POLICY FOR ASEPTIC NON TOUCH TECHNIQUE … · standardised aseptic technique plays a significant...

POLICY FOR ASEPTIC NON TOUCH TECHNIQUE (ANTT)

INFECTION PREVENTION AND CONTROL POLICY NO. 15

Applies to: Employees of Wirral Community NHS Trust Group for Approval Infection Prevention & Control Group Date of Approval 3 May 2013 Committee for ratification Quality and Governance Committee Date Ratified 20 May 2013 Review Date: 2016 Name of Lead Manager Head of Infection Prevention & Control Version 1

UNLESS THIS VERSION HAS BEEN TAKEN DIRECTLY FROM THE TRUST WEB SITE THERE IS NO ASSURANCE THIS IS THE CORRECT VERSION

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Policy for Aseptic Non Touch Technique (ANTT) – Version 1

Policy for Aseptic Non Touch Technique (ANTT)

CONTENTS Paragraph 1 Introduction 2 Statement of intent 3 Definitions 4 Equality impact assessment 5 Duties 6 Procedure 7 Training/Support 8 Process for monitoring effective implementation 9 Other relevant procedural documents 10 References

Appendices 1 Process monitoring tool

Acknowledgement This policy is based on the ANTT Clinical Practice Framework – (2013) Version 3.1 The Association for Safe Aseptic Practice (ASAP). ANTT® Clinical Practice Framework. Version 3.1 www.antt.org

http://www.antt.org/�

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1. INTRODUCTION Wirral Community NHS Trust is committed to reducing Healthcare Associated Infections (HCAI) therefore demonstrating compliance with The Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance (Department of Health, 2010). The Code of Practice specifies that where aseptic procedures are performed the technique should be standardised across the Organisation and all persons undertaking such clinical procedures should receive education and training in such techniques. Due to the invasive nature of clinical procedures, health care workers are inherently the main route of infection. Aseptic Non Touch technique (ANTT) provides health care workers with a practice framework which promotes safe and efficient aseptic technique (The Association for Safe aseptic Practice, 2013). Pratt et al (2007) recognise that standardised aseptic technique plays a significant part in care provision as it has been shown to significantly reduce HCAI and provide safe care. Asepsis is the method by which healthcare workers can prevent microbial contamination during invasive procedures or breaches in the skins integrity. ANTT is the method used to reduce the risk of microbial contamination to a vulnerable site. ANTT is supported by the use of infection control standard precautions for all patients, all of the time. 2. STATEMENT OF INTENT

This policy outlines Wirral Community NHS Trust’s (WCNHST) responsibilities in ensuring that clinical procedures are carried out in a manner that ensures asepsis. The Trust recognises its responsibility in ensuring that care is delivered in the safest way possible to ensure high quality clinical care. The policy details a standard framework approach in relation to clinical procedures. It also details employee’s responsibilities in relation to adherence to a standardised approach to aseptic technique practice.

To comply with The Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance (Department of Health, 2010) WCNHST will:

• Provide training to staff required to perform aseptic technique as part of their role

• Reduce variation in practice through use of standardised technique

• Change culture amongst staff through education, training, audit and ongoing

support

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3. DEFINITIONS

• Aseptic technique: the method by which precautions are taken during invasive clinical procedures to prevent the transfer of microorganisms from the healthcare worker, procedure equipment or the immediate environment to the patient. Regardless of the setting the aim is always to prevent the transfer of pathogenic micro-organisms from the healthcare worker, procedure equipment or the immediate working environment into or onto the patient

• Aseptic Non Touch Technique (ANTT): A specific type of aseptic technique

with a unique Theoretical and Practice Framework. (NICE 2012).

• Aseptic field: a designated aseptic working space that contains and protects the procedure equipment, in ANTT there are differing aseptic fields:

• Critical aseptic field: an aseptic field using a dressing pack or sterile drape

where only aseptic Key-Parts can come into contact with it. A critical aseptic field is used to ensure asepsis and requires critical management

• General aseptic field - is used to promote asepsis rather than ensure it, this may

be through the use of a clean tray or trolley. Micro critical aseptic field (MCAF is used to ensure Key-Part asepsis and requires general management

• Micro critical aseptic field (MCAF): a small critical aseptic field used to protect

a specific key-part, e.g. a syringe cap or needle cover, other examples may include ‘backing’ to dressings

• Critical management: The whole main aseptic field (usually a sterile drape) is

maintained aseptically. i.e. Only sterile or aseptic equipment can come into contact with the critical aseptic field, sterile gloves are used to maintain aseptic continuity

• General management: Whilst the main aseptic field (Usually a plastic or paper

tray) is still managed aseptically and helps to promote a safe working space, it is not as aseptic as a sterile drape and therefore is not relied upon as the primary method of equipment protection. Equipment asepsis is maintained by protecting Key-Parts individually with micro critical aseptic fields (caps and covers).

• Healthcare associated infection (HCAI): any infection acquired by a person as

a consequence of healthcare interventions regardless of where care is delivered

• Key-Part: the critical part of procedural equipment that comes into contact with the patient (a Key-Site) or other procedural equipment i.e. liquid infusion during the procedure.

• Key-Site: can be a wound, insertion and access sites for a medical device

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• Non-touch technique: an integral component in achieving aseptic technique and should always be applied where practically possible and relates to Key-Parts and Key-Sites which should not be handled unless unavoidable to do so

4. EQUALITY IMPACT ASSESSMENT As part of its development, this policy and its impact on equality have been reviewed. The purpose of the assessment is to minimise and if possible remove any disproportionate impact on employees on the grounds of race, sex, disability, age, sexual orientation or religious belief. No detriment was identified. 5. DUTIES Chief Executive The Chief Executive has overall responsibility for Infection Prevention and Control within the Trust. Trust Board The Trust Board has a responsibility for ensuring that it corporately meets its legal duties in relation to Infection Prevention and Control. This responsibility is delegated to the Quality and Governance Committee via the Infection Prevention and Control Group. Director of Infection Prevention and Control It is the responsibility of the Director of Infection Prevention and Control to oversee the development and implementation of infection prevention and control policies and to ensure that the Trust has safe effective management systems in place in relation to HCAI. Quality and Governance Committee The primary function of the Quality and Governance Committee is to provide assurance to the Board of overall compliance with all statutory and regulatory obligations and will ensure the effective management of incidents, complaints, and subsequent dissemination of lessons learnt. The Quality and Governance Committee is responsible for ratifying Infection Prevention and Control policies. Infection Prevention and Control Group The Infection Prevention and Control Group is responsible for approving Trust Infection Prevention and Control policies and for monitoring incidents in relation to infection prevention and control.

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The Infection Prevention and Control Service The IPCS are responsible for developing Trust wide policies. The IPCS are responsible for ensuring this policy is reviewed and amended at the review date or prior to this, following new developments in ANTT research and practice. The Infection Prevention and Control Service (IPCS) are responsible for assuring the Trust board regarding activity in infection prevention and control within the Trust. Written reports are submitted four times per financial year. Divisional Managers Divisional Managers will ensure that appropriate actions are taken for issues reported/escalated directly via the Infection Prevention and Control Group, Divisional Governance meetings/Service Leads and any other relevant Committee or Group. Service Leads/ Managers Service Leads/Managers are responsible for monitoring via Management Supervision attendance at mandatory training within their teams. Service Leads/Managers are responsible for identifying if ANTT training is required for their service and for addressing areas of non compliance. Employees Employees are responsible for carrying out procedures where ANTT is indicated in a safe manner. Employees are responsible for ensuring they attend mandatory training programmes as directed by their Line Manager. Employees must comply with Trust policies. Failure to comply with or act in accordance with Trust policies may result in disciplinary action. 6. ASEPTIC NON TOUCH TECHNIQUE (ANTT) During any invasive clinical procedure the aim of an aseptic technique is to protect the patient from infection. In ANTT, this is achieved by ensuring the asepsis of Key-Parts and Key-Sites by protecting them from the healthcare worker and environmental contamination. The ANTT Clinical Practice Framework provides a comprehensive and robust process by which to apply safe aseptic technique. It is based on 4 Principles and 4 Safeguards (ANTT 2013). Standard-ANTT: is required when procedures are technically simple, short in duration, involve small Key-Sites and Key-Parts and a minimal number of Key-Parts. Standard-ANTT involves protecting Key-Parts individually with Micro Critical Aseptic Fields and other elements of aseptic technique.

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Surgical-ANTT: is required when procedures are technically complex, involve and extended procedure time, involve large open Key-Sites and large or numerous Key-Parts. Surgical-ANTT involves maintaining the whole aseptic field as a Key-Part and usually involves a sterile drape and sterile gloves. It should be noted that while these two approaches differ to accommodate different levels of procedure complexity they both adhere to the same principles of ANTT.

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The two types of ANTT can be simplified into ‘The ANTT-Approach’. The ANTT-Approach highlights and promotes the essential elements of safe aseptic technique:

Risk Assessment: The need for Surgical or Standard ANTT is determined by ANTT risk assessment that is based on the technical difficulty of achieving asepsis. To determine Standard or Surgical-ANTT consider the risks posed by the procedure environment, procedure invasiveness, the number & size of Key-Parts & Key-Sites and length of procedure Manage the environment: there are recognised challenges i.e. patients own environment in performing an aseptic technique within the community. However, the aim of an aseptic technique is always asepsis (i.e. to prevent the introduction of new or further harmful microorganisms) which can easily be achieved in community setting with application of simple control measures to manage the environment Decontaminate and protect: the importance of effective hand hygiene is the single most important measure to prevent the transmission of infection; therefore it plays a crucial role in ANTT. Standard infection control precautions must always be adhered to when performing ANTT

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Use aseptic fields: Aseptic fields help protect procedure equipment from the clinical or home care environment. Standard and Surgical-ANTT use different types of aseptic fields. Use Non-Touch Technique: The safest way to protect a Key-Part is not to touch it. Avoid touching Key-Parts of the procedure equipment and Key-Sites. If these must be handled sterile gloves must be worn. Prevent Cross Infection: By safe and effective equipment disposal and hand decontamination at the end of every procedure. The steps in each procedure are risk evaluated and sequenced to ensure an efficient, logical and safe order; staff must always follow Trust policies and procedures: Step 1. ANTT Risk assessment (use of Standard or Surgical ANTT)

Step 2. Decontaminate hands

Step 3. Clean trolley/tray/create suitable working environment

Step 4. Gather equipment


Step 6. Apply single use disposable apron

Step 7. If required, open dressing pack/sterile drape

Step 8. Open and prepare all equipment


Step 10. Apply gloves (as dictated by ANTT risk assessment)

Step 11. Perform procedure using ANTT

Step 12. Remove gloves & apron

Step 13. Dispose of waste


Step 15. Clean trolley/tray/environment


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7. TRAINING/SUPPORT Infection prevention and control training (including Aseptic Non Touch Technique training) is a mandatory requirement for clinical staff who undertake such procedures as identified on Service Training Matrices. All core mandatory training is recorded centrally by the Quality and Governance service. Quarterly monitoring reports are prepared for the Learning and Development Group to monitor attendance rates. Full details of the processes in place for managing and monitoring attendance are set out in the Policy for Learning and Development GP46. ANTT training is incorporated into relevant clinical training provided by Specialist Nursing Services. The Infection Prevention and Control Service can be contacted for further advice or support. 8. PROCESS FOR MONITORING EFFECTIVE IMPLEMENTATION The monitoring tool (appendix 1) outlines the monitoring arrangements for complying with this policy. 9. OTHER RELEVANT PROCEDURAL DOCUMENTS This policy should be read in conjunction with relevant Organisational documents. 10. REFERENCES Department of Health (2006). Essential Steps to Safe, Clean Care Department of Health (2010). Saving Lives Department of Health (2010) The Health and Social Care Act 2008 Code of practice on the prevention and control of infections and related guidance Pratt, RJ. Pellowe, CM. Wilson, JA. Loveday, HP and the epic guideline development Team (2007) epic2: National Evidence-Based Guidelines for Preventing Healthcare- Associated Infections in NHS Hospitals in England. The Journal of Hospital Infection. February 65S, S15 -19. Rowley, S. (2009) Improving standards of aseptic technique practice through an ANTT trust-wide implementation process: a matter of prioritisation and care. Journal of Infection Prevention, 10(1) The Association for Safe Aseptic Practice (ASAP) (2013) ANTT® Clinical Practice Framework. Version 3.1 www.antt.org

http://www.antt.org/�

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Appendix 1 Process for Monitoring Compliance with Aseptic Non Touch Technique Policy

Minimum requirement to be monitored

Process for monitoring (e.g. audit)

Responsible individual / group/ committee

Frequency of monitoring

Evidence Responsible individual for development of action plan

Responsible committee for monitoring of action plan and Implementation

Process for checking that all permanent staff, as identified in the training needs analysis, complete ANTT training

Trust wide Mandatory Training Attendance Reports Service Training Matrices

Learning & Development Group

Quarterly

Minutes Service training Matrices

Divisional Managers/ Service Leads

Education & Workforce Committee

Process for following up those who fail to attend ANTT training

Trust wide Mandatory Training Attendance Reports

Learning & Development Group

Quarterly Minutes Divisional Managers/ Service Leads

Education & Workforce Committee

Process for monitoring compliance with policy

Essential Steps to Safe, Clean Care observational audit tools

Infection Prevention & Control Group

Quarterly INCA - Essential Steps to Safe, Clean Care observational audits Service Exception reports

Divisional Managers/ Service Leads

Quality & Governance Committee

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