IPC 4.2 Aseptic Non-Touch Technique

Contents

 Introduction
 Standard ANTT
 Surgical ANTT 
 Standard and surgical procedure duration
 Preparation of the patient
 Preparation of staff
 Preparation of the environment
 ANTT in community settings
 Performing the procedure
 Staff training
 References / Source documents
 Appendix 1 (a)
 Appendix 1 (b) Surgical ANTT
 Appendix 1 (C) Wound dressing
 Appendix 2

 

1.0  Introduction

Organism

The key principles of Aseptic Non-Touch Technique (ANTT):

A - Always ensure hands are decontaminated effectively prior to the procedure.

N - Never contaminate key parts of sterile materials/equipment or the patient’s susceptible key sites.

T - Touch non-key parts with confidence.

T - Take appropriate infection prevention and control precautions e.g., use of PPE, safe waste management.

 

Regardless of the setting, the aim of ANTT is always to prevent the transfer of pathogenic micro-organisms from the healthcare worker, the procedure equipment, or the immediate working environment, into or onto the patient.

ANTT must be used for all clinical procedures which bypass the body’s natural defences, such as inserting or accessing intravenous (IV) indwelling devices, phlebotomy, urinary catheterisation and wound dressings.

 ANTT aims to prevent microorganisms from hands, surfaces or equipment being introduced into a susceptible (key) site such as an intravenous device, urinary catheter or wound, by identification and protection of the key parts of any procedure.

 

All staff

The clinicians providing services to the patient are responsible for:

• Ensuring that they are able to access IPC policies.
• Attend relevant training. Complete ANTT elearning 186 - Aseptic Non Touch Technique (ANTT) Course (on ESR) and Aseptic Non Touch Technique (ANTT) on Notts Healthcare E-Learning then advised 2 yearly refresher training.
• Ensuring that they achieve and maintain competency in relation to ANTT practice.

Hand hygiene as per National Infection Prevention Control Manual: NHS England » Chapter 1: Standard infection control precautions (SICPs)

Each procedure should be risk assessed to determine the level of exposure to blood and bodily fluid splashing. Single use gloves and plastic aprons should always be worn where there is a risk of contact with blood or bodily fluids. If a key part has to be handled or a key site touched, then the gloves must be sterile e.g. urinary catheterisation. Eye and face protection may be required if the procedure has a risk of splashing blood or bodily fluids to the face. NHS England » Chapter 1: Standard infection control precautions (SICPs)

Aseptic non-touch technique must be used for all clinical procedures which bypass the body’s natural defences such as:

• Inserting or accessing IV indwelling devices and ongoing care, including insertion site dressing.
• Collection of blood cultures.
• Administering IV (intravenous) /IM (intramuscular) medicines and parenteral nutrition.
• Urinary catheterisation and urine sampling via catheter port.
• When dressing wounds healing by primary intention (before surface skin has sealed), e.g., surgical wounds, burns, lacerations/breaks in the skin, ulcerations.
• Application of dressings to wounds healing by secondary intention e.g., leg ulcers, pressure sores.
• Enteral feed connection.
• Surgical procedures, e.g., Minor Surgery, biopsies.
• Podiatric procedures.
• Phlebotomy.

This list is not exhaustive and healthcare workers will need to identify the key and non-key parts prior to commencing care for all invasive procedures.

The overriding principle of ANTT is that the susceptible key site and key parts should not come into contact with any non-sterile items. A key part is a component that if contaminated with micro-organisms increases the risk of infection. When handling sterilised equipment, only the part of the equipment not in contact with the susceptible key site is handled.

All staff must ensure their actions minimise the likelihood of potentially pathogenic microorganisms being introduced into the patients’ susceptible key site and being spread between patients and colleagues.

There are two types of ANTT, Standard and Surgical-ANTT. These are the types and management of aseptic field(s) depending on the number of Key- Parts and Key-Sites that require protection. Risk assessment should form a vital part of ANTT (Royal College of Nursing, 2020).

 

Standard ANTT

• Standard-ANTT is the technique of choice when procedures meet all of the following criteria: They involve minimal Key-Parts and small Key-Parts, are not significantly invasive, are technically uncomplicated to achieve asepsis and are short in duration.
• Standard ANTT requires the use of a general aseptic field i.e., a clean surface or tray on which to place equipment with key parts protected e.g., caps and covers. See appendix 1(a).

 

Surgical ANTT

Surgical-ANTT is demanded when procedures meet one or more of the following criteria: They involve large or numerous Key-Parts, are significantly invasive, (e.g., Large Key-Sites(s) or central venous access), are technically complex to achieve asepsis or involve extended procedure time. Surgical ANTT requires the use of a critical aseptic field e.g., sterile procedure pack. See appendix 1(b). For wound care see appendix 1(C). 

 

Standard and surgical procedure duration

The longer Key-Parts and Key-Sites are exposed to the environment, the greater the potential for environmental or inadvertent touch contamination. Key parts therefore must remain protected at all times until the point of use e.g., by leaving the sterile packet on a urethral catheter until the point of insertion or caps and covers on syringes.

 

Preparation of the patient

Inform the patient about the procedure, gain consent and make them comfortable. There should be adequate means to protect the patient’s dignity. Unnecessary exposure of vulnerable sites should be avoided.

 

Preparation of staff

• Staff must be bare below the elbow and must ensure that any cuts or abrasions on their hands or forearms are covered with a waterproof occlusive dressing.
• Uniforms/clothing should be protected with a disposable plastic apron if there is a risk of contamination with pathogenic organism or blood and body fluids.
• The PPE (personal protective equipment) should be changed for each patient prior to commencing an aseptic procedure or between different procedures on the same patient.
• Risk assessment for the requirement of eye protection NHS England » Chapter 1: Standard infection control precautions (SICPs).

 

Preparation of the environment

Inpatient/clinic room settings

• The ideal environment for ANTT procedures is a designated clinic room. Where this is impractical, clinical procedures performed at the patients’ bedside must not occur directly after activities such as bed making, which may contribute to airborne contamination.
• Windows must be kept closed and portable air conditioning units or fans turned off during the clinical procedure.
• The immediate environment should be clean and free from visible dirt and dust.
• Assess the need for standard or surgical ANTT and gather the appropriate equipment.
• The trolley/tray/surface on which equipment and dressings are placed for procedures must be thoroughly cleansed with detergent and water, dried and then disinfected with disinfectant wipes or spray. Alternatively, multipurpose wipes which both cleanse and disinfect can be used. Allow the surface to dry before placing the equipment. If a dressing trolley is used it should be designated for this purpose only in a good state of repair and free from tape residue.
• Sterile packs should be checked for expiry dates and ensure there is no evidence of damage or moisture penetration.

 

ANTT in community settings

The environment within some community settings such as the patients’ homes, GP practice, schools, etc. may not always be favourable for carrying out clinical procedures. The healthcare worker may not have access to adequate hand washing facilities, trolleys, or other equipment and standards of environmental cleanliness cannot always be guaranteed. However, the healthcare worker is responsible for ensuring that the environment allows the procedure to be carried out safely and minimises any identified risks. A clean surface where available i.e. table or tray should be used to arrange the necessary equipment. Where this is not possible the sterile field in the dressing pack should be used and placed as near to the patient as possible but away from the patient’s immediate vicinity i.e., not placed on a bed next to the patient or on the floor, to avoid the risk of contamination. Best practice would be for staff to be provided with wipeable plastic trays for carrying out ANTT.

Pets should be kept away from the environment during the procedure.

Items of medical equipment should be stored in a designated box/bag away from the floor.

Where spare non-sterile gloves and aprons are required and are decanted into another bag/container from their original box/packaging, the clinician undertaking this practice must have decontaminated their hands effectively first. This is to prevent contamination from the hands to the personal protective equipment.

Gloves and aprons should not be kept in clinicians’ pockets.

Decontamination of Hands - All staff on domiciliary visits should be supplied with liquid soap, paper towels, alcohol hand rub & hand cream and hand sanitiser NHS England » Chapter 1: Standard infection control precautions (SICPs).

 

Performing the procedure

• Use a non-touch technique at all times.
• Sterile packs must be opened carefully to prevent contamination of contents.
• Identify Key parts and remove equipment from the packaging carefully.
• Assemble all equipment and arrange in an organised manner in the aseptic field ensuring that key parts are protected at all times with caps, covers etc. Key parts should NEVER be touched as doing so will compromise the aseptic technique.
• Ensure that sterile items do not come into contact with unsterile objects and only sterile items come into contact with the susceptible key site. For example, when touching a syringe with a needle, staff may handle the syringe but not the needle as this is a key part.
• If a key part has to be handled or a key site touched, then sterile gloves must be worn e.g., urinary catheterisation.
• Following the clinical procedure gloves and other personal protective equipment must be removed and disposed of appropriately and hands decontaminated.
• The clinical procedure which has been undertaken must be documented in the patient’s health care records. Following access of indwelling devices staff must always document the condition of the insertion and exit sites.

 

 

Staff training

All staff involved in carrying out invasive procedures must receive training in ANTT and be deemed competent. 186 - Aseptic Non Touch Technique (ANTT) Course (on ESR) and Aseptic Non Touch Technique (ANTT) on Notts Healthcare E-Learning 

 

References / Source documents

ANTT (2021) ANTT® Clinical Practice Framework. (Accessed: 25 January 2024).

ANTT (2021) ANTT® Resources. (Accessed: 25 January 2024).

ANTT (2021) ANTT® Implementation Guide. (Accessed: 25 January 2024).

Department of Health (2006) Essential Steps to Safe, Clean Care. (Accessed: 25 January 2024).

Hillier, M.D. (2020) 'Using effective hand hygiene practice to prevent and control infection', Nursing Standard, 35(5), pp. 45-50. doi:10.7748/ns.2020.e11552

The Royal Marsden NHS Foundation Trust (2020). Chapter 4: Infection prevention and control, in Royal Marsden Manual of Clinical and Cancer Nursing Procedures. London. (Accessed: 01 February 2024).

Department of Health and Social Care (2015) Health and Social Care Act 2008: code of practice on the prevention and control of infections. (Accessed: 01 February 2024).

National Patient Safety Agency (2008) Patient Safety Alert Second Edition 2 September 2008: Clean Hands Saves Lives. (Accessed: 01 February 2024).

Loveday, H.P.  et al. (2014) 'epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England'. Journal of Hospital Infection, 86, pp. S1-S70. doi:10.1016/S0195-6701(13)60012-2.

Rowley. S. and Clare, S. (2009) 'Improving standards of aseptic practice through an ANTT trust-wide implementation process: a matter of prioritisation and care'. Journal of Infection Prevention, 10(1), pp. S18-S23. doi:10.1177/1757177409342140.

Rowley, S. and Clare, S. (2020) 'How widely has ANTT been adopted in NHS hospitals and community care organisations in England and Scotland'. British Journal of Nursing, 29(16), pp. 924-932. doi:10.12968/bjon.2020.29.16.924

Royal College of Nursing (2020) Understanding Aseptic Technique: An RCN investigation into clinician views to guide the practice of aseptic technique. (Accessed: 25 January 2024).

Sax, H. et al. (2007) 'My five moments for hand hygiene': a user-centered design approach to understand, train, monitor and report hand hygiene'. Journal of Hospital Infection, 67(1), pp. 9-21. doi:10.1016/j.jhin.2007.06.004.

World Health Organization (2009) 'WHO guidelines on hand hygiene in health care'. (Accessed: 01 February 2024).

World Health Organization (2020) 'Hand hygiene for all initiative: improving access and behaviour in health care facilities'. (Accessed: 01 February 2024).

World Health Organization (2021) 'Five moments for hand hygiene'. (Accessed: 01 February 2024).

 

Appendix 1 (a)

Standard ANTT, all photographs and text in appendix sourced from ANTT E-Learning Nottinghamshire Healthcare E-Academy.

 

 

Appendix 1 (b) Surgical ANTT

 

 

Appendix 1 (C) Wound dressing

 

 

Appendix 2

Record of changes

Version	Date	Expert writer	Status (new, edited)	Comments
18.14 (Issue 2)	08/14	S Smith, D Holmes		Full review of policy to standardise clinical practice in line with national guidelines.
18.14 (Issue 2)	06/15	S Smith, D Holmes		Addition of Appendix 1 - Guidance for Lower Leg Cleansing.
18.14 (Issue 3)	01/18	S Smith, D Holmes		Minor amendments only.
18.14 (Issue 3)	01/21	L West		Review date extended until March 2021.
18.14 (Issue 4)	04/03/21	Emma Ellis		Full review of policy. Minor changes to standardise clinical practice in line with national guidelines and reference list updated. Removed appendices on washing legs.
18.14 (Issue 5)	April 21	L West		Reference number changed to 07.13.
07.13 (Issue 6)	June 2022	I Brackenridge /  S Clarke		Transfer to new Trust policy template. Numbering of related policies/procedures updated, and titles of policies/procedures corrected accordingly. Reference to Appendix 1 Lower Leg Cleansing Guidance removed from contents page as appendix previously removed from the policy (see above).
07.13 (Issue 7)	January 2024	S Clarke	Edited	‘Exceptional Circumstances’ section inserted at Section 16 as per agreement reached by the Trustwide Clinical Policies and Procedures Group (CPPG) on 07 June 2023. Policy review date extended from March 2024 until June 2024 as approved by CPPG on 10 January 2024 to enable development of IPC Manual.
	February 2024 and June 2024	K Hodgkiss and Infection Prevention Control Team	Edited	Policy reviewed and edited to new Trust approved template. Appendix images added. References updated as per library literature search.