UNIQUE IDENTIFIER NO: C-40-2013
Review Date: May 2017
Review Lead: Infection Prevention and Control Nurse
Section G - Aseptic Technique
Version 5
Important: This document can only be considered valid when viewed on the Trust’s
Intranet. If this document has been printed or saved to another location, you must
check that the version number on your copy matches that of the document online.
Page 1 of 10
UNIQUE IDENTIFIER NO: C-40-2013
Review Date: May 2017
Review Lead: Infection Prevention and Control Nurse
Document Summary Table
Unique Identifier Number
Status
Version
Implementation Date
Current/Last
Review
Dates
Next Formal Review
Sponsor
Author
Where available
Target audience
Ratifying Committees
Executive Board
C-40-2013
Ratified
5
October 2007
March 2008, March 2011, April 2013, May 2015
May 2017
Director of Infection Prevention & Control
Infection Prevention & Control Nurse
Trust Intranet
All staff
Consultation Committees
Committee Name
Infection Prevention & Control
Committee
30 July 2015
Committee Chair
Date
Consultant
June 2015
Microbiologist / Infection
Prevention & Control
Doctor
Other Stakeholders Consulted
Stakeholders who were consulted on this document:
Infection Prevention & Control Committee
Infection Prevention & Control Team
Does this document map to other Regulator requirements?
Regulator details
Regulator standards/numbers etc
Document Version Control
Version 5
The policy has been updated and reviewed.
Version 4
Version 3
The policy has been updated and reviewed. The Trust Equality
Statement has been updated.
The document has been redesigned to ensure that all new and
revised procedural documents are set out to a Trust wide format,
the content of which includes a minimum set of criteria which
include:
 the training requirements for implementation
 monitoring arrangements for the document
 Equality Impact of the document
In addition, the monitoring arrangements for this document have
been included.
Page 2 of 10
UNIQUE IDENTIFIER NO: C-40-2013
Review Date: May 2017
Review Lead: Infection Prevention and Control Nurse
Contents
Section
1
2
3
4
5
6
7
8
9
10
11
12
Page
Document Summary Table
Contents
Introduction
Purpose
Principles of Aseptic Non-Touch Technique (ANTT)
Definitions
Duties (Roles and Responsibilities)
Standard and Surgical ANTT
When should Standard ANTT be used?
Training and Implementation
Trust Equalities Statement
Monitoring Compliance with this Policy
Associated Documents / Further Reading
References and Bibliography
2
3
4
4
4
5
6
6
7
8
8
8
8
9
Appendices
App 1
The 10 Foundation Principles of ANTT (ANTT Theory and
Practice Framework, Version 2.2).
Page 3 of 10
10
UNIQUE IDENTIFIER NO: C-40-2013
Review Date: May 2017
Review Lead: Infection Prevention and Control Nurse
1.
Introduction
The aims of an aseptic technique are to prevent the introduction of potentially
pathogenic micro-organisms into susceptible sites such as wounds, the
bladder or bloodstream, prevent the transfer of potentially pathogenic microorganisms from one person to another and to prevent staff from acquiring an
infection.
Aseptic Non Touch Technique (ANTT) is the chosen method for aseptic
technique to be adopted by staff within the Trust. It should be used during any
procedure that bypasses the body’s natural defences.
ANTT:
 supports health care workers to practice safely and efficiently
 supports health care organisations to manage the significant risks of
aseptic technique
 helps to make patients feel safe
Where aseptic procedures are performed:
 clinical procedures should be carried out in a manner that maintains and
promotes the principles of asepsis;
 education, training and assessment in the aseptic technique should be
provided to all persons undertaking such procedures;
 the technique should be standardised across the organisation;
 audit should be undertaken to monitor compliance with the technique.
(Health and Social Care Act, 2008 and EPIC 3 guidelines).
It should be noted that only staff that have received appropriate training and
have been assessed as competent should carry out an aseptic procedure. If
training is required, the key trainer for a particular area should be contacted.
2.
Purpose
The purpose of this policy is to provide information regarding procedures that
require an ANTT and how, when and by whom this should be utilised within
the Trust.
3.
Principles of Aseptic Non-Touch Technique
Standard ANTT is a process for safe and effective practice that can be
applied to procedures such as intravenous therapy, wound care and urinary
catheterisation. It standardises practice and rationalises many different
techniques currently in use.
The principle underlying ANTT is that you cannot contaminate a key part if it is
not touched. Any key part must only come into contact with other key parts
(e.g. syringe tip and needle hub); non-key parts should be touched with
confidence.
Page 4 of 10
UNIQUE IDENTIFIER NO: C-40-2013
Review Date: May 2017
Review Lead: Infection Prevention and Control Nurse




Always wash hands effectiveley
Never contaminate key parts
Touch non key - parts with confidence
Take appropriate infective precautions
Individual healthcare practitioners need to decide between sterile or non
sterile field / gloves by asking themselves: ‘can I do this procedure without
touching key-parts?’
If the answer is NO – use an appropriate pack and sterile gloves.
If YES – use an appropriate pack and non-sterile gloves.
(See Section 6 regarding standard and surgical ANTT).
The principles of carrying out an ANTT are standard, but components of the
technique may vary according to the degree of risk. The 10 Foundation
Principles of ANTT as defined in the ANTT Theory and Practice Framework
(Version 2.2) can be seen in Appendix 1.
4.
Definitions
Aseptic: without micro-organisms.
Aseptic Non-Touch Technique (ANTT): identifying the ‘key parts’ of a
procedure and not touching them either directly or indirectly.
Aseptic Technique: a method developed to ensure that only uncontaminated
objects / fluids make contact with sterile / susceptible sites.
Critical aseptic field (ensuring asepsis): used when an open, invasive
procedure requires a large aseptic working area for an extended length of
time, as in the operating theatre. Only equipment that has been sterilised and
is aseptic can be introduced onto the critical aseptic field; it must be managed
as a key part (i.e. the whole surface area can only come into contact with
other aseptic equipment). (Ref: ANTT Theory and Practice Framework).
Decontamination: the process of rendering an article safe to handle, by
cleaning with or without disinfection or sterilization.
General aseptic field (promoting asepsis): used for standard ANTT when
key parts can easily be protected by micro critical aseptic fields and a non
touch technique (and other basic infection control measures). The main
general aseptic field does not have to be managed critically and is essentially
promoting rather than ensuring asepsis of key parts and key sites; typically,
non-sterile gloves are used. (Ref: ANTT Theory and Practice Framework).
HAI: Hospital Acquired Infection.
HCAI: Health Care Associated Infection.
Page 5 of 10
UNIQUE IDENTIFIER NO: C-40-2013
Review Date: May 2017
Review Lead: Infection Prevention and Control Nurse
Infection: the invasion and multiplication of micro-organisms within tissue
which then results in destruction of the tissue.
Invasive: involving puncture or incision of the skin or insertion of an
instrument or foreign material into the body.
Key part: the parts of the procedure equipment that come into direct or
indirect contact with any liquid infusion or key sites and with any active key
parts connected to the patient” (ANTT Theory and Practice Framework, p 4).
Key parts may include needles, syringe tips, intravenous line connections,
exposed lumens of catheters, tops of ampoules.
Key sites: e.g. open wounds including insertion and puncture sites.
Micro-critical aseptic field: created when key parts are protected by syringe
caps, covers and packaging. (Ref: ANTT Theory and Practice Framework).
Primary Intention: where wound edges are brought together and held in
place by mechanical means, e.g. adhesive strips, staples or sutures.
Risk assessment: the method used to quantify the risk to human health and
the environment.
Secondary Intention: where the wound is left ‘open’ (although usually
covered with an appropriate dressing) and the edges come together naturally
by means of granulation and contraction.
Standard precautions: infection control precautions that should be applied
as standard principles by all healthcare staff to the care of all patients at all
times. (See Section C of the Infection Control Manual).
5.
Duties (Roles and Responsibilities)
The Chief Executive is responsible for ensuring that there are effective
infection prevention and control arrangements in the Trust.
 Line managers are responsible for monitoring staff training and
competency in the use of aseptic technique / ANTT.
6.
Standard and Surgical ANTT (adapted from ANTT Theory and
Practice Framework)
‘Asepsis is maintained with either standard or surgical ANTT’
Standard ANTT (usually utilised for procedures in Wards / Out Patient
Depts.). It is the technique of choice when procedures meet all of the following
criteria:
Page 6 of 10
UNIQUE IDENTIFIER NO: C-40-2013
Review Date: May 2017
Review Lead: Infection Prevention and Control Nurse




they are technically simple
short in duration (approximately less than 20 minutes)
involve small key sites and key parts
have minimal numbers of key parts.
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.
(Please see Appendix 2 for a summary and illustration of the above).
7.
When should standard ANTT be used?
The approach for most procedures carried out in wards / departments, other
than those requiring surgical ANTT should be to use a standard ANTT
technique for:














Care of wounds healing by primary intention, e.g. surgical incisions and
fresh breaks.
Suturing of wounds.
Insertion of urinary catheters.
Insertion, re-siting or dressing intravenous cannulae or other intravascular
devices, such as CVP lines, Hickman lines and Arterial lines.
Insertion of gastrostomy and jejunostomy tubes.
Insertion of tracheostomy tubes or chest drains.
Vaginal examination using instruments (e.g. smear taking, high vaginal
swabbing, colposcopy).
Assisted delivery (e.g. forceps and ventouse).
Biopsies
Venepuncture
Obtaining blood cultures
I V Therapies, including administration of I V antibiotics
Tracheostomy site dressings
Removing drains or sutures
Page 7 of 10
UNIQUE IDENTIFIER NO: C-40-2013
Review Date: May 2017
Review Lead: Infection Prevention and Control Nurse


Maintenance of central lines
Respiratory suction
The timing of procedures such as re-dressing wounds in a ward area can be
an important factor in helping to reduce the risk of infection. They should not
be carried out when tasks such as bed-making are taking place, due to the
risk of micro-organisms being dispersed into the air and potentially
contaminating the sterile equipment or wound. Ideally, these should be
carried out at a time when ward activities are less and cleaning activities
suspended. Clean, non-infected wounds should be dressed first; colostomies
and infected wounds should be dressed last to minimise environmental
contamination and cross-infection.
8.
Training and Implementation
Further information can be obtained by accessing the ANTT section on the
Staff Intranet. Prior to assessment, all staff must have seen the ANTT
presentation and DVD.
9.
Trust Equalities Statement
Calderdale and Huddersfield NHS Foundation Trust aims to design and
implement services, policies and measures that meet the diverse needs of our
service, population and workforce, ensuring that none are placed at a
disadvantage over others. We therefore aim to ensure that in both
employment and services no individual is discriminated against by reason of
their gender, gender reassignment, race, disability, age, sexual orientation,
religion or religious/philosophical belief, marital status or civil partnership.
10.
Monitoring Compliance with this Procedural Document
It is the responsibility of all clinical staff to comply with this policy; senior
clinical staff and managers are asked to lead by example. Continued failure
by an individual to adhere to this policy may be managed under the Trust’s
disciplinary policy.
Audit of the standard ANTT process is led by the Infection Prevention and
Control Team and key trainers.
11.
Associated documents / Further reading



ANTT information and clinical guidelines are available on the Trust intranet
and can be accessed at: http://nww.cht.nhs.uk/divisions/diagnostic-andtherapeutic/infection-prevention-control-news/aseptic-non-touchtechnique/
www.antt.org.uk
Related Infection Control Policies: Standard Infection Control Precautions
(Section C); Decontamination and Disinfection Policy (Section F); Hand
Page 8 of 10
UNIQUE IDENTIFIER NO: C-40-2013
Review Date: May 2017
Review Lead: Infection Prevention and Control Nurse

12.
Hygiene (Section H/I); Isolation Policy (Section J/K); Specimen Policy
(Section R); Multi-resistant organism policy (Section T); Waste disposal
policy (Section U/V).
Uniform Policy
References and Bibliography:
ANTT Theory & Practice Framework, Version 2.2: www.antt.org.uk
ANTT Policy, Version 2, (2012): East Cheshire NHS Trust.
Ayliffe G A J., Fraise A P., Geddes A M., Mitchell K., (2000) Control of
Hospital Infection: A Practical Handbook 4th edition, Arnold Publishers,
London.
Epic 3 Guidelines (2014): Department of Health.
Getting Ahead of the Curve (2002), Department of Health.
Gilmour D., (2000) ‘Is aseptic technique always necessary?’
Community Nursing, 14; 4.
Journal of
The Health & Social Care Act (2008): ‘Code of Practice on the prevention and
control of infections and related guidance.’ Department of Health
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: 9: 1: p 18-23.
Wilson J. (2006), Infection Control in Clinical Practice
Tindall, London.
3rd Edition, Bailliere
Winning Ways: Working Together to Reduce Healthcare Associated Infection
in England. A report by the CMO, Department of Health, 2003.
Page 9 of 10
UNIQUE IDENTIFIER NO: C-40-2013
Review Date: May 2017
Review Lead: Infection Prevention and Control Nurse
Appendix 1
The 10 Foundation Principles of ANTT
(ANTT Theory and Practice Framework)
(Version 2.2)
Principle 1
The main infection risk to the patient is the health care worker
Principle 2
HCWs must understand what asepsis is and how to establish and maintain it
Principle 3
Identifying and protecting key parts and key sites is paramount
Principle 4
Clinical procedures should be risk assessed to determine the level of aseptic
technique required
Principle 5
Asepsis is maintained with either standard or surgical ANTT
Principle 6
Aseptic fields are important.
Standard and surgical ANTT require different aseptic field management
Principle 7
Non touch technique is the most important component of surgical and standard
ANTT
Principle 8
Appropriate infective precautions help promote and ensure asepsis
CLINICAL AND ORGANISATIONAL MANAGEMENT
Principle 9
Aseptic practice should be standardised
Principle 10
Safe aseptic technique is reliant upon effective staff training in infection control, safe
environments and fit for purpose equipment.
Page 10 of 10