Sterile technique and dressings have been recommended for post-operative management of wounds for 24-48 hours by the Centers for Disease Control and Prevention.22 No recommendations are provided beyond 48 hours for wounds with primary closure.22,23 With critical colonization, the organisms attach to the wound surface, replicate and multiply to a level that affects skin cell proliferation and tissue repair without provoking systemic signs of infection. The difference between sterile and aseptic technique is not properly understood. Here are common characteristics of clean vs. sterile methods: Sterile technique involves hand washing with special solutions and the use of sterile instruments, gloves, towels, and dressings. Stotts NA. These findings from two studies add to a growing body of data that support the use of clean technique and could translate into significant cost savings for Mohs surgeons - up to several thousand dollars a year, by one estimate. In the 90’s the controversy of clean vs. aseptic technique began, the outcome is now the current best practice for intermittent self catheterization. Guideline for Prevention of Surgical Site Infection. St. Louis, MO: Elsevier Mosby; 2012:469-475. change technique (clean vs sterile) in open abdominal surgi-cal wounds and studied 2 groups of patients for 3 to 9 days postoperatively (n = 30). A wound is any break in the skin that can vary from a superficial to a full thickness wound. A Sterile Field is an area created by placing sterile towels or surgical drapes around the procedure site Comment in J Wound Ostomy Continence Nurs. Sterile vs. clean is a judgment call in home care settings ... She and colleagues completed a pilot study comparing sterile to clean technique and found no difference in the healing rates for sterile and clean dressing changes. [Context Link], 35. The efficacy and efficiency of sterile versus clean technique for joint injections has not been studied. Principles of asepsis and clean dressing technique. Clean vs. Sterile Dressing Techniques for Management of Chronic Wounds: A Fact Sheet; Sterile Versus Clean Technique in Postoperative Wound Care of Patients With Open Surgical Wounds: A Pilot Study; Clean Technique or Sterile Technique? clean versus sterile techniques of wound care delivery. Rolstad BS, Bryant RA, Nix DP. 20 APIC News POSITION STATEMENT Clean vs Sterile: Management of Chronic Wounds This document is a collaborative effort of the Association for Professionals in Infection Control and 7. The strength of the evidence for the identified studies was identified as level 2 (1 level A, 3 level B). NEW YORK - Clean, nonsterile gloves are just as effective in preventing infection in Mohs surgery as their more expensive sterile counterparts. Gray M, Doughty D. Clean versus sterile technique when changing wound dressings. 2001;9:178-186. Sterile technique is considered most appropriate in acute care hospital settings, for patients at high risk for infection, and for certain procedures such as sharp instrumental wound debridement.3-5, Clean technique. Sterile versus clean technique in postoperative wound care of patients with open surgical wounds: a pilot study J Wound Ostomy Continence Nurs . Adv Skin Wound Care. The final decision on whether to use sterile or clean technique for wound patients in the home is a matter of judgment and professional experience, Stotts adds. 2003;49:56-60. With clean technique, a clean field is set, but some sterile instruments and package contents may be handled with clean gloves, so the sterile-to-sterile transfers are not practiced. * Initially, solutions such as commercially prepared wound cleansers and normal saline are sterile. Infection and inflammation. [Context Link], 33. Wound care experts do not agree upon this historical assumption and debate as to whether clean or sterile wound care technique is most effective (Faller, 1997; Krasner, 1997; Shewmake, 1996; for Sterile Technique Are unsterile items allowed on the sterile field? Guidance for PPE use in the COVID-19 pandemic. Terms sterile,’ clean’ used inconsistently. Bates-Jensen BM, Ovington LG. Nurses must learn to select clean or aseptic technique, and therefore clean or sterile gloves, using a risk assessment protocol. 2006;33:606-609. When staff are instructed to use clean technique, they are being asked to at least wash their hands with soap and water, to remove all visible dirt from their hands, and to … Sterile environments use antiseptic cleaners, are those working in the industry are typically wearing gowns, gloves, masks and are covered from head to toe. In acute care, sterile gloves were used more than non-sterile for packing wounds, in cases of purulence or tunneling, or for open orthopedic wounds. 2008;21:531-540. There is no defi nitive evidence that sterile technique is superior to clean technique, improves outcomes, or is war-ranted when changing dressings on chronic wounds.8 Insuffi cient evidence is available to determine if there are signifi cant differences in infection rates or healing when wounds are treated using clean or sterile technique.14 The question arises: Should a different technique be utilized in the delivery of wound care based on the health care setting? Health care facilities should develop policies and educational programs for staff to enhance understanding and principles of asepsis, choosing and criteria for performing clean or sterile technique. 15:59-60. 2010;14:14-18. Clean wound dressing technique, as opposed to asepsis, involves the use of a clean procedure field, clean gloves, with sterile supplies, and with avoidance of direct contamination of materials and supplies. Sterile technique and dressings have been recommended for post-operative management of wounds for 24-48 hours by the Centers for Disease Control and Prevention.22 No recommendations are provided beyond 48 hours for wounds with primary closure.22,23In 1994, clinical practice guidelines for pressure ulcer treatment, published by the Agency for Health Care Policy and Research, recommended use of clean gloves and cl… 1997 Jan;24(1):10-8. doi: 10.1016/s1071-5754(97)90043-7. Clean technique refers to the use of routine hand washing, hand drying and use of non-sterile gloves. In: Bryant R, Nix D, eds. Angeras, Brandberg, Falk, and Seeman26 compared the use of sterile saline or tap water for cleaning acute traumatic soft tissue wounds and found that the infection rate in the tap water group was 5.4% compared to 10.3% in the group using sterile saline (p < .05) with a 50% decrease in costs for the tap water group. In: Sussman C, Bates-Jensen B, eds. Wound Care: A Collaborative Practice Manual for Physical Therapists and Nurses. Three factors that were identified as the most influential in glove choice were type of wound, exposed bone, and immunosuppression. Instead of regular hand washing with warm soap and water for a few seconds, sterile techniques require a … Upstream decontamination strategies, device and tool sterilization, sterile garments, clean-forward furniture, and aseptic technique all reduce the probability of cross contamination and ensure a high probability of sterility at each touch point of the workflow. Clean technique is defined as a modified aseptic technique used for certain procedures that acknowledges the use of some non-sterile items/fluids but aims to reduce the risk of contamination by pathogenic (harmful) micro-organisms eg chronic leg ulcer care. Here are common characteristics of clean vs. sterile methods: Sterile technique involves hand washing with special solutions and the use of sterile instruments, gloves, towels, and dressings. A clear available work space. In surgical application, sterile indicates completely free of all microbial forms that can either cause disease, sedation, or fermentation. Indications for use of a clean technique may include: APIC News. [Context Link], 23. The basic principles of an aseptic technique must be adopted and sterile dressing materials used: • Clean gloves rather than sterile are acceptable • Good quality potable (drinking) water rather than sterile saline is acceptable for cleansing traumatic wounds and leg ulcers . Cutting KF, White RJ. It is important to know the difference between clean and sterile, especially if you are in the health, food, or pharmaceutical industry. )Anyway, when we chart there is a place to check clean or sterile among other things. clean versus sterile techniques of wound care delivery. Key terms in every chapter * Aseptic (clean technique) vs. surgical aseptic (sterile technique): When is it appropriate to use clean technique or aseptic technique versus the sterile technique or the surgical aseptic technique? All open wounds have some level of bacterial burden that is ordinarily cleared by the host.9-11, Colonization. Careful adherence to proper technique will avoid common pitfalls and problems. Some of the other factors affecting glove choice included type of dressing, type of drainage, time since surgery, licensure (i.e., registered nurse vs. licensed vocational nurse), agency policy, physician preference, and what they were taught in school. A surgical wound that heals in an orderly and expected fashion may be considered an acute wound. 2001;28:24A-26A. }�� ء����5��~�AHvs���_''����!h©AMCE�B��[Pm�56�K�ÃC����+�������o�$�.���Z� �Z�����6���R�`��4���?�Y����5�G�[‹��!^���R���[\�ܥ�o���I�����!�3��Cs8��r&�8��8�8�E|�E�Fg*�c��q�98���\sn��x��޹>�tv�}�s����0���@�a}�xF�����W�?p o@�����x��}9�$tVh%���P�H�7���[��R�}���ڛ���'pE�6���a�������Z����nRBR]�X�r�����b �N�o����%*!m��2�gRk����A� �d��E��/Tlj�Y�&ђ�]�_���4. We have used clean technique for years-(unless of course it is ordered sterile--or for central line dressings or foley insertion) Our policy does require sterile technique for Stage 3 or 4 pressure ulcers. "The variable is how knowledgeable the person doing the dressing change is. Medical Asepsis or Clean Technique is based on maintaining cleanliness to prevent the spread of pathogenic microorganisms and to ensure that the environment is as free of microbes as possible. Signs of inflammation such as a faint halo of erythema and moderate amounts of drainage might be the only signs of an infected arterial wound.17 Studies have shown that in chronic wounds, increasing pain, friable granulation tissue, wound breakdown, and foul odor have high validity for infection.17,18, Wound. 2. with a clean technique may already be heavily colonised by bacteria. The validity of the clinical signs and symptoms used to identify localized chronic wound infection. Position Statement. Ostomy Wound Manag. Washington DC: National Pressure Advisory Panel; 2009. Flores A. Sterile versus non-sterile glove use and aseptic technique. Also, in 1997, Wise, Hoffman, Grant, and Bostrom surveyed staff nurses (N = 723) in five health care agencies about the use of sterile vs. non-sterile gloves for wound care.31 The authors reported great variations in practice and that acute care nurses used sterile gloves for wound care more commonly than home care nurses. 1997;24:144-150. Acta Palulista de Enfermagem. Only sterile-to-sterile contact is allow. [Context Link]. Type, location, and depth of the wound. In another study, cultures were taken from gauze sponges that were saturated directly on their wrappers on hospital over-bed tables of postoperative surgical patients.28 The saturated gauze showed significant growth of microorganisms. The following factors should be considered when planning and selecting dressing technique for chronic wound care.2,34. Unlock Content Over 83,000 lessons in all major subjects Terms have been used interchangeably and all are subject to individual interpretation. Bowler PG. Clean technique is considered most appropriate for long-term care, home care, and some clinic settings; for patients who are not at high risk for infection; and for patients receiving routine dressings for chronic wounds such as venous ulcers, or wounds healing by secondary intention with granulation tissue.1-7, Aseptic technique. Page . Are sterile gowns and sterile gloves required for clean-contaminated procedures (ie, tonsillectomy, cystoscopy)? 1995;4:195-207. Aseptic technique is not the same as surgical asepsis, also known as sterile technique, which refers to a set of infection control practices that it is necessary to use in operating rooms. 1997 Jan;24(1):10-8. doi: 10.1016/s1071-5754(97)90043-7. Aseptic technique: aseptic technique is commonly used in the operative field in medicine or surgery to prevent infection. Sterile versus clean technique in postoperative wound care of patients with open surgical wounds: a pilot study. b. Clean gloves were used for dressing changes of intact surgical wounds and pressure ulcers. Br J Nurs. * What is clean, what is sterile, and what is contaminated? Nurs Stand. Clean technique does not require the use of sterile instruments and equipment. Clean Vs. Sterile. Sterile technique is a set of procedures and operations intended to create and maintain a sterile environment in support of surgical asepsis. Could I get your feedback about whether your agency uses clean or sterile technique for routine dressing changes in the home. Findings: All 4 studies reported no significant difference in the rate of wound infection when using either clean or sterile technique with dressing application. 1993;39:59-62. 2005;51:28-34. Approximately 70% of chronic wounds have biofilm.9 When organisms adhere to the wound surface, they begin to develop biofilm, which is a complex system of microorganisms embedded in an extracellular, polysaccharide matrix that protects from the invasion of other organisms, phagocytosis, and many commonly used antibiotics and antiseptics. Therefore in practice, clean and aseptic techniques are often used interchangeably. [Context Link], 9. 2010;19:117-120. * Use and maintenance may be based on likelihood of exposure to organisms in the care setting. Methods: A two-group design was used for this pilot study. Accessed March 16, 2011. c. Invasiveness of wound care procedure. Accessed January 29, 2011. 4th ed. 6. A partial thickness wound is confined to loss of the epidermis and partial loss of the dermis; whereas a full thickness wound has a total loss of the epidermis and dermis and can involve the deeper subcutaneous and muscle tissues and/or bone.19,20, Acute wound. 11. Clinical signs of infection include lack of healing after 2 weeks of proper topical therapy, erythema, increase in amount or change in character of exudate, odor, increased local warmth, friable granulation tissue, edema or induration, pain or tenderness, fever, chills, elevated white blood cell count, and elevated glucose in patients with diabetes.9 In patients who are immunosuppressed or have ischemic wounds, signs of infection can be subtle. In all, 82% considered the catheter should be kept sterile while inserted but only 16% described all the prerequisites to achieve this. It is a broad term and sterilization can be considered a part of aseptic technique. Mangram AJ, Horan T, Pearson ML, Silver BS, Jarvis WR. Sterile versus clean technique in postoperative wound care of patients with open surgical wounds: a pilot study J Wound Ostomy Continence Nurs . In: Bryant R, Nix D, eds. Sterile technique and dressings have been recommended for post-operative management of wounds for 24-48 hours by the Centers for Disease Control and Prevention.22 No recommendations are provided beyond 48 hours for wounds with primary closure.22,23, In 1994, clinical practice guidelines for pressure ulcer treatment, published by the Agency for Health Care Policy and Research, recommended use of clean gloves and clean dressings for pressure ulcers as long as the dressing procedures complied with the institution's policies.24 Sterile instruments were recommended for debridement. Biofilms are difficult to treat and eradicate.9 Recently it has been proposed that biofilm might be present in all chronic wounds.12,13. Research is needed to provide an evidence-basis to support either "clean" or "sterile" dressing technique to manage chronic wounds. Ment Health Pract. Doughty DB, Sparks-DeFriese B. Clean versus sterile technique. But, in a practical situation, aseptic and sterile techniques are often interchangeable. The Table addresses dressing technique for chronic wounds.1,2,35. 1997;24:10-8. 1999;20:247-248. Br J Nurs. 95-0652.; 1994. Gardner SE, Frantz RA, Doebbling BN. Aziz AM. Pegram A, Bloomfield J. In 1993, Stotts and colleagues conducted a descriptive, exploratory survey of members of WOCN to obtain information regarding wound care practices in the United States.29 Two hundred and forty-two (242) members responded to the survey. Complexity of the process. Lawson, Juliano, and Ratliff32 in a non-experimental, longitudinal study monitored infection rates and supply costs of all patients with open surgical wounds healing by secondary intention before and 3 months after implementing non-sterile wound care. Patient factors, immune status, acute vs. chronic wound. However, infected wounds should not be primarily closed.21. Unit Two – Clean, Aseptic, and Sterile Technique Learning Outcomes. Prevention of surgical site infections. Sterile Technique: The process is less complex and requires moderate investment compared to aseptic process. As with aseptic technique, Stacy still washes her hands prior to procedures. Wound healing physiology. Adv Skin Wound Care. No "sterile to sterile" rules apply. * Keep items apart by using no touch technique. Author 1 0 obj << /FontFile3 91 0 R /CharSet (/space/O/r/i/g/n/a/t/e/d/B/y/colon/D/C/o/m/p/l/fi/f/c/period) /CapHeight 723 /Ascent 776 /Flags 262178 /ItalicAngle 0 /Descent -243 /XHeight 543 /FontName /HPDMJA+StoneSerif-Bold /FontBBox [ -150 -251 1464 972 ] /StemH 38 /Type /FontDescriptor /StemV 200 >> endobj 2 0 obj << /N 1 /Domain [ 0 1 ] /FunctionType 2 /C0 [ 0.17999 ] /C1 [ 0.05 ] >> endobj 3 0 obj [ /Separation /All /DeviceGray 84 0 R ] endobj 4 0 obj << /Nums [ 0 8 0 R ] >> endobj 5 0 obj << /Filter /FlateDecode /Subtype /Type1C /Length 4426 >> stream Large multi-site, randomized studies across health care settings are needed to insure appropriate patient outcomes are achieved in a cost effective manner that does not compromise patient safety. A sterile technique minimizes the possibility of contamination, and a clean technique attempts to do the same but using a clean field and clean gloves. Infection control perspectives. These terms, which can be obviously used in a medical setting, also apply to the safekeeping of food and other perishable goods that can be attacked by bacteria, fungi or viruses. Infection occurs when organisms on the wound surface invade the healthy tissue, reproduce, overwhelm the host resistance, and create cellular injury leading to local or systemic symptoms.9,14 Infection is often described quantitatively as a bacterial count of greater than 105 colony-forming units (CFU) per gram of tissue.9 However, some organisms such as beta-hemolytic streptococci impair wound healing at less than 105 CFU per gram of tissue.15 According to Kravitz,16 infection should be defined as the presence of bacteria in any quantity that impairs wound healing. There is a paucity of research about clean vs. sterile technique for wound care and studies have varied greatly in their design and findings. Sterile technique for operative procedures is known to carry a greater cost [1]. This technique may also be referred to as non-sterile. Cowan T. Biofilms and their management: implications for the future of wound care. Clean technique involves meticulous handwashing, maintaining a clean environment by preparing a clean field, using clean gloves and sterile instruments, and preventing direct contamination of materials and supplies. Identify and apply the clean, aseptic, and sterile technique required for common OMS procedures. 4th ed. Aseptic Vs Sterile. The Difference Between Clean and Sterile Acute and Chronic Wounds: Current Management Concepts. Clean technique refers to the use of routine hand washing, hand drying and use of non-sterile gloves. Medical asepsis involves confining microbes to specific areas and rendering objects as either clean or dirty.. Medical Asepsis – Basic Principles Landis SJ. * What is the environment in which the care will be delivered? Where a more aseptic/sterile procedure is needed (in the hospital environment), replace the word “clean” below (in bold text) with “sterile.” The wound, any supplies, and the environment should not be contaminated by each other. [Context Link], 34. Date Approved by the WOCN Society Board of Directors: Join NursingCenter on Social Media to find out the latest news and special offers. Wayne, PA: Health Management Publications; 2001:357-367. Stotts NA, Barbour S, Slaughter R, et al. Chronic wound infection and antimicrobial use. Surgical wounds heal by primary closure or are left open for delayed primary closure or healing by secondary closure. Wound care: principles of aseptic technique. Acute & Chronic Wounds: Current management Concepts. [Context Link], 15. Various definitions and descriptions of dressing technique for wound care exist. Clean technique or sterile technique? Acute wounds occur suddenly and are commonly due to trauma or surgery, which triggers blood clotting and a wound repair process that leads to wound closure within 2-4 weeks.14,19, Chronic wound. Sterile technique was performed more frequently in acute care than in other settings. In: Bryant RA, Nix DP, eds. Aseptic technique is the process of maintaining sterility during food processing or medical operation procedures. Ostomy Wound Manag. 2009;55(Suppl):15-18. Philadelphia, PA: Lippincott Williams & Wilkins; 2007:1-26. Clinical Practice Guideline No. Wise LC, Hoffman J, Grant L, Bostrom J. There is no scientific evidence or consensus that any one of these conditions is more or less important in selecting the appropriate method of care for the wound. No touch is a method of changing surface dressings without directly touching the wound or any surface that might come in contact with the wound. [Context Link], 13. Regular audits of aseptic technique and education are needed to improve care. This document originated in 2001 as a joint position statement from a collaborative effort of the Wound, Ostomy and Continence Nurses Society and the Association for Professionals in Infection Control and Epidemiology, Inc.1,2 Its purpose was to review the evidence about clean vs. sterile technique and present approaches for chronic wound care management. [Context Link]. Asepsis, therefore, is defined as the reduction 6. Expert opinion is also divided as to which technique is the most effective. Th e 2 groups were randomized into receiving dressing changes 3 times per day, with either clean or sterile technique application, depending upon their group assignment. Rowley S, Clare S, Macqueen S, Molyneux R. ANTT v2: an updated practice framework for aseptic technique. Two studies examined the strike through contamination in saturated sterile dressings. Ferreira AM, de Andrade D. Integrative review of the clean and sterile technique, agreement and disagreement in the execution of dressing. Alexander D, Gammage D, Nichols A, Gaskins D. Analysis of strike-through contamination in saturated sterile dressings. Definitions A medical researcher wearing sterile gloves, an aseptic technique. 2010;19:S5-S11. [Context Link], 21. a. Clean Vs. Sterile. Sterile technique and dressings have been recommended for post-operative management of wounds for 24-48 hours by the Centers for Disease Control and Prevention.22 No recommendations are provided beyond 48 hours for wounds with primary closure.22,23 In 1994, clinical practice guidelines for pressure ulcer treatment, published by the Agency for Health Care Policy and Research, recommended use of clean gloves and cl… Clean vs. Sterile: Management of Chronic Wounds. An aseptic technique describes a set of procedures conducted to promote germ-free and sterile conditions. Aseptic Vs Sterile. Sterile technique involves meticulous hand washing, use of a sterile field, use of sterile gloves for application of a sterile dressing, and use of sterile instruments. Kravitz S. Infection: are we defining it accurately? [Context Link], 30. [Context Link], 17. Healing and healing rates of chronic wounds in the age of molecular pathogen diagnostics. It was also reported that 90% of patients with open wounds being discharged from hospitals were taught to perform non-sterile technique at home regardless of whether clean or sterile technique was used during hospitalization. sterile versus clean gloves in clinical care. St. Louis, MO: Elsevier Mosby; 2012:270-278. J Wound, Ostomy Contin Nurs. [Context Link]. Sterile technique also tries to prevent the transfer of any microorganisms that remain on equipment or surfaces. 4th ed. No definitive scientific evidence exists to guide the policies of the health care institution. 1992;58:347-350. 10. 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