The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [101]
Postprocedure
11 At the end of the procedure, remove gown and gloves as a single unit by pulling the gown away from you so as to turn it and the gloves inside out (see Action Figure 11a, 11b).
12 Consign reusable gowns as infected linen according to local arrangements. To minimize any risk to laundry workers from contaminated items (NHS Executive 1995, C).
13 After removing the gloves and gown, decontaminate your hands. Hands may have become contaminated (Pratt et al. 2007, C).
Action Figure 3a Open the gown pack with clean hands onto a clean surface. Do not touch the inner packet until after the surgical scrub.
Action Figure 3b Open the inner layer of the pack; use sterile towels to dry hands and forearms if required.
Action Figure 4 Lift up the gown by its inner surface and hold it away from the body.
Action Figure 5 Put one hand into the corresponding sleeve and use the other hand to pull the gown towards you. Your hand should not go beyond the cuff.
Action Figure 6 Put the other hand into the other sleeve. Again, your hand should not go beyond the cuff.
Action Figure 7 The assistant opens a pair of sterile gloves and presents the inner packaging for you to take.
Action Figure 8a Take the gloves, keeping your hands inside your sleeves.
Action Figure 8b Open the inner glove packet on the sterile open gown package so that the glove fingers point towards you.
Action Figure 8c Slide the thumb of one hand (still inside the sleeve) under the folded-over cuff of the corresponding glove.
Action Figure 8d Push your hand through the cuff and into the glove.
Action Figure 8e Pull the glove into position using the other hand (still inside its sleeve).
Action Figure 8f Repeat the process with the other glove.
Action Figure 8g Adjust the fit when both gloves are on.
Action Figure 11a At the end of the procedure, remove gown and gloves as a single unit by pulling the gown away from you.
Action Figure 11b Turn it and the gloves inside out.
Aseptic technique
Evidence-based approaches
Rationale
Aseptic technique is the practice of carrying out a procedure in such a way that you minimize the risk of introducing contamination into a vulnerable area or contaminating an invasive device. Aseptic technique is required whenever you are carrying out a procedure that involves contact with a part of the body or an invasive device where introducing micro-organisms may increase the risk of infection. Note that the area or device on which you are working will not necessarily be sterile – wounds, for example, will be colonized with micro-organisms – but your aim must be to avoid introducing additional contamination.
Aseptic non-touch technique (ANTT®) is the practice of avoiding contamination by not touching key elements such as the tip of a needle, the seal of an intravenous connector after it has been decontaminated, or the inside surface of a sterile dressing where it will be in contact with the wound. An example of non-touch technique is illustrated in Figure 3.5. Gloves are normally worn for ANTT but they are mainly for the practitioner’s, rather than the patient’s, protection. Non-sterile gloves are therefore perfectly acceptable.
Figure 3.5 Avoiding contamination by avoiding contact with the key elements. With permission from ICU Medical Europe S.R.L.
As with other infection prevention and control measures, the actions taken to reduce the risk of contamination will depend on the procedure being undertaken and the potential consequences of contamination. Examples of different aseptic techniques and the measures required for them are given in Table 3.5. It is therefore difficult to provide a procedure guideline that will apply to the whole range of aseptic procedures. To provide a context, the following