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  • #69065
    John Ferguson
    Participant

    Author:
    John Ferguson

    Email:
    John.Ferguson@HNEHEALTH.NSW.GOV.AU

    Organisation:

    State:

    Dear Aicalist members,

    As you will know, the new ACSQHC Safety and Quality Standards include these (stretch) requirements:
    3.10 Developing and implementing protocols for aseptic non-touch technique
    3.10.1 The clinical workforce is trained in aseptic non-touch technique
    3.10.2 Compliance with aseptic non-touch technique is regularly audited
    3.10.3 Action is taken to increase compliance with the aseptic non-touch technique protocols
    It is quite a challenge to put in place a system that goes across all practitioners as I’m sure you know!

    The resources attached are available from UK (we have them on order).

    The Commission would be interested to know about programs around the country that have developed ANTT policies and procedures.
    Has anyone started regular auditing (other than say for CL insertion)? If so would you please share your audit tool(s)?
    What examples of action taken to increase compliance do you have?
    Have people had experience with the above UK resources?

    In Hunter New England, in addition to central line insertion, we’ve chosen to focus on IV insertion, wound dressing and IV medication preparation as our initial procedures to codify and audit. We already do skills lab training for IV inserters.

    We’ve also been throwing around the following guiding principles list for ANTT – would welcome your comments! Could we perhaps come up with a natty acronym for these 5 ‘moments’ of ANTT?

    Aseptic non-touch technique (ANTT) : core principles of practice

    1. WHERE TO PERFORM the physical environment for the procedure- where should it be performed; what are the situations where it should not be performed?
    2. SEQUENCING the most efficient and safest sequencing of procedure preparation and performance needs to be known by the operator and followed closely
    3. DISINFECTION- Hands, procedure trolley and the patient procedure site; correct disinfectant, method of application and avoidance of recontamination
    4. ESTABLISH AND PROTECT ASEPTIC FIELDS sterile drapes, plastic trays, sterile glove use, correct procedure sequencing and performance
    5. NON-TOUCH PROCEDURE TECHNIQUE specific to the procedure

    Thanks!

    John

    Dr John Ferguson
    Chair, Healthcare Infection Advisory Committee, Australian Commission on Safety and Quality in Healthcare
    Locked Bag 1, Newcastle Mail Centre, NSW 2310
    Tel 61 2 4921 4444 | Fax 61 2 4921 4440 | Mob +61 428 885 573 | john.ferguson@hnehealth.nsw.gov.au | http://www.hicsiganz.org

    Dear John,

    Thank you for your email and sorry for the slow response. We will post you the ANTT Guideline CD which includes ANTT Audit Tools and the ANTT Practice Framework to the address provided.

    To implement ANTT effectively it is important to blend education with practical training. To support this, The Association for Safe Aseptic Practice (ASAP) provides ANTT Accredited training resources to help support training and implementation. The Implementation Pack includes all the resources required to implement ANTT across a large organisation.

    We charge a small amount for these resources to help support the ongoing development of ANTT resources. I have attached the Resource List along with a information sheet.

    Please let me know if you have any further questions.

    Best regards
    Pat

    Patricia Fernandes
    Administrator and PA to:
    Stephen Rowley

    Clinical Director ANTT
    stephen.rowley@antt.org.uk
    http://www.antt.org.uk
    +44 (0)7739 000597

    Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.

    Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

    Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au

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    #69066
    Wells, Annie
    Participant

    Author:
    Wells, Annie

    Email:
    anne.wells@DHHS.TAS.GOV.AU

    Organisation:

    State:

    Dear John and ACIPClist members,

    You may be interested in the ANTT Guide developed by TIPCU and available on our website:
    http://www.dhhs.tas.gov.au/peh/tasmanian_infection_prevention_and_control_unit/information_for_healthcare_workers/guidance_and_policies_for_healthcare_workers

    Kind regards,

    Annie Wells I CNC, Infection Control, TIPCU
    Population Health I Department of Health and Human Services
    Post GPO Box 125 Hobart Tas 7001 | Email tipcu@dhhs.tas.gov.au
    Phone (03) 6222 7699 | Fax (03) 6233 0553
    A fair and healthy Tasmania

    From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of John Ferguson
    Sent: Monday, 4 June 2012 11:46 AM
    To: AICALIST@AICALIST.ORG.AU
    Subject: Aseptic non-touch technique
    Importance: High

    Dear Aicalist members,

    As you will know, the new ACSQHC Safety and Quality Standards include these (stretch) requirements:
    3.10 Developing and implementing protocols for aseptic non-touch technique
    3.10.1 The clinical workforce is trained in aseptic nontouch technique
    3.10.2 Compliance with aseptic non-touch technique is regularly audited
    3.10.3 Action is taken to increase compliance with the aseptic non-touch technique protocols
    It is quite a challenge to put in place a system that goes across all practitioners as I’m sure you know!

    The resources attached are available from UK (we have them on order).

    The Commission would be interested to know about programs around the country that have developed ANTT policies and procedures.
    Has anyone started regular auditing (other than say for CL insertion)? If so would you please share your audit tool(s)?
    What examples of action taken to increase compliance do you have?
    Have people had experience with the above UK resources?

    In Hunter New England, in addition to central line insertion, we’ve chosen to focus on IV insertion, wound dressing and IV medication preparation as our initial procedures to codify and audit. We already do skills lab training for IV inserters.

    We’ve also been throwing around the following guiding principles list for ANTT – would welcome your comments! Could we perhaps come up with a natty acronym for these 5 ‘moments’ of ANTT?

    Aseptic non-touch technique (ANTT) : core principles of practice

    1. WHERE TO PERFORM the physical environment for the procedure- where should it be performed; what are the situations where it should not be performed?
    2. SEQUENCING the most efficient and safest sequencing of procedure preparation and performance needs to be known by the operator and followed closely
    3. DISINFECTION- Hands, procedure trolley and the patient procedure site; correct disinfectant, method of application and avoidance of recontamination
    4. ESTABLISH AND PROTECT ASEPTIC FIELDS sterile drapes, plastic trays, sterile glove use, correct procedure sequencing and performance
    5. NON-TOUCH PROCEDURE TECHNIQUE specific to the procedure

    Thanks!

    John

    Dr John Ferguson
    Chair, Healthcare Infection Advisory Committee, Australian Commission on Safety and Quality in Healthcare
    Locked Bag 1, Newcastle Mail Centre, NSW 2310
    Tel 61 2 4921 4444 | Fax 61 2 4921 4440 | Mob +61 428 885 573 | john.ferguson@hnehealth.nsw.gov.au | http://www.hicsiganz.org

    From: Stephen Rowley ANTT [mailto:stephen.rowley@antt.org.uk]
    Sent: Monday, 4 June 2012 1:57 AM
    To: John Ferguson
    Subject: Re: Purchase of ANTT package
    Importance: High

    Dear John,

    Thank you for your email and sorry for the slow response. We will post you the ANTT Guideline CD which includes ANTT Audit Tools and the ANTT Practice Framework to the address provided.

    To implement ANTT effectively it is important to blend education with practical training. To support this, The Association for Safe Aseptic Practice (ASAP) provides ANTT Accredited training resources to help support training and implementation. The Implementation Pack includes all the resources required to implement ANTT across a large organisation.

    We charge a small amount for these resources to help support the ongoing development of ANTT resources. I have attached the Resource List along with a information sheet.

    Please let me know if you have any further questions.

    Best regards
    Pat

    Patricia Fernandes
    Administrator and PA to:
    Stephen Rowley

    Clinical Director ANTT
    stephen.rowley@antt.org.uk
    http://www.antt.org.uk
    +44 (0)7739 000597

    Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.

    Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

    Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au

    To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.

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    #69067
    Anonymous
    Inactive

    Author:
    Anonymous

    Organisation:

    State:

    John,

    We have been looking at this from a dental perspective as well as DSU.

    There is a great deal of applying criteria or category to many procedures e.g. using sterile for procedures that dont use sterile, gloves gowns or fields.

    Aseptic set ups when clean hands are used to lay instruments out on bracket tables.

    It will give a great opportunity to apply correct labels and processes to all our dental procedures including in DSU and hopefully this will roll out to all our agencies and other practices..

    Any information or thoughts from anyone will be greatly appreciated.

    Wendy

    Wendy Bacalja
    Principal Nursing Officer
    Infection Control Consultant

    Dental Health Services Victoria
    oral health for better health
    The Royal Dental Hospital of Melbourne
    720 Swanston Street | Carlton | VIC 3053
    T: 03 9341 1151 | M: 0418 335 106 | F: 03 9341 1234

    http://www.dhsv.org.au

    ________________________________
    From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of John Ferguson
    Sent: Monday, 4 June 2012 11:46 AM
    To: AICALIST@AICALIST.ORG.AU
    Subject: [ACIPC_Infexion_Connexion] Aseptic non-touch technique
    Importance: High

    Dear Aicalist members,

    As you will know, the new ACSQHC Safety and Quality Standards include these (stretch) requirements:
    3.10 Developing and implementing protocols for aseptic non-touch technique
    3.10.1 The clinical workforce is trained in aseptic nontouch technique
    3.10.2 Compliance with aseptic non-touch technique is regularly audited
    3.10.3 Action is taken to increase compliance with the aseptic non-touch technique protocols
    It is quite a challenge to put in place a system that goes across all practitioners as I’m sure you know!

    The resources attached are available from UK (we have them on order).

    The Commission would be interested to know about programs around the country that have developed ANTT policies and procedures.
    Has anyone started regular auditing (other than say for CL insertion)? If so would you please share your audit tool(s)?
    What examples of action taken to increase compliance do you have?
    Have people had experience with the above UK resources?

    In Hunter New England, in addition to central line insertion, we’ve chosen to focus on IV insertion, wound dressing and IV medication preparation as our initial procedures to codify and audit. We already do skills lab training for IV inserters.

    We’ve also been throwing around the following guiding principles list for ANTT – would welcome your comments! Could we perhaps come up with a natty acronym for these 5 ‘moments’ of ANTT?

    Aseptic non-touch technique (ANTT) : core principles of practice

    1. WHERE TO PERFORM the physical environment for the procedure- where should it be performed; what are the situations where it should not be performed?
    2. SEQUENCING the most efficient and safest sequencing of procedure preparation and performance needs to be known by the operator and followed closely
    3. DISINFECTION- Hands, procedure trolley and the patient procedure site; correct disinfectant, method of application and avoidance of recontamination
    4. ESTABLISH AND PROTECT ASEPTIC FIELDS sterile drapes, plastic trays, sterile glove use, correct procedure sequencing and performance
    5. NON-TOUCH PROCEDURE TECHNIQUE specific to the procedure

    Thanks!

    John

    Dr John Ferguson
    Chair, Healthcare Infection Advisory Committee, Australian Commission on Safety and Quality in Healthcare
    Locked Bag 1, Newcastle Mail Centre, NSW 2310
    Tel 61 2 4921 4444 | Fax 61 2 4921 4440 | Mob +61 428 885 573 | john.ferguson@hnehealth.nsw.gov.au | http://www.hicsiganz.org

    From: Stephen Rowley ANTT [mailto:stephen.rowley@antt.org.uk]
    Sent: Monday, 4 June 2012 1:57 AM
    To: John Ferguson
    Subject: Re: Purchase of ANTT package
    Importance: High

    Dear John,

    Thank you for your email and sorry for the slow response. We will post you the ANTT Guideline CD which includes ANTT Audit Tools and the ANTT Practice Framework to the address provided.

    To implement ANTT effectively it is important to blend education with practical training. To support this, The Association for Safe Aseptic Practice (ASAP) provides ANTT Accredited training resources to help support training and implementation. The Implementation Pack includes all the resources required to implement ANTT across a large organisation.

    We charge a small amount for these resources to help support the ongoing development of ANTT resources. I have attached the Resource List along with a information sheet.

    Please let me know if you have any further questions.

    Best regards
    Pat

    Patricia Fernandes
    Administrator and PA to:
    Stephen Rowley

    Clinical Director ANTT
    stephen.rowley@antt.org.uk
    http://www.antt.org.uk
    +44 (0)7739 000597

    Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.

    Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

    Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au

    To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.

    You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au

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    Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au

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    #69068
    Joeanne Bendall
    Participant

    Author:
    Joeanne Bendall

    Email:
    Joeanne.Bendall@SESIAHS.HEALTH.NSW.GOV.AU

    Organisation:

    State:

    John
    How about POP ANTT (principles of practice aseptic non-touch technique)

    Thanks

    Joe

    Joe-anne Bendall
    Infection Prevention and Control CNC
    Sydney Hospital and Sydney Eye Hospital
    Macquarie St
    Sydney

    Phone: 93827199
    Page: 21552

    joeanne.bendall@sesiahs.health.nsw.gov.au

    From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of John Ferguson
    Sent: Monday, 4 June 2012 11:46 AM
    To: AICALIST@AICALIST.ORG.AU
    Subject: Aseptic non-touch technique
    Importance: High

    Dear Aicalist members,

    As you will know, the new ACSQHC Safety and Quality Standards include these (stretch) requirements:
    3.10 Developing and implementing protocols for aseptic non-touch technique
    3.10.1 The clinical workforce is trained in aseptic nontouch technique
    3.10.2 Compliance with aseptic non-touch technique is regularly audited
    3.10.3 Action is taken to increase compliance with the aseptic non-touch technique protocols
    It is quite a challenge to put in place a system that goes across all practitioners as I’m sure you know!

    The resources attached are available from UK (we have them on order).

    The Commission would be interested to know about programs around the country that have developed ANTT policies and procedures.
    Has anyone started regular auditing (other than say for CL insertion)? If so would you please share your audit tool(s)?
    What examples of action taken to increase compliance do you have?
    Have people had experience with the above UK resources?

    In Hunter New England, in addition to central line insertion, we’ve chosen to focus on IV insertion, wound dressing and IV medication preparation as our initial procedures to codify and audit. We already do skills lab training for IV inserters.

    We’ve also been throwing around the following guiding principles list for ANTT – would welcome your comments! Could we perhaps come up with a natty acronym for these 5 ‘moments’ of ANTT?

    Aseptic non-touch technique (ANTT) : core principles of practice

    1. WHERE TO PERFORM the physical environment for the procedure- where should it be performed; what are the situations where it should not be performed?
    2. SEQUENCING the most efficient and safest sequencing of procedure preparation and performance needs to be known by the operator and followed closely
    3. DISINFECTION- Hands, procedure trolley and the patient procedure site; correct disinfectant, method of application and avoidance of recontamination
    4. ESTABLISH AND PROTECT ASEPTIC FIELDS sterile drapes, plastic trays, sterile glove use, correct procedure sequencing and performance
    5. NON-TOUCH PROCEDURE TECHNIQUE specific to the procedure

    Thanks!

    John

    Dr John Ferguson
    Chair, Healthcare Infection Advisory Committee, Australian Commission on Safety and Quality in Healthcare
    Locked Bag 1, Newcastle Mail Centre, NSW 2310
    Tel 61 2 4921 4444 | Fax 61 2 4921 4440 | Mob +61 428 885 573 | john.ferguson@hnehealth.nsw.gov.au | http://www.hicsiganz.org

    From: Stephen Rowley ANTT [mailto:stephen.rowley@antt.org.uk]
    Sent: Monday, 4 June 2012 1:57 AM
    To: John Ferguson
    Subject: Re: Purchase of ANTT package
    Importance: High

    Dear John,

    Thank you for your email and sorry for the slow response. We will post you the ANTT Guideline CD which includes ANTT Audit Tools and the ANTT Practice Framework to the address provided.

    To implement ANTT effectively it is important to blend education with practical training. To support this, The Association for Safe Aseptic Practice (ASAP) provides ANTT Accredited training resources to help support training and implementation. The Implementation Pack includes all the resources required to implement ANTT across a large organisation.

    We charge a small amount for these resources to help support the ongoing development of ANTT resources. I have attached the Resource List along with a information sheet.

    Please let me know if you have any further questions.

    Best regards
    Pat

    Patricia Fernandes
    Administrator and PA to:
    Stephen Rowley

    Clinical Director ANTT
    stephen.rowley@antt.org.uk
    http://www.antt.org.uk
    +44 (0)7739 000597

    Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.

    Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

    Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au

    To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.

    You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au

    ———————————————————————————————

    Illawarra Shoalhaven Local Health District, South East Sydney Local Health District and Sydney Children’s Hospital Network (Randwick Campus) Confidentiality Notice

    This email, and the files transmitted with it, are confidential and intended solely for the use of the individual or entity to whom they are addressed. If you are not the intended recipient, you are not permitted to distribute or use this email or any of its attachments in any way. We also request that you advise the sender of the incorrect addressing.

    This email message has been virus-scanned. Although no computer viruses were detected, Illawarra Shoalhaven Local Health District, South East Sydney Local Health District and Sydney Children’s Hospital Network (Randwick Campus) accept no liability for any consequential damage resulting from email containing any computer viruses.

    Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.

    Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

    Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au

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    #69074
    Beth Bint
    Participant

    Author:
    Beth Bint

    Email:
    Beth.Bint@SESIAHS.HEALTH.NSW.GOV.AU

    Organisation:

    State:

    Hi John

    What about 5 MANTTs 5 Moments for Aseptic Non-touch Techniques?? Just a crazy thought.

    Beth

    Beth Bint

    Clinical Nurse Consultant | Infection Management and Control Service
    Level 1 Lawson House, Wollongong Hospital 2500, NSW
    Tel. 02 4222 5869 | Fax. 02 4222 5367 | beth.bint@sesiahs.health.nsw.gov.au

    [cid:image001.jpg@01CD4400.8D6752A0]

    From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of John Ferguson
    Sent: Monday, 4 June 2012 11:46 AM
    To: AICALIST@AICALIST.ORG.AU
    Subject: Aseptic non-touch technique
    Importance: High

    Dear Aicalist members,

    As you will know, the new ACSQHC Safety and Quality Standards include these (stretch) requirements:
    3.10 Developing and implementing protocols for aseptic non-touch technique
    3.10.1 The clinical workforce is trained in aseptic nontouch technique
    3.10.2 Compliance with aseptic non-touch technique is regularly audited
    3.10.3 Action is taken to increase compliance with the aseptic non-touch technique protocols
    It is quite a challenge to put in place a system that goes across all practitioners as I’m sure you know!

    The resources attached are available from UK (we have them on order).

    The Commission would be interested to know about programs around the country that have developed ANTT policies and procedures.
    Has anyone started regular auditing (other than say for CL insertion)? If so would you please share your audit tool(s)?
    What examples of action taken to increase compliance do you have?
    Have people had experience with the above UK resources?

    In Hunter New England, in addition to central line insertion, we’ve chosen to focus on IV insertion, wound dressing and IV medication preparation as our initial procedures to codify and audit. We already do skills lab training for IV inserters.

    We’ve also been throwing around the following guiding principles list for ANTT – would welcome your comments! Could we perhaps come up with a natty acronym for these 5 ‘moments’ of ANTT?

    Aseptic non-touch technique (ANTT) : core principles of practice

    1. WHERE TO PERFORM the physical environment for the procedure- where should it be performed; what are the situations where it should not be performed?
    2. SEQUENCING the most efficient and safest sequencing of procedure preparation and performance needs to be known by the operator and followed closely
    3. DISINFECTION- Hands, procedure trolley and the patient procedure site; correct disinfectant, method of application and avoidance of recontamination
    4. ESTABLISH AND PROTECT ASEPTIC FIELDS sterile drapes, plastic trays, sterile glove use, correct procedure sequencing and performance
    5. NON-TOUCH PROCEDURE TECHNIQUE specific to the procedure

    Thanks!

    John

    Dr John Ferguson
    Chair, Healthcare Infection Advisory Committee, Australian Commission on Safety and Quality in Healthcare
    Locked Bag 1, Newcastle Mail Centre, NSW 2310
    Tel 61 2 4921 4444 | Fax 61 2 4921 4440 | Mob +61 428 885 573 | john.ferguson@hnehealth.nsw.gov.au | http://www.hicsiganz.org

    From: Stephen Rowley ANTT [mailto:stephen.rowley@antt.org.uk]
    Sent: Monday, 4 June 2012 1:57 AM
    To: John Ferguson
    Subject: Re: Purchase of ANTT package
    Importance: High

    Dear John,

    Thank you for your email and sorry for the slow response. We will post you the ANTT Guideline CD which includes ANTT Audit Tools and the ANTT Practice Framework to the address provided.

    To implement ANTT effectively it is important to blend education with practical training. To support this, The Association for Safe Aseptic Practice (ASAP) provides ANTT Accredited training resources to help support training and implementation. The Implementation Pack includes all the resources required to implement ANTT across a large organisation.

    We charge a small amount for these resources to help support the ongoing development of ANTT resources. I have attached the Resource List along with a information sheet.

    Please let me know if you have any further questions.

    Best regards
    Pat

    Patricia Fernandes
    Administrator and PA to:
    Stephen Rowley

    Clinical Director ANTT
    stephen.rowley@antt.org.uk
    http://www.antt.org.uk
    +44 (0)7739 000597

    Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.

    Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

    Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au

    To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.

    You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au

    ———————————————————————————————

    Illawarra Shoalhaven Local Health District, South East Sydney Local Health District and Sydney Children’s Hospital Network (Randwick Campus) Confidentiality Notice

    This email, and the files transmitted with it, are confidential and intended solely for the use of the individual or entity to whom they are addressed. If you are not the intended recipient, you are not permitted to distribute or use this email or any of its attachments in any way. We also request that you advise the sender of the incorrect addressing.

    This email message has been virus-scanned. Although no computer viruses were detected, Illawarra Shoalhaven Local Health District, South East Sydney Local Health District and Sydney Children’s Hospital Network (Randwick Campus) accept no liability for any consequential damage resulting from email containing any computer viruses.

    Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.

    Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

    Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au

    To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.

    You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@a

    #69075
    Lincoln Fowler
    Participant

    Author:
    Lincoln Fowler

    Email:
    lincoln.fowler@HEALTH.WA.GOV.AU

    Organisation:

    State:

    Hi John

    Assuming the acronym is to promote using the correct steps I would suggest: LOCATE

    L: Location of procedure

    O: Order of procedure

    C: Cleaning and disinfection

    A: Aseptic field established

    T: Technique non-touch

    (E: evaluate performace)

    The last is to encourage reflective practice.

    Perhaps someone can dream up something better based on this.

    Cheers

    Lincoln Fowler / Infection Control / CACH

    Department of Health

    Telephone: +61 8 9224 1407 / Fax: +61 8 9224 1612

    Mobile: 0467 771 233

    E: Lincoln.Fowler@health.wa.gov.au

    L3 WASON, 151 Wellington St, PERTH WA 6000

    http://www.health.wa.gov.au

    Delivering a Healthy WA

    ________________________________

    From: ACIPC Infexion Connexion [mailto:AICALIST@aicalist.org.au] On Behalf Of John Ferguson
    Sent: Monday, 4 June 2012 9:46 AM
    To: AICALIST@aicalist.org.au
    Subject: Aseptic non-touch technique
    Importance: High

    Dear Aicalist members,

    As you will know, the new ACSQHC Safety and Quality Standards include these (stretch) requirements:

    3.10 Developing and implementing protocols for aseptic non-touch technique

    3.10.1 The clinical workforce is trained in aseptic nontouch technique

    3.10.2 Compliance with aseptic non-touch technique is regularly audited

    3.10.3 Action is taken to increase compliance with the aseptic non-touch technique protocols

    It is quite a challenge to put in place a system that goes across all practitioners as I’m sure you know!

    The resources attached are available from UK (we have them on order).

    The Commission would be interested to know about programs around the country that have developed ANTT policies and procedures.

    Has anyone started regular auditing (other than say for CL insertion)? If so would you please share your audit tool(s)?

    What examples of action taken to increase compliance do you have?

    Have people had experience with the above UK resources?

    In Hunter New England, in addition to central line insertion, we’ve chosen to focus on IV insertion, wound dressing and IV medication preparation as our initial procedures to codify and audit. We already do skills lab training for IV inserters.

    We’ve also been throwing around the following guiding principles list for ANTT – would welcome your comments! Could we perhaps come up with a natty acronym for these 5 ‘moments’ of ANTT?

    Aseptic non-touch technique (ANTT) : core principles of practice

    1.WHERE TO PERFORM the physical environment for the procedure- where should it be performed; what are the situations where it should not be performed?
    2.SEQUENCING the most efficient and safest sequencing of procedure preparation and performance needs to be known by the operator and followed closely
    3.DISINFECTION- Hands, procedure trolley and the patient procedure site; correct disinfectant, method of application and avoidance of recontamination
    4.ESTABLISH AND PROTECT ASEPTIC FIELDS sterile drapes, plastic trays, sterile glove use, correct procedure sequencing and performance
    5.NON-TOUCH PROCEDURE TECHNIQUE specific to the procedure

    Thanks!

    John

    Dr John Ferguson
    Chair, Healthcare Infection Advisory Committee, Australian Commission on Safety and Quality in Healthcare

    Locked Bag 1, Newcastle Mail Centre, NSW 2310
    Tel 61 2 4921 4444 | Fax 61 2 4921 4440 | Mob +61 428 885 573 | john.ferguson@hnehealth.nsw.gov.au | http://www.hicsiganz.org

    From: Stephen Rowley ANTT [mailto:stephen.rowley@antt.org.uk]
    Sent: Monday, 4 June 2012 1:57 AM
    To: John Ferguson
    Subject: Re: Purchase of ANTT package
    Importance: High

    Dear John,

    Thank you for your email and sorry for the slow response. We will post you the ANTT Guideline CD which includes ANTT Audit Tools and the ANTT Practice Framework to the address provided.

    To implement ANTT effectively it is important to blend education with practical training. To support this, The Association for Safe Aseptic Practice (ASAP) provides ANTT Accredited training resources to help support training and implementation. The Implementation Pack includes all the resources required to implement ANTT across a large organisation.

    We charge a small amount for these resources to help support the ongoing development of ANTT resources. I have attached the Resource List along with a information sheet.

    Please let me know if you have any further questions.

    Best regards

    Pat

    Patricia Fernandes

    Administrator and PA to:

    Stephen Rowley

    Clinical Director ANTT

    stephen.rowley@antt.org.uk

    http://www.antt.org.uk

    +44 (0)7739 000597

    Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.

    Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

    Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au

    To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.

    You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au

    Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.

    Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

    Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au

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    You can unsubscribe from this list be sending ‘signoff aicalist’ (witho

    #69076
    Jackie Miley
    Participant

    Author:
    Jackie Miley

    Email:
    jmiley@BROOKES.AC.UK

    Organisation:

    State:

    HI Lincoln,
    This has potential !
    Well done

    *Jackie *

    *Jackie Miley* MSc, PG Cert Public Health, Cert Infection Control,
    Dip Rn.

    Senior Lecturer Infection Prevention and Control & Continuing Professional
    Development
    Course Leader MSc Infection Prevention and Control
    Course Leader Short Course Infection Prevention & Control

    Oxford Brookes University
    Faculty of Health and Life Sciences
    Jack Straw’s Lane
    Marston
    Oxford OX3 0FL

    jmiley@brookes.ac.uk

    On 6 June 2012 07:59, Fowler, Lincoln wrote:

    > ** ** ** ** **
    >
    > Hi John****
    >
    > Assuming the acronym is to promote using the correct steps I would
    > suggest: LOCATE****
    >
    > L: Location of procedure****
    >
    > O: Order of procedure****
    >
    > C: Cleaning and disinfection****
    >
    > A: Aseptic field established****
    >
    > T: Technique non-touch****
    >
    > (E: evaluate performace)****
    >
    > ** **
    >
    > The last is to encourage reflective practice.****
    >
    > Perhaps someone can dream up something better based on this.****
    >
    > Cheers****
    >
    > *****Lincoln****** Fowler* / Infection Control / CACH****
    >
    > *Department of Health*****
    >
    > Telephone: +61 8 9224 1407 / Fax: +61 8 9224 1612****
    >
    > ****Mobile****: 0467 771 233****
    >
    > E: Lincoln.Fowler@health.wa.gov.au****
    >
    > L3 **WASON****, ****151 Wellington St****, ****PERTH**** WA 6000********
    >
    > **www.health.wa.gov.au********
    >
    > **Delivering a *Healthy WA*****
    > ****
    >
    > ** **
    >
    > ** **
    > ——————————
    >
    > *From:* ACIPC Infexion Connexion [mailto:AICALIST@aicalist.org.au] *On
    > Behalf Of *John Ferguson
    > *Sent:* Monday, 4 June 2012 9:46 AM
    > *To:* AICALIST@aicalist.org.au
    > *Subject:* Aseptic non-touch technique
    > *Importance:* High****
    >
    > ** **
    >
    > Dear Aicalist members,****
    >
    > ** **
    >
    > As you will know, the new ACSQHC Safety and Quality Standards include
    > these (stretch) requirements:****
    >
    > 3.10 Developing and implementing protocols for aseptic non-touch technique
    > ****
    >
    > 3.10.1 The clinical workforce is trained in aseptic non-touch technique***
    > *
    >
    > 3.10.2 Compliance with aseptic non-touch technique is regularly audited***
    > *
    >
    > 3.10.3 Action is taken to increase compliance with the aseptic non-touch
    > technique protocols****
    >
    > It is quite a challenge to put in place a system that goes across all
    > practitioners as I’m sure you know!****
    >
    > ** **
    >
    > The resources attached are available from ****UK**** (we have them on
    > order). ****
    >
    > ** **
    >
    > The Commission would be interested to know about programs around the
    > country that have developed ANTT policies and procedures.****
    >
    > Has anyone started regular auditing (other than say for CL insertion)? If
    > so would you please share your audit tool(s)?****
    >
    > What examples of action taken to increase compliance do you have?****
    >
    > Have people had experience with the above ****UK**** resources?****
    >
    > ** **
    >
    > In Hunter New England, in addition to central line insertion, we’ve chosen
    > to focus on IV insertion, wound dressing and IV medication preparation as
    > our initial procedures to codify and audit. We already do skills lab
    > training for IV inserters. ****
    >
    > ** **
    >
    > We’ve also been throwing around the following guiding principles list for
    > ANTT – would welcome your comments! Could we perhaps come up with a natty
    > acronym for these 5 ‘moments’ of ANTT?****
    >
    > ** **
    >
    > *Aseptic non-touch technique (ANTT) : core principles of practice*****
    >
    > 1. WHERE TO PERFORM- the physical environment for the procedure- where
    > should it be performed; what are the situations where it should not be
    > performed? ****
    > 2. SEQUENCING – the most efficient and safest sequencing of procedure
    > preparation and performance needs to be known by the operator and followed
    > closely ****
    > 3. DISINFECTION- Hands, procedure trolley and the patient procedure
    > site; correct disinfectant, method of application and avoidance of
    > recontamination ****
    > 4. ESTABLISH AND PROTECT ‘ASEPTIC FIELDS’ – sterile drapes, plastic
    > trays, sterile glove use, correct procedure sequencing and performance
    > ****
    > 5. NON-TOUCH PROCEDURE TECHNIQUE – specific to the procedure ****
    >
    > ** **
    >
    > Thanks!****
    >
    > ** **
    >
    > John****
    >
    > ** **
    >
    > *Dr John Ferguson*
    > Chair, Healthcare Infection Advisory Committee, Australian Commission on
    > Safety and Quality in Healthcare****
    >
    > Locked Bag 1, ****Newcastle**** Mail Centre, NSW 2310
    > Tel * *61 2 4921 4444 | Fax * *61 2 4921 4440 | Mob +61 428 885 573 |
    > john.ferguson@hnehealth.nsw.gov.au* *| http://www.hicsiganz.org****
    >
    > ** **
    >
    > ** **
    >
    > ** **
    >
    > *From:* Stephen Rowley ANTT [mailto:stephen.rowley@antt.org.uk]
    > *Sent:* Monday, 4 June 2012 1:57 AM
    > *To:* John Ferguson
    > *Subject:* Re: Purchase of ANTT package
    > *Importance:* High****
    >
    > ** **
    >
    > Dear John, ****
    >
    > ** **
    >
    > Thank you for your email and sorry for the slow response. We will post you
    > the ANTT Guideline CD which includes ANTT Audit Tools and the ANTT Practice
    > Framework to the address provided. ****
    >
    > ** **
    >
    > To implement ANTT effectively it is important to blend education with
    > practical training. To support this, The Association for Safe Aseptic
    > Practice (ASAP) provides ANTT Accredited training resources to help support
    > training and implementation. The Implementation Pack includes all the
    > resources required to implement ANTT across a large organisation. ****
    >
    > We charge a small amount for these resources to help support the ongoing
    > development of ANTT resources. I have attached the Resource List along with
    > a information sheet.****
    >
    > Please let me know if you have any further questions. ****
    >
    > Best regards****
    >
    > Pat****
    >
    > ** **
    >
    > Patricia Fernandes****
    >
    > Administrator and PA to:****
    >
    > Stephen Rowley****
    >
    > ** **
    >
    > *Clinical Director ANTT*****
    >
    > stephen.rowley@antt.org.uk****
    >
    > http://www.antt.org.uk****
    >
    > +44 (0)7739 000597****
    >
    > ** **
    >
    > ** **
    >
    > ** **
    >
    > ** **
    >
    > ** **
    >
    > ** **
    >
    > ** **
    > Messages posted to this list are solely the opinion of the authors,
    > and do not represent the opinion of ACIPC.
    >
    > Archive of all messages are available at http://aicalist.org.au/archives- registration and login required.
    >
    > Replies to this message will be directed back to the list. To create a new
    > message send an email to aicalist@aicalist.org.au
    >
    > To send a message to the list administrator send an email to
    > aicalist-request@aicalist.org.au.
    >
    > You can unsubscribe from this list be sending ‘signoff aicalist’ (without
    > the quotes) to listserv@aicalist.org.au Messages posted to this list are
    > solely the opinion of the authors, and do not represent the opinion of
    > ACIPC.
    >
    > Archive of all messages are available at http://aicalist.org.au/archives- registration and login required.
    >
    > Replies to this message will be directed back to the list. To create a new
    > message send an email to aicalist@aicalist.org.au
    >
    > To send a message to the list administrator send an email to
    > aicalist-request@aicalist.org.au.
    >
    > You can unsubscribe from this list be sending ‘signoff aicalist’ (without
    > the quotes) to listserv@aicalist.org.au
    >
    >

    Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.

    Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

    Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au

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    #69079
    TERRI CRIPPS
    Participant

    Author:
    TERRI CRIPPS

    Email:
    TERRI.CRIPPS@SESIAHS.HEALTH.NSW.GOV.AU

    Organisation:

    State:

    I like this one too!

    Terri Cripps | CNC Infection Control | Sydney Childrens Hospital
    ‘: (02) 9382 1876 | fax: (02) 9382 2084 | : terri.cripps@sesiahs.health.nsw.gov.au| “:www.sch.edu.au| page: 47140

    [cid:image003.jpg@01CD4486.053D1CD0]

    From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Fowler, Lincoln
    Sent: Wednesday, 6 June 2012 5:00 PM
    To: AICALIST@AICALIST.ORG.AU
    Subject: Re: Aseptic non-touch technique Acronym

    Hi John
    Assuming the acronym is to promote using the correct steps I would suggest: LOCATE
    L: Location of procedure
    O: Order of procedure
    C: Cleaning and disinfection
    A: Aseptic field established
    T: Technique non-touch
    (E: evaluate performace)

    The last is to encourage reflective practice.
    Perhaps someone can dream up something better based on this.
    Cheers
    Lincoln Fowler / Infection Control / CACH
    Department of Health
    Telephone: +61 8 9224 1407 / Fax: +61 8 9224 1612
    Mobile: 0467 771 233
    E: Lincoln.Fowler@health.wa.gov.au
    L3 WASON, 151 Wellington St, PERTH WA 6000
    http://www.health.wa.gov.au
    Delivering a Healthy WA

    ________________________________
    From: ACIPC Infexion Connexion [mailto:AICALIST@aicalist.org.au] On Behalf Of John Ferguson
    Sent: Monday, 4 June 2012 9:46 AM
    To: AICALIST@aicalist.org.au
    Subject: Aseptic non-touch technique
    Importance: High

    Dear Aicalist members,

    As you will know, the new ACSQHC Safety and Quality Standards include these (stretch) requirements:
    3.10 Developing and implementing protocols for aseptic non-touch technique
    3.10.1 The clinical workforce is trained in aseptic nontouch technique
    3.10.2 Compliance with aseptic non-touch technique is regularly audited
    3.10.3 Action is taken to increase compliance with the aseptic non-touch technique protocols
    It is quite a challenge to put in place a system that goes across all practitioners as I’m sure you know!

    The resources attached are available from UK (we have them on order).

    The Commission would be interested to know about programs around the country that have developed ANTT policies and procedures.
    Has anyone started regular auditing (other than say for CL insertion)? If so would you please share your audit tool(s)?
    What examples of action taken to increase compliance do you have?
    Have people had experience with the above UK resources?

    In Hunter New England, in addition to central line insertion, we’ve chosen to focus on IV insertion, wound dressing and IV medication preparation as our initial procedures to codify and audit. We already do skills lab training for IV inserters.

    We’ve also been throwing around the following guiding principles list for ANTT – would welcome your comments! Could we perhaps come up with a natty acronym for these 5 ‘moments’ of ANTT?

    Aseptic non-touch technique (ANTT) : core principles of practice

    1. WHERE TO PERFORM the physical environment for the procedure- where should it be performed; what are the situations where it should not be performed?
    2. SEQUENCING the most efficient and safest sequencing of procedure preparation and performance needs to be known by the operator and followed closely
    3. DISINFECTION- Hands, procedure trolley and the patient procedure site; correct disinfectant, method of application and avoidance of recontamination
    4. ESTABLISH AND PROTECT ASEPTIC FIELDS sterile drapes, plastic trays, sterile glove use, correct procedure sequencing and performance
    5. NON-TOUCH PROCEDURE TECHNIQUE specific to the procedure

    Thanks!

    John

    Dr John Ferguson
    Chair, Healthcare Infection Advisory Committee, Australian Commission on Safety and Quality in Healthcare
    Locked Bag 1, Newcastle Mail Centre, NSW 2310
    Tel 61 2 4921 4444 | Fax 61 2 4921 4440 | Mob +61 428 885 573 | john.ferguson@hnehealth.nsw.gov.au | http://www.hicsiganz.org

    From: Stephen Rowley ANTT [mailto:stephen.rowley@antt.org.uk]
    Sent: Monday, 4 June 2012 1:57 AM
    To: John Ferguson
    Subject: Re: Purchase of ANTT package
    Importance: High

    Dear John,

    Thank you for your email and sorry for the slow response. We will post you the ANTT Guideline CD which includes ANTT Audit Tools and the ANTT Practice Framework to the address provided.

    To implement ANTT effectively it is important to blend education with practical training. To support this, The Association for Safe Aseptic Practice (ASAP) provides ANTT Accredited training resources to help support training and implementation. The Implementation Pack includes all the resources required to implement ANTT across a large organisation.

    We charge a small amount for these resources to help support the ongoing development of ANTT resources. I have attached the Resource List along with a information sheet.

    Please let me know if you have any further questions.

    Best regards
    Pat

    Patricia Fernandes
    Administrator and PA to:
    Stephen Rowley

    Clinical Director ANTT
    stephen.rowley@antt.org.uk
    http://www.antt.org.uk
    +44 (0)7739 000597

    Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.

    Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

    Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au

    To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.

    You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.

    Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

    Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au

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    You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au

    ———————————————————————————————

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    #69081
    Wellington, Bronwyn
    Participant

    Author:
    Wellington, Bronwyn

    Email:
    WellingtonB@RAMSAYHEALTH.COM.AU

    Organisation:

    State:

    Hi Lincoln

    Great Acronym

    Regards

    Bronwyn Wellington I Quality and Infection Control Coordinator

    Quality and Infection Control I Glengarry Private Hospital
    53 Arnisdale Road
    Duncraig WA 6023

    Tel: (08) 9246 6362 I Fax: (08) 9246 6367
    Email: wellingtonb@ramsayhealth.com.au I Website: http://www.glengarryprivate.com.au

    [cid:image001.jpg@01CD449A.9113F8F0]
    [cid:image002.gif@01CD449A.9113F8F0]
    Ramsay Health Care is an environmentally responsible corporation, please consider the environment before printing this email.

    ________________________________
    From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Fowler, Lincoln
    Sent: Wednesday, 6 June 2012 3:00 PM
    To: AICALIST@AICALIST.ORG.AU
    Subject: Re: Aseptic non-touch technique Acronym

    Hi John
    Assuming the acronym is to promote using the correct steps I would suggest: LOCATE
    L: Location of procedure
    O: Order of procedure
    C: Cleaning and disinfection
    A: Aseptic field established
    T: Technique non-touch
    (E: evaluate performace)

    The last is to encourage reflective practice.
    Perhaps someone can dream up something better based on this.
    Cheers
    Lincoln Fowler / Infection Control / CACH
    Department of Health
    Telephone: +61 8 9224 1407 / Fax: +61 8 9224 1612
    Mobile: 0467 771 233
    E: Lincoln.Fowler@health.wa.gov.au
    L3 WASON, 151 Wellington St, PERTH WA 6000
    http://www.health.wa.gov.au
    Delivering a Healthy WA

    ________________________________
    From: ACIPC Infexion Connexion [mailto:AICALIST@aicalist.org.au] On Behalf Of John Ferguson
    Sent: Monday, 4 June 2012 9:46 AM
    To: AICALIST@aicalist.org.au
    Subject: Aseptic non-touch technique
    Importance: High

    Dear Aicalist members,

    As you will know, the new ACSQHC Safety and Quality Standards include these (stretch) requirements:
    3.10 Developing and implementing protocols for aseptic non-touch technique
    3.10.1 The clinical workforce is trained in aseptic nontouch technique
    3.10.2 Compliance with aseptic non-touch technique is regularly audited
    3.10.3 Action is taken to increase compliance with the aseptic non-touch technique protocols
    It is quite a challenge to put in place a system that goes across all practitioners as I’m sure you know!

    The resources attached are available from UK (we have them on order).

    The Commission would be interested to know about programs around the country that have developed ANTT policies and procedures.
    Has anyone started regular auditing (other than say for CL insertion)? If so would you please share your audit tool(s)?
    What examples of action taken to increase compliance do you have?
    Have people had experience with the above UK resources?

    In Hunter New England, in addition to central line insertion, we’ve chosen to focus on IV insertion, wound dressing and IV medication preparation as our initial procedures to codify and audit. We already do skills lab training for IV inserters.

    We’ve also been throwing around the following guiding principles list for ANTT – would welcome your comments! Could we perhaps come up with a natty acronym for these 5 ‘moments’ of ANTT?

    Aseptic non-touch technique (ANTT) : core principles of practice

    1. WHERE TO PERFORM the physical environment for the procedure- where should it be performed; what are the situations where it should not be performed?
    2. SEQUENCING the most efficient and safest sequencing of procedure preparation and performance needs to be known by the operator and followed closely
    3. DISINFECTION- Hands, procedure trolley and the patient procedure site; correct disinfectant, method of application and avoidance of recontamination
    4. ESTABLISH AND PROTECT ASEPTIC FIELDS sterile drapes, plastic trays, sterile glove use, correct procedure sequencing and performance
    5. NON-TOUCH PROCEDURE TECHNIQUE specific to the procedure

    Thanks!

    John

    Dr John Ferguson
    Chair, Healthcare Infection Advisory Committee, Australian Commission on Safety and Quality in Healthcare
    Locked Bag 1, Newcastle Mail Centre, NSW 2310
    Tel 61 2 4921 4444 | Fax 61 2 4921 4440 | Mob +61 428 885 573 | john.ferguson@hnehealth.nsw.gov.au | http://www.hicsiganz.org

    From: Stephen Rowley ANTT [mailto:stephen.rowley@antt.org.uk]
    Sent: Monday, 4 June 2012 1:57 AM
    To: John Ferguson
    Subject: Re: Purchase of ANTT package
    Importance: High

    Dear John,

    Thank you for your email and sorry for the slow response. We will post you the ANTT Guideline CD which includes ANTT Audit Tools and the ANTT Practice Framework to the address provided.

    To implement ANTT effectively it is important to blend education with practical training. To support this, The Association for Safe Aseptic Practice (ASAP) provides ANTT Accredited training resources to help support training and implementation. The Implementation Pack includes all the resources required to implement ANTT across a large organisation.

    We charge a small amount for these resources to help support the ongoing development of ANTT resources. I have attached the Resource List along with a information sheet.

    Please let me know if you have any further questions.

    Best regards
    Pat

    Patricia Fernandes
    Administrator and PA to:
    Stephen Rowley

    Clinical Director ANTT
    stephen.rowley@antt.org.uk
    http://www.antt.org.uk
    +44 (0)7739 000597

    Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.

    Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

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