We aimed to implement the Aseptic Non-Touch Technique (ANTT) clinical practice framework in intravenous line maintenance. We decided to address this issue first to reduce HCAI. We realised that intravenous fluid and drug preparation and administration were common invasive procedures. Quality improvement approaches are known to reduce this know-do gap by improving the system’s processes and improving patient safety. 4 8–11 Despite evidence for best practices, implementing and sustaining practices is a challenge. Adherence to evidence-based catheter practices has been shown to reduce HCAI across various age groups admitted in intensive care units, including neonates.

5 7 The ANTT has six core concepts: hand hygiene, correct glove usage, key part and key site protection, non-touch technique (of the critical parts), key part disinfection, and aseptic field management (both before and during an invasive procedure). It is based on a set of well-defined principles that aim to standardise common procedures by maintaining an aseptic field and stresses the protection of key parts and key sites from touch to reduce HCAI. Rowley proposed the standardised approach to aseptic technique called ANTT. There was variability of aseptic techniques with poor adherence to the protection of critical parts on handling invasive devices. Despite acceptable hand hygiene practices, the unit had an HCAI rate of patient days. It was relatively a newer hospital when the study began (4 months) and had a varied nurses’ skill set. Since it was an out-born hospital, the referred patients' sickness level was high, and they ended up getting invasive procedures. There were two consultant doctors (6 hours onsite followed by on-call) and three resident doctors (one per day) were available on-site round the clock. Average nursing strength was around three per shift with a patient: nurse ratio of 1:2–3. There were a total of 12 nurses with an attrition of 30% per year. The unit has five ventilation beds, including high-frequency ventilation. The unit has 12 intensive care beds, with an average occupancy of 80%. It is a referral hospital that caters close to 300–400 outborn admissions each year in the NICU. The Ovum Woman and Child Speciality Hospital is a tertiary care hospital in Bangalore rural district, India. This easily preventable HCAI leads to increased stay and adds to this vulnerable population’s morbidity and outcomes. 4 Although they are performed frequently, there is a lack of standardisation and failure to use aseptic techniques, thus causing HCAI. 3–7 Intravenous fluid and drug- preparation and administration are one of the frequent procedures performed in NICU.

A multimodal approach is required to reduce the burden of HCAI, mainly involving the healthcare professionals’ education, implementing evidence-based care bundles with attention to aseptic techniques, standardisation of procedures, and identifying local determinants of infection and improvement in reporting and surveillance for infections. 3–5 There has been practice variability, inadequate risk assessment, and thus causing uncontrolled standards of practice. 1 2 Previous studies have demonstrated that these invasive procedures are not carried with high standards. Common risk factors include instrumentation and procedures. Healthcare-associated infections (HCAI) are a common challenge faced by most neonatal intensive care units (NICU).

Asepsis technique and nurse