Woodchurch House / POLICY NO: P-29
Reviewed:21/07/17 / Issue No 4
Page 1 of 10
INFECTION PREVENTION AND CONTROL

1. INTRODUCTION

Infection prevention and control in all care settings has attracted heightened interest in recent years as the possibility of cross-infection is substantial.

2. AIMS

This policywill help care staff identify and minimise risks to staff and residents and create a safer working environment.

The information contained within this document addresses the issues that are most likely to impact on health and communicable disease control in care which are:

Standard (Universal) Precautions

  • Hand hygiene
  • Protective clothing and Equipment (PPE)
  • Laundry management, uniform.
  • Waste management and spillages
  • Clean environment
  • Management of exposure to blood or body fluids

3. HAND HYGIENE

Good hand hygiene is essential to reduce the transmission of infection in any care setting and is a critical element of standard infection prevention and control precautions.

3.1 WHO 5 moments hand hygiene

The World Health Organisations publication 5 moments for hand hygiene is now the global benchmark ofWHEN to perform Hand Hygiene.

Some of the principles below may apply even if you are not having resident contact, you may be in contact with blood or body fluids or providing general care to many residents in which case it is advisable to follow the guidance below.

3.2 Choice of handwashing method

Choosing a method of hand decontamination depends on what is appropriate for the episode of care:

  • Soap and Water - Effective handwashing with a non-medicated liquid soap will remove transient micro-organisms and render the hands socially clean. This level of decontamination is sufficient for general social contact and most clinical care activities.
  • Hygienic handrubs (alcohol) – eliminate transient micro-organisms and have the advantage that a source of water is not required for their use, Hygienic hand rubs offer a practical and highly acceptable alternative to handwashing when hands are not grossly soiled and are recommended for routine use.

3.3 Hand decontamination using liquid soap

An effective handwashing technique involves three stages: preparation, washing and rinsing and drying.

  • Preparation requires wetting hands under tepid running water before applying liquid soap.
  • The hand wash solution must come into contact with all of the surfaces of the hand. The hands must be rubbed vigorously together for a minimum of 10 – 15 seconds, paying particular attention to the tips of the fingers, the thumbs and the areas between the fingers (see below)as these are the areas most commonly missed.
  • Hand drying has been shown to be a critical factor in the hand hygiene process, in particular removing any remaining residual moisture that may facilitate transmission of microorganisms. Hands that are not dried properly can become dry and cracked, leading to an increased risk of harbouring microorganisms on the hands that might be transmitted to others

3.4 Hand decontamination using hygienic handrubs (alcohol)

When decontaminating hands using an alcohol hand rub, hands should be free of dirt and organic material.

  • The amount/volume used to provide adequate coverage of the hands should be indicated in the manufacturers’ instructions. This is normally around 3 ml.
  • The steps to perform hand hygiene using alcohol based hand rub are the same as when performing hand washing.
  • The time taken to perform hand hygiene using alcohol based hand rub is at least 20seconds (20-30 seconds is adequate). Manufacturers’ instructions should be followed (a number of these recommend rubbing for 30 seconds)
  • If the solution has not dried by the end of this process allow hands to dry fully before any resident/client procedures are undertaken.

3.5 Hand cream

An emollient hand cream should be applied regularly to protect the skin from the drying effects of regular hand decontamination. If a particular soap or alcohol product causes skin irritation the Occupational Health Team should be consulted.

4. PERSONAL PROTECTIVE EQUIPMENT (PPE)

Personal protective equipment is used to protect both the client and the care worker from the potential risks of cross infection. Uniform is not classed as PPE. Gloves, aprons, masks goggles/visors, and in certain situations hats and footwear are classed as PPE.

Practices should base their selection of PPE on an assessment of the risk of transmission of micro-organisms to the client, and the risk of contamination of the care workers clothing and skin by contact with the client. If there is a risk of contact with blood, body fluids, secretions or excretions, additional precautions may be required.

Following a risk assessment, staff may also require PPE for contact with hazardous chemicals and certain pharmaceuticals.

5. DISPOSABLE GLOVES

Hands have a key role in the transmission of infection and gloves can reduce the number of micro-organisms acquired. However hands should still be washed when gloves are removed.

  • Gloves must be worn for contact with sterile sites and non-intact skin or mucous membranes, and all activities that have been assessed as carrying a risk of exposure to blood, body fluids, secretions or excretions, or sharp or contaminated instruments or infectious agents such as parasites.
  • Gloves that are acceptable to healthcare personnel and conform to European Community (CE) standards on safety and performance must be available.
  • Neither powdered gloves nor polythene gloves should be used in healthcare activities.
  • Gloves must be worn as single-use items and should never be washed, disinfected or re-sterilised. They must be put on immediately before an episode of resident contact or treatment and removed as soon as the activity is completed. Gloves must be changed between caring for different residents, and between different care or treatment activities for the same resident.
  • Gloves must be disposed of as clinical waste and hands decontaminated after the gloves have been removed.
  • Non-latex hypo-allergenic gloves must be available for use by staff with latex allergy. Sensitivity to natural rubber latex in residents, carers and healthcare personnel must be documented, and alternatives to natural rubber latex gloves must be available. (nitrile or neoprene gloves)
  • Oil can weaken and degrade latex, reducing the glove's protection. Avoid using oil-based lotions and moisturisers (e.g. those that contain lanolin, mineral oil, petroleum, coconut oil or palm oil as main ingredients). If you are uncertain about compatibility, check with the lotion manufacturer.
  • Gloved hands should not be washed or alcohol applied in order to decontaminate them, they must be removed after single use.

Copolymer gloves / Are more likely to burst under pressure because of weakness in the welded seams.
Vinyl gloves / Are more permeable to viruses than latex products and are more likely to split than latex. They are not the product of choice when exposure to blood or body fluids is a risk or when high levels of manual dexterity are required.
Latex gloves / Are made from natural products & contain proteins. Frequent users may develop allergies, which can be severe. The cornstarch powder picks up allergens in the rubber and distributes them via the skin or into the air. This increases the risk of sensitisation to residents as well as staff. Low protein powder-free latex gloves provide the best protection.
Latex free
hypo-allergenic gloves / In cases of latex allergy, latex free gloves without allergenic additives can be used. (nitrile or neoprene gloves)

6. DISPOSABLE PLASTIC APRONS

  • Disposable plastic aprons should be worn when there is a risk that clothing may be exposed to blood, body fluids, secretions or excretions, with the exception of sweat.
  • Plastic aprons should be worn as single-use items, for one procedure or episode of resident care, and then discarded and disposed of as clinical waste.
  • Full-body fluid repellent gowns must be worn where there is a risk of extensive splashing of blood, body fluids, secretions, with the exception of sweat, onto the skin or clothing of healthcare practitioners.

8. LAUNDRY

Clean laundry should be stored in a clean room off the floor

PPE should be worn for contact with soiled linen/ clothes

9. WASTE MANAGEMENT

Health care and care organisations and the individuals that work within these organisations, have a legal and moral duty to dispose of waste properly in accordance with statutory ‘duty of care’ requirements.

Changes to legislation governing the management of waste, its storage, carriage, treatment and disposal meant previous guidance on clinical waste provided in the Health Service Advisory Committee (HSAC) publication Safe disposal of clinical waste (1999) required revision, and in December 2006 it was replaced by the Department of Health’s Health technical memorandum 07-01: Safe management of health care waste.

The Safe management of health care waste memorandum 2006 introduces some key changes, specifically:

  • The removal of the old ‘clinical waste group A to E’ definitions
  • The introduction and definition of new identification terms (health care waste, infectious waste, medicinal waste and offensive waste)
  • A revised colour-coded system for the disposal of waste.

While the advice and courses of action contained within the memorandum aren’t mandatory, the memorandum advises that health care organisations must take steps to ensure compliance with relevant legislation, to ensure compliance with all regulatory requirements – from production through to transport and finally disposal.

Employers are responsible for developing and making available an appropriate health care waste management policy which clearly outlines written instructions on the way waste should be managed.

10.1 Waste segregation

Segregating waste at the point of production is critical to the safe management of health care waste. Segregation not only helps control the management costs associated with waste, but ensures the correct pathways are adopted for the storage, transport and ultimate disposal of waste.

For segregation to work effectively the Safe management of health care waste(2006) advises that staff must be provided with colour-coded and labelled waste receptacles and sack holders. These should be positioned in locations as close to the point of production as possible and replaced when three-quarters full, securely tied and appropriately labelled. Liquid or solidified waste should be placed in a rigid, leak-proof container.

Colour coding of waste

Colour stream / Description of waste / Example
/ Waste which requires disposal by incineration Indicative treatment/disposal is incineration in a suitably permitted or licensed facility / Anatomical waste, Infectious waste requiring INCINERATION ONLY
/ Waste which may be “treated” Indicative treatment/disposal required is to be “rendered safe” in a suitably permitted or licensed facilities, usually alternative treatment plans. However this waste may also be disposed of by incineration / Infectious swabs, dressings, wipes, protective clothing and sharps (with no medicine
contamination)
/ Offensive/hygiene waste
Indicative treatment/disposal required is landfill in a suitably permitted or licensed site. This waste should not be compacted in unlicensed/permitted facilities. / Non-infectious swabs, dressings, wipes, protective clothing, nappies, human hygiene waste, sanitary waste.
/ Domestic (municipal) waste
Minimum treatment/disposal required is landfill in a suitably permitted or licensed site. Recyclable components should be removed through segregation. Clear/opaque receptacles may also be used for domestic waste. / Clean packaging, food paper etc
/ Cytotoxic and Cytostatic waste
Indicative treatment/disposal required is incineration in a suitably permitted or licensed facility.
Sharps contaminated with cytotoxic/static medicines, i.e. sharps used for injections of cytotoxic/static drugs. / Medicines used for chemotherapy, certain antivirals,
immuno-suppressants and hormonal drugs
/ Waste which may be “treated”
Sharps not contaminated with any medicines, i.e. sharps used for bloods, glucose, saline, etc. Also suitable for blades and razor blades. / Sharps used for bloods, glucose, saline, etc, and blades
/ Waste which requires disposal by incineration
Sharps contaminated with medicines (non-cytotoxic/static), / Sharps used for injecting medicines

11. SAFE USE AND DISPOSAL OF SHARPS

  • All sharps must be disposed of safely and correctly immediately after use.
  • Discard sharps personally – do not rely on others to do this for you.
  • Sharps must not be passed from hand to hand, and handling should be kept to a minimum.
  • Needles must not be recapped, bent, broken or disassembled before use or disposal. Discard needle & syringe as one unit directly into sharps container.
  • Used sharps must be discarded into a sharps container (conforming to UN3291 and BS7320 standards) at the point of use by the user. These must not be filled above the mark that indicates that they are full.
  • Containers must be assembled correctly according to manufacturer’s instructions i.e. ensuring that the lid is secure.
  • Containers should be kept in a safe location out of the reach of residents and children, e.g. on a flat surface, below eye level, but not on the floor (free wall and trolley brackets are available from sharps bin manufacturers). This will reduce the risk of injury to residents, visitors and staff.
  • When not in use the temporary closing mechanism on sharps containers must be activated
  • Full containers should not be allowed to accumulate. They must be sealed and labelled/identification tag attached before disposal by the licensed route.
  • Needle safety devices must be used where there are clear indications that they will provide safer systems of working for healthcare personnel.
  • Under no circumstances should items be retrieved from a sharps box.
  • Under no circumstances should sharps or sharps boxes be put in yellow bags for disposal.

Under the Health and Safety Act (1974) it is the personal responsibility of the individual using a sharp to dispose of it safely, the exception being in situations where it may be necessary to delegate this responsibility to another named person (e.g. during surgical procedures)

12. INOCULATION ACCIDENTS

include:

  • Skin prick or laceration by a sharp instrument or needle contaminated with blood.
  • Blood splashes onto an abrasion or cut.
  • Contamination of mucous membranes of eyes or mouth with blood.
  • Human bites.

Treatment of inoculation accidents:

  • If it is a small wound, encourage bleeding by squeezing area, do not suck wound. Wash area thoroughly with soap and running water, and then cover with a waterproof dressing if necessary.
  • If the eyes/mouth are involved irrigate with copious amounts of clean water.
  • Following skin exposure, wash the affected area thoroughly with soap and water.
  • Report the incident immediately to your manager.

Human Bites:

  • If a bite does not break the skin, clean with soap and water and record incident no medical intervention necessary.
  • If a bite does break the skin, clean immediately with soap and water and contact your occupational health advisor.

13. SPILLAGES

Treating spills of blood or body fluid may expose the healthcare worker to bloodborne viruses or other pathogens. The task can be carried out more safely if any pathogens in the spill are first destroyed by disinfectant. Disposable gloves should always be worn when cleaning possible contaminated spills. If there is a risk of contaminating clothing, a disposable plastic apron should also be worn.

13.1 Methods of treating body fluid spills

Chlorine-releasing granules*

  • Put on disposable gloves and apron
  • Cover fluid completely with chlorine granules
  • Leave for 2 minutes
  • Remove granules and discard into infectious waste stream
  • Wash the area with detergent and water

Hypochlorite solution*

  • Put on disposable gloves and apron
  • Cover spill with disposable paper towels
  • Pour hypochlorite (10,000 ppm available chlorine) over the towels i.e. half strength Milton 2 diluted with water, HAZ Tabs or other propriety product sufficiently diluted.
  • Leave for 2 minutes
  • Remove towels and discard into infectious waste stream
  • Wash the area with detergent and water

Detergent and water

  • Put on disposable gloves and apron
  • Soak up spill with disposable towels
  • Discard towels into infectious waste stream
  • Wash the area with detergent and water

* Do not use for large spills of urine

14. CLEAN ENVIRONMENT

The cleanliness of any care environment is important to support infection prevention and control and ensure resident confidence.

14.1 Cleaning

Cleaning is a process that removes contaminates including dust, soil large numbers of micro-organisms and the organic matter that shields them. Disinfection kills some micro-organisms but does not leave surfaces and equipment completely free of contamination and is only effective if the equipment or surface is thoroughly cleaned with detergent solution before hand. In most situations, thorough cleaning and rinsing with a freshly prepared solution of detergent and water is adequate and additional disinfection is wasteful.

14.2 Cleaning

Practices should have a regular planned and written cleaning schedule available that details roles and responsibilities, items and environments to be cleaned;

  • Before and after each clinic session
  • Daily
  • Weekly
  • Monthly
  • Annually

1

Appendix 1Risk Assessment – Glove Usage

ARE GLOVES REALLY NECESSARY?