🧱 ANTT — Aseptic Non-Touch Technique

A guide for Australian nursing students on clinical placement — understanding the ANTT framework, Key Parts, Key Sites, Standard vs Surgical ANTT, hand hygiene, PPE, and how to apply ANTT across common clinical procedures.

🇦🇺 Australia All Years Clinical Placement Infection Control ACIPC Framework
🎓 Educational Resource Only: This page supports nursing student learning. Always follow your clinical supervisor's guidance and your facility's specific ANTT/infection control policies. Procedural requirements may vary between health services.

🧱 What is ANTT?

"Aseptic Non-Touch Technique — a specific type of aseptic technique that is based on a unique theory and practice framework."

— ANTT Clinical Practice Framework (ACIPC)

ANTT is the national standard for aseptic practice in Australian healthcare, endorsed by ACIPC (Australasian College for Infection Prevention and Control) and incorporated into SA Health guidelines. It provides a consistent, evidence-based approach to preventing the introduction of micro-organisms into a patient during clinical procedures.

The core idea is simple: identify what must stay sterile, and never touch it. Every clinical procedure that bypasses the body's natural defences requires ANTT.

🎮 The Core Rule
Never directly touch — or allow anything non-sterile to touch — a Key Part or Key Site. If in doubt, treat it as contaminated and replace it.
🔍 When is ANTT Required?
Any procedure that bypasses the body's natural defences — skin, mucous membranes — requires ANTT. This includes IV access, wound care, catheter care, injections, and more.
🏥 Who Uses ANTT?
All healthcare workers performing invasive or sterile procedures — nurses, doctors, paramedics, allied health. As a nursing student, ANTT is one of the most important skills to master on placement.

🔑 Key Parts & Key Sites

The ANTT framework is built on two fundamental concepts. Before any procedure, always identify your Key Parts and Key Sites — then protect them for the entire procedure.

🔴 Key Parts — Equipment

Definition: Parts of equipment that, if contaminated, could introduce micro-organisms directly into a patient.

Examples:

  • Needle and cannula tips
  • Syringe tips and plungers
  • IV catheter hubs and needleless connectors
  • IV line connectors and open ports
  • Urinary catheter tip
  • Inner surface of sterile packaging once opened
  • Sterile gauze and dressing materials
🚨 Never touch a Key Part directly with ungloved or non-sterile hands — not even briefly.
🟣 Key Sites — Patient

Definition: Portals of entry into the patient's body or a connected invasive device — where micro-organisms could enter and cause infection.

Examples:

  • Insertion site of an IV cannula
  • Central venous catheter insertion site
  • Wounds (surgical, traumatic, pressure injuries)
  • Urinary catheter insertion site (meatus)
  • Tracheostomy stoma
  • Surgical incision sites
  • Drain insertion sites
💡 Key Sites must be kept clean and protected — minimise exposure time and cover promptly after procedures.

⚖️ Standard ANTT vs Surgical ANTT

The type of ANTT used depends on the complexity of the procedure and the number and size of Key Parts and Key Sites involved.

🧱 Standard ANTT
For routine procedures with small, manageable Key Parts
When to use
  • Procedures with few, small Key Parts that can each be protected individually
  • Short-duration procedures
  • Key Parts can be kept sterile using their own packaging (Micro Critical Aseptic Field)
Aseptic Field
  • Uses a General Aseptic Field — a clean, non-touch work area (e.g. opened packaging, tray)
  • Key Parts protected individually — e.g. needle tip stays in cap until use
  • Micro Critical Aseptic Fields — the sterile inner packaging immediately around a Key Part
Gloves
  • Clean (non-sterile) gloves — as long as Key Parts are not directly touched
  • Sterile gloves if direct Key Part contact is unavoidable
Common procedures
  • IV cannulation
  • Drawing up and administering IV medications
  • Simple wound dressings
  • Urinary catheter care (not insertion)
  • Blood glucose monitoring
  • Subcutaneous / intramuscular injections
  • Nasogastric tube care
  • Blood cultures (peripheral)
💉 Surgical ANTT
For complex procedures with many or large Key Parts
When to use
  • Procedures with many Key Parts or Key Parts too large to protect individually
  • Longer or more complex procedures
  • Higher risk of infection if contamination occurs
Aseptic Field
  • Requires a large Critical Aseptic Field — a covered sterile drape/surface
  • All Key Parts placed within the Critical Aseptic Field
  • The entire field must be maintained sterile throughout the procedure
Gloves
  • Sterile gloves — required, as direct Key Part handling occurs within the Critical Aseptic Field
  • Applied using aseptic technique (don't contaminate outer surface)
Common procedures
  • Urinary catheter insertion
  • Central venous catheter (CVC) insertion / care
  • Complex or surgical wound dressings
  • Chest drain insertion / management
  • Lumbar puncture
  • Arterial line insertion
  • Surgical procedures (theatre)
💡 Decision rule: Ask yourself — "Can I protect every Key Part individually without touching it?" If yes → Standard ANTT. If no (too many, too large, or too complex) → Surgical ANTT.

✅ Performing ANTT — Step by Step

These steps apply to both Standard and Surgical ANTT, with differences noted where applicable.

1
Prepare yourself — Ensure you are clinically clean. No jewellery below the elbow, short nails, no nail polish or false nails. Remove or roll up long sleeves (bare below elbows).
2
Perform hand hygiene (Moment 2) — Before a clean/aseptic procedure. Use ABHR (alcohol-based hand rub) for at least 20–30 seconds, or wash with soap and water if hands are visibly soiled.
3
Gather and check all equipment — Before entering the patient zone. Check expiry dates, packaging integrity, and that all required items are present. Never re-enter the clean trolley once in the patient zone without re-performing hand hygiene.
4
Prepare the work surface / aseptic field — Clean and dry the work surface. Open sterile packaging using non-touch technique — peel back, do not reach inside. For Surgical ANTT: lay out the sterile drape to create the Critical Aseptic Field.
5
Don appropriate PPE — Minimum: clean gloves. Add apron, mask, eye protection as required by the procedure and local policy. For Surgical ANTT: sterile gloves, sterile gown if indicated.
6
Identify and protect Key Parts throughout — Keep Key Parts within their Micro Critical Aseptic Field until the moment of use. Never place a Key Part down on a non-sterile surface. Never leave a Key Part uncovered and unattended.
7
Perform the procedure — Maintain the aseptic field for the entire procedure. If a Key Part is contaminated — replace it. Do not take shortcuts. Communicate clearly with assistants about what is and isn't sterile.
8
Dispose of sharps and waste immediately — Never resheath needles (unless using a one-handed resheathing device). Dispose of sharps directly into the sharps container at point of care. Remove PPE safely — doff in correct order.
9
Perform hand hygiene (Moment 3 or 4) — After body fluid exposure risk (Moment 3), or after touching the patient (Moment 4). Clean the trolley and work area. Document the procedure.
⚠️
If contamination occurs at any point — stop. Replace contaminated items before continuing. Never proceed with a contaminated Key Part. It is better to pause and restart than to cause a healthcare-associated infection.

🧦 Hand Hygiene — WHO 5 Moments

Hand hygiene is the single most effective way to prevent healthcare-associated infections (HAIs). The WHO 5 Moments define exactly when hand hygiene must be performed.

1
Before touching the patient
When approaching the patient — before any physical contact
2
Before a clean / aseptic procedure
Immediately before ANTT — this is the critical moment for infection prevention
3
After body fluid exposure risk
After contact with blood, body fluids, secretions, excretions or wound dressings
4
After touching the patient
After any physical contact — even if gloves were worn
5
After touching patient surroundings
After touching objects or furniture in the patient's environment
🧦 ABHR vs Soap & Water
  • ABHR (alcohol-based hand rub) is preferred for most clinical situations — faster, less skin damage, more effective against most pathogens
  • Soap and water is required when hands are visibly soiled, after contact with a patient with Clostridioides difficile (C. diff), or after caring for a patient with norovirus
  • Apply ABHR to all surfaces — palm, dorsum, fingers, between fingers, thumbs, fingertips, wrists — rub until dry (~20–30 seconds)
⚠️ Hand Hygiene Pitfalls
  • Wearing rings, watches, or bracelets — increases bacterial load and reduces effectiveness
  • Artificial nails and nail polish harbour micro-organisms — not acceptable in clinical practice
  • Gloves do not replace hand hygiene — perform HH before donning and after doffing gloves
  • Over-reliance on gloves — gloves can become contaminated and spread pathogens just like hands

🧱 PPE for ANTT Procedures

PPE selection depends on the procedure, anticipated exposure to body fluids, and transmission-based precaution requirements.

🧦
Clean gloves
Required for Standard ANTT and all procedures with body fluid exposure risk
🧦
Sterile gloves
Required for Surgical ANTT — when Key Parts must be directly handled
🧣
Apron (plastic)
When clothing may be contaminated with body fluids or infectious material
💉
Surgical mask
When performing Surgical ANTT, or if droplet/contact precautions apply
👀
Eye protection
Goggles or face shield when splash or spray of body fluids is anticipated
🧭
P2/N95 respirator
When performing aerosol-generating procedures or in airborne precaution settings
⚠️ Doff (remove) PPE in the correct order: Gloves → Apron → Eye protection → Mask. Perform hand hygiene after removing each item. The outside of PPE is contaminated — avoid touching your face.

📋 ANTT by Procedure — Quick Reference

Procedure ANTT Type Key Parts Key Site Gloves
IV cannulation Standard Cannula tip, needle, bung/cap Venepuncture insertion site Clean
IV medication administration Standard Syringe tip, needle, IV port IV connector / port Clean
Simple wound dressing Standard Sterile gauze, dressing materials Wound bed Clean (sterile if touching wound directly)
Complex / surgical wound dressing Surgical All sterile materials in field Wound bed, drain sites Sterile
Urinary catheter insertion Surgical Catheter tip, drainage bag connector Urethral meatus Sterile
Urinary catheter care / bag change Standard Catheter-bag connector Catheter junction Clean
SC / IM injection Standard Needle tip, syringe tip Injection site (skin) Clean
Blood cultures Standard Needle, blood culture bottle ports Venepuncture site Clean (strict non-touch)
CVC / PICC line care Surgical All line components, caps, connectors CVC insertion site Sterile
Nasogastric tube insertion Standard Tube tip Nasal/pharyngeal mucosa Clean

​Note: Always confirm ANTT type with your clinical supervisor and facility policy — some facilities apply Surgical ANTT to additional procedures.

⚠️ Common ANTT Mistakes on Placement

✗ What Students Often Get Wrong
  • Touching the tip of a needle or syringe — even briefly — before use
  • Placing a sterile item on a non-sterile surface (e.g. patient's bed, locker top)
  • Reaching across a sterile field — always approach from the side
  • Leaving a Key Part uncapped and unattended
  • Using a swab or dressing that has fallen or been placed non-sterile
  • Skipping hand hygiene because gloves were worn
  • Not checking expiry dates or packaging integrity
  • Allowing a second person to contaminate the field by entering without warning
✓ What to Do Instead
  • Think out loud — narrate your actions during supervised practice ("I'm protecting this Key Part, I'm using a non-touch technique")
  • Set up your field before entering the patient zone — check everything is present first
  • If unsure whether something is contaminated — treat it as contaminated and replace it
  • Always tell your supervisor immediately if you contaminate a Key Part — it's safe to do so
  • Practice ANTT on clinical skill labs before placement so movements become automatic
  • Ask for a second check on your technique — supervisors expect this from students

🔗 Resources & Further Learning