Download ANTT in practice

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ANTT® is a registered Trademark
ANTT© is owned and overseen by The Association for Safe
Aseptic Practice, a non profit organisation with a strategy to
standardise aseptic technique internationally for the benefit
of patients and healthcare organizations.
Please note that these presentations must not be used to
build ANTT titled/specific e-learning resources
For advice please email [email protected]
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To start this ANTT training slide show
go to the top menu bar and select
‘View. Then ‘Slide Show’
Slides will change automatically every 20 seconds.
Or, use the right/left arrow keys to change manually.
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The ANTT Overview presentation explained the
Principles and Safeguards that underpin
the ANTT Clinical Practice Framework.
It also explained how these Principles an Safeguards are
applied to practice using the ANTT-Approach.
This presentation demonstrates the 6 stages of the
ANTT-Approach applied to Intravenous Therapy.
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The ANTT-Approach (IV Preparation and Administration)
‘6 Actions for Safe Aseptic Technique’
1
2
3
4
5
6
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The ANTT-Approach (IV Preparation and Administration)
‘6 Actions for Safe Aseptic Technique’
Key-Part/Site risk assessment
1
Select the right technique
2
3
4
5
6
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The ANTT-Approach (IV Preparation and Administration)
‘6 Actions for Safe Aseptic Technique’
Key-Part/Site risk assessment
1
Select the right technique
2
3
4
This stage is worth looking
at in some detail…
5
6
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ANTT Risk Assessment:
Administering an antibiotic into a PERIPHERAL CANNULA
using the ANTT-Approach
ANTT RISK ASSESSMENT:
‘Is a Critical Aseptic Field required to protect Key-Parts?’ (E.g. A Sterilized Drape).
ANSWER: No it doesn’t. There are only a few small Key-Parts that can be protected with individual
caps and covers and non touch technique – and connecting a syringe into a
port is technically very simple.
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ANTT Risk Assessment:
Administering an antibiotic into a CENTRAL LINE
using the ANTT-Approach
ANTT RISK ASSESSMENT:
‘Is a Critical Aseptic Field required to protect Key-Parts?’ (Eg. A Sterilized Drape).
ANSWER: No it doesn’t. There are only a few small Key-Parts that can be protected with individual
caps and covers and non touch technique – and connecting a syringe into a
port is technically very simple.
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But by this assessment, aseptic technique is exactly the same
for central line access as peripheral access….is that right?
Yes. The equipment and technical challenge of achieving asepsis is identical for
both routes. So why would the technique be different?
In ANTT the focus is always on the technical difficulty of the procedure. Not the
patients diagnosis or type of IV access.
Central IV access
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Peripheral IV access
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But I’ve always used a ‘Sterile Technique’ for central access!
Sterile techniques are not possible due to the multitude of organisms in the air.
In ANTT, the historical term ‘Sterile Technique’ is termed Surgical-ANTT. SurgicalANTT is not required for most peripheral and central IV administration because
Key-Parts can usually be protected easily by using Standard-ANTT. i.e. A re-usable
tray instead of a sterilized drape and non sterile gloves and non touch technique
rather than sterile gloves.
Its not any more difficult to prepare and connect these two Key-Parts for central
lines as it is for cannulas.
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The ANTT-Approach (IV Preparation and Administration)
‘6 Actions for Safe Aseptic Technique’
Key-Part/Site risk assessment
Environmental management
1
Select the right technique
(Standard-ANTT)
Reduce, avoid risks
2
3
4
5
6
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The ANTT-Approach (IV Preparation and Administration)
‘6 Actions for Safe Aseptic Technique’
Key-Part/Site risk assessment
1
Select the right technique
(Standard-ANTT)
Environmental management
2
Reduce, avoid risks
Decontamination/PPE
3
Clean hands, gloves etc. disinfect Key-Parts
(Remember to scrub hubs for 20 seconds)
4
5
6
ANTT® Copyright 2015
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The ANTT-Approach (IV Preparation and Administration)
‘6 Actions for Safe Aseptic Technique’
Key-Part/Site risk assessment
1
Select the right technique
(Standard-ANTT)
Environmental management
2
Reduce, avoid risks
Decontamination/PPE
3
Clean hands, gloves etc. disinfect Key-Parts
(Remember to scrub hubs for 20 seconds)
Aseptic field management
4
Protect Key-Parts/Sites
(A General Aseptic Field and Caps & Covers)
5
6
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The ANTT-Approach (IV Preparation and Administration)
‘6 Actions for Safe Aseptic Technique’
Key-Part/Site risk assessment
1
Select the right technique
(Standard-ANTT)
Environmental management
2
Reduce, avoid risks
Decontamination/PPE
3
Clean hands, gloves etc. disinfect Key-Parts
(Remember to scrub hubs for 20 seconds)
Aseptic field management
4
Protect Key-Parts/Sites
(A General Aseptic Field and Caps & Covers)
5
Non touch technique
Protect Key-Parts/Sites
6
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The ANTT-Approach (IV Preparation and Administration)
‘6 Actions for Safe Aseptic Technique’
Key-Part/Site risk assessment
1
Select the right technique
(Standard-ANTT)
Environmental management
2
Reduce, avoid risks
Decontamination/PPE
3
Clean hands, gloves etc. disinfect Key-Parts
(Remember to scrub hubs for 20 seconds)
Aseptic field management
4
Protect Key-Parts/Sites
(A General Aseptic Field and Caps & Covers)
Non touch technique
5
Protect Key-Parts/Sites
Decontamination
6
Prevent cross infection
Clean hands, gloves etc. disinfect Key-Parts
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ANTT is further standardised by:
Using sequenced Clinical Guidelines to standardise the most
common aseptic procedures.
These guidelines will be displayed as practice prompts in clinical areas
and compliance is mandatory.
Please take a look at the IV guideline ……
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Preparing and administering an IV medication using
Standard-ANTT
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Step 1
1
•
Clean your hands effectively with soap and water or alcohol hand rub . If
you’ve just done this after leaving another patient or location then you
don’t have to repeat at this stage
•
Use the 6 stage hand washing technique shown later in this presentation
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2
Step 2
•
With clean hands clean all the surfaces of your plastic tray thoroughly
according to local policy
•
Clean the inside first. Then the outside
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Step 3
•
3
Whilst the tray dries, gather all your equipment, medications etc., and
place them around the tray
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Step 4
4
•
Now you have cleaned your tray and gathered your equipment you can
perform your final hand clean before preparation
•
Clean hands with alcohol hand rub or soap & water (Depending on
clinical circumstances & local policy).
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Effective hand washing technique (Soap & Water or alco-gel).
Palm-to-palm
Palm over back of the hand
with interlocking fingers.
Swap hands
Palm-to-palm,
interlocking fingers
Rubbing of backs of
fingers into palms
Rotational rubbing of thumb
clasped over opposite palm,
swap hands
Rotational rubbing of
fingers into palms,
swap hands
NB: It only takes 20-30 seconds to do this well
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So what are the hand cleaning steps again?
Don’t move on until you can remember them – you will
be assessed and observed.
Use the same technique whether you are cleaning your
hands with soap and water or using alcohol hand rub.
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Step 5
•
5
Put on non-sterile gloves
Glove wearing at the drug preparation stage is necessary to protect the
clinician from drug exposure (COSHH regulations). It also helps protect the
patient should you inadvertently touch the Key-Parts.
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Step 6
6
•
Open equipment and prepare drugs. Protect Key-Parts using non-touchtechnique
•
Touch non Key-Parts with confidence
•
After drug prep - go straight to the patient. Do not contaminate your
gloves
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A small point….but one many people ask
“What is and what is not permitted in the
aseptic tray”?
Ideally, nothing goes in the tray which is not required for the procedure
However, in a well organised tray, one might include an unopened alcowipe or
syringes protected in their paper packaging.
Remember, for Standard-ANTT you are aiming for asepsis of the Key-Parts
not sterility or asepsis of the whole procedure area.
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This would be ideal – the Key-Parts are protected
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This would be fine too:
because…
• The paper wrapping is dry and likely to be aseptic
• The Key-Parts are protected by ‘Micro Critical Aseptic Fields’
• The aseptic field is organised
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Step 6a
6a
•
Expose the patients IV access port, ensuring free unrestricted access
•
By the way. If you do this before Step 1 you save yourself time because you can
skip Steps 6b to 6d.
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Step 6b
6b
•
But, if you had to expose the patient’s IV access or contaminated your
gloves in any other way you will need to re-establish the asepsis of your
hands
•
Dispose of your gloves
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Step 6c
6c
•
Re-clean your hands with alcohol hand rub or soap and water
(Cleaning hands after glove removal is vital because wearing gloves
encourages the growth of potentially pathogenic micro-organisms
naturally found on and in your skin).
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Step 6d
6d
•
Re-apply non-sterile gloves
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Step 7
7
•
Clean Key-Parts (in this instance the patient’s IV access port):
―
―
―
With a large wipe of 2% Chlorhexidine & 70% alcohol
Apply friction by scrubbing the port tip hard with different parts of the
wipe for 20 seconds.
Allow to dry - this usually takes about 20 seconds
[If in doubt always follow manufacturers instructions for
cleaning & drying times]
NB: If Key-Parts aren't dry they are not aseptic.
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Step 8
8
•
Administer drugs using a non-touch-technique
(Non-touch-technique means not touching the Key-Parts
and not letting the Key-Parts touch anything else. Aseptic
Key-Parts should only touch other aseptic Key-Parts)
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Step 9
9
•
Dispose of sharps & equipment
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Step 10
10
•
Clean your tray
(Not doing so is a perfect way of cross-infecting
patients, and your colleagues)
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Step 11
11
Dispose of gloves.
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Step 12
12
•
Clean hands with soap & water or alcohol hand rub
The clock is now ticking…..
After removing gloves (when your hands are at their dirtiest) you need to
clean your hands immediately - before touching and contaminating the
environment or other patients.
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The following practices and equipment are
prohibited in this organization during ANTT procedures
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Small sterets are too small to clean KeyParts safely.
Use a LARGE alcowipe
containing 2% chlorhexidine and
70% alcohol.
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• Do not DROP your equipment into your tray
(There is a risk some Key-Parts will touch the tray)
• Key-Parts should NEVER be touched
• Only Key-Parts should touch other Key-Parts
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Don’t leave Key-Parts
unprotected and exposed
Key-Parts should always be
protected (By Critical Micro
Aseptic Fields).
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NEVER flick off Key-Parts such as needles or caps
(Your gloved thumb is likely to touch the Key-Part)
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•Don’t do this to identify your drugs (The bungs often leak
around the needle making things wet - so no longer aseptic).
•It also increases risk of needle stick injury and would be
dangerous if they were to fall out the tray).
•Use labels if you need to identify syringes.
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Small paper
trays are
banned
(Because they do not
provide adequate sized
aseptic fields that can
be controlled (cleaned).
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Use plastic trays
Clean well before
and after use
(According to local policy)
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What now?
After you have read the ANTT teaching board, watched the DVD and this
presentation you can start using ANTT in practice. (The guidelines will be
displayed in all of the prep areas).
Within the next few weeks you will be assessed.
ANTT® Copyright 2015
www.antt.org
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© www.antt.org – all rights reserved
ANTT® is a registered Trademark
ANTT© is owned and overseen by The Association for Safe
Aseptic Practice, a non profit organisation with a strategy to
standardise aseptic technique internationally for the benefit
of patients and healthcare organizations.
Please note that these presentations must not be used to
build ANTT titled/specific e-learning resources
For advice please email [email protected]
ANTT® Copyright 2015
www.antt.org
[email protected]