Aseptic Technique module

Question 1

Define what aseptic technique is

Answer 1

Aseptic Technique is a method by which the risk of introducing micro-organisms into a sterile body site are prevented or reduced whilst undertaking a healthcare procedure

Question 2

When should aseptic technique be used ?

Answer 2

It should be used during any procedure that bypasses the body’s natural defences.

Question 3

What are the 2 key principles of aseptic technique ?

Answer 3

1. Identifying parts of equipment that if touched could cause infection
2. Identifying parts of equipment that are contaminated and should be decontaminated prior to being used or accessed e.g. intravenous connections, vial tops.

Question 4

The variation of prevention steps needed to achieve an Aseptic Technique depends on what?

Answer 4

1. Whether the procedure is invasive or not
2. Whether the procedure involves placement of an invasive device
3. The time taken for any procedure to be completed (duration increases the possibility of microbial contamination)
4. The likelihood, type and amount of potential microbial contamination from the sources listed above (environment, equipment and human sources)

Question 5

To minimise the risk of microbial contamination during an Aseptic Technique requires steps to control contamination from what 4 main sources?

Answer 5

1. Environmental sources
2. Equipment sources
3. Healthcare workers
4. Patient’s skin

Question 6

What are the WHO 5 moments of hand hygiene ?

Answer 6

1. before touching a patient
2. before clean/aseptic procedures
3. after body fluid exposure risk
4. after touching a patient
5. after touching a patients surroundings

Question 7

What is the purpose of a Peripheral Vascular Catheters (PVCs) ?

Answer 7

They provide vascular access for the administration of fluids and drugs that cannot be given by any other route.

Question 8

What is the most frequently used invasive medical device ?

Answer 8

PVC

Question 9

3 in 4 patients that suffered from a bloodstresm infection had a what in place?

Answer 9

PVC

Question 10

What are the complications associated with PVCs?

Answer 10

insertion site phlebitis and catheter related blood stream infections (CRBSIs).

Question 11

What are the risk factors for increasing the risk of blood CRBSI

Answer 11

• Use of a PVC
• Incorrect aseptic technique during insertion of PVC
• Poor drug preparation and resulting infusate contamination
• Having a pre-exisiting infection
• Excess duration of PVC use - removal should be considered after 72hrs of use

Question 12

How can infection occur during PVC use ?

Answer 12

Micro-organisms can form a biofilm either migrating along the outside of the catheter from the patient’s skin (extraluminally) or intraluminally, from a healthcare worker’s hand.

This can happen at insertion and at any time whilst the catheter remains in situ:

• When the PVC is accessed i.e. during provision of therapy by insufficient decontamination of the access port/ hub
• Infusion of an unsterile drug or infusate
• Depending on the number of microorganisms in the infusion, infection can arise during the infusion, immediately after the infusion, or some time later if the catheter remains in situ.
• Infections can still arise after a PVC has been removed if there is an infection source left inside the vein.

Question 13

What is a biofilm and how does it occur in PVC’s ?

Answer 13

• Soon after insertion, a sheath of biological material can form on the internal surface of peripheral vascular catheter. Microorganisms are able to adhere to elements of this “biofilm” and microorganisms such as Staphylococcus aureus and Candida secrete a slime contributing to the biofilm.
• The biofilm has the ability to protect microorganisms from the effects of antibiotics. If the catheter remains in situ long enough, parts of the biofilm can float into the blood stream giving rise to a CRBSI, which is considered a significant morbidity risk.

Question 14

What are the indications for PVC use ?

Answer 14

1. Diagnostics
2. Resuscitations
3. Medicines
4. Fluids
5. Transfusions

Question 15

Go over the steps for PVC insertion

Question 16

What is a blood culture and what is it important for ?

Answer 16

• A blood culture can be described as a microbiological test of the blood to detect infection with a microorganism, specifically bacteria or candida species.
• It is a vital test in healthcare to rapidly establish whether a patient has bacteraemia and a guide to antibiotic therapy.

Question 17

Define what blood culture sample contamination is

Answer 17

the growth of bacteria in the blood culture bottle which were not present in the patient’s bloodstream and were introduced during sample collection

Question 18

what are the microorganisms which are commonly associated with contamination of blood cultures ?

Answer 18

• coagulase-negative Staphylococcus
• non haemolytic Streptococci
• diptheriods and Corynebacterium species.

Question 19

When is it preferable to take blood cultures ?

Answer 19

before administration of antibiotics, or a change of antibiotic therapy however it is important to note that antibiotic therapy should not be delayed in critically ill patients.

Question 20

What are the important points to remember about blood culture bottles when taking a sample and checking they are okay to use ?

Answer 20

• Should have two bottles - an aerobic and anaerobic
• The rubber stopper on each culture bottle is not sterile despite being covered with a cap. The caps of bottles must be removed and the tops of the culture bottles decontaminated by swabbing with an antiseptic wipe containing 70% isopropyl alcohol and allow to dry prior to inoculating the bottle.
• The bottom of the bottles should be greenish in colour. An orange/red colour indicates prior contamination and the bottle should not be used.
• Should be filled with 8-10ml of blood

Question 21

If less than the recommended amount of blood is collected for blood cultures what should be done ?

Answer 21

Then inoculate the aerobic bottle first with the recommended volume, then put any remaining blood in the anaerobic bottle.

Question 22

What should you avoid taking blood cultures from ?

Answer 22

1. Femoral vein - difficult to clean and avoid contamination
2. Existing PVC
3. Arteriovenous shunt/fistula - do not that arm or hand

Question 23

Go over the steps for blood culture sampling

Question 24

When labelling blood cultures what is it important to make sure you don’t do ?

Answer 24

Do not remove the barcode from the blood culture bottles as theses are needed in the Microbiology department. Bar codes should not be covered.

Question 25

Describe what urinary catheterisation involves and what it is used for

Answer 25

involves the insertion of a catheter into the bladder mainly to drain urine or sometimes to instil fluids or drugs.

Question 26

What is the most common healthcare associated infection(HAI) ?

Answer 26

UTI’s - In acute hospital 22.6% and within non-acute settings 39% (Health Protection Scotland, 2012)

Question 27

What is the main predisposing factor for healthcare associated UTI’s?

Answer 27

The presence of an indwelling urethral catheter

Question 28

What are the risk factors for catheter associated UTI’s?

Answer 28

• Female
• Elderly
• Having an impaired immune system
• A history of previous catheter use
• The duration the catheter is in situ
• The length of hospital stay prior to catheter insertion

Question 29

What are the 3 routes of microbial contamination of a catheter ?

Answer 29

1. When the catheter is inserted - Bacteria that normally colonise the distal urethra may be picked up on the tip of the catheter and pushed into the bladder
2. The peri-urethral pathway - This is when micro-organisms that colonised the distal urethra travel up into the bladder o the outside of the catheter and the inner side of the urethral wall.
3. The intra-luminal pathway - This involve micro-organisms migrating up inside the catheter from the drainage system. As a result of contamination or the drainage bag either through the out-flow tap or due to disconnection of the catheter and the drainage bag.

Question 30

Insertion of urinary catheter should only take place when?

Answer 30

Ifclinically indicated and after discussion with the patient.

Question 31

Go over the steps for urethral catheter insertion

Question 32

Define what a wound dressing is

Answer 32

A wound dressing is a material applied to a wound for a variety of reasons, including promotion of healing, protection, absorption and drainage of exudate, minimisation of pain and control of odour.

Question 33

Define what a wound is

Answer 33

A wound is a breach in the skin’s defences which can therefore result in an invasion of micro-organisms.

Question 34

Go over the steps for wound care