Antiseptic non touch technique (ANTT)

Antiseptic non touch technique

1. Helen Mary Moni

2. GOAL: To understand what ANTT is  To Understand why ANTT is important To Understand how you can apply  ANTT to your practice

3. What is ANTT? Non touch technique means not touching the key parts and not letting the key parts touch anything else. Aseptic key parts should only touch other aseptic key parts. Asepsis is the prevention of microbial contamination by excluding / removing or killing microorganism.

4. FOCUS OF ANTT: to minimize the introduction of microorganisms, which may occur during preparation, administration and delivery of IV therapy or any other procedures. to reduce the potential for contamination, the technique follows some fundamental rules pertaining to infection control and staff/patient protection such as effective hand washing, maintaining an aseptic environment and the wearing of non-sterile gloves.

5. A lways wash hands effectively N ever contaminate key parts T ouch non-key parts with confidence T ake appropriate infective precautions

6. STANDARDISED PROCEDURES BY ANTT: On-going care of intravenous cannulae or other intravascular devices IV therapies, including administration of IV antibiotics Venipuncture Venipuncture for blood culture sampling Wound Care Catheterization Eye Drop administration Dialysis line management On-going care of gastrostomy, jejunostomy , tracheostomy tubes and chest drains Tracheostomy site dressings Respiratory suction.

7. FAILURE IN ASEPSIS DURING ASEPTIC TECHNIQUE: Contamination of key parts Poor cannulation site care Poor hand cleaning Poor aseptic field management Poor key-part cleaning

8. KEY PARTS: Key parts are the pieces of equipment that come in to direct contact with the patient and therefore have the potential to transmit bacteria and/or microorganisms and are usually parts of equipment that come into direct contact with the infusate.

9. Syringe tip Needle –both the needle tip and the needle hub. Tip of catheters. Tip of canula

10. Tip of ports Bungs Rubber tops of the vial The hub of the central venous access device (CVAD)/Venous Access Device (VAD ).

11. Infusion lines spikes IV bottle

12. Patient's skin sterile gauze wound

13. Types of ANTT Standard-ANTT: procedures are technically simple, short in duration, involve small Key-Sites and Key-Parts and a minimal number of Key-Parts. protecting Key-Parts individually with Micro Critical Aseptic Fields and other elements of aseptic technique.

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

15. THE ANTT RISK ASSESSMENT:

16. continued;

17. THE ANTT Approach

18. STEPS IN ANTT

19. STEP: 1 Clean your hands effectively with soap and water or Alco-gel and use the hand washing technique and dry thoroughly.

20. STEP: 2 Collect plastic tray or trolley suitable for procedure, with a large alcohol wipe clean all the surfaces of your tray thoroughly and leave to dry Clean the tray inside first and then the outside N: B –These large plastic trays are now the standard aseptic field for all IV therapy. Paper trays are now banned for aseptic field use.

21. STEP: 3 Gather all your equipment, medications and diluents etc….and place them around the tray.

22. STEP: 4 Now you have cleaned your tray and gathered your equipment you can perform your final hand clean before preparation. Clean hands with Alco-gel or soap and water. Use the same technique whether you are cleaning your hands with soap and water or using alcohol based gel. Apply single use disposable apron

23. STEP: 5 Put on non-sterile gloves straight from the box. “To decide between sterile or non-sterile gloves simply ask yourself, can I do this procedure without touching key parts? If no, wear sterile gloves .” Nearly always the answer will be yes , therefore nearly always wear non-sterile gloves .

24. STEP: 6 Open equipment by carefully peeling back packaging place syringe ensuring key parts are uppermost/ not in contact with tray. Connect all needles to syringes and draw up and prepare all medications. Ensure all key parts remain uncontaminated. If at any time you think you may have contaminated a piece of equipment, dispose of it immediately and use a new piece. Touch non-key parts with confidence. Prepare drugs, protect key parts using non-touch technique. After drug preparation, go straight to the patient. Do not contaminate your gloves.

25. A small point……..but many people ask. What is and what is not permitted in the aseptic tray? Ideally nothing goes wrong in the tray which is not required for the procedure. However in a well-organized tray, one might include an Alco wipe or ready to use syringes in their paper pockets. Remember you are aiming for asepsis not sterility This would be fine too…….because,

26. The paper wrapping is dry and aseptic. The key parts are protected. The aseptic field is organized. Expose the patients IV access port, ensuring free unrestricted access. Dispose of your gloves. Reclean your hands with Alco-gel or soap and water. (cleaning hands after glove removal is vital because wearing gloves encourages the growth of potentially pathogenic micro-organisms naturally found on and in your skin.) Reapply non-sterile gloves.

27. STEP: 7 Clean key parts with a large wipe of 2% chlorhexidine and 70% alcohol. Apply friction by scrubbing the port tip for 30 seconds, allow to dry. (N: B If key-parts are not dry, they are not aseptic)

28. STEP: 8 Administer drugs using a non-touch technique .

29. STEP: 9 Dispose of sharps and equipment

30. STEP: 10 Clean your tray (Not doing so, is a perfect way of cross-infecting patients, and your colleagues)

31. STEP: 11 Dispose of gloves and Apron Clean hands with soap and water or Alco-gel.

32. Do not drop your equipment into your tray. Do not leave key-parts unprotected and exposed. Ensure other equipment in the tray does not come in to contact with the key parts. Remember to use the plastic trays/trolleys. Always clean well before and after use. Small wipes are too small to clean key parts safely. Use a large wipe containing 2% chlorhexidine and 70% alcohol. TIPS FOR MAINTAINING ANTT :

33. continued; Paper trays are banned. Use plastic trays, clean well before and after use. Change gloves if they may have been contaminated. Gloves are not a replacement for good hand hygiene: therefore staff must decontaminate their hands before wearing and after removing gloves. Well-fitting gloves are another essential part of ANTT. They should be neither too small, with the potential to be punctured by wearer's fingernails, nor too large, Take care when inserting the needle into vials/ampoules not to touch the sides.

34. REFERENCES: http://www.antt.org.uk/ ANTT Site/Home.html http://www.nursingtimes.net/ nursing-practice/clinical-specialisms/infection-control/ antt -a-standard-approach-to-aseptic-technique/5034771.article http://www.deepdyve.com / lp /royal-college-of-nursing- rcn /learning-zone-aseptic-non-touch-technique-in-intravenous-therapy-IXROnC77Jy http://www.journals.elsevierhealth.com/ periodicals/ ymic /article/S0196-6553(11)00528-1/abstract http://bji.sagepub.com/ content/10/1_suppl/s18.abstract https://www.niinfectioncontrolmanual.net/antt http://www.gosh.nhs.uk/health-professionals/clinical-guidelines/aseptic-non-touch-technique-antt-intravenous-therapy http://www.cmft.nhs.uk/directorates/mentor/documents/AscepticNontouchtechniqueLS.pdf https://www.nhmrc.gov.au/book/australian-guidelines-prevention-and-control-infection-healthcare-2010/b1-7-1-aseptic-non-touch http://www.wirralct.nhs.uk/attachments/article/25/IPC15AsepticNonTouchTechnique(ANTT)May13.pdf

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