Infection Prevention, Asepsis, and Sterile Technique
Domain 4: Infection Prevention, Asepsis, and Sterile Technique
This domain tests insertion and maintenance bundles that prevent catheter-related bloodstream infection.
Core rules
- Hand hygiene before and after every step. Use clean gloves for peripheral IV insertion after skin antisepsis; use maximal sterile barrier for central lines and PICCs: cap, mask, sterile gown, sterile gloves, full-body drape.
- Skin antisepsis: chlorhexidine gluconate >0.5% in alcohol, applied with friction, allowed to dry completely. Do not fan or blot. If chlorhexidine is contraindicated, follow the local alternative.
- Ultrasound: use sterile gel inside a sterile probe cover for central or PDVF insertion; non-sterile gel must not contact the sterile field or needle.
- Maintain separation of clean and contaminated items. If a sterile item touches an unsterile surface, replace it.
- Hub disinfection: scrub the access port with alcohol or chlorhexidine-alcohol, allow drying, and access only with sterile devices.
- Daily review: remove any device no longer indicated; check dressing, site, and need.
Worked example
During a PICC insertion, the operator drops the sterile probe cover onto the bed and picks it up with sterile gloves. Reasoning: the cover is contaminated. Stop, remove gloves, re-prep the site if touched, and use a new sterile cover. Continuing risks introducing skin organisms into the puncture site.
Traps
Believing sterile gloves alone equal asepsis; fanning chlorhexidine; touching non-sterile gel; reusing a probe cover; skipping hub scrub; and leaving a dressing loose.