The following excerpt is from the ANMF’s Aseptic Technique (ANTT®) tutorial on the Continuing Professional Education (CPE) website.
Aseptic Non Touch Technique (ANTT®) is based upon a set of foundation principles and safeguards set out in the ANTT® Clinical Practice Framework. ANTT® has become the de facto national standard aseptic technique in England, Australia and Wales and is now used in over 30 countries and is rapidly expanding (ANTT® website).
Aseptic technique is a procedure used to prevent the spread of infection. It aims to prevent microorganisms on hands, surfaces and equipment from being introduced to susceptible sites. Aseptic technique protects patients during invasive clinical procedures by employing infection control measures that minimise, as far as practicably possible, the presence of pathogenic organisms (Tasmanian Infection Prevention and Control Unit).
While the principles of aseptic technique remain constant for all procedures, the level of practice will change depending upon a standard risk assessment (Qld Department of Health).
In Australian healthcare settings, patients are often treated in close proximity to each other. They undergo invasive procedures, have medical devices inserted, and receive broad-spectrum antibiotics and immunosuppression therapies. These conditions create ideal opportunities for the adaptation and spread of pathogenic infectious agents (NSQHS 3).
A hospital-acquired infection may occur in the presence or absence of an invasive procedure or device. Depending on the site of infection, patients with this complication may experience a range of distressing symptoms including fevers, chills, pain, hypotension and dizziness, tachycardia, collapse, delirium, cough, shortness of breath, urinary frequency, diarrhoea, purulent discharges, wound breakdown, and even death (NSQHS 3).
Each year, patients in Australia develop a large number of hospital-acquired multiresistant organisms (MROs), with 3,768 occurring in public hospitals in 2015–16. Patients with MROs experience challenges related to failure to respond to routine antibiotics, causing prolonged therapeutic regimens and use of antimicrobials with potentially problematic side effect profiles (NSQHS 3).
When discussing aseptic technique it is important to understand the relevant terminology. The use of accurate terminology is important in order to promote clarity in practice.
The terms ‘sterile technique’ and ‘aseptic technique’ have been used interchangeably in the past, however they mean very different things.
STERILE
‘FREE FROM MICROORGANISMS’ (WELLER 1997)
Due to the natural multitude of organisms in the atmosphere it is not possible to achieve a sterile technique in a typical healthcare setting. Near sterile techniques can only be achieved in controlled environments such as a laminar air flow cabinet or a specially equipped theatre. The commonly used term, ‘sterile technique’ ie. the instruction to maintain sterility of equipment exposed to air, is obviously not possible and is often applied inaccurately
(Victorian Department of Health 2014).
ASEPSIS
‘FREEDOM FROM INFECTIONOR INFECTIOUS (PATHOGENIC) MATERIAL’ (WELLER 1997)
An aseptic technique aims to prevent pathogenic organisms, in sufficient quantity to cause infection, from being introduced to susceptible sites by hands, surfaces and equipment. Therefore, unlike sterile techniques, aseptic techniques are possible and can be achieved in typical hospital and community settings (Victorian Department of Health 2014).
CLEAN
‘FREE FROM DIRT, MARKS OR STAINS’ (MCLEOD 1991)
Although cleaning followed by drying of equipment and surfaces can be very effective it does not necessarily meet the quality standard of asepsis (Ayliffe 2000). However, the action of cleaning is an important component in helping render equipment and skin aseptic, especially when there are high levels of contamination that require removal or reduction. To be confident of achieving asepsis an application of a skin or hard surface disinfectant is required either during cleaning or afterwards (Mcleod 1991).
ASEPTIC NON TOUCH TECHNIQUE (ANTT®)
The aim of any aseptic technique including ANTT®, is asepsis.
ANTT® is a technique used to prevent contamination of key parts and key sites by microorganisms that could cause infection. In ANTT®, asepsis is ensured by identifying and then protecting key parts and key sites by hand hygiene, non touch technique, using new sterilised equipment and/or cleaning existing key parts to a standard that renders them aseptic prior to use (Rowley and Simon 2011).
KEY SITES AND PARTS
Key sites are any breaches in skin integrity which could be a portal of entry for microorganisms to colonise the patient. This includes wounds and puncture sites.
Key parts are any parts of the equipment which come into contact with procedural equipment or the patient. This includes invasive devices connected to the patient and liquid infusions. Examples include:
- IV cannula bungs; needle tips; sterile gauze used to clean a wound.
If key parts become contaminated they can transfer microorganisms to the patient (Victorian Department of Health 2014).
ASEPTIC FIELD
An aseptic field is a controlled workspace used to promote asepsis during a clinical procedure. There are three types of aseptic technique:
- Sterile – a technique that aims to achieve total absence of microorganisms. This is only ever achieved in an operating theatre or using a laminar air flow cabinet (Royal Children’s Hospital).
- Standard – a technique that utilises a general aseptic field, critical micro aseptic fields, hand hygiene, non touch technique and non sterile gloves to achieve a safe level of asepsis for:
- Technically simple and short procedures
- Procedures that involve few key parts or key sites (Royal Children’s Hospital).
- Surgical – a technique that utilises a critical aseptic field which is treated like a key part and also utilises:
- Full barrier precautions such as sterile gloves, sterile gowns, cap, mask
- Critical micro aseptic fields
- Hand hygiene
- Non touch technique where practical to do so (Royal Children’s Hospital).
It achieves a safe level of asepsis for procedures that are:
- Technically complex procedures
- Extended periods of time
- Large, open or multiple key sites
- Example is PICC insertion (Royal Children’s Hospital).
The use of aseptic technique during invasive clinical procedures minimises the risk of introducing infectious agents into sterile areas of the body. Effective aseptic technique is vital in all areas where invasive devices are used and invasive procedures are performed, and for patients at greater risk of harm associated with healthcare interventions (ACSQHC 2018).
All clinicians who use aseptic technique in their practice need to have their competency assessed from time to time. If necessary, they should be retrained where practice is below accepted levelsof performance. A risk matrix can be used to assist health service organisations prioritise competency assessments, and identify clinical areas and/or procedures of high risk (ACSQHC 2018).
The risk matrix provides a score for each of the following factors:
- The clinical context where aseptic technique is to occur and how frequently it occurs in that setting.
- The treatment type or procedure and how frequently that treatment/procedure occurs.
- The recency of assessment of the healthcare professional for competence in aseptic technique.
For two of these factors, clinical context and treatment type, frequency of occurrence is also a factor (ACSQHC 2018).
A risk rating is determined by adding the scores for each of the three risk factors (detailed information provided in the tutorial). This information can assist in planning the organisation’s response to improve aseptic technique in practice. The higher the risk rating, the greater the risk and need for action to be taken.
30 minutes CPD
The following excerpt is from the ANMF’s Aseptic Technique (ANTT®) tutorial on the Continuing Professional Education (CPE) website. The complete course is allocated two hours of CPD; the reading of this excerpt will give you 30 minutes of CPD towards ongoing registration requirements.
The complete tutorial covers the following:
- Governance and standards;
- Healthcare associated infections;
- ANTT® risk assessment;
- ANTT® peripheral and central access intravenous therapy; and
- ANTT® uncomplicated wound care.
To access the complete tutorial, go to anmf.cliniciansmatrix.com
For further information, contact the education team at education@anmf.org.au
