A. Introduction

Welcome to this lesson on sterile technique and infection control. Preventing healthcare-associated infections (HAIs) is critical, especially in high-risk environments like the ICU. This lesson covers the core principles and practices of asepsis, sterile technique, and standard precautions to help protect both patients and healthcare workers. We’ll define key terms and discuss how to apply these concepts effectively.

B. Understanding Asepsis, Sterile Technique, Disinfection, and Sterilization

Understanding the following terms is crucial:

• Asepsis: The absence of microorganisms that cause infection.
• Sterile Technique: Practices that maintain a sterile environment, preventing microorganism introduction into sterile sites.
• Disinfection: Eliminating many or all pathogenic microorganisms (except bacterial spores) from inanimate objects.
• Sterilization: Eliminating all forms of microbial life, including bacteria, viruses, fungi, and spores.

Asepsis is the overarching goal. Sterile technique is a method to achieve it. Disinfection and sterilization are processes that support it. The chain of infection describes how infectious agents spread, and infection control aims to break this chain.

C. Healthcare-Associated Infections (HAIs)

HAIs, especially in the ICU, are a major concern. Common types include:

• CLABSIs: Central line-associated bloodstream infections.
• CAUTIs: Catheter-associated urinary tract infections.
• VAP: Ventilator-associated pneumonia.
• SSIs: Surgical site infections.
• CDIs: Clostridium difficile infections

Risk factors in the ICU include invasive procedures, immunocompromised patients, and prolonged hospitalization. HAIs increase hospital stays, patient suffering, mortality, and healthcare costs. Prevention is paramount.

D. Standard Precautions

Standard precautions are the minimum infection prevention for all patient care. Key components include:

• Hand hygiene
• PPE use (gloves, gowns, masks, eye protection)
• Safe injection practices
• Safe handling of contaminated equipment/surfaces
• Respiratory hygiene/cough etiquette

Hand hygiene is crucial: before/after patient contact, before/after gloves, after body fluid contact. Use soap and water or hand sanitizer. Select PPE based on the risk of exposure. Practice safe injection techniques and handle contaminated materials carefully. Teach patients and visitors about respiratory hygiene.

E. Transmission-Based Precautions

Use transmission-based precautions in addition to standard precautions for known or suspected infections. These include:

• Contact precautions (for infections spread by direct or indirect contact, e.g., MRSA, C. difficile)
• Droplet precautions (for infections spread by large respiratory droplets, e.g., influenza)
• Airborne precautions (for infections spread by small respiratory droplets, e.g., tuberculosis)

Each type requires specific PPE and practices, which will be detailed in a full lesson.

F. Principles of Sterile Technique

Sterile technique prevents microorganisms from entering sterile sites. Key principles:

• Only sterile items contact other sterile items.
• Contaminated sterile items are considered unsterile.
• Create sterile fields on clean, dry surfaces.
• Monitor sterile fields continuously.
• Sterile individuals touch only sterile items; unsterile only unsterile.
• Avoid reaching across sterile fields.
• Keep sterile fields in view.
• Maintain a safe distance (at least 1 foot) from the sterile field.

A full lesson will detail creating/maintaining sterile fields and donning/removing sterile gloves.

G. Procedures Requiring Sterile Technique

Many ICU procedures require sterile technique, including:

• Central/arterial line insertion
• Indwelling urinary catheter insertion
• Tracheostomy care
• Certain wound dressing changes
• Surgical procedures
• Invasive hemodynamic monitoring

A full lesson will provide step-by-step instructions for specific procedures, emphasizing patient and environment preparation.

H. Specific Infection Control Practices in the ICU

The ICU requires specific practices:

• Central line, ventilator, and urinary catheter bundles
• Surgical site infection prevention
• Hand hygiene compliance monitoring
• Environmental cleaning and disinfection
• Antimicrobial stewardship
• HAI surveillance
• Staff education and training

These involve specific components (e.g., hand hygiene, sterile barriers for central lines) and require a multidisciplinary approach.

I. Environmental Cleaning and Disinfection

Cleaning removes visible soil; disinfection eliminates most pathogens. Procedures include routine cleaning, high-touch surface disinfection, equipment cleaning, proper handling of contaminated materials, and spill management. Follow manufacturer’s instructions for disinfectants.

J. Surveillance and Reporting

HAI surveillance methods include active, passive, and laboratory-based surveillance, and chart reviews. Accurate, timely reporting is essential for identifying outbreaks, implementing interventions, monitoring prevention effectiveness, and contributing to national data. Infection control teams play a key role in this process.

K. Documentation

Accurate and complete documentation of infection control practices is essential.