Learning from ‘asepsis’ history is vital if we are going to continue with advances already accomplished in infection prevention at a clinical level. For the purpose of this item we are not going to revisit one of the usual historical ‘asepsis’ sources such as Pasteur or Lister. Our endeavor is to visit the work of Sue Crow. In the foreword for her book ‘Asepsis, the right touch’ (1989) Dennis Maki describes that for over two decades Crow has preached the gospel of bettering patient care through the consistent and logical application of asepsis. Maki continues by acknowledging that (in 1989) basic asepsis standards have been forgotten. Maki adds that the invasive nature of modern day medicine has increased the importance of an aseptic technique.
Although the book ‘Asepsis, the right touch’ points heavily towards infection transmission and prevention within the operating theatre the text does offer some interesting insights into the origins of an aseptic technique.
Pathogens do not compromise – why should you? This clear message from Crow underpins the concept of role responsibility and ensures that each practitioner develops an approach that supports the delivery of expected aseptic standards. Common sense and an aseptic conscience are described as the core elements of an aseptic standard.
The role of asepsis is to prevent nosocomial infections. Crow suggests that the first indication that touch contamination played a part in the transmission of infection was described by Arpad Gerstu “He showed a great understanding of aseptic technique when he asked surgeons not to resume surgery if they have contaminated their hands until they have been cleaned again”. Furthermore, Crow acknowledges the work of Lister. Describing how it is vital that healthcare personnel must be able to view ‘septic fomites’ with their mental eye just as clearly as they use their true vision. In todays lexicon of IV asepsis the ‘septic fomites’ would be described as ‘contaminated intraluminal and extraluminal parts’. Crow continues “Understanding methods of disease transmission allows you to disconnect the links is the infectious disease chain”. Crow describes how ‘sterile must be kept sterile’ and that cross infection is best prevented at the ‘transmission’ level.
When reflecting upon infection prevention Crow suggests the following elements should be considered:
- Know what is dirty
- Know what is clean
- Know what is sterile
- Keep the first three conditions separate
- Remedy contamination immediately
Her recommendations conclude with the overarching statement that practitioners must not allow clean or disinfected items to come into contact with dirty items. In the world of infusion therapy this involves the protection of intraluminal and extraluminal sources of infection.
Crow, S. (1989) Asepsis, the right touch. Everett Companies, Louisiana.