Document Ref. No: PP(15)266
Trust Policy and Procedure
Aseptic Non-Touch Technique (ANTT) Policy
For use in:
All in-patient clinical areas
For use by:
All clinicians
For use for:
All patients requiring an aseptic procedure
Document owner:
Infection Prevention Team
Status:
Approved
Purpose of the Policy
The purpose of this policy is to provide guidelines to establish an ‘Aseptic Non Touch Technique’
(ANTT) as the safe and effective technique that is used for all aseptic procedures carried out
within the Trust. These national guidelines encompass the necessary infection control measures
to prevent pathogenic micro-organisms on hands, surfaces or equipment from being introduced to
susceptible sites during clinical practice (RCN 2009).
Aseptic technique is an essential procedure aimed at protecting patients from infection during
invasive procedures, and is achieved by minimising the presence of pathogenic microorganisms as is practically possible (Rowley et al 2010).
The Trust will ensure that injury or harm to staff, patients and others by healthcare associated
infections or communicable diseases is reduced to the lowest level of risk possible. To achieve
this, the Trust accepts that the Aseptic Non Touch Technique Policy and set guidance requires a
high level of management commitment. Failure to comply with this policy may result in
disciplinary action. Any incidents where failures have occurred this must be reported
through the incident reporting system.
Source: Infection Prevention Team
Approved
Issue date: January 2015
Review date: January 2018
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Document reference PP(15)266
Contents
Page
Introduction
2
General Aseptic Non-Touch Technique
Procedure
2
Pertinent components of ANTT
4
Clean technique
5
Training and competency assessment
requirements
Training records
6
Staff responsibilities
7
Review and Monitoring
9
Definitions
9
References
10
Development of the Policy
10
Document configuration information
10
Appendices
12-23
7
1.Introduction
Effective prevention and control of infection needs to be embedded in everyday practice. ANTT is
a framework to both ‘standardise practice and to raise clinical standards whilst undertaking
aseptic clinical procedures’ (Rowley 2000).
ANTT aims to prevent the contamination of wounds and other susceptible sites, by ensuring that
only uncontaminated equipment, referred to as ‘key parts’ or sterile fluids come into contact with
susceptible or sterile key- sites during clinical procedures.
ANTT should be undertaken when performing any invasive aseptic procedure i.e. cannulation,
venepuncture, IV medication, wound care, urinary catheterisation and central and peripheral line
management.
Acupuncture sites are currently exempt from the ANTT procedure. The literature will be reviewed
or revisited as necessary.
The ANTT clinical guidelines are designed to allow the practitioner to identify and protect the key
parts during a procedure through a non-touch technique. The guidelines include sections on
effective hand hygiene and indicate the appropriate time to apply personal protective equipment.
(See appendix 5).
Source: Infection Prevention Team
Approved
Issue date: January 2015
Review date: January 2018
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The Health and Social Care Act (DoH 2010) stipulates that:
• ANTT should be carried out in a manner that maintains and promotes the principles of asepsis.
• The technique should be standardised across the organisation, thus reducing variations in
practice.
• All staff undertaking procedures involving asepsis should be provided with education, training
and assessment.
• Yearly audits should be undertaken to monitor compliance.
2. General Aseptic Non-Touch Technique Procedure (refer to specific procedure guidelines for
guidance – see appendix 6)
1. Clean hands with soap and water or alcohol gel using six-step hand washing technique
(See Appendix 1).
2. Clean tray/trolley with detergent wipes.
3. Gather equipment and place around blue tray on ANTT mat/on bottom shelf of dressing
trolley.
4. Clean hands thoroughly with alcohol gel or soap and water. Apply apron and non-sterile
gloves (use sterile gloves if you must touch key-parts).
5. Perform procedure protecting key-parts using non-touch technique. Safely dispose of used
equipment
6. Clean tray/trolley, remove apron and gloves, and dispose of appropriately.
7. Immediately clean hands with alcohol gel or soap and water in accordance with Trust
policy.
A step by step clinical guideline is designed to allow the practitioner to:-
Always decontaminate their hands effectively
Never contaminate key parts or sites
Touch non key parts with confidence
Take appropriate infection control precautions
Standard ANTT (usually utilised for procedures in Inpatient and Outpatient areas.)
Standard ANTT is the technique of choice when procedures meet all of the following criteria:



they are technically simple
short in duration (approximately less than 20 minutes)
involve small key sites and key parts
Source: Infection Prevention Team
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Issue date: January 2015
Review date: January 2018
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The main aseptic field does not need to be managed critically. Typically, Standard ANTT will
employ a general aseptic field and non-sterile gloves.
Surgical ANTT (usually utilised for procedures in Operating Theatres)
Surgical ANTT is demanded when procedures meet one or more of the following criteria:
 they are technically complex
 involve extended procedure time (approx more than 20 minutes)
 involve a large open key-site and large or numerous key parts.
The main aseptic field needs to be managed ‘critically’ i.e. only sterilised and aseptic equipment
can come into contact with the aseptic field. Surgical ANTT will employ a critical aseptic field,
sterile gloves and often full barrier precautions. NB: Where practical to do so, Surgical ANTT
should still utilise micro critical aseptic fields and non-touch technique.
ANTT Approach- 6 steps to safe Aseptic Technique.
1) Risk assessment – assess technical difficulty of achieving asepsis.
2) Manage the environment – avoid or remove contamination risks.
3) Decontaminate and Protect- hand hygiene, personal protective equipment, disinfecting
equipment, surfaces or key parts.
4) Use aseptic fields- general, critical and micro critical aseptic fields. Protect key-parts and
key-sites.
5) Use Non Touch Technique- keys parts must only come into contact with other key-parts
and key-sites.
6) Prevent Cross Infection- safe equipment disposal, decontamination and hand hygiene.
3. Pertinent components of ANTT
Hand Hygiene.
Most healthcare acquired infections continue to be spread by direct contact by the hands of health
care workers; hence, hand washing is the most significant single procedure in preventing cross
infection in hospital. Many organisms can survive on the hands of health care workers.
Personal Protective Equipment (PPE).
Disposable plastic aprons must be worn as single use items when there is close contact with the
patient, when clothing may become contaminated with pathogenic micro-organisms, blood or
body fluids. This includes IV preparation and administration, wound dressings, catheter insertion,
on-going care (this list is not exhaustive).
Glove choice will depend on factors such as the technical difficulty of the procedure, the
number of key-parts, how long the procedure should take and the cleanliness of the environment.
Clinical judgement should be used to gauge choice of glove. If it is necessary to touch key-parts
directly then sterile gloves should be used to minimize the risk of contamination.
Sterile gloves must be worn for wound care, urinary catheterisation or central
venous catheter insertion. Otherwise, non-sterile gloves are usually the glove of choice.
Non sterile gloves can be used for IV medication, venepuncture or cannulation
where it is possible to undertake the procedure without touching any key parts.
Source: Infection Prevention Team
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Issue date: January 2015
Review date: January 2018
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ANTT is an essential part of taking blood cultures. When taking blood cultures please refer to
the Trusts clinical guidance. CG10215-1– Guideline for taking Blood Cultures from adults.
Please ensure the completion of the blood culture sticker found in the blood culture pack and
place this in the patient’s notes.
Equipment
Equipment used for the procedure must be checked to confirm date of sterility, intact packaging.
There must be no re-use of single use items.
Plastic trays used during ANTT must be thoroughly cleaned before and after use. Clean with a
detergent wipe or soap and water if soiled. Dry with a clean paper towel. Do not leave ANTT trays
to soak in water in a sink.
Specialised equipment such as masks, visors, protective eyewear may be necessary as per risk
assessment when caring for high risk patients or undertaking high risk procedures where there is
a risk of splashing.
Please be aware ANTT hard surface mats are no longer a recommendation so therefore will not
be installed in new areas or replaced in areas where they were originally installed.
Environmental / Air contamination
Due to airborne micro-organisms, a perfect sterile technique is not possible in typical health care
settings however practitioners can reduce the potential for environmental infection by taking
sensible precautions such as not preparing drugs at the bed side, especially after activities like
bed making and wound dressings.
4. Clean technique
A clean technique follows the same principles as ANTT but the clinician is not required to wear
sterile gloves, non-sterile gloves can be worn to undertake the procedure safely based on risk
assessment by the clinician. A non-touch technique must be adopted.
Assessment needs to be undertaken by the clinician in order to establish which procedure is
appropriate. In some situations clean non-touch technique is more appropriate such as:






Dressing of wounds healing by secondary intention i.e. leg ulcers, pressure sores
Removal of sutures
Removal of drains
Endotracheal suction
Dressing tracheostomy site
Vaginal examination
Source: Infection Prevention Team
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Issue date: January 2015
Review date: January 2018
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Guidelines for undertaking a Clean technique
1) Prepare all equipment required is placed on a dedicated clean area.
2) Explain the procedure to the patient; obtain informed consent and position the patient so
that the procedure can be performed easily.
3) Decontaminate hands using the hand hygiene technique in appendix 1, staff involved in
patient care/treatment must adhere to bare below the elbow.
4) Wear single use disposable apron and single use disposable gloves.
5) Using a Non-Touch Technique avoid touching any unclean area while performing the
procedure.
6) Single use items must not be reused.
7) On completion of procedure remove gloves then apron, dispose of all waste as per policy.
8) Decontaminate hands using the hand hygiene technique in appendix 1.
9) Record care in the patients notes.
5. Training and competency assessment requirements:
Training will be provided to Trust employees through a ‘Train the Trainer’ approach. Key
assessors identified, trained and deemed competent will be responsible for training other
members of staff who perform ANTT.
All staff undertaking invasive procedures should have ANTT education incorporated into Trust
Corporate induction programmes.
Competency Assessment
1. All staff in conjunction with their Consultant/Line Manager should decide if their role
involves any of the competencies specified.
2. Competency being assessed is the Aseptic Non-Touch Technique practice, not the skills
of the practitioner at cannulation etc.
3. While the policy is being rolled out across the Trust, staff who have been undertaking the
procedures at this Trust may continue to practice as long as they have completed existing
training and assessments and are considered competent by their line manager or
consultant until ANTT training and a formal competency has been performed.
4. Assessment Criteria:
Levels of competency achievement are assessed according to the following criteria:
Level 0 – Cannot perform the activity satisfactorily
Level 1 – Capable of performing the activity under supervision
Level 2 – Competent to practice skill satisfactorily without assistance or supervision.
Level 3 – Can perform this activity proficiently and is competent to teach this activity to
others.
5. Staff assessments should be undertaken by designated assessors. They will be staff who
have been assessed as competent in the procedure & competent to undertake supervision
& assessment of other staff, i.e., level 3 competency.
Source: Infection Prevention Team
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Issue date: January 2015
Review date: January 2018
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6. Staff need only to be assessed on one aseptic procedure. Please note that only staff that
have been assessed as competent by the Clinical Skills Training Department can perform
peripheral intravenous cannulation or venepuncture.
7. In the event of achieving a Level 0 or Level 1, the practitioner will be offered the
opportunity to improve their knowledge, skills and ability, and then be reassessed.
8. Practical competency is to be assessed 3 yearly, while theory assessment will be yearly
within the Infection Prevention Mandatory Update.
6. Training Records
1. When staff have achieved a level 2 or level 3 competency, a copy of the completed
assessment proforma should be forwarded on to the Infection Control Team/ ANTT lead.
2. Staff should be given a copy of their assessment for their CPD record.
3. All assessments will be entered by the infection prevention team onto the electronic staff
training record.
7. Staff Responsibilities
7.1 Chief Executive

To ensure that infection control is a core part of clinical governance and patient safety
programmes.

Promote compliance with infection control policies in order to ensure low levels of health
care associated infections.

Awareness of legal responsibilities to identify, assess and control risk of infection.

Appoint a Director of Infection Prevention and Control.
7.2 Director of Infection Prevention and Control (DIPC)

Oversee infection control policies and their implementation.

Report directly to the Chief Executive and Trust Board.
7.3 Infection Prevention and Control Team / ANTT lead

Review and update ANTT policy.

Give additional advice regarding the implementation of ANTT, where required.

Provide training for ANTT assessors in clinical areas (ANTT key assessors will hold
responsibility for training others in the team).

Promote good practice and challenge poor compliance.
Source: Infection Prevention Team
Approved
Issue date: January 2015
Review date: January 2018
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7.4 Heads of Nursing / Medical Director

Must establish a positive culture across their units and promote compliance with ANTT as
part of infection control guidelines.

Ensure ANTT non-compliance escalation is acted upon.

Support Departmental Managers/ Medical staff in monitoring levels of ANTT compliance
and ensure correct provisions with regards to appropriate equipment.
7.5 Matrons and Directorate Leads

Must establish a positive culture across their units and promote compliance with ANTT as
part of infection control guidelines.

Support Departmental Managers by providing resources for implementation of ANTT in the
clinical areas.

Support Departmental Managers in monitoring levels of ANTT compliance.
7.6 Departmental/ Ward/ Unit Managers

Identify staff to undertake ANTT assessor training.

Will ensure that all staff are only able to undertake invasive techniques following training
and assessment of competence in ANTT procedure.

Will audit standards of compliance with ANTT policy in the clinical area and departments
yearly.

Promote good practice and challenge poor compliance.
7.7 Medical Staff

Apply ANTT principles to all procedures requiring aseptic technique.

Ensure compliance with infection control policies.

Promote good practice and challenge poor compliance.
7.8 All healthcare staff

Must be familiar with and adhere to the relevant infection control policies to reduce the risk
of cross infection of patients including ANTT.

Staff will maintain their ANTT competency through tri-annual re-assessment within the
clinical area.

Promote good practice and challenge poor practice.
Source: Infection Prevention Team
Approved
Issue date: January 2015
Review date: January 2018
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7.9 Clinical Skills Trainers/ Specialist Nurses

Clinical Skills Trainers will ensure that their training, policies, guidelines are ANTT
compliant.
8. Review and Monitoring
This policy will be reviewed every three years unless urgent review is needed.
An annual ANTT audit will be conducted to ensure compliance with this policy.
Requests for variations to the policy to meet specific requirements must be considered on a
clinical need basis only and clearly documented in the patient’s notes
9. Definitions:
Asepsis: the complete absence of bacteria, fungi, viruses or other micro-organisms that could
cause disease
Aseptic technique: the method by which precautions are taken during and invasive procedure to
prevent the transfer of microorganisms from the healthcare practitioner, procedure equipment, or
the immediate environment to the patient.
Aseptic Non Touch Technique (ANTT): A specific type of aseptic technique with a unique
Theoretical and Practical Framework (NICE 2012).
Aseptic Field: a identified working space that contains and protects the procedure equipment.
Termed:
Critical aseptic field: aseptic field using dressing pack or sterile drapes, where only aseptic keyparts come into contact with it. This is used to ensure asepsis and requires critical management
General aseptic field: used to promote asepsis rather than ensure it. i.e. clean tray or clean trolley
Hand hygiene: a general term that applies to hand washing, antiseptic hand wash, antiseptic hand
rub, or surgical hand antisepsis
Invasive procedure: a medical procedure that invades (enters) the body, usually by cutting or
puncturing the skin or by inserting instruments into the body cavity
Key Part: the parts of the procedure equipment that come into contact (direct or indirect) with key
parts connected to the patient, any liquid infusion or key site.
Key Site: open wounds or insertion and puncture sites.
Micro Critical field: a small critical aseptic field used to protect a specific key part. I.e a syringe cap
or ‘backing’ of a dressing
PPE: Personal protective equipment
Source: Infection Prevention Team
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Issue date: January 2015
Review date: January 2018
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10. References
Department of Health (2006) ‘Essential Steps to Safe Clean Care’ DH: London.
Department of Health (2010) ‘Saving Lives’ DH: London.
Department of Health (2010) ‘The Health and Social Care Act 2008/10: code of practice on the
prevention and control of infections and related guidance’ DH: London
Loveday, H, Wilson, J, Pratt, R, Golsorkhi, M, Tingle, A, Bak, A, Browne, J, Prieto, J, Wilcox, M
(2014) ‘epic 3: National-Evidence Based for preventing Healthcare Associated infections in NHS
hospitals in England’ Journal of Hospital Infection 86S1 (2014) S1-S70.
Rowley, S (2009) ‘Improving standards of aseptic technique practice through an ANTT trust-wide
implementation process: a matter of prioritisation and care’ Journal of Infection Prevention 10 (1)
S18-S23.
The Association for Safe Aseptic Practice (ASAP) (2013) ANTT Clinical Practice Framework.
Version 3.1 www.antt.org
11. Development of the Policy
Changes compared to previous document
Initial draft September 2014. Alterations and final draft November 2014.
Contributors and peer review
This document was circulated for comment to the Infection Prevention Control Committee,
Medical Directorate Governance Steering Group, Surgical Directorate Governance Steering
Group and the Policies and Procedures Committee.
Distribution list/dissemination method
This document is available on The West Suffolk Hospital Intranet Pink Book.
12. Document configuration information
Author(s):
Infection Control Team and IP ANTT leads/ audit
nurses.
Other contributors:
Infection Prevention Team,
Clinical Skills Manager
Tissue Viability Team
Urology Nurse Specialist Nurses
Approvals and endorsements:
Infection Prevention Control Committee
Medical and Surgical Governance
Policy and Procedures committee
Consultation:
November 2014
Issue no:
3
File name:
Supercedes:
PP(12)226 August 2012
Source: Infection Prevention Team
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Review date: January 2018
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Equality Assessed
Due regard has been taken into the development of
this policy which is in accordance with the NHS
Litigation Authority Risk Management Standards to
promote a robust framework ensuring compliance
with the Equality Act.
Implementation
This document will be available to all Trust involved
in any aseptic procedure via the Trust intranet.
Monitoring: (give brief details how
this will be done)
Staff who complete the assessment will be entered
on to the Trust OLM Training Record.
The standards laid out in this document will be
monitored by an annual audit of equipment and
clinical practice.
Other relevant policies/documents & ANTT is a way of translating Government initiatives
references:
and legislation into practice. Include Saving Lives:
reducing infection, delivering clean and safe care
(DH 2007), Essential Steps to Safe Clean Care:
Reducing Healthcare-associated infections (DH
2006), EPIC3 (2014) and Winning Ways: Working
Together to Reduce Healthcare Associated
Infection in England (DH 2003).
CG10215-1– Guideline for taking Blood Cultures
from adults
Practice Guidance:
https://www.clinicalskills.net/clientarea/catalogue/section/1
http://staff.wsha.local/Extranet/ClinicalServices/Infec
tionControlManual/GuidelinesPolicies.aspx
Additional Information:
Source: Infection Prevention Team
Approved
Intranet Information ANTT Webpage:
http://staff.wsha.local/Extranet/ClinicalServices/Infec
tionControlManual/AsepticNonTouchTechnique.asp
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APPENDIX 1: Six-step hand washing technique
A six-step hand washing technique was devised by Ayliffe et al. (1978), using soap (or antiseptic
solution/alcohol gel) and running water. Each step consists of five strokes forward and five
backward and should last a minimum of 15 seconds.
Palm to palm.
Right palm over back of left hand and left palm
over back of right hand
Palm to palm fingers interlaced.
Backs of fingers to opposing palms with fingers
interlocked.
Rotational rubbing of right thumb clasped in
left palm and vice versa.
Rotational rubbing, backwards and forwards with
clasped fingers of right hand in left palm and vice
versa.
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APPENDIX 2: Competency Assessment for practicing an Aseptic NonTouch Technique
This competency framework has been designed with reference to the following standard:
 West Suffolk Hospital Aseptic Non-Touch Technique Policy PP (12) 226
I confirm that I have read and understood the West Suffolk Hospital Aseptic Non-Touch
Technique Policy, Self Running PowerPoint presentation, or ANTT Update PowerPoint:
Signature of member of staff:
Assessment Details
Name of member of staff:
Name of assessor:
Job Title & Department:
Job Title & Department:
Date of Assessment:
Aseptic Procedure Being Assessed: (Delete as applicable, only one is needed)
IV administration / cannulation / venepuncture/ urinary catheterisation/
wound dressing
After Completion of Assessment (please circle)
The attached framework has been
successfully completed and competency
confirmed:
YES
If competent circle relevant level:
Level 2 – Competent to perform this task
NO
(Level 0/1)
Level 3 – Competent to perform and teach
this activity
Signature of assessor:
Date:
Once assessment complete, return a copy of this form to ANTT Leads, Infection
Prevention, Old Pharmacy
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APPENDIX 3: Using ANTT to administer drugs via a peripheral venous
cannula
(This assessment tool can also be used for Venepuncture & Peripheral Intravenous
Cannulation)
Observational Assessment
Task completed
satisfactorily YES/NO
Core Competency:
Procedure is discussed with patient and consent gained.
Hands cleaned with soap and water or alcohol gel.
Plastic tray is cleaned with detergent wipes creating an aseptic field.
Whilst tray is drying, equipment is gathered and placed around tray on
ANTT mat.
Clean hands with soap and water or alcohol gel.
Put on apron & apply non-sterile gloves (sterile gloves applied if keyparts are to be touched).
Drugs and equipment are prepared protecting key parts using NonTouch Technique.
Proceed to patient with tray and sharps bin.
If IV port needs exposing:
 IV port is exposed
 Gloves are disposed of
 Clean hands with soap and water or alcohol gel
 Re-glove
Key-parts are cleaned:
 2% chlorhexidine/70% alcohol wipe used
 Scrub the port tip for 30 seconds using 4 different parts of the
wipe, then wipe away from the tip
 Allow to dry for 30 seconds
Drugs are administered using Non-Touch Technique.
Sharps and other equipment are appropriately disposed of.
Tray is cleaned and gloves and apron are removed and disposed of.
Hands are immediately cleaned with soap and water or alcohol gel.
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Knowledge Assessment
The Practitioner can demonstrate:
Task completed
satisfactorily YES/NO
Understanding of the basic principles of Asepsis.
Understanding of the definition of a ‘key-part’.
Identification of the ‘key-parts’ in the procedure.
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APPENDIX 4: Wound Care using ANTT
(This assessment tool can also be used for Urinary Catheterisation)
Observational Assessment
Task completed
satisfactorily YES/NO
Core Competency:
Procedure is discussed with patient and consent gained.
Hands are cleaned with soap and water or alcohol gel. Put on apron.
Dressing trolley is cleaned with detergent wipes and allowed to dry.
Whilst trolley is drying, gather wound dressing equipment.
Equipment is placed on bottom shelf of trolley.
Clean hands with soap and water or alcohol gel.
Proceed to patient. Open dressing pack on to trolley. Prepare patient
and remove old dressing.
Clean hands with soap and water or alcohol gel.
Lay out dressing equipment and protect key-parts using Non-Touch
Technique
 Remove equipment from packaging using non-touch technique
 Arrange equipment in an orderly manner on sterile field
 Consider all of the dressing equipment as key-parts
Put on sterile gloves and place sterile towel under/below wound.
Cleanse wound, assess wound and apply new dressing using NonTouch Technique. All dressing equipment is disposed of appropriately.
Remove gloves. Hands cleaned with soap and water.
Trolley is cleaned after use.
Knowledge Assessment
The Practitioner can demonstrate:
Task completed
satisfactorily YES/NO
Understanding of the basic principles of Asepsis.
Understanding of the definition of a ‘key-part’.
Identification of the ‘key-parts’ in the procedure.
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Appendix 5
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