Aholaakko TK. Reducing surgical nurses' aseptic practice-related stress. J Clin Nurs.. 2011; 20:(23–24)3339-3350

Allegranzi B, Zayed B, Bischoff P New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis.. 2016; 16:(12)e288-e303

Aveyard H. Doing a literature review in health and social care, 4th edn. Maidenhead: Open University Press; 2018

Beers GW, Bowden S. The effect of teaching method on long-term knowledge retention. J Nurs Educ.. 2005; 44:(11)511-514

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol.. 2006; 3:(2)77-101

Bree-Williams FJ, Waterman H. An examination of nurses' practices when performing aseptic technique for wound dressings. J Adv Nurs.. 1996; 23:(1)48-54

Cox JL, Simpson MD, Letts W, Cavanagh HMA. Putting it into practice: infection control professionals' perspectives on early career nursing graduates' microbiology and infection control knowledge and practice. Contemp Nurse. 2014; 49:(1)83-92

Coughlan M, Cronin P, Ryan F. Step-by-step guide to critiquing research: Part 1: quantitative research. Br J Nurs.. 2007; 16:(11)658-663

Critical Appraisal Skills Programme. CASP appraisal checklists. 2018. (accessed 9 January 2020)

Finding the evidence: a key step in the information production process. The Information Standard guide. 2013. (accessed 9 January 2020)

Standard Principles for preventing hospital-acquired infections. J Hosp Infect.. 2001; 47:S21-S37

Ding S, Lin F, Marshall AP, Gillespie BM. Nurses' practice in preventing postoperative wound infections: an observational study. J Wound Care. 2017; 26:(1)28-37

Ford DA, Koehler SH. A creative process for reinforcing aseptic technique practices. AORN J.. 2001; 73:(2)446-450

Fulford K, Thornton T, Graham G. Oxford textbook of philosophy and psychiatry.Oxford: Oxford University Press; 2006

Gould DJ, Chudleigh J, Purssell E Survey to explore understanding of the principles of aseptic technique: qualitative content analysis with descriptive analysis of confidence and training. Am J Infect Control. 2018; 46:(4)393-396

Hallett CE. Infection control in wound care: a study of fatalism in community nursing. J Clin Nurs.. 2000; 9:(1)103-109

Hart S. Using an aseptic technique to reduce the risk of infection. Nurs Stand.. 2007; 21:(47)43-48

Jenks P, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect.. 2014; 86:(1)24-33

Leaper DJ, van Goor H, Reilly J Surgical site infection—a European perspective of incidence and economic burden. Int Wound J.. 2004; 1:(4)247-273

Lówbúrý E, Ayliffe G, Geddes A. Control of hospital infection.Boston: Springer US; 2013

National Institute for Health and Care Excellence. Healthcare-associated infections: prevention and control in primary and community care. 2017.

National Institute for Health and Care Excellence. Surgical site infections: prevention and treatment. NICE guideline [NG125]. 2019.

Neuman B, Fawcett J. The Neuman systems model.Boston (MA): Pearson; 2011

Northamptonshire Healthcare NHS Foundation Trust. Aseptic non-touch technique (ANTT) procedure ICPr014. 2018. (accessed 9 January 2020)

Nursing and Midwifery Council. The code. Professional standards of practice and behaviour for nurses, midwives and nursing associates. 2018. (accessed 9 January 2020)

Nursing and Midwifery Council. Welcome to revalidation. 2019. (accessed 9 January 2020)

Public Health England. Surveillance of surgical site infections in NHS hospitals in England, 2017 to 2018. 2018. (accessed 9 January 2020)

Radden J. The philosophy of psychiatry: a companion.New York (NY): Oxford University Press; 2007

Rowley S, Clare S. ANTT: a standard approach to aseptic technique. Nurs Times. 2011; 107:(36)12-14

Nurse education and the assessment of nurse competence. 2002. (accessed 4 February 2020)

Teija-Kaisa A, Eija M. Reasoning for adherence to aseptic practices in the operating room. Glob Anesth Perioper Med.. 2016; 2:(4)

Timmins BA, Thomas Riché C, Saint-Jean MW, Tuck J, Merry L. Nursing wound care practices in Haiti: facilitators and barriers to quality care. Int Nurs Rev.. 2018; 65:(4)542-549

Unsworth J, Collins J. Performing an aseptic technique in a community setting: fact or fiction?. Prim Health Care Res Dev.. 2011; 12:(01)42-51

Walker JT, Martin TM, Haynie L, Norwood A, White J, Grant L. Preferences for teaching methods in a baccalaureate nursing program: how second-degree and traditional students differ. Nurs Educ Perspect. 2007; 28:(5)246-250

World Health Organization. Guidelines on core components of infection prevention and control programmes at the national and acute health care facility level. 2016. (accessed 9 January 2020)

World Health Organization. The burden of health care-associated infection worldwide. 2019. (accessed 9 January 2020)

Zarb P, Coignard B, Griskeviciene J The European Centre for Disease Prevention and Control (ECDC) pilot point prevalence survey of healthcare-associated infections and antimicrobial use. Euro Surveill.. 2012; 17:(46)

Challenges faced by nurses in complying with aseptic non-touch technique principles during wound care: a review

12 March 2020
Volume 29 · Issue 5



Surgical and wound site infections (SWSIs) are the second most frequent type of healthcare-associated Infection. One way of preventing SWSIs is by adhering to the principles of asepsis. However, many nurses struggle to apply the principles of aseptic non-touch technique (ANTT) during wound management.


To identify the barriers and enablers that influence nurses' adherence to the principles of ANTT during wound care.


A literature search using a systematic approach was carried out. Four databases were searched to identify relevant studies published between January 1993 and December 2018. Titles and abstracts were reviewed. Studies that met the inclusion criteria were reviewed for quality. The extracted data were then synthesised.


A total of seven studies fulfilled the requirements for inclusion. Three themes emerged and were found to be the most dominant factors influencing adherence to the principles of ANTT: material and resources, nurse education, and nurses' behaviour.


Nurses' compliance with aseptic practice is directly influenced by environmental and psychological factors. Ensuring compliance to ANTT may require an integrated approach involving local, national and worldwide organisations, in collaboration with higher education institutions that teach nurses and similar healthcare professionals.

Surgical and wound site infections (SWSIs) are the second most common type of healthcare-associated infection (HAI) in Europe (European Centre for Disease Prevention and Control (ECDC), Zarb et al, 2012). The global impact of SWSIs on individuals and the economy puts major epidemiological burdens on both developing and high-income countries (Allegranzi et al, 2016). Based on data from 48 studies, a study published by Leaper et al (2004) estimated the financial cost of SWSIs in Europe to be €1.47-€19.1 billion, and the average patient stay in hospital increases by 6.5 days, which means it costs three times as much to treat an infected patient (Leaper et al, 2004). Data collected by NHS hospitals in England from April 2010 to March 2012 estimated the length of hospital stay attributed to SWSIs to increase by 7–13 days, with a total of 4694 bed-days lost over this period (Jenks et al, 2014). In 2017–2018, the incidence of SWSI was higher than it was 10 years ago (Public Health England, 2018).

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content