5.3 Asepsis, Sterile Technique & Hazardous Materials

Asepsis, Sterile Technique, and Hazardous Materials

ARRT Patient Care 1.F is disinfection and cleaning: medical asepsis versus sterile technique, patient preparation, the procedural tray, maintenance of sterile fields, and scrubbing. 1.G is handling and disposal of biohazardous sharps and blood, tissue samples, chemotherapeutic agents, and radioactive material. Cardiac interventional work is not a full operating room, but a femoral or radial PCI still implants hardware into an artery. Infection control and a contaminated field are scored Patient Care items, not housekeeping trivia.

Quick Answer: Clean is not sterile. Prep the skin with chlorhexidine and wait the labeled dry time. Gown and glove for the scrub role. If the field is wet, something is dropped below the table, or someone reaches over with a nonsterile arm, the field is broken — replace, do not wipe. Never recap needles. Sharps go in a puncture-resistant container. Label biopsy jars at the bedside. Chemo and radioactive waste have their own streams.

Medical asepsis versus sterile technique

Medical asepsis (clean technique) reduces the number of microbes. It includes hand hygiene, clean (not sterile) gloves for a blood draw or a dirty dressing, wiping a contrast pump or table base with an approved disinfectant, and isolating body fluids. Sterile technique (surgical asepsis) aims for a field without microorganisms: a surgical scrub or approved waterless surgical hand rub, sterile gown and gloves, sterile drape, and a sterile table.

The circulating role is largely clean technique plus protection of the field. The scrub role is sterile. Crossing those jobs without a new gown-and-glove cycle contaminates the table. Hand hygiene before and after every patient contact is medical asepsis and is not skipped because you are about to gown. Jewelry and long nails are incompatible with either a proper scrub or intact gloves.

Disinfection of rooms between cases is medical asepsis: high-touch surfaces, blood on the table, the image-receptor housing, and the lead that will sit near a new sterile field. Dried blood is still biohazardous. Use the contact time on the disinfectant label; a quick wipe that dries in one second is not disinfection.

Patient preparation: chlorhexidine and dry time

Skin prep for arterial access is chlorhexidine-based (typically chlorhexidine gluconate in alcohol) unless the patient has a true chlorhexidine allergy, in which case the lab's iodine or other approved alternative is used. Apply per product directions on clean, dry skin, from the intended puncture outward, covering a wide field — entire groin plus enough abdomen and thigh for femoral work; full wrist and forearm for radial work.

Dry time is not optional. Alcohol-chlorhexidine must air-dry for the manufacturer's labeled interval (product-dependent; some applicators list about 30 seconds, larger applicators about 3 minutes — follow the bottle, not a memorized “ARRT number”). Wet prep is flammable under cautery, is not fully antiseptic, and will wick through a drape (strike-through). Do not wipe the site dry with a nonsterile towel to save time. Do not fan it with your hand. Hair at the site is clipped, not shaved with a razor that nicks skin, per typical infection-control teaching.

Latex allergy changes gloves and some drapes before you open the tray. A chlorhexidine allergy is uncommon but is a real stop: do not paint the groin and then discover the reaction under the drape.

Procedural tray and scrubbing

A procedural tray is opened onto a dry, clean stand inside the sterile field's footprint. Peel wrappers so edges fall away from the field. Add sterile items by dropping or presenting; do not reach over with a bare arm. Manifold, bowls, wires, and catheters stay in the sterile zone. Below table level is not sterile. The circulating technologist does not “just fix” a wire that uncoils onto the patient's nonsterile blanket.

Scrubbing is a timed or counted surgical scrub, or an approved alcohol-based surgical hand rub on already-clean hands, then gown and closed gloving (or assisted gloving). Gown cuffs are covered by gloves. Hands stay in sight, between mid-chest and waist, away from the mask. Double-glove when splash risk is high — thrombectomy, large-bore access, known high-titer bloodborne-pathogen cases per protocol — so a puncture of the outer glove does not automatically end the case. If the outer glove fails, inspect the inner glove and re-glove both if there is any doubt.

Maintenance of the sterile field — when it is broken

The field is broken when:

• A sterile item becomes wet (strike-through). Moisture conducts bacteria from the nonsterile surface underneath.
• An item is dropped below table level or onto a nonsterile surface.
• Someone reaches over the field with a nonsterile arm, lead apron edge, camera cable, or unsterile C-arm drape that has been pulled off.
• A glove is punctured or a gown sleeve is soaked with blood.
• An unsterile instrument is placed in a sterile bowl.
• The drape peels back and exposes unprepared skin.

Correct action is replacement, not embarrassment. Wet drape — re-drape or add a new sterile cover per protocol and replace soaked gear. Punctured glove — re-glove. Contaminated wire or catheter — discard; do not wipe and reuse. If you are not sure, it is contaminated.

Never turn your back on the open table. Never fold arms with hands in the axillae. Masks stay over nose and mouth; a mask pulled under the chin contaminates the tray when you speak. The C-arm may rotate around a sterile-covered image receptor; an uncovered receptor swung over the groin is a reach-over event.

Handling and disposal (1.G)

Biohazardous — sharps and blood. Needles, blades, and the access needle go in a puncture-resistant sharps container at the point of use. Never recap a used needle. Two-handed recapping of a bloody arterial needle is the classic bloodborne-pathogen injury. Blood-soaked drapes, gauzes, and tubing go in biohazard bags, not regular trash. Spills: gloves, approved disinfectant with labeled contact time, absorb, dispose as regulated waste. Wear eye protection when flashback is likely. Hollow-bore needles after arterial puncture are high-risk sharps — they go in the container, not on the mayo stand “for a moment.”

Tissue samples. Endomyocardial biopsy is a CI procedure. Atherectomy debris and occasional structural-tissue samples also leave the room. Specimen jars must be labeled at the bedside with two patient identifiers, site or chamber, date, and collector before the jar leaves. Formalin is a chemical hazard; do not pre-fill a jar and then lose the label. Unlabeled tissue is not “figured out later”; pathology will reject it and the diagnosis is lost. Transport in a leak-proof container per protocol.

Chemotherapeutic agents. Rare in the CI suite, but the outline lists them. Treat as hazardous drugs: designated PPE (often double glove, protective gown, eye protection), no priming that aerosols the drug, a spill kit, and facility-specific hazardous-drug waste — not a regular sharps bucket if policy separates chemo sharps, and not a sink. Body fluids from a patient who just received hazardous chemo may also have handling rules. Do not assume “this is a cardiology lab” exempts the waste stream.

Radioactive material. Hybrid rooms, patients who had a recent nuclear perfusion study, and any live source introduce radioactive contamination. Live sources belong in shielded containers, signed in and out, under radiation-safety control. Contaminated gauze, gloves, and bodily fluids from a radioactive patient are radioactive waste until radiation safety clears them — not automatic biohazard-only trash. Wear your dosimeter. Do not eat in the lab. If a spill involves both blood and radioactivity, follow the stricter combined protocol rather than choosing the more convenient bag.

Break / correct action

Scenario

During PCI a circulating cable drapes across the open bowl of heparinized flush. That bowl is contaminated. Dump it, re-glove if the scrub touched it after the cable, open a new sterile bowl and flush, and do not argue that “it only touched the rim.” Wet, dropped, or reached-over is broken. The same case later produces an endomyocardial biopsy: label the formalin jar with two identifiers in the room before anyone walks to pathology.

Exam traps

• Clean gloves are not sterile gloves.
• Chlorhexidine dry time is part of prep, not optional waiting.
• Recapping is the wrong sharps answer.
• Unlabeled tissue is a patient-safety event.
• Chemotherapeutic and radioactive waste have their own streams even when the case is “mostly cardiology.”