IPPOL17

ASEPTIC NON-TOUCH TECHNIQUE POLICY

(ANTT)
Version: V2

Ratified by: Quality and Safety Committee

Date ratified: 24th September 2015

Name/Department of Sponsor/author: Sponsor: Jane Hentley

Executive Clinical & Operations Director

Author: Julia Shields

Infection Prevention Lead : Julia Shields

Equality Impact Assessed by: Julia Shields

Target audience: All clinical staff in nursing

Distributed to Electronically to All Departments via intranet –

Provide

Related procedural documents CPOL25 - Policy for the administration of IV

drugs in the community
IPPOL23 - Infection Prevention Policy
(Community staff only)
IPPOL3 - Hand Hygiene Policy and Procedure
IPPOL9 - Decontamination of Medical
Equipment Policy and Procedure
MM30 - Medicines Management Policy
IPPOL18 - Management and Safety of Sharps
Policy
Review date: September 2017

It is the responsibility of users to ensure that you are using the most up to date document –
i.e. obtained via the intranet.
In developing/reviewing this document Provide has had regard to the principles of the NHS
Constitution.

Page 1 of 27
Version Control Sheet

Version Date Author Status Comment

V1 April 2011 Julia shields Ratified New

V1.1 September Steph Schuster No change to Updated in line
2013 Quality & review date with
Safety organisation
Administrator name change
and restructure
V1.2 Nov 2015 Julia Shields Review Policy Changes to
training
accountability
for ANTT to
Clinical
Practice
Facilitators
V2 September Julia Shields Review policy 2 year review
2015

Page 2 of 27
Contents

1. Purpose of the policy ..................................................................................................... 4

2. Introduction .................................................................................................................... 4
3. Staff Responsibilities ...................................................................................................... 4
3.1 Chief Executive ........................................................................................................ 4
3.2 Director of Infection Prevention and Control (DIPC) .................................................... 5
3.3 Infection Prevention and Control Lead......................................................................... 5
3.4 Infection Prevention Link Practitioners......................................................................... 5
3.5 Clinical Practice Facilitators …………………………………………………………………5
3.6 Assistant Directors ……………………………………………………………………………5
3.7 Line managers ............................................................................................................ 5
3.8 All Clinical Staff ........................................................................................................... 5
3.9 All Healthcare Staff...................................................................................................... 6
4. What is ANTT?............................................................................................................... 6
5. Training .......................................................................................................................... 6
6. Principles of ANTT ......................................................................................................... 7
6.2 Hand Hygiene ............................................................................................................. 7
6.3 Personal Protective Equipment ................................................................................... 7
6.4 Key Parts .................................................................................................................... 8
6.5 Aseptic Field................................................................................................................ 8
7. ANTT Procedure ............................................................................................................ 8
8. Performing an ANTT ...................................................................................................... 8
9. When to perform an aseptic procedure .......................................................................... 9
9.1 Using an aseptic technique: ........................................................................................ 9
TABLE 1: TECHNIQUES FOR COMMON PROCEDURES ................................................ 10
10. When to use a clean technique? .............................................................................. 11
11. REFERENCES AND BIBLIOGRAPHY ..................................................................... 12
12. Terminology ............................................................................................................. 13
Appendix 1 .......................................................................................................................... 14
Appendix2 ........................................................................................................................... 16
Appendix 3 .......................................................................................................................... 18
Appendix 4 .......................................................................................................................... 19
Appendix 5 .......................................................................................................................... 21

Page 3 of 27
1. Purpose of the policy

The purpose of this policy is to establish ‘Aseptic Non Touch Technique’ (ANTT) as the safe
and effective technique for all aseptic procedures. It encompasses the necessary infection
prevention and control measures to prevent pathogenic micro-organisms on hands, surfaces
or equipment from being introduced to susceptible sites during clinical practices (RCN, 2009)

2. Introduction
Effective prevention and control of infection needs to be embedded in everyday practice.
Developed in the University College Hospital, London, ANTT is a framework to both
‘standardise and raise clinical standards whilst undertaking aseptic clinical procedures’
(Rowley, 2000).

ANTT aims to prevent the contamination of wounds and other susceptible sites, by ensuring
that only uncontaminated equipment, referred to as ‘key parts’ or sterile fluids come into
contact with susceptible or sterile body sites during clinical procedures.

ANTT should be undertaken when performing a medical aseptic procedure i.e. cannulation,
venepuncture, IV medication, wound care, urinary catheterisation and central and peripheral
line management.

The Health and Social Care Act (DH 2008) states:

 ANTT should be carried out in a manner that maintains and promotes the principles of
asepsis

 The technique should be standardised across the organisation

 All staff undertaking procedures involving asepsis should be provided with education,
training and assessment.

 Yearly audits should be undertaken to monitor compliance

3. Staff Responsibilities
3.1 Chief Executive

 To ensure that infection prevention and control is a core part of clinical governance
and patient safety programme

 Promote compliance with infection prevention policies in order to ensure low levels of
Healthcare Associated Infections (HCAI)

 Awareness of legal responsibilities to identify, assess and control the risk of infection.

Page 4 of 27
3.2 Executive Clinical & Operations Director /Director of Infection Prevention
and Control (DIPC)
 Oversee infection prevention policies and their implementation

 Reports directly to the Chief Executive and Board members.

3.3 Infection Prevention and Control Lead

 Review and update ANTT policy

 Give additional advice regarding the implementation of ANTT when required

 Promote good practice and challenge poor compliance

 Will audit standards of compliance with ANTT policy in the clinical areas/departments

3.4 Infection Prevention Link Practitioners & associate practitioners

 Will assess all new clinical staff using ‘Green card ‘(Assessment 1) infection prevention
training book within their department /team/ clinic or unit.

3.5 Clinical Practice Facilitators

 Will provide ANTT training to clinical staff as required and will ensure that their training,
policies and guidelines are ANTT compliant.

3.6 Assistant Directors

 Must establish a positive culture across all services and promote compliance with
ANTT as part of infection control guidelines

 Support managers by providing resources for implementation of ANTT in all clinical

areas

 Support managers and infection prevention link practitioners in monitoring levels of

ANTT compliance

3.7 Line managers

 Identify staff requiring ANTT training

 Will ensure that all staff are only able to undertake invasive techniques following
training and assessment of competence in ANTT procedures

 Promote good practice and challenge poor compliance

3.8 All Clinical Staff

 Apply ANTT principles to all procedures requiring aseptic technique

 Ensure compliance with infection control policies

 Promote good practice and challenge poor compliance

Page 5 of 27
3.9 All Healthcare Staff

 Must be familiar with and adhere to the relevant infection prevention and control
policies to reduce the risk of cross infection of patients including ANTT

 All staff will maintain their ANTT competency through re-assessment as required
within their clinical areas

 Promote good practice and challenge poor practice.

4. What is ANTT?
In the absence of ‘gold standard’ randomised controlled studies on aseptic or sterile
techniques, a theoretical framework has been developed using research-based evidence.
This framework is known as Aseptic Non-Touch Technique (ANTT).

ANTT is a standard for safe and effective aseptic practice that can be applied to all aseptic
procedures such as intravenous therapy, wound care and urinary catheterisation. It
standardises practice and rationalises the many different techniques currently in use.

ANTT improves aseptic technique in three ways:

 The step by step clinical guideline signposts best practice, helping to establish safe,
standardised aseptic technique. All staff are taught to identify and protect the key-parts
of any procedure, perform effective hand washing, institute a non-touch technique and
wear appropriate protective clothing.

 A core component of ANTT is the protection of key parts. These are those parts that if
contaminated by infectious material increase the risk of infection. In IV therapy, key
parts are usually those which come into direct contact with the liquid infusion e.g.
needles, syringe tips, exposed central line lumens, etc.

 By introducing ANTT as an audit cycle, staff are trained and re-trained on an on-going
basis.

The use of ANTT can develop a culture of peer pressure, which in itself helps promote
standardised and safe practice.

5. Training
 Managers will ensure that all staff who perform invasive techniques are trained and
competent in Aseptic Non-Touch Technique (ANTT)

 Staff must have completed their ANTT (Green card) at induction or received training
and been assessed as competent by Clinical Facilitators

 New staff joining Provide, who have received ANTT training from a previous employer,
must provide documentary evidence of competence and current practice to their line
manager

 Local acknowledgement of current compliance reviewed as required (Appendix 1&2)

 The training will be monitored in accordance with LDPOL10 Statutory and Mandatory
Training Policy
Page 6 of 27
6. Principles of ANTT

6.1 The key principles of ANTT are:

 Use Standard Infection Prevention and Control Precautions

 Always decontaminate hands effectively

 Use Personnel Protective Equipment (if required)

6.2 Hand Hygiene

Most healthcare associated infections continue to be spread by direct contact by the hands
of healthcare workers; hence hand decontamination is the most significant procedure in
preventing cross infection in hospital (Pratt, 2007).

Effective hand decontamination is essential to ANTT and should take place prior to and after
all invasive techniques and after removal of gloves. Decontaminate hands following the
NPSA hand decontamination step technique, as per hand hygiene policy (Appendix 3).

6.3 Personal Protective Equipment

Personal protective equipment, such as gloves and aprons, provide a barrier between
microorganisms on hands, clothing and the susceptible site.
Gloves must be worn for:

 Invasive procedures

 Contact with sterile sites

 Non-intact skin

 Mucous membranes

 Activities where a risk of exposure to blood, bodily fluids ,secretions, excretions and
contaminated instruments can occur (Pratt et al 2007)

The step by step clinical guidelines are designed for the practitioner to:

 Always wash hands effectively

 Never contaminate key-parts

 Touch non key-parts with confidence

 Take appropriate infection control precautions

Non sterile gloves can be used for IV medication, venepuncture or cannulation, where
possible to undertake the procedure without touching any key parts.

Sterile gloves must be worn for wound care, urinary catheterisation or central venous
catheter insertion.
Page 7 of 27
6.4 Key Parts

Never contaminate ‘key parts’ and touch ‘no key parts’ with confidence.

Key Parts

A core component of ANTT is maintaining asepsis during invasive procedures. Key parts are
those parts of equipment that if contaminated by infectious material increase the risk of
infection, not touching them either directly or indirectly is perhaps the single most important
component of achieving asepsis.

ANTT must be applied for any invasive procedure, for example wound care, urinary
catheterisation, drug administration.

In IV therapy, key parts are usually those which come into direct contact with the liquid
infusion e.g. needles, syringe tips, exposed central line lumens. In wound care, consider all
of the dressing pack equipment as key parts.

6.5 Aseptic Field

A clean working environment and an aseptic field are essential precautions for all clinical
procedures.

For the majority of IV procedures, one is maintaining the asepsis of only one or two small
key-parts. This can be achieved effectively by a non-touch-method and a basic aseptic field
such as a well cleaned plastic tray.

Plastic trays used during ANTT must be thoroughly cleaned before and after use. Clean with
detergent/disinfectant, sporicidal wipe (i.e. tuffie5). Dry with a clean paper towel.

7. ANTT Procedure
An ‘Aseptic Non-Touch technique’ is achieved by preventing direct and indirect contact of
key parts using a non-touch method and other appropriate infection control precautions.
(Appendices 4, 5, 6)

8. Performing an ANTT
 Clean hands

 Clean aseptic surface i.e. plastic tray or dressing trolley

 Gather equipment for procedure whilst the tray or trolley is drying

 Clean hands again and put on gloves

 Identify key-parts

 Prepare equipment & patient ensuring all key parts are protected

 Remove gloves, clean hands and re-apply new gloves

 Perform procedure ensuring all key parts are protected

Page 8 of 27
 Remove gloves & clean hands

9. When to perform an aseptic procedure

In clinical practice there are times when ANTT as opposed to an aseptic technique will be
used. It is therefore important to be able to differentiate between the two in order to ensure
that the most appropriate method is used. A clean technique would be appropriate for the
majority of chronic wound management procedures.

9.1 Using an aseptic technique:

 When inserting, re-siting or dressing an invasive device, e.g. intravenous cannula,

urinary catheter, wound drain etc.

 When dressing wounds healing by primary intention, e.g. surgical wounds, burns etc.

 When an ANTT is insufficient in relation to the patient’s risk-assessment, e.g. sterile

body areas are entered, there is tracking to deeper areas or the patient is immuno-
compromised

When completing a procedure you must use the individual policy for that procedure and
include the actions identified above.

NB. The individual policy may be a Provide policy or a policy/guideline from The Royal
Marsden Hospital Manual of Clinical Nursing Procedures 7th Edition. (Dougherty & Lister
2008).

Page 9 of 27
Examples of the appropriate technique are given in Table 1.

TABLE 1: TECHNIQUES FOR COMMON PROCEDURES

Procedure Technique Comments
Indwelling urinary catheter Aseptic Routine hand hygiene
insertion Sterile gloves and single use disposable
apron
Use sterile single –use catheter pack

Intermittent urethral Clean in Routine hand hygiene

catheterisation patient’s Sterile gloves and single use disposable
home apron in hospital
Use Aseptic (sterile/single-use) Pack
Aseptic in
hospital

IUD insertion Aseptic Surgical hand hygiene

Use sterile single –use IUCD pack
Sterile gloves

IV medication Preparation for Aseptic non- Routine hand hygiene

immediate use and touch Clean non- sterile nitrile gloves
administration. technique

Peripheral cannula insertion Aseptic non- Routine hand hygiene

touch Clean non- sterile nitrile gloves
technique Use sterile single –use IV pack (cannulation
pack)
Suprapubic catheter insertion Aseptic Surgical hand hygiene
Maximum barrier precautions
Use Sterile single –use pack only
Sterile gloves

Suction-Laryngeal Clean Routine hand hygiene

Endotracheal Clean non -sterile nitrile gloves
Tracheostomy Dispose of catheter after each insertion

Suturing Aseptic Surgical hand hygiene

Maximum barrier precautions
Use Suture pack
Sterile gloves
Wound care for wounds healing Aseptic Routine hand hygiene
by primary intention e.g. surgical Sterile gloves and single use disposable
wound apron
Use wound care pack

Wound care for wounds healing Clean Routine hand hygiene

by secondary intention e.g. Clean non -sterile nitrile gloves and single
venous ulcers use disposable apron

Venepuncture Aseptic non- Routine hand hygiene

touch Clean non -sterile nitrile gloves
technique as
per
venepuncture
policy

Page 10 of 27
10. When to use a clean technique?
This is a modified technique that can be used for:

 wounds healing by secondary intention, e.g. pressure sores, leg ulcers, dry wounds,
simple grazes and removing drains or sutures

 Endo-tracheal suction

 Removal of an indwelling urinary catheter

 emptying a urinary catheter drainage bag

 Finger prick monitoring blood glucose levels

 Removal of a peripheral IV cannula

 Administration of enteral feeds

 Clean, non-sterile nitrile gloves should be worn and a disposable plastic apron. A non-
touch technique should still be used along with sterile single use items.

(NB if wounds enter deeper sterile body areas, then an aseptic technique must be used. If
the Risk Assessment shows the patient to be High Risk, then aseptic technique must be
used).

If two procedures are being undertaken, e.g. suction and a wound dressing, always carry
out the cleanest procedure first, then change gloves and decontaminate hands between
procedures. Gloves will soon become heavily contaminated.

Always

 Use Standard (Universal) Precautions

 Dispose of single use items after one use

 Dispose of single patient use items after treatment

 Decontaminate re-usable items according to local policy and manufacturer’s

instructions (refer to decontamination of medical equipment policy)

 Store sterile equipment in clean, dry conditions, off the floor and away from potential
damage

 Dispose of waste as per local policy

 Minimise interventions, e.g. manipulation of IV lines

Page 11 of 27
11. REFERENCES AND BIBLIOGRAPHY
1. National audit office. The Management and Control of Healthcare Associated Infection
in Acute NHS Trusts in England. London: The stationery Office, 2000

2. Department of Health. Winning Ways: Working together to reduce healthcare infection

in England. London: The stationery Office, 2003

3. Rowley, S. (1996) A safe & efficient handling technique for IV therapy. (Unpublished).

4. Clemence, M.A., Walker, D., Farr, B.M. (1995) Central venous catheter practices:
Results of a survey .American Journal of Infection Control. Feb. p5-12.

5. Eickhoff, T.C. (1994) Airborne nosocomial infection. A contemporary perspective.

Infection Control and Hospital Epidemiology. 15(10) p663-672

6. Gould, D. (1991) Skin Bacteria. What is normal? Nursing Standard. September 18

18(5) p25-28.

7. Adams, B.G; Marrie, T.J. (1982) Hand carriage of gram negative rods may not be
transient. Journal of Hygiene. p23-31.

8. Bauer T.M; Ofner, E; Just, H.M; Daschner, F.D (1990) An epidemiological study
assessing the relative importance of airborne and direct contact transmission of micro
organisms in a medial intensive care unit. Journal of Hospital Infection. May. 15(4)
p301-9.

9. Maki, D.G., Goldman, D.A., Rhame, F.S. (1973) Infection Control in IV therapy. Annals
of Internal Medicine 79(6) p867-887.

10. Dougherty L & Lister (2008). The Royal Marsden Hospital Manual of Clinical Nursing
Procedures. Wiley – Blackwell

11. ICNA (2003) Asepsis: Preventing Healthcare Associated Infection. Infection Control
Nurses Association. ISBN -0-9541962-093

12. ICNA (2002)Hand decontamination guidelines. Infection Control Nurses Association.

ISBN 0-9541962-03.

13. Epic 3: H P Loveday, J A Wilson, R J Pratt, M Golsorski, A Tingle, A Bak, J Browne, J

Prieto, M Wilcox (2013) Nationa Evidence-based Guidelines for Preventing Healthcare
Associated Infections in NHS Hospitals in England: Journal of Hospital Infection: 8651,
S1-S70

14. DOH (2003) Winning Ways. Working together to reduce Healthcare Associated
Infection in England. Report from the Chief Medical Officer. December.

15. ICNA (2003) Kaler, W., Chinn, R (2007) Successful disinfection of needleless access
ports: A matter of time and friction. Java 12(3) p140- 142.

16. NAO (2000) National Audit Office report on The Management and Control of Hospital
Acquired Infection in Acute Trusts in England in 2000. The NAO (2000),

17. NAO (2004) The Challenge of Hospital Acquired Infection. National Audit Office.

18. RCN (2010) Standards for infusion therapy. Royal College of Nursing.
Page 12 of 27
12. Terminology

Sterile Technique

The word ‘sterile' means ‘free from micro-organisms'. Due to the natural multitude of
organisms in the atmosphere it is not possible to achieve a true sterile technique for most
invasive procedures in a typical hospital environment (even when wearing sterile gloves).
Sterile techniques can only be achieved in controlled environments such as a laminar air
flow cabinet or a specially equipped theatre. The commonly used term, ‘sterile technique' is
therefore inaccurate, as practitioners are not actually achieving their stated objective.

Aseptic Technique

For a venous-access-device related infection to occur it must be contaminated by a sufficient

number of virulent, pathogenic organisms. Therefore, a technique that prevents such a level
of pathogenic organisms from entering the patient’s blood stream is a safe technique. Such
a technique is most accurately termed an ‘aseptic technique', as the word asepsis means,
‘freedom from infection or infectious (pathogenic) material'.6 An aseptic technique is the
‘effort to keep a client as free from hospital micro-organisms as possible’.8 Therefore, unlike
sterile techniques, aseptic techniques can be achieved in typical ward and home settings.

Aseptic Non-Touch Technique (ANTT)

This term is both accurate and achievable in normal clinical or non-clinical settings such as
on hospital wards or a patient’s home.
Pathogenic organisms cannot always be removed by effective hand washing. Additionally,
hand washing is not always effective. Therefore, a non-touch technique (i.e. being able to
identify the ‘key-parts’ and not touching them either directly or indirectly) is perhaps the
single most important component of achieving asepsis.

‘Clean’ Technique

This is a modified technique that can be used for dressing chronic wounds healing by
secondary intention, e.g. pressure sores, leg ulcers, dehisced wounds, which will already be
heavily colonised with environmental micro-organisms. It can also be used for simple grazes;
when removing sutures; and for endo-tracheal suction. Personal protective equipment such
as clean, non-sterile gloves and a disposable plastic apron should be worn. In addition,
chronic wounds may be irrigated or cleansed using potable/drinking tap water rather than
sterile fluids.

Page 13 of 27
 Appendix 1

Competency Assessment for ANTT IV aseptic procedure

Name of staff being assessed: Date

Role / band: Ward /Dept./Community Team

Preparation:

1 Were hands cleaned prior to gathering equipment? Yes / No

2 Was the NPSA hand cleaning technique used? Yes / No
3 Which cleaning agent was used? Water only / Soap
& water / Alcohol
gel
4 Was a plastic tray used? Yes / No
5 Were sporicidal wipes or soap & water used to clean the tray Yes / No
if it was visibly soiled? (i.e. tuffie 5)
6 Was the tray allowed to dry. Yes / No
7 After equipment was gathered, were hands cleaned prior to Yes / No
assembling and drawing up?
8 Was the NPSA hand cleaning technique used? (Appendix 3) Yes / No
9 Which cleaning agent was used? Water only / Soap
& water / Alcohol
gel
10 Were non-sterile gloves and plastic apron put on prior to Yes / No
preparing the IV medicines?
11 Was the plastic tray tidy / well organised throughout Yes / No
preparation?
12 Were key-parts touched / contaminated during the Yes / No
preparation?

Page 14 of 27
Procedure
1 Were hands cleaned prior to the start of the administration? Yes / No
2 Which cleaning agent was used? Water only / Soap
& water / Alcohol
gel
3 Was the NPSA hand cleaning technique used? Yes / No
4 Were non-sterile gloves put on prior to administration of the Yes / No
medicines?
5 Were cleaned key-parts allowed to dry prior to use? (30 Yes / No
seconds)
6 Were key-parts touched / contaminated during the procedure? Yes / No
7 Were hands cleaned after gloves were removed? Yes / No
8 Was the equipment cleaned after use? Yes / No

Note: Correct practice is coloured bold. The pass mark is 100%. Any incorrect behaviours
constitute a failure and will necessitate re-education and a repeat competency assessment

Assessors name: Assessor’s signature:

Staff member signature:

Pass: Yes / No

Page 15 of 27
 Appendix2

Competency Assessment for ANTT for Non IV aseptic procedure

Name of staff being assessed: Date

Role / band: Ward / Dept:

Preparation:

1 Were hands cleaned prior to gathering equipment? Yes / No

2 Was the NPSA hand cleaning technique used? (Appendix 3). Yes / No
3 Which cleaning agent was used? Water only / Soap
& water / Alcohol
gel
4 Was a plastic tray or dressing trolley used? Yes / No
5 Was soap & water or sporicidal detergent wipe used to clean the Yes / No
tray/trolley if visibly soiled?
6 Was the tray/trolley dried Yes / No
7 After equipment was gathered, were hands cleaned prior to Yes / No
laying out equipment?
8 Was the NPSA hand cleaning technique used? (Appendix 3) Yes / No
9 Which cleaning agent was used? Water only / Soap
& water / Alcohol
gel
10 Was the equipment laid out onto a sterile field i.e. dressing pack Yes / No
11 Were key-parts touched / contaminated during the preparation? Yes / No

Page 16 of 27
Procedure

1 Were non-sterile gloves put on prior to removal of used/soiled Yes / No

equipment?
2 Were hands cleaned after glove removal & prior to the start of Yes / No
the procedure?
3 Which cleaning agent was used? Water only / Soap
& water / Alcohol
gel
4 Was the NPSA hand cleaning technique used? (Appendix 3) Yes / No
5 Were sterile gloves put on prior to commencing the procedure Yes / No
6 Was the sterile field kept tidy during the procedure and used Yes / No
items discarded immediately in a yellow bag?
7 Were key-parts touched / contaminated during the procedure? Yes / No
8 Were hands washed with soap & water after gloves were Yes / No
removed?
9 Was the equipment cleaned after use? Yes / No

Note: Correct practice is coloured red (bold). The pass mark is 100%. Any incorrect
behaviours constitute a failure and will necessitate re-education and a repeat competency
assessment

Assessors name: Assessor’s signature:

Staff member signature:

Pass: Yes / No

Page 17 of 27
Appendix 3

Page 18 of 27
 Appendix 4

Administering IV Drugs using ANTT

1. Decontaminate hands with alcohol gel or soap and water

Action Rationale
 If hands are socially clean,  Effective hand hygiene is vital
use alcohol gel to reduce the risk of
contaminating key-parts/sites

2. Clean plastic tray. Whilst tray is drying, gather equipment, drugs etc.
Action Rationale
 Clean plastic tray with  To establish a clean working
sporicidal surface
detergent/disinfectant wipe
 Dry with clean paper towel
before use
 Collect equipment & place
next to tray.

Decontaminate hands & put on apron and non-sterile gloves

Action
 Decontaminate hands
 Put on apron
 Put on non-sterile gloves
Rationale
 Hands may have become
contaminated by handling
equipment
 Aprons must be worn where
there is a risk of contamination
from body fluids

4. Prepare drugs & equipment & protect key-parts at all times using a non-touch
technique
Action
 Remove equipment from
packaging carefully
 Assemble equipment and
arrange in an orderly manner
in aseptic field
 Ensure key-parts are
protected at all times with
needle and sheath
 Handle non key-parts with
confidence
Rationale
 Prevents contamination of
key-part during removal from
packaging
 An orderly aseptic field
decreases chance of
contaminating key-parts.
 Exposed key-parts increases
risk of contaminating key-
parts.
 A non-touch technique
protects key-parts/sites

Page 19 of 27
5. Prepare the patient & gain free access to the IV line
Action
 Gain access to the cannula –
remove clothing etc
6. Remove gloves. Decontaminate hands.
Action
Remove gloves
Decontaminate hands
7. Put on clean gloves. Clean key-parts & wait 30 seconds for them to dry.
Administer drugs
Action
 Put on clean non-sterile
gloves
 Cleanse port /injection site
with small 2% chlorohexidine
70% alcohol wipe (i.e. sani-
cloth CHG2%)
 . Wait 30 seconds for this to
dry
 Administer drugs using non-
touch technique then dispose
of all used equipment as per
Waste policy
8. Remove gloves and decontaminate hands
Action
 Remove non-sterile gloves
 Decontaminate hands
 Discard waste placing it in the
correct containers
 Clean plastic tray after use
with sporicidal detergent
/disinfectant wipe (i.e. Tuffie
5)
Page 20 of 27
Rationale
 Ensure IV access is patent
and avoid contamination via
contact during procedure
Rationale
 Hands will have become
contaminated by handling
equipment, bedding, patients
clothing and door handles etc.
Rationale
 Help maintain asepsis
 Drying of any cleaning solution
is vital for disinfection to be
complete
Rationale
 Gloves must only be used for
one procedure
 Hands to be decontaminated
by washing with liquid soap
and water after the gloves
have been removed.
 Ensure safe disposal and
avoid injury to staff
 Appendix 5

Please note: This procedure applies to both peripheral and central venous catheter
care

Wound care using ANTT

1.Decontaminate hands with soap & water or alcohol gel

Action Rationale
 Decontaminate hands with  This is vital to reduce the risk
alcohol gel or soap & water of contaminating dressing
equipment or the wound site

2. Clean dressing trolley. Whilst drying, gather wound dressing equipment.

Action
 Collect the dressing trolley
 Put on plastic apron
 Clean trolley with sporicidal
detergent /disinfectant wipes
 Allow surface to dry before use.
 Gather equipment
Rationale
 In exceptional cases other
suitable, cleaned surfaces may
be used.
 A plastic apron will prevent
contamination of uniform

3. Decontaminate hands
Action Rationale
 Decontaminate hands  Hands may have become
contaminated by handling
equipment

4. Lay out dressing equipment & protect key-parts at all times using a non-touch-
technique
Action Rationale
 Open dressing pack on to trolley  Prevents contamination during
 Remove equipment from removal from packaging
packaging using non-touch  An orderly aseptic field
technique decreases chance of
 Arrange equipment in an orderly contaminating key-parts.
manner on sterile field  All the dressing equipment
 Consider all of the dressing comes into contact with wound.
equipment as key-parts  Exposed key-parts increase
 Keep these protected at all risk of contamination
times

Page 21 of 27
 5. Put on non-sterile gloves; prepare the patient & remove old dressing

Action Rationale
 Put on non-sterile gloves  To avoid contamination from
 Gain access to the wound soiled dressing
 Remove old dressing
 Discard into clinical waste bag
from dressing pack
6. Remove gloves, decontaminate hands with soap and water

Action Rationale
 Remove gloves  Hands will have become
 Decontaminate hands with soap contaminated by handling
& water soiled dressing etc.

7. Apply sterile gloves; cleanse & redress wound

Action Rationale
 Put on sterile gloves from the  To maintain asepsis & prevent
dressing pack contamination of dressing
 Place sterile towel from pack equipment and wound
under / below wound
 Cleanse wound and apply new
dressing using non-touch
technique
 Discard all dressing equipment
(except sharps) in to clinical
waste bag immediately after use
 Discard sharps according to
waste policy

8. Remove gloves. Decontaminate hands with soap and water

Action
 Remove non-sterile gloves
 Clean hands with soap and
water
 Clean plastic tray after use with
sporicidal detergent / disinfectant
wipes.
Rationale
 Hands must be washed after
glove removal as organisms
thrive in the warm, moist
environment beneath gloves
and the exterior surface of the
glove may have become
contaminated during the
procedure.
 To prevent cross-infection

Please note: This procedure can be applied to urinary catheterisation

Page 22 of 27
EQUALITY IMPACT ASSESSMENTS: Framework and outline
briefing notes

Attached is a framework, customised to Provide, and some short advisory notes on

an approach on carrying out Equality Impact Assessments (EIAs).

Briefings are being arranged to explore undertaking such assessments in practice,

using ‘live’ and relevant case studies.

Page 23 of 27
EQUALITY IMPACT ASSESSMENT TEMPLATE: Stage One: ‘Screening’

Name of project/policy/strategy (hereafter referred to as “initiative”):

Aseptic non-touch technique policy (ANTT)

Provide a brief summary (bullet points) of the aims of the initiative and main activities:

To reduce the incidence of health-care associated infections due to insertion and o-

going care of invasive devices and clinical procedures.

Project/Policy Manager: JULIA SHIELDS Date: 18.11.13

This stage establishes whether a proposed initiative will have an impact from an
equality perspective on any particular group of people or community – i.e. on the
grounds of race (incl. religion/faith), gender (incl. sexual orientation), age, disability,
or whether it is “equality neutral” (i.e. have no effect either positive or negative). In the
case of gender, consider whether men and women are affected differently.

Q1. Who will benefit from this initiative? Is there likely to be a positive impact on specific
groups/communities (whether or not they are the intended beneficiaries), and if so, how? Or
is it clear at this stage that it will be equality “neutral”? i.e. will have no particular effect on
any group.

n/a

Q2. Is there likely to be an adverse impact on one or more minority/under-represented or

community groups as a result of this initiative? If so, who may be affected and why?
Or is it clear at this stage that it will be equality “neutral”?

n/a

Q3. Is the impact of the initiative – whether positive or negative - significant enough to
warrant a more detailed assessment (Stage 2 – see guidance)? If not, will there be
monitoring and review to assess the impact over a period time? Briefly (bullet points) give
reasons for your answer and any steps you are taking to address particular issues, including
any consultation with staff or external groups/agencies.

n/a
Page 24 of 27
Guidelines: Things to consider

 Equality impact assessments at Provide take account of relevant equality legislation

and include age, (i.e. young and old,); race and ethnicity, gender, disability, religion
and faith, and sexual orientation.
 The initiative may have a positive, negative or neutral impact, i.e. have no particular
effect on the group/community.
 Where a negative (i.e. adverse) impact is identified, it may be appropriate to make a
more detailed EIA (see Stage 2), or, as important, take early action to redress this –
e.g. by abandoning or modifying the initiative. NB: If the initiative contravenes
equality legislation, it must be abandoned or modified.
 Where an initiative has a positive impact on groups/community relations, the EIA
should make this explicit, to enable the outcomes to be monitored over its lifespan.
 Where there is a positive impact on particular groups does this mean there could be
an adverse impact on others, and if so can this be justified? - e.g. are there other
existing or planned initiatives which redress this?
 It may not be possible to provide detailed answers to some of these questions at the
start of the initiative. The EIA may identify a lack of relevant data, and that data-
gathering is a specific action required to inform the initiative as it develops, and also
to form part of a continuing evaluation and review process.
 It is envisaged that it will be relatively rare for full impact assessments to be carried
out at Provide. Usually, where there are particular problems identified in the
screening stage, it is envisaged that the approach will be amended at this stage,
and/or setting up a monitoring/evaluation system to review a policy’s impact over
time.

Page 25 of 27
Equality Impact Assessment Template: Stage 2:
(To be used where the ‘screening phase has identified a substantial problem/concerns)

This stage examines the initiative in more detail in order to obtain further information
where required about its potential adverse or positive impact from an equality
perspective. It will help inform whether any action needs to be taken and may form
part of a continuing assessment framework as the initiative develops.

Q1. What data/information is there on the target beneficiary groups/communities? Are any of
these groups under- or over-represented? Do they have access to the same resources?
What are your sources of data and are there any gaps?

n/a

Q2. Is there a potential for this initiative to have a positive impact, such as tackling
discrimination, promoting equality of opportunity and good community relations? If yes,
how? Which are the main groups it will have an impact on?

n/a

Q3. Will the initiative have an adverse impact on any particular group or
community/community relations? If yes, in what way? Will the impact be different for
different groups – e.g. men and women?

n/a

Q 4. Has there been consultation/is consultation planned with stakeholders/ beneficiaries/

staff who will be affected by the initiative? Summarise (bullet points) any important issues
arising from the consultation.

n/a

Page 26 of 27
Q.5. Given your answers to the previous questions, how will your plans be revised to
reduce/eliminate negative impact or enhance positive impact? Are there specific factors
which need to be taken into account?

n/a

Q6. How will the initiative continue to be monitored and evaluated, including its impact on
particular groups/ improving community relations? Where appropriate, identify any
additional data that will be required.

n/a

Guidelines: Things to consider

 An initiative may have a positive impact on some sectors of the community but leave
others excluded or feeling they are excluded. Consideration should be given to how
this can be tackled or minimised.
 It is important to ensure that relevant groups/communities are identified who should
be consulted. This may require taking positive action to engage with those groups
who are traditionally less likely to respond to consultations, and could form a specific
part of the initiative.
 The consultation process should form a meaningful part of the initiative as it
develops, and help inform any future action.
 If the EIA shows an adverse impact, is this because it contravenes any equality
legislation? If so, the initiative must be modified or abandoned. There may be another
way to meet the objective(s) of the initiative.

Further information:

Useful Websites
www.equalityhumanrights.com Website for new Equality agency
www.employers-forum.co.uk – Employers forum on disability
www.disabilitynow.org.uk – online disability related newspaper
www.womenandequalityunit.gov.uk – Gender issues in more depth
www.opportunitynow.org.uk - Employer member organisation (gender)
www.efa.org.uk – Employers forum on age
www.agepositive.gov.uk – Age issues in more depth

© MDA 2007

Page 27 of 27