The Health and Social Care Act 2008: Code of Practice for the Prevention and Control of Healthcare Associated Infections has given rise to a number of clinical protocols that NHS bodies must adhere to. As a direct result of this, the aseptic non-touch technique (ANTT) has been instigated by many NHS Trusts.

The National Audit Office provide statistics regarding the number of patients who come to harm unnecessarily in the UK from hospital-acquired infection (HAI). Many people become infected during simple procedures, such as wound care, administration of intravenous medication and care of indwelling catheters, for example. Following investigation of these cases, root cause analysis often leads back to poor hand washing, poor cannula management and a failure to comply with correct procedures.

With a rise in MRSA bacteraemias, strategies to deliver on infection control targets were introduced. ANTT has developed considerably over the last 60 years, and, as a result, is now a safe, modern and efficient evidence-based aseptic technique. The standardization of this technique for clinical procedures aims to help reduce the risk of patients developing a HAI.

ANTT aims to prevent microorganisms from our hands, surfaces or equipment being introduced into an entry site for infection, by identification and protection of key parts of any procedure.

As practitioners, we need to ensure the treatment and procedures we carry out do not result in harm to our patients, and therefore ANTT must be used for all clinical procedures that by-pass the body’s natural defences.

The principles of ANTT are simple:

• Always wash hands effectively (see Chapter 60, Hand washing, for the steps to follow).
  
• Never touch key parts/key sites.
  
• Touch non-key parts with confidence.
  
• Take appropriate infection control precautions.

The principle is that you cannot infect a key part if you don’t touch it. By definition, a key part is a part of equipment or the site on a patient that, if contaminated with microorganisms, increases the risk of infection. The very tools that we use to perform health care are covered in bacteria, therefore maintaining ANTT means we need to adopt a robust hand-washing technique. Correct hand hygiene principles are the key to reducing HAI.

Appropriate infection control precautions need to be taken when carrying out ANTT procedures. Before the procedure is carried out, it is up to the health care professional to complete an assessment of the procedure in order to decide which precautions are required. Personal protective equipment such as gloves and aprons must be worn if there is a risk of exposure to or splashing/spillage of body fluids.

Sterile versus non-sterile gloves often cause discussion. If it is possible to complete the procedure without touching key parts or key sites, then non-sterile gloves can be used. If it is deemed not possible, then sterile gloves must be used.

Following any clinical procedure, gloves and other personal protective equipment must be removed and disposed of appropriately following infection control and health and safety guidelines.

Non-sterile gloves must be used for:

• intravenous medication administration
  
• venepuncture
  
• cannulation and removal of cannulas
  
• injection administration

Sterile gloves must be used for:

• urinary catheterization
  
• central venous line insertion
  
• wound dressings

Sterile towels and dressing packs are not always required, however, a clean working environment is a sensible precaution. The ideal environment for ANTT procedures is a designated clinic room if possible. If it is not possible and needs to be done at the patient’s bedside, then it is advisable not to do it directly after bed making, as this will contribute to airborne contamination. In the community setting, careful consideration will need to be completed before starting the procedure. In all environments, windows must be closed and the use of electrical fans discouraged.

Cleaning of trays and surfaces must be completed with a sanitizing wipe to eliminate bacteria and microorganisms. More importantly, the surface needs adequate time to dry, otherwise it is not aseptic.

When a patient accesses health care, they have a right to be protected from preventable infections. Health care professionals have a duty to safeguard the well-being of patients when they are most vulnerable. While it is difficult to maintain sterility, it is important to reduce the risk of contamination.

In order to standardize practice, compliance is vital. It is therefore essential that health care professionals follow local guidelines and policies and are suitably educated in ANTT before carrying out any procedure.