The INS Infusion Therapy Standards of Practice (the Standards) has introduced a new, dedicated standard for aseptic technique which features the original, internationally used, and explicitly defined ANTT® Clinical Practice Framework. INS has adopted this standard to help improve patient safety by establishing defined standards and universal definitions. We explore and define this standard below. Feel free to comment below how this will may affect your practice, how you may think differently about aseptic procedures in the future, or what you would like to see in sterile kits going forward.
Aseptic Technique
Proper Aseptic Technique is one of the most fundamental principles of infection prevention in a clinical and surgical setting. The word ‘aseptic’ is defined as “free from pathogenic organisms (in sufficient numbers to cause infection)”. According to the Journal of Infusion Nursing, Aseptic Technique is defined as “a set of infection prevention actions aimed at protecting from infection during invasive clinical procedures and management of indwelling medical devices; notably, it is a generic term that is variously defined, interpreted, and used interchangeably with other practice terms, such as clean, sterile, and non-touch technique.”.
The word ‘sterile’ is often used interchangeably with the word ‘aseptic’. Sterile is defined as the absence of all microorganisms. However, sterile is not achievable in a typical healthcare setting due to the multitude of microorganisms in the air environment. Items are only sterile if they are free of potential infectious agents, and once a sterile object meets a non-sterile object, surface, person, dust or airborne particles, the object is no longer sterile. The integrity of sterile packages should be preserved while being opened, dispensed, or transferred.
Aseptic technique prevents the transfer of potentially pathogenic microorganisms to a suspectable site on the body, or to sterile equipment/devices. It is a combination of decontamination processes, sterilized equipment, and handling technique; aseptic technique is used to minimize potential transmission of pathogenic microorganisms. It plays an important role because it is a component of compounding sterile preparations and requires assured competence and specified in standards.
The Aseptic Technique also encompasses practices performed immediately before and during a surgical procedure to reduce post-operative infection. These include:
-Hand washing
-Surgical scrub
-Using surgical barriers, including sterile surgical drapes and personal protective equipment, including head coverings, surgical masks and gowns, gloves, and shoe coverings
-Patient surgical prep
-Maintaining a sterile field
-Using safe operative techniques
-Maintaining a safe environment in the operating room
Aseptic Non-Touch Technique (ANTT)
The Aseptic Non-Touch Technique (ANTT) was designed to help address the variable aseptic technique standards of practice and provide a rationalized, contemporary, evidence-based framework to standardize the critical competency and to help improve the standards of practice. It is defined as:
“A specific and comprehensively defined type of aseptic technique with a unique theory-practice framework based on an original concept of key-part and key-site protection; achieved by integrating standard precautions such as hand hygiene and personal protective equipment with appropriate aseptic field management, non-touch technique, and sterilized supplies.”
ANTT is applied to all infusion-related procedures, including vascular and other infusion access device insertion and management, and administration of infusion medications and solutions, as a critical aspect of infection prevention.
The INS guidelines emphasize the aim with any procedure is Asepsis. To achieve asepsis in practice and support education and research, ANTT uses the terms Key-Part and Key-Site Protection. A key-part is any sterile part of equipment used during an aseptic procedure, such as needle hubs, syringe tips, needles, and dressings. A key-site is the area of the skin penetration that provides a direct route for the transmission of pathogens into the patient and present a significant infection risk.
Surgical-ANTT
Surgical aseptic non-touch technique is demanded when procedures are technically complex, involve extended periods of time, and involve large open key-sites or large or numerous key-parts. It is defined as:
“A combination of Standard Precautions and an approach of protecting key-sites and key-parts collectively using a sterile drape(s) and barrier precautions. Used for clinically invasive procedures where achieving asepsis and protecting Key-Parts and Key-Sites are difficult and/or procedures are long in duration, such as surgery and central vascular access device insertion.”
It should be applied during all invasive procedures when the skin is not intact or when internal areas of the body are being entered.
Standard-ANTT
Standard Aseptic Non-Touch Technique is typically used when carrying out a procedure that is simple, short in duration (approximately 20 minutes or less) and involves a small number of key-sites and equipment with a small number of key-parts. It is defined as:
“A combination of Standard Precautions and an approach of protecting Key-Parts and Key-Sites individually, using non-touch technique and Micro Critical Aseptic Fields within a General Aseptic Field. Used for clinical procedures where achieving asepsis and protecting Key-Parts and Key-Sites is straightforward and short in duration, such as VAD flushing and locking, administration set preparation and change, intravenous medication administration, and simple wound care. In the event of Key-Parts or Key-Sites requiring direct touch, then sterile gloves must be used.”
In Standard ANTT, it is not necessary to treat the general aseptic field as a key-part.
There is a fundamental difference when it comes between surgical and standard ANTT. The requirements in surgical ANTT are to manage the aseptic field itself as a key-part (i.e. intra procedure, key-parts must only come into contact with other aseptic key-parts or key-sites) in order to maintain asepsis of the key parts.
Patient Safety
Patient safety and positive outcomes are at the core of everything we do at Health Line International Corp. Because we ship our products all over the world, we support any universalization of practices, standards, and definitions, because it means improved safety and standard of care for patients everywhere. Standards also help us provide products aligned with the everchanging needs of the healthcare industry. We strive to provide our distributers with the highest-quality vascular access medical devices so healthcare professionals around the world can continue to provide top-of-the-line care to their patients.
Health Line International Corp. is not responsible for any errors, omissions, injury, loss, or damage arising from or relating to the use (or misuse) of any information, statements, or conclusions contained in or implied by the contents of this document or any of the source materials. This content is not intended to replace professional medical advice.
References
Gorski LA, Hadaway L, Hagle ME, et al. Infusion therapy standards of practice. J Infus Nurs. 2021;44(suppl 1):S1S2-S224. Doi:10.1097/NAN.0000000000000396
Moureau, N.. “Vessel Health and Preservation: The Right Approach for Vascular Access.” Vessel Health and Preservation: The Right Approach for Vascular Access (2019): n. pag.