POLICY FOR ASEPTIC NON TOUCH

TECHNIQUE (ANTT)
INFECTION PREVENTION AND
CONTROL POLICY NO. 15

Applies to: Employees of Wirral Community NHS Trust

Group for Approval Infection Prevention & Control Group
Date of Approval 3 May 2013
Committee for ratification Quality and Governance Committee
Date Ratified 20 May 2013
Review Date: 2016
Name of Lead Manager Head of Infection Prevention & Control
Version 1

UNLESS THIS VERSION HAS BEEN TAKEN DIRECTLY FROM THE TRUST WEB SITE
THERE IS NO ASSURANCE THIS IS THE CORRECT VERSION
 Policy for Aseptic Non Touch Technique (ANTT)

CONTENTS

Paragraph
1 Introduction
2 Statement of intent
3 Definitions
4 Equality impact assessment
5 Duties
6 Procedure
7 Training/Support
8 Process for monitoring effective implementation
9 Other relevant procedural documents
10 References

Appendices

1 Process monitoring tool

Acknowledgement
This policy is based on the ANTT Clinical Practice Framework – (2013) Version 3.1 The Association for
Safe Aseptic Practice (ASAP). ANTT® Clinical Practice Framework. Version 3.1 www.antt.org

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Policy for Aseptic Non Touch Technique (ANTT) – Version 1
1. INTRODUCTION

Wirral Community NHS Trust is committed to reducing Healthcare Associated Infections

(HCAI) therefore demonstrating compliance with The Health and Social Care Act 2008
Code of Practice on the prevention and control of infections and related guidance
(Department of Health, 2010). The Code of Practice specifies that where aseptic
procedures are performed the technique should be standardised across the
Organisation and all persons undertaking such clinical procedures should receive
education and training in such techniques.

Due to the invasive nature of clinical procedures, health care workers are inherently the
main route of infection. Aseptic Non Touch technique (ANTT) provides health care
workers with a practice framework which promotes safe and efficient aseptic technique
(The Association for Safe aseptic Practice, 2013). Pratt et al (2007) recognise that
standardised aseptic technique plays a significant part in care provision as it has been
shown to significantly reduce HCAI and provide safe care.

Asepsis is the method by which healthcare workers can prevent microbial contamination
during invasive procedures or breaches in the skins integrity. ANTT is the method used
to reduce the risk of microbial contamination to a vulnerable site. ANTT is supported by
the use of infection control standard precautions for all patients, all of the time.

2. STATEMENT OF INTENT

This policy outlines Wirral Community NHS Trust’s (WCNHST) responsibilities in

ensuring that clinical procedures are carried out in a manner that ensures asepsis. The
Trust recognises its responsibility in ensuring that care is delivered in the safest way
possible to ensure high quality clinical care. The policy details a standard framework
approach in relation to clinical procedures. It also details employee’s responsibilities in
relation to adherence to a standardised approach to aseptic technique practice.

To comply with The Health and Social Care Act 2008 Code of Practice on the prevention
and control of infections and related guidance (Department of Health, 2010) WCNHST
will:

• Provide training to staff required to perform aseptic technique as part of their role
• Reduce variation in practice through use of standardised technique
• Change culture amongst staff through education, training, audit and ongoing
support

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3. DEFINITIONS

• Aseptic technique: the method by which precautions are taken during invasive
clinical procedures to prevent the transfer of microorganisms from the healthcare
worker, procedure equipment or the immediate environment to the patient.
Regardless of the setting the aim is always to prevent the transfer of pathogenic
micro-organisms from the healthcare worker, procedure equipment or the
immediate working environment into or onto the patient

• Aseptic Non Touch Technique (ANTT): A specific type of aseptic technique

with a unique Theoretical and Practice Framework. (NICE 2012).

• Aseptic field: a designated aseptic working space that contains and protects the
procedure equipment, in ANTT there are differing aseptic fields:

• Critical aseptic field: an aseptic field using a dressing pack or sterile drape
where only aseptic Key-Parts can come into contact with it. A critical aseptic field
is used to ensure asepsis and requires critical management

• General aseptic field - is used to promote asepsis rather than ensure it, this may
be through the use of a clean tray or trolley. Micro critical aseptic field (MCAF is
used to ensure Key-Part asepsis and requires general management

• Micro critical aseptic field (MCAF): a small critical aseptic field used to protect
a specific key-part, e.g. a syringe cap or needle cover, other examples may
include ‘backing’ to dressings

• Critical management: The whole main aseptic field (usually a sterile drape) is
maintained aseptically. i.e. Only sterile or aseptic equipment can come into
contact with the critical aseptic field, sterile gloves are used to maintain aseptic
continuity

• General management: Whilst the main aseptic field (Usually a plastic or paper
tray) is still managed aseptically and helps to promote a safe working space, it is
not as aseptic as a sterile drape and therefore is not relied upon as the primary
method of equipment protection. Equipment asepsis is maintained by protecting
Key-Parts individually with micro critical aseptic fields (caps and covers).

• Healthcare associated infection (HCAI): any infection acquired by a person as

a consequence of healthcare interventions regardless of where care is delivered

• Key-Part: the critical part of procedural equipment that comes into contact with
the patient (a Key-Site) or other procedural equipment i.e. liquid infusion during
the procedure.

• Key-Site: can be a wound, insertion and access sites for a medical device

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 • Non-touch technique: an integral component in achieving aseptic technique and
should always be applied where practically possible and relates to Key-Parts and
Key-Sites which should not be handled unless unavoidable to do so

4. EQUALITY IMPACT ASSESSMENT

As part of its development, this policy and its impact on equality have been reviewed.
The purpose of the assessment is to minimise and if possible remove any
disproportionate impact on employees on the grounds of race, sex, disability, age,
sexual orientation or religious belief. No detriment was identified.

5. DUTIES

Chief Executive

The Chief Executive has overall responsibility for Infection Prevention and Control within
the Trust.

Trust Board

The Trust Board has a responsibility for ensuring that it corporately meets its legal duties
in relation to Infection Prevention and Control. This responsibility is delegated to the
Quality and Governance Committee via the Infection Prevention and Control Group.

Director of Infection Prevention and Control

It is the responsibility of the Director of Infection Prevention and Control to oversee the
development and implementation of infection prevention and control policies and to
ensure that the Trust has safe effective management systems in place in relation to
HCAI.

Quality and Governance Committee

The primary function of the Quality and Governance Committee is to provide assurance
to the Board of overall compliance with all statutory and regulatory obligations and will
ensure the effective management of incidents, complaints, and subsequent
dissemination of lessons learnt. The Quality and Governance Committee is responsible
for ratifying Infection Prevention and Control policies.

Infection Prevention and Control Group

The Infection Prevention and Control Group is responsible for approving Trust Infection
Prevention and Control policies and for monitoring incidents in relation to infection
prevention and control.

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The Infection Prevention and Control Service

The IPCS are responsible for developing Trust wide policies. The IPCS are responsible
for ensuring this policy is reviewed and amended at the review date or prior to this,
following new developments in ANTT research and practice.

The Infection Prevention and Control Service (IPCS) are responsible for assuring the
Trust board regarding activity in infection prevention and control within the Trust. Written
reports are submitted four times per financial year.

Divisional Managers

Divisional Managers will ensure that appropriate actions are taken for issues
reported/escalated directly via the Infection Prevention and Control Group, Divisional
Governance meetings/Service Leads and any other relevant Committee or Group.
Service Leads/ Managers

Service Leads/Managers are responsible for monitoring via Management Supervision

attendance at mandatory training within their teams. Service Leads/Managers are
responsible for identifying if ANTT training is required for their service and for
addressing areas of non compliance.

Employees
Employees are responsible for carrying out procedures where ANTT is indicated in a
safe manner. Employees are responsible for ensuring they attend mandatory training
programmes as directed by their Line Manager.

Employees must comply with Trust policies. Failure to comply with or act in accordance
with Trust policies may result in disciplinary action.

6. ASEPTIC NON TOUCH TECHNIQUE (ANTT)

During any invasive clinical procedure the aim of an aseptic technique is to protect the
patient from infection. In ANTT, this is achieved by ensuring the asepsis of Key-Parts
and Key-Sites by protecting them from the healthcare worker and environmental
contamination.

The ANTT Clinical Practice Framework provides a comprehensive and robust process
by which to apply safe aseptic technique. It is based on 4 Principles and 4 Safeguards
(ANTT 2013).

Standard-ANTT: is required when procedures are technically simple, short in duration,

involve small Key-Sites and Key-Parts and a minimal number of Key-Parts. Standard-
ANTT involves protecting Key-Parts individually with Micro Critical Aseptic Fields and
other elements of aseptic technique.

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Surgical-ANTT: is required when procedures are technically complex, involve and
extended procedure time, involve large open Key-Sites and large or numerous Key-
Parts. Surgical-ANTT involves maintaining the whole aseptic field as a Key-Part and
usually involves a sterile drape and sterile gloves.

It should be noted that while these two approaches differ to accommodate different
levels of procedure complexity they both adhere to the same principles of ANTT.

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The two types of ANTT can be simplified into ‘The ANTT-Approach’. The ANTT-
Approach highlights and promotes the essential elements of safe aseptic technique:

Risk Assessment: The need for Surgical or Standard ANTT is determined by ANTT risk
assessment that is based on the technical difficulty of achieving asepsis. To determine
Standard or Surgical-ANTT consider the risks posed by the procedure environment,
procedure invasiveness, the number & size of Key-Parts & Key-Sites and length of
procedure

Manage the environment: there are recognised challenges i.e. patients own
environment in performing an aseptic technique within the community. However, the aim
of an aseptic technique is always asepsis (i.e. to prevent the introduction of new or
further harmful microorganisms) which can easily be achieved in community setting with
application of simple control measures to manage the environment

Decontaminate and protect: the importance of effective hand hygiene is the single
most important measure to prevent the transmission of infection; therefore it plays a
crucial role in ANTT. Standard infection control precautions must always be adhered to
when performing ANTT

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Use aseptic fields: Aseptic fields help protect procedure equipment from the clinical or
home care environment. Standard and Surgical-ANTT use different types of aseptic
fields.

Use Non-Touch Technique: The safest way to protect a Key-Part is not to touch it.
Avoid touching Key-Parts of the procedure equipment and Key-Sites. If these must be
handled sterile gloves must be worn.

Prevent Cross Infection: By safe and effective equipment disposal and hand
decontamination at the end of every procedure.

The steps in each procedure are risk evaluated and sequenced to ensure an efficient,
logical and safe order; staff must always follow Trust policies and procedures:

Step 1. ANTT Risk assessment (use of Standard or Surgical ANTT)

Step 2. Decontaminate hands

Step 3. Clean trolley/tray/create suitable working environment

Step 4. Gather equipment

Step 5. Decontaminate hands

Step 6. Apply single use disposable apron

Step 7. If required, open dressing pack/sterile drape

Step 8. Open and prepare all equipment

Step 9. Decontaminate hands

Step 10. Apply gloves (as dictated by ANTT risk assessment)

Step 11. Perform procedure using ANTT

Step 12. Remove gloves & apron

Step 13. Dispose of waste

Step 14. Decontaminate hands

Step 15. Clean trolley/tray/environment

Step 16. Decontaminate hands

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7. TRAINING/SUPPORT

Infection prevention and control training (including Aseptic Non Touch Technique
training) is a mandatory requirement for clinical staff who undertake such procedures as
identified on Service Training Matrices.

All core mandatory training is recorded centrally by the Quality and Governance service.
Quarterly monitoring reports are prepared for the Learning and Development Group to
monitor attendance rates. Full details of the processes in place for managing and
monitoring attendance are set out in the Policy for Learning and Development GP46.

ANTT training is incorporated into relevant clinical training provided by Specialist

Nursing Services.

The Infection Prevention and Control Service can be contacted for further advice or
support.

8. PROCESS FOR MONITORING EFFECTIVE IMPLEMENTATION

The monitoring tool (appendix 1) outlines the monitoring arrangements for complying
with this policy.

9. OTHER RELEVANT PROCEDURAL DOCUMENTS

This policy should be read in conjunction with relevant Organisational documents.

10. REFERENCES

Department of Health (2006). Essential Steps to Safe, Clean Care

Department of Health (2010). Saving Lives

Department of Health (2010) The Health and Social Care Act 2008 Code of practice on
the prevention and control of infections and related guidance

Pratt, RJ. Pellowe, CM. Wilson, JA. Loveday, HP and the epic guideline development
Team (2007) epic2: National Evidence-Based Guidelines for Preventing Healthcare-
Associated Infections in NHS Hospitals in England. The Journal of Hospital Infection.
February 65S, S15 -19.

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)

The Association for Safe Aseptic Practice (ASAP) (2013) ANTT® Clinical Practice
Framework. Version 3.1 www.antt.org

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 Appendix 1
Process for Monitoring Compliance with Aseptic Non Touch Technique Policy

Minimum requirement Process for Responsible Frequency Evidence Responsible Responsible

to be monitored monitoring (e.g. individual / of individual committee for
audit) group/ monitoring for monitoring of
committee development action plan and
of action Implementation
plan
Process for checking Trust wide Learning & Quarterly Minutes Divisional Education &
that all permanent staff, Mandatory Training Development Managers/ Workforce
as identified in the Attendance Reports Group Service Committee
training needs analysis, Service training Leads
complete ANTT training Service Training Matrices
Matrices
Process for following up Trust wide Learning & Quarterly Minutes Divisional Education &
those who fail to attend Mandatory Training Development Managers/ Workforce
ANTT training Attendance Reports Group Service Committee
Leads

Process for monitoring Essential Steps to Infection Quarterly INCA - Essential Divisional Quality &
compliance with policy Safe, Clean Care Prevention & Steps to Safe, Managers/ Governance
observational audit Control Clean Care Service Committee
tools Group observational Leads
audits
Service
Exception
reports

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