ANTT: Consolidating Standard Aseptic Practice 4/28/2017 Management of Invasive Devices: Catheters & Peripheral Vascular Cannulae (Learning Session Three) ANTT: Consolidating Standard Aseptic Practice 1

Why the need for ANTT?

Problems with aseptic technique No standard Poor equipment choices Poor understanding of asepsis A historical & unhelpful paradigm Poor hand cleaning Ritual based practice Confusion & ambiguity No standard Poor equipment choices Poor understanding of asepsis A historical & unhelpful paradigm Poor hand cleaning Ritual based practice Confusion & ambiguity

Failures in asepsis during aseptic technique Contamination of key-parts Poor cannulation site care Poor hand cleaning Each of these poor practices places the patient at a higher risk of infection. Which do we always get right? Poor aseptic field management Poor key-part cleaning

This is your prep area 4/28/2017 Environment is important: Denture pots with unidentified patients’ teeth (around for 2 weeks), no space to prep IV’s, open food containers (biscuits), paper vomit bowels used for aseptic fields, and old dirty ‘sticky’ folders and non-laminated (and thus not cleanable) paperwork and posters

This is your prep area 4/28/2017 Good technique is of course reliant on good aseptic management in its wider sense. Often technique is compromised by poor equipment, poor organisations, and poor environments.

Aseptic Technique ‘Guidance’ ? DOH ‘Do aseptic technique’ NPSA ‘Use aseptic technique’ QCC ‘Use a standard aseptic technique’ WHO ‘Use aseptic technique’ Royal Marsden Manual ‘Use aseptic technique’ RCN IV Standards ‘Use aseptic technique’

What Does Aseptic Technique Mean to You?

What is ANTT?

The Hospital Collection The Community Collection ANTT is three things A set of aseptic technique clinical guidelines for the common clinical procedures, which are peer reviewed nationally and mandatory. The Hospital Collection The Community Collection

2. Implementation Programme ANTT Implementation audit cycle launch training pre audit assessment ANTT Implementation audit cycle accreditation post audit 2. Implementation Programme

3. A Research & Development programme Generating evidence to support aseptic technique Implementation issues Publishing in support of ANTT 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):s18-s23 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.

ANTT has become the de facto standard aseptic technique in the UK, and is widely used around the world.

How ANTT Works

The ANTT Model for reducing Healthcare Associated Infections (HCAI) 1 2 3 Practice Framework 10 Foundation Principles Practice Framework Clinical Guidelines Implementation Process (Staff are trained) (Practice is standardised) (Compliance is established)

The Theory Practice Framework

ANTT principles & practice ‘From the community to the operating theatre’.

CLINICAL AND ORGANISATIONAL MANAGEMENT 10 principles ANTT Theoretical Practice Framework CLINICAL PRACTICE Principle 1 The main infection risk to the patient is the health care worker Principle 2 Health care workers must understand what asepsis is and how to establish and maintain it Principle 3 Identifying and protecting key-parts and key-sites is paramount Principle 4 Clinical procedures should be risk assessed to determine the level of aseptic technique required Principle 5 Asepsis is maintained with either Standard or Surgical ANTT Principle 6 Aseptic fields are important. Standard and Surgical-ANTT require different aseptic field management. Principle 7 Non-touch technique is the most important component of Surgical and Standard-ANTT Principle 8 Appropriate infective precautions help promote and ensure asepsis CLINICAL AND ORGANISATIONAL MANAGEMENT Principle 9 Aseptic practice should be standardised Principle 10 Safe aseptic technique is reliant upon effective staff training, safe environments and fit for purpose equipment.

The main infection risk to the patient is the Principle1 The ANTT Theory & Practice Framework The main infection risk to the patient is the healthcare worker.

Principle 2 Sterile Asepsis Clean Health care workers must understand what asepsis is and how to establish and maintain it Principle 2 The ANTT Theory & Practice Framework Health care workers must understand what asepsis is and how to establish and maintain it. Sterile Asepsis Clean Free from micro-organisms Free from pathogenic An important action in Not achievable in typical organisms. Achievable in removing dirt to help achieve health care settings. typical health care settings. asepsis. But not a satisfactory standard in itself for invasive procedures.

Identifying and protecting key-parts and key-sites is paramount. Principle 3 The ANTT Theory & Practice Framework Identifying and protecting key-parts and key-sites is paramount.

Principle 4 The ANTT Theory & Practice Framework Clinical procedures must be risk-assessed to determine the level of aseptic technique required. Risk assessment 1 To determine type of technique: ‘With Standard- ANTT, can I ensure aseptic key-parts only come into contact with other aseptic key-parts or key-sites’? Risk assessment 2 To determine sterile or non sterile gloves: ‘Can I perform this procedure without touching key-parts or key-sites directly?’

Principle 5 The ANTT Theory & Practice Framework

Principle 6 The ANTT Theory & Practice Framework Aseptic fields are important. Standard and Surgical-ANTT require different aseptic field management. Standard ANTT Surgical ANTT General aseptic field Critical aseptic field (Doesn’t require to be managed critically*) (Must be managed critically*) Micro critical aseptic fields essential Micro critical aseptic fields desirable * Only sterilised and aseptic equipment can come into contact with the aseptic field.

Standard-ANTT General aseptic field Micro critical aseptic fields

Surgical-ANTT Critical aseptic field Micro critical aseptic fields Exposed key-parts

This is a typical confused aseptic field This is a typical confused aseptic field. A ‘sterile’ drape has been added on the basis the patient is immunosuppressed . Subsequently, the health care worker believes it ok to leave the key-parts unprotected. But rather than add an extra layer of safety, has this not introduced extra risk? Exposed key-parts

Principle 7 The ANTT Theory & Practice Framework Non-touch technique is the most important component of Surgical and Standard-ANTT NTT in Standard-ANTT NTT in Surgical-ANTT

Appropriate infective precautions help promote and ensure asepsis Principle 8 The ANTT Theory & Practice Framework Appropriate infective precautions help promote and ensure asepsis

Aseptic practice should be standardised Principle 9 The ANTT Theory & Practice Framework Aseptic practice should be standardised

(Board to ward support is key) Principle 10 The ANTT Theory & Practice Framework Safe aseptic technique is reliant upon effective staff training in infection control, safe environments and fit for purpose equipment. (Board to ward support is key)

ANTT Guidelines

ANTT Guidelines Are designed by experts in each clinical competency The sequence of procedure and infection control steps are risk assessed using a unique tool designed by ANTT Peer reviewed by experts and users nationally

Sequencing risk assessment tool applied to blood culture collection The red Steps denote the critical steps of each procedure, i.e. the Steps which key-parts or sites are most at risk of contamination

e.g. this blood culture guideline has a number of critical steps

(This is why the order of the guideline is important and mandatory) Safe sequencing ensure all Critical Steps are preceded by decontamination (Green) or ‘benign’ (yellow) activities. (This is why the order of the guideline is important and mandatory)

The critical steps shown on the sequencing risk tool are highlighted on each guideline in red.

Standardising practice in this way with mandatory guidelines for the common clinical procedures has many benefits for patients and health care organisations: It significantly reduces the number of practice variables. (This is all the more important in large clinical workforces) It facilitates easier audit and monitoring. It facilitates a peer-pressure effect.

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