Aseptic Non-Touch Technique ANTT

September 2018

Aseptic Non-Touch Technique ANTT SEPTEMBER 2018

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Document Profile

Document Registration

Added following ratification

Type Policy

Title Aseptic Non-Touch Technique

Author Anne McConomy & ANTT.org

Category clinical /

corporate / education / Health & Safety / HR / Info Governance

Clinical

Description

Provide guidelines to establish an ‘Aseptic Non-Touch Technique” (ANTT) as the safe and effective technique that is used by all staff for all aseptic procedures carried out within the organisation.

Approval Route Organisational Governance Approval Group

Approved by

Date approved 3rd September 2018

Review date 3 years from approval

Document Status This is a controlled document. Whilst this document may be printed, the electronic version posted on the intranet is the controlled copy. Any printed copies of this document are not controlled. As a controlled document, this document should not be saved onto local or network drives but should always be accessed from the intranet.

Version control / changes made

Date Version Summary of changes made Author

March 2020

1.1 Transfer to new template Allison Mills

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CONTENTS

1. INTRODUCTION ................................................................................................. 4

1.1 Rationale ...................................................................................................... 4

1.2 Scope/Purpose ............................................................................................ 4

1.3 Role and Responsibilities ............................................................................. 4

2. DEFINITIONS ..................................................................................................... 5

2.1 What is ANTT ............................................................................................... 6

2.2 Standard Precautions .................................................................................. 6

2.3 Clinical Guidelines ....................................................................................... 7

3. TRAINING AND COMPETENCY ASSESSMENT ............................................... 8

4. MONITORING AND AUDIT ................................................................................. 8

5. CONSULTATION PROCESS.............................................................................. 8

6. IMPLEMENTATION PLAN .................................................................................. 8

7. EQUALITY IMPACT STATEMENT ..................................................................... 8

8. REFERENCES.................................................................................................... 9

9. APPENDIX ........................................................................................................ 10

Appendix 1 Equality Impact Screening Tool ...................................................... 10

Appendix 2 Audit Tool ........................................................................................ 12

Appendix 3 The ANTT Approach ........................................................................ 13

Appendix 4 Direct Observation of Practice ......................................................... 14

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1. INTRODUCTION

1.1 Rationale The purpose of this policy is to direct the standardisation of aseptic technique

throughout the organisation using the ANTT Clinical Practice Framework for all invasive procedures, including maintenance of indwelling medical devices, promoting safe practice and reducing the risk of healthcare associated infections (HCAIs).

1.2 Scope/Purpose

ANTT will be mandatory practice in the organisation when performing an aseptic procedure. There are no exceptions.

This policy is not intended as an exhaustive educational tool for ANTT. The full

ANTT. Clinical Practice Framework is provided on the organisations secure intranet and is also freely available from www.antt.org. The purpose of this policy is to direct the standardization of aseptic technique

throughout the organisation using ANTT Clinical Practice Framework for all invasive procedures, including maintenance of indwelling medical devices, promoting safe practice and reducing the risk of healthcare associated infections (HCAIs). 1.3 Role and Responsibilities

Chief Executive Officer The Chief Executive Officer has overall responsibility for ensuring that there are effective arrangements in place for Infection Prevention and Control (IPC) within the organisation to meet statutory requirements. Quality and Governance Leads The Quality and Governance Leads will ensure systems are in place to:

Update this policy in line with evidence based practice

Monitor, report and investigate incidences of HCAIs and ensure systems are in place to reduce the incidence of HCAIs

Measure adherence to the policy (Appendix 2) Operational Leads Operational Leads will:

Ensure that all staff have access to relevant policies and procedural documents to support their daily working practice

Monitor staff training attendance in accordance with the organisation’s statutory and essential training matrix

Monitor the achievement of staff competence in carrying out procedures

involving ANTT

Facilitate the availability of the necessary tools and resources for ANTT

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Line Managers Line Managers will ensure all staff:

Attend training in accordance with the organisation’s statutory and essential training matrix

Have access to an ANTT competency framework

Achieve competency in carrying out procedures involving ANTT Education Department The Education and Development department is responsible for:

Ensuring the clinical guideline is up to date and in line with evidence based practice in collaboration with Q&G lead

Ensuring sufficient training is available for all staff on ANTT

Maintaining competency records

Overseeing clinical audits and compliance in collaboration with the clinical effectiveness facilitator

All Staff The clinicians providing services to the patient are responsible for:

Ensuring that they access and comply with relevant policies and procedural

documents relevant to ANTT

Attending relevant training

Ensuring that they achieve and maintain competency in relation to ANTT practice

Raising any concerns they have about achieving ANTT with their Line Manager

2. DEFINITIONS

Asepsis – is the absence of bacteria, fungi, viruses or other micro-organisms that could cause disease. Aseptic technique – defines the infection prevention method and precautions taken during invasive clinical procedures to prevent the transfer of microorganisms from the healthcare worker, procedure equipment or the immediate environment to the patient. Aseptic Non-Touch Technique – a specific type of aseptic technique with a unique Theoretical and Clinical Practice Framework based upon the original concept of Key-Part and Key-Site Protection where staff identify and protect key parts and key sites. Key Part – the critical part of equipment that comes into contact with a key site

Key Site – a part of the body that is at risk of contamination if ANTT is not used e.g. wound, urethral meatus, insertion and access sites for medical devices.

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Aseptic field – a designed aseptic working space that contains and protects the procedure equipment from direct and indirect environmental contact-contamination by microorganisms (see aseptic field types below). General Aseptic Field - the main aseptic field that promotes asepsis during procedures by providing basic protection from the procedure environment. Used when key parts can easily and efficiently be protected by micro critical aseptic fields e.g. caps and covers during intravenous therapy and phlebotomy. Critical Aseptic Field – the main aseptic field that ensures asepsis during procedures by the use of a sterile field which protects the procedure environment e.g. urinary catheterisation, complex wound care, surgical procedures. 2.1 What is ANTT

ANTT is a contemporary international standard for safe and effective aseptic practice that is designed for all clinically invasive procedures including maintenance of

indwelling medical devices. ANTT is overseen and disseminated by the Association

for Safe Aseptic Practice (www.the-asap.org). the international adoption of ANTT

standardises practice and practice language for aseptic technique. This in turn reduces practice variability, improving quality and safety for patients.

The aim of ANTT is always asepsis. Asepsis is achieved by a unique educational and practice concept for aseptic technique called Key-Part and Key-Site Protection. This involves the identification and protection of Key-Parts and Key-Sites for all procedures – achieved by pre-requisite basic precautions and the correct utilisation and combination of aseptic field management and non-touch technique.

Standard-ANTT

Standard-ANTT is used for procedures where it is technical straightforward not to touch Key-Parts and Key-Sites directly. There are likely to be few Key-Parts and no very large Key-Parts. Typical procedures include cannulation, IV therapy, venepuncture, simple wound care. Procedure time is likely to be short in duration.

Surgical-ANTT

Surgical-ANTT is used for invasive procedures that are technically complex, longer

in duration (approximately 20 min), involves multiple Key-Parts and/or large Key-Parts. Subsequently it is much harder or not possible to perform the procedure without touching Key-Parts directly. As a result, the main Critical Aseptic Field is managed ‘critically’ i.e. only sterilised aseptic equipment can come into contact with it and the procedure may require full barrier precautions. Typical procedures include: major to minor surgery, central line insertion, urinary catheterisation (See links).

2.2 Standard Precautions

Both types of ANTT include standard precautions such as hand hygiene, wearing of personal protective equipment, e.g. gloves and aprons, the safe handling of sharps, waste and linen, decontamination of patient care equipment and environmental

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cleanliness (ICNA, 2003). ANTT helps standardise the application of these processes and promote staff compliance (Appendices E, F). IV Hubs: a large single use 2% Chlorhexidine / 70% isopropyl wipe (of about hand size). (Loveday et al, 2014). Skin Disinfection: A 2% Chlorhexidine / 70% isopropanol applicator for the size of area disinfected and clinical procedure being performed (Loveday et al, 2014).

Procedure Trays: Will be provided for all staff once training is completed. Correct decontamination of the trays is an essential part of the process. The trays are decontaminated as follows:

Prior to use, the tray needs to be disinfected with a 70% alcohol wipe and allowed to dry naturally

After use and prior to leaving the patient’s bed space or home, the outside of the tray must be decontaminated with a sanitising wipe.

The tray must then be washed with hot water and liquid (dishwashing) detergent in an equipment washing sink. Then dried using paper towels (do not leave tray

to drip dry). NB Hibiscrub or any other liquid hand soap are not suitable for washing IV trays.

If an equipment washing sink is not available the tray can be cleansed using a

sanitising wipe (e.g. Clinell universal wipe). The tray should be allowed to dry naturally (do not use a paper towel to dry tray).

Store all trays away from sink area to prevent re-contamination with water splashes.

2.3 Clinical Guidelines The following procedures have a step by step guide in the appendices which all clinical

staff should have access to and refer to when practising the ANTT approach (Appendix 3), please follow links: https://www.fnhc.org.je/media/43258/iv-drug-administration-antt-policy.pdf https://www.fnhc.org.je/media/43259/urinary-catheter-antt-policy.pdf https://www.fnhc.org.je/media/43261/portacath-antt-policy.pdf https://www.fnhc.org.je/media/43262/cannulation-antt-policy.pdf https://www.fnhc.org.je/media/43263/venepuncture-antt-policy.pdf https://www.fnhc.org.je/media/43260/wound-dressing-antt-policydocx.pdf

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3. TRAINING AND COMPETENCY ASSESSMENT

All clinical staff whom perform invasive procedures or who are responsible for

managing indwelling devices in clients, must demonstrate competence in ANTT. A standardised competency assessment will be used for all staff (Appendix 4). 4. MONITORING AND AUDIT

Adherence to the policy and the clinical standards of ANTT will be monitored via audit. The standardised audit form will be used (Appendix 2). evidence of non-

compliance or poor standards of ANTT should be referred to team leaders and practice development in order for development plans to be devised and additional training requirements assessed.

5. CONSULTATION PROCESS

Identify who has been involved and when including service users and partner agencies

Name Title Date

Gilly Glendewar Clinical Nurse Specialist 16th March 2018

Fiona Le Ber Clinical Nurse Specialist 16th March 2018

Louise Hamilton Team Lead RRRT 2nd June 2018

Clare Stewart Op Lead OOH 2nd June 2018

Tia Hall Op Lead Adult Services 2nd June 2018

Michelle Cumming Op Lead Child & Family Services

2nd June 2018

Jessica Clarke Team Lead DN’s 2nd June 2018

Lindy Henesy Team Lead Children’s Nurses 2nd June 2018

Elspeth Snowie Clinical Effectiveness Facilitator

16th March 2018

6. IMPLEMENTATION PLAN

A summary of how the document will be implemented with time frame

Action Responsible Person Planned timeline

Email to all staff Rachel Evans Within two weeks of ratification

Policy to be placed on Procedural Document Library

Rachel Evans Within two weeks of ratification

Staff to sign up to documents if relevant

Operational Leads Within two weeks of ratification

7. EQUALITY IMPACT STATEMENT

A statement to show that the document does not discriminate against disadvantaged or vulnerable people

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Family Nursing & Home Care is committed to ensuring that, as far as is reasonably practicable, the way services are provided to the public and the way staff are treated reflects their individual needs and does not discriminate against individuals or groups on any grounds. This policy document forms part of a commitment to create a positive culture of respect for all individuals including staff, patients, their families and carers as well as community partners. The intention is to identify, remove or minimise discriminatory practice in the areas of race, disability, gender, sexual orientation, age and ‘religion, belief, faith and spirituality’ as well as to promote positive practice and value the diversity of all individuals and communities. The Family Nursing & Home Care values underpin everything done in the name of the organisation. They are manifest in the behaviours employees display. The organisation is committed to promoting a culture founded on these values. Always:

Putting patients first Keeping people safe Have courage and commitment to do the right thing Be accountable, take responsibility and own your actions Listen actively Check for understanding when you communicate Be respectful and treat people with dignity Work as a team

This policy should be read and implemented with the Organisational Values in mind at all times. Always:

Putting patients first Keeping people safe Have courage and commitment to do the right thing Be accountable, take responsibility and own your actions Listen actively Check for understanding when you communicate Be respectful and treat people with dignity Work as a team

This policy should be read and implemented with the Organisational Values in mind at all times.

8. REFERENCES

ASAP (2017) ANTT ® Theory Practice Framework. Available: www.antt.org Aziz, AM (2009) Variations in aseptic technique and implications for infection control. British Journal of Nursing 18(1): 26-31 Department of Health (2003) White Paper. Winning ways: working together to reduce

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healthcare associated infection in England. London: Department of Health. Department of Health (2010) Health and Social Care Act 2008 Code of Practice on the Prevention and Control of Infections and related guidance (The Code) London: Department of Health. Department of Health (2015) The Health and Social Care Act 2008: code of practice on the prevention and control of infections and related guidance London: Department of Health HSE / HPSC (2011) Health Protection Surveillance Centre Ireland: Guidelines for the Prevention of Catheter-associated Urinary Tract Infection. Available: https://www.hpsc.ie/AZ/MicrobiologyAntimicrobialResistance/InfectionControlandHAI/Guidelines/File,12913,en.pdf Infection Control Nurse’s Association (ICNA) (2003) Asepsis: Preventing Healthcare Associated Infection. Bathgate. Loveday HP, Wilson JA, Pratt RJ, Golsorkhi M, Tingle A, Bak A, Browne J, Prieto J, Wilcox M (2014) epic3: National Evidence-based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England. Journal of Hospital Infection 86(S1): S1-S70 NHMRC (2010) Australian Guidelines for the Prevention and Control of Infection in Healthcare. Commonwealth of Australia. Available: https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cd33_infection_control_healthcare_140616.pdf NICE (2012) Healthcare-associated infections: prevention and control in primary and community care. Available: https://www.nice.org.uk/guidance/CG139 NICE (2014) Quality Standard 61: Prevention and Control of Healthcare-Associated Infections. Available: https://www.nice.org.uk/guidance/qs61 RCN (2010) Royal College of Nursing Infusion Standards. Available: http://www.bbraun.it/documents/RCN-Guidlines-for-IV-therapy.pdf Rowley, S (2001) Aseptic Non-Touch Technique Nursing Times. Infection Control Supplement 97(7): V1-V111 UK Government (2010) The Equality Act. Available: http://www.legislation.gov.uk/ukpga/2010/15/pdfs/ukpga_20100015_en.pdf

9. APPENDIX

Additional material needed to support the document. Appendix 1 Equality Impact Screening Tool

To be completed and attached to any publication document when submitted for approval and ratification.

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Stage 1 - Screening

Title of Procedural Document: Policy

Date of Assessment March 2020 Responsible Department

Name of person completing assessment

Alison Mills Job Title Governance Assistant

Does the policy/function affect one group less or more favourably than another on the basis of :

Yes/No Comments

Age No

Disability

Learning disability; physical disability; sensory impairment and/or mental health problems e.g. dementia

No

Ethnic Origin (including gypsies and travelers) No

Gender reassignment No

Pregnancy or Maternity No

Race No

Sex No

Religion and Belief No

Sexual Orientation No

If the answer to all of the above questions is NO, the EIA is complete. If YES, a full impact assessment is required: go on to stage 2, page 2

Stage 2 – Full Impact Assessment

What is the impact Level of Impact

Mitigating Actions (what needs to be done to minimise /

remove the impact)

Responsible Officer

Monitoring of Actions

The monitoring of actions to mitigate any impact will be undertaken at the appropriate level.

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Appendix 2 Audit Tool

Audit Tool

Audit Tool

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Appendix 3 The ANTT Approach

The ANTT Approach

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Appendix 4 Direct Observation of Practice

Direct observation of practice