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Review Date: January 2012 Page 1 of 28
Aseptic Non-Touch Technique Including Wound Care Policy No. TCP 113
Aseptic Non-Touch Technique (ANTT) including wound care
CROSS REFERENCE This Strategy/ Policy should be read in conjunction with: Intravenous Therapy Administration for Adults Policy (TCP 021) Infection Control Policy (IC01) Chronic Wound Care Guide Consent Policy (TW 074) Urethral Catheterisation policy (TCP 028)
Progress and date of approval (Approved / Under review) Approved 2008 Approved 2007 Approved 2008 Approved 2009 Approved 2007
Following the screening stage of the impact assessment, the Trusts Equality and Human Rights Manager has reviewed the policy and a full impact assessment is not necessary from the information available at the time of the assessment. Manager Responsible: Author: Date: Stephanie Dracott Stephanie Dracott January 2009
Policy Number: Version number: Approving Committee: Review Date :
TCP 113 2 Trustwide Clinical Policies January 2012
Brighton & Sussex University Hospitals NHS Trust
Consultation and Ratification Schedule
Name of Committee
Date of Committee
Name of Person / Team Infection Control Team Wound Care Team IV team
Date August 2008 August 2008 August 2008
Contents Section 1.0 1.1 1.2 1.3 2.0 2.1 2.2 2.3 2.4 3.0 4.0 5.0 5.1 5.2 6.0 7.0 7.1 7.2 7.3 7.4 8.0 Appendix 1 Appendix 2 Appendix 3 Appendix 4 Appendix 5 Appendix 6 Appendix 7a Appendix 7b Appendix 8 Appendix 9 Item Policy statement Purpose/Rationale Scope Principles Roles and responsibilities Responsibilities of the Trust Board Responsibilities of Directorate Management Teams Responsibilities of Ward Managers, Department Managers and Consultant Managers Responsibilities of employees Monitoring for effectiveness Policy Procedure (s) Aseptic technique Important components of aseptic technique Clean technique Wound care Wound healing Colonised wounds Clinically infected wounds Wound swabbing References Aide-memoir for deciding whether to use sterile or non sterile technique Aseptic technique procedure Clean technique procedure Wound care procedure Procedure for the inspection of surgical wounds Competence for newly employed nurses in the application of aseptic technique Elements for the wound care bundle audit tool Audit tool for the wound care bundle IV Aseptic Non-Touch Technique assessment Aseptic Non-Touch Technique assessment Equality Impact Assessment Page 4
11 12 13 15 17 19 20 21 22 23 25 28
1.0 Policy Statement 1.1 Purpose/Rationale The guidelines in this policy aim to ensure that all relevant staff working for Brighton and Sussex University Hospitals NHS Trust (BSUH) are aware of the principles and practices for the following procedures: 1) Aseptic technique 2) Clean technique 3) Wound care 1.2 Scope This policy applies to all relevant BSUH staff who undertake clinical procedures that require an interaction (direct and indirect) with the patient that bypasses the bodys natural defence against infections e.g. insertion of indwelling devices or when performing wound care 1.3 Principles The Code of Practice for the Prevention and Control of Health Care Associated Infections (Health Act) was introduced in 2006. The purpose of the Code is to help NHS bodies plan and implement how they can prevent and control Health Care Associated Infection (HCAI). It sets out criteria by which managers of NHS organisations are to ensure patients are cared for in a clean environment, where the risk of HCAI is kept as low as possible. Failure to observe the Code may result in an improvement notice being issued by the Healthcare Commission or the NHS organisation being reported for significant failings and placed on special measures. In relation to preventing and controlling risks of HCAI, NHS organisations must have in place relevant core policies including aseptic technique In addition, according to the Code, the following should be in place: 1) Clinical procedures should be carried out in a manner that maintains and promotes the principles of asepsis 2) Education, training and assessment in aseptic technique should be provided to all persons undertaking such procedures including temporary staff, on induction 3) The technique should be standardised across the organisation 4) Audit should be undertaken to monitor compliance with aseptic technique. Aseptic Non Touch Technique (ANTT) is the terminology used to describe a procedure that prevents the contamination of wounds or other susceptible sites. ANTT applies equally to procedures undertaken in operating theatres, on wards and units and other treatment areas. ANTT must be used when introducing an invasive device or when carrying out any other activity that breaches the bodys natural defence system
2.0
Roles and responsibilities
2.1 Responsibilities of the Trust board 2.1.1 To comply with any National policies and guidelines that relate to this policy e.g. Department of Health Saving Lives Document, National Patient Safety Agency guidelines, ANTT national guidelines, Epic2 guidelines 2.2 Responsibilities of Directorate Management Teams 2.2.1 To ensure that the Directorate or Division, for which they are responsible, complies with this policy 2.2.2 To ensure staff attend mandatory training sessions in ANTT 2.3 Responsibilities of Ward Managers, Department Managers and Consultant Managers 2.3.1 To ensure that all staff receive mandatory training in ANTT and maintain their competence 2.3.2 To allocate a key trainer in ANTT for their ward, department and support their training needs 2.3.3 To ensure the equipment required to perform ANTT is available in their ward, department 2.4 Responsibilities of employees 2.4.1 To attend mandatory ANTT training sessions 2.4.2 To be assessed as competent by their ward/departmental ANTT key trainer /BSUH ANTT nurse 3.0 Monitoring for effectiveness 1) Compliance with ANTT is monitored as part of Infection Control High Impact interventions on a monthly basis. These audits are performed by the Infection Control Link Nurse Practitioners. These audits monitor ANTT as part of central line ongoing care, peripheral venous catheter insertion/ongoing care, urinary catheter insertion/ongoing care. Results of these audits are displayed on the Infection Control Dashboard 2) Weekly audit in ANTT is performed by the BSUH Trust ANTT nurse. These audits monitor ANTT in wound dressing technique, urinary catheter care, preparation and administration of intravenous medication. Results of these audits are fedBrighton & Sussex University Hospitals NHS Trust
back to the member of staff audited, nurse in charge and a compliance score, action plan is sent to the Ward Manager 4.0 Policy
The aims of this policy are: 1) To minimise the introduction of pathogenic micro-organisms into wounds or other susceptible sites 2) To prevent the transfer of pathogens from the hands, wounds and contaminated equipment to other patients and staff NB: All staff have a responsibility to ensure that they develop and maintain the knowledge and skills to undertake the duties and responsibilities for their post. Regular assessment/review of ANTT competency will be completed for those involved in undertaking relevant clinical procedures. 5.0 Procedure(s)
5.1 Aseptic technique Aseptic non-touch technique (ANTT) is the effort taken to keep a patient free from pathogenic organisms. It is a method used to prevent contamination to wounds, indwelling medical devices and other susceptible sites An ANTT must be used: (Wilson, 2006) 1) When dealing with acute wounds healing by primary intention (before surface skin has sealed) 2) During cannulation e.g. peripheral, central 3) When inserting urinary catheters 4) When suturing 5) During vaginal examination during labour 6) During medically invasive procedures 7) When preparing IV drugs etc
5.2 Important components of aseptic technique Environment/equipment Performing aseptic procedures must be avoided for at least 30 minutes after domestic cleaning or bed-making. This will reduce the risk of contamination by air-bourne microorganisms Equipment used for the procedure must be checked to confirm date of sterility, intact packaging. There must be no re-use of single use items Equipment such as trays and trolleys must be cleaned before and after use with Tristel or detergent wipes, allowed to dry, followed by alcohol wipes, allowed to dry. Plastic/metal cleanable trays/trolleys must be used for IV care; dressing trolleys must be used for wound dressings, catheterisations, or in high risk procedures.
Hand hygiene Research has shown that there can be as many as three million bacteria present per square centimetre of normal skin (Gould, 1991) Hands must therefore be decontaminated before and after every patient contact, or clinical activity. This will reduce the risk of patients developing a hospital acquired infection, as well as the risk to the health care worker Soap and water, and/or alcohol gel must be used appropriately (refer to Hand Hygiene policy (IC0001) Personal Protective Equipment (PPE) Gloves are single use items and must be worn for all invasive procedures, for contact with sterile sites, where there is a risk of exposure to bodily fluids, secretions and when handling sharps or contaminated equipment Non-sterile gloves are acceptable for handling IV lines, catheter tubing, removing wound dressings, and clean dressing techniques. Sterile gloves must be worn for aseptic technique wound dressings and for insertion of invasive devices such as central line and urinary catheters. Disposable plastic aprons must be worn as single use items when there is close contact with the patient, when clothing may become contaminated with pathogenic micro-organisms, blood or body fluids. This includes IV preparation and administration, wound dressings, catheter insertion, ongoing care etc Specialised equipment such as masks, visors, protective eyewear may be necessary as per risk assessment when caring for high risk patients or undertaking high risk procedures where there is a risk of splashing Safe disposal of equipment including sharps A sharps container must be available at the point of care to reduce the risk of needlestick injury. All disposable equipment must be disposed appropriately into clinical waste bag. Reusable equipment if applicable must be placed into HSDU contained for resterilisation. Trolleys/trays must be cleaned and allowed to dry after use with Tristel or detergent wipes, followed by alcohol wipes. A disposable decontamination tag must be completed and applied to the trolley after it has been used and cleaned, or use local decontamination documentation Key parts If key parts of equipment/devices are contaminated by infectious material, they increase the risk of infection. Key parts can be needles, syringe tips, IV line connections, lumens, contents of sterile packaging. To avoid such contamination, key parts must only touch key parts, e.g. a syringe tip connecting to a needle-free connector.
Key parts in IV care must not come into direct contact with a trolley/tray. The key parts must be protected at all times e.g. prepared syringes must be capped or re-inserted into their original packaging. In wound care aseptic technique, the key parts are sterile equipment which must always be opened onto a prepared sterile field Using non-sterile gloves/sterile gloves/forceps depends on the procedure being performed. However, if it is unavoidable to touch key parts, sterile gloves must be used for the procedure 6.0 Clean Technique
A clean technique is undertaken to avoid introducing pathogens into a susceptible site, to prevent transfer to a susceptible site and to prevent transfer of pathogens to other patients and staff. It is acceptable to use a clean technique when (Wilson, 2006): 1) Dressing acute wounds healing by secondary intention 2) Removal of sutures 3) Dressing IV lines 4) Removal of drains 5) Endrotracheal suction 6) Dressing tracheostomy sites 7.0 Wound care
A wound is defined as an injury to the body that involves a break in the continuity of tissue or body structure (Martin, 2002). Wounds fall into six basic categories: 1) 2) 3) 4) 5) 6) Contusion (bruise) Abrasion (graze) Laceration (tear) Incision (cut) Puncture (stab) Burn
The aim of good wound management is to promote prompt healing and minimise the risk of wound infection developing. 7.1 Wound Healing Wound healing is a process whereby damaged, destroyed or injured tissue is restored to normal function. The process of healing occurs by first, second or third intention:
First Intention - the union of the edges of the wound under aseptic conditions, for example an incision or laceration that is closed using sutures, clips or skin adhesive. Second Intention - is used to describe the healing process in wounds where there has been tissue loss and the gap must be gradually filled by new tissue from the base upwards. Examples of these type are heavily infected wounds, surgical and traumatic wounds, pressure ulcers, burns and ulcers Third (Tertiary) Intention - when there has been considerable infection or contamination of the wound, it is left open until clean or free from infection. Once clean the wound edges will be bought together, as with first intention healing (Sussman, 1998) 7.2 Colonised Wounds Wounds on the skin can become colonised with bacteria. Colonisation refers to a wound containing multiplying bacteria that do not cause a host reaction or delay healing. A colonised wound therefore may not show visible signs of infection. Colonisation may however lead to critical colonisation which leads to delayed healing of the wound. At this point there may still not be any visible signs of clinical infection. 7.3 Clinically infected wounds For true infection to be diagnosed (i.e. the invasion of bacteria and their multiplication in the tissues), clinical signs and symptoms must be observed: 1) 2) 3) 4) 5) 6) 7) 8) Delayed healing/dehiscence Pain Swelling Inflammation Pus Increased exudates/purulent discharge Malodour (a acrid or putrid smell can indicate an anaerobic infection) Systemic signs pyrexia/rigor or tachycardia, increased neutrophil count
7.4 Wound Swabbing Swabbing a wound provides information about the type of organism(s) affecting the wound. 1) If pus is present then using a sterile syringe draw off and transfer into a sterile container. 2) Gently cleanse the wound, irrigating it with warm sterile saline to remove any debris before swabbing 3) If the wound has very little exudates, or if it is dry, then moisten the swab in sterile saline prior to swabbing. If this is not done then the swab will record surface bacteria and not necessarily the bacteria that are causing the infection 4) Place swab into the transport medium and secure lid tightly.
A request form must accompany all samples with the following information Patients given name, surname, hospital number and date of birth on request form and specimen container Ward/clinical area Relevant clinical information as this will affect how the specimen is processed Site of infection as this will enable the microbiology staff to distinguish pathogens from normal flora. Specific information is also required i.e. is the wound a surgical site or a chronic wound such as a leg ulcer. Antibiotic therapy Date and time the specimen was collected as different organisms can survive for varying lengths of time Requesting Doctor (name post & bleep number), to enable urgent results to be fed back promptly/allows for further information to be obtained if required. Specimen type and investigation required Swabs must be taken when a wound is showing two or more of the clinical signs of infection listed in section 5.3 above.
8.0 References Ayliffe, G.A.J. et al. 2000. Control of Hospital Infection: A Practical Handbook. 4th ed. London: Hodder Arnold. Cooper, R., Lawrence, J. 1996. The isolation and identification of bacteria from wounds. Journal of wound care 5 (7): 335-340. Cuzzell, J.Z. 1993. The Right way To Culture a Wound. American Journal of Nursing 93 (5): 48-50 Department of Health. 2006. The Health Act: Code of Practice for the Prevention and Control of Health Care Associated Infections. London: Department of Health Department of Health. 2007. Saving Lives, reducing infection, delivering clean and safe care: Reducing the risk of chronic wound-related bloodstream infections: A summary of best practice. London: Department of Health Gilchrist, B. 1996. Wound infection. Journal of Wound Care 5 (8): 386-388 Gilchrist, B. 2000. Taking a wound swab. NT plus, 96 (4) 2 Infection Control Nurses Association (2003). Asepsis: Preventing Healthcare Associated Infections. ICNA. Fitwise. Bathgate Kiernan, M. 1998. Role of swabbing in wound infection management. Nurse prescriber/Community Nurse 4 (6): 45-46 Lawrence, J. C. 1999. Swab taking. Journal of wound care. 8 (5): 251 Martin, E. A. 2002. Concise Colour Medical Dictionary. Oxford: Oxford University Press Pratt, R.J., Pellowe, C.M., Wilson, J.A., Loveday, H.P., Harper, P.J., Jones, S.R.L.J., McDougall, C., Wilcox, M.H. 2007. epic2: National Evidence-Based Guidelines for Preventing Healthcare-associated Infections in NHS Hospitals in England. The Journal of Hospital Infection 65S, S1-S64 Rowley, S. 2008. The ANTT guideline for the administration and preparation of peripheral and central intravenous medications. [Email] Personal email to S. Dracott. [8 Feb 2008] The Royal Marsden NHS Trust. 2004. Aseptic technique. In: The Royal Marsden Hospital Manual of Clinical Nursing Procedures. 6th ed. Oxford: Blackwell Publishing Ltd Wilson, J. 2006. Infection Control in Clinical Practice. 3rd ed. London: Bailliere Tindall
Appendix 1
Aide Memoir for Deciding Whether to Use Sterile or Non Sterile Technique
Is the wound acute or chronic?
Acute e.g. recent surgery or traumatic injury (burn, scald or laceration)
Chronic e.g. leg ulcer, pressure sore or malignant wound, abcess cavities, stoma sites
Drain sites, central lines, IV lines, invasive procedures
Use sterile gloves and aseptic technique
Is the patient immunocompromised? E.g. AIDS-related complex, leukaemia, very elderly or suffering infections
Yes
No
Use aseptic technique
Is the patients circulation compromised? E.g. peripheral ischaemia diabetes, blood disorder
Yes
No
Use aseptic technique
Use clean technique
Appendix 2 Aseptic technique procedure Procedure Explain the procedure to the patient, obtain oral consent Put on a disposable apron Rationale To allow the patient to make an informed choice about their care Protects from blood and body fluids and other environmental contaminates To maintain privacy and dignity Ensures the procedure can be performed easily/reduces the risk of contamination of sterile field and products from non-sterile field and products or from non-sterile inanimate objects To prevent the spread of transient micro-organisms To remove contaminants
Pull the curtains Position the patient and ensure that there is a clean, clear space to carry out the procedure
Wash hands or disinfect hands with alcohol hand rub/gel and put on a clean disposable apron and gloves Clean the trolley or tray with Tristel and allow this to dry
Or, If your area does not yet use Tristel, clean the trolley or tray with detergent wipes, allow to dry, then alcohol wipes, allow to dry Whilst tray/trolley is drying gather all necessary equipment checking these are within their expiry date Open packs, creating and maintaining a sterile field by avoiding contact with the sterile contents Put on sterile gloves for the procedure if you are undertaking invasive procedures e.g. urinary catheterisation. Non-sterile gloves are acceptable for noninvasive procedures e.g. giving IV medications
To prevent the spread of transient micro-organisms To ensure that you do not have to leave the area before the procedure is completed To prevent contamination of sterile equipment Prevents the introduction of microorganisms into susceptible sites. Prevents exposure to blood or bodily fluids
Using the principles of aseptic non-touch technique undertake the procedure
Once the procedure has been completed dispose of any sharps into sharps container, dispose of all waste as per Trust policy
Ensure key parts only touch key parts To prevent contamination of sterile items used on susceptible sites Prevents sharps injuries and the spread of transient microorganisms To remove contaminants To meet the national standard of decontamination of reusable medical devices
Disinfect tray/trolley after use Complete and attach a disposable decontamination tag to the trolley, or use local decontamination documentation
Remove apron and gloves and discard as per Trust policy. Wash hands using soap and water Fully document the procedure
To prevent the spread of transient micro-organisms
Ensure that there is an up to date record of all procedures
Appendix 3 Clean technique procedure Procedure Explain the procedure to the patient, obtain oral consent. Put on disposable apron Rationale To allow the patients to make an informed choice about their care Protects from blood and body fluids and other environmental contaminates To maintain privacy and dignity Ensures the procedure can be performed easily/ reduces the risk of contamination of sterile field and products from non-sterile field and products or from non-sterile inanimate objects To prevent the spread of transient micro-organisms To remove contaminants
Pull the curtains Position the patient and ensure that there is a clean, clear space to carry out the procedure
Wash hands or disinfect hands with alcohol hand rub/gel Wearing gloves and apron, clean the trolley or tray with Tristel and allow this to dry
Or, If your area does not yet use Tristel, clean the trolley or tray with detergent wipes, allow to dry, then alcohol wipes, allow to dry Whilst tray/trolley is drying gather all necessary equipment checking these are within their expiry date Disinfect hands with alcohol hand rub/gel or if contaminated use soap and water. Put on non-sterile disposable gloves Use sterile swabs to clean the site or irrigate with saline. While performing the procedure, ensure that gloved hands do not come into contact with unclean areas. Cover the wound with the most appropriate sterile dressing Using the principles of clean technique undertake the procedure
To prevent the spread of transient micro-organisms To ensure that you do not have to leave the area before the procedure is completed To remove contaminants To prevent the spread of transient micro-organisms Prevents the spread of transient micro-organisms. Prevents contamination of gloved hands Ensures only sterile items come into contact with the susceptible site Ensures that sterile items do not come into contact with non-sterile objects Prevents sharps injuries and the spread of transient microorganisms
Once the procedure is completed dispose of any sharps into sharps container, dispose of all waste as per Trust policy
Disinfect trolley/tray after use Complete and attach a disposable decontamination tag to the trolley, or use local decontamination documentation
To remove contaminants To meet the national standard of decontamination of reusable medical devices
Remove apron and gloves discard as per Trust policy. Decontaminate hands using soap and water Fully document the procedure
Ensures that there is an up to date record of all procedures
Appendix 4 Wound care procedure Procedure Explain the procedure to the patient, obtain oral consent. Offer analgesia Put on a disposable apron Rationale To allow the patient to make an informed choice about their care To ensure the patient is comfortable during the procedure Protects from blood and body fluids and other environmental contamination To maintain privacy and dignity Procedure can be performed easily/ reduces the risk of contamination of sterile field and products from nonsterile inanimate objects To prevent the spread of transient micro-organisms To assess progress of wound /type of dressing required.
Pull the curtains Position the patient and ensure that there is a clean, clear space to carry out the procedure Wash hands or disinfect hands with alcohol hand rub/gel , apply non-sterile gloves Loosen existing dressing and inspect the wound.
Do not leave the wound uncovered, temporarily cover with a sterile dressing towel Wash hands or disinfect hands with alcohol hand rub/gel and put on a clean disposable apron and gloves
Prevents wound contamination from linen and clothing. To remove contaminants To prevent the spread of transient micro-organisms To remove contaminants
Clean the trolley or tray with Tristel and allow this to dry
Or, If your area does not yet use Tristel, clean the trolley or tray with detergent wipes, allow to dry, then alcohol wipes, allow to dry Whilst trolley is drying, gather all necessary equipment, checking expiry dates Place everything required onto the bottom shelf of the trolley Disinfect hands with alcohol hand rub/gel
To prevent the spread of transient micro-organisms To leave a clear field whist opening sterile packaging. To ensure that you do not have to leave the area before the procedure is completed Prevents the spread of transient
micro-organisms. Avoiding contact with sterile items/surfaces carefully open the sterile pack and place onto the clean trolley or tray Open sterile dressing pack, sterile equipment using an aseptic technique If sachets of solutions are required, these should be wiped with an alcohol wipe before being poured onto the sterile field Disinfect hands with alcohol rub/gel, apply non-sterile gloves Remove temporary sterile dressing towel from the wound, and dispose gloves and dressing towel Disinfect hands with alcohol rub/gel, put on sterile gloves for the procedure Prevents contamination of the contents Prevent contamination of equipment
Prevent contamination of the sterile field Prevents the spread of transient micro-organisms.
Using the principles of asepsis undertake the procedure
Once the procedure is completed dispose of any sharps into sharps container, dispose of all waste as per Trust policy Disinfect trolley after use Complete and attach a disposable decontamination tag to the trolley, or use local decontamination documentation
Prevents the introduction of microorganisms into the wound site. Prevents exposure to blood or body fluids Ensures only sterile items come into contact with the susceptible site. Ensures that sterile items do not come into contact with non-sterile objects. Prevents the spread of transient micro-organism.
To remove contaminants To meet the national standard of decontamination of reusable medical devices
Remove apron and gloves discard as per Trust policy. Wash hands with soap and water Fully document the procedure
Ensures that there is an up to date record of all procedures
Appendix 5 Procedure for the inspection of surgical wounds Doctors wishing to inspect surgical wounds must ask a nurse to accompany him/her. If the doctor intends to touch the surgical site, s/he must bring a pair of sterile gloves for that purpose
Explain the procedure to the patient, obtain oral consent. Put on disposable apron
To allow the patient to make an informed choice about their care Protects from blood and body fluids and other environmental contamination To maintain privacy and dignity Procedure can be performed easily/ reduces the risk of contamination of sterile field and products from nonsterile inanimate objects To prevent the spread of transient micro-organisms To assess healing/type of dressing required. Prevents wound contamination from linen and clothing. To prevent contamination of the surgical site from transient microorganisms Prevents the spread of transient micro-organism.
Pull the curtains Position the patient and ensure that there is a clean, clear space to carry out the procedure Wash hands or decontaminate hands with alcohol hand rub/gel, put on non-sterile gloves Loosen existing dressing and inspect wound. Do not leave the wound uncovered, temporarily replace the existing dressing or cover with a sterile dressing towel Sterile gloves must be worn before touching a surgical site
Remove apron and gloves discard as per Trust policy. Wash hands or disinfect hands with alcohol hand rub/gel Using either an aseptic technique or clean procedure, the Health-Care Worker must immediately redress the wound as outlined above
Appendix 6
Competence for nurses in application of aseptic technique
Links to KSF Dimension C1 Level C2 Level C3 Level C6 Level 1 1 1 1 Competence What to achieve Performs aseptic technique as per BSUH policy including Aseptic Non Touch Technique (ANTT) Criteria for achievement Within one month of commencing in clinical area should have attended session with key trainer on principles of aseptic technique Gains consent and evaluates need for analgesia Ensures patient is in appropriate position for procedure and environment is prepared Ensures privacy and dignity of patient Employs hand hygiene appropriately using product most suitable for procedure Identifies appropriate equipment needed for procedures and discusses rationale for use Cleans identified equipment using appropriate product before use Gathers appropriate sterile and non sterile equipment as required. Checks expiry dates Ensures appropriate sharps container and clinical waste bag is available at point of care Identifies appropriate single use personal protective equipment required for procedure and puts it on at point of care Performs procedure as per Aseptic Policy Following procedure, dispose of used equipment in appropriate bin Cleans trolley Safely disposes of sharps and waste as Trust policy Washes hands Comments Date for completion or review
HWB5 Level 2 HWB7 Level 2
Aseptic Non-Touch Technique Including Wound Care Policy number TCP 113
Appendix 7a
Wound care bundle-Elements
Preparation of the sterile field Bare below the elbows policy adhered to? Correct hand hygiene prior to preparing the sterile field Trolley used for wound dressings - thoroughly cleaned with detergent wipes/ soap and water, allowed to dry, then alcohol wipes, allowed to dry Sterile packs to be within expiry date, packaging intact No re-use of single use items Aseptic non-touch technique (ANTT) Hands washed/gelled at the point of care prior to opening packs Sterile packs opened using only the corners of the paper Decanting of liquids/other items aseptically-use alcohol wipe for any sachets such as normal saline Remove dirty dressing using dressing pack disposal bag/non-sterile gloves Hands washed/gelled again prior to applying sterile gloves Clean wounds dressed prior to infected/sloughy wounds/stomas Non-touch technique to be used
Personal protective equipment (PPE) Gloves are single use only and should be discarded in clinical waste Gloves applied touching only the inside of the wrist end of the gloves Apron & gloves to be worn for all wound dressings as a minimum Gown/face mask/visor used if at risk of exposure to bodily fluids Correct hand hygiene procedure before and after use
Wound swab/specimen collection procedure If pus present this should be collected using a sterile syringe and placed into a universal specimen container If there are clinical signs of infection and the patient is symptomatic - i.e. raised white cell count, pyrexia, discomfort, inflammation - a wound swab should be taken Wound swab moistened with normal saline before the swab is taken Specimen/swab/form completed at the patients bedside, with confirmation of patients name, date of birth, hospital number, any current antibiotic prescription, diagnosis, site of swab/specimen
Safe disposal of equipment Sharps container available at the point of care if applicable Disposal of all disposable equipment appropriately into clinical waste bag/HSDU container Cleaning of trolley/dressing tray with detergent wipes/Tristel after use Disposable decontamination tag to be completed, applied to trolley after it has been used and cleaned, or local decontamination documentation used Hand hygiene performed after disposal of equipment and cleaning of trolley
Appendix 7b Audit tool for the wound care bundle
Wound care bundle tool

NAME OF WARD . MEMBER OF STAFF NAME .. DATE .
Sterile field Observations ANTT PPE
Wound swab/Specimen collection
Safe disposal of equipment including sharps
Comments
Yes 1 2 3 4 5 6 7 8 9 10
No
Yes
No
Yes
No
Yes
No
Yes
No
Indicate YES when the entire element was performed correctly and write N/A if it was not applicable (e.g. swab).
Appendix 8 IV Aseptic Non Touch Technique Assessment.

Name of nurse Date of assessment... Self-Assessment: Prior to being assessed, confirm: SIGNATURE I have received training on A.N.T.T from a key Trainer on Date.. I have read the Infection Control Policies (IC01), Hand Hygiene policy (IC01) , ANTT policy (TCP 113), IV policy (TCP 021) I understand my legal and professional responsibilities Theory: PASS Why aseptic non-touch technique (ANTT) should be used for cannulation/preparation/administration of IV drugs Preparations to clean tray/trolley/hands with & when to clean them What Personal Protective Equipment (PPE) should be worn & why. Appropriate timing and environment for procedure to take place. Practice: IV preparation PASS Decontaminates hands prior to procedure? Uses plastic/metal IV tray/IV trolley? Cleans tray/trolley with appropriate cleaning agents, and allows to dry? Uses appropriate PPE - (apron, non-sterile gloves?) Uses aseptic non-touch technique to draw up IV medication? Does not re-sheathe needles? Correctly identifies and protects key parts Disposes of sharps etc safely? Decontaminates hands following procedure? Practice: IV administration PASS Decontaminates hands prior to procedure Uses appropriate PPE - (apron, non-sterile gloves?) Needle-free Swanlock cleaned for 30 seconds with 2% Chlorhexidine & alcohol wipe and allowed to dry? Aseptic non-touch technique used to administer IV medication? Correctly identifies and protects key parts Disposes of used equipment safely? Decontaminates hands following procedure? REFER REFER REFER
Aseptic Technique Assessment Assessors Information. Practice: Decontaminates hands prior to/after procedure: - reduces the risk of cross infection - hands should be washed with soap and water, dried thoroughly and alcohol gel applied **as per BSUH NHS TRUST Infection Control Policy on Hand Hygiene Cleans IV tray/trolley prior to procedure: - creates an aseptic surface to perform the procedure - trays/trolleys should be cleaned with Tristel, allowed to dry or detergent wipes then 70% alcohol wipes - Pulp trays are not permitted as part of the BSUH Trust policy for IV care Uses appropriate PPE: - to reduce cross infection and contamination of clothes - The Marsden Manual recommends the use of disposable plastic aprons during all aseptic procedures - use of non-sterile gloves for IV care Use of aseptic non-touch technique (ANTT): - to maintain asepsis - to protect key parts Disposes of sharps safely - To prevent needle-stick injury - To prevent contamination of key parts Theory: Aseptic technique and ANTT: - aseptic technique helps keep patient free from hospital acquired micro-organisms (especially when breaching the bodys natural defence i.e. the skin), and their own body flora - ANTT maintains asepsis through non-touch. No direct or indirect contact of key parts e.g. PVC/CVC lumens, syringe/needle tips, needle-free systems/Swanlocks ANTT procedures include: Accessing CVC,PICC, Cannulas, IV lines, IV
Appendix 9 Aseptic Non Touch Technique Assessment. (Created by Jane Kingsbury, Sue Dawson, Joy Harwood) Name of nurse Date of assessment...Self-Assessment:
Prior to being assessed, confirm: I have received training on A.N.T.T from a key Trainer on Date.. I have had access to the Marsden Manual for principles of aseptic technique as used by BSUH NHS TRUST I have read the Infection Control Policies (IC01), Hand Hygiene policy (IC01) & ANTT policy (TCP 113) I understand my legal and professional responsibilities Theory: PASS When to use aseptic technique as opposed to non-touch technique (ANTT) & why we use it Preparations to clean trolleys/hands with & when to clean them What Personal Protective Equipment (PPE) should be worn & why. Appropriate timing and environment for procedure to take place. Practice: Type of procedure e.g. Dressing/catheterisation.. PASS Decontaminates hands prior to procedure Cleans trolley prior to procedure Checks and places equipment on bottom shelf Uses appropriate PPE Gains consent, explains & reassures the patient throughout the procedure Removes old dressing appropriately and discards away from sterile field into clinical waste. Hand washing and application of alcohol gel Prepares sterile field (inc swabbing of tear area of cleaning solutions) Puts on sterile gloves correctly. CARRY OUT PROCEDURE: PASS Maintains asepsis throughout procedure (clean hand/dirty hand) Disposes of waste in clinical waste / sharps in container at point of care. Decontaminates hands after procedure Cleaning of trolley Documents appropriately wound care plan. REFER REFER REFER SIGNATURE
Aseptic Technique Assessment Assessors Information. Practice: Decontaminates hands prior to procedure: - reduces the risk of cross infection - hands should be washed with soap and water, dried thoroughly and alcohol gel applied **as per BSUH NHS TRUST Infection Control Policy on Hand Hygiene Cleans trolley prior to procedure: - creates a clean surface to perform procedure - trolleys should be cleaned with should be cleaned with Tristel, allowed to dry, or detergent wipes then 70% alcohol wipes - the whole trolley should be cleaned, working from the top down, including the legs Places equipment on bottom shelf: - to ensure the top shelf is kept as clean as possible. - Check all packaging is intact and within expiry date. Uses appropriate PPE: - to reduce cross infection and contamination of clothes - The Marsden Manual recommends the use of disposable plastic aprons during all aseptic procedures - use on non-sterile gloves to remove old dressing - use of sterile gloves for procedure Gains consent, explains and reassures the patient throughout the procedure: - to ensure informed verbal consent is gained as per NMC guidelines - to reduce patient anxiety about the procedure - appropriate environment condusive to dressing change (i.e. not when beds are being made/bay being cleaned. Removes old dressings appropriately: - can remove outer layer of dressing with non-sterile gloves and dispose of immediately in clinical disposal bag away from sterile field, ideally in clinical waste at point of care. Clinical disposal bags not to be placed on patients bed. Decontaminates hands by handwashing and then applying alcohol gel: - reduces risk of cross infection - to decontaminate before preparing sterile field Prepare sterile field (Inc swabbing tear line of cleaning solution): - to maintain asepsis - open field with corners of paper
gently tip contents of other packs onto sterile field avoiding unnecessary opening of dressings (which is a waste!) swab the tear area of cleaning solution with 70% alcohol wipe before pouring into gallipots
Put on sterile gloves: - to reduce risk of introducing infection - touch only the insides of wrists of gloves when putting gloves on CARRY OUT PROCEDURE Maintains asepsis throughout procedure: - to avoid contamination - only touches sterile field and area of procedure - uses clean hand/dirty hand principles Decontaminates hands after procedure: Documents appropriately: - in the nursing evaluation or in care plan if dressing a wound Theory: Aseptic technique and ANTT: - aseptic technique helps keep patient free from hospital acquired micro-organisms (especially when breaching the bodys natural defence i.e. the skin) and their own body flora - ANTT maintains asepsis through non-touch. No direct or indirect contact of key parts e.g. CVC lumens & syringe tips - Aseptic procedures include: wound dressings, removal of clips, sutures & drains, Catheterisation - ANTT procedures include: Accessing CVC,PICC, Cannulas and IV lines, V&C, removal of catheters Wound care knowledge - Awareness of the wound care section of the BSUH intranet such as: Chronic wound care guide Wound care preferred choice formulary Wound care assessment
Equality Impact Assessment Action Plan Action Sheet Issue Action Required How would you measure impact/outcomes in practice Muslim male-provide, male member of staff where possible Muslim femaleprovide chaperone Time will be taken with procedure to ensure that the patient is as comfortable as possible Ensure enough time is taken to carry out the procedure Ensure understanding-mental capacity South Coast Interpreting services Timescale Responsible Officer
Ongoing
Race
Cultural sensitivity to religious needs
Ongoing
Disability
Patient able to lie flat
Ongoing
Disability
Stroke
Ongoing
Race
Language requirement

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Review Date: January 2012 Page 1 of 28

Aseptic Non-Touch Technique (ANTT) including wound care

Policy Number: Version number: Approving Committee: Review Date :

TCP 113 2 Trustwide Clinical Policies January 2012

Brighton & Sussex University Hospitals NHS Trust

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Consultation and Ratification Schedule

Date August 2008 August 2008 August 2008

Brighton & Sussex University Hospitals NHS Trust

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Brighton & Sussex University Hospitals NHS Trust

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Brighton & Sussex University Hospitals NHS Trust

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Roles and responsibilities

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Brighton & Sussex University Hospitals NHS Trust

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Brighton & Sussex University Hospitals NHS Trust

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Brighton & Sussex University Hospitals NHS Trust

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Is the wound acute or chronic?

Acute e.g. recent surgery or traumatic injury (burn, scald or laceration)

Drain sites, central lines, IV lines, invasive procedures

Use sterile gloves and aseptic technique

Use aseptic technique

Use aseptic technique

Use clean technique

Brighton & Sussex University Hospitals NHS Trust

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Brighton & Sussex University Hospitals NHS Trust

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Using the principles of aseptic non-touch technique undertake the procedure

To prevent the spread of transient micro-organisms

Ensure that there is an up to date record of all procedures

Brighton & Sussex University Hospitals NHS Trust

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To prevent the spread of transient micro-organisms

Ensures that there is an up to date record of all procedures

Brighton & Sussex University Hospitals NHS Trust

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Using the principles of asepsis undertake the procedure

To prevent the spread of transient micro-organisms

Ensures that there is an up to date record of all procedures

Brighton & Sussex University Hospitals NHS Trust

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Brighton & Sussex University Hospitals NHS Trust

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HWB5 Level 2 HWB7 Level 2

Brighton & Sussex University Hospitals NHS Trust

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Wound care bundle-Elements

Brighton & Sussex University Hospitals NHS Trust

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Appendix 7b Audit tool for the wound care bundle

Wound care bundle tool

Safe disposal of equipment including sharps