Sterile

Introduction A basic microbiology understanding is important for everyday life. Most people know that covering your mouth with a tissue when you cough or coughing into your sleeve and washing your hands after using the restroom will help protect you and others from illness, but what additional steps are important for the central service (CS) and operating room (OR) personnel to protect themselves and the patients from exposure to harmful pathogens and prevent healthcare-associated Many thanks to the team at 3M Health Care for working with Managing Infection Control to provide the following accredited course. IAHCSMM has awarded one (1) contact point for completion of this continuing education lesson toward IAHCSMM recertification. The CBSPD has preapproved this inservice for one (1) contact hour for a period of five (5) years from the date of publication, and to be used only once in a recertification period. This inservice is 3M Health Care Provider approved by the California Board of Registered Nurses, CEP 5770 for one (1) contact hour. This form is valid up to five (5) years from the date of publication. Instructions for submitting results are on page 89. Managing Infection Control and 3M Health Care will be working collaboratively to provide continuing education courses in monthly editions of Managing Infection Control. Objectives After completion of this self-study activity, the learner will be able to: 1. Name the major types of microorganisms that cause disease and discuss the common steps to identify them. 2. Discuss ways to break the chain of infection and protect yourself and the patient. 3. Describe the difference between cleaning, decontamination, disinfection and sterilization. 4. Determine which instruments or patient care devices require disinfection or sterilization.


standard-ANTT.
Aseptic non-touch technique starts with a few concepts that must be understood before it can be applied. For all invasive procedures, the "ANTT-approach" identifies key parts and key sites throughout the preparation and implementation of the procedure. A key part is any sterile part of equipment used during an aseptic procedure, such as needle hubs, syringe tips, needles, and dressings. A key site is any nonintact skin, potential insertion site, or access site used for medical devices connected to the patients. Examples of key sites include open wounds and insertion sites for intravenous (IV) devices and urinary catheters.
ANTT includes four underlying principles to keep in mind while performing invasive procedures: • Always wash hands effectively.
• Never contaminate key parts.
• Touch non-key parts with confidence.

Preparing and Preventing Infections Using Aseptic Technique
When planning for any procedure, careful thought and preparation of many infection control factors must be considered beforehand. While keeping standard precautions in mind, identify anticipated key sites and key parts to the procedure.
Consider the degree to which the environment must be managed to reduce the risk of infection, including the expected degree of contamination and hazardous exposure to the clinician. Finally, review the expected equipment needed to perform the procedure and the level of key part or key site handling. See Table \

Environmental control
• Recognize and avoid risks in the environment that may increase risk of infection.
• Ensure clean bed linens.
• Monitor patient lines that are near or across work areas.
• Clean surfaces before establishing a work area.
• Keep food and personal items away from working areas. • Use alcohol-based rub until dry, unless hands are visibly soiled or the patient has Cdiff.

Personal protective equipment (PPE)
• Select sterile or clean gloves based on the need to touch key parts or key sites directly.
• Gloves do not replace the need for hand hygiene.
• Gloves (sterile or clean, based on the procedure) • Mask or respirator • Protective eyewear, goggles, or face shield • Gown (sterile or clean, whichever is appropriate)

Aseptic field management
Determine level of aseptic field needed and how it will be managed before the procedure begins: • General aseptic field: Key parts and sites are easily protected. Sterile field does not need to be set up and managed as a key part.
• Critical aseptic field: Key parts and sites are large, numerous, or not easily protected using non-touch technique. Sterile field needs to be established before and managed during procedure.
General aseptic field:

IV irrigation
Dry dressing changes Critical aseptic field: Urinary catheter placement Central line dressing change

Non-touch technique
• Non-touch is the primary goal, even when sterile gloves are used.
• Requires preparation and knowledge of planned procedure sequencing.
• Touching key sites and key parts is limited, purposeful, and only when needed.
• Handling key parts only at the time needed to assemble or use in procedure • Handling syringes away from the hub • Applying bandages by the edges away from key parts that will contact key sites

Sequencing
• Order of procedure requires planning to be efficient, logical, and safe.
• Practicing guidelines give direction as to optimal order from preparation to completion.
• Generally, follow "clean to dirty" standards, working from least to most contaminated key parts and sites.

Use of Gloves and Sterile Gloves
There are two different levels of medical-grade gloves available to health care providers: clean (exam) gloves and sterile (surgical) gloves. Generally speaking, clean gloves are used whenever there is a risk of contact with body fluids or contaminated surfaces or objects. Examples include starting an intravenous access device or emptying a urinary catheter collection bag. Alternatively, sterile gloves meet FDA requirements for sterilization and are used for invasive procedures or when contact with a sterile site, tissue, or body cavity is anticipated. Sterile gloves are used in these instances to prevent transient flora and reduce resident flora contamination during a procedure, thus preventing the introduction of pathogens. For example, sterile gloves are required when performing central line dressing changes, insertion of urinary catheters, and during invasive surgical procedures. See Figure \(\PageIndex{1}\) [1] for images of a nurse opening and removing sterile gloves from packaging.
See the "Checklist for Applying and Removing Sterile Gloves" for details on how to apply sterile gloves.
Video Review of Applying Sterile Gloves [2] Media, iframe, embed and object tags are not supported inside of a PDF.