clinical skills - cardiff university · powerpoint content last updated 03/06/2016 13:42:25...

Introduction to Aseptic Technique & Wound Dressing?

Clinical Skills and Simulation Team

PowerPoint content last updated 03/06/2016 13:42:25

Introduction to Aseptic Technique and Dressing a Wound

Clinical Skills

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Introduction

The aim of this module is to facilitate student learning regarding aseptic technique and how todress a simple wound. It has been produced using guidance from the Aseptic Non TouchTechnique (ANTT) guidelines designed by The Association for Safe Aseptic Practice (ASAP) alongwith The Royal Marsden Hospital Manual of Clinical Nursing Procedures and video andphotography from local sources.

Learning Outcomes

At the end of the session the student should be able to:

Describe the principles of ANTT.

Discuss the steps required to prepare the patient and environment when dressing a wound.

Describe the equipment required for carrying out a simple wound dressing.

Define the key aspects of the two types of ANTT and identify when each should be utilised.

Demonstrate in a practical procedure session how to apply a simple wound dressing,employing the principles of ANTT.

Evaluate own knowledge of the principles of asepsis and wound management andformulate an action plan to compensate for any deficits.

Introduction

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Introduction

Thousands of patients every year worldwide suffer harm or die as a direct result of contracting health careassociated infections (HCAI).

Approximately 30% of HCAI’s are likely to have been preventable.

Health care workers themselves are a significant risk factor to the patient when it comes to the transfer of micro-organisms and infection. The level of risk can be minimized by using an effective aseptic technique during anyinvasive procedure or when dealing with any invasive device.

ANTT is a comprehensive practice framework for aseptic technique and is used throughout the UK NHS andwidely internationally. It provides health care workers with logical standardized guidelines to follow whichreduces the variability in practice and supports health care workers to practice safely and efficiently.

Introduction

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Introduction

Most technical dictionaries define asepsis as the ‘absence of micro-organisms’ however, this is not achievable in

typical health care settings. As such the ANTT principle defines Asepsis as:

Free from pathogenic organisms in sufficient numbers to cause infection

This module has been designed to help you understand the concept of asepsis and how to effectively use ANTT inclinical practice.

Introduction

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When using ANTT, asepsis is achieved by Key-Part and Key-Site protection. The aim is to protectKey-Parts and Key-Sites from contamination by micro-organisms which can be transferred by thehealth care worker or the immediate environment.

Asepsis can be maintained during any procedure regardless of circumstance or where it iscarried out. The main concept to remember is that all Key-Parts and Key-Sites need to remainprotected at all times.

Introduction

Introduction

KEY SITES

Any portal of entry on a patient:

• Open wounds• Surgical incisions• Puncture sites• Insertion sites

Example:

• Area that a needle of an injection breaks the skin

• Opening of urethra during catheter insertion

KEY PARTS

Critical parts of procedure equipment that come into contact with active Key-Parts connected to the patient, any liquid infusions or Key-Sites:

• Tip of syringe• Needles• Wound side of

dressing• Intravenous port• Catheter

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Introduction

Introduction

KEY

SIT

ES

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Introduction

Aseptic Non-Touch Technique (ANTT)

KEY

PA

RTS

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Introduction

There are two kinds of ANTT used in clinical practice. The type of ANTT chosen by the health care worker for eachclinical procedure is dependent on the complexity of the procedure and the level of precaution required.

Introduction

STANDARD ANTT

Used for technically uncomplicated invasiveprocedure that involve minimal Key-Parts andsmall Key-Parts, are significantly invasive andare short in duration (approximately <20minutes). Some examples are:

• Simple wound dressings

• Reconstituting and administering certainmedication

• Cannulation

• Venepuncture

SURGICAL ANTT

Used for technically complicated invasiveprocedures that involve large or numerous Key-Parts or Key-Sites, significantly invasive or will takelonger than 20 minutes to complete. Someexamples are:

• Surgical wound dressings

• Any procedure involving incisions through skin

• Placement of central venous lines

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ANTT Risk Assessment



To determine Standard or Surgical-ANTT consider the risks posed by:

• The procedure environment

• Procedure invasiveness

• The number and size of Key-Parts and

Key-Sites

• Operator competency

• Procedure duration

Then ask…

‘To maintain asepsis of Key-Parts and Key-Sites does the main aseptic field need *Critical Management?’

(i.e. *only sterilised and aseptic equipment may come into contact with the aseptic field).

Surgical-ANTT

Standard-ANTT

Yes

No

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The choice of Surgical or Standard-ANTT will then determine equipment selection and technique.


Aseptic field management Glove choice

‘To maintain asepsis of Key-Parts and Key-Sites, does the main aseptic field require Critical Management?’

- General Aseptic Field- Micro Critical Aseptic Fields (MCAF)- Non-touch technique (NTT)- Hand Cleansing- Infective precautions

- Critical Aseptic Field- Critical Aseptic Field Management- Surgical hand scrub- MCAFs & NTT desirable- Infective precautions

‘Can I perform this procedure without touching Key-Parts or Key-Sites directly?’

Non-sterilised gloves

Sterilised gloves

Sterilised gloves

Yes

Yes

No

No

No

STA

ND

AR

D A

NT

TSU

RG

ICA

L A

NT

T

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Principles of Aseptic Wound Dressing Technique

Principles of Aseptic Wound Dressing Technique

Obtain informed consent from patient

Maintain patient comfort and dignity throughout

Decontaminate hands pre and post procedure

Keep exposure of wound to a minimum

Maintain Asepsis throughout

Choose correct type of ANTT and use efficiently

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Preparing to use Aseptic Technique for a Wound Dressing

Preparing to use Aseptic Technique for a Wound Dressing

P

P

P

P

Preparation of AREA

Preparation of EQUIPMENT

Preparation of PATIENT

Preparation of SELF

Four main steps to follow – the 4 P’s:

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Introduction to Aseptic Technique & Wound Dressing?Preparing to use Aseptic Technique for a Wound Dressing

Prior to commencement of any aseptic procedure:

Ensure the surrounding area is tidy and free of any clutter

The procedure environment must be visibly clean and free from dust and visible dirt

Where possible, avoid performing aseptic procedures for a minimum of 30 minutes after bed making ordomestic cleaning has concluded.

Pull screens/curtains around the bed area

Turn off any fans and close windows

Ensure adequate lighting is available

P Preparation of AREA

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You will require:

A suitable and appropriate surface or dressing trolley to use as your aseptic/sterile field

P Preparation of EQUIPMENT

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You will also require:

A sterile procedure pack


Sterile Gauze Swabs

Sterile Sheet

Front Back

Sterile Field

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All equipment and items specific to the procedure to be carried out, e.g. the dressing to be used and cleaning solution for the wound (usually sterile normal saline)


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You will need to:

Clean the surface/trolley to be used following local policy and guidelines (usually with detergent and water or detergent wipes – start at top back of surface/trolley and work your way forward and then down, ensuring every area of the surface/trolley is cleaned thoroughly.

Ensure the surface is completely dry

Check expiry dates, sterility and that all packaging is intact on all equipment and solutions to be used. Always discard equipment which has damaged packaging.


Egg timer symbol indicates expiry date on some equipment

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You will need to:

Place all equipment on the bottom of the trolley or clean convenient area close to where you will beperforming the procedure


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Gather all personal protective equipment (PPE) that you will require, e.g. apron, gloves and mask if required


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Explain the procedure and gain consent from the patient

If necessary, administer analgesia and allow sufficient time to take effect

Check comfort of patient, such as their position and whether they require the toilet

Adjust bed clothes and/or personal clothing to allow easy access to the wound

Ensure that warmth, comfort and dignity of the patient is maintained throughout

P Preparation of PATIENT

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Adhere to local uniform and work wear policy ensuring hair is tied back and no items of clothing or jewellery (apart from a wedding band) are worn below the elbow

Perform hand hygiene in accordance with the hand hygiene policy depending on whether preparing for a standard or surgical aseptic procedure

Put on apron, gloves and any other PPE that may be required as indicated by the patients condition

P Preparation of SELF

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P Preparation of SELF

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Aseptic Technique and Dressing a Wound Video

On clicking Play, you will be re-directed to the Cardiff Player Media Library where you may need to log in using your usual credentials (as you would for Learning Central for example).

Aseptic Technique and Dressing a Wound Video

Or type the following URLinto your browser:

https://hml.cardiff.ac.uk/Play.aspx?VideoId=1655

Play

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Indications for Swabbing Wound

Clinical infection my be indicated when the following symptoms are observed:

Swelling Redness

Heat Purulent Discharge, or Increase in Level of Exudate

Wound Deterioration

Systemic Temperature

Change in Appearance of Tissue, e.g. normal granulation becomes dark and bleeds easily

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Introduction to Aseptic Technique & Wound Dressing?Taking a Wound Swab

Cotton tipped swab with transport medium

Sterile saline (optional)

Single use disposable apron

Single use disposable non sterile gloves

Microbiology Form (with attached bag)

Secondary plastic container – these will be provided in surgery / clinic where swabs are

collected

Robust leak proof container

Taking a Wound Swab – Equipment Required

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Taking a Wound Swab - Procedure

Verbally check the identity of the patient, explainprocedure (including an explanation of theinvestigations to be undertaken) and obtain informedconsent and document in patients care plan

To allow the patient / client to make an informeddecision and gain co-operation to confirm that thepatient is the correct recipient of the procedure

Ensure patient is introduced to staff involved inprocedure by name as this Improves communicationand help reduces anxiety

Give a clear explanation of the procedure to beperformed and the care that will follow to gain patientco-operation and enable informed and understoodconsent to the procedure

Taking a Wound Swab

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Decontaminate hands prior to procedure

Apply single use disposable apron, to protect clothing or uniform from contamination and potential transfer ofmicro-organisms

Apply single use disposable non sterile gloves (remove dressing as appropriate)

Taking a Wound Swab

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All wounds should have exudate, necrotic tissue or excess blood removed prior to swabbing regardless of whatthe swab is for. This removes spurious bacteria associated with non-pathogenic bacteria.

If necrotic tissue, dirt, excess exudate or blood are not present, irrigation/cleansing prior to swabbing is notnecessary.

Taking a Wound Swab

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Moisten the swab with sterile saline before taking sample if the wound bed isdry. (In dry wounds a moistened swab will attach bacteria more effectively).

Use a “zig-zag” motion whilst simultaneously rotating the swab between thefingers to ensure all the swab will contain sufficient amounts of bacteria.

Sample the whole wound surface.

Taking a Wound Swab

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Carefully place the specimen straight into the transport medium.

Continue to redress the wound as per care plan using a clean or aseptic non touch technique whereappropriate.

Taking a Wound Swab

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Summary

Summary

Gain Consent

Prepare Area

Prepare Equipment Prepare Patient

Prepare Self

Minimal exposure of Wound

Maintain patient comfort and dignity

Clean area and reusable equipment

Document procedure in patient

notes

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Introduction to Aseptic Technique & Wound Dressing?Summary

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Images courtesy of The Association of Safe Aseptic Practice (The ASAP) ANTT

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ANTT (2013) Aseptic Non Touch Technique. The Association for Safe Aseptic Practice (ASAP). http://www.antt.org/ANTT_Site/theory.html

NICE (2012) Infection: Prevention and control of healthcare-associated infections in primary and community care (NICE guideline). National Institute for Health and Clinical Excellence. http://publications.nice.org.uk/infection-cg139

Web Resources

Web Resources

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http://www.antt.org/ANTT_Site/theory.html

http://publications.nice.org.uk/infection-cg139


Dougherty, L. and Lister, S. (2011) The Royal Marsden Hospital Manual of Clinical Nursing Procedures (8th edn.). Oxford, UK. John Wiley & Sons Ltd

References

References

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clinical skills - cardiff university · powerpoint content last updated 03/06/2016 13:42:25...

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