Aseptic Non-Touch Technique (ANTT) in UK Nursing

ANTT (Aseptic Non-Touch Technique) is the UK national standard aseptic technique. It replaces older varied approaches with a single principle: never touch the parts that touch the patient.

The core concepts

ANTT works through two related concepts:

Key sites are the parts of the patient that must remain uncontaminated:

• IV cannulation site.
• Wound bed.
• Urethral meatus during catheterisation.
• Mucous membranes during certain procedures.

Key parts are the parts of equipment that come into contact with key sites:

• IV cannula tip.
• Syringe tip.
• Dressing surface that contacts the wound bed.
• Catheter tip.

The ANTT rule: key parts only touch key sites, and nothing contaminated touches either.

Standard ANTT vs Surgical ANTT

Standard ANTT applies to short, simple procedures with few key parts:

• Peripheral IV cannulation.
• Simple wound dressing.
• IV bolus administration.
• Subcutaneous injection.

Standard ANTT uses non-sterile gloves and clean equipment. The technique relies on identifying key parts/sites and protecting them through non-touch.

Surgical ANTT applies to longer or more complex procedures with multiple key parts:

• Central venous line insertion.
• Complex wound care.
• Surgical procedures.
• Catheterisation in specific contexts.

Surgical ANTT uses sterile gloves, sterile drapes, and a sterile field. The technique creates a defined sterile area within which key parts can be safely manipulated.

The framework

For any ANTT procedure:

1. Hand hygiene before starting.

2. Gather equipment. Check expiry and packaging integrity.

3. Set up the working area. Clean tray or trolley, alcohol-wiped surface. Lay out equipment without contaminating key parts.

4. Identify key sites and key parts. Decide before you start which parts must be protected.

5. Don gloves. Non-sterile for Standard ANTT; sterile for Surgical ANTT.

6. Perform the procedure maintaining the non-touch principle for key parts and key sites.

7. Dispose of equipment. Sharps in sharps bin; clinical waste in clinical waste bag.

8. Hand hygiene after the procedure.

9. Document. Date, time, procedure, any complications, signature.

The non-touch principle in practice

For a peripheral IV cannulation (Standard ANTT):

• The cannula tip is a key part.
• The patient’s skin at the insertion site is a key site (after cleaning, it’s protected).
• The flush syringe tip is a key part.
• The connection point of the extension set is a key part.

You don’t touch the cannula tip, the cleaned skin, the syringe tip or the extension set connection at any point. Non-sterile gloves protect you and the patient from contamination, but the technique prevents contamination at the key sites regardless.

If you touch a key part (the cannula tip brushes against the trolley), you discard it and start with a fresh piece of equipment.

Common ANTT errors

Touching key parts. The cannula tip resting on a non-sterile surface, the syringe tip touched by a finger. Each contamination is a discard.

Inadequate skin cleaning. Alcohol skin cleaning should be vigorous, with a 30-second drying period before insertion. Inadequate cleaning leaves organisms at the key site.

Recontaminating cleaned skin. Touching the cleaned site after cleaning. The clean skin is now a key site; touching it contaminates it.

Inadequate hand hygiene. Hand hygiene before donning gloves is essential. The gloves don’t sterilise the hands.

Cluttered working area. A trolley with dropped items and contamination around the working field. ANTT requires a clean, organised working area.

ANTT in the OSCE

OSCE skills stations that involve aseptic procedures test ANTT specifically. Examiners watch:

• Pre-procedure hand hygiene.
• Equipment integrity check.
• Identification of key parts (sometimes verbalised).
• Non-touch maintenance throughout.
• Disposal in correct waste streams.
• Post-procedure hand hygiene.
• Documentation.

Verbalising “this is a key part, I won’t touch it” can help the examiner see your reasoning. Some candidates label key parts mentally and demonstrate the technique without verbalisation; both can score well.

ANTT for specific procedures

Peripheral IV cannulation: Standard ANTT. Non-sterile gloves. Alcohol skin clean, 30 seconds dry. Key parts: cannula tip, flush syringe tip, extension connection.

Wound dressing change: Standard ANTT for simple dressings; Surgical ANTT for complex or large wounds. Key sites: wound bed and immediate surrounding tissue.

Urinary catheterisation: Standard ANTT in many UK protocols, Surgical ANTT in others. Trust policy specifies. Key sites: urethral meatus. Key parts: catheter tip, lubricant tip, drainage system connection.

Blood culture collection: Standard ANTT. Particular attention to bottle top decontamination (alcohol wipe, dry). Key parts: needle, syringe tip, bottle top.

The next chapter covers sepsis red flags, the recognition framework that often triggers ANTT-related procedures (blood cultures, IV access).