Public Health Agency


Aseptic Non Touch Technique (ANTT)

ANTT refers to Aseptic non – touch technique.  ANTT is an international set of principles aimed to:

  • Standardise practice
  • Support health care workers to practice safely and effectively
  • Increase patient safety by reducing the risk of introducing infection into a susceptible body site during procedures such as intravenous therapy, wound care and urinary catheterisation.
What is ANTT?

Aseptic non-touch technique uses a defined framework and is a relatively new approach to undertaking aseptic techniques. This standardised approach, developed in University College Hospital (UCH) London, has been shown to significantly improve the aseptic technique of healthcare workers and reduce the numbers of Healthcare Associated Infections (HCAIs).

ANTT is a core nursing and medical skill that defines the infection prevention and control methods and precautions necessary during invasive clinical procedures to prevent the transfer of microorganisms  to ‘key’ or sterile body sites from healthcare professionals, procedure equipment or the immediate environment to a patient.

The ANTT framework is based upon the goal of asepsis rather than sterility and the approach is gauged on the technical difficulty of each procedure rather than the diagnosis or age of the patient.


Asepsis (Medical or Surgical)

Absence of pathogenic micro-organisms or toxins from the blood or tissues (Wilson, 1995).

Aseptic Technique

Should be used during any procedure that bypasses the body’s natural defences. It defines the infection prevention method and precautions taken during invasive clinical procedures to prevent the transfer of microorganisms from the healthcare worker, procedure equipment or the immediate environment to the patient.

Aseptic Non-Touch Technique (ANTT)

Identifying the ‘key parts’ and ‘key sites’ of a procedure and not touching them either directly or indirectly.

Key sites(susceptible site)

Open wounds and insertion/puncture sites for invasive medical devices.

Key part

Key-Parts are the critical parts of the procedure equipment that if contaminated are most likely to cause infection. E.g. needles, syringe tips, intravenous line connections, exposed lumens of catheters, tops of ampoules.




Key-Part/Key-Site Protection

The protection of Key-Parts and/or Key-Sites from pathogenic microorganisms. During clinical procedures

this is achieved by a range of methods including non -touch technique, aseptic field management, basic

infection precautions such as hand cleaning and glove usage etc.

Invasive procedure

A medical procedure that invades (enters) the body, usually by cutting or puncturing the skin or by inserting instruments into a body cavity

Why use ANTT?

Patients suffer harm or may die as a result of Healthcare associated infections (HCAI’S). There is agreement in the literature that one of the most effective ways of reducing HCAI’S is through the application of a standardised ANTT for a clinical procedure (Rowley 2003, Pratt et al 2014).  The aim of using ANTT is to prevent the introduction of micro – organisms into susceptible body sites (Rowley 2001).  The aim is asepsis i.e. the absence of pathogenic organisms or toxins from the blood or tissues (Wilson 1995).  ANTT has been endorsed by the Department of Health EPIC 3 guidelines (Pratt et al 2014).

There are two main types of asepsis, medical and surgical.  Medical asepsis refers to a clean technique to prevent and reduce the number of microorganisms.   Surgical asepsis is a sterile technique, the aim being to eliminate ALL micro – organisms from an object or area during an invasive procedure.   ANTT can be used to achieve medical asepsis.

The main principle of ANTT is that the susceptible or sterile body sites must not come into contact with non – sterile items (Rowley 2004).  Only non-contaminated equipment, referred to as “key parts” or sterile fluid should come into contact with sterile or ‘key’ sites during clinical procedures.

A critical part of the practice is not to touch a “key part” directly or indirectly. 

When should ANTT be used?

ANTT needs to be efficient as well as safe, therefore Surgical-ANTT is used for complicated procedures and Standard-ANTT is used for uncomplicated procedures. Choice of Surgical or Standard ANTT is based on risk assessment, according to the technical difficulty of ensuring Key-part and key-site asepsis.

For ANTT to be safe, healthcare workers must risk assess every procedure for the level of aseptic technique and the infection prevention and control precautions required to maintain asepsis.



Standard ANTT is a process for safe and effective practice that can be applied to any aseptic procedure in primary and secondary care settings and typically will employ a general aseptic field and non-sterile gloves. Standard ANTT is used when carrying out a procedure that is technically simple, short in duration (approximately less than 20minutes) and involves small key sites and equipment with a small number of key parts.

Examples include:

·      wound care

·      On-going care of intravenous cannulae or other intravascular devices

·      On-going care of gastrostomy, jejunostomy, tracheostomy tubes and chest drains

·      Vaginal examination using instruments (e.g. smear taking, high vaginal swabbing, colposcopy)

·      Assisted delivery (e.g. forceps and ventouse)

·      Biosepsis

·      Venepuncture and taking blood cultures

·        IV therapies, including administration of IV antibiotics

·      Tracheostomy site dressings

·      Respiratory suction.

Surgical ANTT (usually utilised for procedures in the operating theatre although not exclusively) is required when carrying out procedures that meet one or more of the following criteria:

·      They are technically complex

·      They involve extended procedure time (more than 20minutes)

·      They involve a large open key site

·      Equipment required has large number of key parts.


The main sterile field needs to be managed ‘critically’ i.e. only sterile equipment can come into contact with it.

Infection Prevention & Control Principles of ANTT

Always decontaminate hands effectively  

Never contaminate ‘key parts’ of the equipment or the patients’ susceptible site

Touch non ‘key parts’ of the equipment with confidence

Take appropriate infection prevention and control precautions

Standard precautions such as effective hand decontamination (link to Hand Hygiene section of the manual) and the use of personal protective equipment (PPE) (link to PPE section of the manual) are central to ANTT practices.

Non-sterile gloves should be worn in most cases as sterile gloves are only necessary if the procedure requires a ‘surgical’ approach or the operator cannot carry out the procedure without the risk of touching a key part.

The ANTT environment is also critical and cleanliness of the tray/trolley must be achieved.


Ayliffe’s Control of Hospital Infection Fifth Edition: A Practical Handbook. Editors: Adam Fraise and Christina Bradley; CRC Press (2009).

Loveday H.P. et al (2014) EPIC3: National Evidence-based Guidelines for Preventing Healthcare associated Infections in NHS Hospitals in England. Journal of Hospital Infection, 86S1(2014) S1-S70

Nursing Times; ANTT: a standard approach to aseptic technique, Vol. 107 No. 36.

Rowley, 2003, as cited in Dept of Health (2003) Winning Ways: Working together to reduce healthcare associated infection in

England. Report from the Chief Medical Officer, Dept of Health.