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Aseptic Non-Touch Technique Procedure ICPr014

This document is uncontrolled once printed. Please refer to the Trust intranet for the current version. ICPr014 review September 2023

Version No.

Date Ratified/ Amended

Date of Implementation

Next Review Date

Reason for Change (eg. full rewrite, amendment to reflect new legislation, updated flowchart, minor amendments, etc.)

1.0 01/03/16 Changed from policy to procedure

2.0 01/03/2018 01/03/2020 Review of procedure no changes

2.1 30/03/2020 31/03/2020 31/12/2020 Decision made by the Chief Nurse and Chief Executive to extend review date to Dec 2020 due to Covoid-19.

3.0 01/09/2021 01/09/2021 01/09/2023 Review and update of procedure

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TABLE OF CONTENTS

INTRODUCTION…………………………………………………………………………………….……4 PRINICIPLES AND SAFEGUARDS……………………………………………………………..…..5 RISK ASSESSMENTS…………………………………………………………………………………….6 KEY PARTS AND KEY SITES……………………………………………………………………..…..6 ANTT………………………..…………………………………………………………………………….….7 ACCOUNTABILITY……………………………………………………………………………………….7 MICROBIOLOGY OF HANDS………………………………………………………………………..8 PERSONAL PROTECTIVE EQUIPMENT……………………………………………………….…9 PATIENT ENVIRONMENT………………………………………………………………………….…9 COMMUNITY SETTING…………………………………………………………………………...….9 WASTE MATERIAL…………………………………………………………………………………….10 EQUALITY CONSIDERATIONS………………………………………………………………….…10 REFERENCES………………………………………………………………………………………….….11 Appendix 1 - Risk assessment for ANTT………….…………………………….………..…15 Appendix 2 -ANTT Approach…….……………….…………………….……………………….16 Appendix 3 - ANTT Procedures……………..………………………………………………….17 Appendix 4- Competency checklist example…………………………………………….18 Appendix 5 - Other guidelines for ANTT involvement……………………………….20 Appendix 6 - Example of sterile fields……………………………………………………….21

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INTRODUCTION Aseptic non-touch technique (ANTT) is a global standardised framework for aseptic technique providing a common practice process. Aseptic Technique aims to prevent pathogenic microorganisms from being introduced to susceptible sites by hands, surfaces and/or equipment. ANTT is a specific type of aseptic technique that ensures asepsis is achieved by ensuring Key Parts and Key Sites are not touched. ANTT framework applies theory and practice into a specific type of aseptic technique. Its purpose is to reduce the risk of transmitting pathogens to patients and reduce the incidence of Healthcare Associated Infections (HCAIs) by ensuring that only uncontaminated Key Parts come into contact with Key Sites during certain clinical procedures, thus preventing the transfer of micro-organisms from one person to another or from one site of the patient’s own body to another of their more susceptible body site (Endogenous infections). Aseptic non touch technique should be used during any procedure which bypasses the body’s natural defences. Therefore, should be used where sterile body areas are entered, where there is tracking to deeper areas or when the patient is immuno-compromised. Using an aseptic non touch technique supports the health care worker to practice safely, effectively and reduces the risk of transmitting an infection during procedures. Implementing an aseptic non-touch technique ensures practitioners use a systematic approach for all patients following the step by step process. There are other benefits of using an aseptic non-touch technique which can:

• Provide an effective way of educating and training staff in safe aseptic non-touch techniques making this measurable through competencies and auditing.

• Standardises aseptic non touch techniques across organisations and reduces variability in practice ensuring gold standards of care.

• Improves patient safety by supporting effective education, competency assessment and safe clinical practice.

• Aseptic non touch technique is a part of the whole aseptic technique that ensures the risk of transmitting pathogens is reduced.

ANTT is designed and should be used for all invasive procedures in any setting, from major surgery to simple maintenance of indwelling medical devices. To be efficient as well as safe, the ANTT Practice Framework incorporates two approaches to maintaining asepsis and includes a simple risk assessment (appendix 1) for determining the most appropriate approach (appendix 2) for any given procedure. The following procedures would be classed as having a potential high risk of infection transmission, thus requiring the use of an Aseptic Non-Touch Technique:

• Urinary catheterisation

• IV therapy

• Surgical Wounds (up to 48 hours post op)

• The management of an invasive device, e.g. intravenous line (PICC), wound drain.

• Insertion of intrauterine device/system

• Insertion/removal of contraceptive implant

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• Burns

• Deep wounds into sterile area.

• Bones / tendons exposed

Those considered most at risk of developing infections:

• Patients with arterial insufficiency (ischaemic / arterial ulceration)

• Immuno-compromised patients e.g. Diabetes, receiving chemotherapy, high dose steroids

• Babies

• Patients with chronic disease or poor nutritional status

Principles and Safeguards For healthcare professionals to achieve the goal of asepsis practitioners should work within the clinical ANTT practice framework. This consists of four clinical and two organisational principles and four safeguards. The main principle of Aseptic Non-Touch Technique is that susceptible body sites do not come into contact with non-sterile items. Clinical Principles: 1: The aim of ANTT for invasive clinical procedures or invasive medical device maintenance is always asepsis. 2: Asepsis is achieved by protecting Key Sites and Key Parts from microorganism transmission from the healthcare worker or the environment. 3: ANTT needs to be efficient as well as safe. 4: Choice of Surgical or Standard ANTT is based on a risk assessment – according to technical difficulty or protecting key sites and key parts. Organisational Principles: 5: Aseptic technique practices should be standardised. 6: Safe aseptic techniques are reliant upon effective healthcare worker training and environments that are fit for purpose. Safeguards: 1: Standard infection control precautions (SICPs) such as handwashing and environmental controls, significantly reduce the risk of contamination of key sites and key parts. 2: Identification of Key Parts (equipment used in procedures) and Key Sites (open wounds and medical device access sites.) 3: Aseptic Non-Touch Technique is a critical skill that protects key parts and key sites from the healthcare worker and environment. 4: Aseptic field management to assist in maintaining the aseptic key parts and key sites. Surgical and Standard ANTT require different field management.

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Risk Assessments According to the technical difficulty of maintaining key part and key site asepsis then a risk assessment should be carried out to decide if a Surgical or Standard aseptic non-touch technique should be performed. A simple question should be asked – Is it straightforward to perform a ANTT without touching the key parts? If yes, then can proceed following the standard ANTT approach. If no, then will need to follow the surgical ANTT process. See Appendix 1 for risk assessment considerations. Both standard and surgical ANTT must take into consideration the following:

• ANTT Risk assessment

• Environmental Management

• Decontamination and Protection

• Aseptic field selection and management

• Likelihood of non-touch Technique being achieved Standard aseptic technique is the process for safe and effective practice to apply an aseptic non touch technique with a micro critical aseptic field. Key parts are protected within the micro critical aseptic field and ANTT is mandatory. No gloves or non-sterile gloves can be used if the healthcare worker can ensure key parts and key sites will not be touched throughout the ANTT procedure, if not then sterile gloves must be used. Typically, the procedure will be short in duration (in general less than 20 minutes), should involve small and minimal key parts. For example, procedures such as IV therapy, peripheral cannulation, venepuncture and simple wound care. See appendix 3. Surgical aseptic technique tends to be for more complex procedures. These will be longer in duration, involve large open key sites or have larger size or quantity of key parts. These procedures tend to be significantly invasive. The critical aseptic field needs to be managed well – only sterile items must come into contact with the critical aseptic field. ANTT is desirable where possible but if working within the critical aseptic field then key parts are protected. Sterile gloves are essential. The surgical aseptic technique would be used for procedures such as catheterisation, management of invasive devices such as PICC lines, surgery in an operating theatre or central venous catheter insertion in ITU. See appendix 3. See Appendix 2 for ANTT approaches. For examples for which procedures would likely be standard or surgical see appendix 3.

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Key Parts and Key Sites Key parts are the critical parts of equipment used during the procedure that may come into contact directly or indirectly with a key site on a patient’s body. For example, this may be a needle, the hub of a syringe or an indwelling urethral catheter. Key Sites are areas on a patient’s body that are vulnerable to infection. For example, wounds, surgical incisions, entry/exit sites of invasive devices or intact skin where invasive devices are to be inserted. Aseptic Fields Aseptic Fields, previously known as Sterile Fields, are a designated area that protects the equipment from direct or indirect environmental contact-contamination by microorganisms. There a variety of fields and dependent on the procedure and complexity plus number of Key Parts and Key Sites will determine what Aseptic Fields are utilised. For a visual guide for the types of sterile fields, see appendix 6. General Aseptic Field – A workspace that promotes asepsis and is utilised when key parts and/or key sites can be easily protected. Critical Aseptic Field – A workspace that ensures asepsis and is managed as a key part. It is utilised when Key Part and/or Key Sites are large or numerous and can’t be easily protected by covers or caps and Non-Touch Technique is not possible at guaranteed. Micro-Critical Aseptic Field – A small critical aseptic field used to protect a Key Part e.g. packaging, a needle cover or cap over the tip of a urinary catheter bag. To be utilised at all times when using a General Aseptic Field when using a Critical Aseptic Field utilised where possible. General Aseptic Field Management – Required equipment and covering which may not be aseptic are allowed on the general aseptic field as all Key Parts are protected by micro critical aseptic fields. Critical Aseptic Field Management – Only aseptic or sterilised equipment may come into contact with a Critical Aseptic Field. Sterilised gloves are essential to maintain aseptic continuity. Aseptic Non-Touch technique (ANTT) Aseptic Non-Touch technique (ANTT) is possibly the most important component of standard and surgical aseptic technique. The safest way in protecting key parts/key sites is to not touch them, making this a core element of both aseptic techniques. ANTT is a method used to prevent contamination of key sites by ensuring that only sterile key parts come into the contact with these sites and that the risk of contamination is minimised.

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Both aseptic techniques require hand decontamination at the appropriate moments, the use of appropriate personal protective equipment, preparation of the environment and maintenance of an aseptic field at all times. It is important that all sterile packaged equipment is stored in a clean, dry and dust free environment. Before use, the package should be checked for any damage and be within the expiry date. Key parts and key sites should be identified at the beginning of the process to ensure these are not touched, thus reducing the risk of transmitting microorganisms. Examples of equipment required for ANTT:

• Sterile dressing pack containing plastic tray, gauze swabs, sterile gloves, apron, sterile

field, disposable bag e.g. Softdrape or Dressit (Richardson Healthcare) or Nitrile Lilac

Polyfield Patient Pack (Premier)

• Sterile fluids for cleansing and / or irrigation.

• Appropriate equipment depending on the procedure required – ie; dressing if doing

wound care (See Northants Dressing Formulary on Intranet) or appropriate IV dressing

if performing care of invasive device or urinary catheter or cannulation equipment.

• Alcohol hand gel

• For indwelling catheter – need to consider size, expiry date and length of time the

catheter is required.

• Extra equipment that may be needed during procedure, e.g. sterile scissors for cutting

primary dressings, forceps, wound probe, needles, syringe, IV line flush etc

• Clinell universal wipes for cleaning the environment and equipment.

• Dressing trolley if available.

All key parts should be checked for damage, expiry date and when opened onto the sterile field the key parts should not be touched by the user or by the outer side of the packaging. Accountability The NMC Code states that as a qualified nurse, in order to practice effectively nurses and midwifes need to “be accountable for our decisions to delegate tasks and duties to other people” (NMC The Code 2018). For this to be achieved, the healthcare proffesional must only delegate tasks and duties that are within the other person’s scope of competence. Qualified clinical staff or assistants who are assessed as competent should perform either a surgical or standard aseptic technique during which ANTT is demonstrated and record this with a competency document on a yearly basis– See Appendix 4 for example of a competency checklist, for wound management. Appendix 5 states links to other competency checklists where ANTT is involved.

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Hand Hygiene Healthcare workers must ensure good hand hygiene is achieved by following the 6 steps of hand hygiene and achieving this at the 5 moments of hand hygiene. In order to achieve good hand hygiene healthcare workers need to be bare below the elbows. All clinicians must be proficient in performing hand hygiene and should familiarise themselves with the Hand Hygiene Procedure ICPR010 - http://thestaffroom.nhft.nhs.uk/download.cfm?doc=docm93jijm4n3296&ver=38475 The wearing of personal protective equipment (PPE) (as outlined in the Standard Precautions Policy ICP002) such as gloves and an apron will provide a barrier between microbes present on hands and clothing and the susceptible sites, e.g. a wound. See the Standard Precautions Policy for full details and guidance -ICP002 – http://thestaffroom.nhft.nhs.uk/download.cfm?doc=docm93jijm4n17722&ver=43040 Hand washing must be performed prior to the aseptic technique. Hand sanitising and hand washing may be required at intervals throughout the aseptic technique, according to the procedure being performed. An example of an interval may be between removing a soiled wound dressing, performing hand hygiene and then donning sterile gloves before starting the ANTT procedure. Hands will need to be washed at the end of the procedure, in accordance with the five moments of hand hygiene. Microbiology of your Hands Your hands are colonised by resident and transient bacteria. Resident Skin Flora: These comprise mainly of Gram-positive organisms of low pathogenicity, e.g. diphtheroid, micrococci, coagulase negative staphylococci (S. epidermidis). Their function is mainly protective and are difficult to remove without the use of a disinfectant hand wash. The disinfectant hand wash and method of hand washing may help to reduce the level of resident skin flora organisms. Alcohol containing hand sanitisers may help to suppress the organism’s growth. (WHO guidelines 2009) However, these organisms are opportunists and may cause infection if introduced into a wound. Transient Skin Flora: These comprise of Gram-negative and positive organisms, many of which are harmful to man if introduced into a susceptible site or to a susceptible person, e.g., coliforms - Klebsiella, Proteus, Acinetobacter, E. Coli and MRSA. These organisms particularly favour damp conditions, e.g. under rings and false nails, but they can be found on all parts of the hands, clothing and in the environment.

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Personal protective Equipment (PPE) Depending on the assessment for which aseptic non-touch technique will be used the expected requirements for PPE may be different.

Aseptic technique

Disposable Gloves

Disposable Aprons

Face mask

Eye protection (single use or reusable)

Standard ANTT

Non sterile gloves if ANTT

can be assured.

Single use apron Risk assess for potential

exposure to bodily fluids -Surgical fluid resistant face

mask

Risk assess for anticipation of

spraying or splashing of bodily fluids

Surgical ANTT

Sterile Gloves only

Single use apron May need a sterile gown if doing a surgical procedure.

Risk assess for potential

exposure to bodily fluids -Surgical fluid resistant face

mask

Risk assess for anticipation of

spraying or splashing of bodily fluids

Patient environment During the risk assessment consideration must be made about the patient environment and its influence on maintaining the sterile field. This is particularly important in the community setting. If in an inpatient area or a clinic setting, then use the equipment available to ensure that the sterile field can be maintained, ie; a dressings trolley. All equipment should be cleaned before and after use. Community setting: When carrying out procedures in patient’s homes, the healthcare worker may not have access to specific equipment that would be available in a hospital/clinic setting e.g. a dressing trolley. Therefore, adaptations and creativity are often required to ensure the environment is conducive to the procedure being performed and the equipment remains sterile or clean. The use of a clean surface such as table, tray or a chair should be used to arrange the required procedural equipment. Be aware a dusty or dirty environment can increase the risk of infection. If simple work surfaces like tables or trays aren’t cleanable, then place a sterile drape or two over a surface and work from that, isolating the procedure equipment to this drape and using a non-touch technique.

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An open sterile packet, for example; catheter, gauze or other dressings, may soon become contaminated if left open in a patient’s home. Discard all opened packets at the end of every procedure as would be expected for a single use item. Do not tape down and use for the next occasion. Using large containers/multiple use items, for example, saline aerosols, saline pods, creams and ointments. These all carry the risk of cross infection if used incorrectly. All of the above should be single patient use only in all care settings. For example, a tub of Aqueous Cream should not be used for multiple patients, even with the use of wooden spatulas. The outside of tubs, aerosols, pods and tubes cannot be classed as clean. When using these items, ensure you don’t touch them with dirty gloves as this increases the risk of cross infection. If you touch the containers with clean gloves, ensure you do not then touch a patient’s key site- ie; an open wound. Any multiple use item or container should be cleaned prior to each use and cleaned after the procedure has been completed. Further guidance for the use of ANTT within wound care can be found in the Guidelines for the assessment and management of wounds–CLPg005 - http://thestaffroom.nhft.nhs.uk/download.cfm?doc=docm93jijm4n17721&ver=43039 Waste materials Part of the process for aseptic technique includes the management of waste materials, which need to be considered. Before starting the ANTT procedure staff should be aware of how you will dispose of any waste material/equipment without contaminating your hands. Before the procedure the clinician needs to familiarise themselves with the Waste management policy and procedure manual (HSCp001)- http://thestaffroom.nhft.nhs.uk/download.cfm?doc=docm93jijm4n835&ver=36062 and know how to dispose of any waste correctly, to ensure safety of themselves and others. This includes the safe disposal of sharps waste. It is essential that clinicians have a sharps box available to dispose of the sharps waste at the point of use. EQUALITY CONSIDERATIONS The author has considered the needs of the protected characteristics in relation to the operation of this policy and protocol to align with the outcomes with IP&C Assurance Framework. We have identified that ensuring that communication reaches all vulnerable groups. The service has been designed to ensure communication relevant to any outbreaks or other healthcare associated infections reaches all sections of the community. This includes taking into consideration communication barriers relating to language or specific needs to reach the whole population. IP&C work closely with multi agency groups and community partners where appropriate we will undertake engagement and outreach activity. We targeted action to relevant groups follow public health England’s communication framework. Some groups are particularly vulnerable in relation to their protected characteristics, e.g. age, ethnic minority communities and disability and where we identify that, the expectation is that staff will meet the needs appropriately.

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REFERENCES AND BIBLIOGRAPHY Department of Health (2003) Winning Ways: working together to reduce healthcare associated infection in England. Report from the Chief Medical Officer. DOH: London. Department of health (2007) Essential Steps to safe, clean care. London: DH Dougherty L, Lister S (eds) 2004) The Royal Marsden Hospital Manual of Clinical Nursing Procedures 6th edition. Oxford: Blackwell Publishing. Infection Control Nurses Association (2003) Asepsis: Full compliance with Aseptic technique is essential. ICNA, Bathgate. Mangnall J, Watterson L. (2006) Principles of aseptic technique in urinary catheterisation. Nursing Standard, 21:8 p49-56. Loveday HP, Wilson JA, Pratt RJ et al (2014) epic3: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England. The Journal of Hospital Infection 86S1, S1-S70. Viewed 15th June 2021. epic3: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England (his.org.uk) Pratt RJ, Pellowe CM, Wilson JA et al (2007) epic2: National Evidence- Based. Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England. The Journal of Hospital Infection 655,S1-S64. Rowley, S, Clare, S (2011) ANTT: a standard approach to aseptic technique. Nursing Times, 107, 36:Proquest p12 Sax, H, Allegranzi, B, Uckay, I et al (20017) ‘My five moments for hand hygiene’: a user-centred design approach to understand, train, monitor and report hand hygiene. The Journal of Hospital Infection 67, p9-21 Xavier G (1999) Asepsis. Nursing Standard; 13:36, p49-53. National Institute for Clinical Excellence (NICE) 2012 (updated 2017) Healthcare-associated infections: Prevention and control in Primary and Community Care, NICE, Guidance CG139, Viewed 15th June 2021. Overview | Healthcare-associated infections: prevention and control in primary and community care | Guidance | NICE Department of Health (2006)The Health Act: Code of Practice for the Prevention and Control of Healthcare Associated Infections London DH Department of Health (2008) The Health and Social Care Act: Code of Practice for the Prevention and Control of Healthcare Associated Infections and related guidance London DH

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Nursing and Midwifery Council, 2015, The Code - Professional standards of practice and behaviours for nurses, midwifes and nursing associates, Nursing and Midwifery Council, Viewed 11th November 2020, < https://www.nmc.org.uk/standards/code/read-the-code-online/#fourth> The Northern Ireland Regional Infection Prevention and Control Manual n.d., ANTT, Public Health Agency, Viewed 18th November 2020, <http://www.niinfectioncontrolmanual.net/antt> ANTT-Aseptic Non-Touch Technique, the international standard for aseptic technique. The Association for Safe Aseptic practice, Viewed 12th July 2021, Home (antt.org) Rowley S, Clare S, 2011, ANTT: A standard approach to aseptic technique, Nursing Times, Viewed 18th November 2020, https://www.nursingtimes.net/clinical-archive/infection-control/antt-a-standard-approach-to-aseptic-technique-09-09-2011/ WHO guidelines on Hand Hygiene in healthcare: First global patient safety challenge clean care is safer care, 2009, Viewed 15th June 2021. Definition of terms - WHO Guidelines on Hand Hygiene in Health Care - NCBI Bookshelf (nih.gov)

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Appendix 1 – Risk assessment for ANTT

ANTT Risk Assessment: Is it straightforward to perform this procedure without touching key parts?

Yes

Standard ANTT

Key parts are protected individually with micro

critical aseptic fields

Non Touch Technique is mandatory

No gloves or non sterile gloves

Both techniques must also consider the environment, the procedure invasiveness, the amount of and complexity of

key parts and the expected duration of the procedure

No

Surgical ANTT

Key parts are protected collectively on a critical

aseptic field (sterile drape)

Non Touch Technique is still desirable

Sterile gloves are essential

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Appendix 2 – Two types of ANTT approach

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Appendix 3 – Typical procedures for surgical or standard ANTT approach

Standard ANTT

Surgical ANTT

Uncomplicated wound care

Peripheral and central intravenous

medication

Preparation & administration

Peripheral cannulation

Blood Culture Collection

Venepuncture

Intermittent urinary catheterisation

Emptying a urinary catheter bag

Surgery

Complicated wound care

Central intravenous line insertion

and maintenance

Urinary Catheterisation

Spinal epidural

Other invasive devices

Usually short duration of procedure

(less than twenty minutes)

Minimal key parts required

Procedures often more complex

and longer in duration

Multiple key parts required

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Appendix 4 -Example of a competency checklist - Competency for Aseptic Non-Touch Technique (ANTT) in Wound Management Name: ................................................... Job Title: ...................................... Band: ...... Workplace: ............................................................. Date Assessed: ................................

Element Achieved? Y/N

1 Read care plans/documentation available prior to procedure

2 Explained and discussed the procedure with the patient.

3 Washed hands with liquid soap and dried with paper towels (recommended) AND applied alcohol hand gel to all areas of physically clean hands.

4 Cleaned trolley (if available) with soap and water (dried with paper towels). Applied 70% alcohol solution and allowed to dry.

5 Placed all the equipment required for the procedure on the bottom shelf of the clean dressing trolley.

6 Positioned the patient comfortably. Ensured the area was easily accessible without exposing the patient unduly.

7 Cleaned hands with alcohol hand gel.

8 Checked the dressing pack was sterile i.e. the pack is undamaged, intact and dry. Opened the outer cover of the sterile pack and slid the contents onto the top shelf of the trolley (or alternative surface available).

9 Opened the sterile field using only the corners of the paper.

10 Checked other packs were sterile and opened by carefully tipping their contents onto the centre of the sterile field.

11 Put on the disposable plastic apron from the pack.

12 Cleaned hands with alcohol hand gel.

13 Placed hand inside sterile disposable bag and arranged contents of dressing pack.

14 Removed used dressing from patient, hand covered with the disposable bag, inverted bag and stuck to trolley/or used non-sterile gloves, without touching any open wounds.

15 If using saline sachets, swabbed along the ‘tear area’ with 70% alcohol wipe. Poured saline into indented plastic tray.

16 Put on sterile gloves, touching only the inside of the wrist end.

17 If using saline pods or aerosol, creams or ointments, did not touch containers with contaminated gloves. Did not continue dressing the wound without new sterile gloves.

18 Redressed wound with appropriate dressings.

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Element Achieved? Y/N

19 Ensured that the patient was comfortable.

20 Removed gloves. Disposed of waste as per Trust Policy - Waste Management Procedure Guidelines FIN 03a.

21 Cleaned trolley with soap and water (dried with paper towels). Checked the trolley was dry and physically clean.

24 Any single use equipment that became contaminated during the procedure was discarded.

25 Any reusable equipment that became contaminated during the procedure was cleaned with a disinfectant wipe.

22 Washed hands with liquid soap and dried with paper towels.

23 Documented procedure and updated care plans appropriately in patient records

The healthcare worker will only be assessed as competent at ANTT if ALL elements are completed. If any one element is failed the healthcare worker must be assessed again. Assessed by competent ANTT Assessor: Signature: ...................................................... Print Name: .............................................. Job Title: ............................................................................................ Band: ............... Workplace: ............................................................................................................................

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Appendix 5 – NHFT Competency checklists and procedure guidelines where ANTT is required.

Adult Catheterisation Insertion and management Guidelines CLPg071 -Catheter competency checklist

Procedure

Appendix Page Number

Procedure for Female Catheterisation

Appendix 1

Pages 21 - 23

Procedure for Male Catheterisation

Appendix 2

Pages 24 -26

Procedure for Suprapubic Catheterisation

Appendix 3

Pages 27- 29

Procedure for Collecting a Catheter Specimen Urine (CSU)

Appendix 6

Pages 33- 34

Procedure for Administering a Catheter Maintenance Solution

Appendix 8

Pages 97- 39

Protocol for community intravenous therapy and the management of vascular devices MMPr031 -Competency checklist.

Standard operating procedure for Administration of IV Medicines

Appendix 1

Pages 17 - 19

Peripheral cannulation and midline insertion and removal procedure CLPr042 – Guidance and competency

Procedural guidelines for use with adult patients in community and community hospital settings

Pages 7-12

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Appendix 6 – Examples of a Standard and Surgical ANTT aseptic field.

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