Training requirements for student placements
Hand hygiene, Aseptic and Non-touch Technique
learning module – Transcript
December 2015
Slide 1
Welcome to the hand hygiene, Aseptic and non-touch Technique learning module.
Slide 2 – Learning Objectives
The learning objectives for this presentation is to be able to identify how and when to perform
different hand hygiene techniques and to understand the core concepts of ANTT. ANTT stands for
aseptic and non-touch technique and describes infection control principles surrounding invasive
procedures. Within Hospital and Health Services it is the responsibility of each facility, unit, service
or department to assess the need for more specific education and training of new staff and students.
Slide 3 – Hand hygiene is…
The unwashed hands of healthcare workers are the major route of transmission of micro-organisms
such as MRSA in healthcare facilities. On average, these potentially preventable infections occur in
7 to 10% of hospital admissions.
Hand hygiene is the process to reduce the number of micro–organisms on hands and is the
cornerstone of all infection prevention and control programs.
Hand hygiene is the most important measure in preventing or reducing healthcare associated
infections. Health Care Workers must perform hand hygiene in many clinical and non-clinical
instances. For example: a music therapist between appointments or a podiatrist after attending a
patient’s bedside. It is everyone’s responsibility.
Slide 4 – When do you perform hand hygiene?
Try to think of instances when you might perform hand hygiene.
Slide 5 – 5 moments of hand hygiene
One of the most important infection control messages is the 5 moments for hand hygiene. They are:
1. Before touching a patient
2. Before performing a clinical procedure
3. After a procedure of if you have been exposed to a body fluid exposure risk
4. After touching a patient, and
5. After touching a patients surroundings
Slide 6 – Three techniques of hand hygiene
Technique #1: Routine Technique
There are 3 techniques for hand hygiene. You need to ensure that you use the appropriate
technique for the circumstance.
The first technique is known as routine or social hand hygiene. As the name suggests this type of
hand hygiene is the most frequently performed by allied health staff and students. It involves either a
hand wash or a hand rub. A routine technique should be used at any of the 5 moments of hand
hygiene. For example, a leisure therapist before touching a patient, a physio before performing a
suction, a speech pathologist after an oromotor and swallow assessment, a social worker after
touching a patient or a psychologist after touching a patient’s surroundings.
Slide 7 – How to hand wash
This is a diagram produced by the world health organisation. It shows the correct steps to take for
routine hand hygiene techniques. This diagram shows washing hands with soap and water.
Soap and water are to be used when hands are visibly soiled.
Image Transcript: How to Hand wash?
Wash hands when visibly soiled! Otherwise, use hand rub
Duration of the entire procedure: 40-60 seconds
Wet hands with water
1. Apply enough soap to cover all hand surfaces
2. Rub hands palm to palm
3. Right palm over left dorsum with interlaced fingers and vice versa
4. Palm to palm with fingers interlaced
5. Backs of fingers to opposing palms with fingers interlocked;
6. Rotational rubbing of left thumb clasped in right palm and vice versa;
7. Rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm
and vice versa
8. Rinse hands with water
9. Dry hands thoroughly with single use towel
10. Use towel to turn off facet
11. Your hands are now safe
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Slide 8 – How to hand rub
This next diagram demonstrates the steps for using alcohol based hand rubs. This cleaning method
and product should be used when hands are not visibly soiled and applied at the 5 moments for
hand hygiene. Alcohol Based Hand Rubs act to reduce bacterial count on hands and are more
effective than a standard hand wash. Alcohol based hand rubs are proven to reduce infection rates
and require less time.
Image Transcript: How to Hand rub
Rub hands for hand hygiene! Wash hands when visibly soiled.
Duration of the entire procedure: 20 - 30 seconds
1. a & b. Apply a palmful of the product in a cupped hand, covering all surfaces
2. Rub hands palm to palm
3. Right palm over left dorsum with interlaced fingers and vice versa
4. Palm to palm with fingers interlaced
5. Backs of fingers to opposing palms with fingers interlocked;
6. Rotational rubbing of left thumb clasped in right palm and vice versa;
7. Rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm
and vice versa
8. Once dry, your hands are safe.
Slide 9 – Video
This video demonstrates a health care worker completing routine hand hygiene. Note the steps that
this health worker takes.
Video Transcript: Wet hands
1. Apply soap
2. Rub hands palm to palm
3. Right palm over left dorsum with interlaced fingers and vice versa
4. Palm to palm with fingers interlaced
5. Backs of fingers to opposite palms with fingers interlocked
6. Rotational rubbing of left thumb clasped in right palm and vice versa
7. Rotational rubbing, backwards and forwards with clasped fingers or right hand in left palm
and vice versa
8. Rinse hands with water
9. Dry hands thoroughly with a single use towel.
Slide 10 – Technique # 2: Clinical technique
Let’s now discuss Clinical hand hygiene and the way this differs from social hand hygiene.
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Clinical hand hygiene is undertaken prior to a care activity that requires a direct or indirect contact
with a mucous membrane, non-intact skin or an invasive medical device. It is only required if you
open a sterile field. An easy way to consider whether you need to do a clinical hand wash is if a
dressing pack is present. This will rarely apply to allied health staff. The procedure for clinical hand
hygiene is the same as for routine hand hygiene, however ph neutral or antimicrobial soap should
be used rather than alcohol based hand rub and the time to hand wash is longer.
Slide 11 – Technique # 3: Surgical technique
Few Allied health staff will provide cares that require a surgical hand wash.
Further training is provided on site for staff and students who will use a surgical hand wash. For
example, when an orthotist is fitting a HALO in theatre.
Slide 12 – Hand hygiene is more effective when..
Hand hygiene is more effective when skin is intact. It is important to take care of your skin for this
reason. A compatible moisturiser which is supplied by your facility should be used a minimum of 3
times per shift.
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Slide 13 – Bare below the elbows at all times
All staff undertaking direct patient contact must be bare below the elbows at all times. This means
you should:
•
Remove jewellery
•
Have sleeves which finish above your elbows
•
Remove false nails, nail varnish and ensure that nails are not past the finger tip.
Slide 14 – Gloves
You do not need to wear gloves for every patient contact!
Indications for glove use include possible contact with body fluids, mucous membranes or non-intact
skin or for patients with additional precautions
Gloves are an adjunct, not a substitute for hand hygiene
Hand hygiene techniques are to be used before and after all glove use
Gloves need to be changed when going from dirty to clean sites on the same patient.
Slide 15 – 10 foundation principles of Aseptic Non-touch
technique (ANTT)
ANTT is an acronym for aseptic and non-touch technique. It describes a set of rules that clinical
staff need to follow and understand when performing invasive clinical procedures and is described in
10 foundation principles. Not all allied health clinicians will be involved in procedures that require
ANTT. Local training is available where required. Examples of invasive clinical procedure for Allied
Health are acute open wounds, suctioning and HALOs in surgery.
Slide 16 – ANTT terminology
So what is an aseptic technique? The terminology surrounding ANTT can be confusing. The term
aseptic means the process for keeping away disease producing micro-organisms. Asepsis is
achieved by observing the ANTT principles such as identification of at risk sites, not touching these
high risk areas, assessing the level of complexity and risk involved in a procedure and applying this
to the choice of field or patient area. Non touch technique is at it sounds. It means DO NOT
TOUCH high risk areas. Following is an example of the application of ANTT principles.
Slide 17 – Video of Physiotherapist undertaking a
suction
This is a demonstration of the use of aseptic and non-touch technique principles while performing a
suction of a tracheostomy. Standard contact precautions have been considered by performing hand
hygiene with alcohol based hand gel, donning personal protective equipment including apron,
gloves and goggles.
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The first step is to identify at risk, also known as key sites and key parts. For this procedure the
suction catheter is a key part and the trachea is the key site.
The next step is to NOT touch these key areas. Because it is necessary to touch the end of the
catheter, a sterile glove must be worn.
Video transcript: (Action on sim-man: Physio plugs catheter into suction tubing, turns on suction
tubing and tests pressure, then puts suction equipment under arm, dons sterile glove, retracts
catheter and passes catheter into trachy.)
Slide 18 – Which technique is required?
Which technique is required when a speech therapist performs an oromotor and swallowing
assessment?
The answer is a general hand hygiene.
Slide 19 – Which technique is required?
Which technique is required for an orthotist to enter theatre and place a HALO? The answer is a
surgical hand wash and observing ANTT principles. This is because of the invasive nature of HALO
placement. The field in this instance would be critical.
Slide 20 – Which technique is required?
Which technique is required for an audiologist when completing a hearing assessment? The
answer is routine hand hygiene. It may be a hand wash with soap and water or a hand rub with
alcohol based hand gel.
Slide 21 – Which technique is required?
Which technique is required for a physiotherapist to perform a suction of a tracheostomy? The
answer is routine hand hygiene and to observe ANTT principles.
Slide 22 – Take home message – How can I reduce
risks?
To significantly reduce the risks of infection health care workers and students are required to
routinely employ the following basic but essential precautions:
You must:
1. Employ hand hygiene techniques during the 5 moments in clinical care.
2. Be bare below the elbows and wash or rub your hands using the correct technique
Lastly, where indicated employ ANTT principles.
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