Aseptic Non-Touch Technique (ANTT)

ASEPTIC NON-TOUCH TECHNIQUE (ANTT)

Purpose

To provide nurses/carers with evidence base guidelines to enable them to undertake the administration of intravenous therapy using Aseptic Non-Touch Technique (ANTT).

Introduction

Ineffective standards of aseptic technique are a significant cause of healthcare acquired infection. ANTT is a unique, standardized approach to aseptic practice that has been shown to support the reduction of healthcare acquired infection. As a result, ANTT has become the standard aseptic technique in the UK and is now used in over 25 countries.

Healthcare acquired infections (HAI) result in significant mortality and morbidity internationally. It is estimated that 30% of HAI’s are preventable. Due to the invasive nature of clinical procedures involving aseptic technique, healthcare workers are inherently a significant vector of infection.

Considering the many years that aseptic technique has been established, actual practice is not standardized. As a consequence, the effectiveness of aseptic technique and practice has commonly been substandard and is accepted as a significant cause of health care acquired infection.

ANTT was the first comprehensive practice framework for aseptic technique. It addresses the historical weaknesses that have inhibited practice and provides health care workers with a logical practice framework which promotes safe and efficient aseptic technique.

Definitions

Sterile

The term sterile is defined as “absence of micro-organisms”. With the constant presence of airborne micro-organisms, sterile is not possible to achieve in typical healthcare environments. Therefore, the term “sterile technique” or “sterile field” is discouraged. Sterile is the quality standard for sterilized equipment but equipment can only be considered sterile inside unopened packaging. Once, open it is instantly exposed to airborne organisms and is considered aseptic.

Clean

Clean is defined as “free from visible marks and stains”. Using the word clean is confusing and not applicable when referring to procedures. A “clean technique” is an outdated term and no longer applicable.

Asepsis or Aseptic

The term asepsis means “free from pathogenic micro-organisms”. This can be achieved through standard infection control precautions. As a result, ANTT is based on the premise that asepsis is the common aim of all clinical procedures that entail an infection risk. Whether the procedure is complex e.g. IV administration, the aim is always to prevent introducing pathogenic micro-organisms into or onto the patient.

Principles of ANTT

The ANNT Theoretical Framework for Clinical Practice provides a set of foundation principles for safe and efficient aseptic technique. Understanding the principles helps determine the type of aseptic technique and the level of precautions required for different clinical procedures.

There are 10 principles to consider:

The main infection risk to the patient is the health professional.

It is essential that the healthcare organisations and individual health professionals understand and address the risks they pose to patients.

Health professionals must understand what asepsis is and how to establish and maintain it.

Poor understanding and application of the terms “sterile”, “asepsis” and “clean” have contributed to confused aseptic technique. The ain ANTT from the operating theatre to the community is the standard of asepsis.

Identifying and protecting key parts and key sites is paramount.

Key parts – These key parts are the pieces of equipment that come into direct contact with the patient and therefore have the potential to transmit bacteria and/or microorganisms and are usually parts of equipment that come into direct contact with the infusate.

Key sites – Key sites are open wounds and insertion and puncture sites e.g., the skin where a cannula will be inserted once it’s been cleaned with 2% Chlorhexidine and 70% Alcohol.

Asepsis is achieved with standard ANTT or Surgical ANTT

Standard ANTT is the technique of choice if procedures are technically uncomplicated, short in duration (approximately <20 minutes), involve small key sites, and key parts. Standard ANTT typically requires a main general aseptic field and non-sterile gloves. It relies heavily on a non-touch technique and the use of critical micro aseptic fields to protect key parts. Examples of procedures requiring standard ANTT include IV administration or cannulation.

Surgical ANTT is needed when procedures are technically complex, last approximately >20minutes, involve large open key sites and large numerous key parts. Subsequently, a main critical aseptic field and sterile gloves are demanded and usually full barrier precautions. Examples of procedures requiring surgical ANTT include surgery in a theatre, insertion of a central line or insertion of a urinary catheter.

Clinical procedures should be risk assessed to determine the need for standard or surgical ANTT.

Clinical procedures vary in their technical difficulty and subsequent clinical risk. For an aseptic technique to be safe and efficient, every procedure must be assessed for the level of aseptic technique and infective precautions required to maintain asepsis.

When assessing whether to use Standard or Surgical ANTT the following question should be asked:

Using Standard ANTT can I ensure that key parts only come into contact with other key parts or key sites?

Yes – Standard ANTT

No – Surgical ANTT

Aseptic fields are important. Standard and Surgical ANTT require different aseptic field management

Critical Aseptic Field

Critical aseptic fields are used when key parts, usually due to their size or number, can’t easily be protected at all times with covers, caps, or handled at all times by a non-touch technique or when particularly open, invasive or technical procedures which demand large aseptic working areas. In such cases, the main critical aseptic field demands to be managed as a key part (i.e., only equipment that has been sterilised and is aseptic can be introduced into the critical aseptic field, which consequently demands the use of sterile gloves). As a result, management of the critical aseptic field is relatively more complicated.

Critical Micro Aseptic Field

A sub-type of critical aseptic field is the critical micro aseptic field. Critical aspect fields are items such as syringe caps, sheathed needles, covers or packaging. The inside of such caps and covers have been sterilised and therefore provide optimum protection of key parts.

General Aseptic Field

General aseptic fields are used when key parts can easily and optimally be protected by critical micro aseptic fields (above) and non-touch technique. As a result, the main general aseptic field does not have to be managed as a key part and is essentially promoting rather than ensuring asepsis. Subsequently, aseptic technique is considerably simplified and typically involves non-sterile gloves as sterile gloves would not provide added value.

Non-touch technique is the most important component of Standard and Surgical ANTT.
Appropriate infective precautions help promote and ensure asepsis.

Although non-touch technique and appropriate aseptic field management are the core components of key part and key site protection, basic infection prevention precautions such as effective hand washing, and glove usage are important and help ensure asepsis.

Aseptic practice should be standardised across and between healthcare organisations.

ANTT has been used to good effect reactively but in the best interest of patients, it is best used proactively to standardise aseptic practice across workforces. Standardising practice reduces practice variability and the number of variables in practice.

Safe aseptic technique is reliant on effective staff training in infection control, safe environments and equipment that is fit for purpose.

Effective aseptic technique is dependent on healthcare taking a systematic approach to asepsis management in general. The effective education and training of healthcare workers is paramount, as is ensuring equipment is fit for purpose.

Technique – Preparation of IV medication

Put on a plastic apron.
Wash hands using appropriate cleansing solution and dry thoroughly following hand hygiene guidelines.
Collect plastic tray/ appropriate surface and clean with sanitising wipes. Leave to dry completely. Remember to clean from the inside out.
Collect all necessary equipment.
Wash hands again using appropriate cleaning solution and dry thoroughly.
Put on a pair of well-fitting gloves.
Open equipment by carefully peeling back packaging. Place syringe ensuring key parts are uppermost and not in contact with tray.
Connects all needles to syringe and draw up and prepare medication. Ensure all key parts remain uncontaminated. If at any time you think you may have contaminated a piece of equipment, dispose of immediately and use a new piece.
Clean the end of the needle free connector with 2% Chlorhexidine and 70% Alcohol wipe for a minimum of 30 seconds using friction. Allow to dry naturally, visibly checking that it’s dry.
Insert syringe into the needle free connector and administer medications as prescribed. Remember to keep all syringe tips uppermost and not in contact with the tray.
Dispose of all used equipment appropriately.
Clean the plastic tray/surface by washing with liquid detergent and drying straight away or clean the tray/surface using the Clinell hard surface wipes.
If not already done so, remove gloves and wash hands, using appropriate cleansing solution and dry thoroughly.

Tips for maintaining ANTT

Do not drop your equipment into the tray.
Ensure other equipment in the tray does not come into contact with key parts.
Do not use paper trays or dressing towels for IV preparations.
Gloves are not a replacement for good hand hygiene, therefore decontaminate hands before putting on gloves and after removing them.

Date: January 2024

Version: 2 (Revision)

Source: Expert Care Manager