Borg MA. Lowbury lecture 2013. Cultural determinants of infection control behaviour: understanding drivers and implementing effective change. J Hosp Infect. 2014; 86:(3)161-168

Borg MA, Waisfisz B, Frank U. Quantitative assessment of organizational culture within hospitals and its relevance to infection prevention and control strategies. J Hosp Infect. 2015; 90:(1)75-77

Brewer JD. Ethnography. Understanding social research.Buckingham: Open University Press; 2000

Bryman A. Social research methods, 5th edn. Oxford: Oxford University Press; 2015

Burns N, Grove S. Understanding nursing research: Building an evidence-based practice, 5th edn. Maryland Heights (MO): Elsevier Saunders; 2011

Medical engagement: a journey not an event. 2014. (accessed 10 January 2019)

Cargan L. Doing social research.Lanham (MD): Rowman & Littlefield Publishers; 2007

Cooper T. Putting educational theory into clinical practice. J Hosp Infect. 2007; 65:124-127

Cruz EV, Higginbottom G. The use of focused ethnography in nursing research. Nurse Res. 2013; 20:(4)36-43

De Bono S, Heling G, Borg MA. Organizational culture and its implications for infection prevention and control in healthcare institutions. J Hosp Infect. 2014; 86:(1)1-6

Dixon-Woods M, Baker R, Charles K Culture and behaviour in the English National Health Service: overview of lessons from a large multimethod study. BMJ Qual Saf. 2014; 23:(2)106-115

Dulcan MK. Practitioner perspectives on evidence-based practice. Child Adolesc Psychiatr Clin N Am. 2005; 14:(2)225-240

Edberg MC. Essential readings in health behavior: theory and practice.Sudbury (MA): Jones & Bartlett; 2010

Feist GJ, Gorman ME Handbook of the psychology of science.(eds). New York NY: Springer Publishing Company; 2012

Franklin N, Melville P. Competency assessment tools: an exploration of the pedagogical issues facing competency assessment for nurses in the clinical environment. Collegian. 2015; 22:(1)25-31

Harrison C. Teachers developing assessment for learning: mapping teacher change. Teacher Development. 2005; 9:(2)255-263

Iedema R, Hor SY, Wyer M An innovative approach to strengthening health professionals' infection control and limiting hospital-acquired infection: video-reflexive ethnography. BMJ Innovations. 2015; 1:(4)157-162

Jenner EA, Watson PWB, Miller L, Jones F, Scott GM. Explaining hand hygiene practice: an extended application of the theory of planned behaviour. Psychology, Health and Medicine. 2002; 7:(3)311-326

Karahanna E, Evaristo R, Strite M. Levels of culture and individual behavior: an integrative perspective. Journal of Global Information Management. 2005; 13:(2)1-20

Kirkpatrick DL. Evaluating training programmes: the four levels.San Francisco CA: Berrett-Koehler; 1994

Knowles MS, Holton EF, Swanson RA. The adult learner: the definite classic in adult education and human resource development.Oxford: Elsevier/Butterworth-Heinemann; 1998

LoBiondo-Wood G, Haber J. Nursing research: methods and critical appraisal for evidence-based practice, 6th edn. St Louis (MO): Mosby/Elsevier; 2006

McAteer J, Stone S, Fuller C, Michie S. Using psychological theory to understand the challenges facing staff delivering a ward-led intervention to increase hand hygiene behavior: a qualitative study. Am J Infect Control. 2014; 42:(5)495-499

National Institute for Health and Care Excellence. Patient and public involvement policy. 2013. (accessed 10 January 2019)

Pittet D. The Lowbury lecture: behaviour in infection control. J Hosp Infect. 2004; 58:(1)1-13

Public Health Wales. Model policy. Aseptic non touch technique (ANTT): a national standardised approach to aseptic technique. 2017. (accessed 10 January 2019)

Reeves S, Lewin S, Espin S, Zwarenstein M. Interprofessional teamwork for health and social care.Chichester: John Wiley & Sons; 2010

Reio TG, Rocco TS, Smith DH, Chang E. A critique of Kirkpatrick's evaluation model. New Horizons in Adult Education and Human Resource Development. 2017; 29:(2)35-53

Rowley S, Clare S. Improving standards of aseptic practice through an ANTT trust-wide implementation process: a matter of prioritisation and care. Journal of Infection Prevention. 2009; 10:(1)S18-S23

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

Rowley S, Clare S. Aseptic non-touch technique (ANTT): reducing healthcare associated infections (HCAI) by standardising aseptic technique with ANTT across large clinical workforces. Am J Infect Control. 2011b; 39:(5)

Shah N, Castro-Sánchez E, Charani E, Drumright LN, Holmes AH. Towards changing healthcare workers' behaviour: a qualitative study exploring non-compliance through appraisals of infection prevention and control practices. J Hosp Infect. 2015; 90:(2)126-134

Tarrant C, O'Donnell B, Martin G, Bion J, Hunter A, Rooney KD. A complex endeavour: an ethnographic study of the implementation of the Sepsis Six clinical care bundle. Implement Sci. 2016; 11:(1)

Tope D, Chamberlain LJ, Crowley M, Hodson R. The benefits of being there: evidence from the literature on work. Journal of Contemporary Ethnography. 2005; 34:(4)470-493

Ward DJ. The application of the theory of planned behaviour to infection control research with nursing and midwifery students. J Clin Nurs. 2013; 22:296-298

Wilson S. The use of ethnographic techniques in educational research. Rev Educ Res. 1977; 47:(2)245-265

Wolcott HF. Transforming qualitative data: description, analysis, and interpretation.Thousand Oaks (CA): Sage Publications; 1994

Paediatric nurses' adoption of aseptic non-touch technique

24 January 2019
14 min read
Volume 28 · Issue 2



in 2015, NHS Wales introduced a national standardised approach to aseptic non-touch technique (ANTT). This approach aims to standardise practice and promote better clinical outcomes.


to provide insight into the challenges faced by clinical staff adopting ANTT during intravenous therapy.


focused ethnography across two paediatric wards in NHS Wales. Data collection included participant observation, audit questionnaires and semi-structured interviews. Data were analysed according to Wolcott's (1994) process and emerging themes were reflected upon against the theoretical framework of Kirkpatrick's (1994) model of training evaluation.


absence of feedback following training, individual preference, lack of opportunity to practise the ANTT technique, lack of clarity and standardisation and expectations of parents/medical staff are all challenges faced by registered nurses.

Implications of the study:

the findings may be used by NHS managers to support national initiatives within staff training and development programmes, and to improve infection prevention initiatives. Organisational culture is a modifier of healthcare worker behaviour and requires further attention locally and nationally. Quality assurance in the adoption of standardised best practice must take into account staff training and development needs, and workplace culture.

All healthcare organisations should adopt a single standardised approach to aseptic non-touch technique (ANTT) (Box 1) and review their policies, procedures, training and audit of practice in relation to aseptic technique (Public Health Wales, 2017). In 2015, the Welsh Government invested in a quality assured clinical practice framework in relation to ANTT with the aim of reducing inappropriate variation (Rowley and Clare, 2011a). All healthcare organisations were to adopt a single standardised approach to ANTT and review their policies, procedures, training and audit of practice in relation to aseptic technique (Public Health Wales, 2017). The Association of Safe Aseptic Practice pledged to work in partnership with healthcare organisations to significantly reduce healthcare-associated infections through standardising aseptic technique (Rowley and Clare, 2011b).

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