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By Root 1984 0

procedure contains steps for changing a wound dressing but is presented as a guide to aseptic technique in general. Local guidance and training should be sought before carrying out specific procedures. Some specific procedures are described in other chapters of this manual.

Table 3.5 Examples of aseptic procedures

Procedure Precautions required

Surgical joint replacement Must be carried out in an operating theatre with specialist ventilation by a team who will wear sterile gowns and gloves, or even full body suits with individual exhaust systems to eliminate airborne contamination

Urinary catheterization Can be carried out in an open ward by a practitioner wearing an apron and sterile gloves

Peripheral intravenous cannulation Can be performed wearing non-sterile gloves and using an appropriate non-touch technique

Procedure guideline 3.9 Aseptic technique, for example, changing a wound dressing

Essential equipment (will vary depending on procedure)

Sterile dressing pack containing gallipots or an indented plastic tray, low-linting swabs and/or medical foam, disposable forceps, gloves, sterile field, disposal bag. Please note that there may be different packs specifically for particular procedures, for example IV packs. Usage and availability of these will vary locally so reference is generally made to ‘sterile dressing pack’

Fluids for cleaning and/or irrigation. Normal saline is normally appropriate

Hypo-allergenic tape (if required)

Appropriate dressing (if required)

Alcohol handrub (handwashing is an acceptable alternative but will take more time and may entail leaving the patient; alcohol handrub is most appropriate for hand hygiene during a procedure as long as hands are physically clean)

Any other material as determined by the procedure being carried out

Any extra equipment that may be needed during procedure, for example sterile scissors

Traceability system for any reusable surgical instruments and patient record form

Detergent wipe for cleaning trolley

Preprocedure

Action Rationale

1 Check that all the equipment required for the procedure is available and, where applicable, is sterile (i.e. that packaging is undamaged, intact and dry; that sterility indicators are present on any sterilized items and have changed colour where applicable). To ensure that only sterile products are used (MHRA 2010, C); to ensure that the patient is not disturbed unnecessarily if items are not available and to avoid unnecessary delays during the procedure. E

2 Explain and discuss the procedure with the patient. To ensure that the patient understands the procedure and gives their valid consent (NMC 2008b, C).

Procedure

3 Clean hands with alcohol handrub or wash with soap and water and dry with paper towels. Hands must be cleaned before and after every patient contact and before commencing the preparations for aseptic technique, to prevent cross-infection (Pratt et al. 2007, C).

4 Clean trolley with detergent and water or detergent wipes and dry with a paper towel. If disinfection is also required (e.g. by local policy), use disposable wipes saturated with 70% isopropyl alcohol and leave to dry. To provide a clean working surface (Fraise and Bradley 2009, E); alcohol is an effective and fast-acting disinfectant that will dry quickly (Fraise and Bradley 2009, E).

5 Place all the equipment required for the procedure on the bottom shelf of the clean dressing trolley. To maintain the top shelf as a clean working surface. E

6 Take the patient to the treatment room or screen the bed. Ensure that any fans in the area are turned off and windows closed. Position the patient comfortably and so that the area to be dealt with is easily accessible without exposing the patient unduly. To allow any airborne organisms to settle before the sterile field (and in this case, the wound) is exposed. Maintain the patient’s dignity and comfort. E

7 Put on a disposable plastic apron. To reduce the risk of contaminating clothing or contaminating the wound or any sterile items from clothing. E

8 Take the trolley to the treatment room or