Definition of Aseptic Technique
Doctors, nurses, and other healthcare practitioners strive to protect patients from hospital-acquired infections, scientifically termed nosocomial diseases. One way to achieve this is to ensure that the hospital equipment and materials used are sterile. Thus, the aseptic procedure entails medical procedures and practices to limit patients from contracting microbes such as bacteria, fungi, and viruses (Chamberlain, 2021). It focuses on ensuring that both microorganisms are prevented from being acquired by the patients, thus preventing healthcare-associated infections (HCAI). Therefore, it is an important infection prevention method for protecting patients from nosocomial diseases (Woodard et al., 2019). The technique ranges from simple actions such as iodine and alcohol to sterilize skin to surgical asepsis, which entails using gowns, masks, and gloves.
Origin of Aseptic Technique
Aseptic techniques have existed for many years as health practitioners have known the value of sterilizing an area. The method was significantly adopted in the late 19th century. Still, before this, health personnel had started to clean tools, equipment, and locations that needed to be sterile, such as during the performance of surgery. In the 19th century, Louis Pasteur conducted several experiments demonstrating the factuality of the germ theory to disapprove of the idea of spontaneous generation (Thiel, 2017). At around this historical time, anesthesia was being developed which allowed surgeons to perform more complex and longer surgeries, which significantly increased infection risk.
Joseph Lister is considered the founder of antiseptic surgery, as he used phenol as a disinfectant during surgeries. In the 1860s, he sterilized surgical tools and operating theatre with phenol (Chetan, 2021). Joseph Lister would soak the bandages in phenol before dressing the surgical wounds. Although it effectively prevented infection, he failed to spot the importance of asepsis at the historical time. In his Anthrax and tuberculosis study, Robert Kotch identified that specific microorganisms caused particular diseases. In the late 19th and 20th centuries, sterilized gloves and gowns became commonly used (O’donnell et al., 2020). Around 1890, William Stewart Halstead suggested that a company make gloves with the early intention of protecting the nurses’ hands from the detrimental caustic effects of phenol (Abboud, 2017). It became strong that disinfection of the gloves in this technique and adhering to aseptic protocols were superior. Autoclaves became incorporated into sterilizing gowns and gloves, and around 1960, Ansell Company manufactured the first pre-sterilized gloves (Ball & Featherstone, 2020). It was a fundamental stage in the aseptic management of surgical procedures.
Reasons for Performing Aseptic Techniques
A person is predisposed to infection after a skin break, irrespective of it being an accident or a surgical incision. In many medical procedures, there is a predisposition to acquiring HCAI because of the environment or the tools used. A patient’s immune system is compromised, and thus if dirty and contaminated tools are used, they carry microbes past the patient’s immune defense system. The best and safest way to HCAI prevention is to ensure the cleanliness of the environment, equipment, and tools used in the medical procedures (Bennallick, 2018). Thus, this cleanliness is achieved through the aseptic procedure to keep pathogenic microorganisms away from wounds and prevent the patient from acquiring nosocomial infections. Aseptic approaches are crucial in catheter insertion, running intravenous fluids, wound dressing, performing dialysis, inserting chest tubes, performing surgery, and inserting other drainage devices (Thomson & Francis, 2019). These procedures are an accessible entrance through which microbes that would not have entered the body can thus affect body organs; therefore, the fundamental reason for ensuring sterility is to prevent infections.
Benefits of the Aseptic Technique
There are tremendous benefits when a health practitioner considers asepsis in performing medical procedures on a patient. In child delivery, asepsis helps reduce maternal and infant mortality due to infection that may be acquired through sepsis (Thomson & Francis, 2019). Infection may be obtained through the umbilical cord; the aseptic technique significantly helps in avoiding such conditions. Using sterile approaches in catheterization helps prevent many urinary tract infections (UTIs), as ignoring asepsis may transfer pathogens such as Escherichia coli, Proteus spp, and Klebsiella spp (Thomson & Francis, 2019). Asepsis helps avoid the formation of abscesses in suturing wounds, primarily associated with bacterial contamination of wound surfaces. The aseptic routine helps prevent complications such as empyema thoracic, pericarditis, and pneumonia in inserting a chest tube.
Other significances of the aseptic technique can be noted when performing dialysis. It is significant in preventing ascites and reducing the chances of bacteria entering the abdominal cavity (Bennallick, 2018). In administering injections, aseptic procedures are crucial in avoiding sepsis that could result from an individual acquiring microbes from contaminated needles. Some of the flora on the skin is non-pathogenic, but when it gets into the body, it may cause infections. One such organism is Staphylococcus epidermidis which may cause endocarditis, wound infections, sinus infections, and other inflammations (Thomson & Francis, 2019). Ensuring sterility before inserting IV fluid lines prevents such microorganisms from disseminating into the body. Aseptic methods in wound dressing help the faster recovery of the wound and prevent abscess formation.
Operating Room Aseptic Techniques Requirements
The operating room has specific principles that ensure sterility is maintained at the highest level. In the operating area, the scrubbed individuals must operate within the sterile area to avoid contact with the non-sterile members of the surgical unit who are in the periphery (Spruce, 2017). The scrubbed person must wear a mask, sterile gloves, and a surgical gown. Sterile drapes may be used to establish an aseptic barrier essential in minimizing the transfer of microbes from the nonsterile to the sterile areas. It is a necessity that all the items that are used in the sterile area should be clean. Sterile and non-sterile items should never be mixed; when a sterile item touches a non-sterile one, the sterile object is regarded as non-sterile.
Sterilization ensures the highest safety for fluids, sutures, instruments, and drapes void of microbes. All items brought into the sterile field must be opened and transferred by techniques that maintain sterility (Spruce, 2017). The non-sterile personnel must use the proper judgment when transferring sterile items to the sterile area by securely placing them on the sterile field or directly presenting them to the scrub nurse. The sterile area must be monitored regularly to avoid non-sterile individuals and object contamination. The personnel moving within the sterile area must remain close to the site and avoid wandering around the operating room (Suvikas-Peltonen et al., 2017). Unnecessary movement within the space may cause contamination of the sterile field. People should be regularly oriented to the sterile field guidelines to understand how to behave in the operating room appropriately.
Surgical Technologists and Aseptic Technique Performance
The Association of Surgical Technologists has specific recommendations to be followed for bowel technique, catheterization, gowning and gloving, surgical drapes, handling and care of specimens in the operating room, and monitoring sterility. When planning any medical procedures, preparation for infection control factors must be regarded (Spruce, 2017). The personnel must keep standard precautions in thought and acknowledge the anticipated essential parts and sites of the process to be undertaken. They must recognize risks in the environment that may enhance the infection risk. Hand hygiene must be maintained to the highest standards to avoid possible SSIs (Nelson et al., 2019). Sterile gloves must be employed on the essentiality to touch key sites or vital parts directly. It must be noted that clean or sterile gloves do not replace the need for a high standard of hand hygiene. The touching key site should be purposeful, limited, and only when required; sterile gloves must be used.
Medical Students and Aseptic Techniques Performance
Aseptic techniques are crucial in preparing students for future clinical practice. Hawker et al. (2021) revealed that the nursing students showed varied understanding of aseptic techniques but high confidence in performing different methods. Students reported limited opportunities for performing and assessment in clinical placements and universities. A recommendation for education and practice of the aseptic techniques and students must be regularly updated on guidelines for the performance. Dy-Boarman et al. (2018) showed that students watching videos performing aseptic techniques only once did not significantly improve their clinical performance. The students can learn better the aseptic technique when looking at real clinical placements than by watching videos. Adewunmi and Salawu (2021) recommended that lectures and all health care practitioners appropriately guide the students on the recommended aseptic procedures, their performance, and how they can be applied in the clinical setting. It is in line with helping the students become better practitioners in the future and avoid HCAI. Hawker et al. (2020) showed that undergraduate training on aseptic practices requires further scrutiny. It will assist in preparing the nurses and other health care practitioners on how to best use the skills in their clinical practice after graduating.
Surgeons and Aseptic Techniques Performance
Cranioplasty entails skull repair by inserting either a biological object such as bone or a nonbiological object, such as plastic. Sarmast et al. (2017) argued that surgical procedures such as cranioplasty have complications; however, if performed correctly and within the appropriate time under the aseptic technique, a better outcome is pronounced. It thus shows the significance of surgeons adhering to aseptic procedures during operations. George and Stewart (2018) suggested that surgeons’ adherence to the aseptic technique using povidone-iodine reduces postoperative endophthalmitis after cataract surgery. Surgeons occasionally preferring to use intracameral antibiotics must optimize their aseptic techniques, and the surgical team must have the appropriate training. Adhikari et al. (2021) showed that most Surgical Site Infections (SSIs) have antibiotic-resistant bacteria, and thus surgeons have a vital role in prevention. SSIs are top nosocomial infections and a significant cause of mortality in patients who have undergone surgery. Through camera monitoring, Khan and Nausheen (2017) noted that many surgeons and operating room technicians did not srub for the recommended timeline. The surgical scrubbing approach was not based on the recommended guidelines. It is detrimental to patients as it increases the risk of nosocomial infections.
Universal Practice of Aseptic Techniques
Globally, invasive procedures are dependent on healthcare workers and organizations to prevent them infections. Rowley and Clare (2019) showed approximately 1.7 million nosocomial infections in hospitals in the USA and about 100,000 deaths. The sterile and aseptic technique thus remains vital in preventing these mortalities. Hosney (2021) showed that nurses had poor knowledge of preventing infections in hemodialysis patients. It was recommended that nurses undergo continuous education to refresh their understanding of avoiding infection in hemodialysis units. Ogunmola (2022) reported that aseptic technique education among healthcare workers improved their cognition and attitude towards taking caution to counter infections. A positive attitude towards practicing and incorporating aseptic techniques will significantly save many lives. Rowley and Clare (2022) concluded that aseptic cannot be achieved in a home environment and requires proper education with defined clinical practice to enhance the patient’s health. Hui et al. (2017) reported differences when comparing aseptic techniques in teaching and non-teaching community hospitals. Physicians within the teaching hospitals practiced higher standards of aseptic techniques such as handwashing with soap up to the elbow, using sterile drapes, antiseptic solutions, and many other aseptic methods.
Different Approaches to Aseptic Techniques
IN any aseptic technique, there are four main aspects: patient equipment and preparation, contact guidelines, environmental control, and barriers. Aseptic Non-touch Technique (ANTT) is the frequently utilized and globally accepted aseptic technique in healthcare institutions (Rowley & Clare, 2022). ANTT encompasses two types: standard-ANTT and surgical-ANTT. Standard-ANTT is used when performing a technically simple medical procedure that takes a shorter time and involves small entry sites. Surgical-ANTT entails combing set precautions of protecting key areas and critical parts using barrier precautions and sterile drapes. It includes four principles that an individual must never forget when undertaking invasive procedures (Holloway, 2020). The first principle advocates health practitioners always wash their hands thoroughly and effectively. The second one encourages the medical personnel never to contaminate the essential parts and objects used in an invasive procedure. The third advocates for health workers to touch the non-key parts with confidence. The final one encourages them to take the applicable actions to avoid sterile field contamination and tools.
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