All About Aseptic Technique
Published: 14 May 2024
Published: 14 May 2024
There are approximately 165,000 incidences of healthcare-associated infection (HAI) every year in Australian acute care facilities alone, with over half of these being preventable (NHMRC 2023).
Aseptic technique is a fundamental component of infection control and prevention that helps to decrease the risk of HAIs.
Aseptic technique aims to achieve asepsis during invasive clinical procedures - that is, the absence of sufficient pathogens to cause an infection in the client (ACSQHC 2021).
It should be used when performing procedures that could potentially introduce pathogens to the client’s susceptible body sites to ensure that no contamination occurs via surfaces, equipment or the healthcare worker’s hands (SA Health 2022).
Poorly-performed aseptic technique has been identified as a significant contributor to preventable HAI (WACHS 2023).
It is important to note that achieving asepsis is not the same as being sterile, i.e. completely free from microorganisms. This is almost impossible to achieve unless the procedure is taking place in a specially equipped controlled environment (e.g. operating theatres) (ACSQHC 2021).
Aseptic technique is outlined in Action 3.11 of the National Safety and Quality Health Service Standards, under Standard 3: Preventing and Controlling Infections.
This action aims to minimise the risk of infection being transmitted during clinical procedures by ensuring health service organisations implement a risk-based aseptic technique process (ACSQHC 2023).
Health service organisations are required to:
(ACSQHC 2023)
Standard 5: Clinical Care - Outcome 5.2: Preventing and controlling infections in clinical care under the strengthened Aged Care Quality Standards (Action 5.2.2) requires aged care providers to establish processes for reducing and managing infection when providing clinical care. These processes should include the use of aseptic technique (ACQSC 2024).
Activities that require aseptic technique include:
(WACHS 2023)
The following two terms are integral to aseptic technique:
(NHMRC 2023)
The primary goal of aseptic technique is to prevent key sites and key parts from coming into contact with pathogens. This is ensured through the following components of infection control:
Prior to commencing the procedure, staff must conduct a risk assessment. This should be the first step of the aseptic technique process. The aim is to determine whether there are any environmental risks present that could cause contamination through movement, touch or proximity (ACIPC 2015). Examples include:
(ACIPC 2015; Kumar 2021)
Any environmental risks should be removed prior to performing the procedure (Kumar 2021).
Hand hygiene is one of the most important measures for preventing infection transmission (Health.vic 2023). In aseptic procedures, hand hygiene is used to ensure that:
(Health.vic 2023)
Staff must perform hand hygiene:
(Health.vic 2023)
Gloves should be used to protect the client from contamination, as well as to protect the staff member from exposure to body fluids. They must be single use. If the staff member needs to touch a key site or key part, or if there is any risk of the staff member accidentally touching a key site or key part, sterile gloves must be worn. Non-sterile gloves are appropriate otherwise (Health.vic 2023; ACIPC 2015).
Staff should avoid touching key parts and key sites whenever possible, even if they are wearing sterile gloves. This is the safest way to avoid contamination of key sites and key parts (ACIPC 2015).
Once the key sites and key parts have been identified, they must be protected. Aseptic key parts must only make contact with key sites and other aseptic key parts (The Women’s 2020).
The aseptic field is the working space wherein key parts are held and protected from contamination. The type of aseptic field that is required depends on the procedure, as well as the key sites and key parts involved (WACHS 2023).
There are three types of aseptic field:
(WACHS 2023; ACSQHC 2021; ACIPC 2015)
All key parts must be made aseptic before being re-used. For example, if a client has an IV cannula in-situ that has been disconnected from the intravenous fluid line 1, the intravenous line must be replaced with a new line and the IV cannula access site must be made aseptic before re-accessing it. Follow your organisation’s policies and procedures (Kumar 2021).
Equipment such as trolleys should also be decontaminated before use (Kumar 2021).
There are two types of aseptic technique: standard aseptic technique and surgical aseptic technique. The most appropriate type of aseptic technique should be chosen based on the procedure as well as the key sites and key parts involved.
Note that the terms ‘sterile technique’ and ‘clean technique’ are no longer used. They have been replaced by surgical aseptic technique and standard aseptic technique respectively.
Standard aseptic technique | Surgical aseptic technique | |
---|---|---|
Number of key parts and key sites | Few | Many |
Size of key parts and key sites | Small | Large |
Complexity of procedure | Simple | Complex |
Duration of procedure | Less than 20 minutes | More than 20 minutes |
Aseptic field required | General aspect field and micro critical aseptic fields | Critical aseptic fields |
Type of gloves required | Non-sterile (unless there is a risk of accidentally touching key sites or key parts) | Sterile gloves |
Procedure examples |
|
|
(WACHS 2023; CHHS 2018)
(ACIPC 2015)
Always follow the World Health Organisation’s 5 Moments for Hand Hygiene while performing the procedure.
The Australian Commission on Safety and Quality in Health Care has developed a risk matrix to help organisations identify high-risk clinical areas or procedures, and determine whether staff competency needs to be reassessed. The matrix assesses:
(ACSQHC 2018)
This tool uses a scoring system. Each component of the matrix should be added together to determine the risk score for a specific procedure.
1. The clinical context where aseptic technique occurs | |||
Frequency (how often aseptic technique occurs in this setting) |
Controlled (e.g. theatres, interventional radiology, oncology units) |
Semi-controlled (e.g. medical wards) |
Uncontrolled (e.g. emergency department) |
Infrequently | 1 = Low | 4 = Low | 6 = Medium |
Occasionally | 4 = Low | 6 = Medium | 8 = High |
Frequently | 6 = Medium | 8 = High | 10 = Very High |
2. Type of procedure | |||
Frequency (how often the procedure is performed) |
Simple procedure (e.g. simple wound dressing) |
Complex procedure (e.g. wound debridement) |
Invasive procedure (e.g. insertion of a peripheral or central venous access device) |
Infrequently | 1 = Low | 4 = Low | 6 = Medium |
Occasionally | 4 = Low | 6 = Medium | 8 = High |
Frequently | 6 = Medium | 8 = High | 10 = Very High |
3. How recently the specific staff member was last assessed for competency | ||||
Recently (within the last 12 months) | Recently, but the staff member is working in a changed clinical context | 1-3 years ago | More than 3 years ago or unknown | |
1 = Low | 4 = Medium | 4 = Medium | 8 = High |
Once the score for each of these three components has been determined, add them together to determine their total risk score. The organisation can then use this information to determine whether a reassessment of staff competency or other actions are required (ACSQHC 2018).
Score | Risk |
---|---|
3 - 9 | Low |
10 - 16 | Medium |
17 - 24 | High |
25 - 28 | Very high |
(All tables adapted from ACSQHC 2018)
Note: This article is intended as a refresher and should not replace best-practice care. Always refer to your organisation's policy on aseptic technique.
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