing hands with alcohol-based formulation for 20-30 secs
Used when hands are not visibly soiled
Faster, effective, and better tolerated

Handwashing technique

A must when hands are visibly soiled
Use antimicrobial soap/liquids and water
Regular handwash: 40-60 secs
Surgical handwash: 2 - 5 minutes (as recommended by manufacturer)

Contact info: info@nursesinternational.org

9 of 26

Personal Protective Equipment (PPE)

Department of Health Minnesota, n.d

Clothing or equipment worn for protection against infectious materials.
Creates barriers between infectious material and health care worker.
Includes:

Gloves
Gowns
Masks
Eye-protection/Goggles
Head covers
Shoe covers
Face shields

Contact info: info@nursesinternational.org

10 of 26

What Would the Nurse Do?

The nurse is measuring the temperature of a febrile client with an electronic device.

Is asepsis necessary for this non-invasive temperature procedure? Why or why not?

Contact info: info@nursesinternational.org

11 of 26

Surgical Asepsis

Medical Asepsis

Aims to reduce number of organisms and prevent spread of organisms¹.
Used in procedures that³:
involve small number of key parts and key sites

involve small key parts/key sites
are technically simple
are short in duration (e.g less than 20 minutes)

Handwashing takes shorter time³.
Need to wear clean gloves³.

Aims to eliminate, rather than reduce, organisms and prevent infection².
Used in procedures that³:
involve large number of key parts or key sites

involve large key parts/key sites
are technically complex
are long in duration (e.g more than 20 minutes)

Handwashing takes longer time³.
Need to wear sterile gloves³.

Loveday et al., 2014, as cited in Denton & Hallam, 2020
NICE, 2012, cited in Denton & Hallam, 2020
Department of Health and Human Services Victoria, 2014

Contact info: info@nursesinternational.org

12 of 26

Surgical Asepsis

Medical Asepsis

Examples:

preparation and administration of IV fluids or medications
simple wound dressings
insertion of an IV cannula
emptying or changing drainage bags

Examples:

complex wound dressings
insertion of a

Peripherally inserted central catheter (PICC) line

or Central Venous Catheter (CVC)

surgery

Department of Health and Human Services Victoria, 2014

Contact info: info@nursesinternational.org

13 of 26

Gloves

World Health Organization & WHO Patient Safety, 2009

Must be used when contact with following is reasonably anticipated-

Blood
Mucous membranes
non-intact skin
other potentially infectious materials

Medical Clean gloves

Not soiled or dirty, free from marks/stains,
No process of sterilization involved
Multiple pairs in each package

Medical Sterile gloves

Absence of viable organisms through sterilization
Comes as a pair in a single package

Contact info: info@nursesinternational.org

14 of 26

Use of gloves does not replace the need for hand hygiene!

World Health Organization & WHO Patient Safety, 2009

Contact info: info@nursesinternational.org

15 of 26

Non-Touch Technique

NHMRC, 2010, as cited in Department of Health, Victoria, 2014

Technique that protects key part or key site from contamination.
Key site or key part are not touched throughout the procedure regardless of donning gloves.

Contact info: info@nursesinternational.org

16 of 26

Aseptic Field

Designated work space that ensures and/or promotes asepsis during procedure.
This field contains and protects procedural equipment from becoming contaminated.
Three types:

Critical aseptic fields
Micro critical aseptic fields
General aseptic fields

Department of Health, Victoria, 2014

Contact info: info@nursesinternational.org

17 of 26

Aseptic Field

Department of Health, Victoria, 2014
NHMRC, 2010, as cited in Department of

Health Victoria, 2014

Critical aseptic field is used when key parts/sites cannot be easily protected from contamination¹.

Field must be managed as a key part itself.
Handled with sterile gloves if non-touch technique is not possible.

Micro critical aseptic fields is used to protect a single key part¹.

Sterile packaging, cover, cap or sheath of a key part.

General aseptic fields²

Micro critical aseptic fields and non-touch technique used.

Contact info: info@nursesinternational.org

18 of 26

Ensuring Asepsis and Sterility of Equipment

Key part and key site identification and protection

Know which are key parts and key sites
Protect these from contamination
Aseptic key parts must contact only with

Other aseptic key parts
Key sites

Decontamination

Contaminated key parts must be made aseptic prior to use
Important to decontaminate trays/trolleys prior to use

Environmental control

Prior to aseptic procedure, environmental risks to procedure must be removed/resolved

Department of Health, Victoria, 2014

Contact info: info@nursesinternational.org

19 of 26

What Would the Nurse Do?

The nurse is taking a temperature on a client. How will the nurse maintain asepsis during this procedure?

Contact info: info@nursesinternational.org

20 of 26

Principles of Sterile Technique

All objects used in a sterile field must be sterile.
Sterile object becomes non-sterile when touched by a non-sterile object
Sterile items that are below the waist level, or items held below waist level, are considered to be non-sterile.
Sterile fields must always be kept in sight to be considered sterile.
When opening sterile equipment and adding supplies to a sterile field, take care to avoid contamination.
Once set up and before use, sterile fields should be covered with a sterile towel

Doyle & McCutcheon, 2015

Contact info: info@nursesinternational.org

21 of 26

Principles of Sterile Technique

Any puncture, moisture, or tear that passes through a sterile barrier must be considered contaminated.
Once a sterile field is set up, the border of one inch at the edge of the sterile drape is considered non-sterile.
If there is any doubt about the sterility of an object, it is considered non-sterile.
Sterile persons or sterile objects may only contact sterile areas; non-sterile persons or items contact only non-sterile areas.
Movement around and in the sterile field must not compromise or contaminate the sterile field.
Covered sterile field are only considered sterile for a limited time.

Doyle & McCutcheon, 2015

Contact info: info@nursesinternational.org

22 of 26

What Would the Nurse Do?

The nurse took the following steps when preparing for a foley catheter insertion:

Collected necessary equipment making sure they were not expired and packaging were intact.
The nurse informed client of the procedure.
The nurse took client’s informed consent.
Raised the level of bed to a working height and positioned the client appropriately.
Set up sterile field
Wore sterile gloves.
Washed hands after insertion of catheter using sterile technique.

Identify nurse’s actions pertaining to asepsis.
What should the nurse have done differently?

Contact info: info@nursesinternational.org

23 of 26

References:

Denton A. & Hallam C. (2020). Principles of asepsis 1: the rationale for using aseptic technique. Nursing Times [online]; 116: 38-41. Retrieved https://www.nursingtimes.net/clinical-archive/infection-control/principles-of-asepsis-1-the-rationale-for-using-aseptic-technique-14-04-2020/

Department of Health Victoria (2014). Standard 3 Aseptic Technique Learning Module (Preventing and Controlling Healthcare Associated Infections). https://www2.health.vic.gov.au/Api/downloadmedia/%7B7DA52320-927A-4D49-94AD-D487AF3EBE73%7D

Doyle, G.R., McCutcheon, J.A. (2015). Clinical Procedures for Safer Patient Care. Victoria, BC: BCcampus. https://opentextbc.ca/clinicalskills/chapter/surgical-asepsis/

Contact info: info@nursesinternational.org

24 of 26

References:

LibreTexts. (2020, August). Surgical Asepsis and the Principles of Sterile Technique. Licensed under CC BY. https://med.libretexts.org/Bookshelves/Nursing/Book%3A_Clinical_Procedures_for_Safer_Patient_Care_(Doyle_and_McCutcheon)/01%3A_Infection_Control/1.05%3A_Surgical_Asepsis_and_the_Principles_of_Sterile_Technique

Minnesota Department of Health. (n.d.). Personal Protective Equipment (PPE) for Infection Control. https://www.health.state.mn.us/facilities/patientsafety/infectioncontrol/ppe/index.html

Contact info: info@nursesinternational.org

25 of 26

References:

WHO (2009). Hand Hygiene: Why, How & When? [Brochure]. https://www.who.int/gpsc/5may/Hand_Hygiene_Why_How_and_When_Brochure.pdf

World Health Organization & WHO Patient Safety. (‎2009)‎. WHO guidelines on hand hygiene in health care. https://apps.who.int/iris/handle/10665/44102

Contact info: info@nursesinternational.org

26 of 26

Please go to

My Learning Experience

to provide feedback on your experience.

Thank you, and come back soon!

Contact info: info@nursesinternational.org