Aseptic Non Touch Technique (ANTT®) (G136)

Introduction

This guideline aims to outline the principles and practices of Aseptic Non Touch Technique (ANTT®) when carrying out any clinical procedure that involves a risk of infection to the patient. NHSA&A are committed to the delivery of high-quality care, this includes reducing the incidence of healthcare associated infections (HAI).

This document is organised with core information followed by exemplar templates. Quality improvement, audit and research within clinical areas signifies that the evidence base is constantly evolving. Practitioners should endeavour to use the most up-to-date evidence on which to base their practice.

Invasive clinical procedures are regularly performed in community and hospital settings. The definition of aseptic technique is often misunderstood and appears to have contributed to practice variability, inadequate risk assessment and uncontrolled standards of practice. Implementing ANTT®:

• Provides a robust set of principles to teach safe and effective aseptic technique that practitioners can apply to all clinical procedures. This is identifiable in practice as the ‘The ANTT®-Approach.’
• Reduces variability in practice.

This approach is supported by EPIC 3 (2014), Royal College of Nursing (RCN) Standards for Infusion Therapy (2016) and The National Institute for Clinical Excellence (NICE) (2017).

The ANTT® website provides further information.

Scope

The ANTT® guideline applies to practitioners in NHSA&A Paediatric services when performing an aseptic procedure. The term practitioner refers to all health care workers involved in carrying out aseptic procedures.

Examples of aseptic procedures include, but are not limited to:

• Insertion and maintenance of vascular access devices
• Administration of Intravenous (IV) medication/maintenance fluids and flush
• Care of wounds, surgical incisions, removal of drains and/or sutures
• Insertion of a urinary catheter.

This guideline should be used in conjunction with other relevant legislation, guidelines and standards. Standard Infection Control Precautions (SICPs) should be embedded into all care delivery.

Roles and responsibilities

All practitioners should be appropriately trained and supervised in all clinical procedures until considered competent. A practitioner can be described as competent if they have had the necessary training, clinical experience, skills and knowledge to undertake a task safely and without supervision. If a practitioner deems it appropriate to adapt the guidelines, a risk assessment must be undertaken and documented appropriately.

Aseptic technique: the method by which precautions are taken during invasive clinical procedures to prevent the transfer of microorganisms from the health care practitioner, procedure equipment or the immediate environment to the patient. Regardless of the setting, the aim is always to prevent the transfer of pathogenic microorganisms into or onto the patient.

Non-touch technique (NTT): An integral component in achieving asepsis whereby Key-Parts and Key-Sites avoid contamination; if Key-Parts and Key-sites are required to be touched, sterile gloves should be used to carry out the procedure.

Aseptic non-touch technique (ANTT®): a specific type of aseptic technique with a unique theoretical and practice framework that combines the aseptic technique, and non-touch techniques.

Aseptic/asepsis: free from pathogenic organisms.

Key-Parts: The critical parts of procedural equipment that comes in to contact with the patient (a Key-Site) or other procedural equipment. Examples are syringe tips, needles (both the tip and hub), needle free access device or tops of medicine vials.

Example:-

Key-Site: The point where the patient’s skin is breached. Examples may include wounds, the insertion site of peripheral venous catheter (PVC) or central venous catheter (CVC).

Example:-

Aseptic field: a designated aseptic working space. This space contains and protects the procedure equipment. When utilising an aseptic non-touch technique there may be differing aseptic fields.

General Aseptic Field: a term used to promote asepsis rather than ensure it. This may be with decontaminated and disinfected procedure tray or trolley. The maintenance of equipment asepsis is by protecting Key-Parts individually with micro critical aseptic fields (caps and covers)

Examples:-

Critical Aseptic Field: an example of this is a dressing pack or sterile drape. It is used when Key-Parts and/or Key-Sites cannot be easily protected from contamination during a procedure. These critical aseptic fields require only sterile equipment to be placed within it; sterile gloves are required to maintain asepsis.

Example:-

Micro Critical Aseptic Field: a small critical aseptic field used to protect a specific key part.

Examples:-

Critical aseptic management: the complete main aseptic field (usually a sterile drape) requires critical aseptic maintenance, i.e. only sterile or aseptic equipment can come in to contact with the critical aseptic field. Sterile gloves maintain aseptic continuity.

The ANTT® Clinical Practice Framework provides a logical and standard set of principles and safeguards that practitioners need to understand and comply with, in order to apply safe aseptic technique to a wide range of clinical procedures. In addition, it provides healthcare organisations with a robust practice framework to ensure standardisation and effective clinical governance of this critical clinical competency.

For further information on the ANTT® principles click here.

The aim of ANTT® is asepsis, which is achieved through ‘Key-Part’ and ‘Key-Site’ protection. ANTT® states that the key principle to preventing infection is to maintain the asepsis of Key-Parts and Key-Sites. A Key-Part (e.g. tip of syringe) being any part of a device that will come into direct contact with Key-Sites, or other aseptic Key-Parts (e.g. insertion point/needle free access device). These Key-Parts can be protected by the use of Micro Critical Aseptic Fields such as the inside of a syringe wrapper, or a sterile cap. This minimizes the risk of contamination of Key-Parts and Key-Sites which can potentially lead to infection.

For further information of the 6 ANTT® actions for safe aseptic technique click here.

There are two types of ANTT® approach: Standard-ANTT® and Surgical-ANTT®. To determine the correct approach practitioners must undertake a risk assessment based on the technical difficulty of achieving asepsis and length of procedure time.

For further information on choosing standard or surgical approach, refer to the ANTT Clinical Practice Framework.

Note: If a Key-Part or Key-Site is not aseptic it is considered an ‘Inactive Key-Part/Key-Site’, in order to use it the site or component must be disinfected to create an ‘Active Key-Part/Key-Site’ (e.g. IV port disinfection prior to access)

Hand hygiene is the single most effective way to prevent the spread of infection and is a fundamental aspect of ANTT®. Both sterile and non-sterile gloves are part of Protective Personal Equipment (PPE) for healthcare practitioners from exposure to blood and body fluids. The choice of sterile versus non-sterile gloves should be based on a risk assessment by the practitioner. The best possible way of not contaminating a ‘Key-Part’ is simply not to touch it. If the procedure requires direct contact with ‘Key-Parts’ or ‘Key-Sites’ sterile gloves must be worn. All gloves should be well fitting.

Non-sterile gloves are typically worn to protect practitioners from blood, body fluid or medicine exposure. As these gloves are not sterile, they will not protect from contamination if ‘Key-Parts’ and ‘Key-Sites’ are touched. Non-sterile gloves are satisfactory for administering IV medications, accessing vascular access devices, simple wound care, venepuncture or peripheral venous cannulation where it is possible to undertake the procedure without contaminating ‘Key-Parts’ or ‘Key-Sites’. Micro Critical Aseptic Fields (e.g. sterile caps or syringe packets) are used to protect ‘Key-Parts’ and ‘Key-Sites’.

Sterile gloves are a necessity for urinary catheterisation or central venous catheter insertion and complex wound care for procedures that direct contact with ‘Key-Parts’ or ‘Key-Sites’ may occur.

* Please refer to Nutrition Resource Manual for managing patients on parental nutrition.

Note: Glove use is not a substitute for hand hygiene, and gloves must be used appropriately and in accordance with manufacturers’ instructions, together with standard infection control and transmission based precautions, policies and mandatory legislative requirements (e.g. COSHH Standards).

• Remember to use a plastic procedure tray or procedure trolley. Always decontaminate and disinfect correctly, as per local procedures with a general purpose detergent wipe before and after use and dry thoroughly.
• All equipment/packs should be peeled open to avoid contamination of Key-Parts and maintain asepsis.
• Do not drop your equipment into your plastic procedure tray. There is a risk Key-Parts may become contaminated by contact with the Use a Micro Critical Aseptic Field (such as the inside of syringe packets) to protect Key-Parts (such as the syringe tip).
• Ensure other equipment in the plastic procedure tray does not come into contact with the Key-Parts (e.g. blood bottles rolling around tray, extension tubing being placed on top of equipment/Key-Parts).
• Take care when inserting the needle into vials/ampoules not to touch the outer sides.
• Take care not to contaminate syringe tips when placing and removing sterile syringe caps.
• The dorsal bung (top port) of a PVC must only be used on insertion or in emergencies.

This NHSA&A guideline has incorporated and adapted content from the NHSGGC guideline Aseptic Non Touch Technique (ANTT®). It has been reviewed and modified to reflect local pathways, standards, and clinical practice within NHS Ayrshire & Arran.

Following agreement with Chief Nurses/Chief of Medicine, it was then reviewed and ratified by the following groups:

• NHSA&A Board Clinical Governance Forum

This document will be due for review May 2028.

Aseptic Non Touch Technique: ANTT®

Loveday H.P., Wilson J.A., Pratt R.J., Golsorkhi, A., Bak J.B., Prieto J. and Wilcox M. (2014) Epic 3: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England. Journal of Hospital Infection. Supplement S1-S70.

NHS Services Scotland: National Infection Prevention and Control Manual

NHS Education for Scotland: Scottish Infection Prevention and Control Education

NHSA&A: Infection Prevention and Control (available on Athena intranet)

NHSA&A: Care and Maintenance of Vascular Access Devices (VADs) in Paediatrics

NHSA&A: Sharps (available on Athena intranet)

NICE: Infection Prevention and Control

NICE: Healthcare-Associated Infections: Prevention and Control

RCN: Standards for Infusion Therapy

The following templates are for guidance on implementing an ANTT® approach. The equipment shown is for demonstration of the ANTT® approach. Practitioners will still be required and have responsibility to make appropriate decisions on using particular equipment (such as drapes/dressings or passive disinfection caps).

These posters are available from Medical Illustration:

Note: Patients may have allergies or intolerance to particular products. Practitioners are responsible to ensure that suitable alternative products are used. Local policies and guidelines should be adhered to.

NHS Ayrshire & Arran would like to acknowledge the kind permission granted by the Association for Safe Aseptic Practice (www.antt.org) for the use and reproduction of ANTT® resources in the making of this local guideline.

*Ensure all relevant documentation is completed at the end of each procedure*

NHSA&A Peripheral cannulation using standard ANTT® 

NHSA&A Venepuncture/phlebotomy using standard ANTT® 

NHSA&A Simple wound care using standard ANTT®

NHSA&A Intravenous (IV) medicine preparation and administration using standard ANTT®

NHSA&A Peripherally inserted central catheter (PICC) dressing change using surgical ANTT®