B1.7.1 Aseptic non-touch technique (ANTT)

ANTT is a framework for aseptic practice — the principles are intended for use in a range of settings from the operating theatre to the community. Since 1993, the ANTT project (www.antt.org.uk) has helped implement ANTT through clinical guidelines and a standard implementation process, into hundreds of hospitals and community health organisations in the UK and internationally. As a result, ANTT has become the first standardised method of aseptic technique to exist in multiple hospitals and community care organisations. Hospitals that have implemented ANTT robustly have reported significant improvements in practice that have helped reduce rates of healthcare-associated infection (Rowley & Clare 2009).

Terminology

Historically, the practice of protecting patients from contamination and infection during clinical procedures has generated an inaccurate and confusing paradigm based on the terminology of undefined sterile, aseptic and clean techniques.

The use of accurate terminology is important in order to promote clarity in practice.

Sterile

Free from microorganisms’ (Weller 1997)

Due to the natural multitude of organisms in the atmosphere it is not possible to achieve a sterile technique in a typical healthcare setting. Near sterile techniques can only be achieved in controlled environments such as a laminar air flow cabinet or a specially equipped theatre. The commonly used term, ‘sterile technique’ i.e. the instruction to maintain sterility of equipment exposed to air, is obviously not possible and is often applied inaccurately.

Asepsis

Freedom from infection or infectious (pathogenic) material' (Weller 1997)

An aseptic technique aims to prevent pathogenic organisms, in sufficient quantity to cause infection, from being introduced to susceptible sites by hands, surfaces and equipment. Therefore, unlike sterile techniques, aseptic techniques are possible and can be achieved in typical hospital and community settings.

Clean

Free from dirt, marks or stains’ (Mcleod 1991).

Although cleaning followed by drying of equipment and surfaces can be very effective it does not necessarily meet the quality standard of asepsis (Ayliffe 2000). However, the action of cleaning is an important component in helping render equipment and skin aseptic, especially when there are high levels of contamination that require removal or reduction. However, to be confident of achieving asepsis an application of a skin or hard surface disinfectant is required either during cleaning or afterwards.

Consequently, the aim of any aseptic technique including ANTT, is asepsis.

ANTT in practice

ANTT is a technique used to prevent contamination of key parts and key sites by microorganisms that could cause infection. In ANTT, asepsis is ensured by identifying and then protecting key parts and key sites by hand hygiene, non-touch technique, using new sterilised equipment and/or cleaning existing key parts to a standard that renders them aseptic prior to use (Rowley et al 2010).

Risk assessment

While the principles of ANTT remain constant for all clinical procedures, the level of practice will change depending upon a standard ANTT risk assessment. Taking into account the technical difficulty of the procedure and his or her own competence, the healthcare worker assesses whether procedures can be performed without touching key parts and key sites directly. Infective precautions are then selected to counter the risks identified. For example, if it were necessary to touch a key part directly, sterile gloves would be the gloves of choice. Otherwise non-sterile gloves would be used.