Aseptic Non-Touch Technique (ANTT®) Policy

1. Policy Statement

It is the policy of this organization that Aseptic Non Touch Technique (ANTT®) shall be employed as the standardized framework for preventing infection during all invasive procedures and device management. ANTT integrates evidence-based infection control principles with practical clinical application, creating a unified methodology applicable across all care settings and procedure types. The protection of Key-Parts and Key-Sites from microbial contamination through disciplined hand hygiene, appropriate PPE, aseptic field management, and non-touch practice is a non-negotiable clinical standard.

2. Purpose

This policy exists to:

• Establish ANTT® as the organization’s single, standardized aseptic technique framework for all invasive procedures and device management.
• Define core ANTT terminology and the risk assessment framework guiding selection between Standard-ANTT and Surgical-ANTT.
• Specify the essential components of effective ANTT practice for consistent, safe implementation.
• Establish competency requirements and quality assurance expectations for ongoing ANTT compliance.

3. Scope

This policy applies to:

• All clinical personnel performing invasive procedures, managing vascular access devices, preparing or administering infusions, or conducting any procedure with potential to introduce microorganisms into a patient.
• All care settings, including inpatient, ambulatory, home care, and long-term care.
• All procedures involving Key-Sites and Key-Parts as defined in this policy.

4. Policy Requirements

4.1 Foundational Concepts and Rationale

4.1.1 Aseptic Non Touch Technique (ANTT®) addresses historical variability in aseptic practice by providing a standardized, internationally recognized framework for preventing infection during invasive procedures and device management. The approach integrates evidence-based infection control principles with practical clinical application across all care settings.

4.1.2 The fundamental premise of ANTT centers on protecting critical procedural components from microbial contamination. This protection is achieved through the deliberate combination of hand hygiene, personal protective equipment, appropriate surface management, and disciplined non-touch practices. When applied consistently, ANTT has demonstrated measurable reductions in healthcare-associated infections, particularly those related to vascular access devices.¹²³

4.2 Core Terminology and Definitions

4.2.1 Key-Site refers to any anatomical location that serves as a portal of entry into the patient’s body. In vascular access practice, this includes catheter insertion sites, injection ports, and any open wounds that could serve as pathways for microbial transmission. The significance of Key-Sites lies in their vulnerability; contamination at these points creates direct access for pathogens to enter sterile body compartments.

4.2.2 Key-Part describes equipment components that, if contaminated, pose a direct risk of introducing microorganisms to the patient. Examples include syringe tips, male Luer connectors, administration set spikes, and needle hubs. These components represent the final barrier between the external environment and the patient’s vascular system or tissues.

4.2.3 The relationship between Key-Sites and Key-Parts is central to infection prevention: contaminated Key-Parts that contact Key-Sites create a direct pathway for pathogen transmission. Maintaining the sterility of Key-Parts until their intended contact with Key-Sites represents the essential goal of aseptic practice.

4.2.4 General Aseptic Field describes a surface that has been cleaned and disinfected to reduce microbial contamination. Procedure trays, preparation carts, and single-use procedure kits serve this function. While a General Aseptic Field promotes asepsis, it does not guarantee sterility. Key-Parts placed on this surface require additional protection through Micro Critical Aseptic Fields when not actively in use.

4.2.5 Critical Aseptic Field provides a higher level of protection through the use of sterile draping. This approach creates an environment where all procedure equipment can be placed and managed collectively with confidence in maintained sterility.

4.2.6 Micro Critical Aseptic Field offers targeted protection for individual Key-Parts. Sterile caps, protective covers, and the interior surfaces of recently opened sterile packaging all function as Micro Critical Aseptic Fields. This concept enables efficient protection of Key-Parts during simpler procedures without requiring full sterile draping.

4.3 ANTT Risk Assessment Framework

4.3.1 Clinical procedures vary substantially in complexity, duration, and infection risk. ANTT addresses this variability through a structured risk assessment that guides the selection between Standard-ANTT and Surgical-ANTT.

4.3.2 The assessment process centers on a single question: Can all Key-Parts and Key-Sites be protected individually throughout the procedure? When the answer is yes, Standard-ANTT provides appropriate protection. When individual protection becomes impractical due to the number of components, procedure complexity, or environmental factors, Surgical-ANTT becomes necessary.

4.3.3 Variables informing this determination include: the quantity and size of Key-Parts; procedure duration; the procedure’s invasiveness and associated infection risk; environmental factors including workspace limitations and potential interruptions; and the level of personal protective equipment required.

4.3.4 Standard-ANTT applies to procedures of shorter duration involving fewer, smaller Key-Parts that can be readily protected through Micro Critical Aseptic Fields and non-touch technique. Typical applications include:

• Vascular access device flushing and locking
• Administration set preparation and replacement
• Intravenous medication administration
• Routine wound care

When performing Standard-ANTT, non-sterile gloves generally suffice unless direct contact with Key-Parts or Key-Sites becomes necessary, in which case sterile gloves are required.

4.3.5 Surgical-ANTT addresses longer, more complex procedures where collective protection through sterile draping proves more practical and reliable than individual Key-Part protection. Central vascular access device insertion and exchange exemplify procedures requiring this approach. Surgical-ANTT incorporates sterile gloving and enhanced barrier precautions while maintaining non-touch technique for Key-Part protection whenever practical.

4.4 Essential Components of ANTT Practice

4.4.1 Hand hygiene serves as the foundation, performed according to established guidelines at each required opportunity before, during, and after procedures. Refer to the Hand Hygiene Policy for full requirements.

4.4.2 Personal protective equipment selection follows standard precautions while adapting to specific procedure requirements and the ANTT risk assessment.

4.4.3 Aseptic field management begins with surface decontamination and continues throughout the procedure. For Standard-ANTT, this involves establishing a General Aseptic Field and utilizing Micro Critical Aseptic Fields for Key-Part protection. For Surgical-ANTT, sterile draping creates a Critical Aseptic Field where all equipment maintains collective protection.

4.4.4 Non-touch technique represents the behavioral discipline that ultimately protects Key-Parts and Key-Sites from contamination. Even when wearing sterile gloves during Surgical-ANTT, clinicians shall employ non-touch methods whenever practical, recognizing that gloves provide a backup rather than primary protection.

4.4.5 Skin antisepsis and device disinfection ensure that Key-Sites are appropriately prepared and that reusable device components receive adequate decontamination. These practices complement Key-Part protection by addressing potential contamination sources at the patient interface.

4.5 Competency Requirements and Quality Assurance

4.5.1 ANTT proficiency represents a core clinical competency that extends beyond initial education to require ongoing assessment and periodic reeducation. Organizations shall establish comprehensive training programs utilizing multimodal educational resources aligned with the ANTT Clinical Practice Framework. Application of ANTT in home healthcare settings presents unique logistical and environmental challenges that require tailored educational approaches and environmental adaptation strategies distinct from those used in inpatient practice.⁴

4.5.2 Competency documentation shall address all relevant aspects of infusion therapy, including solution and medication preparation and administration, vascular access device insertion and management, and related clinical procedures. Individual clinicians bear ultimate responsibility for ensuring consistent, correct application of ANTT principles in their practice.

4.5.3 Quality assurance through periodic clinical audit serves multiple purposes: validating individual competency, identifying practice gaps, and driving continuous improvement. Audit tools shall evaluate compliance with the ANTT Clinical Practice Framework and applicable organizational procedures, with findings informing targeted education and practice refinement. Systematic quality improvement initiatives targeting ANTT compliance in intravenous line maintenance have demonstrated measurable reductions in healthcare-associated infection rates, underscoring the direct patient safety impact of sustained ANTT adherence.⁵

4.6 Environmental Management

4.6.1 Prior to clinical intervention, purposeful decontamination shall reduce the microbial burden on surfaces that may contact clinical equipment or serve as contamination sources.

4.6.2 Durable medical equipment used during ANTT procedures requires particular attention. Ultrasound devices, infusion pumps, and similar equipment shall undergo appropriate cleaning and disinfection before, during, and after clinical use. This practice prevents equipment from serving as vectors for pathogen transmission between patients or from environment to patient.

5. Compliance

5.1 Monitoring. Compliance shall be monitored through direct clinical observation audits using ANTT-aligned audit tools, infection surveillance data (particularly CLABSI and catheter-associated infection rates), and competency assessment completion records.

5.2 Key Performance Indicators.

• ANTT audit compliance rate (target: ≥90%).
• Central Line-Associated Bloodstream Infection (CLABSI) rate (target: zero preventable events).
• ANTT competency documentation completion rate for applicable roles (target: 100%).
• Peripheral IV-associated infection rate trended quarterly.

5.3 Enforcement. Observed deviations from ANTT standards during invasive procedures shall be addressed through immediate intervention and coaching. Procedure halt may be required if Key-Site or Key-Part contamination occurs. Persistent non-compliance shall be escalated through the organization’s performance management and clinical governance processes.

6. Exceptions

6.1 In life-threatening emergencies requiring immediate intervention, full ANTT implementation may be temporarily suspended. The minimum aseptic protections feasible shall still be applied, and the deviation shall be documented in the patient record. A formal review shall occur within 24 hours of the emergency procedure.

6.2 No exception shall be granted to the requirement for hand hygiene as the foundation of ANTT practice, regardless of clinical urgency.

7. Related Documents

• Hand Hygiene Policy (this collection)
• Standard Precautions Policy (this collection)
• Transmission-Based Precautions Policy (this collection)
• POL-003: Evidence-Based Selection and Clinical Monitoring Standards
• POL-007: Competency and Competency Validation in Vascular Access
• POL-012: Documentation in the Health Record for Vascular Access
• SOP-VA-010: PICC Insertion Using Surgical-ANTT
• SOP-VA-020: Peripheral IV Insertion Using Standard-ANTT
• SOP-VA-030: CVC Dressing Change Using Surgical-ANTT
• ANTT® Clinical Practice Framework (The Association for Safe Aseptic Practice)

8. Revision History

ANTT® is a registered trademark of The Association for Safe Aseptic Practice (ASAP).

References