Aseptic Technique and Aseptic Non-Touch
Technique
Clinical Guideline
Developed in response to:
Best Practice Health and Social Act
2008
8
Contributes to CQC Outcome
Consulted with
Katheryn Hobbs
Ronan Fenton
Katherine Hine
Ryan Curtis
Cathy Paget
Marcie Tunbridge
Gregory Wain
Professionally Approved By
Version Number
Issuing Directorate
Ratified by
Ratified on
Trust Executive Sign Off Date
Next Review Date
Author/Contact for Information
Register No: 08038
Status : Public
Post/Committee/Group
Senior Infection Prevention Nurse
Infection Prevention Group
Chief Medical Officer
General Manager, Theatres
Health and Safety Manager
Occupation Health Manager
Lead Nurse for Opthalmology
Lead Nurse for Tissue Viabiltiy
Dr. Louise Teare, DIPC
Date
March 2014
March 2014
March 2014
March 2014
March 2014
March 2014
March 2014
March 2014
March 2014
2.0
Corporate
Document Ratification Group
22nd May 2014
June 2014
May 2017
Sue Adams – Infection Prevention Nurse x 6398
Amanda Kirkham – Lead Nurse, Infection Prevention
All staff
Policy to be followed by (target
staff)
Distribution Method
Intranet and Website
Related Trust Policies (to be read All infection prevention and control policies
in conjunction with)
Exposure Injuries to BBV
Safe Handling and Disposal of Sharps Policy.
Decontamination Policy
Hand hygiene Policy
Prevention of IV Related Infections
Review No
1
2
Reviewed by
Infection control team
Infection Prevention Team
Review Date
2008
March 2014
It is the responsibility of staff to ensure they are accessing the most up to date version of this
document which will always be the version on the intranet.
1
INDEX
1.
Purpose
2.
Aims
3.
Scope
4.
Equality & Diversity
5.
Roles and Responsibilities
6.
Definitions
7.
Principles of Aseptic Non-Touch technique (ANTT)
8.
Applying ANTT
9.
Audit and Monitoring
10.
Training
11.
Implementation and Communication
12.
References
Appendix 1:
Appendix 2:
Appendix 3;
Appendix 4:
The ANTT Approach - a diagrammatic representation
Skin antisepsis
The 6 Principles and 4 Safeguards of ANTT
ANTT Clinical Guideline for the preparation and administration of I.V.
drugs
2
1.
Purpose
1.1
This policy details the practice framework and the theory for Aseptic Non-Touch
Technique (ANTT) as the basis for standardising aseptic technique throughout the
Trust.
1.2
The purpose of this document is to provide guidance and rationale to all staff
undertaking aseptic technique so as to reduce the contamination of key parts and key
sites, thereafter reducing the patient’s risk of acquiring healthcare associated
infections.
2.
Aims of the Policy
2.1
The aim of this document is to ensure that all staff understand the principles and
practice of ANTT when carrying out all clinical procedures that involve a risk of
infection to the patient.
2.2
This document also aims to ensure all staff undertaking aseptic technique apply ANTT
to practice effectively.
3.
Scope
3.1
This policy applies to all staff employed by the Trust on a substantive or temporary
basis.
3.2
An aseptic non-touch technique should be used for any procedure that breaches the
body’s natural defence mechanisms including;
•
•
•
Insertion and maintenance of invasive devices
Infusion of sterile fluids and medication
Care of wounds and surgical incisions (epic3, 2013)
4.
Equality and Diversity
4.1
The Trust is committed to the provision of a service that is fair, accessible and meets
the needs of all individuals.
5.
Roles and Responsibilities
5.1
Chief Executive
The Chief Executive has overall responsibility for ensuring that the Trust has the
necessary management systems in place to enable the effective implementation of
this policy and overall responsibility for the health and safety of staff, patients and
visitors.
5.2
Chief Medical officer
The Chief Medical Officer has strategic responsibility to ensure that systems are in
place to make medical staff aware of this policy and to give appropriate support to
enable staff to adhere to practice as outlined in the document.
3
5.3
Chief Nurse
The Chief Nurse has strategic responsibility for ensuring systems are in place to
facilitate nursing staff awareness of this policy and appropriate support is given to
enable staff in delivering practice as outlined in this policy.
5.4
Director of Infection Prevention and Control (DIPC)
The DIPC will have operational responsibility for the effective implementation of this
policy.
5.5
Infection Prevention and Control Team (IPT)
The Infection Prevention and Control Team is responsible for ensuring all staff are
made aware of this policy, to cascade ANTT training and undertake ANTT
competency assessments for junior doctors on induction.
5.6
Occupational Health Manager
The Occupational Health Manager provides the professional leadership for
management of needle stick injuries and staff exposure to blood borne viruses.
5.7
All staff
All staff must comply with this policy and act in a responsible manner, liaising with the
IPT in a timely manner if they need advice or support. All staff who undertake aseptic
procedures have the responsibility to ensure that ANTT is embedded into practice and
applied consistently at all times.
6.
Definitions
6.1
Aseptic technique
Aseptic technique is defined as the infection prevention precautions taken during
invasive clinical procedures to prevent the transfer of micro-organisms from the
healthcare worker, the procedure equipment or the immediate environment to the
patient.
6.2
Aseptic Non-Touch Technique (ANTT)
ANTT is a specific technique which involves maintenance of sterility of key-parts and
key-sites and may be applied as standard ANTT or surgical ANTT The ANTT
approach can be seen in Appendix 1.
6.3
Standard ANTT
Involves technically simple procedures, short in duration (in general less than 20
minutes), and involve smaller key-sites and key-parts e.g. peripheral cannulation and
I.V. therapy.
6.4
Surgical ANTT
Procedures are technically complex, involve extended periods of time, large open keysites or large or numerous key-parts e.g. surgery in operating theatre or central
venous catheter insertion in ITU.
4
6.5
Key sites
• Key sites are those areas on the patient’s body that are vulnerable to infection,
such as wounds, entry / exit sites of invasive medical devices and intact skin
where invasive devices are to be inserted.
6.6
Key parts
6.7
•
Key-parts provide a direct route for the transmission of pathogens into a
susceptible site on a patient
•
Key parts are the critical parts of equipment used during the procedure that may
come into contact directly or indirectly with a key site on a patient’s body. This may
be a needle, a hub of a syringe or infusion fluid for example
•
Key parts will be sterile initially, but may become contaminated over time and
require decontamination prior to manipulation, such as ports of IV devices
Aseptic field
•
6.8
An aseptic field provides basic protection from the care environment. However,
generally the key-parts will be easily protected by caps, covers, and a non-touch
technique and so for standard ANTT procedures the aseptic field will often be a
clean, disinfected tray.
Hand Hygiene
•
Hand hygiene is an essential component of ANTT
•
Hand hygiene in Standard ANTT is considered to be the promoter of asepsis and
for Surgical ANTT is considered an ensurer of asepsis and demands surgical hand
scrub
•
The 5 moments for hand hygiene is reflected in ANTT to reduce the transfer of
micro-organisms at all times
6.9
Decontamination and disinfection
• A single use application of 2% Chlorhexidine in 70% alcohol (e.g. Sanicloth CHG
2% wipes) is recommended to disinfect key-parts such as I.V. ports or blood
culture bottles. This should be used for a minimum of 15 seconds and allowed to
dry before being accessed (epic3, 2013)
• Where patients have a sensitivity to Chlorhexidine, povidone iodine in alcohol
should be used to decontaminate access ports (epic3, 2013)
• 70% alcohol (Sanicloth 70) wipes should be used for disinfecting clean trays to be
used as an aseptic field
• Key-sites such as the patient’s skin must be disinfected prior to an invasive
procedure. Generally single use sterile applications of 2% Chlorhexidine in 70%
alcohol (e.g. Chloraprep) is recommended. More detail can be seen in Appendix 2
7.
The Principles and Safeguards of ANTT
7.1
The ANTT practice framework is based upon 6 principles and 4 safeguards.
(Refer to Appendix 3)
7.2
The principles of ANTT are based on the premises that asepsis is achievable, and
asepsis is the common aim of all clinical procedures that entail an infection risk.
Asepsis means free from introducing pathogenic micro-organisms onto or into patient.
7.3
To re-enforce asepsis, the terms ‘clean technique’ and ‘sterile technique’ are not used
in ANTT.
5
7.3
Principles and safeguards provide a logical and standard set of ‘rules’ that all staff
need to understand in order to apply a safe and effective aseptic technique in a wide
range of clinical procedures.
7.4
Safeguards help to ensure asepsis is maintained at all times.
8.
Applying ANTT
8.1
Clinical guidelines are available for certain procedures (e.g. IV drug administration –
see Appendix 4) and are a simple way of translating ANTT into practice. They provide
a visual guide and prompt sequencing of the steps of a procedure, so standardising
equipment and procedure order.
8.2
Risk assessment remains important, as staff will need to apply ANTT principles and
safeguards to a range of clinical procedures that do not have guidelines.
8.3
When applying ANTT, staff should carry out a risk assessment based on the technical
difficulty of maintaining key part or key site asepsis. This helps to determine the
choice of Surgical-ANTT or Standard-ANTT (Refer to Appendix 1).
8.4
Risk assessment should consider the following in the promotion of asepsis;
•
•
•
•
Aseptic field management
Non-touch technique
Protection of the key parts and key sites
Infection prevention precautions
8.5
The immediate environmental risks such as bed making, high dusting and any patient
activity increases the risk of airborne contamination and also needs to be assessed.
8.6
Hand hygiene is an essential component of ANTT and should reflect the six steps
technique as outlined in the Hand Hygiene policy (2014). Gloves do not replace the
need for hand hygiene.
9.
Audit and Monitoring
9.1
The Infection Prevention and Control Group reviews the Infection Control Policies.
9.2
Directorate Lead Nurses are required to monitor compliance with ANTT and ensure
that any necessary remedial action is taken as a result of inappropriate practices and
develop localised action plans which are monitored through the Directorate
Governance Group for that clinical area.
9.3
Any training needs are identified and highlighted during monitoring within the
directorate.
9.4
The results of any monitoring undertaken are appropriately documented, with a copy
of the remedial actions sent to the Infection Control Lead Nurse.
6
10.
Training
10.1
Any training needs are identified and highlighted during monitoring within the
directorate.
10.2
ANTT training is included in the Professional Development programme and
Mandatory Risk Management courses that all staff must attend.
10.3
Infection Prevention team will provide ANTT training to be cascaded throughout the
organisation.
11.
Implementation and Communication
11.1
The requirements detailed within this policy are already in place.
11.2
This policy will be issued to the following to disseminate to staff within their area(s) of
responsibility;
• Ward Managers
• Bed Management Team
• Directorate Lead Nurses
• Heads of Nursing
• Clinical Directors
• Medical Consultants
11.3
The guideline will also be available on the Intranet.
12.
References
Aziz, AM (2008) Variation in aseptic technique and implications for infection control, British
Journal of Nursing, Vol. 8, 1(26-31)
The Health and Social Act: Code of Practice for the Prevention and Control of Health Care
Associated Infections (2008). Department of Health, London
Hospital Infection Society (2002) Behaviours and Rituals in the Operating Theatre
Journal of Hospital Infection (2002) 51: 241- 255
Loveday HP, Wilson JA, Pratt RJ, Golsorkhi M, Tingle A, Bak A, Browne J, Prieto J & Wilcox
M (2013) epic3; National Evidence–Based Guidelines for Preventing Healthcare-Associated
Infections in NHS Hospitals in England. Journal of Hospital Infection, Vol 86 (S1 – S70)
Rowley. S (2011) Aseptic Non-Touch technique (ANTT) a Practice Framework for Clinical
Practice-Theory applied to practice, The Association for Safe Aseptic Practice (ASAP)
www.antt.org
Rowley. S., Clare. S., Macqueen, S & Molyneux, R (2010), ANTT V2: An update practice
framework for aseptic technique, British Journal of Nursing,
Rowley, S & Clare, S (2009) Improving standards of aseptic practice through an ANTT trust
wide-wide implementation process: a matter of prioritisation and care, Journal of Infection
Prevention, Vol. 10 (S18-S23)
7
Appendix 1
8
Appendix 2
Skin Antisepsis
Procedure
Product
CHECK PATIENT’S ALLEGY STATUS
Chlorhexidine 2% in
Pre-operative skin
70% alcohol
preparation
Disinfection of skin near
eyes prior to ophthalmic
theatre procedures
Povidone iodine 10%
alcoholic solution
500ml (Videne
Alcoholic Tincture)
Povidone Iodine
antiseptic solution half
strength (Povidone
Iodine 5% containing
0.5% available Iodine
Standard skin disinfection
prior to all invasive
procedures including;
• Peripheral line
insertions
• Central line insertions
• Blood culture
sampling
• Epidural lines
• Lumbar puncture
Injection sites;
• Intramuscular
• Subcutaneous
Chlorhexidine 2% in
70% alcohol
(Chloraprep).
Venepuncture
(but NOT for blood culture
sampling)
Chlorhexidine 2% in
70% alcohol
impregnated swabs
(Sanicloth CHG 2%)
Mucous membranes
Povidine iodine 10%
antiseptic aqueous
solution 500ml
(Videne Antiseptic
Solution)
Sodium chloride 0.9%
irrigation fluid 25ml /
100ml sachets
Chlorhexidine
gluconate 0.015%
(Unisept)
Wound cleansing
Urethral catheter care
Traumatic wound
cleansing (Theatres / A&E
only
Use / Comment
Single use sterile application (e.g.
Chloraprep) preferred
Where multiple-use solution is used the
bottle must be labelled with the date of
opening and used within 3 months.
For invasive procedures in patients allergic
or sensitive to Chlorhexidine. Bottle must
be labelled with the date of opening and
used within 3 months.
Chloraprep should be applied to the skin
for 30 seconds and then allowed to dry
fully.
Great Ormond St and Addenbrookes
Hospitals recommend and use this product
prior to lumbar puncture and there are no
adverse effects as long as the prepared
skin is fully dry prior to the procedure.
70% alcohol wipes
or
Clean the site for 30 seconds and allow to
dry. (Skin must be dry for antisepsis to be
effective and to ensure that irritation is not
caused by the preparation being injected
into the tissue)
Note – for most invasive procedures,
alcohol solutions are deemed more
efficient than aqueous (Hospital Infection
Society, 2002)
NOT for skin decontamination
Appendix 3
6 Principles and 4 Safeguards of ANTT
Clinical Practice
Principle 1
The aim of ANTT for invasive clinical procedure and maintenance of invasive medical
devices is always asepsis
Principle 2
Asepsis is achieved by protecting Key-parts and Key-sites from microorganisms transferred
from healthcare worker and immediate environment
Principle 3
ANTT needs to be efficient as well as safe
(Surgical-ANTT is used for complicated procedures and Standard-ANTT for uncomplicated
procedures – ‘From Surgery to Community Care)
Principle 4
Choice of Surgical-ANTT or Standard-ANTT is based on ANTT risk assessment – according
to the technical difficulty of protecting Key-part and Key-site
Safeguard 1
Basic Infection Precautions
Basic infection precautions such as hand cleaning and environmental controls significantly
reduce the risk of contaminating Key-Parts and Key-sites
Safeguard 2
Identification of Key-Parts and Key-Sites
Key-Parts are the critical parts of the procedure equipment that if contaminated are most
likely to cause infection. Key-Sites are open wounds and medical device access sites
Safeguard 3
Non-Touch Technique
Non-Touch Technique is a critical skill that protects Key-Parts & Key-Sites from healthcare
worker and the procedure environment – in both Surgical and Standard-ANTT
Safeguard 4
Aseptic Field Management
Aseptic Fields protect Key-Parts and Key-Sites from the immediate procedure environment.
Surgical and Standard-ANTT require different aseptic field management
Clinical and Organisation Management
Principle 5
Aseptic practice should be standardised
Principle 6
Safe aseptic technique is reliant upon effective healthcare worker training and environments
and equipment that are fit for purpose
Appendix 4
ANTT Clinical Guideline for the preparation and adminstration of I.V. drugs
Appendix 4