Perioperative Nursing: Infection Control and Asepsis Techniques

This report presents a literature review focusing on infection control and aseptic techniques within perioperative nursing, specifically examining the application of ACORN (Australian College of Operating Room Nurses) standards. The student has conducted a comprehensive search strategy, utilizing databases like Pubmed, Biomed, ScienceDirect, and CINAHL, to identify relevant peer-reviewed articles published from 2015 onward. The review analyzes the selected articles, discussing key issues such as inconsistencies in practice, lack of nurse skills, and non-adherence to ACORN guidelines. The report explores various research studies, including those evaluating the effectiveness of aseptic techniques in different environments, the implementation of guidelines for surgical site infection prevention, barriers and facilitators to adherence to evidence-based wound management, and the impact of standardized audit tools and training methods. Furthermore, the report highlights the importance of factors like organizational culture, contextual elements, and patient-centered care in ensuring patient safety and improving aseptic practices. The student synthesizes the findings, emphasizing the importance of consistent application of aseptic techniques and adherence to the ACORN standards to reduce the risk of microbial contamination and improve patient outcomes.

Running head: INFECTION CONTROL AND ASEPTIC TECHNIQUE
INFECTION CONTROL AND ASEPSIS TECHNIQUE
Name of Student
Name of University
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Table of Contents
ASEPSIS....................................................................................................................................2
Critique and Analysis of the Literature......................................................................................2
MAIN ISSUES ASSOCIATED WITH ACORN STANDARD................................................7
ACORN STANDARDS AND PATIENT SAFETY.................................................................7
References..................................................................................................................................8

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ASEPSIS
Critique and Analysis of the Literature
For performing a literature review of this study, an electronic search strategy was
used. The databases used for the study was Pubmed, Biomed, Science direct, CINHL. The
keywords used were perioperative care, aseptic technique, government framework, cultural
and organizational framework, ACORN nurse training, non -adherence to asepsis guidelines.
The inclusion criteria chosen for this study – journal articles from the year 2015 to present
and exclusion criteria excludes all the articles before 2015. This has been done to gain a
broader perspective of aseptic technique compliance in the recent years. Different articles
with different issues related to clinical practice has been used for literature review to re-
analyze the ‘errors’ and problem solving from different point of view.
Austin, Hand and Elia (2015) aimed to test whether the risk of microbial dose
contamination reduces by aseptic preparation of sterile doses additives or parenteral doses in
a pharmaceutical environment rather than a clinical environment. This research provides a
meta-analysis and systemic review of clinical risk posed by microbial contamination in a
comparative study of aseptic techniques between pharmaceutical and clinical environments.
Meta analyses, t-tests were used in comparing dose contamination frequencies. The article
concluded that very limited evidence on microbial contamination rates supports in favor of
dose preparation in pharmaceutical environment rather than in clinical environments. The
article even do not support batch preparation within clinical environments. The research
articles analyses two different environments – pharmaceutical and clinical (perioperative) in
securing patient safety against microbial contamination and statistical tests like T-tests and
meta-analyses were used to compare the results. A pharmaceutical setting is devoid of
patients and is generally sustained with high sterility, thus reducing the rate of contamination

3INFECTION CONTROL AND ASEPSIS
as compared to the aseptic technique (clinical) used in accordance with ACORN (The
Australian College of Operating Room Nurses) standards. The evidence is mentioned as
‘limited’ though, which supports the ACORN standard reciprocally for the final aseptic
techniques and infection prevention needs to be done carefully in a clinical setting.
Camilla, Karin and Ulrica (2018) did a national survey of operating room nurses’
aseptic interventions and techniques for patient preparation in reduction of surgical site
infections. The research study focused on surgical site infections prevention techniques like
disinfection of the skin, maintenance of patient’s body temperature and sustaining a highly or
completely aseptic environment. The study focusses on the extent of implementation of these
preventive interventions in a clinical environment. The study is based on the daily
interventions of the Swedish operating room nurses to prevent surgical site infections
following the national guidelines. A cross-sectional study (descriptive) was used in
methodology. A Web-based questionnaire was used as a research tool amongst Swedish
nurses. The given questionnaire included 32 items of which patient skin (n = 12), choice of
materials (n = 10) and maintenance of patient temperature (n = 10). The answering (response)
format comprised of both open and closed-ended answers. The study concluded that
implementing the laid guidelines is the key priority. The study also concluded that operation
room nurses have a high compliance with recommended national guidelines in regards to
interventions preventing bacterial growth and surgical site infections. When the guidelines
were found lacking, preventive interventions lost their conformity. The Australian College of
Operation Room Nurses recommends similar guidelines as Association of Perioperative
registered nurses in terms of procedural aseptic and infection control technique and supports
the same evidence based outcome if the guidelines are followed or not followed. The
methodology used is qualitative which happens to be perceptual and not analytical. Hence, a
quantitative method would have given a better insight into the scenario.

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Francis et al. (2018) aimed to identify the barriers and facilitators to operating room
nurses’ adherence to an evidence‐based wound management (using clinical practice
guidelines) in prevention of surgical site infections in an Australian hospital. The research
used a qualitative study with incorporated ethnographic techniques of data collection. The
methodology followed was semi structured interviews with thematic analysis using inductive
and deductive processes. Data analysis depicted four main themes- 1. Knowledge and
information seeking, 2. Adhering to aseptic technique, 3. Educating and involving patients in
wound care and 4. Documenting wound care. Barriers and facilitators within each of the
themes were then identified. Facilitators enhanced active information‐seeking behavior of the
participant, a clear understanding of aseptic technique’s vitality along with active
participation. Barriers on the other hand occluded participants’ knowledge and included skills
deficits involved with best practices of aseptic technique according to the procedure
document, the timing of patient education and suboptimal wound care documentation. The
research concluded that there is a necessity in developing new interventions to improve
operating room nurses’ adherence to the recommended clinical practice guidelines. The
guideline includes following each of the aseptic technique principles, documentation, hand
washing and hand cleaning hygiene and active promotion of patient education. The research
article also concluded that the hospital’s procedure documents needs to reflect the current
recommended clinical practice guidelines. A thematic analysis highlights the key areas of
action in best practice and it empowers a collaborative nurse patient management which is a
great point of view that needs to be addressed. Again, a qualitative method is used which has
data complexities, perceptual biases, cognitive biases which have its own drawbacks.
Shirley et al. (2015) focused on monitoring compliance with standardized aseptic
technique practices at a large Australian healthcare. A method used was a focus group
feedback which indicated that the staff knowledge of aseptic technique was good but the

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clinical practice varied from nurse to nurse and was inconsistent with guidelines. Formal
training, assessment and auditing was found to be lacking and for which Train the Trainer
method was used instead. Then about 500 audits was conducted with a compliance of 88
percent. Electronic audit tool and new aseptic technique guidelines were established. And a
post intervention auditing took the compliance to 97 percent. The study concluded that the
usage of Train the Trainer method in key elements along with incorporation of standardized
electronic audit tool and regular reporting enhanced aseptic techniques in a nationwide
manner. This research study involved a drastic change in assessment, audit and execution
methods of clinical practice delivery. The methods were successful in restoration of
consistency in aseptic technique practices were elaborate, decisive and systematic at the same
time.
Simon and Stephen (2017), aimed at determining whether standardizing aseptic
technique with invasive intra venous procedures, using the aseptic non touch technique
(ANTT) - Clinical Practice Framework - increases staff compliance with the infection
prevention guidelines. The guidelines should be followed to achieve an effective aseptic
technique and the study also analyzed if the practice is sustainable over time. A pragmatic
evaluation with mixed-methods approach including an observational audit of practice,
structured interviews with key stakeholders and a self-report survey. The study concluded
that implementation of ‘aseptic non touch technique’ enhanced compliance rates for safe
aseptic technique as defined by Clinical practice framework. The study found out that
enhancements in compliance were actually sustained for more than four years. The study
succeeded in proving the efficacy of aseptic non touch technique in improving compliance
rates of infection control.
Kate et al. (2016) aimed to identify barriers to infection control practice using a
clinical governance framework. A cross sectional online survey of professionals dealing with

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infection control (in Australia and New Zealand) was used as a method in order to elicit
perceptions about leadership, culture and context within their organizations. Their responses
were then mapped against the given dimensions of Scally and Donaldson’s clinical
governance framework. The study concluded that facilitation of evidence based practices
depends on strengthening of contextual factors like infrastructure, coherence and culture
inside the organization. Although the methodology used was qualitative but it succeeded in
answering its research question but a quantitative statistical method would have given clearer
insight into the framework and as to what are exact parameters in the contextual factors that
needs to be fixed.
Andra et al. (2016) applied a standardized tool Audit ‘Scrub the hub’ practices.
Reviewing existing literature to identify nine key components and an observation method of
clinical staffs was used as a method. The research study concluded that standardized audit
tool was helpful in facilitating quality improvement in patient centered care of high-risk
inpatient and patients in ambulatory care departments. The method used was qualitative and
lacked insight, analytical and critical components. Also the design was limited with one-
dimensional perspective of complications addressed. Moreover, an interview or a
questionnaire would have been more efficient in proving the facts, given the research
circumstances.
Davison (2016) aimed to teach aseptic technique by applying the basics. One hour
skill development sessions incorporated with an evidence based practice of aseptic technique,
demonstration of the techniques and practice by the attending nurses – was used as a
methodology. The research concluded that the guidelines laid the foundation for the practical
session and vascular assess skill was incorporated with other skills.

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MAIN ISSUES ASSOCIATED WITH ACORN STANDARD
The main issues associated with the clinical practice of ACORN standards are
inconsistency in practice, lack of nurse skills and non-adherence (Megeus et al. 2015). Lack
of audit (Mago et al. 2018), feedback, assessments and supervision within the organizational
framework (Singh and Sitting 2015) are the underlying causes that led to the above
mentioned causes. Other gaps in cultural and contextual framework are the secondary issues
gives rise to the loop holes in the ACORN’s clinical practice. Complex problems patient
complications, age group, clinical knowledge, nurse training and experiential knowledge of
the registered nurse influences the practice of ACORD standards in a crucial way.
ACORN STANDARDS AND PATIENT SAFETY
Refraining from holding unsterile items over sterile items helps in preventing any
microbial contamination in first instance. Ensuring all the items in sterile field as sterile is
critical to prevent any additional contamination in case. Setting up instrument tables
immediately prior to the surgical procedure helps in reducing chances of direct contamination
of the patient. Ensure sterile drapes in maintenance of a sterile field and considering and
ensuring that when impervious drapes are not used, a sterile plastic drape must be used in
prevention of strike thorough maintain sterility and avoiding contamination. Forming a cuff
with a sterile drape over the gloved hands should be used to diminish the risk of any potential
contamination.

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References
Austin, P. D., Hand, K. S., & Elia, M. 2015. Systematic review and meta-analysis of the risk
of microbial contamination of parenteral doses prepared under aseptic techniques in clinical
and pharmaceutical environments: an update. Journal of Hospital Infection, 91(4), 306-318.
Clare, S. and Rowley, S., 2018. Implementing the Aseptic Non Touch Technique (ANTT®)
clinical practice framework for aseptic technique: a pragmatic evaluation using a mixed
methods approach in two London hospitals. Journal of infection prevention, 19(1), pp.6-15.
Davidson, M., 2016. Teaching aseptic technique–Applying the basics. Infection, Disease &
Health, 21(3), p.139.
Desra, A.P., Breen, J., Harper, S., Slavin, M.A. and Worth, L.J., 2016. aseptic technique for
accessing central venous catheters: applying a standardised tool to audit ‘scrub the
hub’practices. The journal of vascular access, 17(3), pp.269-272.
Halton, K., Hall, L., Gardner, A., MacBeth, D. and Mitchell, B., 2016. Using a clinical
governance framework to identify barriers to infection control practice. Infection, Disease &
Health, 21(3), pp.143-144.
Leong, S., Bass, P., Worth, L., Miley, J., Klintworth, G., Spilsbury, S. and Watson, K., 2017.
‘It's all about technique’: Monitoring compliance with standardised aseptic technique
practices at a large Australian health service. Infection, Disease & Health, 22, p.S1.
Lin, F., Gillespie, B.M., Chaboyer, W., Li, Y., Whitelock, K., Morley, N., Morrissey, S.,
O’Callaghan, F. and Marshall, A.P., 2018. Preventing surgical site infections: Facilitators and
barriers to nurses’ adherence to clinical practice guidelines—A qualitative study. Journal of
clinical nursing.

9INFECTION CONTROL AND ASEPSIS
Mago, R., Fagiolini, A., Weiller, E. and Weiss, C., 2018. Healthcare professionals’
perceptions on the emotional impact of having an inadequate response to antidepressant
medications: survey and prospective patient audit. Annals of general psychiatry, 17(1), p.20.
Megeus, V., Nilsson, K., Karlsson, J., Eriksson, B.I. and Andersson, A.E., 2015. Hand
hygiene and aseptic techniques during routine anesthetic care-observations in the operating
room. Antimicrobial Resistance and Infection Control, 4(1), p.5.
Singh, H. and Sittig, D.F., 2015. Advancing the science of measurement of diagnostic errors
in healthcare: the Safer Dx framework. BMJ Qual Saf, 24(2), pp.103-110.
Spangler, H., Piehl, M., Lane, A. and Robertson, G., 2019. Improving Aseptic Technique
During the Treatment of Pediatric Septic Shock: A Comparison of 2 Rapid Fluid Delivery
Methods. Journal of Infusion Nursing, 42(1), p.23.
Wistrand, C., Falk-Brynhildsen, K. and Nilsson, U., 2018. National Survey of Operating
Room Nurses' Aseptic Techniques and Interventions for Patient Preparation to Reduce
Surgical Site Infections. Surgical infections, 19(4), pp.438-445.