Challenges undertaking procedures requiring asepsis: a qualitative interview study with nurses

Background Invasive devices and breaches to skin and mucous membranes increase susceptibility to infection. Nurses frequently undertake procedures requiring asepsis (PRAs) but report challenges and unwarranted variations in practice. Objective To explore nurses’ experiences, perceived gaps in information and support needed to conduct PRAs. Methods We undertook qualitative interviews with 20 nurses in the health service in the United Kingdom September 2021-January 2022 employing approaches to sampling and data collection adopted in Grounded theory. Results Informants were employed in diverse clinical settings. They thought that outside operating theatres, attempts to maintain asepsis would inevitably be compromised but that much could still be done to contain risk of contaminating susceptible sites irrespective of circumstances. Suboptimal practice was reported and informants were unclear whether asepsis was needed to perform routine procedures (e. g. dressing chronic wounds, manipulating indwelling intravascular lines). Problems were attributed to inadequacies in nursing education, poor access to continuing professional development and carelessness of junior nurses and medical staff. Informants wanted more detailed guidelines to conduct PRAs. Senior nurses wanted procedures to be conducted in the same way regardless of circumstance. Nurses who undertook PRAs regularly suggested that guidelines should be flexible. Conclusion Need exists for detailed guidelines to inform PRAs, better access to clinical updating and improvements in pre-registration nursing education. To meet contemporary standards, guideline generation should adopt recognised methodology. Student nurses should be introduced to the knowledge and skills required to undertake and adjust PRAs according to circumstance during simulated practice before contact with real patients.