a. Gram-positive

bacteria

Yes Yes Yes Yes Yes Good (Strep >

Staph)

b. Gram-negative

bacteria

Yes Yes Yes Yes No Fair

c. Spores No No No No No No

d. Tubercle

bacillus

Yes Yes No No No Fair

e. Viruses Lipophilic only Yes Yes Yes Yes Fair

f. Fungi Yes Yes Yes Yes Yes Fair

 8. Use associated

with resistance

No No No Contamination Yes Ineffective against

Pseudomonas

 9. Rapid action Yes Yes No (4–5 min) Yes No Intermediate

10. Easily inactivated

by extraneous

organic matter

Maybe (inactivated

by nonbacterial

protein)

Yes No (good for

crevice and fat

penetration)

No Yes Minimal

MRSA, methicillin resistant staphylococcus aureus; CNS, central nervous system; EDTA, ethylenediaminetetra-acetic acid; Strep, Streptococcus species; Staph, Staphylococcus

species.

Chapter 5 ■ Aseptic Preparation 35

(6) Exclude from patient care all personnel with

exudative lesions or weeping dermatitis until

these conditions have resolved.

2. Recognize that no antiseptic is totally effective or without risk (Table 5.1).

3. Always allow antiseptics and disinfectants to dry before

starting procedure.

a. A drying time of at least 30 seconds is required for

optimal effect (10).

b. Contamination of instruments with antiseptic is

undesirable and may invalidate specimens taken for

culture.

c. If hand disinfectants are not allowed to dry, alcoholbased disinfectant vapors can accumulate inside

incubators (11).

4. Avoid removal of iodophor preparations prior to procedure. Removal negates the residual slow-release effect.

5. After the procedure, remove iodophor from all but

immediate area of procedure to prevent absorption

through skin (5,12,13).

6. Never allow antiseptic to pool under infant. Skin damage may result (14).

7. Use hexachlorophene for skin preparation in newborns

only as recommended by the American Academy of

Pediatrics (15).

a. Use only in term infants during outbreak of

Staphylococcus aureus infection if other infectioncontrol measures have been unsuccessful.

b. Wash off solution completely, and never use for routine bathing of infants.

8. Reapply alcohol prior to each attempt at procedure or

with any delay, as efficacy is short-lived and flora will

regenerate quickly.

9. Keep all antiseptics away from eyes.

10. Store antiseptics in closed containers. Reusable dispensers should be thoroughly cleaned, dried, and

refilled frequently. Disposable containers are available.

11. Gloving cannot be used as an alternative to hand

washing.

a. The warm, wet skin surface under gloves offers an

ideal environment for bacterial multiplication.

b. Gloves are not completely impermeable to microorganisms.

c. Latex and vinyl gloves offer comparable permeability,

but vinyl gloves leak more readily.

F. Special Circumstances

1. In clinical situations where traditional hand-washing

facilities are unavailable, such as during patient transport, alcohol-based hand rinses, foams, or wipes may be

used for hand cleaning. When an alcohol solution is

used, make three to five applications of 3 to 5 mL each

and rub hands well until completely dry. Gloves should

be used as otherwise indicated. This technique is not

adequate when hands are soiled with organic matter.

2. In medical emergencies, aseptic technique should be

used as allowed by the situation, with at least antiseptic

skin preparation of the patient, use of gloves, and a sterile field as large as possible under the circumstances.

3. Personnel suffering from allergies to antimicrobial

soaps may wash thoroughly for 3 to 5 minutes with

plain soap or 70% isopropanol with glycerin prior to

gloving (8).

4. Personnel suffering from skin cracking due to frequent

use of antiseptic soaps may use moisturizing skin products or barrier creams after hand washing. Products

with a bacteriostatic ingredient, such as gels containing

60% ethanol, and emollients are safe and effective in

reducing skin problems (8). Containers with a flip top,

rather than a screw cap, are recommended. Routine

hand decontamination can be done with soap and

water or alcohol-based hand rubs (8).

5. Non—latex-containing gloves should be available for

staff with latex allergy and to avoid allergic reactions in

the patient, particularly in susceptible patients such as