Back to Basics

By Tricia Cooper, BScN, RN, Clinical Solutions Manager at Medline nopember30 / iStock / Getty Images Plus via Getty Images

When asked what the difference is between aseptic non touch technique( ANTT ®) and sterile technique, my answer is this:“ That’ s the wrong question.” The real question is,“ How do you educate and support staff to maintain a sterile field?”

Healthcare facilities can pay a lot of money for a central lineassociated bloodstream infection, and statistics show that patients with CLABSIs are associated with a 10 % to 20 % mortality rate. 1 On top of that, research has found that up to 70 % of CLABSIs are preventable. 2 That’ s why it’ s important to understand how to properly maintain the sterile field through ANTT.

Understanding differences in verbiage My first job was decontaminating medical and surgical trays, wrapping them and putting them in the steam sterilizer. That’ s sterile. But as nurses, we often use the terms aseptic and sterile interchangeably, so they’ ve lost some technical meaning, making the verbiage confusing. Here, we clarify some definitions and practical differences.

Aseptic: Focuses on maintaining a contamination-free environment during procedures. The goal is to prevent the introduction of microorganisms into a controlled environment.“ Asepsis” means“ the absence of harmful microorganisms in sufficient quantity to cause infection.” 3

Sterile: Commonly defined as,“ the complete absence of microorganisms.” 3

ANTT: First, some background on this acronym. While the term“ aseptic non touch technique” has been used for decades, the UK-based Association for Safe Aseptic Practice( ASAP) has formalized it with a clear and universal definition. ANTT is appropriate for any invasive clinical procedure. Defined by the UK’ s National Institute for Health & Care Excellence, ANTT

I always encourage Infection Preventionists to assess current practices, so they can observe first-hand how nurses may break the sterile field, such as:

• Using an item on a patient and placing it back on the sterile field

• Not changing gloves

• Not donning sterile gloves correctly

• Touching within the sterile field with something non-sterile

• Touching something on the patient that’ s not sterile

• Not cleaning or clearing the table prior to setting a sterile kit down

is a“ specific type of aseptic technique with a unique theory and practice framework” that is meant to protect key parts of the procedures— such as syringe tips and catheter hubs— and key sites of the procedure, including the IV insertion point. 4 ANTT ultimately is intended to help improve patient safety, reduce infection and increase efficiency. 4

References 1 Appendix 3. Guidelines to prevent Central Line-Associated Blood Stream Infections.( n. d.). Agency for Healthcare Research and Quality. https:// www. ahrq. gov / hai / clabsi-tools / appendix-3. html # sl4 2 Beville, A. S. M., Heipel, D., Vanhoozer, G., & Bailey, P.( 2021). Reducing Central Line Associated Bloodstream Infections( CLABSIs) by Reducing Central Line Days. Current infectious disease reports, 23( 12), 23. https:// doi. org / 10.1007 / s11908-021-00767-w 3. Aseptic vs Sterile.( n. d.). Ossila. https:// www. ossila. com / pages / aseptic-vs-sterile-technique Umscheid, C. A., Mitchell, M. D., Doshi, J. A., Agarwal, R., Williams, K., & Brennan, P. J.( 2011). Estimating the Proportion of Healthcare- Associated Infections That Are Reasonably Preventable and the Related Mortality and Costs. Infection Control & Hospital Epidemiology, 32( 2), 101 – 114. doi: 10.1086 / 657912 4 What is ANTT?( n. d.). https:// www. antt. org / what-is-antt. html

When it comes to invasive procedures, such as central line insertion and dressing changes, maintaining the sterility of previously sterilized items and the sterile field requires the application of aseptic non touch technique( ANTT).

How to assess for ANTT Infection preventionists often see the dressing when it’ s on the patient, but they don’ t always have the opportunity to watch the dressing change itself, which means they might not see missteps in the process. During our Vascular Assessments, missteps do happen. I’ ve seen both novice and experienced nurses contaminate the sterile field, leaving patients open to infection.

Advantages of ANTT The use of the words aseptic and sterile have been blurred, which is why I urge healthcare facilities to lean into and learn more about ANTT as it’ s been defined by ASAP. It is a useful and practical way to consistently maintain the sterile field, using principles that can be used and adapted in any clinical circumstance. Read our Q & A with ANTT founder Stephen Rowley on page 20 to learn why many organizations are adopting the ANTT framework.

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