Table of Contents Show
Almost all of us might have seen the meme wherein a junior doctor is being yelled at by his senior for accidentally breaking the “Sterile Bubble”.
What is the sterile bubble? Why is it so dear to the surgeon? And most importantly, why is the junior getting yelled at?
Today’s article will answer all of the aforementioned. Any and every doubt that you have about “Asepsis”; will be discussed today. Be it the origin of the practice or the current trends, we’ve got you covered.
Starting with the core basics of the read – What is Asepsis or the Aseptic technique?
1. What Is Asepsis Or The Aseptic technique?
For a medical practitioner, asepsis is a fundamental concept that revolves around maintaining a sterile dressing technique1 or an infection-free environment. But for normal people like us, it refers to the state of being free from disease-causing organisms to prevent the spread of infections.
If you thought that surgical aseptic techniques were confined only to the healthcare field; you’re highly mistaken. Asepsis is implemented in various fields like microbiology; with healthcare being its primary focus. Even beyond the health sector, asepsis is still a hero. For starters, in the food industry, preserving food quality and safety is a must.
Preventing food infestation is the answer to preventing foodborne illnesses2. Furthermore, pharmaceutical companies rely on aseptic techniques to not only manufacture drugs but also to ensure the products’ efficacy.
The list doesn’t end here. In laboratories, asepsis is essential if you want accurate results. Moreover, it becomes even more pivotal if you are looking to reduce the risk of contamination3.
2. Origin Of The Medical Marvel
Every masterpiece takes time. The aseptic technique also underwent many changes over the timeline and is still in the process of getting better day by day.
And why should it not; It is the basis of all other medical innovations. Let us have a look at the progression from a limited orthodox understanding of infection control to the establishment of a fundamental pillar of modern medicine.
2.1. Pre-Modern Era:
Ancient civilizations had a completely different idea about asepsis. Though it was intended to disinfect people and places; the methodologies involved were very traditional.
Practices such as boiling water, using honey as an antiseptic, and burning aromatics were employed to counter infections. However, the role of microorganisms, or how they were transmitted; was still not known to the world.
2.2. 18th Century:
It wasn’t until the 18th century that the “Enlightenment era” stepped in. We see significant advancements in the understanding of infectious diseases. It was this time when scientists like Edward Jenner and Louis Pasteur stepped into the game.
Though we were introduced to concepts like vaccination and pasteurization4; our understanding of asepsis was still limited. There were still many deaths owing to the unhygienic practices being followed during operations.
2.3. 19th Century:
The 19th century is by far the most innovatively active time in the history of asepsis. One of the earliest champions of asepsis was Ignaz Semmelweis, a Hungarian physician. He observed a high mortality rate among women due to puerperal fever in the maternity wards. His curiosity led him to find the reason and also the solution to this issue.
It was then discovered through rigorous washing with chlorinated lime solutions that it was the healthcare professionals who were vectors. This was a groundbreaking work, yet it received nothing but ridicule and resistance. It went on to become the “Semmelweis Effect”.
The coming years were no less than a rollercoaster ride. Starting from Joseph Lister revolutionizing the surgical realm with the use of carbolic acid (phenol) to the discovery of steam sterilization by Charles Chamberland.
That’s not the end of the list. We also have inline William Halsted, the scientist credited with the development of sterilized gloves.
2.4. 20th Century:
This century was more like a “Standardization and Advancement” era. It witnessed the active standardization of aseptic practices. Since we were now well-versed in the mechanism and science behind it, it was easier for us to upgrade and modify the same.
The 20th century is also special as it saw the advent of antibiotics which further complemented infection control efforts. With the introduction of disposable gloves, single-use instruments, and sterile packaging; the risk of contamination went down by almost 45%.
2.5. Contemporary Era:
Today, the aseptic technique is firmly established as a cornerstone of modern healthcare. The understanding of infection transmission, efficient antiseptic development, and new-age sterilization techniques have become the very basics.
You walk into any hospital, the very first sight is the floor being swept with a disinfectant. Strict adherence to aseptic protocols is now an essential component of healthcare training and education. Undoubtedly, we have a lot more coming.
3. Application In The Medical Field
3.1 Infection Prevention:
The foremost line of protection that our bodies go for is our physical barriers. If we use infected or unsterilized equipment for surgeries and wound dressings; we’ll land up in a grave situation. As you know, during medical procedures and surgeries, the human body’s natural defence is often compromised. This ends up in the patient becoming much more vulnerable to microbial invasion.
Consider it as getting shot from all angles without a single armour to protect. By maintaining a sterile environment and employing aseptic practices, healthcare professionals prevent the introduction of pathogens. If they enter the body system, they could lead to several serious healthcare-associated infections.
Moreover, this would complicate the surgery more and more. For those of you wondering, how bad it can be. These infections could range from relatively mild skin infections to life-threatening systemic infections like kidney and gall bladder infections.
3.2 Reduced Complications
Like the aforementioned, we invite complications with every little surgical mistake that we make. Aseptic techniques play a pivotal role in reducing post-operative and post-procedural complications. Take an example of a surgical setting wherein one is required to do a simple task like wound dressing.
If not given proper aseptic treatment, a simple cut could end up being a nasty big wound with delayed healing and the formation of abscesses.
How does asepsis help? Asepsis minimizes the chances of contamination at the surgical site, thereby reducing the risk of complications. Eventually, we can alleviate the need for additional interventions to a great extent.
3.3 Patient Safety:
The Hippocratic oath that the doctors take at the very beginning of their career teaches them the core value of how important human life is. Patient safety is the heart of healthcare practices and asepsis is a linchpin in achieving the same.
Why do I say so? By employing proper hand hygiene, using sterile equipment, and maintaining sterile fields; the risk factors drop down by a sweeping 78%. This commitment to aseptic practices is not just a regular medical protocol that is followed for namesake.
It reflects a fundamental principle of medical ethics: ensuring that patients are not exposed to additional risks due to healthcare interventions.
3.4 Enhanced Recovery:
Asepsis contributes to speedy and enhanced patient recovery. Now, this is a very obvious topic of discussion. We are all aware of how important it is for patients to be kept in an aseptic environment. Patients who undergo surgeries in environments where aseptic techniques are rigorously followed experience fewer complications.
In addition, they have faster healing and shorter hospital stays. On the contrary, patients who are operated on under unfurnished conditions like those being treated in refugee camps or war victims are much more susceptible to death.
3.5 Cost Saving:
It is self-understood that a healthy body is home to a healthy mind. Today, we should add another virtue to the pact. A healthy body is also home to a very very healthy pocket.
By preventing infections and complications, healthcare facilities can significantly reduce the financial burden on the patient. Moreover, asepsis promotes the efficient use of healthy resources by minimizing the need for further medical interventions and the allocation of resources to manage preventable complications. Yup, it’s that important!!!
4. Types of Aseptic Techniques
When it comes to distinguishing the different kinds of aseptic measures, we have two main categories:
4.1 Medical Asepsis (Clean Technique)
As the name suggests, medical asepsis focuses on reducing the number of microorganisms and preventing their spread from one area to another. It is commonly used in routine patient care settings such as administering medications, wound dressing, or, in general, for any patient interaction. The various principles of medical asepsis include:
- Hand hygiene: Researchers state that more than 78% of disease contact or transmission occurs through our very own hands. In such cases, it becomes very important to follow a strict regime. Thorough and regular hand washing with soap and water or using an alcohol-based hand sanitiser is crucial. Hand hygiene is all the more important not only because of its benefits to the patient’s recovery but also because of its necessity for the healthcare worker’s safety.
- Personal protective equipment (PPE): Covid-19 brought many new words to our tongues. One of them was the PPE kits. The white plastic-textured gowns that doctors wore while treating corona patients. While medical asepsis doesn’t require the same level of sterility as surgical asepsis; PPE such as gloves, masks, and eye protection are still used to knock out any hint of doubt.
- Proper Disinfection: Surfaces, equipment, and patient care items like their towels, and robes are regularly cleaned. The reason is very simple – to reduce the presence of pathogens and to eliminate the risk of contamination to the maximum that we can.
- Isolation Precaution: Another very commonly used word during the pandemic was “quarantine”. Well, we know very well what quarantine is and what great significance it carries. Patients with contagious infections might require isolation precautions for the safety of themselves as well as the staff serving them.
4.2 Surgical Asepsis (Sterile Dressing Techniques)
The main aim of the sterile technique of this category is to maintain a completely sterile environment to prevent any microbial contamination during invasive procedures, surgical procedures, or other risky operations.
You might have guessed by now as to which is the more pivotal of the two. Though both of them hold importance in their respective areas of work, surgical asepsis is a boon for procedures where the risk of infection is high.
4.3. Sterile Environment:
The entire operating area is maintained in a sterile state. It is the same ‘sterile bubble’ that we talked about in the introductory paragraphs. It is very very important to create a sterile field using sterile drapes, sterile surgical instruments, and even sterile gowns.
4.4. No-Touch Sterile Technique:
When handling sterile items, a “no-touch” technique is used. What is the technique? It is quite simple yet clever. This means that healthcare professionals avoid directly touching sterile items and only touch them with sterile gloves or other sterile devices.
5. Limitations of Asepsis
Is it that easy to create and maintain a sterile bubble? Certainly not. There are various challenges associated with maintaining asepsis. These challenges can arise due to several reasons including human factors, equipment limitations, and many more. Some of the most concerning issues have been listed for you.
5.1 Human Error:
There is a very evident phrase going about in the market that states that AI is very far away from replacing healthcare professionals. It is quite true, looking at the current situation of health services we have.
And since we have humans with a mind and non-programmed intelligence, we are bound to have errors that have no reasoning except for the fact that a human cannot be errorless. Despite training and protocols, human error can lead to lapses in aseptic practices. Factors like fatigue or high patient loads can contribute to these mishaps.
5.2 Training and Education:
Aseptic techniques might look simple on the surface, but they have many technicalities. In-depth knowledge and proper training are essential for the proper application of the techniques in real-life emergencies. An inadequate understanding of the importance of asepsis can lead to inconsistent implementation of protocols and thereby have severe consequences.
Over time, healthcare professionals might become complacent about the aseptic practices due to routine or familiarity. It is much like us getting bored of doing the same chore daily.
But we need to remember that if we don’t dust our house, we won’t risk our lives. But if a doctor skips a sterilization process, he/she might be risking a life. This attitude can compromise the rigour required for maintaining sterility and infection prevention.
5.4 Equipment Limitation:
If we cannot rely on humans to be flawless, you can very well imagine how accurate mere machines could be. Malfunctioning sterilization equipment or inadequate disinfection processes can hinder aseptic practices. Inconsistent sterilization or disinfection can lead to the persistence of microorganisms, increasing the risk of infections.
5.5 Pathogen Evolution:
Like our aseptic practices, the pathogens are also on their walk of evolution. By the time we upgrade our sterile technique, we might have a hundred different variants of the pathogen5 available. This impacts the effectiveness of aseptic techniques over time.
5.6 Emerging Infectious Disease:
The rate of emergence of new diseases is constantly surging. The development of such highly contagious and antibiotic-resistant pathogens poses challenges to our current aseptic practices. Moreover, healthcare facilities need to adapt rapidly to new threats and update their protocols accordingly.
5.7 Time Constraints:
In the present times, time constraints can lead to rushed procedures and shortcuts in aseptic practices. With a long line of patients waiting to get treated, we can not expect the doctors to wash their hands after every appointment. This compromises the thoroughness required for maintaining sterility.
6. What Does The Future Hold?
6.1 Advanced Sterilization Technique:
Emerging sterilization methods, such as plasma-based sterilization6 and innovative uses of ultraviolet (UV) light, hold promise for faster and more efficient decontamination of equipment and surfaces.
Nanomaterials with inherent antimicrobial properties could be integrated into medical devices, surfaces, and textiles, reducing the need for frequent disinfection and enhancing infection prevention.
6.3 Robotics and Automation:
Robotics could play a significant role in maintaining asepsis, particularly in high-risk environments like surgical theatres. Autonomous robotic systems could perform tasks with precision, reducing the potential for human error and surgical site infections.
6.4 Smart Surfaces and Materials:
The development of self-cleaning surfaces and materials that repel pathogens could become more prevalent. Moreover, these materials might be incorporated into medical devices and frequently touched surfaces to minimize contamination.
6.5 Point-of-Care Sterilization:
Portable and rapid sterilization technologies could be employed at the point of care, ensuring immediate access to sterile instruments and reducing delays during critical procedures.
6.6 Personalized Healthcare-Associated Infections Control:
Advances in genomics and diagnostics might enable tailored infection control strategies based on an individual’s susceptibility to certain pathogenic organisms. Personalized approaches could optimize aseptic practices for each patient.
7. In The End
In conclusion, asepsis is not a static concept but a dynamic and evolving field that adapts to the challenges and opportunities of modern healthcare. Future trends in asepsis will be shaped by technological innovations, scientific breakthroughs, and the need to address emerging infectious threats.
- Kent, Dea J., et al. “Does the use of clean or sterile dressing technique affect the incidence of wound infection?.” Journal of Wound, Ostomy and Continence Nursing 45.3 (2018): 265-269. ↩︎
- Mitchell, Roger E., Angela M. Fraser, and Lucille B. Bearon. “Preventing food-borne illness in food service establishments: Broadening the framework for intervention and research on safe food handling behaviors.” International Journal of Environmental Health Research 17.1 (2007): 9-24. ↩︎
- Mark, David, et al. “Mobile phones in clinical practice: reducing the risk of bacterial contamination.” International journal of clinical practice 68.9 (2014): 1060-1064. ↩︎
- Convit, Jacinto, et al. “Therapy of Venezuelan patients with severe mucocutaneous or early lesions of diffuse cutaneous leishmaniasis with a vaccine containing pasteurized Leishmania promastigotes and bacillus Calmette-Guerin: preliminary report.” Memórias do Instituto Oswaldo Cruz 99 (2004): 57-62. ↩︎
- Sokurenko, Evgeni V., David L. Hasty, and Daniel E. Dykhuizen. “Pathoadaptive mutations: gene loss and variation in bacterial pathogens.” Trends in microbiology 7.5 (1999): 191-195. ↩︎
- Laroussi, Mounir. “Low temperature plasma‐based sterilization: overview and state‐of‐the‐art.” Plasma processes and polymers 2.5 (2005): 391-400. ↩︎