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Chapter 5: Aseptic Technique

John S. Rose

INTRODUCTION

The proper use and understanding of aseptic technique are critical for the care of patients in the Emergency Department (ED). Aseptic technique dovetails with prescribed universal precautions and is central to the practice of Emergency Medicine. Knowledge of proper aseptic technique ensures that procedures performed in the ED provide maximal protection for the patient and the Emergency Physician while keeping the risk of contamination as low as possible.1-19

Wound infection and sepsis are the two major complications resulting from poor and improper aseptic technique. Other complications that may contribute to the patient’s morbidity and mortality include increased length and cost of hospital stay, patient discomfort, scarring, and death. Aseptic technique is warranted except in the direst circumstances.

Numerous terms are used to describe the establishment and maintenance of a “sterile” environment. These include aseptic, disinfection, and sterile technique, to name a few. Many people often incorrectly interchange these terms. The proper definitions of the terms used to describe aseptic technique or associated with it can be found in Table 5-1.

TABLE 5-1Definitions of Terms Used to Describe Aseptic Technique or Associated Processes
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TABLE 5-1 Definitions of Terms Used to Describe Aseptic Technique or Associated Processes
Term Definition
Aseptic Freedom from infection. Prevention of contact with microorganisms. Involves the use of sterile technique and skin disinfection.
Clean technique The practice of using nonsterile equipment to perform procedures. This is considered as part of the universal body fluid precautions.
Disinfection The cleaning of an area to make it free of pathogenic organisms and microbes.
Sterile field The zone in which strict sterile technique is maintained. Generally consists of an area 3 to 10 times larger than the area of the primary procedure.
Sterile technique The practice of utilizing sterile equipment and procedures to maintain an aseptic environment.
Super aseptic Ultra-high state of an aseptic environment. Usually, this is achievable only in the operating room.

ANATOMY AND PATHOPHYSIOLOGY

The skin and hair are colonized with various organisms. The stratum corneum layer of the epidermis is colonized with a polymicrobial flora. This includes molds, Staphylococcus aureus, Staphylococcus epidermidis, various Streptococcus species, viruses, and yeasts. Many of these organisms are nonpathogenic, even when placed in environments considered appropriate for infection. S. aureus is the most common cause of wound infections. It can result in an infection when introduced into deeper skin layers. Some species (e.g., S. epidermidis) are pathologic only when inoculated into deeper layers of the skin and soft tissue. A significant inoculation is required for most infections to create a critical level for microbial growth. Aseptic technique decreases bacterial exposure and reduces the level of potentially pathologic organisms.

INDICATIONS

The role of aseptic technique in the ED is primarily for invasive procedures. Invasive procedures require ...

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