Aseptique Technique: Preventing or Alleviating Problems

Today I saw a program on ABC's Good Morning America about organisms like bacteria living in make-up. If anyone has much knowledge of basic biology, he or she knows that micro-organisms are ubiquitous. The program did a good job of educating viewers to not keep make-up beyond a reasonable shelf-life so that the abundance of microbes in the make-up is kept to a minimum. I would like to further extend this concept to include aseptic technique.

What is aseptic technique? Most people understand, "sterile," kills microbes. For example, an autoclave uses steam heat and pressure to kill micro-organisms. Aseptic technique keeps contamination to a minimum rather than killing off all micro-organisms. When you scrub your hands with soap and water well, rinse them, then use a clean towel to shut off the water and open the door leaving the bathroom, you are using good aseptic technique, for example. Poor technique? You wash your hands and then open the door picking up bacteria, viruses, fungi, and mycoplasmas left behind by the people who didn't wash their hands. A few more examples of [applied] good aseptic technique:

• capping toothpaste
• closing the toilet seat before you flush
• not putting food (or medicine) back into it's container when you don't use it all (rather use a separate (labeled)container---not to contaminate the source container)
• not flailing open petri dishes around a room
• surface sterilizing surfaces (like computer key boards)
• not using antibiotic soaps and detergents (Using such antibiotics unnecessarily allows microbes to adapt to them and makes them less useful in battling human diseases. The bacteria develop resistance and won't help cure you when needed... How many doctor's offices and hospitals have I seen where they have antibacterial soaps? This can create super germs like MRSA, C-diff, VRE, and how many more?)
  
• Not using antibiotics unnecessarily in other areas, like milk and meat production (same reason)
  

Let's look at some dictionary definitions, then, I'll give you more examples.

technique, aseptic,

n task performed in a sterile environment in order to avoid contact with harmful bacteria. [Source: http://medical-dictionary.thefreedictionary.com/aseptic+technique Accessed May 12, 2010.]

Aseptic technique is a set of specific practices and procedures performed under carefully controlled conditions with the goal of minimizing contamination by pathogens. [Emphasis is Dr. J's. Source: Aseptic technique is a set of specific practices and procedures performed under carefully controlled conditions with the goal of minimizing contamination by pathogens. [Emphasis is Dr. J's. Source: http://www.answers.com/topic/aseptic-technique-surgical-term. Accessed May 12, 2010]

Of these two definitions, the second one shows a better understanding of microbes, even though the first one is labeled, "medical," and is a common misuse of the term aseptic. While aseptic and sterile are similar, they are not the same. You see, aseptic technique is used on surfaces like your hands, which can't be autoclaved while you are living anyway. You can't, "sterilize," your hands. Rather, one does one's best to eliminate pathogens by washing with soap and water. One can use the alcohol squirts to enhance but not to replace soap and water. That is important to understand. Why? The soap and water kills some pathogens the alcohol doesn't! Using both is good practice by anyone who understands germs.

Two further sections from www.answers.com/topic/aseptic-technique-surgical-term are presented and I encourage you to go to the source and read it. This reading applies to medical uses and so people may feel it doesn't apply to them. It does and I will try to show you how further on.

Aseptic technique is employed to maximize and maintain asepsis, the absence of pathogenic organisms, in the clinical setting. The goals of aseptic technique are to protect the patient from infection and to prevent the spread of pathogens. Often, practices that clean (remove dirt and other impurities), sanitize (reduce the number of microorganisms to safe levels), or disinfect (remove most microorganisms but not highly resistant ones) are not sufficient to prevent infection. [Source: http://www.answers.com/topic/aseptic-technique-surgical-term. Accessed May 12, 2010.]

The Centers for Disease Control and Prevention (CDC) estimates that over 27 million surgical procedures are performed in the United States each year. Surgical site infections are the third most common nosocomial (hospital-acquired) infection and are responsible for longer hospital stays and increased costs to the patient and hospital. Aseptic technique is vital in reducing the morbidity and mortality associated with surgical infections. [Source: http://www.answers.com/topic/aseptic-technique-surgical-term. Accessed May 12, 2010.]

I have seen too many people pick up nosocomial infections at the hospital. I don't want anyone to blame another elderly person for getting a super germ because that elderly person is old and has bad immunity. I want people to immediately look for flaws in aseptic technique. Be vigilant. Don't let yourself or your loved ones be blamed. Of course strengthening immunity is a good thing, too. But, many diseases could be avoided, even with lowered immunity, if good aseptic technique is used.

Sample nosocomial infections people I have known have acquired at hospitals:

• mycoplasma leading to 5 miscarriages
• VRE
• MRSA
• c-diff leading to internal bleeding
• pneumonia leading to death
  

Keep reading, I will tell you later how one of my community college students stopped an epidemic in Boston after learning of aseptic technique in my biology class. I really am a stickler for that. If you don't get aseptic technique, you fail. Why? Because if you don't get it, I won't let you get out. Your lack of aseptic technique can kill whole cities...

For now, let's look at some additional definitions. Here's one from microbiology:

Microbiologists and students of microbiology may use an aseptic technique to attempt to keep specimens of microorganisms free of microbial contamination. People may commonly use the aseptic technique when transferring bacteria from one test tube or flask to another. Such a procedure, using a flame sterilization method, might occur as follows.

1. A person would assemble the closed tube or flask from which, and the closed tube or flask to which the specimen is to be transferred, an innoculating loop , and a fire source, all on a clean, preferably microbe-free surface with some overhead protection from airborne microbes.
2. The person would start the fire, and move the end of the innoculating loop, in a slow back-and-forth motion, through the top of the blue part of the flame. The person would not allow the loop to touch anything except the specimen itself, until the entire procedure is finished.
3. Preparing to execute the specimen transfer, the person would hold both of the tubes or flasks in one hand, probably the opposite of the writing hand. The person would then open the tube or flask containing the specimen source and briefly hold the top of it in the flame, to kill unwanted microbes.
4. Quickly, so as to minimize the possible time for contamination of the specimen in the source tube or flask, the person would use the innoculating loop with their writing hand to retrieve the specimen, and then sterilize the top of the tube or flask again before immediately closing it.
5. Keeping in mind that the specimen on the innoculating loop could be contaminated during every unit of time it is exposed, the person would repeat the previous step identically with the tube or flask in which the specimen is to be deposited; however, the person would be depositing the sample into the tube or flask. [Source: http://www.bio-medicine.org/biology-definition/Aseptic_technique_in_microbiology/; Accessed MAy 12, 2010.]
   

You can see how the prior definitions were in medical settings and this one is in a laboratory setting. How could you use this at home? People canning their own food use similar techniques. But, even with a tube of toothpaste, you can keep the cap between your pinky and ring finger while you squeeze out the toothpaste and then re-cap the tube. While not perfect, it does keep out many more germs than laying an open tube on the sink and dropping the cap anywhere. Can you see that? Not to make you a fanatic, this explanation is to help explain that aseptic isn't sterile but is less contaminated than ignoring microbe populations.

Here is another quote on aseptic technique:

Clinical areas outside of the operating room generally do not allow for the same strict level of asepsis. However, avoiding potential infection remains the goal in every clinical setting. Observation of medical aseptic practices will help to avoid nosocomial infections, or those acquired in the hospital. General habits that help to preserve a clean medical environment include:

• Safe removal of hazardous waste (i.e., prompt disposal of contaminated needles or blood-soaked bandages to containers reserved for such purposes).
• Prompt removal of wet or soiled dressings.
• Prevention of accumulation of bodily fluid drainage (i.e., regular checks and emptying of receptacles such as surgical drains or nasogastric suction containers).
• Avoidance of backward drainage flow toward patient (i.e., keeping drainage tubing below patient level at all times).
• Immediate clean-up of soiled or moist areas.
• Labeling of all fluid containers with date, time, and timely disposal per institutional policy.
• Maintaining seals on all fluids when not in use.

These general practices are important for keeping the environment as free of microorganisms as possible. In addition, specific situations outside of the operating room require a strict application of aseptic technique. Some of these situations include:

• wound care
• drain removal and drain care
• intravascular procedures
• vaginal exams during labor
• insertion of urinary catheters
• respiratory suction [Source: http://www.novelguide.com/a/discover/genh_0002_0001_0/genh_0002_0001_0_00078.html Accessed May 12, 2010]

The above quote is again related to clinical settings. Can you think how to expand it to your every day life? Do you wash the empty sugar canister or ketchup bottle before re-filling it?

Here's a quote geared to nurses and showing a problem. Can you spot it? I'll help you:

A surgical scrub requires use of a long-acting, powerful, antimicrobial soap[Eek! Why create super germs when you don't have to!!!! Eek!!!!!! Use soap and water, scrub well...leave the antibacterial soaps with added antibiotics alone...We should stop making them.], careful scrubbing of the fingernails, and a longer period of time for scrubbing. Institutional policy usually designates an acceptable minimum length of time required. Thorough drying is essential, as moist surfaces invite the presence of pathogens. Contact after handwashing with the faucet or other potential contaminants should be avoided. The faucet can be turned off with a dry paper towel, or, in many cases, through use of foot pedals. Despite this careful scrub, bare hands are always considered potential sources of infection. An important principle of aseptic technique is that fluid (a potential mode of pathogen transmission) flows in the direction of gravity. With this in mind, hands are held below elbows during the surgical scrub and above elbows following the surgical scrub. [Source: http://www.enotes.com/nursing-encyclopedia/aseptic-technique; Accessed MAy 12, 2010.]

I am sure that many nurses were taught that way, and many doctors, too, but, think for yourself. Super germs develop resistance to antibiotics by frequent and improper use of antibiotics. These soaps sell well and make money but are, to the best of my thinking, an improper use. What do you think? If regular good hand-washing with ordinary soap works so well, adding the antibiotic to, "antibacterial," soaps is overkill, misuse and dangerous in the long run (yielding superbugs with nothing to kill them), isn't it?

You don't want, or at least shouldn't want, a sterile home. Why? You need good micro-organisms. Here's an example which may help you see why. I know a woman who cleans her home and herself trying to kill every microbe. The result, she and her daughter have vaginal infection after vaginal infection. You need good microbes to keep out bad ones. No matter how much I try to explain why some germs are needed, the good ones, she insists that all are bad. She kills off the bacteria and gets fungal infections. It is important to understand the balance of nature in any discussion of aseptic technique. Simply, an area populated with healthy, good-for-you germs, resists infection by bad germs and, as a result, helps you stay healthy.

I encourage you to use good aseptic technique in your home. Please remember that I am not a medical doctor. I do however have my doctorate and I have studied chemistry, biology, physics, microbiology, mycology and many subjects that medical doctors study. I have taught future doctors and nurses and allied medical professionals for years. Use your doctor for medical advise. My post should help you understand how the basic biology fits into the reality of life and point you to sources that can help you in discussions with your doctor. I want to encourage you to use your own brain in making decisions to wash your hands and in drawing conclusions from discussions with your doctor. In using this information, you accept that I am not giving you medical advice and the information is not intended to diagnose, treat, or cure any disease. Your use of the information is at your own risk. The post, simply a discussion of good hygiene and aseptic technique, for your information and to assist you in reading and developing your scientific literacy. Be well.
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I may add more later, but, I'll stop for now. I will go wash my hands... and eat yogurt. I hope you are laughing. I am teasing a bit. I do like yogurt and I do wash my hands before eating, after riding the trains, after going to the bathroom (oh, and before going to the bathroom, too...no sense adding anything unwanted to my flora.). So, teasing to serious again in a way that I hope helps you to remember aseptic technique.

The reading method here: checking many sources of definitions and thinking about all of them...a science literacy tool.

Coming soon: How the student stopped the epidemic in Boston...


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http://www.edexcel.com/migrationdocuments/BTEC%20Nationals%20from%202010/Unit_15_Microbiological_Techniques.pdf
(c)1975-2010. J S Shipman.