What is aseptic technique?

Definition

Aseptic technique involves applying preventive measures to minimize the chance of introducing into clinical settings the microorganisms, such as viruses and harmful bacteria (known as pathogens), that cause disease. In other words, its purpose is to maintain asepsis, or the absence of pathogens, in clinical settings. Aseptic technique is intended to protect the patient and the health care worker from pathogens and to prevent their spread.

Pathogens may introduce infection to a patient through contact with the environment, with personnel, or with medical equipment. The environment contains potential hazards that may disseminate pathogens through movement, touch, or proximity.

Aseptic technique involves a set of procedures designed to remove or kill microorganisms on hands and objects, reducing a patient’s risk of exposure. It includes the use of sterile instruments and of barriers such as personal protective equipment, adequate handwashing, patient preparation, and maintenance of sterile fields and a safe environment in surgical and other areas for medical procedures.

Minimizing Contamination During Surgery

Interventions such as minimizing surgical-room traffic, isolating a patient to
reduce airborne contamination, and using low-particle-generating surgical attire
contribute to reducing environmental hazards. Equipment or supplies can be
sterilized through chemical treatment, radiation, gas, or
heat.

The most prominent example of aseptic technique occurs in the operating room, in which clinicians work to prevent postoperative infection. Aseptic technique protocols during surgical procedures include patient skin preparation, handwashing and surgical scrub, barrier protection for the patient (draping) and the surgical team (surgical attire), and maintenance of the sterile field.

Hand hygiene among medical personnel is the most important aspect of reducing contamination. Adequate handwashing involves removing jewelry, avoiding contact with the sink, and performing vigorous hand scrubbing. Thorough drying is critical because moist surfaces encourage pathogen growth. Bare hands are potential sources of infection, and glove use is important.

Sterile surgical clothing and protective devices such as gloves, face masks, goggles, and transparent eye and face shields serve as barriers against microorganisms. Surgical attire must be worn with deliberate care to prevent contact of sterile surfaces with nonsterile objects, including skin. Procedures for putting on surgical attire include covering facial hair, tucking hair out of sight, and removing jewelry or other dangling objects that may contain microorganisms. Personnel assist the surgeon in putting on gloves and the surgical gown and in arranging equipment to minimize the risk of contamination. Creating surgical fields with drapes, which are sterilized linens placed on the patient or around the field to define sterile areas, helps maintain asepsis in the operating room during surgery or other invasive procedures.

Other principles applied to maintain asepsis include ensuring that all items in a sterile field are actually sterile. Also sterile packages should be opened as close as possible to time of use.

Moist areas are not considered sterile. Contaminated items must be removed
immediately, and nonsterile items should not cross a sterile field. Edges of
sterile fields are not considered sterile, and a margin of safety is maintained
between sterile and nonsterile objects. Drapes or wrapped kits of equipment are
opened in a manner to prevent contents from touching nonsterile surfaces. Others
who work close to the sterile field, such as anesthesia personnel, also must
follow aseptic technique. During a procedure, staff members are positioned so that
those who have undergone surgical scrub and are wearing sterile attire are closest
to the patient while unscrubbed staff members remain on the perimeter to obtain
supplies, acquire assistance, and communicate with outside personnel.

Nonsurgical Clinical Settings

Aseptic technique is also used in a variety of settings outside the operating room. A primary difference between the operating room and other clinical environments is that areas outside the operating room generally do not allow for the same rigorous level of asepsis. Avoiding potential infection is still the goal, however. For example, changing a surgical dressing at the patient’s bedside should still include thorough handwashing, use of gloves and other protective garb, creation of a sterile field, and avoidance of contact with nonsterile items.

Typical situations that require aseptic measures include insertion of intravenous lines, urinary or other catheters, and drains; changing of wound dressings; vaginal exams during labor; and respiratory suction. General habits such as prompt disposal of contaminated needles or blood-soaked bandages and dressings and the prevention of accumulation of drained bodily fluids through regular emptying of receptacles help preserve and maintain a clean medical environment and keep it as free of microorganisms as possible.

Impact

Practices that clean (remove dirt and other impurities), sanitize (reduce the number of microorganisms), or disinfect (remove most microorganisms) are not always adequate to prevent infection. The Centers for Disease Control and Prevention estimated in 2015 that more than 50 million surgical procedures are performed in the United States each year. Surgical site infections are among the most common nosocomial, or hospital-acquired, type of infection and result in longer hospital stays and greater patient costs. Aseptic technique is vital in reducing the morbidity and mortality associated with surgical infections. Aseptic technique is especially important in cases involving patients who have compromised (weak) immune systems.

Bibliography

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