Section G - Aseptic Technique Version 5 Important: This document can only be considered valid when viewed on the Trust s Intranet. If this document has been printed or saved to another location, you must check that the version number on your copy matches that of the document online. Page 1 of 10
Document Summary Table Unique Identifier Number C-40-2013 Status Ratified Version 5 Implementation Date October 2007 Current/Last Review March 2008, March 2011, April 2013, May 2015 Dates Next Formal Review May 2017 Sponsor Director of Infection Prevention & Control Author Infection Prevention & Control Nurse Where available Trust Intranet Target audience All staff Ratifying Committees Executive Board 30 July 2015 Consultation Committees Committee Name Committee Chair Date Infection Prevention & Control Committee June 2015 Consultant Microbiologist / Infection Prevention & Control Doctor Other Stakeholders Consulted Stakeholders who were consulted on this document: Infection Prevention & Control Committee Infection Prevention & Control Team Does this document map to other Regulator requirements? Regulator details Regulator standards/numbers etc Document Version Control Version 5 The policy has been updated and reviewed. Version 4 Version 3 The policy has been updated and reviewed. The Trust Equality Statement has been updated. The document has been redesigned to ensure that all new and revised procedural documents are set out to a Trust wide format, the content of which includes a minimum set of criteria which include: the training requirements for implementation monitoring arrangements for the document Equality Impact of the document In addition, the monitoring arrangements for this document have been included. Page 2 of 10
Contents Section Page Document Summary Table 2 Contents 3 1 Introduction 4 2 Purpose 4 3 Principles of Aseptic Non-Touch Technique (ANTT) 4 4 Definitions 5 5 6 7 Duties (Roles and Responsibilities) Standard and Surgical ANTT When should Standard ANTT be used? 8 Training and Implementation 8 9 Trust Equalities Statement 8 10 Monitoring Compliance with this Policy 8 11 Associated Documents / Further Reading 8 12 References and Bibliography 9 Appendices 6 6 7 App 1 The 10 Foundation Principles of ANTT (ANTT Theory and Practice Framework, Version 2.2). 10 Page 3 of 10
1. Introduction The aims of an aseptic technique are to prevent the introduction of potentially pathogenic micro-organisms into susceptible sites such as wounds, the bladder or bloodstream, prevent the transfer of potentially pathogenic microorganisms from one person to another and to prevent staff from acquiring an infection. Aseptic Non Touch Technique (ANTT) is the chosen method for aseptic technique to be adopted by staff within the Trust. It should be used during any procedure that bypasses the body s natural defences. ANTT: supports health care workers to practice safely and efficiently supports health care organisations to manage the significant risks of aseptic technique helps to make patients feel safe Where aseptic procedures are performed: clinical procedures should be carried out in a manner that maintains and promotes the principles of asepsis; education, training and assessment in the aseptic technique should be provided to all persons undertaking such procedures; the technique should be standardised across the organisation; audit should be undertaken to monitor compliance with the technique. (Health and Social Care Act, 2008 and EPIC 3 guidelines). It should be noted that only staff that have received appropriate training and have been assessed as competent should carry out an aseptic procedure. If training is required, the key trainer for a particular area should be contacted. 2. Purpose The purpose of this policy is to provide information regarding procedures that require an ANTT and how, when and by whom this should be utilised within the Trust. 3. Principles of Aseptic Non-Touch Technique Standard ANTT is a process for safe and effective practice that can be applied to procedures such as intravenous therapy, wound care and urinary catheterisation. It standardises practice and rationalises many different techniques currently in use. The principle underlying ANTT is that you cannot contaminate a key part if it is not touched. Any key part must only come into contact with other key parts (e.g. syringe tip and needle hub); non-key parts should be touched with confidence. Page 4 of 10
Always wash hands effectiveley Never contaminate key parts Touch non key - parts with confidence Take appropriate infective precautions Individual healthcare practitioners need to decide between sterile or non sterile field / gloves by asking themselves: can I do this procedure without touching key-parts? If the answer is NO use an appropriate pack and sterile gloves. If YES use an appropriate pack and non-sterile gloves. (See Section 6 regarding standard and surgical ANTT). The principles of carrying out an ANTT are standard, but components of the technique may vary according to the degree of risk. The 10 Foundation Principles of ANTT as defined in the ANTT Theory and Practice Framework (Version 2.2) can be seen in Appendix 1. 4. Definitions Aseptic: without micro-organisms. Aseptic Non-Touch Technique (ANTT): identifying the key parts of a procedure and not touching them either directly or indirectly. Aseptic Technique: a method developed to ensure that only uncontaminated objects / fluids make contact with sterile / susceptible sites. Critical aseptic field (ensuring asepsis): used when an open, invasive procedure requires a large aseptic working area for an extended length of time, as in the operating theatre. Only equipment that has been sterilised and is aseptic can be introduced onto the critical aseptic field; it must be managed as a key part (i.e. the whole surface area can only come into contact with other aseptic equipment). (Ref: ANTT Theory and Practice Framework). Decontamination: the process of rendering an article safe to handle, by cleaning with or without disinfection or sterilization. General aseptic field (promoting asepsis): used for standard ANTT when key parts can easily be protected by micro critical aseptic fields and a non touch technique (and other basic infection control measures). The main general aseptic field does not have to be managed critically and is essentially promoting rather than ensuring asepsis of key parts and key sites; typically, non-sterile gloves are used. (Ref: ANTT Theory and Practice Framework). HAI: Hospital Acquired Infection. HCAI: Health Care Associated Infection. Page 5 of 10
Infection: the invasion and multiplication of micro-organisms within tissue which then results in destruction of the tissue. Invasive: involving puncture or incision of the skin or insertion of an instrument or foreign material into the body. Key part: the parts of the procedure equipment that come into direct or indirect contact with any liquid infusion or key sites and with any active key parts connected to the patient (ANTT Theory and Practice Framework, p 4). Key parts may include needles, syringe tips, intravenous line connections, exposed lumens of catheters, tops of ampoules. Key sites: e.g. open wounds including insertion and puncture sites. Micro-critical aseptic field: created when key parts are protected by syringe caps, covers and packaging. (Ref: ANTT Theory and Practice Framework). Primary Intention: where wound edges are brought together and held in place by mechanical means, e.g. adhesive strips, staples or sutures. Risk assessment: the method used to quantify the risk to human health and the environment. Secondary Intention: where the wound is left open (although usually covered with an appropriate dressing) and the edges come together naturally by means of granulation and contraction. Standard precautions: infection control precautions that should be applied as standard principles by all healthcare staff to the care of all patients at all times. (See Section C of the Infection Control Manual). 5. Duties (Roles and Responsibilities) The Chief Executive is responsible for ensuring that there are effective infection prevention and control arrangements in the Trust. Line managers are responsible for monitoring staff training and competency in the use of aseptic technique / ANTT. 6. Standard and Surgical ANTT (adapted from ANTT Theory and Practice Framework) Asepsis is maintained with either standard or surgical ANTT Standard ANTT (usually utilised for procedures in Wards / Out Patient Depts.). It is the technique of choice when procedures meet all of the following criteria: Page 6 of 10
they are technically simple short in duration (approximately less than 20 minutes) involve small key sites and key parts have minimal numbers of key parts. The main aseptic field does not need to be managed critically. Typically, Standard ANTT will employ a general aseptic field and non sterile gloves. Surgical ANTT (usually utilised for procedures in Operating Theatres) Surgical ANTT is demanded when procedures meet one or more of the following criteria: they are technically complex involve extended procedure time (approx more than 20 minutes) involve a large open key-site and large or numerous key parts. The main aseptic field needs to be managed critically i.e. only sterilised and aseptic equipment can come into contact with the aseptic field. Surgical ANTT will employ a critical aseptic field, sterile gloves and often full barrier precautions. NB: Where practical to do so, Surgical ANTT should still utilise micro critical aseptic fields and non-touch technique. (Please see Appendix 2 for a summary and illustration of the above). 7. When should standard ANTT be used? The approach for most procedures carried out in wards / departments, other than those requiring surgical ANTT should be to use a standard ANTT technique for: Care of wounds healing by primary intention, e.g. surgical incisions and fresh breaks. Suturing of wounds. Insertion of urinary catheters. Insertion, re-siting or dressing intravenous cannulae or other intravascular devices, such as CVP lines, Hickman lines and Arterial lines. Insertion of gastrostomy and jejunostomy tubes. Insertion of tracheostomy tubes or chest drains. Vaginal examination using instruments (e.g. smear taking, high vaginal swabbing, colposcopy). Assisted delivery (e.g. forceps and ventouse). Biopsies Venepuncture Obtaining blood cultures I V Therapies, including administration of I V antibiotics Tracheostomy site dressings Removing drains or sutures Page 7 of 10
Maintenance of central lines Respiratory suction The timing of procedures such as re-dressing wounds in a ward area can be an important factor in helping to reduce the risk of infection. They should not be carried out when tasks such as bed-making are taking place, due to the risk of micro-organisms being dispersed into the air and potentially contaminating the sterile equipment or wound. Ideally, these should be carried out at a time when ward activities are less and cleaning activities suspended. Clean, non-infected wounds should be dressed first; colostomies and infected wounds should be dressed last to minimise environmental contamination and cross-infection. 8. Training and Implementation Further information can be obtained by accessing the ANTT section on the Staff Intranet. Prior to assessment, all staff must have seen the ANTT presentation and DVD. 9. Trust Equalities Statement Calderdale and Huddersfield NHS Foundation Trust aims to design and implement services, policies and measures that meet the diverse needs of our service, population and workforce, ensuring that none are placed at a disadvantage over others. We therefore aim to ensure that in both employment and services no individual is discriminated against by reason of their gender, gender reassignment, race, disability, age, sexual orientation, religion or religious/philosophical belief, marital status or civil partnership. 10. Monitoring Compliance with this Procedural Document It is the responsibility of all clinical staff to comply with this policy; senior clinical staff and managers are asked to lead by example. Continued failure by an individual to adhere to this policy may be managed under the Trust s disciplinary policy. Audit of the standard ANTT process is led by the Infection Prevention and Control Team and key trainers. 11. Associated documents / Further reading ANTT information and clinical guidelines are available on the Trust intranet and can be accessed at: http://nww.cht.nhs.uk/divisions/diagnostic-andtherapeutic/infection-prevention-control-news/aseptic-non-touchtechnique/ www.antt.org.uk Related Infection Control Policies: Standard Infection Control Precautions (Section C); Decontamination and Disinfection Policy (Section F); Hand Page 8 of 10
Hygiene (Section H/I); Isolation Policy (Section J/K); Specimen Policy (Section R); Multi-resistant organism policy (Section T); Waste disposal policy (Section U/V). Uniform Policy 12. References and Bibliography: ANTT Theory & Practice Framework, Version 2.2: www.antt.org.uk ANTT Policy, Version 2, (2012): East Cheshire NHS Trust. Ayliffe G A J., Fraise A P., Geddes A M., Mitchell K., (2000) Control of Hospital Infection: A Practical Handbook 4 th edition, Arnold Publishers, London. Epic 3 Guidelines (2014): Department of Health. Getting Ahead of the Curve (2002), Department of Health. Gilmour D., (2000) Is aseptic technique always necessary? Journal of Community Nursing, 14; 4. The Health & Social Care Act (2008): Code of Practice on the prevention and control of infections and related guidance. Department of Health Rowley S and Clare S (2009): Improving standards of aseptic practice through an ANTT trust-wide implementation process: a matter of prioritisation and care. Journal of Infection Prevention: 9: 1: p 18-23. Wilson J. (2006), Infection Control in Clinical Practice Tindall, London. 3rd Edition, Bailliere Winning Ways: Working Together to Reduce Healthcare Associated Infection in England. A report by the CMO, Department of Health, 2003. Page 9 of 10
Appendix 1 The 10 Foundation Principles of ANTT (ANTT Theory and Practice Framework) (Version 2.2) Principle 1 The main infection risk to the patient is the health care worker Principle 2 HCWs must understand what asepsis is and how to establish and maintain it Principle 3 Identifying and protecting key parts and key sites is paramount Principle 4 Clinical procedures should be risk assessed to determine the level of aseptic technique required Principle 5 Asepsis is maintained with either standard or surgical ANTT Principle 6 Aseptic fields are important. Standard and surgical ANTT require different aseptic field management Principle 7 Non touch technique is the most important component of surgical and standard ANTT Principle 8 Appropriate infective precautions help promote and ensure asepsis CLINICAL AND ORGANISATIONAL MANAGEMENT Principle 9 Aseptic practice should be standardised Principle 10 Safe aseptic technique is reliant upon effective staff training in infection control, safe environments and fit for purpose equipment. Page 10 of 10