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33

5 Aseptic Preparation

Nickie Niforatos

Khodayar Rais-Bahrami

A. Definitions

1. Antiseptic

a. Bactericidal or bacteriostatic substance that can be

safely applied to skin

b. Not reliable as a sporicidal

c. Reduces but does not eliminate bacterial counts on

the skin

(1) Has an immediate effect

(2) Has variable residual activity by binding to the

stratum corneum of the skin

2. Disinfectant

a. Chemical germicidal substance

b. Not reliable as a sporicidal

c. Too harsh to be used on skin

3. Resident flora

a. Organisms, usually of low virulence, which survive

and multiply on skin and can be cultured repeatedly

(e.g., Staphylococcus epidermidis)

b. Cannot be completely eradicated without destroying the skin

c. Regenerate rapidly on skin when surgical gloves are

worn

4. Transient flora

a. Organisms, occasionally pathogenic, but do not survive and multiply on skin (e.g., gram-negative organisms such as Escherichia coli)

b. Can be transmitted to patients from the hands of

health care workers

c. Do not usually remain on the skin for more than

24 hours

d. Can be eradicated completely by hand washing with

antiseptic solutions

B. Background

Bloodstream bacterial infection is an extremely common

complication of prematurity. The majority of etiologic pathogens are nosocomial, most often transmitted by health care

personnel. Use of aseptic technique is critical in reducing the

number of bloodstream infections as well as in decreasing

the number of contaminated blood cultures, which in turn

leads to a decrease in the unnecessary use of antibiotics and

the potential for antibiotic resistance. Protocols and procedures for aseptic technique in neonatal intensive care units

(NICUs) are constantly being re-evaluated and updated,

and hand hygiene guidelines are routinely published by the

U.S. Centers for Disease Control (CDC) (1,2). Hospital

managers continuously develop and update strict policies

and regulations (3) as well as quality improvement projects

aimed to promote adherence to aseptic technique and hand

hygiene (4).

C. Indications

1. Preparation of patient’s skin and the hands of personnel

prior to performing a procedure

a. To remove transient flora

b. To decrease and temporarily suppress most resident

skin flora

2. Decontamination of hands after a procedure

D. Contraindications

1. Iodine solutions for preparation of skin in premature

and low-birthweight infants (may cause skin and

thyroid problems in high concentrations) (5)

2. Halogenated bisphenols (e.g., hexachlorophene) for

preparation of skin in premature and low-birthweight

infants (see E7), or used on burned or denuded skin of

all infants

3. Hypersensitivity to halogenated bisphenols

4. Hypersensitivity to chlorhexidine

5. Chlorhexidine for preparation of external auditory meatus

E. Precautions

1. Universal (6,7)

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