Performing an aseptic technique in a community setting: fact or fiction?

Background - Maintaining the principles of asepsis when performing wound care and other invasive procedures is one of the fundamental approaches of preventing healthcare-acquired infection. Such an approach has been advocated for community practitioners. Literature - The performance of an aseptic technique is an under-researched area. The few studies that have been conducted have identified how strict adherence to the technique is difficult and contamination of hands/gloves is common and that community nurses often have a fatalistic view about whether asepsis is possible in a community setting. Aim - The overall aim of this research project was to examine how experienced practitioners have adapted the aseptic technique within a community setting and to what extent the changed procedure still adhered to the principles of asepsis. Methods - This study used a mixture of non-participant observation and individual semi-structured interviews to examine adherence to the principles of the aseptic technique among the district nurses. Data were collected from one Trust in England with a total of 10 district nurses taking part and 30 aseptic procedures been observed. Results - The results show that almost all of the staff understood the principles of asepsis and had adapted the standard procedure for use in a patient’s home. Common challenges included wound cleaning using a single nurse procedure, the contents of the pack and the home environment. The research also identified misconceptions about clean versus aseptic procedures and a lack of training for staff. Conclusions - This study highlights the challenges of maintaining the principles of asepsis in a home environment and the fact that district nurses are often relied upon to find creative solutions to such challenges. The study also highlights issues around the implementation of evidence-based practice and the need for clearer guidance about how evidence should be used alongside existing procedures.