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Is Sterile Technique Vital in the Cath Lab?
June 2008
The concept of asepsis, or the prevention of microbial contamination, evolved with the development of sterilization. Surgeons learned that all things that come in contact with a wound should be sterile. Following the development of sterilization, other aspects of aseptic technique evolved. These included the refinement of surgical techniques, methods and universal precautions to protect patients and personnel from infection.1
Because of the frequency of community-acquired infections and the potential development of nosocomial infection, the ideal state of an infection-free procedure is not always a reality. Careful attention to the creation and maintenance of a safe and therapeutic environment is mandatory. Knowledge and methods of control are the basis of prevention of infection.1
Aseptic and sterile techniques based on sound scientific principles are carried out primarily to prevent transmission of microorganisms that cause infection. To prevent infection, all possible measures are taken to create and maintain a therapeutic environment for the patient; a single break in technique may result in a potentially fatal complication. Therefore, knowledge of the 10 basic principles of sterile technique and their application can prevent infection. These principles are recommendations for optimal levels of achievable technical and aseptic practice.1
1. Only sterile items are used within the sterile field.
2. Sterile persons are gowned and gloved.
3. Tables are considered sterile only at table level.
4. Sterile persons touch only sterile items or areas; unsterile persons only touch only unsterile items or areas.
5. Unsterile persons avoid reaching over the sterile field; sterile persons avoid leaning over unsterile areas.
6. Edges of sterile containers are not considered sterile once the package has been opened.
7. Sterile field is created as close as possible to the time of use.
8. Sterile areas are continuously kept in view.
9. Sterile persons keep well within the sterile area.
10. Sterile persons keep contact with the sterile field.2,3
In spite of many variables associated with sepsis, people remain the major source of microorganisms in the environment. The skin of patients, cath lab team members and visitors constitute hazards. Hair follicles and sweat glands contain abundant microbial flora. It is estimated that 4,000 to 10,000 possible particles are shed by an average individual’s skin per minute. Microbial shedding is thus contained most effectively by maximum skin coverage.4
Although air is a major vehicle for transmission of pathogens, direct person-to-person contact is the most frequent means by which infection is spread. Human error is a source of contamination that should not be underestimated. If breaks in the sterile technique occur through lack of knowledge or lack of adherence to the principles of sterile technique and their applications, the patient is exposed to a risk that could have been prevented. Any breaks of the sterile process must be readily admitted and corrected. Care, caution, and conscientiousness are essential in the part of all team members. Thorough hand washing is imperative after contact with patients, blood, body fluids, excretions or environmental items. Wearing gloves when handling blood or items contaminated with body substances cannot be overemphasized.5
Even though it is impossible to exclude all microorganisms from the environment, control of the environment is a necessary part of overall infection prevention. With regards to the cath lab, most will agree that procedures are safely done using aseptic technique, but not always under sterile conditions, because all physicians and cath lab personnel should be adhering to the 10 basic principles of sterile technique as previously mentioned. A cardiac catheterization is also known as “clean” invasive procedure, done through a puncture site, whereas most procedures done in the operating room involve many different types of instruments and are entered into the cavity of a patient’s body.
There is no compromise with sterility. In clinical practice, an item is considered sterile or unsterile. Every effort is made to minimize and control the safety of both patients and personnel. The methods by which contaminations are prevented in the catheterization lab are referred to as aseptic technique. These practices are the key to containment of microorganisms. That certainty relies on the fact that all necessary conditions have been met and all factors in the sterilization process have been observed. Although it is impossible to prove that every package is free from bacteria, a single break in technique can compromise the life of a patient. All persons must maintain the high standards of sterile technique they know are essential. Everyone is accountable for his or her own role in infection control.
Because of the frequency of community-acquired infections and the potential development of nosocomial infection, the ideal state of an infection-free procedure is not always a reality. Careful attention to the creation and maintenance of a safe and therapeutic environment is mandatory. Knowledge and methods of control are the basis of prevention of infection.1
Aseptic and sterile techniques based on sound scientific principles are carried out primarily to prevent transmission of microorganisms that cause infection. To prevent infection, all possible measures are taken to create and maintain a therapeutic environment for the patient; a single break in technique may result in a potentially fatal complication. Therefore, knowledge of the 10 basic principles of sterile technique and their application can prevent infection. These principles are recommendations for optimal levels of achievable technical and aseptic practice.1
1. Only sterile items are used within the sterile field.
2. Sterile persons are gowned and gloved.
3. Tables are considered sterile only at table level.
4. Sterile persons touch only sterile items or areas; unsterile persons only touch only unsterile items or areas.
5. Unsterile persons avoid reaching over the sterile field; sterile persons avoid leaning over unsterile areas.
6. Edges of sterile containers are not considered sterile once the package has been opened.
7. Sterile field is created as close as possible to the time of use.
8. Sterile areas are continuously kept in view.
9. Sterile persons keep well within the sterile area.
10. Sterile persons keep contact with the sterile field.2,3
In spite of many variables associated with sepsis, people remain the major source of microorganisms in the environment. The skin of patients, cath lab team members and visitors constitute hazards. Hair follicles and sweat glands contain abundant microbial flora. It is estimated that 4,000 to 10,000 possible particles are shed by an average individual’s skin per minute. Microbial shedding is thus contained most effectively by maximum skin coverage.4
Although air is a major vehicle for transmission of pathogens, direct person-to-person contact is the most frequent means by which infection is spread. Human error is a source of contamination that should not be underestimated. If breaks in the sterile technique occur through lack of knowledge or lack of adherence to the principles of sterile technique and their applications, the patient is exposed to a risk that could have been prevented. Any breaks of the sterile process must be readily admitted and corrected. Care, caution, and conscientiousness are essential in the part of all team members. Thorough hand washing is imperative after contact with patients, blood, body fluids, excretions or environmental items. Wearing gloves when handling blood or items contaminated with body substances cannot be overemphasized.5
Even though it is impossible to exclude all microorganisms from the environment, control of the environment is a necessary part of overall infection prevention. With regards to the cath lab, most will agree that procedures are safely done using aseptic technique, but not always under sterile conditions, because all physicians and cath lab personnel should be adhering to the 10 basic principles of sterile technique as previously mentioned. A cardiac catheterization is also known as “clean” invasive procedure, done through a puncture site, whereas most procedures done in the operating room involve many different types of instruments and are entered into the cavity of a patient’s body.
There is no compromise with sterility. In clinical practice, an item is considered sterile or unsterile. Every effort is made to minimize and control the safety of both patients and personnel. The methods by which contaminations are prevented in the catheterization lab are referred to as aseptic technique. These practices are the key to containment of microorganisms. That certainty relies on the fact that all necessary conditions have been met and all factors in the sterilization process have been observed. Although it is impossible to prove that every package is free from bacteria, a single break in technique can compromise the life of a patient. All persons must maintain the high standards of sterile technique they know are essential. Everyone is accountable for his or her own role in infection control.
Alnettia W. Johnson can be contacted at alnettia.johnson@carolinas.org
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