Aseptic Non-Touch Technique

Objective

To provide guidance on the safe use of Aseptic Non-Touch Technique (ANTT) to prevent infection when performing clinical procedures on residents.

Further information: Preventing Infection Workbook - Page 43

Why is ANTT important?

ANTT ensures that invasive devices (e.g., urinary catheters) or vulnerable sites (e.g., wounds) are protected from contamination. Introducing microorganisms to these sites can increase infection risk. Only staff trained and assessed as competent should perform ANTT.

Principles of ANTT

• Protect key parts (caps, covers) and key sites (sterile field) from contamination.
• Avoid touching key parts or key sites with hands unless sterile gloves are used.
• Safe practice relies on:
• Effective staff training.
• Appropriate environment and equipment.

When to Use ANTT Common scenarios include:

• Dressing surgical wounds or wounds healing by primary intention.
• Dressing deep wounds with cavities or sinuses.
• Inserting invasive devices (e.g., urinary catheters).
• Caring for residents who are immunosuppressed, diabetic, or at high risk of infection.

Procedure for dressing a wound using ANTT

Preparation

Step 1 - Bare Below the Elbows (BBE): sleeves above elbows, no jewellery except plain band ring, no nail polish/false nails.
Step 2 - Hand hygiene.
Step 3 - Decontaminate dressing trolley with detergent and warm water. If using a flat surface, clean in an S-shaped motion.
Step 4 - Collect dressing pack and equipment. Check packaging is intact and in date. Place items on the bottom shelf of the trolley.

Procedure

Step 5 - Put on a disposable apron.
Step 6 - Loosen adhesive/tape securing the existing dressing.
Step 7 - Hand hygiene.
Step 8 - Open sterile dressing pack onto cleaned trolley surface, creating a sterile field. Add any extra sterile items carefully, without contaminating the field.
STep 9 - Put on non-sterile gloves.
Step 10 - Remove the soiled dressing carefully and discard into waste.
Step 11 - Remove gloves and perform hand hygiene.
Step 12 - Put on sterile gloves.
Step 13 - Perform wound care as indicated, maintaining a sterile field at all times.
Step 14 - Apply new dressing without touching key parts.

Completion

Step 15 - Dispose of all used items into a sealed clinical waste bag.
Step 16 - Remove and dispose of PPE appropriately.
Step 17 - Perform hand hygiene.
Step 18 - Decontaminate trolley with detergent and warm water. If disinfection is required, follow with 70% alcohol wipes.
Step 19 - Perform hand hygiene again.
Step 20 - Complete all documentation (wound assessment, dressing applied, date/time, signature).

Good Practice

• Safe aseptic technique is reliant upon effective staff training and the environment and equipment being fit for purpose.
• If the procedure can be undertaken without touching the key site or key part, such as a wound, with your hands, then non-sterile gloves can be worn. If you need to touch the key site or key part with your hands, then sterile gloves must be worn.

Training Requirements

• Mandatory for all Healthcare Support Workers in Wales since 2015 (NHS Wales).
• All staff must complete nationally agreed ANTT e-learning:
  • Learning@NHS Wales: https://learning.wales.nhs.uk/
• Local teaching provided by Community Infection Prevention Nurses or trained key facilitators using ANTT resources:
  • ANTT Resources: http://antt.org/ANTT-Site/resources.html

Competency and Assessment

• Direct Observation of Practice (DOP) assessment is required using the standard ANTT DOP tool.
• Recommended within 3 months of completing e-learning.
• Re-assessment every 3 years as part of local appraisal.
• Staff must inform line managers of any lapse or difficulty in competency.
• If changing specialties or roles, risk assessment and additional training may be required.

Professional Accountability

• Nurses and professional registrants must follow their code of conduct (e.g., NMC Code 2015): https://www.nmc.org.uk/standards/code/.
• All HCWs are accountable for providing safe care and maintaining ANTT competency

Resources
Infection Prevention Control Aseptic Technique Competency Annual Assessment Tool: Aseptic technique competencyhttps://www.infectionpreventioncontrol.co.uk/wp-content/uploads/2023/09/Aseptic-technique-competency-assessment-tool-for-Care-Homes-v3-August-2023.pdf

References and Further Guidance Links:
PHW - Aseptic Non-Touch Technique Policy: phw.nhs.wales/about-us/policies-and-procedures/policies-and-procedures-documents/clinical-governance-and-infection-control-policies/aseptic-non-touch-technique-antt-policy/
ANTT Official Guidance and Resources: https://antt.org/