It is recognised that an aseptic technique is important, but that it is largely based on repeated practice rather than researched evidence; it is also noted that staff perform poorly in this area (Hartley 2005). There is therefore debate around which procedures need an aseptic technique (Aziz 2009), whether gloves should always be sterile (Flores 2008) and whether asepsis or a clean technique can be used (Gilmour 1999). An initiative called ANTT (aseptic non-touch technique) is a best-practice guideline endorsed by the Department of Health (DH 2009) and epic2 (Pratt et al 2007). It is a means of standardizing the technique and applying it across healthcare providers. Guidelines are provided for different procedures (intravenous practice, urinary catheterisation, wound care, cannula insertion and central venous catheter insertion), training is expected and audit is perpetual (ANTT 2008). It should also be noted that, whereas asepsis is one of the key components in reducing HCAIs, Pratt et al (2007) also put significance on hospital environmental hygiene, hand hygiene, use of personal protective equipment and the safe use and disposal of sharps. The DH (2009) places these things within the context of the whole of healthcare provision (prescribing, laboratory and mortuary services etc.).

The term ‘surgical asepsis’ describes the depth to which pathogens are removed from an environment, for example in operating theatres; ‘medical asepsis’ refers to that which is often used for generally ward-based procedures, such as catheterisation or inserting cannulae, when the transmission of pathogens is reduced as much as possible. It is accepted that an ANTT is used when referring to medical asepsis. Gilmour (2000), however, also describes a clean technique in which some of the non-touch principles are upheld but non-sterile gloves are worn.