Adopting ANTT for training patients to manage home parenteral nutrition
Abstract:
Background and aims: Aseptic technique is integral to the prevention of catheter related blood stream infection (CRBSI) in patients that require home parenteral support (HPS). Traditional sterile/aseptic techniques persist in administration of HPS. However, evidence suggests that an aseptic non-touch technique (ANTT) without the use of sterile gloves can be successful in training patients/carers administering HPS. The aim of this study was to compare the time taken to train patients/carers and episodes of CRBSI when using sterile/aseptic technique versus Standard-ANTT in the administration of HPS.
Methods: An inhouse training programme was initiated and a training package developed using Standard-ANTT to train patients/carers in self-management of HPS. A cohort study was undertaken to compare outcomes of two groups of patients between January to December 2024 (January-June patients trained using sterile/aseptic technique, July-December trained using Standard-ANTT). A convenience sample of all HPS discharged patients during the study period were selected. Hours of training provided and episodes of CRBSI reported within the study period were collated on an Excel spreadsheet.
Results: In total 27 patients were discharged with 20 patients/carers trained: aseptic technique group n=11 male 46%, mean age 52yrs. Standard-ANTT group n =9, male 22%, mean age 51yrs. Time to train: mean (SD) 85(98) hours and 8(3) hours, median (IQR) 23 hours (18-117) and 8 hours (3-9) respectively (p=0.01). In the Standard-ANTT group, training was significantly quicker with a 66% reduction in time taken. There were three episodes of CRBSI in the aseptic technique group during the study period. There were no CRBSI in the Standard-ANTT group (RR 0.21, CI 0.0124 to 3.7163 p=0.29).
Conclusion: Overall, this study found that patients trained using Standard-ANTT took significantly less time to become independent with HPS than those using traditional sterile/aseptic techniques. A lower risk of CRBSI was observed in the Standard-ANTT group. Adopting Standard-ANTT in training patients who require HPS is safe and effective.
Reference:
Malhi H, Fitzpatrick N, Lewis D, Williams V, Woodham D, Fletcher J. Comparison of traditional aseptic technique versus Standard Aseptic Non-Touch Technique (ANTT) in training patients to manage home parenteral support – a single centre cohort study. Clin Nutr ESPEN. 2025 May 7:S2405-4577(25)00305-5. doi: 10.1016/j.clnesp.2025.05.008. Epub ahead of print. PMID: 40345650.