Aseptic Non Touch Technique

The purpose of aseptic technique in nursing is to prevent the unnecessary spread of microorganisms to a patient through the observation of appropriate technique during any clinical procedure (Denton and Hallam, 2020). The Royal College of Nursing (RCN, 2020), identified some of the procedures which require the application of an aseptic technique: 

Aseptic Non Touch Technique is a more specialised and stringent approach within the broader framework of aseptic technique. It is used in situations where the risk of contamination must be minimised to an exceptional degree, where even the slightest touch by a healthcare provider's bare hands could compromise the sterility of the environment or equipment.

It is the role of the nurse to understand whether a particular procedure must be undertaken aseptically. Such decisions will be informed by local policy

The nurse must consider the nature of an intervention or procedure before undertaking it, and be confident as to whether the procedure is:

• clean
• aseptic
• sterile

Cleanliness requires basic hygienic preparation, which might include handwashing and the use of personal protective equipment (PPE). These are standard precautions which might readily prevent cross-contamination (National Institute for Health and Care Excellence (NICE), 2017). Aseptic technique indicates reducing the chance of contamination by a pathogen. On the other hand, for a procedure to be sterile, the environment in which it takes place must be sterile (ie the removal of all microorganisms). This varies across healthcare environments, where a theatre environment cannot be sterile per se, but the operating field can be sterile.

The preparation of equipment to be used for an aseptic procedure should be undertaken in a clean area and includes the preparation of a working surface, such as a dressing trolley, which should be cleaned thoroughly, according to local policy, usually using some form of detergent wipe (Denton and Hallam, 2020).

All equipment, including sterile treatment and dressing packs should be inspected to ensure they are undamaged and remain within their use by date. Any equipment, such as sterile saline used for irrigation and cleaning, should be gathered up, but not placed on the cleaned surface, instead placed in a disposable tray.

The nurse must think through the procedure to ensure they have all the equipment and items they need to:

• Remove and safely dispose of any waste produced (eg old dressings, used dressing pack materials and gloves)
• Undertake the procedure, including any necessary cleaning (eg with sterile saline)
• Protect

Cleaning should be scheduled to prevent disturbing dust and the creation of aerosols. Windows should be shut and any fans turned off to prevent the distribution of any dust particles (Denton and Hallam, 2020).

The procedure should be explained to the patient, and their consent should be gained if they are conscious and have capacity. Nurses should ensure the privacy of the procedure and always protect the patient’s dignity and comfort.

The nurse should wear any appropriate PPE as per local policy. The nurse should perform good hand hygiene, the cornerstone of aseptic technique (NHS, 2023).

There is no single process for aseptic technique, although it is important to follow a set of principles. These principles form the basis of any aseptic procedure, and nurses should be familiar and skilled at undertaking them (Nursing and Midwifery Council, 2018).

If a dirty dressing must be removed to apply

Failing to use aseptic technique, or applying it inappropriately, may have far-reaching consequences for patients who acquire an unnecessary healthcare-associated infections (NICE, 2019). This may also create additional costs for the NHS and potentially lead to fitness to practice proceedings.

The RCN (2020) identified that many registered nurses were confused about the reasons for using aseptic technique, as well as what exactly the technique involves. Some of this confusion relates to the use of terminology which is not universally understood. Such confusion has the potential to cause nurses to undertake procedures in different ways, which may impact patient outcomes (RCN, 2020).

While it is the responsibility of all health and social care staff to observe appropriate hand hygiene and standard precautions, individual nurses who undertake procedures requiring the application of aseptic technique must ensure that they stay up to date with the training, knowledge and skills - in line with the requirements of revalidation - in order to achieve this.

Nursing and Midwifery Council: standards of proficiency for registered nurses

Part 2: Procedures for the planning, provision and management of person-centred nursing care

4.6 use aseptic techniques when undertaking wound care including dressings, pressure bandaging, suture removal, and vacuum closures

4.7 use aseptic techniques when managing wound and
drainage processes

9.3 use effective aseptic, non-touch techniques

Denton A, Hallam C. Principles of asepsis 1: the rationale for using aseptic technique. Nursing Times. 2020;116:38-41.

Gallagher R. Infection prevention and control. In: Delves-Yates C (ed). Essentials of Nursing Practice. 3rd edn. London: Sage; 2022: 365-387

Loveday HP, Wilson JA, Pratt RJ, et al. National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals. J Hosp Inf. 2014;86 Suppl 1:S1-S70. https://doi.org/10.1016/S0195-6701(13)60012-2 

National Institute for Health and Care Excellence (NICE). Healthcare-associated infections: prevention and control in primary and community care
2017. https://www.nice.org.uk/guidance/cg139 (accessed 20 October 2023)

NHS. How to wash your hands. 2023. https://www.nhs.uk/live-well/best-way-to-wash-your-hands/ (accessed 20 October 2023)

Nursing and Midwifery Council. Future nurse: standards of proficiency for registered nurses. 2018. https://www.nmc.org.uk/globalassets/sitedocuments/education-standards/future-nurse-proficiencies.pdf  (accessed 20 October 2023)

Royal College of Nursing (RCN). Understanding aseptic technique: an RCN investigation into clinician views to guide the practice of aseptic technique. 2020. https://www.rcn.org.uk/professional-development/publications/pub-007928 (accessed 20 October 2023)