Asepsis and Hand Hygiene in Healthcare

Dr. Neha Sharma

Introduction

  • Infection prevention is a fundamental component of safe healthcare practice.

  • Hospitals and laboratories are high-risk environments for the spread of microorganisms.

  • Healthcare-associated infections (HAIs) increase patient morbidity, mortality, and healthcare costs.

  • Asepsis refers to the prevention of contamination by harmful microorganisms.

  • It includes practices designed to reduce or eliminate microbial presence.

  • Medical asepsis focuses on reducing the number and spread of microorganisms.

  • Surgical asepsis aims to eliminate all microorganisms, including spores.

  • Hand hygiene is the most effective and economical infection control measure.

  • Proper aseptic techniques help break the chain of infection.

  • These practices protect both patients and healthcare workers.

  • Strict adherence improves clinical outcomes and patient safety.

Asepsis

Asepsis refers to the absence of disease-causing microorganisms. It includes all practices that prevent contamination by pathogens and reduce the risk of infection.

Aseptic practices aim to:

  • Prevent introduction of pathogens into sterile body sites

  • Reduce microbial load in clinical settings

  • Protect healthcare workers and patients

  • Interrupt the chain of infection

 

Historical Background of Asepsis

The concept of asepsis evolved in the 19th century:

  • Ignaz Semmelweis demonstrated that hand washing dramatically reduced maternal deaths due to puerperal fever.

  • Joseph Lister introduced antiseptic surgery using carbolic acid, reducing postoperative infections.

Their discoveries revolutionized infection control and laid the foundation of modern aseptic techniques.

Types of Asepsis

Asepsis is broadly classified into two types:

  1. Medical Asepsis (Clean Technique)

  2. Surgical Asepsis (Sterile Technique)

Both play distinct but complementary roles in infection prevention.

Medical Asepsis

Medical asepsis consists of practices that reduce the number and spread of microorganisms. It does not eliminate all microorganisms but minimizes their transmission.

Objectives

  • Prevent cross-contamination

  • Reduce microbial load

  • Control spread of infection within healthcare settings

Core Principles

  • Perform regular and proper hand hygiene

  • Use appropriate personal protective equipment (PPE)

  • Clean from least contaminated to most contaminated areas

  • Avoid shaking linens to prevent airborne spread

  • Dispose biomedical waste safely

  • Isolate infectious patients when necessary

Cleaning and Disinfection in Medical Asepsis

Cleaning

Cleaning is the physical removal of dirt, organic matter, and debris using water and detergents. It is the first and most essential step before disinfection or sterilization.

Disinfection

Disinfection destroys most pathogenic microorganisms, except bacterial spores.

Levels of Disinfection:

  • High-level disinfection (kills all microbes except spores)

  • Intermediate-level disinfection (kills mycobacteria, most viruses, bacteria)

  • Low-level disinfection (kills some bacteria and viruses)

Common hospital pathogens controlled through medical asepsis include:

  • Staphylococcus aureus

  • Escherichia coli

  • Pseudomonas aeruginosa

  • Klebsiella pneumoniae

 

Applications of Medical Asepsis

Medical asepsis is practiced in:

  • General ward care

  • Bed making and linen handling

  • Oral medication administration

  • Handling laboratory specimens

  • Cleaning patient surroundings

  • Dressing non-sterile wounds

  • Routine suctioning

 

Surgical Asepsis

Surgical asepsis involves procedures that eliminate all microorganisms, including bacterial spores. It is mandatory during invasive and surgical procedures.

Objectives

  • Prevent introduction of pathogens into sterile body cavities

  • Maintain sterility during procedures

  • Prevent surgical site infections (SSI)

Principles of Surgical Asepsis

  • Only sterile items should contact sterile items

  • Sterile field must remain in constant view

  • Items below waist level are considered contaminated

  • Moisture contaminates a sterile field

  • If sterility is in doubt, consider it contaminated

Sterilization Methods Used in Surgical Asepsis

1. Moist Heat Sterilization (Autoclaving)

  • 121°C at 15 psi for 15–20 minutes

  • Destroys spores

  • Most reliable and commonly used method

2. Dry Heat Sterilization

  • 160–170°C for 2 hours

  • Used for glassware, metal instruments

3. Gas Sterilization

  • Ethylene oxide

  • Suitable for heat-sensitive equipment

4. Radiation Sterilization

  • Gamma radiation for disposable medical supplies

 

Sterility Monitoring

  • Physical indicators (temperature, pressure monitoring)

  • Chemical indicators (color-changing strips)

  • Biological indicators (spore testing)

 

Hand Hygiene

Hand hygiene is the single most effective measure to prevent healthcare-associated infections.

According to the World Health Organization, proper hand hygiene significantly reduces infection transmission in healthcare settings.

Types of Hand Hygiene

1. Routine Hand Washing

  • Soap and water

  • 40–60 seconds

  • Required when hands are visibly dirty

2. Alcohol-Based Hand Rub (ABHR)

  • 20–30 seconds

  • Effective when hands are not visibly soiled

  • Rapid antimicrobial action

3. Surgical Hand Scrub

  • 2–5 minutes

  • Includes hands and forearms

  • Performed before surgery

 

WHO’s Five Moments of Hand Hygiene

  1. Before touching a patient

  2. Before clean/aseptic procedures

  3. After body fluid exposure

  4. After touching a patient

  5. After touching patient surroundings

 

Proper Hand Washing Technique

  1. Wet hands with water

  2. Apply soap

  3. Rub palms together

  4. Rub backs of hands

  5. Interlace fingers

  6. Clean thumbs

  7. Clean fingertips and nails

  8. Rinse thoroughly

  9. Dry with clean towel

Duration: 40–60 seconds.

Importance of Hand Hygiene in Laboratory Practice

For Medical Laboratory Technologists (MLTs):

  • Perform hand hygiene before and after specimen handling

  • Use gloves appropriately

  • Avoid touching face during procedures

  • Decontaminate work surfaces

  • Follow biomedical waste protocols

 

Medical vs Surgical Asepsis: Key Differences

Feature Medical Asepsis Surgical Asepsis
Objective Reduce microorganisms Eliminate all microorganisms
Also Known As Clean technique Sterile technique
Used In Routine care Invasive procedures
Sterility Required No Yes

Consequences of Poor Aseptic Practices

Failure to follow aseptic principles may result in:

  • Surgical site infections

  • Bloodstream infections

  • Sepsis

  • Increased hospital stay

  • Antimicrobial resistance

  • Increased healthcare costs