Aseptic Technique

Serial	Recommendations
1.	For standard aseptic procedure, clean hands effectively with soap and water or ABHR (Strong recommendation, High grade evidence)
2.	Wear clean gloves, rather than sterile gloves, for the insertion of peripheral intravascular catheters, if the access site is not touched after the application of skin antiseptics. (Conditional recommendation, Moderate grade evidence)
3.	Wear either clean or sterile gloves when changing the dressing on intravascular catheters. (Strong recommendation, Moderate grade evidence)
4.	Non- touch technique is always required to maintain asepsis (Strong recommendation, High grade evidence)
5.	If it is necessary to touch key parts or key sites directly, sterile gloves are used to minimize the risk of contamination. (Conditional recommendation, Moderate grade evidence)
6.	Only sterile items contact the key site (Strong recommendation, High grade evidence)
7.	For surgical aseptic procedure a surgical hand scrub is required. (Strong recommendation, High grade evidence)
8.	Sterile gloves are used for aseptic procedures and contact with sterile sites (Strong recommendation, High grade evidence)
9.	Non-sterile gloves are typically the gloves of choice for standard aseptic procedures. (Strong recommendation, High grade evidence)
10.	Wear a surgical mask when placing a catheter or injecting material into the spinal canal or subdural space (i.e., during myelograms, lumbar puncture and spinal or epidural anaesthesia) (Strong recommendation, Moderate grade evidence)

➡️ Rationale
1.1.1.1   The clean hands break any potential transmission of infection from the clinical ward environment to the clean preparation area/room.
1.1.1.2   Effective hand cleaning is vital to reduce the risk of contaminating Key-Parts and Key-sites. The same technique of hand cleaning (covering all surfaces of the hand) should be used when both soap and water or alcohol gel is being used.
1.1.1.3   Wet hands more easily transport bacteria
1.1.1.4   Risk assessment will ensure the correct choice of glove type. (See notes below).
1.1.1.5   Gloves protect the user from exposure to drugs and blood products.
1.1.1.6    In the event the HCW unknowingly touches a Key-part, non-sterile gloves also act as a safety net as gloves will typically be cleaner than skin.
1.1.1.7   A non-touch-technique is the most important aspect of aseptic technique as even if other aspects have been compromised a non-touch technique can still ensure the ultimate aseptic procedure
1.1.1.8   Use a non-touch technique at all times.
1.1.1.9   Identify Key-Parts and remove equipment from packaging carefully.
1.1.1.10    Assemble equipment to be arranged in an organized manner in the aseptic field according to the order of procedures.
1.1.1.11       Ensure Key-Parts are protected at all times.
1.1.1.12       Key-Parts are the critical elements of a piece of equipment that will come into contact with any liquid infusion, Key-Site or other Key-Part connected to the patient or directly involved with the procedure. Contamination of these parts will directly compromise patient safety by providing a direct route of transmission for micro-organisms between healthcare worker and patient.
 
1.1.1.13       Standard Aseptic Technique
 
1.1.1.14       Surgical Aseptic Technique
Surgical aseptic technique practices are required when key-parts / sites are large and numerous or cannot be protected easily using covers / caps or managed with a non-touch technique.
Surgical aseptic technique practices include surgical procedures and/or complex or large dressings, including invasive procedures performed in the operating room, procedure room and in clinical areas, and insertion of vascular access devices such as central lines or epidurals.
 
Table (3): Types of aseptic technique

	Standard AT - Promotes asepsis	Surgical AT - Ensures asepsis
Procedure	Technically simple. Short duration < 20 minutes. Few key sites.	Technically complex. Takes > 20 minutes. Large open key sites.
Aseptic Field	Use general aseptic field and/or critical micro aseptic field.	Use a critical aseptic field and critical micro aseptic field.
PPE	Non-sterile gloves to remove dressing. Sterile gloves if key part at risk of being touched. Apron / face protection as per standard precautions.	Sterile gloves, sterile gown, mask, hair covering, sterile drapes.
Environment	Work surface cleaned with detergent before and after the procedure. e.g. dressing trolley. Cleaning / bed making activities in close proximity are to be avoided.	Work area and surfaces cleaned with detergent before and after a procedure. HCW activity strictly controlled. Environmental risk removed or avoided.

1.2       Indicators for Monitoring
To ensure the effectiveness of aseptic technique practices in hospitals and reduce the risk of HAIs, specific indicators should be monitored regularly. These are some indicators which can provide measurable data to assess compliance, identify areas for improvement, and guide interventions. Here are some key indicators that can be included in hospital guidelines for monitoring aseptic techniques and care bundles implementation:
1.2.1     Overall Aseptic Bundle Compliance Rate: Bundle compliance is an effective approach for monitoring and improving the adherence to aseptic techniques in infection prevention and control. A bundle consists of a set of evidence-based practices that, when performed collectively and consistently, improve patient outcomes.
➡️  Definition: Percentage of clinical procedures in which all elements of the aseptic technique bundle are followed.
➡️ Target: Each organization should set its target according to the strength of recommendation and gap analysis.
➡️  Method of Measurement: Audits of procedures to ensure all bundle components are applied.
 
1.2.2         Compliance with Aseptic Techniques in Clinical Procedures*
➡️  Definition: Percentage of procedures where aseptic techniques are properly followed (e.g., during catheter insertions or wound dressing).
➡️  Target: Each organization should set its target according to the strength of recommendation and gap analysis.
➡️  Method of Measurement: Direct observation and review of procedure checklists.
*Additional analysis: this can be done for each individual component of the bundle to evaluate points for improvement as Hand Hygiene Compliance Rate, PPE Adherence Rate, Sterile Field Integrity Compliance, Equipment Sterilization Compliance, etc….
 
1.2.3             Education and Training as Part of Bundle Implementation
➡️   Definition: Percentage of staff trained on the aseptic technique bundle within the last 12 months.
➡️    Target: Each organization should set its target according to the strength of recommendation and gap analysis.
➡️   Method of Measurement: Review of training logs and competency assessments.
 
1.2.4             Training and Competency Compliance Rate
➡️  Definition: Percentage of healthcare workers who complete aseptic technique training and competency assessments annually.
➡️   Target: Each organization should set its target according to the strength of recommendation and gap analysis.
➡️   Method of Measurement: Training records and competency assessment results.
 
1.2.5             Reporting and Documentation Accuracy
➡️   Definition: Percentage of aseptic technique monitoring activities and results accurately documented.
➡️  Target: Each organization should set its target according to the strength of recommendation and gap analysis.
➡️   Method of Measurement: Review of audit and monitoring records.
 
1.2.6         Reduction in Infection Rates from Bundle Implementation
➡️    Definition: Percentage reduction in infection rates linked to compliance with the aseptic technique bundle.
➡️  Target: Each organization should set its target according to the strength of recommendation and gap analysis.
➡️   Method of Measurement: Analysis of infection rates before and after bundle compliance.
 
1.2.7             Infection Rate Reduction Linked to Aseptic Breaches
➡️  Definition: Reduction in healthcare-associated infection rates associated with breaches in aseptic technique.
➡️   Target: Each organization should set its target according to the strength of recommendation and gap analysis.
➡️   Method of Measurement: Analysis of infection control reports and infection trend data.
 
1.2.8             Environmental Hygiene Audit Score
➡️ Definition: Average score from audits evaluating the cleanliness and disinfection of clinical environments in which procedures are carried out and can impact the procedure.
➡️ Target: Each organization should set its target according to the strength of recommendation and gap analysis.
➡️ Method of Measurement: Routine environmental hygiene audits.
 
1.3       Plan to Update this National Clinical Guideline
1.3.1      This guideline will be reviewed and updated at least every three years, or when new evidence emerges that is likely to influence the recommendations.
 

             Standard AT practices are utilized during procedures such as:

-   venipuncture

-  insertion of a peripheral vascular catheter

-   maintenance of vascular access devices, including line or dressing changes, or medicine administration through these devices

-   blood culture collection.

-   urinary catheterization

-  emptying or changing drainage bag.

-   nasogastric tube insertion / management

-   simple dressings

-   collecting of swabs and other specimens.