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Aseptic Technique

St Mark's IF with AuSPEN
30 - 31 October 2015

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Aseptic Technique

  1. 1. Aseptic Technique: Sue Larsen, CNS- Auckland • Acknowledgment - St Mark’s Intestinal Course
  2. 2. Introduction  Discuss what is meant by an aseptic technique and how it should be performed  Present the evidence base surrounding key aspects of an aseptic technique for the care of central venous catheters
  3. 3. What is an aseptic technique?
  4. 4. Asepsis  “The absence of pathogenic organisms or their toxins from the blood or tissues” Wilson J (1995) Infection Control in Clinical Practice. Bailliere Tindall, London  Difficult to achieve  Pathogenic organisms are present in many different areas of the body
  5. 5. Techniques: definitions Aseptic • Necessary infection control measures to prevent pathogenic micro- organisms on hands, surfaces or equipment from being introduced into susceptible sites during clinical practice Clean • A method involving hand decontamination, maintaining a clean environment, clean non-sterile gloves, sterile instruments and prevention of direct contamination of materials and supplies No touch • A method of manipulation of invasive devices or wounds without directly touching the wound, device, or any surfaces that may come into contact with those sites Dougherty et al (2010) Association for Professionals in Infection Control and Epidemiology (2001)
  6. 6. Aseptic Non Touch Technique Peer reviewed & tested clinical guidelines  Basic infection prevention & control principles Aim to standardize & improve the efficacy of the aseptic technique thereby reducing healthcare associated infections  Standard or Surgical depending on length & complexity of procedure Rowley (1994, 2004)
  7. 7. Aseptic technique: The evidence base  No clinical or economic evidence that any one approach is more clinically or cost-effective than another  All recommendations are Class D/GPP Loveday et al (2014) Loveday et al (2014) UK Department of Health epic3: National Evidence-based guidelines for preventing healthcare-associated infections. J Hosp Infect;86:S1–70
  8. 8. What technique would you recommend for parenteral nutrition?
  9. 9. Standard ANTT  Technically uncomplicated procedures  < 20 minutes in length  Involves small key sites  Minimal key parts Surgical ANTT  Technically complicated procedures  > 20 minutes in length  Involves large open key sites  Large or numerous key sites Principles are the same. The main difference is the complexity of the aseptic field and how it is managed Rowley & Clare (2011)
  10. 10. Key sites in CVC care
  11. 11. Should the technique be standardised?
  12. 12. Current position  The technique should be standardized across the organisation Health and Social Care Act, Department of Health (2008)  A standardised procedure for parenteral nutrition is lacking  Confusing for patients & staff  Could impact upon efficacy  Biggest impact on home care nursing
  13. 13. Which elements of central venous catheter care are evidence- based?
  14. 14. • Fendler et al (2002), Pittet et al (2000)Hand decontamination* • Kaler & Chin (2007), Simmons et al (2011)Disinfectant/method/ time for CVC hubs* • Sweet et al (2012), Wright et al (2013)70% IPA port protection* • Calop et al (2000), Worthington et al (2010)Prefilled syringes • Mitchell et al (2009), Schallom et al (2012)Flushing solution* Evidence based elements of CVC care Loveday et al (2014) UK Department of Health epic3: National Evidence-based guidelines for preventing healthcare-associated infections. J Hosp Infect;86:S1–70
  15. 15. CVC hub disinfection  Single use 2% CHG & 70% IPA  Minimum of 15 seconds  Mechanical friction  Allow to dry for at least 30 seconds Loveday et al (2014) UK Department of Health epic3: National Evidence-based guidelines for preventing healthcare-associated infections. J Hosp Infect;86:S1–70
  16. 16. Aspects of catheter care Aspect of catheter care Number of procedures (%) Disinfection time/method/dry time* No disinfection time/method/dry time 3 (8%) 6 (17%) Flushing solution 0.9% sodium chloride for injection * 0.9% sodium chloride + heparinised saline Heparinised saline only Prefilled syringe* 21 (60%) 13 (38%) 1 (2%) 21(60%) Glove type Sterile Non sterile Not specified None 29 (83%) 2 (6%) 3 (8%) 1 (3%) Needle-free connector protection Gauze & tape 70% IPA protector* 14 (40%) 13 (93%) 1 (7%) * Evidence-based  Supported by national practice guidelines
  17. 17. 70% IPA port protection  Single use protective cover with 70% isopropyl alcohol foam disc  Provides continuous passive disinfection, plus a physical barrier to cross contamination  Initial studies promising in reducing CRBSI Sweet et al (2012), Wright et al (2013)  ?if superior to active disinfection  ?if equally effective on all brands of needlefree connector  ?if all brands equally effective Added to Bionector ® Curos® Port Protector with 70% isopropyl alcohol disc Alcohol disc passively disinfects needlefree connector
  18. 18. Curos® evaluation in HPN patients Phased introduction of Curos® to all HPN patients (n=285)  Patients still to actively disinfect with 2% CHG & 70% IPA  All patients using Vygon Bionector Infection rates decreased at St Mark’s Small (2014) Abstract Infection pre Curos Infection post Curos P value 1.3/1000 CVC days 0.4/1000 CVC days <0.001
  19. 19. How can the efficacy of an aseptic technique be assessed?
  20. 20. Catheter related infection  Monitoring catheter related infection is an important outcome measure  Differences in classifying infection  Specifically catheter related bloodstream infection (CRBSI) & central line associated bloodstream infection (CLABSI)  Availability of culturing methods, & whether catheter tips are available for analysis make direct comparison of infection rates difficult
  21. 21. Assessing inter rater reliability  Infection data for a calendar year were reviewed by 24 raters to assess for variation and agreement with original classification of CRBSI, CLABSI and non systemic infection  12 raters classified the data on 2 occasions  Large observed variation in practice Small et al (2014) Abstract
  22. 22. The ideal procedure… Focus on the principles of asepsis rather than a step by step list of instructions Hospitals should incorporate evidence based recommendations into their procedures