4.3 Infection Prevention, Control & Aseptic Technique

4.3 Infection Prevention, Control & Aseptic Technique

Infection Prevention and Control (IPC) is a vital pillar of clinical safety in New Zealand healthcare. Registered nurses are responsible for breaking the chain of infection, reducing Healthcare-Associated Infections (HAIs) such as Central Line-Associated Bloodstream Infections (CLABSI), Surgical Site Infections (SSI), and Catheter-Associated Urinary Tract Infections (CAUTI), and adhering to Aseptic Non-Touch Technique (ANTT) during invasive procedures.

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The Chain of Infection & Standard Precautions

Infectious agents spread through a six-link chain: Infectious Agent → Reservoir → Portal of Exit → Mode of Transmission → Portal of Entry → Susceptible Host. Interrupting any single link prevents disease transmission.

Standard Precautions

Standard precautions are the baseline IPC practices applied to all patients at all times, regardless of suspected or confirmed infection status. They include:

1. Hand Hygiene: Performed according to the 5 Moments framework.
2. Personal Protective Equipment (PPE): Used based on risk assessment of body fluid exposure.
3. Respiratory Hygiene / Cough Etiquette: Tissues, mask wearing, and elbow covering.
4. Environmental Cleaning & Waste Management: Appropriate handling of clinical waste and linen.
5. Sharps Safety: Immediate disposal of sharps into puncture-resistant containers at point of use; never recapping needles.

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World Health Organization (WHO) 5 Moments for Hand Hygiene

Hand hygiene is the single most effective intervention to prevent HAI transmission. Hand hygiene must be performed using Alcohol-Based Hand Rub (ABHR) (20–30 seconds) for clean hands, or Soap and Water (40–60 seconds) when hands are visibly soiled or after caring for patients with spore-forming organisms (e.g., Clostridioides difficile or Norovirus).

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|                   WHO 5 MOMENTS FOR HAND HYGIENE                            |
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|  MOMENT 1  --> Before touching a patient                                    |
|  MOMENT 2  --> Before a clean / aseptic procedure                           |
|  MOMENT 3  --> After body fluid exposure risk                               |
|  MOMENT 4  --> After touching a patient                                     |
|  MOMENT 5  --> After touching patient surroundings                          |
+-----------------------------------------------------------------------------+

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Transmission-Based Precautions

When standard precautions alone are insufficient to prevent pathogen transmission, Transmission-Based Precautions are implemented based on the mode of transmission.

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Personal Protective Equipment (PPE) Sequences

Adhering to correct donning (putting on) and doffing (taking off) sequences is mandatory to avoid self-contamination.

Donning Sequence (Before Patient Entry)

1. Perform Hand Hygiene (ABHR or soap & water).
2. Put on Gown / Apron (secure ties at neck and waist).
3. Put on Mask or Fit-Tested N95 Respirator (perform fit check for N95).
4. Put on Eye Protection (goggles or face shield).
5. Put on Gloves (pull cuffs over gown sleeves).

Doffing Sequence (At Doorway or Anteroom)

1. Remove Gloves (glove-in-glove or beak technique; most contaminated item).
2. Perform Hand Hygiene.
3. Remove Gown (unfasten ties, pull away from neck/shoulders touching inside only, roll inside out).
4. Perform Hand Hygiene.
5. Remove Eye Protection (handle by headband or ear pieces).
6. Remove Mask / N95 Respirator (touch elastic straps only; do not touch front of mask).
7. Perform Hand Hygiene.

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Aseptic Non-Touch Technique (ANTT) Framework

Aseptic Non-Touch Technique (ANTT) is the clinical framework utilized throughout New Zealand healthcare to standardize aseptic practice during wound dressings, IV therapy, urinary catheterisation, and central line management.

Core Concepts: Key Parts & Key Sites

• Key Parts: The critical sterile components of medical equipment that, if contaminated by direct or indirect contact, will infect the patient (e.g., syringe tips, needle hubs, IV line male luer connectors, sterile catheter tips).
• Key Sites: Open wounds, surgical incisions, insertion sites for invasive devices (IV sites, drain sites), or body cavities.

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|                         ANTT CLINICAL GUIDING RULES                         |
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|  1. ALWAYS PERFORMS HAND HYGIENE (Moment 2).                                |
|  2. NEVER TOUCH KEY PARTS OR KEY SITES DIRECTLY.                            |
|  3. IDENTIFY & PROTECT KEY PARTS WITH STERILE WRAPS / CAPS.                  |
|  4. CLEAN SURFACES & DISINFECT HUBS (e.g., 70% alcohol for 15s scrub).      |
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Surgical ANTT vs. Standard ANTT

• Standard ANTT: Used for short duration, simple procedures (< 20 minutes, few key parts/sites), e.g., peripheral IV insertion, simple wound dressing. Utilises non-sterile gloves provided Key Parts are never touched directly.
• Surgical ANTT: Used for complex, long duration procedures (> 20 minutes, large or multiple key sites/parts), e.g., complex surgical dressings, central venous catheter insertion, urinary catheterisation. Utilises sterile gloves, full sterile drapes, and a dedicated sterile field.