aseptic non-touch technique (ANTT)

see also:

• clinically important bacteria
• hand hygiene for health workers
• prevention of infection in healthcare - standard precautions
• sterilisation
• fire and emergency procedures

• aseptic non-touch technique is critical in reducing risk of iatrogenic infections in healthcare

• before attending to a patient
• before performing an aseptic procedure
• after body fluid exposure risk
• after attending a patient
• after contact with patient surroundings¹⁾

• ANNT is becoming the international de facto framework for asepsis ²⁾
• see also Australian NHMRC book on ANNT

• the aim of ANTT is always asepsis
  • aseptic technique should be used during a procedure or when a medical device breaches one or more of the body’s natural defences, such as the skin, mucous membranes, or body cavity.
  • Minimise contamination of key sites
  • Protect patients from their own pathogenic microorganisms that may cause infection
  • Reduce the transmission of microorganisms
  • Maintain the sterility of equipment and key parts used for aseptic procedures
• asepsis
  • “free from sufficient numbers of pathogenic organisms to cause infection”
• aseptic fields
  • controlled work spaces that are designed to maintain the integrity of key parts and key sites during clinical procedures.
  • Critical aseptic field - large areas for complex procedures requiring strict maintenance of sterility with use of sterile gown
  • Micro critical aseptic field - small parts needing to be kept sterile such as needle tips
  • General aseptic field - simple field when small number key parts and small key sites such as wound dressings
• key part / key site protection from contamination
  • key part - the item that must be protected from contamination
  • key site - site on the patient that must be protected from contamination
• standard ANNT vs surgical ANNT
  • standard ANNT for “uncomplicated” procedures where key parts are small and duration of procedure is only a few minutes for example intravenous line insertion and medications
    • only the key parts are managed critically, and thus requires Micro Critical Fields, non-touch technique +/- general aseptic fields
  • surgical ANNT for “complicated” procedures where “in order to maintain asepsis of key parts and key sites, the main aseptic field needs to be managed critically, so that only sterilised and aseptic equipment can come into contact with the aseptic field”
    • eg. insertion of PICC line requiring large aseptic field as large and many key parts
    • requires use of a critical aseptic field and personal protective equipement such as sterilised gloves
• risk assessment:
  • number and size of key parts and key sites
  • the procedure environment
  • degree of invasiveness of procedure
  • duration of the procedure
  • competency of the user

• basic infective precautions:
  • hand cleaning
  • appropriate use of personal protective equipment such as gloves
  • procedure-specific precautions such effective cleaning and sterilisation of equipment
    • eg. key parts such as iv ports must be disinfected before use
• identification of key parts and key sites
  • these are the areas where contamination potentially allows pathogens to enter the body
  • key sites include aspiration sites, needle puncture sites, open wounds, etc
  • key parts are those which may come in contact with the key sites, other key parts or infusions and include iv needleless port, needle, sterilised swab for wound care, urinary catheter and its drainage bag, wound side of sterilised dressing
  • inactive key parts or key sites needs to be rendered aseptic prior to use by cleaning and disinfecting
• non-touch technique
  • the most effective method of avoiding contamination and should also be used in surgical ANNT where possible
• aseptic field management
  • critical aseptic fields
    • eg. the main field used in surgical ANNT
    • used when the key parts are too many or too large to be managed as in standard ANNT
  • micro critical aseptic fields
    • in standard ANNT such as sterilised syringe caps or inner wrapper of urinary catheters which protect key parts from touch and air contamination
    • can be used in surgical ANNT
  • general aseptic fields
    • used in standard ANNT to promote asepsis of the working space and procedure equipment such as disposable sterilised plastic trays

• sequencing
  • risk assessment and decision on field type needed and whether environment is appropriate
  • pre-procedure preparation - prepare environment and equipment and plan
  • performing the procedure - no touch of key sites or parts, maintain fields
  • post-procedure - remove PPE, dispose waste, etc, documentation
• environmental controls
  • avoid contamination risks from floor cleaning nearby, or bed making
  • clean work area - no rusty equipment
• 5 moments of hand hygiene
  • routine hand hygiene - alcohol-based hand rub or soap and running water.
  • surgical scrub - using an approved surgical scrub (90% alcohol hand rub or 4% CHG antimicrobial skin cleanser)
  • barriers to good hygiene - artificial nails, damaged skin, inappropriate glove use, not bare below the elbow.
• maintenance of aseptic fields
• use of PPE
  • non-sterile gloves may be necessary to protect the clinician from blood or body fluids or exposure to toxic drugs during administration
  • sterile gloves are required in procedures where key parts and / or key sites are touched directly

• risk assessment
  • to determine whether surgical ANNT should be used instead of standard ANNT
• manage the environment
  • in surgical ANNT, minimise staff activity, delay procedure following cleaning to avoid aerosolised microbacterial from cleaning services, bed making, ETC
  • in standard ANNT, minimise aerosolised microbacterial by keeping distance from nearby toileting or bed making
• decontaminate and protect:
  • in surgical ANNT:
    • surgical hand scrub
    • use of sterilised gloves
    • a mask
    • wear a sterilised gown if full barrier protection is required
    • use sterilised equipment
  • in standard ANNT:
    • hand cleaning
    • use of non-sterilised gloves, and only need sterilised gloves if key parts need to be touched
    • disposable aprons
    • render key parts aseptic by disinfection prior to use
    • cleaning and disinfection of equipment prior to use
• use aseptic fields
  • in surgical ANNT use a Critical Aseptic Field and sterilised drape to protect Key Parts
  • in standard ANNT use General Aseptic Field and Micro Critical Aseptic Fields
• use non-touch tehniques
  • not essential in surgical ANNT but desirable in case of inadvertent contamindation
  • essential in standard ANNT
• prevent cross-infection
  • decontamination of procedure area
  • safe equipment disposal