Reflection of the Aseptic Technique
During my community placement I was given many opportunities to dress wounds, replace catheters and attend to PEG’s, all of which are done using the ‘Aseptic Technique’. For procedures such as pressure sores, leg ulcers, simple grazes’ removing drains or sutures, the ‘clean technique’ is used which is a modified aseptic technique and aims to avoid introducing micro organisms to a susceptible site and also to prevent cross contamination to patients and staff, it differs from an aseptic technique, as the use of sterile equipment and the environment are not as crucial as would be required for asepsis (Gough 2009).
The Aseptic technique is one of a number of procedures that contributes to preventing Health Care Associated Infections (HCAI) and is a means of preventing or minimising the risk of introducing harmful micro-organisms into sterile areas of the body when undertaking clinical procedures (DoH 2008). Especially in hospitals, effort is made to care for surgical or medically vulnerable patients in a fully aseptic way.
However it is a little different practising the aseptic technique out in the community and in a patient’s home as the nature of a home environment can make it difficult to maintain control over any procedure, but particular problems arise when the procedure involves trying to prevent contamination. The DoH (2008) has advocated the use of aseptic technique as one of the fundamental approaches to preventing HCAIs both within a hospital and community setting.
As a result of the increasingly high profile of infection control, nursing staff practicing in the community are being asked to provide assurances that the principles of asepsis are adhered to. Aseptic technique can be divided in to two different processes: surgical asepsis and aseptic non-touch technique (ANTT). Surgical aseptic technique is used within an operating theatre or during invasive procedures within critical care departments. ANTT is a method which is used to prevent contamination of susceptible sites by micro organisms that could cause infection.
This is achieved by ensuring the use of sterile equipment and fluids, effective hand hygiene, sterile gloves and ensuring that any device is only handled by the part which will not be in contact with the susceptible site. There are a number of problems for community nurses, such as maintain a sterile field, being a lone practioner, no dressing trolley and limited access to single-use sterile items. To some extent contamination of the sterile field arises from a break in the aseptic rocedure to perform wound cleansing either because of the use of tap water or because irrigation systems such as pods or aerosol canisters are not sterile on the outside (although the fluid it contains is sterile). The other major constraint relates to having to place the sterile field on furniture within a patient’s home rather than on a clean trolley as it would be rather difficult for nurses to carry trolleys around in their cars. There are a couple of things which are done to reduce the risk of contamination of the sterile field.
Firstly the sterile field is placed at a height which would prevent contamination of the field from skin scales and fibres while changing a dressing and the sterile field should be ideally be placed on a clean table, ensuring that the sterile packs are fit for purpose as Unsworth (2010) clearly states that it is common for manufacturers to incorporate items in to the packs which should be available to the nurse prior to opening the pack as packs contain aprons and gloves may appear to make the process easier but in fact they compromise the integrity of the sterile filed as the nurse has to open the pack before they are able to put the protective equipment on. Gough (2009) stipulates that if aseptic technique is to be performed in a patient’s home as a nurse you must ensure that you have the appropriate equipment to ensure a safe procedure. The sterile field should not be placed on the directly on the floor, a plastic tray could be utilised and could be ‘cold sterilised’ by washing with GPD and hot water, rinsed and dried then wiped with a 70% alcohol wipe. Within any wound care procedure there must be separation of the activity of wound cleansing with tap water, e. g. he washing of a patients leg ulcer and the application of a dressing using an aseptic technique. This separation is achieved using a dressing aid to remove the old dressing together with gloves and a clinical sheet/towel to dry the leg. Once this is completed the aseptic procedure can begin to apply the new dressing. Every case in the district whether medical or surgical, should be carried out with exactly the same aseptic precautions as in hospital Community nurses can be assisted to adhere to the principles of asepsis through the implementation of evidence based procedures which assist them to address the challenges presented by community practice (Unsworth 2010).
