Aseptic Techniques: Practices observed in the clinic/hospital setting (including the laboratory) to protect patients and the staff from being infected with pathogenic micro-organisms and to prevent the contamination of people and their working environment in general.

Antiseptics: Chemical compounds that inhibit growth pathogens and are generally applied to living tissues in the form of wet dressings reams, ointments or other substances that involve prolonged contact with the body.

Aseptic technique aims to prevent pathogenic organisms, in sufficient quantity to cause infection, from being introduced to susceptible sites by hands, surfaces and equipment. (National Health and Medical Research Council, 2010).

Importance of Aseptic Techniques

To provide sterile equipment that should be used properly to exercise strict personal hygiene on the part of the operator (hospital/laboratory staff).

To prevent health care workers and clients from being infected with pathogenic micro-organisms.

To prevent the environment (community) from being exposed to dangerous pathogens from hospitals.

Cleaning and Disinfection

Cleaning of general hospital environment general waste disposal, and laundry.

Use of chemical disinfectants, especially when there is spillage of body fluids.

Heat-disinfection of ward equipment (e.g. bedpans, mop-heads, and clothes) and storing them in dry places after use.

Pre-cleaning of contaminated instruments before disinfection or sterilization.

Skin Disinfection and Antiseptics

Thorough hand washing by hospital/ laboratory staff is essential after any procedure involving close contact with the patient.

Pre-operative disinfection of patient’s skin and for surgical scrubs is mandatory within the operating theatre.

Regular replacement of dilute ‘in-use’ antiseptic solutions so that they are not colonized with gram-negative bacteria.

Ideally, single-use preparations should be used.

Prophylactic Antibiotics

Rational use of antibiotic prophylaxis plays an important role in infection control.

Specific indications include

Peri-operative prophylaxis in gastro-intestinal, gynaecological, and urological surgery.

An antibiotic policy which limits choice of broad-spectrum agents is important.

Personal Protective Equipment

Different activities within the hospital or laboratory require different degrees of protection of staff and patients. For example, clinical coat, aprons, sterile gowns, sterile gloves, headgear, goggles, boots and face-masks (to minimize shedding of micro-organisms).

Plastic aprons and gloves should be used for any ward procedures where there may be soiling, or for barrier nursing of patients with infectious disease

Isolation

It may be necessary to isolate patients (source isolation) to protect others,( e.g. keeping them in cubicles (cubicle isolation).

Hospital and Laboratory Designs

Hospital and laboratory buildings should be designed in such a way that they do not encourage spread of micro-organisms.

Floors, benches, and other surfaces should permit easy cleaning.

The designs should consider minimizing potential hospital-acquired infections especially in operating theatres, laboratories, and air-conditioning systems.

Equipment Selection

Any object or item of equipment for clinical use should be assessed to determine the appropriate method, frequency, and site of decontamination

Personnel Health Records

Staff should receive pre-employment screenings and appropriate immunizations (e.g. Hepatitis B).

All staff including students should receive general health protection.

Disinfectants are chemicals that kill or inhibit all microorganisms except bacteria endospores on inanimate objects.

There are three types of disinfectants.

High-level disinfectants

These are substances that kill all bacteria, viruses, fungi, and mycobacterium tuberculosis.

Some high-level disinfectants are also chemical sterilants and, given sufficient time, will destroy bacterial endospores.

Examples of disinfectants: glutaraldehydes 2% (cidex), sporicidin 2%, chlorhexidine 4%, centrimide 5%, hydrogen peroxide and chlorine 0.5%

Intermediate-level disinfectants

Kill bacteria and most viruses

Examples are: alcohols: isopropyl 60-70%, ethanol 70-90%, methylated spirit 60-90%, iodines and iodophor 10% solutions, povidone – iodine 2.5%, formaldehyde 8%

Low-level disinfectants

Kill some bacteria and some viruses and fungi, but do not kill tuberculosis-causing microorganisms and bacterial endospores.

Examples are: Hydrogen peroxide 3%, Phenolics 1-2%, Dettol, Lysol 5%, Carbolic acid 5%

Common Disinfectant

10% bleach (sodium hypochlorite solution).

10% bleach solution (Common brand name of Jik).

A 10% bleach solution effectively kills/inactivates most common germs, including bacteria (like E. coli, Salmonella), fungi, and many viruses (like influenza, SARS-CoV-2), by destroying their protein structures.

Glutaral

Glutaral is an effective disinfectant against vegetative forms of gram-positive and gram-negative bacteria.

It is also effective against acid-fast bacteria, bacterial spores, some fungi and viruses

Cresol and Soap Solution

Cresol and soap solution (Lysol) is an old preparation which is still widely used in East Africa as a general disinfectant for hospital and domestic use

Lysol is a potent, concentrated disinfectant containing about 50% cresol (a phenolic disinfectant) mixed with soap, acting as a cleaner and germicide for surfaces, instruments, and drains in healthcare settings requiring dilution (e.g. 2-5%) before use for effective, broad spectrum microbial control against bacteria, fungi, and viruses, while needing careful handling due to its corrosive and toxic nature.

Selection Criteria for Disinfectants

Bactericidal not bacteriostatic

Active against a wide range of microorganisms

Not readily inactivated by organic matter (i.e. stable when in contact)

Rapid activity

Non-toxic

Non-corrosive

Non-damaging to equipment/substances treated

Cost-effective and available

Antiseptic or antimicrobial agent (terms used interchangeably): Chemicals that are applied to the skin or other living tissues to inhibit or kill microorganisms (both transient and resident) thereby reducing the total bacterial count.

Antisepsis: Process of reducing the number of microorganisms on the skin, mucous membranes or other body tissues by applying an antimicrobial antiseptic agent.

Common Antiseptics

70% methanol and isopropyl alcohol

70% methylated spirit (absolute methanol) and isopropyl alcohol

These two antiseptics are used for cleansing the skin of micro-organisms prior to venous or capillary puncture in blood collection.

A simple hand-washing antiseptic is made by 2% bleach solution.

Ethanol

It has a bactericidal action against most vegetative organisms at a concentration of 60% and 95%, but is not effective against bacterial spores.

Povidone Iodine

Acts by inhibiting enzymes essential to microbial metabolism.

It kills on contact a broad spectrum of pathogenic bacteria, viruses, fungi, protozoa and yeasts.

Chlorhexidine

An antiseptic which is effective against a wide range of vegetative gram-positive and gram-negative bacteria, although it has no activity against acid fast bacteria, bacterial spores and some viruses.

Cetrimide

A quaternary ammonium disinfectant that has bacterial activity against both gram positive and gram-negative organisms.

Chlorhexidine

An antiseptic which is effective against a wide range of vegetative gram-positive and gram negative bacteria, although it has no activity against acid fast bacteria.

Selection Criterion for Antiseptics

Should be safe and non toxic

Microbial activity should be known

Should have instructions on how to use

Should not have residual effects

Should be cost effective

Should be active against a wide range of microorganisms

Should be stable when in contact with organic matter

Should be effective

Should be easy to procure

Hand hygiene is an action intended to prevent hand-borne infections by removing dirt and debris and inhibiting or killing microorganisms on skin.

Hand hygiene includes care of hands, nails, skin, and the use of lotions and surgical scrub.

Failure to perform appropriate hand hygiene is considered to be a leading cause of nosocomial (hospital-acquired) infections and the spread of multiresistant micro-organisms, and has been recognized as a significant contributor to outbreaks of disease.

Types of hand hygiene

There are four types of hand hygiene with different uses for each. They include:

Routine hand washing

Hand antisepsis

Alcohol hand rub

Surgical hand scrub

Routine Handwashing

Handwashing is a process of mechanically removing soil, debris and organisms from the skin using plain soap and water.

Simple hand wash using soap, water and friction removes 99% of transient bacteria.

Four elements are essential for effective handwashing

Soap

Running water

Friction

Drying

When to perform hand washing

There are specific times when hand washing is required for quality IPC practices.

Hands must be washed before

Examining (direct contact with) a patient/client

Putting on sterile surgical gloves prior to any invasive or surgical procedure

Eating

Hands must also be washed after any situation in which they may become contaminated, such as:

Handling soiled instruments and other items

Touching mucous membranes, blood or other body fluids (secretions or excretions)

Using the toilet

Having prolonged and intense contact with a patient

Removing gloves

Steps for Hand Washing

Step 1

Wet the hands and forearms.

Apply the specified amount of appropriate antimicrobial solution, according to the manufacturer’s recommendations, from the dispenser (one downward stroke action).

Work the cleaning solution into the hands palm to palm, creating a lather.

Step 2

Rub the right palm over the back of the left and vice versa with the fingers interlaced.

Step 3

Rub hands palm to palm, with fingers interlaced.

Step 4

Perform rotational rubbing backwards and forwards with clasped fingers of the right hand into the left palm hand and vice versa.

Step 5

Perform rotational rubbing of the right thumb clasped in the left hand and vice versa.

Step 6

Rub the fingertips of the left hand on the palm of the right hand and vice versa.

Step 7

Continue with the rotating action down opposing arms, working to just below the elbows.

Step 8

Rinse and repeat steps 1-7 keeping hands raised above elbows at all times.

The second wash should only cover two-thirds of the forearms to avoid compromising the cleanliness of the hands.

Local policy may include repeating these steps a third time but to wrists only.

The scrub procedure should last for 5 minutes, with further scrubs during the day lasting 3 minutes.

Step 9

Rinse the hands under running water, allowing the water to run from fingertips to elbows.

Turn the tap off (if necessary) with your elbow and keep your hands up, allowing water to drip from your elbows.

Step 10

Pick up one hand towel from the top of the gown pack and step back from the surface.

Grasp the towel and open it fully. Do not allow the towel to touch any unsterile object or unsterile parts of your body.

Hold your hands and arms above your elbow, and keep your arms away from your body.

Step 11

Holding one end of the towel with one hand dry the fingers of the opposite hand using a blotting rotational motion.

Move to the dry area of the towel and continue in this manner down the forearm to the elbow.

Ensure you do not retrace from the forearm back up to the hands and do not wipe the skin dry. This may contaminate your hands with micro-organisms from your proximal forearm – you will be asked to re-scrub.

Repeat with the other towel from the pack for the other hand and arm.

How to Wash Your

Hands (WHO 2005)

Importance of Washing Hands

Is the most important precaution for the prevention of infections

Washing hands with soap and water eliminates microorganisms from the skin and hands

Hand washing helps stop the spread of germs between patients and between staff and patients.

It protects both the patients and the caregivers

Hand Antisepsis

Removes soil and reduces or slows the growth of both transient and resident flora on the hands.

The technique is similar to plain hand washing except that it involves the use of an antiseptic agent instead of liquid soap.

Hand antisepsis should be performed before

Examining or caring for highly susceptible patients (e.g., premature infants, elderly patients, those with advanced AIDS);

Performing an invasive procedure such as placement of an intravascular device; and

Leaving the room of patients on contact precautions (e.g., flu, hepatitis A or E) or who have drug resistance infections (e.g., methicillin-resistant S. aureus [MRSA]).

Alcohol Hand Rub

This is a liquid solution which removes transient flora and reduces resident flora, for use in place of hand washing.

Sometimes known as antiseptic hand rub

Most contain 60-90% ethyl or isopropyl alcohol, an emollient and often an additional antiseptic, such as chlorhexidine, that has a residual action.

Can only be used when hands are not visibly soiled.

Can remove transient flora, reduce resident microorganisms and protect the skin.

Apply 5 mls of handrub to palm of hand; rub vigorously into hands, especially between fingers and under nails, until dry.

Surgical hand scrub

It is the mechanical removal of soil, debris and transient organisms on hands using liquid soap, running water, antiseptics and friction before surgical procedure.

Wash hands and arms with a non-medicated soap before entering the operating theatre area.

Wash hands also each time they are visibly soiled.

In high risk areas such as the operation room and neonatal ICU, hand scrub protocols that use disposable soft brushes or sponges for a shorter time (at least 2 minutes) should replace harsh scrubbing with hard brushes for 6-10 minutes.

Steps to perform surgical hand scrub

Remove rings, watches and bracelets.

Thoroughly wash hands and forearms to the elbows with liquid soap and water.

Clean under the nails.

Rinse with clean, running water thoroughly.

Apply an antiseptic agent.

Vigorously scrub all surfaces of hands, fingers and forearms for at least 2 minutes.

Rinse hands and arms thoroughly with clean water, holding hands higher than the elbows.

Keep hands up and away from the body, do not touch any surface or article, and dry hands with sterile dry towel or air dry.

Put sterile surgical gloves on both hands.

Indications for

Hand Hygiene

Five moments for

hand hygiene

Barriers for hand hygiene

Administrative/Health care system related

Infrastructure

Resources/supplies

Work load

Health care worker related

Allergies

Nail paint,

Knowledge,

Attitudes, and

Skills.

Products available for Hand Hygiene and Antisepsis

The most widely used hand hygiene products can be classified into the following 3 categories:

Hydroalcoholic liquid rubs.

These rubs contain alcohol (most often ethanol, n-propanol, and isopropanol), which acts as an antiseptic.

They also contain surfactants, which add a wetting, emulsifying, and foaming action, and emollients or other skin conditioning agents to prevent the skin from drying.

Alcohol-based gel rubs.

Another type of hand sanitizing product is the alcohol-based antiseptic in a gel formulation.

These products are very similar in composition to the liquid rubs and have an alcohol content of between 60% and 75%.

The alcohol most often used is ethanol, but some of these products combine ethanol with 1-propanol or 2-propanol.

Antiseptic soaps.

The active ingredients in antiseptic soaps are usually chlorhexidine and triclosan.

Other components used are chloroxylenol, hexachlorophene, iodides such as povidone-iodine, and quaternary ammonium compounds.

GRACIAS!