Antt Training

HƯỚNG DẪN KỸ THUẬT VÔ KHUẨN
1
MỤC LỤC
2
DANH MỤC CHỮ VIẾT TẮT
3
MỘT SỐ THUẬT NGỮ LIÊN QUAN ĐẾN KỸ THUẬT VÔ KHUẨN
Glossary
Historically, and still today, the common practice terms used to describe the aim and the intended process of aseptic
practice have unfortunately been given multiple meanings and are interpreted variously (Preston, 2005; Flores, 2008;
Aziz, 2009; Rowley et al, 2010; Unsworth and Collins, 2011). This ambiguity, at the heart of an important clinical
competency has been further exacerbated by terms for the aim of aseptic practice being confused with terms for the
process of aseptic practice. For example, the term ‘Clean Technique’ was so termed to describe a simpler process of
achieving asepsis for simple procedures. Over time, it has also been used to describe the aim of practice. i.e., a lesser
aim than asepsis. Ambiguity isn’t just about words, it’s about patient safety.
So below, is more than just a routine glossary. It is an inter-related set of definitions that are technically accurate and
actually achievable. The ambition for safer patient care through a universal language for aseptic technique with ANTT
starts here.
Aseptic Fields used in ANTT
Critical Aseptic Field

Typically a sterilized drape. The main aseptic field
that ensures asepsis during procedures by providing
essential & primary protection from the procedure
environment. Critical Aseptic Fields require ‘Critical
Management’ (See below)*.
General Aseptic Field

Typically a disinfected plastic procedure tray. The
Note. Unique practice terms of ANTT are identified main aseptic field that promotes asepsis during
bold italic. procedures by providing basic protection from the
procedure environment. General Aseptic Fields are
Aseptic/Asepsis used when the procedure Key-Parts are easily and
Free from harmful organisms in sufficient quantity to primarily protected by Micro Critical Aseptic Fields
cause infection (caps and covers). Therefore, General Aseptic Fields
only require ‘General Aseptic Field Management’
(See below)**.
Aseptic technique
A generic term for a collection of infection prevention
measures required to protect patients from microbial Micro Critical Aseptic Field
contamination during invasive clinical procedures and A small Critical Aseptic Field used to protect a Key-
the maintenance of indwelling medical devices. Part, e.g. sterile cap, syringe cap or the inside of
unopened or recently opened sterile packaging.
Aseptic Non Touch Technique (ANTT®)
An original and specific type of aseptic technique with Clean - Free from visible marks and stains
a unique theory and clincal practice framework
intended for all clinical procedures in all settings Clean Technique
(NICE 2012). A historical term often used interchangeably with
aseptic technique and non-touch technique. Describes
Aseptic field the action and process of rendering an object or body
Often used intercaheably with ‘Sterile field’. A part free from visible marks and stains. ANTT does not
designated clinical aseptic working space that contains use this term to describe or define aseptic technique
and protects the procedure equipment from direct and because micro-organsims are invisible!. Beware of
indirect environmental contact-contamination by definitions that imply a clean technique doesn’t have to
microorganisms. See septic field types below. be aseptic.
4
Decontamination
A general term that refers to one or a combination of the
processes below:
Cleaning: reduces the bio burden and removes

foreign material. In healthcare it is typically
performed with water, soap or detergent and material
such as paper towels or impregnated wipes.
Disinfection: the destruction of pathogenic

microorganisms, usually by thermal or chemical
means.
Sterilization: A process by which all viable forms

of microorganisms (including spores) are destroyed
(APIC 2009).
Key-Part
Key-Parts are the parts of the procedure equipment
that come into contact with Key-Sites, any liquid
infusion, or with any other active Key-Parts connected
to the patient via a medical device. If contaminated
during a procedure, Key-Parts provide a route for the
transmission of pathogens onto or into the patient, and
present a significant infection risk.
Key-Site
Open wounds and insertion and puncture sites for
invasive medical devices.
Key-Part/Site Protection
The concept of identifying and protecting procedure
Key-Parts and/or body Key-Sites from harmful
microorganisms during invasive clinical procedures.
This is achieved primarily by non-touch technique and
the use of aseptic fields integrated with Standard
Precautions such as hand cleaning, surface cleaning
and the use of appropriate PPE.
Sterile
Free from (ALL) microorganisms
Sterile Technique
A historical term often used interchangeably with
aseptic technique. (The ANTT Framework does not
use this term, because due to the ever presence of
microorganisms in air, it is virtually impossible to
achieve a ‘sterile’ technique in even the most specialist
health care environments).
Sterile Field
Often used interchangeably with ‘aseptic field’. It is
not actually possible to maintain a so-called ‘sterile
field’ due to the ever presence of microorganisms in
the air. ANTT therefore, does not use this term. (See
aseptic field types above).
5
HỌC THUYẾT VỀ KỸ THUẬT VÔ KHUẨN
A Theoretical Framework for ANTT
What ANTT and differentiated as Standard-ANTT and Surgical-
is ANTT, including a technical rather subjective method
Surprisingly, ANTT was, and remains, the first and of selecting the most appropriate technique for simple or
only comprehensively defined, evidence-based more complex procedures.
theoretical and clinical practice framework for aseptic
practice and is intended for all clinical procedures in
all care settings. …’From Surgery to Community The clinical need for ANTT
Care’. ANTT is a unique and contemporary approach
to defining and educating the clinical practice and Over the last 50 years, medical advances in a range
practice language of aseptic practice. A logical of invasive clinical procedures such as surgical
approach to aseptic practice is integrated with the best intervention, insertion of indwelling medical devices
available infection prevention evidence. Through a and wound care management have revolutionized
global network of working clinicians and experts, this and significantly improved outcomes for patients
theory-practice framework continues to be monitored worldwide. However, at the same time, such
and updated in the light of new evidence and new procedures introduce access ways for pathogens to
approaches to healthcare. bypass normal body defence mechanisms, resulting
in infection related morbidity and mortality; modern
health care still comes with very real risk of harm to
patients who often remain dependant upon the
practitioners ability to practice aseptically.
1 out of
every 31
patients
ANTT is used in all care settings
will acquire an HAI
The original ANTT Theoretical Framework (1995) (Healthcare- Associated
deconstructed a well documented historical aseptic infection) during their
technique that was articulated variably and was hospital stay
subsequently ambiguous. Then, based on the
syngenic relationship between harmful micro
organisms, the care environment, the patient and the It has been estimated that 653,000 healthcare-
healthcare worker during invasive procedures, associated infections (HAI) occur every year among
originated a new and novel practice framework adult inpatients in English NHS hospitals, with a
grounded in original terminology that was accurate financial cost of £2.7 billion and a human cost of 28,000
deaths and a much greater number of patient morbidity
and importantly, achievable. The ANTT Practice
(Guest et al 2020). In hospitals in the USA, it is
Framework explained the aim and components of estimated that
safe aseptic technique using an original educational 1.7 million HAI’s cause 99,000 patients a year to die of
and clinical practice concept termed ‘Key-Part and HAI with 1 in every 31 hospital patients on any given
Key-Site Protection’. The two different day experiencing a healthcare associated infection at a
cost of $28.4 billion (CDC 2022). In Australia there are
handling techniques used variably with aseptic around 165,000 HAI’s in health facilities each year,
making healthcare associated infection the most
practice traditionally, were better defined, explained
common complication affecting patients in Australian
hospitals (Mitchell 2017)
6
HAI incidence is similar in countries worldwide and also shown that organisms such as MRSA,
further exacerbating this concerning ‘norm’ is the acinetobacter and fungal spores can be found in the air
continuing global increase in anti-microbial resistance in the areas in which patients are placed (Taori et al
(ECDC 2017). Antimicrobial resistance is an urgent 2022, Wong et al 2021, Boswell & Fox 2006).
and and present global public health threat, killing at
least
Putting all this altogether, ANTT preparations and
1.27 million people worldwide and associated with
procedures are clearly at risk from contaminants from
nearly 5 million deaths in 2019 (Murray et al 2022). It
these sources, especially if transferred through the air,
is strikingly clear, that with treatment options for
where they can eventually settle on the surfaces and
infection reducing, infection prevention is
equipment around procedure areas, posing a threat for
everything. However, given that most HAI’s are
Key-Part and Key-Site contamination (Menezes
generally considered to be preventable (NSQHS 2021)
2022). Equally, ANTT preparations and procedures
(DOH 2003), infection prevention is failing and
are at risk of inadvertent touch contamination from
innefective standards of aseptic technique is central to
those practitioners who don’t have the appreciation of
this failure (Sharma et al 2020, Loftus et al 2020,
these risks to take the necessary actions to prevent
Megeus et al 2015). The challenge is equally clear; the
them. By recognizing and prioritizing environmental
protection from infection that ANTT affords patients
surface hygiene in clinical procedure areas, healthcare
when applied effectively, must be optimized and done
facilities can significaintly reduce the risk of invasive
so with urgency.
procedures and device related infections, bolster
patient safety, and ultimately improve patient
Prevention begins with appreciating outcomes. Environmental surface hygiene is not
merely an adjunct to aseptic technique; it is an integral
the risk and essential component.
Effective infection prevention and ANTT doesn’t The hands of practitioners interact with and touch
begin with practicing it. First and foremost, it begins multiple surfaces, equipment and patients and are
with practitioners having a clear understanding of the worth special mention. If effective hand hygiene and
ever- presence of harmful microorganisms in care glove-changing protocols are not complied with, the
settings and how they are transferred, often hands of practitioners, whether wearing non-sterile,
inadvertently involving themselves. Failure to sterile or no gloves at all, are high potential vectors for
appreciate this, will likely result in failed ANTT and microbial contamination. Practitioners can tire and
patient infection, as the microbiological environment become complacent with hand hygiene training and
in which any invasive procedure is undertaken plays a campaigns (Ahmadipour et al 2022, Brown 2019), but
central role in the risk of healthcare-associated nevertheless, it can’t be more simple: ineffective hand
infection. hygiene equates to ineffective ANTT and ultimately
patient harm.
When undertaking invasive clinical procedures, the
immediate procedure environment of any healthcare It may come as a surprise that hand cleaning sinks also
setting is rife with potential sources of microbial warrant special mention and should be considered with
contamination for the procedure equipment and caution as a ‘two-way street’. The contamination
vulnerable body sites. These include airborne particles removed from hands can contaminate the drainage
such as dust (normally human skin), splashes from system, creating potential for surfaces around sinks to
hand hygiene sinks and touch contamination from become contaminated with multi-resistant organisms,
hands, surfaces and objects. ironically from the very organisms removed from the
hands by hand cleaning. Infection outbreak reports
No matter how clean an object or surface looks, the have demonstrated that sinks in equipment preparation
human eye is not a reliable informant of whether a areas such as clean utility rooms have been implicated
surface is clean or not. More specialised assessment (Garvey 2018, Hota et al 2009). A recent observational
techniques such as microbiological sampling, UV dot study has shown that preparation areas are not the only
removal or the use of ATP (Adenosine Triphosphate) risk, as IV access equipment was stored within a sink
detection are rarely used routinely outside of splash zone (less than 2 metres) at 65% of sinks in an
pharmaceutical aseptic suites. Micro organisms are of intensive care unit with subsequent contamination
course invisible and hardy. They are increasingly able identified (Garvey et al 2023).
to attach to surfaces and protect themselves in a
biofilm, in which, like MRSA, can remain viable for at
least a year, and once established, are difficult to
remove. Other multi-resistant organisms, such as
acnitobacter, are also able to survive for extended
periods through this mechanism. Many studies have
The three routes of contamination and process of ANTT are utilised in preparing and
performing the clinical procedure. Staff are trained to
Ultimately, there are three ways, or routes, in which establish and maintain attention to the protection of all
environmental microorganisms can contaminate procedure Key-Parts and Key-Sites; achieved by
clinical procedures (Figure 1.). When performing integrating Standard Precautions with a combination of
invasive procedures and maintenance of indwelling the most appropriate types of aseptic fields and non-
medical devices, practitioners need to be keenly aware touch technique, according to whether Standard-ANTT
of these three routes in order to take the pre-requisite or Surgical-ANTT is being employed.
steps to negate them – with Standard precautions,
environmental controls and ANTT. The risks of
contamination and infection posed by the
microbiological environment from these ‘3 routes of
contamination’ during clinical procedures should be
Fig 1.
The latest national infection control advice from NHS

England and similarly in other countries, makes
explicit the importance of infection prevention Fig
and
control strategies and actions in preventing 1. patient
harm; “Standard infection control precautions (SICPs)
are to be used by all staff, in all care settings, at all
times, for all patients whether infection is known to
be present or not, to ensure the safety of those being
cared for, staff and visitors in the care environment”.
central to ANTT education and training and related
elements of organizational clinical governance.
Prior to preparing an aseptic procedure, practitioners

must first be trained to almost mentally, and certainly
physically, extricate themselves from the
(microbiologically) ‘dirty’ environment they are
working in and take the necessary infection prevention
actions to begin preparing and then perform a clinical
procedure safely. This involves decontaminating hands
and procedure surfaces prior to gathering procedure
equipment and medical supplies. Once these important
pre-requisites are completed, the principles
ANTT® Clinical Practice Framework. Version 6.0 Copyright © 2024 The Association for Safe Aseptic Practice (The-ASAP)
www.antt.org
9
Hand cleaning in aseptic practice infection prevention are integrated with the core
principles and Safeguards of ANTT. The reason why
Naturally, the importance of hand cleaning warrants asepsis is the aim of ANTT, rather than other
particular highlighting in a framework for effective microbiological states, is explained in Principle 1. Also
aseptic practice. Practitioners may well be tired of hand note, whilst figure 2 outlines actions taken by the
hygiene campains (Sands & Aunger 2023, Hoffmann et practitioner undertaking the procedure, wider
al 2019), nevertheless effective hand cleaning remains ‘background’ factors also have important influence on
critical to infection prevention and patient safety when the effectiveness of asepsis being established and
practicing ANTT (APIC 2009, WHO 2009, Widmer maintained. These include including general cleaning
2004). protocols and ensuring ergononomic workspaces for
aseptic preparation.
Despite the confidence that organisations may illicit

from local hand hygiene audits, often recording
compliance rates around >90%, such audits typically
involve staff auditing their own areas, and have
potential to represent a tick box culture to meeting
routine local clinical governance processes. More Fig
objective, larger studies continue to raise concern at the 2.
frequency and effectiveness of hand cleaning among A note about glove use &
practitioners (Mouajou 2022, Kingston et al 2016, sustainability
Brühwasser et al 2016, Fuller et al, 2011). As stated, if The World Health Organisation recently described
hand cleaning is not effective prior to aseptic practice, climate change as the 'single biggest threat facing
aseptic practice will be ineffective and patients will humanity' (WHO 2023), and in the UK the 2022 Health
likely suffer infection. and Care Act explicitly cites sustainability as a key
factor in healthare decision making in the NHS (DH
The longstanding and ongoing challenge of establishling 2022). The Association supports efforts to reduce waste
compliance to hand cleaning – just one infection and promote sustainable choices in healthcare; however,
prevention action, only serves to highlight the even recognising WHO guidance that “… no trade-offs can
greater andmore complex challenge of establishing be accepted between environmental sustainability and
compliance to aseptic practice – that requires multiple core health systems performance …”, they and we, are
infection prevention actions. These actions also need to cautious around questions of healthcare worker safety.
be integrated with one another effectively. (See Clinical A recent focus on reducing glove use in is welcomed
Governance Section p 24). The ANTT Practice and actively supported by the Associations own
Framework promotes effective hand cleaning generally, sustaniabilty initiative. However, calls to remove gloves
and also specifically by ensuring it is integrated and from IV medication preparation should be considerd
sequenced effectively into safe aseptic practices. carefully given the risks to practitioners. Both the FDA
(USA) and CoSHH / UK REACH Regulation (UK),
Unequivocally, the aim is asepsis require manufactures to provide safety data sheets,
detailing the safe handling of medications and both
provide a legislative framework for enforcing standards
Of course, effective hand cleaning is fundamental to the (FDA 2024, HSE 2024). Predominantly, these sheets
aim of ANTT; achieving asepsis (See Principle 2). advise gloves for most of the common intravenous
When performing invasive clinical procedures, the medications including many antibiotics. In most
practitioner aims first to establish, and then maintain, countries, individual healthcare organisations are legally
the state of ‘asepsis’ throughout the procedure. Figure 2 obliged to adhere to such regulation and are ultimately
below, illustrates this process, showing how standard accountable for staff safety and any consequentialy
infective harm.
www.antt.org
10
Problems affecting aseptic practice & how ANTT is designed to help
Historically, many factors have inhibited effective standards of aseptic practice. These are outlined in figure 3, and
some of the more significant factors are elaborated upon below. The now widespread international usage of ANTT is
helping to address a number of these problems, but of course, problems with aseptic practice still prevail, and need to
be understood and addressed for ANTT to be optimized for optimum protection of patients.
Lack of
Variable definition Variable education
infection
surveillance
Lack of training Ignorance
Problems
inhibiting
Human factors Aseptic Lack of investment
Technique
Lack of research Short staffing
Innefective
Politic Access to equipment environmental
s cleaning
Fig 3. Many challenges inhibit aseptic practice
A common language for aseptic practice is critical to understanding & patient safety
Healthcare services employ some of the largest
section (page 24). A fundamental problem, that has been
workforces of any industry. Typically, large clinical
well illustrated in the literature, has been been a lack of
workforces need to be trained effectively in a number of
consensus for what aseptic practice even means.
clinical competencies. This education and assessment is
(Gilmour, 2000; Hallett, 2000; Preston, 2005; Aziz,
naturally easier and optimised when a clinical
2009; Unsworth and Collins, 2011; Denton & Hallam
competency is well defined and consensus exists regards
2020).
its meaning and process. Prior to ANTT, this
unfortunately was not the case for aseptic practice.
Despite this lack of concensus and subsequent concern
for practice standards, a review of national and
Although the importance of effective aseptic practice is international infection prevention guidance over many
generally accepted (Loveday et al 2014), establishing years identified that ‘Aseptic Technique’ was
consistent and effective practice has proved highly nevertheless typically ‘prescribed’, but not ‘described’.
problematic (Unsworth & Collins 2011). Many different A common assumption prevailed, that something as
and wide ranging factors have contributed to this long standing and as commonly performed as aseptic
phenomena including complacency, access to technique must therefore be well defined and
appropriate medical supplies, fit for purpose workforce understood. However, such ‘prescription without
and sufficient staff education and training. (Some of description’ left interpretation of aseptic technique to
these factors are addressed in a new Clinical individual practitioners and care organisations, resulting
Governance in wide variation and effectiveness of practice.
Concern for the variability and ambiguity of practice terms for aseptic practice began to be widely documented
during the 1980s and probably before that. Every decade since, multiple authors internationally have researched
and reiterated this phenomena (Thomlinson, 1987; Johnson, 1988, Bree-Williams and Waterman, 1996; Rowley
2001, Rowley et al 2010, Gargiulo et al 2012 Suvikas-Peltonen 2017). It is most evident that exploring and
www.antt.org
11
highlighting this phenomenon is no longer particularly useful, or news. It is therefore not elaborated upon further
here, as ANTT is now well advanced in providing a badly needed universal standard for aseptic practice with a
common practice ‘language’, and the Association is committed to its ongoing development and further
dissemination.
Pic 1. A universal practice language improves undersanding
Standardized clinical practice

Perhaps the most obvious example of the advantages of
= safer clinical practice a single standard for a critical clinical competency is
cardiopulmonary resuscitation (CPR). Globally, CPR
In healthcare and other high volume, safety critical theory, process and practice are essentially the same,
client-based industries, such as aviation, the benefits of based on a shared practice language and a defined set of
standardised practice have long since been realized. The guidelines and evidence-based recommendations
World Health Organisation has been committed to (Perkins et al, 2017; Olasveengen et al, 2017).
improving standardisation in healthcare since 2006,
with the ongoing ‘High 5s project’ (WHO, 2013). As a Just like CPR, aseptic technique is a critical competency
general principle, standardisation reduces variability in and high quality performance and effectiveness is
understanding and practice, and subsequently helps essential. An important aspect of any quality system is
improve quality and safety (Sidiropoulos et al, 2009; to work according to an unambiguous standard (pic 2.).
Lavelle et al, 2015). The advantages in standardising The ANTT Clinical Practice Framework is now
important clinical competencies is no different and providing a universal standardised aseptic and a
provides a more effective and efficient foundation for common practice language for aseptic practice to
education, practice and research. individual practitioners and healthcare organisaitons
internationally.
C ANTT
P
R
Pic 2. Universal Techniques; standardised practice = safer practice
www.antt.org
12
How ANTT helps Second to providing the first comprehensive practice
Invasive clinical procedures are performed in framework for aseptic practice, ANTT’s widespread
community home care settings and hospitals many adoption internationally, helps improve patient safety
hundreds or thousands of occasions every day – and globally, by providing a single universal approach to
failures occur frequently. Suvikas-Peltonen reported aseptic practice, and importantly a common practice
…“Many patient deaths have been reported because of language. Similarly, an increasing number of
administration of contaminated intravenous medicines publications are now using ANTT to describe the
due to incorrect aseptic techniques” (Suvikas-Peltonen aseptic practice component of clinical studies making
et al 2017). From hand hyginene observational research such studies more meaningful and understandable to
in operating rooms, Megeus concluded that “… Lowest more people, subsequently increasing the
adherence was observed during the induction phase generalisability of research findings (Shettigar 2021,
before an aseptic task …” (Megeus et al 2015). By Khurana 2018,
recognising the significant risks to patients that these Simarmatar 2017).
critical clinical staff-patient ‘interactions’ present,
healthcare organisations can use ANTT to define and ANTT also helps improve standards of aseptic practice
educate practice, and monitor standards of aseptic by describing practice rather than just prescribing it.
practice. When done robustly, HAI can be minimized, Accurate description of aseptic practice with ANTT
and financial and reputational risks to healthcare better supports effective education and competency
organisations significantly reduced. assessment. Lastly, ANTT helps by providing the pre
requisite foundation for clinical governance (See page
24).
Progress
The-ASAP published results of an exhaustive audit of the adoption of the ANTT Framework in English and Scotish
NHS healthcare organisations using the process of the ‘Freedom of Information Act’ (Rowley & Clare 2020). In
England, 88% of NHS Trusts stated they used ANTT as their single practice standard for aseptic technique. This
increased to 93% when used in in combination with another model. In Scotland, it was 56% and 73% which was
notable, given that Scottish Trusts were meant to use a different model, but had independatly selected ANTT instead.
Wales was not included in the survey as it was mandated by Welsh Government in 2015. Northern Ireland and the UK
Private sector has not yet been audited. However, the Association’s ANTT Accreditation Programme indicates very
similar ANTT adoption with the private sector probably even higher. This represents a paradigm shift over 20 years in
the making, with aseptic practice in the UK transforming from total variance to a single practice standard.
England 2001 England 2020
ANTT
81%
Fig 4.
Aseptic Practice in 2001 compared to 2020 in England: Hospitals reported multiple aseptic practice types in 2001
compared to ANTT being reported as a national standard in 2020
www.antt.org
13
Since the last update of the ANTT Framework
practice, either as a stand-alone initiative or part of a
(2015), adoption of ANTT
clinical care bundle to help protect patients from
internationally has grown
preventable infection. Examples of this are increasingly
exponentially and the Association’s ambition to help
being presented by authors from different nations and
improve patient safety, by establishing a universal single
from widely different clinical settings (Barton et al
practice standard for the critical competency of aseptic
2022, Perumal et al 2022, Shettigar et al 2021,
technique with ANTT, is now not only reaslistic but
Goodman 2021, Al-Azzawi, 2021, Khurana et al
getting closer with ANTT now used in over 30
2018, Clare and
countries variously. This adoption ranges from 'ground
Rowley 2018, Gerçeker 2018, Simarmatar 2017,
up' organic adoption from health care organisations
Beaumont 2016, Mulalib et al 2015, Flynne 2015,
(such as in England and Scotland), to Government
Melville 2014, Ramachandran 2009).
mandate or endorsement at natonal level (such as in
Australia (NHMRC 2019) and NHS, Public Health
Wales (Wales 2015). Government sponsored national
adoption in non- English speaking countries (such as The next 10 years; whats needed to best
Algeria and Romania) is also increasing. protect patients from preventable
The development of ANTT as a universal standard infection
requires a multi-modal approach and widespread ANTT
adoption has been complimented by other important With HAI projected to rise (Guest et al 2020),
factors such as international publication, with increasing healthcare costs, and the ever-present and
collaborations in medical texts across a range of evolving dangers of antimicrobial resistance (AMR), it
countries including Poland, Czech Republic and Russia; is vital now more than ever to keep HAI under control
and importantly, an ever increasing body of evidence and better protect patients from preventable harm.
from researchers and opinion-leaders, using ANTT to Represeting the ‘last line of defence’ for patients during
improve practice is also adding and maintaining invasive clinical procedures, it is imperative that the
ANTT’s momentum (Barton et al 2022, Shettigar 2021, significant progress in standardizing aseptic technique
Khurana 2018, Simarmatar 2017). internationally with ANTT is consolidated and further
developed. This should include:
Lastly, multiple stakeholder organisations around the
world have acknowledged, or utilised the benefits of  ANTT training and competency assessment should
ANTT as a single standard for aseptic practice. These be mandatory in all care oroganisaitons. (Like CPR
include, The National Institute for Clinical Excellence - is).
UK (NICE 2012), The Australian Guidelines for the  ANTT re-assessment should be periodic and
Prevention and Control of Infection in Healthcare informed by (at least) annual audit of ANTT
(NHMRC 2019). The Health Service Executive – standards.
Republic of Ireland (HSE 2022), The Infusion Nurses  More standardised infection surveillance to better
Society - USA (Gorski et al 2021, Nickel et al 2024), inform the effectivness of saseptic practice.
The Association for Vascular Access - USA (Rowley &
Clare 2019).
Although of course most welcome, more important than

endorsements, is seing practitioners use ANTT in
clinical
www.antt.org
14
ANTT® Principles, Safeguards and Process
To practice ANTT safely and efficiently, it is imperative that the Principles and Safeguards of ANTT are first
fully understood. ANTT Principles outline the aim of asepsis and how to achieve it with the most appropriate
type of ANTT that is determined by risk assessment. ANTT Safeguards represent the essential practice
components of ANTT including Standard Pracautions.
Principle 1
A ‘microbial mindset’
Harmful microorganisms are ever-present in all care settings. Appreciation of
the risks they pose to patient safety, and their control, lies at the heart of
effective ANTT
Principle 2
Asepsis is the aim
Asepsis is the practice aim for all invasive clinical procedures and maintenance
of invasive clinical devices in all care settings (‘From surgery to community care’)
Principle 3
Key-Part & Key-Site Protection
Asepsis is achieved by ‘Protecting Key-Parts & Key-Sites from
microorganisms in the immediate procedure environment & transferred by
the healthcare worker.
Principle 4
There are two types of ANTT
ANTT needs to be efficient as well as safe; therefore Surgical-ANTT is used for
complicated procedures where Key-Parts are protected ‘collectively’, and
Standard-ANTT is used for uncomplicated procedures where Key-Parts are
protected individually.
Principle 5
Risk Assessment is technically based
The need for Surgical-ANTT or Standard-ANTT is determined by ANTT risk
Safeguard 1
Standard Precautions
Standard precautions such as environmental controls, hand and surface
cleaning & disinfecting medical devices, significantly reduce the risk of
contaminating Key-Parts and Key-Sites. They are applied before, during and
after clinical procedures
Safeguard 2
Identification of Key-Parts & Key-Sites
Key-Parts are the parts of the procedure equipment that if contaminated are
most likely to cause infection. Key-Sites include open wounds, medical device
insertion sites & body
orifices
Safeguard 3
Non-Touch Technique
Non-touch technique is a fundamental clinical skill that protects Key-Parts &
Key-Sites from microbial contamination
Safeguard 4
Aseptic Field Management
Aseptic Fields provide important environmental and touch protection of Key-Parts
and Key- Sites. Surgical-ANTT and Standard-ANTT require different types of
Fig 5.
www.antt.org
15
Principle 1
ANTT addresses such ambiguity with a clear
A ‘microbial mindset’ principle that the aim of clinical practice is always
Harmful microorganisms are ever-present in and unambiguously asepsis, regardless of setting.
all care settings and their control lies at the Why the aim is ‘asepsis’ and not ‘sterile’ is outlined
heart of effective ANTT and patient safety below with a brief look at some of the common terms
used in practice.
It is essential to patient safety that practitioners have a
clear understanding of the ever-presence of harmful
microorganisms in all care settings and how they are
‘Clean’ / Clean Technique
transferred, often inadvertently by the practitioner
themselves. Failure to appreciate this, will likely result Typically defined as meaning, ‘Free from marks and
in failed ANTT and patient infection, as the natural and stains’. This is perhaps effective for washing dishes,
dynamic microbiological environment in which any but for aseptic practice it is flawed. A visual term isn’t
invasive procedure is undertaken, plays a central role in useful when managing invisible microorganisms. The
the risk of healthcare associated infection. term clean used to describe the process or aim of
aseptic practice has caused significant confusion and
It is imperative that healthcare organisaitons and all should be avoided; any lesser aim than asepsis for
stakeholder groups find ways to educate, encourage and invasive clinical procedures and maintenance of
motivate practitioners to have a ‘microbial mindset’ invasive medical devices is unsafe, and is ethically
when preparing and performing aseptic procedures. and legally problematic for healthcare organisations.
‘Sterile’ - Sterile Technique

Principle 2
Typically defined as meaning, ‘Free from ALL living
Asepsis is the practice aim for all invasive microorganisms’ (APIC 2009). Because of the
clinical procedures and maintenance of presence of microorganisms in the air, it is by
indwelling clinical devices in all care settings definition impossible to achieve a ‘sterile technique’
(‘From surgery to community care’). or maintain a ‘sterile field’ in typical healthcare
settings. So in practice, while aseptic procedures use
sterile equipment, it needs to be understood that once
It is important to note that the aim of asepsis is for ALL
open to air, equipment is immediately rendered aseptic
clinical procedures from major surgery in hospitals to
– at best.
care in community settings.
Historically, a multitude of terms have been used to

describe technique for aseptic practice and have been ‘Asepsis’ / Aseptic Technique
used subjectively and interchangeably (Rowley et al
2010). It has become ambiguous in the literature and in The term ‘asepsis’ or ‘aseptic’ is typically defined as
clinical practice whether these terms are being used to meaning, ‘Free from HARMFUL microorganisms’
describe the aim, or the process of practice, or both. (Merriam-Webster, 2010). ‘The process for keeping
This isn’t just for pendants. A healthcare worker, or away disease producing microorganisms’ (APIC
worse, a workforce, that considers a so-called ‘clean’ 2009). It can be seen that by common definition,
technique doesn’t require an aseptic aim is mistaken ANTT’s aim of asepsis is safe and importantly is
and puts patients at risk. The origins of the term ‘clean achievable.
technique’ simply reflected that some simple aseptic
procedures could be performed safely with a much When originating the ANTT Framework, the new and
simpler process than the so-called ‘sterile’ technique. rationalized term Aseptic Non Touch Technique was
What became lost, is that the aim remains the same designed to reflect the aim of asepsis and the
regardless of the process. Similarly, it has been well fundamental importance of non-touch technique in
documented that some practitioners don’t consider it achieving it.
achievable to achieve asepsis in some community home
settings (Hallett 2000).
Principle 3
Key-Part & Key-Site Protection Surgical-ANTT
Asepsis is achieved by ‘Protecting Key-Parts
Surgical-ANTT is typically required when invasive
& Key-Sites from microorganisms in the clinical procedures meet one or more of the following
immediate procedure environment & from criteria: They involve large or numerous Key-Parts,
the healthcare worker. ‘Aseptic Key-Parts are significantly invasive (e.g., Large Key-Sites(s) or
must only come into contact with other central venous access), are technically complex to
aseptic Key-Parts, or Key-Sites’. achieve asepsis or involve extended procedure time
(approximately >20 minutes).
A fundamental principle of ANTT is that equipment
‘Key- Parts’ and body ‘Key-Sites’ require protecting
from harmful microorganisms during invasive clinical
procedures or the maintenance of invasive medical
devices. In ANTT, this is uniquely termed Key-Part
and Key-Site Protection. The Key-Part and Key-Site
Rule is simple and effective, ‘Aseptic Key-Parts must
only come into contact with other aseptic Key-Parts, or
Key-Sites’. They must be protected at all times during
the procedure from the three routes of contamination: Standard-ANTT
touch contact from the healthcare worker, touch contact
with any other object or surface and where practically Pic 3. For Surgical-ANTT, all procedure Key-Parts are protected
possible, from airborne contamination. ‘collectively’ on one or more large sterile drapes. (Critical Aseptic Fields).
Principle 4 Standard-ANTT
There are two types of ANTT Standard-ANTT is the technique of choice when
procedures meet all or most of the following criteria:
ANTT needs to be efficient as well as safe; They involve few and small Key-Parts, are not
therefore Surgical-ANTT is used for significantly invasive, are technically uncomplicated
complicated procedures where Key-Parts are to achieve asepsis and are short in duration
protected collectively, and Standard-ANTT (approximately <20 minutes).
for uncomplicated procedures where Key-
Parts are protected individually.
Different clinical procedures present different levels of

complexity. Therefore, in order to be efficient as well as
safe, the ANTT Framework defines what type of
infection prevention precautions and actions are
required for both simple and complex procedures, and
how to decide between the two approaches (Principle 4).
Standard-ANTT is used for technically uncomplicated
procedures and Surgical-ANTT for complicated
procedures. It is important to note that whilst the two
approaches have very different ways of protecting Key- Pic 4. For Standard-ANTT, all procedure Key-Parts are protected
Parts they still have exactly the same aim of asepsis. ‘individually’ by sterile caps, covers and the inside of recently opened
sterile packaging. (Micro Critical Aseptic Fields
www.antt.org
17
Principle 5
Selection of Surgical-ANTT or Standard- Historically, risk assessment for aseptic technique has
ANTT is determined by ANTT Risk been confused by subjective and ambiguous criteria
such as the patients’ age or diagnosis. Contrastingly,
Assessment - based on the technical ANTT Risk Assessment is based upon the technical
difficulty of achieving asepsis. difficulty of protecting Key-Part and Key-Sites for any
given procedure (Figure 6).
It is essential that practitioners are trained how to assess
the risk of procedure contamination in order to
determine selection of Standard-ANTT or Surgical-
ANTT.
ANTT Risk Assessment

To determine Standard or Surgical-ANTT Then ask… Standard-ANTT
for any given procedure consider
Yes
the risks of contamination posed by: ‘Is it technically simple
to perform this
 The procedure environment
No
Surgical-ANTT
 Procedure invasiveness procedure without
 Number & size of Key-Parts & Key-Sites touching the Key-
 Operator competency Parts?
 Procedure duration
Fig
“transmission based precautions” (TBP) may6. be
required when caring for patients with known /
suspected infection or colonisation (NHS England
2023).
Safeguard 1
Applied before, during and after clinical Other personal protective equipment
procedures*. Standard Infection Control (PPE)
Precautions such as environmental The requirement for Standard Infection Control
management and hand and surface cleaning Precautions (SICP) during aseptic procedures is
contingent upon the risks of the healthcare worker
significantly reduce the risk of being exposed to parenteral, mucous membrane, and
contaminating Key-Parts and Key-Sites nonintact skin exposures of health-care workers to
during aseptic procedures. bloodborne pathogens. This is either determined by
risk assessment or local policy or both (NHS England
The healthcare worker can significantly reduce the risks 2023).
that the procedure environment and they themselves
pose to the patient by routinely employing standard
infective precautions.
Glove use
Clinical gloves are single use items (NHS England
2023). Sterilized gloves are mandatory for Surgical-
Hand cleaning ANTT. Non- sterilized gloves are used for Standard-
Effective hand cleaning performed at the correct time is ANTT when the procedure, local policy or health &
an essential safeguard of safe aseptic technique. For safety legislation requires them (e.g., CoSHH 2024).
Standard-ANTT, hand cleaning should reflect the When practicing ANTT, it may occasionally be
sequenced techniques set out by the WHO (2009) necessary to touch a Key- Part or Key-Site directly (e.g.,
re-palpation during peripheral venous cannulation). In
*Standard infection control precautions may be such an event, sterilized gloves would be introduced to
insufficient to prevent cross transmission of specific minimize the risk of touch contamination at this point
infectious agents and additional precautions called (Rowley et al 2010).
www.antt.org
18
Maximal Barrier Precautions Key-Parts are those parts of the procedure equipment
Maximal barrier precautions (MBP), including clothing that if contaminated significantly increase the risk of
and other specialised PPE, should be employed for patient contamination and infection.
particularly invasive procedures such as central line
insertion or other surgery (Loveday et al 2014).
Typically, MBPs are in addition to Critical Management
demanded by Surgical-ANTT and are designed to Safeguard 3
provide heightened protection during particularly
invasive clinical procedures. Non-touch technique is a fundamental
clinical skill that protects Key-Parts &
Managing the immediate procedure Key Sites microbial contamination.
environment The safest way to protect a procedure Key-Part from
Prior to undertaking aseptic procedures, practitioners microorganisms is not to touch it with anything other
must take steps to limit the immediate environmental than other aseptic Key-Parts or Key-Sites. Therefore,
risks. Surfaces used for the procedure or near to the non-touch technique is a simple but fundamental and
procedure should be disinfected. There is increasing critical clinical skill.
acknowledgement of the airborne transmission of
bacteria such as staph aureus, MRSA and even Because Standard-ANTT involves wearing non-
clostridium-difficile (Dalton 2020, Suleyman 2018, sterilized gloves or no gloves at all, non-touch
Anderson 2017). The risks of airborne contamination technique is mandatory. Due to procedure complexity,
can be reduced by ensuring activities such as bed it is not possible to utilize non-touch technique at all
making and commode usage are suspended prior to times using Surgical-ANTT. However, because sterile
aseptic procedures. gloves can be contaminated inadvertently, the
safeguard of non-touch technique is still applied when
it is practical to do so.
Safeguard 2
Identification of Key-Parts and Key-Sites: Safeguard 4

Key- Parts are the parts of the procedure Aseptic fields provide important environmental
equipment that if contaminated are most and touch protection of Key-Parts and Key-
likely to cause infection. Key-Sites include Sites. Surgical-ANTT and Standard-ANTT
open wounds, medical device insertion sites require different aseptic field management
and body orifices.
Aseptic fields have a particularly important role in
protecting Key-Parts and Key-Sites from inadvertent
It is an essential component of ANTT education and
touch and environmental contamination during aseptic
training that practitioners can identify Key-Parts and
procedures. For flexibility, ANTT employs three types
Key-Sites.
of aseptic field that require different management,
depending on whether their primary purpose is to
Key-Sites are any ‘portal of entry’ for microorganisms,
ensure or more simply promote asepsis. (pic. 5-7).
including open wounds, insertion and puncture sites,
and, not withstanding natural structures of protection,
some body orifices in certain circumstances – such as
dentistry.
www.antt.org
19
Critical Aseptic Field
Critical Aseptic Fields (sterile drapes) are utilized for
more complex procedures that require Key-Parts to be
protected ‘collectively’ using Surgical-ANTT. Their
aim is to help ‘ensure’ asepsis of procedure Key-
Parts. Only sterile equipment can be placed onto a
Critical Aseptic Field and the healthcare worker will
wear sterile gloves (pic 5).
Pic 5.
Micro Critical Aseptic

Fields Micro Critical Aseptic Fields are very simply small
Critical Aseptic Fields. They have the aim of
‘ensuring’ asepsis of Key-Parts and they include
sterile caps, covers, and the inside of recently opened
sterile packaging. Despite being very much smaller,
they provide the same level of protection as a Critical
Aseptic Field, and in addition packaging elements
(tear-open wrapper) can help protect Key-Parts from
airborne contamination too (e.g., pic 6).
Pic 6.
General Aseptic Fields

General Aseptic Fields are procedure trays and
disinfected working surfaces. It is important to note
that General Aseptic Fields are only used to ‘promote’
asepsis. Key-Parts placed on or within them are
primarily protected by Micro Critical Aseptic Fields
such as sterile caps and covers (pic 7).
Pic 7.
It is important that whatever type of aseptic field is employed, it must be fit for purpose and managed appropriately. In
particular, procedure trays should be large enough and have high enough sides to provide a safe working space and
contain equipment, sharps and spillages. Plastic and metal procedure trays must be disinfected according to local
policy prior to, and after use. Pulp trays must also be of appropriate size and stored safely as they cannot be cleaned.
ANTT Type
Aseptic field type Aseptic field purpose
Surgical-ANTT Critical Aseptic Field. Ensure asepsis of Key-Parts

(Sterile drapes)
Micro Critical Aseptic Fields Ensure asepsis of Key-Parts
(optional)
Standard-ANTT General Aseptic Field. Promote asepsis of Key-Parts

(Procedure tray)
Micro Critical Aseptic Fields Ensure asepsis of Key-Parts
www.antt.org
20
An overview of Standard-ANTT and Surgical-ANTT – showing the similarities and the differences between the
two techniques.
ANTT Risk
Can the procedure beAssessment
performed easily
without
touching Key-Parts & Key-
Ye Sites? N
Standard-ANTT Surgical-ANTT
s Environmental Management o
- Environmental risks removed or avoided
- Environmental risks removed or avoided
- Working areas/surfaces are disinfected
- Work surfaces are cleaned or disinfected
- Staff activity is controlled
Decontamination & Protection

- Hand cleaning - Hand decontamination or surgical hand scrub
- Non-sterilized gloves or no gloves - Sterilized gloves
- Personal protective equipment (PPE) - Personal protective equipment (PPE)
- Disinfecting IV hubs etc. - Sterilized gown if full barrier precautions
Aseptic Fields
Key-Parts are protected INDIVIDUALLY Key-Parts are protected
with Micro Critical Aseptic Fields COLLECTIVELY within a large Critical
(Sterile caps, inside of packaging etc.) Aseptic Field (Sterile Drape)
Micro Critical Aseptic Fields are contained in a Only sterilized equipment must be
General Aseptic Field placed on a Critical Aseptic Field, sterilized
(Disinfected or disposable tray) gloves are required to maintain asepsis
Non-Touch Technique
Non-Touch
(Rowley Technique is essential
& Clare Non-Touch Technique is desirable
2023) Fig 7.
www.antt.org
Prevent Cross Infection
www.antt.org
21
The process of practicing ANTT
Not withstanding the importance of flexibility when the situation demands it, the process of applying ANTT to any
invasive clinical procedure, or maintenance of indwelling medical devices is largely a linear process, where the order
or sequence of actions is important to the achieving and maintenance of asepsis. This is illustrated below in condensed
examples of Standard-ANTT and Surgical-ANTT being practiced.
Applying the process of Standard-ANTT to clinical practice:
Preparing and administering an intravenous medication: Brief overview
Reducing the risks from the environment & Gather equipment - Hand Clean Prepare equipment
self: Includes: - Gloves if clinically - Using non-touch
- Hand Cleaning or policy indicated technique and Micro
- Surface Cleaning Critical Aseptic Fields
(caps and covers) to
protect Key-Parts
Preventing cross infection

- Dispose of sharps safely
‘Scrub the IV hub’ Administer medications - Remove gloves & immediately clean hands
- Use a disinfection wipe - Using non-touch - Clean procedure tray and clean hands
as per local policy technique to protect (Fig.8
Key-Parts )
How the underlying Standard-ANTT theory supports effective practice
 Standard-ANTT was determined by ANTT Risk Assessment; based on the procedure being short in
duration (<15 mins) and relatively simple to establish and maintain asepsis, involving the protection of
a small number of small Key-Parts (Principle 5).
 Hands were cleaned to reduce microbial contamination before commencing the preparation and before
assembling the equipment (Safegard 1).
 Non-sterile gloves were applied in accordance with National Health & Safety Guidelines (Such as
CoSHH) for the intravenous medications administered (Local policy dictates).
 The procedure tray was disinfected to reduce microbial contamination (Safeguard 1, 4 & Principle 1)
and once dry established a General Aseptic Field, used to promote but not ensure asepsis.
 Handswere re-cleaned after gathering equipment due to the touching of common microbial loaded
‘touch points’ such as cupbard handles and storage boxes (Principle 1 & Safeguard 1).
www.antt.org
22
 One by one, equipment was assembled using non-touch technique (Safeguard3). Unless being used
immediately, Key-Parts were protected immediately by Micro Critical Aseptic Fields, such as sterile
caps or the inside of recently opened sterile packaging, and placed into the tray (Safeguard4). All Key-
Parts were managed ‘individually’ (Principle 3).
 Even though the healthcare worker has more aseptic fields to manage than in Surgical-ANTT, aseptic
practice is actually simplified.
 In this example, the healthcare worker was working at the patient’s bedside and was able to proceed
directly from preparation to administration.
 A suitably large disinfection wipe was opened fully and non-touch technique used to place the hub tip
into the centre of one side of the wipe, with the healthcare worker’s hand on the other side. With the
aim of asepsis still very much in mind (Principle 1), the tip was then scrubbed hard creating friction for
15 seconds.
 Once the IV hub was dry, the two Key-Parts (syringe tip and IV hub) were connected together using
non- touch technique (Principle 1 & Safeguard 4).
 Once completed, and mindful of the risks of cross infection, the healthcare worker, disposed of the
equipment safely, removed gloves and immediately cleaned their hands to prevent cross infection. The
procedure tray was cleaned and stored appropriately and hands were re-cleaned (Principle 1).
Applying the process of Surgical-ANTT to clinical practice:

A complex wound procedure: Brief overview
Reducing the risks from the environment &

self: Includes: Gather equipment
- Hand Clean Prepare equipment
- Hand Cleaning
- PPE as clinically - Using non-touch
- Surface Cleaning technique. Key-Parts are
or policy indicated;
sterile gloves used primarily protected on a
to ensure asepsis Critical Aseptic Field
Preventing cross infection

- Dispose of waste safely
- Remove gloves / PPE & immediately clean hands
- Clean procedure trolley and clean hands
The existing dressing is Following dressing New sterile dressing
carefully removed using disposal, glove removal, applied using non-touch
non-touch technique & and hand cleaning, sterile technique
non-sterile gloves if gloves are put on and (Fig.9)
indicated wound site care
performed
www.antt.org
23
How the underlying Surgical-ANTT theory supports effective practice
 Due to the above procedure being relatively long in duration (>15 mins) and quite complex to establish
and maintain asepsis, due to the need to protect a large open wound (Key-Site) and a number of Key-
Parts, ANTT Risk Assessment determined the user use Surgical-ANTT (Principle 5).
 Hands were cleaned to reduce microbial contamination (Safegard 1).
 Any preparation surfaces and the procedure trolley was disinfected to reduce microbial contamination
(Safeguard 1 & Principle 1).
 Hand were re-cleaned after gathering equipment due to the touching of common microbial loaded
‘touch points’ such as cupbard handles and storage boxes (Principle 1 & Safeguard 1).
 Once the sterile drape was opened and exposed to air it was no longer sterile and became a Critical
Aseptic Field. Additional items of equipment were then carefully dropped onto the drape using non-
touch technique (Safeguard 3) and are all managed ‘collectively’ (Safeguard 4).
 Non-touch technique was used to open and place equipment on the Critical Aseptic Field in order to
prevent microbial contamination (Safeguard 3 & Safeguard 4).
 Removing a dressing may involve the mobilisation of harmful microorganisms. Therefore, it was
removed carefully with non-sterile gloves as the old dressing was blood stained. Most importantly, once
the ‘dirty’ component of the procedure was complete and all waste safely disposed of, hands were re-
cleaned in order to re-establish and maintain procedure asepsis (Principle 1).
 Non-touch technique was used to apply the new sterilized dressing in order to microbial contamination.
(Principle 1 & Safeguard 3).
 At the end of the procedure, all waste was disposed of and equipment was disinfected. Hands were
cleaned immediately after removing gloves to prevent risk of cross infection (Principle 1).
The Clinical Governance of ANTT robust approach has more recently been encouraged by
Clinical Governance has been defined as, ‘The ANTT Accreditation, a voluntary participation in a
framework through which healthcare organisations are structured programme of assessment, evaluation and
accountable for continuously improving the quality of peer-review. The ANTT Accreditation Programme can
their services and safeguarding high quality of care’. also be used as criteria or a benchmark for regulators to
(NHS 1999). Fig 3 on page 11 outlined the problems assess a healthcare organisations adherence to
inhibiting aseptic technique and organisational factors requirements for aseptic technique, such as those set out
essential to support aseptic practice. These include safe in the 2008 Health and Social Care Act (DH 2024) in
staffing levels, appropriate medical supplies and clean England and Wales, and similarly internationally.
ergonomically organised clinical environments.
The positive effect that the ANTT Framework can
This fact that effective aseptic practice requires a have on the organisational clinical governance of
number of pre-requsities to be in place is generally aseptic technique was demonstrated in a near
under appreciated and underinvested in, especially a exhaustive survey of NHS Trusts in England. Trusts
lack of mandated training and competency assessment (Large health care organisations) that used ANTT as
for aseptic practice. their single standard for aseptic technique,
demonstrated a higher incidence of having the
To help support care organisations, ANTT provides a components of clinical governance in place than NHS
multi-model approach to Clinical Governance including Trusts that did not (Rowley & Clare 2020). This was a
education, training, competency assessment and notable finding because the effective Clinical
auditing of practice standards. This comprehensive and Governance of ANTT is as important to patient safety
as the effectiveness of the practice itself.
Fig.10 Organisations that

used ANTT as a single-
standard, were more
likely to have Clinical
Governance in place to
support aseptic practice.
www.antt.org
24
The advantages for patient safety in having a single, Given the high potential for infection and patient harm
universal standard for CPR are highlighted on page 12. from ineffective aseptic technique, it is imperative that
CPR is typically supported by effective clinical healthcare organisations are ‘Concerned’ with
governance including mandatory training and practice standards. This concern is most likely to be
competency assessment. Organisations may wish to informed by effective monitoring of practice standards
consider the potential for significant improvements in and infection surveillance. Without suitable infection
patient safety and in cost savings if ANTT was afforded surveillance, morbidity and mortality as a result of
a similar level of clinical governance. poor aseptic technique can, and likely will, continue
Recommendations from the Association for Safe ‘invisibly’ to the higher organization that are best
Aseptic Practice for the pre-requisite elements of positioned to do something about it. Infection
Clinical Governance to support safe aseptic practice surveillance is more challenging in some clinical
with ANTT are provided below. settings such as home and community settings, but is
nevertheless important for patient safety.
The ‘4 C’s’ To successfully influence and support aseptic

technique across what are often large clinical
From working with many different types of healthcare workforces, healthcare organisations need to provide
organisations internationally, the Association identified ‘Clarity’ in aseptic practice. The ANTT Practice
four factors in particular that can be viewed as ‘success Framework provides this clarity by providing the
indicators’ for those organisations that are providing foundation for local policy, education, practice and
effective clinical governance of ANTT, or as factors to research. This clarity is further enhanced by ANTT’s
work towards for those organisations that are not. These widespread adoption internationally, facilitating
factors can be summarized as ‘the 4 C’s’(figure 11), and practitioners to have meaningful conversation about
are pre-requisite to the safe clinical governance of aseptic practices externally as well as locally.
ANTT, and aimed to be useful for organisations seeking
improvements in aseptic practice and for health care Just like any other important clinical ‘Competency,’
regulators. This is a provided as a conceptual model and ANTT requires staff to be assessed clinically. ANTT
Competency Assessment has been found to be most
effective when assessment combines both observation
of clinical practice and questioning of ANTT theory
and practice terminology as its being applied to
practice.
Only when these three pre-requisites to effective

aseptic technique are in place can an organization
realistically hope to address ‘Compliance’.
Compliance to ANTT is best achieved through a
multi-modal approach of education, competency
assessment and monitoring of practice standards
though periodic audit. The Association define
compliance to ANTT as there existing a, ‘High level
Fig. 11 of assurance that patients receive all of the
not an exhaustive list. The more practical components of ANTT on each and every occasion of
elements for effective clinical governance of ANTT are aseptic practice’.
provided in the Clinical Goverance Recommendations
section (page 26).
Recommendations internationally. The CDC (2017) noted published
reports over four decades demonstrating that
The recommendations below are provided by the standardized aseptic practice helped reduce risks of
Association for Safe Aseptic Practice to help infection. Where no such standardisation exists, the
healthcare organisations provide effective Clinical adverse effects on HCAI are well documented (DH
Governance for aseptic practice with ANTT: 2003). The widespread adoption of ANTT as an
international standard helps standardize the
education, clinical practice, clinical governance and
ANTT Clinical research of aseptic practice. In addition, ANTT’s
Governance already wide adoption provides a common and
increasingly universal practice language. Not least,
Recommendation 1 this is helping facilitate more meaningful discussion
Practitioners should receive between practitioners, healthcare organisations and
appropriate education, training and industry about important issues of aseptic practice,
competency assessment and provides opportunities for shared learning and
practice development. Standardisation of aseptic
During invasive clinical procedures and maintenance practice with ANTT, has reduced variability in
of indwelling medical devices, patients are dependent clinical practice, raised standards of practice and
upon the practitioner to protect them from the subsequently helped reduce HCAI (Clare & Rowley
inherent risks of procedure contamination, 2018, Pike et al 2009, Rowley & Clare 2009).
subsequent potential infection and patient harm.
Given the inadvertent role practitioners have in “The consistent and correct use of ANTT
microbial transference within care settings, it could will maximise the incorporation of best
be viewed that the biggest risk to the patient is the evidence of effectiveness into infection
practitioner performing the procedure: Therefore, all prevention and control practice which will
practitioners involved in aseptic procedures should enhance patient safety” (Professor Pratt 2010)
receive education, training and competency
assessment in ANTT. It is essential that practitioners Standardised practice can be supported by
fully understand the risks of infection during the using ANTT Procedure Guidelines – see page
preparation and delivery of invasive procedures and 28.
how to mitigate them with effective ANTT. This
knowledge and clinical competence should be
demonstrable in clinical practice. ANTT Clinical
Governance
ANTT Clinical Recommendation 4
Governance ANTT should be a mandatory
Recommendation 2 clinical competency
Practitioners should have access to fit-for-
purpose equipment and medical supplies Patient safety during invasive clinical procedures is
so reliant on the clinical competency of ANTT that
Healthcare organisations must ensure that staff have education and training should be mandatory and
access to fit-for-purpose medical equipment and refreshed periodically. The frequency of review
supplies when performing ANTT. This is more should be based and evidenced by (at least) yearly
challenging in some care settings. For example, in audit of ANTT standards. A minimum 3-yearly cycle
the homecare setting, practitioners often need to of competency review is recommended.
travel to and between patients homes with medical
supplies or arrange home storage. Therefore, such
logistics and subsequent planning are an important
consideration in ensuring safe aseptic practice.
ANTT Clinical
Governance
Recommendation 3
Aseptic technique should be standardized with
ANTT
Aseptic technique should be standardized across,
and between, healthcare organisations
ANTT® Clinical Practice Framework. Version 6.0 Copyright © 2024 The Association for Safe Aseptic Practice (The-ASAP) www.antt.org 26
ANTT Clinical
Governance The ANTT audit cycle and the process of ANTT
Implementation is supported by the Association
Recommendation 5 with a bundle of free educational, audit and
Clinical preparation areas for aseptic procedures competency assessment resources. A free ANTT
should be designed & managed to promote asepsis Implementation Guide is also available on request
or direct via the ANTT website.
It is imperative that aseptic procedures are prepared in
clinical areas or spaces that are conducive to ANTT Educational Governance
environmental controls and the adoption of standard
precautions. This includes appropriately sized working In line with increasingly rigorous
surfaces that are easily cleanable, protected storage of recommendations for the design of clinical
equipment and medical supplies that are out of the ‘splash guidelines (NICE 2012), The-ASAP has long used
zone’ of hand washing sinks, and have medical supplies an education governance model to promote and
easily at hand, laid out ergonomically in order to promote ensure high quality guidance based upon the best
an uninterrupted aseptic workflow. available evidence. The-ASAP uses a methodology
that draws upon the GRADE structure
(Schunemann et al 2023) and the NICE Guidelines
Manual (NICE 2014). ANTT resources have a
x
reputation for simplicity and usability by a wide
range of clinical staff and The- ASAP recognises
that good governance is a vital component of
continuing to provide good quality resources for
staff in both the public and private sectors.
Periodic involvement with patient organisations
has added critical perspectives to our guidance, and
increased patient involvement is a priority moving
forward.
�
�
Pic
8.
ANTT Clinical Governance Fig. 12
Recommendation 6 The wide-scale adoption of ANTT internationally has

ANTT should be implemented as an audit led to healthcare organisations in other counties
cycle carrying out their own validation of our resources;
moreover, in the UK the design and development of
ANTT Procedure Guidelines has helped in the
Just like any other important clinical competency,
development of a large and diverse peer review group
ANTT needs to be first implemented effectively
of healthcare professionals. Indeed, this new update to
and maintained continuously. The ANTT Audit
the Framework was circulated to clinical experts and
Cycle provides a simple but useful structure for
over 200 trained healthcare professionals of all
achieving this.
disciplines and care settings prior to final publication.
Change management is a complex and challenging
endeavor for healthcare organisations. ANTT
recognises this, and ANTT implementation is
designed to be as simple and straightforward as
possible with the steps outlined in figure 12. It has
been shown that implementation is more likely to
be effective across an organization when there is
active support from executive leadership such as
the CEO or Chief Nurse (Rowley & Clare 2009).
ANTT Clinical Procedure Guidelines
First and foremost, practitioners need to be able to From a clinical governance perspective, they provide
understand and apply the ANTT practice principles and healthcare organisations with a method to set out a clear
safeguards to practice safely and efficiently. A well expectancy of practice, ensure specific equipment and
trained and assessed practitioner of ANTT will be able
medical supplies are used for specific procedures,
to apply these principles to any procedure in any setting.
incorporate evidence-based practice and international
Effective, standardized aseptic practice, can be further infection prevention guidance and a method to help
supported by using ANTT Procedure Guidelines to help monitor performance.
‘prescribe out’ variability. These simple visual guidelines
‘translate’ ANTT Principles and Safeguards into process
via simple practice prompts which are displayed in ANTT Procedure Guidelines are used very widely
clinical areas. internationally and are available in various languages for
acute and primary care settings. Practitioners and
Although very much simpler than typical NICE organisations are encouraged to create local guidelines
Guidelines, ANTT Procedure Guidelines are formulated for niche procedures, a process the Association
and maintained according to the principles set out by supports.
NICE for guideline developent (NICE 2014); This
includes them being designed by experts in each core
competency and periodically peer-reviewed
internationally. The actions in each guideline are risk
evaluated and sequenced to ensure an efficient, logical
and safe order.
ANTT Procedure Guidelines

are available freely from
[email protected]
For latest version control see:

https://www.antt.org/antt-procedure-guidelines.html
28
Appendix 1
Effective hand cleaning technique: For soap and water & alcohol solution
(WHO, 2009)
ANTT® Clinical Practice Framework. Version 6.0 Copyright © 2024 The Association for Safe Aseptic Practice (The-ASAP) www.antt.org 29
Appendix 2
The 5-Moments for Hand Hygiene. World Health Organization (2009)

ANTT is intended to complement the ‘5-Moments for Hand Hygiene’ by providing comprehensive instruction for
aseptic technique during invasive clinical procedures (Step 2). The ‘5-Moments for Hand Hygiene’ complements
ANTT by supporting the reduction of microorganism transference in the clinical environment during everyday
healthcare activity, hence leading to less chance of patient contamination during invasive clinical procedures.
Printed with kind permission of the Word Health Organisaiton
www.antt.org
2
Appendices
Appendix 3
Examples of risk factors and decision making in selecting Standard-ANTT or Surgical-ANTT.
(Not intended to be prescriptive or exhaustive).
Procedure ANTT Environment Decontaminate / Aseptic Field Non-Touch
Risks type Management Protection (PPE) Management Technique
 Few Key-Parts  Remove or  Hand cleaning  Micro Critical  Non-touch

Peripheral
 Moderately avoid any  Non-sterilized Aseptic Fields technique is
Cannulation invasive. environmental gloves  Supported by a essential
 Small Key-Parts Standard risks  Tray cleaning for General
 Single small ANTT General Aseptic Aseptic Field
Key-Site Field
Central  Many Key-Parts  Remove or  Surgical hand-  Critical Aseptic  Non-touch

 Highly invasive avoid any scrub Field technique is
venous
 Large Key-Part environmental  Sterilized gloves  Micro Critical desirable
line Surgical risks  Other full barrier Aseptic Fields where
 High activity
insertion environment ANTT precautions where practical practical
 Large procedure e.g. Handling of
area PICC line
Intravenous  Few Key-Parts  Remove or  Hand cleaning  Key-Parts  Non-touch

 Small Key-Parts avoid any Non-sterilized protected by technique is
medication Standard gloves & apron Micro Critical essential
 Moderately environmental
preparation & invasive ANTT  Tray cleaning for Aseptic Fields
risks
administration procedure General Aseptic  Supported by a
Field General
Aseptic Field
 Multiple Key-  Remove or  Hand cleaning  Critical Aseptic  Non-touch

Parts avoid any  Non-sterilized or Field technique is
Complex  Large Key-Site Surgical environmental sterilized gloves desirable
wound ANTT risks as required where
 Irrigation or practical
care dressing
soaking
performed with
aseptic
receptacle
 Minimall  Remove or  Hand cleaning  Key-Parts  Non-touch

y invasive avoid any  Non-sterilized protected by technique is
Venepuncture  Few Key-Parts Standard environmental gloves & apron Micro Critical essential
 Small Key-Parts ANTT risks  Tray cleaning for Aseptic Fields
General Aseptic  Supported by a
Field General
Aseptic Field
 Multiple Key-  Full Theatre  Surgical scrub  Critical Aseptic  Scrub nurse
Parts Room  Sterilized gowns Field  Non-touch
 Large Key- Surgical Precautions & gloves technique is
Complex Parts ANTT  Full barrier still desirable
surgical  Large Key-Site precautions where
procedures  Long duration practical
 Highly invasive
 Controlled area
but many
personnel
www.antt.org
3
References
related infections. Available at:
https://www.cdc.gov/infectioncontrol/guidelines/bsi/index
Ahmadipour, M., Dehghan, M., Ahmadinejad, M.,
.html. Accessed: 22.01.2024.
Jabarpour, M., Mangolian, Shahrbabaki, P., Ebrahimi, Rigi
Z. (2022) Barriers to hand hygiene compliance in intensive
Centers for Disease Control and Prevention [CDC] (2022)
care units during the COVID-19 pandemic: A qualitative
National Center for Emerging and Zoonotic Infectious
study. Front Public Health. 10,3389. Available at:
Diseases (NCEZID), Division of Healthcare Quality
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9433968/
Promotion (DHQP). Available at:
pdf/fpubh-10-968231.pdf. Accessed: 22/01/2024.
https://www.cdc.gov/policy/polaris/healthtopics/hai/index.
html#:~:text=On%20any%20given%20day%2C%201,occur
Anderson, D.J., Chen, L.F., Weber, D.J., Moehring, R.W.,
% 20in%20other%20healthcare
Lewis, S.S., Triplett, P.F., et al. (2017) Enhanced terminal
%20settings.Accessed:16/10/2 023.
room disinfection and acquisition and infection caused by
multidrug-resistant organisms and Clostridium difficile (the
Clare, S., Rowley, S. (2018) Implementing the Aseptic
Benefits of Enhanced Terminal Room Disinfection study):
Non Touch Technique (ANTT®) clinical practice
a cluster-randomised, multicentre, crossover study. The
framework for aseptic technique: a pragmatic evaluation
Lancet.389(10071),805–814.
using a mixed methods approach in two London hospitals.
Journal of Infection Prevention 19(1), 6-15.
APIC (2009) APIC text of infection control and
epidemiology 3rd edition. Volume 1 Essential Elements.
CoSHH (2024) The Control of Substances Hazardous to
ISBN 1-933013- 44-3 APIC Publishing. Washington DC.
Health Regulations 2002 (as amended) Approved Code of
Practice and guidance. (2013) 6th edition. Health and Safety
Al-Azzawi, B., Lambert, E. (2021) Using interactive
Executive. Available at:
study days to enable staff to appropriately manage
https://www.hse.gov.uk/pubns/books/l5.htm. (Accessed:
patients’ wounds. Wounds UK. 17(1). Available at:
22/01/2024).
https://wounds- uk.com/journal-articles/using-interactive-
study-days- enable-staff-appropriately-manage-patients-
Dalton, K.R., Rock, C., Carroll, K.C., Davis, M.F. (2020)
wounds/.
One Health in hospitals: how understanding the dynamics
Accessed: 22/01/2024.
of people, animals, and the hospital built-environment can
be used to better inform interventions for antimicrobial-
Aziz, A. M. (2009) Variations in aseptic technique and
resistant gram-positive infections. Antimicrob Resist Infect
implications for infection control. British Journal of
Control. 9(1),78.
Nursing 18(1),26–31.
Denton, A., Hallam, C. (2020) Principles of asepsis
Barton, A., Bitmead, J., Clare, S., Daniels, R., Gregory,
1: the rationale for using aseptic technique. Nursing
B., Lee, P., Leitch, A., McDonald, C. (2022) How to
Times [online]. 116,38-41.
improve aseptic technique to reduce bloodstream infection
during vascular access procedures. British Journal of
DH (2022) Health and Care Act 2022. Available at:
Nursing.
https://www.legislation.gov.uk/ukpga/2022/31/section/1.
31(17) [Oncology Supplement]. Accessed: 25/01/2024.
Beaumont, K., Wyland, M., Lee, D. (2016) A multi- DH (2003) Winning Ways Working together to reduce
disciplinary approach to ANTT implementation: What Healthcare Associated Infection in England Report from the
you can achieve in 6 months. Infection, Disease & Health. Chief Medical Officer December 2003. Available at:
21(2),67-71. https://webarchive.nationalarchives.gov.uk/ukgwa/201301
07105354/http:/www.dh.gov.uk/prod_consum_dh/groups/
Boswell, T.C. and P.C. Fox PC. (2006) Reduction in MRSA dh_digitalassets/@dh/@en/documents/digitalasset/dh_40
environmental contamination with a portable HEPA- 64689.pdf. Accesses: 22/01/2024.
filtration unit. J Hosp Infect. 63(1),47-54.
DH (2024) Health and Social Care Act 2008. Available at:
Bree-Williams, F.J., Waterman, H. (1996) An examination https://www.legislation.gov.uk/ukpga/2008/14/contents.
of nurses’ practices Accessed: 22/01/2024.
when performing aseptic technique for wound dressings. J
Adv Nurs.23(1),48–54. European Centre for Disease Prevention and Control
[ECDC]. (2017). Surveillance of antimicrobial resistance
Brown, M. M. (2019) Don't be the "Fifth Guy": in Europe 2017. Available at:
Risk, Responsibility, and the Rhetoric of https://www.ecdc.europa.eu/en/publications-
Handwashing Campaigns. J Med Humanit. data/surveillance-antimicrobial-resistance-europe-2017.
40(2),211-224. Accessed: 22/01/2024.
Brühwasser, C., Hinterberger, G., Mutschlechner, W., FDA (2024) USC.21 Federal Food, Drug, and Cosmetic
Kaltseis, J., Lass-Flörl, C., Mayr, A. (2016) A point Act (FD&C Act). Available at:
prevalence survey on hand hygiene, with a special focus on https://www.fda.gov/regulatory- information/laws-
Candida species. Am J Infect Control. 44(1),71–73. enforced-fda/federal-food-drug-and- cosmetic-act-fdc-act.
Accessed: 25.01.2024.
Centers for Disease Control and Prevention [CDC]
(2017) Guidelines for the prevention of intravascular
catheter-
www.antt.org
4
Flores, A. (2008) Sterile versus non-sterile glove use
Hota, S., et al. (2009) Outbreak of multidrug-resistant
and aseptic technique. Nursing
Pseudomonas aeruginosa colonization and infection
Standard. 23(6),35–39.
secondary to imperfect intensive care unit room design.
Infect Control Hosp Epidemiol. 30(1),25-33.
Flynn, J., Keogh, S. J., Gavin, N. S. (2015) Sterile v aseptic
non-touch technique for needle-less connector care on
HSE (2022) Community Infection Prevention and Control
central venous access devices in a bone marrow transplant
Manual: A practical guide to implementing Standard and
population: A comparative study. European Journal of
Transmission-Based Precautions in Community Health
Oncology Nursing 19(6), 694-700.
and Social Care Settings. Available at:
http://hdl.handle.net/10147/631787. Accessed:
Fuller, C., Savage, J., Besser, S., et al. (2011) ‘The dirty
22/01/2024.
hand in the latex glove’: a study of hand hygiene
compliance when gloves are worn. Infect Control Hosp
HSE (2024) Control of Substances Hazardous to
Epidemiol.
Health (COSHH). Available at:
32(12),1194–1199. https://www.hse.gov.uk/coshh/. Accessed: 25/01/2024.
Gargiulo, D.A., Sheridan, J., Webster, C.S., et al. (2012) Johnson, A. (1988) Wound management: are you getting it
Anaesthetic drug administration as a potential contributor right? Prof Nurse.
to healthcare-associated infections: a prospective 3(8):306–309.
simulation-based evaluation of aseptic techniques in the
administration of anaesthetic drugs. BMJ Qual Saf. Khurana, S., Saini, S.S., Sundaram, V., Dutta, S., Kumar,
21(10),826-34. P. (2018) Reducing healthcare associated infections in
neonates by standardizing and improving compliance to
Garvey, M.I., Bradley, C.W, and Holden E. (2018) aseptic non-touch techniques: a quality improvement
Waterborne Pseudomonas aeruginosa transmission in a approach. Indian Pediatr. 55(9),748–752.
hematology unit? Am J Infect Control. 46(4),383-386.
Kingston, L., O’Connell, N.H., Dunne, C.P. (2016)
Garvey, M.I., et al., (2023) The sink splash zone. J Hosp Hand hygiene-related clinical trials reported since
Infect. 135,154-156. 2010: a systematic review. J Hosp Infect. 92(4),309–
320.
Gerçeker G.Ö., Sevgili, S.A., Yardımcı, F. (2018) Impact
of ﬂushing with aseptic non-touch technique using pre- Lavelle, J., Schast, A., Keren, R. (2015) Standardizing
filled ﬂush or manually prepared syringes on central care processes and improving quality using pathways and
venous catheter occlusion and bloodstream infections in continuous quality improvement. Current Treatment
pediatric hemato-oncology patients: A randomized Options in Pediatrics. 1(4),347–358.
controlled study. Eur J Oncol Nurs. 33:78-84. Loftus, R., et al. (2008) Transmission of pathogenic
bacterial organisms in the anaesthesia work area. The
Gilmour, D. (2000) Is the aseptic technique always American Society of Anesthesiologists. 109,399-407.
necessary? Journal of Community Nursing. 14(4),32-35.
Loftus RW, Dexter F, Goodheart MJ, Mcdonald M, Keech
Goodman, G.J., Liew, S., Callan, P., Hart, S. (2020) Facial J, Noiseux N, et al. (2020) The effect of improving basic
aesthetic injections in clinical practice: Pre-treatment and preventive measures in the perioperative arena on
posttreatment consensus recommendations to minimise Staphylococcus aureus transmission and surgical site
adverse outcomes. Australasian Journal of Dermatology. infections: a randomized clinical trial. JAMA Netw Open.
March. Available from: https://doi.org/10.1111/ajd.13273. 3(3),e201934.
Accessed: 22/01/2024.
Loveday, H,P., Wilson, J.A., Pratt, R.J., et al. (2014)
Gorski, L. A., Hadaway, L., Hagle, M., Broadhurst, D., Epic3: national evidence-based guidelines for preventing
Clare, S., Kleidon, T., Meyer, B., Nickel, B., Rowley, S., healthcare-associated infections in NHS hospitals in
Sharp, E., & Alexander, M.A. (2021). Infusion therapy England. J Hosp Infect. 86 Suppl. 1,S1-S70.
standards of practice. Journal of Infusion Nursing.
44(supl1). Megeus, V., et al. (2015) Hand hygiene and aseptic
techniques during routine anesthetic care - observations in
Guest, J.F., Keating, T., Gould, D., Wigglesworth, N. (2020) the operating room. Antimicrobial Resistance and Infection
Modelling the annual NHS costs and outcomes attributable Control. 4(1),5.
to healthcare-associated infections in England. BMJ Open.
10(1),e033367. Ministry of Health, Population and Hospital Reform,
Hallett, C.E. (2000) Infection control in wound care: a study People's Democratic Republic of Algeria (2019)
of fatalism in community nursing. J Clin Nurs. 9(1),103– PREVENTION OF INFECTIONS ASSOCIATED WITH
109. ACTS OF
CARE. General Directorate of Prevention and
Hoffmann M., Sendlhofer G., Pregartner G., Gombotz V., Health Promotion.
Tax C., Zierler R., Brunner G. (2019). Interventions to
increase hand hygiene compliance in a tertiary university Mitchell, B.G., Shaban, R.Z., MacBeth, D., Wood, C.J., Russo,
hospital over a period of 5 years: An iterative process of P. L. (2017) The burden of healthcare-associated infectio
information, training and feedback. Journal of Clinical
Nursing. 28,912–919.
www.antt.org
5
www.antt.org
6
in Australian hospitals: a systematic review of the literature. Infection, Disease & Health. 22(3):117-28.
Melville, S., Paulus, S. (2014) Impact of a central venous line care bundle on rates of central line associated blood stream infection
(CLABSI) in hospitalised children. J Infect Prev.
15(4),139-141.
Menezes, R.P., et al. (2022) Inanimate Surfaces and Air Contamination with Multidrug Resistant Species of Staphylococcus in the Neonatal
Intensive Care Unit Environment. Microorganisms. 10(3),567.
Merriam-Webster (2010) Merriam-Webster Online Dictionary: Aseptic. Available at: http://www.merriam- webster.com/dictionary/Aseptic.
Accessed: 22.01.2024.
Mouajou V., Adams K., DeLisle G., Quach C. (2022). Hand hygiene compliance in the prevention of hospital-acquired infections: A
systematic review. Journal of Hospital Infection. 119,33–48.
Murray et al 2022. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet.
399,629–55.
Mutalib, M., Evans, V., Hughes, A., Hill, S. (2015) Aseptic non touch technique and catheter related blood stream infection in children
receiving total parental nutrition at home. United European Gastroenterology Journal.
3(4),393-398.
National Health and Medical Research Council [NHMRC] (2019) Australian Guidelines for the Prevention and Control of Infection in
Healthcare. Canberra: Commonwealth of Australia. Available at: https://www.safetyandquality.gov.au/publications-and- resources/resource-
library/australian-guidelines- prevention-and-control-infection-healthcare. Accessed: 22/01/2024.
NHS (1999) Clinical Governance: Quality in the new NHS. Health Services Circular (March 1999/065). Available at:
www.doh.gov.uk/pub/docs/doh/hsc065.pdf.
NHS England (2023). National infection prevention and control manual (NIPCM) for England. V2.6. 4 July 2023. Available at:
https://www.england.nhs.uk/national- infection-prevention-and-control-manual-nipcm-for- england/chapter-1-standard-infection-control-
precautions- sicps/. Accessed 20.10.2023.
NICE (2012) Infection: prevention and control of healthcare- associated infections in primary and community care.
National Clinical Guideline Centre Available at: http://guidance.nice.org.uk/CG139/Guidance/pdf/English. Accessed: 22/01/2024.
NICE (2014) Process and methods guides: Developing NICE guidelines: the manual. Available at:
https://www.nice.org.uk/process/pmg20/resources/d eveloping-nice-guidelines-the-manual-pdf- 72286708700869. Accessed
22.01.2024.
www.antt.org
7
Nickel B, Gorski L, Kleidon T, Kyes A, DeVries M, Keogh S, Meyer B, Sarver MJ, Crickman R, Ong J, Clare S, Hagle ME.
(2024) Infusion Therapy Standards of Practice, 9th Edition. Journal of Infusion Nursing. 47(1S),S1-S285.
Olasveengen, T.M., de Caen, A.R., Mancini, M.E., et al. ILCOR collaborators. (2017) International consensus on
cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations summary.
Circulation. 136(23),e424– e440.
Perumal, V., Abdulrhman, Alheraish, Y., Shahzad, M., et al. (2022) Knowledge, Skills, and Compliance of Nurses Related to
Central Line Associated Bloodstream Infection in the Cardiovascular Department at King Faisal Hospital and Research Centre,
Riyadh. Cureus. 14(10),e30597.
Pike, D. Dodgson, A. Cawthorne J, Ladds., et al (2009) Reduction of HCAI by the Adoption of Aseptic Non-Touch Technique
(ANTT) Central Manchester University Hospitals NHS Foundation Trust. Poster. http://www.cmft.nhs.uk.
Pratt, R. (2010) 3rd ANTT National Conference. London. November 12th 2010. Presentation available from www.antt.org.uk.
Perkins, G.D., Neumar, R., Monsieurs, K.G., et al. (2017) International Liaison Committee on Resuscitation. The International
Liaison Committee on Resuscitation—review of the last 25 years and vision for the future. Resuscitation. 121,104–116.
Preston, R.M. (2005) Aseptic technique: evidence-based approach for patient safety.
Br J Nurs. 14(10),540–546.
Ramachandran, R., Agarwal, C., Hopkins, R., Madhu, J., Panwar, C., Killbride, S., Stichova, F., Gurreebun (2009) Audit on the
impact of ANTT (Aseptic Non Touch Technique) on reducing infection in Neonates with Central lines. International Journal of
Gynaecology & Obstetrics. 107(S2),S93-S96.
Rowley, S. (2001) Aseptic Non Touch Technique Nursing Times. Infection Control Supplement. 97(7),V1-V111.
Rowley, S., 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 10(1): Supplement.
Rowley, S., Clare, S., Macqueen, S., Molyneux, R. (2010) ANTT v2: An updated practice framework for aseptic technique.
British Journal of Nursing. 19(5),S5-S11.
Rowley, S., Clare, S. (2019) Association for Vascular Access (AVA) Guidance Document: Standardizing the Critical Clinical
Competency of Aseptic, Sterile, and Clean Techniques with a Single International Standard: Aseptic Non Touch Technique
(ANTT®). Available from: https://www.avainfo.org/resource/resmgr/files/position_st atements/ANTT.pdf. Accessed: 22/01/2024.
Rowley, S., Clare, S. (2020) How widely has ANTT been adopted in NHS hospitals and community care
www.antt.org
8
organisations in England and Scotland? Br J Nurs. 29(16),924-932.
Sands, M., & Aunger, R. (2023). Process Evaluation of an Acute-Care Nurse-Centred Hand Hygiene Intervention in US Hospitals.
Evaluation Review 0(0), 1-29. Available at: https://doi.org/10.1177/0193841X231197253. Accessed: 22/01/2024.
Schunemann HJ, et al. (2023) The development methods of official GRADE articles and requirements for claiming the use of
GRADE: A statement by the GRADE guidance group. Journal of Clinical Epidemiology. 159,79-84.
Sharma, A., Fernandez, P.G., Rowlands, J.P. et al. (2020) Perioperative Infection Transmission: the Role of the Anesthesia Provider in
Infection Control and Healthcare- Associated Infections. Curr Anesthesiol Rep. 10,233–241.
Shettigar, S., Aradhya, A.S., Ramappa, S., Reddy, V., Venkatagiri, P. (2021) Reducing healthcare-associated infections by improving
compliance to aseptic non-touch technique in intravenous line maintenance: a quality improvement approach. BMJ Open Qual.
10(Suppl.1),e001394.
Sidiropoulos, N., Dumont, L.J., Golding, A.C., Quinlisk, F.L., Gonzalez, J.L., Padmanabhan, V. (2009) Quality improvement by
standardization of procurement and processing of thyroid fine-needle aspirates in the absence of on-site cytological evaluation. Thyroid.
19(10),1049-52.
Simarmatar, R., Indriani, S. (2017) Implementation of aseptic non touch technique (ANTT®) for procedure IV preparation and
administration, IV cannulation and blood sampling to reduce HAIs rate at Premier Jatinegara Hospital [poster]. 4th International Conference
on Prevention & Infection Control, Switzerland, 20-23 June 2017.
Antimicrobial Resistance and Infection Control. 6(Suppl. 3),52.
Suleyman, G., Alangaden, G. & Bardossy, A.C. (2018) The Role of Environmental Contamination in the Transmission of Nosocomial
Pathogens and Healthcare-Associated Infections. Curr Infect Dis Rep. 20(6),12.
Suvikas-Peltonen, E., Hakoinen, S., Celikkayalar, E., Laaksonen, R., Airaksinen, M. (2017) Incorrect aseptic techniques in medicine
preparation and recommendations for safer practices: a systematic review. Eur J Hosp Pharm. 24(3),175-181.
Taori, S.K., et al. (2022) First experience of implementing Candida auris real-time PCR for surveillance in the UK: detection of multiple
introductions with two international clades and improved patient outcomes. J Hosp Infect.
127,111-120.
Thomlinson, D. (1987) To clean or not to clean. Cleaning discharging surgical

wounds. Nurs Times. 83(9),71–75.
Unsworth, J., & Collins, J. (2011). Performing an aseptic technique in a community setting: Fact or fiction? Primary Health Care Research &
Development. 12(1),42-51.
Vickery, K., et al. (2012) Presence of biofilm containing viable multiresistant organisms despite terminal cleaning on clinical
surfaces in an intensive care unit. J Hosp Infect.
80(1),52-5.
Welsh Government. Welsh Health Circular. (2015) WHC/2015/026. Aseptic Non
Touch Technique (ANTT): implementation of a national standardised approach. Available at:
https://www2.nphs.wales.nhs.uk/GPOne.nsf/f2cf6db40785 8fb780257bf3003735de/af427dcde4e99ab480257e5b0035
c04f/$FILE/WHC%202015%20026Aseptic%20Non%20Touch
%20Technique.pdf. Accessed: 22/01/2024.
Widmer, A. F., Dangel, M. (2004). Alcohol-based hand rub: evaluation of technique and microbiological efficacy with
international infection control professionals. Infection Control and Hospital Epidemiology. 25(3),207-20
Wong, S.C., et al. (2021) Air dispersal of multidrug-resistant Acinetobacter baumannii: implications for nosocomial transmission
during the COVID-19 pandemic. J Hosp Infect, 2021. 116,78-86.
World Health Organisation [WHO] (2009) Guidelines on hand hygiene in healthcare. World Health Organization. Available at:
https://www.who.int/publications/i/item/9789241597906. Accessed: 22/01/2024.
WHO (2013) The high 5s project: interim report. Available at: https://www.who.int/publications/i/item/978924150 7257.
Accessed: 22/01/2024.
WHO (2017) Environmentally sustainable health systems: a strategic document WHO Regional Office for Europe. Available
at: https://iris.who.int/bitstream/handle/10665/340375/ WHO-EURO-2017-2241-41996-57723-
eng.pdf?sequence=3. Accessed: 25.01.2
www.antt.org
9

Antt Training

Uploaded by

Copyright:

Available Formats

Antt Training

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Antt Training

Uploaded by

Copyright:

Available Formats

HƯỚNG DẪN KỸ THUẬT VÔ KHUẨN

Aseptic Fields used in ANTT

Critical Aseptic Field

General Aseptic Field

Cleaning: reduces the bio burden and removes

Disinfection: the destruction of pathogenic

Sterilization: A process by which all viable forms

The latest national infection control advice from NHS

Prior to preparing an aseptic procedure, practitioners

Despite the confidence that organisations may illicit

Lack of training Ignorance

Lack of research Short staffing

Fig 3. Many challenges inhibit aseptic practice

Pic 1. A universal practice language improves undersanding

Standardized clinical practice

Pic 2. Universal Techniques; standardised practice = safer practice

England 2001 England 2020

Although of course most welcome, more important than

‘Sterile’ - Sterile Technique

Historically, a multitude of terms have been used to

Different clinical procedures present different levels of

ANTT Risk Assessment

Identification of Key-Parts and Key-Sites: Safeguard 4

Micro Critical Aseptic

General Aseptic Fields

Surgical-ANTT Critical Aseptic Field. Ensure asepsis of Key-Parts

Standard-ANTT General Aseptic Field. Promote asepsis of Key-Parts

Decontamination & Protection

Prevent Cross Infection

Applying the process of Standard-ANTT to clinical practice:

Preparing and administering an intravenous medication: Brief overview

Preventing cross infection

How the underlying Standard-ANTT theory supports effective practice

Applying the process of Surgical-ANTT to clinical practice:

Reducing the risks from the environment &

Preventing cross infection

Fig.10 Organisations that

The ‘4 C’s’ To successfully influence and support aseptic

Only when these three pre-requisites to effective

ANTT Clinical Governance Fig. 12

Recommendation 6 The wide-scale adoption of ANTT internationally has

ANTT Procedure Guidelines

For latest version control see:

The 5-Moments for Hand Hygiene. World Health Organization (2009)

Printed with kind permission of the Word Health Organisaiton

 Few Key-Parts  Remove or  Hand cleaning  Micro Critical  Non-touch

Central  Many Key-Parts  Remove or  Surgical hand-  Critical Aseptic  Non-touch

Intravenous  Few Key-Parts  Remove or  Hand cleaning  Key-Parts  Non-touch

 Multiple Key-  Remove or  Hand cleaning  Critical Aseptic  Non-touch

 Minimall  Remove or  Hand cleaning  Key-Parts  Non-touch

Thomlinson, D. (1987) To clean or not to clean. Cleaning discharging surgical

You might also like