Clinical
Aseptic Technique: Standard Operating Procedure
Document Control Summary
Status:
Replacement.
Replaces: Aseptic and Clean Dressing (Non Touch) Technique
v2.1
Version:
v1.0
Author/Title:
Judy Carr - Lead Infection Prevention and Control Nurse
Owner/Title:
Kenny Laing - Deputy Director of Nursing
Approved by:
Policy and Procedures Committee
Date:
17/12/15
Ratified:
Policy and Procedures Committee
Date:
17/12/15
Related Trust Strategy
and/or Strategic Aims
Provide high quality services, built on best known practice and
evaluated through clear process and outcome measures
Implementation Date:
December 2015
Review Date:
December 2018
Key Words:
Wound, dressings
Associated Policy or
Standard Operating
Procedures
Date:
November 2015
Infection Prevention Control and Decontamination Policy
Standard Precautions SOP
Hand hygiene SOP
Decontamination of Medical Devices
Mental Capacity Act
Contents
1.
Introduction .............................................................................................................. 2
2.
Purpose..................................................................................................................... 2
3.
Scope ........................................................................................................................ 2
4.
Aseptic Technique ................................................................................................... 2
Aseptic Technique SOP/ December 2015
5.
Definitions ................................................................................................................ 3
6.
Aseptic Non-touch Technique (ANTT) .................................................................... 4
7.
Clean Non-touch Technique CNTT ......................................................................... 6
8.
Aseptic and Clean Technique table ........................................................................ 6
9.
Community Settings ................................................................................................ 6
10.
Wound Swabbing ..................................................................................................... 6
11.
Monitoring Compliance ........................................................................................... 7
12.
References ................................................................................................................ 7
Appendix 1 - Commonly Performed Procedure……….………………………………………9
Change Control – Amendment History
Version
Dates
Amendments
1. Introduction
Aseptic technique is used to keep the patient as free as possible from potentially pathogenic
micro organisms when undertaking any clinical procedure. It is the policy of the Trust that
clinical procedures will be carried out using a high standard of aseptic technique or clean
non touch technique with all appropriate sterile items being used for each procedure.
2. Purpose
This SOP aims to promote the prevention and control of healthcare acquired infection
(HCAI), especially in situations where the body’s natural defences are breached during
invasive procedures. An aseptic technique should be used when carrying out any invasive
procedure.
3. Scope
This SOP will apply to all registered and unregistered practitioners who undertake invasive
clinical procedures (i.e. where the body’s natural defences are breached).
4. Aseptic Technique
An aseptic technique should be used during any invasive procedure which breaches the
body’s natural defences, i.e. the skin or mucous membranes, or when handling equipment
which will enter a normally sterile body cavity, such as urinary catheters. The aim of the
aseptic technique is to protect the patient from infection and to reduce the healthcare
worker’s risk of exposure to potentially infectious body fluids. All interventions undertaken in
relation to invasive procedures should be performed using an aseptic non touch technique or
clean technique as appropriate.
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Aseptic Technique SOP/ December 2015
5. Definitions
Aseptic technique is a method employed to prevent contamination of wounds and other
susceptible sites by potentially pathogenic organisms. An aseptic technique must be used
during any procedure, which breaches the body’s natural defences.
An aseptic technique can be divided into the following three categories:
 Surgical or Sterile Asepsis
 Aseptic Non-Touch Technique (ANTT)
 Clean Non-Touch Technique (CNTT)
Surgical or Sterile Aseptic Technique
This is a technique, the aim of which is to eliminate micro-organisms from a body site or the
environment, and is only achievable in a specialised area such as an operating theatre or
treatment area which has strict environmental controls.
Aseptic Non-Touch Technique (ANTT) is a method used to avoid adding new organisms
to the microbial flora of a wound. Wounds are almost never sterile after their initial causation
e.g. Coagulase negative staphylococci and diphtheroids will migrate over the surface from
damaged skin. This can be achieved by ensuring that only sterile equipment and fluids are
used during dressing procedures.
Examples of when ANTT is required see appendix one
 Dressing of wounds healing by primary intention e.g. surgical incision, burns
 Catheterisation
 Insertion of invasive devices e.g. Peg feeds
This list is not exhaustive. It is intended to act as a guide to the types of procedure that will
require an aseptic technique to be used
Clean/ (non touch) technique (CNTT) is modified aseptic technique and aims to avoid
introducing microorganisms to a susceptible site and also to prevent cross-infection. Sterile
materials are required, but the dressing technique can be greatly simplified.
Clean technique also uses a non touch technique; do not touch the ends of the sterile
connections, or other items that will touch the susceptible site.
Examples of when CNTT is required see appendix one
 traumatic wound,
 pressure ulcers,
 leg ulcers,
 tracheostomy sites.
 dehisced wounds
 simple grazes,
 removing drains or sutures,
 endo-tracheal suction.
NB if wounds enter deeper sterile body areas, then an ASEPTIC (non touch) TECHNIQUE
must be used.
This list is not exhaustive. It is intended to act as a guide to the types of procedure that will
require an aseptic technique to be used
These wounds may be heavily colonised by bacteria, although not necessarily showing signs
of infection. The patient therefore may be an infection risk to others. An occlusive dressing
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Aseptic Technique SOP/ December 2015
material should be considered both to promote healing and to prevent contamination of the
patient's immediate environment.
The aim of dressing any wound is to protect the wound from trauma or bacterial
contamination, promote healing and prevent the transfer of organisms from an infected
wound to other sites on the same or other patients. Therefore, choice of a suitable dressing
material is an important part of infection prevention and the healing process.
Always consider:
• Is a dressing really necessary on a particular patient?
• What is the function of the dressing?
• Is specialist advice required i.e. Tissue Viability or Leg Ulcer Specialist Nurses
The manufacturer’s recommendations for all clinical supplies must be followed at all times.
The reuse of single-use items must not occur and could results in legal, economic, and
ethical consequences.
ANTT/CNTT techniques should be seen as a single procedure. For example, it would
not be good practice to carry out several dressing changes on different sites using
the same sterile pack and equipment
6. Aseptic Non-touch Technique (ANTT)
The aim of the aseptic technique is to prevent the transmission of microorganisms to
wounds, or other susceptible sites, to reduce the risk of infection. Correct aseptic technique
is a long recognised method for preventing infection during invasive procedures (DoH,
2004).
Basic principles of asepsis include:







The use of sterile equipment for the procedure, that has been stored appropriately
until use (e.g. dry, in an appropriate container, and within its expiry date)
Avoidance of direct contact with the susceptible site
A ‘non touch’ technique – this involves the use of sterile gloves or forceps
Effective hand hygiene. This means using effective hand decontamination technique
that ensures all surfaces of the hands are covered. As an addition to this, all clinical
staff who are undertaking aseptic techniques, must be bare below the elbow, e.g.
sleeves are short or rolled back, no wrist jewellery/watches, and no stoned rings.
Effectively cleaned equipment such as dressing trolleys
Appropriate use of Personal Protective Equipment (PPE)
Safe disposal of the used equipment at the end of the procedure.
Procedure Guidelines
A step by step clinical guideline is designed to allow the practitioner to:




Always decontaminate their hands
Never contaminate key parts or sites
Touch non key parts with confidence
Take appropriate infection control precautions
The procedure should be explained to the patient, and informed consent gained.
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Aseptic Technique SOP/ December 2015
Avoid exposing or dressing wounds or performing an aseptic procedure for at least 30
minutes after bed making or domestic cleaning. Air movement should be kept to a minimum
with closed windows and reduced local activity this applies to inpatient / clinical settings and
in the patient’s own home where possible.
1. Collect equipment together and place on the bottom shelf of a clean, dry dressing
trolley where available. Suitable agents for cleaning the trolley are detergent wipes,
or warm water and detergent. The shelves and the sides of the trolley should be
cleaned between uses. When carrying out dressing procedures in a patient’s home
or if a dressing trolley is not available adaptations and creativity are often required
to ensure the environment is conducive to the procedure being performed and the
equipment remains sterile or clean. The use of a clean surface such as table or a
chair should be used to arrange the dressing equipment.
2. Put on a plastic apron, and decontaminate hands with soap and water, or alcohol
hand rub (if hands are physically clean). Ensure hands are dried thoroughly.
3. Ensure the patients privacy is protected by using curtains or a mobile screen.
4. Take the trolley to the patient’s bed or area, disturbing the screens/curtains as little
as possible. This will reduce the risk of airborne contamination.
5. Loosen the patient’s dressing (if applicable) using non sterile gloves.
6. Discard gloves and decontaminate hands again with alcohol hand rub.
7. Open the sterile pack suitable for the type of procedure to be carried out. Open the
other sterile items (e.g. dressings), and drop onto the sterile field, taking care not to
contaminate the sterile field by touching it. Open the appropriate cleaning fluid and
pour into the galipot using a no touch technique
8. Decontaminate hands again with alcohol hand rub, as hands may have become
contaminated from handling the outer packaging of items.
9. Place hand inside disposable bag, and arrange contents of sterile field for easy
accessibility. This can also be done using a pair of sterile forceps.
10. Remove used dressing with disposable bag.
Turn bag inside out without
contaminating hands, and continue to use for waste items.
11. Decontaminate hands again with alcohol hand rub or soap and water.
12. Put on sterile gloves, touching only the inside wrist end to avoid
contaminating
them. Forceps can also be used to achieve a non touch technique, but gloves
generally provide a better sensitivity and dexterity.
13. Carry out procedure (e.g. dressing change, catheterisation).
appropriate policies for guidelines on specific procedures.
14. Take trolley and its contents to the dirty utility.
decontaminate hands
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Please refer to
Remove gloves and apron,
Aseptic Technique SOP/ December 2015
15. Clean the dressing trolley with detergent wipes or detergent and warm water.
Dispose of all waste in the appropriate waste streams.
16. Decontaminate hands thoroughly with soap and water.
17. Document procedure in the patient’s medical records.
7. Clean Non-touch Technique CNTT
Procedure Guidelines
The basic principles of an aseptic technique must be adopted and sterile dressing materials
used.
1. Clean gloves rather than sterile gloves are acceptable
2. A ‘clean area’ is required, rather than the use of a sterile dressing pack
3. Good quality potable water, rather than sterile saline is acceptable for cleansing traumatic
wounds & leg ulcers. NB: water used to clean a wound must be of drinking (potable) water
quality.
8. Aseptic and Clean Technique Table
Aseptic technique
Clean technique
Gloves
Sterile non latex
Non-sterile -Non latex
Dressings
Sterile
Sterile
Technique
No-touch
No-touch
Hand decontamination
Wash with liquid soap and dry
with paper towels, or alcohol
hand rub if hands are
physically clean
Wash with liquid soap and
dry with paper towels OR
alcohol hand rub to all
areas of hands if physically
clean
Cleansing solution
Sterile water/saline OR
chlorhexidine
Potable/drinking OR tap
water
9. Community Settings
When carrying out dressing procedures in a patient’s home, the healthcare worker does not
have specific equipment as in a hospital setting, for example a dressing trolley; therefore
adaptations and creativity are often required to ensure the environment is conducive to the
procedure being performed and the equipment remains sterile or clean. The use of a clean
surface such as table or a chair should be used to arrange the dressing equipment.
10. Wound Swabbing
Swabbing should only be undertaken if wound/site of invasive device exhibits signs of
infection. They should not be taken routinely, or if wound/site is healing.
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Aseptic Technique SOP/ December 2015
11. Monitoring Compliance
This SOP will be reviewed three yearly or earlier in light of new national guidance or other
significant change in circumstances.
Compliance with this SOP will be monitored through the mechanisms detailed in the table
below. Where compliance is deemed to be insufficient and the assurance provided is limited
then remedial actions will be drawn together through an action plan. This progress against
the action plan will be monitored at the specified committee/group. The results of the annual
audit will be escalated to the appropriate committee/group where appropriate.
Aspect of compliance or
effectiveness being
monitored
Monitoring
method
Individual or
department
responsible
for the
monitoring
Frequency
of the
monitoring
activity
Group/Committe
e/forum which
will receive the
findings/monitor
ing report
Committee/
individual
responsible for
ensuring that the
actions are
completed
Staff compliance with
Aseptic/clean technique
Appraisal
locally and
through
essential
steps
audit
Training
Reports
Manager
Monthly
Infection Control
Committee
Manager and
individual
Learning
and
Developme
nt
Department
Monthly
HRODE
Committee
HRODE
Committee
Organisation’s
expectations in relation
to staff training, as
identified in the training
needs analysis
12. References
Department of Health (1995) Hospital Infection Control: Guidance on the Control of Infection
in Hospitals. Department of Health, London.
Department of Health (2003) Winning Ways: Working together to reduce Healthcare
Associated Infection in England. Report from the Chief Medical Officer. Department of
Health, London. Available from www.doh.gov.uk/cmo
Department of Health (2005) Saving Lives: a delivery programme to reduce Healthcare
Associated Infection including MRSA. Department of Health, London.
Department of Health (2007) Essential steps to safe clean care: reducing health care
associated infections in primary care trusts, mental health trusts, and learning disability
organisations,, independent health care facilities, care homes, hospices,GP practices and
ambulance services. London. Department of Health.
Hart, S (2007). Using Aseptic technique to reduce the risk of infection. Nursing Standard. 21
(47):43-48.January 26.
Hospital Infection Society (2007) The 3rd Prevalence Study of HCAI’s in Acute Hospitals –
Results for England. Available from www.his.org.uk
Royal Marsden
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Aseptic Technique SOP/ December 2015
Pratt, RJ et al (2007), epic 2 National Evidence based guidelines for preventing Health Care
Associated Infections in NHS hospitals in England. The Journal of Hospital infection.65
(supplement): S 1-S31.
Page 8 of 9
Appendix 1
Aseptic Technique SOP/ December 2015
Commonly Performed Procedures
Procedure
Technique
Indwelling urinary catheterisation,
manipulation of the catheter i.e.
installation of bladder washout
Intermittent urinary catheterisation
Comments
Aseptic
Clean meatus prior to catheterisation
using soap and water. Use sterile
lubricant to reduce trauma
i)
Aseptic
ii)
Clean
i) By healthcare professional (due to
increased risk of infection
transmission)
ii) By client at home
Cervical smear
Clean
Use a clean speculum that has been
sterilised after each use
IUCD insertion
Aseptic
Use a sterile speculum
Aseptic
Clean
i) Recently formed tracheostomy
ii) Established tracheostomy
Dispose of suction catheter after each
insertion
Clean
See Enteral Feeding Policy
Suction (laryngeal, endotracheal,
tracheal)
i)
ii)
Enteral feed administration, enteral
tube manipulation
IV line insertion, manipulation of
the device (central or tunnelled)
Aseptic
See Policy for the Administration of
Intravenous Drugs and Management of
Intravenous Devices in the Community
IV line insertion, manipulation of
the device (peripheral)
Clean
See Policy for the Administration of
Intravenous Drugs and Management of
Intravenous Devices in the Community
Venepuncture
Clean
See Venepuncture Policy
Aseptic
Clean
i) Wounds healing by primary intention
ii) Chronic wounds
Wound dressing
i)
ii)
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