ANTT Procedure

SH CP 13
Aseptic Non Touch Technique and Clean

Technique Procedure
(Infection Prevention and Control Policy: Appendix 7)
This Aseptic Non Touch Technique and Clean Technique Procedure must be read in
conjunction with the Infection Prevention and Control Policy.
Version: 1
Once you have read this procedure, you MUST

follow the link at the end to complete the e-
Assessment
Summary: Provide a standardised approach to Aseptic Non
Touch Technique (ANTT) and clear indication where a
Standard ANTT is required and when clean technique
is indicated.
Target Audience: All staff of all disciplines.
Next Review Date: January 2014.
Approved by: IP&C Committee. Date of meeting:

26th January 2012.
Date issued: February 2012.
Author: Jacky Hunt – Nurse Infection Prevention and Control

(North).
Sponsor: Sue Harriman

Interim Chief Operating Officer and Director of
Infection Prevention and Control.
Aseptic Technique Procedure.

Author: Jacky Hunt – Nurse IP&C (North). 1
Version: 1.
Date: February 2012.
! Don’t forget! You MUST complete the e-assessment. link on last page of this document !
Version Control
Change Record
Date Author Version Page Reason for Change
Reviewers/contributors
Name Position Version Reviewed &
Date

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CONTENTS
Page
1 Introduction 4
2 Definitions 4
3 Process -The Basic Principles of Standard ANTT 8
4 Applying the principles of Standard ANTT 11
5 Principles of Clean Technique 14
6 Indications table 15
7 Training 19
8 Supporting References 21
Appendices
 7.1 Aseptic Technique Clinical Competency 22
 7.2 Best Practice Statement for Performing a Dressing in 28

the Home Environment
9 Link to e-Assessment - only complete AFTER you have 31

watched the e-presentation and read this procedure

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Aseptic Non Touch Technique and Clean Technique Procedure
1. Introduction
The purpose of this appendix is to:
1.1 Provide a standardised approach to Aseptic Non Touch Technique (ANTT) and clear
indication where a Standard ANTT is required and when clean technique is indicated.
1.2 Ensure the principles of asepsis are observed during any invasive procedure that
bypasses the bodies natural defences ie skin or mucous membrane
1.3 Ensure compliance with The Health and Social Care Act (Dept of Health 2010).
1.4 Give formal guidance to staff and their managers as to when competence has been
achieved in Standard Aseptic Non Touch Technique (Standard ANTT).
Please note that Surgical Aseptic Non Touch Technique is beyond the scope of this
document. Staff working in theatre environments should follow the Southern Health
Foundation Trust Theatre Policy for Surgical Hand Hygiene and Asepsis
2. Definitions
2.1 Asepsis- is recognised as the state of being free from pathogenic microorganisms
2.2 Aseptic technique- is defined as a means of preventing or minimising the risk of

introducing harmful micro-organisms onto key parts or key sites of the body when
undertaking clinical procedures.
2.3 Aseptic Field – An aseptic field is an area created to control the environment around
the procedure and protect the key parts and key sites. Often this can be achieved by
placing a sterile towel/s around the procedure site and on the surface that will hold
sterile instruments and other items such as dressings.
2.4 Standard Aseptic Non-Touch Technique (Standard ANTT) - The overriding basic
principle is that the key sites eg wound, must not come into contact with any item
(hand, equipment, solution) that is not sterile.
Sterile gloves are not always required for Standard ANTT. Each procedure must be
risk assessed.
Whether sterile or non sterile gloves are worn depends if you can avoid touching the
sterile parts of equipment which will come into contact with the service users
susceptible areas eg their wound/cannula.
If the procedure is complex or the patient is particularly immunocompromised sterile

gloves must be worn.
If however you can carry out the procedure without touching the key part with your
hands, non sterile clean gloves may be worn (See Section 6 of this Appendix
‘Indications Table’ as a guide).

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These methods have been developed to ensure that only uncontaminated
objects/fluids make contact with key parts or key sites
Aseptic technique is traditionally segregated into two different processes:
Aseptic Non-Touch Technique
Surgical Aseptic Non Standard Aseptic Non -Touch

Touch Technique Technique (Standard ANTT)
(Pratt et al, 2007).

Although the processes are the same, the differences take into account the location
and procedure being undertaken (Hart, 2007).
2.5 Clean Technique – is a non touch technique. It is defined as a modified aseptic non-
touch technique. Measures are taken to control the number of micro organisms
entering a key site eg wound, but it does not aim for sterility.
The clean technique uses a non-touch technique where practical (eg hands that are
wearing non-sterile clean gloves should not touch sterile dressing surfaces which will
be in contact with the wound bed).To ensure that the equipment used for the care
carried out in a patients home is as clean as possible and convenient for transportation,
this Trust recommends that all wound care is carried out using a sterile dressing pack
e.g. Polyfield pack
2.6 Clean surface– wiped surface e.g. wiped with Clinell sanitising wipe, to make free from
dust and soil. Cleaning is an important action in removing dirt to help achieve asepsis.
2.7 Healing by secondary intention –refers to healing of an open wound, from the base
upwards but is not necessarily a cavity wound or sinus.
A clean technique is used for dressing most wounds healing by secondary intention in
a non hospital setting or by service users dressing their own wounds caused through
self harming behaviour. Clean technique must not be used to dress cavity wounds e.g.
with sinus, visible bone or wounds of patients who are significantly immuno-
compromised.
2.8 Key site - An area belonging to the service user where pathogenic organisms can
enter the body and cause infection eg wounds, urinary tract, cannula insertion site.
2.9 Key Parts - Refers to the key sterile equipment parts. These key parts are the pieces
of equipment that are manufactured sterile and would be in direct contact with the key
sites of the service user
They have the potential to transmit bacteria and / or microorganisms if they become
contaminated. During Standard ANTT, key parts must be protected from
contamination.
The principle is that you cannot infect a key part if it is not touched. Any key part must
only come into contact with other key parts (e.g. sterile glove, sterile syringe tip and
needle hub) non-key parts can be gripped firmly.
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For examples of ‘key equipment parts’ relevant to intravenous therapy, urinary
catheterisation and wound care please see pages 5 & 6.
Examples of ‘key equipment parts’ relevant to Intravenous therapy:
Syringe needle
Syringe needle hub
Drug itself
Neck of vial/ampoule
Syringe tip
Drug itself
Injectable bung
Giving Set Spike
Internal neck/connection point of

intravenous fluid bag
Infusate fluid
Sterile part of the dressing in direct

contact with the cannula insertion
site
Examples of ‘key equipment parts’ relevant to urinary catheterisation therapy
Examples of ‘key equipment parts’ relevant to wound care

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Dressing in direct contact
with wound
Forceps tips or gauze

swabs which will be in
contact with the wound
Sterile Saline
Sterile galipot for holding

infusate
THIS IS NOT AN EXHAUSTIVE LIST of KEY PARTS
2.10 Pathogenic microorganism – An organism of microscopic size, usually a bacteria or

virus, that causes disease. See ‘Asepsis’ definition.
2.11 Sterile- Free from micro-organisms. Because it is impossible to maintain sterility of

sterilized equipment once exposed to the air, it is by definition impossible to achieve a
‘sterile technique’ or maintain a ‘sterile field’ in typical health care settings (ANTT
2012).
2.12 Surgical Aseptic Non Touch Technique - Surgical Aseptic Non Touch Technique is
a strict process and includes procedures to eliminate micro-organisms from an area. It
is practiced by health care workers in operating theatres and some dedicated minor
operation areas. This method aims to maintain asepsis and minimise the risk of
introducing pathogens into a surgical wound (Hart 2007; Wilson 2006)
Surgical asepsis is achieved in theatres by using sterilised instruments placed within a

critical aseptic field. A critical aseptic field is created by ensuring that the patient,
operating table, and instrument trolleys are covered in sterile drapes. All equipment
and instruments are sterile and are placed within the critical aseptic field, and all staff
operating within the surgical field have performed a surgical scrub and are wearing
sterile gowns and gloves
2.13 Transient Microorganisms – Microorganisms on the surface of the skin which come
and go as we touch things and move around.
Please see table below for the relationship between

Surgical ANTT, STANDARD ANTT and Clean Technique
Asepsis
Surgical Aseptic Standard Aseptic Non Touch Clean technique
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Non Touch Technique
Technique
Aims Aims to prevent Aims to prevent Aim to control the
microorganisms on microorganisms on hands, number of micro
hands, surfaces or surfaces or equipment from organisms entering a
equipment from being introduced to a key part key site eg wound,
being introduced to or site such as a new wound, but it does not aim for
a surgical wound catheter or central venous line sterility.
whilst in a theatre (DH 2007).
setting.
Gloves Sterile only Non- sterile clean gloves if you Non sterile
can do the task without
touching ‘key parts or key sites’
Sterile gloves if you have to

touch ‘key parts/sites’ to do the
task or if the service user is
immuno-compromised.
Non-touch Yes Yes Yes
technique
Dressings Sterile Sterile Sterile
eg wound
dressings
Cleansing Sterile Sterile Non-sterile
solutions
Clean work Yes Yes Yes
surface
Sterile Yes Yes Yes
paper towel
3. Process - The Basic Principles of STANDARD ANTT
3.1 Planning ahead

Prepare the area and the patient. Assemble every thing that is needed in advance of
the procedure ensuring you have sufficient time for the procedure and help if needed.
Eliminate distractions (telephone) where possible
3.2 Hand Hygiene

Effective hand hygiene is crucial to the prevention of cross infection. Transient bacteria
can be removed by effective hand hygiene techniques. This means using the six-step
decontamination technique that ensures all surfaces of the hands are covered (NHS
2008).
For standard ANTT and clean procedures either soap and water or alcoholic hand rub
may used (see Hand Hygiene Appendix). Antiseptic hand hygiene products are used
for Surgical Aseptic Non Touch Technique. As an addition to this, all clinical staff that
undertakes standard ANTT must have sleeves that are short or rolled back, no wrist
jewellery/watches, no false nails and no stoned rings. Cuts and grazes must be
covered with a plaster.
3.3 Environment

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Storage of Equipment - Sterile equipment must be stored as recommended by the
manufacturer, in clean dry conditions at the correct temperature, off the floor and away
from potential damage (eg spray from a sink) and protected from dust.
In a home environment, where safe and possible, request a clean, preferably wipeable
box from the service user to store sterile equipment (See page 27 for Best Practice
Statement – Principles Performing a Wound Care Dressing in Patients own home).
Cleaning – Immediately prior to the procedure, prepare the setting including

decontamination of work surfaces using sanitising wipes eg Clinell universal sanitising
wipes and allow to dry before use.
If a trolley is used, clean trolley with sanitizing wipes eg Clinell universal sanitising
wipes before use and allow to dry before use. Trolleys used for standard ANTT should
not be used for other tasks.
Airborne Contamination Control – Standard ANTT procedures in an inpatient

environment should not be undertaken for at least 30 minutes after bed making or
domestic cleaning. Limit through traffic and number of people in the area where an
standard ANTT is being performed.
If the standard ANTT is interrupted for more than 30 minutes, new sterile packs must
be opened as airborne contamination may have occurred. Close doors and windows
during procedures wherever possible to minimise dust and eliminate insects. Do not
use fans whilst undertaking any procedure. In the community request that pets be
removed from the room.
Clinical Rooms – Clinical rooms/procedure rooms should be designed to minimise

cross infection risks. New builds should conform to HTM /HBN standards. Refer to
Infection Control Team for advice when planning new clinics. Surfaces within the
procedure room should be free of clutter such as paper work, books. The room and
areas and surfaces that may have been contaminated during a procedure should be
cleaned and disinfected between patients eg using a Clinell Universal Sanitising wipe.
This includes examination couches, dressing trolleys and examination lamps.
Sterility of Equipment - Sterile equipment/dressings used for the procedure must be

checked to confirm sterility before use ie the pack is not past use by date, packaging is
intact and not spoiled by moisture.
Sterile packs, single use tubes, sachets, ampoules, bottles of liquid must always be
considered contaminated on the out side (so clean hands after touching and before
putting on sterile gloves).inside sterile packs remain sterile if peeled open properly.
3.4 Maintaining an aseptic field.

 Recognize an aseptic area or field (keep clean and dirty areas separate).
 Place only sterile items within the aseptic field.
 Decontaminated items eg ampoule cleaned with alcoholic 2% chlorhexidine solution
can be placed on the edge of the aseptic field
 If an object comes in contact with a non-sterile object or person or with dust or other
airborne particles, the object is no longer sterile. If sterility is breached replace item.
 At no time should the aseptic field be contaminated
 Do not allow people to reach across the aseptic field. Avoid contamination of the
aseptic field with non sterile objects. If a sterile barrier has become wet, cut or torn,
consider it contaminated and replace.

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 Carry out procedure taking care to avoid contamination of sterile fields, key parts and
key sites. Do not touch key parts unless you are wearing sterile gloves.
 At all times strive for a non touch technique.
 Dispose of clinical waste as per Trust Waste Policy
3.5 Personal Protective Equipment (PPE)

PPE should be worn to prevent the transfer of potentially pathogenic micro-organisms
from patient to staff or staff to patient. For indications on what PPE is required see
‘Indications’ Section 6 of this Appendix. For information on how to put on sterile gloves
without compromising sterility see below.
1

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3.6 Site/skin preparation
Good skin preparation reduces the risk of infection by lowering the risk of
contamination from patients own skin flora. For example 2% chlorhexidine gluconate
and 70% iso-propanol alcohol is used to decontaminate the skin before cannulation.
3.7 Non touch technique

Avoid touching sterile parts of equipment which will be in contact with the patient’s
sterile or vulnerable sites.
4. Applying the principles of Standard ANTT
1) Prepare the patient
Action Rationale
 Have pets removed from the room (if To allow dust and airborne
present) organisms to settle before opening
 Request that any visitors/relatives also the sterile procedure pack.
vacate the room for the duration of the
procedure.
 Ensure bed making and floor vacuuming
has ceased for at least 30 minutes.
 If in a communal setting ensure privacy eg Maintain patients dignity and comfort
close doors use screens
2) Prepare the trolley /work surface and collect equipment
Action Rationale
Clean hands. Then To provide a clean working surface.
clean trolley (or
work surface if not
using a trolley) with
sanitizing wipes or
detergent wipes
working from top to
bottom of trolley
Clean hands after To remove any contamination of

cleaning hands acquired during cleaning.
Collect equipment To ensure equipment is all to hand

together (place on so the procedure can be performed
bottom shelf of as quickly as possible and that
trolley or other sterility has not been breeched eg
suitable work out of date, wet torn
surface)
Check for sterility of

the procedure pack
Put on a single use To protect uniform from

apron after cleaning contamination and to prevent the
is complete uniform becoming a source of

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contamination for the patient
3) Clean Hands
Action Rationale
Clean hands with To reduce cross infection risk.
liquid soap from a
dispenser or alcohol
hand rub (if hands
are visibly clean)
4) Lay out equipment and protect key parts at all times using a non-touch
Technique
Action Rationale
Open out the aseptic field So that areas of contamination are
using only the corners of kept to a minimum
the paper.

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Check any other packs for Prevents contamination during
sterility and open, tipping removal from packaging
their contents gently onto
the centre of the aseptic An orderly aseptic field decreases
field, without touching any chance of contaminating key-parts.
of the sterile contents.
Protect key-parts and decrease risk
Only sterile items may of contamination of key sites.
touch the field, no bottles
or sachets.
Place hand in the yellow
bag and arrange aseptic
field contents as required.
If performing wound care

keep hand in sterile yellow
bag and remove old
dressing
5) Secure waste bag
Action Rationale
Secure the bag to the Stretching over the aseptic field to
trolley side, below the discard waste may contaminate the
aseptic field. If not using a field and any sterile contents.
trolley choose a nearby
surface, not in contact with
your aseptic field.
6) Clean Hands
Action Rationale

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Decontaminate hands To prevent contamination from
using alcohol gel hands to patient or equipment
7) Put on sterile gloves and perform the procedure
Action Rationale
Put on sterile gloves – Reduce risk of contaminating key
see page 9. parts or key sites with germs from
hands.
Place sterile towel from Protect vulnerable sites like wounds

pack close to part of from environmental contamination.
patient where you will be
carrying out the procedure
eg below wound
8) Discard Waste as per Trust Policy

Action Rationale
Once procedure Comply with Trust waste policy
completed, fold up
remaining
non sharp items, including
protective clothing and
sterile towel in the dressing
field and place in disposal
bag.
Seal the disposal bag and
dispose of according to
Trust policy.
9) Wipe down trolley/work surface and clean hands and document the procedure
Action Rationale
Clean trolley (or work To remove any contamination of

surface if not using a surface/trolley acquired during the
trolley) with sanitizing procedure.
wipes or detergent wipes,
then clean hands with
alcohol rub.
Clean hands with liquid To remove hand contamination from

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soap from a dispenser or the procedure
alcohol hand rub (if hands
are visibly clean).
Document the procedure. For communication and to meet

legal requirements.
5. Principles of Clean Technique
The principles / sequence of events for performing a clean technique are in essence
the same as that for performing a standard ANTT, the difference being the choice of
gloves worn and the equipment selected for use. With clean technique sterile
equipment is not always used.
Clean technique allows:

 the use of warmed tap water (e.g. administered via a dressing pack tray,
clean receptacles in the patients own home(bath, shower, bucket of water).
 non -sterile examination gloves (latex free) are acceptable, however in order to ensure
that the equipment used for wound care in a patients home is as clean as possible and
convenient for transportation, this Trust recommends that all wound care is carried out
using a sterile dressing pack eg Polyfield pack
 multi-pack secondary absorbent dressings (such as dry un-sterile gauze) for suitable
dressings in the community.
 multi-use containers of creams and ointments. These should still be for named
individual patients and be handled in a manner that prevents the microbial
contamination of the unused part. Store with lid on. Prior to procedure sufficient
cream/ointment must be decanted e.g. non sterile clean glove and fresh gauze If
during procedure more cream is required remove gloves, clean hands and decant as
above. If a bucket is used to soak / clean a leg wound for example this must be
stored clean and dry. Use a new plastic bag (single patient use only) as a disposable
liner for each use and wash the bucket with detergent and water and dry after each
use.
6. Indications Table
Procedure Standard Gloves Sterile Apron Comment
ANTT/ Sterile Non Gown
Clean Sterile
Urinary
Catheter
Bladder Standard √ √ Sterile solutions. Please
washout ANTT note routine bladder
washouts are not
advisable
Insertion Standard √ √ Sterile normal saline,
urethral or ANTT sterile anaesthetic
suprapubic lubricant
catheter
Intermittent self Clean Washed NB if intermittent
catheterisation hands catheterisation is
performed by a
healthcare worker or

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anyone else other than
the patient or a close
family member
STANDARD ANTT
(sterile gloves) must be
used.
Urethral Standard √ √ Routine meatal hygiene
catheter care ANTT as part of daily personal
care –not sterile,
Obtain a Standard √ √ sterile syringe and
Catheter ANTT container
Specimen of
Urine
Suprapubic Standard √ √ Sterile normal saline,
catheter care ANTT products and dressings
hospitalised
patients
Suprapubic Clean √ √ Non-sterile solutions eg
catheter care tap water as part of daily
for non- personal hygiene.
hospitalised
patients if the
insertion took
place more
than 3 days
ago
Wound Care
Community Standard √ √ Sterile products, solutions
(non-inpatient ANTT and dressings
setting)
Dressing of
wounds by staff
that:
 Are less than
48 hours old
or
 Contain a
cavity or
Belong to an
immuno-
compromised
service user
Community Clean √ √ Sterile dressings Non

(non-inpatient sterile solutions e.g. tap
setting) water,
Dressing of .
wounds by staff
that:
 are more
than 48
hours old (no
cavity
present,
service user
not immuno-
compromise
d)
Hospital In- Standard √ √ Sterile products, solutions

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patient Setting ANTT and dressings
– wounds
dressed by staff
(including self
harm)
Any cavity Standard √ √ Sterile products, solutions
wounds all ANTT and dressings
settings
Dressing any Standard √ √ Sterile products, solutions
wound for an ANTT and dressings
immuno-
compromised
service user- all
settings
Superficial Clean √ √
trauma wounds
e.g. grit in
grazes in MIU
Self harm Clean NA NA Non sterile unless deep
wounds wounds.
(48hours old)
dressed by
service user
them selves
any setting
Central
Venous
Access Device
(CVAD)
CVAD insertion Surgical √ √ In theatre unless life
Aseptic Non threatening emergency,
Touch use Chloraprep wand,
Technique sterile pack, sterile drapes,
sterile gown
CVAD care Standard √ √ Sterile solutions, dressings
including ANTT and products only.
dressing Decontaminate bungs for
changes, injection using sterile 2%
intravenous alcoholic chlorhexidine
additives, wipes.
parental
nutrition
Peripheral
Cannula
Peripheral Standard √ √ Sterile products, dressings
cannula ANTT and solutions -2%
insertion alcoholic chlorhexidine
skin clean
Peripheral Standard √ Sterile products, dressings
Cannula care ANTT and solutions -2%
and medicine alcoholic chlorhexidine to
administration clean bungs
Venepuncture Standard √ Consider Disinfect skin with 2%
on service ANTT apron alcoholic chlorhexidine
–users patients
in an in-patient
setting (except
Mental Health
areas)

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Venepuncture Standard √ Consider Clean skin (warm water
in community or ANTT apron and soap) if visibly soiled
outpatient before procedure.
setting
Blood culture Standard √ √ Sterile products, solutions
collection ANTT -2% alcoholic
chlorhexidine to clean
skin and culture bottle
infection ports with 2%
alcoholic chlorhexidine
(Saving Lives 2011)
Enteral
Feeding
Insertion of a Surgical √ √ Sterile solutions, products
percutaneous ANTT and dressings
endoscopic NB No insertion to take
gastrostomy place in mental health
( PEG) settings.
Insertion of Clean √ √
nasogastric
tube
Care of NG Clean √ √
tube
Care of PEG Standard √ √ Sterile solutions, products
site if insertion ANTT and dressings
site (less than 3
days
old)Saving
Lives 2011
Care of PEG √ √ Non-sterile solution as part
site if insertion Clean of routine daily personal
site more than hygiene, dressing only
3 days old) required if site discharges
or if service user
prefers.(Saving Lives
2011)
Feeding Standard √ √ Sterile water for flushing
through enteral ANTT (Saving Lives 2011)
tubes
-in hospital
setting
-if immuno-
compromised
or
-if being fed
into the jejunum
(PEG)
Feeding Clean √ √ Tap water (freshly drawn
through enteral or boiled water) for flushes
tubes in other
patients not
listed above
Other
Changing of Standard √ √ Sterile products, solutions
tracheostomy ANTT and dressings. Initial
tube insertion must be in
theatre using Sterile
Surgical Aseptic Non

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Touch Technique unless
life threatening
emergency.
Tracheostomy Standard √ √ Include face protection
care in-patient ANTT when suctioning.
setting e.g.
dressing
changes,
endotracheal
suctioning
Tracheostomy Clean √ √ Include face protection
care in home (Standard when suctioning.
setting e.g. ANTT if site
dressing <72hours
changes, old)
endotracheal
suctioning
Laryngeal or Clean √ √ Include face protection
Oropharyngeal when suctioning if contact
Suctioning with body fluid aerosols
likely
Removal of Standard √ √ No solutions required.
drains eg ANTT Provide sterile dressing if
wound, chest covering needed.
Vaginal Clean √ √ No solutions
examination
Insertion of Standard √ √ Sterile products
intrauterine ANTT
device
Removal of Standard √ √ Solutions if used must be
sutures ANTT sterile. If wound dehisced
use STANDARD ANTT
with sterile gloves
7. Training Requirements
7.1 Staff will complete required standard ANTT ‘e presentation’ and ‘e assessment’ via the
Management, Learning and Education System prior to clinical skills training. Face to
face training will be required if the e assessment can not be passed after 2 attempts.
7.2 Staff must be competent (level 3) before performing standard ANTT. Please see page
21 for competency levels
7.3 Staff are made aware of standard ANTT procedures as part of clinical skills education
eg urinary catheterisation
7.4 Following attendance at a clinical skills training session, competency can be achieved
following assessment by a practitioner who has achieved competency level 4 or above
7.5 Competency must be completed and documented within a 6 month time frame of the
training.
7.6 The Infection Prevention and Control Team (IPCT) will work with the Area/Modern
Matrons, Community Matrons, Clinical Directors, Clinical Leads, Locality Managers and
Infection Control Champions and Links to improve adherence to Infection Control
policy and appendices.
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7.7 LEaD (Leadership, Education & Development Training Needs Analysis)
If there are any training implications in your policy, please complete the form below and
make an appointment with the LEAD department (Deputy Head of LEAD or LEAD Strategic
Education Lead) before the policy goes through Policy Board.
Strategic &
Training Course Delivery Recording
Frequency Trainer(s) Operational
Programme Length Method Attendance
Responsibility
ANTT e Once as part of Management,
Strategic: DIPC
learning and a competency Learning and
2-3 hours e-learning Delegate Operational:
e assessment assessment Education
Line Manager
programme or as required System
Directorate Division Target Audience
Adult Mental
MH/LD Health All staff who carry out standard aseptic non touch technique
Learning
Disabilities All staff who carry out standard aseptic non touch technique

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Older Persons
All staff who carry out standard aseptic non touch technique
Mental Health
Specialised
Services All staff who carry out standard aseptic non touch technique
TQtwentyone
Adults
Childrens &
ICS Wellbeing All staff who carry out standard aseptic non touch technique
Dental
All (HR,
Corporate Finance,
Not applicable
Services Governance,
Estates etc.)

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8. Supporting References
 Aseptic Non Touch Technique (ANTT) 2012 Version 2.8 A Practice Framework
for Clinical Practice. www.antt.org.uk
 Department of Health (2010). The Health Act and Social Care Act: Code of
Practice for the Prevention and Control of Health Care Associated Infections.
London: DH.
 Hart S (2007) Using an aseptic technique to reduce the risk of infection.

Nursing Standard 21(47): 43-48.
 National Institute for Clinical Excellence (2003). Infection control: Prevention of

healthcare associated infection in primary and community care. London. NICE.
 Pratt, R.J., Pellowe, C.M., Wilson, J.A., Loveday, H.P., Harper, P.J., Jones,
S.J., McDougall, C., and Wilcox, M.H., (2007). Epic 2: National Evidence-based
Guidelines for Preventing Healthcare Associated Infections in NHS Hospitals in
England. Journal of Hospital Infection 2007. 65 (Supplement): S1-S31.
 Wilson J (2006) Infection control in clinical practice. Edinburgh, Elsevier
 Saving Lives (Jan 2011) available on www.hcai.dh.gov.uk

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Appendix 7.1: Aseptic Technique Clinical Competency
Level of achievement Level

Novice Cannot perform this activity satisfactorily to the level 0
required in order to participate in the clinical
environment
Can perform this activity but not without constant 1
supervision and assistance
Can perform this activity with a basic understanding of 2

theory and practice principles, but requires some
supervision and assistance
Competent Can perform this activity with understanding of theory 3
Practitioner and practice principles without assistance and/or direct
supervision
Can perform this activity with understanding of theory 4
and practice principles without assistance and/or direct
supervision, at an appropriate pace and adhering to
evidence based practice
At this level competence will have been maintained for

at least 6 months and/or is used frequently (2-3 times
/week) The practitioner will demonstrate confidence
and proficiency and show fluency and dexterity in
practice
This is the minimum level required to be able to
assess practitioners as competent
Can perform this activity with understanding of theory 5

evidence based practice.
At this level the practitioner will be able to adapt

knowledge and skill to special/ novel situations where
there maybe increased levels of complexity and/or risk
Expert Can perform this activity with understanding of theory 6
evidence based practice.
Demonstrate initiative and adaptability to special
problem situations, and can lead others in performing
this activity
At this level the practitioner is able to co-ordinate, lead

and assess others who are assessing competence.
Ideally they will have a teaching and /or mentor
qualification

Version: 1.
Adapted from: Herman GD, Kenyon RJ (1987) Competency-Based Vocational Education. A
Case Study, Shaftsbury, FEU, Blackmore Press, cited in Fearon, M. (1998) Assessment and
measurement of competence in practice, Nursing Standard 12(22), pp43-47.
Appendix 7.1: Aseptic Technique Clinical Competency
Name: Role:
Base: Date of Clinical Skills Training :
Date e assessment passed: Signature :
Competency Statement:
The participant demonstrates clinical knowledge and skill in the use of aseptic technique without assistance and/or
direct supervision (level 3 - see level descriptors). Assessment in practice must be by a Practitioner who can
demonstrate competence at level 4 or above
Assessment Level Assesso

Performance Criteria Date
Method achieved r
The Participant will be able

to:
1. Demonstrate practical
knowledge in the use of
aseptic technique
a) Define the terms Questioning
a. Surgical Aseptic Non
Touch Technique
b. Clean technique
c. Aseptic Non Touch
Technique (standard
ANTT)
d. Key Part
e. Key site
f. Aseptic field
b) Describe the general Questioning
principles of standard
ANTT
c) Identify the indications for Questioning
the use of standard ANTT
and Clean Technique.
d) Describe how the Questioning
components of the
technique may change
according to degree of risk
f) Identify the appropriate
technique for commonly
performed procedures
eg:
 Enteral feed
 Indwelling urinary
catheter insertion
 Intermittent
catheterisation
 Peripheral IV device
insertion
Version: 1.
Administration of IV

medication
 Venepuncture
 Laryngeal suction via
tracheostomy
 Wound Care
g) Describe how sterile Questioning
equipment is best stored
and how to tell if sterility of
equipment has been
breeched.
2. Demonstrate practical skill Direct Observation
to perform an standard
ANTT procedure
a) Inform patient about the Direct observation
procedure and seek verbal
consent
b) Demonstrate appropriate Direct observation
selection of PPE for the
task
c) Demonstrate appropriate Direct observation
selection and preparation
of dressings/ devices for
the task
d) Demonstrate preparation Direct observation
of the environment
e) Demonstrate correct hand Direct observation

hygiene technique (as per
Trust Hand Hygiene
Appendix)
f) Demonstrate ability to Direct observation
carry non touch technique
h) Demonstrate ability to Direct observation

carry out clean procedure
i) Demonstrate correct Direct observation

method for disposal of
waste
j) make clear, accurate and Direct observation
contemporaneous records
of any actions taken
Date all elements of Competency Tool completed to level 3________

I confirm that I have attended initial training on _________and that I am confident and competent in
aseptic technique
Practitioner____________ Signature _______________Status___________ Date ______
I confirm that I have assessed the above named Practitioner and can verify that he/she demonstrates
competency in aseptic technique.
Assessor ______________ Signature _______________ Status ___________ Date _______

Version: 1.
Copy of assessment received by Line Manger Signature _______________Date___________
Appendix 7.1: Aseptic Technique Clinical Competency (with suggested answers)
Name: Role:
Base: Date of Clinical Skills Training :
Date e assessment passed: Signature
Competency Statement:
The participant demonstrates clinical knowledge and skill in the use of aseptic technique without assistance
and/or direct supervision (level 3 - see level descriptors). Assessment in practice must be by a Practitioner who
can demonstrate competence at level 4 or above.
Performance Criteria
The Participant will be able to:

1. Demonstrate practical
knowledge in the use of
aseptic technique
a) Define the terms: Surgical Aseptic Non Touch Technique- Surgical Aseptic
f. Surgical Aseptic Non Non Touch Technique is a strict process and includes
Touch Technique procedures to eliminate micro-organisms from an area. It is
g. Clean technique practiced by health care workers in operating theatres
h. Aseptic No Touch
Technique (Standard Clean Technique- a modified aseptic non- touch technique.
ANTT) Measures are taken to control the number of micro organisms
i. Key Part entering a susceptible site eg wound, but it does not aim for
j. Key site sterility.
k. Aspetic field Eg tap water may be used
Standard ANTT- The overriding basic principle is that the

susceptible sites eg wound, must not come into contact with any
item (hand, equipment, solution) that is not sterile.
Key Part- are the pieces of equipment that are manufactured

sterile and come into direct contact with the patient, which have
the potential to transmit infection if they become contaminated..
Key Site – an area belonging to the service user where

pathogenic organisms can enter the body and cause infection
eg wounds, urinary tract, cannula insertion site.
Aspetic Field- an area that is created by placing a sterile towel

around the procedure site and on the surface that will hold
sterile instruments and other items such as dressings.
b) Describe the general  Planning ahead
principles of standard ANTT  Hand hygiene
 Protection from infection from the environment (storage of
sterile equipment, limiting airborne contamination)
 Maintaining an aseptic field
 Personal protective equipment
 Site/skin prep
 Do not touch key parts unless with sterile gloves
 Key sites
 Key parts
Version: 1.
c) Identify the indications for The principles / sequence of events for performing a clean
the use of standard ANTT technique are in essence the same as that for performing an
and Clean Technique. aseptic technique, the difference being the choice of gloves
worn and the equipment selected for use. With clean technique
sterile equipment is not always used.
Clean technique allows:
 the use of warmed tap water (e.g. administered via a dressing
pack tray, clean receptacles in the patients own home(bath,
shower, bucket of water).
 non -sterile examination gloves (latex free).
 multi-pack secondary absorbent dressings (such as dry un-
sterile gauze) for suitable dressings in the community.
 multi-use containers of creams and ointments. These should
still be for named individual patients and be handled in a
manner that prevents the microbial contamination of the
unused part and stored to prevent entry of dust.
 If a bucket is used to soak / clean a leg wound for example
this must be stored clean and dry. Line buckets with a
disposable liner and washed with detergent and water then
dry after each use.
 sterile packs and equipment can be used in conjunction with
a clean technique if they are convenient and cost effective
d) Describe how the Non- sterile gloves if you can perform the procedure using
components of the technique STANDARD ANTT without touching key parts, sterile gloves if
may change according to you can’t.
degree of risk If in doubt, the procedure involves deep tissue layers or the
service user is severely immunocompromised always use
STANDARD ANTT.
f) Identify the appropriate Enteral feeding Home- clean non sterile gloves and
technique for commonly aprons, tap water
performed procedures eg: Hospital- STANDARD ANTT, non
 Enteral feed sterile gloves and apron, sterile
 Indwelling urinary water for flushing (Saving Lives
catheter insertion 2010)
 Changing a suprapubic Indwelling urethral STANDARD ANTT- Sterile normal
catheter catheter insertion saline, sterile anaesthetic lubricant,
 Peripheral IV device sterile gloves, disposable apron.
insertion
 Administration of IV
medication Changing a suprapubic Home- Use clean technique if
 Venepuncture catheter insertion more than 3 days ago, non
 Laryngeal suction via sterile gloves and disposable apron,
tracheostomy tap water to clean site.
 Wound Care Hospital – STANDARD ANTT non-
sterile gloves and disposable apron,
sterile saline to clean and sterile
dressings
Peripheral IV device STANDARD ANTT, non sterile

insertion gloves, disposable apron ,skin prep
chlorhexidine and alcohol
Venepuncture Home - STANDARD ANTT – non

sterile gloves, no skin prep if visibly
clean
Hospital- STANDARD ANTT- non
sterile gloves, skin prep with
chlorhexidine and alcohol
Laryngeal suction via In patient- STANDARD ANTT non
tracheostomy sterile gloves, apron (consider eye
Version: 1.
protection)
Non in patient –Clean technique
providing tracheotomy site is more
than 48hours old. Non sterile gloves
apron (consider eye protection)
Wound Care In-patient –STANDARD ANTT
Non inpatient – Clean technique if
wound is older than 48hours old
(unless the wound is a cavity or the
patient is immuno-compromised.)
g) Describe how sterile Store sterile packs away from moisture, damage, dust and off
equipment is best stored and the floor.
how to tell if sterility of In a home environment, where safe and possible, request a
equipment has been clean, preferably wipeable box from the service user to store
breeched. sterile equipment.
Sterility check- check the pack is not past use by date,
packaging is intact and not spoiled by moisture.
2. Demonstrate practical skill to Direct Observation
perform an standard ANTT
procedure
a) Inform patient about the Direct observation
procedure and seek verbal
consent
b) Demonstrate appropriate Direct observation
selection of PPE for the task
c) Demonstrate appropriate Direct observation

selection and preparation of
dressings/ devices for the
task
d) Demonstrate preparation of Direct observation
the environment
e) Demonstrate correct hand Direct observation
hygiene technique (as per
Trust Hand Hygiene
Appendix)
f) Demonstrate ability to carry Direct observation
non touch technique
h) Demonstrate ability to carry Direct observation
out clean procedure
i) Demonstrate correct method Direct observation
for disposal of waste
j) make clear, accurate and Direct observation

contemporaneous records of
any actions taken
Date all elements of Competency Tool completed to level 3________

I confirm that I have attended initial training on _________and that I am confident and competent in
aseptic technique
Practitioner____________ Signature _______________Status___________ Date ______
I confirm that I have assessed the above named Practitioner and can verify that he/she demonstrates
competency in aseptic technique.
Assessor ______________ Signature _______________ Status ___________ Date

_______
Copy of assessment received by Line Manger Signature ______________ Date___________
Version: 1.
Appendix 7.2: Best Practice Statement for Performing a Dressing in the Home Environment
Standard Aseptic Non Touch Technique (Standard ANTT)
Aim- every effort is taken to keep the patient as free from contamination by micro – organisms as possible during the procedure. Aseptic technique
involves methods to reduce exposure to micro-organisms, including hand washing, and using an aseptic field, sterile fluid for irrigation, sterile
instruments, sterile gloves, and sterile dressing. See Aseptic Technique Appendix - available on Trust Internet site : www.southernhealth.nhs.uk
Indications for standard ANTT

- Any surgical wound that has been created in the last 48 hours or less
- Any wound connecting to a deep body cavity
- If you have identified that the patient is severely immunocompromised eg neutropenic
Clean Technique
Aim –To prevent harmful contamination to the wound. This is a modified technique that can be used for dressing chronic wounds healing by
secondary intention, e.g. pressure sores, leg ulcers, dehisced wounds, which will already be heavily colonised with environmental microorganisms.
It can also be used for simple grazes. Clean, non-sterile gloves should be worn and a disposable plastic apron. In addition chronic wounds may be
irrigated or cleansed using potable/drinking tap water rather than sterile fluids.
Indications Clean Technique – Any wound care dressing in the home if the
- Wound has not been created surgically in the last 48hours
- The wound does not connect to a deep body cavity
- If the patient is not neutropenic

Version: 1.
Appendix 7.2: Best Practice Statement for Performing a Dressing in the Home Environment
Infection Prevention Principles of Clean Technique (Wound Care)
1) Storage of Equipment
If more than one visit planned you may need to store equipment within the home. To store equipment free from dust and soil, ask for the patient to
provide a box with a lid (preferably one that can be wiped clean as required with a Clinell Sanitising Wipe).
2) Dressing packs
The Trust recommends that you use a procedure pack for each dressing as this provides: a disposable apron, disposable gloves, waste bag and an
aseptic field in a clean manner. Sterile gloves are not required for clean technique but using a pack system ensures products are easy to store and
transport in a hygienic manner. These are available on FP10 or OMPOS .
3) Protective Clothing
A plastic disposable apron must be worn to protect your uniform from microbial contamination and skin scales.
Disposable gloves are required for body fluid contact as part of standard precautions. Eye protection is only required if splashing of body fluid to the
eye is likely.
4) Working from a clean surface

Identity an area to perform the dressing within the home free from obvious soiling, place a sterile towel from your dressing pack place under the area
you are performing the dressing on. Clinell sanitising wipes may be used to clean surfaces prior to dressing procedures if concerned. If you are likely
to perform a dressing on a patient with a heavily exudating wound or patient is neutropenic, consider extra protection eg MedMat®.
5) Scissors
Re-usable scissors can be used for all procedures unless: a) Cutting a sterile primary dressing b) Dressing a surgical wound within first 48 hours. If
performing a) or b) use single-use sterile scissors. Re-usable scissors must be single-patient use only. After use wipe these scissors after use with a
Clinell sanitising wipe and store the scissors in the patient’s equipment box if safe to do so.
NB Use a pre manufactured keyhole dressing around drains, supra -pubic catheter
6) Hand Hygiene

Version: 1.
Ask the patient or their carers to provide liquid soap and disposable paper towels for your visit. Carry your own supply of alcohol hand rub with you
into the home (or leave a bottle in the patient’s equipment box if safe to do so) to supplement facilities in the home. Clinell Sanitising wipes can be
used for hand hygiene
Minimum hand cleaning standard = decontaminate before starting the dressing and on finishing the dressing.
NB Remove old dressing using disposable bag in your dressing pack. Wash hands after removing dressing.
7) Irrigation of wounds
Use tap water for irrigation of wounds if using clean technique.
Mix hot and cold tap water to achieve water of correct temperature for irrigation. Collect the tap water in a clean container eg new specimen container.
After use wash out the clean container with detergent and hot water, dry and return to the storage box for dressings that the patient has provided.
Buckets, if used must be lined with a single use disposable liner before filling with water, to prevent contamination of the bucket itself. After use,
discard the fluid into the patients toilet and clean out the bucket with a Clinell sanitising wipe, store bucket dry.
If concerned about the quality of the tap water (e.g. discoloured) use sterile saline for irrigation (not from aerosol can).
Click here to go back to the LEaD training website to complete the

assessment.

Version: 1.

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SH CP 13

Aseptic Non Touch Technique and Clean

Once you have read this procedure, you MUST

Target Audience: All staff of all disciplines.

Next Review Date: January 2014.

Approved by: IP&C Committee. Date of meeting:

Date issued: February 2012.

Author: Jacky Hunt – Nurse Infection Prevention and Control

Sponsor: Sue Harriman

Aseptic Technique Procedure.

Aseptic Technique Procedure.

3 Process -The Basic Principles of Standard ANTT 8

4 Applying the principles of Standard ANTT 11

5 Principles of Clean Technique 14

 7.1 Aseptic Technique Clinical Competency 22

 7.2 Best Practice Statement for Performing a Dressing in 28

9 Link to e-Assessment - only complete AFTER you have 31

Aseptic Technique Procedure.

2.2 Aseptic technique- is defined as a means of preventing or minimising the risk of

If the procedure is complex or the patient is particularly immunocompromised sterile

Aseptic Technique Procedure.

Aseptic technique is traditionally segregated into two different processes:

Aseptic Non-Touch Technique

Surgical Aseptic Non Standard Aseptic Non -Touch

(Pratt et al, 2007).

Examples of ‘key equipment parts’ relevant to Intravenous therapy:

Syringe needle hub

Giving Set Spike

Internal neck/connection point of

Sterile part of the dressing in direct

Examples of ‘key equipment parts’ relevant to urinary catheterisation therapy

Examples of ‘key equipment parts’ relevant to wound care

Aseptic Technique Procedure.

Forceps tips or gauze

Sterile galipot for holding

THIS IS NOT AN EXHAUSTIVE LIST of KEY PARTS

2.10 Pathogenic microorganism – An organism of microscopic size, usually a bacteria or

2.11 Sterile- Free from micro-organisms. Because it is impossible to maintain sterility of

Surgical asepsis is achieved in theatres by using sterilised instruments placed within a

Please see table below for the relationship between

Sterile gloves if you have to

3. Process - The Basic Principles of STANDARD ANTT

3.1 Planning ahead

3.2 Hand Hygiene

Aseptic Technique Procedure.

Cleaning – Immediately prior to the procedure, prepare the setting including

Airborne Contamination Control – Standard ANTT procedures in an inpatient

Clinical Rooms – Clinical rooms/procedure rooms should be designed to minimise

Sterility of Equipment - Sterile equipment/dressings used for the procedure must be

3.4 Maintaining an aseptic field.

Aseptic Technique Procedure.

3.5 Personal Protective Equipment (PPE)

Aseptic Technique Procedure.

3.7 Non touch technique

4. Applying the principles of Standard ANTT

1) Prepare the patient

2) Prepare the trolley /work surface and collect equipment

Clean hands after To remove any contamination of

Collect equipment To ensure equipment is all to hand

Check for sterility of

Put on a single use To protect uniform from

Aseptic Technique Procedure.

Aseptic Technique Procedure.

If performing wound care

Practitioner____ Signature _Status_ Date __

Assessor ______ Signature _ Status _ Date ___

Assessor ______ Signature _ Status _____ Date