Aseptic Non Touch Technique (ANTTĀ®) is a practice framework for aseptic technique developed by the Association for Safe Aseptic Practice (ASAP). ANTT describes a set of key principles and processes that must be applied to invasive procedures and care of indwelling medical devices to reduce the risk of healthcare-associated infections.
ThisĀ guide provides a step-by-step approach to ANTT in an OSCE setting; it is NOTĀ intended to be used to guide patient care.
ANTT terminology and concepts
Key-Part (active)
Active Key-Parts are essential components of procedural equipment that directly contact Key-Sites, fluids being infused, or other active Key-Parts connected to the patient through medical devices.
If these parts become contaminated during a procedure, they can serve as a direct pathway for pathogens to enter the patient, posing a serious risk of infection.
Example
When inserting an intravenous (IV) cannula, Key-Parts include the needle and catheter being introduced into the vein, as both come into direct contact with the Key-Site (the puncture site) and the hub of the cannula (which has contact with infusion fluids and other active Key-Parts connected to the patient).
Key-Part (inactive)
Key-Parts may remain connected to the patient but be inactive.
Example
Closed IV ports are inactive. It may not be practical to continually maintain asepsis of Key-Parts when they are inactive; however, they must be made aseptic beforeĀ reuseĀ through effective cleaning and disinfection. E.g.Ā disinfecting and protecting a closed IV port prior to reconnecting it to an infusion line.
Key-Site
Key sites are areas of the patientās body where the introduction of microorganisms may lead to infection.
Example
Key-Sites include open wounds and insertion and puncture sites for invasive medical devices.
Aseptic field
An aseptic field is a defined procedural area in which equipment, including Key-Parts and Key-Sites, is carefully controlled to avoid the introduction of pathogens. Types of aseptic field include:
- General Aseptic Field: aĀ disinfected area such as a procedural tray
- Micro Critical Aseptic Field: an area specifically protecting Key-Parts, such as covers, caps and packaging
- Critical Aseptic Field: an area maintaining sepsis with sterile drapes/aseptic field. Only sterile and aseptic equipment may be placed within the field, and sterile gloves must be worn.
Standard-ANTT
If the infection risk posed by an invasive procedure is low, a Standard-ANTT approach may be deemed appropriate.
A Standard-ANTT approach maintains asepsis using General and Micro Critical Aseptic Fields to protectĀ individual Key-Parts. An example would be preparation of intravenous medications within a disinfected procedural tray (General Aseptic Field), with Key-Parts such as syringe hubs protected using sterile caps (Micro Critical Aseptic Field).
Typically, Standard-ANTT techniques are used in procedures that are relatively simple and short in duration, where the Key-Parts are small and few, and asepsis is easy to maintain using General and Micro Critical Aseptic Fields.
Non Touch Technique is essential when using a Standard-ANTT approach.
Surgical-ANTT
Surgical-ANTT is typically required if the risk of infection posed by a procedure is deemed high.
A Surgical-ANTT approach minimises infection risk by protecting Key-Parts collectively within a Critical Aseptic Field, such as a sterile drape. The field is critically managed, meaning that only sterile and aseptic equipment is allowed to enter the Critical Aseptic Field, and sterile gloves must be worn. An example would be urinary catheterisation, in which equipment is carefully opened, without contamination, from sterile packaging onto a Critical Aseptic Field, and sterile gloves are worn.
Typically, Surgical-ANTT techniques are used in moreĀ complexĀ procedures in which maintaining asepsis may prove more challenging. Such procedures may involve many large Key-Parts andĀ takeĀ longer.
Risk assessment
Risk assessing the procedure to be undertaken will determine whether Surgical-ANTT or Standard-ANTT is required. Local policy may provide further guidance on which type of ANTT technique to follow.
When carrying out a risk assessment, the practice variables that must be considered include:
- The procedure environment
- Procedure invasiveness
- The number and size of Key-Parts and Key-Sites
- Competency of the practitioner
- Procedure duration
Based on the assessed risk, the practitioner should next consider whether the main aseptic field would need to be critically managed to maintain asepsis of Key-Parts and Key-Sites.
Critical management means that only Key-Parts are protected collectively on a sterile drape, and Surgical-ANTT must be used. If it is technically simple to protect Key-Parts individually, with Non Touch Technique and Micro Critical Aseptic Fields, then Standard-ANTT is used.
Introduction
Wash your handsĀ using alcohol gel. If your hands are visibly soiled, wash them with soap and water.
Don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Confirm the patientās name and date of birth.
Briefly explain what the procedure will involve using patient-friendly language.
Gain consent to proceed.
Check if the patient has any allergies (e.g. latex).
Undertaking a procedure using ANTT
1. Wash your hands.
2. Don non-sterile gloves and a disposable apron.
3. Disinfect surfaces, such as a trolley or tray, with a universal disinfectant wipe.
4. Remove and dispose of gloves and apron.
5. Wash your hands.
6. Check equipment is available, and all packaging is intact, undamaged and sterile, including expiry dates and any sterility indicators.
7. Place all equipment required in a suitable, clean area, such as the bottom shelf of a dressing trolley.
8. Take the trolley to the personās bedside, avoiding potential environmental contamination, such as curtains.
9. Wash hands and don disposable apron.
If Standard-ANTT is to be used
10. Open the equipment into a suitable General Aseptic Field, such as a disinfected procedural tray.
- Ensure that all Key-Parts remain protected within a Micro Critical Aseptic Field, e.g. covers and caps, within the recently opened equipment sterile packaging.
11. Wash your hands and don non-sterile gloves.
- Sterile gloves may be used in some circumstances, such as blood culture collection.
12. Carry out and complete the relevant procedure using ANTT, avoiding contamination of Key-Parts, Key-Sites and the aseptic field at all times.
If Surgical-ANTT is to be used
10. Open the outer cover of the sterile pack and place the inner contents, without touching them, onto the top shelf of the trolley (or suitable work surface).
11. Wash your hands.
12. Open the sterile drape (Critical Aseptic Field) using only the corners of the field.
13. Open additional equipment packs, tipping their contents gently onto the centre of the aseptic field.
14. If using ampules such as 0.9% sodium chloride solution, use a suitable disinfecting wipe to clean the outer packaging for 30 seconds, then allow to dry for 30 seconds.
- Once dry, the packaging can be opened (without touching the Key-Site) and its contents poured into a suitable receiver already within the aseptic field.
15. Wash hands and don sterile gloves.
16. Carry out and complete the relevant procedure using ANTT, avoiding contamination of Key-Parts, Key-Sites and the aseptic field at all times.
To complete the procedureā¦
ExplainĀ to the patient that the procedure is nowĀ complete.
Provide the patient with any post-procedure information.
Thank the patientĀ for their time.
Dispose of your PPE and other clinical waste into an appropriate clinical waste bin.
Wash your hands.
Document the details of the procedure and any required clinical documentation.
References
- Rowley S. Aseptic Non Touch Technique. Nursing Times. 2001.
- The Association for Safe Aseptic Practice (ASAP). The ANTTĀ® Clinical Practice Framework. 2024.
- NMC. Test of Competence: Marking Criteria. Adult Nursing. 2025. Available from: [LINK].
Image references
- Figure 1.Ā The Association for Safe Aseptic Practice (ASAP). The ANTTĀ® Clinical Practice Framework. 2024. Available from: [LINK].
- Figure 2.Ā The Association for Safe Aseptic Practice (ASAP). ANTTĀ® Risk Assessment. Available from: [LINK].
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