Document level: Trustwide (TW) Code: IC8 Issue number:6 Policy for the procedure for Aseptic Non Touch Technique (ANTT) Lead executive Authors details Type of document Target audience Document purpose Director of Infection, Prevention and Control Infection Prevention and Control (IPC) Team Policy All CWP staff All interventions undertaken in relation to invasive care involving mucous membranes or devices left in place should be performed using an aseptic following a risk assessment. Approving meeting Infection Prevention and Control Sub Committee 15-Jun-15 Implementation date 15-Jun-15 followed by an annual compliance review CWP documents to be read in conjunction with HR6 Mandatory Employee Learning (MEL) policy IC2 Hand decontamination policy and procedure HS1 Waste management policy IC3 Standard (universal) infection control precautions policy Document change history Document reviewed, changes made to in relation to the TNA and What is different? competency. Appendices / electronic forms What is the impact of change? N/A Low Training requirements Financial resource implications Yes - Training requirements for this policy are in accordance with the CWP Training Needs Analysis (TNA) with Learning and Development (L&D) No External references 1. Dougherty, L & Lister, S.E. editors (2011) The Royal Marsden Hospital Manual of Clinical Nursing Procedures, 8th Edition. Blackwell, Oxford. 2. Department of Health (2010) Health and Social Care Act 2008. 3. Department of Health (DH) (2006) Essential steps to safe, clean care. 4. National Patient safety Agency (2007) Clean Your Hands Campaign. 5. National Patient Safety Agency (2008) Patient Safety Alert, Clean Hands Saves Lives. 6. Aseptic non-touch technique (2001). Nursing Times. Vo:97, Issue 07. 7. Department of Health (2010). Saving Lives: reducing infection, delivering clean and safe care. Equality Impact Assessment (EIA) - Initial assessment Yes/No Comments Does this document affect one group less or more favourably than another on the basis of: - Race No Page 1 of 8
Equality Impact Assessment (EIA) - Initial assessment Yes/No Comments - Ethnic origins (including gypsies and travellers) No - Nationality No - Gender No - Culture No - Religion or belief No - Sexual orientation including lesbian, gay and bisexual people No - Age No - Disability - learning disabilities, physical disability, sensory impairment and mental health problems No Is there any evidence that some groups are affected differently? No If you have identified potential discrimination, are there any exceptions valid, legal and/or justifiable? Is the impact of the document likely to be negative? No - If so can the impact be avoided? N/A - What alternatives are there to achieving the document without N/A the impact? - Can we reduce the impact by taking different action? N/A Where an adverse or negative impact on equality group(s) has been identified during the initial screening process a full EIA assessment should be conducted. If you have identified a potential discriminatory impact of this procedural document, please refer it to the human resource department together with any suggestions as to the action required to avoid / reduce this impact. For advice in respect of answering the above questions, please contact the human resource department. Was a full impact assessment required? No What is the level of impact? Low To view the documents Equality Impact Assessment (EIA) and see who the document was consulted with during the review please click here Page 2 of 8
Content 1. Introduction... 4 1.1 Definitions... 4 1.1.1 Considerations... 4 2. Procedure for Aseptic Non Touch Technique (ANTT)... 4 2.1 Preparation... 4 2.2 Dressing procedure... 5 2.3 Post procedure... 5 3. Duties and responsibilities... 5 3.1 All clinical staff... 5 3.2 Managers... 5 Appendix 1 - Checklist prior to undertaking ANTT procedure... 6 Appendix 2 - Infection prevention and control risk assessment - Urinary Catheter checklist... 7 Appendix 3 - Infection prevention and control risk assessment - Enteral Feeding Checklist... 8 Page 3 of 8
1. Introduction All interventions undertaken in relation to invasive site or wound care should be performed using an aseptic technique. 1.1 Definitions Asepsis is the complete absence of bacteria, fungi, viruses or other micro-organisms that could cause disease. Aseptic Non Touch Technique (ANTT) is the practice of carrying out a procedure in a way that minimises the risk of introducing micro-organisms into a susceptible part of the body, wound or insertion area where they may cause an infection. ANTT aims to prevent micro-organisms from the service user being transferred to healthcare staff or others. The area to be worked on may be colonised with micro-organisms but the aim must be to avoid introducing additional contamination. The underlying principles of ANTT are: Effective hand washing; Do not contaminate key parts e.g. tip of a needle, the inside surface of a sterile dressing where it will be in contact with the wound; Institute a non touch technique; Wear appropriate personal protective equipment. 1.1.1 Considerations The aim of dressing any wound / insertion site is to protect the wound from trauma or bacterial contamination, promote healing and prevent the transfer of organisms from an infected wound to others sites on the same person or others. Therefore, choice of a suitable dressing material is an important part of infection prevention and the healing process; The manufacturer s recommendations for all clinical supplies must be followed at all times. The reuse of single-use items MUST NOT occur and could result in legal, economic, and ethical consequences; Prior to ANTT for chronic wounds, e.g. leg ulcers put on non sterile gloves and apron to loosen or remove dressings. Dispose of outer dressings, gloves and apron in waste bag; Prior to ANTT good quality (drinking) water rather than sterile fluids is acceptable for the cleansing of some chronic wounds i.e. PEG stomas and leg ulcers; When carrying out these procedures in a community setting the healthcare worker does not have specific equipment as in a hospital setting, for example a dressing trolley; therefore adaptations and creativity are often required to ensure the environment is conducive to the procedure being performed and the equipment remains sterile or clean. The use of a cleanable surface such as table or a chair should be used to arrange the dressing equipment; Any items that have contact with the susceptible site are disposed of appropriately. 2. Procedure for Aseptic Non Touch Technique (ANTT) 2.1 Preparation Action 1 Explain the procedure to the patient 2 Close nearby windows; Restrict activities around bed / treatment area, e.g. bed making, dusting or mopping / hovering of the floor. 3 Clean hands with liquid soap and water or with alcohol gel. 4 Check that all the equipment required is available and sterile; packaging is intact and in date. 5 Clean trolley if available with detergent and water and dry with a paper towel. 6 Place all equipment required on bottom shelf of the trolley, or away from the sterile field if no trolley available. Page 4 of 8
Action 7 Pull curtains around bed / treatment area. 8 Position the person comfortably and in a dignified manner. 2.2 Dressing procedure Action 1 Clean hands with liquid soap and water or with alcohol gel. 2 Open dressing pack and empty contents onto top shelf if available. Open sterile field by holding outer corners of paper sheet / wrapper. 3 Open any supplementary items, including sterile specimen swabs if required. Pick up disposable plastic bag by corner, place hand into the bag by using this as a glove, 4 arrange contents of dressing pack. Continue using the disposal bag as a glove to collect the dirty dressing from the wound. Invert the bag so that the dressing is contained within it and stick it to the bottom shelf of the trolley or 5 away from the sterile field if no trolley available. This is now the disposal bag for the remaining of the procedure for any waste other than sharps. 6 If cleansing is necessary swab along tear area of cleaning sachet with alcohol wipe and tear open sachet and pour cleansing fluid into gallipot or plastic tray. 7 Decontaminate hands with liquid soap and water or alcohol gel. 8 Put on sterile gloves touching only the inside wrist end. 9 Put on sterile apron. 10 Carry out the procedure maintaining asepsis throughout. 11 If needed, gently cleanse the wound using non woven gauze swabs. 12 Inspect wound to aid documentation i.e. size, colour etc and take laboratory swab / specimen if necessary 13 Apply the dressing as prescribed 14 Ensure all dressing is adhered and covers the wound with at least a 1cm border. 15 Make the patient comfortable. 2.3 Post procedure Actions Place all used disposable items, including gloves and apron into the waste bag and seal the bag 1 carefully. Dispose of any sharps in sharps disposal bin and close lid in temporary closed position or 2 locked position if 2/3 full. 3 Dispose of all waste as per waste policy 4 Wash hands; clean the trolley with detergent / hot water and dry with paper towels. 5 Report and record condition of wound and update care plan if needed. 6 Label swabs giving full details of wound and send to laboratory. For healthcare workers generating waste within a service user s home environment refer to the CWP waste management policy. 3. Duties and responsibilities For general duties and responsibilities in infection prevention and control, please refer to Infection prevention and control policy. For additional and specific duties and responsibilities related to this policy, please see below. 3.1 All clinical staff All clinical staff required to undertake any part of this procedure will be familiar and competent with this procedure and will use the risk assessments (appendix 1, appendix 2 and appendix 3) to form part of the service users care plan. 3.2 Managers Will ensure that staff carrying out this procedure has the appropriate equipment. Page 5 of 8
Appendix 1 - Checklist prior to undertaking ANTT procedure Name Ward NHS Number DOB Checklist complete prior to undertaking procedure Yes / No* 1 2 Have you completed competency training with a recommended person and been signed off as competent? The procedure is for the correct person, correct procedure, correct time and correct frequency, and this is clearly documented? 3 If required, has the procedure been prescribed by a Doctor? 4 Have you access to the correct equipment to care for the service user as trained to do? 5 Have you access to sufficient equipment as and when replacement is required? 6 7 Do you have access to appropriate Personal Protective Equipment and necessary equipment to perform a non touch aseptic technique? Is the service user cared for in an environment where staff has access to direct hand washing facilities / alcohol gel? 8 Is the policy/procedure readily available? *If the answer to any of these questions is No, do not proceed with the procedure Page 6 of 8
Appendix 2 - Infection prevention and control risk assessment - Urinary Catheter checklist Name NHS Number Ward DOB To be read in conjunction with The Royal Marsden Hospital manual of Clinical Nursing Procedures (eighth edition) Urinary Catheter checklist Complete prior to undertaking procedure Yes/No* Signature 1. Have you completed competency training with a recommended person and been signed off as competent? 2. The procedure has been prescribed by a member of the medical staff and this is documented and the prescription is clear? 3. Have you access to the correct equipment to care for the service user as trained to do? 4. Have you access to sufficient equipment as and when replacement is required? 5. Do you have access to appropriate Personal Protective Equipment and necessary equipment to perform a non touch aseptic technique? 6. Is the service user cared for in an environment where staff have access to direct hand washing facilities? 7. The skin is correctly cleaned prior to insertion and daily cleansing is encouraged? 8. Is the collection equipment single use only? 9. Have you ensured that all collection equipment is replaced after seven days and this is documented? 10. Is the policy/procedure readily available? *If the answer to any of these questions is No, do not proceed with the procedure. Page 7 of 8 Do not retain a paper version of this document, always view from the website www.cwp.nhs.uk to ensure it is the correct version
Appendix 3 - Infection prevention and control risk assessment - Enteral Feeding Checklist Name NHS Number Ward DOB To be read in conjunction with The Royal Marsden Hospital manual of Clinical Nursing Procedures (eighth edition) Enteral Feeding Checklist Complete prior to undertaking procedure Yes/No* Signature 1. Have you completed competency training with a recommended person and been signed off as competent? 2. Have you access to the correct equipment to care for the service user as trained to do? 3. Have you access to sufficient equipment if a replacement is required? 4. Do you have a contact number for the service user s lead dietetic team/person? 5. Do you have access to appropriate Personal Protective Equipment to perform an Aseptic Non Touch Technique? 6. Is the service user cared for in an environment where staff have access to direct hand washing facilities? 7. Is all administration equipment cleaned on a daily basis and this is recorded? 8. Is there evidence the equipment is used and maintained as per the manufacturer s instructions? 9. Is the administration equipment labelled with date and time? 10. Have you ensured that all containers are changed every 24 hours if not reprocessed? 11. Is the service users local policy / procedure for Enteral feeding readily available? *If the answer to any of these questions is No, do not proceed with the procedure Page 8 of 8 Do not retain a paper version of this document, always view from the website www.cwp.nhs.uk to ensure it is the correct version