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Infection Control Practices; 5 steps of Aseptic Technique

Key Infection Control Practices

Understanding key infection control practices will help any CSSD professional understand the importance of indirect patient care and how their responsibilities directly relate to the patient’s care outcomes. Incorporating standard infection control practices in your reprocessing department’s education plan can not only provide powerful and useful knowledge to your team, but also help to prevent injury and illness to both the staff and patients. Hospital acquired infections and surgical site infections are extremely dangerous to patients and can be very costly. Teaching how the five principles of asepsis work can not only eliminate cross contamination potential but help keep the unidirectional workflow of the department in place. CS supports infection prevention by cleaning all devices properly deeming them safe for handling and preparing them for a biocidal process. Having a clear understanding of the links in the chain of infection will help lower the risk of spread and your role in CSSD to prevent the spread.


The Five Principles of Asepsis

  1. Knowing what is dirty
  2. Knowing what is clean 
  3. Knowing what is sterile 
  4. Keeping the 3 conditions entirely separate
  5. Remedy contamination immediately and safely


Knowing What is Dirty

Items that have been used for patient care are considered contaminated. An item is considered to be either contaminated or not contaminated depending on what it has been used on, touched or opened in the environment of direct patient care. For medical device preparers the terms DIRTY and CONTAMINATED are one in the same. Because microbial contamination cannot be seen with the naked eye, however, it can be present even when it is not seen. This is why our role in CS is so important in following standard precautions. Examples of contaminated items include opened instrument sets, surgical instrument trays and devices, single use medical devices like scalpel blades, disposable medical devices like hypo needles, positioning equipment, IV pumps, anesthesia blades and even suction pumps.


Knowing What is Clean

Cleanliness is the basis of aseptic technique. There is clean asepsis and surgical asepsis, which dictate if items are free from all microbes or simply minimizing the amount. Surgical asepsis is when items are sterilized, while clean is simply clean. While mechanical cleaning removes soil and most microorganisms it does not deem an item sterile. Any item that has been properly cleaned via manual or mechanical means is considered clean. If that item has been cleaned with a detergent, disinfectant or thermal decontamination process, it is considered clean and decontaminated. Whether you are cleaning your work surfaces in decontamination or cleaning the instruments you prepare, all of these are considered to be “clean” in the aspect of aseptic practice.


Knowing what is Sterile

Sterility can be defined as the absence of all microbes. Because sterility is impossible to see with our human eye, one cannot look at a specific item and determine its sterility, that is why we use the indicators and tools in CS to help us identify when an items has been exposed to a sterilization process. Extreme caution and careful practices must be adhered, in order for any CS to keep the sterile items with the sterile items and so forth. The absence of microbes can only be achieved by use of sterilization whether it be steam, chemical or gas methods, all should result in the same outcome. Knowing what items are sterile in sterile processing is the basis of what we do everyday and attention to detail in this area is any departments key to success. One failure in this practice could result in infection or even worse for patients.  


Keeping these 3 conditions entirely separate

The first step in maintaining environmental integrity is to control the traffic that passes through the CS, and adhering to best practices in order to keep clean, sterile and dirty areas separated. The physical separation of the functional areas in the department is a key step in ensuring these do not cross contaminate. Another key practice is air flow, humidity control and temperatures ranges to ensure the contaminated air doesn’t flow to the clean areas of the department. There must be a workflow that supports one direction from dirty to clean to ensure the flow of goods is kept up. Lastly the storing of sterile items and clean items in dedicated spaces that are kept free of dirt and dust and moisture will help to keep these separated also.


Remedy contamination immediately and safely

Cross contamination in the CS environment means something that is clean or sterile was contaminated in which it needs to b reprocessed again. The traffic control patterns in the department and keeping a uni-directional workflow will help to avoid cross contamination. When dirty, clean and sterile areas or items have not been separated, the situation must be corrected immediately. There are times when only a cs tech will know or suspect that something may be contaminated and they have to address it immediately. Examples may include a sterile peel pouch falls to the floor, a clean instrument falls to the floor while assembling, a sterile tray is sent to decontamination on the dirty elevator floor, or even the items are opened in patients rooms during the procedure and paced back on the sterile shelf when not used. Anytime something is in question it should be treated as contaminated and reprocessed.