In this reflection I am going to discuss a procedure that I have carried out whilst I have been on placement and the importance of infection control using the Aspetic Non Touch Technique (ANTT).
The procedure I am going to discuss is a dressing change to a leg ulcer which took place during a routine home visit with the community nurse. I am going to use Gibbs Model of Reflection (1988), to reflect on the experience and evaluate my thoughts and feelings of the procedure, and to outline what I have gained from the experience for my future practice. After observing my mentor and other nurses performing various dressing changes using the Aseptic Non Touch technique (ANTT), and practicing the procedure under supervision a number of times I was asked to change the dressing on a patients leg ulcer. The patient was an elderly lady, who I had visited in her home to change her leg ulcer dressings previously.
After introducing myself to her again and gaining permission for the procedure I washed my hands and opened the sterile dressing pack onto the floor. This was now my sterile field to put any new sterile dressings or other equipment onto in order to minimise the risk of the wound becoming contaminated and possibly infected. Within the dressing pack there are a pair of sterile gloves and an apron, some sterile gauze and a plastic bag to put any waste into. I put on the sterile apron and gloves taking care not to touch the outside of them in order to keep them sterile. I could then touch anything on my sterile field without contaminating it and so placed a second sterile sheet underneath the patient’s leg to prevent any debris from the wound from spreading across the floor. I then started to remove the dressings that were already on the wound. I did this and then disposed of them in the plastic bag provided in the dressing pack. I then used sterile water to clean the wound, taking care to only use each piece of gauze once before disposing of it in the plastic bag. Once the wound was clean and the Nurse observing me carry out the procedure had assessed the wound, I reapplied the new dressings, which in this case were Inadine and Allevyn Gentle. Once the dressings were securely on and the procedure had been finished, I removed my apron and gloves and disposed of them in the plastic bag, along with everything thing else I had used and then washed my hands again.
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After leaving the patients home I discussed my practical experience with the Nurse who informed me that I although I had carried out the procedure well it was actually carried out using a clinically clean technique rather than the Aseptic Non Touch Technique as I had thought. As I had used the same gloves to remove the dirty dressings from the leg ulcer and then apply new sterile dressings I had not maintained the Aseptic Non Touch Technique. The Nurse informed me that this was perfectly suitable for the procedure I carried out as the wound was still kept as clean as possible and dressings and equipment used were sterile. Whilst carrying out the procedure I felt confident with my practice of the dressing change using the Aseptic technique. Although I was slightly nervous and self-conscious as I was aware that the trained Nurse was observing me, I felt that this did not come across in my body language or my practice.
When the Nurse told me that I was not using the Aseptic Non Touch Technique I felt unsure of the whole process which then led to me re-evaluating my practice within this area. The Lincolnshire Community Health Service (LCHS) guidelines on Infection Prevention and Control (LCHS, 2011), define the Aseptic Technique as a practice or procedure undertaken to ensure the freedom from microbial contamination. It also states that the Non Touch Technique should be performed without directly touching the wound or any other surface it may come into contact with. Although at the time I thought I was performing the procedure using the Aseptic Technique upon evaluation of the experience I have realised that the procedure was not carried out using the Aseptic Non Touch Technique. By using my sterile gloves to remove the dirty dressing I contaminated my gloves, meaning they were no longer sterile. I then used the same gloves to clean the wound and apply new sterile dressings, meaning the procedure was not a sterile one.
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Despite the procedure not being sterile, it was however clinically clean. This is a modified Aseptic Technique, were the use of the sterile equipment is not as crucial. It employs the principals of the Non Touch Technique as outlined above, however the gloves can be clean as opposed to sterile (LCHS, 2011).
The Infection Prevention and Control Guidelines issued by the LCHS (Appendix 7) outlines the indications for when the clinically clean technique can be used as opposed to the Aseptic Technique.
This includes the application of dressings to wounds such as leg ulcers and pressure sores within the patients’ own homes. As I was within the patient’s home and performing a dressing change on a leg ulcer, I was within the guidelines for clinically clean techniques. After research into the different methods of infection prevention and control, and reflection on my own experience of these techniques within practice, I now have a better understanding of the reasoning behind the Aseptic Technique and the differences between that and the Clinically Clean technique. I am now more aware of these procedures within practice and am continuing to practice both of these techniques whilst on placement. I am also now more aware of the local trusts policies and procedures regarding dressing changes within the home, and I feel more confident with my practice of this procedure and that it is safe and evidence based as all nursing practice should be.
