ANTT®
Aseptic non-contact operation
Aseptic Non-Touch Technique
For all invasive procedures and all clinical settings.
International Standard Framework for Protecting Patients from Infection
- ANTT Framework Full Text and Thematic Materials
- For the first time, a common language for aseptic technique
- Healthcare-associated infections remain a serious challenge.
- Key terms for understanding ANTT
- Five principles and four infection control measures
- Standard ANTT and Surgical ANTT
- The 5 Moments for Hand Hygiene
- Guidelines for Selecting ANTT Type by Procedure
- ANTT is now moving towards global standards.
- FAQ
- References
ANTT Framework Full Text and Thematic Materials
You can view the full PDF of the ANTT Clinical Practice Framework (Japanese version) and the individual guidelines (by procedure) below.
ANTT® Copyright © 2024 The Association for Safe Aseptic Practice (ASAP). All rights reserved. V6.0
Provided by the Japanese IV Catheter Guideline Committee
For the first time, a common language for aseptic technique
ANTT (Aseptic Non Touch Technique) is an aseptic technique with a unique theoretical system and clinical practice framework, designed for all clinical settings and all invasive clinical procedures (NICE, 2012).
Historically, terms such as "aseptic technique," "sterile technique," and "clean technique" have been used ambiguously, leading to variations in interpretation in medical settings worldwide. ANTT was developed in 1995 to address this issue and has since been proven as the standard aseptic technique within the UK's NHS (National Health Service). It is now recommended or mandated at the government level in countries such as Australia, Wales, and Algeria.
Just as Cardiopulmonary Resuscitation (CPR) has universal procedures and terminology, ANTT provides an equivalent "international standard and common language" for aseptic technique.
Healthcare-associated infections remain a serious challenge.
Invasive procedures, such as surgical operations, insertion of indwelling medical devices, and wound management, have significantly advanced medical care, but they also bring the risk of infection. In the UK, it is estimated that approximately 653,000 healthcare-associated infections (HAIs) occur annually, leading to around 28,000 deaths (Guest et al., 2020).
Worsening the problem further is the global spread of antimicrobial resistance (AMR). In 2019, at least 1.27 million people worldwide died directly from AMR (Murray et al., 2022). With fewer treatment options for infections, the importance of prevention is clear.
Many healthcare-associated infections are preventable, yet one of the central factors contributing to inadequate infection prevention is the suboptimal standard of aseptic technique practice. The appropriate implementation of ANTT is one of the most crucial means of improving this situation.
Key terms for understanding ANTT
ANTT has its own clearly defined terminology to establish a common language for aseptic technique. A correct understanding of the following concepts is the first step toward safe practice.
(Touchless Operation)
Five principles and four infection control measures
ANTT is comprised of five fundamental principles and four safeguards (infection prevention measures). Understanding and practicing these is the cornerstone of safe and efficient ANTT.
Thinking about microorganisms
Harmful microorganisms are constantly present in all care environments. Correctly recognizing and controlling these risks is the cornerstone of ANTT.
Achieving sterility is the goal.
In all invasive procedures, from surgery to community care, achieving "asepsis" is a common practical goal.
Protection of Key-Parts and Key-Sites
Aseptic conditions are achieved by protecting the Key-Part and Key-Site from microbial contamination by healthcare personnel and the surrounding environment.
Two types of ANTT
To practice safely and efficiently, use Surgical-ANTT for complex procedures and Standard-ANTT for simple procedures.
Risk assessment due to technical factors
The choice of which ANTT to use is determined by the technical difficulty of aseptically maintaining the Key-Part/Key-Site.
Standard Precautions
Environmental management, hand hygiene, surface disinfection, and equipment cleaning and disinfection. Applicable at all stages before, during, and after clinical procedures.
Identification of Key Parts and Key Sites
Accurately identify the critical parts (Key-Parts) of an instrument that are most at risk of causing infection when contaminated, and the sites that serve as entry points for infection (Key-Sites).
Non-Touch Technique
Basic and essential clinical skills for protecting Key Parts and Key Sites from microbial contamination. Essential in Standard ANTT.
Aseptic Field Management
Select and manage the Critical, Micro Critical, and General Aseptic Field appropriately according to the complexity of the procedure.
Standard ANTT and Surgical ANTT
The ANTT must be both safe and efficient. Therefore, we use two approaches depending on the complexity of the procedure. The important thing is that both have the same goal: "achieving asepsis."
Standard ANTT
- The number of key parts is small and the size is small
- Minimally invasive procedure
- Maintaining aseptic conditions is technically easy
- Short duration (approximately less than 20 minutes)
- Protect Key-Parts individually in a Micro Critical Aseptic Field
- Unsterile gloves or no gloves
- Non-contact operation isRequired
Surgical ANTT
- The number of Key-Parts is large, or the size is large.
- Highly invasive procedures (such as central venous catheterization)
- Maintaining a sterile environment is technically complex.
- Long time required (generally over 20 minutes)
- Place all key parts together on the sterile drape (Critical Aseptic Field) and protect them collectively.
- Sterile gloves and surgical handwashing are mandatory
- non-contact operationDesirable
ANTT Risk Assessment — Which to Choose
A simple technique that allows individual protection of key parts. For example, peripheral venous catheterization, intravenous drug administration, and venipuncture.
Complex, time-consuming, and highly invasive procedures. Examples include central venous catheter insertion, complex wound management, and surgical procedures.
The 5 Moments for Hand Hygiene
Effective hand hygiene is the cornerstone of ANTT. The "Five Moments for Hand Hygiene" established by the World Health Organization (WHO, 2009) complement ANTT and reduce the risk of patient contamination during invasive procedures.
Before touching the patient
Before approaching or touching a patient. To protect the patient from harmful microorganisms on your hands.
Before cleaning and aseptic operations
Before performing clean or sterile procedures such as blood collection, insertion, or contact with procedure equipment.
After Body Fluid Exposure
After contact with body fluids, excretions, mucous membranes, wounds, or gloves. To protect yourself and the healthcare environment.
After touching a patient
After touching the patient, or immediately after finishing touching them. To prevent the transfer of microorganisms from the patient to yourself or others.
After touching the patient's surroundings
After touching bed rails, tables, and surrounding items. To prevent the spread of environmental microorganisms within the hospital.
How to wash your hands: Hand hygiene with soap and running water is40-60 secondsAlcohol-based hand sanitizers are20-30 secondsis the guideline (WHO, 2009). Sink for handwashing requires attention to the splash zone, and it is recommended that equipment for venous access be stored at least 2 meters away from the sink.
Guidelines for Selecting ANTT Type by Procedure
Below is a guide for selecting the ANTT type for common clinical procedures (from Appendix 3). Please make decisions based on your institution's policy and individual circumstances.
* The above is a guideline and should be judged based on each facility's policy, individual circumstances, and the performer's competence (from Appendix 3).
ANTT is now moving towards global standards.
Since its first edition in 1995, ANTT has been introduced in various forms in over 30 countries worldwide. Its adoption has spread rapidly, ranging from mandatory and recommended implementation at the national level to voluntary adoption by healthcare institutions.1The following is a list of the most common problems with the
Evolution of Aseptic Technique Standards in the UK's NHS in England1
2001 (Before Implementation)
is big
2020 (after widespread adoption)
Hiring as a sole candidate
✓ Trust's 93% Adopts ANTT
ANTT Adoption Status in Major Countries and Regions
FAQ
What's the difference between "clean technique" and "ANTT (Aseptic Non-Touch Technique)"? ＋
"Clean Technique" was originally a historical term referring to a simplified procedure to achieve asepsis in relatively simple procedures. However, over time, it came to be misunderstood as "not requiring sterility," leading to patients being exposed to infection risks. ANTT clearly defines that the goal in all procedures is always "achieving asepsis" and does not use the term "clean technique."
What is the difference between "sterilization" and "aseptic technique"? ＋
"Sterile" means a state in which all living microorganisms are absent. However, because microorganisms are always present in the air, it is definitionally impossible to maintain a "completely sterile state" in a normal medical environment. On the other hand, "asepsis" means "a state in which harmful microorganisms are absent," and is a realistic and achievable goal. ANTT uses "achieving asepsis" as its practical objective and does not use the term "sterile field."
How do I differentiate between Standard ANTT and Surgical ANTT? ＋
The question, "Is it technically easy to perform this procedure without involving Key-Part or Key-Site?" serves as the decision criterion for risk assessment. If it is easy, Standard-ANTT is chosen; if it is difficult, Surgical-ANTT is chosen. The key point is to make the decision based on the technical difficulty of the procedure, rather than subjective criteria such as the patient's age or diagnosis.
Can ANTT be used in home and community healthcare settings? ＋
Yes. ANTT is designed to encompass "From Surgery to Community Care." While some healthcare professionals believe that achieving sterility is not practical in certain settings, such as home healthcare, ANTT principles clearly state that "achieving sterility is a common goal in all clinical environments." It requires practical implementation by devising logistics for supply and storage of items according to the environment.
Does ANTT have an education and certification system? ＋
ASAP offers the ANTT Accreditation Programme, a systematic program that ensures the quality of practices through education, assessment, and peer review. Free educational, audit, and competency assessment resources for ANTT are available at www.antt.org. J-IVCARES plans to promote educational support within Japan in the future.
References
*The above is a partial list of the main references cited in the ANTT Clinical Practice Framework (V6.0, 2024). Please refer to the original framework (pp. 32–35) for the complete list of references.