Infection Control & Aseptic Non-Touch Technique Sally Aucken & Catherine Jones

Learning Objectives Understand why critically ill pateints are vulnerable to infection Identify key principles infection control within a critical environment. Identify the key principles of Aseptic Non-Touch Technique (ANTT) Demonstrate knowledge of differences between standard and surgical ANTT

Infection Control WHY ARE CRITICALLY ILL PATIENTS MORE VULNERABLE TO INFECTION?

Infection Control: Vigilant bedspace decontamination between patients. (Soapy Wipes) Deep Clean Team for infected patients. Daily dampdusting. Personal Protective Equipment: Visors available at each bedspace. Gloves & Apron to be worn for any patient contact. Relatives to gel hands on entering unit & wear aprons at bedspace Full plastic gown for ‘dirtier’ procedures e.g. reaching over patient for roll.

Infection Control:

Infection Control: DAILY DAMPDUSTING IS MANDATORY

Catheter Care: Daily catheter care with soap & water Observe & document entry site daily Always hang the catheter bag below the level of the bladder Do not allow the catheter to come into contact with the floor Interruption of closed catheter circuit should only be undertaken with good clinical reason – Sterile gloves should be worn. Label catheter bag & change every 7 days

Failures in asepsis during aseptic technique observed in NHS Trusts (2006-2010). Contamination of key-parts Poor cannulation site care Poor hand cleaning Each of these poor practices places the patient at high risk of infection. Which do you always get right? Poor aseptic field management Poor key-part cleaning 8

This presentation shows ANTT applied to IV therapy However, … ANTT can be applied to any aseptic technique You are now going to look at two ways in which safe ANTT can be taught and practiced. By understanding the principles underpinning ANTT. By learning the sequence of the IV ANTT guideline.

The main infection risk to the patient is the health care professional Principle 1 The main infection risk to the patient is the health care professional principle1 The ANTT Theory & Practice Framework www.antt.org.uk enquiries@antt.org.uk

principle 2 Sterile Asepsis Clean The ANTT Theory & Practice Framework Health care workers must understand what asepsis is and how to establish and maintain it principle 2 The ANTT Theory & Practice Framework 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. www.antt.org.uk enquiries@antt.org.uk

Identifying and protecting key-parts and key-sites is paramount Principle 3 Identifying and protecting key-parts and key-sites is paramount Key-sites are open wounds, including insertion and puncture sites. Key-parts are the parts of the procedure equipment that come into direct or indirect contact with any liquid infusion or key-sites and with any active key-parts connected to the patient. If contaminated they present a very high risk of infection to the patient. principle 3 The ANTT Theory & Practice Framework www.antt.org.uk enquiries@antt.org.uk

principle 4 The ANTT Theory & Practice Framework Principle 4 Clinical procedures must be risk-assessed to determine the level of aseptic technique required principle 4 The ANTT Theory & Practice Framework 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?’ www.antt.org.uk enquiries@antt.org.uk

Asepsis is maintained with either Standard or Surgical ANTT Principle 5 Asepsis is maintained with either Standard or Surgical ANTT principle 5 The ANTT Theory & Practice Framework www.antt.org.uk enquiries@antt.org.uk

principle 6 The ANTT Theory & Practice Framework Principle 6 Aseptic fields are important. Standard and Surgical-ANTT require different aseptic field management. principle 6 The ANTT Theory & Practice Framework 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. www.antt.org.uk enquiries@antt.org.uk

Standard-ANTT - aseptic field management www.antt.org.uk enquiries@antt.org.uk 17

Standard-ANTT - The general aseptic field does not require managing critically Micro critical aseptic fields (Essential) www.antt.org.uk enquiries@antt.org.uk 18

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 www.antt.org.uk enquiries@antt.org.uk

principle 7 NTT in Standard-ANTT NTT in Surgical-ANTT The ANTT Theory & Practice Framework Principle 7 Non-touch technique is the most important component of Surgical and Standard-ANTT NTT in Standard-ANTT NTT in Surgical-ANTT www.antt.org.uk enquiries@antt.org.uk

Appropriate infective precautions help promote and ensure asepsis Principle 8 Appropriate infective precautions help promote and ensure asepsis principle 8 The ANTT Theory & Practice Framework www.antt.org.uk enquiries@antt.org.uk

Aseptic practice should be standardised Principle 9 Aseptic practice should be standardised principle 9 The ANTT Theory & Practice Framework www.antt.org.uk enquiries@antt.org.uk

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