Sterile Technique

Sterile Technique

     Using a clean technique works for most procedures you perform at home.  However, specific jobs may be too high risk to count on clean technique alone. When you complete a process that requires you to put a foreign body into the bloodstream, the potential exists to introduce bacteria. Once the bacteria enter the bloodstream, it has direct access to the heart and brain as it circulates throughout the body. Using sterile technique helps reduce the risk of total body infection (sepsis).

 

I use a sterile technique whenever I’m putting anything into a body opening (other than the mouth or anus). Some would argue you can use a clean method for urinary catheterizations and even doing a stick for a lab test or start an IV.  I recommend discussing what is best in your situation with your healthcare provider based on the health of the care-receiver. Some who are immunocompromised will need to have a sterile technique used, while others who are stronger may be able to use the clean method. 

Opening and Putting on Sterile Gloves

1.       Open the package containing the sterile gloves, touching only the outer side of the glove wrapper.

2.       Remove the inner package containing the gloves and place them on a dry flat surface.

3.       Open the inner package, touching only the outer edge of the wrapper.

4.       Use the thumb and fingers of your nondominant hand to grasp the folded inner surface portion of the glove for the dominant hand, touching only the inner part of the glove to avoid contaminating the outer portion of the glove.

5.       Lift the glove and insert your dominant hand into the glove, palm side up.

6.       Pull down the cuff by touching only the inner surface of the glove. Gently stretch the glove over your hand.  Make sure the outside of the glove doesn’t touch the nonsterile surface.

7.       Insert the four fingers of your dominant gloved hand into the sterile outer cuff of the other glove, keeping your thumb pulled back out of the way.

8.       Lift the glove and insert the nondominant hand into the glove.  Allow the cuff to come uncuffed as you finish putting it on, but don’t touch the skin of the arm with your gloved hand.

9.       Adjust the fingers of the gloves after both your hands are gloved.

10.   Keep your hands above the waist level to decrease the potential for contamination.

 Lippincott Nursing Procedures (2019) 8th Ed. Philadelphia:Wolters Kluwer. (716)

Indewelling Urinary Catheter Supplies

Opening a Sterile Kit or Pouch

Opening a Sterile Kit

1.        Remove the outer plastic wrapper from the kit

2.       Place the inner wrapped package on a dry flat surface.

3.       Touching only the very edge of the wrapper, open the farthest wrapper first and peel it back, then peel back each of the side wrappers, and finally, the bottom wrapper.  The kit should be exposed.

Opening a Peel-Back Container or Pouch

1.       Grasp the unsealed corner of the wrapper and pull it toward you.

2.       Open a peel-pack pouch by grasping each side of the unsealed edge with the thumb side of each hand parallel to the seal and pulling apart gently

3.       Hold the sides back, so the wrap covers your hands and exposes the sterile item.

4.       If the item is light, drop it onto the sterile field. Don’t allow the piece to slide across the package side when dropping the item onto the sterile field.

5.       You may also use the inside of the package as your sterile field. Be very careful not to touch the inside of the package.

 Lippincott Nursing Procedures (2019) 8th Ed. Philadelphia:Wolters Kluwer. (715)

Why Clean vs. sterile technique at home?

     In the hospital, everyone throws everything away that touches anyone or anything, and if someone breaches sterile technique even the slightest, everyone goes nuts.  Why is it okay when someone goes home to forget the need to use sterile procedures?

 

     I’m sure lots of people wonder about that question, and I’m surprised that more don’t ask why.  Here’s the reason.  It has to do with the number of germs that you are available for potential exposure in one place versus another.

 

Healthcare Worker Travel Around

     In the hospital, the healthcare workers travel from one patient to another all day. They don’t just see the ones on their floors; they also encounter those in the halls they pass on the way to lunch, to treatment rooms, to business meetings and parking areas.  All of those people who potentially cough, sneeze, touch, bleed, or drip their germs onto surfaces that the healthcare worker might touch with their hands, sleeve, feet, or other body part and bring into your room to deposit on one of your table surfaces. 

 

Lots of People Enter Your Room

     Although hospitals clean patient rooms frequently, people are continually bringing new germs in and out of them.  Therefore, to decrease the number of potential bacteria that enter your body openings, only sterile products not used on anyone else or for anything else are used on you. Hospitals also don’t use products exposed to open air due to contamination from airborne particles floating down to land on what you might receive.

 

Fewer People are At Your Home

     On the other hand, at your home, the number of people coming in and out every day would probably total less than ten. Even if you went to the grocery store and hundreds of people crossed your path, you probably washed your hands after you got home and maybe also took your shoes off.  Even if you kept your shoes on when you entered your house, you probably took them off before you climbed into bed.  It’s just not the same level of risk.

 

                         

While substantially less, it’s not entirely gone. Besides, there is nothing that says you can’t practice sterile technique if you want to do so.

 

Reference: http://preferredhomecare.com/wp-content/uploads/2014/04/A-guide-for-tracheostomy-care-at-home-PHC-Master_20140522.pdf A Caregiver’s Guide for Tracheostomy Care at Home. Preferred HomeCare /LifeSolutions. Phoenix, AZ. 

How Procedures are Adapted from Hospital to Home

When Doing Sterile Technique

  • Handwashing
  • Wear sterile gloves
  • Use new equipment each time, 
  • Use sterile water which you replace every 24 hours
  • Discard  equipment after each use

 Clean Technique

  • Handwashing takes on primary focus
  • Wearing gloves is optional – gloves may be sterile or non-sterile; usually non-sterile.
  • May re-use equipment after proper cleaning
  • Use prepared sterile water and normal saline from home
  • May re-use the same supplies and equipment if cleaned properly

You need the following supplies: Use distilled or tap water (distilled is preferred), Two 2-quart pans with lids, One quart-size jar and lid, and a Funnel.  Sorry, this procedure must be done on the stovetop. Do not use the dishwasher.

Steps:

  • Wash your hands, and all the dishes with mild soapy water and rinse.
  • Fill one pan with 4 cups of water
  • Bring to a boil, cover, and boil for 10 minutes from the time you see a bubbling boil.
  • In the other pan, place the quart jar, lid, and funnel, cover with water, bring to a bubbling boil, apply top and let it boil for 10 minutes from the time the bubbling boil starts, also.
  • After 10 minutes of boiling, remove heat and let cool to room temperature.
  • Remove jar from the water. Do not touch the inside of the jar.
  • Pour prepared water into the jar using a funnel. Apply the jar lid and label as “Sterile Water” Add date.

Supplies: You will need distilled or tap water (distilled preferred), Table salt (non-iodized), Measuring cup and measuring spoon, Two (2) quart pans with lids, One-quart size jar with lid, and a Funnel

Steps:

  • Wash your hands and necessary dishes with warm soapy water and rinse.
  • Fill quart pan with 4 cups of water
  • Add two level teaspoons of salt to the water
  • Bring to a bubbling boil and time for 10 minutes of bubbling time.
  • Place quart jar, lid, and funnel in the pan and cover with water. Bring to a boil, cover, and let boil for 10 minutes at a bubbling boil.
  • After 10 minutes, remove both from heat, let cool to room temperature.

Without touching inside of the jar, pour the salt solution into the jar, apply lid, and label as Normal Saline with the date.

Accordion ContentUse 50 % white distilled vinegar mixed with 50% water. Soak items for 15-30 minutes, rinse thoroughly, and dry.

YouTube Videos Demonstrating Sterile Technique

How to Put on or Don Sterile Gloves for Nursing Students & Health Care Workers 

Watch how to put on (donning) sterile gloves as a nursing student or new nurse. When you insert foley catheters, change central line dressings, access subq port, etc you have to know how to do sterile gloves. There is a proper technique to putting on sterile gloves in nursing. You must ensure that you don’t contaminate the gloves. In this video, you’ll learn the technique for sterile gloving.

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 Sterile Field SetUp

Demonstration showing how to set up a sterile field, pour into a basin on a field and add items to a field.

Caregiver Marketplace Check out links to products recommended to help caregivers cope with the challenges of caregiving at home. Ideas are available on everything from positioning to self-help booksmobility devices, to skincare. 

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