Visit https://ebookluna.

com to download the full version and

explore more ebooks

(Original PDF) Clinical Psychomotor Skills 5th

Australia

_____ Click the link below to download _____

https://ebookluna.com/product/original-pdf-clinical-
psychomotor-skills-5th-australia/

Explore and download more ebooks at ebookluna.com

Here are some recommended products that might interest you.
You can download now and explore!

Clinical Psychomotor Skills (5-Point) 7th Edition Joanne

Tollefson - eBook PDF

https://ebookluna.com/download/clinical-psychomotor-skills-5-point-
ebook-pdf/

ebookluna.com

(eBook PDF) Clinical Psychomotor Skills (5-Point Bondy):

Assessment Tools for Nurses, 7th Edition

https://ebookluna.com/product/ebook-pdf-clinical-psychomotor-
skills-5-point-bondy-assessment-tools-for-nurses-7th-edition/

ebookluna.com

(Original PDF) Essential Clinical Skills Enrolled Nurses

3rd Australia

https://ebookluna.com/product/original-pdf-essential-clinical-skills-
enrolled-nurses-3rd-australia/

ebookluna.com

(Original PDF) Basic Building and Construction Skills 5th

Australia Edition

https://ebookluna.com/product/original-pdf-basic-building-and-
construction-skills-5th-australia-edition/

ebookluna.com
(eBook PDF) Clinical Sports Nutrition (Australia
Healthcare Medical Medical) 5th Edition

https://ebookluna.com/product/ebook-pdf-clinical-sports-nutrition-
australia-healthcare-medical-medical-5th-edition/

ebookluna.com

Essential Clinical Skills: Enrolled Nurses - eBook PDF

https://ebookluna.com/download/essential-clinical-skills-enrolled-
nurses-ebook-pdf/

ebookluna.com

(eBook PDF) Clinical Dosage Calculations 2nd Edition

Australia

https://ebookluna.com/product/ebook-pdf-clinical-dosage-
calculations-2nd-edition-australia/

ebookluna.com

(eBook PDF) Clinical Nursing Skills and Techniques 9th

Edition

https://ebookluna.com/product/ebook-pdf-clinical-nursing-skills-and-
techniques-9th-edition/

ebookluna.com

(eBook PDF) Clinical Nursing Skills and Techniques 9th

Edition

https://ebookluna.com/product/ebook-pdf-clinical-nursing-skills-and-
techniques-9th-edition-2/

ebookluna.com
 JOANNE Tollefson

Clinical
Psychomotor Skills
A s s e s s me n t s k il l s f or nur s e s // 5 t h E di t ion

Tollefson 5ed SB 9780170216364 CVR 1pp.indd 2 16/05/12 12:57 PM

INTRODUCTION
Nursing bodies in Australia have developed the Australian Nursing and Midwifery Council
(ANMC) National Competency Standards for the Registered Nurse as the minimum requirements
for registration as a nurse (see the current version of these standards in Appendix 1). The
competency standards are instrumental in determining the model for tertiary nursing.
‘Competency’ denotes an entry-level standard for practice across a global range of
nursing activities to uphold, amongst other considerations, legal accountability, patient
rights, safety issues and trust. Although professional pride and the transferability of skills
are two of the outcomes of utilising competency standards, competency is very difficult to
determine when most of the work done by nurses is interpersonal and therefore resists
measurement of output. This difficulty in assessing skill competency is outlined by the
ANRAC below.

Competence is the ability of a person to fulfil the nursing role effectively and/or
expertly. It is an inner, highly differentiated characteristic of a person, which is
applicable to the very demanding and very specific context of nursing. It is an ability
that effectively encompasses the entire demands of the nursing role; and therefore
nursing competence itself possesses a complexity that increases with experience and as
responsibilities become more intricate.
ANRAC Nursing Competencies Assessment Project, 1990, vol. 1, p. 22

Clinical Psychomotor Skills outlines the practical aspects of competencies necessary

for the skill assessment of registered nurses. The text is structured to enable theoretical
knowledge to be applied experientially. This assists students to effectively master the
practical applications of the theory they are learning. The the tools in this book minimise
the difficult in assessing student skill competencies and are already used extensively
throughout Australian nursing schools.

New to this edition

This edition includes five new skills, which were requested by academics and clinicians:
● personal protective equipment
● administering an enema
● stoma care
● height, weight and waist circumference measurement
● pressure area care.
Minor adjustments to some of the skills have been made upon the recommendations of
clinicians and clinical facilitators, students and preceptors, who have kindly critiqued them
and sent their comments to me.

Psychomotor skills assessment

Psychomotor skills are only one aspect of the overall competency of an individual nurse.
Other aspects to be assessed include specialised knowledge, cognitive skills, technical
skills, interpersonal skills and (personal) traits. Students do demonstrate some of these other
aspects when they are performing psychomotor skills, and the observer or expert nurse will
reassess overall performance as new ‘cues’ are added to the dataset of the observation.
From this, over time, an idea about the competencies of the nurse can be derived.
Students as beginner practitioners benefit from guidelines and direction, and need to
have complex interactions simplified into recognisable and achievable steps to enhance
their learning and to reduce any possible distress. If skills are broken down into steps, the
student is better able to concentrate on the complexities of the situation than if the task

INTRODUCTION vii
 were an overwhelming whole. Initially, these skills are taught in the safety of the laboratory
using demonstrations and discussions with the laboratory leader, who is a skilled, current
nursing practitioner. The skills and the linked theory can be read, digested,
conceptualised and discussed before the student attempts a new skill on a vulnerable
person. This increases student confidence and fosters critical thinking.
The information that forms the theory underlying the skills in this book comes from a
number of sources. Nursing fundamentals texts were used as a base, and searches of
various databases found recent, research-based material to make the information as current
as possible. For this edition, any evidence-based material from 2008 to the publication date
that was found has been included. The databases searched were CINAHL, Medline,
Cochrane Library, Joanna Briggs Institute, Proquest 5000, Ingenta and Informit.
Government, medical and health-related websites were accessed for evidence-based
information as well. This edition has benefited from a number of evidence-based summaries
and clinician information releases produced by the Joanna Briggs Institute in 2009–2011.
However, many of the basic nursing-care skills in this book still do not have solid evidence-
or research-based foundations so are carried out following the traditional methods.
The information presented is not exhaustive in relation to the subject but does give the
student and assessor a mutual, basic understanding of the procedure. It is expected that
foundational nursing texts and medical surgical texts will be used to supplement the
material in the theoretical links to practice. Use of diagrams and lengthy explanations have
been minimised to enable the book to be easily carried into and used in clinical and
assessment situations.

Using this assessment tool

This book has been developed to guide the student when learning a new skill, and needs to be
studied in conjunction with the relevant policies and protocols of the facility’s clinical setting.
The knowledge provided here is generic and needs to be adapted to and integrated
with the specific context (i.e., type of facility, geographical location, staff available, shift,
time of day, day of the week, season and so on) and the individual differences between
patients (i.e., age and developmental stage, culture, gender, wellness, needs and desires,
diagnosis, stress levels, ability to communicate and so on).
This book contains many of the major psychomotor skills taught throughout the three
years of an undergraduate-nursing program. It is meant to be used throughout the entire
three years of study, both on clinical placement and theory-building encounters during
semester. At the end of three years, the student will have a record of the skills that have
been assessed and the results they have achieved from the start to the finish of their
nursing education.
This textbook can be used in skills laboratories, or during demonstrations and
discussions by the laboratory leader on various aspects of a skill. It can also be used as a
summative assessment tool by the facilitator or preceptor. In this use, they give structure to
the assessment process so that feedback and comments on the student’s performance can
be more comprehensive, constructive and objective. The facilitator or preceptor can utilise
the student’s individual performance in various areas of each skill as exemplars of the
student’s ability to meet many of the ANMC competencies.
The clinical skills competencies in this book are meant to encompass entire skills, not
just a task or procedure. The student who has had limited exposure to clinical situations
must still demonstrate a level of competence to be deemed competent. The balance and
integration of the skills and knowledge acquired by the student determines their competency, not

viii INTRODUCTION
 within one skill, but as an overall judgement of their readiness for nursing. Students are assessed
on their ability to interact with the patient, to solve problems and to effectively manage the time
and resources at their disposal; they are also assessed on their ability to complete the procedure as
efficiently as possible while cleaning up afterwards and finalising their documentation. Each clinical
skill competency has two or three pages that give an overview of the procedure’s theory, which is
mandatory for the student to know. However, and as noted at the beginning of each part of this
book, the content of each clinical skill is a summary of the most important points in the procedure
and are not exhaustive on the subject. Evidence-based information has been included where it was
available. The student is expected to have read widely, attended laboratory and tutorial sessions
and absorbed the material from them, and discussed issues with the clinical educator or with
registered nurses, to broaden their knowledge prior to implementing a skill in the clinical setting.
In this assessment tool, each criterion is linked to one or more of the cue standards in the
ANMC Competency Standards for the Registered Nurse; the number of the appropriate ANMC
Competency Standard has been written beside each criterion to facilitate linking the student’s
performance with the relevant standard. The facilitator can gather many cues in relation to
one competency standard before giving the student a formal judgement of their performance
and verbal or written observation of their progress for each ANMC Competency Standard.

Performance criteria
The performance criteria have been broken into arbitrary sections. However, the entire
skill should be seamless. If it is at all possible, the student should not be assessed on their
first attempt to complete a procedure. Practice improves performance and fosters
confidence in the student. I decided to use a three-point scale, rather than the five-point
Bondy-rating scale, for simplicity and to decrease the discrimination that the educator
would need to decide between very similar ratings. This is because the distinctions
between like ratings (such as dependent/marginal) are always subjective and debatable,
unless there is a lot of supporting examples for the educators to follow. The criteria for
completion – ‘Competent’, ‘Requires Supervision’ and ‘Requires Development’ – are meant
as a guide for the student in their progress towards becoming a confident and competent
practitioner of nursing. A brief description of the criteria for completion follows:
● ‘Competent’ indicates that the student is able to complete the procedure/skill efficiently
and without any cues from the clinical facilitator. This student can discuss the theory as it
relates to the practical situation for the individual patient. The clinical facilitator would
feel confident that the student is able to perform this procedure, or one similar, without
supervision. This would be equivalent to ‘independent’ on the Bondy scale.
● ‘Requires supervision’ indicates that the student is able to complete the procedure.
However, they may require direction, prompting or more time to complete the skill. The
student can discuss the theory behind the procedure in a general way. Conversely, the
student may be able to complete the psychomotor skill but not discuss the rationale
behind what they are doing. The clinical facilitator would not feel confident allowing the
student to complete this or a similar procedure without at least some supervision. This
would be equivalent to ‘assisted/supervised’ on the Bondy scale.
● ‘Requires development’ indicates that the student is unable to complete the procedure
without assistance from the clinical facilitator. This student has difficulty in linking
theory to the practice. The clinical facilitator would not allow this student to complete
this or a similar procedure without supervision. This would be equivalent to ‘dependant/
marginal’ on the Bondy scale.

INTRODUCTION ix
 I would like to thank Elspeth Hillman, RN, BN, PGCert Ed, MN, who has assisted in the
research of the skills and who has acted as my clinical sounding board for each skill, for
her significant contributions to this edition.
I would also like to thank Dr David Lindsay and Dr Lee Stewart and their staff at James
Cook University School of Nursing and Midwifery for providing support during the revision
of this book.
I hope that you find this book helpful in the development of clinical skills – so that you
can provide excellent care to your patients.

Joanne Tollefson
RN, BGS, MSc, PhD

RESOURCES ACCOMPANYING THIS TEXT

For Students - www.cengagebrain.com
Login through Cengage Brain for access to student skills preparation quizzes. These
quizzes test your knowledge and understanding of the skills in each chapter. The marking
system gives instant feedback to assist with revision.

For Instructors
The Instructor companion website, accessible from http://login.cengage.com, contains an
instructor’s manual to guide tutors and instructors in understanding and assessing a
student’s preparedness for the clinical environment.

Clinical Nursing Skills DVD: This DVD provides relevant and engaging visual teaching
demonstrations to match all of the skills covered in the text.

ABOUT THE AUTHOR

Joanne Tollefson (RN, BGS, MSc, PhD) was a Senior Lecturer at the School of Nursing
Sciences at James Cook University. She is a registered nurse with many years of clinical
experience in several countries and extensive experience in nursing education at both
the hospital and tertiary levels. Research interests include competency-based education
and clinical assessment, development of reflective practitioners for a changing work
environment, chronic pain and arbovirus disease in the tropics. Joanne is also a two-time
recipient of the National Awards for Outstanding Contributions to Student Learning (Carrick
Award, 2007 and Australian Teaching and Learning Council Award, 2008).

ACKNOWLEDGEMENTS
The publisher would like to thank the following reviewers for their incisive and helpful
comments:
Maree Bauld Victoria Kain Jacqui Sawle
Teresa Downer Jackie Lea Monica Schoch
Julie Harris Karen Livesay Carol Thorogood
Fiona James Sandra Oster Matthew Walsh

x INTRODUCTION
PART 1

Aseptic technique
1 Hand hygiene
2 Personal protective equipment
3 Aseptic technique
4 Surgical scrub
5 Gowning and gloving

Note: These notes are summaries of the most important points in the assessments/procedures, and are not exhaustive on the subject. References of
the materials used to compile the information have been supplied. The student is expected to have learned the material surrounding each skill as
presented in the references. No single reference is complete on each subject.

1
 1
Hand hygiene
Indications
Hand hygiene is a basic infection-control method that reduces the number of micro-organisms on the
hands, reducing the risk of transferring micro-organisms to a patient. Hand hygiene encompasses both
handwashing and use of alcohol-based hand rub (ABHR). Hand hygiene reduces the risk of cross-
contamination, i.e., spreading micro-organisms from one patient to another. Hand hygiene reduces the
risk of infection among health-care workers and transmission of infectious organisms to oneself. Hand
hygiene must occur at the start of and end of each shift, prior to and following each incident of patient
contact, or contact with any contaminated or organic material including body fluids, excreta, non-intact
skin and wound dressings, equipment, before moving from a contaminated body site to a clean body site
during patient care, before donning gloves and after their removal, before preparing medications or food,
following use of the toilet, and prior to and following meals (Smith, Duell & Martin, 2012). WHO (2009)
condense these times into ‘5 moments of hand hygiene’ which are: 1) before touching a patient; 2) before
a procedure; 3) after a procedure or body fluid exposure risk; 4) after touching a patient; and 5) after
touching a patient’s surroundings. Grayson et al. (2009) recommend an additional ‘moment’ – after
removal of gloves. Contact with contaminated hands is a primary source of nosocomial infection.
Handwashing with soap and warm water is undertaken if there is visible soil or following gross
contamination of the hands. Smith, Duell and Martin (2012) recommend that handwashing with soap
and water be used every third time the hands are cleansed.

Preparation of hands
This includes inspection for any lesions and removal of jewellery (rings, bracelet, watch). These
precautions protect both the nurse and the patient. Inspection for any lesions (open cuts, abrasions) will
allow the nurse to select the appropriate soap or handwashing solution and will dictate whether further
precautions – for example, gloving or non-contact (some agencies prevent nurses with open lesions from
caring for high-risk patients) – are needed. Jewellery harbours micro-organisms in its nooks and
crannies, and between the jewellery and the skin. Removing jewellery will reduce the number of micro-
organisms to be removed and provide for greater access of soap and friction to the underlying skin, as
well as protecting valuable property from damage during the course of care. A simple wedding band may
be left on, but must be moved about on the finger during washing so that soap and friction are applied to
the metal and to the underlying skin to dislodge dirt and micro-organisms. Even a simple band should be
removed in any high-risk setting (NHMRC, 2010). Prior to handwashing, protective clothing should be put
on as necessary so that touching hair or clothing does not later contaminate clean hands. Long or
artificial nails, or nails with chipped or old nail polish, harbour four times the micro-organisms than either
unpolished or freshly polished nails do, so nails should be clipped short and nail polish removed (Grayson
et al., 2009). NHMRC (2010, p. 42) emphasises that it is the patient’s right to question health-care workers
about their performance of hand hygiene.

Gather equipment
For hand hygiene the following are needed.
● Running water – ensure it can be regulated to warm, as this is less damaging to the skin than hot
water, which opens pores, removes protective oils and causes irritation. Cold water is less effective
at removing micro-organisms and can be uncomfortable.
● The sink – a convenient height and large enough to minimise splashing since damp uniforms/
clothing allow microbes to travel and grow.
● Soap or an antimicrobial solution – used to cleanse the hands. The choice is dictated by the condition
of the patient. Antimicrobial soap is recommended if the nurse will attend immunosuppressed
patients or the pathogens present are virulent. A convenient dispenser (preferably non-
hand-operated) increases handwashing compliance.
● Paper towels – preferred for drying hands because they are disposable and prevent the transfer of
micro-organisms. Ensure removal without contaminating the remaining paper towels, which could
lead to cross-infection (Dougherty & Lister, 2011).
● An orange stick – this (or similar device) may be required for cleaning under fingernails.

2 PART 1: ASEPTIC TECHNIQUE

 Handwashing
Turning on the water flow
Using whatever mechanism is available (hand, elbow, knee or foot control), establish a flow of warm water
to rinse dirt and micro-organisms from the skin and flush them into the sink.

Thoroughly wet hands and apply soap

When wetting hands, do not touch the inside or outside of the sink. The sink is contaminated and touching
it will transfer micro-organisms onto the nurse’s hands. Care must also be taken not to contaminate the
taps, sink or nozzle of the soap dispenser with dirt or organic material which is washed off the hands
(Dougherty & Lister, 2011). Wet hands to above the wrists. Keep hands lower than elbows to prevent water
from flowing onto the arms and, when contaminated, back onto the cleaner hands. Add liquid soap or an
antimicrobial cleanser – five millilitres is sufficient to be effective; less does not effectively remove
microbes and more would be wasteful of resources. If only bar soap is available, lather and rinse the bar
to remove microbes before you start to wash your hands, and do not put the bar down until you have
sufficient lather to last the duration of the wash. Lather hands to above the wrists.

Cleaning under the fingernails

Under the nails is a highly soiled area and high concentrations of microbes on hands come from beneath
fingernails. The area under the nails should be cleansed of debris with either an orange stick or the nails
of the opposite hand. Some authors suggest cleansing the nails prior to washing; others suggest that
cleansing during washing is more effective. Cleaning this area under flowing water is most effective for
removing debris.

Washing hands
Lather and scrub your hands for at least 15 to 30 seconds before care or after care if touching ‘clean’
objects (clean materials, limited patient contact such as pulse taking), and one to two minutes if engaged
in ‘dirty’ activities (Larsen & Lusk, 2006) such as direct contact with excreta or secretions. This provides a
clinical or medical aseptic hand wash.
Scrub one hand with the other, using vigorous movements since friction is effective in dislodging dirt
and micro-organisms. Pay particular attention to palms, backs of hands, knuckles and webs of fingers.
Dirt and micro-organisms lodge in creases. Lather and scrub up over the wrists and onto the lower
forearm to remove dirt and micro-organisms from this area. The wrists and forearms are considered less
contaminated than the hands, so they are scrubbed after the hands to prevent the movement of micro-
organisms from a more contaminated to a less contaminated area. Repeat the wetting, lathering with
additional soap and scrubbing if hands have been heavily contaminated.

Rinsing hands
Rinse the forearms, hands and fingers, in that order (Laws, 2009) under running water to wash micro-
organisms and dirt from the least contaminated area, over a more contaminated area and off into the
sink. Rinse well to prevent residual soap from irritating the skin. (Note: general hand-washing differs here
from the surgical scrub of the hands.)

Drying hands
Using paper towels, pat the fingers, hands and forearms well to dry the skin and prevent chapping. Damp
hands are a source of microbial growth and transfer, as well as contributing to chapping and then lesions
of the hands.

Turning off taps

Using dry paper towels, turn hand-manipulated taps off, taking care not to contaminate hands on the sink
or taps. Carefully discard paper towels so that hands are not contaminated. Turn off other types of taps
with a foot, knee or elbow as appropriate. Apply lotion to hands to prevent chapping. Chapped skin
becomes a reservoir for micro-organisms.

Alcohol-based hand rub (ABHR)

Hands must be visibly clean and dry prior to using the ABHR. Hand hygiene using a waterless ABHR has
been demonstrated to reduce the microbial load on hands when 3 ml of the 60–80 per cent ethanol-based

1 Hand hygiene 3
 solution is vigorously rubbed over all hand and finger surfaces (use the same attention to the palms, back
of the hands, finger webs, knuckles and wrists as during the traditional hand wash) for 10–30 seconds,
until the hands are thoroughly dry. The use of ABHR is effective for minimally contaminated hands. Use of
ABHR increases compliance and reduces skin irritation. Messina, Lindsey, Brodell, Brodell and Mostow
(2008) state that the rate of cutaneous adverse reactions is 0.47 per cent, much less than the 20 per cent
claimed for soap or antiseptic solution hand washing. Thorough handwashing is still required for
contaminated hands or following ‘dirty’ activities (Pincheansathian, 2004; Morritt et al., 2006). ABHR is
more expensive than soap or antiseptic hand washing solutions, but has been demonstrated to save time,
increase compliance and reduce infections (Messina et al., 2008). Rathnayake (2011, p. 2) recommends
using ABHR routinely in preference to washing with soap and antiseptic solutions and water when the
hands are minimally contaminated.
Part of hand hygiene is the maintenance of healthy and intact skin. Moisturising the hands contributes
to healthy skin (NHMRC, 2010, p. 41) and restores moisture and oils that repeated use of soaps or ABHR
remove. Hand moisturisng reduces chapping and drying and should be undertaken as frequently as is
individually necessary. Applying the lotion prior to breaks and while off-duty is a good beginning.
Emollients that are compatible with the ABHR or the antiseptic soap in use in the facility should be
employed to ensure there is no reduction in the effectiveness of either.

References
Crisp, J. & Taylor, C. (Eds.). (2009). Potter & Perry’s fundamentals of nursing (3rd Australian ed.). Chatswood, NSW: Mosby Elsevier.
Dougherty, L. & Lister, S. (Eds.) (2011). The Royal Marsden Hospital manual of clinical nursing procedures (8th ed.). Oxford: John Wiley & Sons.
Grayson, L., Russo, P., Ryan, K. et al. (2009). Hand hygiene Australia manual. Australian Commission for Safety and Quality in Health Care and
World Health Organization.
Hogston, R. & Marjoram, B. (2011). Foundations of nursing practice – themes, concepts and frameworks (4th ed.). London: Palgrave Macmillan.
Larson, E. & Lusk, E. (2006). Evaluating handwashing technique. Journal of Advanced Nursing, 10, 546–50.
Laws, T. (2012). Chapter 32: Infection Prevention and Control. In A. Berman, S. Snyder, T. Levett-Jones, T. Dwyer, M. Hales, N. Harvey, …
D. Stanley, Kozier & Erb’s fundamentals of nursing (2nd Australian ed., Vol. 2, pp. 739–792). Frenchs Forest: Pearson.
Messina, M., Lindsey, A., Brodell, B. A., Brodell, R. M. & Mostow, E. N. (2008). Hand hygiene in the dermatologist’s office: To wash or to rub?
Journal of the American Academy of Dermatologists, 59, 1043–9.
Morritt, M. L., Harrod, M. E., Crisp, J., Senner, A., Galway, R., Petty, S., et al. (2006). Handwashing practice and policy variability when caring
for central venous catheters in paediatric intensive care. Australian Critical Care, 19(1), 15–21.
National Health and Medical Research Council (NHMRC). (2010). Australian guidelines for the prevention and control of infection in healthcare.
Commonwealth of Australia.
Pincheansathian, W. (2004). A systematic review of the effectiveness of alcohol-based solutions for hand hygiene. International Journal of
Nursing Practice, 10, 3–9.
Queensland Health (2010). Infection control guidelines, p. 5. Accessed 15 June 2012 at http://www.health.qld.gov.au/chrisp/ic_guidelines/
contents.asp.
Rathnayake, T. (2011). Evidence summary: Asepsis: Clinician information. Adelaide: Joanna Briggs Institute.
Rathnayake, T. (2011). Hand hygiene and alcohol based solutions. Adelaide: Joanna Briggs Institute.
Smith, S. F., Duell, D. J. & Martin, B. C. (2012). Clinical nursing skills: Basic to advanced skills (8th ed.). Upper Saddle River, NJ: Pearson.
World Health Organization. (2009). Guidelines on hand hygiene in healthcare. Geneva: Author.

4 PART 1: ASEPTIC TECHNIQUE

CLINICAL SKILLS COMPETENCY

HAND HYGIENE
Demonstrates the ability to effectively reduce the risk of infection by handwashing/
performing hand hygiene

Performance criteria C S D
(numbers indicate ANMC National Competency Standards for the (competent) (requires (requires
Registered Nurse) supervision) development)

1. Identifies indication (2.5, 4.2, 9.5)

2. Prepares and assesses hands (2.5, 3.2, 9.5)

3. Gathers equipment (7.1, 7.3)

●
warm, running water
●
soap
●
paper towels
●
or alcohol-based hand rub

4. Turns on and adjusts water flow (2.5, 3.2, 9.5)

5. Wets hands, applies soap (2.5, 3.2, 9.5)

6. Cleans under the fingernails (2.5, 3.2, 9.5)

7. Thoroughly washes hands (2.5, 3.2, 9.5)

8. Rinses hands (2.5, 3.2, 9.5)

9. Dries hands (2.5, 3.2, 9.5)

10. Turns off the water (2.5, 3.2, 9.5)

11. Demonstrates ability to link theory to practice (3.2, 4.1, 4.2)

Student:

Educator: Date:

1 Hand hygiene 5
 Visit https://ebookluna.com
now to explore a diverse
collection of ebooks available
in formats like PDF, EPUB, and
MOBI, compatible with all
devices. Don’t miss the chance
to enjoy exciting offers and
quickly download high-quality
materials in just a few simple
steps!
 2
Personal protective equipment
Indications
Preventable infections associated with health care produce pain and suffering for the patient and family,
prolong health care stays and create an economic burden on the health system (NHMRC, 2010, p. 7).
These infections occur in all settings that involve patient care (e.g., acute care, long-term care, child care,
office-based care) and their prevention is a critical aspect of nursing care.
The following factors all influence the risk of infection following exposure to pathogens:
● the health status of the patient
● their immune competence
● their age (e.g., neonates and the aged are more susceptible to infection)
● the virulence of the pathogen
● the length of stay in the hospital
● the length of exposure to the pathogen (e.g., surgical procedures, indwelling catheters).
People can harbour pathogens without signs or symptoms of disease. Personal protective equipment
(PPE) is worn to prevent transmission of infection from the reservoir of infection to a susceptible host
(i.e., from patient to nurse, from nurse to patient or from nurse to his/her own family/friends as well as
from the patient to his/her family and friends and vice versa). Some patients’ family and friends will
need to be taught how to use PPE.
Using PPE is part of the ‘standard precautions’ used in health-care facilities, many or which have a
system (e.g., cards, colour coding, care plan notations) to assist in determining the level of risk, and the
equipment needed for various patients and for procedures.
Personal protective equipment refers to a number of barriers, used either singly or in combination, to
interrupt the transmission of contaminated material. These are used when, in the clinical judgement of the
nurse, there is a risk of: transmitting an infection to a patient; contaminating sterile materials (e.g., when
preparing medications, intravenous fluids); or danger of exposing the nurse’s mucous membranes, eyes,
respiratory tract, areas of broken skin or clothing to another person’s bodily secretions, blood, excretions
or other body substances. The decision to use the equipment is based on an assessment of the risk of
exposure to blood or other bodily fluids, the mode of transmission of the micro-organism and the body
substance involved.

Gather equipment
This is done prior to initiating interaction with the patient or visitors and is dependent on the procedure
to be undertaken and the clinical judgement of the nurse as well as hospital policy. A thorough
understanding of the modes by which infection is transmitted is necessary to apply infection prevention
measures and therefore the use of PPE.
Equipment includes the following.
● Goggles or safety glasses plus surgical masks or a full face shield – required when there is a risk
of airborne, droplet or spray contamination of the mucous membranes (eyes, nose, mouth) of
the nurse, which are portals of entry for pathogens. They are rigid plastic and usually reusable and
are used for procedures involving the respiratory tract or for procedures that generate splashes and
sprays (NHMRC, 2010, p. 49) and are put on before scrubbing.
● Surgical masks – fit loosely over the mouth and nose and are only used once. They are fluid
resistant. They prevent splashes from reaching the nurse’s mouth and nose, and provide some
protection from a droplet spreading infection. They also protect the patient from droplets expelled
from the nurse’s respiratory tract (Xue, 2010a). Disposable masks are preferred. The top of the
mask has a metal strip embedded in the band. To apply the mask, place it across the bridge of the
nose and tie the upper ties behind the head (or loop them over the ears and tie under the chin).
With the bottom of the mask under the chin, tie the lower ties at the nape of the neck or over the top
of the head. Next, pinch the metal strip so it sits snugly over the nose. If glasses are worn, the
edge of the mask should be under the glasses to minimise fogging. Masks are worn only once and
discarded promptly when no longer effective (i.e., damp, or the procedure is complete). Surgical
masks should be replaced when they become damp or soiled; the front of the mask should not be
touched; and the mask should be removed immediately after use (do not leave it dangling around your
neck). Hand hygiene needs to be completed before untying the ties and after discarding the mask.

6 PART 1: ASEPTIC TECHNIQUE

 P2 Respirator masks have a ‘duckbill’ and are sturdier than surgical masks, offering greater
protection against airborne and droplet infection as well as contact from splashes and sprays. This
mask is better fitted to the face and is also only used once.
● An apron – impervious plastic, protects the nurse’s uniform from contamination by droplets or
sprayed substances. Aprons are used when the risk of contamination is small, or confined to the
front of the nurse’s uniform.
● A gown – protects exposed body parts and prevents contamination of clothing by potentially
pathogenic substances (Xue, 2010a). Gowns are made of cloth (reusable) or impervious material
(disposable) and are used when possible contaminants are widespread, or to protect the patient
from the microbes carried by the nurse. Aprons/gowns are used to minimise cross-contamination
of body substances from one person to another via a nurse’s clothing. They should be used when
there is a risk of contamination with blood, body substances (except sweat), secretions or excretions
or when there is close contact with the patient or equipment or materials that may contaminate the
nurse’s skin or uniform. A patient’s gown worn over the nurse’s uniform provides no protection for
the nurse nor prevents cross-contamination. Gowns are usually reusable and will need to be
laundered prior to next use.
● Gloves – either sterile or non-sterile and protect both the nurse and the patient. The use of gloves is
determined by the procedure. Sterile gloves are used for aseptic procedures and contact with sterile
sites and contact with non-intact skin or mucous membranes. Non-sterile gloves are used when there is
potential for contact with contaminated fluids, excretions or instruments during general care, and for
patient protection if the nurse has broken skin on his/her hands. They are put on just prior to undertaking
a procedure, removed immediately after the procedure and discarded in the contaminated waste bin.
They are changed after each episode of patient care and between patients. Non-sterile gloves should
remain in their original box until needed, not kept in a pocket (Xue, 2010c, p. 3). This reduces the gloves’
incidence of contamination from hands and pocket debris, and maintains their integrity.
● The sharps container – while not strictly a piece of PPE, is nevertheless an important part of nurse
protection and containment of contamination. Although there are many devices available that have
been engineered to eliminate the risks of sharps injuries (e.g., needleless and retractable safety
devices), many procedures require the use of sharp instruments. When sharps are used, handling
must be minimised, (instruments rather than fingers used to grasp sharps when possible; use of
neutral zones such as basins for scalpel transfer; and disposable needles should not be ‘processed’ –
bent, broken or recapped after use). All used disposable sharps (e.g., blades, needles, catheter stylets
and glass vials) must be placed into clearly labelled, puncture proof, leak proof and untippable point-
of-use containers to minimise the chances of a sharps injury and nurse contamination (Xue, 2010b).

Hand hygiene
Perform appropriate hand hygiene procedure (see Clinical Skill 1).

Evidence of therapeutic interaction

Interacting with the patient, carers or visitors is an important aspect of minimising harm to the patient
and demonstrating respect for them as individuals. Wearing goggles, a plastic apron and gloves could
indicate to the patient that they are ‘dirty’ and need to be treated in a different manner to other patients.
Patients should, therefore, be familiarised with the health-care facility’s infection prevention strategies
and informed of the specific risks they face because of their medical or surgical status. Patients should
also be encouraged to disclose any health-risk status they may have (e.g., immune compromised, or
positive for hepatitis C, for instance). Both patients and visitors should be encouraged to minimise
infection risks by following basic hand and respiratory hygiene practices, and be provided with information
as necessary. Patients must be informed that it is their right to ask health-care professionals if hand
hygiene has been performed and if PPE should be used.

Safely and effectively dons/uses PPE

The sequence recommended by the NHMRC (2010, p. 55–6) for putting on PPE to minimise the risk of
transmitting pathogens is shown below. This differs from the sequence used in surgical scrubs as outlined below.

2 Personal protective equipment 7

 ● Aprons – to be placed over the head and the ties fastened behind the back.
● Gowns – to be picked up, held out in front and allowed to unfold (without being contaminated by body
substances) while the nurse grasps the neckline. Arms and hands are slid into the sleeves. The back
of the gown is overlapped and tied to cover the back of the uniform and keep the gown close to the
body to prevent inadvertent contamination.
● Masks – to be held by the upper ties, and placed over the nose and mouth. The upper ties are tied at
the back of the head or strung over the ears and tied under the chin. The lower ties are tied at the nape
of the neck or the top of the head to secure a tight fit to the face. The aluminum strip is smoothed over
the nose. If glasses are worn, the mask fits under them to reduce clouding from exhalation.
● Eyewear (goggles or a face mask) – to be placed over the eyes (and face) and are settled on the face
(and over glasses) for comfort and to exclude the possibility of contamination from splashes.
● Gloves (clean) – to be put on using the principles of infection control – minimising the contamination
of the surface that will be in contact with the patient. If wearing a gown, the gloves are pulled up
over the cuffs, and if no gown is used, the gloves protect the wrists (see Clinical Skill 5 for putting
on sterile gloves).

Removal of the PPE

Personal protective equipment is designed to be used only once and so must be removed when a specific
procedure is completed or a session of patient care is finished. This prevents contamination of other sites,
other people and the environment. It is to be removed in the area where the patient care occurred. The
correct sequence is: removal of the gloves; hand hygiene; removal of the eyewear, gown and mask.
Gloves are removed by pinching the outside of the wrist of the glove on the non-dominant hand and
peeling the glove off the hand. Keep the soiled glove in the still-gloved hand and slide the ungloved fingers
inside the wrist of the remaining glove, and peel it off the dominant hand and over the first glove. Discard
the bundle in the contaminated rubbish receptacle.
Perform hand hygiene.
Remove eyewear by touching only the headband or earpieces. Discard it into a container for cleansing
or into the waste receptacle if disposable.
Carefully remove the apparel (gown, apron, surgical mask) by undoing the ties, folding the
contaminated surface inside (touch only the areas that have been next to your own skin/clothing) and
rolling the material into a bundle with the contaminated side inwards before disposing of it into the
contaminated rubbish receptacle or linen hamper as appropriate. Take care not to contaminate yourself
while removing the apparel, for example, hand hygiene should be undertaken when gloves are removed
and prior to touching ties of gowns, masks or aprons, or removing face shields or eye protection.

Clean, replace and dispose of equipment

Dispose of single-use safety equipment into the contaminated rubbish receptacle in the patient’s
area. Non-disposable items such as goggles or face shields will require cleaning according to the
manufacturer’s instructions. The front of the shield or goggles is considered contaminated and should not
be touched with bare hands. Generally, cleansing with a mild detergent and warm water, and drying well
prior to replacing the equipment is sufficient. If there is gross contamination or the contaminating
material is definitely infectious, disinfection using an instrument-grade disinfectant is required (NHMRC,
2010, p. 51). Hand hygiene is again performed as a last infection control measure.

References
Berman, A. & Snyder, S. (2012). Skills in clinical nursing (7th ed.). Upper Saddle River, NY: Pearson.
National Health and Medical Research Council (NHMRC). (2010). Australian guidelines for the prevention and control of infection in healthcare.
Commonwealth of Australia. (This document is extensive and is available online at: http://www.nhmrc.gov.au. It should be consulted by all
health-care workers to gain an adequate understanding of managing the risks of spreading microorganisms.)
Xue, Y. (2010a). Aprons, gowns, face masks and eye protection. Adelaide, Joanna Briggs Institute.
Xue, Y. (2010b). Sharp and needle stick injuries. Adelaide, Joanna Briggs Institute.
Xue, Y. (2010c). Summary evidence: gloves. Adelaide, Joanna Briggs Institute.

8 PART 1: ASEPTIC TECHNIQUE

CLINICAL SKILLS COMPETENCY

USE OF PERSONAL PROTECTIVE

EQUIPMENT
Demonstrates the ability to choose personal protective equipment appropriate to the
situation and utilise the equipment to prevent interpersonal transmission of micro-
organisms that are transmitted by contact, droplet or airborne mechanisms.

Performance criteria C S D
(numbers indicate ANMC National Competency Standards for the (competent) (requires (requires
Registered Nurse) supervision) development)

1. Identifies the indication (2.5, 4.2, 5.1, 9.5, 10.1)

2. Demonstrates problem-solving abilities, such as obtaining personal

protective equipment prior to handwashing (5.1, 7.1, 9.5)

3. Identifies and gathers appropriate equipment (7.1, 7.3)

●
goggles/face mask
●
apron or gown
●
gloves
●
sharps container

4. Performs hand hygiene (7.1, 9.5)

5. Evidence of therapeutic interaction with the patient, carers or visitors

(2.3, 9.1, 9.2)

6. Safely and effectively dons/uses the appropriate equipment (7.1)

7. Disposes of/replaces used items safely (9.5, 10.1)

Student:

Educator: Date:

2 Personal protective equipment 9

 3
Aseptic technique
Aseptic non-touch technique
The National Health and Medical Research Council (NHMRC) (2010, p. 85) states that ‘aseptic technique
protects patients during invasive clinical procedures by employing infection-control measures that
minimise, as far as practically possible, the presence of pathogenic organisms’. A standardised framework
of aseptic non-touch technique (ANTT) has been adopted which involves guidelines for protecting patients
from contamination and infection during clinical procedures. Aseptic technique aims to prevent pathogenic
organisms, in sufficient quantity to produce infection, from being introduced to susceptible sites by hands,
surfaces and equipment (NHMRC, 2010, p. 86). Cleaning and drying surfaces and equipment is the first
consideration. To achieve asepsis of hands and hard surfaces, a disinfectant should be used either to
clean, or following the cleaning process. For hand hygiene, using a non-touch technique and new,
sterilised equipment contribute to asepsis.
The core infection-control components of ANTT are summarised below.
● Key part and key site identification and protection – this involves determining the key part (i.e., the part
of the equipment, dressing material or cleansing material) that will come into contact with the
susceptible key site (the part of the patient that is vulnerable, such as incisions or open wounds).
Protection of the key parts means that these areas only come into contact with other key parts or
the key site. Non-touch of the key part is a vital component of maintaining asepsis. For example,
a key site (incision) can only be touched by an aseptically clean key part (a sterilised gauze square
dampened with sterilised normal saline using a sterilised forcep).
● Non-touch technique – requires not touching the key parts directly but using a sterile instrument,
dressing or solution to do so.
● Hand hygiene – an essential component of ANTT. (See Clinical Skills 1 and 4.)
● Glove use – sterile gloves are used if it is necessary to directly touch any key parts or key sites. If
not, non-sterile gloves are usually used. Risk assessment by the health-care worker determines
whether they can perform the procedure and maintain asepsis without touching either the key part
or the key site and contaminating it. Long procedures are usually more difficult and inexperience
often dictates the need to use additional infective precautions, such as sterile gloves rather than
non-sterile gloves.
The aseptic field is established either to ensure asepsis or promote asepsis. Critical aseptic fields
ensure asepsis. These fields are used when key parts and key sites cannot be protected easily using non-
touch techniques or when key sites are extensive and a large working area or long duration of contact is
required (e.g., in the operating theatre). Usually, sterilised equipment, sterile gloves and other barriers
such as gowns are required. Critical aseptic fields are used in surgical ANTT. Critical micro-aseptic fields is
a subtype of the critical aseptic field and includes key parts that are protected from contamination by their
own sterile cover (e.g., capped syringes, sheathed needles or packaged sterile gauze). Used along with a
non-touch technique, they provide an aseptic field for key parts and contribute to a general aseptic field,
which promotes asepsis.
The NHMRC (2010) outlines two ANTTs as follows.
1. Standard ANTT – clinical procedures managed with standard ANTT will characteristically be
technically simple, short in duration (approximately less than 20 minutes) and involve relatively few
and small key sites, and key parts. Standard ANTT requires a main general aseptic field and non-
sterile gloves. The use of critical micro-aseptic fields and a non-touch technique is essential to
protect key parts and key sites.
2. Surgical ANTT – surgical ANTT is demanded when procedures are technically complex, involve
extended periods of time and large, open key sites, or large or numerous key parts. To counter
these risks, a main critical aseptic field and sterile gloves are required, and often full-barrier
precautions are needed too. Surgical ANTT should still utilise critical micro-aseptic fields and non-
touch techniques when practical to do so (NHMRC, 2010, p. 89).

Indications
Aseptic technique (surgical asepsis) is used when preparing for and undertaking any invasive procedure,
i.e., one that penetrates the body’s natural defence of intact skin and mucus membrane. The principles
used in the practice of aseptic technique (Crisp & Taylor, 2009, p. 708; AORN, 2006; Laws, 2009) are that:

10 PART 1: ASEPTIC TECHNIQUE

● sterile objects remain sterile only when touched by another sterile object
● only sterile objects may be placed in an aseptic field
● sterile objects/aseptic fields become contaminated by prolonged exposure to air
● sterile objects or aseptic fields should be kept in view
● a sterile surface that comes in contact with a wet contaminated surface becomes contaminated by
capillary action
● a fluid flows in the direction of gravity or by capillary action
● the edges of an aseptic field are considered contaminated
● skin cannot be made sterile, but washing reduces the number of micro-organisms on it
● sterile gloves are used to further prevent transfer of micro-organisms
● conversation should be minimised to reduce the spread of droplets
● whatever sterile object is opened for one patient can only be used for that patient
● unused sterile supplies are discarded or re-sterilised if they are to be used for another patient.
These principles are similar and compatible with the transmission-based precautions recommended
by the NHMRC (2010) and by Rathnayake (2011b). Conscientiousness, alertness and honesty are essential
qualities in maintaining surgical asepsis. Unless these principles and guidelines are strictly followed,
patient safety is compromised and infection may occur. Nurses must assess their patients for risk and
choose to use an aseptic technique if there is an increased chance of infection even in non-invasive
procedures where clean technique is often used (Flores, 2008). The following is very general and could
be used for any aseptic procedure (e.g., dressing change or catheterisation).

Evidence of therapeutic interaction

Explaining the procedure will reduce the contamination of sterile items. Explanation of the positioning and
the expectations of the patient will ensure his/her cooperation, reduce the risk that he/she will touch and
contaminate something sterile and reduce the necessity of talking during the procedure.

Gather and prepare equipment

The equipment required is dependent on the procedure to be done. All supplies must be available before
you proceed to the patient’s room so that the critical aseptic field, once established, is not left unattended.
A critical aseptic field left unattended is considered contaminated. Any additional items that are needed
for the procedure that are not on the trolley will have to be brought and added by a second person, which
is an unnecessary, time-consuming action.
● A trolley – collected and to be wiped down with the solution recommended by the facility to establish
a clean (not sterile) work surface. This removes much of the bacterial load from the trolley surface
and helps prevent cross-contamination. Let the trolley dry thoroughly to eliminate the transfer of
micro-organisms via moisture. Place all unopened plastic-, paper- and cloth-wrapped items on the
bottom shelf of the trolley, and leave the top surface as clean as possible for the aseptic procedure
(Rathnayake, 2011a).
● A large plastic bag – for discarding used materials, is taped to the side of the trolley, or sometimes
the bed. Place it closer to the patient than the trolley top surface so that contaminated material is
not brought over the critical aseptic field. Open the mouth of the bag wide enough so that material
can be dropped into the bag, preventing contamination of forceps or gloves.

Confirm the sterility of the packages

Check the colour change of the sterility indicator, the use-by date and whether the package is dry, has
tears, water damage, stains or, in the case of a bottle, a broken seal. The sterility indicator indicates that
the package has undergone sterilisation. Out-of-date sterile objects have been shelved for an extended
period of time and their contents are not sterile because of the time factor. Tears and punctures create
a pathway from the exterior to the interior of the package for micro-organisms to gain access. Stains,
dampness or water damage indicate that the wrapping has been wet and micro-organisms have travelled
into the package by capillary action. A broken seal on a bottle indicates the contents have been exposed to
the air and are contaminated.
Take the trolley to the patient’s bedside.

3 Aseptic technique 11
 Position the patient comfortably
Positioning the patient reduces or eliminates movement during the procedure, which can contaminate
sterile items. Consider the patient’s position in relation to the time they will need to stay still, and to the
body part which needs to be accessible for examination or treatment. Pain medication (if required) should
be administered approximately 30 minutes prior to a procedure. Toileting requirements need to be
anticipated and attended to prior to positioning the patient and setting up the critical aseptic field. Maintain
privacy to enhance the patient’s dignity.

Wash hands
Hands are washed for two to six minutes (as per hospital policy) (Osborn, Wraa & Watson, 2010) to
remove micro-organisms and prevent cross-contamination.

Open the package

Initially, remove the outer plastic wrap (in prepackaged supplies) and drop the inner, sterile tray onto the
clean trolley surface. The still-wrapped tray package (e.g., dressing tray or catheter tray) is placed flat on
the top surface of the clean trolley, with the initial folded flap facing the nurse. Touch only the outside
surface of the wrapper to maintain the sterility of the inner surface. Using thumb and forefinger, grasp the
flap is grasped and folded out, away from the nurse to eliminate reaching over the then-exposed sterile
contents and risking contaminating them. The side flaps are carefully folded out, using the right hand for
the right flap and the left hand for the left flap, again to prevent the need to reach over sterile contents.
Finally, the last flap is folded towards the nurse to form a critical aseptic field. Adjustments to the position
of the critical aseptic field are made from underneath (the outside surface of) the wrapper. The inside
surface of the wrapper has formed a sterile surface, with the object (dressing tray, catheter tray, bowl,
etc.) in the centre of the critical aseptic field. The area inside a border 5 cm from each edge is sterile.

Add the necessary sterile supplies

Use the following methods to place supplies on the sterile tray. All packages are opened while standing
back from the established critical aseptic field to avoid contaminants falling from the packaging material
onto the field.
● Peeling pouches – grasp the opposite edges of the two sides of the wrapper and carefully peel down,
fully exposing the item (gauze squares, instruments, IV catheters, etc.). Without reaching across the
critical aseptic field or touching the non-sterile wrapping to the critical aseptic field, drop the item onto
the critical aseptic field from the wrapper, making sure it is within the 5 cm border. Items are dropped
from about 15 cm so that the packaging material and your hand do not touch the critical aseptic field.
● Unwrapping hospital-wrapped items – grasp the item in your non-dominant hand with the top flap
opening away from you. Remove the sterilisation tape and, using your dominant hand, open the flap
away from you, folding the corners well back from the item. Take care not to touch the contents of
the wrapper as you carefully and fully expose the item by folding the side and front flaps away from
the contents. Grasp the loose corner material from the wrapper and secure it at your wrist with your
dominant hand before carefully dropping the item onto the critical aseptic field. This keeps the now
unsterile wrapping material from inadvertently contaminating the critical aseptic field.
● Opening solution bottles – ensure there is a container available for the contents of the bottle on the
critical aseptic field before you open it, and read the label three times to make sure you have the
correct solution. Break the seal on the solution bottle and remove the cap. Place the cap on a clean
surface, inside up. Check the label and then hold the bottle with the label covered by the palm to
protect it from inadvertent splashes or dribbles that might obscure the writing. Hold the bottle
directly over the container and about 10 cm up to prevent accidentally touching the critical aseptic
field, and pour slowly to prevent splashes, since moisture will contaminate the field by facilitating
micro-organism movement through the sterile drape. Some agencies consider previously opened
bottles to remain sterile for 24 to 48 hours. If this is the case, recap the bottle immediately without
touching the inside of the lid to maintain sterility. Write a time and date clearly on the label and
initial it. To re-use such a bottle, pour a small amount of the contents into the sink or plastic bin
prior to pouring it into the sterile container to clean the lip of the bottle.

12 PART 1: ASEPTIC TECHNIQUE

 ● Hand hygiene – an alcohol-based rub or another surgical hand wash is required prior to an aseptic
technique as hands have been contaminated by touching the packaging of the items that are put onto
the critical aseptic field. Depending on hospital policy or your own risk assessment (NHMRC, 2010),
you may need sterile gloves.

Manipulating the items

Rearranging items on the critical aseptic field is to be done with sterile forceps included in commercial
dressing trays. These are a different colour and the most easily accessible of the forceps. As some sterile
trays do not include an extra forceps, add one with the other sterile supplies. After all additional items
have been placed on the critical aseptic field, the forceps is carefully picked up, touching nothing else.
Using the principles of asepsis, the forceps is used to conveniently manipulate the items on the field. If
the forceps are used for anything wet, keep the tip lower than your wrist to prevent liquids from running
down the forceps by gravity and then back to the tips to make the forceps unsterile. When this is
completed to your satisfaction, discard the forceps either into the disposal bag (if plastic) or onto the
bottom shelf of the trolley (if metal). If wearing sterile gloves, the items on the field can be manipulated
directly with the fingers.

Perform the required procedure

Use the principles of the aseptic technique to perform the procedure.

Clean, replace and dispose of equipment

Contaminated disposables are to be sealed in the disposal bag, which is then wrapped in the (disposable)
wrapper that has formed the critical aseptic field. This material should then be placed in the contaminated
garbage bin in the dirty utility room. The trolley is to be wiped down with the recommended solution. If
gross contamination has occurred, soap and water should be used prior to the solution. Return the trolley
to its position in the clean service area of the unit. Shelve solutions to be re-used in front of unopened
solutions so that they can be used quickly and to avoid waste. Wash dry and return non-disposable items
to the Central Sterile Supply Department (CSSD) for re-sterilisation. Place non-disposable linens in a
laundry skip (contaminated if necessary) so they can be returned to the laundry for washing.

Documentation
Documentation is not necessary. Aseptic technique is a process used in other procedures and is therefore
not recorded.

References
Association of Operating Room Nurses (AORN) Recommended Practices Committee. (2006). Recommended practices for maintaining a sterile
field. AORN Journal, 83(2), 402–12.
Crisp, J. & Taylor, C. (Eds.). (2009). Potter & Perry’s fundamentals of nursing (3rd Australian ed.). Chatswood, NSW: Mosby Elsevier.
Flores, A. (2008). Sterile versus non-sterile glove use and aseptic technique. Nursing Standard, 23(6), 35–9.
Laws, T. (2009). Chapter 32: Integral Components of Client Care. In A. Berman, S. Snyder, T. Levett-Jones, T. Dwyer, M. Hales, N. Harvey, …
D. Stanley, Kozier & Erb’s fundamentals of nursing (2nd Australian ed., Vol. 2, pp. 739–792). Frenchs Forest: Pearson.
Osborn, K., Wraa, C. A. & Watson, A. B. (2010). Medical-surgical nursing: Preparation for practice. Boston: Pearson.
National Health and Medical Research Council (NHMRC). (2010). Australian guidelines for the prevention and control of infection in healthcare.
Commonwealth of Australia. (This document is extensive and is available online at: http://www.nhmrc.gov.au. It should be consulted by all
health-care workers to gain an adequate understanding of managing the risks of spreading microorganisms.)
Rathnayake, T. (2011a). Asepsis: Clinician information. Adelaide, Joanna Briggs Institute.
Rathnayake, T. (2011b). Surgical site infection: A sterile field. Adelaide, Joanna Briggs Institute.
Smith, S. F., Duell, D. J. & Martin, B. C. (2012). Clinical nursing skills: Basic to advanced skills (8th ed.). Upper Saddle River, NJ: Pearson.

3 Aseptic technique 13
 CLINICAL SKILLS COMPETENCY

ASEPTIC TECHNIQUE
Demonstrates the ability to effectively and safely establish and maintain a critical
aseptic field.

Performance criteria C S D
(numbers indicate ANMC National Competency Standards for the (competent) (requires (requires
Registered Nurse) supervision) development)

1. Identifies indication (2.5, 4.2, 5.1, 9.5, 10.1)

2. Evidence of therapeutic interaction with patient, e.g., gives explanation

(2.1, 2.3, 9.1, 9.2)

3. Gathers equipment (7.1, 7.3)

4. Confirms the sterility of the packages (7.1, 9.5)

5. Demonstrates problem-solving abilities, e.g., positions patient comfortably

(5.1, 5.2, 5.3, 7.1, 9.5)

6. Washes hands (7.1, 9.5)

7. Opens the tray/package (7.1, 9.5)

8. Adds necessary sterile supplies (7.1, 9.5)

9. Uses sterile forceps to handle sterile supplies (7.1, 9.5)

10. Performs required procedure (7.1)

11. Cleans, replaces and disposes of equipment appropriately (9.5, 10.1)

12. Documents relevant information (1.1, 1.2, 1.3, 2.6, 9.2, 10.2)

13. Demonstrates ability to link theory to practice (3.2, 4.1, 4.2)

Student:

Educator: Date:

14 PART 1: ASEPTIC TECHNIQUE

Other documents randomly have
different content
 Section 4. Information about Donations to
the Project Gutenberg Literary Archive
Foundation
Project Gutenberg™ depends upon and cannot survive without
widespread public support and donations to carry out its mission
of increasing the number of public domain and licensed works
that can be freely distributed in machine-readable form
accessible by the widest array of equipment including outdated
equipment. Many small donations ($1 to $5,000) are particularly
important to maintaining tax exempt status with the IRS.

The Foundation is committed to complying with the laws

regulating charities and charitable donations in all 50 states of
the United States. Compliance requirements are not uniform
and it takes a considerable effort, much paperwork and many
fees to meet and keep up with these requirements. We do not
solicit donations in locations where we have not received written
confirmation of compliance. To SEND DONATIONS or determine
the status of compliance for any particular state visit
www.gutenberg.org/donate.

While we cannot and do not solicit contributions from states

where we have not met the solicitation requirements, we know
of no prohibition against accepting unsolicited donations from
donors in such states who approach us with offers to donate.

International donations are gratefully accepted, but we cannot

make any statements concerning tax treatment of donations
received from outside the United States. U.S. laws alone swamp
our small staff.

Please check the Project Gutenberg web pages for current

donation methods and addresses. Donations are accepted in a
number of other ways including checks, online payments and
credit card donations. To donate, please visit:
www.gutenberg.org/donate.

Section 5. General Information About

Project Gutenberg™ electronic works
Professor Michael S. Hart was the originator of the Project
Gutenberg™ concept of a library of electronic works that could
be freely shared with anyone. For forty years, he produced and
distributed Project Gutenberg™ eBooks with only a loose
network of volunteer support.

Project Gutenberg™ eBooks are often created from several

printed editions, all of which are confirmed as not protected by
copyright in the U.S. unless a copyright notice is included. Thus,
we do not necessarily keep eBooks in compliance with any
particular paper edition.

Most people start at our website which has the main PG search
facility: www.gutenberg.org.

This website includes information about Project Gutenberg™,

including how to make donations to the Project Gutenberg
Literary Archive Foundation, how to help produce our new
eBooks, and how to subscribe to our email newsletter to hear
about new eBooks.
back
Welcome to our website – the ideal destination for book lovers and
knowledge seekers. With a mission to inspire endlessly, we offer a
vast collection of books, ranging from classic literary works to
specialized publications, self-development books, and children's
literature. Each book is a new journey of discovery, expanding
knowledge and enriching the soul of the reade

Our website is not just a platform for buying books, but a bridge
connecting readers to the timeless values of culture and wisdom. With
an elegant, user-friendly interface and an intelligent search system,
we are committed to providing a quick and convenient shopping
experience. Additionally, our special promotions and home delivery
services ensure that you save time and fully enjoy the joy of reading.

Let us accompany you on the journey of exploring knowledge and

personal growth!

ebookluna.com